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Article ; Online: One-year mortality of hematopoietic stem cell recipients admitted to an intensive care unit in a dedicated Brazilian cancer center

Leticia Vicentin Finencio Archanjo / Pedro Caruso / Antonio Paulo Nassar Junior

São Paulo Medical Journal, Vol 141, Iss 2, Pp 107-

a retrospective cohort study

2022 Volume 113

Abstract: ABSTRACT BACKGROUND: Hematopoietic stem cell transplantation (HSCT) recipients requiring intensive care unit (ICU) admission early after transplantation have a poor prognosis. However, many studies have only focused on allogeneic HSCT recipients. ... ...

Abstract	ABSTRACT BACKGROUND: Hematopoietic stem cell transplantation (HSCT) recipients requiring intensive care unit (ICU) admission early after transplantation have a poor prognosis. However, many studies have only focused on allogeneic HSCT recipients. OBJECTIVES: To describe the characteristics of HSCT recipients admitted to the ICU shortly after transplantation and assess differences in 1-year mortality between autologous and allogeneic HSCT recipients. DESIGN AND SETTING: A single-center retrospective cohort study in a cancer center in Brazil. METHODS: We included all consecutive patients who underwent HSCT less than a year before ICU admission between 2009 and 2018. We collected clinical and demographic data and assessed the 1-year mortality of all patients. The effect of allogeneic HSCT compared with autologous HSCT on 1-year mortality risk was evaluated in an unadjusted model and an adjusted Cox proportional hazard model for age and Sequential Organ Failure Assessment (SOFA) at admission. RESULTS: Of the 942 patients who underwent HSCT during the study period, 83 (8.8%) were included in the study (autologous HSCT = 57 [68.7%], allogeneic HSCT = 26 [31.3%]). At 1 year after ICU admission, 21 (36.8%) and 18 (69.2%) patients who underwent autologous and allogeneic HSCT, respectively, had died. Allogeneic HSCT was associated with increased 1-year mortality (unadjusted hazard ratio, HR = 2.79 [confidence interval, CI, 95%, 1.48–5.26]; adjusted HR = 2.62 [CI 95%, 1.29–5.31]). CONCLUSION: Allogeneic HSCT recipients admitted to the ICU had higher short- and long-term mortality rates than autologous HSCT recipients, even after adjusting for age and severity at ICU admission.
Keywords	Critical care ; Hematopoietic stem cell transplantation ; Mortality ; Bone marrow transplantation ; Renal replacement therapy ; Hematological malignancy ; Intensive care ; Mechanical ventilation ; Vasopressors ; Medicine ; R
Subject code	610
Language	English
Publishing date	2022-08-01T00:00:00Z
Publisher	Associação Paulista de Medicina
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Desfecho neurológico após parada cardíaca

Cristina Granja / Antonio Paulo Nassar Junior

Revista brasileira de terapia intensiva , Vol 27, Iss 4, Pp 305-

problemas frios e sombrios

2015 Volume 306

Keywords	Medical emergencies. Critical care. Intensive care. First aid ; RC86-88.9 ; Internal medicine ; RC31-1245 ; Medicine ; R
Language	English
Publishing date	2015-12-01T00:00:00Z
Publisher	Associação de Medicina Intensiva Brasileira
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Mortality and Life-Sustaining Therapy Decisions in Patients With Cancer and Acute Respiratory Failure Due to COVID-19 or Other Causes

Renato Scarsi Testa / Ana Paula Agnolon Praça / Antonio Paulo Nassar Junior / Pauliane Vieira Santana / Valdelis Novis Okamoto / Ramon Teixeira Costa / Pedro Caruso

Frontiers in Medicine, Vol

An Observational Study

2021 Volume 8

Abstract: It is unknown if patients with cancer and acute respiratory failure due to COVID-19 have different clinical or cancer-related characteristics, decisions to forgo life-sustaining therapies (LST), and mortality compared to patients with cancer and acute ... ...

