MARLON JULIANO ROMERO ALIBERTI
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/66, Hospital das Clínicas, Faculdade de Medicina
LIM/66, Hospital das Clínicas, Faculdade de Medicina
15 resultados
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article 3 Citação(ões) na Scopus Empowering older adults and their communities to cope with depression in resource-limited settings(2022) ALIBERTI, Marlon Juliano Romero; SUEMOTO, Claudia Kimie- A 2-Minute Cognitive Screener for Predicting 1-Year Functional Recovery and Survival in Older Adults After Hip Fracture Repair(2022) FORTES-FILHO, Sileno De Queiroz; ALIBERTI, Marlon Juliano Romero; MELO, Juliana de Araujo; APOLINARIO, Daniel; SITTA, Maria do Carmo; SUZUKI, Itiro; GARCEZ-LEME, Luiz EugenioBackground: Implementing cognitive assessment in older people admitted to hospital with hip fracture-lying in bed, experiencing pain-is challenging. We investigated the value of a quick and easy-to-administer 10-point Cognitive Screener (10-CS) in predicting 1-year functional recovery and survival after hip surgery. Methods: Prospective cohort study comprising 304 older patients (mean age = 80.3 +/- 9.1 years; women = 72%) with hip fracture consecutively admitted to a specialized academic medical center that supports secondary hospitals in Sao Paulo Metropolitan Area, Brazil. The 10-CS, a 2-minute bedside tool including temporal orientation, verbal fluency, and three-word recall, classified patients as having normal cognition, possible cognitive impairment, or probable cognitive impairment on admission. Outcomes were time-torecovery activities of daily living (ADLs; Katz index) and mobility (New Mobility Score), and survival during 1-year after hip surgery. Hazard models, considering death as a competing risk, were used to associate the 10-CS categories with outcomes after adjusting for sociodemographic and clinical measures. Results: On admission, 144 (47%) patients had probable cognitive impairment. Compared to those cognitively normal, patients with probable cognitive impairment presented less postsurgical recovery of ADLs (77% vs 40%; adjusted sub-hazard ratio [HR] = 0.44; 95% confidence interval (CI] = 0.32-0.62) and mobility (50% vs 30%; adjusted sub-HR = 0.52; 95% CI = 0.34-0.79), and higher risk of death (15% vs 40%; adjusted HR = 2.08; 95% CI = 1.03-4.20) over 1-year follow-up. Conclusions: The 10-CS is a strong predictor of functional recovery and survival after hip fracture repair. Cognitive assessment using quick and easy-to-administer screening tools like 10-CS can help clinicians make better decisions and offer tailored care for older patients admitted with hip fracture.
bookPart Avaliação geriátrica ampla(2022) SEIFARTH, Filipe Pedroso; ALMEIDA, Anna Elisa Marcus; ALIBERTI, Márlon Juliano Romero- Potentially inappropriate medications in older adults visiting a geriatric emergency department(2022) MARTINI, Isadora D.; CORREA, Fabiane G.; CASTELO, Pedro R.; MORINAGA, Christian V.; GIL-JUNIOR, Luiz A.; ALIBERTI, Marlon J. R.; CURIATI, Pedro K.; AVELINO-SILVA, Thiago J.
