104 results on '"Zambon, Lair"'
Search Results
2. Desafios e implementação do Programa Mais Médicos Campineiro
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Dimarzio, Giuliano, primary, Pinto, Ilione de Cassia, additional, Guimarães, Alóide Ladeia, additional, Rollo, Adail de Almeida, additional, Gonçalves, Aguinaldo, additional, Zambon, Zeliete Linhares Leite, additional, Bedrikow, Rubens, additional, Nunes, Monica, additional, Silva, Camila Ramos da, additional, Costa, Douglas, additional, Cugliari, Luciana, additional, Abrahão, Carlos Eduardo Cantusio, additional, Tófoli, Luis Fernando, additional, Zambon, Lair, additional, Souza, Carmino Antonio de, additional, and Souza, Clarissa Vasconcellos de, additional
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- 2023
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3. Association of Fibrinolytic Potential and Risk of Mortality in Cancer Patients.
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Gois, Gabriele Silva Souza, Montalvão, Silmara Aparecida Lima, Anhaia, Thaizy Ramires Alencar, Almeida, Millene Evelyn Alves, Martinelli, Beatriz Moraes, Fernandes, Maria Carmen Gonçalves Lopes, Hubers, Stephany Cares, Ferreira, Monique R. M., Ribeiro, Daniel Dias, Teixeira, Júlio César, Carvalheira, José Barreto Campello, Lima, Carmen Silvia Passos, Andreollo, Nelson Adami, Etchebehere, Maurício, Zambon, Lair, Ferreira, Ubirajara, Tincani, Alfio José, Martins, Antônio Santos, Coy, Cláudio Saddy Rodrigues, and Seabra, José Cláudio Teixeira
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STATISTICS ,MULTIVARIATE analysis ,FIBRINOLYSIS ,RISK assessment ,CANCER patients ,DESCRIPTIVE statistics ,TUMORS ,THROMBIN ,LONGITUDINAL method ,PROPORTIONAL hazards models - Abstract
Simple Summary: Cancer is a leading cause of death before age 70 and has significant impacts on public health. Cancer patients are at risk for blood clots, tumor progression, and death. The fibrinolytic system, which is involved in blood clotting, shows cooperative effects that facilitate the growth of tumors and the appearance of metastases. This prospective study evaluates the fibrinolytic potential in cancer patients and its association with mortality outcomes. Cancer patients were found to have a hypercoagulability profile and increased plasmin production compared to healthy individuals. Two thrombin generation parameters, maximum amplitude and area under the curve, showed an association with mortality risk. In conclusion, measuring thrombin concentration may help identify cancer patients with an elevated risk of death and further studies can play a crucial role in shedding light on the findings presented here. Cancer is a leading cause of death, and the fibrinolytic system shows cooperative effects that facilitate the growth of tumors and the appearance of metastases. This prospective study aimed to evaluate the fibrinolytic potential in cancer patients and its association with mortality outcomes using the fluorometric method of simultaneous thrombin and plasmin generation. The study included 323 cancer patients and 148 healthy individuals. During the 12-month follow-up, 68 patients died. Compared to the control group, cancer patients showed alterations in thrombin production consistent with a hypercoagulability profile, and an increase in plasmin generation. Mortality risk was associated with two parameters of thrombin in both univariate and multivariable analysis: maximum amplitude (Wald 11.78, p < 0.001) and area under the curve (Wald 8.0, p < 0.005), while such associations were not observed for plasmin. In conclusion, this was the first study able to demonstrate the simultaneous evaluation of thrombin and plasmin generation in newly diagnosed untreated cancer patients. Patients with cancer have been observed to exhibit a hypercoagulable profile. During the study, two parameters linked to thrombin generation, MA and AUC, were identified and found to have a potential association with mortality risk. However, no associations were found with parameters related to plasmin generation. [ABSTRACT FROM AUTHOR]
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- 2023
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4. PUBLIC POLICIES TO ENGAGE DOCTORS IN PRIMARY HEALTH SYSTEM: AN EXPERIENCE REPORT FROM THE CITY OF CAMPINAS (BRAZIL)
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Dimarzio, Giuliano, primary, de Cássia Pinto, Ilione, additional, Guimarães, Aloide Ladeia, additional, de Almeida Rollo, Adail, additional, Gonçalves, Aguinaldo, additional, Zambon, - Zeliete Linhares Leite, additional, Bedrikow, Rubens, additional, de Toledo Macedo Nunes, Mônica Regina Prado, additional, da Silva, Camila Ramos, additional, Costa, Douglas, additional, Cugliari, Luciana, additional, Abrahão, Carlos Eduardo Cantusio, additional, de souza, clarissa Vasconcellos, additional, Tófoli, Luís Fernando, additional, Zambon, Lair, additional, and de Cassia Pinto, Ilione, additional
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- 2022
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5. EGFR activating mutations and their association with response to platinum-doublet chemotherapy in Brazilian non-small cell lung cancer patients
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Honma, Helen N., Perroud, Jr., Maurício W., Leme, Maurício S. T., Barbeiro, Aristóteles S., Saad, Bruna A., Morcillo, André M., Vassallo, José, Costa, Daniel B., and Zambon, Lair
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- 2014
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6. Clusters of SARS-CoV-2 Lineage B.1.1.7 Infection after Vaccination with Adenovirus-Vectored and Inactivated Vaccines
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de Souza, William M., primary, Muraro, Stéfanie P., additional, Souza, Gabriela F., additional, Amorim, Mariene R., additional, Sesti-Costa, Renata, additional, Mofatto, Luciana S., additional, Forato, Julia, additional, Barbosa, Priscilla P., additional, Toledo-Teixeira, Daniel A., additional, Bispo-dos-Santos, Karina, additional, Parise, Pierina L., additional, Brunetti, Natalia S., additional, Moreira, Joselia C. O., additional, Costa, Vitor A., additional, Cardozo, Daniela M., additional, Moretti, Maria L., additional, Barros-Mazon, Silvia, additional, Marchesi, Gabriela F., additional, Ambrosio, Christiane, additional, Spilki, Fernando R., additional, Almeida, Valeria C., additional, Vieira, Andre S., additional, Zambon, Lair, additional, Farias, Alessandro S., additional, Addas-Carvalho, Marcelo, additional, Benites, Bruno D., additional, Marques, Rafael E., additional, Sabino, Ester C., additional, Zuben, Andrea B. Von, additional, Weaver, Scott C., additional, Faria, Nuno R., additional, Granja, Fabiana, additional, Angerami, Rodrigo N., additional, and Proença-Módena, José Luiz, additional
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- 2021
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7. miRNAs as biomarkers of adverse drug reactions to platinum-based agents in patients with non-small-cell lung cancer
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Vasconcelos, Pedro ENS, primary, Visacri, Marília B, additional, Pincinato, Eder de C, additional, Torso, Nadine de G, additional, Seguin, Cecília S, additional, Zambon, Lair, additional, Barbeiro, Aristóteles de S, additional, Junior, Maurício WP, additional, and Moriel, Patricia, additional
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- 2021
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8. Peripheral oxygen measurements in suspected elderly COVID-19 patients can be an effective tool for alerting physicians
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Souza, Carmino A De, primary, Miranda, Eliana C M, additional, Hadich, Deise, additional, Nunes, Monica, additional, Masetto, Debora, additional, Morato, Daiane C P, additional, Scandiuzzi, Raquel, additional, Ferreira, Maria do Carmo, additional, Zambon, Lair, additional, and Zuben, Andrea von, additional
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- 2021
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9. Influence of p53 codon 72 exon 4, GSTM1, GSTT1 and GSTP1*B polymorphisms in lung cancer risk in a Brazilian population
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Honma, Helen N., De Capitani, Eduardo M., Perroud, Maurício W., Jr., Barbeiro, Aristóteles S., Toro, Ivan F.C., Costa, Daniel B., Lima, Carmen S.P., and Zambon, Lair
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- 2008
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10. Clusters of SARS-CoV-2 Lineage B.1.1.7 Infection After Vaccination With Adenovirus-Vectored and Inactivated Vaccines: A Cohort Study
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de Souza, William M., primary, Muraro, Stefanie Primon, additional, Souza, Gabriela Fabiano, additional, Amorim, Mariene R., additional, Sesti-Costa, Renata, additional, Mofatto, Luciana S., additional, Forato, Julia, additional, Barbosa, Priscilla P., additional, Toledo-Teixeira, Daniel Augusto de, additional, Bispo-dos-Santos, Karina, additional, Parise, Pierina L., additional, Brunetti, Natalia S., additional, Moreira, Joselia C.O., additional, Costa, Vitor A., additional, Cardozo, Daniela Maira, additional, Moretti, Maria Luiza, additional, Barros-Mazon, Silvia, additional, Marchesi, Gabriela Felix, additional, Ambrosio, Christiane, additional, Spilki, Fernando R., additional, Almeida, Valeria Correia, additional, Vieira, Andre S., additional, Zambon, Lair, additional, Farias, Alessandro, additional, Addas-Carvalho, Marcelo, additional, Benites, Bruno D., additional, Marques, Rafael Elias, additional, Sabino, Ester C., additional, Von Zuben, Andrea, additional, Weaver, Scott C., additional, Faria, Nuno R., additional, Granja, Fabiana, additional, Angerami, Rodrigo N., additional, and Proenca-Modena, Jose Luiz, additional
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- 2021
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11. GSTM1 and codon 72 P53 polymorphism in multiple myeloma
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Ortega, Manoela M., Honma, Helen N., Zambon, Lair, Lorand-Metze, Irene, Costa, Fernando F., De Souza, Carmino A., and Lima, Carmen S. P.
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- 2007
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12. hsa‑miR‑455‑3P as a predictive biomarker of anemia in patients with non‑small cell lung cancer treated with carboplatin plus paclitaxel.
