142 results on '"Tura, Bernardo Rangel"'
Search Results
2. Inibidores BTK e BCL-2 no Tratamento de Primeira Linha da Leucemia Linfocítica Crônica em Pacientes de Alto Risco: Revisão Sistemática e Meta-Análise em Rede
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Albuquerque, Rita de Cássia Ribeiro de, primary, Vieira, Cláudia Lima, additional, Santiago, Isabel Cristina de Almeida, additional, Nascimento, Aline do, additional, Chança, Raphael Duarte, additional, Tura, Bernardo Rangel, additional, Correia, Marcelo Goulart, additional, and Barufaldi, Laura Augusta, additional
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- 2024
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3. Creating an HLA-homozygous iPS cell bank for the Brazilian population: Challenges and opportunities
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Martins de Oliveira, Marcio Lassance, primary, Tura, Bernardo Rangel, additional, Meira Leite, Mauro, additional, Melo dos Santos, Eduardo José, additional, Pôrto, Luís Cristóvão, additional, Pereira, Lygia V., additional, and Campos de Carvalho, Antonio Carlos, additional
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- 2023
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4. Prevalence and impact of sarcopenia in individuals with heart failure with reduced ejection fraction (the SARC-HF study): A prospective observational study protocol.
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Nascimento, Pablo Marino Corrêa, Rodrigues Junior, Luiz Fernando, Felix Mediano, Mauro Felippe, Gonçalves da Silva, Valéria, Tura, Bernardo Rangel, Nogueira, Fabio César Sousa, Domont, Gilberto, Carvalho, Adriana Bastos, de Carvalho, Antônio Carlos Campos, Kasai-Brunswick, Taís Hanae, Mesquita, Claudio Tinoco, Junior, Humberto Villacorta, and Rey, Helena Cramer Veiga
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SARCOPENIA ,BRAIN natriuretic factor ,VENTRICULAR ejection fraction ,HEART failure ,DUAL-energy X-ray absorptiometry ,RESPIRATORY muscles - Abstract
Sarcopenia, a clinical syndrome primarily associated with reduced muscle mass in the elderly, has a negative impact on quality of life and survival. It can occur secondarily to other diseases such as heart failure (HF), a complex clinical syndrome with high morbidity and mortality. The simultaneous occurrence of these two conditions can worsen the prognosis of their carriers, especially in the most severe cases of HF, as in patients with reduced left ventricular ejection fraction (LVEF). However, due to the heterogeneous diagnostic criteria for sarcopenia, estimates of its prevalence present a wide variation, leading to new criteria having been recently proposed for its diagnosis, emphasizing muscle strength and function rather than skeletal muscle mass. The primary objective of this study is to evaluate the prevalence of sarcopenia and/or dynapenia in individuals with HF with reduced LVEF according to the most recent criteria, and compare the gene and protein expression of those patients with and without sarcopenia. The secondary objectives are to evaluate the association of sarcopenia and/or dynapenia with the risk of clinical events and death, quality of life, cardiorespiratory capacity, ventilatory efficiency, and respiratory muscle strength. The participants will answer questionnaires to evaluate sarcopenia and quality of life, and will undergo the following tests: handgrip strength, gait speed, dual-energy X-ray absorptiometry, respiratory muscle strength, cardiopulmonary exercise, as well as genomic and proteomic analysis, and dosage of N-terminal pro-B-type natriuretic peptide and growth differentiation factor-15. An association between sarcopenia and/or dynapenia with unfavorable clinical evolution is expected to be found, in addition to reduced quality of life, cardiorespiratory capacity, ventilatory efficiency, and respiratory muscle strength. [ABSTRACT FROM AUTHOR]
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- 2024
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5. Budget impact of applying appropriateness criteria for myocardial perfusion scintigraphy: The perspective of a developing country
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dos Santos, Mauro Augusto, Santos, Marisa Silva, Tura, Bernardo Rangel, Félix, Renata, Brito, Adriana Soares X., and De Lorenzo, Andrea
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- 2016
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6. Autorização para uso off-label pode ser benéfica para o Sistema Único de Saúde?
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Santos, Marisa da Silva, Costa, Márcia Gisele Santos da, Tura, Bernardo Rangel, Torres, Priscila, Martins, Sandro José, and Toscas, Fotini Santos
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- 2023
7. IMPACTO DO RASTREAMENTO DE CÂNCER DE PRÓSTATA ATRAVÉS DA DOSAGEM DO ANTÍGENO PROSTÁTICO ESPECÍFICO (PSA) PARA O SISTEMA ÚNICO DE SAÚDE
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Malveira, Roberto Ribeiro, Cristiane Rocha Magalhães, Da Silva, Marcela Dutra, Kátia Marie Simões E Senna, and Tura, Bernardo Rangel
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câncer de próstata, rastreamento, sobrediagnóstico, antígeno prostático específico ,prostate cancer, screening, overdiagnosis, prostate-specific antigen - Abstract
A população mundial está envelhecendo e a estrutura etária da população brasileira será semelhante à que observamos nos países desenvolvidos no início do século XXI. O câncer de próstata (CaP) é o câncer masculino mais comum com um total de 72.000 novos casos por ano. A utilização de rastreamento populacional para detecção de câncer de próstata utilizando o teste diagnóstico para o antígeno prostático específico (PSA) é controverso. O tratamento do câncer de próstata pode causar incontinência urinária e disfunção erétil.Objetivo:Avaliar o impacto do rastreamento populacional de câncer de próstata utilizando o teste diagnóstico do PSA.Métodos:Calculou-se o impacto orçamentário para o Sistema Único de Saúde, a quantidade de indivíduos com sobrediagnóstico, as biópsias da próstata e prostatectomias desnecessárias, e a quantidade de indivíduos com sequelas pós prostatectomias. Para uma coorte hipotética com característica semelhante a população brasileira, o impacto orçamentário para o rastreamento populacional é de R$ 2.258.589.515,04 incluindo a realização 14.914.944 biópsias desnecessárias.Resultados:Em 1.322 prostatectomias, temos 622 indivíduos com incontinência urinária e 741 com disfunção erétil. Ao estimar o sobrediagnóstico em 60%, dos 3.095 homens detectados com câncer de próstata, 1.857 homens tinham tumores indolentes. As prostatectomias desnecessárias somaram 793.Conclusão:O resultado da avaliação demonstra a necessidade de uma grande quantidade de recursos para a realização de rastreamento populacional de câncer de próstata, submetendo grande parte da população masculina à procedimentos desnecessários.
