Santa Marcelina Hospital

São Paulo, Brazil

Santa Marcelina Hospital

São Paulo, Brazil

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Asevedo E.,Linc Inc | Mendes A.C.,Santa Marcelina Hospital | Berk M.,Deakin University | Berk M.,University of Melbourne | Brietzke E.,Linc Inc
Revista Brasileira de Psiquiatria | Year: 2014

Objective: To conduct the first systematic literature review of clinical trials of N-acetylcysteine (NAC) for the treatment of substance abuse disorders and addictive behaviors. Methods: A search of the MEDLINE, Embase and PsycINFO databases was conducted. The inclusion criteria for the review were clinical trials that used NAC in the treatment of a disorder related to substance use and/or addictive behaviors, limited to texts in English, Spanish, or French. The selected studies were evaluated with respect to type of trial, sample size, diagnostic input, intervention, length of follow-up, outcome variables, and results. Results: Nine studies analyzing a total of 165 patients met the eligibility criteria and were included in qualitative analysis. These studies evaluated the role of NAC in cocaine dependence (three studies), cannabis dependence (two studies), nicotine dependence (two studies), methamphetamine addiction (one study), and pathological gambling (one study). Five of these trials were double-blind, randomized, and placebo-controlled. Conclusions: The studies analyzed suggest a potential role for NAC in the treatment of addiction, especially of cocaine and cannabis dependence. These results are concordant with the hypothesis of the involvement of glutamatergic pathways in the pathophysiology of addiction. © 2014 Associação Brasileira de Psiquiatria.


D'Ottaviano F.G.,Santa Casa de Misericordia de Sao Paulo | Linhares Filho T.A.,Brazilian Associaton of ENT HNS | de Andrade H.M.T.,Santa Marcelina Hospital | Alves P.C.L.,Federal University of São Paulo | Rocha M.S.G.,Federal University of São Paulo
Brazilian Journal of Otorhinolaryngology | Year: 2013

Amyotrophic lateral sclerosis (ALS) is a progressive degenerative motor neuron disease that adversely affects the muscles responsible for swallowing. Objective: To assess the oral preparatory, oral transit and pharyngeal phases of swallowing in ALS patients through endoscopic evaluation. Method: This cross-sectional historical cohort study included ALS patients submitted to endoscopic examination. Eleven patients (six males and five females; mean age of 61.7 years) were enrolled in the study from january to december of 2011. Results: All patients had alterations in phases of the swallowing process, but only 72.7% complained of dysphagia. The oral preparatory phase was altered in 63.6% of the subjects; the oral transit and pharyngeal phases were altered in all studied individuals, regardless of food consistency. Laryngeal penetration or tracheal aspiration were seen in 90.9% of the patients during the pharyngeal phase while they were swallowing fluids. Conclusion: Even in the absence of complaints, dysphagia is a frequent comorbidity in ALS patients. The oral transit and pharyngeal phases were the most frequently affected. Laryngeal penetration or tracheal aspiration occurred more frequently during the pharyngeal phase while patients were swallowing fluids.


Barnett A.G.,Queensland University of Technology | Graves N.,Queensland University of Technology | Rosenthal V.D.,International Nosocomial Infection Control Consortium | Salomao R.,Santa Marcelina Hospital | Rangel-Frausto M.S.,Specialties IMSS Hospital
Infection Control and Hospital Epidemiology | Year: 2010

OBJECTIVE. To estimate the excess length of stay in an intensive care unit (ICU) due to a central line-associated bloodstream infection (CLABSI), using a multistate model that accounts for the timing of infection. DESIGN. A cohort of 3,560 patients followed up for 36,806 days in ICUs. SETTING. Eleven ICUs in 3 Latin American countries: Argentina, Brazil, and Mexico. PATIENTS. All patients admitted to the ICU during a defined time period with a central line in place for more than 24 hours. RESULTS. The average excess length of stay due to a CLABSI increased in 10 of 11 ICUs and varied from -1.23 days to 4.69 days. A reduction in length of stay in Mexico was probably caused by an increased risk of death due to CLABSI, leading to shorter times to death. Adjusting for patient age and Average Severity of Illness Score tended to increase the estimated excess length of stays due to CLABSI. CONCLUSIONS. CLABSIs are associated with an excess length of ICU stay. The average excess length of stay varies between ICUs, most likely because of the case-mix of admissions and differences in the ways that hospitals deal with infections. © 2010 by The Society for Healthcare Epidemiology of America. All rights reserved.


