26 results on '"Silva PS"'
Search Results
2. Unplanned extubation in pediatric critically ill patients: a systematic review and best practice recommendations.
- Author
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Lucas da Silva PS and de Carvalho WB
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- 2010
- Full Text
- View/download PDF
3. Internal carotid artery pseudoaneurysm with life-threatening epistaxis as a complication of deep neck space infection.
- Author
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da Silva PS and Waisberg DR
- Published
- 2011
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4. Slitlike ventricle syndrome: a life-threatening presentation.
- Author
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da Silva PS, Suriano IC, Neto HM, da Silva, Paulo Sérgio Lucas, Suriano, Italo Capraro, and Neto, Henrique Monteiro
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- 2009
- Full Text
- View/download PDF
5. Teaching Video NeuroImage: Calf Hypertrophy and Myoedema Unravel a Diagnosis of Severe Hypothyroidism.
- Author
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Camargos S, Ribeiro PS, and Barbosa LSM
- Subjects
- Humans, Hypertrophy, Hypothyroidism complications, Hypothyroidism diagnosis, Muscular Diseases
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- 2024
- Full Text
- View/download PDF
6. INTEGRATING MACULAR OPTICAL COHERENCE TOMOGRAPHY WITH ULTRAWIDE-FIELD IMAGING IN A DIABETIC RETINOPATHY TELEMEDICINE PROGRAM USING A SINGLE DEVICE.
- Author
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Aiello LP, Jacoba CMP, Ashraf M, Cavallerano JD, Tolson AM, Tolls D, Sun JK, and Silva PS
- Subjects
- Humans, Tomography, Optical Coherence methods, Cohort Studies, Retrospective Studies, Diabetic Retinopathy diagnosis, Macular Edema diagnostic imaging, Telemedicine, Ophthalmology, Diabetes Mellitus
- Abstract
Purpose: To determine the effect of combined macular spectral-domain optical coherence tomography (SD-OCT) and ultrawide field retinal imaging (UWFI) within a telemedicine program., Methods: Comparative cohort study of consecutive patients with both UWFI and SD-OCT. Ultrawide field retinal imaging and SD-OOCT were independently evaluated for diabetic macular edema (DME) and nondiabetic macular abnormality. Sensitivity and specificity were calculated with SD-OCT as the gold standard., Results: Four hundred twenty-two eyes from 211 diabetic patients were evaluated. Diabetic macular edema severity by UWFI was as follows: no DME 93.4%, noncenter involved DME (nonciDME) 5.1%, ciDME 0.7%, ungradable DME 0.7%. SD-OCT was ungradable in 0.5%. Macular abnormality was identified in 34 (8.1%) eyes by UWFI and in 44 (10.4%) eyes by SD-OCT. Diabetic macular edema represented only 38.6% of referable macular abnormality identified by SD-OCT imaging. Sensitivity/specificity of UWFI compared with SD-OCT was 59%/96% for DME and 33%/99% for ciDME. Sensitivity/specificity of UWFI compared with SDOCT was 3%/98% for epiretinal membrane., Conclusion: Addition of SD-OCT increased the identification of macular abnormality by 29.4%. More than 58.3% of the eyes believed to have any DME on UWF imaging alone were false-positives by SD-OCT. The integration of SD-OCT with UWFI markedly increased detection and reduced false-positive assessments of DME and macular abnormality in a teleophthalmology program.
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- 2023
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7. ASSESSMENT OF FLUORESCEIN ANGIOGRAPHY NONPERFUSION IN EYES WITH DIABETIC RETINOPATHY USING ULTRAWIDE FIELD RETINAL IMAGING.
