MARIO CICERO FALCAO | Universidade de São Paulo (original) (raw)

Papers by MARIO CICERO FALCAO

Revista do Hospital das Clínicas, Dec 1, 1999

Chronic lung disease (CLD) results from the effects of positive pressure ventilation on a structu... more Chronic lung disease (CLD) results from the effects of positive pressure ventilation on a structurally and functionally immature lung. Chorioamnionitis and an inflammatory cascade have also been implicated in the pathogenesis of CLD, but their precise role is uncertain. CLD is characterised primarily by prolonged need for ventilatory support, O2 requirements, need for home oxygen and readmission with respiratory illness in the first year of life. CLD was in the past defined as oxygen requirements beyond 28 days with abnormal xray 1. However, a more meaningful definition in the current era is respiratory support (supplemental oxygen or CPAP in air) beyond 36 weeks post-conceptual age 2 , which will be used in this document. The pathological condition of bronchopulmonary dysplasia (BPD) is frequently used interchangeably with CLD. Pathologists can recognize changes in the lungs of infants soon after birth including airway epithelial necrosis and squamous metaplasia, organisation of hyaline membranes, and fibroblastic proliferation in the lung interstitium. This leads to eventual lung fibrosis and emphysematous changes. Risk Factors Perinatal-Controversial Chorioamnionitis ± umbilical vasculitis (CAM). There is a widely held belief that CAM is associated with an increased risk of CLD, with review articles stating it as if an established fact 3,4,5,6. Evidence for this belief is largely based on the paper by Watterberg et al 7 who reported on 53 ventilated babies <2000 grams from the late 1980's who received neither antenatal steroids nor surfactant replacement, and two other small studies 8, 9. However, babies who develop CLD in the current era are generally a different population, being mainly <28 weeks GA, and receiving both antenatal steroids and surfactant, and experiencing much less mechanical ventilation. Recent studies, with babies more typical of the current era, found that there was either no increase in CLD following CAM 10,11,12,13 , or that CAM was associated with a reduced incidence of CLD 14,15. Recent research in this department 16a showed that chorioamnionitis alone (OR 0.49, CI 0.31-0.78), or chorioamnionitis plus vasculitis (OR 0.23, CI 0.15-0.25) dramatically reduce the odds of RDS, and therefore the need for and severity of ventilation. It was thus counter-intuitive that CAM would be the cause of worse CLD, and in a further study 16b we have shown that after adjusting for confounders, chorioamnionitis plus vasculitis remains protective of CLD (OR 0.57 CI 0.34-0.96). However, chorioamnionitis alone is also protective (OR 0.69 CI 0.39-1.23) but not significantly. These findings combined with those above 14,15 cast serious doubt on the assertion that CAM is a risk factor for CLD. Perinatal-Definite Gestational Age. This is the primary risk factor, and is well demonstrated by data from this Unit in the Figure below. Low birth weight percentile. At each week of gestation, there is a stepwise increase in risk for lower birth weight percentile categories 17,18,19. Male gender 17,19

Nutricion Hospitalaria, May 1, 2007

Objective: Analyze the importance of biochemical data and their relationship with anthropometric ... more Objective: Analyze the importance of biochemical data and their relationship with anthropometric data in the longitudinal nutritional assessment of very low birth weight infants. Methods: A prospective cohort study was performed on 55 very low birth weight preterm infants (birth weight < 1.500 g and < 37 weeks of gestational age). Measurements of weight, length, head and mid-arm circumferences, mid-arm circumference: head circumference ratio, ponderal index, and body mass index. Serum prealbumin and retinol-binding protein were studied as biochemical parameters. All variables were collected at birth and days 14 and 28 of life. Results: The infants presented a mean birth weight of 1,076.7 ± 286 g and mean gestational age of 30.7 ± 2.1 weeks. At birth, the mean serum prealbumin was 7.0 ± 1.7 mg/dl and mean retinol-binding protein was 1.3 ± 0.4 mg/dl. There was a significant increase in all variables studied from birth to day 28. According to nutritional adequacy, there were no differences between appropriate and small for gestational age infants neither in the anthropometric nor in the biochemical data. The anthropometric measurements did not correlate with biochemical parameters. The serum protein concentrations were converted to serum protein mass (SPM) as follows: SPM = serum protein concentration X (100 X weight) X (1-hematocrit)] since the studied proteins are largely intravascular and the protein mass would be a more accurate index of nutritional status. The SPM of both protein and anthropometric parameters were correlated, except for the ponderal index. Conclusions: The serum protein mass of the prealbumin and the retinol-binding protein were better nutritio

