GERHARD DA PAZ LAUTERBACH
Projetos de Pesquisa
Unidades Organizacionais
LIM/20 - Laboratório de Terapêutica Experimental, Hospital das Clínicas, Faculdade de Medicina
6 resultados
Resultados de Busca
Agora exibindo 1 - 6 de 6
- 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.
- Blood leukocyte transcriptional modules and differentially expressed genes associated with disease severity and age in COVID-19 patients(2023) BANDO, Silvia Y.; BERTONHA, Fernanda B.; VIEIRA, Sandra E.; OLIVEIRA, Danielle B. L. de; CHALUP, Vanessa N.; DURIGON, Edison L.; PALMEIRA, Patricia; CURI, Ana Cristina P.; FARIA, Caroline S.; ANTONANGELO, Leila; LAUTERBACH, Gerhard da P.; REGALIO, Fabiane A.; CESAR, Roberto M.; MOREIRA-FILHO, Carlos A.Since the molecular mechanisms determining COVID-19 severity are not yet well understood, there is a demand for biomarkers derived from comparative transcriptome analyses of mild and severe cases, combined with patients' clinico-demographic and laboratory data. Here the transcriptomic response of human leukocytes to SARS-CoV-2 infection was investigated by focusing on the differences between mild and severe cases and between age subgroups (younger and older adults). Three transcriptional modules correlated with these traits were functionally characterized, as well as 23 differentially expressed genes (DEGs) associated to disease severity. One module, correlated with severe cases and older patients, had an overrepresentation of genes involved in innate immune response and in neutrophil activation, whereas two other modules, correlated with disease severity and younger patients, harbored genes involved in the innate immune response to viral infections, and in the regulation of this response. This transcriptomic mechanism could be related to the better outcome observed in younger COVID-19 patients. The DEGs, all hyper-expressed in the group of severe cases, were mostly involved in neutrophil activation and in the p53 pathway, therefore related to inflammation and lymphopenia. These biomarkers may be useful for getting a better stratification of risk factors in COVID-19.
- Human Leukocyte Transcriptional Response to SARS-CoV-2 Infection(2020) VIEIRA, Sandra Elisabete; BANDO, Silvia Yumi; LAUTERBACH, Gerhard da Paz; MOREIRA-FILHO, Carlos Alberto
- Patient Safety under Flexible and Standard Duty-Hour Rules(2019) LANDRIGAN, Christopher P.; CZEISLER, Charles A.; SQUIERS, John J.; LAUTERBACH, Gerhard P.; VALENTE, Fernando S.; NUNES, Maria P. T.
- InsulinAPP application protocol for the inpatient management of type 2 diabetes on a hospitalist-managed ward: a retrospective study(2022) TOYOSHIMA, Marcos Tadashi Kakitan; BRANDES, Pedro Henrique Ribeiro; LAUTERBACH, Gerhard da Paz; MARAES, Jessica Ribeiro Andrade; PAIVA, Edison Ferreira de; UMPIERREZ, Guillermo E.; NERY, Marcia; KONDO, Rodrigo HiddObjective: We assessed metrics related to inpatient glycemic control using InsulinAPP, an application available for free in Brazil, on the hospitalist-managed ward of our hospital. Subjects and methods: We performed a retrospective study of patients with type 2 diabetes (T2D) admitted from November 2018 to October 2019. InsulinAPP recommends NPH and regular insulins three times a day, in bolus-correction or basal-bolus schemes. Parameters that included BG within range of 70-180 mg/ dL, insulin treatment regimen and frequency of hypoglycemia were evaluated. Results: A total of 147 T2D individuals (23% medicine and 77% surgery) were included (mean age 62.3 +/- 12.7 years, HbA1c: 8.3 +/- 3.0%). The initial insulin regimen was 50% bolus-correction, 47% basal-bolus and 3% with sliding scale insulin. During hospitalization, 71% patients required a bolus-basal regimen. In the first 10 days of the protocol, 71% BG measurements were between 70-180 mg/dL and 26% patients experienced one or more episodes of hypoglycemia < 70 mg/dL, and 5% with BG < 54 mg/dL. Conclusion: The results of this retrospective study indicate the InsulinAPP application using human insulin formulations was effective and safe for the management of hyperglycemia on a hospitalist-managed ward, with more than 70% BG measurements within the therapeutic range and a low rate of hypoglycemia. Arch Endocrinol Metab. 2022;66(4):498-505
- Analysis of the Perception of Interns, Residents, and Preceptors through the Mini-CEX Evaluation Method (Mini-Clinical Evaluation Exercise)(2020) MARINHO, Mayra Costa Baltazar; CASTRO JÚNIOR, Euton Freitas de; LAUTERBACH, Gerhard da Paz; NUNES, Maria do Patrocínio Tenório; AUGUSTO, Kristopherson LustosaAbstract: Introduction: Mini-CEX is an evaluation method that covers the domains: anamnesis, physical examination, counseling, clinical judgment, organization, and professionalism. It has been tested and validated for use in any practice scenario. With its characteristic of providing feedback after a clinical assessment, the Mini-CEX can also be used as a training method to guide the professional development of students and teachers, promoting greater knowledge retention in undergraduate students and continuously providing information for students to realize how far they are from the desired objectives. The aim of this study was to assess the perception of interns, residents, and preceptors of Internal Medicine (IM) regarding the Mini-CEX instrument. Methods: Qualitative study, using the focus group technique, carried out from February to July 2017. Twenty interns, thirteen residents, and five IM preceptors participated. It consisted of six focus groups, two with interns, two with residents, and two with preceptors, using semi-structured questions that identified perceptions, through the methodology used, on the quality of the evaluation and possible repercussions for the teaching-learning process. Results: In the focus group of interns, the feedback moment of the assessment was considered essential for the learning process, although the bedside assessment was tense due to the preceptor’s presence. The residents reported that the evaluation was a valid one, as it led them to review some points in the medical literature, in addition to stimulating clinical reasoning in the face of a real situation. The preceptors validated the importance of the feedback for those who were evaluated and identified the bedside assessment as a moment for the best analysis of the individualities. Conclusion: Through the perceptions of the groups in focus, the mini-CEX was identified as a fundamental instrument for the teaching and learning process of all those involved and the need to structure the moment of feedback aiming to attain a more effective result. During the bedside assessment, the stimulus to clinical reasoning was identified as a positive point and the strangeness, anxiety, and tension as negative points.