Jorge Guerra - Academia.edu (original) (raw)
Papers by Jorge Guerra
Revista da Sociedade Brasileira de Medicina Tropical
Background: Chagas disease is gaining importance in the Brazilian Amazon region as a differential... more Background: Chagas disease is gaining importance in the Brazilian Amazon region as a differential diagnosis of febrile syndrome. The most recent microoutbreak occurred in Ipixuna, in Amazonas state. Methods: An epidemiological survey was conducted using parasitological and serological tests, and electrocardiographic analysis. Results: The patients belonged to one family and had ingested açaí acquired from Ipixuna. All patients reported fever and initially a thick blood smear test was done to identify Trypanosoma cruzi. Benznidazole treatment was administered to all patients. Conclusions: Knowledge of the epidemiological dynamics of Chagas disease allows us to improve control and management measures for this disease.
Alzheimer's & Dementia, 2020
Across Latin American and Caribbean countries (LACs), the fight against dementia faces pressing c... more Across Latin American and Caribbean countries (LACs), the fight against dementia faces pressing challenges, such as heterogeneity, diversity, political instability, and socioeconomic disparities. These can be addressed more effectively in a collaborative setting that fosters open exchange of knowledge. In this work, the Latin American and Caribbean Consortium on Dementia (LAC‐CD) proposes an agenda for integration to deliver a Knowledge to Action Framework (KtAF). First, we summarize evidence‐based strategies (epidemiology, genetics, biomarkers, clinical trials, nonpharmacological interventions, networking, and translational research) and align them to current global strategies to translate regional knowledge into transformative actions. Then we characterize key sources of complexity (genetic isolates, admixture in populations, environmental factors, and barriers to effective interventions), map them to the above challenges, and provide the basic mosaics of knowledge toward a KtAF. ...
International Journal of Infectious Diseases, 2021
To compare topical granulocyte and macrophage colony-stimulating factor (GM-CSF) and miltefosine ... more To compare topical granulocyte and macrophage colony-stimulating factor (GM-CSF) and miltefosine (G + M) versus placebo and miltefosine (P + M) or parenteral meglumine antimoniate (MA) in the treatment of 150 patients with cutaneous leishmaniasis (CL) caused by Leishmania guyanensis in the Amazon. Design: A randomized and double-blinded clinical trial. Results: At 90 days after the initiation of therapy, the cure rates were 66%, 58%, and 52% for the groups P + M, G + M, and MA, respectively (p > 0.05). Cure rates at 180 days did not differ. Healing time was similar in the 3 groups, but faster in the MA group as compared to the G + M group (p = 0.04). Mild and transitory systemic adverse events were frequent in all groups (above 85%). Nausea (85%) and vomiting (39%) predominated in the miltefosine groups and arthralgia (51%) and myalgia (48%) in the MA group. One patient (group MA) stopped treatment after presenting with fever, exanthema, and severe arthralgia. Conclusions: Miltefosine did not present a higher cure rate than MA, and the association of GM-CSF did not improve the therapeutic response. Nevertheless, because of its less toxicity, easier administration, and a similar cure rate when compared with MA, miltefosine should remain as one of the main drugs for treating CL due to L. guyanensis.
Revista da Sociedade Brasileira de Medicina Tropical, 2018
Cardiorenal syndrome type 1 (CRS 1) occurs when acute heart failure leads to acute kidney injury.... more Cardiorenal syndrome type 1 (CRS 1) occurs when acute heart failure leads to acute kidney injury. There are several etiologies of CRS 1, including Chagas disease. Here, we present the first case report of CRS 1 in a patient with acute Chagas disease. Electrocardiography, transthoracic echocardiography, and cardiac magnetic resonance imaging showed signs of acute myocarditis. Laboratory examination revealed severe loss of kidney function, with a creatinine clearance of 30 mL/min, which fully normalized after treatment. Due to emergence of Chagas disease in the Brazilian Amazon, it is important to report unique clinical features in order to improve patients' outcomes.
