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Article ; Online: Eltrombopag for Adults and Children with Immune-Refractory Thrombocytopenic Purpura

Danielle Francisco Honorato de Barros Torelli / Crystian Bitencourt Soares Oliveira / Gisele Alborghetti Nai / Evelinda Marramon Trindade / Luiz Euribel Prestes-Carneiro

Journal of Clinical Medicine, Vol 12, Iss 3872, p

A Systematic Review

2023 Volume 3872

Abstract: Eltrombopag is an agonist that binds to the membrane-bound domain of the thrombopoietin receptor used in immune thrombocytopenic purpura (ITP). We conducted a meta-analysis of randomized controlled trials to assess the efficacy and safety of eltrombopag ... ...

Abstract	Eltrombopag is an agonist that binds to the membrane-bound domain of the thrombopoietin receptor used in immune thrombocytopenic purpura (ITP). We conducted a meta-analysis of randomized controlled trials to assess the efficacy and safety of eltrombopag in adults and children with refractory ITP. Adults who received eltrombopag had a significantly better platelet response (relative risk [RR], 3.65; 95% confidence interval [CI], 2.39–5.55), but there were no differences in the incidence of bleeding (RR, 0.8; 95% CI, 0.52–1.22) and adverse effects (RR, 0.99; 95% CI, 0.55–1.78) compared with the placebo. In children, there was no difference between eltrombopag and placebo for a platelet response >50,000/mm 3 (RR, 3.93; 95% CI, 0.56–27.79) and the number of adverse events (RR, 0.99; 95% CI, 0.25–1.49); however, a lower incidence of bleeding was observed (RR, 0.47; 95% CI, 0.27–0.83). Treatment with eltrombopag protected adults and children from severe disease and death.
Keywords	immune thrombocytopenic purpura ; erythropoietin receptors ; systematic review ; blood coagulation ; hematologic drugs ; Medicine ; R
Subject code	610
Language	English
Publishing date	2023-06-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Evidences in the treatment of idiopathic normal pressure hydrocephalus

Matheus Fernandes de Oliveira / Rodolfo Casimiro Reis / Evelinda Marramon Trindade / Fernando Campos Gomes Pinto

Revista da Associação Médica Brasileira, Vol 61, Iss 3, Pp 258-

2015 Volume 262

Abstract: Summary Introduction: idiopathic normal pressure hydrocephalus (INPH) is characterized by gait apraxia, cognitive dysfunction and urinary incontinence. There are two main treatment options: ventriculoperitoneal shunt (VPS) and endoscopic third ... ...

Abstract	Summary Introduction: idiopathic normal pressure hydrocephalus (INPH) is characterized by gait apraxia, cognitive dysfunction and urinary incontinence. There are two main treatment options: ventriculoperitoneal shunt (VPS) and endoscopic third ventriculostomy (ETV). However, there are doubts about which modality is superior and what type of valve should be applied. We are summarizing the current evidence in INPH treatment. Methods: an electronic search of the literature was conducted on the Medline, Embase, Scielo and Lilacs databases from 1966 to the present to obtain data published about INPH treatment. Results: the treatment is based on three pillars: conservative, ETV and VPS. The conservative option has fallen into disuse after various studies showing good results after surgical intervention. ETV is an acceptable mode of treatment, but the superiority of VPS has made the latter the gold standard. Conclusion: well-designed studies with a high level of appropriate evidence are still scarce, but the current gold standard for treatment of INPH is conducted using VPS.
Keywords	hidrocefalia de pressão normal ; tratamento avançado ; neuroendoscopia ; derivação ventriculoperitoneal ; Medicine (General) ; R5-920
Language	English
Publishing date	2015-06-01T00:00:00Z
Publisher	Associação Médica Brasileira
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: QUALITY OF LIFE IN PATIENTS WITH ROTATOR CUFF ARTHROPATHY

ARNALDO AMADO FERREIRA NETO / EDUARDO ANGELI MALAVOLTA / JORGE HENRIQUE ASSUNÇÃO / MAURO EMILIO CONFORTO GRACITELLI / GUILHERME PEREIRA OCAMPOS / EVELINDA MARRAMON TRINDADE

Acta Ortopédica Brasileira, Vol 25, Iss 6, Pp 275-

2017 Volume 278

Abstract: ABSTRACT Objective: To compare quality of life (according to the SF-12) in patients with rotator cuff arthropathy with controls paired by sex and age. Secondary objectives are to compare the groups according to the ASES and VAS scales. Methods: This ... ...