- Author
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Silva PS, Liu D, Glassman AR, Aiello LP, Grover S, Kingsley RM, Melia M, and Sun JK
- Subjects
- Fluorescein Angiography methods, Humans, Photography methods, Retina pathology, Retinal Vessels pathology, Diabetes Mellitus, Diabetic Retinopathy complications, Macular Edema
- Abstract
Purpose: Evaluate association of retinal nonperfusion (NP) on ultrawide field (UWF) fluorescein angiography (FA) with diabetic retinopathy (DR) severity and predominantly peripheral lesions (PPL)., Methods: Multicenter observational study, 652 eyes (361 participants) having nonproliferative DR (NPDR) without center-involved diabetic macular edema in at least one eye. Baseline 200° UWF-color and UWF-FA images were graded by a central reading center for color-PPL and FA-PPL, respectively. UWF-FA was graded for NP index within concentric zones: posterior pole (<10 mm from fovea), midperiphery (10-15 mm), and far periphery (>15 mm)., Results: Baseline Early Treatment Diabetic Retinopathy Study DR severity was 31.7% no DR/mild NPDR, 24.1% moderate NPDR, 14.0% moderately severe NPDR, 25.6% severe/very severe NPDR, and 4.6% proliferative DR. Worse DR severity was associated with increased NP index overall (P = 0.002), in the posterior pole (P < 0.001), midperiphery (P < 0.001), and far periphery (P = 0.03). On average, 29.6% of imaged retinal NP was in the posterior pole, 33.7% in midperiphery, and 36.7% in far periphery. Increased NP index was associated with FA-PPL (P < 0.001) but not with color-PPL (P = 0.65)., Conclusion: Approximately, 70% of NP in diabetic eyes is located outside the posterior pole. Increased NP is associated with the presence of FA-PPL, suggesting UWF-FA may better predict future DR worsening than UWF-color alone.
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- 2022
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8. Commentary on "Intra- and Interrater Reliability of the Spanish Version of the Gross Motor Function Measure (GMFM-SP-88)".
- Author
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de Carvalho Chagas PS and Drumond CM
- Abstract
Competing Interests: The authors declare no conflict of interest.
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- 2022
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9. Radon Concentrations in a Nuclear Reactor Center in Brazil.
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Cardoso da Silva PS, de Campos MP, Mohamad El Hajj T, and de Lima Reis G
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- Brazil, Humans, Nuclear Reactors, Air Pollutants, Radioactive analysis, Air Pollution, Indoor analysis, Radiation Monitoring methods, Radon analysis
- Abstract
Abstract: Radiation workers are normally exposed to doses resulting from their day-to-day activities. Besides that, background radiation, such as radon, can contribute to the exposure rates. The radionuclide 222Rn is a noble gas belonging to the uranium series, and its indoor concentration in the air depends on the exhalation from surrounding soil and the exhalation from building materials. Radon exhaling from porous building materials containing high uranium concentrations can become a significant exposure factor in areas with limited ventilation. The objective of this study was to evaluate the 222Rn concentrations in the radiochemistry and radiometric laboratories in the nuclear reactor building of the Nuclear Reactor Center (CERPq) located in the Institute of Nuclear and Energy Research (IPEN), São Paulo, Brazil. Measurements were done using a Radon Gas Monitor, model RAD7, equipped with a solid-state alpha detector. A passive method (SSNTD) was also used, consisting of square pieces of C-39 foils (2.5 cm × 2.5 cm) placed within small diffusion chambers. The CR-39 detectors were etched in KOH 30% solution at 80 °C for 5.5 h in a constant-temperature bath. After etching, the detectors were washed, dried, and scanned using a microscope to obtain the track density measurements. The activity concentrations measured with both techniques varied from 52 to 103 Bq m-3 in the studied areas of the CERPq. These values may be compared to the reference level of 100 Bq m-3 established by the World Health Organization to ensure safety environments., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Health Physics Society.)
- Published
- 2021
- Full Text
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10. Situations That Lead Women to Seek Treatment for Drug Addiction.
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Moll MF, Santos VO, Duarte CF, Silva PS, and Ventura CAA
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- Brazil, Female, Humans, Interpersonal Relations, Behavior, Addictive, Substance-Related Disorders
- Abstract
Introduction: Investigating the situations that lead women to seek treatment for drug addiction is necessary, as women experience the organic, social, and family damage caused by addiction intensely., Objective: The aim of this study was to describe situations that lead women to seek treatment for drug addiction., Method: This is an exploratory, descriptive study, with a qualitative approach, carried out in a CAPS Ad service in the state of Minas Gerais (CAAE: 92864518.4.0000.5145). Open interviews were conducted in September 2018 with 24 of 28 women assisted by the service. The discourse of the collective subject was the basis of the data analysis., Results: Social, family, and health problems were the main damaging impact of drug addiction among the women and were represented by the following: death of loved ones, violence from partners, theft, cognitive problems, hypertension, and diabetes. Specifically, it was affective and material losses experienced during the period of addiction that led the women to seek treatment., Final Considerations: It is necessary to facilitate women's access to treatment for drug addiction and to incorporate their families into the treatment through activities that will reinforce the former's commitment to any proposed therapeutics; in addition, goals to reconstruct bonds within the family environment should be established., Competing Interests: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article., (Copyright © 2021 International Nurses Society on Addictions.)