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Vasconcelos, Pedro Eduardo Nascimento Silva, Seguin, Cecília Souto, Barbeiro, Aristóteles de Souza, Zambon, Lair, Honma, Helen Naemi, Perroud Jr, Maurício Wesley, Geraldo, Murilo Vieira, Pincinato, Eder de Carvalho, and Moriel, Patricia
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NON-small-cell lung carcinoma ,CHEMOTHERAPY complications ,PACLITAXEL ,CARBOPLATIN ,ANEMIA - Abstract
Lung cancer is the leading cause of cancer-related morbidity and mortality worldwide. The initial treatment of lung cancer depends on the definition of the tumor type and its staging. The most common treatment is chemotherapy, and the first-line treatment is a combination of carboplatin and paclitaxel. Although this treatment has good efficacy, there is a high prevalence of adverse events, particularly hematological reactions. Studies on new biomarkers related to these adverse events, such as circulating microRNAs (miRNAs/miRs), are important for optimizing the quality of life of patients. miRNAs have high stability in several biological fluids and they have specific expressions in different tissues or pathologies. Thus, the present study aimed to assess the relationship between circulating miRNAs and adverse hematologic reactions caused by treatment with carboplatin + paclitaxel in patients with lung cancer. Blood was collected from patients before and 15 days after chemotherapy for hematological adverse reaction analysis, microarray and quantitative (q)PCR validation. Adverse reactions were classified according to the Common Terminology Criteria for Adverse Events v4.0. Microarray analysis was performed using plasma from six patients without anemia and six patients with anemia, and nine miRNAs were differentially expressed. miR-1273g-3p, miR-3613-5p and miR-455-3p, identified using microarray, were assessed using qPCR in 20 patients without anemia and 26 patients with anemia. Bioinformatic analyses of miR-455-3p were performed using miRWalk, the Database for Annotation, Visualization and Integrated Discovery and GeneMania software. Microarray analysis of patients with and without anemia revealed nine significant differentially-expressed plasma miRNAs among these patients. Of these, miR-1273g-3p, miR-3613-5p and miR-455-3p were chosen for further assessment. Only miR-455-3p demonstrated a significant reduction in expression (P=0.04) between the groups before chemotherapy with carboplatin + paclitaxel. Bioinformatics analysis of miR-455-3p revealed a relationship between this miRNA and the hematopoietic pathway, particularly with respect to the RUNX family transcription factor 1 (RUNX1) and TAL bHLH transcription factor 1, erythroid differentiation factor (TAL1) genes. The most prevalent adverse reactions in patients with lung cancer treated with carboplatin + paclitaxel were hematological, particularly anemia. This adverse reaction, caused by dysfunction of the hematopoietic system, may be explained by a possible association between the important genes in this system, RUNX1 and TAL1, and hsa-miR-455-3p. [ABSTRACT FROM AUTHOR]
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- 2024
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13. Assessing quality of care for the dying from the bereaved relatives’ perspective : using pre-testing survey methods across seven countries to develop an international outcome measure
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Zambon, Lair, 1956 and UNIVERSIDADE ESTADUAL DE CAMPINAS
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Cognitive interviewing ,Terminal care ,Quality of care for the dying ,Artigo original ,Survey and questionnaire ,Avaliação da qualidade dos cuidados de saúde ,Quality assurance, Health care ,Proxy - Abstract
Agradecimentos: The author(s) disclosed receipt of the following financial support for the research, authorship and/or publication of this article: The ERANet-LAC CODE project: ‘International Care Of the Dying Evaluation (CODE): quality of care for cancer patients as perceived by bereaved relatives’ (ref. ELAC2015/T07-0545, Jan 2017–2020) was funded through the 2nd Joint Call for Transnational Research and/or Innovation Projects within the ERANet-LAC framework, co-funded by the European Commission’s 7th Framework Programme (FP7), with the overall aim to improve the quality of care and quality of life of dying cancer patients. The following national funding agencies are acknowledged: The Research Council of Norway (RCN); National Centre for Research and Development (NCBR), Poland; National Research and Innovation Agency of Uruguay (ANII); Ministry for Science, Technology and Productive Innovation (MINCyT), Argentina; Federal Ministry of Education and Research (BMBF/ DLR), Germany; Research Support Foundation of the State of Sao Paulo (FAPESP), Brazil. In addition, within the United Kingdom, funding was provided by Marie Curie and the Wellcome Trust Public Engagement fund Abstract: The provision of care for dying cancer patients varies on a global basis. In order to improve care, we need to be able to evaluate the current level of care. One method of assessment is to use the views from the bereaved relatives. The aim of this study is to translate and pre-test the ‘Care Of the Dying Evaluation’ (CODETM) questionnaire across seven participating countries prior to conducting an evaluation of current quality of care. The three stages were as follows: (1) translation of CODE in keeping with standardised international principles; (2) pre-testing using patient and public involvement and cognitive interviews with bereaved relatives; and (3) utilising a modified nominal group technique to establish a common, core international version of CODE. Hospital settings: for each country, at least five patient and public involvement representatives, selected by purposive sampling, fed back on CODETM questionnaire; and at least five bereaved relatives to cancer patients undertook cognitive interviews. Feedback was collated and categorised into themes relating to clarity, recall, sensitivity and response options. Structured consensus meeting held to determine content of international CODE (i-CODE) questionnaire. In total, 48 patient and public involvement representatives and 35 bereaved relatives contributed to the pre-testing stages. No specific question item was recommended for exclusion from CODETM. Revisions to the demographic section were needed to be culturally appropriate. Patient and public involvement and bereaved relatives’ perceptions helped enhance the face and content validity of i-CODE. A common, core international questionnaire is now developed with key questions relating to quality of care for the dying Fechado
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- 2019
14. Good Quality Care for Cancer Patients Dying in Hospitals, but Information Needs Unmet: Bereaved Relatives' Survey within Seven Countries.
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Haugen, Dagny Faksvåg, Hufthammer, Karl Ove, Gerlach, Christina, Sigurdardottir, Katrin, Hansen, Marit Irene Tuen, Ting, Grace, Tripodoro, Vilma Adriana, Goldraij, Gabriel, Yanneo, Eduardo Garcia, Leppert, Wojciech, Wolszczak, Katarzyna, Zambon, Lair, Passarini, Juliana Nalin, Saad, Ivete Alonso Bredda, Weber, Martin, Ellershaw, John, Mayland, Catriona Rachel, Faksvåg Haugen, Dagny, Sigurdardottir, Katrin Ruth, and Tuen Hansen, Marit Irene
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MEDICAL quality control ,HOSPITALS ,SOCIAL support ,EMPATHY ,CONFIDENCE intervals ,TERMINALLY ill ,INTERVIEWING ,MEDICAL care ,MEDICAL personnel ,FAMILY attitudes ,PATIENTS' families ,HEALTH ,INFORMATION resources ,POSTAL service ,QUESTIONNAIRES ,DESCRIPTIVE statistics ,COMMUNICATION ,INFORMATION needs ,DIGNITY ,RESPECT ,ODDS ratio ,CANCER patient medical care ,BEREAVEMENT - Abstract
Background: Recognized disparities in quality of end‐of‐life care exist. Our aim was to assess the quality of care for patients dying from cancer, as perceived by bereaved relatives, within hospitals in seven European and South American countries. Materials and Methods: A postbereavement survey was conducted by post, interview, or via tablet in Argentina, Brazil, Uruguay, U.K., Germany, Norway, and Poland. Next of kin to cancer patients were asked to complete the international version of the Care Of the Dying Evaluation (i‐CODE) questionnaire 6–8 weeks postbereavement. Primary outcomes were (a) how frequently the deceased patient was treated with dignity and respect, and (b) how well the family member was supported in the patient's last days of life. Results: Of 1,683 potential participants, 914 i‐CODE questionnaires were completed (response rate, 54%). Approximately 94% reported the doctors treated their family member with dignity and respect "always" or "most of the time"; similar responses were given about nursing staff (94%). Additionally, 89% of participants reported they were adequately supported; this was more likely if the patient died on a specialist palliative care unit (odds ratio, 6.3; 95% confidence interval, 2.3–17.8). Although 87% of participants were told their relative was likely to die, only 63% were informed about what to expect during the dying phase. Conclusion: This is the first study assessing quality of care for dying cancer patients from the bereaved relatives' perspective across several countries on two continents. Our findings suggest many elements of good care were practiced but improvement in communication with relatives of imminently dying patients is needed. (ClinicalTrials.gov Identifier: NCT03566732). Implications for Practice: Previous studies have shown that bereaved relatives' views represent a valid way to assess care for dying patients in the last days of their life. The Care Of the Dying Evaluation questionnaire is a suitable tool for quality improvement work to help determine areas where care is perceived well and areas where care is perceived as lacking. Health care professionals need to sustain high quality communication into the last phase of the cancer trajectory. In particular, discussions about what to expect when someone is dying and the provision of hydration in the last days of life represent key areas for improvement. Disparities exist in the quality of end‐of‐life care. This article assesses the quality of care for dying cancer patients, as perceived by bereaved relatives, within hospitals in seven European and South American countries. [ABSTRACT FROM AUTHOR]
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- 2021
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15. 5 The international ‘care of the dying evaluation’ (CODE) project: using bereaved relatives to assess care for dying cancer patients in europe and south america
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R Mayland, Catriona, primary, Sigurdardottir, Katrin, additional, Irene Tuen Hansen, Marit, additional, Leppert, Wojciech, additional, Wolszczak, Katarzyna, additional, Garcia Yanneo, Eduardo, additional, Tripodoro, Vilma, additional, Goldraij, Gabriel, additional, Weber, Martin, additional, Gerlach, Christina, additional, Zambon, Lair, additional, Nalin Passarini, Juliana, additional, Bredda Saad, Ivete, additional, Ting, Grace, additional, Ellershaw, John, additional, and Faksvåg Haugen, Dagny, additional
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- 2019
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16. Assessing quality of care for the dying from the bereaved relatives’ perspective: Using pre-testing survey methods across seven countries to develop an international outcome measure
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Mayland, Catriona Rachel, primary, Gerlach, Christina, additional, Sigurdardottir, Katrin, additional, Hansen, Marit Irene Tuen, additional, Leppert, Wojciech, additional, Stachowiak, Andrzej, additional, Krajewska, Maria, additional, Garcia-Yanneo, Eduardo, additional, Tripodoro, Vilma Adriana, additional, Goldraij, Gabriel, additional, Weber, Martin, additional, Zambon, Lair, additional, Passarini, Juliana Nalin, additional, Saad, Ivete Bredda, additional, Ellershaw, John, additional, and Haugen, Dagny Faksvåg, additional
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- 2019
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17. International Care of the Dying Evaluation
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Mayland, Catriona Rachel, primary, Gerlach, Christina, additional, Sigurdardottir, Katrin, additional, Hansen, Marit Irene Tuen, additional, Leppert, Wojciech, additional, Stachowiak, Andrzej, additional, Krajewska, Maria, additional, Garcia-Yanneo, Eduardo, additional, Tripodoro, Vilma Adriana, additional, Goldraij, Gabriel, additional, Weber, Martin, additional, Zambon, Lair, additional, Passarini, Juliana Nalin, additional, Saad, Ivete Bredda, additional, Ellershaw, John, additional, and Haugen, Dagny Faksvåg, additional
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- 2019
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18. Mature autologous dendritic cell vaccines in advanced non-small cell lung cancer: a phase I pilot study
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Vassallo José, Gilli Simone CO, Almeida Maria T, Barbeiro Aristóteles S, Honma Helen N, Perroud Maurício W, Saad Sara TO, and Zambon Lair
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Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Background Overall therapeutic outcomes of advanced non-small-cell lung cancer (NSCLC) are poor. The dendritic cell (DC) immunotherapy has been developed as a new strategy for the treatment of lung cancer. The purpose of this study was to evaluate the feasibility, safety and immunologic responses in use in mature, antigen-pulsed autologous DC vaccine in NSCLC patients. Methods Five HLA-A2 patients with inoperable stage III or IV NSCLC were selected to receive two doses of 5 × 107 DC cells administered subcutaneous and intravenously two times at two week intervals. The immunologic response, safety and tolerability to the vaccine were evaluated by the lymphoproliferation assay and clinical and laboratorial evolution, respectively. Results The dose of the vaccine has shown to be safe and well tolerated. The lymphoproliferation assay showed an improvement in the specific immune response after the immunization, with a significant response after the second dose (p = 0.005). This response was not long lasting and a tendency to reduction two weeks after the second dose of the vaccine was observed. Two patients had a survival almost twice greater than the expected average and were the only ones that expressed HER-2 and CEA together. Conclusion Despite the small sample size, the results on the immune response, safety and tolerability, combined with the results of other studies, are encouraging to the conduction of a large clinical trial with multiples doses in patients with early lung cancer who underwent surgical treatment. Trial Registration Current Controlled Trials: ISRCTN45563569
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- 2011
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19. Factors affecting quality of end-of-life hospital care - a qualitative analysis of free text comments from the i-CODE survey in Norway.