Emerging Infectious Diseases, 2018
In the Brazilian Amazon, the suspected source of infection in an outbreak of acute Chagas disease... more In the Brazilian Amazon, the suspected source of infection in an outbreak of acute Chagas disease involving 10 patients was Euterpe oleracea (açaí berry) juice. Patient blood and juice samples contained Trypanosoma cruzi TcIV, indicating oral transmission of the Chagas disease agent.
Anais Brasileiros de Dermatologia, 2015
Efficacy and safety of a single dose pentamidine (7mg/kg) for patients with cutaneous leishmanias... more Efficacy and safety of a single dose pentamidine (7mg/kg) for patients with cutaneous leishmaniasis caused by L. guyanensis: a pilot study *
Parasites & Vectors, 2014
Background: Chagas disease in the Amazon region is considered an emerging anthropozoonosis with a... more Background: Chagas disease in the Amazon region is considered an emerging anthropozoonosis with a predominance of the discrete typing units (DTUs) TcI and TcIV. These DTUs are responsible for cases of acute disease associated with oral transmission. Chronic disease cases have been detected through serological surveys. However, the mode of transmission could not be determined, or any association of chronic disease with a specific T. cruzi DTU's. The aim of this study was to characterize Trypanosoma cruzi in patients with chronic Chagas disease in the State of Amazonas, Brazil. Methods: Blood culture and xenodiagnosis were performed in 36 patients with positive serology for Chagas disease who participated in a serological survey performed in urban and rural areas of Manaus, Amazonas. DNA samples were extracted from the feces of triatomines used for xenodiagnosis, and the nontranscribed spacer of the mini-exon gene and the mitochondrial gene cytochrome oxidase subunit II (COII) were amplified by PCR and sequenced. Results: Blood culture and xenodiagnosis were negative in 100% of samples; however, molecular techniques revealed that in 13 out of 36 (36%) fecal samples from xenodiagnosis, T. cruzi was characterized as the DTU TcI, and different haplotypes were identified within the same DTU. Conclusion: The DTU TcI, which is mainly associated with acute cases of Chagas disease in the Amazon region, is also responsible for chronic infection in patients from a region in the State of Amazonas.
Revista do Instituto de Medicina Tropical de São Paulo, 2007
An open trial to evaluate the azithromycin efficacy in cutaneous leishmaniasis patients was carri... more An open trial to evaluate the azithromycin efficacy in cutaneous leishmaniasis patients was carried out in Manaus (AM), where Leishmania (Viannia) guyanensis is the main etiologic agent. Forty-one patients with skin lesions of less than 12 weeks duration, without specific treatment for the last three months and a positive imprint to Leishmania sp. were included. From these, 31 (75.6%) were male with median age of 30.2. All of them received a daily-single oral dose of 500 mg of azithromycin for ten days. At 25th day, 16 (39%) presented therapeutic failure and received intramuscular pentavalent antimonial, four were considered lost, 21, that had improved or were inaltered received another ten-day series of azithromycin and were monthly followed, but nine (21.9%) of them presented a poor clinical response and switched to intramuscular pentavalent antimonial on day 55. Of the 12 remaining cases evaluated on day 55, despite of clinical improvement, three asked for antimony therapy and 9 ...
