Papers by Bianca Stefanello
Hematology, Transfusion and Cell Therapy, Feb 1, 2024
Revista de Medicina, Sep 28, 2018
Introduction: Immune thrombocytopenia (ITP) is an acquired decrease of platelets, caused by autoa... more Introduction: Immune thrombocytopenia (ITP) is an acquired decrease of platelets, caused by autoantibodies against platelets, in the absence of an associated condition. ITP is associated to low morbidity and mortality, however there is reduced quality of life on the patients under treatment. This study has as objectives to describe the clinical features of the patients and the evaluation of risk factors related to the response to treatment. Methods: A retrospective analysis was achieved, regarding the medical records of 99 patients diagnosed with ITP and seen between May of 1992 and August of 2016 in a hospital. Results: 99 patients were analyzed, 71 female (71.7%). Mean age 39 years old to diagnosis (variation 2-84). 83.3% of the patients were chronic ITP and the mean follow up 49.2 months (0,1-289). 74.7% of patients presented bleeding to diagnosis. 76.7% of patients required treatment, and there was remission in 7 (30.4%) of the 23 patients who did not receive any treatment. 37 patients were submitted to splenectomy, 30 (81.1%) of those obtained partial or complete response and 18 (48.6%) presented loss of response. 30% of patients were submitted to posterior treatments. Only two patients had death related to ITP. In bivariate analysis of risk factors to response to the treatment, the only predictors of chronicity were initially the absence of corticosteroid dependence and absence of response to splenectomy, however in multivariate analysis those factors had their significance discarded. The presented results did not confirm a higher progression rate to chronicity in non corticosteroid-dependent patients and in those who did not present response to splenectomy. The clinical features, response pattern and survival of analyzed patients were similar to other studies reported.
Journal of thrombosis and thrombolysis, Mar 25, 2024
Jornal Brasileiro De Psiquiatria, 2012
Verificar a frequência de ideação suicida e os sintomas depressivos associados a ela nos paciente... more Verificar a frequência de ideação suicida e os sintomas depressivos associados a ela nos pacientes internados em enfermarias de clínica médica. Métodos: Todos os adultos consecutivamente admitidos nas enfermarias de clínica médica de um hospital universitário foram randomizados e avaliados durante a primeira semana de internação. Coletaram-se dados sociodemográficos e aplicaram-se: o Patient Health Questionnaire (a pergunta sobre ideação suicida), o Inventário Beck de Depressão e o índice Charlson de comorbidade física. Utilizaram-se os testes t de Student, do qui-quadrado e a regressão logística. resultados: Dos 1.092 sujeitos, 79 (7,2%) apresentaram ideação suicida. Na análise multivariada, foram capazes de discriminar esses pacientes, após controlar para sexo, idade, comorbidade física e presença de uma síndrome depressiva, os seguintes sintomas, quando presentes em intensidade moderada a grave: tristeza [RR: 3,18; IC 95% = 1,78-5,65; p < 0,001], sensação de fracasso [RR: 2,01; IC 95% = 1,09-3,72; p = 0,03], perda do interesse nas pessoas [RR: 2,69; IC 95% = 1,47-4,94; p = 0,001] e insônia [RR: 1,74; IC 95% = 1,05-2,89; p = 0,03]. Conclusão: Os pacientes internados no hospital geral em enfermarias clínicas apresentaram prevalência de 7,2% de ideação suicida. Alguns sintomas, quando presentes em intensidade moderada a grave, deveriam alertar ao clínico-geral para investigar a presença de ideação suicida: tristeza, sensação de fracasso, perda do interesse nas pessoas e insônia. aBStraCt objective: To assess the prevalence of suicidal ideation and the depressive symptoms associated to it in medical inpatients. Methods: All adults consecutively admitted to the medical wards of a University Hospital had their names recorded, were randomized and evaluated during the first week of admission. Socio-demographic data were collected and the Patient Health Questionnaire (question 9, assessing suicidal ideation), the Beck Depression Inventory and the Charlson comorbidity index were applied. The Student t test, chi-square