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Hansen, Marit Irene Tuen, Haugen, Dagny Faksvåg, Sigurdardottir, Katrin Ruth, Kvikstad, Anne, Mayland, Catriona R., Schaufel, Margrethe Aase, on behalf of the ERANet-LAC CODE project group, Hufthammer, Karl Ove, Leppert, Wojciech, Wolszczak, Katarzyna, Yanneo, Eduardo Garcia, Tripodoro, Vilma, Goldraij, Gabriel, Weber, Martin, Gerlach, Christina, Zambon, Lair, Passarini, Juliana Nalin, Saad, Ivete Bredda, Ellershaw, John, and Ting, Grace
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PSYCHOLOGICAL adaptation ,BEREAVEMENT ,CANCER patients ,PALLIATIVE treatment ,PATIENT safety ,QUALITY assurance ,QUESTIONNAIRES ,PSYCHOLOGY of Spouses ,SURVEYS ,UNCERTAINTY ,QUALITATIVE research ,EXTENDED families ,JOB performance ,PSYCHOSOCIAL factors ,SOCIAL support - Abstract
Background: The ERANet-LAC CODE (Care Of the Dying Evaluation) international survey assessed quality of care for dying cancer patients in seven countries, by use of the i-CODE questionnaire completed by bereaved relatives. The aim of this sub study was to explore which factors improve or reduce quality of end-of-life (EOL) care from Norwegian relatives' point of view, as expressed in free text comments. Methods: 194 relatives of cancer patients dying in seven Norwegian hospitals completed the i-CODE questionnaire 6–8 weeks after bereavement; recruitment period 14 months; response rate 58%. Responders were similar to non-responders in terms of demographic details.104 participants (58% spouse/partner) added free text comments, which were analyzed by systematic text condensation. Results: Of the 104 comments, 45% contained negative descriptions, 27% positive and 23% mixed. 78% described previous experiences, whereas 22% alluded to the last 2 days of life. 64% of the comments represented medical/surgical/oncological wards and 36% palliative care units. Four main categories were developed from the free text comments: 1) Participants described how attentive care towards the practical needs of patients and relatives promoted dignity at the end of life, which could easily be lost when this awareness was missing. 2) They experienced that lack of staff, care continuity, professional competence or healthcare service coordination caused uncertainty and poor symptom alleviation. 3) Inadequate information to patient and family members generated unpredictable and distressing final illness trajectories. 4) Availability and professional support from healthcare providers created safety and enhanced coping in a difficult situation. Conclusions: Our findings suggest that hospitals caring for cancer patients at the end of life and their relatives, should systematically identify and attend to practical needs, as well as address important organizational issues. Education of staff members ought to emphasize how professional conduct and communication fundamentally affect patient care and relatives' coping. [ABSTRACT FROM AUTHOR]
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- 2020
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20. Response to cytotoxic chemotherapy and overall survival in non-small cell lung cancer patients with positive or negative ERCC1 expression
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Honma, Helen Naemi, primary, Perroud Jr, Maurício Wesley, additional, Morcillo, André Moreno, additional, Vassallo, José, additional, and Zambon, Lair, additional
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- 2018
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21. What do bereaved relatives of cancer patients dying in hospital want to tell us? Analysis of free-text comments from the International Care of the Dying Evaluation (i-CODE) survey: a mixed methods approach.
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Gerlach, Christina, Baus, Miriam, Gianicolo, Emilio, Bayer, Oliver, Haugen, Dagny Faksvåg, Weber, Martin, Mayland, Catriona R., ERANet-LAC CODE Core scientific group, Sigurdardottir, Katrin, Hansen, Marit Irene Tuen, Hufthammer, Karl Ove, Leppert, Wojciech, Wolszczak, Katarzyna, Yanneo, Eduardo Garcia, Tripodoro, Vilma, Goldraij, Gabriel, Zambon, Lair, Passarini, Juliana Nalin, Saad, Ivete Bredda, and Ellershaw, John
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Purpose: We conducted an international survey of bereaved relatives of cancer patients dying in hospitals in seven countries, with the aim to assess and improve the quality of care. The survey used the i-CODE (International Care of the Dying Evaluation) questionnaire. Here, we report findings from the free-text comments submitted with the questionnaires. We explored for topic areas which would potentially be important for improving the quality of care. Further, we examined who reported free-texts and in what way, to reduce bias without ignoring the function the free-texts may have for those contributing. Methods: We used a combined qualitative-quantitative approach: logistic regression analysis to study the effect of respondents’ socio-demographic characteristics on the probability of free-texts contributions and thematic analysis to understand the free-text meaning. The primary survey outcomes, (1) how frequently the dying person was treated with dignity and respect and (2) support for the relative, were related to free-text content. Results: In total, 914 questionnaires were submitted; 457/914 (50%) contained free-text comments. We found no socio-demographic differences between the respondents providing free-texts and those who did not. We discovered different types of free-texts (“feedback,” “narrative,” “self-revelation”) containing themes of which “continuity of care,” “the one person who can make a difference,” and “the importance of being a companion to the dying” represent care dimensions supplementing the questionnaire items. A free-text type of grateful feedback was associated with well perceived support for the relative. Conclusion: Bereaved relatives used the free-texts to report details related to i-CODE items and to dimensions otherwise not represented. They highlighted the importance of the perceived support from human interaction between staff and the dying patient and themselves; and that more than professional competence alone, personal, meaningful interactions have profound importance. [ABSTRACT FROM AUTHOR]
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- 2023
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22. VARIANTES ALÉLICAS DO GENE ABCB1 E REAÇÕES ADVERSAS DERMATOLÓGICAS RELACIONADAS AO GEFITINIBE, EM PACIENTES COM CÂNCER DE PULMÃO: UM ESTUDO PILOTO.
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BARBEIRO, ARISTÓTELES, SEGUIN, CECÍLIA, PINCINATO, EDER, ZAMBON, LAIR, MORAU, MARIANA, PERROUD JR., MAURÍCIO, and MORIEL, PATRICIA
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- 2023
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23. Polymorphism of the CYP1A1*2A gene and susceptibility to lung cancer in a Brazilian population
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Honma, Helen Naemi, De Capitani, Eduardo Mello, Barbeiro, Aristóteles de Souza, Costa, Daniel Botelho, Morcillo, André, and Zambon, Lair
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Metabolismo ,Metabolism ,Lung neoplasms ,Neoplasias pulmonares ,Polimorfismo genético ,respiratory system ,Polymorphism, genetic - Abstract
OBJECTIVE: To estimate and compare the frequency of CYP1A1*2A gene polymorphisms in a Brazilian population and determine the possible contribution of these genetic variations to lung cancer risk. METHODS: The study population included 200 patients with lung cancer, and the control group consisted of 264 blood donors. Genomic DNA was obtained from peripheral blood samples. The PCR-RFLP method was used for analysis of the CYP1A1*2A gene. RESULTS: There was no statistically significant difference between the lung cancer patients and the controls in terms of the distribution of CYP1A1*2A polymorphisms (p = 0.49). A multivariate logistic regression model analysis by ethnic group revealed that, within the lung cancer group, the CYP1A1*2A genotype CC plus TC was more common among the African-Brazilian patients than among the White patients (adjusted OR = 3.19; 95% CI: 1.53-6.65). CONCLUSIONS: The CYP1A1*2A gene cannot be linked with lung cancer risk in Brazilian patients at this time. Larger epidemiologic studies are needed in order to establish whether the CC plus TC polymorphism increases the risk of lung cancer in African-Brazilians. OBJETIVO: Estimar e comparar a frequência do gene polimórfico CYP1A1*2A na população brasileira e determinar uma possível contribuição dessas variações genéticas no risco para câncer de pulmão. MÉTODOS: A população estudada incluiu 200 pacientes com câncer de pulmão e o grupo controle consistiu em 264 doadores de sangue. O DNA genômico foi obtido de amostras de sangue periférico. O método usado para a análise do gene CYP1A1*2A foi a PCR-RFLP. RESULTADOS: A distribuição do gene CYP1A1*2A polimórfico não foi estatisticamente diferente entre os pacientes com câncer de pulmão e os controles (p = 0,49). Uma análise multivariada utilizando-se o modelo de regressão logística por grupo étnico revelou uma maior frequência do genótipo CC + TC do gene CYP1A1*2A no grupo de pacientes afro-brasileiros do que no grupo de pacientes caucasoides com câncer de pulmão (OR ajustada = 3,19; IC95%: 1,53-6,65). CONCLUSÕES: O gene CYP1A1*2A não pode ser associado ao risco de câncer de pulmão nesta amostra de pacientes. Um extenso estudo epidemiológico é necessário para estabelecer se os genótipos CC + TC aumentam o risco de câncer de pulmão em afro-brasileiros.