PLoS Neglected Tropical Diseases, 2011
Background: Leishmania (Viannia) braziliensis is a parasite recognized as the most important etio... more Background: Leishmania (Viannia) braziliensis is a parasite recognized as the most important etiologic agent of mucosal leishmaniasis (ML) in the New World. In Amazonia, seven different species of Leishmania, etiologic agents of human Cutaneous Leishmaniasis, have been described. Isolated cases of ML have been described for several different species of Leishmania: L. (V.) panamensis, L. (V.) guyanensis and L. (L.) amazonensis. Methodology: Leishmania species were characterized by polymerase chain reaction (PCR) of tissues taken from mucosal biopsies of Amazonian patients who were diagnosed with ML and treated at the Tropical Medicine Foundation of Amazonas (FMTAM) in Manaus, Amazonas state, Brazil. Samples were obtained retrospectively from the pathology laboratory and prospectively from patients attending the aforementioned tertiary care unit. Results: This study reports 46 cases of ML along with their geographical origin, 30 cases caused by L. (V.) braziliensis and 16 cases by L. (V.) guyanensis. This is the first record of ML cases in 16 different municipalities in the state of Amazonas and of simultaneous detection of both species in 4 municipalities of this state. It is also the first record of ML caused by L. (V.) guyanensis in the states of Pará, Acre, and Rondô nia and cases of ML caused by L. (V.) braziliensis in the state of Rondô nia. Conclusions/Significance: L. (V.) braziliensis is the predominant species that causes ML in the Amazon region. However, contrary to previous studies, L. (V.) guyanensis is also a significant causative agent of ML within the region. The clinical and epidemiological expression of ML in the Manaus region is similar to the rest of the country, although the majority of ML cases are found south of the Amazon River.
Parasitology Research, 2010
In the State of Amazonas, American tegumentary leishmaniasis is endemic and presents a wide spect... more In the State of Amazonas, American tegumentary leishmaniasis is endemic and presents a wide spectrum of clinical variability due to the large diversity of circulating species in the region. Isolates from patients in Manaus and its metropolitan region were characterized using monoclonal antibodies and isoenzymes belonging to four species of the parasite: Leishmania (Viannia) guyanensis, 73% (153/ 209); Leishmania (Viannia) braziliensis, 14% (30/209); Leishmania (Leishmania) amazonensis, 8% (17/209); and Leishmania (Viannia) naiffii, 4% (9/209). The most prevalent species was L. (V.) guyanensis. The principal finding of this study was the important quantity of infections involving more than one parasite species, representing 14% (29/209) of the total. The findings obtained in this work regarding the parasite are further highlighted by the fact that these isolates were obtained from clinical samples collected from single lesions.
Anais Brasileiros de Dermatologia, 2011
FUNDAMENTOS: O tratamento da leishmaniose tegumentar americana (LTA) ainda constitui desafio, poi... more FUNDAMENTOS: O tratamento da leishmaniose tegumentar americana (LTA) ainda constitui desafio, pois a maioria dos medicamentos é injetável e têm-se poucos ensaios clínicos randomizados comparando a eficácia das drogas. Além disso, é provável que as espécies de Leishmania tenham influência nas respostas terapêuticas. OBJETIVOS: Avaliar e comparar a eficácia e a segurança dos esquemas de tratamento na LTA, ocasionada por Leishmania (Viannia) guyanensis. MÉTODOS: 185 pacientes foram selecionados, conforme critérios de elegibilidade, e distribuídos, aleatoriamente, em 3 grupos - 2 com 74 enfermos e outro com 37 - que receberam, respectivamente, antimoniato de meglumina, isotionato de pentamidina e anfotericina B em doses, períodos e vias de administração padronizados. Os enfermos foram reexaminados um, dois e seis meses após o final dos tratamentos. RESULTADOS: Não houve diferença entre os grupos terapêuticos em relação ao sexo, idade, número ou local das lesões. A análise por intenção d...
