VITOR FALCAO DE OLIVEIRA
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
PAHC, Hospital das Clínicas, Faculdade de Medicina - Médico
PAHC, Hospital das Clínicas, Faculdade de Medicina - Médico
17 resultados
Resultados de Busca
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- Itraconazole Serum Trough Concentrations Using Oral Capsules for the Treatment of Chronic Pulmonary Aspergillosis: What is the Target?(2023) OLIVEIRA, Vitor Falcao de; TABORDA, Mariane; ARCIERI, Vitor Ciampone; KRUSCHEWSKY, Wdson Luis Lima; COSTA, Andre Nathan; DUARTE, Nilo Jose Coelho; ROMANO, Paschoalina; EBNER, Persio de Almeida Rezende; MAGRI, Adriana Satie Goncalves Kono; ABDALA, Edson; LEVIN, Anna S. S.; MAGRI, Marcello Mihailenko ChavesBackgroundIn regions where there is only itraconazole capsule as a therapeutic option for treatment of chronic pulmonary aspergillosis (CPA), measuring the serum concentrations becomes even more important for therapeutic success.ObjectiveEvaluate the initial itraconazole serum trough concentrations after the administration of oral capsule of itraconazole for the treatment of CPA.MethodsThe measurement was performed at least 7-days after initiation of therapy. The standard treatment at our institution was a 200 mg capsule every 12 h. We defined that an adequate serum trough concentration of itraconazole during treatment was 1-4 mg/L.ResultsThis study recruited 28 patients. The median value was 0.30 mg/L (IQR 0.01-0.70). Only 11% (n = 3) had adequate serum concentrations based on guideline recommendation. All patients with clinical deterioration had itraconazole serum levels <= 0.8 mg/L.ConclusionThe initial serum concentrations of itraconazole after capsule formulation administration were low. Increasing the dose should be considered when the itraconazole concentration is low, especially if it is <= 0.8 mg/L, and the patient presents with clinical deterioration. Larger studies are needed to evaluate the adequate concentrations recommended for CPA.
- Challenges and insights in immunization in patients with demyelinating diseases: a bench-to-bedside and evidence-based review(2022) SILVA, Guilherme Diogo; OLIVEIRA, Vitor Falcao de; MENDONCA, Leonardo OliveiraBackground: Infections are among the main causes of death in patients with demyelinating diseases of the central nervous system (CNSDD). Vaccines are effective methods in reducing hospitalization and death from infectious diseases, but they are challenging in patients with CNSDD because of autoimmunity and immunosuppression. Objectives: To summarize the pathophysiological rationale and main evidence for vaccine recommendations in patients with CNSDD. Methods: Specialists with different backgrounds on the subject: a neurologist specialized in demyelinating diseases, an infectious diseases specialist and an immunologist, presented a critical narrative review of vaccination literature in patients with CNSDD, highlighting which vaccines should or should not be administered and the best time for it. Results: Patients with DDSNC are at increased risk of vaccine-preventable viral and bacterial infections.Vaccines can prevent herpes zoster, hepatitis B reactivation, HPV-associated warts and tumors, viral and bacterial pneumonia, and meningitis. Live attenuated virus vaccines should not be used when the patient is on immunosuppression. Vaccines should be avoided during relapses. The greatest vaccine efficacy is given before treatment or at the end of medication. Conclusion: Patients with DDSNC need differentiated immunization in relation to additional vaccines, contraindicated vaccines and timing of vaccination.
- Sensitivity of Antigen, Serology, and Microbiology Assays for Diagnosis of the Subtypes of Chronic Pulmonary Aspergillosis at a Teaching Hospital in Sao Paulo, Brazil(2023) OLIVEIRA, Vitor Falcao de; VIANA, Joshua Araujo; SAWAMURA, Marcio Valente Yamada; MAGRI, Adriana Satie Goncalves Kono; COSTA, Andre Nathan; ABDALA, Edson; MARIANI, Alessandro Wasum; BENARD, Gil; MAGRI, Marcello Mihailenko ChavesChronic pulmonary aspergillosis (CPA) is divided into five subtypes. The diagnosis of CPA is complicated due to poor sensitivity of the laboratory tests. Diagnostic performance of different antigen, serological, and microbiologi-cal methods in subtypes of CPA is unknown. The purpose of this study was to evaluate the diagnostic performance in different subtypes of CPA. A total of 91 participants with CPA were included, and the study was performed at Hospital das Clinicas of University of Sao Paulo. Bronchoalveolar lavage galactomannan (73%, 11/15), serology by immunodiffu-sion test (81%, 61/75), and histology (78%, 39/50) had the best sensitivity. The counterimmunoelectrophoresis (CIE) titers had a significant statistical difference between the CPA subtypes (P < 0.001), in which the forms chronic fibrosing pulmonary aspergillosis (CFPA) and subacute invasive aspergillosis (SAIA) had higher titers: 1/64 (interquartile range [IQR]: 1/32-1/256) and 1/64 (1/32-1/128).C-reactive protein generally presented lower values (median 15 mg/L, IQR: 6-33), with higher values in SAIA and lower values for Aspergillus nodule. Overall, we found a low diagnostic sensitivity of current tests. Regarding the CPA subtypes, we did not find great differences in the performance of the tests, but it is observed that the inflammatory markers and CIE titers tend to be higher in forms of the more extensive lung parenchyma involvement, such as SAIA and CFPA.
