DAVID DE SOUZA GOMEZ
Projetos de Pesquisa
Unidades Organizacionais
LIM/04 - Laboratório de Microcirurgia, Hospital das Clínicas, Faculdade de Medicina
22 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 22
- Clinical Outcome and Antimicrobial Therapeutic Drug Monitoring for the Treatment of Infections in Acute Burn Patients(2017) MACHADO, Anna Silva; OLIVEIRA, Maura S.; SANCHES, Cristina; SILVA JUNIOR, Carlindo Vieira da; GOMEZ, David S.; GEMPERLI, Rolf; SANTOS, Silvia Regina Cavani Jorge; LEVIN, Anna S.Purpose: In critical burn patients, the pharmacokinetic parameters (absorption, distribution, metabolism, and excretion) of many classes of drugs, including antibiotics, are altered. The aim of this study was to compare 2 groups of burn patients undergoing treatment for health care associated infections with and without therapeutic drug monitoring. Methods: A retrospective analysis of a clinical intervention (ie, a before/after study) was conducted with patients with health care associated pneumonia, burn infection, bloodstream infection, and urinary tract infection in the burn intensive care unit of a tertiary care hospital. The patients were divided into 2 groups: (1) those admitted from May 2005 to October 2008 who received conventional antimicrobial dose regimens; and (2) those admitted from November 2008 to June 2011 who received antibiotics (imipenem, meropenem, piperacillin, and vancomycin) with doses adjusted according to plasma monitoring and pharmacokinetic modeling. General characteristics of the groups were analyzed, as were clinical outcomes and 14-day and in-hospital mortality. Findings: Sixty-three patients formed the conventional treatment group, and 77 comprised the monitored treatment group. The groups were homogeneous, median age was 31 years (range: 1-90) and 66% were male. Improvement occurred in 60% of the patients under monitored treatment (vs 52% with conventional treatment); 14-day mortality was 16% vs 14%; and the in-hospital mortality was similar between groups (39% vs 36%). In the final multivariate models, variables significantly associated with in-hospital mortality were total burn surface area >= 30%, older age, and male sex. Treatment group did not affect the prognosis.
- Case Report: Stage VI Morel-Lavallee Lesion with a Large Challenging Defect(2021) NICOLAS, Gregory; ABBAS, Laielly; PRADO, Ariadne; TAKEMURA, Rafael Eiki; WADA, Alexandre; GOMEZ, David Souza; GEMPERLI, RolfMorel-Lavallee lesion (MLL) is a closed degloving soft-tissue injury that results in the accumulation of a hemolymphatic fluid between the skin/superficial fascia and the deep fascia. This is a rare injury that may be challenging to diagnose, and necessitates early identification and treatment to achieve the best outcomes. We report the case of a 45-year-old male patient who was referred to our institution for large wound closure after undergoing debridement of a misdiagnosed MLL that became complicated by infection and sepsis. The patient was retrospectively diagnosed with a Stage VI MLL and had to undergo 4 operations with skin grafting and vacuum-assisted closure therapy playing an essential role in achieving tissue closure. This case was presented as a reminder of this rare diagnosis, and the importance of considering it when faced with a patient presenting with a relevant clinical picture post trauma. An early diagnosis is important because early intervention can prevent complications and lead to better outcomes. The misdiagnosis in the case of our patient and delayed treatment led to an aggressive debridement with a large wound that was challenging to close.
- Minced skin grafts for chronic wounds compared to conventional mesh grafts(2023) SANCHES-PINTO, Debora C.; ERIKSSON, Elof; GOMEZ, David S.; NUNES, Maria P. T.; GEMPERLI, Rolf; SORIANO, Francisco G.Background and AimsSkin grafting is the single most effective method to close a chronic wound. The current standard of care is to use meshed split thickness skin grafts. This entails the use of surgical instruments that need to be autoclaved and to have a power source, which usually requires an OR facility. The minced skin technique uses single use, presterilized instruments and the procedure can be done under local anesthesia, by a wound care practitioner, in a wound clinic, a physician's office or even at the bedside. The current study was designed to determine if the results from micrografting were non inferior to conventional mesh grafting. MethodsIn a prospective non inferiority study, 26 chronic ulcers were treated with micrografting (MSG) and 24 with conventional mesh grafts 1:3 (control group-CG) in a total of 21 patients, 10 male and 11 female. The donor site areas in the MSG group were predetermined to 2.5 x 5 cm and the mesh grafts expansion was set at 1:3. ResultsIn the first weeks postoperatively, micrograft healing initially lagged behind the conventional mesh grafts but at 60 days after grafting, all MSG wounds were healed. The MSG wounds had better pigmentation, less itching, and less scarring. The micrografting procedure was easy to learn and expeditious to perform. The MSG mean expansion was 9.1 compared to three times (CG). ConclusionThe MSG procedure is not inferior to conventional mesh grafting, requires smaller donor sites, and can be done with single use instruments, under local anesthesia, with early discharge.
