46 results on '"Hohl, Alexandre"'
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2. 2023 UPDATE: Luso-Brazilian evidence-based guideline for the management of antidiabetic therapy in type 2 diabetes
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Bertoluci, Marcello Casaccia, Silva Júnior, Wellington S., Valente, Fernando, Araujo, Levimar Rocha, Lyra, Ruy, de Castro, João Jácome, Raposo, João Filipe, Miranda, Paulo Augusto Carvalho, Boguszewski, Cesar Luiz, Hohl, Alexandre, Duarte, Rui, Salles, João Eduardo Nunes, Silva-Nunes, José, Dores, Jorge, Melo, Miguel, de Sá, João Roberto, Neves, João Sérgio, Moreira, Rodrigo Oliveira, Malachias, Marcus Vinícius Bolívar, Lamounier, Rodrigo Nunes, Malerbi, Domingos Augusto, Calliari, Luis Eduardo, Cardoso, Luis Miguel, Carvalho, Maria Raquel, Ferreira, Hélder José, Nortadas, Rita, Trujilho, Fábio Rogério, Leitão, Cristiane Bauermann, Simões, José Augusto Rodrigues, dos Reis, Mónica Isabel Natal, Melo, Pedro, Marcelino, Mafalda, and Carvalho, Davide
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- 2023
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3. Fezolinetant for the treatment of vasomotor symptoms associated with menopause: a meta-analysis.
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Chavez, Matheus Pedrotti, Pasqualotto, Eric, Ferreira, Rafael Oliva Morgado, Hohl, Alexandre, de Moraes, Francisco Cezar Aquino, Schmidt, Pedro Henrique Siedschlag, Rodrigues, Anna Luíza Soares de Oliveira, and de Sa, Joao Roberto
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SLEEP interruptions ,MENOPAUSE ,POSTMENOPAUSE ,RANDOMIZED controlled trials ,QUALITY of life - Abstract
Copyright of Climacteric is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2024
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4. Effects of Bariatric Surgery in Male Obesity-Associated Hypogonadism
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Rigon, Fernanda Augustini, Ronsoni, Marcelo Fernando, Hohl, Alexandre, and van de Sande-Lee, Simone
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- 2019
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5. Chronic Metabolic Derangement-Induced Cognitive Deficits and Neurotoxicity Are Associated with REST Inactivation
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Remor, Aline Pertile, da Silva, Rodrigo Augusto, de Matos, Filipe José, Glaser, Viviane, de Paula Martins, Roberta, Ghisoni, Karina, da Luz Scheffer, Débora, Andia, Denise Carleto, Portinho, Daniele, de Souza, Ana Paula, de Oliveira, Paulo Alexandre, Prediger, Rui Daniel, Torres, Alicia I., Linhares, Rose Marie Mueller, Walz, Roger, Ronsoni, Marcelo Fernando, Hohl, Alexandre, Rafacho, Alex, Aguiar, Jr, Aderbal Silva, De Paul, Ana Lucia, and Latini, Alexandra
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- 2019
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6. Portuguese-Brazilian evidence-based guideline on the management of hyperglycemia in type 2 diabetes mellitus
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Bertoluci, Marcello Casaccia, Salles, João Eduardo Nunes, Silva-Nunes, José, Pedrosa, Hermelinda Cordeiro, Moreira, Rodrigo Oliveira, da Silva Duarte, Rui Manuel Calado, da Costa Carvalho, Davide Mauricio, Trujilho, Fábio Rogério, dos Santos Raposo, João Filipe Cancela, Parente, Erika Bezerra, Valente, Fernando, de Moura, Fábio Ferreira, Hohl, Alexandre, Melo, Miguel, Araujo, Francisco Garcia Pestana, de Araújo Principe, Rosa Maria Monteiro Castro, Kupfer, Rosane, Costa e Forti, Adriana, Valerio, Cynthia Melissa, Ferreira, Hélder José, Duarte, João Manuel Sequeira, Saraiva, José Francisco Kerr, Rodacki, Melanie, Castelo, Maria Helane Costa Gurgel, Monteiro, Mariana Pereira, Branco, Patrícia Quadros, de Matos, Pedro Manuel Patricio, de Melo Pereira de Magalhães, Pedro Carneiro, Betti, Roberto Tadeu Barcellos, Réa, Rosângela Roginski, Trujilho, Thaisa Dourado Guedes, Pinto, Lana Catani Ferreira, and Leitão, Cristiane Bauermann
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- 2020
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7. Fezolinetant for VMS: a balanced view on efficacy and safety needed – author's reply.
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Chavez, Matheus Pedrotti, Pasqualotto, Eric, Ferreira, Rafael Oliva Morgado, Hohl, Alexandre, de Moraes, Francisco Cezar Aquino, Schmidt, Pedro Henrique Siedschlag, Rodrigues, Anna Luíza Soares de Oliveira, and de Sa, Joao Roberto
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ENDOMETRIAL cancer ,POSTMENOPAUSE ,HORMONE therapy ,DISEASE risk factors ,PATIENT monitoring - Abstract
This document is a reply to comments made on a previous article about the use of fezolinetant for treating vasomotor symptoms associated with menopause. The US Food and Drug Administration (FDA) investigated the potential increased risk of neoplasms (abnormal growth of tissue) with fezolinetant and found that while there was an apparent dose-response for malignancy, there were no consistent patterns related to drug exposure duration, body system, or cancer type. The authors of the reply acknowledge the increased incidence of neoplasms in patients treated with fezolinetant, but they argue that comparing the data between the fezolinetant and placebo groups with unequal follow-up durations may lead to skewed conclusions. They recommend additional long-term safety studies and close monitoring of patients using fezolinetant to make better-informed decisions about managing menopause symptoms. [Extracted from the article]
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- 2024
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8. Mitochondrial Respiration Chain Enzymatic Activities in the Human Brain: Methodological Implications for Tissue Sampling and Storage
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Ronsoni, Marcelo Fernando, Remor, Aline Pertile, Lopes, Mark William, Hohl, Alexandre, Troncoso, Iris H. Z., Leal, Rodrigo Bainy, Boos, Gustavo Luchi, Kondageski, Charles, Nunes, Jean Costa, Linhares, Marcelo Neves, Lin, Kátia, Latini, Alexandra Susana, and Walz, Roger
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- 2016
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9. Plasma levels of oxidative stress biomarkers and hospital mortality in severe head injury: A multivariate analysis
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Hohl, Alexandre, Gullo, Jackson da Silva, Silva, Cláudia Carvalho Pestana, Bertotti, Melina Moré, Felisberto, Francine, Nunes, Jean Costa, de Souza, Bruna, Petronilho, Fabricia, Soares, Flávia Mahatma Schneider, Prediger, Rui Daniel Schroder, Dal-Pizzol, Felipe, Linhares, Marcelo Neves, and Walz, Roger
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- 2012
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10. Posttraumatic Amnesia and Personality Changes after Severe Traumatic Brain Injury: Preliminary Findings
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Diaz, Alexandre P., Schwarzbold, Marcelo L., Guarnieri, Ricardo, de Oliveira Thais, Maria Emília R., Hohl, Alexandre, Nunes, Jean C., Linhares, Marcelo N., Schroder Prediger, Rui D., and Walz, Roger
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- 2014
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11. Brain MAPKs Levels are Differentially Associated with Seizures Threshold and Severity Progression in Pentylenetetrazole-Kindled Mice
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Ben, Juliana, Gonçalves, Filipe Marques, Oliveira, Paulo Alexandre, Peres, Tanara Vieira, Hohl, Alexandre, Leal, Rodrigo Bainy, Cavalheiro, Esper Abrão, Prediger, Rui Daniel Schroder, and Walz, Roger
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- 2013
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12. Plasma Levels of Oxidative Stress Biomarkers and Long-Term Cognitive Performance after Severe Head Injury
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de Oliveira Thais, Maria Emília Rodrigues, Cavallazzi, Gisele, Schwarzbold, Marcelo Liborio, Diaz, Alexandre Paim, Ritter, Cristiane, Petronilho, Fabrícia, Hohl, Alexandre, Prediger, Rui D. S., Linhares, Marcelo Neves, Pizzol, Felipe Dal, and Walz, Roger
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- 2012
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13. Cardiovascular safety of naltrexone and bupropion therapy: Systematic review and meta‐analyses.