Annals of Hematology, Sep 29, 2022
Revista de Medicina, Sep 28, 2018
Introduction: Immune thrombocytopenia (ITP) is an acquired decrease of platelets, caused by autoa... more Introduction: Immune thrombocytopenia (ITP) is an acquired decrease of platelets, caused by autoantibodies against platelets, in the absence of an associated condition. ITP is associated to low morbidity and mortality, however there is reduced quality of life on the patients under treatment. This study has as objectives to describe the clinical features of the patients and the evaluation of risk factors related to the response to treatment. Methods: A retrospective analysis was achieved, regarding the medical records of 99 patients diagnosed with ITP and seen between May of 1992 and August of 2016 in a hospital. Results: 99 patients were analyzed, 71 female (71.7%). Mean age 39 years old to diagnosis (variation 2-84). 83.3% of the patients were chronic ITP and the mean follow up 49.2 months (0,1-289). 74.7% of patients presented bleeding to diagnosis. 76.7% of patients required treatment, and there was remission in 7 (30.4%) of the 23 patients who did not receive any treatment. 37 patients were submitted to splenectomy, 30 (81.1%) of those obtained partial or complete response and 18 (48.6%) presented loss of response. 30% of patients were submitted to posterior treatments. Only two patients had death related to ITP. In bivariate analysis of risk factors to response to the treatment, the only predictors of chronicity were initially the absence of corticosteroid dependence and absence of response to splenectomy, however in multivariate analysis those factors had their significance discarded. Conclusion: The presented results did not confirm a higher progression rate to chronicity in non corticosteroid-dependent patients and in those who did not present response to splenectomy. The clinical features, response pattern and survival of analyzed patients were similar to other studies reported.
Trabalho de Conclusão de Curso - Universidade Federal de Santa Catarina. Curso de Medicina. Depar... more Trabalho de Conclusão de Curso - Universidade Federal de Santa Catarina. Curso de Medicina. Departamento de Clínica Médica
Arquivos Brasileiros de Cardiologia, 2014
Os anúncios veiculados nesta edição são de exclusiva responsabilidade dos anunciantes, assim co... more Os anúncios veiculados nesta edição são de exclusiva responsabilidade dos anunciantes, assim como os conceitos emitidos em artigos assinados são de exclusiva responsabilidade de seus autores, não refletindo necessariamente a opinião da SBC. Material de distribuição exclusiva à classe médica. Os Arquivos Brasileiros de Cardiologia não se responsabilizam pelo acesso indevido a seu conteúdo e que contrarie a determinação em atendimento à Resolução da Diretoria Colegiada (RDC) nº 96/08 da Agência Nacional de Vigilância Sanitária (Anvisa), que atualiza o regulamento técnico sobre Propaganda, Publicidade, Promoção e informação de Medicamentos. Segundo o artigo 27 da insígnia, "a propaganda ou publicidade de medicamentos de venda sob prescrição deve ser restrita, única e exclusivamente, aos profissionais de saúde habilitados a prescrever ou dispensar tais produtos (...)". Garantindo o acesso universal, o conteúdo científico do periódico continua disponível para acesso gratuito e integral a todos os interessados no endereço: www.arquivosonline.com.br.
