LUIZ ROBERTO COMERLATTI
Índice h a partir de 2011
2
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
11 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 11
- Clinical swallowing prognostic indicators in patients with acute ischemic stroke(2019) LEITE, Karoline Kussik de Almeida; SASSI, Fernando Chiarion; MEDEIROS, Gisele Chagas de; COMERLATTI, Luiz Roberto; ANDRADE, Claudia Regina Furquim deA swallowing disorder is present in more than 50% of patients with acute stroke. Objective: To identify clinical prognostic indicators of the swallowing function in a population with acute ischemic stroke and to determine prioritization indicators for swallowing rehabilitation. Methods: Participants were adults admitted to the emergency room who were diagnosed with acute ischemic stroke. Data gathering involved a swallowing assessment to determine the functional level of swallowing (American Speech-Language-Hearing Association National Outcome Measurement System - ASHA NOMS) and the verification of demographic and clinical variables. Results: The study sample included 295 patients. For analysis purposes, patients were grouped as follows: ASHA NOMS levels 1 and 2 - ASHA1 (n = 51); levels 3, 4 and 5 - ASHA2 (n = 96); levels 6 and 7 - ASHA3 (n = 148). Statistical analyses indicated that patients who presented a poorer swallowing function (ASHA1) were older (age >= 70 years); had anterior circulation infarct: had lower scores on the Glasgow Coma Scale (GCS <= 14 points); took longer to initiate swallowing rehabilitation: had longer hospital stays; made more use of alternative feeding methods: needed more sessions of swallowing rehabilitation to remove alternate feeding methods: took longer to return to oral feeding and had poorer outcomes (fewer individuals discharged from swallowing rehabilitation sessions and increased mortality). Conclusion: Patients with acute ischemic stroke, admitted to the emergency room, aged >= 70 years. score on the GCS <= 14, anterior circulation infarct and dementia should be prioritized for swallowing assessment and rehabilitation.
- Risk factors independently associated with the maintenance of severe restriction of oral intake and alternative feeding method indication at hospital outcome in patients after acute ischemic stroke(2023) LEITE, Karoline Kussik de Almeida; SASSI, Fernanda Chiarion; PERISSINOTTI, Iago Navas; COMERLATTI, Luiz Roberto; ANDRADE, Claudia Regina Furquim deBackground and aims: From a clinical point of view, post-stroke patients present difficulties in swallowing management. The purpose of this research was to identify risk factors that were independently related to the maintenance of a severe restriction of oral intake in patients affected by acute ischemic stroke.Methods: The authors conducted a prospective observational cohort study of patients with dysphagia post-acute ischemic stroke who were admitted to an Emergency Room (ER). Demographic and clinical data were collected at ER admission. Swallowing data was based on The Functional Oral Intake Scale (FOIS) and was collected at two distinct moments: initial swallowing assessment and at the patient outcome. Patients were divided into two groups according to their FOIS level assigned on the last swallowing assessment (at hospital outcome): G1 with severe restriction of oral intake and indication of feeding tube - patients with FOIS levels 1 to 4; G2 without restriction of food consistencies in oral intake - patients with FOIS levels 5 to 7.Results: One hundred and six patients were included in our study. Results of the multivariate logistic regression model for the prediction of maintenance of a severe restriction of oral intake at hospital outcome in patients post acute ischemic stroke indicated that increasing age (p = 0.006), and dysarthria (p = 0.003) were associated with higher chances of presenting severe restriction of oral intake at hospital outcome.Conclusions: Patients with acute ischemic stroke in an Emergency Room may experience non-resolved severe dysphagia, indicating the need to prepare for the care/rehabilitation of these patients.
- A comparative study of visual outcome in patients with optic neuritis treated with five or seven days of intravenous corticosteroid treatment(2023) SILVA, Guilherme Diogo; TERRIM, Sara; FALCAO, Fernando Cavalcantide Sa e Benevides; FALCA, Maria Alice Pimentel; CHAVES, Cleuber Esteves; APOSTOLOS-PEREIRA, Samira; FORTINI, Ida; GONCALVES, Marcia Rubia Rodrigues; COMERLATTI, Luiz Roberto; CASTRO, Luiz Henrique Martins; CALLEGARO, Dagoberto; MONTEIRO, Mario Luiz RibeiroBackground: Optic neuritis (ON), a major cause of visual impairment in young adults, is generally associated with rapid visual recovery when treated with intravenous methylprednisolone treatment (IVMPT). However, the optimal duration of such treatment is unknown, ranging from three to seven days in clinical practice. We aimed to compare the visual recovery in patients treated with 5-day or 7-day duration IVMPT.Methods: We performed a retrospective cohort study of consecutive patients with ON in Sa similar to o Paulo, Brazil, from 2016 to 2021. We compared the proportion of participants with visual impairment in 5-day and 7-day treatment schedules at discharge, at 1 month and between 6 and 12 months after the diagnosis of ON. The findings were adjusted to age, severity of the visual impairment, co-intervention with plasma exchange, time from symptom onset to IVMPT and the etiology of the ON to mitigate indication bias.Results: We included 73 patients with ON treated with 5 or 7-day duration of 1 g/d intravenous methylprednisolone therapy. Visual impairment at 6-12 months in the 5-day or the 7-day treatment groups was similar (57% x 59%, p > 0.9, Odds Ratio 1.03 [95% CI 0.59-1.84]). The results were similar after adjusting for prognostic variables and when observed at different time points.Conclusion: Visual recovery is similar in patients treated with 5-day and 7-day duration treatments of 1 g/day intravenous methylprednisolone, suggesting a ceiling effect. Limiting the duration of the treatment can reduce hospital stay and costs, without interfering with clinical benefit.
