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Article ; Online: Vitamin D: enough already?

Lichtenstein, Arnaldo

Revista da Associação Médica Brasileira (1992)

2015 Volume 61, Issue 4, Page(s) 291–292

MeSH term(s)	Dietary Supplements/standards ; Humans ; Vitamin D/administration & dosage ; Vitamin D Deficiency/drug therapy ; Vitamins/administration & dosage
Chemical Substances	Vitamins ; Vitamin D (1406-16-2)
Language	English
Publishing date	2015-08
Publishing country	Brazil
Document type	Editorial
ZDB-ID	2027973-5
ISSN	1806-9282 ; 0104-4230
ISSN (online)	1806-9282
ISSN	0104-4230
DOI	10.1590/1806-9282.61.04.291
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Article ; Online: Poncet's disease: a reactive arthritis secondary to pulmonary tuberculosis.

Stumpf, Matheo Augusto Morandi / Kffuri Filho, José Moreira / Lichtenstein, Arnaldo

Clinical rheumatology

2022 Volume 41, Issue 5, Page(s) 1615–1616

MeSH term(s)	Arthritis, Reactive/complications ; Humans ; Tuberculosis/complications ; Tuberculosis, Pulmonary/complications ; Tuberculosis, Pulmonary/diagnostic imaging
Language	English
Publishing date	2022-02-02
Publishing country	Germany
Document type	Journal Article
ZDB-ID	604755-5
ISSN	1434-9949 ; 0770-3198
ISSN (online)	1434-9949
ISSN	0770-3198
DOI	10.1007/s10067-022-06088-0
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Article ; Online: Rhombencephalitis with longitudinal extensive transverse myelitis in lupus: an overlap syndrome?

Stumpf, Matheo Augusto Morandi / Barbosa, Otávio Silva Salles / Souza, Mariana Ataide / Lichtenstein, Arnaldo

The Lancet. Rheumatology

2022 Volume 5, Issue 6, Page(s) e361–e362

MeSH term(s)	Humans ; Myelitis, Transverse/diagnosis ; Autoimmune Diseases ; Connective Tissue Diseases ; Syndrome
Language	English
Publishing date	2022-03-08
Publishing country	England
Document type	Journal Article
ISSN	2665-9913
ISSN (online)	2665-9913
DOI	10.1016/S2665-9913(22)00063-7
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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.

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

Clinics (Sao Paulo, Brazil)

2022 Volume 77, Page(s) 100015

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 ... ...

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/m 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.
MeSH term(s)	Ambulatory Care Facilities ; Bone Density ; Cross-Sectional Studies ; Female ; Hip Fractures/complications ; Hip Fractures/epidemiology ; Humans ; Male ; Osteoporotic Fractures/epidemiology ; Osteoporotic Fractures/etiology ; Risk Assessment/methods ; Risk Factors
Language	English
Publishing date	2022-03-12
Publishing country	United States
Document type	Journal Article ; Observational Study
ZDB-ID	2182801-5
ISSN	1980-5322 ; 1807-5932
ISSN (online)	1980-5322
ISSN	1807-5932
DOI	10.1016/j.clinsp.2022.100015
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Article ; Online: Immunothrombosis and COVID-19 ‒ a nested post-hoc analysis from a 3186 patient cohort in a Latin American public reference hospital.

de Lima, Clarice Antunes / Gonçalves, Fabio Augusto Rodrigues / Besen, Bruno Adler Maccagnan Pinheiro / Pereira, Antônio José Rodrigues / Perazzio, Sandro Félix / Trindade, Evelinda Marramon / Fonseca, Luiz Augusto Marcondes / Sumita, Nairo Massakazu / Pinto, Vanusa Barbosa / Duarte, Alberto José da Silva / Manin, Carolina Broco / Lichtenstein, Arnaldo

Clinics (Sao Paulo, Brazil)

2023 Volume 78, Page(s) 100178

Abstract: Objective: COVID-19 is associated with an elevated risk of thromboembolism and excess mortality. Difficulties with best anticoagulation practices and their implementation motivated the current analysis of COVID-19 patients who developed Venous ... ...