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- 2023
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8. Mortality and comorbidities in patients with bronchiectasis over a 3-year follow-up
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Mateus, Simone Paulo, primary, Ribeiro-Alves, Marcelo, additional, Salles, Raquel Esteves Brandão, additional, Costa, Walter, additional, Costa, Claudia Henrique da, additional, Lopes, Agnaldo José, additional, Bártholo, Thiago Prudente, additional, Mafort, Thiago Thomaz, additional, Tura, Bernardo Rangel, additional, and Rufino, Rogério, additional
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- 2022
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9. Cost Utility of Vaccination Against COVID-19 in Brazil
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Fernandes, Ricardo Ribeiro Alves, primary, Santos, Marisa da Silva, additional, Magliano, Carlos Alberto da Silva, additional, Tura, Bernardo Rangel, additional, Macedo, Luana Schroeder Damico Nascimento, additional, Padila, Matheus Piccin, additional, França, Ana Cláudia Wekmuller, additional, and Braga, Andressa Araujo, additional
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- 2022
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10. Risk of coronary artery disease in individuals infected with human immunodeficiency virus
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Vilela, Felippe Dantas, de Lorenzo, Andrea Rocha, Tura, Bernardo Rangel, Ferraiuoli, Giovanna Ianini, Hadlich, Marcelo, de Lima Barros, Marcelo Viana, Ribeiro Lima, Ana Beatriz, and Meirelles, Vanderson
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- 2011
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11. Análise de Custo-Efetividade da Sinvastatina versus Atorvastatina na Prevenção Secundária de Eventos Cardiovasculares no Sistema Único de Saúde Brasileiro
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Araujo, Denizar Vianna, Ribeiro de Souza, Camila Pepe, Bahia, Luciana Ribeiro, Rey, Helena Cramer Veiga, dos Santos Junior, Braulio, Tura, Bernardo Rangel, Berwanger, Otavio, Buehler, Anna Maria, and Silva, Marcus Tolentino
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- 2011
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12. Follow-up of a cohort of patients with noncystic fibrosis bronchiectasis for 1 year
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Mateus, Simone Paulo, primary, Salles, Raquel Esteves Brandão, additional, Costa, Walter, additional, Costa, Claudia Henrique da, additional, Lopes, Agnaldo José, additional, Tura, Bernardo Rangel, additional, and Rufino, Rogério, additional
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- 2022
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13. Prevalence of potential bacterial respiratory pathogens in the oral cavity of hospitalised individuals
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Zuanazzi, David, Souto, Renata, Mattos, Marcelo Barbosa Accioly, Zuanazzi, Maura Rodrigues, Tura, Bernardo Rangel, Sansone, Carmelo, and Colombo, Ana Paula Vieira
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- 2010
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14. The Association Between Physical Performance and Health-Related Quality of Life Based on the EQ-5D-3L Questionnaire in Patients With Chagas Disease
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Almeida Lins, Wylisson Marcelo, primary, Tura, Bernardo Rangel, additional, and Kasal, Daniel Arthur, additional
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- 2021
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15. Cortisol levels and adrenal response in severe community-acquired pneumonia: A systematic review of the literature
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Salluh, Jorge I.F., Shinotsuka, Cássia Righy, Soares, Márcio, Bozza, Fernando A., Lapa e Silva, José Roberto, Tura, Bernardo Rangel, Bozza, Patrícia T., and Vidal, Carolina Garcia
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- 2010
16. Normalización del ultrasonido en el cateterismo en el Sistema Único de Saúde (SUS): una recomendación del análisis de coste-efectividad
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Boller, Carlos Eduardo Pessanha, Senna, Kátia Marie Simões, Teixeira, Roberta da Silva, Goulart, Marcelo Correa, Tura, Bernardo Rangel, and Santos, Marisa da Silva
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Ultrasonografía intervencional ,Guía de práctica clínica ,Avaliação de custo-efetividade ,Interventional ,practice guideline ,Vena subclavia ,Cateterismo venoso central ,Subclavian Vein ,Veia subclávia ,Guia de prática clínica ,Catheterization ,Central venous ,Ultrassonografia de intervenção ,Evaluación de costo-efectividad ,Cost-Effectiveness evaluation ,Ultrasonography - Abstract
The standardization process of certain technologies in the Brazilian Unified Health System must be proceded by cost-effectiveness analyzes. The catheterization procedure is performed in 8% of hospitalized patients and in 15% it causes complications. In view of this scenario, a technology that can provide safety for patients and professionals and reduce the rate of complications must be analyzed and perhaps incorporated into the medical routine. In this way, the objective is to determine the economic feasibility of the technique of central catheterization in a subclavian vein guided by ultrasound compared to guidance by anatomical references, from the perspective of the Brazilian Unified Health System. Through cost-effectiveness analysis using a decision tree model under a population of adult patients in a tertiary health care setting with materials and procedures costs estimated in Brazilian purchase records banks. The outcomes were defined in a literature review by incidence. The results showed that the intervention cost the procedure R$53.81. Despite this, 80.1% of the simulations proved to be cost-effective and 16.5% “dominant”. Other factores corroborated the discussion, concluding the intervention as very cost-effective and the result brings security to de manager when making decisions regarding the standardization of technology. El processo de estandarización de ciertas tecnologias en el Sistema Único de Salud de Brasil debe estar precedido por análises de costo-efectividas. El procedimento de cateterización se realiza em el 8% de los pacientes hospitalizados y em el 15% causa complicaciones. Ante este escenario, una tecnología que puede proporcionar seguridad para pacientes y profesionales y reducir la tasa de complicaciones debería analizarse y quizás incorporarse a la rutina médica. De esta manera, el objetivo es determinar la viabilidad económica de la técnica de cateterismo central en una vena subclavia guiada por ultrasonido en comparación con la guía por referencias anatómicas, desde la perspectiva del Sistema Único de Salud de Brasil. Mediante el análisis de costo-efectividad utilizando un modelo de árbol de decisión en una población de pacientes adultos en um entorno de atención de salud terciaria com costos de materiales y procedimientos estimados em bancos de registros de compra brasileños. Los resultados se definieron en una revisión de la literatura por incidencia. Los resultados mostraron que la intervención le costó al procedimento R$53.81. A pesar de esto, el 80.1% de las simulaciones demostraron ser rentables y el 16.5% "dominantes". Otors factores corroboraron la discusión, concluyendo que la intervención es muy rentable y el resultado brinda seguridad la gerente para la toma de decisiones con respecto a la estandarización de la tecnología. O processo de padronização de determinadas tecnologias no Sistema Único de Saúde Brasileiro deve ser precedido de análises de custo-efetividades. O procedimento de cateterismo é realizado em 8% dos pacientes internados e em 15% acarretam complicações. Diante desse cenário uma tecnologia que possa proporcionar segurança para pacientes e profissionais e reduzir a taxa de complicações deve ser analisada e quiçá incorporada a rotina médica. Desta forma objetiva-se determinar a factibilidade econômica da técnica de cateterismo central em veia subclávia guiada pelo ultrassom comparado à orientação por referenciais anatômicos, sob a perspectiva pagadora do Sistema Único de Saúde brasileiro. Através de análise de custo-efetividade utilizando modelo de árvore de decisão sob uma população de pacientes adultos em um cenário de uma unidade terciária de saúde com custos de materiais e procedimentos estimados em bancos brasileiros de registros de compras. Os desfechos foram definidos em revisão de literatura pela incidência. Os resultados mostraram que a intervenção onerou o procedimento em R$53,81. Apesar disso 80,1% das simulações mostraram-se custo-efetivas e 16,5% “dominantes”. Outros fatores corroboraram na discussão concluindo-se a intervenção como muito custo-efetiva e o resultado traz ao gestor segurança para tomadas de decisões quanto a padronização da tecnologia.
