Augusto Scalabrini Neto
University of São Paulo
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Featured researches published by Augusto Scalabrini Neto.
Pacing and Clinical Electrophysiology | 2002
Sergio S. C. Costa; Augusto Scalabrini Neto; Roberto Costa; José Guilherme Mendes Pereira Caldas; Martino Martinelli Filho
DO CARMO DA COSTA, S.S., et al.: Incidence and Risk Factors of Upper Extremity Deep Vein Lesions After Permanent Transvenous Pacemaker Implant: A 6‐Month Follow‐Up Prospective Study. The incidence of venous lesions after permanent pacemaker insertion is around 45%. However, this incidence has been based on retrospective studies in a small series; moreover, factors predicting the development of these venous injuries have not been clearly defined. The aim of this study was to identify the risk factors for higher incidence of upper extremity deep vein thrombosis after transvenous permanent pacemaker insertion. The study included 229 patients and the criteria were age above 12 years and first permanent transvenous pacemaker implant. Exclusion criteria were pulmonary embolism, lower or upper extremity deep venous thrombosis, previous use of central venous catheters, coagulation disturbances, and malignancy. Age, race, sex, underlying cardiac disease, functional class to heart failure, LVEF, venous access, number, material and caliber of the leads, and previous use of a transvenous temporary pacemaker were considered. Six months after the pacemaker was implanted, 202 patients were submitted to digital subtraction venography ipsilateral to pacemaker implant. The venographies were normal in 73 (36%) patients and abnormal in 129 (64%) patients. Patients with previous use of transvenous temporary leads (P = 0,0001, OR = 4,260, confidence limits = 2,133–8,465) and LVEF ≤ 40% (P = 0,0378, OR = 3,437, confidence limits = 1,064–12,326), had higher incidence of venous lesions. Previous use of a temporary pacemaker and LVEF ≤ 0.40 were considered independent risk factors to a higher incidence of venous stenosis or thrombosis 6 months after permanent pacemaker insertion.
Revista Brasileira de Educação Médica | 2011
Margarita Victoria Gomez; Joaquim Edson Vieira; Augusto Scalabrini Neto
Neste trabalho, relata-se os resultados obtidos no primeiro momento de uma pesquisa que objetiva conhecer o perfil e a formacao de professores da area da saude que usam a simulacao como estrategia didatica no Laboratorio de Habilidades (LabHab) da Faculdade de Medicina da Universidade de Sao Paulo. Com previsao de dois anos, a pesquisa busca contribuir para uma proposta de formacao docente que observe as prioridades e a relevância da simulacao nas suas atividades didaticas. A ideia e analisar como esse profissional recria seus conhecimentos em grupo para trabalhar a simulacao na atuacao clinica e observar como ele percebe o alcance dos processos de simulacao aprimorados pela tecnologia e pelas propostas de inovacao educativa.
Respiratory Care | 2011
Carlos Frederico Dantas Anjos; Guilherme Schettino; Marcelo Park; Vladimir Silva Souza; Augusto Scalabrini Neto
BACKGROUND: Acquired immunodeficiency syndrome (AIDS) is a pandemic disease commonly associated with respiratory infections, hypoxemia, and death. Noninvasive PEEP has been shown to improve hypoxemia. In this study, we evaluated the physiologic effects of different levels of noninvasive PEEP in hypoxemic AIDS patients. METHODS: Thirty AIDS patients with acute hypoxemic respiratory failure received a randomized sequence of noninvasive PEEP (5, 10, or 15 cm H2O) for 20 min. PEEP was provided through a facial mask with pressure-support ventilation (PSV) of 5 cm H2O and an FIO2 of 1. Patients were allowed to breathe spontaneously for a 20-min washout period in between each PEEP trial. Arterial blood gases and clinical variables were recorded after each PEEP treatment. RESULTS: The results indicate that oxygenation improves linearly with increasing levels of PEEP. However, oxygenation levels were similar regardless of the first PEEP level administered (5, 10, or 15 cm H2O), and only the subgroup that received an initial treatment of the lowest level of PEEP (ie, 5 cm H2O) showed further improvements in oxygenation when higher PEEP levels were subsequently applied. The PaCO2 also increased in response to PEEP elevation, especially with the highest level of PEEP (ie, 15 cm H2O). PSV of 5 cm H2O use was associated with significant and consistent improvements in the subjective sensations of dyspnea and respiratory rate reported by patients treated with any level of PEEP (from 0 to 15 cm H2O). CONCLUSIONS: AIDS patients with hypoxemic respiratory failure improve oxygenation in response to a progressive sequential elevation of PEEP (up to 15 cm H2O). However, corresponding elevations in PaCO2 limit the recommended level of PEEP to 10 cm H2O. At a level of 5 cm H2O, PSV promotes an improvement in the subjective sensation of dyspnea regardless of the PEEP level employed.