Nutricion Hospitalaria, 2010

This study aims to analyze the superior artery bloodflow in healthy premature neonates with birth... more This study aims to analyze the superior artery bloodflow in healthy premature neonates with birth weightbetween 1,000 g and 1,500 g, on the first and seventhdays of live.It is a prospective cohort study, including 15 prema-ture neonates with mean weight of 1,243g ± 173.6 (ran-ging from 1,000 to 1,495 g). Exclusion criteria were:unstable hemodynamic conditions; assisted ventilationwith high parameters; large deformations or clinicalsyndromes; feeding intolerance; necrotizing enteroco-litis; and conditions those alter the mesenteric flow:phototherapy, umbilical catheters, patient ductus arte-riosus and sepsis.The Doppler velocimetric examination was done bya 8 MHz imaging transducer, and the pulsed color Dop-pler readings were obtained by sonographic waves at 4MHz. The neonate was kept in a supine position, withthe transducer positioned in the epigastric region,immediately below the xyphoid appendix, obtainingtwo dimensional images of the celiac trunk and of thesuperior mesenteric art...

Revista do Hospital das Clínicas, 2000

Revista do Hospital das Clínicas, 2000

We are commemorating the 500 years, which have past since the discovery of Brazil. I confess, I f... more We are commemorating the 500 years, which have past since the discovery of Brazil. I confess, I felt delighted when I saw the 'Letter of Discovery' in which Pero Vaz de Caminha, on the 1 st of May 1500, tells D. Manuel, King of Portugal, about the discovery of the new territory. The objective of this brief introduction is to emphasize the importance of communication in the History of Humanity, from the rudimentary printing press of Gutemberg, to the modern press, the telegraph, telephone, radio and television, ending with computer communication through Internet. Up-to-date information is fundamental for the growth of Humanity. The necessity to update information runs parallel to the velocity with which this information is available to us. The evolution of the communication network is leading to the globalization of information. The means available today to access this information is without doubt the Internet. As a result of the constant additions of propedeutic and thera

Arquivos Brasileiros de Cardiologia, 2010

Jornal Brasileiro De Pneumologia, Aug 31, 2021

einstein (São Paulo)

To relate omphalocele and biliary atresia and investigate possible embryological correlations tha... more To relate omphalocele and biliary atresia and investigate possible embryological correlations that justify the simultaneous occurrence. A female preterm newborn diagnosed as omphalocele; cesarean delivery, weight 2,500g, 46 XX karyotype. Initially, the newborn remained fasting and on parenteral nutrition, and enteral diet was introduced later, with good acceptance. On the 12 th day of life, the newborn presented direct hyperbilirubinemia, increased levels of liver enzymes and fecal acholia, with a presumptive diagnosis of biliary atresia. However, the ultrasound was inconclusive, due to anatomical changes resulting from omphalocele. A surgical approach was chosen on the 37 th day of life aiming to confirm diagnosis of biliary atresia and to repair omphalocele. During the surgical procedure, structural alterations compatible with biliary atresia were observed, later confirmed by pathological examination; a hepatoportoenterostomy was performed and the omphalocele was corrected. She evolved well in the postoperative period, with a decrease in direct bilirubin and liver enzymes, as well as resolution of fecal acholia, and was discharged in good clinical condition. This is a bizarre and extremely rare association, but the prognosis may be good when an early diagnosis is made and surgery performed, besides support and clinical management to prevent complications in the perioperative period. Although the pathogenesis of the diseases has not been fully defined yet, there is, to date, no direct relation between them. The association between omphalocele and biliary atresia is extremely uncommon, with only two published cases.