- Published
- 2021
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11. Reply.
- Author
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Marques RE, Guerra PS, Sousa DC, Ferreira NP, Gonçalves AI, Quintas AM, and Rodrigues W
- Subjects
- Anterior Chamber, Sulfur Hexafluoride
- Published
- 2018
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12. Sulfur Hexafluoride 20% Versus Air 100% for Anterior Chamber Tamponade in DMEK: A Meta-Analysis.
- Author
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Marques RE, Guerra PS, Sousa DC, Ferreira NP, Gonçalves AI, Quintas AM, and Rodrigues W
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- Fuchs' Endothelial Dystrophy surgery, Graft Survival, Humans, Retrospective Studies, Visual Acuity, Air, Anterior Chamber surgery, Corneal Diseases surgery, Descemet Stripping Endothelial Keratoplasty methods, Endotamponade methods, Endothelium, Corneal transplantation, Sulfur Hexafluoride administration & dosage
- Abstract
Purpose: To compare intracameral 20% sulfur hexafluoride (SF6) versus 100% air as tamponade for graft attachment in Descemet membrane endothelial keratoplasty (DMEK)., Methods: Using an electronic database search on MEDLINE and CENTRAL from inception to December 2017, we performed a literature review and meta-analysis including all comparative studies of SF6 at a 20% concentration (20% SF6) versus pure air (100% air) for anterior chamber tamponade in DMEK. The primary outcome was the rebubbling rate at the final observation. The secondary outcomes were 1) the graft detachment rate, 2) mean difference (MD) in best-corrected visual acuity (BCVA), 3) manifest refraction spherical equivalent, 4) central corneal thickness (CCT), 5) percentage of endothelial cell loss (ECL), and 6) rate of pupillary block by the final observation. Statistical analysis was performed using RevMan5.3 software., Results: Five retrospective studies were included, assessing 1195 eyes (SF6 277; air 918). The main indication for surgery was Fuchs endothelial dystrophy (SF6 85.2%; air 86.2%) and bullous keratopathy (SF6 10.8%; air 10.0%). Overall, studies were of moderate to good methodological quality. Patients in the SF6 group required 58% less rebubbling procedures (risk ratio 0.42, 95% confidence interval (CI), 0.31-0.56, P < 0.0001). No differences were found regarding BCVA improvement (MD 0.03, 95% CI, -0.05 to 0.11, P = 0.49). SF6 was associated with a minor hyperopic shift (MD 0.37 D, 95% CI, -0.95 to -0.21, P = 0.21). No differences were found regarding CCT, ECL, and rate of pupillary block (P > 0.05)., Conclusions: In DMEK, 20% SF6 tamponade and longer postoperative time supine were associated with 58% fewer rebubbling procedures, and an ECL not statistically different from using 100% air.
- Published
- 2018
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13. Age-Correlated Phenotypic Alterations in Cells Isolated From Human Degenerated Intervertebral Discs With Contained Hernias.