International Journal of Pediatric Otorhinolaryngology | 2008
Eliane de Fáveri F. Barbiero; Luiz Carlos Marques Vanderlei; Augusto Scalabrini Neto; Pc Nascimento
OBJECTIVES Assess the effect of re-expansive respiratory patterns associated to respiratory biofeedback (RBF) on pulmonary function, respiratory muscle strength and habits in individuals with functional mouth breathing (FMB). METHODS Sixty children with FMB were divided into experimental and control groups. The experimental group was submitted to 15 sessions of re-expansive respiratory patterns associated to RBF (biofeedback pletsmovent; MICROHARD((R)) V1.0), which provided biofeedback of the thoracic and abdominal movements. The control group was submitted to 15 sessions using biofeedback alone. Spirometry, maximum static respiratory pressure measurements and questions regarding habits (answered by parents/guardians) were carried out before and after therapy. The Students t-test for paired data and non-parametric tests were employed for statistical analysis at a 5% level of significance. RESULTS Significant changes were found in forced vital capacity, Tiffeneau index scores, maximum expiratory pressure, maximum inspiratory pressure and habits assessed in FMB with the use of RBF associated to the re-expansive patterns. No significant differences were found comparing the experimental and control groups. CONCLUSIONS The results allow the conclusion that RBF associated to re-expansive patterns improves forced vital capacity, Tiffeneau index scores, respiratory muscle strength and habits in FMB and can therefore be used as a form of therapy for such individuals.
American Journal of Emergency Medicine | 2016
Rafael Oliveira Ximenes; Alberto Queiroz Farias; Augusto Scalabrini Neto; Márcio Augusto Diniz; Gabriel Taricani Kubota; Maurício Menezes Aben-Athar Ivo; Caroline Gracia Plena Sol Colacique; Luiz Augusto Carneiro D'Albuquerque; Roger Daglius Dias
BACKGROUND Patients with cirrhosis have high risk of bacterial infections and cirrhosis decompensation, resulting in admission to emergency department (ED). However, there are no criteria developed in the ED to identify patients with cirrhosis with bacterial infection and with high mortality risk. STUDY OBJECTIVE The objective of the study is to identify variables from ED arrival associated with bacterial infections and inhospital mortality. METHODS This is a retrospective single-center study using a tertiary hospitals database to identify consecutive ED patients with decompensated cirrhosis. Clinical variables and laboratory results were obtained by chart review. Logistic regression models were built to determine variables independently associated with bacterial infection and mortality. Scores using these variables were designed. RESULTS One hundred forty-nine patients were enrolled, most of them males (77.9%) with alcoholic cirrhosis (53%) and advanced liver disease (Child-Pugh C, 47.2%). Bacterial infections were diagnosed in 72 patients (48.3%), and 36 (24.2%) died during hospital stay. Variables independently associated with bacterial infection were lymphocytes less than or equal to 900/mm(3) (odds ratio [OR], 3.85 [95% confidence interval {CI}, 1.47-10]; P = .006) and C-reactive protein greater than 59.4 mg/L (OR, 5.05 [95% CI, 1.93-13.2]; P = .001). Variables independently associated with mortality were creatinine greater than 1.5 mg/dL (OR, 4.35 [95% CI, 1.87-10.1]; P = .001) and international normalized ratio greater than 1.65 (OR, 3.71 [95% CI, 1.6-8.61]; P = .002). Scores designed to predict bacterial infection and mortality (Mortality in Cirrhosis Emergency Department Score) had an area under the receiver operating characteristic curve of 0.82 and 0.801, respectively. The Mortality in Cirrhosis Emergency Department Score performed better than Model for End-Stage Liver Disease score. CONCLUSIONS In this cohort of ED patients with decompensated cirrhosis, lymphopenia and elevated C-reactive protein were related to bacterial infections, and elevated creatinine and international normalized ratio were related to mortality. Scores built with these variables should be prospectively validated.