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Sposito, Andrei C., Bonilha, Isabella, Luchiari, Beatriz, Benchimol, Alexander, Hohl, Alexandre, Moura, Fabio, Cercato, Cíntia, Geloneze, Bruno, Nadruz, Wilson, Aguilar‐Salinas, Carlos, and Carvalho, Luiz Sergio F.
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BUPROPION ,NALTREXONE ,SMOKING cessation ,CARDIOVASCULAR diseases risk factors ,WEIGHT loss - Abstract
Summary: Despite being approved for clinical use, evidence of cardiovascular safety (CV) is lacking for treatment with bupropion, naltrexone, or their combination (B‐N). The purpose of the study is to determine the relationship between these treatments and the risk of major cardiovascular adverse events (MACE). Phase 3 randomized clinical trials (RCT) evaluating bupropion, naltrexone, or B‐N versus control with reported incidence of MACE. The meta‐analysis included 12 RCTs, 69% for weight loss and 29% for smoking cessation, with 19,176 patients and 7354 patient‐years who were randomized to an active treatment (bupropion [n = 2965] or B‐N [n = 6980] or naltrexone [n = 249]) versus control (placebo [n = 6968] or nicotine patch [n = 2014]). The mean age was 54 ± 8 years (55% female), and the baseline BMI was 32 ± 5 kg/m2. The additive network meta‐analysis model for random effects showed no association between bupropion, B‐N, or naltrexone and MACE (odds ratio [OR] = 0.90 [95%CI 0.65–1.25], p = 0.52; OR = 0.97 [95%CI 0.75–1.24], p = 0.79; OR = 1.08 [95%CI 0.71–1.63], p = 0.73, respectively; I2 = 0%, p = 0.86). Meta‐regression analyses showed no significant association between MACE and potential confounders from RCT demographic disparities (p = 0.58). The statistical power (post hoc two‐tailed) for non‐inferiority was 91%, giving a strong probability of validity. Naltrexone, bupropion, or B‐N is not associated with the incidence of MACE as compared with placebo. [ABSTRACT FROM AUTHOR]
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- 2021
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14. Effect of whole body vibration on clinical and metabolic outcomes in adults with type 2 diabetes: an observational pilot trial.
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Michels, Manuella de L Please confirm that given names (blue) and surnames/family names (vermilion) have been identified correctly. -->, Spivakoski, Camila S, Réus, Bruna da S, Alves, Débora M dos S, Mattje, Priscila ND, Hohl, Alexandre, Ronsoni, Marcelo F, and Sande‐Lee, Simone
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- 2021
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15. Bariatric surgery‐induced weight loss in patients with and without type 2 diabetes mellitus.
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Carvalho, Thatiany A., Ronsoni, Marcelo F., Hohl, Alexandre, and Sande‐Lee, Simone
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- 2020
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16. Luteinizing Hormone and Testosterone Levels during Acute Phase of Severe Traumatic Brain Injury: Prognostic Implications for Adult Male Patients.
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Hohl, Alexandre, Zanela, Fernando Areas, Ghisi, Gabriela, Ronsoni, Marcelo Fernando, Diaz, Alexandre Paim, Schwarzbold, Marcelo Liborio, Dafre, Alcir Luiz, Reddi, Benjamin, Lin, Kátia, Pizzol, Felipe Dal, and Walz, Roger
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LUTEINIZING hormone ,TESTOSTERONE ,BRAIN injuries - Abstract
Traumatic brain injury (TBI) is a worldwide core public health problem affecting mostly young male subjects. An alarming increase in incidence has turned TBI into a leading cause of morbidity and mortality in young adults as well as a tremendous resource burden on the health and welfare sector. Hormone dysfunction is highly prevalent during the acute phase of severe TBI. In particular, investigation of the luteinizing hormone (LH) and testosterone levels during the acute phase of severe TBI in male has identified a high incidence of low testosterone levels in male patients (36.5-100%) but the prognostic significance of which remains controversial. Two independent studies showed that normal or elevated levels of LH levels earlier during hospitalization are significantly associated with higher mortality/morbidity. The association between LH levels and prognosis was independent of other predictive variables such as neuroimaging, admission Glasgow coma scale, and pupillary reaction. The possible mechanisms underlying this association and further research directions in this field are discussed. Overall, current data suggest that LH levels during the acute phase of TBI might contribute to accurate prognostication and further prospective multicentric studies are required to develop more sophisticated predictive models incorporating biomarkers such as LH in the quest for accurate outcome prediction following TBI. Moreover, the potential therapeutic benefits of modulating LH during the acute phase of TBI warrant investigation. [ABSTRACT FROM AUTHOR]
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- 2018
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17. Brazilian guidelines on prevention of cardiovascular disease in patients with diabetes: a position statement from the Brazilian Diabetes Society (SBD), the Brazilian Cardiology Society (SBC) and the Brazilian Endocrinology and Metabolism Society (SBEM).
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Bertoluci, Marcello Casaccia, Moreira, Rodrigo Oliveira, Faludi, André, Izar, Maria Cristina, Schaan, Beatriz D., Valerio, Cynthia Melissa, Bertolami, Marcelo Chiara, Chacra, Ana Paula, Bolivar Malachias, Marcus Vinicius, Vencio, Sérgio, Kerr Saraiva, José Francisco, Betti, Roberto, Turatti, Luiz, Helfenstein Fonseca, Francisco Antonio, Bianco, Henrique Tria, Sulzbach, Marta, Bertolami, Adriana, Nunes Salles, João Eduardo, Hohl, Alexandre, and Trujilho, Fábio
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CARDIOVASCULAR disease prevention ,DIABETES prevention ,DIABETES risk factors ,PLATELET aggregation inhibitors ,ENDOCRINOLOGISTS - Abstract
Background: Since the first position statement on diabetes and cardiovascular prevention published in 2014 by the Brazilian Diabetes Society, the current view on primary and secondary prevention in diabetes has evolved as a result of new approaches on cardiovascular risk stratification, new cholesterol lowering drugs, and new anti-hyperglycemic drugs. Importantly, a pattern of risk heterogeneity has emerged, showing that not all diabetic patients are at high or very high risk. In fact, most younger patients who have no overt cardiovascular risk factors may be more adequately classified as being at intermediate or even low cardiovascular risk. Thus, there is a need for cardiovascular risk stratification in patients with diabetes. The present panel reviews the best current evidence and proposes a practical riskbased approach on treatment for patients with diabetes. Main body: The Brazilian Diabetes Society, the Brazilian Society of Cardiology, and the Brazilian Endocrinology and Metabolism Society gathered to form an expert panel including 28 cardiologists and endocrinologists to review the best available evidence and to draft up-to-date an evidence-based guideline with practical recommendations for risk stratification and prevention of cardiovascular disease in diabetes. The guideline includes 59 recommendations covering: (1) the impact of new anti-hyperglycemic drugs and new lipid lowering drugs on cardiovascular risk; (2) a guide to statin use, including new definitions of LDL-cholesterol and in non-HDL-cholesterol targets; (3) evaluation of silent myocardial ischemia and subclinical atherosclerosis in patients with diabetes; (4) hypertension treatment; and (5) the use of antiplatelet therapy. Conclusions: Diabetes is a heterogeneous disease. Although cardiovascular risk is increased in most patients, those without risk factors or evidence of sub-clinical atherosclerosis are at a lower risk. Optimal management must rely on an approach that will cover both cardiovascular disease prevention in individuals in the highest risk as well as protection from overtreatment in those at lower risk. Thus, cardiovascular prevention strategies should be individualized according to cardiovascular risk while intensification of treatment should focus on those at higher risk. [ABSTRACT FROM AUTHOR]
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- 2017
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18. 388 - Chronic Hyperglycemia Promotes Hippocampal REST Epigenetic Gene Inactivation with Cognitive Impairment and Neurotoxicity
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Remor, Aline Pertile, da Silva, Rodrigo Augusto, de Matos, Filipe José, Glaser, Viviane, Portinho, Daniele, Carleto Andia, Denise, de Souza, Ana Paula, Rafacho, Alex, de Oliveira, Paulo Alexandre, Prediger, Rui Daniel Schröder, Torres, Alicia, Hohl, Alexandre, Aguiar Jr, Aderbal, Paul, Ana Lucia De, and Latini, Alexandra
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- 2016
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19. DESFECHOS METABÓLICOS DE PACIENTES SUBMETIDOS A BYPASS GÁSTRICO EM Y DE ROUX EM UM HOSPITAL UNIVERSITÁRIO.