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Molinos M, Cunha C, Almeida CR, Gonçalves RM, Pereira P, Silva PS, Vaz R, and Barbosa MA
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- Adolescent, Adult, Age Factors, Aged, Biomarkers metabolism, Cell Separation methods, Cells, Cultured, Diskectomy methods, Female, Hernia metabolism, Humans, Intervertebral Disc metabolism, Intervertebral Disc surgery, Intervertebral Disc Degeneration metabolism, Intervertebral Disc Degeneration surgery, Male, Mesenchymal Stem Cells metabolism, Mesenchymal Stem Cells pathology, Middle Aged, Young Adult, Hernia pathology, Intervertebral Disc pathology, Intervertebral Disc Degeneration pathology, Phenotype
- Abstract
Study Design: Human intervertebral disc (hIVD) cells were isolated from 41 surgically excised samples and assessed for their phenotypic alterations with age., Objective: Toward the design of novel anti-aging strategies to overcome degenerative disc disease (DDD), we investigated age-correlated phenotypic alterations that occur on primary hIVD cells., Summary of Background Data: Although regenerative medicine holds great hope, much is still to be unveiled on IVD cell biology and its intrinsic signaling pathways, which can lead the way to successful therapies for IDD. A greater focus on age-related phenotypic changes at the cell level would contribute to establish more effective anti-aging/degeneration targets., Methods: The study was subdivided in four main steps: i) optimization of primary cells isolation technique; ii) high-throughput cell morphology analysis, by imaging flow cytometry (FC) and subsequent validation by histological analysis; iii) analysis of progenitor cell surface markers expression, by conventional FC; and iv) statistical analysis and correlation of cells morphology and phenotype with donor age., Results: Three subsets of cells were identified on the basis of their diameter: small cell (SC), large cell (LC), and super LC (SLC). The frequency of SCs decreased nearly 50% with age, whereas that of LCs increased nearly 30%. Interestingly, the increased cells size was due to an enlargement of the pericellular matrix (PCM). Moreover, the expression pattern for CD90 and CD73 was a reflexion of age, where older individuals show reduced frequencies of positive cells for those markers. Nevertheless, the elevated percentages of primary positive cells for the mesenchymal stem cells (MSCs) marker CD146 found, even in some older donors, refreshed hope for the hypothetical activation of the self-renewal potential of the IVD., Conclusion: These findings highlight the remarkable morphological alterations that occur on hIVD cells with aging and degeneration, while reinforcing previous reports on the gradual disappearance of an endogenous progenitor cell population., Level of Evidence: N/A.
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- 2018
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14. Unplanned Expenses: Paying for Unplanned Extubations.
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da Silva PS, de Carvalho WB, and Fonseca MC
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- Female, Humans, Male, Airway Extubation economics, Hospital Costs, Intensive Care Units, Pediatric economics, Length of Stay
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- 2015
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15. Reply: To PMID 24830822.
- Author
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Silva PS and Aiello LP
- Subjects
- Female, Humans, Male, Diabetic Retinopathy surgery, Lens Implantation, Intraocular, Phacoemulsification, Visual Acuity physiology, Vitrectomy
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- 2015
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16. Visual outcomes from pars plana vitrectomy versus combined pars plana vitrectomy, phacoemulsification, and intraocular lens implantation in patients with diabetes.
- Author
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Silva PS, Diala PA, Hamam RN, Arrigg PG, Shah ST, Murtha TL, Schlossman DK, Cavallerano JD, Sun JK, and Aiello LP
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- Adult, Aged, Aged, 80 and over, Diabetes Mellitus, Type 1 complications, Diabetes Mellitus, Type 2 complications, Diabetic Retinopathy diagnosis, Diabetic Retinopathy physiopathology, Disease Progression, Female, Humans, Male, Middle Aged, Pseudophakia physiopathology, Retrospective Studies, Tomography, Optical Coherence, Diabetic Retinopathy surgery, Lens Implantation, Intraocular, Phacoemulsification, Visual Acuity physiology, Vitrectomy
- Abstract
Purpose: To compare visual acuity outcomes and diabetic retinopathy progression after pars plana vitrectomy (PPV) versus combined pars plana vitrectomy and phacoemulsification (PPVCE) in patients with diabetes., Methods: Retrospective review of 222 consecutive diabetic patients undergoing PPV or PPVCE., Results: A total of 251 eyes of 222 patients were evaluated (PPV = 122, PPVCE = 129). Four-year follow-up was 64% (161 eyes). Overall, patients undergoing PPVCE had better preoperative visual acuity (PPVCE = 20/80, PPV = 20/160, P = 0.03). At 4-year follow-up, visual acuity improved (PPV = +22, PPVCE = +11 letters) compared with baseline in both groups. After correcting for baseline differences in visual acuity, no statistically significant difference in final visual acuity was observed (PPVCE = 20/32, PPV = 20/50, P = 0.09). Results did not differ substantially by surgical indication (vitreous hemorrhage, traction retinal detachment, epiretinal membrane, and/or diabetic macular edema). Cataract progression occurred in 64%, and cataract surgery was performed in 39% of phakic eyes undergoing PPV. Rates of diabetic retinopathy progression, vitreous hemorrhage, and retinal detachment were not statistically different. Neovascular glaucoma developed in 2 patients (2%) after PPV and 6 patients (8%) after PPVCE (P = 0.07)., Conclusion: In diabetic patients, equivalent visual acuity improvement over 4 years was observed after PPV or PPVCE. Visual outcomes and retinopathy progression rates were not significantly different after either intervention, suggesting that PPVCE may be appropriate when indicated in patients with diabetes.