Abstract	Objective: COVID-19 is associated with an elevated risk of thromboembolism and excess mortality. Difficulties with best anticoagulation practices and their implementation motivated the current analysis of COVID-19 patients who developed Venous Thromboembolism (VTE). Method: This is a post-hoc analysis of a COVID-19 cohort, described in an economic study already published. The authors analyzed a subset of patients with confirmed VTE. We described the characteristics of the cohort, such as demographics, clinical status, and laboratory results. We tested differences amid two subgroups of patients, those with VTE or not, with the competitive risk Fine and Gray model. Results: Out of 3186 adult patients with COVID-19, 245 (7.7%) were diagnosed with VTE, 174 (5.4%) of them during admission to the hospital. Four (2.3% of these 174) did not receive prophylactic anticoagulation and 19 (11%) discontinued anticoagulation for at least 3 days, resulting in 170 analyzed. During the first week of hospitalization, the laboratory most altered results were C-reactive protein and D-dimer. Patients with VTE were more critical, had a higher mortality rate, worse SOFA score, and, on average, 50% longer hospital stay. Conclusion: Proven VTE incidence in this severe COVID-19 cohort was 7.7%, despite 87% of them complying completely with VTE prophylaxis. The clinician must be aware of the diagnosis of VTE in COVID-19, even in patients receiving proper prophylaxis.
MeSH term(s)	Humans ; Adult ; Thromboinflammation ; COVID-19/diagnosis ; COVID-19/epidemiology ; Latin America/epidemiology ; Hospitals, Public ; Venous Thromboembolism/epidemiology ; Venous Thromboembolism/etiology ; Venous Thromboembolism/prevention & control ; Incidence ; Risk Factors ; Anticoagulants/administration & dosage ; Male ; Female ; Length of Stay
Chemical Substances	Anticoagulants
Language	English
Publishing date	2023-02-28
Publishing country	United States
Document type	Journal Article
ZDB-ID	2182801-5
ISSN	1980-5322 ; 1807-5932
ISSN (online)	1980-5322
ISSN	1807-5932
DOI	10.1016/j.clinsp.2023.100178
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Article ; Online: Kidney injury and other complications related to colonoscopy in inpatients at a tertiary teaching hospital.

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

Clinics (Sao Paulo, Brazil)

2018 Volume 73, Page(s) e456

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 ... ...

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.
MeSH term(s)	Acute Kidney Injury/etiology ; Adult ; Aged ; Aged, 80 and over ; Colonoscopy/adverse effects ; Colorectal Neoplasms/diagnosis ; Cross-Sectional Studies ; Female ; Glomerular Filtration Rate ; Hospitals, Teaching ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Tertiary Care Centers ; Young Adult
Language	English
Publishing date	2018-10-18
Publishing country	United States
Document type	Journal Article ; Observational Study
ZDB-ID	2182801-5
ISSN	1980-5322 ; 1807-5932
ISSN (online)	1980-5322
ISSN	1807-5932
DOI	10.6061/clinics/2018/e456
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Article: Refractory hypoglycemia in a patient with functional adrenal cortical carcinoma.

Marchetti, Katia Regina / Pereira, Maria Adelaide Albergaria / Lichtenstein, Arnaldo / Paiva, Edison Ferreira

Endocrinology, diabetes & metabolism case reports

2016 Volume 2016

Abstract: Adrenacarcinomas are rare, and hypoglycemic syndrome resulting from the secretion of insulin-like growth factor II (IGF-II) by these tumors have been described infrequently. This study describes the case of a young woman with severe persistent ... ...