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- 2020
17. O Polimorfismo Genético do Receptor Beta-Adrenérgico Tipo 1 Ser49Gly é Preditor de Morte em Pacientes Brasileiros com Insuficiência Cardíaca
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Albuquerque, Felipe Neves de, Brandão, Andrea Araujo, Silva, Dayse Aparecida, Rocha, Ricardo Mourilhe, Bittencourt, Marcelo Imbroinise, Sales, Ana Luiza Ferreira, Spineti, Pedro Pimenta de Mello, Duque, Gustavo Salgado, Azevedo, Lucas Rangel de Souza, Pozzan, Roberto, Tura, Bernardo Rangel, and Albuquerque, Denilson Campos de
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Hospitalização ,Epinephrine/therapeutic use ,animal structures ,Heart Failure/mortality ,integumentary system ,Doenças Cardiovasculares ,Epidemiology ,Polimorfismo Genético ,Epinefrina/uso terapêutico ,Receptores Adrenérgicos beta ,Cardiotoxicity ,Hospitalization ,Polymorfism, Geetic ,Receptors,Adreneic, beta ,embryonic structures ,Insuficiência Cardíaca/mortalidade ,cardiovascular Dieases ,Cardiotoxicidade ,Epidemiologia - Abstract
Resumo Fundamento O papel do polimorfismo genético do receptor beta1-adrenérgico Ser49Gly (PG-Rβ1-Ser49Gly) como preditor de eventos na insuficiência cardíaca (IC) não está definido para a população brasileira. Objetivos Avaliar a relação entre PG-Rβ1-Ser49Gly e desfechos clínicos em indivíduos com IC com fração de ejeção reduzida. Métodos Análise secundária de prontuários de 178 pacientes e identificação das variantes do PG-Rβ1-Ser49Gly, classificadas como Ser-Ser, Ser-Gly e Gly-Gly. Avaliar sua relação com evolução clínica. Foi adotado nível de significância de 5%. Resultados As médias da coorte foram: seguimento clínico, 6,7 anos; idade, 64,4 anos; 63,5% de homens e 55,1% brancos. A etiologia da IC foi predominantemente isquêmica (31,5%), idiopática (23,6%) e hipertensiva (15,7%). O perfil genético teve a seguinte distribuição: 122 Ser-Ser (68,5%), 52 Ser-Gly (28,7%), e 5 Gly-Gly (2,8%). Houve relação significativa entre esses genótipos e a classe funcional da New York Heart Association (NYHA) ao final do acompanhamento (p = 0,014) com o Gly-Gly associado a NYHA menos avançada. Com relação aos desfechos clínicos, houve associação significativa (p = 0,026) entre mortalidade e PG-Rβ1-Ser49Gly: o número de óbitos em pacientes com Ser-Gly (12) ou Gly-Gly (1) foi menor que com Ser-Ser (54). O alelo Gly teve um efeito protetor independente mantido após análise multivariada e foi associado à redução na chance de óbito de 63% (p = 0,03; odds ratio 0,37 – IC 0,15 a 0,91). Conclusão A presença do PG-Rβ1 Gly-Gly associou-se a melhor evolução clínica avaliada pela classe funcional da NYHA e foi preditor de menor risco de mortalidade, independentemente de outros fatores, em seguimento de 6,7 anos. (Arq Bras Cardiol. 2020; 114(4):616-624) Abstract Background The role of Ser49Gly beta1-adrenergic receptor genetic polymorphism (ADBR1-GP-Ser49Gly) as a predictor of death in heart failure (HF) is not established for the Brazilian population. Objectives To evaluate the association between ADBR1-GP-Ser49Gly and clinical outcomes in individuals with HF with reduced ejection fraction. Methods Secondary analysis of medical records of 178 patients and genotypes of GPRβ1-Ser49Gly variants, classified as Ser-Ser, Ser-Gly and Gly-Gly. To evaluate their association with clinical outcome. A significance level of 5% was adopted. Results Cohort means were: clinical follow-up 6.7 years, age 63.5 years, 64.6% of men and 55.1% of whites. HF etiologies were predominantly ischemic (31.5%), idiopathic (23.6%) and hypertensive (15.7%). The genetic profile was distributed as follows: 122 Ser-Ser (68.5%), 52 Ser-Gly (28.7%) and 5 Gly-Gly (2.8%). There was a significant association between these genotypes and mean NYHA functional class at the end of follow-up (p = 0.014) with Gly-Gly being associated with less advanced NYHA. In relation to the clinical outcomes, there was a significant association (p = 0.026) between mortality and GPRβ1-Ser49Gly: the number of deaths in patients with Ser-Gly (12) or Gly-Gly (1) was lower than in those with Ser-Ser (54). The Gly allele had an independent protective effect maintained after multivariate analysis and was associated with a reduction of 63% in the risk of death (p = 0.03; Odds Ratio 0.37 – CI 0.15–0.91). Conclusion The presence of β1-AR-GP Gly-Gly was associated with better clinical outcome evaluated by NYHA functional class and was a predictor of lower risk of mortality, regardless of other factors, in a 6.7-year of follow-up. (Arq Bras Cardiol. 2020; 114(4):613-615)
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- 2020
18. Mortalidade de uma Coorte de Portadores da Resposta Cardioinibitória à Massagem do Seio Carotídeo - Estudo Longitudinal com 11 Anos de Seguimento
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Lacerda, Gustavo de Castro, de Lorenzo, Andrea Rocha, Tura, Bernardo Rangel, dos Santos, Marcela Cedenilla, Guimarães, Artur Eduardo Cotrim, de Lacerda, Renato Côrtes, and Pedrosa, Roberto Coury
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Carotid Artery Diseases ,Male ,Massagem Seio Carotídeo/mortalidade ,Kaplan-Meier Estimate ,Síncope ,Statistics, Nonparametric ,Syncope ,Electrocardiography ,Risk Factors ,Bradycardia ,Diseases of the circulatory (Cardiovascular) system ,Humans ,Longitudinal Studies ,Bradicardia ,Aged ,Proportional Hazards Models ,Carotid Sinus,Massage/mortality ,Cardiac Pacing, Artificial ,Middle Aged ,Heart Arrest ,Carotid Sinus ,Heart Injuries ,Estimulação Cardíaca Artificial ,RC666-701 ,Original Article ,Female ,Follow-Up Studies - Abstract
Background: Cardioinhibitory carotid sinus hypersensitivity (CICSH) is defined as ventricular asystole ≥ 3 seconds in response to 5-10 seconds of carotid sinus massage (CSM). There is a common concern that a prolonged asystole episode could lead to death directly from bradycardia or as a consequence of serious trauma, brain injury or pause-dependent ventricular arrhythmias. Objective: To describe total mortality, cardiovascular mortality and trauma-related mortality of a cohort of CICSH patients, and to compare those mortalities with those found in a non-CICSH patient cohort. Methods: In 2006, 502 patients ≥ 50 years of age were submitted to CSM. Fifty-two patients (10,4%) were identified with CICSH. Survival of this cohort was compared with that of another cohort of 408 non-CICSH patients using Kaplan-Meier curves. Cox regression was used to examine the relation between CICSH and mortality. The level of statistical significance was set at 0.05. Results: After a maximum follow-up of 11.6 years, 29 of the 52 CICSH patients (55.8%) were dead. Cardiovascular mortality, trauma-related mortality and the total mortality rate of this population were not statistically different from that found in 408 patients without CICSH. (Total mortality of CICSH patients 55.8% vs. 49,3% of non-CICSH patients; p: 0.38). Conclusion: At the end of follow-up, the 52 CICSH patient cohort had total mortality, cardiovascular mortality and trauma-related mortality similar to that found in 408 patients without CICSH. Resumo Fundamento: A resposta cardioinibitória (RCI) à massagem do seio carotídeo (MSC) caracteriza-se por assistolia ≥ 3 segundos provocada por 5 a 10 segundos de MSC. Existe uma preocupação de que pacientes com RCI e episódios prolongados de assistolia possam falecer em consequência direta de bradiarritmia, ou em decorrência de lesão cerebral, trauma grave ou arritmia ventricular pausa dependente. Objetivos: Determinar a mortalidade total, a mortalidade cardiovascular e a mortalidade relacionada ao trauma de uma coorte de pacientes com RCI à MSC e comparar essas mortalidades com as de uma coorte de pacientes sem RCI à MSC. Métodos: Em 2006, 502 pacientes com idade igual ou superior a 50 anos foram submetidos à MSC. Destes, 52 pacientes (10,4%) foram identificados com RCI. A sobrevida desta coorte foi comparada àquela observada em uma coorte de 408 pacientes sem RCI por meio de curvas de Kaplan-Meier. A regressão de Cox foi utilizada para avaliação da relação entre a RCI à MSC e a mortalidade. Variáveis com p < 0,05 foram consideradas estatisticamente significativas. Resultados: Após seguimento máximo de 11,6 anos, 29 dos 52 portadores de RCI (55,8%) faleceram. A mortalidade total, a mortalidade cardiovascular e a mortalidade relacionada ao trauma desta coorte de pacientes não foram significativamente diferentes daquelas encontradas nos 408 pacientes sem RCI (mortalidade total com RCI: 55,8% versus 49,3% sem RCI; p: 0,38). Conclusões: No fim do seguimento, a mortalidade dos 52 portadores de RCI foi semelhante à observada em uma coorte de pacientes sem RCI. A mortalidade cardiovascular e a relacionada ao trauma também foi semelhante nas duas coortes.
