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Kirschbaum MR, Devido MS, Azeka E, Demarchi LMMF, Santos JS, Pinto DVR, Hajjar LA, Tarasoutchi F, Park M, Avila WS. COVID-19 in pregnant women with heart diseases. Adverse maternal and fetal outcomes. Case series from InCor registry of Pregnancy and Heart Disease. Eur Heart J 2021. [PMCID: PMC8574523 DOI: 10.1093/eurheartj/ehab724.2890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Heart disease is the leading non-obstetric cause of maternal death during pregnancy. In this field, the emergence of pandemic COVID-19 has caused the worst-case scenario considering that pregnant women are more susceptible to viral infections, and preexisting cardiac disease is the most prevalent co-morbidity among COVID-19 deaths. Purpose To assess the maternal and fetal outcomes of COVID-19 during pregnancy of women with heart diseases. Methods During the year 2020, among 82 pregnant women with heart disease followed consecutively at the Instituto do Coração-InCor, seven of them with an average age of 33.2 years had COVID-19 during their pregnancies. The underlying heart diseases were rheumatic valve disease (5 pt), congenital heart disease (1 pt) and one case with acute myocarditis, without preexisting cardiopathy. The prescription (antibiotics, inotropes, corticosteroids and others) used was according to the clinical conditions required for each patient, however subcutaneous or intravenous heparin was used in all patients. Results Only one case had an uneventful maternal-fetal course, the other six women required hospitalization / ICU for an average of 25.3 days, including the need for mechanical ventilation in two of them. Serious complications were related to respiratory failure (ADRS), recurrent atrial flutter with hemodynamic instability, acute pulmonary edema, and cardiogenic shock associated with sepsis which caused two maternal deaths. There were two emergency mitral valve interventional, percutaneous balloon valvuloplasty and valve bioprosthesis replacement, respectively. There were five premature births with an average gestational age of 34.2 weeks of gestation, which resulted in one stillbirth. Pathological findings of three placental and the six-months follow-up of the babies did not confirm vertical transmission of COVID-19. Conclusions The uncertain evolution given of the overlapping complications of three conditions – COVID-19, pregnancy, and heart disease – implies an increased risk for women with heart diseases of childbearing age, for whom pregnancy should be discouraged and planned after vaccination FUNDunding Acknowledgement Type of funding sources: None.
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Affiliation(s)
- M R Kirschbaum
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - M S Devido
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - E Azeka
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - L M M F Demarchi
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - J S Santos
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - D V R Pinto
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - L A Hajjar
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - F Tarasoutchi
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - M Park
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - W S Avila
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
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Dioh W, Chabane M, Tourette C, Azbekyan A, Morelot-Panzini C, Hajjar LA, Lins M, Nair GB, Whitehouse T, Mariani J, Latil M, Camelo S, Lafont R, Dilda PJ, Veillet S, Agus S. Testing the efficacy and safety of BIO101, for the prevention of respiratory deterioration, in patients with COVID-19 pneumonia (COVA study): a structured summary of a study protocol for a randomised controlled trial. Trials 2021; 22:42. [PMID: 33430924 PMCID: PMC7797700 DOI: 10.1186/s13063-020-04998-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 12/23/2020] [Indexed: 11/16/2022] Open
Abstract
Objectives As of December, 1st, 2020, coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2, resulted in more than 1 472 917 deaths worldwide and death toll is still increasing exponentially. Many COVID-19 infected people are asymptomatic or experience moderate symptoms and recover without medical intervention. However, older people and those with comorbid hypertension, diabetes, obesity, or heart disease are at higher risk of mortality. Because current therapeutic options for COVID-19 patients are limited specifically for this elderly population at risk, Biophytis is developing BIO101 (20-hydroxyecdysone, a Mas receptor activator) as a new treatment option for managing patients with SARS-CoV-2 infection at the severe stage. The angiotensin converting enzyme 2 (ACE2) serves as a receptor for SARS-CoV-2. Interaction between ACE2 and SARS-CoV2 spike protein seems to alter the function of ACE2, a key player in the renin-angiotensin system (RAS). The clinical picture of COVID-19 includes acute respiratory distress syndrome (ARDS), cardiomyopathy, multiorgan dysfunction and shock, all of which might result from an imbalance of the RAS. We propose that RAS balance could be restored in COVID-19 patients through MasR activation downstream of ACE2 activity, with 20-hydroxyecdysone (BIO101) a non-peptidic Mas receptor (MasR) activator. Indeed, MasR activation by 20-hydroxyecdysone harbours anti-inflammatory, anti-thrombotic, and anti-fibrotic properties. BIO101, a 97% pharmaceutical grade 20-hydroxyecdysone could then offer a new therapeutic option by improving the respiratory function and ultimately promoting survival in COVID-19 patients that develop severe forms of this devastating disease. Therefore, the objective of this COVA study is to evaluate the safety and efficacy of BIO101, whose active principle is 20-hydroxyecdysone, in COVID-19 patients with severe pneumonia. Trial design Randomized, double-blind, placebo-controlled, multi-centre, group sequential and adaptive which will be conducted in 2 parts. Part 1: Ascertain the safety and tolerability of BIO101 and obtain preliminary indication of the activity of BIO101, in preventing respiratory deterioration in the target population Part 2: Re-assessment of the sample size needed for the confirmatory part 2 and confirmation of the effect of BIO101 observed in part 1 in the target population. The study is designed as group sequential to allow an efficient run-through, from obtaining an early indication of activity to a final confirmation. And adaptive – to allow accumulation of early data and adapt sample size in part 2 in order to inform the final design of the confirmatory part of the trial. Participants Inclusion criteria