Abstract	It is unknown if patients with cancer and acute respiratory failure due to COVID-19 have different clinical or cancer-related characteristics, decisions to forgo life-sustaining therapies (LST), and mortality compared to patients with cancer and acute respiratory failure due to other causes. In a cohort study, we tested the hypothesis that COVID-19 was associated with increased in-hospital mortality and decreased decisions to forgo LST in patients with cancer and acute respiratory failure. We employed two multivariate logistic regression models. Propensity score matching was employed as sensitivity analysis. We compared 382 patients without COVID-19 with 65 with COVID-19. Patients with COVID-19 had better performance status, less metastatic tumors, and progressive cancer. In-hospital mortality of patients with COVID-19 was lower compared with patients without COVID-19 (46.2 vs. 74.6%; p < 0.01). However, the cause of acute respiratory failure (COVID-19 or other causes) was not associated with increased in-hospital mortality [adjusted odds ratio (OR) 1.27 (0.55–2.93; 95% confidence interval, CI)] in the adjusted model. The percentage of patients with a decision to forgo LST was lower in patients with COVID-19 (15.4 vs. 36.1%; p = 0.01). However, COVID-19 was not associated with decisions to forgo LST [adjusted OR 1.21 (0.44–3.28; 95% CI)] in the adjusted model. The sensitivity analysis confirmed the primary analysis. In conclusion, COVID-19 was not associated with increased in-hospital mortality or decreased decisions to forgo LST in patients with cancer and acute respiratory failure. These patients had better performance status, less progressive cancer, less metastatic tumors, and less organ dysfunctions upon intensive care unit (ICU) admission than patients with acute respiratory failure due to other causes.
Keywords	cancer ; respiratory insufficiency ; COVID-19 ; intensive care unit ; critical care outcomes ; Medicine (General) ; R5-920
Language	English
Publishing date	2021-05-01T00:00:00Z
Publisher	Frontiers Media S.A.
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Excess mortality by specific causes of deaths in the city of São Paulo, Brazil, during the COVID-19 pandemic.

Gisele Aparecida Fernandes / Antonio Paulo Nassar Junior / Gulnar Azevedo E Silva / Diego Feriani / Ivan Leonardo Avelino França E Silva / Pedro Caruso / Maria Paula Curado

PLoS ONE, Vol 16, Iss 6, p e

2021 Volume 0252238

Abstract: Background To investigate the excess of deaths by specific causes, in the first half of 2020 in the city of São Paulo-Brazil, during the COVID-19 pandemic. Methods Ecological study conducted from 01/01 to 06/30 of 2019 and 2020. Population and mortality ... ...

Abstract	Background To investigate the excess of deaths by specific causes, in the first half of 2020 in the city of São Paulo-Brazil, during the COVID-19 pandemic. Methods Ecological study conducted from 01/01 to 06/30 of 2019 and 2020. Population and mortality data were obtained from DATASUS. The standardized mortality ratio (SMR) by age was calculated by comparing the standardized mortality rate in 2020 to that of 2019, for overall and specific mortality. The ratio between the standardized mortality rate due to COVID-19 in men as compared to women was calculated for 2020. Crude mortality rates were standardized using the direct method. Results COVID-19 was responsible for 94.4% of the excess deaths in São Paulo. In 2020 there was an increase in overall mortality observed among both men (SMR 1.3, 95% CI 1.17-1.42) and women (SMR 1.2, 95% CI 1.06-1.36) as well as a towards reduced mortality for all cancers. Mortality due to COVID-19 was twice as high for men as for women (SMR 2.1, 95% CI 1.67-2.59). There was an excess of deaths observed in men above 45 years of age, and in women from the age group of 60 to 79 years. Conclusion There was an increase in overall mortality during the first six months of 2020 in São Paulo, which seems to be related to the COVID-19 pandemic. Chronic health conditions, such as cancer and other non-communicable diseases, should not be disregarded.
Keywords	Medicine ; R ; Science ; Q
Subject code	310
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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Article ; Online: Despertar, exercitar, sentar-se, deambular e extubar

