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  1. Article ; Online: Beyond ventilatory support

    Juliana Ferreira Ferranti / Isadora Souza Rodriguez / Emiliana Motta / Cíntia Johnston / Werther Brunow de B. Carvalho / Artur Figueiredo Delgado

    Revista da Associação Médica Brasileira, Vol 66, Iss 4, Pp 521-

    challenges in general practice and in the treatment of critically Ill children and adolescents with SARS-CoV-2 infection

    2020  Volume 527

    Abstract: SUMMARY Severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2 infection) is a new challenge for all countries, and children are predisposed to acquire this disease. Some studies have demonstrated more severe diseases in adults, but critically ill ... ...

    Abstract SUMMARY Severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2 infection) is a new challenge for all countries, and children are predisposed to acquire this disease. Some studies have demonstrated more severe diseases in adults, but critically ill pediatric patients have been described in all ages. Pulmonary involvement is the major feature, and ventilatory support is common in critical cases. Nevertheless, other very important therapeutic approaches must be considered. In this article, we reviewed extensively all recent medical literature to point out the main clinical attitudes to support these pediatric patients during their period in respiratory support. Radiologic findings, fluid therapy, hemodynamic support, use of inotropic/vasopressors, nutritional therapy, antiviral therapy, corticosteroids, antithrombotic therapy, and immunoglobulins are analyzed to guide all professionals during hospitalization. We emphasize the importance of a multi-professional approach for adequate recovery.
    Keywords Child ; Coronavirus ; Sars-CoV-2 ; COVID-19 ; Medicine (General) ; R5-920
    Subject code 610
    Language English
    Publishing date 2020-06-01T00:00:00Z
    Publisher Associação Médica Brasileira
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: Update on the diagnosis and management of COVID-19 in pediatric patients

    Ana Paula de Carvalho Panzeri Carlotti / Werther Brunow de Carvalho / Cíntia Johnston / Alfredo Elias Gilio / Heloisa Helena de Sousa Marques / Juliana Ferreira Ferranti / Isadora Souza Rodriguez / Artur Figueiredo Delgado

    Clinics, Vol

    2020  Volume 75

    Abstract: Coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), became a pandemic in March 2020, affecting millions of people worldwide. However, COVID-19 in pediatric patients represents 1-5% of all cases, and the ...

    Abstract Coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), became a pandemic in March 2020, affecting millions of people worldwide. However, COVID-19 in pediatric patients represents 1-5% of all cases, and the risk for developing severe disease and critical illness is much lower in children with COVID-19 than in adults. Multisystem inflammatory syndrome in children (MIS-C), a possible complication of COVID-19, has been described as a hyperinflammatory condition with multiorgan involvement similar to that in Kawasaki disease or toxic shock syndrome in children with evidence of SARS-CoV-2 infection. This review presents an update on the diagnostic methods for COVID-19, including reverse-transcriptase polymerase chain reaction (RT-PCR) tests, serology tests, and imaging, and summarizes the current recommendations for the management of the disease. Particular emphasis is placed on respiratory support, which includes noninvasive ventilation and invasive mechanical ventilation strategies according to lung compliance and pattern of lung injury. Pharmacological treatment, including pathogen-targeted drugs and host-directed therapies, has been addressed. The diagnostic criteria and management of MIS-C are also summarized.
    Keywords COVID-19 ; Diagnosis ; Respiratory Support ; Pharmacological Treatment ; Multisystem Inflammatory Syndrome in Children ; Medicine (General) ; R5-920
    Subject code 610
    Language English
    Publishing date 2020-11-01T00:00:00Z
    Publisher Elsevier España
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: Miocardite fulminante associada ao vírus influenza H1N1

    Maria Lúcia Saraiva Lobo / Ângela Taguchi / Heloísa Amaral Gaspar / Juliana Ferreira Ferranti / Werther Brunow de Carvalho / Artur Figueiredo Delgado

    Revista brasileira de terapia intensiva , Vol 26, Iss 3, Pp 321-

    relato de caso e revisão de literatura

    2014  Volume 326

    Keywords Miocardite ; Influenza humana ; Ecocardiografia ; Criança ; Relatos de casos ; 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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  4. Article ; Online: An autopsy study of the spectrum of severe COVID-19 in children