bookPart Coma e outras alterações da consciência(2021) STUDART NETO, Adalberto; CALDERARO, Marcelo; COMERLATTI, Luiz Roberto; CASTRO, Luiz Henrique Martins- Outcomes of acute basilar artery occlusion-real-world experience in a middle-income country(2022) GUERRA, Felipe Borelli Del; SILVA, Guilherme Diogo; PERISSINOTI, Iago Navas; MORAIS, Livia; MARSOLLA, Felipe Lorenzo Dornelas; COMERLATTI, Luiz Roberto; PUGLIA JUNIOR, Paulo; CONFORTO, Adriana BastosObjectives Our goal was to describe outcomes in a single-center, real-world series of patients with acute basilar artery occlusion in a middle-income country. In addition, we assessed potential outcome predictors. Material and Methods Data from 28 patients were retrospectively reviewed. The primary outcome was death until last follow-up. Other outcomes were rates of favorable outcome until last follow-up and rates of intracranial hemorrhage. Outcomes were compared in subgroups according to several variables, including reperfusion (REP group) or no reperfusion (NOREP group) interventions, with chi-squared, Fisher's exact test, or Mann-Whitney tests. Results The rate of overall intrahospital death was 46%. Death until last follow-up occurred in 8/17 (47%) in the REP and in 7/11 (63%) of the NOREP group. Favorable outcomes were observed in 35.7% of the patients: 8/17 (47%) in REP and in 2/11 (18.1%) in NOREP. NIH stroke scale scores were significantly lower in patients with favorable outcomes. Intracranial hemorrhage was observed in 6/28 (21.4%) of the patients (all in REP group). Twenty patients were treated with anticoagulants within the first 24 h. No hemorrhage was observed in those treated with enoxaparin, while three occurred in subjects treated with unfractionated heparin. Conclusion Together with other series, our results underscore the relevance of NIH stroke scale at admission as a prognostic marker, the importance of reperfusion to improve outcomes, and the need of clinical trials to compare the impact of treatment with anticoagulants within first 24 h in basilar artery occlusion.
- Anticoagulation and Stroke(2022) TINONE, Gisela; HOSHINO, Mauricio; LUCATO, Leandro; COMERLATTI, Luiz RobertoIn 2019, the American Heart Association did not recommend the emergent use of anticoagulation to prevent recurrence or progression of acute ischemic stroke. However, its indication in patients with extracranial artery intraluminal thrombus with artery-to-artery cerebral embolization must be analyzed. In this article, we will also discuss other indications of anticoagulation. This treatment could be indicated in patients with ischemic stroke caused by embolization from cervical artery dissection, catastrophic antiphospholipid antibodies syndrome (APS) and some cases of Covid 19. For secondary prevention, anticoagulation is recommended for Cardioembolic stroke such as nonvalvular atrial fibrillation and other cardiopathies, some patients with cervical artery dissection, stroke associated with cancer, and thrombophilia such as APS. The timing to restart anticoagulation after a large ischemic stroke or after a cerebral hemorrhagic transformation always represent a challenge. Even in patients with high risk of thromboembolism it should be delayed at least two weeks, ideal after four weeks.
- Intraventricular Neurocysticercosis: The Role of Advanced MRI Sequences(2020) GUEDES, Bruno F.; FREUA, Fernando; PARMERA, Jacy B.; MILANO, Breno G.; COMERLATTI, Luiz R.; SILVA, Guilherme D.; LUCATO, Leandro T.
- Real-world application of the 2022 diagnostic criteria for first-ever episode of optic neuritis(2023) TERRIM, Sara; SILVA, Guilherme Diogo; FALCAO, Fernando Cavalcanti de Sa e Benevides; PEREIRA, Clarissa dos Reis; BENASSI, Thais de Souza Andrade; FORTINI, Ida; GONCALVES, Marcia Rubia Rodrigues; CASTRO, Luiz Henrique Martins; COMERLATTI, Luiz Roberto; RIMKUS, Carolina de Medeiros; ADONI, Tarso; PEREIRA, Samira Luisa Apostolos; MONTEIRO, Mario Luiz; CALLEGARO, DagobertoOptic neuritis (ON) admits diverse differential diagnoses. Petzold proposed diagnostic criteria for ON in 2022, although real-world application of these criteria is missing. We conducted a retrospective review of patients with ON. We classified patients into definite or possible ON, and into groups A (typical neuritis), B (painless), or C (binocular) and estimated the frequency of etiologies for each group. We included 77 patients, with 62% definite and 38% possible ON. CRION and NMOSD-AQP4 negative-ON were less commonly seen in definite ON. Application of the 2022 criteria revealed a lower-than-expected frequency of definite ON, particularly for seronegative non-MS causes.
conferenceObject Topic: AS28 Stroke in Low- and Middle-Income Countries A SINGLE CENTER RETROSPECTIVE REALWORLD EXPERIENCE IN ACUTE BASILAR ARTERY OCCLUSION(2021) GUERRA, F. Del; SILVA, G.; PERISSINOTI, I.; MORAIS, L.; COMERLATTI, L.; JUNIOR, P.; CONFORTO, A.bookPart Cefaleia no pronto-socorro(2021) SOUZA, Márcio Nattan Portes; COMERLATTI, Luiz Roberto; CALDERARO, Marcelo