JULIO FLAVIO MEIRELLES MARCHINI
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/51 - Laboratório de Emergências Clínicas, Hospital das Clínicas, Faculdade de Medicina
LIM/51 - Laboratório de Emergências Clínicas, Hospital das Clínicas, Faculdade de Medicina
12 resultados
Resultados de Busca
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- Biomarker-associated Monocyte Inflammatory Signaling in Myocardial Infarction(2023) GUIMARÃES, Raphael Boesche; MARCHINI, Julio; GOMEZ, Luz Marina; LEITE, Rogério Sarmento; DUTRA, Oscar; CASTRO, Iran; MANICA, André LuizAbstract Background: Monocytes are essential components in inflammatory signaling, and their recruitment is crucial in the signaling pathway, which directs and determines cell adhesion to the activated endothelium. A better understanding of the correlation between monocyte subsets and inflammatory signaling in patients with atherosclerotic disease in acute coronary syndrome (ACS) is essential for the development of more effective therapies for the prevention and treatment of cardiovascular diseases. Objective: To analyze differences between biomarkers and monocyte activation in the setting of ischemic heart disease. Methods: This was a case-control study comparing biomarkers and monocyte subsets between patients with ACS with and without ST-segment elevation and individuals without coronary stenosis. The nonparametric Kruskal-Wallis test was used to assess differences between groups, and Dunn's post hoc test was used to identify which groups were different. Cuzick's test for ordered group trends was used to assess falling or rising trends. Participants were classified into 3 groups: control (0); non-ST-elevation myocardial infarction (NSTEMI) (1); ST-elevation myocardial infarction (STEMI) D1 (2). Results: Forty-seven patients with ACS and 19 controls with no obstructive lesions on coronary angiography were recruited. Monocyte profile assessment was statistically different regarding time of symptom onset and the presence or absence of atherosclerotic disease (Kruskal-Wallis, p = 0.0009). Dunn's post hoc test showed a significant difference between the control group and the STEMI D1 (p = 0.0014), STEMI D3 (p = 0.0036), and STEMI D7 (p = 0.0195) groups, corresponding to a 2-fold increase in classical (p = 0.0022) and nonclassical (p = 0.0031) monocytes compared with controls. For classical monocytes, there was a difference between the control group and all STEMI groups and between the NSTEMI group and the STEMI D1, D3, and D7 groups. For nonclassical monocytes, there was a difference between the control group and the STEMI D7 group (p = 0.0056) and between the NSTEMI group and the STEMI D7 group (p = 0.0166). Conclusion: This study found that there was an increase in total and classical monocyte mobilization at the time of acute myocardial infarction in patients with ACS.
conferenceObject COVID-19 and H1N1 Pneumonia: Reanalysis and Comparison of Two Cohorts(2022) SORICE, E.; STERNLICHT, J.; SANTOS, L. B.; BRANDAO, R.; MARINO, L.; MARCHINI, J.; ALENCAR, J.; GOMEZ, L.; SOUZA, H.- Mortality and other outcomes of patients with coronavirus disease pneumonia admitted to the emergency department: A prospective observational Brazilian study(2021) BRANDAO NETO, Rodrigo A.; MARCHINI, Julio F.; MARINO, Lucas O.; ALENCAR, Julio C. G.; LAZAR NETO, Felippe; RIBEIRO, Sabrina; SALVETTI, Fernando V.; RAHHAL, Hassan; GOMEZ, Luz Marina Gomez; BUENO, Caue G.; FARIA, Carine C.; CUNHA, Victor P. da; PADRAO, Eduardo; VELASCO, Irineu T.; SOUZA, Heraldo Possolo deBackground The first cases of coronavirus disease (COVID-19) in Brazil were diagnosed in February 2020. Our Emergency Department (ED) was designated as a COVID-19 exclusive service. We report our first 500 confirmed COVID-19 pneumonia patients. Methods From 14 March to 16 May 2020, we enrolled all patients admitted to our ED that had a diagnosis of COVID-19 pneumonia. Infection was confirmed via nasopharyngeal swabs or tracheal aspirate PCR. The outcomes included hospital discharge, invasive mechanical ventilation, and in-hospital death, among others. Results From 2219 patients received in the ED, we included 506 with confirmed COVID-19 pneumonia. We found that 333 patients were discharged home (65.9%), 153 died (30.2%), and 20 (3.9%) remained in the hospital. A total of 300 patients (59.3%) required ICU admission, and 227 (44.9%) needed invasive ventilation. The multivariate analysis found age, number of comorbidities, extension of ground glass opacities on chest CT and troponin with a direct relationship with all-cause mortality, whereas dysgeusia, use of angiotensin converting enzyme inhibitor or angiotensin-ii receptor blocker and number of lymphocytes with an inverse relationship with all-cause mortality Conclusions This was a sample of severe patients with COVID-19, with 59.2% admitted to the ICU and 41.5% requiring mechanical ventilator support. We were able to ascertain the outcome in majority (96%) of patients. While the overall mortality was 30.2%, mortality for intubated patients was 55.9%. Multivariate analysis agreed with data found in other studies although the use of angiotensin converting enzyme inhibitor or angiotensin-ii receptor blocker as a protective factor could be promising but would need further studies.
