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Institution

University of São Paulo

EducationSão Paulo, Brazil
About: University of São Paulo is a education organization based out in São Paulo, Brazil. It is known for research contribution in the topics: Population & Health care. The organization has 136513 authors who have published 272320 publications receiving 5127869 citations. The organization is also known as: USP & Universidade de São Paulo.


Papers
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Journal ArticleDOI
06 Oct 2020-JAMA
TL;DR: Among patients with COVID-19 and moderate or severe ARDS, use of intravenous dexamethasone plus standard care compared with standard care alone resulted in a statistically significant increase in the number of ventilator-free days over 28 days.
Abstract: Importance Acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19) is associated with substantial mortality and use of health care resources. Dexamethasone use might attenuate lung injury in these patients. Objective To determine whether intravenous dexamethasone increases the number of ventilator-free days among patients with COVID-19–associated ARDS. Design, Setting, and Participants Multicenter, randomized, open-label, clinical trial conducted in 41 intensive care units (ICUs) in Brazil. Patients with COVID-19 and moderate to severe ARDS, according to the Berlin definition, were enrolled from April 17 to June 23, 2020. Final follow-up was completed on July 21, 2020. The trial was stopped early following publication of a related study before reaching the planned sample size of 350 patients. Interventions Twenty mg of dexamethasone intravenously daily for 5 days, 10 mg of dexamethasone daily for 5 days or until ICU discharge, plus standard care (n =151) or standard care alone (n = 148). Main Outcomes and Measures The primary outcome was ventilator-free days during the first 28 days, defined as being alive and free from mechanical ventilation. Secondary outcomes were all-cause mortality at 28 days, clinical status of patients at day 15 using a 6-point ordinal scale (ranging from 1, not hospitalized to 6, death), ICU-free days during the first 28 days, mechanical ventilation duration at 28 days, and Sequential Organ Failure Assessment (SOFA) scores (range, 0-24, with higher scores indicating greater organ dysfunction) at 48 hours, 72 hours, and 7 days. Results A total of 299 patients (mean [SD] age, 61 [14] years; 37% women) were enrolled and all completed follow-up. Patients randomized to the dexamethasone group had a mean 6.6 ventilator-free days (95% CI, 5.0-8.2) during the first 28 days vs 4.0 ventilator-free days (95% CI, 2.9-5.4) in the standard care group (difference, 2.26; 95% CI, 0.2-4.38;P = .04). At 7 days, patients in the dexamethasone group had a mean SOFA score of 6.1 (95% CI, 5.5-6.7) vs 7.5 (95% CI, 6.9-8.1) in the standard care group (difference, −1.16; 95% CI, −1.94 to −0.38;P= .004). There was no significant difference in the prespecified secondary outcomes of all-cause mortality at 28 days, ICU-free days during the first 28 days, mechanical ventilation duration at 28 days, or the 6-point ordinal scale at 15 days. Thirty-three patients (21.9%) in the dexamethasone group vs 43 (29.1%) in the standard care group experienced secondary infections, 47 (31.1%) vs 42 (28.3%) needed insulin for glucose control, and 5 (3.3%) vs 9 (6.1%) experienced other serious adverse events. Conclusions and Relevance Among patients with COVID-19 and moderate or severe ARDS, use of intravenous dexamethasone plus standard care compared with standard care alone resulted in a statistically significant increase in the number of ventilator-free days (days alive and free of mechanical ventilation) over 28 days. Trial Registration ClinicalTrials.gov Identifier:NCT04327401

928 citations

Journal ArticleDOI
TL;DR: In this article, the authors proposed a method to solve the problem of single-input single-output (SISO) communication in the context of artificial neural networks (ANNs).

927 citations

Journal ArticleDOI
07 Apr 1995-Cell
TL;DR: An enzymatic rather than a structural protein defect causing a muscular dystrophy is demonstrated, a defect that may have regulatory consequences, perhaps in signal transduction.

927 citations

Journal ArticleDOI
19 Jan 2012-Nature
TL;DR: Signs of a transition to a disturbance-dominated regime include changing energy and water cycles in the southern and eastern portions of the Amazon basin.
Abstract: Agricultural expansion and climate variability have become important agents of disturbance in the Amazon basin. Recent studies have demonstrated considerable resilience of Amazonian forests to moderate annual drought, but they also show that interactions between deforestation, fire and drought potentially lead to losses of carbon storage and changes in regional precipitation patterns and river discharge. Although the basin-wide impacts of land use and drought may not yet surpass the magnitude of natural variability of hydrologic and biogeochemical cycles, there are some signs of a transition to a disturbance-dominated regime. These signs include changing energy and water cycles in the southern and eastern portions of the Amazon basin.