- Risk and protective factors for dementia: epidemiological evidence and windows of opportunity(2022) SUEMOTO, C. K.; NITRINI, R.; GRINBERG, L. T.; LEITE, R. E. P.; PASQUALLUCCI, C. A.; BERTOLA, L.; VIDAL-FERREIRA, N.; SZLEFJ, C.; CARAMELLI, P.; BENSENOR, I. M.; LOTUFO, P. A.; ALIBERTI, M. J. R.; FERRI, C. P.; JACOB-FILHO, W.Background: Most people with dementia already live in low- to middle-income countries (LMIC). However, most evidence regarding dementia prevention comes from high-income countries that have different socioeconomic status (SES) and risk factors prevalence than LMIC. In this session, we will present results on risk and protective factors for dementia from the Longitudinal Study of Adult Health (ELSA-Brasil), the Brazilian Longitudinal Study of Aging (ELSI-Brazil), and the Brazilian Biobank for Aging Studies (BAS). Method: The ELSA-Brasil follows 15,105 public servants since 2008-10. The ELSI-Brazil is a nationally representative study with 9,412 adults aged 50 years and older, who were enrolled in 2015-16. The BAS is a neuropathology study that started in 2004 and is the largest brain bank in Latin America with a collection of 1,441 brains. The focus of this presentation will be on the associations of education, SES, and cardiovascular factors with dementia using data from these three studies. Result: In the BAS, 77% of the sample has less than 5 years of education and 56% unskilled occupations. Compared to the group without education, those with formal education had better cognitive performance (1-4 years: β = -0.99, 95%CI = –1.85; –0.14, p = 0.02; ≥5 years: = –1.42, 95% CI = –2.47; –0.38, p = 0.008). On the other hand, occupation complexity and demands were unrelated to cognition. Similarly, we showed that education and early-life SES were the main contributors to cognitive performance in the ELSA-Brasil, while later SES had a lower influence on cognitive scores. Cardiovascular factors are also important contributors to brain health. Ideal vascular health was related to better cognitive function in the ELSA-Brasil. Participants with intermediate (β = 0.064, 95%CI = 0.033; 0.096) and optimal health (β = 0.108, 95%CI = 0.052; 0.164) had better cognitive z-scores. Moreover, carotid artery atherosclerosis evaluated by morphometric measurements was related to cognitive impairment in BAS and with cognitive decline in the ELSA-Brasil after 8 years of follow-up (β = -0.028, 95%CI = -0.036; -0.020, p<0.001). Finally, hypertension was related to worse cognition (β = -0.09; 95%CI = -0.15, -0.04; p = 0.001) in ELSI-Brazil, mainly in non-frail participants. Conclusion: Studies from LMIC regarding dementia risk factors are essential to implement tailored public policies for dementia primary prevention. © 2022 the Alzheimer's Association.
- Reply to: Comment on: Potentially inappropriate medications in older adults visiting a geriatric emergency department(2022) MARTINI, Isadora D.; ALIBERTI, Marlon J. R.; AVELINO-SILVA, Thiago J.; CURIATI, Pedro K.
- Patient-Centered Outcomes Following COVID-19: Frailty and Disability Transitions in Critical Care Survivors*(2022) TANIGUCHI, Leandro Utino; AVELINO-SILVA, Thiago Junqueira; DIAS, Murilo Bacchini; JACOB-FILHO, Wilson; ALIBERTI, Marlon Juliano RomeroOBJECTIVES: As the pandemic advances, the interest in the long-lasting consequences of COVID-19 increases. However, a few studies have explored patient-centered outcomes in critical care survivors. We aimed to investigate frailty and disability transitions in COVID-19 patients admitted to ICUs. DESIGN: Prospective cohort study. SETTING: University hospital in Sao Paulo. PATIENTS: Survivors of COVID-19 ICU admissions. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We assessed frailty using the Clinical Frailty Scale (CFS). We also evaluated 15 basic, instrumental, and mobility activities. Baseline frailty and disability were defined by clinical conditions 2-4 weeks before COVID-19, and post-COVID-19 was characterized 90 days (day 90) after hospital discharge. We used alluvial flow diagrams to visualize transitions in frailty status, Venn diagrams to describe the overlap between frailty and disabilities in activities of daily living, and linear mixed models to explore the occurrence of new disabilities following critical care in COVID-19. We included 428 participants with a mean age of 64 years, 57% males, and a median Simplified Acute Physiology Score-3 score of 59. Overall, 14% were frail at baseline. We found that 124/394 participants (31%) were frail at day 90, 70% of whom were previously non-frail. The number of disabilities also increased (mean difference, 2.46; 95% CI, 2.06-2.86), mainly in participants who were non-frail before COVID-19. Higher pre-COVID-19 CFS scores were independently associated with new-onset disabilities. At day 90, 135 patients (34%) were either frail or disabled. CONCLUSIONS: Frailty and disability were more frequent 90 days after hospital discharge compared with baseline in COVID-19 patients admitted to the ICU. Our results show that most COVID-19 critical care survivors transition to poorer health status, highlighting the importance of long-term medical follow-up for this population.