The American Journal of Tropical Medicine and Hygiene, 2011
Respiratory Care, Jul 7, 2020
BACKGROUND: Hyperoxygenation and hyperinflation, preferably with a mechanical ventilator, is the ... more BACKGROUND: Hyperoxygenation and hyperinflation, preferably with a mechanical ventilator, is the most commonly used technique to prevent the adverse effects of open endotracheal suctioning on arterial oxygenation and pulmonary volume. However, limited data are available on the effects of oxygen concentrations < 100% and PEEP with zero end-expiratory pressure (0 PEEP) to improve oxygenation and to maintain adequate ventilation during open endotracheal suctioning. The aim of this study was to analyze the behavior of S pO 2 and end-tidal CO 2 pressure (P ETCO 2) in open endotracheal suctioning using the 0 PEEP technique with baseline F IO 2 (0 PEEP baseline F IO 2) and 0 PEEP + hyperoxygenation of 20% above the baseline value (0 PEEP F IO 2 + 0.20) in critically ill subjects receiving mechanical ventilation. METHODS: This was a prospective, randomized, single-blind crossover study, for which 48 subjects with various clinical and surgical conditions were selected; of these, 38 subjects completed the study. The subjects were randomized for 2 interventions: 0 PEEP baseline F IO 2 and 0 PEEP F IO 2 + 0.20 during the open endotracheal suctioning procedure. Oxygenation was assessed via oxygen saturation as measured with pulse oximetry (S pO 2), and changes in lung were monitored via P ETCO 2 using volumetric capnography. RESULTS: In the intragroup analysis with 0 PEEP baseline F IO 2 , there was no significant increase after open endotracheal suctioning in either S pO 2 (P 5 .63) or P ETCO 2 (P 5 .11). With 0 PEEP F IO 2 + 0.20, there was a significant increase in S pO 2 (P < .001), with no significant changes in P ETCO 2 (P 5 .55). In the intergroup comparisons, there was a significant increase compared to the basal values only with the 0 PEEP + 0.20 method at 1 min after hyperoxygenation (P < .001), post-immediately (P < .001), at 1 min after (P < .001), and at 2 min after open endotracheal suctioning (P < .001). CONCLUSIONS: The appropriate indication of the hyperinflation strategy via mechanical ventilation using 0 PEEP with or without hyperoxygenation proved to be efficient to maintain S pO 2 and P ETCO 2 levels. These results suggest that the technique can minimize the loss of lung volume due to open endotracheal suctioning. (ClinicalTrials.gov registration NCT02440919).
Revista Ibero-Americana de Humanidades, Ciências e Educação, Jan 31, 2023
Research, Society and Development
The 2019 novel coronavirus (SARS-CoV-2) is the virus that causes COVID-19. It can cause severe il... more The 2019 novel coronavirus (SARS-CoV-2) is the virus that causes COVID-19. It can cause severe illness, with significant increase in morbidity and mortality rates, requiring the need for hospitalization and mechanical ventilation. This study aims to describe a functional rehabilitation protocol applied to a patient with COVID-19 after 21 days of mechanical ventilation (MV). We report a case of a 56-year-old female patient diagnosed with COVID-19 who presented severe hypoxemic respiratory failure, chronic critical disease, intensive care unit acquired weakness, difficult and prolonged weaning, organ dysfunction, and needed tracheotomy. The patient responded satisfactorily to a late functional rehabilitation protocol showing the importance of well-designed and individualized protocols to achieve maximum functional recovery.
Research, Society and Development, Mar 3, 2023
Outcomes of a functional rehabilitation protocol in chronic critical disease by COVID-19: A case ... more Outcomes of a functional rehabilitation protocol in chronic critical disease by COVID-19: A case report Desfechos de um protocolo de reabilitação funcional na doença crítica crônica por COVID-19: Relato de caso Resultados de un protocolo de rehabilitación funcional en enfermedad crítica crónica por COVID-19: Reporte de caso
Research, Society and Development
The 2019 novel coronavirus (SARS-CoV-2) is the virus that causes COVID-19. It can cause severe il... more The 2019 novel coronavirus (SARS-CoV-2) is the virus that causes COVID-19. It can cause severe illness, with significant increase in morbidity and mortality rates, requiring the need for hospitalization and mechanical ventilation. This study aims to describe a functional rehabilitation protocol applied to a patient with COVID-19 after 21 days of mechanical ventilation (MV). We report a case of a 56-year-old female patient diagnosed with COVID-19 who presented severe hypoxemic respiratory failure, chronic critical disease, intensive care unit acquired weakness, difficult and prolonged weaning, organ dysfunction, and needed tracheotomy. The patient responded satisfactorily to a late functional rehabilitation protocol showing the importance of well-designed and individualized protocols to achieve maximum functional recovery.