Journal of Clinical Apheresis, 2014
Thrombotic thrombocytopenic purpura (TTP) is a thrombotic microangiopathy caused by decreased act... more Thrombotic thrombocytopenic purpura (TTP) is a thrombotic microangiopathy caused by decreased activity of ADAMTS13, resulting in reduced clearance of ultralarge von Willebrand factor (VWF) multimers. Treatment of TTP is therapeutic plasma exchange (TPE) with replacement with fresh frozen plasma (FFP). Cryoprecipitate-poor plasma (CPP) is a plasma product with lower concentrations of large VWF multimers, and similar amounts of ADAMTS13. CPP is regarded as at least as efficacious as FFP in TTP but evidence of additional benefits has not been demonstrated. Furthermore, there are limited data on the frequency of adverse events associated with CPP. In our center, the choice between CPP and FFP is performed before the 1st TPE session at the physicians&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; discretion. Here, we retrospectively evaluated the efficacy and safety of CPP based on the number of sessions, volume of plasma exposure, frequency of exacerbations/relapses, and adverse events. Fourteen patients with newly diagnosed TTP were included in this analysis. The proportion of CPP:FFP use was 5:9. There were no significant differences in age, gender, initial hemoglobin, platelet count, LDH, or etiology of TTP between groups. We observed a trend toward a higher number of TPE sessions and higher plasma exposure in CPP, compared to FFP-treated patients. Acute exacerbations were more frequent among patients treated with CPP (OR 26.6; 95%CI 1.01-703.51; P = 0.03). Mild allergic reactions were the most common treatment-related adverse event in both groups. Our data suggest that CPP should not be used as 1st line treatment for newly diagnosed TTP patients.
Arquivos Brasileiros de Cardiologia, 2016
Os anúncios veiculados nesta edição são de exclusiva responsabilidade dos anunciantes, assim co... more Os anúncios veiculados nesta edição são de exclusiva responsabilidade dos anunciantes, assim como os conceitos emitidos em artigos assinados são de exclusiva responsabilidade de seus autores, não refletindo necessariamente a opinião da SBC. Material de distribuição exclusiva à classe médica. Os Arquivos Brasileiros de Cardiologia não se responsabilizam pelo acesso indevido a seu conteúdo e que contrarie a determinação em atendimento à Resolução da Diretoria Colegiada (RDC) nº 96/08 da Agência Nacional de Vigilância Sanitária (Anvisa), que atualiza o regulamento técnico sobre Propaganda, Publicidade, Promoção e informação de Medicamentos. Segundo o artigo 27 da insígnia, "a propaganda ou publicidade de medicamentos de venda sob prescrição deve ser restrita, única e exclusivamente, aos profissionais de saúde habilitados a prescrever ou dispensar tais produtos (...)". Garantindo o acesso universal, o conteúdo científico do periódico continua disponível para acesso gratuito e integral a todos os interessados no endereço: www.arquivosonline.com.br.
Journal of Clinical Apheresis, 2014
Thrombotic thrombocytopenic purpura (TTP) is a thrombotic microangiopathy caused by decreased act... more Thrombotic thrombocytopenic purpura (TTP) is a thrombotic microangiopathy caused by decreased activity of ADAMTS13, resulting in reduced clearance of ultralarge von Willebrand factor (VWF) multimers. Treatment of TTP is therapeutic plasma exchange (TPE) with replacement with fresh frozen plasma (FFP). Cryoprecipitate-poor plasma (CPP) is a plasma product with lower concentrations of large VWF multimers, and similar amounts of ADAMTS13. CPP is regarded as at least as efficacious as FFP in TTP but evidence of additional benefits has not been demonstrated. Furthermore, there are limited data on the frequency of adverse events associated with CPP. In our center, the choice between CPP and FFP is performed before the 1st TPE session at the physicians&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; discretion. Here, we retrospectively evaluated the efficacy and safety of CPP based on the number of sessions, volume of plasma exposure, frequency of exacerbations/relapses, and adverse events. Fourteen patients with newly diagnosed TTP were included in this analysis. The proportion of CPP:FFP use was 5:9. There were no significant differences in age, gender, initial hemoglobin, platelet count, LDH, or etiology of TTP between groups. We observed a trend toward a higher number of TPE sessions and higher plasma exposure in CPP, compared to FFP-treated patients. Acute exacerbations were more frequent among patients treated with CPP (OR 26.6; 95%CI 1.01-703.51; P = 0.03). Mild allergic reactions were the most common treatment-related adverse event in both groups. Our data suggest that CPP should not be used as 1st line treatment for newly diagnosed TTP patients.