Marcelo Park / Ruy Camargo Pires-Neto / Antonio Paulo Nassar Junior

Revista brasileira de terapia intensiva , Vol 26, Iss 3, Pp 203-

uma mudança nos paradigmas para pacientes mecanicamente ventilados

2014 Volume 204

Keywords	Medical emergencies. Critical care. Intensive care. First aid ; RC86-88.9 ; Internal medicine ; RC31-1245 ; Medicine ; R
Language	English
Publishing date	2014-09-01T00:00:00Z
Publisher	Associação de Medicina Intensiva Brasileira
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Terlipressin versus norepinephrine in the treatment of hepatorenal syndrome

Antonio Paulo Nassar Junior / Alberto Queiroz Farias / Luiz Augusto Carneiro D' Albuquerque / Flair José Carrilho / Luiz Marcelo Sá Malbouisson

PLoS ONE, Vol 9, Iss 9, p e

a systematic review and meta-analysis.

2014 Volume 107466

Abstract: Background Hepatorenal syndrome (HRS) is a severe and progressive functional renal failure occurring in patients with cirrhosis and ascites. Terlipressin is recognized as an effective treatment of HRS, but it is expensive and not widely available. ... ...

Abstract	Background Hepatorenal syndrome (HRS) is a severe and progressive functional renal failure occurring in patients with cirrhosis and ascites. Terlipressin is recognized as an effective treatment of HRS, but it is expensive and not widely available. Norepinephrine could be an effective alternative. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of norepinephrine compared to terlipressin in the management of HRS. Methods We searched the Medline, Embase, Scopus, CENTRAL, Lilacs and Scielo databases for randomized trials of norepinephrine and terlipressin in the treatment of HRS up to January 2014. Two reviewers collected data and assessed the outcomes and risk of bias. The primary outcome was the reversal of HRS. Secondary outcomes were mortality, recurrence of HRS and adverse events. Results Four studies comprising 154 patients were included. All trials were considered to be at overall high risk of bias. There was no difference in the reversal of HRS (RR = 0.97, 95% CI = 0.76 to 1.23), mortality at 30 days (RR = 0.89, 95% CI = 0.68 to 1.17) and recurrence of HRS (RR = 0.72; 95% CI = 0.36 to 1.45) between norepinephrine and terlipressin. Adverse events were less common with norepinephrine (RR = 0.36, 95% CI = 0.15 to 0.83). Conclusions Norepinephrine seems to be an attractive alternative to terlipressin in the treatment of HRS and is associated with less adverse events. However, these findings are based on data extracted from only four small studies.
Keywords	Medicine ; R ; Science ; Q
Subject code	610
Language	English
Publishing date	2014-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Apresentação clínica e evolução de pacientes com infecção por Influenza A (H1N1) que necessitaram de terapia intensiva durante a pandemia de 2009 Influenza A (H1N1) patients admitted to intensive care units during the 2009 pandemics

Antonio Paulo Nassar Junior / Amílcar Oshiro Mocelin / André Luiz Baptiston Nunes / Leonardo Brauer

Revista brasileira de terapia intensiva , Vol 22, Iss 4, Pp 333-

clinical features and outcomes

2010 Volume 338

Abstract: OBJETIVOS: Descrever a apresentação clínica e a evolução dos pacientes admitidos com diagnóstico de infecção por influenza pandêmica (H1N1) em duas unidades de terapia intensiva de hospitais privados de São Paulo. MÉTODOS: Foi realizada coorte ... ...