Age: 45 and above A confirmed diagnosis of COVID-19 infection, within the last 14 days, prior to randomization, as determined by PCR or other approved commercial or public health assay, in a specimen as specified by the test used. Hospitalized, in observation or planned to be hospitalized due to COVID-19 infection symptoms with anticipated hospitalization duration ≥3 days With evidence of pneumonia based on all of the following:
Clinical findings on a physical examination Respiratory symptoms developed within the past 7 days
With evidence of respiratory decompensation that started not more than 4 days before start of study medication and present at screening, meeting one of the following criteria, as assessed by healthcare staff:
Tachypnea: ≥25 breaths per minute Arterial oxygen saturation ≤92% A special note should be made if there is suspicion of COVID-19-related myocarditis or pericarditis, as the presence of these is a stratification criterion
Without a significant deterioration in liver function tests:
ALT and AST ≤ 5x upper limit of normal (ULN) Gamma-glutamyl transferase (GGT) ≤ 5x ULN Total bilirubin ≤ 5×ULN
Willing to participate and able to sign an informed consent form (ICF). Or, when relevant, a legally authorized representative (LAR) might sign the ICF on behalf of the study participant Female participants should be: at least 5 years post-menopausal (i.e., persistent amenorrhea 5 years in the absence of an alternative medical cause) or surgically sterile; OR
Have a negative urine pregnancy test at screening Be willing to use a contraceptive method as outlined in inclusion criterion 9 from screening to 30 days after last dose.
Male participants who are sexually active with a female partner must agree to the use of an effective method of birth control throughout the study and until 3 months after the last administration of the investigational product.
(Note: medically acceptable methods of contraception that may be used by the participant and/or partner include combined oral contraceptive, contraceptive vaginal ring, contraceptive injection, intrauterine device, etonogestrel implant, each supplemented with a condom, as well as sterilization and vasectomy).Female participants who are lactating must agree not to breastfeed during the study and up to 14 days after the intervention. Male participants must agree not to donate sperm for the purpose of reproduction throughout the study and until 3 months after the last administration of the investigational product. For France only: Being affiliated with a European Social Security.
Exclusion criteria
Not needing or not willing to remain in a healthcare facility during the study Moribund condition (death likely in days) or not expected to survive for >7 days – due to other and non-COVID-19 related conditions Participant on invasive mechanical ventilation via an endotracheal tube, or extracorporeal membrane oxygenation (ECMO), or high-flow Oxygen (delivery of oxygen at a flow of ≥16 L/min.). Participant is not able to take medications by mouth (as capsules or as a powder, mixed in water). Disallowed concomitant medication: Consumption of any herbal products containing 20-hydroxyecdysone and derived from Leuzea carthamoides; Cyanotis vaga or Cyanotis arachnoidea is not allowed (e.g. performance enhancing agents). Any known hypersensitivity to any of the ingredients, or excipients of the study medication, BIO101. Renal disease requiring dialysis, or known renal insufficiency (eGFR≤30 mL/min/1.73 m2, based on Cockcroft & Gault formula). In France only:
Non-affiliation to compulsory French social security scheme (beneficiary or right-holder). Being under tutelage or legal guardianship.
Participants will be recruited from approximately 30 clinical centres in Belgium, France, the UK, USA and Brazil. Maximum patients’ participation in the study will last 28 days. Follow-up of participants discharged from hospital will be performed through post-intervention phone calls at 14 (± 2) and 60 (± 4) days. Intervention and comparator Two treatment arms will be tested in this study: interventional arm 350 mg b.i.d. of BIO101 (AP 20-hydroxyecdysone) and placebo comparator arm 350 mg b.i.d of placebo. Administration of daily dose is the same throughout the whole treatment period. Participants will receive the study medication while hospitalized for up to 28 days or until a clinical endpoint is reached (i.e., ‘negative’ or ‘positive’ event). Participants who are officially discharged from hospital care will no longer receive study medication. Main outcomes Primary study endpoint: The proportion of participants with ‘negative’ events up to 28 days. ‘Negative’ events are defined as respiratory deterioration and all-cause mortality. For the purpose of this study, respiratory deterioration will be defined as any of the following:
Requiring mechanical ventilation (including cases that will not be intubated due to resource restrictions and triage). Requiring extracorporeal membrane oxygenation (ECMO). Requiring high-flow oxygen defined as delivery of oxygen at a flow of ≥16 L/min.
Only if the primary endpoint is significant at the primary final analysis the following Key secondary endpoints will be tested in that order:
Proportion of participants with events of respiratory failure at Day 28 Proportion of participants with ‘positive’ events at Day 28. Proportion of participants with events of all-cause mortality at Day 28
A ‘positive’ event is defined as the official discharge from hospital care by the department due to improvement in participant condition. Secondary and exploratory endpoints: In addition, a variety of functional measures and biomarkers (including the SpO2 / FiO2 ratio, viral load and markers related to inflammation, muscles, tissue and the RAS / MAS pathways) will also be collected. Randomization Randomization is performed using an IBM clinical development IWRS system during the baseline visit. Block-permuted randomization will be used to assign eligible participants in a 1:1 ratio.