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- 2009
24. Insuficiência respiratória aguda como manifestação da síndrome de eosinofilia-mialgia associada à ingestão de L-triptofano
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Grangeia, Tiago de Araujo Guerra, Schweller, Marcelo, Paschoal, Ilma Aparecida, Zambon, Lair, and Pereira, Mônica Corso
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Triptofano ,Tryptophan ,Insuficiência respiratória ,Respiratory insufficiency ,Eosinophilia-myalgia syndrome ,Síndrome de eosinofilia-mialgia - Abstract
A síndrome da eosinofilia-mialgia foi descrita em 1989 em pacientes que apresentavam mialgia progressiva e incapacitante e eosinofilia sérica, nos líquidos e secreções. A maioria dos pacientes relatava uso prévio de L-triptofano. Sintomas respiratórios são relatados em até 80% dos casos, eventualmente como manifestação única. O tratamento inclui suspensão da droga e corticoterapia. Relatamos o caso de uma mulher de 61 anos com insuficiência respiratória aguda após uso de L-triptofano, hidroxitriptofano e outras drogas. A paciente apresentava eosinofilia no sangue, lavado broncoalveolar e derrame pleural. Após a suspensão da medicação e corticoterapia, houve melhora clínica e radiológica em poucos dias. Eosinophilia-myalgia syndrome was described in 1989 in patients who presented progressive and incapacitating myalgia and eosinophilia in blood, fluids and secretions. Most patients report previous L-tryptophan intake. Respiratory manifestations are found in up to 80% of the cases, occasionally as the only manifestation. Treatment includes drug discontinuation and administration of corticosteroids. Here, we describe the case of a 61-year-old female admitted with acute respiratory failure after using L-tryptophan, hydroxytryptophan and other drugs. The patient presented eosinophilia, together with elevated eosinophil counts in the bronchoalveolar lavage and pleural effusion. After discontinuation of the drugs previously used, corticosteroids were administered, resulting in clinical and radiological improvement within just a few days.
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- 2007
25. Alveolar hemorrhage after parenteral injection of industrial silicone
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Macedo, Ronaldo Ferreira, primary, Lobao, Ricardo Ananias, additional, Capitani, Eduardo Mello De, additional, Zanovello, Maira Eliza Petrucci, additional, Caruso, Paula Catarina, additional, Leme, Mauricio Souza de Toledo, additional, Cerqueira, Elza Maria Figueiras Pedreira de, additional, and Zambon, Lair, additional
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- 2013
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26. Autologous Dendritic Cell Vaccines in Lung Cancer
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Zambon, Lair, primary
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- 2013
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27. A polymorphism in the angiogenesis inhibitor, endostatin, in lung cancer susceptibility
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Zambon, Lair, Honma, Helen N., Lourenço, Gustavo J., Saad, Ivete A.B., Mussi, Ricardo K., and Lima, Carmen S.P.
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- 2008
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28. Utilização da ventilação não invasiva em edema agudo de pulmão e exacerbação da doença pulmonar obstrutiva crônica na emergência: preditores de insucesso
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Passarini, Juliana Nalin de Souza, primary, Zambon, Lair, additional, Morcillo, André Moreno, additional, Kosour, Carolina, additional, and Saad, Ivete Alonso Bredda, additional
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- 2012
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29. Mature autologous dendritic cell vaccines in advanced non-small cell lung cancer: a phase I pilot study
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Perroud, Maurício W, primary, Honma, Helen N, additional, Barbeiro, Aristóteles S, additional, Gilli, Simone CO, additional, Almeida, Maria T, additional, Vassallo, José, additional, Saad, Sara TO, additional, and Zambon, Lair, additional
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- 2011
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30. Evolução do status de performance, índice de massa corpórea e distância percorrida no teste de caminhada de seis minutos em pacientes com câncer de pulmão avançado submetidos à quimioterapia
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Machado, Luciana, primary, Saad, Ivete Alonso Bredda, additional, Honma, Helen Naemi, additional, Morcillo, André Moreno, additional, and Zambon, Lair, additional
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- 2010
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31. Carcinoma bronquico
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Zambon, Lair, primary
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32. Polymorphism of the CYP1A1*2A gene and susceptibility to lung cancer in a Brazilian population
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Honma, Helen Naemi, primary, De Capitani, Eduardo Mello, additional, Barbeiro, Aristóteles de Souza, additional, Costa, Daniel Botelho, additional, Morcillo, André, additional, and Zambon, Lair, additional
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- 2009
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33. Insuficiência respiratória aguda como manifestação da síndrome de eosinofilia-mialgia associada à ingestão de L-triptofano
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Grangeia, Tiago de Araujo Guerra, primary, Schweller, Marcelo, additional, Paschoal, Ilma Aparecida, additional, Zambon, Lair, additional, and Pereira, Mônica Corso, additional
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- 2007
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34. Há Concordância Entre as Medidas das Pressões Respiratórias Máximas Realizadas com Manovacuômetro Digital e Analógico em Pneumopatas?
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Bredda Saad, Ivete Alonso, Paganin, Carolina, Lazari Guidetti, Eduarda, da Silva, Yasmim Bastos, Portela Santos, Bárbara, and Zambon, Lair
- Abstract
Copyright of Unopar Cientifica Ciencias Biologicas e da Saude is the property of Unopar Cientifica Ciencias Biologicas e da Saude 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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- 2015
35. Clinical variables of preoperative risk in thoracic surgery
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Saad, Ivete Alonso Bredda, primary, De Capitani, Eduardo Mello, additional, Toro, Ivan Felizardo Contrera, additional, and Zambon, Lair, additional
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- 2003
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36. Pulmonary silicosis and systemic lupus erythematosus in men: a report of two cases
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Costallat, Lilian Tereza Lavras, primary, De Capitani, Eduardo Mello, additional, and Zambon, Lair, additional
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- 2002
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37. Silicose pulmonaire et lupus érythémateux disséminé chez l’homme. À propos de deux observations
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Costallat, Lilian Tereza Lavras, primary, De Capitani, Eduardo Mello, additional, and Zambon, Lair, additional
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- 2002
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38. Use of non-invasive ventilation in acute pulmonary edema and chronic obstructive pulmonary disease exacerbation in emergency medicine: predictors of failure.
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de Souza Passarini, Juliana Nalin, Zambon, Lair, Moreno Morcillo, André, Kosour, Carolina, and Bredda Saad, Ivete Alonso
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ADULT respiratory distress syndrome , *EDEMA , *METABOLIC disorder treatment , *OBSTRUCTIVE lung disease treatment , *DISEASE exacerbation , *EMERGENCY medicine - Abstract
Objective: This study analyzed acute respiratory failure caused by acute pulmonary edema, as well as chronic obstructive pulmonary disease exacerbation, that was treated with non-invasive mechanical ventilation to identify the factors that are associated with the success or failure non-invasive mechanical ventilation in urgent and emergency service. Methods: This study was a prospective, descriptive and analytical study. We included patients of both genders aged ≥18 years who used non-invasive mechanical ventilation due to acute respiratory failure that was secondary to acute pulmonary edema or chronic obstructive pulmonary disease exacerbation. Patients with acute respiratory failure that was secondary to pathologies other than acute pulmonary edema and chronic obstructive pulmonary disease or who presented with contraindications for the technique were excluded. Expiratory pressures between 5 and 8 cmH2O and inspiratory pressures between 10 and 12 cmH2O were used. Supplemental oxygen maintained peripheral oxygen saturation at >90%. The primary outcome was endotracheal intubation. Results: A total of 152 patients were included. The median non-invasive mechanical ventilation time was 6 hours (range 1 - 32 hours) for chronic obstructive pulmonary disease patients (n=60) and 5 hours (range 2 - 32 hours) for acute pulmonary edema patients (n=92). Most (75.7%) patients progressed successfully. However, reduced APACHE II scores and lower peripheral oxygen saturation were observed. These results were statistically significant in patients who progressed to intubation (p<0.001). BiPAP (Bi-level Positive Airway Pressure portable ventilator), as continuous positive airway pressure use increased the probability of endotracheal intubation 2.3 times (p=0.032). Patients with acute pulmonary edema and elevated GCS scores also increased the probability of success. Conclusion: Respiratory frequency >25 rpm, higher APACHE II scores, BiPAP use and chronic obstructive pulmonary disease diagnosis were associated with endotracheal intubation. Higher GCS and SpO2 values were associated with NIV success. Noninvasive mechanical ventilation can be used in emergency services in acute respiratory failure cases caused by acute pulmonary edema and chronic obstructive pulmonary disease exacerbation, but patients with variables related to a higher percentage of endotracheal intubation should be specially monitored. [ABSTRACT FROM AUTHOR]
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- 2012
39. Evolution of performance status, body mass index, and six-minute walk distance in advanced lung cancer patients undergoing chemotherapy.
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Machado, Luciana, Saad, Ivete Alonso Bredda, Honma, Helen Naemi, Morcillo, André Moreno, and Zambon, Lair
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BODY mass index ,PERFORMANCE evaluation ,LUNG cancer patients ,CANCER chemotherapy ,EXERCISE ,FOLLOW-up studies (Medicine) ,METALS in medicine - Published
- 2010
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40. Resposta à quimioterapia citotóxica e sobrevida global em pacientes com câncer de pulmão não pequenas células com expressão positiva ou negativa para ERCC1.
