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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: Salivary, serological, and cellular immune response to the CoronaVac vaccine in health care workers with or without previous COVID-19

    Marina Mazzilli Ortega / Laís Teodoro da Silva / Érika Donizetti Candido / Yingying Zheng / Bruna Tiaki Tiyo / Arthur Eduardo Fernandes Ferreira / Simone Corrêa-Silva / Guilherme Pereira Scagion / Fabyano Bruno Leal / Vanessa Nascimento Chalup / Camila Araújo Valério / Gabriela Justamante Händel Schmitz / Carina Ceneviva / Aline Pivetta Corá / Alexandre de Almeida / Edison Luiz Durigon / Danielle Bruna Leal Oliveira / Patricia Palmeira / Alberto José da Silva Duarte /
    Magda Carneiro-Sampaio / Telma Miyuki Oshiro

    Scientific Reports, Vol 12, Iss 1, Pp 1-

    2022  Volume 12

    Abstract: Abstract We investigated the anti-SARS-CoV-2 post-vaccine response through serum and salivary antibodies, serum antibody neutralizing activity and cellular immune response in samples from health care workers who were immunized with two doses of an ... ...

    Abstract Abstract We investigated the anti-SARS-CoV-2 post-vaccine response through serum and salivary antibodies, serum antibody neutralizing activity and cellular immune response in samples from health care workers who were immunized with two doses of an inactivated virus-based vaccine (CoronaVac) who had or did not have COVID-19 previously. IgA and IgG antibodies directed at the spike protein were analysed in samples of saliva and/or serum by ELISA and/or chemiluminescence assays; the neutralizing activity of serum antibodies against reference strain B, Gamma and Delta SARS-CoV-2 variants were evaluated using a virus neutralization test and SARS-CoV-2 reactive interferon-gamma T-cell were analysed by flow cytometry. CoronaVac was able to induce serum and salivary IgG anti-spike antibodies and IFN-γ producing T cells in most individuals who had recovered from COVID-19 and/or were vaccinated. Virus neutralizing activity was observed against the ancestral strain, with a reduced response against the variants. Vaccinated individuals who had previous COVID-19 presented higher responses than vaccinated individuals for all variables analysed. Our study provides evidence that the CoronaVac vaccine was able to induce the production of specific serum and saliva antibodies, serum virus neutralizing activity and cellular immune response, which were increased in previously COVID-19-infected individuals compared to uninfected individuals.
    Keywords Medicine ; R ; Science ; Q
    Subject code 570
    Language English
    Publishing date 2022-06-01T00:00:00Z
    Publisher Nature Portfolio
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: Derrame pleural incomum

    Leila Antonangelo / Adriana Gonçalves Rosa / Aline Pivetta Corá / Milena Marques Pagliarelli Acencio / Luís César Moreira / Francisco Vargas Suso

    Jornal Brasileiro de Pneumologia, Vol 35, Iss 6, Pp 606-

    metástase pleuropulmonar de tumor neuroectodérmico primitivo Uncommon pleural effusion: pleuropulmonary metastasis from primitive neuroectodermal tumor

    2009  Volume 609

    Abstract: O tumor neuroectodérmico primitivo é uma neoplasia com diferenciação neural de comportamento invasivo que origina metástases para diversos órgãos. Relatamos um caso de tumor neuroectodérmico primitivo primário em axila com metástases para pulmão, pleura, ...

    Abstract O tumor neuroectodérmico primitivo é uma neoplasia com diferenciação neural de comportamento invasivo que origina metástases para diversos órgãos. Relatamos um caso de tumor neuroectodérmico primitivo primário em axila com metástases para pulmão, pleura, osso, músculo ilíaco e medula óssea. Enfatizamos o achado incomum da análise citológica do líquido pleural. Primitive neuroectodermal tumor is an invasive neoplasm with neuronal differentiation, which frequently results in metastasis in various organs. We report the case of a patient with primitive neuroectodermal tumor whose primary site was the axilla. The patient presented with metastases in the lung, pleura, bone, iliac muscle and bone marrow. We highlight the uncommon finding in the pleural fluid cytology.
    Keywords Tumores neuroectodérmicos primitivos ; Metástase neoplásica ; Citologia ; Derrame pleural ; Neuroectodermal tumors ; primitive ; Neoplasm metastasis ; Cytology ; Pleural effusion ; Diseases of the respiratory system ; RC705-779 ; Specialties of internal medicine ; RC581-951 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Internal medicine ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
    Language Portuguese
    Publishing date 2009-06-01T00:00:00Z
    Publisher Sociedade Brasileira de Pneumologia e Tisiologia
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article ; Online: Use and misuse of biomarkers and the role of D-dimer and C-reactive protein in the management of COVID-19

