This study aims to evaluate the effects of whole-body electrical stimulation (WB-EMS) in the rehabilitation of patients undergoing lung transplantation. This is a randomized clinical trial with patients from the inpatient unit of Dom Vicente Scherer Hospital of Irmandade Santa Casa de Misericórdia from Porto Alegre (ISCMPA) who will be allocated to a control group (which will receive physiotherapy from routine) or intervention group (which will receive physiotherapy from routine and WB-EMS). Interventions with WB-EMS will occur every day from the moment of extubation until hospital discharge (15 sessions per patient). Assessments will be carried out pre-lung transplantation, after extubation, during intervention protocols and at the time of hospital discharge.

Start Date20 Dec 2024

Sponsor / Collaborator

Irmandade Da SAnta Casa De Misericórdia De Porto Alegre

RBR-29xt8nh

/ Not yet recruitingNot Applicable

Etonogestrel Implant in Kidney Transplant

Start Date01 Sep 2024

Sponsor / Collaborator

Irmandade Da SAnta Casa De Misericórdia De Porto Alegre

[+1]

RBR-7nrvmmm

/ Not yet recruitingNot ApplicableIIT

Incidence of complications related to multiple Central Venous Access in the internal jugular vein: multicenter randomized non-inferiority clinical trial

Start Date01 Jul 2024

Sponsor / Collaborator

Irmandade Da SAnta Casa De Misericórdia De Porto Alegre

100 Clinical Results associated with Irmandade Da SAnta Casa De Misericórdia De Porto Alegre

0 Patents (Medical) associated with Irmandade Da SAnta Casa De Misericórdia De Porto Alegre

Literatures (Medical) associated with Irmandade Da SAnta Casa De Misericórdia De Porto Alegre

01 Dec 2024·The Journal of Heart and Lung Transplantation

Efficacy and safety of sotatercept across ranges of cardiac index in patients with pulmonary arterial hypertension: A pooled analysis of PULSAR and STELLAR

Article

Author: Grünig, Ekkehard ; Hoeper, Marius M ; Johnson-Levonas, Amy O ; Gomberg-Maitland, Mardi ; Kopeć, Grzegorz ; Meyer, Gisela ; Xing, Aiwen ; de Oliveira Pena, Janethe ; Gibbs, J Simon R ; Perchenet, Loïc ; Badesch, David B ; Strait, James ; Rosenkranz, Stephan ; McLaughlin, Vallerie V ; Humbert, Marc ; Souza, Rogerio ; Waxman, Aaron B ; Olsson, Karen M ; Preston, Ioana R ; Ardeschir Ghofrani, H ; Cornell, Alexandra G

BACKGROUNDThis analysis examined the effects of the activin signaling inhibitor, sotatercept, in pulmonary arterial hypertension (PAH) subgroups stratified by baseline cardiac index (CI).METHODSPooled data from PULSAR (N = 106; NCT03496207) and STELLAR (N = 323; NCT04576988) were analyzed using 2 different CI thresholds, <2.0 and ≥2.0 liter/min/m² as well as <2.5 and ≥2.5 liter/min/m². Median changes from baseline at week 24 were evaluated using Hodges-Lehmann estimator and least squares (LS) means, with 95% confidence intervals and p-values (significance: p = 0.05). Categorial endpoints and time-to-clinical worsening were analyzed by Cochran-Mantel-Haenszel and Cox model respectively.RESULTSOf 429 participants, 51 had CI <2.0 and 378 ≥2.0 liter/min/m², while 179 had CI <2.5 and 250 ≥2.5 liter/min/m². Sotatercept significantly improved median 6-minute walk distance (range: 33.9 to 63.7 m: p < 0.001), pulmonary vascular resistance (range: -202.8 to -395.4 dyn•s•cm^-⁵; p ≤ 0.002), and N-terminal pro-B-type natriuretic peptide (range: -317.3 to -1,041.2 pg/ml; p < 0.001) across subgroups. LS means showed reductions in pulmonary and right atrial pressures, decreased right ventricular size, and improved tricuspid annular plane systolic excursion/systolic pulmonary artery pressure. Sotatercept delayed time to first occurrence of death or a worsening event for CI ≥2.5 (hazard ratio [HR] 0.12; p < 0.001), ≥2.0 (HR 0.13; p < 0.001), and <2.5 (HR 0.21; p < 0.001) liter/min/m². Improvements were observed in WHO functional class (all p < 0.050) and ESC/ERS risk scores (all p < 0.001).CONCLUSIONSSotatercept demonstrated consistent efficacy and safety across CI subgroups, supporting its use in PAH patients irrespective of baseline cardiac hemodynamics.