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- 2014
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17. Appendiceal intussusception.
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Epifanio M, Lima MA, Spolidoro JV, Eloi J, Baldissera M, Lorenzi D, Corrêa PS, and Baldisserotto M
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- Child, Female, Humans, Appendix pathology, Cecal Diseases diagnosis, Intussusception diagnosis
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- 2014
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18. Clinical and image findings in bisphosphonate-related osteonecrosis of the jaws.
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Farias DS, Zen Filho EV, de Oliveira TF, Tinôco-Araújo JE, Sampieri MB, Antunes HS, and Santos PS
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- Adult, Aged, Debridement, Female, Follow-Up Studies, Humans, Male, Middle Aged, Postoperative Complications diagnosis, Postoperative Complications surgery, Radiography, Panoramic, Tomography, X-Ray Computed, Tooth Extraction adverse effects, Zoledronic Acid, Alendronate adverse effects, Bisphosphonate-Associated Osteonecrosis of the Jaw diagnosis, Bisphosphonate-Associated Osteonecrosis of the Jaw surgery, Diphosphonates adverse effects, Imidazoles adverse effects
- Abstract
Bisphosphonate-related osteonecrosis of the jaws (BRONJ) is characterized as exposed bone in the jaws for more than 8 weeks in patients with current or previous history of therapy with bisphosphonates (BPs) and no history of radiotherapy in the head and neck. We report a case series of 7 patients with BRONJ and analyze the variations of clinical and imaging signs, correlating them with the presence or absence of bone exposure. Among the patients, 6 were women and 1 was a man, aged 42-79 years. Five of the patients were using zoledronic acid and the other 2 alendronate. The use of BPs varied from 3 to 13 years. In 5 patients, tooth extraction was the triggering event of injuries. Panoramic radiographs and computed tomography (CT) were evaluated by a radiologist blinded to the cases. There were persistent unremodeled extraction socket even several months after tooth extraction in 3 of the cases that were consistent wit CT findings that also showed areas of osteosclerosis and osteolysis. Patients were treated according to the recommendations of the AAOMS, with surgical debridement and antibiotic coverage with amoxicillin in the symptomatic patients. The follow-up of these patients ranged from 8 to 34 months, with a good response to treatment. The image findings in this case series were not specific and showed no difference between each stages of BRONJ (AAOMS, 2009). The image features were similar in presence or absence of exposed bone.
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- 2013
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19. Risk factors and outcomes of unplanned PICU postoperative admissions: a nested case-control study.
- Author
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da Silva PS, de Aguiar VE, and Fonseca MC
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- Anesthesia, General adverse effects, Case-Control Studies, Child, Child, Preschool, Emergencies, Female, Humans, Hypoxia complications, Infant, Infant, Newborn, Intensive Care Units, Pediatric, Male, Prevalence, Respiratory System Abnormalities complications, Risk Factors, Tertiary Care Centers, Treatment Outcome, Critical Care statistics & numerical data, Intraoperative Complications epidemiology, Patient Admission statistics & numerical data, Postoperative Care statistics & numerical data, Postoperative Complications epidemiology
- Abstract
Background: Although unplanned postoperative admission to PICUs (unplanned intensive care admission [UIA]) is uncommon, it might be associated with increased costs, morbidity, and mortality. However, detailed knowledge of risk factors and outcomes after UIA in children is still lacking., Objectives: To determine prevalence, risk factors, and outcomes of UIA patients compared with non-UIA patients., Design: Case-control study., Setting: A tertiary university-affiliated hospital., Patients: All postoperative children admitted to the PICU were monitored for UIA. About 28 cases and 88 controls were included., Interventions: none., Measurements and Main Results: The overall prevalence of UIA was 2.6%. About 28 patients (24.1%) of 116 had unplanned admission. Multiple logistic regression revealed that factors predicting UIA were airway abnormality (odds ratio 16.2, 95% confidence interval 2.65-99.6), anesthetic factors (odds ratio 5.8, 95% confidence interval 1.06-32.2), and hypoxia intraoperative (odds ratio 7.4, 95% confidence interval 1.21-46.24). Procedures on abdomen, emergency surgery, combined anesthesia, and occurrence of intraoperative adverse events were also risk factors for an UIA. Patients with UIA had longer duration of mechanical ventilation than non-UIA patients (4.5 vs. 2 days, p = 0.01), but there were no differences in length of PICU and hospital stays. Preventable adverse events were detected in 25% of UIA children., Conclusions: Airway abnormality, anesthetic factors, and hypoxia intraoperative were risk factors associated with UIA. Although preventable events contribute significantly to unplanned PICU admissions, they constitute a room of opportunity in quality improvement programs.