In part 1, randomization will be stratified by RAS pathway modulator use (yes/no) and co-morbidities (none vs. 1 and above). In Part 2, randomization will be stratified by centre, gender, RAS pathway modulator use (yes/no), co-morbidities (none vs. 1 and above), receiving Continuous Positive Airway Pressure/Bi-level Positive Airway Pressure (CPAP/BiPAP) at study entry (Yes/No) and suspicion of COVID-19 related myocarditis or pericarditis (present or not).
Blinding (masking) Participants, caregivers, and the study team assessing the outcomes are blinded to group assignment. All therapeutic units (TU), BIO101 b.i.d. or placebo b.i.d., cannot be distinguished in compliance with the double-blind process. An independent data-monitoring committee (DMC) will conduct 2 interim analyses. A first one based on the data from part 1 and a second from the data from parts 1 and 2. The first will inform about BIO101 safety, to allow the start of recruitment into part 2 followed by an analysis of the efficacy data, to obtain an indication of activity. The second interim analysis will inform about the sample size that will be required for part 2, in order to achieve adequate statistical power. Numbers to be randomised (sample size) Number of participants randomized: up to 465, in total
Part 1: 50 (to obtain the proof of concept in COVID-19 patients). Part 2: 310, potentially increased by 50% (up to 465, based on interim analysis 2) (to confirm the effects of BIO101 observed in part 1).
Trial Status The current protocol Version is V 10.0, dated on 24.09.2020. The recruitment that started on September 1st 2020 is ongoing and is anticipated to finish for the whole study by March2021. Trial registration The trial was registered before trial start in trial registries: EudraCT, No. 2020-001498-63, registered May 18, 2020; and Clinicaltrials.gov, identifier NCT04472728, registered July 15, 2020. Full protocol The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-020-04998-5.
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Affiliation(s)
- W Dioh
- Biophytis SA, Sorbonne Université - BC9, 4 place Jussieu, 75005, Paris, France
| | - M Chabane
- Biophytis SA, Sorbonne Université - BC9, 4 place Jussieu, 75005, Paris, France
| | - C Tourette
- Biophytis SA, Sorbonne Université - BC9, 4 place Jussieu, 75005, Paris, France
| | - A Azbekyan
- Biophytis, Inc, 210 Broadway, Suite #201, Cambridge, MA, 02139, USA
| | - C Morelot-Panzini
- Service de Pneumologie, Médecine Intensive et Réanimation - R3S (SPMIR-R3S), Hôpital Pitié-Salpêtrière - APHP, Paris, France
| | - L A Hajjar
- Universidade de São Paulo Instituto do Coração, São Paulo, SP, Brasil
| | - M Lins
- General Hospital Sint-Maarten, Mechelen, Belgium
| | - G B Nair
- Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | - T Whitehouse
- Queen Elizabeth Hospital Birmingham, Birmingham, B15 2GW, UK
| | - J Mariani
- Sorbonne Université, CNRS - Institut de Biologie Paris Seine (B2A), 75005, Paris, France
| | - M Latil
- Biophytis SA, Sorbonne Université - BC9, 4 place Jussieu, 75005, Paris, France
| | - S Camelo
- Biophytis SA, Sorbonne Université - BC9, 4 place Jussieu, 75005, Paris, France
| | - R Lafont
- Sorbonne Université, CNRS - Institut de Biologie Paris Seine (BIOSIPE), 75005, Paris, France
| | - P J Dilda
- Biophytis SA, Sorbonne Université - BC9, 4 place Jussieu, 75005, Paris, France
| | - S Veillet
- Biophytis SA, Sorbonne Université - BC9, 4 place Jussieu, 75005, Paris, France
| | - S Agus
- Biophytis, Inc, 210 Broadway, Suite #201, Cambridge, MA, 02139, USA.
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Nakashima CAK, Dallan LAO, Lisboa LAF, Hajjar LA, Soeiro AM, Silva BA, Costa MSS, Dornas CJCB, Dalcoquio TF, Furtado RHM, Baracioli LM, Fukushima JT, Gurbel PA, Giugliano RP, Nicolau JC. P1839Platelet aggregability evaluation in patients with acute coronary syndromes scheduled for coronary artery bypass graft. The PLAT-CABG study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Dual antiplatelet therapy is recommended for patients (pts) with acute coronary syndromes (ACS). However, 10–15% of pts have indication of coronary artery bypass graft (CABG) for the index event and current guidelines recommend stopping clopidogrel at least 5 days prior to CABG. This waiting time could increase hospital length of stay, thus having negative impacts on costs and clinical complications.
Purpose
To evaluate if release to CABG based on platelet aggregability by Multiplate AnalyzerTM would be non-inferior in comparison with common practice (5 days) in terms of 24-hours post-CABG bleeding.
Methods
The PLAT-CABG (NCT 02516267) is a randomized, open label, non-inferiority trial (boundary 25%) testing a strategy of platelet aggregability-guided release to CABG versus standard-of-care on the primary endpoint of chest tube drainage in the first 24 hours post CABG. A total of 190 pts admitted with ACS, treated with aspirin + clopidogrel and with indication for CABG, were assigned to clopidogrel discontinued 5 days prior to CABG (control group) vs. daily measurements of platelet aggregability to ADP using Multiplate AnalyzerTM (intervention group) with CABG occurring after recovering from platelet inhibition (pre-defined as a threshold of 46 AU).
