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  1. Article ; Online: Vitamin D

    Arnaldo Lichtenstein

    Revista da Associação Médica Brasileira, Vol 61, Iss 4, Pp 291-

    enough already?

    2015  Volume 292

    Keywords Medicine (General) ; R5-920
    Language English
    Publishing date 2015-08-01T00:00:00Z
    Publisher Associação Médica Brasileira
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: Risk of osteoporotic fracture in women using the FRAX tool with and without bone mineral density score in patients followed at a tertiary outpatient clinic ‒ An observational study

    Maria Helena Sampaio Favarato / Maria Flora de Almeida / Arnaldo Lichtenstein / Milton de Arruda Martins / Mario Ferreira Junior

    Clinics, Vol

    2022  Volume 77

    Abstract: ABSTRACT Objectives: Fragility fractures increase morbidity and mortality. Adding assessment of clinical risk factors independently or as a previous step to Bone Densitometry (BD) should provide better accuracy in fracture risk prediction. FRAX tool ... ...

    Abstract ABSTRACT Objectives: Fragility fractures increase morbidity and mortality. Adding assessment of clinical risk factors independently or as a previous step to Bone Densitometry (BD) should provide better accuracy in fracture risk prediction. FRAX tool might be used to stratify patients in order to rationalize the need for BD and risk classification. The primary objective of this study is to describe and perform comparisons between the estimated risk of fractures in 10 years using the FRAX calculator based on clinical factors with and without BD results for women aged 40 or more with clinical diseases monitored in tertiary care service in internal medicine. Methods: Cross-sectional. Women over 40 years with BD in the previous year. After medical chart review, identification of risk factors and risk estimations using FRAX-BRAZIL with (FRAX BDI) and without (FRAX BDNI) the inclusion of T-score. Results: 239 women. Age 65 ± 10.35 years. BMI 29.68 ± 6.27kg/m2. Risk factors: 32(13.4%) previous fractures; 23 (9.6%) current smoking; 78 (32.6%) corticosteroids use; 44 (18.4%) rheumatoid arthritis; 38 (15.9%) secondary causes; FRAX scores were higher when BD was not included. Spearman correlation coefficients between FRAX BDNI and FRAX BDI for major fractures r = 0.793 (95% CI 0.7388‒0.836). For hip fractures r = 0.6922 (95% CI 0.6174‒0.75446) Conclusion: Using FRAX to estimate 10-year fracture risk without BD data might be a reliable tool for screening, even for patients with a high prevalence of risk factors, improving accessibility and equity in health systems. The present study’s data suggest an overestimation of fracture risk with FRAX BDNI, suggesting that it is safe to be widely used as a screening tool.
    Keywords Osteoporosis ; Screening ; Multimorbidity ; Medicine (General) ; R5-920
    Subject code 610
    Language English
    Publishing date 2022-04-01T00:00:00Z
    Publisher Elsevier España
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: Kidney injury and other complications related to colonoscopy in inpatients at a tertiary teaching hospital

    Ligia Fidelis Ivanovic / Bruno C. Silva / Arnaldo Lichtenstein / Edison Ferreira de Paiva / Maria Lucia Bueno-Garcia

    Clinics, Vol 73, Iss

    2018  

    Abstract: OBJECTIVES: To describe clinical complications related to colonoscopy in inpatients with multiple diseases. Among the known complications, acute kidney injury was the primary focus. METHODS: This was an observational retrospective study of 97 inpatients. ...

