Showing papers by "Ludhmila Abrahão Hajjar published in 2023"
TL;DR: In this article , the authors search Embase, BioMed Central, medRxiv, bioRxivas, PubMed, and the Cochrane Central Register of Controlled Trials for any randomized trial or matched study ever performed on adult patients with severe and critical coronavirus disease 2019 (Covid-19) not receiving oxygen therapy treated with intravenous or oral glucocorticoids versus any comparator (standard therapy or placebo); there were no restrictions on dose or time of administration.
Abstract: BackgroundGlucocorticoids reduce mortality in hospitalized patients with severe and critical coronavirus disease 2019 (Covid-19), although a possible harm was documented in patients with Covid-19 not requiring oxygen.MethodsWe searched Embase, BioMed Central, medRxiv, bioRxiv, PubMed, and the Cochrane Central Register of Controlled Trials for any randomized trial or matched study ever performed on adult patients with Covid-19 not receiving oxygen therapy treated with intravenous or oral glucocorticoids versus any comparator (standard therapy or placebo); there were no restrictions on dose or time of administration. The primary end point was all-cause mortality at the longest available follow-up.ResultsFive randomized trials and one propensity-matched study involving 6634 hospitalized patients not on oxygen were finally included (3704 received glucocorticoids and 2930 received standard treatment). The overall mortality of patients treated with glucocorticoids was significantly higher than the mortality of patients in the control group (509 of 3704 [14%] in the glucocorticoid group vs. 294 of 2930 [10%] in the control group; odds ratio, 1.56 [95% confidence interval, 1.27 to 1.92], with three articles reporting mortality events and contributing to the combined odds ratio; P<0.001; number needed to harm=27).ConclusionsGlucocorticoid use likely increases mortality in hospitalized patients with Covid-19 not receiving oxygen, with a number needed to harm of 27. (PROSPERO number CRD42022342996.)
2 citations
TL;DR: In this article , the authors investigated whether physical capacity increase in patients with heart failure with reduced ejection fraction (HFrEF) is associated with muscle sympathetic nerve activity reduction and muscle blood flow (MBF) increase.
2 citations
TL;DR: A síndrome carcinoide (SC) as discussed by the authors is a paraneoplasica often diagnosed in pacientes with tumores neuroendócrinos (TNEs) associados with secreção de fatores humorais.
Abstract: Introdução A Síndrome Carcinoide (SC) é uma síndrome paraneoplásica frequentemente diagnosticada em pacientes com tumores neuroendócrinos (TNEs) associados com secreção de fatores humorais. Esses fatores incluem a serotonina (5-HT), a qual parece ser a substância mais comum associada à síndrome, além de histamina, calicreína, prostaglandinas e taquicininas. Entre os pacientes diagnosticados com TNEs localizados no duodeno e intestino delgado, cerca de 20% irão desenvolver SC durante o acompanahmento. A presença de SC está fortemente associada com maior grau e estágio [...]
TL;DR: In this paper , the authors reviewed the role of haemodynamic monitoring in the perioperative setting, highlighting who are the patients who most benefit, describing the type of devices, analyzing the scientific evidence, and suggesting algorithms of care in high-risk surgical patients.
Abstract: Purpose of review The aim of this study was to review the role of haemodynamic monitoring in the perioperative setting, highlighting who are the patients who most benefit, to describe the type of devices, to analyse the scientific evidence and to suggest algorithms of haemodynamic care in high-risk surgical patients. Recent findings In the last 50 years, many advances have contributed to better understand cardiovascular physiology at bedside, and haemodynamic monitoring has moved from invasive methods to minimally invasive and noninvasive devices. Randomized clinical trials have shown benefits of perioperative haemodynamic therapy to improve outcomes in high-risk surgical patients. A multimodal approach is purposed in the perioperative setting to optimize haemodynamic parameters, involving clinical analysis at bedside, the use of dynamic tests for fluid responsiveness and integration of variables, including cardiac output, systolic volume, tissue oxygen markers and echocardiographic measures. Summary In this review, we summarize the benefits of haemodynamic monitoring, the type of devices with advantages and disadvantages, the scientific evidence supporting perioperative haemodynamic therapy, and we suggest a multimodal approach to improve patients’ care.