- Estabelecimento de protocolo para armazenamento de pele autógena refrigerada(2017) CONCEIÇÃO, RENATA OLIVEIRA DA; PAGGIARO, ANDRÉ OLIVEIRA; POLO, EUGÊNIO FERRAMUNDO; MARTINES, KARINA; ISAAC, CESAR; CARVALHO, VIVIANE FERNANDES DE; GOMEZ, DAVID DE SOUZA; GEMPERLI, ROLFABSTRACT Introduction: Autologous skin grafts are used for treatment of burn patients. These grafts can be stored and preserved, as long as the storage process is performed with strict quality control to reduce the risk of infection. Methods: A retrospective cohort study was conducted in the Burn Unit of the Hospital das Clínicas de São Paulo from February 2015 to July 2016. During this period, a protocol was established to store refrigerated skin, with control of collection, preservation, and packaging, and recording of all processes. To ensure quality, graft biopsies were collected for preand poststorage microbiology testing and a cross-sectional study for contamination was performed. Results: Critical deficiencies included inadequate packaging, lack of processing records, lack of biopsies for microbiology testing, and failure to discard specimens. Most of the samples were contaminated before and after storage (84.2%). Only two samples were sterile before storage but became contaminated after storage, with growth of Gram-positive skin bacteria. Conclusion: A promising method for the storage of refrigerated skin was established, but requires minor adjustments in quality control.
conferenceObject Meropenem extended infusion versus intermittent infusion against nosocomial MIC 4 mg/L strains to guarantee drug effectiveness by PK/PD approach in burn patients at the earlier period of septic shock(2021) MORALES JR., R.; KUPA, L. V. K.; VIANNA, K. B.; GARCIA, C. M.; SANTOS, V. J.; CAMPOS, E. V.; SILVA JR., J. M.; SILVA JR., E. M.; OLIVEIRA, T. C.; GOMEZ, D. S.; SANTOS, S. R. C. J.- Estudo epidemiológico de queimaduras em crianças atendidas em hospital terciário na cidade de São Paulo(2012) MILLAN, Lincoln Saito; GEMPERLI, Rolf; TOVO, Fernando Melhado; MENDAÇOLLI, Thiago Jung; GOMEZ, David Souza; FERREIRA, Marcus CastroBACKGROUND: This study describes the experience with the care of burned children in the Burn Treatment Unit, Division of Plastic Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (Hospital of the Faculty of Medicine, University of São Paulo - HCFMUSP) over 15 consecutive months. METHODS: The data of 98 patients up to 13 years of age treated in the Burn Treatment Unit of HCFMUSP from October 2009 to December 2010 were analyzed. RESULTS: The average age of the children was 5.2 years; 67 (68.4%) were boys. Accidents were responsible for burns in 93 (94.9%) cases, whereas 1 (1%) case of burns was caused by aggression. There was a higher incidence of burns in children under 2 years of age. The main agent causing burns was hot liquids (48%), followed by fire (17%) and hot solids (17%). The mean body surface area affected by second- and third-degree burns was 10%. Six (6.1%) patients had burns over more than 20% of their body surface area - 5 (83.3%) of them had burns due to burning alcohol and 1 (16.7%) due to scalding water. All cases in which more than 30% of the body surface was affected by second- and third-degree burns were due to alcohol burns. CONCLUSIONS: This survey demonstrates the importance of burn injuries in pediatric patients. The dataset suggests prevention efforts should focus on the domestic environment, particularly against scalding in children less than 5 years of age. In children older than 5 years, prevention programs should focus on both domestic and extradomestic environments.
- Characterization of critically ill adult burn patients admitted to a Brazilian intensive care unit(2014) CAMPOS, Edvaldo Vieira de; PARK, Marcelo; GOMEZ, David Souza; FERREIRA, Marcus Castro; AZEVEDO, Luciano Cesar PontesIntroduction: To characterize the evolution of clinical and physiological variables in severe adult burn patients admitted to a Brazilian burn ICU, we hypothesized that characteristics of survivors are different from non-survivors after ICU admission. Methods: A five-year observational study was carried out. The clinical characteristics, physiological variables, and outcomes were collected during this period. Results: A total of 163 patients required ICU support and were analyzed. Median age was 34 [25,47] years. Total burn surface area (TBSA) was 29 [18,43]%, and hospital mortality rate was 42%. Lethal burn area at which fifty percent of patients died (LA50%) was 36.5%. Median SAPS3 was 41 [34,54]. Factors associated with hospital mortality were analyzed in three steps, the first incorporated ICU admission data, the second incorporated first day ICU data, and the third incorporated data from the first week of an ICU stay. We found a significant association between hospital mortality and SAPS3 [OR(95%CI) = 1.114(1.062-1.168)], TBSA [OR(95%CI) = 1.043(1.010-1.076)], suicide attempts [OR(95%CI) = 8.126(2.284-28.907)], and cumulative fluid balance per liter within the first week [OR(95%CI) = 1.090(1.030-1.154)]. Inhalation injury was present in 45% of patients, and it was not significantly associated with hospital mortality. Conclusions: In this study of an ICU in a developing country, the mortality rate of critically ill burn patients was high and the TBSA was an independent risk factor for death. SAPS3 at admission and cumulative fluid balance in the first seven days, were also associated with unfavorable outcomes. The implementation of judicious fluid management after an acute resuscitation phase may help to improve outcomes in this scenario.