Abstract	ABSTRACT Objective: To compare quality of life (according to the SF-12) in patients with rotator cuff arthropathy with controls paired by sex and age. Secondary objectives are to compare the groups according to the ASES and VAS scales. Methods: This cross-sectional study with controls paired by sex and age compared patients with rotator cuff arthropathy with surgical indication for reverse shoulder arthroplasty. The groups were compared according to the SF-12, ASES, and VAS scales. Results: The groups consisted of 38 individuals, 28 women. The SF-12 demonstrated a significant difference in the physical component, with the cases scoring 31.61 ± 6.15 and the controls 49.39 ± 6.37 (p<0.001). For the mental component, the difference was not significant, with the cases scoring 44.82 ± 13.18 and the controls 48.96 ± 8.65 (p=0.109). The cases scored 7.34 ± 2.11 on the VAS and 31.26 ± 15.12 on the ASES, while the controls scored 0.55 ± 1.31 and 97.53 ± 6.22, respectively (p<0.001). Conclusion: Patients with rotator cuff arthropathy had poorer results for the physical component of the SF-12 than the controls. They also had poorer functional results according to the ASES scale, and more pain according to the VAS. Level of Evidence III, Case Control Study.
Keywords	Arthroplasty ; replacement. Joint diseases. Osteoarthritis. Rotator cuff. Quality of life ; Medicine ; R ; Orthopedic surgery ; RD701-811
Subject code	616
Language	English
Publishing date	2017-12-01T00:00:00Z
Publisher	Sociedade Brasileira de Ortopedia e Traumatologia
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Improving preoperative risk-of-death prediction in surgery congenital heart defects using artificial intelligence model

João Chang Junior / Fábio Binuesa / Luiz Fernando Caneo / Aida Luiza Ribeiro Turquetto / Elisandra Cristina Trevisan Calvo Arita / Aline Cristina Barbosa / Alfredo Manoel da Silva Fernandes / Evelinda Marramon Trindade / Fábio Biscegli Jatene / Paul-Eric Dossou / Marcelo Biscegli Jatene

PLoS ONE, Vol 15, Iss 9, p e

A pilot study.

2020 Volume 0238199

Abstract: Background Congenital heart disease accounts for almost a third of all major congenital anomalies. Congenital heart defects have a significant impact on morbidity, mortality and health costs for children and adults. Research regarding the risk of pre- ... ...

Abstract	Background Congenital heart disease accounts for almost a third of all major congenital anomalies. Congenital heart defects have a significant impact on morbidity, mortality and health costs for children and adults. Research regarding the risk of pre-surgical mortality is scarce. Objectives Our goal is to generate a predictive model calculator adapted to the regional reality focused on individual mortality prediction among patients with congenital heart disease undergoing cardiac surgery. Methods Two thousand two hundred forty CHD consecutive patients' data from InCor's heart surgery program was used to develop and validate the preoperative risk-of-death prediction model of congenital patients undergoing heart surgery. There were six artificial intelligence models most cited in medical references used in this study: Multilayer Perceptron (MLP), Random Forest (RF), Extra Trees (ET), Stochastic Gradient Boosting (SGB), Ada Boost Classification (ABC) and Bag Decision Trees (BDT). Results The top performing areas under the curve were achieved using Random Forest (0.902). Most influential predictors included previous admission to ICU, diagnostic group, patient's height, hypoplastic left heart syndrome, body mass, arterial oxygen saturation, and pulmonary atresia. These combined predictor variables represent 67.8% of importance for the risk of mortality in the Random Forest algorithm. Conclusions The representativeness of "hospital death" is greater in patients up to 66 cm in height and body mass index below 13.0 for InCor's patients. The proportion of "hospital death" declines with the increased arterial oxygen saturation index. Patients with prior hospitalization before surgery had higher "hospital death" rates than who did not required such intervention. The diagnoses groups having the higher fatal outcomes probability are aligned with the international literature. A web application is presented where researchers and providers can calculate predicted mortality based on the CgntSCORE on any web browser or smartphone.
Keywords	Medicine ; R ; Science ; Q
Subject code	610
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: Cardiac Surgery Costs According to the Preoperative Risk in the Brazilian Public Health System

