Maria Angélica Pires Ferreira - Academia.edu (original) (raw)

Papers by Maria Angélica Pires Ferreira

Brasil. O controle dos sintomas e prevenção de exacerbações são feitos por broncodilatadores e co... more Brasil. O controle dos sintomas e prevenção de exacerbações são feitos por broncodilatadores e corticoesteróides inalatórios, comumente administrados por nebulizador ou por sprays. Os métodos são igualmente eficazes, entretanto os sprays são mais custo-efetivos, contanto que a técnica de inalação utilizada esteja correta. A instrução e treinamento do paciente quanto à correta técnica inalatória durante internação possibilitaria o uso da medicação de forma mais efetiva. Assim, o presente estudo objetiva avaliar a técnica de uso dos sprays administrada pelo próprio paciente internado ou pelo responsável pelos cuidados do mesmo e verificar a freqüência e a qualidade da orientação a respeito da técnica de uso dos sprays durante a internação. População e Métodos: Estudo transversal com 100 pacientes (40 adultos e 60 pediátricos) internados, em utilização de broncodilatadores e/ou corticoesteróides inalatórios por spray, sendo excluídos aqueles com idade inferior a 5 anos, sedados, incapazes de informar, em ventilação mecânica e com traqueostomia. Os pacientes são identificados através de relatórios diários obtidos pelo sistema AGH. Dados de identificação e dados terapêuticos são coletados através dos prontuários. Duas visitas são realizadas aos pacientes, nas quais avalia-se a técnica inalatória na aplicação do spray e realiza-se entrevista sobre orientações na internação sobre a técnica inalatória. Resultados e conclusão: Até então foram avaliados os dados de 20 pacientes, entre os quais nenhum realizou a técnica de forma completamente correta. O erro mais comum foi a falta de coordenação inspiratória. Apenas metade dos pacientes recebeu orientação durante a internação sobre a técnica inalatória. Estudo ainda em andamento.

Revista Brasileira de Farmácia Hospitalar e Serviços de Saúde, 2020

Objectives: To describe the clinical and demographic profile of hospitalized patients undergoing ... more Objectives: To describe the clinical and demographic profile of hospitalized patients undergoing noinvasive ventilation (NIV) and/or tracheostomy (TQT) with prescription of the pressurized inhaler (pMDI) and the difficulties and interventions performed to adapt the inhalation technique. Methods: This is an observational, retrospective and descriptive study of a series of cases, carried out in three clinical units of a university hospital in the years 2017 and 2018. Results: We analyzed data from 25 patients who received NIV and/or TQT for whom guidance has been requested from the Inhalation Techniques Guidance and Training Group (GOTTI). Of these, 15 patients (60%) were using NIV, 5 (20%) were tracheostomized and 5 (20%) were tracheostomized with NIV. The difficulties identified in these patients were insecurity in removing the support, preference for nebulization, adaptation of the pMDI to the cannula and asynchrony between the jet firing and the beginning of inspiration. Conclusio...

Intrapulmonary vascular dilatations (IPVD) are the most common pulmonary vascular abnormality and... more Intrapulmonary vascular dilatations (IPVD) are the most common pulmonary vascular abnormality and the main cause of acute hypoxemia in patients with severe liver disease. The association of liver disease, increased alveolar-arterial oxygen gradient and IPVD is known as "hepatopulmonary syndrome". The chief aim of this study was to determine whether IPVD levels, as determined by contrast echocardiography, are related to intrapulmonary shunt intensity, as measured by Tc-99m MAA scintigraphy and by 100% oxygen gasometry. Twenty-eight IPVD patients, all candidates for liver transplant, were studied. IPVD were identified using echocardiography and graded on the semiquantitative scale (levels I to IV). The mean age was 47.5 years. Liver disease was classified as Child-Pugh B in 60.7% of cases. IPVD intensity was classified as level I, II, III and IV in 13 (46.4%), 9 (32.1%), 2 (7.1%) and 4 (14.3%) cases, respectively. Of the 28 patients, shunt intensity was determined using both scintigraphy and gasometry in 21 patients (75%), by scintigraphy only in 6 (21.4%) and by gasometry only in 1 (21.4%). Mean PaO 2 was 89.1 ± 11.0mmHg among level I and II patients and 74.7 ± 13.2mmHg among level III and IV patients (p = 0.01). The mean shunt by scintigraphy was 14.9 ± 9.0% of cardiac output (minimum 6.9% and maximum 39%), being 11.7 ± 3.8% among level I and II patients and 26.3 ± 9.7% among level III and IV patients (p = 0.01). The mean shunt by gasometry was 9.8 ± 3.9%, being 8.3 ± 2.3% among level I and II patients and 16.3 ± 2.6% among level III and IV patients (p < 0.001). There was a significative correlation between IPVD level and shunt intensity: r s = 0.609; p < 0.01 by gasometry and r s = 0.567; p < 0.001 by scintigraphy. In those patients undergoing both tests, a significant relation was found between shunt intensity as measured by scintigraphy and by gasometry: r s = 0.666; p < 0.001. Hypoxemic individuals had significantly higher levels of intrapulmonary vascular dilatation than did nonhypoxemic individuals. Semiquantitative evaluation of IPVD level showed moderate to good correlation with shunt intensity under each of the two methods used, with the better correlation being found under 100% oxygen gasometry.