Revista da Sociedade Brasileira de Medicina Tropical
Background: Chagas disease is gaining importance in the Brazilian Amazon region as a differential... more Background: Chagas disease is gaining importance in the Brazilian Amazon region as a differential diagnosis of febrile syndrome. The most recent microoutbreak occurred in Ipixuna, in Amazonas state. Methods: An epidemiological survey was conducted using parasitological and serological tests, and electrocardiographic analysis. Results: The patients belonged to one family and had ingested açaí acquired from Ipixuna. All patients reported fever and initially a thick blood smear test was done to identify Trypanosoma cruzi. Benznidazole treatment was administered to all patients. Conclusions: Knowledge of the epidemiological dynamics of Chagas disease allows us to improve control and management measures for this disease.
Alzheimer's & Dementia, 2020
Across Latin American and Caribbean countries (LACs), the fight against dementia faces pressing c... more Across Latin American and Caribbean countries (LACs), the fight against dementia faces pressing challenges, such as heterogeneity, diversity, political instability, and socioeconomic disparities. These can be addressed more effectively in a collaborative setting that fosters open exchange of knowledge. In this work, the Latin American and Caribbean Consortium on Dementia (LAC‐CD) proposes an agenda for integration to deliver a Knowledge to Action Framework (KtAF). First, we summarize evidence‐based strategies (epidemiology, genetics, biomarkers, clinical trials, nonpharmacological interventions, networking, and translational research) and align them to current global strategies to translate regional knowledge into transformative actions. Then we characterize key sources of complexity (genetic isolates, admixture in populations, environmental factors, and barriers to effective interventions), map them to the above challenges, and provide the basic mosaics of knowledge toward a KtAF. ...
International Journal of Infectious Diseases, 2021
To compare topical granulocyte and macrophage colony-stimulating factor (GM-CSF) and miltefosine ... more To compare topical granulocyte and macrophage colony-stimulating factor (GM-CSF) and miltefosine (G + M) versus placebo and miltefosine (P + M) or parenteral meglumine antimoniate (MA) in the treatment of 150 patients with cutaneous leishmaniasis (CL) caused by Leishmania guyanensis in the Amazon. Design: A randomized and double-blinded clinical trial. Results: At 90 days after the initiation of therapy, the cure rates were 66%, 58%, and 52% for the groups P + M, G + M, and MA, respectively (p > 0.05). Cure rates at 180 days did not differ. Healing time was similar in the 3 groups, but faster in the MA group as compared to the G + M group (p = 0.04). Mild and transitory systemic adverse events were frequent in all groups (above 85%). Nausea (85%) and vomiting (39%) predominated in the miltefosine groups and arthralgia (51%) and myalgia (48%) in the MA group. One patient (group MA) stopped treatment after presenting with fever, exanthema, and severe arthralgia. Conclusions: Miltefosine did not present a higher cure rate than MA, and the association of GM-CSF did not improve the therapeutic response. Nevertheless, because of its less toxicity, easier administration, and a similar cure rate when compared with MA, miltefosine should remain as one of the main drugs for treating CL due to L. guyanensis.
Revista da Sociedade Brasileira de Medicina Tropical, 2018
Cardiorenal syndrome type 1 (CRS 1) occurs when acute heart failure leads to acute kidney injury.... more Cardiorenal syndrome type 1 (CRS 1) occurs when acute heart failure leads to acute kidney injury. There are several etiologies of CRS 1, including Chagas disease. Here, we present the first case report of CRS 1 in a patient with acute Chagas disease. Electrocardiography, transthoracic echocardiography, and cardiac magnetic resonance imaging showed signs of acute myocarditis. Laboratory examination revealed severe loss of kidney function, with a creatinine clearance of 30 mL/min, which fully normalized after treatment. Due to emergence of Chagas disease in the Brazilian Amazon, it is important to report unique clinical features in order to improve patients' outcomes.