Revista de Fisioterapia Centro Universitário. UniFMU, 2003

Ciencia Animal Brasileira, Oct 15, 2008

Corneal sequestrum is an affliction of cats, which is not well defined. The lesion is characteriz... more Corneal sequestrum is an affliction of cats, which is not well defined. The lesion is characterized by degeneration of collagen, followed by accumulation in the cornea of a darkened pigment of variable intensity. Various treatments are adopted taking into account the depth and stage of the lesion, where lamellar keratectomy is the option most often taken. In the present work, four cases are described of Persian breed cats afflicted with corneal se-questrum, that were submitted to lamellar keratectomy followed by third eyelid flap or conjunctival pedicle flap, and afterward treated topically with the aqueous extract of Triticum vulgare (Bandvet ®), without adverse effects. The results obtained showed that Bandvet ® , despite that it is a pharmaceutical not for ophthalmic use, can be employed in cats after superficial keratectomy.

The Breast Journal, 2003

The Breast Journal, Volume 9, Number 6, 2003 503–504 Address correspondence and reprint requests ... more The Breast Journal, Volume 9, Number 6, 2003 503–504 Address correspondence and reprint requests to: Ruffo de Freitas, Jr., MD, Avenida T-04 no. 835, Apto. 901, St. Bueno, Goiânia/GO, CEP 74230-030, Brazil, or email: ruffo@medicina.ufg.br. Blackwell Publishing Ltd. Oxford, UK TBJ he Breast Journal 1075-122X 2 03 Blackwel Publishing November/December 2003 96 riginal Artic e G ade III Dermatitis with Paclitaxel and Radiotherapy de r it s et al. Grade III Dermatitis in a Patient Treated with Paclitaxel and Radiotherapy

Jornal Vascular Brasileiro

The aim of this study was to report on use of ethanol lock in long-term catheters in newborns wit... more The aim of this study was to report on use of ethanol lock in long-term catheters in newborns with severe intestinal dysfunction, dependent on total and prolonged parenteral nutrition, in a Neonatal Intensive Care Center (tertiary level), between 2015 and 2020. Six infants (0.65%) out of the 914 admitted during the period met the inclusion criteria. The median age at catheter placement was 121.5 days. Two Powerpicc (PICC Power Sinergy™, São Paulo), one Groshong (Groshong™ Central Venous Catheter BD, São Paulo), and three silicone catheters were used, all tunneled, and the median dwell duration was 182.5 days. Four patients had at least one episode of infection related to the central venous catheter, and Gram-positive, Gram-negative, and fungal agents were isolated. The median length of hospital stay was 555 days and mortality was 33.3%. The ethanol lock did not cause any side effects and was relatively effective in preventing infections related to the central venous catheter.

Jornal Vascular Brasileiro

Resumo O objetivo deste estudo foi relatar o uso de lock de etanol na profilaxia infecciosa de ca... more Resumo O objetivo deste estudo foi relatar o uso de lock de etanol na profilaxia infecciosa de cateteres venosos de longa permanência em recém-nascidos com disfunção intestinal grave e dependentes de nutrição parenteral total e prolongada, internados em um Centro de Terapia Intensiva Neonatal (nível terciário) entre 2015 e 2020. Das 914 admissões, seis (0,65%) recém-nascidos preencheram os critérios de inclusão. A mediana da idade da passagem do cateter foi de 121,5 dias, sendo dois cateteres PowerPicc (PICC Power Sinergy™, São Paulo), um cateter Groshong (Groshong™ Central Venous Catheter BD, São Paulo) e três cateteres de silicone, todos tunelizados. O tempo de permanência apresentou mediana de 182,5 dias. Cinco pacientes apresentaram pelo menos um episódio de infecção associada ao cateter venoso central, sendo isolados agentes Gram-positivos, negativos e fungos. A mediana de dias de internação foi de 555, e a mortalidade, 33,3%. O lock de etanol não apresentou efeitos colaterais ...