    Abstract OBJECTIVES: To describe clinical complications related to colonoscopy in inpatients with multiple diseases. Among the known complications, acute kidney injury was the primary focus. METHODS: This was an observational retrospective study of 97 inpatients. Data relating to age; gender; comorbidities; current medication; blood tests (renal function, blood glucose and LDL cholesterol levels); length of hospital stay; indication, results, and complications of colonoscopies; and time to the development of kidney injury were collected between June 2011 to February 2012. RESULTS: A total of 108 colonoscopies (9 screening and 88 diagnostic) were conducted in 97 patients. Renal injury occurred in 41.2% of the patients. The univariate analysis revealed that kidney injury was related to the use of diuretics, statins, calcium channel blockers, and angiotensin converting enzyme inhibitor; however, the multivariate analysis showed that only the use of diuretics was associated with kidney injury. The occurrence of kidney injury and the time to its development were independent of the previous glomerular filtration rate as calculated with the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. CONCLUSIONS: The use of diuretics was the only independent variable associated with the development of kidney injury in inpatients with multiple comorbidities who underwent colonoscopy. The occurrence of kidney injury and the time to its development were independent of previous CKD-EPI-based assessments of renal function. These results highlight the increased risk of colonoscopy in such patients, and its indication should be balanced strictly and perhaps avoided as a screening test.
    Keywords Colonoscopy ; Kidney Injury ; Complications ; Medicine (General) ; R5-920
    Subject code 616
    Language English
    Publishing date 2018-10-01T00:00:00Z
    Publisher Elsevier España
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. 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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  5. Article ; Online: Vitamina D

    Arnaldo Lichtenstein / Mario Ferreira-Júnior / Maria Mirtes Sales / Francisco Bueno de Aguiar / Luiz Augusto M. Fonseca / Nairo M. Sumita / Alberto J.S. Duarte

    Revista da Associação Médica Brasileira, Vol 59, Iss 5, Pp 495-

    ações extraósseas e uso racional

    2013  Volume 506

    Abstract: O número de dosagens do nível sérico de vitamina D tem apresentado crescimento muito expressivo nos últimos anos em todo o mundo. No Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo houve aumento de cerca de 700% em quatro anos ...

    Abstract O número de dosagens do nível sérico de vitamina D tem apresentado crescimento muito expressivo nos últimos anos em todo o mundo. No Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo houve aumento de cerca de 700% em quatro anos nas solicitações desse hormônio. No entanto, há controvérsias na literatura sobre a real utilidade de sua dosagem e/ou suplementação, exceto em situações diretamente relacionadas ao metabolismo ósseo. No presente trabalho são revistos o metabolismo, as fontes e as ações da vitamina D no organismo. Estudos observacionais, ensaios clínicos, revisões sistemáticas e metanálises, cujo foco é a relação entre vitamina D e doenças ou condições clínicas, como câncer, doenças cardiovasculares, diabetes e quedas, foram pesquisados na literatura, analisados e discutidos. Os resultados estão apresentados em forma de perguntas e respostas, tabelas e figura. Discute-se o papel da vitamina D em todas essas situações, e salientam-se os pontos controvertidos.
    Keywords Vitamina D ; Doenças cardiovasculares ; Câncer ; Diabetes ; Quedas ; Revisão ; Medicine (General) ; R5-920
    Language English
    Publishing date 2013-10-01T00:00:00Z
    Publisher Associação Médica Brasileira
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  6. Article ; Online: Proteína C reativa

    Francisco J.B. Aguiar / Mario Ferreira-Júnior / Maria M. Sales / Luiz M. Cruz-Neto / Luiz A.M. Fonseca / Nairo M. Sumita / Nilo J.C. Duarte / Arnaldo Lichtenstein / Alberto J.S. Duarte

    Revista da Associação Médica Brasileira, Vol 59, Iss 1, Pp 85-

    aplicações clínicas e propostas para utilização racional C-reactive protein: clinical applications and proposals for a rational use

    2013  Volume 92

    Abstract: A proteína C reativa (PCR) é uma das proteínas de fase aguda cuja solicitação tem crescido de forma exponencial em vários países, incluindo o Brasil. Neste estudo, a utilidade da PCR em diversas situações clínicas foi revisada por um grupo de médicos ... ...