Abstract	Adrenacarcinomas are rare, and hypoglycemic syndrome resulting from the secretion of insulin-like growth factor II (IGF-II) by these tumors have been described infrequently. This study describes the case of a young woman with severe persistent hypoglycemia and a large adrenal tumor and discusses the physiopathological mechanisms involved in hypoglycemia. The case is described as a 21-year-old woman who presented with 8 months of general symptoms and, in the preceding 3 months, with episodes of mental confusion and visual blurring secondary to hypoglycemia. A functional assessment of the adrenal cortex revealed ACTH-independent hypercortisolism and hyperandrogenism. Hypoglycemia, hypoinsulinemia, low C-peptide and no ketones were also detected. An evaluation of the GH-IGF axis revealed GH blockade (0.03; reference: up to 4.4 ng/mL), greatly reduced IGF-I levels (9.0 ng/mL; reference: 180-780 ng/mL), slightly reduced IGF-II levels (197 ng/mL; reference: 267-616 ng/mL) and an elevated IGF-II/IGF-I ratio (21.9; reference: ~3). CT scan revealed a large expansive mass in the right adrenal gland and pulmonary and liver metastases. During hospitalization, the patient experienced frequent difficult-to-control hypoglycemia and hypokalemia episodes. Octreotide was ineffective in controlling hypoglycemia. Due to unresectability, chemotherapy was tried, but after 3 months, the patient's condition worsened and progressed to death. In conclusion, our patient presented with a functional adrenal cortical carcinoma, with hyperandrogenism associated with hypoinsulinemic hypoglycemia and blockage of the GH-IGF-I axis. Patient's data suggested a diagnosis of hypoglycemia induced by an IGF-II or a large IGF-II-producing tumor (low levels of GH, greatly decreased IGF-I, slightly decreased IGF-II and an elevated IGF-II/IGF-I ratio). Learning points: Hypoglycemyndrome resulting from the secretion of insulin-like growth factor II (IGF-II) by adrenal tumors is a rare condition.Hypoinsulinemic hypoglycemia associated with hyperandrogenism and blockage of the GH-IGF-I axis suggests hypoglycemia induced by an IGF-II or a large IGF-II-producing tumor.Hypoglycemia in cases of NICTH should be treated with glucocorticoids, glucagon, somatostatin analogs and hGH.
Language	English
Publishing date	2016-11-04
Publishing country	England
Document type	Journal Article
ZDB-ID	2785530-2
ISSN	2052-0573
ISSN	2052-0573
DOI	10.1530/EDM-16-0101
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Article ; Online: Perception of usefulness of laboratory tests ordering by internal medicine residents in ambulatory setting: A single-center prospective cohort study.

Doi, Dimitria / Vale, Romulo Ribeiro do / Monteiro, Jean Michell Correia / Plens, Glauco Cabral Marinho / Ferreira Junior, Mario / Fonseca, Luiz Augusto Marcondes / Perazzio, Sandro Félix / Besen, Bruno Adler Maccagnan Pinheiro / Lichtenstein, Arnaldo / Taniguchi, Leandro Utino / Sumita, Nairo Massakazu / Corá, Aline Pivetta / Eisencraft, Adriana Pasmanik / Duarte, Alberto José da Silva

PloS one

2021 Volume 16, Issue 5, Page(s) e0250769

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.
MeSH term(s)	Adult ; Ambulatory Care Facilities/statistics & numerical data ; Attitude of Health Personnel ; Clinical Laboratory Techniques ; Cohort Studies ; Female ; Humans ; Internal Medicine/education ; Internship and Residency/statistics & numerical data ; Male
Language	English
Publishing date	2021-05-11
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	1932-6203
ISSN (online)	1932-6203
DOI	10.1371/journal.pone.0250769
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Article ; Online: Improving serum calcium test ordering according to a decision algorithm.