Revista do Hospital das Clínicas, Dec 1, 1999

Chronic lung disease (CLD) results from the effects of positive pressure ventilation on a structu... more Chronic lung disease (CLD) results from the effects of positive pressure ventilation on a structurally and functionally immature lung. Chorioamnionitis and an inflammatory cascade have also been implicated in the pathogenesis of CLD, but their precise role is uncertain. CLD is characterised primarily by prolonged need for ventilatory support, O2 requirements, need for home oxygen and readmission with respiratory illness in the first year of life. CLD was in the past defined as oxygen requirements beyond 28 days with abnormal xray 1. However, a more meaningful definition in the current era is respiratory support (supplemental oxygen or CPAP in air) beyond 36 weeks post-conceptual age 2 , which will be used in this document. The pathological condition of bronchopulmonary dysplasia (BPD) is frequently used interchangeably with CLD. Pathologists can recognize changes in the lungs of infants soon after birth including airway epithelial necrosis and squamous metaplasia, organisation of hyaline membranes, and fibroblastic proliferation in the lung interstitium. This leads to eventual lung fibrosis and emphysematous changes. Risk Factors Perinatal-Controversial Chorioamnionitis ± umbilical vasculitis (CAM). There is a widely held belief that CAM is associated with an increased risk of CLD, with review articles stating it as if an established fact 3,4,5,6. Evidence for this belief is largely based on the paper by Watterberg et al 7 who reported on 53 ventilated babies <2000 grams from the late 1980's who received neither antenatal steroids nor surfactant replacement, and two other small studies 8, 9. However, babies who develop CLD in the current era are generally a different population, being mainly <28 weeks GA, and receiving both antenatal steroids and surfactant, and experiencing much less mechanical ventilation. Recent studies, with babies more typical of the current era, found that there was either no increase in CLD following CAM 10,11,12,13 , or that CAM was associated with a reduced incidence of CLD 14,15. Recent research in this department 16a showed that chorioamnionitis alone (OR 0.49, CI 0.31-0.78), or chorioamnionitis plus vasculitis (OR 0.23, CI 0.15-0.25) dramatically reduce the odds of RDS, and therefore the need for and severity of ventilation. It was thus counter-intuitive that CAM would be the cause of worse CLD, and in a further study 16b we have shown that after adjusting for confounders, chorioamnionitis plus vasculitis remains protective of CLD (OR 0.57 CI 0.34-0.96). However, chorioamnionitis alone is also protective (OR 0.69 CI 0.39-1.23) but not significantly. These findings combined with those above 14,15 cast serious doubt on the assertion that CAM is a risk factor for CLD. Perinatal-Definite Gestational Age. This is the primary risk factor, and is well demonstrated by data from this Unit in the Figure below. Low birth weight percentile. At each week of gestation, there is a stepwise increase in risk for lower birth weight percentile categories 17,18,19. Male gender 17,19

Nutricion Hospitalaria, May 1, 2007

Objective: Analyze the importance of biochemical data and their relationship with anthropometric ... more Objective: Analyze the importance of biochemical data and their relationship with anthropometric data in the longitudinal nutritional assessment of very low birth weight infants. Methods: A prospective cohort study was performed on 55 very low birth weight preterm infants (birth weight < 1.500 g and < 37 weeks of gestational age). Measurements of weight, length, head and mid-arm circumferences, mid-arm circumference: head circumference ratio, ponderal index, and body mass index. Serum prealbumin and retinol-binding protein were studied as biochemical parameters. All variables were collected at birth and days 14 and 28 of life. Results: The infants presented a mean birth weight of 1,076.7 ± 286 g and mean gestational age of 30.7 ± 2.1 weeks. At birth, the mean serum prealbumin was 7.0 ± 1.7 mg/dl and mean retinol-binding protein was 1.3 ± 0.4 mg/dl. There was a significant increase in all variables studied from birth to day 28. According to nutritional adequacy, there were no differences between appropriate and small for gestational age infants neither in the anthropometric nor in the biochemical data. The anthropometric measurements did not correlate with biochemical parameters. The serum protein concentrations were converted to serum protein mass (SPM) as follows: SPM = serum protein concentration X (100 X weight) X (1-hematocrit)] since the studied proteins are largely intravascular and the protein mass would be a more accurate index of nutritional status. The SPM of both protein and anthropometric parameters were correlated, except for the ponderal index. Conclusions: The serum protein mass of the prealbumin and the retinol-binding protein were better nutritio

