JURACI APARECIDA ROCHA
Projetos de Pesquisa
Unidades Organizacionais
PAHC, Hospital das Clínicas, Faculdade de Medicina - Médico
8 resultados
Resultados de Busca
Agora exibindo 1 - 8 de 8
- Criterion validity and inter-rater reliability o a palliative care screening tool for patients admitted to an emergency department intensive care unit(2018) RIBEIRO, Sabrina Correa da Costa; CARVALHO, Ricardo Tavares de; ROCHA, Juraci Aparecida; DIAS, Roger DagliusObjective. The use of palliative care (PC) screening criteria to trigger PC consultations may optimize the utilization of PC services, improve patient comfort, and reduce invasive and futile end-of-life care. The aim of the present study was to assess the criterion validity and inter-rater reliability of a PC screening tool for patients admitted to an emergency department intensive care unit (ED-ICU). Method. Observational retrospective study evaluating PC screening criteria based on the presence of advanced diagnosis and the use of two ""surprise questions"" (traditional and modified). Patients were classified at ED-ICU admission in four categories according to the proposed algorithm. Result. A total of 510 patients were included in the analysis. From these, 337 (66.1%) were category 1, 0 (0.0%) category 2, 63 (12.4%) category 3, and 110 (21.6%) category 4. Severity of illness (Simplified Acute Physiology Score III score and mechanical ventilation), mortality (ED-ICU and intrahospital), and PC-related measures (order for a PC consultation, time between admission and PC consultation, and transfer to a PC bed) were significantly different across groups, more evidently between categories 4 and 1. Category 3 patients presented similar outcomes to patients in category 1 for severity of illness and mortality. However, category 3 patients had a PC consultation ordered more frequently than did category 1 patients. The screening criteria were assessed by two independent raters (n = 100), and a substantial interrater reliability was found, with 80% of agreement and a kappa coefficient of 0.75 (95% confidence interval = 0.62, 0.88). Significance of results. This study is the first step toward the implementation of a PC screening tool in the ED-ICU. The tool was able to discriminate three groups of patients within a spectrum of increasing severity of illness, risk of death, and PC needs, presenting substantial inter-rater reliability. Future research should investigate the implementation of these screening criteria into routine practice of an ED-ICU.
- High Muscle Sympathetic Nerve Activity Is Associated With Left Ventricular Dysfunction in Treated Hypertensive Patients(2013) SOUZA, Silvia Beatriz Cavasin de; ROCHA, Juraci Aparecida; CUOCO, Marco Antonio Romeu; GUERRA, Grazia Maria; FERREIRA-FILHO, Julio Cesar; BORILE, Suellen; KRIEGER, Eduardo Moacyr; BORTOLOTTO, Luiz Aparecido; CONSOLIM-COLOMBO, Fernanda MarcianoThe presence of asymptomatic left ventricular diastolic dysfunction (LVDD) in hypertensive patients can be associated with the development of cardiac events. The increase in sympathetic activity may be 1 of the mechanisms that predisposes to this outcome. In this study, we analyzed 2 hypotheses: (i) whether sympathetic activity is higher in the presence of LVDD, independent of blood pressure control and (ii) whether different classes of LVDD have a different effect on sympathetic activity. After analyzing left ventricular function using echo Doppler cardiography, 45 hypertensive patients receiving treatment were allocated into 3 groups: normal function (LV-NF, n 15), impaired relaxation (LV-IR, n 15), and pseudonormal or restrictive (LV-P/R, n 15). An age-, sex-, and body mass indexmatched control group of normotensive volunteers (N, n 14) was included. Muscle sympathetic nerve activity (MSNA), heart rate, and systolic blood pressure variabilities and baroreflex sensitivity were evaluated while the patient was in a supine position. Blood pressure and antihypertensive drug use were similar among the hypertensive groups. The LV-IR and LV-P/R groups had similar MSNA (331 and 321 bursts/min, respectively), which was significantly higher than that of the LV-NF and N groups (263 and 152 bursts/min, respectively). The LV-IR and LV-P/R groups had significantly higher LF-systolic blood pressure variability and significantly lower baroreflex sensitivity compared with the N group. The presence of asymptomatic LVDD is associated with increased MSNA, independent of blood pressure control. The sympathetic hyperactivity associated with LVDD is similar in the different patterns of LVDD studied.
