DAVID DE SOUZA GOMEZ
Projetos de Pesquisa
Unidades Organizacionais
LIM/04 - Laboratório de Microcirurgia, Hospital das Clínicas, Faculdade de Medicina
4 resultados
Resultados de Busca
Agora exibindo 1 - 4 de 4
- 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.
- 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.
article 0 Citação(ões) na Scopus Amphotericin B Plasma Monitoring for One Burn Child Using High-Performance Liquid Chromatography(2011) SANCHES-GIRAUD, Cristina; GOMEZ, David S.; CAMPOS, Edvaldo V.; AZEVEDO, Rodrigo P. de; DESPINOY, Alessandra; PEREZ, Grazziela S.; FERREIRA, Marcus C.; SANTOS, Silvia R. C. J.A bioanalytical micromethod was described for the quantification of amphotericin B in plasma by HPLC. The method showed high absolute recovery, good linearity (0.1-10.0 mu g/mL, r(2) = 0.999), sensitivity (limits of quantification: 0.1 mu g/mL), and acceptable stability. Inter/intraday precisions were 6.8 %/23 % and mean accuracy was 94.3 %. The method was applied to plasma monitoring of one burn child, 3 years old, 25 kg, thermal injury (18 % total burn surface area - TBSA). Amphotericin B (1 mg/kg) was prescribed from 24(tg) to 35(tg) day of the accident and plasma monitoring and pharmacokinetics was performed by serial blood collections on 274 and 354 days post burn. Plasma concentrations obtained were respectively 0.7 mu g/mL and 1.2 mu g/mL. Pharmacokinetics at both periods (27(tg) vs 35(tg) day) also was compared: 13.8 vs 14.3 h (t(1/2 beta)); 0.5 vs 03 mL/min.kg (CL(T)) and 0.65 vs 038 L/kg (Vd(ss)). In conclusion, drug plasma monitoring by HPLC was quite useful to guarantee low risk and drug efficacy in a paediatric burn patient.