Maki D.G.,University of Wisconsin - Madison | Rosenthal V.D.,Colegiales and Bernal Medical Centers | Salomao R.,Santa Marcelina Hospital | Franzetti F.,Sacco Hospital | Sigfrido Rangel-Frausto M.,Specialties Instituto Mexicano del Seguro Social Hospital
Infection Control and Hospital Epidemiology | Year: 2011

Background. We report a meta-analysis of 4 identical time-series cohort studies of the impact of switching from use of open infusion containers (glass bottle, burette, or semirigid plastic bottle) to closed infusion containers (fully collapsible plastic containers) on central line-associated bloodstream infection (CLABSI) rates and all-cause intensive care unit (ICU) mortality in 15 adult ICUs in Argentina, Brazil, Italy, and Mexico. Methods. All ICUs used open infusion containers for 6-12 months, followed by switching to closed containers. Patient characteristics, adherence to infection control practices, CLABSI rates, and ICU mortality during the 2 periods were compared by x2 test for each country, and the results were combined using meta-analysis. Results. Similar numbers of patients participated in 2 periods (2,237 and 2,136). Patients in each period had comparable Average Severity of Illness Scores, risk factors for CLABSI, hand hygiene adherence, central line care, and mean duration of central line placement. CLABSI incidence dropped markedly in all 4 countries after switching from an open to a closed infusion container (pooled results, from 10.1 to 3.3 CLABSIs per 1,000 central line-days; relative risk [RR], 0.33 [95% confidence interval {CI}, 0.24-0.46]; P < .001). All-cause ICU mortality also decreased significantly, from 22.0 to 16.9 deaths per 100 patients (RR, 0.77 [95% CI, 0.68-0.87]; P < .001). Conclusions. Switching from an open to a closed infusion container resulted in a striking reduction in the overall CLABSI incidence and all-cause ICU mortality. Data suggest that open infusion containers are associated with a greatly increased risk of infusion-related bloodstream infection and increased ICU mortality that have been unrecognized. Furthermore, data suggest CLABSIs are associated with significant attributable mortality. © 2011 by The Society for Healthcare Epidemiology of America.


Rodrigues L.C.L.,Santa Marcelina Hospital | Natour J.,Federal University of São Paulo
Journal of Negative Results in BioMedicine | Year: 2014

Background: Corticoids have potent anti-inflammatory effects, which may help in relieving pain and dysfunction associated with lumbar canal stenosis. We assessed the effectiveness of a decreasing-dose regimen of oral corticoids in the treatment of lumbar canal stenosis in a prospective, double-blind, randomized, placebo-controlled trial.Results: Sixty-one patients with lumbar canal stenosis (50-75 years; canal area < 100 mm2 at L3/L4, L4/L5, and/or L5/S1on magnetic resonance imaging; and claudication within 100 m were electronically randomized to an oral corticoid group (n = 31) or a placebo group (n = 30). The treatment group received 1 mg/kg of oral corticoids daily, with a dose reduction of one-third per week for 3 weeks. Patients and controls were assessed by the Short Form 36 Health Survey, Roland-Morris Questionnaire, 6-min walk test, visual analog scale, and a Likert scale. All instruments showed similar outcomes for the corticoid and placebo groups (P > 0.05). Obese patients exhibited more severe symptoms compared with non-obese patients. L4/L5 stenosis was associated with more severe symptoms compared with stenosis at other levels.Conclusion: The oral corticoid regimen used in this study was not effective in the treatment of lumbar canal stenosis. © 2014 Rodrigues and Natour; licensee BioMed Central Ltd.


Epelman C.L.,Santa Marcelina Hospital
Current Oncology Reports | Year: 2012

Pediatric palliative care at the end-of-life is focused on ensuring the best possible quality of life for patients with life-threatening illness and their families. To achieve this goal, important needs include: engaging with patients and families; improving communication and relationships; relieving pain and other symptoms, whether physical, psychosocial, or spiritual; establishing continuity and consistency of care across different settings; considering patients and families in the decision-making process about services and treatment choices to the fullest possible and desired degree; being sensitive to culturally diverse beliefs and values about death and dying; and responding to suffering, bereavement, and providing staff support. Any effort to improve quality of palliative and endof- life care in pediatric oncology must be accompanied by an educational strategy to enhance the level of competence among health care professionals with regard to palliative care and end-of-life management skills as well as understanding of individualized care planning and coordination processes. © 2012 Springer Science+Business Media, LLC.