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- 2020
19. Atenção e memória de enfermeiros intensivistas: repercussões na segurança do paciente
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Bridi, Adriana Carla, primary, Tura, Bernardo Rangel, additional, Victoria, Mara Sizino da, additional, Cunha, Karinne Cristinne da Silva, additional, Machado, Daniel Aragão, additional, Handem, Priscila de Castro, additional, Marta, Cristiano Bertolossi, additional, and Silva, Roberto Carlos Lyra da, additional
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- 2021
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20. Padronização do ultrassom para cateterismo no Sistema Único de Saúde (SUS) brasileiro: recomendação da análise de custo-efetividade
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Boller, Carlos Eduardo Pessanha, primary, Senna, Kátia Marie Simões, additional, Teixeira, Roberta da Silva, additional, Goulart, Marcelo Correa, additional, Tura, Bernardo Rangel, additional, and Santos, Marisa da Silva, additional
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- 2020
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21. O Polimorfismo Genético do Receptor Beta-Adrenérgico Tipo 1 Ser49Gly é Preditor de Morte em Pacientes Brasileiros com Insuficiência Cardíaca
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Albuquerque, Felipe Neves de, primary, Brandão, Andrea Araujo, additional, Silva, Dayse Aparecida, additional, Rocha, Ricardo Mourilhe, additional, Bittencourt, Marcelo Imbroinise, additional, Sales, Ana Luiza Ferreira, additional, Spineti, Pedro Pimenta de Mello, additional, Duque, Gustavo Salgado, additional, Azevedo, Lucas Rangel de Souza, additional, Pozzan, Roberto, additional, Tura, Bernardo Rangel, additional, and Albuquerque, Denilson Campos de, additional
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- 2020
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22. Interrupções nas atividades de enfermeiros intensivistas: repercussões cognitivas no profissional e na segurança do paciente
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Bridi, Adriana Carla, primary, Tura, Bernardo Rangel, additional, Victoria, Maria Sizino da, additional, Cunha, Karinne cristinne da Silva, additional, Machado, Daniel Aragão, additional, Handem, Priscila de Castro, additional, Marta, Cristiano Bertolossi, additional, and Silva, Roberto Carlos Lyra da, additional
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- 2020
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23. Impact of Complications of Myocardial Revascularization Surgery on Expenses During Hospital Stay
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Barbosa,João Luís, Thiers,Clarissa Antunes, Silva,Anderson Ferreira Rolim da, Vianna,Marcos Maia, Gedeon,Paulo Otávio de Paula Ravaglia, Martins Neto,Lauro, Moreira,Marina Brunner Uchôa Dantas, Faria,Luiz Felipe, and Tura,Bernardo Rangel
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Hospitalization ,Myocardial Revascularization/economy ,Hospital Costs/trends ,Myocardial Revascularization/complications ,Cardiovascular Diseases/economy - Abstract
Background: Coronary artery bypass grafting (CABG) is an important treatment option for obstructive coronary artery disease, but it represents a high expense for paying sources. The complications of CABG impose an additional expense to the procedure that is not yet clearly established. Objective: To determine the economic impact of postoperative complications of CABG during hospitalization in a hospital of the unified health system (SUS). Methods: This is an observational study involving 240 patients undergoing isolated CABG in a reference hospital in cardiology in 2013. Patients aged over 30 years with proven coronary artery disease and indication to perform CRVM were included. Patients who performed CRVM associated with other procedures were excluded. Results: The average cost of hospitalization was R$ 22,647.24 (SD = R$ 28,105.66). In 97 patients who presented some complication the average cost was R$ 35,400.28 (SD = R$ 40,509.47), and in the 143 patients without complications the average cost was R$ 13,996.57 (SD = R$ 5,800.61) (p < 0.001). Expenditures ranged from R$ 17,344.37 in patients with one complication up to R$ 104,596.52 in patients with five complications (p < 0.001). Conclusions: The occurrence of complications during hospitalization for CABG significantly increases the costs of the procedure, but the magnitude of this increase depends on the type of complication developed, and higher expenses related to cardiovascular complications, infections and bleeding. With this information, managers can improve the allocation of resources to health.
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- 2018
24. Impact of Risk Factors for Coronary Artery Disease on Hospital Costs of Patients Undergoing Myocardial Revascularization Surgery in the Brazilian Unified Health System (SUS)
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Barbosa, João Luis, Thiers, Clarissa Antunes, Cunha, Carlos Felipe dos Santos, Moutella, Juliana, Tura, Bernardo Rangel, Orsi, Giulia Principe, Feldman, Karen, Silva, Nathália Rodrigues da, and Faria, Luiz Felipe
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Fatores de Risco ,Risk Factors ,Doença da Artéria Coronariana ,Unified Health System ,Coronary Artery Disease ,Revascularização Miocárdica / economia ,Hospital Costs ,Custos Hospitalares ,Sistema Único de Saúde ,Myocardial Revascularization / economics - Abstract
Background: Cardiovascular diseases are a major cause of mortality and morbidity. Myocardial revascularization surgery may be indicated for the relief of symptoms and to reduce mortality. However, surgery is a costly procedure and the impact of the number of cardiovascular risk factors on the cost of the procedure has not been established. Objectives: To identify the impact of risk factors for coronary artery disease on myocardial revascularization surgery cost. Methods: We selected 239 patients undergoing myocardial revascularization surgery at the National Institute of Cardiology in the period from 01 January to 31 December 2013. We included patients aged over 30 years, with indication for the procedure. Patients undergoing combined procedures were excluded. Results: Seven patients had only one risk factor, 32 patients had two risk factors, 75 patients had 3 risk factors, 78 patients had four risk factors, 36 patients had 5 risk factors and 11 patients presented 6 risk factors. The total costs, on average, was R$ 14,143.22 in the group with 1 risk factor, R$ 18,380.40 in the group with 2 risk factors, R$ 21,229.51 in the group with 3 risk factors, R$ 24,620.86 in the group with 4 risk factors, R$ 21,337.92 in the group with 5 risk factors and R$ 36,098,35 in the group with 6 risk factors (p = 0.441). Conclusion: This study demonstrates that, in a public referral center for highly complex cardiology procedures, there was no significant correlation between the number of cardiovascular risk factors and hospitalization costs. Resumo Fundamentos: As doenças cardiovasculares representam uma importante causa de mortalidade e morbidade. A cirurgia de revascularização do miocárdio pode ser indicada para o alívio dos sintomas e para diminuir a mortalidade. Entretanto, a cirurgia é um procedimento de custo elevado e não está estabelecido o impacto do número de fatores de risco cardiovasculares nos gastos do procedimento. Objetivos: Identificar o impacto dos fatores de risco para a doença arterial coronariana nos gastos com a cirurgia de revascularização do miocárdio. Métodos: Foram selecionados 239 pacientes submetidos à cirurgia de revascularização do miocárdio isolada no Instituto Nacional de Cardiologia no período entre 01 de Janeiro a 31 de Dezembro de 2013. Foram incluídos pacientes com idade superior a 30 anos e indicação de revascularização cirúrgica do miocárdio. Foram excluídos os pacientes submetidos a procedimentos combinados. Resultados: Sete pacientes apresentaram apenas 1 fator de risco, 32 pacientes apresentaram 2 fatores de risco, 75 pacientes apresentaram 3 fatores de risco, 78 pacientes apresentaram 4 fatores de risco, 36 pacientes apresentaram 5 fatores de risco e 11 pacientes apresentaram 6 fatores de risco. O total dos gastos, em média, foi de R$ 14 143,22 no grupo com 1 fator de risco, R$ 18 380,40 no grupo com 2 fatores de risco, R$ 21 229,51 no grupo com 3 fatores de risco, R$ 24 620,86 no grupo com 4 fatores de risco, R$ 21 337,92 no grupo com 5 fatores de risco e R$ 36 098,35 no grupo com 6 fatores de risco (p = 0,441). Conclusão: Este trabalho demonstra que, em uma unidade pública de referência para a realização de procedimentos cardiológicos de alta complexidade, não houve uma correlação significativa entre o número de fatores de risco cardiovascular e os custos da internação.