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Honma, Helen Naemi, Perroud Jr, Maurício Wesley, Morcillo, André Moreno, Vassallo, José, and Zambon, Lair
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- 2018
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41. <atl>Pulmonary silicosis and systemic lupus erythematosus in men: a report of two cases
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Costallat, Lilian Tereza Lavras, De Capitani, Eduardo Mello, and Zambon, Lair
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SILICOSIS , *LUPUS erythematosus , *AUTOIMMUNE diseases - Abstract
We report two cases of coexistence of pulmonary silicosis and systemic lupus erythematosus (SLE). The patients are two men with SLE exposed to silica for 20 years. The hypothesis that silica exposure is linked to a wide variety of known or suspected autoimmune diseases , including SLE, has been discussed in the last decade but few cases of pulmonary silicosis and SLE were reported. Our purpose was to bring attention to the increasing evidence that silica may also cause or stimulate SLE, and to suggest that the researchers look for occupational exposure, mainly in male SLE patients. [Copyright &y& Elsevier]
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- 2002
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42. Pulmonary silicosis and systemic lupus erythematosus in men: a report of two cases.
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Costallat, Lilian Tereza Lavras, De Capitani, Eduardo Mello, and Zambon, Lair
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SILICOSIS , *SYSTEMIC lupus erythematosus - Abstract
We report two cases of coexistence of pulmonary silicosis and systemic lupus erythematosus (SLE). The patients are two men with SLE exposed to silica for 20 years.The hypothesis that silica exposure is linked to a wide variety of known or suspected autoimmune diseases, include SLE, has been discussing in the last decade but few cases of pulmonary silicosis and SLE were reported. Our purpose was to bring attention to the increasing evidence that silica may also cause or stimulate SLE, and to suggest that the researchers looked for the occupational exposure, mainly in male SLE patients. [ABSTRACT FROM AUTHOR]
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- 2002
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43. Variaveis pre-operatorias preditivas de risco para complicações pulmonares no pos-operatorio imediato de cirurgias de torax e abdomen alto
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Saad, Ivete Alonso Bredda, Zambon, Lair, 1956, Universidade Estadual de Campinas. Faculdade de Ciências Médicas, Programa de Pós-Graduação em Ciências Médicas, and UNIVERSIDADE ESTADUAL DE CAMPINAS
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Cirurgia ,Fisioterapia - Abstract
Orientador: Lair Zambon Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas Resumo: O objetivo deste estudo foi identificar variáveis que facilitam o aparecimento de complicação pulmonar pós-operatória nos pacientes submetidos às cirurgias e1etivas de tórax e abdômen alto. Forram estudados 297 pacientes, avaliados e classificados em baixo, moderado e alto risco para desenvolvimento de CPP através da escala PORT, idealizada por TORRINGTON & HENDERSON ( 1988). Todos os pacientes foram acompanhados por 72 horas no pós-operatório e foram consideradas como CPP: ate1ectasia com repercussão clínica ou radiológica, pneumonia, traqueobronquite, broncoespasmo, intubação e/ou ventilação mecânica prolongada. Através da análise univariada, estudamos as seguintes variáveis independentes: idade, grau nutricional (IMC), sintomas respiratórios, doença respiratória, tabagismo, espirometria, gasometria arterial, escala ASA e tempo cirúrgico. Posteriormente submetemos tais variáveis a análise de regressão logística multivariada para avaliar a relação entre as variáveis independentes com as complicações pulmonares pósoperatórias, a incidência de CPP observada foi de 12.1%. Através aplicação da análise de regressão logística multivariada as variáveis expectoração amarela (OR= 3.8); a cirurgia torácica em relação a abdominal (OR=2.9); diminuição da unidade do IMC (OR=1.13); tempo em anos de tabagismo (OR=1.03) e tempo cirúrgico prolongado (OR=I.007). Na aplicação da análise da regressão logística, considerando somente a cirurgia torácica, as variáveis foram: bronco espasmo (OR= 6.2); diminuição da unidade do IMC (OR= 1.15); tempo em anos de tabagismo (OR=1.04) e tempo cirúrgico prolongado (OR=1.007). Com relação à gasometria arterial e a escala ASA, não mostraram significância estatística. Na aplicação da escala PORT, os pacientes classificados no grau moderado apresentaram um rtumento de chances de quatro vezes de apresentar complicações e no alto risco 18 vezes quando comparados ao baixo risco. Conclui-se que as variáveis de risco pré-operatórias que aumentaram a chance de CPP nas cirurgias de tórax e abdômen alto foram: tosse com expectoração amarela; cirurgia torácica, diminuição da unidade do IMC; tempo de tabagismo e tempo cirúrgico prolongado. Nas cirurgias de tórax as variáveis encontradas foram: história de broncoespasmo, diminuição da unidade do IMC, tempo de tabagismo e tempo cirúrgico prolongado. A escala PORT, apesar de não predizer morbidade ou mortalidade, facilitou o reconhecimento do paciente potencialmente de risco aumentado para complicações e pode auxiliar o fisioterapeuta e a equipe muItiprofissional na profilaxia pré-operatória, evitando ou minimizando complicações pulmonares pós-operatórias Abstract: To identifY risk variables leading to early postoperative puImonary complications (POPC) in thoracic and upper abdominal surgery. 297 patients undergoing elective surgery were c1assified as low, moderate and high risk for POPC using the PORT scale, as proposed by Torrington & Henderson (1988). The patients were followed for 72 hours afier the operation. POPC were defined as atelectasis, pneumonia, tracheobronchitis, wheezing, prolonged intubation and for prolonged mechanical ventilation. Univariate ana1ysis was applied to study these independent variables: type of surgery, age; nutricional status (BMI), respiratory disease, smoking habit, spirometry, ASA scale and surgical time. Multivariate logistic regression ana1ysis was performed in order to evaluate the relationship between independent and dependent (POPC) variables. The of incidence POPC was 12.1%. According to the results of multivariate logistic regression ana1ysis the variables increasing the chance of POPC were cough with yellow mucus (OR= 3.8), thoracic surgery ( OR=2.9) compared to abdominal surgery, BMI (OR=1.13), duration of smoking habits (OR=1.03) and prolonged duration of surgery (OR=1.007). In the thoracic surgery group, multivariate logistic regression ana1ysis showed that wheezing (OR=6.2), BMI (OR=1.15), smoking for a long time (OR= 1.04) and prolonged duration of surgery ( OR= 1.007) were related to POPC. ASA scale did not show. statistic significance and PORT scale showed a 4 - fold increased risk in the mode;rate group and a 18 - fold increase in the high risk group indicated the need for a multiprofissional team included a physiotherapist in the preoperative care of those patients. The variables that increased the chance for POPC in thoracic and upper abdominal surgery were: cough with yellow mucus, thoracic surgery, decreased BMI, duration of smoking habits and duration of surgery. In the thoracic surgery group the significant variables were wheezing, decreased BMI, duration of smoking and duration of surgery. Key words: Surgery; Physical therapy; Postoperative complications Mestrado Ciências Biomédicas Mestre em Ciências Médicas
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- 2021
44. Qualidade de vida no pos-operatorio de ressecção de parenquima pulmonar por neoplasia maligna
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Saad, Ivete Alonso Bredda, Toro, Ivan Felizardo Contrera, 1957, Zambon, Lair, Vieira, Reinaldo Wilson, Aquino, José Luiz Braga de, Oberg, Telma Dagmar, Universidade Estadual de Campinas. Faculdade de Ciências Médicas, Programa de Pós-Graduação em Cirurgia, and UNIVERSIDADE ESTADUAL DE CAMPINAS
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Qualidade de vida ,Cuidados pós-operatórios ,Pulmões - Cirurgia ,Pulmões - Câncer - Abstract
Orientador: Ivan Felizardo Contrera Toro Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas Resumo: Pouco se sabe sobre o estado funcional e a qualidade de vida (QV) dos pacientes após a ressecção pulmonar. O potencial beneficio obtido após a cirurgia, a qualidade da sobrevida e/ou alívio dos sintomas dolorosos, pode ter efeito negativo. Questionários que determinem o impacto do procedimento cirúrgico no estado funcional e nas atividades de vida diária, visando uma melhora da QV são fundamentais e devem ser instituídos como rotina para estes pacientes. O objetivo deste estudo foi verificar a associação entre a variável dependente e as independentes e pesquisar preditores de melhora elou piora da qualidade de vida através do questionário genérico em QV SF-36, em pacientes com ressecção por neoplasia. Os pacientes foram avaliados no pré-operatório e aos 30°,90° e 180°dias do pós-operatório. Realizaram fisioterapia respiratória durante a internação hospitalar e posteriormente exercícios de reabilitação pulmonar. Utilizou-se como modelo estatístico as Equações de Estimação Generalizadas (GEE), onde a variável dependente (QV) muda para cada paciente ao longo dos tempos de coleta, considerando as seguintes variáveis independentes: sexo, idade, escolaridade, tipo de cirurgia, radioterapia elou quimioterapia, capacidade vital forçada (CVF), teste de caminhada de seis minutos (TC), escala analógica visual (EAV) e escala hospitalar de ansiedade e depressão (HAD). O nível de significância adotado para os testes estatísticos foi de 5%. Foram obtidos os seguintes resultados: trinta e seis pacientes, de ambos os sexos concluíram o estudo sendo 20 homens e 16 mulheres, com idade mediana de 55.5 :1:13,4anos. Dezessete deles foram submetidos à lobectomia, dez pneumectomia, seis segmentectomia e três bilobectomia. Apresentaram complicações pulmonares pós-operatórias nas primeiras 72 horas do procedimento três pacientes; 15 deles receberam quimioterapia, dois radioterapia e outros dois radio e/ou quimioterapia. Concluiu-se através deste estudo que foram encontrados preditores de melhora da QV naqueles pacientes com melhor desempenho da CVF pesquisada ao longo dos quatro tempos na dimensão capacidade funcional; nos pacientes com melhor desempenho no TC nas dimensões capacidade funcional, aspectos fisicos e estado geral de