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Becker, Tatiana Scheuer, Ronsoni, Marcelo Fernando, Hohl, Alexandre, and van de Sande-Lee, Simone
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Copyright of Clinical & Biomedical Research is the property of Clinical & Biomedical Research and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2014
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20. Hypercalcemia and acute renal insufficiency following use of a veterinary supplement.
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Ronsoni, Marcelo Fernando, de Cassia dos Santos, Heloisa, da Silveira Colombo, Bruno, Correa, Carina Gabriela, Gomes Moritz, Ana Paula, Cesar Coral, Marisa Helena, van de Sande- Lee, Simone, and Hohl, Alexandre
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- 2017
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21. Role of hormonal levels on hospital mortality for male patients with severe traumatic brain injury.
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Hohl, Alexandre, Ronsoni, Marcelo Fernando, Debona, Rodrigo, Ben, Juliana, Schwarzbold, Marcelo Liborio, Diaz, Alexandre Paim, Thais, Maria Emília Rodrigues de Oliveira, Linhares, Marcelo Neves, Latini, Alexandra, Prediger, Rui Daniel, Pizzol, Felipe Dal, and Walz, Roger
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BRAIN injury diagnosis , *BRAIN injuries , *CONFIDENCE intervals , *DEMOGRAPHY , *FOLLICLE-stimulating hormone , *HORMONES , *HOSPITAL patients , *HOSPITALS , *HYDROCORTISONE , *LONGITUDINAL method , *LUTEINIZING hormone , *EVALUATION of medical care , *DEATH rate , *PHARMACOLOGY , *SERIAL publications , *THYROTROPIN , *U-statistics , *HUMAN growth hormone , *ACUTE diseases , *ODDS ratio - Abstract
Introduction: Changes in hormone blood levels during the acute phase of traumatic brain injury (TBI) have been described in the literature. The objective was to investigate the association among several hormones plasma levels in the acute phase of severe TBI and the hospital mortality rate of male patients. Methods: The independent association among plasma levels of TSH, LH, FSH, GH, free T4, cortisol, IGF-1 and total testosterone was measured 10 hours and 30 hours after severe TBI and the hospital mortality of 60 consecutive male patients was evaluated. Results: At least one hormonal level abnormality was demonstrated in 3.6-73.1% of patients. The multiple logistic regressions showed a trend for an independent association among hospital mortality and normal or elevated LH levels measured at 10 hours (OR = 3.7, 95% CI = 0.8-16.3, p = 0.08) and 30 hours (OR = 3.9, 95% CI = 0.9-16.7, p = 0.06). Admission with abnormal pupils and a lower Glasgow Coma Score also were independently associated with hospital mortality. Conclusion: The hormonal changes are frequent in the acute phase of severe TBI. The hormones plasma levels, excepting the LH, are not highly consistent with the hospital mortality of male patients. [ABSTRACT FROM AUTHOR]
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- 2014
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22. Limited predictive power of hospitalization variables for long-term cognitive prognosis in adult patients with severe traumatic brain injury.
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Oliveira Thais, Maria Emília Rodrigues, Cavallazzi, Gisele, Formolo, Douglas Afonso, Castro, Lucas D'Ávila, Schmoeller, Roseli, Guarnieri, Ricardo, Schwarzbold, Marcelo Liborio, Diaz, Alexandre Paim, Hohl, Alexandre, Prediger, Rui D. S., Mader, Maria Joana, Linhares, Marcelo Neves, Staniloiu, Angelica, Markowitsch, Hans J., and Walz, Roger
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BRAIN injuries ,PATIENTS ,COGNITION disorders ,HOSPITAL care ,MILD cognitive impairment ,RETROSPECTIVE studies ,NEUROPSYCHOLOGICAL tests ,HEALTH outcome assessment ,DISEASE management ,PROGNOSIS - Abstract
Objectives Traumatic brain injury ( TBI) is a main cause of mortality and morbidity. Association studies between hospitalization variables and cognitive impairment after TBI are frequently retrospective, including non-consecutive patients showing variable degrees of TBI severity, and poor management of missing (drop out) cases. Methods We assessed prospectively the demographic and hospitalization variables of 234 consecutive patients with severe TBI (admission Glasgow Coma Scale [ GCS] ≤8) and determined their independent association with cognitive performance in a representative sample ( n = 46) of surviving patients ( n = 172) evaluated 3 (±1.8) years after hospitalization. Results In all, 85% of patients were male and the mean age was 34 ( SD ±13) years. The education level was 9 (±4.7) years. As expected, education and age showed a moderately to strong linear relationship with the cognitive performance in 14 of 15 neuropsychological tests ( R coefficient = 0.6-0.8). The cognitive test scores were not independently associated with gender, admission GCS, associated trauma, and Marshal CT classification. Admission-elevated blood glucose levels and the presence of sub-arachnoid haemorrhage were independently associated with lower scores on Rey Auditory Verbal Learning retention and Logical Memory-I tests, respectively. Conclusions After correction for education and age distribution, the variables that are commonly associated with mortality or Glasgow Outcome Scale including admission pupils' examination, Marshal CT Classification, GCS, and serum glucose showed a limited predictive power for long-term cognitive prognosis. Identification of clinical, radiological, and laboratory variables as well as new biomarkers independently associated with cognitive outcome remains an important challenge for further work involving severe TBI patients. [ABSTRACT FROM AUTHOR]
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- 2014
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23. Linagliptin: farmacology, efficacy and safety in type 2 diabetes treatment.
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Guedes, Erika Paniago, Hohl, Alexandre, De Melo, Thais Gomes, and Lauand, Felipe
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TYPE 2 diabetes treatment , *DRUG efficacy , *GLYCOSYLATED hemoglobin , *BLOOD sugar , *CD26 antigen , *PHARMACOKINETICS - Abstract
Type 2 diabetes mellitus (T2DM) has a high prevalence and incidence around the world. The complex pathophysiology mechanism is among the barriers for diabetes treatment. Type 2 diabetes patients have dysfunction in incretin hormones (as glucagon-like peptide-1 or GLP-1, and glucose-dependent insulinotropic polypeptide or GIP). By inhibiting the dipeptidyl peptidase-4 (DPP-4) enzyme, it is possible to slow the inactivation of GLP-1 and GIP, promoting blood glucose level reduction in a glucose-dependent manner. Linagliptin is a highly specific and potent inhibitor of DPP-4 that is currently indicated for the treatment of type 2 diabetes. Clinical studies with linagliptin demonstrated efficacy in reducing glycated hemoglobin (HbA1c) levels in type 2 diabetes patients, while maintaining a placebo-like safety and tolerability profile. Linagliptin has an interesting pharmacokinetic profile in terms of its predominantly non-renal elimination and the main implication of this characteristic is that no dose adjustment is necessary in patients with renal disease. Also, no dose adjustment is required in patients with hepatic insufficiency, as well in elderly or obese patients. This article will review the pharmacokinetic profile, efficacy data and safety aspects of linagliptin in type 2 diabetes patients. [ABSTRACT FROM AUTHOR]
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- 2013
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24. Interleukin-10 Is an Independent Biomarker of Severe Traumatic Brain Injury Prognosis.