Faria, Daniel K / Taniguchi, Leandro U / Fonseca, Luiz A M / Ferreira-Junior, Mario / Aguiar, Francisco J B / Lichtenstein, Arnaldo / Sumita, Nairo M / Duarte, Alberto J S / Sales, Maria M

Journal of clinical pathology

2018 Volume 72, Issue 3, Page(s) 232–236

Abstract: Aim: To detect differences in the pattern of serum calcium tests ordering before and after the implementation of a decision algorithm.: Methods: We studied patients admitted to an internal medicine ward of a university hospital on April 2013 and ... ...

Abstract	Aim: To detect differences in the pattern of serum calcium tests ordering before and after the implementation of a decision algorithm. Methods: We studied patients admitted to an internal medicine ward of a university hospital on April 2013 and April 2016. Patients were classified as critical or non-critical on the day when each test was performed. Adequacy of ordering was defined according to adherence to a decision algorithm implemented in 2014. Results: Total and ionised calcium tests per patient-day of hospitalisation significantly decreased after the algorithm implementation; and duplication of tests (total and ionised calcium measured in the same blood sample) was reduced by 49%. Overall adequacy of ionised calcium determinations increased by 23% (P=0.0001) due to the increase in the adequacy of ionised calcium ordering in non-critical conditions. Conclusions: A decision algorithm can be a useful educational tool to improve adequacy of the process of ordering serum calcium tests.
MeSH term(s)	Algorithms ; Blood Chemical Analysis/methods ; Calcium/blood ; Decision Making, Computer-Assisted ; Humans ; Practice Patterns, Physicians'
Chemical Substances	Calcium (SY7Q814VUP)
Language	English
Publishing date	2018-05-18
Publishing country	England
Document type	Journal Article
ZDB-ID	80261-x
ISSN	1472-4146 ; 0021-9746
ISSN (online)	1472-4146
ISSN	0021-9746
DOI	10.1136/jclinpath-2018-205026
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Article ; Online: Vitamin D: non-skeletal actions and rational use.

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

Revista da Associacao Medica Brasileira (1992)

2013 Volume 59, Issue 5, Page(s) 495–506

Abstract: Recent years have witnessed a substantial increase in the number of seric determinations of vitamin D, in a worldwide basis. At Hospital das Clínicas of Faculdade de Medicina of Universidade de São Paulo that increase reached 700% over the last four ... ...

Abstract	Recent years have witnessed a substantial increase in the number of seric determinations of vitamin D, in a worldwide basis. At Hospital das Clínicas of Faculdade de Medicina of Universidade de São Paulo that increase reached 700% over the last four years. Nevertheless there are many controversies on the literature about the role of vitamin D in conditions unrelated to the musculoskeletal system. In this study the metabolism, sources and actions of vitamin D on the body are reviewed. Observational studies, clinical trials, systematic reviews and metanalysis which focused on the relationship between the vitamin and conditions such as cancer, cardiovascular disease, diabetes and falls were searched on the literature, analyzed and discussed. Results are presented as quiz and answer, tables and a figure. The role of vitamin D on the above-mentioned conditions is discussed, and the controversial issues stressed.
MeSH term(s)	Accidental Falls/prevention & control ; Cardiovascular Diseases/etiology ; Cholecalciferol/metabolism ; Clinical Trials as Topic ; Diabetes Mellitus, Type 2/etiology ; Epidermis/metabolism ; Epidermis/radiation effects ; Evaluation Studies as Topic ; Humans ; Meta-Analysis as Topic ; Neoplasms/etiology ; Parathyroid Hormone/physiology ; Sunlight ; Vitamin D/blood ; Vitamin D/physiology ; Vitamin D Deficiency/complications
Chemical Substances	Parathyroid Hormone ; Vitamin D (1406-16-2) ; Cholecalciferol (1C6V77QF41)
Language	Portuguese
Publishing date	2013-09
Publishing country	Brazil
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	2027973-5
ISSN	1806-9282 ; 0104-4230
ISSN (online)	1806-9282
ISSN	0104-4230
DOI	10.1016/j.ramb.2013.05.002
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