Abstract	OBJETIVOS: Descrever a apresentação clínica e a evolução dos pacientes admitidos com diagnóstico de infecção por influenza pandêmica (H1N1) em duas unidades de terapia intensiva de hospitais privados de São Paulo. MÉTODOS: Foi realizada coorte retrospectiva com a avaliação de dados demográficos, da apresentação clínica inicial, escores prognósticos [Simplified Acute Physiology Score (SAPS) 3 e Sequential Organ Failure Assessment (SOFA)], comorbidades, de evolução e de tratamento de todos os pacientes que foram admitidos com diagnóstico confirmado de infecção por influenza pandêmico entre Julho e Setembro de 2009. RESULTADOS: Durante o período analisado, foram admitidos 22 pacientes. A mediana de idade foi de 30 (25-43,5) anos. As medianas do SAPS 3 e do SOFA foram, respectivamente de 42 (37-49) e 2 (1-3,5). Comorbidades foram comuns (50%), especialmente a obesidade (22,7%). Duas (9,1%) pacientes eram gestantes. Cinco (22,7%) pacientes foram submetidos à ventilação mecânica, mas houve necessidade de altas pressões expiratórias nestes (mediana de 16cm H2O e intervalos interquartis 10-25cmH2O). A taxa de falha de ventilação não-invasiva foi de 50%. A maior parte (77,2%) dos pacientes foi tratada com oseltamivir. A mortalidade hospitalar foi de 4,5%. SAPS 3, SOFA e relação PaO2/FiO2 iniciais associaram-se com a necessidade de ventilação mecânica (p<0,01). CONCLUSÕES: A infecção por influenza pandêmico acometeu principalmente indivíduos jovens, especialmente obesos. Neste estudo, os pacientes eram menos graves que os descritos anteriormente, o que explica as menores mortalidade e necessidade de ventilação mecânica. No entanto, uma necessidade de altas pressões expiratórias nos pacientes que precisaram de ventilação mecânica. OBJECTIVES: To describe the clinical features and outcomes of patients admitted with influenza A (H1N1) infection in two private hospitals' intensive care units in São Paulo, Brazil, during the 2009 pandemics. METHODS: A retrospective cohort study was conducted to evaluate demographic data, initial clinical presentation, prognostic scores [Simplified Acute Physiology Score (SAPS) 3 and Sequential Organ Failure Assessment (SOFA)], comorbidities, outcomes and treatment of patients with confirmed pandemic influenza diagnosis from July to September 2009. RESULTS: 22 patients were admitted. Median age was 30 (25-43.5) years. Median SAPS 3 and SOFA were 42 (37-49) and 2 (1-3.5), respectively. Comorbidities were common (45.4%), especially obesity (22.7%). Two (9.1%) patients were pregnant. Five (22.7%) patients required invasive mechanical ventilation, with high positive end expiratory pressures (median of 16 cmH2O, interquartile range 10-25cmH2O). There was a 50% incidence of non-invasive ventilation failure. Most (77.2%) of patients were treated with oseltamivir. Hospital mortality was 4.5%. Initial SAPS 3, SOFA and PaO2/FiO2 ratio were associated with mechanical ventilation requirement (p<0.01). CONCLUSIONS: Pandemic influenza infection mainly affected young and obese patients. In this study, patients were less severe than those previously described, what explains our low mortality and mechanical ventilation needs. However, high positive end expiratory pressures were required for mechanically ventilated patients.
Keywords	Vírus da influenza A subtipo H1N1 ; Surtos de doenças ; Unidades de terapia intensiva ; Respiração artificial ; Influenza A virus ; H1N1 subtype ; Diseases outbreaks ; Intensive care units ; Respiration ; artificial ; Medical emergencies. Critical care. Intensive care. First aid ; RC86-88.9 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Internal medicine ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
Language	English
Publishing date	2010-12-01T00:00:00Z
Publisher	Associação de Medicina Intensiva Brasileira
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Evaluation of the characteristics of infection prevention and control programs and infection control committees in Brazilian hospitals

Beatriz Arns / Crepin Aziz Jose Oluwafoumi Agani / Guilhermo Prates Sesin / Jaqueline Driemeyer C. Horvath / Débora Vacaro Fogazzi / Fernanda Kelly Romeiro Silva / Lauren Sezera Costa / Adriano Jose Pereira / Antônio Paulo Nassar Junior / Bruno Tomazini / Camila Dietrich / Viviane Cordeiro Veiga / Daniela G.M. Catarino / Maysa Yukari Cheno / Alexandre Biasi Cavalcanti / Bianca Ramos Ferronatto / Bil Randerson Bassetti / Caio Cesar Ferreira Fernandes / Caroline Deutschendorf /

