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  1. Article ; Online: Perception of usefulness of laboratory tests ordering by internal medicine residents in ambulatory setting

    Dimitria Doi / Romulo Ribeiro do Vale / Jean Michell Correia Monteiro / Glauco Cabral Marinho Plens / Mario Ferreira Junior / Luiz Augusto Marcondes Fonseca / Sandro Félix Perazzio / Bruno Adler Maccagnan Pinheiro Besen / Arnaldo Lichtenstein / Leandro Utino Taniguchi / Nairo Massakazu Sumita / Aline Pivetta Corá / Adriana Pasmanik Eisencraft / Alberto José da Silva Duarte

    PLoS ONE, Vol 16, Iss 5, p e

    A single-center prospective cohort study.

    2021  Volume 0250769

    Abstract: The demand for high value health care uncovered a steady trend in laboratory tests ordering and inappropriate testing practices. Residents' training in laboratory ordering practice provides an opportunity for quality improvement. We collected information ...

    Abstract The demand for high value health care uncovered a steady trend in laboratory tests ordering and inappropriate testing practices. Residents' training in laboratory ordering practice provides an opportunity for quality improvement. We collected information on demographics, the main reason for the appointment, preexisting medical conditions and presence of co-morbidities from first-visit patients to the internal medicine outpatient service of our university general hospital. We also collected information on all laboratory tests ordered by the attending medical residents. At a follow-up visit, we recorded residents' subjective perception on the usefulness of each ordered laboratory test for the purposes of diagnosis, prognosis, treatment or screening. We observed that 17.3% of all ordered tests had no perceived utility by the attending resident. Tests were usually ordered to exclude differential diagnoses (26.7%) and to help prognosis estimation (19.1%). Age and co-morbidity influenced the chosen category to legitimate usefulness of tests ordering. This study suggests that clinical objectives (diagnosis, prognosis, treatment or prevention) as well as personalization to age and previous health conditions should be considered before test ordering to allow a more appropriate laboratory tests ordering, but further studies are necessary to examine this framework beyond this medical training scenario.
    Keywords Medicine ; R ; Science ; Q
    Language English
    Publishing date 2021-01-01T00:00:00Z
    Publisher Public Library of Science (PLoS)
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: Severe clinical spectrum with high mortality in pediatric patients with COVID-19 and multisystem inflammatory syndrome

    Maria Fernanda Badue Pereira / Nadia Litvinov / Sylvia Costa Lima Farhat / Adriana Pasmanik Eisencraft / Maria Augusta Bento Cicaroni Gibelli / Werther Brunow de Carvalho / Vinicius Rodrigues Fernandes / Thais de Toledo Fink / Juliana Valéria de Souza Framil / Karine Vusberg Galleti / Alice Lima Fante / Maria Fernanda Mota Fonseca / Andreia Watanabe / Camila Sanson Yoshino de Paula / Giovanna Gavros Palandri / Gabriela Nunes Leal / Maria de Fatima Rodrigues Diniz / João Renato Rebello Pinho / Clovis Artur Silva /
    Heloisa Helena de Sousa Marques / Alfio Rossi Junior / Artur Figueiredo Delgado / Anarella Penha Meirelles de Andrade / Claudio Schvartsman / Ester Cerdeira Sabino / Mussya Cisotto Rocha / Kelly Aparecida Kanunfre / Thelma Suely Okay / Magda Maria Sales Carneiro-Sampaio / Patricia Palmeira Daenekas Jorge

    Clinics, Vol

    2020  Volume 75

    Abstract: OBJECTIVES: To assess the outcomes of pediatric patients with laboratory-confirmed coronavirus disease (COVID-19) with or without multisystem inflammatory syndrome in children (MIS-C). METHODS: This cross-sectional study included 471 samples collected ... ...

