Navegando por Autor "Nobre Junior, Vandack Alencar"
Agora exibindo 1 - 4 de 4
Resultados por página
Opções de Ordenação
Item Factors associated with short and long term cognitive changes in patients with sepsis.(2018) Calsavara, Allan Jefferson Cruz; Costa, Priscila de Almeida; Nobre Junior, Vandack Alencar; Teixeira, Antônio LúcioThis study aimed to assess cognition in patients with severe sepsis or septic shock and whether cognitive impairment was associated with clinical and laboratory parameters. We conducted a cohort study of patients with severe sepsis and septic shock evaluated within 24 h and one year after ICU discharge. Demographic, clinical and laboratory data were analyzed, and the following neuropsychological tests were applied: Consortium to Establish Registry for Alzheimer’s Disease, Mini- Mental State Examination, and Trail Making Test forms A and B. We included 33 patients, mean age of 49, 19% were female. Patients underperformed on most measures 24 h after ICU discharge, with improvement on follow-up. IQCODE, APACHE II scores, NSE and IFN-γ levels at ICU discharge were associated with poor cognitive performance, while higher educational level was associated with good cognitive performance. The time to first antibiotic dose, accumulated dose of haloperidol during UCI stay and mean glycemia were also associated with poor cognitive outcome. In general, patients with severe sepsis or septic shock have cognitive impairment that can improve over time. This improvement was associated with factors identified during their ICU stay, such as cognitive reserve, educational level, mean glycemia during ICU stay and NSE level.Item Plasmin and plasminogen prevent sepsis severity by reducing neutrophil extracellular traps and systemic inflammation.(2023) Silva, Juliana Priscila Vago da; Zaidan, Isabella; Perucci, Luiza Oliveira; Brito, Larissa Froede; Teixeira, Lívia Cristina Ribeiro; Silva, Camila Meirelles Souza; Miranda, Thaís Cristina de; Melo, Eliza Mathias; Bruno, Alexandre Santos; Queiroz Júnior, Celso Martins; Sugimoto, Michelle Adriane Amantéa; Tavares, Luciana Padua; Ferreira, Lais Cunha Grossi; Borges, Isabela Nascimento; Schneider, Ayda Henriques; Baik, Nagyung; Silva, André Talvani Pedrosa da; Ferreira, Raphael Gomes; Alves Filho, José Carlos Farias; Nobre Junior, Vandack Alencar; Teixeira, Mauro Martins; Parmer, Robert J.; Miles, Lindsey A.; Sousa, Lirlândia Pires deSepsis is a lethal syndrome characterized by systemic inflammation and abnormal coagulation. Despite therapeutic advances, sepsis mortality remains substantially high. Herein, we investigated the role of the plasminogen/plasmin (Plg/Pla) system during sepsis. Plasma levels of Plg were significantly lower in mice subjected to severe compared with nonsevere sepsis, whereas systemic levels of IL-6, a marker of sepsis severity, were higher in severe sepsis. Plg levels correlated negatively with IL-6 in both septic mice and patients, whereas plasminogen activator inhibitor-1 levels correlated positively with IL-6. Plg deficiency render mice susceptible to nonsevere sepsis induced by cecal ligation and puncture (CLP), resulting in greater numbers of neutrophils and M1 macrophages, liver fibrin(ogen) deposition, lower efferocytosis, and increased IL-6 and neutrophil extracellular trap (NET) release associated with organ damage. Conversely, inflammatory features, fibrin(ogen), and organ damage were substantially reduced, and efferocytosis was increased by exogenous Pla given during CLP- and LPS-induced endotoxemia. Plg or Pla protected mice from sepsis-induced lethality and enhanced the protective effect of antibiotics. Mechanistically, Plg/Pla– afforded protection was associated with regulation of NET release, requiring Pla-protease activity and lysine binding sites. Plg/Pla are important host-protective players during sepsis, controlling local and systemic inflammation and collateral organ damage.Item Post-sepsis cognitive impairment and associated risk factors : a systematic review.(2017) Calsavara, Allan Jefferson Cruz; Nobre Junior, Vandack Alencar; Barichello, Tatiana; Teixeira, Antônio LúcioIntroduction: Post-sepsis cognitive impairment is one of the major sequelae observed in survivors ofsepsis. This cognitive impairment can be global or may affect specific domains. A better understandingof these deficits and associated risk factors could influence the care of patients with sepsis.Objective: To perform a systematic review to investigate the presence of cognitive impairment and itsassociated risk factors among patients who survived sepsis.Methods: The search was conducted in MEDLINE (1966 to March 2017) and EMBASE (1988 to March 2017).We included studies with individuals who were 18 years or older with post-sepsis cognitive impairment.Results: We analysed 577 articles. Sixteen studies met the inclusion criteria. More than 74,000,000patients were evaluated in the selected studies. Significant variation was observed in the definitionof sepsis and cognitive impairment. Twelve studies used ACCP/SCCM criteria for sepsis, while cogni-tive impairment was defined per test used. Post-sepsis cognitive impairment was observed in 12.5 to21% of survivors of sepsis. Attention, cognitive flexibility, processing speed, associative learning, visualperception, work memory, verbal memory, and semantic memory were the specific domains affected.Depressive symptoms, central nervous system infection, length of hospitalisation due to infection, andtemporal proximity to the last period of infection were associated with cognitive impairment.Conclusion: The studies are heterogeneous, and there is urgent need for a common language, includ-ing definitions and neuropsychological tests, for the investigation of post-sepsis cognitive impairment.Despite this, there is mounting evidence for the clinical relevance of post-sepsis cognitive impairment.Item Prevalence and risk factors for post-traumatic stress, anxiety, and depression in sepsis survivors after ICU discharge.(2021) Calsavara, Allan Jefferson Cruz; Costa, Priscila de Almeida; Nobre Junior, Vandack Alencar; Teixeira, Antônio LúcioObjective: Sepsis survivors present a wide range of sequelae; few studies have evaluated psychiatric disorders after sepsis. The objective of this study was to define the prevalence of and risk factors for anxiety, depression and post-traumatic stress disorder (PTSD) symptoms in sepsis survivors. Method: Anxiety, depression and post-traumatic stress symptoms in severe sepsis and septic shock survivors 24 h and 1 year after intensive care unit (ICU) discharge were assessed using the Beck Anxiety/Depression Inventories and the PTSD Checklist-Civilian Version. Differences in psychiatric symptoms over time and the influence of variables on these symptoms were calculated with marginal models. Results: A total of 33 patients were enrolled in the study. The frequencies of anxiety, depression and PTSD 24 h after ICU discharge were 67%, 49%, and 46%, respectively and, among patients re evaluated 1 year after ICU discharge, the frequencies were 38%, 50%, and 31%, respectively. Factors associated with PTSD included serum S100B level, age, and Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) score. Factors associated with depression included patient age and cumulative dose of dobutamine. IQCODE score and cumulative dose of haloperidol in the ICU were associated with anxiety after ICU discharge. Conclusion: Patients who survive sepsis have high levels of psychiatric symptoms. Sepsis and asso ciated treatment-related exposures may have a role in increasing the risk of subsequent depression, anxiety, and PTSD.