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Schneider Soares, Flávia Mahatma, Menezes de Souza, Nicole, Libório Schwarzbold, Marcelo, Paim Diaz, Alexandre, Costa Nunes, Jean, Hohl, Alexandre, Nunes Abreu da Silva, Priscilla, Vieira, Juliana, Lisboa de Souza, Rafael, Moré Bertotti, Melina, Schoder Prediger, Rui Daniel, Neves Linhares, Marcelo, Bafica, André, and Walz, Roger
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Background: Cytokines have been shown to be involved in traumatic brain injury (TBI). We investigated the independent association between serum levels of IL-10 and TNF-α and hospital mortality of patients with severe TBI. Methods: Serum IL-10 and TNF-α levels were determined after a median period (interquartile range (IQ) 25-75) of 10 h (IQ 5-18) after severe TBI in 93 consecutive patients and in randomly selected patients with mild (n = 18) and moderate (n = 16) TBI. In patients with severe TBI, additional blood samples were analyzed 30 h (IQ 22-37) and 68 h (IQ 55-78) after TBI. Age, gender, computed tomography findings, Glasgow Coma Scale score (GCS) and pupil reactions at admission, associated trauma and hospital mortality were collected. Results: Elevated serum levels of IL-10, but not TNF-α, correlated significantly with GCS severity (R
2 coefficient, p < 0.0001) and were found to be associated with hospital mortality in patients with severe TBI. Elevated IL-10 remained associated with mortality (p = 0.01) in a subset of patients with isolated severe TBI (n = 74). Multiple logistic regression analysis showed that higher IL-10 levels (>90 pg/ml) at 10 or 30 h after TBI were 6 times (odds ratio (OR) 6.2, 95% confidence interval (CI) 1.2-25.1, p = 0.03) and 5 times (OR 5.4, 95% CI 1.2-25.1, p = 0.03), respectively, more frequently associated with hospital mortality than lower levels (<50 pg/ml), independently of age, GCS as well as pupil reactions at admission and associated trauma. Conclusions: Serum IL-10 levels may be a useful marker for severe TBI prognosis. Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]- Published
- 2012
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25. Psychiatric disorders and traumatic brain injury.
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Schwarzbold, Marcelo, Diaz, Alexandre, Martins, Evandro Tostes, Rufino, Armanda, Amante, Lúcia Nazareth, Thais, Maria Emília, Quevedo, João, Hohl, Alexandre, Linhares, Marcelo Neves, and Walz, Roger
- Published
- 2008
26. Plasma Levels of Oxidative Stress Biomarkers and Long-Term Cognitive Performance after Severe Head Injury.
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Thais, Maria Emília Rodrigues de Oliveira, Cavallazzi, Gisele, Schwarzbold, Marcelo Liborio, Diaz, Alexandre Paim, Ritter, Cristiane, Petronilho, Fabrícia, Hohl, Alexandre, Prediger, Rui D. S., Linhares, Marcelo Neves, Pizzol, Felipe Dal, and Walz, Roger
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BLOOD plasma ,OXIDATIVE stress ,BIOMARKERS ,HEAD injuries ,COGNITIVE ability ,LETTERS to the editor - Published
- 2012
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27. How predictable is the erectile function of patients with epilepsy?
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de Faria Vieira, Fábio Cavalcanti, Ronsoni, Marcelo Fernando, Hohl, Alexandre, Claudino, Lúcia Sukis, Diaz, Alexandre Paim, Schwarzbold, Marcelo Libório, Guarnieri, Ricardo, Nunes, Jean Costa, Lin, Kátia, and Walz, Roger
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TREATMENT of sexual dysfunction , *IMPOTENCE , *PEOPLE with epilepsy , *TARGETED drug delivery , *HORMONES , *PREDICTION models - Abstract
Introduction Erectile dysfunction (ED) is often reported by patients with epilepsy and may be related to endocrine system abnormalities, side effects of antiepileptic drugs, psychiatric comorbidities, and family or social difficulties. Aims This study aimed to identify independent predictor factors for ED in patients with epilepsy. Main outcome measures the five-question form of the International Index of Erectile Function (IIEF-5). Methods Independent predictive factors for ED evaluated by the IIEF-5 questionnaire in 36 patients (mean age: 39 years) with focal epilepsy (mean: 6 seizures/month) were identified by multiple linear regression analysis. Results Eight (21.1%) patients were asymptomatic. Among the symptomatic patients, 11 (28.9%) had mild dysfunction, 10 (26.3%) had moderate dysfunction, and 9 (23.7%) showed severe ED. The multiple linear regression model including family income (B = 0.005; p = 0.05), education levels in years (B = 0.54; p = 0.03), depressive symptoms determined by HADS depression subscale (B = − 0.49; p = 0.03), and prolactin levels (B = − 0.45; p = 0.07) showed a moderate association (r = 0.64) with the IIEF questionnaire and explained 41% (r 2 = 0.41) of its variation. Conclusions Erectile dysfunction is highly prevalent in patients with focal epilepsies. Education, depressive symptoms, and prolactin levels can predict erectile dysfunction in up to 41% of patients with epilepsy. This preliminary report justifies further efforts to make a large sample size study to identify independent biomarkers and therapeutic targets for ED treatment in patients with epilepsy. [ABSTRACT FROM AUTHOR]
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- 2015
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28. Validity and screening properties of three depression rating scales in a prospective sample of patients with severe traumatic brain injury.
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Schwarzbold, Marcelo L., Diaz, Alexandre P., Nunes, Jean C., Sousa, Daniel S., Hohl, Alexandre, Guarnieri, Ricardo, Linhares, Marcelo N., and Walz, Roger
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BRAIN injuries , *RECEIVER operating characteristic curves , *MEDICAL screening , *NEUROBEHAVIORAL disorders - Abstract
Objective: To evaluate the validity and utility of the Hamilton Rating Scale for Depression (HAM-D), Beck Depression Inventory (BDI), and Hospital Anxiety and Depression Scale (HADS) as screening tools for depression after severe traumatic brain injury (TBI). Methods: Forty-six consecutive survivors of severe TBI were evaluated at a median of 15 months after injury. Receiver operating characteristic (ROC) analysis was performed using HAM-D, BDI, and HADS as predictors, and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) as gold standard. Results: The area under the curve (AUC) for HAM-D was 0.89, and the optimal cutoff point was 7 (sensitivity 92.9%, specificity 78.1%); for the BDI, the AUC was 0.946 and the optimal cutoff point was 14 (sensitivity 92.3%, specificity 96.7%); for the HADS, the AUC was 0.947 and the optimal cutoff point was 9 (sensitivity 100%, specificity 80.7%); and for the HADS depression subscale, the AUC was 0.937 and the optimal cutoff point was 6 (sensitivity 92.9%, specificity 83.9%). There were no statistically significant differences among the AUCs. Conclusion: Our findings support a high validity and utility for the HAM-D, BDI, and HADS as screening tools for depression in patients with severe TBI, without major changes in standard cutoff points. [ABSTRACT FROM AUTHOR]
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- 2014
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29. Personality changes and return to work after severe traumatic brain injury: a prospective study.