conferenceObject Piperacillin/tazobactam effectiveness in septic burn patients requiring vasopressors by applying pharmacokinetics-pharmacodynamics approach(2021) MORALES JR., R.; CHALOM, M. Y.; ROMANO, P.; EBNER, P. A. R.; SANTOS, M. S.; KUPA, L. V. K.; SUMITA, N. M.; DUARTE, N. J. C.; DUARTE, A. J. S.; GOMEZ, D. S.; SANTOS, S. R. J. C.- Os desafios no tratamento de paciente grande queimado e politraumatizado com trombose arterial em membro inferior durante a pandemia de COVID-19: relato de caso(2021) TAKEMURA, RAFAEL EIKI; NICOLAS, GREGORY; WADA, ALEXANDRE; GOMEZ, DAVID DE SOUZA; GEMPERLI, ROLF■ ABSTRACT Introduction: The COVID-19 pandemic spread rapidly worldwide, bringing the need for emergency actions to control the disease at the collective and individual level. Thus, the Division of Plastic Surgery and Burns of the largest hospital complex in Latin America was physically aimed at the infected. In this context, we find the challenges of treating a large burned and polytraumatized patient, who presented arterial thrombosis in the lower limb, a rare complication associated with the thermal burn. All treatment was performed in a hospital not specialized in trauma care. Case Report: Case Report: Male patient, 18 years old, without comorbidities, with predominantly third-degree burns of 50% of body surface burned and severe neurotrauma. He presented arterial thrombosis in his right leg 24 hours after the burn. The patient underwent limb amputation and serial surgical interventions for debridement and skin grafting. Despite the prevention protocols, the patient was infected by COVID-19 during hospitalization. Conclusion: This case focuses on a rare complication related to burn injury, which does not yet have diagnostic criteria and defined prophylactic measures. Besides, the COVID-19 pandemic has impacted various health services areas, and it is essential to share knowledge during this pandemic by seeking adaptations to the crisis situation.
- Individualised vancomycin doses for paediatric burn patients to achieve PK/PD targets(2013) GOMEZ, David S.; CAMPOS, Edvaldo V.; AZEVEDO, Rodrigo P. de; SILVA- JR., Joao Manoel da; FERREIRA, Marcus C.; SANCHES-GIRAUD, Cristina; SILVA- JR., Carlindo Vieira; SANTOS, Silvia R. C. J.Background: The objective of the study was to investigate vancomycin dose adjustment in pediatric burn patients by evaluating trough drug concentrations and the pharmacokinetic and pharmacodynamic (PK/PD) correlation. Methods: Study subjects included 13 patients who were 6.0 years old, 25 kg (median). with normal renal function. These had at least a 30% total burn surface area and inhalation injury were present in 7/13 patients. The patients were investigated prospectively. Plasma monitoring and PK assessments were performed by serial blood sample collections (30 sets). Only 0.2 mL of each plasma sample was required for our plasma measurements, which were made by high performance liquid chromatography. The vancomycin PK/PD target was set at AUC(0-24)(ss)/MIC > 400. Results: Trough values less than 10 mu g/mL were obtained in 16/30 sets (53%) as a consequence of increased plasma clearance and the apparent volume of distribution. The daily dose was subsequently increased from 43.4 +/- 9.0 mg/kg (mean +/- SD) to 98.0 +/- 17.9 mg/kg, p < 0.05. The PK/PD target was reached for pathogens with 0.5 mg/L, 1 mg/L, 2 mg/L and 4 mg/L MIC in 93.3% (28/30), 66.7% (20/30), 33.3% (10/30) and 3.3% (1/30) of the sets, respectively. Conclusions: To more rapidly achieve the PK/PD targets in pediatric burn patients with normal renal function, an initial dose of approximately 90-100 mg/kg/day is recommended; however, this higher dosage regimen should be further evaluated in this population in terms of efficacy and toxicity as well as in terms of achieving pharmacodynamic goals.
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