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- 2013
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20. Periodontal manifestations and ambulatorial management in a patient with Sturge-Weber syndrome.
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Pagin O, Del Neri NB, Battisti Mde P, Capelozza AL, and Santos PS
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- Adult, Humans, Male, Ambulatory Care, Periodontal Diseases etiology, Periodontal Diseases therapy, Sturge-Weber Syndrome complications
- Abstract
Sturge-Weber syndrome is a nonhereditary congenital condition characterized by leptomeningeal and facial skin angiomatous malformation following the trigeminal nerve path. The intraoral angiomatosis are presented in 40% of cases and results in an important periodontal alteration, increasing the risk of bleeding during dental procedures. A 43-year-old male patient presented with port wine stain on the right side of the face, the entire hard and soft palates, the alveolar ridge, and buccal mucosa, and had an excessive accumulation of calcified masses in both supragingival and subgingival sites, with swelling and generalized inflammation throughout the gingiva and alveolar mucosa. He reported not having sanitized the area for years for fear of bleeding. Periodontal management, to remove calculus and to control gingivitis initiated in the supragingival region and gradually reaching the subgingival region to control oral microbiota, was performed with mild bleeding. The redness of the staining greatly diminished with time and the extreme halitosis of the patient also improved sharply leading to a dramatic improvement in quality of life. Ambulatory care is a feasible alternative for periodontal management that within safety limits for bleeding risks reduces the operational cost.
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- 2012
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21. Unplanned endotracheal extubations in the intensive care unit: systematic review, critical appraisal, and evidence-based recommendations.
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da Silva PS and Fonseca MC
- Subjects
- Airway Extubation adverse effects, Airway Extubation statistics & numerical data, Analgesia, Benchmarking, Case-Control Studies, Cohort Studies, Conscious Sedation, Female, Humans, Intubation, Intratracheal adverse effects, Intubation, Intratracheal methods, Male, Nurses statistics & numerical data, Respiration, Artificial, Restraint, Physical, Risk Factors, Sex Factors, Treatment Outcome, Ventilator Weaning, Airway Extubation methods, Evidence-Based Medicine, Intensive Care Units
- Abstract
Background: In this study, we updated the state of knowledge on unplanned tracheal extubations in the intensive care unit. We focused on the following topics: incidence, risk factors, reintubation after unplanned extubation, outcomes, and prevention. Based on this review, recommendations were made for preventing unplanned extubations., Methods: Electronic databases were searched for relevant publications from January 1, 1950 through June 30, 2011 on the MEDLINE, EMBASE, CINAHL, SciELO, LILACS, and Cochrane systems. Fifty articles were eligible for data abstraction. Study quality was assessed using the Newcastle-Ottawa Scale. Grades of recommendation were assessed according to the Oxford Centre for Evidence-Based Medicine., Results: Unplanned extubations occur at a rate of 0.1 to 3.6 events per 100 intubation days. Risk factors associated with unplanned extubations included male gender (odds ratio [OR] 4.8), APACHE score ≥17 (OR 9.0), chronic obstructive pulmonary disease, restlessness/agitation (OR 3.3-30.6), lower sedation level (OR 2.0-5.4), higher consciousness level (OR 1.4-2.0), and use of physical restraints (OR 3.1). Reintubation rates ranged from 1.8% to 88% of unplanned extubations. Thirteen studies assessed preventive measures for avoiding unplanned extubations. These studies focused on data collection tools, standardization of procedures, staff education, staff surveillance, and identification and management of high-risk patients. These studies reported reductions in unplanned extubation rate from 22% to 53%. The best methods of securing the endotracheal tube and use of physical restraints remain controversial issues., Conclusions: Despite numerous publications on unplanned extubation, few studies assess preventive strategies for adverse events, and few clinical trials have assessed unplanned extubations. Recommendations are proposed based on the currently available literature.