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Diaz, Alexandre P., Schwarzbold, Marcelo L., Thais, Maria E., Cavallazzi, Gisele G., Schmoeller, Roseli, Nunes, Jean C., Hohl, Alexandre, Guarnieri, Ricardo, Linhares, Marcelo N., and Walz, Roger
- Subjects
- *
BRAIN injuries , *RETURN to work programs , *HOSPITAL care , *INDUSTRIAL safety ,PSYCHIATRIC research - Abstract
Objective: To evaluate predictors of non-return to work (nRTW) among social, demographic, clinical, and psychiatric variables after severe traumatic brain injury (TBI) in a cohort of Brazilian patients. Methods: Prospective study. Forty-three community-dwelling individuals treated at a Level I trauma center at the time of TBI were evaluated 18 months after trauma. Measures included DSM-IV-TR criteria for personality changes after TBI and Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) to assess psychiatric diagnosis. Hospitalization variables included Glasgow Coma Scale scores, pupil examination findings, associated limb trauma, Marshall computed tomography classification, and blood glucose levels. Results: After multiple logistic regression analysis, only the diagnosis of personality changes was found to be independently associated with nRTW, with an adjusted odds ratio of 10.92 (p = 0.02, 95% confidence interval 1.41-84.28). Conclusions: In this study, personality changes were an independent predictor of nRTW after severe TBI. Ways to predict risk factors associated with personality changes after severe brain injury could aid in identification of early and effective interventions that might ease the burden associated with this condition. [ABSTRACT FROM AUTHOR]
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- 2014
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30. Differential effects of insulin on peripheral diabetes-related changes in mitochondrial bioenergetics: Involvement of advanced glycosylated end products
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Remor, Aline Pertile, de Matos, Filipe José, Ghisoni, Karina, da Silva, Thiago Lenoir, Eidt, Greici, Búrigo, Marília, de Bem, Andreza Fabro, Silveira, Paulo César Lock, de León, Andrés, Sanchez, Maria Cecilia, Hohl, Alexandre, Glaser, Viviane, Gonçalves, Carlos-Alberto, Quincozes-Santos, André, Borba Rosa, Rafael, and Latini, Alexandra
- Subjects
- *
BIOENERGETICS , *GLYCOSYLATION , *CLINICAL trials , *TREATMENT of diabetes , *LABORATORY rats , *STREPTOZOTOCIN , *CARDIOTONIC agents , *OXIDATIVE stress - Abstract
Abstract: Large scale clinical trials have demonstrated that an intensive antihyperglycemic treatment in diabetes mellitus (DM) in individuals reduces the incidence of micro- and macrovascular complications, e.g. nephropathy, retinopathy, DM-accelerated atherosclerosis, myocardial infarction, or limb amputations. Here, we investigated the effect of short- and long-term insulin administration on mitochondrial function in peripheral tissues of streptozotocin (STZ)-induced hyperglycemic rats. In addition, the in vitro effect of methylglyoxal (MG), advanced glycation end products (AGEs) and human diabetic plasma on mitochondrial activity was investigated in skeletal muscle and liver mitochondria and in rat skin primary fibroblasts. Hyperglycemic STZ rats showed tissue-specific patterns of energy deficiency, evidenced by reduced activities of complexes I, II and/or IV after 30days of hyperglycemia in heart, skeletal muscle and liver; moreover, cardiac tissue was found to be the most sensitive to the diabetic condition, since energy metabolism was impaired after 10days of the hyperglycemia. Insulin-induced tight glycemic control was effective in protecting against the hyperglycemia-induced inhibition of mitochondrial enzyme activities. Furthermore, the long-term hormone replacement (30days) also increased these activities in kidney from STZ-treated animals, where the hyperglycemic state did not modify the electron transport activity. Results from in vitro experiments indicate that mitochondrial impairment could result from oxidative stress-induced accumulation of MG and/or AGEs. Further investigations demonstrated that human plasma AGE accumulation elicits reduced mitochondrial function in skin fibroblast. These data suggest that persistent hyperglycemia results in tissue-specific patterns of energy deficiency and that early and continuous insulin therapy is necessary to maintain proper mitochondrial metabolism. [Copyright &y& Elsevier]
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- 2011
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31. Intermittently Scanned Continuous Glucose Monitoring Performance in Patients With Liver Cirrhosis.
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Rigon FA, Ronsoni MF, Hohl A, Vianna AGD, Sande-Lee SV, and Schiavon LL
- Abstract
Aim: To evaluate the use of intermittently scanned continuous glucose monitoring (isCGM) in patients with liver cirrhosis (LC)., Methods: Observational study including 30 outpatients with LC (Child-Pugh B/C): 10 without diabetes (DM) (G1), 10 with newly diagnosed DM by oral glucose tolerance test (G2), and 10 with a previous DM diagnosis (G3). isCGM (FreeStyle Libre Pro) was used for 56 days (four sensors/patient). Blood tests were performed at baseline and after 28 and 56 days., Results: No differences were found in the baseline characteristics, except for higher age in G3. There were significant differences between G1, G2 and G3 in glucose management indicator (GMI) (5.28 ± 0.17, 6.03 ± 0.59, 6.86 ± 1.08%, P < .001), HbA1c (4.82 ± 0.39, 5.34 ± 1.26, 6.97 ± 1.47%, P < .001), average glucose (82.79 ± 7.06, 113.39 ± 24.32, 149.14 ± 45.31mg/dL, P < .001), time in range (TIR) (70.89 ± 9.76, 80.2 ± 13.55, 57.96 ± 17.96%, P = .006), and glucose variability (26.1 ± 5.0, 28.21 ± 5.39, 35.31 ± 6.85%, P = .004). There was discordance between GMI and HbA1c when all groups were considered together, with a mean difference of 0.35% (95% SD 0.17, 0.63). In G1, the mean difference was 0.46% (95% SD 0.19, 0.73) and in G2 0.69% (95% SD 0.45, 1.33). GMI and HbA1c were concordant in G3, with a mean difference of -0.10 % (95% SD [-0.59, 0.38])., Conclusion: Disagreements were found between the GMI and HbA1c levels in patients with LC. isCGM was able to detect abnormalities in glycemic control that would not be detected by monitoring with HbA1c, suggesting that isCGM can be useful in assessing glycemic control in patients with LC., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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- 2024
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32. Flash glucose monitoring system in special situations.
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Rigon FA, Ronsoni MF, Vianna AGD, de Lucca Schiavon L, Hohl A, and van de Sande-Lee S
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- Pregnancy, Female, Humans, Blood Glucose Self-Monitoring, Blood Glucose, Glycated Hemoglobin analysis, Glucose, Hypoglycemic Agents, Hypoglycemia, Diabetes Mellitus, Diabetes Mellitus, Type 1
- Abstract
The management of diabetes mellitus (DM) requires maintaining glycemic control, and patients must keep their blood glucose levels close to the normal range to reduce the risk of microvascular complications and cardiovascular events. While glycated hemoglobin (A1C) is currently the primary measure for glucose management and a key marker for long-term complications, it does not provide information on acute glycemic excursions and overall glycemic variability. These limitations may even be higher in some special situations, thereby compromising A1C accuracy, especially when wider glycemic variability is expected and/or when the glycemic goal is more stringent. To attain adequate glycemic control, continuous glucose monitoring (CGM) is more useful than self-monitoring of blood glucose (SMBG), as it is more convenient and provides a greater amount of data. Flash Glucose Monitoring (isCGM /FGM) is a widely accepted option of CGM for measuring interstitial glucose levels in individuals with DM. However, its application under special conditions, such as pregnancy, patients on hemodialysis, patients with cirrhosis, during hospitalization in the intensive care unit and during physical exercise has not yet been fully validated. This review addresses some of these specific situations in which hypoglycemia should be avoided, or in pregnancy, where strict glycemic control is essential, and the application of isCGM/FGM could alleviate the shortcomings associated with poor glucose control or high glycemic variability, thereby contributing to high-quality care.