David Provenzale Titinger / Luiz Augusto Ferreira Lisboa / Bruna La Regina Matrangolo / Luis Roberto Palma Dallan / Luis Alberto Oliveira Dallan / Evelinda Marramon Trindade / Ivone Eckl / Roberto Kalil Filho / Omar Asdrúbal Vilca Mejía / Fabio Biscegli Jatene

Arquivos Brasileiros de Cardiologia, Iss 0, Pp 00-

2015 Volume 00

Abstract: Abstract Background: Heart surgery has developed with increasing patient complexity. Objective: To assess the use of resources and real costs stratified by risk factors of patients submitted to surgical cardiac procedures and to compare them with the ... ...

Abstract	Abstract Background: Heart surgery has developed with increasing patient complexity. Objective: To assess the use of resources and real costs stratified by risk factors of patients submitted to surgical cardiac procedures and to compare them with the values reimbursed by the Brazilian Unified Health System (SUS). Method: All cardiac surgery procedures performed between January and July 2013 in a tertiary referral center were analyzed. Demographic and clinical data allowed the calculation of the value reimbursed by the Brazilian SUS. Patients were stratified as low, intermediate and high-risk categories according to the EuroSCORE. Clinical outcomes, use of resources and costs (real costs versus SUS) were compared between established risk groups. Results: Postoperative mortality rates of low, intermediate and high-risk EuroSCORE risk strata showed a significant linear positive correlation (EuroSCORE: 3.8%, 10%, and 25%; p < 0.0001), as well as occurrence of any postoperative complication EuroSCORE: 13.7%, 20.7%, and 30.8%, respectively; p = 0.006). Accordingly, length-of-stay increased from 20.9 days to 24.8 and 29.2 days (p < 0.001). The real cost was parallel to increased resource use according to EuroSCORE risk strata (R$ 27.116,00 ± R$ 13.928,00 versus R$ 34.854,00 ± R$ 27.814,00 versus R$ 43.234,00 ± R$ 26.009,00, respectively; p < 0.001). SUS reimbursement also increased (R$ 14.306,00 ± R$ 4.571,00 versus R$ 16.217,00 ± R$ 7.298,00 versus R$ 19.548,00 ± R$935,00; p < 0.001). However, as the EuroSCORE increased, there was significant difference (p < 0.0001) between the real cost increasing slope and the SUS reimbursement elevation per EuroSCORE risk strata. Conclusion: Higher EuroSCORE was related to higher postoperative mortality, complications, length of stay, and costs. Although SUS reimbursement increased according to risk, it was not proportional to real costs.
Keywords	Procedimentos Cirúrgicos Cardíacos / economia ; Custos Hospitalares ; Sistema Único de Saúde (SUS) ; Grupos de Risco ; Cuidados Pré-Operatórios ; Mortalidade Hospitalar ; Morbidade ; Diseases of the circulatory (Cardiovascular) system ; RC666-701 ; Specialties of internal medicine ; RC581-951 ; Internal medicine ; RC31-1245 ; Medicine ; R
Subject code	610
Language	English
Publishing date	2015-01-01T00:00:00Z
Publisher	Sociedade Brasileira de Cardiologia - SBC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Cardiac Surgery Costs According to the Preoperative Risk in the Brazilian Public Health System