TL;DR: A síndrome carcinoide (SC) as mentioned in this paper is a paraneoplasica often diagnosed in pacientes with tumores neuroendócrinos (TNEs) associados with secreção de fatores humorais.
Abstract: Introdução A Síndrome Carcinoide (SC) é uma síndrome paraneoplásica frequentemente diagnosticada em pacientes com tumores neuroendócrinos (TNEs) associados com secreção de fatores humorais. Esses fatores incluem a serotonina (5-HT), a qual parece ser a substância mais comum associada à síndrome, além de histamina, calicreína, prostaglandinas e taquicininas. Entre os pacientes diagnosticados com TNEs localizados no duodeno e intestino delgado, cerca de 20% irão desenvolver SC durante o acompanahmento. A presença de SC está fortemente associada com maior grau e estágio [...]
TL;DR: The COVID-OCT trial as mentioned in this paper evaluated the safety, tolerability, and diagnostic value of optical coherence tomography (OCT) for the assessment of patients with pneumonia for pulmonary microvascular thromboinflammatory syndrome.
Abstract: Background Microvascular lung vessels obstructive thromboinflammatory syndrome has been proposed as a possible mechanism of respiratory failure in COVID-19 patients. However, it has only been observed in post-mortem studies and has never been documented in vivo, probably because of a lack of CT scan sensitivity in small pulmonary arteries. The aim of the present study was to assess the safety, tolerability, and diagnostic value of optical coherence tomography (OCT) for the assessment of patients with COVID-19 pneumonia for pulmonary microvascular thromboinflammatory syndrome. Methods The COVID-OCT trial was a multicenter, open-label, prospective, interventional clinical study. Two cohorts of patients were included in the study and underwent pulmonary OCT evaluation. Cohort A consisted of patients with COVID-19 with a negative CT scan for pulmonary thrombosis and elevated thromboinflammatory markers (D-dimer > 10,000 ng/mL or 5,000 < D-dimer < 10,000 ng/mL and one of: C-reactive Protein > 100 mg/dL, IL-6 > 6 pg/mL, or ferritin > 900 ng/L). Cohort B consisted of patients with COVID-19 and a CT scan positive for pulmonary thrombosis. The primary endpoints of the study were: (i) to evaluate the overall safety of OCT investigation in patients with COVID-19 pneumonia, and (ii) to report on the potential value of OCT as a novel diagnostic tool for the diagnosis of microvascular pulmonary thrombosis in COVID-19 patients. Results A total of 13 patients were enrolled. The mean number of OCT runs performed in each patient was 6.1 ± 2.0, both in ground glass and healthy lung areas, achieving a good evaluation of the distal pulmonary arteries. Overall, OCT runs identified microvascular thrombosis in 8 patients (61.5%): 5 cases of red thrombus, 1 case of white thrombus, and 2 cases of mixed thrombus. In Cohort A, the minimal lumen area was 3.5 ± 4.6 mm2, with stenosis of 60.9 ± 35.9% of the area, and the mean length of thrombus-containing lesions was 5.4 ± 3.0 mm. In Cohort B, the percentage area obstruction was 92.6 ± 2.6, and the mean thrombus-containing lesion length was 14.1 ± 13.9 mm. No peri-procedural complications occurred in any of the 13 patients. Conclusion OCT appears to be a safe and accurate method of evaluating the distal pulmonary arteries in hospitalized COVID-19 patients. Here, it enabled the first in vivo documentation of distal pulmonary arterial thrombosis in patients with elevated thromboinflammatory markers, even when their CT angiogram was negative for pulmonary thrombosis. Clinical trial registration ClinicalTrial.gov, identifier NCT04410549.