FELIPPE LAZAR NETO
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina
4 resultados
Resultados de Busca
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- Comparative assessment of mortality risk factors between admission and follow-up models among patients hospitalized with COVID-19(2021) LAZAR NETO, Felippe; SALZSTEIN, Guilherme A.; CORTEZ, Andre L.; BASTOS, Thais L.; BAPTISTA, Fabiola V. D.; MOREIRA, Joanne A.; LAUTERBACH, Gerhard P.; OLIVEIRA, Julio Cesar de; ASSIS, Fabio C. de; AGUIAR, Marilia R. A.; DEUS, Aline A. de; DIAS, Marcos Felipe D. S.; SOUSA, Felipe C. B.; DUAILIBI, Daniel F.; KONDO, Rodrigo H.; MORAES, Augusto Cesar F. de; MARTINS, Milton A.Objectives: This study aimed to compare differences in mortality risk factors between admission and follow-up incorporated models. Methods: A retrospective cohort study of 524 patients with confirmed COVID-19 infection admitted to a tertiary medical center in S?o Paulo, Brazil from 13 March to 30 April 2020. Data were collected on admission, and the third, eighth and fourteenth days of hospitalization. The hazard ratio (HR) was calculated and 28-day in-hospital mortality risk factors were compared between admission and followup models using a time-dependent Cox regression model. Results: Of 524 patients, 50.4% needed mechanical ventilation. The 28-day mortality rate was 32.8%. Compared with follow-up, admission models under-estimated the mortality HR for peripheral oxygen saturation 92% (1.21 versus 2.09), heart rate 100 bpm (1.19 versus 2.04), respiratory rate >24/min (1.01 versus 1.82) and mechanical ventilation (1.92 versus 12.93). Low oxygen saturation, higher oxygen support and more biomarkers?including lactate dehydrogenase, C-reactive protein, neutrophillymphocyte ratio, and urea remained associated with mortality after adjustment for clinical factors at follow-up compared with only urea and oxygen support at admission. Conclusions: The inclusion of follow-up measurements changed mortality hazards of clinical signs and biomarkers. Low oxygen saturation, higher oxygen support, lactate dehydrogenase, C-reactive protein, neutrophil-lymphocyte ratio, and urea could help with prognosis of patients during follow-up. ? 2021 The Authors.
- Methemoglobinemia and hemolytic anemia after COVID-19 infection without identifiable eliciting drug: A case-report(2021) LOPES, Desiree Verde; NETO, Felippe Lazar; MARQUES, Lais C.; LIMA, Rodrigo B. O.; BRANDAO, Antonio Adolfo Guerra SoaresWe report a second case of methemoglobinemia and non-autoimmune hemolytic anemia after contracting the SARS-CoV-2 infection in the absence of an identifiable eliciting drug. A 35-year old male without previous known comorbidities was admitted after he was diagnosed with the COVID-19 infection and had large pulmonary involvement. Seven days later, he desaturated but was without any signs of respiratory distress. A check of arterial blood gas revealed normal partial pressure of oxygen and follow-up tests confirmed a methemoglobinemia diagnosis. Over the next few days, hemolysis was established after decreased levels of hemoglobin and increased levels of indirect bilirubin and lactate dehydrogenase. A hemolytic anemia investigation panel came back normal, including G6PD. A second G6PD test was ordered at the 5-month follow-up appointment and revealed decreased levels. Clinicians should thus be aware of possible false negative tests when testing for G6PD during hemolytic crisis. In addition, whether the COVID-19 infection alone would be responsible for this chain of events remains a challenging question. (C) 2020 The Authors.