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- 2018
25. Custo-efetividade do cateterismo venoso central guiado por ultrassonografia no sistema único de saúde (SUS)
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Boller, Carlos Eduardo Pessanha, primary, Senna, Kátia Marie Simões, additional, Goulart, Marcelo Correa, additional, Tura, Bernardo Rangel, additional, and Santos, Marisa da Silva, additional
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- 2019
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26. Follow-up of a cohort of patients with non-cystic fibrosis bronchiectasis for 1 year
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Mateus, Simone Paulo, primary, Salles, Raquel Esteves Brandão, additional, Costa, Walter, additional, Costa, Claudia Henrique da, additional, Lopes, Agnaldo José, additional, Tura, Bernardo Rangel, additional, and Rufino, Rogerio, additional
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- 2019
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27. The Association Between Physical Performance and Health-Related Quality of Life Based on the EuroQol 5-Dimensional Questionnaire in Patients With Chagas Disease
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Almeida Lins, Wylisson Marcelo, Tura, Bernardo Rangel, and Kasal, Daniel Arthur
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Chagas disease (CD) is a chronic disease to millions worldwide, and many patients develop heart disease. In addition, they are part of an aging population. These characteristics can be associated with a reduction in physical performance and health-related quality of life (HRQoL). This study evaluated HRQoL, and the relationship between physical performance and HRQoL in patients with chronic CD.
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- 2021
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28. Performance of Diagnostic Tests for Intermediate Probabilities of Coronary Heart Disease: A Decision Making Analysis
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Thiers, Clarissa Antunes, Barbosa, João Luis, Tura, Bernardo Rangel, Arruda, Edilson Fernandes, and Pereira, Basilio de Bragança
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Probabilidade ,da Artéria Coronariana ,Diagnóstico ,Metanalise ,Clinical Decision-Making ,Diagnosis ,Tomada de Decisão Clínica ,Coronary Artery Disease ,Probability ,Meta-Analysis - Abstract
Patients with intermediate probability of coronary disease are a diagnostic challenge and it is precisely in this population where the degree of uncertainty is greater that the diagnostic tests have their greater applicability. However, according to the current definition, subjecting to tests a population with a disease probability between 10 and 90% can generate unnecessary tests and misleading results. Knowing the characteristics of each test, as well as risks and benefits of drug treatment for coronary disease and combining this information through diagnostic thresholds brings a new perspective to decision making. To review the origin of the currently recommended concepts of intermediate probability and to determine the thresholds for diagnosis and treatment of noninvasive tests and, based on them, propose a new concept of intermediate probability of coronary disease. Through the bibliographic review, meta-analyses were extracted in which data of sensitivity, specificity, positive and negative likelihood ratio, risks and benefits of the tests and treatment were provided. Using an algorithm developed by Pauker et al. it was possible to obtain the diagnostic and treatment thresholds adjusted for each tests in question. The concept of intermediate probability of coronary disease is quite broad, ranging, according to the authors, between 10 and 90%, 1 and 92%, 15 and 85%, with different rationale. Considering the discriminatory power of each test, risks and treatment benefits, the diagnostic and treatment thresholds were defined for exercise testing (22-58%), eco-stress (10-72%), myocardial scintigraphy (12-80%), nuclear magnetic resonance (16-80%) and coronary angiotomography (6.7-81%). The decision to submit to diagnostic tests should be individualized, taking into account the diagnostic and treatment thresholds of each method in question. Resumo Pacientes com probabilidade intermediária de doença coronariana são um desafio diagnóstico e é justamente nessa população onde o grau de incerteza é maior que os testes diagnósticos têm sua maior aplicabilidade. Entretanto, de acordo com a definição vigente, submeter uma população com probabilidade de doença entre 10 e 90% pode gerar exames desnecessários e resultados equivocados. Conhecer as características de cada teste, assim como riscos e benefícios do tratamento medicamentoso para doença coronariana e conjugar essas informações através dos limiares de diagnóstico trazem uma nova perspectiva à tomada de decisão. Objetivos: Revisar a origem dos conceitos atualmente preconizados de probabilidade intermediária e determinar os limiares de diagnóstico e tratamento dos testes não invasivos e, com base neles, propor um novo conceito de probabilidade intermediária de doença coronariana. Através da revisão bibliográfica foram extraídas metanálises nas quais dados de sensibilidade, especificidade, razão de verossimilhança positiva e negativa, riscos e benefícios dos testes e tratamento foram fornecidos. Utilizando-se algoritmo desenvolvido por Pauker e colaboradores foi possível obter os limiares de diagnóstico e tratamento ajustados para cada exame em questão. O conceito de probabilidade intermediária de doença coronariana é bastante amplo, variando, conforme os autores, entre 10 e 90%, 1 e 92%, 15 e 85%, com racionalidade distinta. Contemplando-se o poder discriminatório de cada exame, riscos dos testes, riscos e benefícios do tratamento, os limiares de diagnóstico e tratamento foram definidos para teste ergométrico (22-58%), eco-stress (10-72), cintilografia miocárdica (12-80%), ressonância nuclear magnética (16-80%) e angiotomografia de coronárias (6,7-81%). A decisão quanto à submissão aos testes diagnósticos deve ser individualizada, levando-se em consideração os limiares de diagnóstico e tratamento de cada método em questão.
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- 2017
29. Análise do impacto orçamentário da viscossuplementação no tratamento não cirúrgico da osteoartrite de joelho
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Silva, Grasiela Martins da, primary, Senna, Katia Marie Simões e, additional, Sousa, Eduardo Branco de, additional, and Tura, Bernardo Rangel, additional
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- 2019
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30. Effect of Using Triclosan-Impregnated Polyglactin Suture to Prevent Infection of Saphenectomy Wounds in CABG: A Prospective, Double-Blind, Randomized Clinical Trial
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Santos-Filho, Paulo Samuel, primary, Santos, Marisa, additional, Colafranceschi, Alexandre Siciliano, additional, Pragana, Andrea Nunes de Souza, additional, Correia, Marcelo Goulart, additional, Simões, Heloisa Helena, additional, Rocha, Fernando Alves, additional, Soggia, Maria Eduarda de Vasconcelos, additional, Santos, Ana Paula Malta Samuel, additional, Coutinho, Annie de Azeredo, additional, Figueira, Matheus Swarovsky, additional, and Tura, Bernardo Rangel, additional
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- 2019
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31. Attention and memory of intensive care nurses: repercussions on patient safety.
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Bridi, Adriana Carla, Tura, Bernardo Rangel, da Victoria, Mara Sizino, da Silva Cunha, Karinne Cristinne, Machado, Daniel Aragão, Castro Handem, Priscila de, Marta, Cristiano Bertolossi, and Lyra da Silva, Roberto Carlos
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- 2021
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32. Impact of Complications of Myocardial Revascularization Surgery on Expenses During Hospital Stay
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Barbosa, João Luís, primary, Thiers, Clarissa Antunes, additional, Silva, Anderson Ferreira Rolim da, additional, Vianna, Marcos Maia, additional, Gedeon, Paulo Otávio de Paula Ravaglia, additional, Martins Neto, Lauro, additional, Moreira, Marina Brunner Uchôa Dantas, additional, Faria, Luiz Felipe, additional, and Tura, Bernardo Rangel, additional
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- 2018
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33. Mortality and morbidity of patients on the waiting list for coronary artery bypass graft surgery
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da Fonseca, Viviane Belidio Pinheiro, primary, De Lorenzo, Andrea, additional, Tura, Bernardo Rangel, additional, Pittella, Felipe José Monassa, additional, and da Rocha, Antônio Sérgio Cordeiro, additional
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- 2017
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34. Impact of Risk Factors for Coronary Artery Disease on Hospital Costs of Patients Undergoing Myocardial Revascularization Surgery in the Brazilian Unified Health System (SUS)
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Barbosa, João Luis, primary, Thiers, Clarissa Antunes, additional, Cunha, Carlos Felipe dos Santos, additional, Moutella, Juliana, additional, Tura, Bernardo Rangel, additional, Orsi, Giulia Principe, additional, Feldman, Karen, additional, Silva, Nathália Rodrigues da, additional, and Faria, Luiz Felipe, additional
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- 2017
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35. Performance of Diagnostic Tests for Intermediate Probabilities of Coronary Heart Disease: A Decision Making Analysis
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Thiers, Clarissa Antunes, primary, Barbosa, João Luis, additional, Tura, Bernardo Rangel, additional, Arruda, Edilson Fernandes, additional, and Pereira, Basilio de Bragança, additional
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- 2017
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36. Patient and physician preferences for attributes of coronary revascularization.