Journal of Critical Care | 2016
Roger Daglius Dias; Augusto Scalabrini Neto
PURPOSE Medical simulation is fast becoming a standard of health care training throughout undergraduate, postgraduate and continuing medical education. Our aim was to evaluate if simulated scenarios have a high psychological fidelity and induce stress levels similarly to real emergency medical situations. MATERIALS AND METHODS Medical residents had their stress levels measured during emergency care (real-life and simulation) in baseline (T1) and immediately post-emergencies (T2). Parameters measuring acute stress were: heart rate, systolic and diastolic blood pressure, salivary α-amylase, salivary interleukin-1β, and State-Trait Anxiety Inventory score. RESULTS Twenty-eight internal medicine residents participated in 32 emergency situations (16 real-life and 16 simulated emergencies). In the real-life group, all parameters increased significantly (P < .05) between T1 and T2. In the simulation group, only heart rate and interleukin-1β increased significantly after emergencies. The comparison between groups demonstrates that acute stress response (T2 - T1) and State-Trait Anxiety Inventory score (in T2) did not differ between groups. CONCLUSIONS Acute stress response did not differ between both groups. Our results indicate that emergency medicine simulation may create a high psychological fidelity environment similarly to what is observed in a real emergency room.
Stress | 2017
Roger Daglius Dias; Augusto Scalabrini Neto
Abstract Providing care for simulated emergency patients may induce considerable acute stress in physicians. However, the acute stress provoked in a real-life emergency room (ER) is not well known. Our aim was to assess acute stress responses in residents during real emergency care and investigate the related personal and situational factors. A cross-sectional observational study was carried out at an emergency department of a tertiary teaching hospital. All second-year internal medicine residents were invited to voluntarily participate in this study. Acute stress markers were assessed at baseline (T1), before residents started their ER shift, and immediately after an emergency situation (T2), using heart rate, systolic, and diastolic blood pressure, salivary α-amylase activity, salivary interleukin-1 β, and the State-Trait Anxiety Inventory (STAI-s and STAI-t). Twenty-four residents were assessed during 40 emergency situations. All stress markers presented a statistically significant increase between T1 and T2. IL-1 β presented the highest percent increase (141.0%, p < .001), followed by AA (99.0%, p = .002), HR (81.0%, p < .001), DBP (8.0%, p < .001), and SBP (3.0%, p < .001). In the multivariable analysis, time of residency had a negative correlation with HR during the emergency (adjusted R-square = .168; F = 8.69; p = .006), SBP response (adjusted R-square = .210; F = 6.19; p = .005) and DBP response (adjusted R-square = .293; F = 9.09; p = .001). Trait anxiety (STAI-t) was positively correlated with STAI-s (adjusted R-square = .326; F = 19.9; p < .001), and number of procedures performed during emergency care had a positive association with HR response (adjusted R-square = .241; F = 5.02; p = .005). In the present study, emergency care provoked substantial acute stress in residents. Resident experience, trait anxiety, and number of emergency procedures were independently associated with acute stress response.
Journal of Electrocardiology | 2007
Vera Pontieri; Augusto Scalabrini Neto; André Ferrari de França Camargo; Marcia Kiyomi Koike; Irineu Tadeu Velasco
Archive | 2013
Herlon Saraiva Martins; Rodrigo Antonio BRANDãO Neto; Augusto Scalabrini Neto; Irineu Tadeu Velasco
Archive | 2006
Herlon Saraiva Martins; Augusto Scalabrini Neto; Irineu Tadeu Velasco