- Distinct Outcomes in COVID-19 Patients with Positive or Negative RT-PCR Test(2022) MENEZES, Maria Clara Saad; PESTANA, Diego Vinicius Santinelli; FERREIRA, Juliana Carvalho; CARVALHO, Carlos Roberto Ribeiro de; FELIX, Marcelo Consorti; MARCILIO, Izabel Oliva; SILVA, Katia Regina da; COBELLO JUNIOR, Vilson Cobello; MARCHINI, Julio Flavio; ALENCAR, Julio Cesar; GOMEZ, Luz Marina Gomez; MAUA, Denis Deratani; SOUZA, Heraldo PossoloIdentification of the SARS-CoV-2 virus by RT-PCR from a nasopharyngeal swab sample is a common test for diagnosing COVID-19. However, some patients present clinical, laboratorial, and radiological evidence of COVID-19 infection with negative RT-PCR result(s). Thus, we assessed whether positive results were associated with intubation and mortality. This study was conducted in a Brazilian tertiary hospital from March to August of 2020. All patients had clinical, laboratory, and radiological diagnosis of COVID-19. They were divided into two groups: positive (+) RT-PCR group, with 2292 participants, and negative (-) RT-PCR group, with 706 participants. Patients with negative RT-PCR testing and an alternative most probable diagnosis were excluded from the study. The RT-PCR(+) group presented increased risk of intensive care unit (ICU) admission, mechanical ventilation, length of hospital stay, and 28-day mortality, when compared to the RT-PCR(-) group. A positive SARS-CoV-2 RT-PCR result was independently associated with intubation and 28 day in-hospital mortality. Accordingly, we concluded that patients with a COVID-19 diagnosis based on clinical data, despite a negative RT-PCR test from nasopharyngeal samples, presented more favorable outcomes than patients with positive RT-PCR test(s).
- Timing to Intubation COVID-19 Patients: Can We Put It Off until Tomorrow?(2022) ALENCAR, Julio Cesar Garcia de; STERNLICHT, Juliana Martes; VEIGA, Alicia Dudy Muller; MARCHINI, Julio Flavio Meirelles; FERREIRA, Juliana Carvalho; CARVALHO, Carlos Roberto Ribeiro de; MARCILIO, Izabel; SILVA, Katia Regina da; COBELLO JUNIOR, Vilson; FELIX, Marcelo Consorti; GOMEZ, Luz Marina Gomez; SOUZA, Heraldo Possolo de; MAUA, Denis DerataniBackground: The decision to intubate COVID-19 patients receiving non-invasive respiratory support is challenging, requiring a fine balance between early intubation and risks of invasive mechanical ventilation versus the adverse effects of delaying intubation. This present study analyzes the association between intubation day and mortality in COVID-19 patients. Methods: We performed a unicentric retrospective cohort study considering all COVID-19 patients consecutively admitted between March 2020 and August 2020 requiring invasive mechanical ventilation. The primary outcome was all-cause mortality within 28 days after intubation, and a Cox model was used to evaluate the effect of time from onset of symptoms to intubation in mortality. Results: A total of 592 (20%) patients of 3020 admitted with COVID-19 were intubated during study period, and 310 patients who were intubated deceased 28 days after intubation. Each additional day between the onset of symptoms and intubation was significantly associated with higher in-hospital death (adjusted hazard ratio, 1.018; 95% CI, 1.005-1.03). Conclusion: Among patients infected with SARS-CoV-2 who were intubated and mechanically ventilated, delaying intubation in the course of symptoms may be associated with higher mortality. Trial registration: The study protocol was approved by the local Ethics Committee (opinion number 3.990.817; CAAE: 30417520.0.0000.0068).