Cintia Magalhães Carvalho Grion / Claudia Fernanda de Lacerda Vidal / Cláudio Dornas de Oliveira / Eliana Bernadete Caser / Emerson Boschi / Everton Macêdo Silva / Felipe Dal Pizzol / Hugo Correa de Andrade Urbano / Iany Silva / Israel Silva Maia / Leila Rezegue de Moraes Rego / Luana Pontes Oliveira / Maria Brandão Tavares / Marianna Deway Andrade Dracoulakis / Marina Peres Bainy / Nicole Alberti Golin / Pablo Oscar Tomba / Pedro Martins Pereira Kurtz / Rafael Botelho Foernges / Rejane Martins Prestes / Rodrigo Morel Vieira de Melo / Rodrigo Reghini Da Silva / Tatiana Gozzi Pancev Toledo / Valéria Paes Lima / Vanildes de Fátima Fernandes / Wilson José Lovato / Alexandre Prehn Zavascki

Antimicrobial Stewardship & Healthcare Epidemiology, Vol

A countrywide cross-sectional study – CORRIGENDUM

2023 Volume 3

Keywords	Infectious and parasitic diseases ; RC109-216 ; Public aspects of medicine ; RA1-1270
Language	English
Publishing date	2023-01-01T00:00:00Z
Publisher	Cambridge University Press
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Article ; Online: Elderly patients with cancer admitted to intensive care unit

Antonio Paulo Nassar Junior / Mariane da Silva Trevisani / Barbara Beltrame Bettim / Fernando Godinho Zampieri / José Albani Carvalho / Amilton Silva / Flávio Geraldo Rezende de Freitas / Jorge Eduardo da Silva Soares Pinto / Edson Romano / Silvia Regina Ramos / Guilherme Brenande Alves Faria / Ulysses V Andrade E Silva / Robson Correa Santos / Edmundo de Oliveira Tommasi / Ana Paula Pierre de Moraes / Bruno Azevedo da Cruz / Fernando Augusto Bozza / Pedro Caruso / Jorge Ibrahin Figueira Salluh /

Marcio Soares

PLoS ONE, Vol 15, Iss 8, p e

A multicenter study in a middle-income country.

2020 Volume 0238124

Abstract: Background Very elderly critically ill patients (ie, those older than 75 or 80 years) are an increasing population in intensive care units. However, patients with cancer have encompassed only a minority in epidemiological studies of very old critically- ... ...

Abstract	Background Very elderly critically ill patients (ie, those older than 75 or 80 years) are an increasing population in intensive care units. However, patients with cancer have encompassed only a minority in epidemiological studies of very old critically-ill patients. We aimed to describe clinical characteristics and identify factors associated with hospital mortality in a cohort of patients aged 80 or older with cancer admitted to intensive care units (ICUs). Methods This was a retrospective cohort study in 94 ICUs in Brazil. We included patients aged 80 years or older with active cancer who had an unplanned admission. We performed a mixed effect logistic regression model to identify variables independently associated with hospital mortality. Results Of 4604 included patients, 1807 (39.2%) died in hospital. Solid metastatic (OR = 2.46; CI 95%, 2.01-3.00), hematological cancer (OR = 2.32; CI 95%, 1.75-3.09), moderate/severe performance status impairment (OR = 1.59; CI 95%, 1.33-1.90) and use of vasopressors (OR = 4.74; CI 95%, 3.88-5.79), mechanical ventilation (OR = 1.54; CI 95%, 1.25-1.89) and renal replacement (OR = 1.81; CI 95%, 1.29-2.55) therapy were independently associated with increased hospital mortality. Emergency surgical admissions were associated with lower mortality compared to medical admissions (OR = 0.71; CI 95%, 0.52-0.96). Conclusions Hospital mortality rate in very elderly critically ill patients with cancer with unplanned ICU admissions are lower than expected a priori. Cancer characteristics, performance status impairment and acute organ dysfunctions are associated with increased mortality.
Keywords	Medicine ; R ; Science ; Q
Language	English
Publishing date	2020-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Questões éticas na esclerose múltipla sob o ponto de vista de médicos e pacientes Ethical issues in multiple sclerosis under physicians and patients point of view