Nutricion Hospitalaria, 2010

This study aims to analyze the superior artery bloodflow in healthy premature neonates with birth... more This study aims to analyze the superior artery bloodflow in healthy premature neonates with birth weightbetween 1,000 g and 1,500 g, on the first and seventhdays of live.It is a prospective cohort study, including 15 prema-ture neonates with mean weight of 1,243g ± 173.6 (ran-ging from 1,000 to 1,495 g). Exclusion criteria were:unstable hemodynamic conditions; assisted ventilationwith high parameters; large deformations or clinicalsyndromes; feeding intolerance; necrotizing enteroco-litis; and conditions those alter the mesenteric flow:phototherapy, umbilical catheters, patient ductus arte-riosus and sepsis.The Doppler velocimetric examination was done bya 8 MHz imaging transducer, and the pulsed color Dop-pler readings were obtained by sonographic waves at 4MHz. The neonate was kept in a supine position, withthe transducer positioned in the epigastric region,immediately below the xyphoid appendix, obtainingtwo dimensional images of the celiac trunk and of thesuperior mesenteric art...

Revista do Hospital das Clínicas, 2000

Revista do Hospital das Clínicas, 2000

We are commemorating the 500 years, which have past since the discovery of Brazil. I confess, I f... more We are commemorating the 500 years, which have past since the discovery of Brazil. I confess, I felt delighted when I saw the 'Letter of Discovery' in which Pero Vaz de Caminha, on the 1 st of May 1500, tells D. Manuel, King of Portugal, about the discovery of the new territory. The objective of this brief introduction is to emphasize the importance of communication in the History of Humanity, from the rudimentary printing press of Gutemberg, to the modern press, the telegraph, telephone, radio and television, ending with computer communication through Internet. Up-to-date information is fundamental for the growth of Humanity. The necessity to update information runs parallel to the velocity with which this information is available to us. The evolution of the communication network is leading to the globalization of information. The means available today to access this information is without doubt the Internet. As a result of the constant additions of propedeutic and thera

Arquivos Brasileiros de Cardiologia, 2010

Jornal Brasileiro De Pneumologia, Aug 31, 2021

einstein (São Paulo)

To relate omphalocele and biliary atresia and investigate possible embryological correlations tha... more To relate omphalocele and biliary atresia and investigate possible embryological correlations that justify the simultaneous occurrence. A female preterm newborn diagnosed as omphalocele; cesarean delivery, weight 2,500g, 46 XX karyotype. Initially, the newborn remained fasting and on parenteral nutrition, and enteral diet was introduced later, with good acceptance. On the 12 th day of life, the newborn presented direct hyperbilirubinemia, increased levels of liver enzymes and fecal acholia, with a presumptive diagnosis of biliary atresia. However, the ultrasound was inconclusive, due to anatomical changes resulting from omphalocele. A surgical approach was chosen on the 37 th day of life aiming to confirm diagnosis of biliary atresia and to repair omphalocele. During the surgical procedure, structural alterations compatible with biliary atresia were observed, later confirmed by pathological examination; a hepatoportoenterostomy was performed and the omphalocele was corrected. She evolved well in the postoperative period, with a decrease in direct bilirubin and liver enzymes, as well as resolution of fecal acholia, and was discharged in good clinical condition. This is a bizarre and extremely rare association, but the prognosis may be good when an early diagnosis is made and surgery performed, besides support and clinical management to prevent complications in the perioperative period. Although the pathogenesis of the diseases has not been fully defined yet, there is, to date, no direct relation between them. The association between omphalocele and biliary atresia is extremely uncommon, with only two published cases.