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Magliano, Carlos Alberto da Silva, Monteiro, Andrea Liborio, Tura, Bernardo Rangel, Oliveira, Claudia Silvia Rocha, Rebelo, Amanda Rebeca de Oliveira, and Pereira, Claudia Cristina de Aguiar
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THERAPEUTICS ,HEART diseases ,MYOCARDIAL revascularization ,CORONARY artery abnormalities ,HEART disease diagnosis ,ATRIAL fibrillation - Abstract
Background: Patients with a diagnosis of coronary artery disease (CAD) may face important decisions regarding treatment options, with the "right choice" depending on the relative weights of risks and benefits. Studies performed as discrete choice experiments are used to estimate these weights, and attribute selection is an essential step in the design of these studies. Attributes not included in the design cannot be analyzed. In this study, we aimed to elicit, rank, and rate attributes that may be considered important to patients and physicians who must choose between angioplasty and surgery for coronary revascularization. Methods: The elicitation process involved performing a systematic review to search for attributes cited in declared preference studies in addition to face-to-face interviews with cardiologists and experts. The interviews were audio-recorded in digital format, and the collected data were transcribed and searched to identify new attributes. The criterion used to finish the data collection process was sampling saturation. Results: A systematic review resulted in the selection of the following 14 attributes: atrial fibrillation, heart failure, incision scar, length of stay, long-term survival, myocardial infarction, periprocedural death, postoperative infection, postprocedural angina, pseudoaneurysm, renal failure, repeat coronary artery bypass grafting, repeat percutaneous coronary intervention, and stroke. The interviews added no new attributes. After rating, we identified significant differences in the values that patients and cardiologists placed on renal insufficiency (p<0.001), periprocedural death (p<0.001), and long-term survival (p<0.001). Conclusion: Decisions regarding the best treatment option for patients with CAD should be made based on differences in risk and the patient's preference regarding the most relevant endpoints. We elicited, ranked, and rated 14 attributes related to CAD treatment options. This list of attributes may help researchers who seek to perform future preference studies of CAD treatment options. [ABSTRACT FROM AUTHOR]
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- 2018
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37. Feasibility of visual aids for risk evaluation by hospitalized patients with coronary artery disease: results from face-to-face interviews.
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Magliano, Carlos Alberto da Silva, Monteiro, Andrea Liborio, Tura, Bernardo Rangel, Oliveira, Claudia Silvia Rocha, Rebelo, Amanda Rebeca de Oliveira, and Pereira, Claudia Cristina de Aguiar
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PATIENT decision making ,VISUAL aids ,HOSPITAL patients ,CORONARY artery abnormalities ,PUBLIC hospitals - Abstract
Purpose: Communicating information about risk and probability to patients is considered a difficult task. In this study, we aim to evaluate the use of visual aids representing perioperative mortality and long-term survival in the communication process for patients diagnosed with coronary artery disease at the National Institute of Cardiology, a Brazilian public hospital specializing in cardiology. Patients and methods: One-on-one interviews were conducted between August 1 and November 20, 2017. Patients were asked to imagine that their doctor was seeking their input in the decision regarding which treatment represented the best option for them. Patients were required to choose between alternatives by considering only the different benefits and risks shown in each scenario, described as the proportion of patients who had died during the perioperative period and within 5 years. Each participant evaluated the same eight scenarios. We evaluated their answers in a qualitative and quantitative analysis. Results: The main findings were that all patients verbally expressed concern about perioperative mortality and that 25% did not express concern about long-term mortality. Twelve percent considered the probabilities irrelevant on the grounds that their prognosis would depend on "God's will." Ten percent of the patients disregarded the reported likelihood of perioperative mortality, deciding to focus solely on the "chance of being cured." In the quantitative analysis, the vast majority of respondents chose the "correct" alternatives, meaning that they made consistent and rational choices. Conclusion: The use of visual aids to present risk attributes appeared feasible in our sample. The impact of heuristics and religious beliefs on shared health decision making needs to be explored better in future studies. [ABSTRACT FROM AUTHOR]
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- 2018
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38. Prevalência de transtornos psiquiátricos em portadores de prótese valvar mecânica com e sem febre reumática
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Silva, Regina Ponce da, Tura, Bernardo Rangel, Nardi, Antonio Egidio, and Silva, Adriana Cardoso de Oliveira e
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psychiatric disorders ,transtornos psiquiátricos ,Próteses valvulares cardíacas ,saúde mental ,febre reumática ,rheumatic fever ,mental health ,Heart valve prosthesis - Abstract
OBJETIVO: Valvulopatias cardíacas, causadas por febre reumática e outras etiologias, podem levar ao implante de prótese valvar mecânica e anticoagulação oral obrigatória. Comorbidade psiquiátrica pode reduzir a adesão à anticoagulação. Esse estudo teve como objetivo avaliar a prevalência de transtornos psiquiátricos em pacientes com prótese valvar mecânica. MÉTODOS: Foram avaliados 193 portadores de prótese valvar mecânica, sendo 135 com cardiopatia reumática, tendo sido utilizada a Mini International Neuropsychiatric Interview, versão 5.0.0, para investigação quanto à presença de transtornos psiquiátricos. RESULTADOS: Foram encontrados os seguintes transtornos psiquiátricos nos pacientes avaliados: transtornos de ansiedade generalizada (16,6%), agorafobia (11,9%), fobia social (10,4%), depressão (9,8%), distimia (4,1% atual e 1% no passado), transtorno obsessivo-compulsivo (3,6%), pânico - vida inteira (1,6%), dependência ou abuso de substâncias (2%), dependência ou abuso de álcool (1%), episódio hipomaníaco (0,5% atual e 0,5% no passado), bulimia (0,5%). O risco de suicídio detectado foi de 13,4%. Ao ser comparada a prevalência dos transtornos no grupo com e sem cardiopatia reumática, não foi encontrada diferença estatisticamente significativa. CONCLUSÃO: Foi encontrada elevada comorbidade de transtornos psiquiátricos, principalmente transtornos ansiosos e depressão, sendo também elevado o risco de suicídio nessa população. OBJECTIVE: Valvular heart diseases, caused by rheumatic fever and another causes, can lead to implant of mechanical valve prosthesis and mandatory oral anticoagulation. Psychiatric comorbidity may reduce adherence to treatment. This study aimed at assessing the prevalence of psychiatric disorders in patients with mechanical heart valve prostheses. METHODS: This study assessed 193 patients with mechanical heart valve prostheses, 135 of whom diagnosed with rheumatic heart disease. The Mini International Neuropsychiatric Interview, version 5.0.0, was used to assess the presence of psychiatric disorders. RESULTS: The following psychiatric disorders were found in the patients with mechanical heart valve prostheses assessed: generalized anxiety disorder (16.6%); agoraphobia (11.9%); social phobia (10.4%); depression (9.8%); dysthymia (4.1% current and 1% past); obsessive-compulsive disorder (3.6%); panic - lifetime (1.6%); substance dependence or abuse (2%); alcohol dependence or abuse (1%); hypomanic episode (0.5% current; 0.5% past); and bulimia (0.5%). A 13.4% suicide risk was detected. When comparing the prevalence of psychiatric disorders in the groups with and without rheumatic heart disease, no statistically significant difference was found. CONCLUSION: High comorbidity of psychiatric disorders, mainly depression and anxiety disorders, was observed in that population, in addition to a high suicide risk.