Arquivos Brasileiros de Cardiologia, Iss 0, Pp 00-

2015 Volume 00

Abstract	Abstract Background: Heart surgery has developed with increasing patient complexity. Objective: To assess the use of resources and real costs stratified by risk factors of patients submitted to surgical cardiac procedures and to compare them with the values reimbursed by the Brazilian Unified Health System (SUS). Method: All cardiac surgery procedures performed between January and July 2013 in a tertiary referral center were analyzed. Demographic and clinical data allowed the calculation of the value reimbursed by the Brazilian SUS. Patients were stratified as low, intermediate and high-risk categories according to the EuroSCORE. Clinical outcomes, use of resources and costs (real costs versus SUS) were compared between established risk groups. Results: Postoperative mortality rates of low, intermediate and high-risk EuroSCORE risk strata showed a significant linear positive correlation (EuroSCORE: 3.8%, 10%, and 25%; p < 0.0001), as well as occurrence of any postoperative complication EuroSCORE: 13.7%, 20.7%, and 30.8%, respectively; p = 0.006). Accordingly, length-of-stay increased from 20.9 days to 24.8 and 29.2 days (p < 0.001). The real cost was parallel to increased resource use according to EuroSCORE risk strata (R$ 27.116,00 ± R$ 13.928,00 versus R$ 34.854,00 ± R$ 27.814,00 versus R$ 43.234,00 ± R$ 26.009,00, respectively; p < 0.001). SUS reimbursement also increased (R$ 14.306,00 ± R$ 4.571,00 versus R$ 16.217,00 ± R$ 7.298,00 versus R$ 19.548,00 ± R$935,00; p < 0.001). However, as the EuroSCORE increased, there was significant difference (p < 0.0001) between the real cost increasing slope and the SUS reimbursement elevation per EuroSCORE risk strata. Conclusion: Higher EuroSCORE was related to higher postoperative mortality, complications, length of stay, and costs. Although SUS reimbursement increased according to risk, it was not proportional to real costs.
Keywords	Procedimentos Cirúrgicos Cardíacos / economia ; Custos Hospitalares ; Sistema Único de Saúde (SUS) ; Grupos de Risco ; Cuidados Pré-Operatórios ; Mortalidade Hospitalar ; Morbidade ; Diseases of the circulatory (Cardiovascular) system ; RC666-701 ; Specialties of internal medicine ; RC581-951 ; Internal medicine ; RC31-1245 ; Medicine ; R
Subject code	610
Language	English
Publishing date	2015-01-01T00:00:00Z
Publisher	Sociedade Brasileira de Cardiologia - SBC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Cardiac Surgery Costs According to the Preoperative Risk in the Brazilian Public Health System