Emerging Infectious Diseases, 2018
In the Brazilian Amazon, the suspected source of infection in an outbreak of acute Chagas disease... more In the Brazilian Amazon, the suspected source of infection in an outbreak of acute Chagas disease involving 10 patients was Euterpe oleracea (açaí berry) juice. Patient blood and juice samples contained Trypanosoma cruzi TcIV, indicating oral transmission of the Chagas disease agent.
Anais Brasileiros de Dermatologia, 2015
Efficacy and safety of a single dose pentamidine (7mg/kg) for patients with cutaneous leishmanias... more Efficacy and safety of a single dose pentamidine (7mg/kg) for patients with cutaneous leishmaniasis caused by L. guyanensis: a pilot study *
Parasites & Vectors, 2014
Background: Chagas disease in the Amazon region is considered an emerging anthropozoonosis with a... more Background: Chagas disease in the Amazon region is considered an emerging anthropozoonosis with a predominance of the discrete typing units (DTUs) TcI and TcIV. These DTUs are responsible for cases of acute disease associated with oral transmission. Chronic disease cases have been detected through serological surveys. However, the mode of transmission could not be determined, or any association of chronic disease with a specific T. cruzi DTU's. The aim of this study was to characterize Trypanosoma cruzi in patients with chronic Chagas disease in the State of Amazonas, Brazil. Methods: Blood culture and xenodiagnosis were performed in 36 patients with positive serology for Chagas disease who participated in a serological survey performed in urban and rural areas of Manaus, Amazonas. DNA samples were extracted from the feces of triatomines used for xenodiagnosis, and the nontranscribed spacer of the mini-exon gene and the mitochondrial gene cytochrome oxidase subunit II (COII) were amplified by PCR and sequenced. Results: Blood culture and xenodiagnosis were negative in 100% of samples; however, molecular techniques revealed that in 13 out of 36 (36%) fecal samples from xenodiagnosis, T. cruzi was characterized as the DTU TcI, and different haplotypes were identified within the same DTU. Conclusion: The DTU TcI, which is mainly associated with acute cases of Chagas disease in the Amazon region, is also responsible for chronic infection in patients from a region in the State of Amazonas.
Revista do Instituto de Medicina Tropical de São Paulo, 2007
An open trial to evaluate the azithromycin efficacy in cutaneous leishmaniasis patients was carri... more An open trial to evaluate the azithromycin efficacy in cutaneous leishmaniasis patients was carried out in Manaus (AM), where Leishmania (Viannia) guyanensis is the main etiologic agent. Forty-one patients with skin lesions of less than 12 weeks duration, without specific treatment for the last three months and a positive imprint to Leishmania sp. were included. From these, 31 (75.6%) were male with median age of 30.2. All of them received a daily-single oral dose of 500 mg of azithromycin for ten days. At 25th day, 16 (39%) presented therapeutic failure and received intramuscular pentavalent antimonial, four were considered lost, 21, that had improved or were inaltered received another ten-day series of azithromycin and were monthly followed, but nine (21.9%) of them presented a poor clinical response and switched to intramuscular pentavalent antimonial on day 55. Of the 12 remaining cases evaluated on day 55, despite of clinical improvement, three asked for antimony therapy and 9 ...