    Abstract OBJECTIVES: To assess the outcomes of pediatric patients with laboratory-confirmed coronavirus disease (COVID-19) with or without multisystem inflammatory syndrome in children (MIS-C). METHODS: This cross-sectional study included 471 samples collected from 371 patients (age<18 years) suspected of having severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The study group comprised 66/371 (18%) laboratory-confirmed pediatric COVID-19 patients: 61 (92.5%) patients tested positive on real-time reverse transcription-polymerase chain reaction tests for SARS-CoV-2, and 5 (7.5%) patients tested positive on serological tests. MIS-C was diagnosed according to the criteria of the Center for Disease Control. RESULTS: MIS-C was diagnosed in 6/66 (9%) patients. The frequencies of diarrhea, vomiting, and/or abdominal pain (67% vs. 22%, p=0.034); pediatric SARS (67% vs. 13%, p=0.008); hypoxemia (83% vs. 23%, p=0.006); and arterial hypotension (50% vs. 3%, p=0.004) were significantly higher in patients with MIS-C than in those without MIS-C. The frequencies of C-reactive protein levels >50 mg/L (83% vs. 25%, p=0.008) and D-dimer levels >1000 ng/mL (100% vs. 40%, p=0.007) and the median D-dimer, troponin T, and ferritin levels (p<0.05) were significantly higher in patients with MIS-C. The frequencies of pediatric intensive care unit admission (100% vs. 60%, p=0.003), mechanical ventilation (83% vs. 7%, p<0.001), vasoactive agent use (83% vs. 3%, p<0.001), shock (83% vs. 5%, p<0.001), cardiac abnormalities (100% vs. 2%, p<0.001), and death (67% vs. 3%, p<0.001) were also significantly higher in patients with MIS-C. Similarly, the frequencies of oxygen therapy (100% vs. 33%, p=0.003), intravenous immunoglobulin therapy (67% vs. 2%, p<0.001), aspirin therapy (50% vs. 0%, p<0.001), and current acute renal replacement therapy (50% vs. 2%, p=0.002) were also significantly higher in patients with MIS-C. Logistic regression analysis showed that the presence of MIS-C was significantly ...
    Keywords COVID-19 ; Children ; Adolescent ; Outcome ; Immunosuppression ; Multisystem Inflammatory Syndrome ; Medicine (General) ; R5-920
    Subject code 610 ; 616
    Language English
    Publishing date 2020-08-01T00:00:00Z
    Publisher Elsevier España
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: Differences in children and adolescents with SARS-CoV-2 infection

    Heloisa Helena de Sousa Marques / Maria Fernanda Badue Pereira / Angélica Carreira dos Santos / Thais Toledo Fink / Camila Sanson Yoshino de Paula / Nadia Litvinov / Claudio Schvartsman / Artur Figueiredo Delgado / Maria Augusta Bento Cicaroni Gibelli / Werther Brunow de Carvalho / Vicente Odone Filho / Uenis Tannuri / Magda Carneiro-Sampaio / Sandra Grisi / Alberto José da Silva Duarte / Leila Antonangelo / Rossana Pucineli Vieira Francisco / Thelma Suely Okay / Linamara Rizzo Batisttella /
    Carlos Roberto Ribeiro de Carvalho / Alexandra Valéria Maria Brentani / Clovis Artur Silva / Adriana Pasmanik Eisencraft / Alfio Rossi Junior / Alice Lima Fante / Aline Pivetta Cora / Amelia Gorete A. de Costa Reis / Ana Paula Scoleze Ferrer / Anarella Penha Meirelles de Andrade / Andreia Watanabe / Angelina Maria Freire Gonçalves / Aurora Rosaria Pagliara Waetge / Camila Altenfelder Silva / Carina Ceneviva / Carolina dos Santos Lazari / Deipara Monteiro Abellan / Emilly Henrique dos Santos / Ester Cerdeira Sabino / Fabíola Roberta Marim Bianchini / Flávio Ferraz de Paes Alcantara / Gabriel Frizzo Ramos / Gabriela Nunes Leal / Isadora Souza Rodriguez / João Renato Rebello Pinho / Jorge David Avaizoglou Carneiro / Jose Albino Paz / Juliana Carvalho Ferreira / Juliana Ferreira Ferranti / Juliana de Oliveira Achili Ferreira / Juliana Valéria de Souza Framil

    Clinics, Vol

    a cohort study in a Brazilian tertiary referral hospital

    2021  Volume 76

    Abstract: OBJECTIVES: To compare demographic/clinical/laboratory/treatments and outcomes among children and adolescents with laboratory-confirmed coronavirus disease 2019 (COVID-19). METHODS: This was a cross-sectional study that included patients diagnosed with ... ...