saúde; nos pacientes com menor ressecção cirúrgica na dimensão aspectos fisicos; após três meses da cirurgia, na dimensão aspecto social do SF-36. Quanto aos preditores de piora naqueles com maior pontuação da sub-escala de ansiedade (HAD) na dimensão aspectos emocionais; nos pacientes com maior intensidade de dor (EAV) nas dimensões capacidade funcional, aspectos físicos, dor e aspectos emocionais; mediante radioterapia e/ou quimioterapia nas dimensões capacidade funcional, aspectos físicos, vitalidade e aspectos sociais; nos primeiros 30 dias do pós-operatório nas dimensões capacidade funcional e aspectos físicos; sexo feminino na dimensão aspectos sociais Abstract: The pulmonary function and quality of life (QL) of patients with pulmonary resection is unknow. The potential benefits obtained with the surgery, the quality of survival and/or relief ITompainful symptoms may have a negative effect. Questionnaires that determine the impact of the surgical procedure on functional status and daily life activities, aiming at an improved QL are essential in the routine care of these patients. The objective of this study was to verify the association between the dependent and independent variables, investigating predictors for improvement and/or worsening ofQL by means ofthe SF-36 for patients who needed resection due to neoplasma. The patients were evaluated in the preoperative period and at 30, 90 and 180 days after surgery. They had respiratory physical therapy while hospitalized and later on pulmonary rehabilitation exercises. Therefore, Generalized Estimation Equations (GEE) were chosen as statistical model, where the dependent variable (QL) changes for each patient along the collection times, considering the independent variables of interest: sex, age, educational leveI, type of surgery, radiotherapy and/or chemotherapy, forced vital capacity (FVC), walk test (WT), visual analog scale (VAS) and the hospital anxiety and depression scale (HAD). The significance leveI adopted for the statistical tests was 5%. The results was thirty-six patients ofboth sexes, 20 men and 16women, with a mean age of 55.5:f: 13,4 years, completed the study. Seventeen ofthese were submitted to lobectomy, ten to pneumectomy, six to segmentectomy and three to bilobectomy. Three ofthe patients presented postoperative pulmonary complications in the first 72 hours after the procedure, 15 received chemotherapy, two received radiotherapy and two others received combined radio and chemotherapy. It was concluded that there was predictors improvement in QL in the subscales: in patients with better FVC on the subscale SF 36 functional capacity; better WT performance on subscale functional capacity, physical aspects and general health status; in patients with smaller surgical resection on subscale physical aspects; three months after surgery on social aspects. There was predictors worsening of QL in the domains: emotional aspects in those with anxiety symptoms (HAD); in patients with higher sensitivity to pain (VAS) on subscales functional capacity, physical aspects, pain and emotional aspects; radio and/or chemotherapy treatment on functional capacity, physical aspects, vitality, social aspects; there also was worsening of QL during the first 30 postoperative days in the functional capacity and physical aspects subscales; in the female sex social aspects Doutorado Pesquisa Experimental Doutor em Cirurgia
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- 2021
45. Uso da cintilografia pulmonar com cortes tomograficos na previsão da função pulmonar pos-opratoria em pacientes com cancer de pulmão
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Piai, Dair Bicudo, Quagliato Júnior, Reynaldo, 1943, Campos, Jose Ribas Milanez de, Aquino, José Luiz Braga de, Zambon, Lair, Capitani, Eduardo Mello de, Universidade Estadual de Campinas. Faculdade de Ciências Médicas, and UNIVERSIDADE ESTADUAL DE CAMPINAS
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Volume expiratorio forçado ,Exploração por radioisotopos ,Tomografia computadorizada de emissão de foton único ,Pulmões - Tumores - Abstract
Orientador: Reinaldo Quagliato Junior Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas Resumo: A cintilografia pulmonar é o método mais usado na avaliação regional da função pulmonar em candidatos a resseção pulmonar que tenham função respiratória limítrofe. Esse método processa aquisições planares e fornece imagens bidimensionais dos pulmões e considera todos os segmentos dos lobos pulmonares como tendo o mesmo volume e função, não considerando a sobreposição espacial de áreas com diferentes funções. A cintilografia pulmonar com cortes tomográficos por outro lado, fornece imagens tomográficas dos pulmões, podendo ser um método mais acurado para a avaliação regional da função pulmonar. Nesse estudo prospectivo, o volume expiratório forçado no primeiro segundo previsto para o período pós-operatório (VEF1ppo) foi estimado em 26 pacientes com câncer de pulmão usando-se espirometria, cintilografia pulmonar de perfusão com aquisições planares (CPAP) e cintilografia pulmonar de perfusão com cortes tomográficos (CPCT). Os valores de VEF1ppo estimados por ambos métodos (CPAP e CPCT) foram comparados com os valores de volume expiratório forçado no primeiro segundo (VEF1) medidos após a operação de ressecção pulmonar (média: 48 ± 44 dias; intervalo: 15 a 180 dias; mediana: 32 dias). O coeficiente de correlação linear de Pearson foi 0.8840 (valor de p
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- 2021
46. Analise de uma serie de 87 pacientes com cancer de pulmão não pequenas celulas operados nos estadios I e II
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Barbeiro, Aristoteles de Souza, Zambon, Lair, 1956, Santoro, Ilka Lopes, Toro, Ivan Felizardo Contrera, Universidade Estadual de Campinas. Faculdade de Ciências Médicas, Programa de Pós-Graduação em Clínica Médica, and UNIVERSIDADE ESTADUAL DE CAMPINAS
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Tórax - Cirurgia ,Câncer ,Quimioterapia - Abstract
Orientador: Lair Zambon Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas Resumo: o câncer de pulmão têm grande importância em saúde pública devido à sua :freqüência e letalidade em todo o mundo. Os pacientes nos estádios iniciais que têm a possibilidade de serem submetidos à cirurgia representam o melhor prognóstico desta patologia. O objetivo deste estudo foi avaliar e conhecer dados epidemiológicos de uma população específica, sobrevida, avaliação dos fatores prognósticos, padrões de recidiva e da resposta terapêutica empregada. Foram analisados 87 pacientes com câncer de pulmão não pequenas células nos estádios I e II cuja terapêutica inicial foi a cirurgia radical e que acompanhamos no Ambulatório de Oncopneumologia de 1990 a 2000. O estadiamento pós-operatório foi o seguinte: estádio IA com 17 casos (19,5%), IB com 24 casos (27,6%), IIA com 6 casos (6,9%) e IIB com 40 casos (46%). O tipo bistológico mais :freqüente foi o carcinoma epiderm6ide seguido do adenocarcinoma. Em relação aos sintomas, 25(28,7%) pacientes eram assintomáticos e a tosse com 50 casos(80,6%) foi o sintoma mais :freqüente.O hábito tabágico esteve presente em 89,7% dos casos e esteve mais associado com carcinoma epidermoide. A quimioterapia foi realizada em 34 pacientes no estadio II, sendo que 30 casos estavam no estadio IB, com sobrevida mediana de 38 meses e o tempo livre de doença mediano foi de 31 meses. No grupo de 12 pacientes que estavam no estadio II e que não fizeram quimioterapia, a sobrevida mediana foi de 38, meses e tempo livre mediano livre de doença foi de 30 meses. Na análise de sobrevivência não houve diferença significativaentre os 2 grupos, com ou sem quimioterapia. A análise de sobrevivência de todos os 85 pacientes foi de 67,2%. A comparação da sobrevida entre os estádios I e II comprovou a diferença significativacom a maior sobrevivênciaa dos pacientes com estádio I (86,9% versus 54,2%). Em relação ao dois tipos histológicos e à sobrevivência destes pacientes, esta ocorreu em grau mais elevado no grupo de pacientes com carcinoma epidermóide (77,2% no final do seguimento) do que no de adenocarcinomas (37,3%). Quanto às recidivas, eJas ocorreram em 28 pacientes (32,9%) com 4 locais e 24 a distância. O cérebro e os ossos com 8 casos foram os locais mais fteqüentemente acometidos. Na análise de Cox e considerando as variáveis idade (maior ou menor que sessenta anos), ausência ou presença de sintomas, histologia (adenocarcinoma e carcinoma epidermóide), estadio I e TI, e se foi re~dizada quimioterapia ou não, mostrou risco significativo apenas para histologia e estadio. A análise mostra que a chance para ocorrer óbito pela neopJasia no adenocarcinoma é de 3,622 vezes maior do que os pacientes com carcinoma epidermóide. Para os pacientes com estadio TI, o risco de ocorrer óbito pela neoplasia é de 5,405 vezes maior do que os pacientes no estadio I Abstract: Lung cancer has great importance in public health due to its frequency and death rate all over the world The patients in the initial stages that have the possibility to be submitted to the surgery, represent the best prognostic ofthis pathology. The objective of this study is to evaluate and to know epidemiological data of a specmc population, life expectation, evaluation of the prognostics, factors patterns recidivism and of the therapeutic answer used. Eigthy seven patients with non-small cells lung cancer in the stages I and II and whose initial therapy was radical surgery, and that we have followed in the Ambulatorio de Oncopneumologia ftom 1990 to 2000 were analyzed. In the staging IA we had 17 cases (19,5%), in the m 24 cases (27,6%), in the IIA 6 cases (6,9%) and the 1m 40 cases (46%). The most ftequent histological types were the squamous carcinoma followed by the adenocarcinoma. In relation to the symptoms, 25 (28,7%) patients were didn't present any symptoms, and the cough, with 50 patients (80,6%), was the most ftequent symptom. Smoking habits were present in 89,7% of the cases and it was more associated with squamous carcmoma. The chemotherapy was performed in 34 patients in the stage II, and 30 cases were in the stage IIB, with life expectation average of 38 months and the average period without the disease was 31 months. In the 12-patient group that was in the stage II and didn't have chemotherapy, the average life expectation was 38 months and the average period without the disease was 30 months. In the life expectation analysis there was no significant difference between the 2 groups, with or without chemotherapy. The value of the life expectation accumulated at the end of the period for all 85 patients was 67,2%. It was found that there is a significant difference in patient's life expectation between stages II, and I and the longest expectation was found in stage I (86,9",10versus 54,2%). In relation to the two histological types, the life expectation of these patients was larger in the patients' group with squamous carcinoma (77,2% at the end of the period) than the adenocarcinoma group (37,3%). In reJation to recidivism, they happened in 28 patients (32,9%) 4 of them were local and 24 were distant. The brain and the bones with 8 cases were the most ftequently attacked pJaces. In the analysis of Cox and considering variables the age (larger or smaller than sixty years), the absence or presence of symptoms, the histology (adenocarcinoma and squamous carcinoma), the stages I and II, and if chemotherapy was used or not, it showed significant risk just for histology and stages. In the multi-varied analysis, it is showed that the chance of death in the adenocarcinoma is 3,622 times larger than the patients with squamous carcinoma. For the stage II patients, the risk of death for the cancer is 5,405 times higher than the stage I patients Mestrado Clínica Médica Mestre em Clínica Médica