Journal of Clinical Apheresis, 2014
Introduction: Thrombotic thrombocytopenic purpura (TTP) is a thrombotic microangiopathy caused by... more Introduction: Thrombotic thrombocytopenic purpura (TTP) is a thrombotic microangiopathy caused by decreased activity of ADAMTS13, resulting in reduced clearance of ultralarge von Willebrand factor (VWF) multimers. Treatment of TTP is therapeutic plasma exchange (TPE) with replacement with fresh frozen plasma (FFP). Cryoprecipitate-poor plasma (CPP) is a plasma product with lower concentrations of large VWF multimers, and similar amounts of ADAMTS13. CPP is regarded as at least as efficacious as FFP in TTP but evidence of additional benefits has not been demonstrated. Furthermore, there are limited data on the frequency of adverse events associated with CPP. Material and methods: In our center, the choice between CPP and FFP is performed before the 1st TPE session at the physicians' discretion. Here, we retrospectively evaluated the efficacy and safety of CPP based on the number of sessions, volume of plasma exposure, frequency of exacerbations/relapses, and adverse events. Results: Fourteen patients with newly diagnosed TTP were included in this analysis. The proportion of CPP:FFP use was 5:9. There were no significant differences in age, gender, initial hemoglobin, platelet count, LDH, or etiology of TTP between groups. We observed a trend toward a higher number of TPE sessions and higher plasma exposure in CPP, compared to FFP-treated patients. Acute exacerbations were more frequent among patients treated with CPP (OR 26.6; 95%CI 1.01-703.51; P 5 0.03). Mild allergic reactions were the most common treatmentrelated adverse event in both groups. Discussion: Our data suggest that CPP should not be used as 1st line treatment for newly diagnosed TTP patients. J. Clin. Apheresis 00:000-000,
Jornal Brasileiro De Psiquiatria, 2012
General Hospital Psychiatry, 2011
Objective: To identify psychosocial and clinical correlates of suicidal ideation in medical inpat... more Objective: To identify psychosocial and clinical correlates of suicidal ideation in medical inpatients. Method: In a cross-sectional study, all adults consecutively admitted to the medical wards of a University Hospital had their names recorded and were randomized and evaluated during the first week of admission. Suicidal ideation was assessed using Item 9 of Patient Health Questionnaire-9. The Beck Depression Inventory, the Beck Anxiety Inventory, the WHO Subjective well-being scale, the Charlson Comorbidity Index and other numerical rating scales (pain and self-reported physical illness severity) were used. Patients with less than four confidants were considered with poor social support. The Student's t test, Mann-Whitney U test, chi-square test and stepwise logistic regression analysis were used. Results: Of the 1092 patients who composed the sample, 7.2% reported having suicidal ideation. After adjusting for psychosocial and clinical confounders, prior suicide attempts (OR: 4.41; 95% CI: 2.12-9.15; Pb.001), depressive symptoms (OR: 1.11; 95% CI: 1.06-1.17; Pb.001), severe anxiety symptoms (OR: 3.04; 95% CI: 1.47-6.26; P=.003) and poor social support (OR: 2.02; 95% CI:1.03-3.96; P=.04) were independently associated with suicidal ideation. Conclusions: Three out of the four correlates of suicidal ideation in medical inpatients are potentially modifiable factors: severe anxiety, depressive symptoms and poor social support. The fourth variable, prior suicide attempts, is not modifiable but should serve as a red flag to suspect and investigate current suicide risk. These findings highlight the importance of suicidal ideation as a proxy for the distress that is incumbent upon physicians to manage if they wish to provide excellent and comprehensive inpatient care.
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Papers by Bianca Stefanello