    Amaro Nunes Duarte-Neto / Elia Garcia Caldini / Michele Soares Gomes-Gouvêa / Cristina Takami Kanamura / Renata Aparecida de Almeida Monteiro / Juliana Ferreira Ferranti / Andrea Maria Cordeiro Ventura / Fabiane Aliotti Regalio / Daniela Matos Fiorenzano / Maria Augusta Bento Cicaroni Gibelli / Werther Brunow de Carvalho / Gabriela Nunes Leal / João Renato Rebello Pinho / Artur Figueiredo Delgado / Magda Carneiro-Sampaio / Thais Mauad / Luiz Fernando Ferraz da Silva / Paulo Hilario Nascimento Saldiva / Marisa Dolhnikoff

    EClinicalMedicine, Vol 35, Iss , Pp 100850- (2021)

    From SARS to different phenotypes of MIS-C

    2021  

    Abstract: Background: COVID-19 in children is usually mild or asymptomatic, but severe and fatal paediatric cases have been described. The pathology of COVID-19 in children is not known; the proposed pathogenesis for severe cases includes immune-mediated ... ...

    Abstract Background: COVID-19 in children is usually mild or asymptomatic, but severe and fatal paediatric cases have been described. The pathology of COVID-19 in children is not known; the proposed pathogenesis for severe cases includes immune-mediated mechanisms or the direct effect of SARS-CoV-2 on tissues. We describe the autopsy findings in five cases of paediatric COVID-19 and provide mechanistic insight into the mechanisms involved in the pathogenesis of the disease. Methods: Children and adolescents who died with COVID-19 between March 18 and August 15, 2020 were autopsied with a minimally invasive method. Tissue samples from all vital organs were analysed by histology, electron microscopy (EM), reverse-transcription polymerase chain reaction (RT-PCR) and immunohistochemistry (IHC). Findings: Five patients were included, one male and four female, aged 7 months to 15 years. Two patients had severe diseases before SARS-CoV-2 infection: adrenal carcinoma and Edwards syndrome. Three patients were previously healthy and had multisystem inflammatory syndrome in children (MIS-C) with distinct clinical presentations: myocarditis, colitis, and acute encephalopathy with status epilepticus. Autopsy findings varied amongst patients and included mild to severe COVID-19 pneumonia, pulmonary microthrombosis, cerebral oedema with reactive gliosis, myocarditis, intestinal inflammation, and haemophagocytosis. SARS-CoV-2 was detected in all patients in lungs, heart and kidneys by at least one method (RT-PCR, IHC or EM), and in endothelial cells from heart and brain in two patients with MIS-C (IHC). In addition, we show for the first time the presence of SARS-CoV-2 in the brain tissue of a child with MIS-C with acute encephalopathy, and in the intestinal tissue of a child with acute colitis. Interpretation: SARS-CoV-2 can infect several cell and tissue types in paediatric patients, and the target organ for the clinical manifestation varies amongst individuals. Two major patterns of severe COVID-19 were observed: a primarily pulmonary disease, with severe acute respiratory disease and diffuse alveolar damage, or a multisystem inflammatory syndrome with the involvement of several organs. The presence of SARS-CoV-2 in several organs, associated with cellular ultrastructural changes, reinforces the hypothesis that a direct effect of SARS-CoV-2 on tissues is involved in the pathogenesis of MIS-C. Funding: Fundação de Amparo à Pesquisa do Estado de São Paulo, Conselho Nacional de Desenvolvimento Científico e Tecnológico, Bill and Melinda Gates Foundation.
    Keywords Covid-19 ; Sars-cov-2 ; Autopsy ; Pathology ; Minimally invasive autopsy ; Children ; Medicine (General) ; R5-920
    Subject code 610
    Language English
    Publishing date 2021-05-01T00:00:00Z
    Publisher Elsevier
    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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  6. Article ; Online: Novas perspectivas no estadiamento e tratamento do câncer de esôfago New perspectives in esophageal cancer staging and treatment