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- 2011
39. Análisis a largo plazo en el síndrome coronario agudo: ¿Existen diferencias en la morbimortalidad?
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Aguiar, Adolfo Alexandre Farah de, Mourilhe-Rocha, Ricardo, Esporcatte, Roberto, Amorim, Liana Correa, Tura, Bernardo Rangel, and Albuquerque, Denilson Campos de
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drug evaluation ,Sindrome coronariana aguda ,heart failure ,morbidity ,Síndrome coronario agudo ,morbilidad ,Acute coronary syndrome ,insuficiência cardíaca ,insuficiencia cardíaca ,morbidade ,avaliação de medicamentos ,evaluación de medicamentos - Abstract
FUNDAMENTO: A insuficiência cardíaca (IC) tem grande importância como preditor de morbimortalidade em pacientes com síndrome coronariana aguda (SCA). OBJETIVO: Avaliar os preditores de morbimortalidade na SCA em longo prazo. MÉTODOS: Foi um estudo de coorte de 403 pacientes consecutivos com queixas de dor torácica. Descreveram-se dados demográficos, clínicos, laboratoriais e terapêuticos, sendo avaliados durante a internação e até oito anos após alta, em relação à presença ou ausência de eventos cardiovasculares e óbitos. RESULTADOS: Foram 403 pacientes com queixas de dor torácica, em que 65,8% apresentavam diagnóstico de SCA sem supra de ST, 27,8% SCA com supra de ST e 6,5% sem SCA. Destes, foram avaliados os 377 pacientes com SCA, em que 37,9% eram do sexo feminino, e a média de idade foi de 62,2 ± 11,6 anos. A presença de IC antes ou durante a hospitalização influenciou a mortalidade. Dos fatores prognósticos, a creatinina inicial merece destaque, sendo o ponto de corte de 1,4 mg/dl (acurácia = 62,1%; HR = 3,27; p < 0,001). Notamos pior prognóstico para cada acréscimo de dez anos de idade (HR = 1,37; p < 0,001) e para cada incremento de 10 bpm na frequência cardíaca (HR = 1,22 p < 0,001). Quanto às terapias utilizadas antes e após 2002, houve aumento de uso de betabloqueadores, inibidores da enzima conversora da angiotensina (IECAs), estatinas e antiplaquetários, tendo impacto na mortalidade. CONCLUSÃO: Presença de IC admissional, creatinina, idade e FC foram preditores independentes de mortalidade. Observou-se que pacientes com IC atendidos antes de 2002 apresentaram pior sobrevida em relação aos atendidos após 2002 e que a mudança na terapia foi a responsável por isso. BACKGROUND: Heart failure (HF) is extremely important as a predictor of morbidity and mortality in patients with acute coronary syndrome (ACS). OBJECTIVE: To evaluate the predictors of morbidity and mortality in ACS in the long term. METHODS: A cohort study of 403 consecutive patients with complaints of chest pain. Demographic, clinical, laboratory and therapy-related data were described and the patients were evaluated during hospitalization and for up to eight years after being discharged, for the presence or absence or cardiovascular events and deaths. RESULTS: There were 403 patients complaining of chest pain, 65.8% of whom had been diagnosed as having ACS without ST elevation, 27.8% had ACS with ST elevation and 6.5% without ACS. Among such patients, the 377 patients with ACS were evaluated (37.9% of whom were females), and the mean age was 62.2 ± 11.6 years. The presence of HF before or during hospitalization influenced mortality. Among the prognostic factors, emphasis should be placed on the initial creatinine level, with the cutoff point being set at 1.4 mg/dl (accuracy = 62.1%, HR = 3.27; p < 0.001). We noted a worse prognosis for each additional ten years of age (HR = 1.37, p < 0.001) and for each increment of 10 bpm heart rate (HR = 1.22 p < 0.001). As for the therapies used before and after 2002, there was an increase of beta-blockers, angiotensin-converting enzyme inhibitors (ACEIs), statins and antiplatelet agents, having an impact on mortality. CONCLUSION: HF upon admission, creatinine, age and HR were independent predictors of mortality. It was observed that HF patients treated before 2002 had a worse survival when compared with that seen after 2002 and the change in therapy was responsible for it. FUNDAMENTO: La insuficiencia cardíaca (IC) tiene gran importancia como predictor de morbimortalidad en pacientes con síndrome coronario agudo (SCA). OBJETIVO: Evaluar los predictores de morbimortalidad en la SCA a largo plazo. MÉTODOS: Fue un estudio de cohorte de 403 pacientes consecutivos con quejas de dolor torácico. Se describieron datos demográficos, clínicos, de laboratorio y terapéuticos, siendo evaluados durante la internación y hasta ocho años después del alta, en relación a la presencia o ausencia de eventos cardiovasculares y óbitos. RESULTADOS: Fueron 403 pacientes con quejas de dolor torácica, en que 65,8% presentaban diagnóstico de SCA sin supra de ST, 27,8% SCA con supra de ST y 6,5% sin SCA. De estos, fueron evaluados los 377 pacientes con SCA, en que 37,9% eran del sexo femenino, y la media de edad fue de 62,2±11,6 años. La presencia de IC antes o durante la hospitalización influenció la mortalidad. De los factores pronósticos, la creatinina inicial merece destacarse, siendo el punto de corte de 1,4mg/dL (precisión=62,1%; HR=3,27; p
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- 2010
40. Budget impact analysis of the percutaneous septal occluder for treatment of ostium secundum atrial septal defects in the Brazilian Unified National Health System
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Senna, Kátia Marie Simões e, primary, Sarti, Flavia Mori, additional, Costa, Márcia Gisele Santos da, additional, Nita, Marcelo Eidi, additional, Santos, Marisa da Silva, additional, Tura, Bernardo Rangel, additional, and Correia, Marcelo Goulart, additional
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- 2015
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41. Predictores de mortalidad hospitalaria en pacientes con embolia pulmonar estables hemodinámicamente
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Volschan, André, Albuquerque, Denilson, Tura, Bernardo Rangel, Knibel, Marcos, Esteves, José Péricles, Bodanese, Luiz Carlos, Silveira, Francisco, Pantoja, João, Souza, Paulo Cesar Pereira da Silva e, Mansur, João, and Mesquita, Evandro Tinoco
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Mortalidad hospitalaria ,embolia pulmonar ,pulmonary embolism ,doença cardiopulmonar ,taquicardia sinusal ,Hospital mortality ,pulmonary heart disease ,Mortalidade hospitalar ,sinus ,enfermedad cardiopulmonar ,tachycardia - Abstract
FUNDAMENTO: A embolia pulmonar apresenta alta mortalidade em pacientes com hipotensão arterial ou choque circulatório. Entretanto, em pacientes hemodinamicamente estáveis, a associação de algumas variáveis clínicas com a mortalidade ainda não está claramente estabelecida. OBJETIVOS: Derivar um modelo de estratificação do risco de mortalidade intra-hospitalar em pacientes com embolia pulmonar hemodinamicamente estáveis. MÉTODOS: Estudo de coorte multicêntrico prospectivo de 582 pacientes consecutivos que foram admitidos em unidades de emergência ou de terapia intensiva, com suspeita clínica de embolia pulmonar, e que tiveram o diagnóstico confirmado por meio de um ou mais dos seguintes exames: arteriografia pulmonar, angiotomografia computadorizada helicoidal, angioressonância magnética, ecodopplercardiograma, cintilografia pulmonar ou duplex-scan venoso. Os dados sobre características demográficas, comorbidades e manifestações clínicas foram coletados e incluídos em uma análise de regressão logística para compor o modelo de predição. RESULTADOS: A mortalidade global foi de 14,1%. Foram identificadas como variáveis independentes de risco de óbito: idade > 65 anos; repouso no leito > 72h; cor pulmonale crônico; taquicardia sinusal e taquipnéia. Após a estratificação por faixas de risco, observaram-se mortalidades de 5,4%, 17,8% e 31,3%, respectivamente nos subgrupos de baixo, moderado e alto riscos. O modelo mostrou sensibilidade de 65,5% e especificidade de 80%, com uma área sob a curva de 0,77. CONCLUSÃO: Em pacientes hemodinamicamente estáveis com embolia pulmonar, a idade > 65 anos, o repouso no leito > 72h, o cor pulmonale crônico, a taquicardia sinusal e a taquipnéia foram preditores independentes da mortalidade intra-hospitalar. Entretanto o modelo de predição necessita ser validado em outras populações para sua incorporação à prática clínica. BACKGROUND: Pulmonary embolism is associated with high mortality in patients with hypotension or circulatory shock. However, the association between some clinical variables and mortality is still unclear in hemodynamically stable patients. OBJECTIVES: To derive an in-hospital mortality risk stratification model in hemodynamically stable patients with pulmonary embolism. METHODS: This is a prospective multicenter cohort study of 582 consecutive patients admitted in emergency units or intensive care units with clinically suspected pulmonary embolism and whose diagnosis was confirmed by one or more of the following tests: pulmonary arteriography, spiral CT