Publications by authors named "L Azevedo"

763 Publications

Effect of Slower vs Faster Intravenous Fluid Bolus Rates on Mortality in Critically Ill Patients: The BaSICS Randomized Clinical Trial.

JAMA 2021 Sep;326(9):830-838

HCor Research Institute, São Paulo, Brazil.

Importance: Slower intravenous fluid infusion rates could reduce the formation of tissue edema and organ dysfunction in critically ill patients; however, there are no data to support different infusion rates during fluid challenges for important outcomes such as mortality.

Objective: To determine the effect of a slower infusion rate vs control infusion rate on 90-day survival in patients in the intensive care unit (ICU).

Design, Setting, And Participants: Unblinded randomized factorial clinical trial in 75 ICUs in Brazil, involving 11 052 patients requiring at least 1 fluid challenge and with 1 risk factor for worse outcomes were randomized from May 29, 2017, to March 2, 2020. Follow-up was concluded on October 29, 2020. Patients were randomized to 2 different infusion rates (reported in this article) and 2 different fluid types (balanced fluids or saline, reported separately).

Interventions: Patients were randomized to receive fluid challenges at 2 different infusion rates; 5538 to the slower rate (333 mL/h) and 5514 to the control group (999 mL/h). Patients were also randomized to receive balanced solution or 0.9% saline using a factorial design.

Main Outcomes And Measures: The primary end point was 90-day survival.

Results: Of all randomized patients, 10 520 (95.2%) were analyzed (mean age, 61.1 years [SD, 17.0 years]; 44.2% were women) after excluding duplicates and consent withdrawals. Patients assigned to the slower rate received a mean of 1162 mL on the first day vs 1252 mL for the control group. By day 90, 1406 of 5276 patients (26.6%) in the slower rate group had died vs 1414 of 5244 (27.0%) in the control group (adjusted hazard ratio, 1.03; 95% CI, 0.96-1.11; P = .46). There was no significant interaction between fluid type and infusion rate (P = .98).

Conclusions And Relevance: Among patients in the intensive care unit requiring fluid challenges, infusing at a slower rate compared with a faster rate did not reduce 90-day mortality. These findings do not support the use of a slower infusion rate.

Trial Registration: ClinicalTrials.gov Identifier: NCT02875873.
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http://dx.doi.org/10.1001/jama.2021.11444DOI Listing
September 2021

Antioxidant/pro-oxidant and antiproliferative activities of phenolic-rich foods and extracts: A cell-based point of view.

Adv Food Nutr Res 2021 9;98:253-280. Epub 2021 Mar 9.

Federal University of Alfenas, Nutrition Faculty, Alfenas, MG, Brazil. Electronic address:

Phenolic compounds have demonstrated several in vitro beneficial properties by acting as antioxidant and pro-oxidant agents. This chapter approaches the relationship among oxidative stress, cancer, phenolic compounds and antiproliferative activity. Moreover, it discusses in vitro techniques and their biological applications, regarding cell viability and intracellular measure of reactive oxygen assays. The in vitro methods are important tools for screening and understanding the pathways involved on antiproliferative and antioxidant/pro-oxidant effects of phenolic compounds. These findings open avenues for the development of innovative food, chemical structures, technological applications and future perspectives in this research field.
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http://dx.doi.org/10.1016/bs.afnr.2021.02.010DOI Listing
March 2021

Quality of life of parents with children with congenital abnormalities: a systematic review with meta-analysis of assessment methods and levels of quality of life.

Qual Life Res 2021 Sep 5. Epub 2021 Sep 5.

Faculdade de Medicina da Universidade do Porto (FMUP), Porto, Portugal.

Purpose: To quantify and understand how to assess the quality of life and health-related QoL of parents with children with congenital abnormalities.

Methods: We conducted a systematic review with meta-analysis. The search was carried out in 5 bibliographic databases and in ClinicalTrials.gov. No restriction on language or date of publication was applied. This was complemented by references of the studies found and studies of evidence synthesis, manual search of abstracts of relevant congresses/scientific meetings and contact with experts. We included primary studies (observational, quasi-experimental and experimental studies) on parents of children with CA reporting the outcome quality of life (primary outcome) of parents, independently of the intervention/exposure studied.

Results: We included 75 studies (35 observational non-comparatives, 31 observational comparatives, 4 quasi-experimental and 5 experimental studies). We identified 27 different QoL instruments. The two most frequently used individual QoL instruments were WHOQOL-Bref and SF-36. Relatively to family QoL tools identified, we emphasized PedsQL FIM, IOFS and FQOL. Non-syndromic congenital heart defects were the CA most frequently studied. Through the analysis of comparative studies, we verified that parental and familial QoL were impaired in this population.

Conclusions: This review highlights the relevance of assessing QoL in parents with children with CA and explores the diverse QoL assessment tools described in the literature. Additionally, results indicate a knowledge gap that can help to draw new paths to future research. It is essential to assess QoL as a routine in healthcare providing and to implement strategies that improve it.
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http://dx.doi.org/10.1007/s11136-021-02986-zDOI Listing
September 2021

Evaluation of microaeration strategies in the digestion zone of UASB reactors as an alternative for biogas desulfurization.

Environ Technol 2021 Sep 10:1-15. Epub 2021 Sep 10.

Departments of Sanitary and Environmental Engineering, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.

This study aimed at evaluating the microaeration as an alternative for hydrogen sulfide removal from biogas of UASB reactors treating sewage. The set-up consisted of two pilot-scale UASB reactors, including a conventional anaerobic and a modified UASB reactor, operated under microaerated conditions. Air was supplied in the digestion zone, at 1 and 3 m from the bottom of the reactor, and three different air flows were investigated: 10, 20, and 30 mL.min, corresponding to 0.003, 0.005 and 0.005 LO/L, respectively. The main results showed that the microaeration provided a substantial decrease in hydrogen sulfide concentrations when compared to the concentrations observed in the biogas of the anaerobic UASB reactor. Hydrogen sulfide concentrations remained below 70 ppm throughout the experimental period, corresponding to an average removal efficiency of 98%. Although a decrease in methane concentrations in biogas was observed, the feasibility of energy use would not be affected. The effect of microaeration on the overall performance of the reactor was evaluated, however, no significant differences were observed. The feasibility of limiting aeration conditions in the reactor digestion zone as an efficient alternative for hydrogen sulfide removal from biogas was demonstrated.
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http://dx.doi.org/10.1080/09593330.2021.1974574DOI Listing
September 2021

Human astrovirus types 1, 4 and 5 circulating among children with acute gastroenteritis in a rural Brazilian state, 2010-2016.

Arch Virol 2021 Aug 21. Epub 2021 Aug 21.

Instituto de Medicina Tropical, Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, nº 470, São Paulo, SP, 05403-000, Brazil.

This study combined conventional epidemiology of human astroviruses. From 2010 to 2016, 232 stool samples from children under 5 years of age were screened using NGS and conventional RT-PCR followed by genetic analysis in order to investigate the genotypic diversity of classical human astrovirus (HAstV) circulating in Tocantins State, Brazil. HAstV was detected in 16 cases (6.9%). Seven specimens (43.7%; 7/16) were positive according RT-PCR and next-generation sequencing (NGS) to investigate the molecular to both NGS and RT-PCR. NGS and RT-PCR individually revealed six (37.5%; 6/16) and three (18.8%; 3/16) additional positive samples, respectively. Sequencing of the HAstV-positive samples revealed HAstV-1a (9/16), HAstV-4c (3/16), and HAstV-5c (4/16) lineages.
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http://dx.doi.org/10.1007/s00705-021-05206-8DOI Listing
August 2021
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