921 citations

Journal ArticleDOI
Nuno R. Faria1, Nuno R. Faria2, Raimunda do Socorro da Silva Azevedo1, Moritz U. G. Kraemer2, Renato Pereira de Souza3, Mariana Sequetin Cunha3, Sarah C. Hill2, Julien Thézé2, Michael B. Bonsall2, Thomas A. Bowden4, Ilona Rissanen4, Iray Maria Rocco3, Juliana Silva Nogueira3, Adriana Yurika Maeda3, Fernanda Giseli da Silva Vasami3, F. L. L. Macedo3, Akemi Suzuki3, Sueli Guerreiro Rodrigues1, Ana Cecília Ribeiro Cruz1, Bruno Tardeli Nunes1, Daniele Barbosa de Almeida Medeiros1, Daniela Sueli Guerreiro Rodrigues1, Alice Louize Nunes Queiroz1, Eliana Vieira Pinto da Silva1, Daniele Freitas Henriques1, Elisabeth Salbe Travassos da Rosa1, Consuelo Silva de Oliveira1, Lívia Carício Martins1, Helena Baldez Vasconcelos1, Livia Medeiros Neves Casseb1, Darlene B. Simith1, Jane P. Messina2, Leandro Abade2, José Lourenço2, Luiz Carlos Junior Alcantara5, Maricélia Maia de Lima6, Marta Giovanetti5, Simon I. Hay4, Simon I. Hay7, Rodrigo Santos de Oliveira1, Poliana da Silva Lemos1, Layanna Freitas de Oliveira1, Clayton Pereira Silva de Lima1, Sandro Patroca da Silva1, Janaina Mota de Vasconcelos1, L. C Franco1, Jedson Ferreira Cardoso1, João Lídio Silva Gonçalves Vianez-Júnior1, Daiana Mir5, Gonzalo Bello5, Edson Delatorre5, Kamran Khan8, Kamran Khan9, Marisa I Creatore8, Giovanini E. Coelho, Wanderson Kleber de Oliveira, Robert B. Tesh10, Oliver G. Pybus2, Márcio Roberto Teixeira Nunes10, Márcio Roberto Teixeira Nunes1, Pedro Fernando da Costa Vasconcelos1 
15 Apr 2016-Science
TL;DR: Results of phylogenetic and molecular clock analyses show a single introduction of ZikV into the Americas, which is estimated to have occurred between May and December 2013, more than 12 months before the detection of ZIKV in Brazil.
Abstract: Brazil has experienced an unprecedented epidemic of Zika virus (ZIKV), with ~30,000 cases reported to date. ZIKV was first detected in Brazil in May 2015, and cases of microcephaly potentially associated with ZIKV infection were identified in November 2015. We performed next-generation sequencing to generate seven Brazilian ZIKV genomes sampled from four self-limited cases, one blood donor, one fatal adult case, and one newborn with microcephaly and congenital malformations. Results of phylogenetic and molecular clock analyses show a single introduction of ZIKV into the Americas, which we estimated to have occurred between May and December 2013, more than 12 months before the detection of ZIKV in Brazil. The estimated date of origin coincides with an increase in air passengers to Brazil from ZIKV-endemic areas, as well as with reported outbreaks in the Pacific Islands. ZIKV genomes from Brazil are phylogenetically interspersed with those from other South American and Caribbean countries. Mapping mutations onto existing structural models revealed the context of viral amino acid changes present in the outbreak lineage; however, no shared amino acid changes were found among the three currently available virus genomes from microcephaly cases. Municipality-level incidence data indicate that reports of suspected microcephaly in Brazil best correlate with ZIKV incidence around week 17 of pregnancy, although this correlation does not demonstrate causation. Our genetic description and analysis of ZIKV isolates in Brazil provide a baseline for future studies of the evolution and molecular epidemiology of this emerging virus in the Americas.

921 citations


Authors

Showing all 138091 results

NameH-indexPapersCitations
George M. Whitesides2401739269833
Peter Libby211932182724
Robert C. Nichol187851162994
Paul M. Thompson1832271146736
Terrie E. Moffitt182594150609
Douglas R. Green182661145944
Richard B. Lipton1762110140776
Robin M. Murray1711539116362
George P. Chrousos1691612120752
David A. Bennett1671142109844
Barry M. Popkin15775190453
David H. Adams1551613117783
Joao Seixas1531538115070
Matthias Egger152901184176
Ichiro Kawachi149121690282
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Performance
Metrics
No. of papers from the Institution in previous years
YearPapers
20241
2023331
20222,547
202118,134
202017,960
201916,297