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- 2022
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33. Testosterone therapy for women with low sexual desire: a position statement from the Brazilian Society of Endocrinology and Metabolism.
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Weiss RV, Hohl A, Athayde A, Pardini D, Gomes L, Oliveira M, Meirelles R, Clapauch R, and Spritzer PM
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- Adolescent, Adult, Aged, Androgens adverse effects, Androgens blood, Female, Humans, Middle Aged, Practice Guidelines as Topic, Societies, Medical, Testosterone adverse effects, Testosterone blood, Young Adult, Androgens therapeutic use, Libido drug effects, Sexual Dysfunction, Physiological drug therapy, Testosterone therapeutic use
- Abstract
Objective: To summarize current evidence regarding testosterone treatment for women with low sexual desire., Materials and Methods: The Female Endocrinology and Andrology Department of the Brazilian Society of Endocrinology and Metabolism invited nine experts to review the physiology of testosterone secretion and the use, misuse, and side effects of exogenous testosterone therapy in women, based on the available literature and guidelines and statements from international societies., Results: Low sexual desire is a common complaint in clinical practice, especially in postmenopausal women, and may negatively interfere with quality of life. Testosterone seems to exert a positive effect on sexual desire in women with sexual dysfunction, despite a small magnitude of effect, a lack of long-term safety data, and insufficient evidence to make a broad recommendation for testosterone therapy. Furthermore, there are currently no testosterone formulations approved for women by the relevant regulatory agencies in the United States, Brazil, and most other countries, and testosterone formulations approved for men are not recommended for use by women., Conclusion: Therefore, testosterone therapy might be considered if other strategies fail, but the risks and benefits must be discussed with the patient before prescription. Arch Endocrinol Metab. 2019;63(3):190-8.
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- 2019
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34. Diretriz brasileira baseada em evidências sobre prevenção de doenças cardiovasculares em pacientes com diabetes: posicionamento da Sociedade Brasileira de Diabetes (SBD), da Sociedade Brasileira de Cardiologia (SBC) e da Sociedade Brasileira de Endocrinologia e Metabologia (SBEM).
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Faludi AA, Izar MCO, Saraiva JFK, Bianco HT, Chacra APM, Bertoluci MC, Moreira RO, Turatti LAA, Bertolami A, Sulzbach ML, Schaan BD, Valerio CM, Bertolami MC, Malachias MVB, Vencio S, Betti RTB, Fonseca FAH, Salles JEN, and Hohl A
- Subjects
- Brazil, Cholesterol, LDL, Diabetic Cardiomyopathies etiology, Humans, Hypercholesterolemia complications, Risk Assessment, Risk Factors, Societies, Medical, Cardiovascular Diseases etiology, Cardiovascular Diseases prevention & control, Diabetic Cardiomyopathies prevention & control, Evidence-Based Medicine standards
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- 2017
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35. Hypercalcemia and acute renal insufficiency following use of a veterinary supplement.
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Ronsoni MF, Santos HCD, Colombo BDS, Correa CG, Moritz APG, Coral MHC, Sande-Lee SV, and Hohl A
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- Acute Kidney Injury complications, Humans, Hypercalcemia complications, Male, Young Adult, Acute Kidney Injury chemically induced, Hypercalcemia chemically induced, Veterinary Drugs adverse effects, Vitamin A adverse effects, Vitamin D adverse effects, Vitamin E adverse effects, Vitamins adverse effects
- Abstract
A previously healthy 24 yo male presented with a two-month history of epigastric pain, nausea, vomiting, fatigue and malaise. He reported abuse of different substances, including an injectable veterinary vitamin compound, which contains high doses of vitamin A, D and E, and an oily vehicle that induces local edema and enhances muscle volume. Serum creatinine was 3.1 mg/dL, alanine transaminase 160 mg/dL, aspartate transaminase 11 mg/dL, total testosterone 23 ng/dL, 25-OH-vitamin D >150 ng/mL (toxicity >100), 1,25-OH-vitamin D 80 pg/mL, vitamin A 0.7 mg/dL, parathormone <3 pg/mL, total calcium 13.6 mg/dL, 24-hour urinary calcium 635 mg/24h (RV 42-353). A urinary tract ultrasound demonstrated signs of parenchymal nephropathy. The diagnosis was hypercalcemia and acute renal failure secondary to vitamin D intoxication. He was initially treated with intravenous hydration, furosemide and prednisone. On the fifth day of hospitalization a dose of pamidronate disodium was added. The patient evolved with serum calcium and renal function normalization. Thirty days later he presented normal clinical and laboratory tests, except 25-OH-vitamin D that was persistently increased (107 ng/mL), as it may take several months to normalize. This case report is a warning of the risks related to the use of veterinary substances for aesthetics purposes.
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- 2017
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36. Positioning about the Flexibility of Fasting for Lipid Profiling.
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Scartezini M, Ferreira CEDS, Izar MCO, Bertoluci M, Vencio S, Campana GA, Sumita NM, Barcelos LF, Faludi AA, Santos RD, Malachias MVB, Aquino JL, Galoro CAO, Sabino C, Gurgel MHC, Turatti LAA, Hohl A, and Martinez TLDR
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- Brazil, Humans, Reference Standards, Reference Values, Time Factors, Cholesterol blood, Fasting blood, Postprandial Period, Triglycerides blood
- Published
- 2017
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37. How predictable is the erectile function of patients with epilepsy?
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Vieira FC, Ronsoni MF, Hohl A, Claudino LS, Diaz AP, Schwarzbold ML, Guarnieri R, Nunes JC, Lin K, and Walz R
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- Adult, Anticonvulsants administration & dosage, Comorbidity, Depression diagnosis, Depression epidemiology, Erectile Dysfunction drug therapy, Erectile Dysfunction epidemiology, Humans, Linear Models, Male, Middle Aged, Predictive Value of Tests, Prevalence, Prolactin blood, Severity of Illness Index, Surveys and Questionnaires, Anticonvulsants adverse effects, Epilepsies, Partial epidemiology, Erectile Dysfunction etiology, Penile Erection physiology
- Abstract
Introduction: Erectile dysfunction (ED) is often reported by patients with epilepsy and may be related to endocrine system abnormalities, side effects of antiepileptic drugs, psychiatric comorbidities, and family or social difficulties., Aims: This study aimed to identify independent predictor factors for ED in patients with epilepsy., Main Outcome Measures: the five-question form of the International Index of Erectile Function (IIEF-5)., Methods: Independent predictive factors for ED evaluated by the IIEF-5 questionnaire in 36 patients (mean age: 39 years) with focal epilepsy (mean: 6 seizures/month) were identified by multiple linear regression analysis., Results: Eight (21.1%) patients were asymptomatic. Among the symptomatic patients, 11 (28.9%) had mild dysfunction, 10 (26.3%) had moderate dysfunction, and 9 (23.7%) showed severe ED. The multiple linear regression model including family income (B=0.005; p=0.05), education levels in years (B=0.54; p=0.03), depressive symptoms determined by HADS depression subscale (B=-0.49; p=0.03), and prolactin levels (B=-0.45; p=0.07) showed a moderate association (r=0.64) with the IIEF questionnaire and explained 41% (r(2)=0.41) of its variation., Conclusions: Erectile dysfunction is highly prevalent in patients with focal epilepsies. Education, depressive symptoms, and prolactin levels can predict erectile dysfunction in up to 41% of patients with epilepsy. This preliminary report justifies further efforts to make a large sample size study to identify independent biomarkers and therapeutic targets for ED treatment in patients with epilepsy., (Copyright © 2015 Elsevier Inc. All rights reserved.)