Results
The main results are depicted in the table
Main results of PLAT-CABG study Variables Control Group (n=95) Intervention Group (n=95) P-value for superiority P-value for non-inferiority Chest tube drainage (mL), Median (25th–75th) 350 (250–500) 350 (250–500) 0.680 0.001 Time symptom to CABG (hours), Median (25th–75th) 191 (150–281) 166 (119–225) <0.001 NA Time surgery indication to CABG (hours), Median (25th–75th) 136 (112–161) 112 (66–142) <0.001 NA CABG = coronary artery bypass graft.
Conclusion
Platelet-aggregability guided release to CABG is non-inferior to standard of care in ACS patients awaiting CABG in terms of peri-operative bleeding and significantly shortens the time to CABG.
Acknowledgement/Funding
Roche Diagnostica Brazil
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Affiliation(s)
- C A K Nakashima
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - L A O Dallan
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - L A F Lisboa
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - L A Hajjar
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - A M Soeiro
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - B A Silva
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - M S S Costa
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | | | - T F Dalcoquio
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - R H M Furtado
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - L M Baracioli
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - J T Fukushima
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - P A Gurbel
- Duke University Medical Center, Durham, United States of America
| | - R P Giugliano
- Brigham and Womens Hospital, Boston, United States of America
| | - J C Nicolau
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
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4
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Avila Samuel W, Lobo CG, Abreu SB, Rossi EG, Bortolotto MR, Testa CB, Tarasoutchi F, Hajjar LA. P5451Pregnancy and heart valve prostheses: maternal and fetal outcomes. comparative study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- W Avila Samuel
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - C G Lobo
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - S B Abreu
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - E G Rossi
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - M R Bortolotto
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - C B Testa
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - F Tarasoutchi
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
| | - L A Hajjar
- Heart Institute (InCor) - University of Sao Paulo Clinics Hospital, Sao Paulo, Brazil
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Rocon C, Tavares De Melo MD, Araujo Filho JA, Parga Filho JR, Hajjar LA, Kalil Filho R, Bocchi EA, Salemi VM. P899Clinical, electrocardiographic, echocardiographic and cardiac magnetic resonance imaging follow-up in patients with non-compaction cardiomyopathy in isolation or in association with other diseases. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- C Rocon
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | | | - J A Araujo Filho
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - J R Parga Filho
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - L A Hajjar
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - R Kalil Filho
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - E A Bocchi
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - V M Salemi
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
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Rocon C, Tabassian M, Tavares De Melo MD, Araujo Filho JA, Parga Filho JR, Hajjar LA, Kalil Filho R, Bocchi EA, D'hooge J, Salemi VMC. P6485Biventricular imaging markers to predict outcome in non-compaction cardiomyopathy: a machine learning study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- C Rocon
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | | | | | - J A Araujo Filho
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - J R Parga Filho
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - L A Hajjar
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - R Kalil Filho
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - E A Bocchi
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - J D'hooge
- University of Leuven, Leuven, Belgium
| | - V M C Salemi
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
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Caldas JR, Panerai RB, Salinet AM, Seng-Shu E, Ferreira GSR, Camara L, Passos RH, Galas FRBG, Almeida JP, Nogueira RC, de Lima Oliveira M, Robinson TG, Hajjar LA. Dynamic cerebral autoregulation is impaired during submaximal isometric handgrip in patients with heart failure. Am J Physiol Heart Circ Physiol 2018; 315:H254-H261. [PMID: 29652541 DOI: 10.1152/ajpheart.00727.2017] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The incidence of neurological complications, including stroke and cognitive dysfunction, is elevated in patients with heart failure (HF) with reduced ejection fraction. We hypothesized that the cerebrovascular response to isometric handgrip (iHG) is altered in patients with HF. Adults with HF and healthy volunteers were included. Cerebral blood velocity (CBV; transcranial Doppler, middle cerebral artery) and arterial blood pressure (BP; Finometer) were continuously recorded supine for 6 min, corresponding to 1 min of baseline and 3 min of iHG exercise, at 30% maximum voluntary contraction, followed by 2 min of recovery. The resistance-area product was calculated from the instantaneous BP-CBV relationship. Dynamic cerebral autoregulation (dCA) was assessed with the time-varying autoregulation index estimated from the CBV step response derived by an autoregressive moving-average time-domain model. Forty patients with HF and 23 BP-matched healthy volunteers were studied. Median left ventricular ejection fraction was 38.5% (interquartile range: 0.075%) in the HF group. Compared with control subjects, patients with HF exhibited lower time-varying autoregulation index during iHG, indicating impaired dCA ( P < 0.025). During iHG, there were steep rises in CBV, BP, and heart rate in control subjects but with different temporal patterns in HF, which, together with the temporal evolution of resistance-area product, confirmed the disturbance in dCA in HF. Patients with HF were more likely to have impaired dCA during iHG compared with age-matched control subjects. Our results also suggest an impairment of myogenic, neurogenic, and metabolic control mechanisms in HF. The relationship between impaired dCA and neurological complications in patients with HF during exercise deserves further investigation. NEW & NOTEWORTHY Our findings provide the first direct evidence that cerebral blood flow regulatory mechanisms can be affected in patients with heart failure during isometric handgrip exercise. As a consequence, eventual blood pressure modulations are buffered less efficiently and metabolic demands may not be met during common daily activities. These deficits in cerebral autoregulation are compounded by limitations of the systemic response to isometric exercise, suggesting that patients with heart failure may be at greater risk for cerebral events during exercise.