Bloqueadores da bomba de prótons (BBP) são considerados os inibidores mais eficazes da acidez gás... more Bloqueadores da bomba de prótons (BBP) são considerados os inibidores mais eficazes da acidez gástrica, substituindo os inibidores H2 (IH2) em grande parte das situações clínicas. Há evidências de uso indiscriminado de BBPs, levando a discussões quanto à segurança e custos para os pacientes e sistema de saúde. Não foi demonstrada superioridade dos BBPs sobre IH2 para todas as situações clínicas e há evidências de que a supressão ácida está associada a efeitos adversos como pneumonia, anemia por deficiência de vitamina B12 e infecções por Clostridium difficille. Objetivos: Avaliar o perfil de uso de omeprazol intravenoso (IV) em pacientes internados em hospital universitário, observando adesão às recomendações de uso (adesão ao protocolo institucional), indicações, esquemas posológicos e formas farmacêuticas empregadas. Material e métodos: Estudo transversal, após introdução do protocolo. Avaliados pacientes internados que usaram omeprazol IV. Cento e dois cursos de omeprazol foram avaliados. Resultados e conclusão: Análise parcial, até o momento, dos pacientes tratados após a implantação do protocolo mostrou que tempo de uso médio foi de 6,3 dias (DP 4,6), sendo recomendado o uso por até 72 horas ou enquanto NPO. As indicações mais freqüentes de uso foram hemorragia digestiva alta (32,4%), úlcera péptica (8,8%), prevenção de úlcera péptica (8,8%). Em 63,7% dos casos foi encontrada uma indicação não prevista nas recomendações de uso. A indicação de supressão ácida com BBP foi encontrada em 66,7% dos casos; enquanto a adequação da via IV e da posologia foram vistos em apenas 28,4% e 44,1%. Quarenta e três pacientes (42,1%) tinham indicação adequada e usaram a dose correta. Adesão é parcial, sendo os maiores problemas relacionados ao esquema de administração.

ObjectiveChagas disease (CD) continues to be a major public health burden in Latina America, wher... more ObjectiveChagas disease (CD) continues to be a major public health burden in Latina America, where co-infection with SARS-CoV-2 can occur. However, information on the interplay between COVID-19 and Chagas disease is lacking. Our aim was to assess clinical characteristics and in-hospital outcomes of patients with CD and COVID-19, and to compare it to non-CD patients.MethodsPatients with COVID-19 diagnosis were selected from the Brazilian COVID-19 Registry, a prospective multicenter cohort, from March to September, 2020. CD diagnosis was based on hospital record at the time of admission. Study data were collected by trained hospital staff using Research Electronic Data Capture (REDCap) tools. Genetic matching for sex, age, hypertension, DM and hospital was performed in a 4:1 ratio.ResultsOf the 7,018 patients who had confirmed infection with SARS-CoV-2 in the registry, 31 patients with CD and 124 matched controls were included. Overall, the median age was 72 (64.-80) years-old and 44....

Clinical and Biomedical Research, 2011

Introduction: Direct costs for treating Guillain-Barré Syndrome (GBS) represent a significant fin... more Introduction: Direct costs for treating Guillain-Barré Syndrome (GBS) represent a significant financial burden to public hospitals. Few studies compared the cost of plasma exchange (PE) treatment with human intravenous immunoglobulin (IVIg). Objectives: To compare the cost of two therapies for GBS: IVIg and PE. Secondary objective was to evaluate compliance to IVIg prescription guidelines of the Pharmacy and Therapeutics Committee (PTC). Methods: A cross-sectional study included 25 patients with GBS admitted in a university affiliated hospital from June, 2003 through June, 2008. The costs of IVIg (n=20) and PE (n=5) were evaluated through the cost minimization method, considering direct medical costs yield by the management of the institution. Patients receiving treatments other than PE or IVIg were excluded. Data were collected by medical records review. Clinical endpoint was disability on discharge, established by the 7-point scale of Hughes. Compliance to the PTC guidelines was e...