- Palliative care in Hospitalized Middle-Aged and Older Adults With COVID-19(2022) ALMEIDA, Lyna Kyria Rodrigues; AVELINO-SILVA, Thiago J.; SILVA, Debora Carneiro de Lima e; CAMPOS, Bruna A.; VARELA, Gabriela; FONSECA, Cristina Mara Baghelli; AMORIM, Victor Lp; PIZA, Felipe Maia de Toledo; ALIBERTI JR., Marlon; DEGANI-COSTA, Luiza HelenaContext. As COVID-19 overwhelms health systems worldwide, palliative care strategies may ensure rational use of resources while safeguarding patient comfort and dignity. Objective. To describe palliative care practices in hospitalized middle-aged and older adults in two of the largest COVID-19 treatment centers in Sao Paulo, Brazil. Methods. Retrospective cohort. Eligible patients were those aged 50 years or older hospitalized between March and May 2020 with a laboratory confirmation of SARS-CoV-2 infection. Palliative care implementation was defined as present if medical notes indicated a decision to limit escalation of life support measures, or when opioids or sedatives were prescribed for palliative management of symptoms. Results. We included 1162 participants (57% male, median 65 years). Overall, 21% were frail and 54% were treated in intensive care units, but only 17% received palliative care. Stepwise logistic regression demonstrated that age >= 80 years, dementia, history of stroke or cancer, frailty, having a PaO2/FiO(2)<200 or a C-reactive protein >= 150mg/dL at admission predicted palliative care implementation. Patients placed under palliative care stayed longer (13 vs.11 days) and were more likely to die in hospital (86 vs.27%). They also spent more days in ICU and received vasoactive drugs, hemodialysis, and invasive ventilation more frequently. Conclusions. One in five middle-aged and older adults hospitalized with COVID-19 received palliative care in our cohort. Patients who were very old, multimorbid, frail, and had severe COVID-19 were more likely to receive palliative care. However, it was often delayed until advanced and invasive life support measures had already been implemented.
- Development and validation of the MMCD score to predict kidney replacement therapy in COVID-19 patients(2022) FIGUEIREDO, Flavio de Azevedo; RAMOS, Lucas Emanuel Ferreira; SILVA, Rafael Tavares; PONCE, Daniela; CARVALHO, Rafael Lima Rodrigues de; SCHWARZBOLD, Alexandre Vargas; MAURILIO, Amanda de Oliveira; SCOTTON, Ana Luiza Bahia Alves; GARBINI, Andresa Fontoura; FARACE, Barbara Lopes; GARCIA, Barbara Machado; SILVA, Carla Thais Candida Alves da; CIMINI, Christiane Correa Rodrigues; CARVALHO, Cintia Alcantara de; DIAS, Cristiane dos Santos; SILVEIRA, Daniel Vitorio; MANENTI, Euler Roberto Fernandes; CENCI, Evelin Paola de Almeida; ANSCHAU, Fernando; ARANHA, Fernando Graca; AGUIAR, Filipe Carrilho de; BARTOLAZZI, Frederico; VIETTA, Giovanna Grunewald; NASCIMENTO, Guilherme Fagundes; NOAL, Helena Carolina; DUANI, Helena; VIANNA, Heloisa Reniers; GUIMARAES, Henrique Cerqueira; ALVARENGA, Joice Coutinho de; CHATKIN, Jose Miguel; MORAIS, Julia Drumond Parreiras de; MACHADO-RUGOLO, Juliana; RUSCHEL, Karen Brasil; MARTINS, Karina Paula Medeiros Prado; MENEZES, Luanna Silva