DANIEL RUBIO DE SOUZA

Índice h a partir de 2011
6
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina
IRLM, Hospital das Clínicas, Faculdade de Medicina
LIM/41 - Laboratório de Investigação Médica do Sistema Músculoesquelético, Hospital das Clínicas, Faculdade de Medicina

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Revista / Livro: Spinal Cord ×

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  • article 13 Citação(ões) na Scopus
    Post-discharge mortality in patients with traumatic spinal cord injury in a Brazilian hospital: a retrospective cohort
    (2019) LEITE, Victor F.; SOUZA, Daniel R. de; IMAMURA, Marta; BATTISTELLA, Linamara R.
    Study design Retrospective cohort. Objective To evaluate the survival outcomes in patients with traumatic spinal cord injury (TSCI). Setting A teaching hospital in Brazil. Methods A total of 434 patients diagnosed with TSCI (2004-2014) were included. Overall survival, standardized mortality ratios (SMR), and causes of death were assessed by Student's t-test, chi(2) test, Kaplan-Meier analysis, and Cox proportional-hazards regression. Results The mean follow-up was 4.8 years (+/- 3.3 years). Individuals with tetraplegia had a median survival of 11 years, with participants in the paraplegia group not reaching median survival. The overall mortality rate was 37 per 1000 person-years. Age-adjusted SMR was 28.8 (95% CI: 22.8-36). There were 77 deaths with 56 defined causes, of which pneumonia was the most frequent (35.7%). Combined infectious etiologies caused 55.3% of deaths. Multivariate analysis revealed higher mortality among individuals with tetraplegia vs. paraplegia in the first 2 years post injury (HR = 8.28, 95% CI: 2.76-24.80), after 2 years post injury (HR = 2.35, 95% CI: 1.31-4.24), and in all years combined (HR = 3.36, 95% CI: 2.04-5.52). Conclusion Mortality among patients with TSCI was 28.8 times higher than in the reference population. In more than half of the cases, the cause of death was linked to infectious diseases. Pneumonia caused two times more deaths in individuals with tetraplegia than in individuals with paraplegia, with a higher impact in the first 2 years post injury. Reported findings indicate the need for a surveillance and prevention program with emphasis on vaccination and respiratory rehabilitation.
  • article 14 Citação(ões) na Scopus
    Proximal tibia fracture in a patient with incomplete spinal cord injury associated with robotic treadmill training
    (2015) FILIPPO, T. R. M.; CARVALHO, M. C. L. De; CARVALHO, L. B.; SOUZA, D. R. de; IMAMURA, M.; BATTISTELLA, L. R.
    Study design: One case report of proximal tibia fracture in a patient with incomplete spinal cord injury (SCI) associated with robotic treadmill training. Objective: To raise the awareness that bone densitometry may be recommended before starting the robotic treadmill therapy, as well as the active vigilance of symptoms after therapy. Setting: Institute of Physical and Rehabilitation Medicine, Lucy Montoro Institute for Rehabilitation, Hospital das Clinicas, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil. Case report: The patient, female gender, with a fracture of vertebra T12 and arthrodesis from T9 to L1 (American Spinal Injury Association Classification (ASIA-C)). Training on Lokomat consisted of five 30-min weekly sessions, under the supervision of a qualified professional. At the beginning of the 19th session, the patient complained of pain in the anterior region of the left knee. Lokomat and any other body support therapy were discontinued. Magnetic resonance imaging (MRI) evidenced a transverse, oblique, metaphyseal proximal anterior and medial tibial fracture. Conclusion: Fractures are among the chronic complications of a SCI, affecting 34% and many times arising from minimal traumas. Lokomat resembles physiological walking, and more studies show its benefits. Many studies encourage the use of robotic devices for the rehabilitation of lower limbs, but there are still several unanswered questions. However, there are not enough studies to show whether there is a higher risk of fracture incidence in patients with osteopenia or osteoporosis who trained on the Lokomat.