Background Previous studies that assessed risk factors for venous thromboembolism (VTE) in COVID-... more Background Previous studies that assessed risk factors for venous thromboembolism (VTE) in COVID-19 patients have shown inconsistent results. Our aim was to investigate VTE predictors by both logistic regression (LR) and machine learning (ML) approaches, due to their potential complementarity. Methods This substudy of a large Brazilian COVID-19 Registry included COVID-19 adult patients from 16 hospitals. Symptomatic VTE was confirmed by objective imaging. LR analysis, tree-based boosting and bagging were used to investigate the association of variables upon hospital presentation with VTE. Results Among 4,120 patients (55·5% men, 39·3% critical patients), VTE was confirmed in 6·7%. In multivariate LR analysis, obesity (OR 1·50, 95%CI 1·11-2·02); being an ex-smoker (OR 1·44, 95%CI 1·03-2·01); surgery ≤ 90 days (OR 2·20, 95%CI 1·14-4·23); axillary temperature (OR 1·41, 95%CI 1·22-1·63); D-dimer ≥ 4 times above the upper limit of reference value (OR 2·16, 95%CI 1·26-3·67), lactate (OR 1...

International Journal of Infectious Diseases

Objectives The majority of available scores to assess mortality risk of coronavirus disease 19 (C... more Objectives The majority of available scores to assess mortality risk of coronavirus disease 19 (COVID-19) patients in the emergency department have high risk of bias. Therefore, our aim was to develop and validate a score at hospital admission for predicting in-hospital mortality in COVID-19 patients, and to compare this score with other existing ones. Methods Consecutive patients (≥18 years) with confirmed COVID-19 admitted to the participating hospitals were included. Logistic regression analysis was performed to develop a prediction model for in-hospital mortality, based on the 3978 patients admitted between March-July, 2020. The model was validated in the 1054 patients admitted during August-September, as well as in an external cohort of 474 Spanish patients. Results Median (25th-75th percentile) age of the model-derivation cohort was 60 (48-72) years, and in-hospital mortality was 20.3%. The validation cohorts had similar age distribution and in-hospital mortality. Seven significant variables were included in the risk score: age, blood urea nitrogen, number of comorbidities, C-reactive protein, SpO2/FiO2 ratio, platelet count and heart rate. The model had high discriminatory value (AUROC 0.844, 95% CI 0.829 to 0.859), which was confirmed in the Brazilian (0.859 [95% CI 0.833 to 0.885]) and Spanish (0.894 [95% CI 0.870 to 0.919]) validation cohorts, and displayed better discrimination ability than other existing scores. It is implemented in a freely available online risk calculator (https://abc2sph.com/). Conclusions We designed and validated an easy-to-use rapid scoring system based on characteristics of COVID-19 patients commonly available at hospital presentation, for early stratification for in-hospital mortality risk of patients with COVID-19.

Molecular Genetics and Metabolism

Menkes disease is a rare X-linked neurodegenerative disorder caused by defect in copper metabolis... more Menkes disease is a rare X-linked neurodegenerative disorder caused by defect in copper metabolism. Parenteral copper supplementation has been used as a potential disease-modifying treatment of Menkes disease for decades. However, recent evidence suggests its efficacy only when treatment is started within days after birth, which also has important implications related to the techniques that enable early diagnosis. We aim at proposing a guideline for prenatal and neonatal diagnosis and for disease-modifying treatment of Menkes disease, guided by a systematic review of the literature, and built in conjunction with medical experts, methodologists and patient representatives. Thirteen articles were used for our recommendations that were based on GRADE system. Reviewed evidence suggests that prenatal genetic diagnosis in families with previous diagnosis of Menkes disease is feasible; analysis of plasma catecholamine levels is accurate for neonatal diagnosis of Menkes disease; treatment with copper-histidine is effective to increase survival and reduce neurologic burden of the disease if initiated in the neonatal period; and, treatment indication should not be guided by patient's genotype. In conclusion, our guideline can contribute to standardize some aspects of the clinical care of patients with Menkes disease, especially reducing disease burden and mortality and providers' and families' anxiety.

British Journal of Clinical Pharmacology, 2016

Rev Hcpa Fac Med Univ Fed Rio Gd Do Sul, 2011

Revista do Instituto de Medicina Tropical de Sao Paulo, 2021

Respiratory syncytial virus (RSV) is the main cause of lower respiratory disease in infants and c... more Respiratory syncytial virus (RSV) is the main cause of lower respiratory disease in infants and children under five years of age. As there is no specific treatment for RSV infections, prophylaxis with the specific monoclonal antibody palivizumab (PVZ) has been widely recommended for high-risk cases during the RSV season. The present study aimed to evaluate the effectiveness of a public prophylaxis program with palivizumab on the incidence of hospitalizations for lower respiratory tract infections and RSV in children at high risk for severe RSV infections. A retrospective cohort study was carried out with preterm children or children under two years of age with chronic lung disease or hemodynamically significant congenital heart disease; the children were selected on the basis of their exposure status, which was defined as the prophylactic use of palivizumab during the RSV season. Children were enrolled retrospectively in two hospitals located in Southern Brazil, from May 2009 to Aug...

Clinical & Biomedical Research