Arquivos Brasileiros de Cardiologia, Iss 0, Pp 00-

2015 Volume 00

Abstract	Abstract Background: Heart surgery has developed with increasing patient complexity. Objective: To assess the use of resources and real costs stratified by risk factors of patients submitted to surgical cardiac procedures and to compare them with the values reimbursed by the Brazilian Unified Health System (SUS). Method: All cardiac surgery procedures performed between January and July 2013 in a tertiary referral center were analyzed. Demographic and clinical data allowed the calculation of the value reimbursed by the Brazilian SUS. Patients were stratified as low, intermediate and high-risk categories according to the EuroSCORE. Clinical outcomes, use of resources and costs (real costs versus SUS) were compared between established risk groups. Results: Postoperative mortality rates of low, intermediate and high-risk EuroSCORE risk strata showed a significant linear positive correlation (EuroSCORE: 3.8%, 10%, and 25%; p < 0.0001), as well as occurrence of any postoperative complication EuroSCORE: 13.7%, 20.7%, and 30.8%, respectively; p = 0.006). Accordingly, length-of-stay increased from 20.9 days to 24.8 and 29.2 days (p < 0.001). The real cost was parallel to increased resource use according to EuroSCORE risk strata (R$ 27.116,00 ± R$ 13.928,00 versus R$ 34.854,00 ± R$ 27.814,00 versus R$ 43.234,00 ± R$ 26.009,00, respectively; p < 0.001). SUS reimbursement also increased (R$ 14.306,00 ± R$ 4.571,00 versus R$ 16.217,00 ± R$ 7.298,00 versus R$ 19.548,00 ± R$935,00; p < 0.001). However, as the EuroSCORE increased, there was significant difference (p < 0.0001) between the real cost increasing slope and the SUS reimbursement elevation per EuroSCORE risk strata. Conclusion: Higher EuroSCORE was related to higher postoperative mortality, complications, length of stay, and costs. Although SUS reimbursement increased according to risk, it was not proportional to real costs.
Keywords	Procedimentos Cirúrgicos Cardíacos / economia ; Custos Hospitalares ; Sistema Único de Saúde (SUS) ; Grupos de Risco ; Cuidados Pré-Operatórios ; Mortalidade Hospitalar ; Morbidade ; Diseases of the circulatory (Cardiovascular) system ; RC666-701 ; Specialties of internal medicine ; RC581-951 ; Internal medicine ; RC31-1245 ; Medicine ; R
Subject code	610
Language	English
Publishing date	2015-01-01T00:00:00Z
Publisher	Sociedade Brasileira de Cardiologia - SBC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Cardiac Surgery Costs According to the Preoperative Risk in the Brazilian Public Health System

Arquivos Brasileiros de Cardiologia, Iss 0, Pp 00-

2015 Volume 00

Abstract	Abstract Background: Heart surgery has developed with increasing patient complexity. Objective: To assess the use of resources and real costs stratified by risk factors of patients submitted to surgical cardiac procedures and to compare them with the values reimbursed by the Brazilian Unified Health System (SUS). Method: All cardiac surgery procedures performed between January and July 2013 in a tertiary referral center were analyzed. Demographic and clinical data allowed the calculation of the value reimbursed by the Brazilian SUS. Patients were stratified as low, intermediate and high-risk categories according to the EuroSCORE. Clinical outcomes, use of resources and costs (real costs versus SUS) were compared between established risk groups. Results: Postoperative mortality rates of low, intermediate and high-risk EuroSCORE risk strata showed a significant linear positive correlation (EuroSCORE: 3.8%, 10%, and 25%; p < 0.0001), as well as occurrence of any postoperative complication EuroSCORE: 13.7%, 20.7%, and 30.8%, respectively; p = 0.006). Accordingly, length-of-stay increased from 20.9 days to 24.8 and 29.2 days (p < 0.001). The real cost was parallel to increased resource use according to EuroSCORE risk strata (R$ 27.116,00 ± R$ 13.928,00 versus R$ 34.854,00 ± R$ 27.814,00 versus R$ 43.234,00 ± R$ 26.009,00, respectively; p < 0.001). SUS reimbursement also increased (R$ 14.306,00 ± R$ 4.571,00 versus R$ 16.217,00 ± R$ 7.298,00 versus R$ 19.548,00 ± R$935,00; p < 0.001). However, as the EuroSCORE increased, there was significant difference (p < 0.0001) between the real cost increasing slope and the SUS reimbursement elevation per EuroSCORE risk strata. Conclusion: Higher EuroSCORE was related to higher postoperative mortality, complications, length of stay, and costs. Although SUS reimbursement increased according to risk, it was not proportional to real costs.
Keywords	Procedimentos Cirúrgicos Cardíacos / economia ; Custos Hospitalares ; Sistema Único de Saúde (SUS) ; Grupos de Risco ; Cuidados Pré-Operatórios ; Mortalidade Hospitalar ; Morbidade ; Diseases of the circulatory (Cardiovascular) system ; RC666-701 ; Specialties of internal medicine ; RC581-951 ; Internal medicine ; RC31-1245 ; Medicine ; R
Subject code	610
Language	English
Publishing date	2015-01-01T00:00:00Z
Publisher	Sociedade Brasileira de Cardiologia - SBC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Estratificação de risco cirúrgico como instrumento de inovação em programas de cirurgia cardíaca no Sistema Único de Saúde do Estado de São Paulo