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Affiliation(s)
- J R Caldas
- Department of Anesthesia, Heart Institute, University of Sao Paulo , Sao Paulo , Brazil.,Department of Neurosurgery, Hospital das Clinicas, University of São Paulo , São Paulo , Brazil.,Critical Care Unit, Hospital São Rafael , Salvador , Brazil
| | - R B Panerai
- Department of Cardiovascular Sciences, University of Leicester , Leicester , United Kingdom.,NIHR Leicester Biomedical Research Centre, Glenfield Hospital , Leicester , United Kingdom
| | | | - E Seng-Shu
- Department of Neurosurgery, Hospital das Clinicas, University of São Paulo , São Paulo , Brazil
| | - G S R Ferreira
- Department of Anesthesia, Heart Institute, University of Sao Paulo , Sao Paulo , Brazil
| | - L Camara
- Department of Anesthesia, Heart Institute, University of Sao Paulo , Sao Paulo , Brazil
| | - R H Passos
- Critical Care Unit, Hospital São Rafael , Salvador , Brazil
| | - F R B G Galas
- Department of Anesthesia, Heart Institute, University of Sao Paulo , Sao Paulo , Brazil
| | | | - R C Nogueira
- Department of Neurosurgery, Hospital das Clinicas, University of São Paulo , São Paulo , Brazil
| | - M de Lima Oliveira
- Department of Neurosurgery, Hospital das Clinicas, University of São Paulo , São Paulo , Brazil
| | - T G Robinson
- Department of Cardiovascular Sciences, University of Leicester , Leicester , United Kingdom.,NIHR Leicester Biomedical Research Centre, Glenfield Hospital , Leicester , United Kingdom
| | - L A Hajjar
- Department of Cardiopneumology, Heart Institute, University of Sao Paulo , São Paulo , Brazil
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8
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Caldas JR, Panerai RB, Bor-Seng-Shu E, Almeida JP, Ferreira GSR, Camara L, Nogueira RC, Oliveira ML, Jatene FB, Robinson TG, Hajjar LA. Cerebral hemodynamics with intra-aortic balloon pump: business as usual? Physiol Meas 2017; 38:1349-1361. [PMID: 28333037 DOI: 10.1088/1361-6579/aa68c4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Intra-aortic balloon pump (IABP) is commonly used as mechanical support after cardiac surgery or cardiac shock. Although its benefits for cardiac function have been well documented, its effects on cerebral circulation are still controversial. We hypothesized that transfer function analysis (TFA) and continuous estimates of dynamic cerebral autoregulation (CA) provide consistent results in the assessment of cerebral autoregulation in patients with IABP. APPROACH Continuous recordings of blood pressure (BP, intra-arterial line), end-tidal CO2, heart rate and cerebral blood flow velocity (CBFV, transcranial Doppler) were obtained (i) 5 min with IABP ratio 1:3, (ii) 5 min, starting 1 min with the IABP-ON, and continuing for another 4 min without pump assistance (IABP-OFF). Autoregulation index (ARI) was estimated from the CBFV response to a step change in BP derived by TFA and as a function of time using an autoregressive moving-average model during removal of the device (ARI t ). Critical closing pressure and resistance area-product were also obtained. MAIN RESULTS ARI with IABP-ON (4.3 ± 1.2) were not different from corresponding values at IABP-OFF (4.7 ± 1.4, p = 0.42). Removal of the balloon had no effect on ARI t , CBFV, BP, cerebral critical closing pressure or resistance area-product. SIGNIFICANCE IABP does not disturb cerebral hemodynamics. TFA and continuous estimates of dynamic CA can be used to assess cerebral hemodynamics in patients with IABP. These findings have important implications for the design of studies of critically ill patients requiring the use of different invasive support devices.
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Affiliation(s)
- J R Caldas
- Department of Anesthesia, University of São Paulo, São Paulo, Brazil. Department of Neurosurgery, Hospital das Clinicas, University of São Paulo, São Paulo, Brazil
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Caldas JR, Panerai RB, Haunton VJ, Almeida JP, Ferreira GSR, Camara L, Nogueira RC, Bor-Seng-Shu E, Oliveira ML, Groehs RRV, Ferreira-Santos L, Teixeira MJ, Galas FRBG, Robinson TG, Jatene FB, Hajjar LA. Cerebral blood flow autoregulation in ischemic heart failure. Am J Physiol Regul Integr Comp Physiol 2016; 312:R108-R113. [PMID: 27927624 DOI: 10.1152/ajpregu.00361.2016] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 12/01/2016] [Accepted: 12/01/2016] [Indexed: 12/24/2022]
Abstract
Patients with ischemic heart failure (iHF) have a high risk of neurological complications such as cognitive impairment and stroke. We hypothesized that iHF patients have a higher incidence of impaired dynamic cerebral autoregulation (dCA). Adult patients with iHF and healthy volunteers were included. Cerebral blood flow velocity (CBFV, transcranial Doppler, middle cerebral artery), end-tidal CO2 (capnography), and arterial blood pressure (Finometer) were continuously recorded supine for 5 min at rest. Autoregulation index (ARI) was estimated from the CBFV step response derived by transfer function analysis using standard template curves. Fifty-two iHF patients and 54 age-, gender-, and BP-matched healthy volunteers were studied. Echocardiogram ejection fraction was 40 (20-45) % in iHF group. iHF patients compared with control subjects had reduced end-tidal CO2 (34.1 ± 3.7 vs. 38.3 ± 4.0 mmHg, P < 0.001) and lower ARI values (5.1 ± 1.6 vs. 5.9 ± 1.0, P = 0.012). ARI <4, suggestive of impaired CA, was more common in iHF patients (28.8 vs. 7.4%, P = 0.004). These results confirm that iHF patients are more likely to have impaired dCA compared with age-matched controls. The relationship between impaired dCA and neurological complications in iHF patients deserves further investigation.