- Lung ultrasound score predicts outcomes in COVID-19 patients admitted to the emergency department(2021) ALENCAR, Julio Cesar Garcia de; MARCHINI, Julio Flavio Meirelles; MARINO, Lucas Oliveira; RIBEIRO, Sabrina Correa da Costa; BUENO, Caue Gasparotto; CUNHA, Victor Paro da; LAZAR NETO, Felippe; BRANDAO NETO, Rodrigo Antonio; SOUZA, Heraldo PossoloBackground During the COVID-19 pandemic, creating tools to assess disease severity is one of the most important aspects of reducing the burden on emergency departments. Lung ultrasound has a high accuracy for the diagnosis of pulmonary diseases; however, there are few prospective studies demonstrating that lung ultrasound can predict outcomes in COVID-19 patients. We hypothesized that lung ultrasound score (LUS) at hospital admission could predict outcomes of COVID-19 patients. This is a prospective cohort study conducted from 14 March through 6 May 2020 in the emergency department (ED) of an urban, academic, level I trauma center. Patients aged 18 years and older and admitted to the ED with confirmed COVID-19 were considered eligible. Emergency physicians performed lung ultrasounds and calculated LUS, which was tested for correlation with outcomes. This protocol was approved by the local Ethics Committee number 3.990.817 (CAAE: 30417520.0.0000.0068). Results The primary endpoint was death from any cause. The secondary endpoints were ICU admission and endotracheal intubation for respiratory failure. Among 180 patients with confirmed COVID-19 who were enrolled (mean age, 60 years; 105 male), the average LUS was 18.7 +/- 6.8. LUS correlated with findings from chest CT and could predict the estimated extent of parenchymal involvement (mean LUS with < 50% involvement on chest CT, 15 +/- 6.7 vs. 21 +/- 6.0 with > 50% involvement, p < 0.001), death (AUC 0.72, OR 1.13, 95% CI 1.07 to 1.21; p < 0.001), endotracheal intubation (AUC 0.76, OR 1.17, 95% CI 1.09 to 1.26; p < 0.001), and ICU admission (AUC: 0.71, OR 1.14, 95% CI 1.07 to 1.21; p < 0.001). Conclusions In COVID-19 patients admitted in ED, LUS was a good predictor of death, ICU admission, and endotracheal intubation.
- First-attempt intubation success and complications in patients with COVID-19 undergoing emergency intubation(2020) ALENCAR, Julio Cesar Garcia de; MARQUES, Bruno; MARCHINI, Julio Flavio Meirelles; MARINO, Lucas Oliveira; RIBEIRO, Sabrina Correa da Costa; BUENO, Caue Gasparotto; CUNHA, Victor Paro da; LAZAR NETO, Felippe; VALENTE, Fernando Salvetti; RAHHAL, Hassan; PEREIRA, Juliana Batista Rodrigues; PADRAO, Eduardo Messias Hirano; WANDERLEY, Annelise Passos Bispos; COSTA, Millena Gomes Pinheiro; BRANDAO NETO, Rodrigo Antonio; SOUZA, Heraldo PossoloObjectivesTo evaluate the first-attempt success rates and complications of endotracheal intubation of coronavirus disease 2019 (COVID-19) patients by emergency physicians. MethodsThis prospective observational study was conducted from March 24, 2020 through May 28, 2020 at the emergency department (ED) of an urban, academic trauma center. We enrolled patients consecutively admitted to the ED with suspected or confirmed COVID-19 submitted to endotracheal intubation. No patients were excluded. The primary outcome was first-attempt intubation success, defined as successful endotracheal tube placement with the first device passed (endotracheal tube) during the first laryngoscope insertion confirmed with capnography. Secondary outcomes included the following complications: hypotension, hypoxemia, aspiration, and esophageal intubation. ResultsA total of 112 patients with confirmed or suspected COVID-19 were enrolled. Median age was 61 years and 61 patients (54%) were men. The primary outcome, first-attempt intubation success, was achieved in 82% of patients. Among the 20 patients who were not intubated on the first attempt, 75% were intubated on the second attempt and 20% on the third attempt; cricothyrotomy was performed in 1 patient. Forty-eight (42%) patients were hypotensive and required norepinephrine immediately post-intubation. Fifty-eight (52%) experienced peri-intubation hypoxemia, and 2 patients (2%) had cardiac arrest. There were no cases of failed intubation resulting in death up to 24 hours after the procedure. ConclusionEmergency physicians achieve high success rates when intubating COVID19 patients, although complications are frequent. However, these findings should be considered provisional until their generalizability is assessed in their institutions and setting.