PLoS Neglected Tropical Diseases, 2011
Background: Leishmania (Viannia) braziliensis is a parasite recognized as the most important etio... more Background: Leishmania (Viannia) braziliensis is a parasite recognized as the most important etiologic agent of mucosal leishmaniasis (ML) in the New World. In Amazonia, seven different species of Leishmania, etiologic agents of human Cutaneous Leishmaniasis, have been described. Isolated cases of ML have been described for several different species of Leishmania: L. (V.) panamensis, L. (V.) guyanensis and L. (L.) amazonensis. Methodology: Leishmania species were characterized by polymerase chain reaction (PCR) of tissues taken from mucosal biopsies of Amazonian patients who were diagnosed with ML and treated at the Tropical Medicine Foundation of Amazonas (FMTAM) in Manaus, Amazonas state, Brazil. Samples were obtained retrospectively from the pathology laboratory and prospectively from patients attending the aforementioned tertiary care unit. Results: This study reports 46 cases of ML along with their geographical origin, 30 cases caused by L. (V.) braziliensis and 16 cases by L. (V.) guyanensis. This is the first record of ML cases in 16 different municipalities in the state of Amazonas and of simultaneous detection of both species in 4 municipalities of this state. It is also the first record of ML caused by L. (V.) guyanensis in the states of Pará, Acre, and Rondô nia and cases of ML caused by L. (V.) braziliensis in the state of Rondô nia. Conclusions/Significance: L. (V.) braziliensis is the predominant species that causes ML in the Amazon region. However, contrary to previous studies, L. (V.) guyanensis is also a significant causative agent of ML within the region. The clinical and epidemiological expression of ML in the Manaus region is similar to the rest of the country, although the majority of ML cases are found south of the Amazon River.
Parasitology Research, 2010
In the State of Amazonas, American tegumentary leishmaniasis is endemic and presents a wide spect... more In the State of Amazonas, American tegumentary leishmaniasis is endemic and presents a wide spectrum of clinical variability due to the large diversity of circulating species in the region. Isolates from patients in Manaus and its metropolitan region were characterized using monoclonal antibodies and isoenzymes belonging to four species of the parasite: Leishmania (Viannia) guyanensis, 73% (153/ 209); Leishmania (Viannia) braziliensis, 14% (30/209); Leishmania (Leishmania) amazonensis, 8% (17/209); and Leishmania (Viannia) naiffii, 4% (9/209). The most prevalent species was L. (V.) guyanensis. The principal finding of this study was the important quantity of infections involving more than one parasite species, representing 14% (29/209) of the total. The findings obtained in this work regarding the parasite are further highlighted by the fact that these isolates were obtained from clinical samples collected from single lesions.
Anais Brasileiros de Dermatologia, 2011
FUNDAMENTOS: O tratamento da leishmaniose tegumentar americana (LTA) ainda constitui desafio, poi... more FUNDAMENTOS: O tratamento da leishmaniose tegumentar americana (LTA) ainda constitui desafio, pois a maioria dos medicamentos é injetável e têm-se poucos ensaios clínicos randomizados comparando a eficácia das drogas. Além disso, é provável que as espécies de Leishmania tenham influência nas respostas terapêuticas. OBJETIVOS: Avaliar e comparar a eficácia e a segurança dos esquemas de tratamento na LTA, ocasionada por Leishmania (Viannia) guyanensis. MÉTODOS: 185 pacientes foram selecionados, conforme critérios de elegibilidade, e distribuídos, aleatoriamente, em 3 grupos - 2 com 74 enfermos e outro com 37 - que receberam, respectivamente, antimoniato de meglumina, isotionato de pentamidina e anfotericina B em doses, períodos e vias de administração padronizados. Os enfermos foram reexaminados um, dois e seis meses após o final dos tratamentos. RESULTADOS: Não houve diferença entre os grupos terapêuticos em relação ao sexo, idade, número ou local das lesões. A análise por intenção d...