- Published
- 2021
47. Pesquisa de mutações nos genes p53 e K-ras em pacientes com carcinoma bronquico atendidos no serviço de oncopneumologia FCM/UNICAMP
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Perroud Junior, Mauricio Wesley, 1971, Zambon, Lair, 1956, Costa, Fernando Ferreira, 1950, Melo, Mônica Barbosa de, Toro, Ivan Felizardo Contrera, Universidade Estadual de Campinas. Faculdade de Ciências Médicas, Programa de Pós-Graduação em Clínica Médica, and UNIVERSIDADE ESTADUAL DE CAMPINAS
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Câncer - Prognóstico ,Traqueia ,Ciclo celular ,Câncer - Diagnóstico ,Oncogenes ,Biologia molecular - Abstract
Orientadores: Lair Zambon, Fernando Ferreira Costa Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas Resumo: Considerada uma doença rara no início do século XX, o carcinoma de pulmão hoje é a neoplasia visceral mais comum e a principal causa de morte por câncer. O estudo dos eventos moleculares envolvidos no câncer de pulmão é importante para o conhecimento do processo de carcinogênese, e para a determinação do espectro mutacional dos genes relacionados ao carcinoma brônquico. No futuro poderemos empregar as técnicas de biologia molecular no diagnóstico precoce e na correlação entre variáveis clínicas, tumorais e genéticas para definir os fatores de prognóstico e a abordagem terapêutica. Realizamos a pesquisa de mutações nos genes p53 e K-ras em pacientes com neoplasia de pulmão. Em relação ao gene p53, pesquisamos mutações nos exons 5 a 10 em 38 pacientes com carcinoma de pulmão não pequenas células, e nos exons 5 a 9 em nove pacientes com carcinoma de pequenas células. A freqüência de mutações foi, respectivamente, de 21 e 33%. A pesquisa de mutações no gene K-ras foi realizada em 8 pacientes com adenocarcinoma e em quatro com carcinoma de grandes células. Não encontramos mutações, provavelmente, devido ao tamanho da amostra. Nos pacientes com carcinoma não pequenas células a presença de mutação no gene p53 não interferiu na sobrevida (p=0,53), no estadiamento (p=0,67) e no tempo de sintomatologia (p=0,15). Comparamos as mutações encontradas no gene p53 com o banco de dados mantido pela Organização Mundial de Saúde (International Agency for Research on Cancer). Considerando que o banco de dados da IARC foi atualizado em março/2002 (16285 entradas), provavelmente somos o primeiro grupo a descrever a mutação no codon 237 (ATGàAAG) em carcinoma brônquico, independente do tipo histológico; da mutação no codon 337 (CGCàCAC) em carcinoma de grandes células e da mutação silenciosa no codon 295 (CCT>CCC) (IARC, 2002) Abstract: Considered a rare illness in the beginning of 20th century, the lung cancer today is the more common visceral neoplasia and the main cause of death by cancer. The study of the molecular events involved in lung cancer is important for the knowledge of the process of carcinogenesis and for the determination of the mutational spectrum of the genes related to lung cancer. In the future we will be able to use the techniques of molecular biology in the early diagnosis, and the correlation between clinical, tumoral and genetic variables will be useful for us to define the factors of prognostic and therapeutic approach. We carried out the study of mutations in the genes p53 and K-ras in patients with lung cancer. In relation to the p53 gene, we have looked for mutations in exons 5 to 10 in 38 patients with non-small cell lung cancer, and in exons 5 to 9 in nine patients with small cell lung cancer. The frequency of mutations was, respectively, 21 and 33%. The analysis of mutations in the K-ras gene was carried out in 8 patients with adenocarcinoma and four with large cell carcinoma. We didn¿t find mutations, probably, due to the size of the sample. In patients with non-small cell lung cancer, the presence of mutation in the p53 gene did not correlate with survival (p=0,53), staging (p=0,67) and time of symptoms (p=0,15). We compared the mutations found in the p53 gene with the database kept by the World Health Organization (International Agency for Research on Cancer). Taking into account that the IARC data bank was updated in March/2002 (16,285 entries), we are probably the first group to describe the transversion on codon 237 (ATGàAAG) in bronchial cancer, independent of the histological type and the mutation on codon 337 in large cell cancer (IARC, 2002) Mestrado Clínica Médica Mestre em Clínica Médica
- Published
- 2021
48. Óbitos por pneumonia associada à ventilação mecânica no Hospital Estadual Sumaré
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Tomaleri, Joan Pinton, 1988, Freire, June Barreiros, Zambon, Lair, Cabrera, Eliana Márcia Sotello, Universidade Estadual de Campinas. Faculdade de Ciências Médicas, Programa de Pós-Graduação em Saúde Coletiva, Política e Gestão em Saúde, and UNIVERSIDADE ESTADUAL DE CAMPINAS
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Mortalidade ,Ventilator-associated pneumonia ,Infection control ,Pneumonia associada à ventilação mecânica ,Mortality ,Controle de infecções - Abstract
Orientador: June Barreiros Freire Dissertação (mestrado profissional) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas Resumo: Trata-se de um estudo analítico dos óbitos relacionados a pneumonia associada a ventilação mecânica (PAV), ocorridos na Unidade de Terapia Intensiva Adulto do Hospital Estadual Sumaré, SP, de 2007 à 2012. O estudo retrospectivo dos prontuários contou com uma amostra de 56 casos com uma taxa de mortalidade devido a PAV de 6,77%, com média de idade de 50,9 anos, desvio padrão de 18,1 anos e mediana de 55,5 anos. A maioria dos pacientes foram admitidos na Unidade de Terapia Intensiva Adulto devido a fatores clínicos (44,6%) e neurológicos (37,5%). Em relação aos pacientes que evoluíram para óbito 84% apresentavam alguma comorbidade, prevalecendo Hipertensão arterial (57,1%), Diabetes mellitus (30,4%) e Cardiopatias (30,4%). Trinta e um casos (57,4%) que evoluíram para óbito por pneumonia associada a ventilação mecânica apresentaram etiologia definida. Pseudomonas aeruginosa foi a bactéria mais frequente, tendo sido identificada em nove casos (16%). Em nove pacientes (16%) foram identificados microrganismos multirresistentes, sendo que em três (5%) deles foi isolado Acinetobacter baumannii. Foi evidenciado em apenas 19 (33,9%) dos óbitos a adesão às boas práticas, mensuráveis individualmente, na prevenção à pneumonia associada a ventilação mecânica. O monitoramento e intervenções baseadas nas boas práticas para prevenção das infecções relacionadas à Assistência em Saúde, em especial à PAV, podem contribuir para evitar o surgimento de situações de risco, complicações clínicas e óbitos dos pacientes Abstract: This is an analytical study of deaths related to ventilator-associated pneumonia (VAP), in adult intensive care unit (ICU) of Hospital Estadual Sumaré, SP, from 2007 to 2012. The retrospective study of medical records included a sample of 56 cases with a mortality rate due to VAP of 6.77%, with a mean age of 50.9 years, standard deviation of 18.1 years and a median of 55.5 years . Most patients were admitted to ICU Adult due to clinical factors (44.6%) and neurological (37.5%). As regards patients who died, 84% had a comorbidity, prevailing arterial hypertension (57.1%), diabetes mellitus (30.4%) and Cardiac (30.4%). Thirty-one cases (57.4%) who died of pneumonia associated with mechanical ventilation had definite etiology. Pseudomonas aeruginosa is the most common bacterium, has been identified in nine cases (16%). In nine patients (16%) multiresistant microorganisms were identified, of which three (5%) of Acinetobacter baumannii was isolated. Was found in only 19 (33.9%) of deaths adherence to best practices, measurable individually in preventing VAP. Was found in only 19 (33.9%) of deaths adherence to best practices, measurable individually in preventing VAP. The monitoring and interventions based on best practices for preventing infections related to health care, especially with VAP, may contribute to preventing the emergence of risk situations, clinical complications and deaths of patients Mestrado Política, Gestão e Planejamento Mestre em Saúde Coletiva, Política e Gestão
- Published
- 2021
49. Análise da evolução da qualidade de vida, performance-status, teste de caminhada de seis minutos e índice de massa corpórea em pacientes com câncer de pulmão avançado submetidos à quimioterapia
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Machado, Luciana, Zambon, Lair, 1956, Saad, Ivete Alonso Bredda, Paulin, Elaine, Lima, Carmen Silvia Passos, Universidade Estadual de Campinas. Faculdade de Ciências Médicas, Programa de Pós-Graduação em Clínica Médica, and UNIVERSIDADE ESTADUAL DE CAMPINAS
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Tolerância ao exercício ,Quality of life ,Qualidade de vida ,Neoplasias pulmonares ,Lung neoplasms ,Exercise tolerance ,Chemotherapy ,Quimioterapia - Abstract