PubMed | Santa Marcelina Hospital
Type: Journal Article | Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology | Year: 2016

8561 Background: The incidence of retinoblastoma is higher in developing countries than in Europe and United States. In some developing countries, incidence rates per million may be two to six times higher or even more, since very little information is available from rural areas, where retinoblastoma appears to be particularly common. This tumor is characterized by a rapid growth rate. When the disease is detected at early stages and confined to the eye, children have a good prognosis. However, in children with disease that extents beyond the eye, specially to distant parts of the body, the five-year disease free survival is poor. The percentage of children with extraocular disease at diagnosis is much higher in developing countries (approximately 35 to 50%).The commonest early sign observed in children is leukocoria (cats eye reflex). This easy sign to recognize offer a unique opportunity to call attention for retinoblastoma when it is still curable. Therefore a National Campaign for early diagnosis of Retinoblastoma in Brazil was initiated in September 2002 with the support of TUCCA (Children Brain Tumor Association) and INCTR(International Network for Cancer and Treatment Research). The campaign includes educational material for the population, for the primary health care workers and for ophtalmologists. A toll free number is available for information to the entire country. The video is on in different public channels in Brazil and was translated to 10 different languages.More than 20 cases were already diagnosed through the campaign Conclusions: The initiative is cost effective. This experience can be a model to other coutries with similar problems. Routine dilated funduscopic examination is recommended. No significant financial relationships to disclose.


PubMed | Santa Marcelina Hospital and Discipline of Neurosurgery
Type: Journal Article | Journal: The Indian journal of surgery | Year: 2016

The eyebrow incision associated with medial supraorbital craniotomy is a minimally invasive alternative approach to the lesions located in the medial anterior cranial fossa. The main advantages of the medial supraorbital craniotomy regarding frontolateral supraorbital craniotomy are the absence of manipulation of the temporal muscle, less risk of injury to the frontotemporal branch of the facial nerve and a more medial view of the anterior structures such as frontal sinus, olfatory groove and frontal lobe. We report a unique case of cranial stab wound in which a piece of the knife stayed in the frontal sinus and removal was performed using the medial supraorbital approach. There were no complications during surgery, the patient reported mild hypoesthesia in the left frontal region and was discharged on the 7th postoperative day. During follow-up after 2months, good cosmetic result of the surgical wound and preserved sensitivity of the left frontal region were noted.


Epelman S.,Santa Marcelina Hospital
Current Oncology Reports | Year: 2012

The most frequent neoplasm of the eye in children is retinoblastoma. It is a rare disease with an average incidence of 1 in 14, 000 to 18, 000 live births. The incidence is greater in developing countries. Early detection may allow widespread use of eye-sparing treatments, minimizing the morbidity of this disease. Although leukocoria is usually the first sign that parents notice especially when a flash photograph is taken, the diagnosis is not performed since this presentation is not known by health care providers and the public. Improving public awareness and knowledge of the early signs may lead to early diagnosis, which can save more eyes and lives. Advances in both the basic science and clinical applications of new therapies continue to emerge for this rare cancer. We expect that all conservative treatments will be available worldwide and consequently more children will be cured and maintain the vision. © 2012 Springer Science+Business Media, LLC.


Epelman S.,Santa Marcelina Hospital
Current Oncology Reports | Year: 2013

The management of adolescents and young adults with brain tumors, which consist of many different histologic subtypes, continues to be a challenge. Better outcome with a decrease of the side effects of the disease and therapy and improvement of quality of life has been demonstrated in recent decades for some tumors. Significant differences in survival and cure are also observed between adult and pediatric tumors of the same histologic grade. Genetic, developmental, and environmental factors likely influence the type of tumor and response observed, even though no clear pathologic features differentiate these lesions among children, adolescents, and adults. Similarly, treatment strategies are not identical among these populations; most patients receive surgery, followed by radiation therapy and multiagent chemotherapy. Advances in understanding the biology underlying the distribution of tumors in adolescents and young adults may influence the development of prospective trials. A more individualized view of these tumors will likely influence stratification of patients in future studies as well as selection for targeted agents. Accordingly, outcomes may improve and long-term morbidities may decrease. © 2013 Springer Science+Business Media New York.

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