The American Journal of Tropical Medicine and Hygiene, 2011
Respiratory Care, Jul 7, 2020
BACKGROUND: Hyperoxygenation and hyperinflation, preferably with a mechanical ventilator, is the ... more BACKGROUND: Hyperoxygenation and hyperinflation, preferably with a mechanical ventilator, is the most commonly used technique to prevent the adverse effects of open endotracheal suctioning on arterial oxygenation and pulmonary volume. However, limited data are available on the effects of oxygen concentrations < 100% and PEEP with zero end-expiratory pressure (0 PEEP) to improve oxygenation and to maintain adequate ventilation during open endotracheal suctioning. The aim of this study was to analyze the behavior of S pO 2 and end-tidal CO 2 pressure (P ETCO 2) in open endotracheal suctioning using the 0 PEEP technique with baseline F IO 2 (0 PEEP baseline F IO 2) and 0 PEEP + hyperoxygenation of 20% above the baseline value (0 PEEP F IO 2 + 0.20) in critically ill subjects receiving mechanical ventilation. METHODS: This was a prospective, randomized, single-blind crossover study, for which 48 subjects with various clinical and surgical conditions were selected; of these, 38 subjects completed the study. The subjects were randomized for 2 interventions: 0 PEEP baseline F IO 2 and 0 PEEP F IO 2 + 0.20 during the open endotracheal suctioning procedure. Oxygenation was assessed via oxygen saturation as measured with pulse oximetry (S pO 2), and changes in lung were monitored via P ETCO 2 using volumetric capnography. RESULTS: In the intragroup analysis with 0 PEEP baseline F IO 2 , there was no significant increase after open endotracheal suctioning in either S pO 2 (P 5 .63) or P ETCO 2 (P 5 .11). With 0 PEEP F IO 2 + 0.20, there was a significant increase in S pO 2 (P < .001), with no significant changes in P ETCO 2 (P 5 .55). In the intergroup comparisons, there was a significant increase compared to the basal values only with the 0 PEEP + 0.20 method at 1 min after hyperoxygenation (P < .001), post-immediately (P < .001), at 1 min after (P < .001), and at 2 min after open endotracheal suctioning (P < .001). CONCLUSIONS: The appropriate indication of the hyperinflation strategy via mechanical ventilation using 0 PEEP with or without hyperoxygenation proved to be efficient to maintain S pO 2 and P ETCO 2 levels. These results suggest that the technique can minimize the loss of lung volume due to open endotracheal suctioning. (ClinicalTrials.gov registration NCT02440919).
Revista Ibero-Americana de Humanidades, Ciências e Educação, Jan 31, 2023
Research, Society and Development
The 2019 novel coronavirus (SARS-CoV-2) is the virus that causes COVID-19. It can cause severe il... more The 2019 novel coronavirus (SARS-CoV-2) is the virus that causes COVID-19. It can cause severe illness, with significant increase in morbidity and mortality rates, requiring the need for hospitalization and mechanical ventilation. This study aims to describe a functional rehabilitation protocol applied to a patient with COVID-19 after 21 days of mechanical ventilation (MV). We report a case of a 56-year-old female patient diagnosed with COVID-19 who presented severe hypoxemic respiratory failure, chronic critical disease, intensive care unit acquired weakness, difficult and prolonged weaning, organ dysfunction, and needed tracheotomy. The patient responded satisfactorily to a late functional rehabilitation protocol showing the importance of well-designed and individualized protocols to achieve maximum functional recovery.
Research, Society and Development, Mar 3, 2023
Outcomes of a functional rehabilitation protocol in chronic critical disease by COVID-19: A case ... more Outcomes of a functional rehabilitation protocol in chronic critical disease by COVID-19: A case report Desfechos de um protocolo de reabilitação funcional na doença crítica crônica por COVID-19: Relato de caso Resultados de un protocolo de rehabilitación funcional en enfermedad crítica crónica por COVID-19: Reporte de caso
Research, Society and Development
The 2019 novel coronavirus (SARS-CoV-2) is the virus that causes COVID-19. It can cause severe il... more The 2019 novel coronavirus (SARS-CoV-2) is the virus that causes COVID-19. It can cause severe illness, with significant increase in morbidity and mortality rates, requiring the need for hospitalization and mechanical ventilation. This study aims to describe a functional rehabilitation protocol applied to a patient with COVID-19 after 21 days of mechanical ventilation (MV). We report a case of a 56-year-old female patient diagnosed with COVID-19 who presented severe hypoxemic respiratory failure, chronic critical disease, intensive care unit acquired weakness, difficult and prolonged weaning, organ dysfunction, and needed tracheotomy. The patient responded satisfactorily to a late functional rehabilitation protocol showing the importance of well-designed and individualized protocols to achieve maximum functional recovery.