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Affiliation(s)
- J R Caldas
- Department of Anesthesia, Heart Institute, University of São Paulo, São Paulo, Brazil.,Department of Neurosurgery, Hospital das Clinicas, University of São Paulo, São Paulo, Brazil
| | - R B Panerai
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom; .,Leicester National Institute for Health Research Biomedical Research Unit in Cardiovascular Disease, Glenfield Hospital, Leicester, United Kingdom
| | - V J Haunton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom.,Leicester National Institute for Health Research Biomedical Research Unit in Cardiovascular Disease, Glenfield Hospital, Leicester, United Kingdom
| | - J P Almeida
- Department of Anesthesia, Heart Institute, University of São Paulo, São Paulo, Brazil
| | - G S R Ferreira
- Department of Anesthesia, Heart Institute, University of São Paulo, São Paulo, Brazil
| | - L Camara
- Department of Anesthesia, Heart Institute, University of São Paulo, São Paulo, Brazil
| | - R C Nogueira
- Department of Neurosurgery, Hospital das Clinicas, University of São Paulo, São Paulo, Brazil.,Department of Neurology, Hospital das Clinicas, University of São Paulo, São Paulo, Brazil; and
| | - E Bor-Seng-Shu
- Department of Neurosurgery, Hospital das Clinicas, University of São Paulo, São Paulo, Brazil
| | - M L Oliveira
- Department of Neurosurgery, Hospital das Clinicas, University of São Paulo, São Paulo, Brazil
| | - R R V Groehs
- Department of Anesthesia, Heart Institute, University of São Paulo, São Paulo, Brazil
| | - L Ferreira-Santos
- Department of Anesthesia, Heart Institute, University of São Paulo, São Paulo, Brazil
| | - M J Teixeira
- Department of Neurosurgery, Hospital das Clinicas, University of São Paulo, São Paulo, Brazil
| | - F R B G Galas
- Department of Anesthesia, Heart Institute, University of São Paulo, São Paulo, Brazil
| | - T G Robinson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom.,Leicester National Institute for Health Research Biomedical Research Unit in Cardiovascular Disease, Glenfield Hospital, Leicester, United Kingdom
| | - F B Jatene
- Department of Cardiopneumology, Heart Institute, University of São Paulo, São Paulo, Brazil
| | - L A Hajjar
- Department of Cardiopneumology, Heart Institute, University of São Paulo, São Paulo, Brazil
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Ayub-Ferreira SM, Souza Neto JD, Almeida DR, Biselli B, Avila MS, Colafranceschi AS, Stefanello B, Carvalho BM, Polanczyk CA, Galantini DR, Bocchi EA, Chamlian EG, Hojaij EM, Gaiotto FA, Pinton FA, Jatene FB, Ramires FJA, Atik FA, Figueira F, Bacal F, Galas FRBG, Brito FS, Conceição-Souza GE, Ribeiro GCA, Pinheiro Jr. JA, Souza JM, Rossi Neto JM, Lima JLC, Mejía JC, Fernandes JR, Baumworcel L, Moura LAZ, Hajjar LA, Beck-da-Silva L, Rohde LEP, Seguro LFBC, Pinheiro ML, Park M, Fernandes MR, Montera MW, Alves MSL, Wanderley Jr. MRB, Hossne N, Fernandes PMP, Lemos P, Schneidewind RO, Uchoa RB, Honorato R, Mangini S, Falcão SNRS, Lopes SAV, Strabelli TMV, Guimarães TCF, Campanili TCGF, Issa VS. Diretriz de assistência circulatória mecânica da sociedade brasileira de cardiologia. Arq Bras Cardiol 2016; 107:1-33. [DOI: 10.5935/abc.20160128] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Gerent A, Almeida JP, Galas F, Fukushima JT, Osawa E, Park C, Franco R, Sakr Y, Hajjar LA. Goal-directed therapy in cancer surgery: a randomised and controlled trial (GRICS II). Intensive Care Med Exp 2015. [PMCID: PMC4796640 DOI: 10.1186/2197-425x-3-s1-a819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Azeka