    Fabio Augusto Rodrigues Gonçalves / Bruno Adler Maccagnan Pinheiro Besen / Clarice Antunes de Lima / Aline Pivetta Corá / Antônio José Rodrigues Pereira / Sandro Félix Perazzio / Christiane Pereira Gouvea / Luiz Augusto Marcondes Fonseca / Evelinda Marramon Trindade / Nairo Massakazu Sumita / Alberto José da Silva Duarte / Arnaldo Lichtenstein / Eloisa Bonfa / Edivaldo M. Utiyama / Aluisio C. Segurado / Beatriz Perondi / Anna Miethke-Morais / Amanda C. Montal / Leila Harima /
    Solange R. G. Fusco / Marjorie F. Silva / Marcelo C. Rocha / Izabel Marcilio / Izabel Cristina Rios / Fabiane Yumi Ogihara Kawano / Maria Amélia de Jesus / Ésper George Kallas / Carolina Carmo / Clarice Tanaka / Heraldo Possolo de Souza / Julio F. M. Marchini / Carlos Carvalho / Juliana C. Ferreira / Anna Sara Shafferman Levin / Maura Salaroli Oliveira / Thaís Guimarães / Carolina dos Santos Lázari / Ester Sabino / Marcello M. C. Magri / Tarcisio E. P. Barros-Filho / Maria Cristina Peres Braido Francisco / Silvia F. Costa

    Clinics, Vol

    A post-hoc analysis of a prospective cohort study

    2021  Volume 76

    Abstract: OBJECTIVE: Coronavirus disease 2019 (COVID-19) is associated with high mortality among hospitalized patients and incurs high costs. Severe acute respiratory syndrome coronavirus 2 infection can trigger both inflammatory and thrombotic processes, and ... ...

    Abstract OBJECTIVE: Coronavirus disease 2019 (COVID-19) is associated with high mortality among hospitalized patients and incurs high costs. Severe acute respiratory syndrome coronavirus 2 infection can trigger both inflammatory and thrombotic processes, and these complications can lead to a poorer prognosis. This study aimed to evaluate the association and temporal trends of D-dimer and C-reactive protein (CRP) levels with the incidence of venous thromboembolism (VTE), hospital mortality, and costs among inpatients with COVID-19. METHODS: Data were extracted from electronic patient records and laboratory databases. Crude and adjusted associations for age, sex, number of comorbidities, Sequential Organ Failure Assessment score at admission, and D-dimer or CRP logistic regression models were used to evaluate associations. RESULTS: Between March and June 2020, COVID-19 was documented in 3,254 inpatients. The D-dimer level ≥4,000 ng/mL fibrinogen equivalent unit (FEU) mortality odds ratio (OR) was 4.48 (adjusted OR: 1.97). The CRP level ≥220 mg/dL OR for death was 7.73 (adjusted OR: 3.93). The D-dimer level ≥4,000 ng/mL FEU VTE OR was 3.96 (adjusted OR: 3.26). The CRP level ≥220 mg/dL OR for VTE was 2.71 (adjusted OR: 1.92). All these analyses were statistically significant (p<0.001). Stratified hospital costs demonstrated a dose-response pattern. Adjusted D-dimer and CRP levels were associated with higher mortality and doubled hospital costs. In the first week, elevated D-dimer levels predicted VTE occurrence and systemic inflammatory harm, while CRP was a hospital mortality predictor. CONCLUSION: D-dimer and CRP levels were associated with higher hospital mortality and a higher incidence of VTE. D-dimer was more strongly associated with VTE, although its discriminative ability was poor, while CRP was a stronger predictor of hospital mortality. Their use outside the usual indications should not be modified and should be discouraged.
    Keywords COVID-19 ; Biomarkers ; Cohort Studies ; Venous Thromboembolism ; Health Care Costs ; Medicine (General) ; R5-920
    Subject code 310
    Language English
    Publishing date 2021-12-01T00:00:00Z
    Publisher Elsevier España
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  5. 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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