ALEXANDRE ARCHANJO FERRARO
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Pediatria, Faculdade de Medicina - Docente
LIM/21 - Laboratório de Neuroimagem em Psiquiatria, Hospital das Clínicas, Faculdade de Medicina
LIM/21 - Laboratório de Neuroimagem em Psiquiatria, Hospital das Clínicas, Faculdade de Medicina
6 resultados
Resultados de Busca
Agora exibindo 1 - 6 de 6
- The importance of viral load in the severity of acute bronchiolitis in infants(2021) PAULIS, Milena De; OLIVEIRA, Danielle Bruna Leal; THOMAZELLI, Luciano Matsumiya; FERRARO, Alexandre Archanjo; DURIGON, Edison Luiz; VIEIRA, Sandra E.OBJECTIVE: The relationship between viral load and the clinical evolution of bronchiolitis is controversial. Therefore, we aimed to analyze viral loads in infants hospitalized for bronchiolitis. METHODS: We tested for the presence of human respiratory syncytial virus (HRSV) or human rhinovirus (HRV) using quantitative molecular tests of nasopharyngeal secretions and recorded severity outcomes. RESULTS: We included 70 infants [49 (70%) HRSV, 9 (13%) HRV and 12 (17%) HRSV+HRV]. There were no differences among the groups according to the outcomes analyzed individually. Clinical scores showed greater severity in the isolated HRSV infection group. A higher isolated HRSV viral load was associated with more prolonged ventilatory support, oxygen therapy, and hospitalization days, even after adjustment for the age and period of nasopharyngeal secretion collection. In the co-infection groups, there was a longer duration of oxygen therapy when the HRSV viral load was predominant. Isolated HRV infection and co-infection with a predominance of HRV were not associated with severity. CONCLUSION: Higher HRSV viral load in isolated infections and the predominance of HRSV in co-infections, independent of viral load, were associated with greater severity. These results contribute to the development of therapeutic and prophylactic approaches and a greater understanding of the pathophysiology of bronchiolitis.
- Differences among Severe Cases of Sars-CoV-2, Influenza, and Other Respiratory Viral Infections in Pediatric Patients: Symptoms, Outcomes and Preexisting Comorbidities(2020) SOUSA, Braian L. A.; SAMPAIO-CARNEIRO, Magda; CARVALHO, Werther B. de; SILVA, Clovis A.; FERRARO, Alexandre A.OBJECTIVES: Previous studies focusing on pediatric patients hospitalized with severe coronavirus disease 2019 (COVID-19) have been limited to small case series. We aimed to evaluate the characteristics of a large population of pediatric patients with severe COVID-19 and compare them with patients with severe cases of influenza and other respiratory viruses (ORV). METHODS: We performed a cross-sectional study of Brazilian data from the National Epidemiological Surveillance Information System, gathered from January 1st to July 14th, 2020. The sample included 4,784 patients (2,570 with confirmed COVID-19, 659 with influenza, 1,555 with ORV). Outcome measures included clinical features, preexisting comorbidities, pediatric intensive care unit admissions, need for ventilatory support, and death. RESULTS: Compared with the influenza and ORV groups, the COVID-19 group had a higher proportion of newborns and adolescents, as well as lower frequencies of fever, cough, dyspnea, respiratory distress, and desaturation. Although use of invasive ventilatory support was similar among groups, death rate was highest for COVID-19 (15.2% vs. 4.5% vs. 3.2%, p <0.001), with death risk more than three times the other groups (adjusted OR=3.7 [95% CI 2.5-5.6]). The presence of two or more comorbidities further increased this risk (OR=4.8 [95% CI 3.5-6.6]). Preexisting comorbidities were reported in 986 patients with severe COVID-19 (38%). Mortality rate among COVID-19 patients was significantly higher for almost all comorbidities reported. CONCLUSION: Severe COVID-19 had a higher mortality rate than other viral respiratory illnesses, despite the lower frequency of fever, cough, dyspnea, respiratory distress, and desaturation. Death risk was strongly associated with preexisting comorbidities.
- Profile of health professionals who completed a master's, doctoral, or post-doctoral degree in one Brazilian pediatric program(2020) SILVA, Clovis Artur; TRINDADE, Vitor Cavalcanti; CRUZ, Amanda Monteiro da; BLANCO, Bruna Paccola; SANTOS, Joao Fernando Vecchi; FERRARO, Alexandre Archanjo; ODONE-FILHO, Vicente; TANNURI, Uenis; CARVALHO, Werther Brunow; CARNEIRO-SAMPAIO, Magda; VIEIRA, Sandra Elisabete; GRISI, Sandra Josefina Ferraz ElleroOBJECTIVE: This study aimed to determine the personal and professional characteristics, and the physical, psychiatric/psychological, and professional issues that exist among master's-, doctoral-, and post-doctoral-level health professionals. METHODS: A cross-sectional, online, self-reported survey of 452 postgraduates who completed master's, doctoral, or post-doctoral degrees in one graduate program in pediatrics in Sao Paulo, Brazil, was conducted. RESULTS: The response rate was 47% (211/453). The majority of participants were women (78%) and physicians (74%), and the median age was 47 years (28-71). Master's, doctoral, and post-doctoral degrees were reported by 73%, 53%, and 3%, respectively. High workload (440 hours/week) occurred in 59%, and 45% earned >= 15 minimum wages/month. At least one participation in scientific meeting in the past year was reported by 91%, and 79% had published their research. Thirty-nine percent served as a member of a faculty of an institution of higher learning. The data were analyzed by two age groups: participants aged <= 48 years (group 1) and participants aged 448 years (group 2). The median rating of overall satisfaction with the profession in the past year [8 (0-10) vs. 9 (1-10), p=0.0113]; workload 440 hours/week (53% vs. 68%, p=0.034); and >= 15 minimum wages/month (37% vs. 56%, p=0.0083) were significantly lower in group 1. Further analysis by gender revealed that the median rating of overall satisfaction with the profession in the past year [8 (0-10) vs. 9 (3-10), p=0.0015], workload 440 hours/week (53% vs. 83%, p=0.0002), and >= 15 minimum wages/month (37% vs. 74%, p=0.0001) were significantly lower in women compared with men. The median rating of overall satisfaction with the mentorship supervision provided was significantly higher among the women 10 (5-10) vs. 10 (2-10), p=0.0324]. CONCLUSIONS: The majority of master's-, doctoral-, and post-doctoral-level health professionals were women and physicians, and had published their thesis. Younger postgraduates and women reported low salaries, less likelihood of working 440 hours/week, and less overall satisfaction with their profession. Further longitudinal and qualitative studies are warranted to assess career trajectories after graduation.