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- 2012
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22. Serum sickness and severe acute renal failure after rabbit antithymocyte globulin treatment in aplastic anemia: a case report.
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da Silva PS, Passos RM, Waisberg DR, and Park MV
- Subjects
- Acute Kidney Injury diagnosis, Acute Kidney Injury drug therapy, Anemia, Aplastic diagnosis, Animals, Child, Female, Humans, Rabbits, Serum Sickness diagnosis, Serum Sickness drug therapy, Steroids therapeutic use, Treatment Outcome, Acute Kidney Injury complications, Anemia, Aplastic drug therapy, Antilymphocyte Serum therapeutic use, Serum Sickness complications
- Abstract
Serum sickness is an immune-complex-mediated illness that frequently occurs in patients after polyclonal antibody therapy (thymoglobulin). Although serum sickness has been described secondary to thymoglobulin therapy in adults, there are no reports in children on thymoglobulin-induced acute renal failure. We report a case of serum sickness in a 10-year-old girl who was treated for severe aplastic anemia using rabbit antithymocyte globulin (ATG). Eleven days after being started on antithymocyte globulin treatment, she developed fever, gross hematuria, arthralgia, rash, and acute renal failure. Laboratory results showed decreased complement levels, hypergammaglobulinemia, serum creatinine of 4.8 mg/dL (0.6 mg/dL at baseline), and blood urea nitrogen of 79 mg/dL (28 mg/dL at baseline). Peritoneal dialysis was required for 14 days. The patient's symptoms resolved after 13 days on treatment with a short course of high-dose steroids for 3 days, followed by a prednisolone taper. Early recognition and accurate diagnosis is the key for managing thymoglobulin-induced serum sickness, as treatment is highly effective at achieving good outcomes.
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- 2011
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23. Massive pericardial effusion in a child: an unusual presentation of hypothyroidism.
- Author
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da Silva PS and Lau AR
- Subjects
- Child, Female, Humans, Hypothyroidism complications, Hypothyroidism diagnostic imaging, Hypothyroidism drug therapy, Pericardial Effusion diagnostic imaging, Pericardial Effusion drug therapy, Thyroxine therapeutic use, Ultrasonography, Hypothyroidism diagnosis, Pericardial Effusion etiology
- Published
- 2010
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24. Value of repeat cranial computed tomography in pediatric patients sustaining moderate to severe traumatic brain injury.
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da Silva PS, Reis ME, and Aguiar VE
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- Adolescent, Brain Injuries mortality, Brain Injuries surgery, Child, Child, Preschool, Diffuse Axonal Injury diagnostic imaging, Diffuse Axonal Injury mortality, Diffuse Axonal Injury surgery, Female, Follow-Up Studies, Glasgow Coma Scale, Humans, Infant, Intensive Care Units, Pediatric, Intracranial Hemorrhage, Traumatic diagnostic imaging, Intracranial Hemorrhage, Traumatic mortality, Intracranial Hemorrhage, Traumatic surgery, Intracranial Hypertension diagnostic imaging, Male, Neurologic Examination, Retrospective Studies, Survival Rate, Brain Injuries diagnostic imaging, Tomography, X-Ray Computed
- Abstract
Background: Repeat head computed tomography (CT) is standard practice for traumatic brain injury (TBI) at many centers. The few studies available in children remain unclear over the value of repeat CT within 24 hours to 48 hours of lesion in such patients. The purpose of the present study was to assess the value of repeat cranial CT in children presenting moderate or severe TBI., Methods: A retrospective study performed within a pediatric intensive care unit between January 2000 and December 2006. All patients with moderate and severe TBI who survived the first 24 hours after admission were included. Clinical data collected included age, lesion mechanism, time between first and second CTs, disease severity score at admission, and Glasgow Coma Scale (GCS) both at admission and day of repeat CT., Results: A total of 63 children were assessed whose mean age was 72 months (48-112). The time between the first and the second CT scans averaged 25.78 hours +/- 13.75 hours (range, 6-48 hours). The reasons for ordering repeat CT scans were divided as follows: follow-up (78%), neurologic deterioration (20.4%), and increased intracranial pressure (1.6%). The change on the follow-up CT scan was compared with the GCS score. The GCS score was improved in 66.6% of patients, remained the same in 15.9%, and worsened in 17.5%. The appearance on the CT scans was better, the same or worse in 41.3%, 34.9%, and 23.8% of patients, respectively. There was a significant association between GCS and changes in findings on repeat CT (OR = 34.5, confidence interval [5.98-199.04], p = 0.000009). The positive and negative predictive values were 82% and 89%, respectively. One patient with a worsened GCS required surgical intervention based on the repeat CT scan., Conclusion: An unchanged or improving neurologic examination in children sustaining moderate or severe TBI who are appropriately monitored may be adequate to exclude the possibility of neurosurgical intervention and, hence, repeat head CT scan.