    Leonardo Gomes da Fonseca / André Beer Furlan / Juliana Ferreira Ferranti / Guilherme Naccache Namour / Frederico Lafraia Lobo / Sérgio Szachnowicz / Rubens Antônio Aissar Sallum / Ivan Cecconello

    ABCD: Arquivos Brasileiros de Cirurgia Digestiva, Vol 20, Iss 4, Pp 274-

    2007  Volume 279

    Abstract: INTRODUÇÃO: O câncer de esôfago apresenta-se como uma das neoplasias mais freqüentes e letais. O acometimento linfático aparece como principal fator individual de pior prognóstico, sendo a esofagectomia com linfadenectomia extensa ainda seu tratamento de ...

    Abstract INTRODUÇÃO: O câncer de esôfago apresenta-se como uma das neoplasias mais freqüentes e letais. O acometimento linfático aparece como principal fator individual de pior prognóstico, sendo a esofagectomia com linfadenectomia extensa ainda seu tratamento de escolha. Ressecções mais extensas através da toracotomia estão associadas com maior sobrevida, mas apresentam altas taxas de morbimortalidade. O conceito de micrometástases pode nos trazer avaliação mais acurada do estadiamento dos tumores operados, com detecção através de imunoistoquímica ou reação em cadeia de polimerase de metástases não diagnosticadas pelos métodos convencionais. MÉTODOS: Realizou-se revisão bibliográfica de artigos científicos publicados e disponíveis no PubMed, através do site www.pubmed.gov. cruzando-se os descritores neoplasias esofágicas, biologia molecular, estadiamento de neoplasias, linfonodo sentinela, metástase linfática. REVISÃO DA LITERATURA: O conceito do linfonodo sentinela, onde se pesquisa durante a cirurgia os possíveis primeiros sítios de metástases, direcionando desta maneira a rota da ressecção linfática no intuito de permitir ressecções completas não necessariamente extensas, possibilita diminuir a morbimortalidade e restringir as indicações de procedimentos muitas vezes super-dimensionados que podem não trazer benefício aos pacientes. CONCLUSÃO: O estadiamento preciso através da procura de micrometástase e o tratamento mais regrado pelo método do linfonodo sentinela, podem trazer novas perspectivas no tratamento do câncer de esôfago, principalmente em casos de tumores precoces. BACKGROUND: The esophageal cancer presents as one of the most frequent and lethal neoplasia. Lymphatic involvement appears to be the principal individual factor for poor prognosis, thus esophagectomy with extensive lymphadenectomy still is the choice treatment. Thoracotomy for extensive resection is related to higher survival rate, as well as higher morbid-mortality rates. Micrometastasis concept involves a more accurate staging method for resected tumors, using immunohistochemistry or polymerase chain reaction techniques, which were not diagnosed by conventional methods. METHODS: A literature review was made over scientific articles published and available at PubMed site (www.pubmed.gov), crossing the following headings: esophageal neoplasm, molecular biology, neoplasm staging, sentinel lymph node, lymphatic metastasis. LITERATURE REVIEW: Sentinel lymph node concept consist of intraoperative identification of possible primary dissemination metastasis sites, thus guiding to a more complete and not so extensively lymphatic resection, decreasing morbid-mortality and restraining an over-dimensioned procedure that may not benefit the patient. CONCLUSION: Accurate staging by micrometastasis identification and precise treatment using sentinel lymph node method may bring new perspectives in the esophageal cancer treatment, especially on early-stages tumors.
    Keywords Neoplasias esofágicas ; Biologia molecular ; Estadiamento de neoplasias ; Linfonodo sentinela ; Metástase linfática (EXISTEM ?) ; Esophageal neoplasm ; Molecular biology ; Neoplasm staging ; Sentinel lymphnode ; Lymphatic metastasis ; Surgery ; RD1-811 ; Diseases of the digestive system. Gastroenterology ; RC799-869
    Language English
    Publishing date 2007-12-01T00:00:00Z
    Publisher Colégio Brasileiro de Cirurgia Digestiva
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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