    Abstract A proteína C reativa (PCR) é uma das proteínas de fase aguda cuja solicitação tem crescido de forma exponencial em vários países, incluindo o Brasil. Neste estudo, a utilidade da PCR em diversas situações clínicas foi revisada por um grupo de médicos composto por especialistas em Medicina Interna, Emergências Médicas, Terapia Intensiva, Rastreamento e Medicina Laboratorial com o objetivo de analisar a literatura pertinente e propor diretrizes para o uso mais racional desse exame laboratorial. O resultado foi a criação de fluxogramas orientadores da solicitação de PCR adaptados a quatro ambientes assistenciais diferentes, sendo eles unidades de terapia intensiva, pronto-socorro, enfermarias e ambulatórios. Esses fluxogramas e uma discussão mais detalhada sobre as diversas indicações clínicas do exame são apresentados neste estudo. C-reactive protein (CRP) is an acute-phase protein whose requests have been growing exponentially in several countries, including Brazil. In this study, the use of CRP in several clinical situations was reviewed by a group of physicians comprised by specialists in internal medicine, medical emergencies, intensive care, screening, and laboratory medicine, aiming to analyze the applicable literature and to propose guidelines for a more rational use of this laboratory test. The result was the creation of flowcharts guiding CRP request, adjusted to four different healthcare environments, namely, intensive care units, emergency room, wards, and outpatient clinics. These flowcharts, as well as a more detailed discussion on several clinical recommendations for the test, are presented in this study.
    Keywords Proteína C reativa ; Exames laboratoriais ; Uso clínico ; CRP ; C-reactive protein ; Laboratory tests ; Clinical use ; Medicine (General) ; R5-920
    Language English
    Publishing date 2013-02-01T00:00:00Z
    Publisher Associação Médica Brasileira
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  7. Article ; Online: Fatal pulmonary embolism in hospitalized patients

    Solange Aparecida Petilo Carvalho Bricola / Edison Ferreira Paiva / Arnaldo Lichtenstein / Reinaldo José Gianini / Jurandir Godoy Duarte / Samuel Katsuyuki Shinjo / Jose Eluf-Neto / Milton Arruda Martins

    Clinics, Vol 68, Iss 5, Pp 679-

    a large autopsy-based matched case-control study

    2013  Volume 685

    Abstract: OBJECTIVE: Pulmonary embolism is an underdiagnosed major cause of death for hospitalized patients. The objective of this study was to identify the conditions associated with fatal pulmonary embolism in this population. METHODS: A total of 13,074 autopsy ... ...

    Abstract OBJECTIVE: Pulmonary embolism is an underdiagnosed major cause of death for hospitalized patients. The objective of this study was to identify the conditions associated with fatal pulmonary embolism in this population. METHODS: A total of 13,074 autopsy records were evaluated in a case-control study. Patients were matched by age, sex, and year of death, and factors potentially associated with fatal pulmonary embolism were analyzed using univariate and multivariate conditional logistic regression. RESULTS: Pulmonary embolism was considered fatal in 328 (2.5%) patients. In the multivariate analysis, conditions that were more common in patients who died of pulmonary embolism were atherosclerosis, congestive heart failure, and neurological surgery. Some conditions were negatively associated with fatal pulmonary embolism, including hemorrhagic stroke, aortic aneurism, cirrhosis, acquired immune deficiency syndrome, and pneumonia. In the control group, patients with hemorrhagic stroke and aortic aneurism had short hospital stays (8.5 and 8.8 days, respectively), and the hemorrhage itself was the main cause of death in most of them (90.6% and 68.4%, respectively), which may have prevented the development of pulmonary embolism. Cirrhotic patients in the control group also had short hospital stays (7 days), and 50% died from bleeding complications. CONCLUSIONS: In this large autopsy study, atherosclerosis, congestive heart failure, and neurological surgery were diagnoses associated with fatal pulmonary embolism.
    Keywords Atherosclerosis ; Heart Failure ; Neurosurgery ; Pulmonary Embolism ; Venous Thromboembolism ; Medicine (General) ; R5-920
    Subject code 610 ; 616
    Language English
    Publishing date 2013-05-01T00:00:00Z
    Publisher Elsevier España
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  8. Article ; Online: Venous thromboembolism risk assessment in hospitalised patients

    Carolina Alves Vono Alckmin / Mariana Dionisia Garcia / Solange Aparecida Petilo de Carvalho Bricola / Milton de Arruda Martins / Arnaldo Lichtenstein / Edison Ferreira de Paiva

    Clinics, Vol 68, Iss 11, Pp 1416-

    A new proposal

    2013  Volume 1420

    Abstract: OBJECTIVE: Cross-sectional studies have been conducted to evaluate the adequacy of prophylaxis for venous thromboembolism. However, these studies often evaluate prophylaxis on the data collection day, without analysing the prophylactic dose or duration ... ...