- Published
- 2015
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38. Hirsutism: diagnosis and treatment.
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Hohl A, Ronsoni MF, and Oliveira Md
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- Androgens blood, Female, Humans, Hyperandrogenism complications, Life Style, Medical Illustration, Physical Examination methods, Sex Factors, Women's Health, Hair Follicle physiology, Hirsutism diagnosis, Hirsutism etiology, Hirsutism therapy, Polycystic Ovary Syndrome complications
- Abstract
Hirsutism is defined as excessive terminal hair growth in androgen-dependent areas of the body in women, which grows in a typical male distribution pattern. Hirsutism is a common clinical problem in women, and the treatment depends on the cause. The condition is often associated with a loss of self-esteem. Hirsutism reflects the interaction between circulating androgen concentrations, local androgen concentrations, and the sensitivity of the hair follicle to androgens. Polycystic ovary syndrome and idiopathic hirsutism are the most common causes of the condition. A woman's history and, physical examination are particularly important in evaluating excess hair growth. The vast majority of women with hirsutism have the idiopathic variety, and the diagnosis is made by exclusion. Serum testosterone level>200 ng/dL is highly suggestive of adrenal or ovarian tumor. Treatment of hirsutism should be based on the degree of excess hair growth presented by the patient and in the pathophysiology of the disorder. Treatment includes lifestyle therapies, androgen suppression, peripheral androgen blockage, and cosmetic treatments. The current review discusses definition, pathogenesis, physiopathology, differential diagnosis, diagnostic strategies, and treatment.
- Published
- 2014
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39. Limited predictive power of hospitalization variables for long-term cognitive prognosis in adult patients with severe traumatic brain injury.
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de Oliveira Thais ME, Cavallazzi G, Formolo DA, de Castro LD, Schmoeller R, Guarnieri R, Schwarzbold ML, Diaz AP, Hohl A, Prediger RD, Mader MJ, Linhares MN, Staniloiu A, Markowitsch HJ, and Walz R
- Subjects
- Adult, Analysis of Variance, Attention physiology, Female, Glasgow Coma Scale, Humans, Intensive Care Units, Logistic Models, Longitudinal Studies, Male, Memory physiology, Middle Aged, Neuropsychological Tests, Predictive Value of Tests, Prognosis, Brain Injuries complications, Cognition Disorders diagnosis, Cognition Disorders etiology, Hospitalization statistics & numerical data
- Abstract
Objectives: Traumatic brain injury (TBI) is a main cause of mortality and morbidity. Association studies between hospitalization variables and cognitive impairment after TBI are frequently retrospective, including non-consecutive patients showing variable degrees of TBI severity, and poor management of missing (drop out) cases., Methods: We assessed prospectively the demographic and hospitalization variables of 234 consecutive patients with severe TBI (admission Glasgow Coma Scale [GCS] ≤8) and determined their independent association with cognitive performance in a representative sample (n = 46) of surviving patients (n = 172) evaluated 3 (±1.8) years after hospitalization., Results: In all, 85% of patients were male and the mean age was 34 (SD ±13) years. The education level was 9 (±4.7) years. As expected, education and age showed a moderately to strong linear relationship with the cognitive performance in 14 of 15 neuropsychological tests (R coefficient = 0.6-0.8). The cognitive test scores were not independently associated with gender, admission GCS, associated trauma, and Marshal CT classification. Admission-elevated blood glucose levels and the presence of sub-arachnoid haemorrhage were independently associated with lower scores on Rey Auditory Verbal Learning retention and Logical Memory-I tests, respectively., Conclusions: After correction for education and age distribution, the variables that are commonly associated with mortality or Glasgow Outcome Scale including admission pupils' examination, Marshal CT Classification, GCS, and serum glucose showed a limited predictive power for long-term cognitive prognosis. Identification of clinical, radiological, and laboratory variables as well as new biomarkers independently associated with cognitive outcome remains an important challenge for further work involving severe TBI patients., (© 2012 The British Psychological Society.)
- Published
- 2014
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40. Effects of endocrine disruptors in the development of the female reproductive tract.
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Costa EM, Spritzer PM, Hohl A, and Bachega TA
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- Animals, Dioxins toxicity, Female, Humans, Mice, Pesticides toxicity, Pregnancy, Puberty, Precocious chemically induced, Disorders of Sex Development chemically induced, Endocrine Disruptors toxicity, Environmental Exposure adverse effects, Ovarian Diseases chemically induced
- Abstract
Environmental agencies have identified a growing number of environmental contaminants that have endocrine disrupting activity, and these can become a major public health problem. It is suggested that endocrine disruptors could account for the higher-than-expected increase in the prevalence of some non-communicable diseases, such as obesity, diabetes, thyroid diseases, and some cancers. Several endocrine Disrupting Chemicals (EDCs), such as pesticides, bisphenol A, phthalates, dioxins, and phytoestrogens, can interact with the female reproductive system and lead to endocrine disruption. Initially, it was assumed that EDCs exert their effects by binding to hormone receptors and transcription factors, but it is currently known that they may also alter the expression of enzymes involved in the synthesis or catabolism of steroids. Biomonitoring studies have identified these compounds in adults, children, pregnant women, and fetuses. Among the diseases of the female reproductive tract associated with EDCs exposure are the following: precocious puberty, polycystic ovary syndrome, and premature ovarian failure. The different populations of the world are exposed to a great number of chemicals through different routes of infection; despite the various available studies, there is still much doubt regarding the additive effect of a mixture of EDCs with similar mechanisms of action.
- Published
- 2014
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41. Psychiatric disorders and health-related quality of life after severe traumatic brain injury: a prospective study.
- Author
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Diaz AP, Schwarzbold ML, Thais ME, Hohl A, Bertotti MM, Schmoeller R, Nunes JC, Prediger R, Linhares MN, Guarnieri R, and Walz R
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- Adult, Female, Humans, Male, Prevalence, Retrospective Studies, Brain Injuries complications, Brain Injuries psychology, Mental Disorders complications, Mental Disorders epidemiology, Quality of Life psychology
- Abstract
Traumatic brain injury (TBI) is a major cause of death and disability and impairs health-related quality of life (HRQOL). Psychiatric disorders have been recognized as major components of TBI morbidity, yet few studies have addressed the relationship between these outcomes. Sample size, selection bias, and retrospective design, are methodological limitations for TBI-related psychiatric studies. For this study, 33 patients with severe TBI were evaluated prospectively regarding demographic, clinical, radiological, neurosurgical, laboratory, and psychosocial characteristics, as well as psychiatric manifestations and HRQOL, 18 months after hospitalization. Psychiatric manifestations were assessed using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), the Hospital Anxiety and Depression Scale (HADS), the Brief Psychiatric Rating Scale (BPRS), and the Apathy Evaluation Scale (AES). HRQOL was determined using the Medical Outcomes Study's 36-item Short-Form Health Survey (SF-36). Following TBI, a significant increase in the prevalence of major depressive disorder (MDD) and generalized anxiety disorder (p=0.02), and a significant decrease in the prevalence of alcohol and cannabinoid abuse (p=0.001) were observed. The most frequent psychiatric disorders following severe TBI were found to be MDD (30.3%), and personality changes (33.3%). In comparison to patients without personality changes, patients with personality changes experienced a decline in general health and impairments in physical and social functioning. Patients with MDD showed impairment in all SF-36 domains compared to non-depressed patients. This prospective TBI-related psychiatric study is the first to demonstrate a significant association between MDD, personality changes, and HRQOL, following severe TBI in a well-defined sample of patients.
- Published
- 2012
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42. [Late evaluation of the pituitary-gonadal axis in survivors of severe traumatic brain injury].