angiography, magnetic resonance angiography, Doppler echocardiography, pulmonary scintigraphy, or venous duplex scan. Data on demographics, comorbidities and clinical manifestations were collected and included in a logistic regression analysis so as to build the prediction model. RESULTS: Overall mortality was 14.1%. The following parameters were identified as independent death risk variables: age > 65 years, bed rest > 72h, chronic cor pulmonale, sinus tachycardia, and tachypnea. After risk stratification, mortalities of 5.4%, 17.8%, and 31.3% were found in the low, moderate and high-risk subgroups, respectively. The model showed 65.5% sensitivity and 80% specificity, with a 0.77 area under the curve. CONCLUSION: In hemodynamically stable patients with pulmonary embolism, age > 65 years, bed rest > 72h, chronic cor pulmonale, sinus tachycardia and tachypnea were independent predictors of in-hospital mortality. However, further validation of the prediction model in other populations is required so that it can be incorporated into the clinical practice. FUNDAMENTO: La embolia pulmonar presenta alta mortalidad en pacientes con hipotensisn arterial o shock circulatorio. Sin embargo, en pacientes hemodinamicamente estables, la asociacisn de algunas variables clmnicas con la mortalidad todavma no esta claramente establecida. OBJETIVO: Derivar un modelo de estratificacisn del riesgo de mortalidad intrahospitalaria en pacientes con embolia pulmonar hemodinamicamente estables. MITODOS: Estudio de cohorte multicintrico prospectivo de 582 pacientes consecutivos que ingresaron en unidades de emergencia o de terapia intensiva, con sospecha clmnica de embolia pulmonar, y que tuvieron el diagnsstico confirmado por medio de uno o mas de los examenes: arteriografma pulmonar, angiotomografma computadorizada helicoidal, angiorresonancia magnitica, ecocardiografma doppler, centellografma pulmonar o duplex scan venoso. Los datos sobre caractermsticas demograficas, comorbilidades y manifestaciones clmnicas se recolectaron e se incluyeron en un analisis de regresisn logmstica para componer el modelo de prediccisn. RESULTADOS: La mortalidad global fue del 14,1%. Se identificaron como variables independientes de riesgo de sbito: edad > 65 aqos; reposo en la cama > 72h; cor pulmonale crsnico; taquicardia sinusal y taquipnea. Tras la estratificacisn por franjas de riesgo, se observaron mortalidades del 5,4%, el 17,8% y el 31,3%, respectivamente en los subgrupos de bajo, moderado y alto riesgos. El modelo revels sensibilidad del 65,5% y especificidad del 80%, con un area bajo la curva de 0,77. CONCLUSISN: En pacientes hemodinamicamente estables con embolia pulmonar, la edad > 65 aqos, el reposo en la cama > 72h, el cor pulmonale crsnico, la taquicardia sinusal y la taquipnea fueron predictores independientes de la mortalidad intrahospitalaria. Sin embargo, el modelo de prediccisn necesita validarse en otras poblaciones para su incorporacisn a la practica clmnica. (Arq Bras Cardiol 2009; 93(2) : 132-137)
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- 2009
42. Mortality and morbidity of patients on the waiting list for coronary artery bypass graft surgery.
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Pinheiro da Fonseca, Viviane Belidio, De Lorenzo, Andrea, Tura, Bernardo Rangel, Monassa Pittella, Felipe José, and Rocha, Antônio Sérgio Cordeiro da
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- 2018
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43. Mortality from Coronary Artery Disease during Dengue Epidemics
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Oliveira, Marcio Lassance Martins de, primary, Mattos, Marco Antonio, additional, Santos, Marisa, additional, and Tura, Bernardo Rangel, additional
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- 2015
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44. Cost-Effectiveness of Procedures for Treatment of Ostium Secundum Atrial Septal Defects Occlusion Comparing Conventional Surgery and Septal Percutaneous Implant
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Costa, Márcia Gisele Santos da, primary, Santos, Marisa da Silva, additional, Sarti, Flávia Mori, additional, Senna, Kátia Marie Simões e., additional, Tura, Bernardo Rangel, additional, and Goulart, Marcelo Correia, additional
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- 2014
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45. Budget impact of applying appropriateness criteria for myocardial perfusion scintigraphy: The perspective of a developing country.
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Santos, Mauro, Santos, Marisa, Tura, Bernardo, Félix, Renata, Brito, Adriana, Lorenzo, Andrea, Dos Santos, Mauro Augusto, Santos, Marisa Silva, Tura, Bernardo Rangel, Félix, Renata, Brito, Adriana Soares X, and De Lorenzo, Andrea
- Abstract
Myocardial perfusion imaging is widely used for the risk stratification of coronary artery disease. In view of its cost, besides radiation issues, judicious evaluation of the appropriateness of its indications is essential to prevent an unnecessary economic burden on the health system. We evaluated, at a tertiary-care, public Brazilian hospital, the appropriateness of myocardial perfusion scintigraphy indications, and estimated the budget impact of applying appropriateness criteria. An observational, cross-sectional study of 190 patients with suspected or known coronary artery disease referred for myocardial perfusion imaging was conducted. The appropriateness of myocardial perfusion imaging indications was evaluated with the Appropriate Use Criteria for Cardiac Radionuclide Imaging published in 2009. Budget impact analysis was performed with a deterministic model. The prevalence of appropriate requests was 78%; of inappropriate indications, 12%; and of uncertain indications, 10%. Budget impact analysis showed that the use of appropriateness criteria, applied to the population referred to myocardial perfusion scintigraphy within 1 year, could generate savings of $ 64,252.04 dollars. The 12% inappropriate requests for myocardial perfusion scintigraphy at a tertiary-care hospital suggest that a reappraisal of MPI indications is needed. Budget impact analysis estimated resource savings of 18.6% with the establishment of appropriateness criteria for MPI. [ABSTRACT FROM AUTHOR]
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- 2016
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46. Software livre e de código aberto para avaliação de imagens de angiotomografia de coronárias
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Hadlich, Marcelo Souza, primary, Oliveira, Gláucia Maria Moraes, additional, Feijóo, Raúl A., additional, Azevedo, Clerio F., additional, Tura, Bernardo Rangel, additional, Ziemer, Paulo Gustavo Portela, additional, Blanco, Pablo Javier, additional, Pina, Gustavo, additional, Meira, Márcio, additional, and Souza e Silva, Nelson Albuquerque de, additional
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- 2012
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47. Valor prognóstico do peptídeo natriurético tipo B na mortalidade de pacientes com Síndrome Coronariana Aguda
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Scotti, Alexandre Vaz, primary, Tura, Bernardo Rangel, additional, Rocha, Ronilson Gonçalves, additional, and Albuquerque, Denilson Campos de, additional
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- 2012
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48. Effects of an exercise program on the functional capacity of patients with chronic Chagas' heart disease, evaluated by cardiopulmonary testing
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Fialho, Paloma Hargreaves, primary, Tura, Bernardo Rangel, additional, Sousa, Andréa Silvestre de, additional, Oliveira, Claudia Rosa de, additional, Soares, Carla Cristiane Santos, additional, Oliveira, Juliana Rega de, additional, Souza, Marcus Vinícius, additional, Coelho, Marina Pereira, additional, Souza, Fernando César de Castro e, additional, Cunha, Ademir Batista da, additional, and Kopiler, Daniel Arkader, additional
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- 2012
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49. Adverse events related to intravenous antibiotic therapy: a prospective observational study in the treatment of infective endocarditis
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De Paula, Débora Holanda Gonçalves, primary, Tura, Bernardo Rangel, additional, and Lamas, Cristiane da Cruz, additional
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- 2012
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50. External Validation of Models for Predicting Pneumonia after Cardiac Surgery
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Santos, Marisa da Silva, primary, Tura, Bernardo Rangel, additional, Rouge, Alexandre, additional, and Braga, José Ueleres, additional
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- 2011
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