    Abstract OBJECTIVE: Cross-sectional studies have been conducted to evaluate the adequacy of prophylaxis for venous thromboembolism. However, these studies often evaluate prophylaxis on the data collection day, without analysing the prophylactic dose or duration and without reference to inappropriate use in patients without risk. A prospective, observational study was performed to assess the adequacy of prophylaxis in a general medicine ward of a university hospital. METHOD: In the analysis, the use of the proper prophylactic dose at the correct time, the use in patients with contraindications, and the misuse in patients without risk of venous thromboembolism were considered. RESULTS: A total of 245 patients were evaluated. Of these patients, 104 (42.4%) were considered to be at risk, and 82.7% either received adequate prophylaxis (i.e., the correct dose at the right time) or did not receive prophylaxis because it was contraindicated. Among the 141 patients who were not at risk, 81 (57.4%) incorrectly received prophylaxis, the majority (61/81) of whom presented with risk factors but did not demonstrate reduced mobility. Among the entire group, only 59.6% of patients were properly treated. CONCLUSIONS: The evaluation of prophylaxis adequacy should consider not only whether the correct dose is administered at the correct time but also whether it is used in patients with contraindications and whether it is inappropriately administered to patients who are not at risk.
    Keywords Deep Vein Thrombosis ; Guidelines ; Inpatients ; Pulmonary Embolism ; Prophylaxis ; Medicine (General) ; R5-920
    Subject code 610
    Language English
    Publishing date 2013-11-01T00:00:00Z
    Publisher Elsevier España
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  9. 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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  10. Article ; Online: Rational use of blood calcium determinations

    Mario Ferreira-Junior / Arnaldo Lichtenstein / Maria Mirtes Sales / Leandro Utino Taniguchi / Francisco José Bueno de Aguiar / Luiz Augusto Marcondes Fonseca / Nairo Massakazu Sumita / Alberto José da Silva Duarte

    São Paulo Medical Journal, Vol 132, Iss 4, Pp 243-248

    Abstract: CONTEXT AND OBJECTIVE:This study was motivated by the recent excessive increase in requests for blood calcium determinations and laboratory tests in general, in the Hospital das Clínicas complex of Faculdade de Medicina, Universidade de São Paulo ( ... ...

    Abstract CONTEXT AND OBJECTIVE:This study was motivated by the recent excessive increase in requests for blood calcium determinations and laboratory tests in general, in the Hospital das Clínicas complex of Faculdade de Medicina, Universidade de São Paulo (HCFMUSP). Its aim was to suggest rules for the determination of total and ionized calcium in our intensive care units, emergency department, wards and outpatient services, thus contributing towards improving the quality of medical care and achieving more appropriate use of human and financial resources.DESIGN AND SETTING:Critical analysis on clinical and laboratory data and the pertinent scientific literature, conducted by the study group for rational clinical laboratory use, which is part of the Central Laboratory Division, HCFMUSP.METHODS:The study group reviewed scientific publications, statistics and clinical and laboratory data concerning requests for total and ionized calcium determinations in the settings of intensive care units, emergency department, wards and outpatient services.RESULTS:From this critical analysis, clinical decision flow diagrams aimed at providing guidance for ordering these tests were constructed.CONCLUSIONS:Use of the proposed flow diagrams may help to limit the numbers of inappropriate requests for ionized and total calcium determinations, with consequent reductions in the number of tests, risks to patients and unnecessary costs.
    Keywords Clinical laboratory techniques ; Blood chemical analysis ; Calcium ; Practice management ; medical ; Decision making ; Medicine ; R
    Language English
    Publisher Associação Paulista de Medicina
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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