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Hohl A, Daltrozo JB, Pereira CG, Weber TR, Pinto HF, Gullo Jda S, Bernardini JD, Coral MH, and Walz R
- Subjects
- Accidents, Traffic, Adolescent, Adult, Aged, Brain Injuries blood, Brain Injuries physiopathology, Epidemiologic Methods, Female, Gonads physiopathology, Humans, Hypogonadism blood, Male, Middle Aged, Pituitary Gland physiopathology, Testosterone blood, Young Adult, Brain Injuries complications, Gonadotropins, Pituitary blood, Hypogonadism etiology, Hypothalamo-Hypophyseal System physiopathology, Pituitary-Adrenal System physiopathology, Survivors
- Abstract
Objective: The purpose of this study is to evaluate pituitary function impairment in order to verify the prevalence of sex hormone deficiency and to analyze the profile of TBI population., Methods: Thirty patients were studied, 22 were male and 8 were female. All patients had their gonadal function assessed and they were evaluated at a median of 4 years post-trauma., Results: The average age of the men was 38 years at the time of the evaluation, while the mean age of women was 42 years. The majority of TBI was related to traffic accidents (63.3%). Three patients (10%) had low FSH and only 1 patient (3.3%) had low LH. There was no biochemical evidence of hypogonadism in women. Two male patients presented low testosterone (9.1%) and were diagnosed with hypogonadism. Prolactin levels were normal in all patients., Conclusion: Two cases of hypogonadism (9.1%) were diagnosed among men in this study. It is therefore necessary that medical professionals involved in the management of TBI patients are aware of hypogonadism as a complication of TBI, in order to diagnose it early.
- Published
- 2009
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43. [Men's health: so neglected, mainly by men. ].
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Meirelles RM and Hohl A
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- Adult, Andrology, Child, Humans, Hypogonadism etiology, Male, Sex Factors, Attitude to Health, Men's Health
- Published
- 2009
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44. Hypogonadism after traumatic brain injury.
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Hohl A, Mazzuco TL, Coral MH, Schwarzbold M, and Walz R
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- Adult, Hormone Replacement Therapy, Humans, Hypogonadism physiopathology, Pituitary Gland anatomy & histology, Pituitary Gland physiopathology, Young Adult, Brain Injuries complications, Hypogonadism etiology
- Abstract
Traumatic brain injury (TBI) is the most common cause of death and disability in young adults. Post-TBI neuroendocrine disorders have been increasingly acknowledged in recent years due to their potential contribution to morbidity and, probably, to mortality after trauma. Marked alterations of the hypothalamic-pituitary axis during the post-TBI acute and chronic phases have been reported. Prospective and longitudinal studies have shown that some abnormalities are transitory. On the other hand, there is a high frequency (15% to 68%) of pituitary hormone deficiency among TBI survivors in a long term setting. Post-TBI hypogonadism is a common finding after cranial trauma, and it is predicted to develop in 16% of the survivors in the long term. Post-TBI hypogonadism has been associated with adverse results in the acute and chronic phases after injury. These data reinforce the need for identification of hormonal deficiencies and their proper treatment, in order to optimize patient recovery, improve their life quality, and avoid the negative consequences of non-treated hypogonadism in the long term.
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- 2009
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45. Evaluation of late-onset hypogonadism (andropause) treatment using three different formulations of injectable testosterone.
- Author
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Hohl A, Marques MO, Coral MH, and Walz R
- Subjects
- Analysis of Variance, Brazil, Hormone Replacement Therapy, Humans, Hypogonadism blood, Injections, Intramuscular, Male, Middle Aged, Testosterone adverse effects, Testosterone therapeutic use, Androgens therapeutic use, Andropause drug effects, Hypogonadism drug therapy, Testosterone analogs & derivatives
- Abstract
Objective: To compare the modalities of treatment for male hypogonadism available in Brazil., Methods: Thirty-two men with late-onset hypogonadism ('andropause') were followed-up in the Hospital de Guarnição de Florianópolis, in Florianópolis, south Brazil. Clinical diagnosis was established according to AMS questionnaire (positive if equal to or higher than 27 points), and laboratory diagnosis was made through low values of total testosterone (under 300 ng/dL) and/or free calculated testosterone (under 6.5 ng/dL). Patients were randomized to three non-enteral treatment groups (Deposteron--11 patients; Durateston--11 patients; and Nebido--10 patients)., Results: Clinically, Nebido seemed to be superior when compared to Deposteron (mean value of improvement percentage; p = 0.03) and when compared to Durateston (post-treatment average AMS score; p = 0.03). According to laboratory analysis, Nebido showed higher testosterone levels than Deposteron and Durateston (p < 0.001)., Conclusions: All non-enteral testosterone formulas available in the Brazilian market are efficient in raising testosterone levels and in clinical improvement of hypogonadal patients. Nebido showed both a better clinical and laboratory effectiveness.
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- 2009
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46. Mortality in severe traumatic brain injury: a multivariated analysis of 748 Brazilian patients from Florianópolis City.
- Author
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Martins ET, Linhares MN, Sousa DS, Schroeder HK, Meinerz J, Rigo LA, Bertotti MM, Gullo J, Hohl A, Dal-Pizzol F, and Walz R
- Subjects
- Adolescent, Adult, Age Distribution, Brazil epidemiology, Child, Confidence Intervals, Craniocerebral Trauma diagnosis, Female, Humans, Male, Middle Aged, Multivariate Analysis, Odds Ratio, Prognosis, Prospective Studies, Sex Distribution, Survival Rate trends, Young Adult, Craniocerebral Trauma mortality, Glasgow Coma Scale, Urban Population
- Abstract
Background: Traumatic brain injury (TBI) is a major cause of incapacity and mortality worldwide, with most of the burden occurring in low-income and middle-income countries. A number of clinical, demographic, and neurosurgical variables of patients with TBI were associated with their outcome., Methods: We investigated the mortality of Brazilian patients with severe TBI at the time of discharge, using a multiple logistic regression analysis. Clinical, demographic, radiologic, and neurosurgical variables, and mortality at time of discharge of all consecutive patients (n = 748) with severe TBI (admission Glasgow scale < or = 8) treated in our intensive care unit were analyzed. The variables were collected in a prospective manner between January 1994 and December 2003., Results: Eighty-four percent (n = 631) of the patients were men. The mean age was 34.8 (+/-16.3) years and the mortality was 33.3%. After the multiple logistic regression, the adjusted odds ratio (OR) for death was higher in older (> 60 years) than younger (up to 30 years) patients (OR = 2.51, 95% confidence interval [CI] 1.31-4.79, p = 0.006). The mortality was also associated with sub-arachnoid hemorrhage (OR = 1.86, 95% CI = 1.23-2.81, p = 0.003) on computed tomography (CT) scan; admission Glasgow Scale of 3 or 4 in comparison to 7 or 8 (OR = 3.97, 95% CI = 2.49- 6.31, p < 0.001); bilateral midryasis (OR = 11.52, 95% CI = 5.56-23.87, p < 0.0001), or anisocoria (OR = 2.65, 95% CI = 1.69-4.17, p < 0.0001) in comparison to isocoric pupils. There was a trend for higher mortality in patients with type III injury on the Marshall classification of CT (OR = 3.63, 95% CI = 0.84-15.76, p = 0.08) than in patients with normal CT. Patients without thoracic trauma disclose higher mortality than patients with associated thoracic trauma do (OR = 2.02, 95% CI = 1.19-3.41, p = 0.009). The final model presented disclosed 76.9% of overall correct prediction with the survival and death predicted at 87.6% and 55.6%, respectively., Conclusion: Age, CT findings, Glasgow coma scale, pupil examination, and the presence of thoracic trauma at admission were independently associated with mortality at the time of discharge in Brazilian patients with severe TBI.
- Published
- 2009
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