Omar Asdrúbal Vilca Mejía / Luiz Augusto Ferreira Lisboa / Luis Alberto Oliveira Dallan / Pablo Maria Alberto Pomerantzeff / Evelinda Marramon Trindade / Fabio Biscegli Jatene / Roberto Kalil Filho

Revista Brasileira de Cirurgia Cardiovascular, Vol 28, Iss 2, Pp 263-

ESTUDO SP-SCORE-SUS

2013 Volume 269

Abstract: Doenças cardiovasculares representam a maior carga de morbimortalidade para o sistema de saúde e a cirurgia cardíaca desempenha importante impacto na sua resolutividade. O agrupamento das informações demográficas e clínicas relevantes dos pacientes ... ...

Abstract	Doenças cardiovasculares representam a maior carga de morbimortalidade para o sistema de saúde e a cirurgia cardíaca desempenha importante impacto na sua resolutividade. O agrupamento das informações demográficas e clínicas relevantes dos pacientes acometidos, no nível de estratos específicos e em correlação com os conjuntos de recursos requeridos, representa a possibilidade de adaptar, aprimorar e inovar nos programas assistenciais. Este projeto tem por objetivo remodelar o escore de risco "InsCor" para formulação do SP-SCORE (São Paulo System for Cardiac Operative Risk Evaluation), visando refletir melhor a complexidade da assistência cirúrgica cardíaca. Os hospitais participantes integram os Núcleos de Avaliação de Tecnologias da Secretaria de Estado da Saúde de São Paulo (NATSs/SES-SP). Para a elaboração do SP-SCORE, serão utilizadas as 10 variáveis do modelo InsCor e 8 outras com suposta influência no Brasil. Os desfechos primários consistem na morbidade e na mortalidade hospitalar. A técnica de bootstrap junto a procedimentos de seleção automatizada de variáveis "stepwise" será utilizada para desenvolver um modelo parcimonioso por meio da regressão logística múltipla. Este projeto visa subsidiar a sustentabilidade e o financiamento do SUS-SP para as Redes Regionalizadas de Atenção à Saúde (RRAS) de cirurgias de coronária e/ou valva, promovendo alocação equitativa, incremento do acesso e efetividade, bem como caracterizar a magnitude dos recursos disponíveis e seu impacto.
Keywords	Fatores de risco ; Procedimentos cirúrgicos cardiovasculares ; Mortalidade hospitalar ; Morbidade ; Base de dados ; Diseases of the circulatory (Cardiovascular) system ; RC666-701 ; Specialties of internal medicine ; RC581-951 ; Internal medicine ; RC31-1245 ; Medicine ; R
Language	Portuguese
Publishing date	2013-06-01T00:00:00Z
Publisher	Sociedade Brasileira de Cirurgia Cardiovascular
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Efeito econômico do uso da oxigenação extracorpórea para suporte de pacientes adultos com insuficiência respiratória grave no Brasil

Marcelo Park / Pedro Vitale Mendes / Fernando Godinho Zampieri / Luciano Cesar Pontes Azevedo / Eduardo Leite Vieira Costa / Fernando Antoniali / Gustavo Calado de Aguiar Ribeiro / Luiz Fernando Caneo / Luiz Monteiro da Cruz Neto / Carlos Roberto Ribeiro Carvalho / Evelinda Marramon Trindade

Revista brasileira de terapia intensiva , Vol 26, Iss 3, Pp 253-

uma análise hipotética

2014 Volume 262

Keywords	Oxigenação por membrana extracorpórea/economia ; Custos e análise de custo ; Insuficiência respiratória ; Respiração artificial ; Unidades de terapia intensiva ; 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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