Orientadores: Lair Zambon, Ivete Alonso Bredda Saad Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas Resumo: O câncer de pulmão (CP) é um grave problema de saúde pública por ser um dos tipos de câncer mais frequentes e o responsável por uma maior mortalidade. A maioria dos pacientes está em estágio avançado da doença no momento da apresentação. A quimioterapia é o tratamento mais indicado para esse perfil de paciente. Entretanto, o tratamento pode vir acompanhado de efeitos colaterais que podem interferir diretamente nas capacidades funcionais bem como na qualidade de vida (QV) do paciente. O objetivo desse estudo foi avaliar o efeito da quimioterapia sobre a condição física e QV de pacientes com CP avançado. Foram avaliados 50 pacientes com câncer de pulmão não pequenas células (CPNPC) nos estágios IIIB e IV e com performance status PS-ECOG entre zero e dois. Todos receberam quimioterapia com as drogas paclitaxel e derivados da platina e foram avaliados em três momentos: pré-quimioterapia, pós-quimioterapia e seis após o início do tratamento. Avaliou-se o PS pelo índice ECOG, índice de massa corpórea (IMC) e teste de caminhada de seis minutos (TC6) e a QV pelos questionários SF-36, EORTC QLQ C-30 juntamente com seu módulo LC13 e escala hospitalar de ansiedade e depressão (HAD). Trinta e um pacientes concluíram o estudo após seis meses. Na evolução, 19 foram a óbito ou pioraram o PS-ECOG. O SF-36 não mostrou significância estatística em nenhum dos domínios, o EORTC-C30 mostrou melhora no domínio social e no sintoma insônia e piora para o sintoma náusea; pelo LC13, houve melhora dos sintomas dispnéia, tosse, hemoptise, alopécia e dor torácica, porém piora da neuropatia periférica. Pela aplicação da HAD, os pacientes não apresentaram ansiedade e depressão. Não houve diferença estatisticamente significante entre as avaliações para o IMC e o TC6 não apresentou diferença estaticamente significante em nenhum dos tempos avaliados. Em relação ao PS-EGOG, houve benefício da quimioterapia, principalmente no aumento de pacientes assintomáticos após seis meses de acompanhamento. Conclui-se que houve benefício do uso da quimioterapia em relação à melhoria do PS. A avaliação do IMC e do TC6 não apresentou alteração durante o estudo, o que pode sugerir uma manutenção da condição física. A QV também não apresentou evidências de piora nem de melhora Abstract: Lung cancer (LC), one of the most common types of cancer, is a serious public health problem and responsible for a higher number of mortality. Most of the patients are in advanced stage of disease at presentation. Chemotherapy is the most appropriate treatment for this patient profile. However treatment is often accompanied by side effects that may directly interfere in functional capabilities and the quality of life (QoL) of patients. The aim of this study was to evaluate the effect of chemotherapy on the physical condition and QoL of patients with advanced LC. We evaluated 50 patients with non-small cell lung cancer (NSCLC) in stage IIIB and IV and performance status ECOG-PS between zero and two. All received chemotherapy drugs paclitaxel and platinum derivatives, and were evaluated in three stages: pre-chemotherapy, after-chemotherapy and six after six treatment initiation. We evaluated the ECOG-PS and the index, body mass index (BMI) and six minutes walk test (6MWT) and QoL by SF-36, EORTC QLQ C-30 along with your module LC13 and hospital anxiety and depression scale (HAD). Thirty one patients completed the study after six months. At progression, 19 died or deteriorated ECOG-PS. The SF-36 showed no statistical significance in any of the fields, the EORTC-C30 showed improvement in social and insomnia, and worsening for the symptom nausea, the LC13, his symptoms improved dyspnea, cough, hemoptysis, pain and alopecia chest, but worsening of peripheral neuropathy and by the application of HAD patients did not have anxiety and depression. There was no statistically significant difference between assessments for BMI, the 6MWT did not show statistically significant difference in any of the evaluated time. Regarding EGOG, there was a benefit of chemotherapy, mainly in the increase of asymptomatic patients after six months of follow up (p = 0.031). It is concluded that there was benefit from the use of chemotherapy in relation to the improvement of PS. The assessment of BMI and 6MWT did not change during the study, which may suggest maintenance of physical condition. QoL also showed no evidence of worsening or improvement Mestrado Ciências Básicas Mestre em Clínica Médica
- Published
- 2021
50. Analysis of a series of cases of non- small cell lung cancer, correlating clinical and therapeutic variables with EGFR and K-Ras genes and its protein expression
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Helen Naemi Honma, Zambon, Lair, 1956, Santoro, Ilka Lopes, Takagaki, Teresa Yae, Melo, Mônica Barbosa de, Toro, Ivan Felizardo Contrera, Universidade Estadual de Campinas. Faculdade de Ciências Médicas, Programa de Pós-Graduação em Clínica Médica, and UNIVERSIDADE ESTADUAL DE CAMPINAS
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Neoplasias pulmonares ,Lung neoplasms ,Epidermal growth factor receptor ,Molecular target therapy ,Chemotherapy ,Terapia de alvo molecular ,Quimioterapia ,Receptor do fator de crescimento epidérmico - Abstract
Orientador: Lair Zambon Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas Resumo: câncer de pulmão é a neoplasia com maior taxa de mortalidade, apesar do tratamento agressivo com cirurgia e da evolução no tratamento com quimioterapia e radioterapia. Os derivados de cisplatina são considerados o padrão ouro de tratamento de pacientes Carcinoma de Pulmão Não Pequenas Células (CPNPC). Entretanto, o desenvolvimento da resistência à cisplatina é comum e constitui o principal obstáculo à cura de tumores sensíveis. Recentemente, o avanço do conhecimento sobre as estruturas moleculares tem permitido novos estudos clínicos, principalmente nas vias de sinalização de receptores de tirosina quinase, que resultaram no desenvolvimento de terapias alvo, como os inibidores de tirosina quinase (ITKs) e alguns anticorpos monoclonais. Os aspectos moleculares do carcinoma de pulmão são poucos conhecidos na nossa população. Por isso, este estudo teve o objetivo de analisar as frequências das mutações e expressões dos genes EGFR e K-Ras e correlacionar esses achados com os aspectos clínicos, além de avaliar a influência dessas mutações e/ ou expressões na resposta à quimioterapia e na sobrevida. Foram analisados 129 pacientes para as mutações nos exons 18 ao 21 do gene EGFR. Nove (7%) apresentaram mutações (6 com deleções no exon 19 E746_A750 e 3 com mutações de ponto em heterozigose no exon 21, L858R, CTG para CGG). Em relação ao gene K-Ras, foram analisados 126 pacientes para os códons 12 e 13. Três (2,4%) apresentaram mutações no códon 12 (GGT para TGT). A expressão do EGFR foi positiva em 49,2% dos 132 pacientes avaliados e a expressão do K-Ras em 63,2% de 136 pacientes. Por fim, 50 pacientes atenderam aos critérios de inclusão e exclusão e completaram os 4 ciclos de quimioterapia citotóxica. Destes, 6 tinham mutações no gene EGFR (4 com deleções no exon 19, E746_A750 e 2 com mutações de ponto em heterozigose no exon 21, L858R) com frequência de 12% e uma mutação no gene K-Ras códon 12, GGT para TGT (1/44=2,3%). Dos seis pacientes CPNPC com mutação no EGFR, a taxa de resposta à quimioterapia citotóxica foi de 83,33% (5/6 casos) contrastando significativamente com a resposta dos 44 casos restantes que foi de 34,1% (15/44 casos; p= 0,032). Por meio da análise multivariada, observou-se que pacientes com essa mutação apresentam uma taxa de resposta 9,67 vezes maior do que pacientes sem a mutação (p= 0,047 e IC 95%: 1,03 - 90,41). A mediana do tempo de sobrevida global do grupo que apresentava mutação do EGFR 19-21 foi 37,76 meses [IC95%: indefinido] e do grupo sem a mutação foi de 10,26 meses [IC95%: 6,81 ¿ 13,72] (p = 0,008 Log Rank Test). Não houve correlação significativa da mutação do gene K-Ras ou das expressões com os aspectos clínicos, resposta à quimioterapia ou sobrevida. Os achados deste estudo evidenciaram que os pacientes com mutação no gene EGFR respondem melhor à quimioterapia citotóxica e têm maior sobrevida global quando comparados aos pacientes sem mutações Abstract: Lung cancer is the cancer with highest mortality rate, despite aggressive treatment with surgery and the evolution of treatment with chemotherapy and radiotherapy. Derivatives of cisplatin are considered the gold standard therapy for non-small cell lung cancer (NSCLC) patients. However, development of cisplatin resistance is common and constitutes the main obstacle for tumors sensitive cure. Recently, the advancement in knowledge of molecular structure has allowed new clinical studies, mainly in the receptor tyrosine kinase signaling pathways, which resulted in the development of targeted therapies, such as tyrosine kinase inhibitors (TKIs) and some monoclonal antibodies. Molecular aspects of lung carcinoma are little known in our population. Therefore, this study aimed to analyze the frequency of mutations and expressions of EGFR and K-Ras and correlate these findings with the clinical aspects, in addition to evaluating the influence of these mutations and/or expressions in chemotherapy response and survival. 129 patients were analyzed for the EGFR gene mutations at exons 18 to 21 and 9 patients (7%) presented mutations (6 with deletions at exons 19, E746_A750 and 3 with heterozygous point mutations at exon 21, L858R, CTG to CGG). In relation to the K-Ras gene, 126 patients were analyzed at codons 12 and 13 and 3 patients (2.4%) presented mutations at codon 12 (GGT for TGT). The expression of EGFR was positive in 49.2% of 132 patients evaluated and the expression of K-Ras in 63.2% of 136 patients was positive as well. Finally, 50 patients met inclusion and exclusion criteria and completed the 4 cycles of cytotoxic chemotherapy. Of these, 6 were EGFR gene mutations (4 with deletions at exon 19, E746_A750 and 2 with heterozygous point mutations at exon 21, L858R, CTG to CGG) with 12% frequency and 1 mutation in the K-Ras gene, codon 12, GGT for TGT (1/44 = 2.3%). Of the six patients with EGFR mutation in NSCLC, the response rate to cytotoxic chemotherapy was 83.33% (5/6 cases), in significantly contrasting with the response of the 44 remaining cases which was 34.1% (15/44 cases; p = 0.032). Using multivariate analysis, it was observed patients with this mutation have a response rate of 9.67 times greater than patients without the mutation (p = 0.047 and 95% CI: 1.03-90.41). The median overall survival time of the group that presented the EGFR mutation 19-21 was 37.76 months [95% CI: undefined] and the group without the mutation was 10.26 months [95% CI: 6.81-13.72] (p = 0.008 Log Rank Test). There was no significant correlation of mutation of K-Ras gene or the expressions with clinical aspects, response to chemotherapy or survival. The findings of this study showed patients with mutations in EGFR gene respond better to chemotherapy and have greater cytotoxic overall survival when compared with patients without mutation Doutorado Clínica Médica Doutora em Ciências
- Published
- 2015
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