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- 2008
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25. Functional derangement and cardiac innervation in the apical ballooning syndrome: a 123I-meta-iodobenzylguanidine scintigraphic and dobutamine stress echocardiographic study.
- Author
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Moreo A, De Chiara B, Possa M, Sara R, Bossi I, Orrego PS, Nicolosi E, Mauri F, and Parodi O
- Subjects
- Aged, Coronary Angiography, Electrocardiography, Female, Humans, Myocardial Reperfusion, Radionuclide Imaging, Syndrome, Ventricular Dysfunction, Left diagnostic imaging, 3-Iodobenzylguanidine, Echocardiography, Stress, Radiopharmaceuticals, Ventricular Dysfunction, Left diagnosis, Ventricular Dysfunction, Left physiopathology
- Abstract
Several cases of transient left ventricular apical ballooning syndrome have already been described, but the pathophysiological mechanisms of this syndrome still remain unclear. We report the case of a patient evaluated in the acute phase of apical ballooning by coronary angiography and echocardiography who was submitted to I-meta-iodobenzylguanidine (MIBG) myocardial scintigraphy and dobutamine stress echocardiography one month after the discharge. MIBG scintigraphy demonstrated a decreased tracer uptake in the apical and periapical anterior regions, whilst myocardial perfusion at rest was normal. Dobutamine induced an increased left ventricular outflow tract gradient and hypokinesis in the apical and periapical segments, mimicking the findings that occurred in the acute phase, and in agreement with the location of MIBG abnormalities. After a two-month treatment with carvedilol, MIBG uptake increased in the apical and periapical anterior regions.
- Published
- 2007
- Full Text
- View/download PDF
26. Negative-pressure pulmonary edema: a rare complication of upper airway obstruction in children.
- Author
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Silva PS, Monteiro Neto H, Andrade MM, and Neves CV
- Subjects
- Bradycardia etiology, Child, Preschool, Device Removal, Exudates and Transudates, Hemorrhage etiology, Humans, Hypoxia etiology, Intubation, Intratracheal adverse effects, Male, Masks, Positive-Pressure Respiration, Pressure, Pulmonary Edema physiopathology, Pulmonary Edema therapy, Testis surgery, Airway Obstruction complications, Laryngismus complications, Postoperative Complications etiology, Pulmonary Edema etiology
- Abstract
Unlabelled: Negative-pressure pulmonary edema is a rare but life-threatening complication of upper airway obstruction. Because negative-pressure pulmonary edema may occur in a large spectrum of pathologies associated with upper airway obstruction, awareness of this condition is crucial during daily clinical practice. We report a case of negative-pressure pulmonary edema during anesthetic recovery to highlight this condition., Case: A 2-year-old boy was scheduled for orchidopexy under general anesthesia. Shortly after an uneventful operation, the patient presented airway obstruction. Serious oxygen desaturation and bradycardia ensued, during inefficient attempts at positive-pressure ventilation. After emergency intubation, copious pink secretions emerged from the airway. Pulmonary edema was confirmed by clinical examination, pulse oximetry, and chest radiography. The finding of pulmonary edema was resolved within 24 hours after mechanical ventilation and positive end-expiratory pressure. The child suffered no sequelae. This report highlights the clinical features of negative-pressure pulmonary edema and serves as a reminder to the pediatrician who must be able to recognize and initiate treatment for conditions that are uncommon but life-threatening.
- Published
- 2005
- Full Text
- View/download PDF
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