E, Jatene MB, Jatene IB, Horowitz ESK, Branco KC, Souza Neto JD, Miura N, Mattos S, Afiune JY, Tanaka AC, Santos CCL, Guimarães ICB, Manso PH, Pellizari RCRS, Santos MVC, Thomaz AM, Cristofani LM, Ribeiro ACL, Kulikowski LD, Sampaio MC, Pereira AC, Soares A, Soares Junior J, Oh GHY, Moreira V, Mota CCC, Afiune CMC, Pedra C, Pedra S, Pedrosa A, Guimarães V, Caneo LF, Ferreiro CF, Cavalheiro Filho C, Stefanello B, Negrão CE, Turquetto ALR, Mesquita SMF, Maeda WF, Zorzanelli L, Panajotopolos N, Siqueira AWS, Galas FRB, Hajjar LA, Benvenuti LA, Vincenzi P, Odone V, Lopes MH, Strabelli TMV, Franchi SM, Takeuti AD, Duarte MF, Leon RGP, Hermida RPM, Sorpreso ICE, Soares Junior JM, Melo NR, Baracat EC, Bortolotto MRFL, Scanavacca M, Shimoda MS, Foronda G, Romano BW, Silva DB, Omura MM, Barbeiro CPM, Vinhole ARG, Palomo JSH, Gonçalves MAB, Reis ICF, Oliveira LG, Ribeiro CC, Isosaki M, Vieira LP, Feltrim MIZ, Manoel LA, Abud KCO, Paschotto DR, Neves ILI, Senaha LE, Garcia ACCN, Cipriano SL, Santos VC, Ferraz AS, Moreira AELC, De Paulo ARSA, Duque AMPC, Trindade E, Bacal F, Auler Junior JOC, Almeida DR. [I Guidelines of heart failure and heart transplantation in the fetus, in children and adults with congenital cardiopathy, The Brazilian Society of Cardiology]. Arq Bras Cardiol 2015; 103:1-126. [PMID: 25591041 DOI: 10.5935/abc.2014s005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Gonzalez MM, Timerman S, Gianotto-Oliveira R, Polastri TF, Canesin MF, Schimidt A, Siqueira AW, Pispico A, Longo A, Pieri A, Reis A, Tanaka ACS, Santos AM, Quilici AP, Ribeiro ACL, Barreto ACP, Pazin-Filho A, Timerman A, Machado CA, Franchin Neto C, Miranda CH, Medeiros CR, Malaque CMS, Bernoche C, Gonçalves DM, Sant'Ana DG, Osawa EA, Peixoto E, Arfelli E, Evaristo EF, Azeka E, Gomes EP, Wen FH, Ferreira FG, Lima FG, Mattos FR, Galas FG, Marques FRB, Tarasoutchi F, Mancuso FJN, Freitas GR, Feitosa-Filho GS, Barbosa GC, Giovanini GR, Miotto HC, Guimarães HP, Andrade JP, Oliveira-Filho J, Fernandes JG, Moraes Junior JBMX, Carvalho JJF, Ramires JAF, Cavalini JF, Teles JMM, Lopes JL, Lopes LNGD, Piegas LS, Hajjar LA, Brunório L, Dallan LAP, Cardoso LF, Rabelo MMN, Almeida MFB, Souza MFS, Favarato MH, Pavão MLRC, Shimoda MS, Oliveira Junior MT, Miura N, Filgueiras Filho NM, Pontes-Neto OM, Pinheiro PAPC, Farsky OS, Lopes RD, Silva RCG, Kalil Filho R, Gonçalves RM, Gagliardi RJ, Guinsburg R, Lisak S, Araújo S, Martins SCO, Lage SG, Franchi SM, Shimoda T, Accorsi TD, Barral TCN, Machado TAO, Scudeler TL, Lima VC, Guimarães VA, Sallai VS, Xavier WS, Nazima W, Sako YK. [First guidelines of the Brazilian Society of Cardiology on Cardiopulmonary Resuscitation and Cardiovascular Emergency Care]. Arq Bras Cardiol 2014; 101:1-221. [PMID: 24030145 DOI: 10.5935/abc.2013s006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Azeka E, Jatene MB, Tanaka AC, Galas FR, Hajjar LA, Miura N, Auler Junior JOC. Clinical recommendations for postoperative care after heart transplantation in children: 21 years of a single-center experience. Clinics (Sao Paulo) 2014; 69 Suppl 1:47-50. [PMID: 24860859 PMCID: PMC3884164 DOI: 10.6061/clinics/2014(sup01)09] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Heart transplantation is an option for children with complex congenital heart disease and cardiomyopathies. A patient's quality of life and long-term survival depend on successful management of the surgical complications and adverse side effects of immunosuppression. The purpose of this review was to summarize the practical management of postoperative care in this patient population and to make recommendations for the future.