    Abstract OBJECTIVES: To compare demographic/clinical/laboratory/treatments and outcomes among children and adolescents with laboratory-confirmed coronavirus disease 2019 (COVID-19). METHODS: This was a cross-sectional study that included patients diagnosed with pediatric COVID-19 (aged <18 years) between April 11, 2020 and April 22, 2021. During this period, 102/5,951 (1.7%) of all admissions occurred in neonates, children, and adolescents. Furthermore, 3,962 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection samples were processed in patients aged <18 years, and laboratory-confirmed COVID-19 occurred in 155 (4%) inpatients and outpatients. Six/155 pediatric patients were excluded from the study. Therefore, the final group included 149 children and adolescents (n=97 inpatients and 52 outpatients) with positive SARS-CoV-2 results. RESULTS: The frequencies of sore throat, anosmia, dysgeusia, headache, myalgia, nausea, lymphopenia, pre-existing chronic conditions, immunosuppressive conditions, and autoimmune diseases were significantly reduced in children and adolescents (p<0.05). Likewise, the frequencies of enoxaparin use (p=0.037), current immunosuppressant use (p=0.008), vasoactive agents (p=0.045), arterial hypotension (p<0.001), and shock (p=0.024) were significantly lower in children than in adolescents. Logistic regression analysis showed that adolescents with laboratory-confirmed COVID-19 had increased odds ratios (ORs) for sore throat (OR 13.054; 95% confidence interval [CI] 2.750-61.977; p=0.001), nausea (OR 8.875; 95% CI 1.660-47.446; p=0.011), and lymphopenia (OR 3.575; 95% CI 1.355-9.430; p=0.010), but also had less hospitalizations (OR 0.355; 95% CI 0.138-0.916; p=0.032). The additional logistic regression analysis on patients with preexisting chronic conditions (n=108) showed that death as an outcome was significantly associated with pediatric severe acute respiratory syndrome (SARS) (OR 22.300; 95% CI 2.341-212.421; p=0.007) and multisystem inflammatory syndrome in children ...
    Keywords COVID-19 ; Children ; Adolescent ; Outcome ; Chronic Disease ; Multisystem Inflammatory Syndrome ; Medicine (General) ; R5-920
    Subject code 610
    Language English
    Publishing date 2021-11-01T00:00:00Z
    Publisher Elsevier España
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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    Inter-library loan at ZB MED

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  4. Article ; Online: Influence of growth hormone replacement on neurological and psychomotor development. Case report

    Felipe Motta / Adriana Pasmanik Eisencraft / Lindiane Gomes Crisostomo

    Einstein (São Paulo), Vol 16, Iss 2

    Abstract: ABSTRACT The height response to the use of growth hormone in short height cases has already been confirmed in the literature. The influence of the insulin-like growth factor 1 (GH-IGF1) axis components on development, function, regeneration, ... ...

    Abstract ABSTRACT The height response to the use of growth hormone in short height cases has already been confirmed in the literature. The influence of the insulin-like growth factor 1 (GH-IGF1) axis components on development, function, regeneration, neuroprotection, cognition, and motor functions has been evaluated in experimental studies and in adults with central nervous system lesions. However, there is still little research on the clinical impact of hormone replacement on neurological and psychomotor development. This report presents the case of a patient with excellent weight-height recovery and, even more surprisingly, neurological and psychomotor development in response to use of growth hormone. The result strengthens the correlation between experimental and clinical findings related to cerebral plasticity response to growth hormone in children. A preterm male patient with multiple health problems during the neonatal and young infancy period, who for six years presented with a relevant deficit in growth, bone maturation, and neurological and psychomotor development. At six years of age, he had low stature (z-score −6.89), low growth rate, and low weight (z-score −7.91). He was incapable of sustaining his axial weight, had not developed fine motor skills or sphincter control, and presented with dysfunctional swallowing and language. Supplementary tests showed low IGF-11 levels, with no changes on the image of the hypothalamus-pituitary region, and bone age consistent with three-year-old children — for a chronological age of six years and one month. Growth hormone replacement therapy had a strong impact on the weight-height recovery as well as on the neurological and psychomotor development of this child.
    Keywords Desenvolvimento infantil ; Hormônio do crescimento humano ; Nanismo hipofisário ; Relatos de casos ; Medicine ; R
    Subject code 616
    Language English
    Publisher Instituto Israelita de Ensino e Pesquisa Albert Einstein
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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