Revista de Fisioterapia Centro Universitário. UniFMU, 2003

Ciencia Animal Brasileira, Oct 15, 2008

Corneal sequestrum is an affliction of cats, which is not well defined. The lesion is characteriz... more Corneal sequestrum is an affliction of cats, which is not well defined. The lesion is characterized by degeneration of collagen, followed by accumulation in the cornea of a darkened pigment of variable intensity. Various treatments are adopted taking into account the depth and stage of the lesion, where lamellar keratectomy is the option most often taken. In the present work, four cases are described of Persian breed cats afflicted with corneal se-questrum, that were submitted to lamellar keratectomy followed by third eyelid flap or conjunctival pedicle flap, and afterward treated topically with the aqueous extract of Triticum vulgare (Bandvet ®), without adverse effects. The results obtained showed that Bandvet ® , despite that it is a pharmaceutical not for ophthalmic use, can be employed in cats after superficial keratectomy.

The Breast Journal, 2003

The Breast Journal, Volume 9, Number 6, 2003 503–504 Address correspondence and reprint requests ... more The Breast Journal, Volume 9, Number 6, 2003 503–504 Address correspondence and reprint requests to: Ruffo de Freitas, Jr., MD, Avenida T-04 no. 835, Apto. 901, St. Bueno, Goiânia/GO, CEP 74230-030, Brazil, or email: ruffo@medicina.ufg.br. Blackwell Publishing Ltd. Oxford, UK TBJ he Breast Journal 1075-122X 2 03 Blackwel Publishing November/December 2003 96 riginal Artic e G ade III Dermatitis with Paclitaxel and Radiotherapy de r it s et al. Grade III Dermatitis in a Patient Treated with Paclitaxel and Radiotherapy

Jornal Vascular Brasileiro

The aim of this study was to report on use of ethanol lock in long-term catheters in newborns wit... more The aim of this study was to report on use of ethanol lock in long-term catheters in newborns with severe intestinal dysfunction, dependent on total and prolonged parenteral nutrition, in a Neonatal Intensive Care Center (tertiary level), between 2015 and 2020. Six infants (0.65%) out of the 914 admitted during the period met the inclusion criteria. The median age at catheter placement was 121.5 days. Two Powerpicc (PICC Power Sinergy™, São Paulo), one Groshong (Groshong™ Central Venous Catheter BD, São Paulo), and three silicone catheters were used, all tunneled, and the median dwell duration was 182.5 days. Four patients had at least one episode of infection related to the central venous catheter, and Gram-positive, Gram-negative, and fungal agents were isolated. The median length of hospital stay was 555 days and mortality was 33.3%. The ethanol lock did not cause any side effects and was relatively effective in preventing infections related to the central venous catheter.

Jornal Vascular Brasileiro

Resumo O objetivo deste estudo foi relatar o uso de lock de etanol na profilaxia infecciosa de ca... more Resumo O objetivo deste estudo foi relatar o uso de lock de etanol na profilaxia infecciosa de cateteres venosos de longa permanência em recém-nascidos com disfunção intestinal grave e dependentes de nutrição parenteral total e prolongada, internados em um Centro de Terapia Intensiva Neonatal (nível terciário) entre 2015 e 2020. Das 914 admissões, seis (0,65%) recém-nascidos preencheram os critérios de inclusão. A mediana da idade da passagem do cateter foi de 121,5 dias, sendo dois cateteres PowerPicc (PICC Power Sinergy™, São Paulo), um cateter Groshong (Groshong™ Central Venous Catheter BD, São Paulo) e três cateteres de silicone, todos tunelizados. O tempo de permanência apresentou mediana de 182,5 dias. Cinco pacientes apresentaram pelo menos um episódio de infecção associada ao cateter venoso central, sendo isolados agentes Gram-positivos, negativos e fungos. A mediana de dias de internação foi de 555, e a mortalidade, 33,3%. O lock de etanol não apresentou efeitos colaterais ...