conferenceObject SEVERE SARS-COV-2 INFECTION IN PATIENTS WITH CHRONIC KIDNEY DISEASE AND LUNG DISEASE. OUTCOMES AND REFERRAL FOR PALLIATIVE CARE IN A TERTIARY CENTER IN SAO PAULO, BRAZIL(2022) GUELLI, Mariana Sandoval Terra Campos; ZAMPIER, Daniela; MONEZZI, Paula Pinto; TSUDA, Victor Massatochi Kawakami; BRANDAO, Ana Beatriz; GARCIA, Monica Estuque; ROCHA, Juraci; CARVALHO, Ricardo Tavares de- Evaluation of a New Triage Protocol for Palliative Care for Patients with COVID-19 in Brazil(2023) CORREA, Tulio Loyola; SIMAO, Aurea Maria Salomao; SOBREIRA, Joyce Veceli Barros; ANBAR, Fernanda Baeninger; YARSHELL, Flavia; BRANDAO, Ana Beatriz; ESTUQUE, Monica Queiros; ROCHA, Juraci Aparecida; CARVALHO, Ricardo Tavares deObjectives: To evaluate the implementation of a triage protocol for palliative care (PC) during the COVID-19 pandemic (PALI-COVID) at a referral center in Brazil.Methods: A retrospective observational study was conducted. Based on the triage protocol, patients were classified into a red group, a yellow group, and a green group (GG). Patients should receive PC as recommended for each group.Results: A total of 1517 patients were included in the analysis. About 11% (n = 162) of patients received PC. About 35% (n = 529) of all patients died. There was a significant difference in the mortality rate between the groups; the GG had the highest mortality rate. Most patients who died (77.1%) did not receive PC.Conclusion: PALI-COVID was effective in identifying patients who had a higher risk of death and needed end-of-life support. Despite the protocol, few patients received PC.
- Increase in cholinergic modulation with pyridostigmine induces anti-inflammatory cell recruitment soon after acute myocardial infarction in rats(2016) ROCHA, Juraci Aparecida; RIBEIRO, Susan Pereira; FRANCA, Cristiane Miranda; COELHO, Otavio; ALVES, Gisele; LACCHINI, Silvia; KALLAS, Esper Georges; IRIGOYEN, Maria Claudia; CONSOLIM-COLOMBO, Fernanda M.
conferenceObject Eight Years of Experience in Palliative Care Consultation in a University Hospital for Inpatients With Advanced Heart Disease. What Have We Learned So Far and Which Are the Perspectives for the Future?(2018) DEI, Santi Daniel; CANOSA, Henrique; ROCHA, Juraci; CRISPIM, Douglas; CARVALHO, Ricardo T.- Role of Exercise Training on Autonomic Changes and Inflammatory Profile Induced by Myocardial Infarction(2014) RODRIGUES, Bruno; LIRA, Fabio S.; CONSOLIM-COLOMBO, Fernanda M.; ROCHA, Juraci A.; CAPERUTO, Erico C.; ANGELIS, Katia De; IRIGOYEN, Maria-ClaudiaThe cardiovascular autonomic imbalance in patients after myocardial infarction (MI) provides a significant increase in mortality rate, and seems to precede metabolic, hormonal, and immunological changes. Moreover, the reduction in the parasympathetic function has been associated with inflammatory response in different pathological conditions. Over the years, most of the studies have indicated the exercise training (ET) as an important nonpharmacological tool in the management of autonomic dysfunction and reduction in inflammatory profile after a myocardial infarction. In this work, we reviewed the effects of ET on autonomic imbalance after MI, and its consequences, particularly, in the post-MI inflammatory profile. Clinical and experimental evidence regarding relationship between alterations in autonomic regulation and local or systemic inflammation response after MI were also discussed.
- Cholinergic Stimulation Improves Oxidative Stress and Inflammation in Experimental Myocardial Infarction(2017) BEZERRA, Otavio C.; FRANCA, Cristiane Miranda; ROCHA, Juraci Aparecida; NEVES, Gizele A.; SOUZA, Pamella Ramona M.; GOMES, Mariana Teixeira; MALFITANO, Christiane; LOLEIRO, Tatiane C. Alba; DOURADO, Paulo Magno; LLESUY, Susana; ANGELIS, Katia de; IRIGOYEN, Maria Claudia C.; ULLOA, Luis; CONSOLIM-COLOMBO, Fernanda M.We previously reported that cholinergic stimulation with pyridostigmine (PY) induces anti-inflammatory cell recruitment soon after myocardial infarction (MI). In this study, we evaluated the anti-inflammatory effects of PY during the proliferative phase of cardiac repair by analyzing the infiltration of macrophages, Treg lymphocytes, oxidative stress and inflammatory cytokines. Wistar rats underwent control sham surgery or ligation of the left coronary artery and were randomly allocated to remain untreated (untreated infarcted group, I) or to receive PY (30 mg.kg(-1).day(-1)) in the supplied water (infarcted treated group, I + PY). Blood pressure and heart rate variability were registered at day 5 post-MI. The animals were euthanized 7 days after thoracotomy, when the hearts were removed and processed for immunohistochemistry (CD68, CD206, FOXP3), cytokines (IL-1 beta, IL-6, IL-10, TNF-alpha) and oxidative stress (superoxide dismutase, catalase, glutathione peroxidase, lipidic and protein peroxidation). PY treatment increased parasympathetic modulation, M2 macrophages and the antioxidant enzyme activity but reduced protein oxidation (carbonyls) and the concentration of IL-1 beta, IL-6, TNF-alpha and IL-10. Cholinergic stimulation induces parasympathetic neuro-immune modulation and anti-inflammatory cell enrollment as well as prevents oxidative stress and cytokine production after MI.