- Orthopedic infections due to Trichosporon species: Case series and literature review(2022) LOPEZ, Andres; NETO, Luiz Alves da Silva; OLIVEIRA, Vitor Falcao de; CARVALHO, Vladimir Cordeiro de; OLIVEIRA, Priscila Rosalba Domingos de; LIMA, Ana Lucia Lei MunhozReports of orthopedic fungal infections caused by Trichosporon species are extremely scarce, thus we aimed to describe a case series and review the cases published in the literature. Patients were retrospectively included if a previous culture of bone, joint, or soft tissues had resulted positive for Trichosporon species along with a clinical diagnosis of an orthopedic infection. Eight patients were included with diverse orthopedic conditions, most of them cases of osteomyelitis. The main isolated species was Trichosporon asahii. All patients were treated with antifungals, mainly voriconazole, and surgical management, resulting in high rates of clinical improvement and low associated mortality. Lay Summary Reports of orthopedic infections caused by Trichosporon species are scarce. We described a case series of orthopedic infections caused by Trichosporon species and reviewed the previous published cases in the literature. We observed a high rate of clinical improvement and a low associated mortality.
bookPart Covid-19(2023) SCARPELLINI, Bruno; MARCHINI, Julio Flávio Meirelles; HENRIQUES, Claudio Maeirovitch Pessanha; OLIVEIRA, Vitor Falcão de; NUNES, Maria do Patrocínio Tenório- Systematic review and meta-analysis of galactomannan antigen testing in serum and bronchoalveolar lavage for the diagnosis of chronic pulmonary aspergillosis: defining a cutoff(2023) OLIVEIRA, Vitor Falcao de; SILVA, Guilherme Diogo; TABORDA, Mariane; LEVIN, Anna S.; MAGRI, Marcello Mihailenko ChavesBackgroundA clear cutoff value of galactomannan (GM) has not been established for chronic pulmonary aspergillosis (CPA) and is frequently extrapolated from invasive pulmonary aspergillosis. We performed a systematic review and meta-analysis to evaluate the diagnostic performance of serum and bronchoalveolar lavage (BAL) GM, and to propose a cutoff.MethodsWe extracted from the studies the cutoff of serum or/and BAL GM associated with true positives, false positives, true negatives, and false negatives. We performed a multi-cutoff model and a non-parametric random effect model. We estimated the optimal cutoff and the area under the curve (AUC) for GM in serum and BAL samples.ResultsNine studies from 1999 to 2021 were included. Overall, the optimal cutoff of serum GM was 0.96 with a sensitivity of 0.29 (95%CI: 0.14-0.51); specificity of 0.88 (95%CI: 0.73-0.95); and AUC of 0.529 (with a CI: [0.415-0.682] [0.307-0.713]). The AUC for the non-parametric ROC model was 0.631. For BAL GM the cutoff was 0.67 with a sensitivity of 0.68 (95%CI: 0.51-0.82), specificity of 0.84 (95%CI: 0.70-0.92), and AUC of 0.814 (with a CI: [0.696-0.895] [0.733-0.881]). The AUC for the non-parametric model was 0.789.ConclusionThe diagnosis of CPA requires the assessment of a combination of mycological and serological factors, as no single serum and/or BAL GM antigen test is adequate. BAL GM performed better than serum, with better sensitivity and excellent accuracy.