Antonio Paulo Nassar Junior / Daniela Soriano Pignataro / Melissa Martins Fuzaro / Charles Peter Tilbery

Arquivos de Neuro-Psiquiatria, Vol 63, Iss 1, Pp 133-

2005 Volume 139

Abstract: A esclerose múltipla (EM) é afecção neurológica que acomete principalmente adultos jovens e evolui, geralmente, para graus variados de incapacidade física dos pacientes. Assim, a abordagem destes pacientes faz com que o médico depare-se com diversas ... ...

Abstract	A esclerose múltipla (EM) é afecção neurológica que acomete principalmente adultos jovens e evolui, geralmente, para graus variados de incapacidade física dos pacientes. Assim, a abordagem destes pacientes faz com que o médico depare-se com diversas questões éticas. OBJETIVO: Identificar as percepções de médicos e pacientes sobre a doença e, com isso, melhorar o relacionamento médico-paciente. MÉTODO: Foram feitos dois questionários, um respondido por 44 médicos e outro, por 103 pacientes, abordando questões sobre o diagnóstico e a conduta na EM. RESULTADOS: 96,1% dos pacientes sabiam seu diagnóstico, os outros gostariam de sabê-lo. Daqueles, 74,7% achavam que a forma contada foi correta e 90,9% que o médico é que deve contá-lo. Os sintomas que mais os incomodam são a fadiga (29,1%) e os déficits motores (28,1%). Por outro lado, 68% dos pacientes afirmaram sofrer com a doença. O motivo mais importante para os médicos contarem o diagnóstico foi para melhorar a adesão ao tratamento (56,8%). A presença de um familiar neste momento é exigida por 54,6% dos médicos. Quando perguntados sobre as orientações de uma gravidez, 50% dos médicos não responderam adequadamente. Finalmente, 50% dos médicos manifestaram-se de forma contrária às terapias complementares. CONCLUSÃO: Os pacientes querem saber seu diagnóstico e o médico deve contá-lo da forma mais adequada e dar mais informações. Um debate sobre cuidados paliativos também faz-se necessário. Multiple sclerosis (MS) is a neurologic disorder that mostly affects young adults and can usually evolute to physical disability. Thus, caring patients with MS brings many ethic questions for the physician. OBJECTIVE: To identify physicians and patients' perceptions about the illness and so improve doctor-patient relationship. METHOD: It was made two different questionnaires, one for patients and another for physicians, 103 patients and 44 physicians answered them. RESULTS: 96.1% of patients knew their diagnosis, all others would like to know it. From those, 74.7% thought that that way it was disclosured was correct and 90.9% said that the doctor should tell us it. The worst symptoms described were fatigue (29.1%) and motor deficits (28.1%). By other side, 68% of patients told they suffered because of the illness. The most important reason for doctors to tell the diagnosis to the patients was to improve adherence to treatment (56.8%). A familiar present at this moment was demanded for 54.6% of doctors. When asked about orientations in a pregnancy, 50% of physicians did not answer correctly. Finally, 50% of physicians were against complementary and alternative therapies. CONCLUSION: Patients want to know their diagnosis and doctors should tell them in the most adequate moment and give more information. A debate about palliative care is also necessary.
Keywords	esclerose múltipla ; ética ; relacionamento médico-paciente ; multiple sclerosis ; ethics ; doctor-patient relationship ; Neurosciences. Biological psychiatry. Neuropsychiatry ; RC321-571 ; Internal medicine ; RC31-1245 ; Medicine ; R ; DOAJ:Neurology ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
Subject code	170
Language	English
Publishing date	2005-03-01T00:00:00Z
Publisher	Academia Brasileira de Neurologia - ABNEURO
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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