Monteiro; COUTO, Luciana Siuves Ferreira; CASTRO, Luis Cesar de; NASI, Luiz Antonio; CABRAL, Maderson Alvares de Souza; FLORIANI, Maiara Anschau; SOUZA, Maira Dias; SOUZA-SILVA, Maira Viana Rego; CARNEIRO, Marcelo; GODOY, Mariana Frizzo de; BICALHO, Maria Aparecida Camargos; LIMA, Maria Clara Pontello Barbosa; ALIBERTI, Marlon Juliano Romero; NOGUEIRA, Matheus Carvalho Alves; MARTINS, Matheus Fernandes Lopes; GUIMARAES-JUNIOR, Milton Henriques; SAMPAIO, Natalia da Cunha Severino; OLIVEIRA, Neimy Ramos de; ZIEGELMANN, Patricia Klarmann; ANDRADE, Pedro Guido Soares; ASSAF, Pedro Ledic; MARTELLI, Petronio Jose de Lima; DELFINO-PEREIRA, Polianna; MARTINS, Raphael Castro; MENEZES, Rochele Mosmann; FRANCISCO, Saionara Cristina; ARAUJO, Silvia Ferreira; OLIVEIRA, Talita Fischer; OLIVEIRA, Thainara Conceicao de; SALES, Thais Lorenna Souza; AVELINO-SILVA, Thiago Junqueira; RAMIRES, Yuri Carlotto; PIRES, Magda Carvalho; MARCOLINO, Milena SorianoBackground: Acute kidney injury (AKI) is frequently associated with COVID-19, and the need for kidney replacement therapy (KRT) is considered an indicator of disease severity. This study aimed to develop a prognostic score for predicting the need for KRT in hospitalised COVID-19 patients, and to assess the incidence of AKI and KRT requirement. Methods: This study is part of a multicentre cohort, the Brazilian COVID-19 Registry. A total of 5212 adult COVID-19 patients were included between March/2020 and September/2020. Variable selection was performed using generalised additive models (GAM), and least absolute shrinkage and selection operator (LASSO) regression was used for score derivation. Accuracy was assessed using the area under the receiver operating characteristic curve (AUC-ROC). Results: The median age of the model-derivation cohort was 59 (IQR 47-70) years, 54.5% were men, 34.3% required ICU admission, 20.9% evolved with AKI, 9.3% required KRT, and 15.1% died during hospitalisation. The temporal validation cohort had similar age, sex, ICU admission, AKI, required KRT distribution and in-hospital mortality. The geographic validation cohort had similar age and sex; however, this cohort had higher rates of ICU admission, AKI, need for KRT and in-hospital mortality. Four predictors of the need for KRT were identified using GAM: need for mechanical ventilation, male sex, higher creatinine at hospital presentation and diabetes. The MMCD score had excellent discrimination in derivation (AUROC 0.929, 95% CI 0.918-0.939) and validation (temporal AUROC 0.927, 95% CI 0.911-0.941; geographic AUROC 0.819, 95% CI 0.792-0.845) cohorts and good overall performance (Brier score: 0.057, 0.056 and 0.122, respectively). The score is implemented in a freely available online risk calculator (https://www.mmcdscore.com/). Conclusions: The use of the MMCD score to predict the need for KRT may assist healthcare workers in identifying hospitalised COVID-19 patients who may require more intensive monitoring, and can be useful for resource allocation.
- Tailoring treatments to older people in intensive care. A way forward(2022) ALIBERTI, Marlon Juliano Romero; BAILLY, Sebastien; ANSTEY, Matthew