conferenceObject Brazilian Airway Registry COoperation: The First 1,000 Emergency Intubations of the BARCO Study(2023) MAIA, I. W. A.; ALENCAR, J.; MARCHINI, J.; SILVA, E. L. O. J.; GOMES, L.; MARINO, L.; VAISBERG, V.; STANZANI, G.; NOGUEIRA, C.; KROEFF, B.; SOUZA, H.conferenceObject Brazilian Airway Registry COoperation: Comparison Between Intubations Performed by Emergency Physicians or Non-Emergency Physicians(2023) BETONI, H.; MAIA, I. W. A.; MARCHINI, J.; ALENCAR, J.; MARINO, L.; OLIVEIRA, G.; ALONSO, G.; STANZANI, G.; VAISBERG, V.; GOMEZ, L.; SOUZA, H.conferenceObject Brazilian Airway Registry COoperation: Comparison Between Intubations Performed With or Without Videolaryngoscope(2023) OLIVEIRA, G.; MAIA, I. W. A.; ALENCAR, J.; ALONSO, G.; BETONI, H.; GOMES, L.; MARCHINI, J.; MARINO, L.; SOUZA, H.; VAISBERG, V.; STANZANI, G.conferenceObject Neuronal Death-associated Proteins S100B, Tau and Neuron Specific Enolase Association to Sepsis-related Organ Dysfunction and Death in the Elderly: A Prospective Single Center Cohort Study(2022) VAISBERG, V.; ALENCAR, Garcia J. de; SARDINHA, A.; CARVALHO, M. de; GOMEZ, L. G.; ITO, G.; MAIA, I. A.; MARINO, L.; MARCHINI, J.; SOUZA, H. de- Endothelial injury in COVID-19 and septic patients(2022) HOKAMA, Larissa Tami; VEIGA, Alicia Dudy Muller; MENEZES, Maria Clara Saad; PINTO, Agnes Araujo Sardinha; LIMA, Thais Martins de; ARIGA, Suely Kunimi Kubo; BARBEIRO, Hermes Vieira; BARBEIRO, Denise Frediani; MOREIRA, Claudia de Lucena; STANZANI, Gabriela; BRANDAO, Rodrigo Antonio; MARCHINI, Julio Flavio; ALENCAR, Julio Cesar; MARINO, Lucas Oliveira; GOMEZ, Luz Marina; SOUZA, Heraldo P.Systemic inflammatory response, as observed in sepsis and severe COVID-19, may lead to endothelial damage. Therefore, we aim to compare the extent of endothelial injury and its relationship to inflammation in both diseases. We included patients diagnosed with sepsis (SEPSIS group, n = 21), mild COVID-19 (MILD group, n = 31), and severe COVID-19 (SEVERE group, n = 24). Clinical and routine laboratory data were obtained, circulating cytokines (INF-gamma, TNF-alpha, and IL-10) and endothelial injury markers (E-Selectin, Tissue Factor (TF) and von Willebrand factor (vWF)) were measured. Compared to the SEPSIS group, patients with severe COVID-19 present similar clinical and laboratory data, except for lower circulating IL-10 and E-Selectin levels. Compared to the MILD group, patients in the SEVERE group showed higher levels of TNF-alpha, IL-10, and TF. There was no clear relationship between cytokines and endothelial injury markers among the three studied groups; however, in SEVERE COVID-19 patients, there is a positive relationship between INF-gamma with TF and a negative relationship between IL-10 and vWF. In conclusion, COVID-19 and septic patients have a similar pattern of cytokines and endothelial dysfunction markers. These findings highlight the importance of endothelium dysfunction in COVID-19 and suggest that endothelium should be better evaluated as a therapeutic target for the disease.