- The Predictive Value of Sepsis Scores for In-Hospital Mortality in Patients with Left-Sided Infective Endocarditis(2024) ALMEIDA, Bianca Leal de; STRABELLI, Tania Mara Varejao; BITTENCOURT, Marcio Sommer; OLIVEIRA, Vitor Falcao de; GUALANDRO, Danielle Menosi; MANSUR, Alfredo Jose; TARASOUCHI, Flavio; POCEBON, Lucas; PAIXAO, Milena; GOLDEMBERG, Flora; SALOMAO, Reinaldo; SICILIANO, Rinaldo FocacciaBackground: As infective endocarditis has particular characteristics compared to other infectious diseases, it is not clear if sepsis scores are reported with good accuracy in these patients. The aim of this study is to evaluate the accuracy of the qSOFA and SOFA scores to predict mortality in patients with infective endocarditis. Methods: Between January 2010 and June 2019, 867 patients with suspected left-sided endocarditis were evaluated; 517 were included with left-sided infective endocarditis defined as ""possible"" or ""definite"" endocarditis, according to the Modified Duke Criteria. ROC curves were constructed to assess the accuracy of qSOFA and SOFA sepsis scores for the prediction of in-hospital mortality. Results: The median age was 57 years, 65% were male, 435 (84%) had pre-existing heart valve disease, and the overall mortality was 28%. The most frequent etiologies were Streptococcus spp. (36%), Enterococcus spp. (10%), and Staphylococcus aureus (9%). The sepsis scores from the ROC curves used to predict in-hospital mortality were qSOFA 0.601 (CI95% 0.522-0.681) and SOFA score 0.679 (CI95% 0.602-0.756). A sub-group analysis in patients with and without pre-existing valve disease for SOFA >= 2 showed ROC curves of 0.627 (CI95% 0.563-0.690) and 0.775 (CI95% 0.594-0.956), respectively. Conclusions: qSOFA and SOFA scores were associated with increased in-hospital mortality in patients with infective endocarditis. However, as accuracy was relatively lower compared to other sites of bacterial infections, we believe that this score may have lower accuracy when predicting the prognosis of patients with IE, because, in this disease, the patient's death may be more frequently linked to valvular and cardiac dysfunction, as well as embolic events, and less frequently directly associated with sepsis.
- Characterization of Severe Acute Respiratory Syndrome Coronavirus 2 Omicron Variant Shedding and Predictors of Viral Culture Positivity on Vaccinated Healthcare Workers With Mild Coronavirus Disease 2019(2022) LUNA-MUSCHI, Alessandra; NOGUERA, Saidy Vasconez; BORGES, Igor C.; V, Anderson De Paula; CORTES, Marina Farrel; LAROCCA, Carolina; MARI, Julia Ferreira; GUIMARAES, Lara Silva Pereira; TORRES, Pablo Munoz; SCACCIA, Nazareno; VILLAS-BOAS, Lucy S.; JR, Almir Ribeiro da Silva; ANDRADE, Pamela S.; TEIXEIRA, Juliana C.; ESCADAFAL, Camille; OLIVEIRA, Vitor Falcao de; TOZETTO-MENDOZA, Tania R.; MENDES-CORREA, Maria Cassia; LEVIN, Anna S.; SABINO, Ester C.; COSTA, Silvia F.We evaluated the duration of viral culture positivity compared to rapid antigen test (RAT) and real-time reverse-transcription polymerase chain reaction (RT-PCR) in mild Omicron infection. Vaccinated persons are potentially transmissible up to day 7. RAT and RT-PCR are predictors of viral culture positivity. In this prospective cohort of 30 vaccinated healthcare workers with mild Omicron variant infection, we evaluated viral culture, rapid antigen test (RAT), and real-time reverse-transcription polymerase chain reaction (RT-PCR) of respiratory samples at days 5, 7, 10, and 14. Viral culture was positive in 46% (11/24) and 20% (6/30) of samples at days 5 and 7, respectively. RAT and RT-PCR (Ct <= 35) showed 100% negative predictive value (NPV), with positive predictive values (PPVs) of 32% and 17%, respectively, for predicting viral culture positivity. A lower RT-PCR threshold (Ct <= 24) improved culture prediction (PPV = 39%; NPV = 100%). Vaccinated persons with mild Omicron infection are potentially transmissible up to day 7. RAT and RT-PCR might be useful tools for shortening the isolation period.
bookPart Meningites(2023) MACHADO, Luis dos Ramos; LIVRAMENTO, José Antonio; VIANNA, Liliana Scaff; OLIVEIRA, Vitor Falcão de; NUNES, Maria do PatrocínioTenório- Diagnosis of Chronic Pulmonary Aspergillosis: Challenges and Limitations Response to ""Diagnosis of Chronic Pulmonary Aspergillosis: Which Is the Best Investigation?"" and ""Diagnosis of Chronic Pulmonary Aspergillosis"" Reply(2023) OLIVEIRA, Vitor Falcao De; MAGRI, Marcello Mihailenko Chaves