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Affiliation(s)
- Estela Azeka
- Heart Institute (InCor), Faculdade de Medicina, Hospital das Clinicas, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Marcelo Biscegli Jatene
- Heart Institute (InCor), Faculdade de Medicina, Hospital das Clinicas, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Ana Cristina Tanaka
- Heart Institute (InCor), Faculdade de Medicina, Hospital das Clinicas, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Filomena Regina Galas
- Heart Institute (InCor), Faculdade de Medicina, Hospital das Clinicas, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Ludhmilla Abrahao Hajjar
- Heart Institute (InCor), Faculdade de Medicina, Hospital das Clinicas, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Nana Miura
- Heart Institute (InCor), Faculdade de Medicina, Hospital das Clinicas, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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Cavalcanti AB, Silva UV, Normílio-Silva KN, Silva AN, Zancani R, Giorgi MJ, Dias AD, Simone AT, Safra PL, Figueiredo AC, Tunes-da-Silva G, Lima AC, Hajjar LA, Auler JO, Eluf-Neto J, Galas FR. Health-related quality of life and survival of cancer patients admitted to ICUs: Results of the QALY study. Crit Care 2012. [PMCID: PMC3363829 DOI: 10.1186/cc11018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Almeida JP, Galas F, Vincent JL, Fukushima JT, Nakamura RE, Kalil Filho R, Jatene FB, Auler JOC, Hajjar LA. Red blood cell transfusion is an independent risk factor for cardiovascular complications in adult patients undergoing cardiac surgery: a propensity score-matched analysis. Crit Care 2011. [PMCID: PMC3124215 DOI: 10.1186/cc10213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Hajjar LA, Galas F, Almeida J, Nagaoka D, Duarte FA, Nakamura RE, Simoes C, Kalil-Filho R, Hoff PM, Auler JOC. Outcomes of 3,400 patients with cancer admitted to intensive care unit: a Brazilian prospective study. Crit Care 2011. [PMCID: PMC3124155 DOI: 10.1186/cc10153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Hajjar LA, Vincent JL, Galas FRBG, Almeida JP, Jatene FB, Bueno PC, Fukushima JT, Nakamura RE, Silva CM, Kalil Filho R, Auler JOC. Lactate and base deficit are predictors of mortality in critically ill patients with cancer. Crit Care 2011. [PMCID: PMC3124168 DOI: 10.1186/cc10166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kalil Filho R, Hajjar LA, Bacal F, Hoff PM, Diz MDP, Galas FRBG. I Diretriz Brasileira de Cardio-Oncologia da Sociedade Brasileira de Cardiologia. Arq Bras Cardiol 2011. [DOI: 10.1590/s0066-782x2011000700001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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Hajjar LA, Mauad T, Galas FRBG, Kumar A, da Silva LFF, Dolhnikoff M, Trielli T, Almeida JP, Borsato MRL, Abdalla E, Pierrot L, Kalil Filho R, Auler JOC, Saldiva PHN, Hoff PM. Severe novel influenza A (H1N1) infection in cancer patients. Ann Oncol 2010; 21:2333-2341. [PMID: 20511340 PMCID: PMC2990816 DOI: 10.1093/annonc/mdq254] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: The natural history and consequences of severe H1N1 influenza infection among cancer patients are not yet fully characterized. We describe eight cases of H1N1 infection in cancer patients admitted to the intensive care unit of a referral cancer center. Patients and methods: Clinical data from all patients admitted with acute respiratory failure due to novel viral H1N1 infection were reviewed. Lung tissue was submitted for viral and bacteriological analyses by real-time RT-PCR, and autopsy was conducted on all patients who died. Results: Eight patients were admitted, with ages ranging from 55 to 65 years old. There were five patients with solid organ tumors (62.5%) and three with hematological malignancies (37.5%). Five patients required mechanical ventilation and all died. Four patients had bacterial bronchopneumonia. All deaths occurred due to multiple organ failure. A milder form of lung disease was present in the three cases who survived. Lung tissue analysis was performed in all patients and showed diffuse alveolar damage in most patients. Other lung findings were necrotizing bronchiolitis or extensive hemorrhage. Conclusions: H1N1 viral infection in patients with cancer can cause severe illness, resulting in acute respiratory distress syndrome and death. More data are needed to identify predictors of unfavorable evolution in these patients.
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Affiliation(s)
- L A Hajjar
- Department of Anesthesia and Intensive Care
| | - T Mauad
- Department of Pathology, Universidade de São Paulo, Sao Paulo, Brazil
| | | | - A Kumar
- Department of Section of Critical Care Medicine, University of Manitoba, Manitoba, Canada
| | - L F F da Silva
- Department of Pathology, Universidade de São Paulo, Sao Paulo, Brazil
| | - M Dolhnikoff
- Department of Pathology, Universidade de São Paulo, Sao Paulo, Brazil
| | - T Trielli
- Department of Anesthesia and Intensive Care
| | | | - M R L Borsato
- Department of Pathology, Universidade de São Paulo, Sao Paulo, Brazil
| | | | | | | | | | - P H N Saldiva
- Department of Pathology, Universidade de São Paulo, Sao Paulo, Brazil
| | - P M Hoff
- Department of Oncology, Universidade de São Paulo, São Paulo, Brazil.
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Abstract
Gonorrhea is a common bacterial infection caused by Neisseria gonorrhoeae, a Gram-negative diplococcus that is transmitted almost exclusively by sexual contact or perinatally. It primarily affects the mucous membranes of the lower genital tract and less frequently those of the rectum, oropharynx, and conjunctivae. Ascending genital infection in women leads to the predominant complication, acute salpingitis, one of the most common causes of female infertility in the world. Since the 1990s, a remarkable surge of information ensued regarding the pathogenesis of gonorrhea and its agent. Gonorrhea has proven difficult to control in most populations and remains a prime example of the influence that social, behavioral, and demographic factors can have on the epidemiology of an infectious disease. The management of gonorrhea and other sexually transmitted infections requires both treatment of the patient as an individual and of his or her sexual partner(s) as a public health measure to interrupt the onward spread of infection and prevent long-term complications.
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Affiliation(s)
- G O Penna
- Hospital Universitário de Brasília, DF, Brasil
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