- Early-life weight and weight gain as predictors of obesity in Brazilian adolescents(2013) FERNANDES, Maria Teresa Bechere; FERRARO, Alexandre Archanjo; PIRES, Adriana; SANTOS, Erica; SCHVARTSMAN, ClaudioOBJECTIVE: To test whether weight and the weight gain rate during different age periods are associated with being overweight/obese at 10 years of age. METHODS: A nested case-control study was performed in a clinical historic cohort that was selected based on medical records from the Albert Einstein Hospital Social Program in Sao Paulo, Brazil. A sample of 378 eutrophic and overweight/obese children was analyzed. RESULTS: After adjusting for birth weight and gestational age, the likelihood of being overweight/obese at 10 years of age was 4.04-fold greater when progressing from one quartile of weight gain to the immediately superior quartile in the first semester of life and 3.24-fold greater when this occurred from 2-5 years of age. A one-quartile change in weight gain in the first semester was associated with a 0.5 z-score increase in BMI at age 10. A robust independent effect of weight at age 5 confirmed that earlier weight gain was an important predictor. CONCLUSIONS: The amount of weight gain during the first 6 months of life and between 2 and 5 years of age and weight at age 5 were important predictors of overweight/obesity at 10 years of age.
- Excess body weight in children may increase the length of hospital stay(2015) FERNANDES, Maria Teresa Bechere; DANTI, Gabriel Vecchi; GARCIA, Denise Maximo Lellis; FERRARO, Alexandre A.OBJECTIVES: To investigate the prevalence of excess body weight in the pediatric ward of University Hospital and to test both the association between initial nutritional diagnosis and the length of stay and the in-hospital variation in nutritional status. METHODS: Retrospective cohort study based on information entered in clinical records from University Hospital. The data were collected from a convenience sample of 91 cases among children aged one to 10 years admitted to the hospital in 2009. The data that characterize the sample are presented in a descriptive manner. Additionally, we performed a multivariate linear regression analysis adjusted for age and gender. RESULTS: Nutritional classification at baseline showed that 87.8% of the children had a normal weight and that 8.9% had excess weight. The linear regression models showed that the average weight loss z-score of the children with excess weight compared with the group with normal weight was -0.48 (p = 0.018) and that their length of stay was 2.37 days longer on average compared with that of the normal-weight group (p = 0.047). CONCLUSIONS: The length of stay and loss of weight at the hospital may be greater among children with excess weight than among children with normal weight.
- Etiological diagnosis reduces the use of antibiotics in infants with bronchiolitis(2012) FERRONATO, Angela Esposito; GILIO, Alfredo Elias; FERRARO, Alexandre Archanjo; PAULIS, Milena de; VIEIRA, Sandra E.OBJECTIVE: Acute bronchiolitis is a leading cause of infant hospitalization and is most commonly caused by respiratory syncytial virus. Etiological tests are not required for its diagnosis, but the influence of viral screening on the therapeutic approach for acute bronchiolitis remains unclear. METHODS: A historical cohort was performed to assess the impact of viral screening on drug prescriptions. The study included infants up to one year of age who were hospitalized for bronchiolitis. Virus screening was performed using immunofluorescence assays in nasopharyngeal aspirates. The clinical data were obtained from the patients' medical records. Therapeutic changes were considered to be associated with viral screening when made within 24 hours of the release of the results. RESULTS: The frequency of prescriptions for beta agonists, corticosteroids and antibiotics was high at the time of admission and was similar among the 230 patients. The diagnosis of pneumonia and otitis was associated with the introduction of antibiotics but did not influence antibiotics maintenance after the results of the virus screening were obtained. Changes in the prescriptions were more frequent for the respiratory syncytial virus patients compared to patients who had negative viral screening results (p=0.004), especially the discontinuation of antibiotics (p<0.001). The identification of respiratory syncytial virus was associated with the suspension of antibiotics (p=0.003), even after adjusting for confounding variables (p=0.004); however, it did not influence the suspension of beta-agonists or corticosteroids. CONCLUSION: The identification of respiratory syncytial virus in infants with bronchiolitis was independently associated with the discontinuation of antibiotics during hospitalization.