01 Oct 2024·Clinics and Research in Hepatology and Gastroenterology

Alkaline phosphatase and liver fibrosis at diagnosis are associated with deep response to ursodeoxycholic acid in primary biliary cholangitis

Article

Author: Cunha, Simone Muniz Carvalho Fernandes da ; Cançado, Guilherme Grossi Lopes ; Ivantes, Claudia Alexandra Pontes ; Mendes, Liliana Sampaio Costa ; Nardelli, Mateus Jorge ; Villela-Nogueira, Cristiane Alves ; Pace, Fabio Heleno de Lima ; Cançado, Eduardo Luiz Rachid ; Ferraz, Maria Lucia Gomes ; Oliveira, Maria Beatriz ; Signorelli, Izabelle Venturini ; Rotman, Vivian ; Bittencourt, Paulo Lisboa ; Oliveira, Elze Maria Gomes ; Codes, Liana ; Terrabuio, Debora Raquel Benedita ; Pessôa, Mário Guimarães ; Fucuta, Patrícia da Silva ; Villela‑Nogueira, Cristiane Alves ; Coral, Gabriela Perdomo ; de Almeida e Borges, Valéria Ferreira ; Braga, Michelle Harriz ; Silva, Marlone Cunha da ; Faria, Luciana Costa ; Couto, Cláudia Alves ; Gomes, Nathalia Mota de Faria ; de Almeida E Borges, Valéria Ferreira

OBJECTIVEPrimary biliary cholangitis is a chronic and progressive autoimmune liver disease, whose prognosis can be improved by normalizing alkaline phosphatase and bilirubin. While ursodeoxycholic acid (UDCA) is first line standard of care, approximately 40 % of patients exhibit incomplete response. We aimed to identify prognostic markers for deep response to UDCA therapy at presentation.PATIENT AND METHODSData from the Brazilian Cholestasis Study Group cohort were analyzed retrospectively. Patients were assessed for deep response, defined as normal alkaline phosphatase and bilirubin, after 1 year of UDCA treatment. Additionally, the performance of the UDCA response score in predicting deep response was evaluated.RESULTSA total of 297 patients were analyzed, with 57.2 % achieving an adequate response according to the Toronto criteria, while 22.9 % reached deep response. Cirrhosis (OR 0.460; 95 % CI 0.225-0.942; p = 0.034) and elevated baseline alkaline phosphatase levels (OR 0.629; 95 % CI 0.513-0.770; p < 0.001) were associated with reduced odds of deep response. The UDCA response score exhibited moderate discrimination power (AUROC = 0.769) but lacked calibration.CONCLUSIONSBaseline ALP and liver fibrosis emerge as the most important prognostic factors to predict normalization of alkaline phosphatase and bilirubin after UDCA. The UDCA response score was inadequate for predicting deep response in the Brazilian PBC population.

01 May 2024·European Journal of Gastroenterology & Hepatology

A new and simple score to predict adequate and deep response to ursodeoxycholic acid in patients with primary biliary cholangitis: the ALP-A score

Article

Author: Borges, Valéria Ferreira de Almeida e ; Mendes, Liliana Sampaio Costa ; Cançado, Guilherme Grossi Lopes ; Pace, Fabio Heleno de Lima ; Ferraz, Maria Lucia Gomes ; Oliveira, Elze Maria Gomes ; Pessôa, Mário Guimarães ; Filho, Roberto José de Carvalho ; Codes, Liana ; Terrabuio, Debora Raquel Benedita ; Oliveira, Maria Beatriz ; Cunha, Simone Muniz Carvalho Fernandes da ; Rotman, Vivian ; Gomes, Nathalia Mota de Faria ; Signorelli, Izabelle Venturini ; Nardelli, Mateus Jorge ; Ivantes, Claudia Alexandra Pontes ; Fucuta, Patrícia ; Mazo, Daniel Ferraz de Campos ; Coral, Gabriela Perdomo ; Couto, Cláudia Alves ; Bittencourt, Paulo Lisboa ; Braga, Michelle Harriz ; Cançado, Eduardo Luiz Rachid ; Villela-Nogueira, Cristiane Alves ; Faria, Luciana Costa

BackgroundUrsodeoxycholic acid (UDCA) is the standard treatment for primary biliary cholangitis (PBC), but a significant proportion of patients do not respond adequately, leading to increased risk of adverse outcomes. This study aims to develop a new and straightforward predictive score to identify PBC patients likely to achieve a complete response to UDCA.MethodsA logistic regression analysis was conducted using a derivation cohort of PBC patients to identify pre-treatment variables associated with response to UDCA. This analysis led to the development of the ALP-A score, calculated as: Age at diagnosis divided by (alkaline phosphatase at diagnosis/upper limit of normal). ALP-A score accuracy was evaluated using the area under the ROC curve, validated with a large external cohort from Brazil. Additionally, the correlation between the ALP-A score and the previously validated UDCA response score (URS) was assessed.ResultsALP-A score had good predictive power for adequate (AUC 0.794; 95% CI, 0.737–0.852) and deep (0.76; 95% CI, 0.69–0.83) UDCA response at 1 year of treatment. A cutoff score of 17 and 23 points was determined to be the optimal threshold for distinguishing adequate and deep responders, respectively, from non-responders. ALP-A score demonstrated a sensitivity of 73%, specificity of 71%, positive predictive value of 65%, negative predictive value of 78%, and overall accuracy of 72% for biochemical response. The URS displayed similar discriminative ability (AUC 0.798; 95% CI, 0.741–0.855).ConclusionALP-A score performs comparably to URS but offers the great advantage of simplicity for routine clinical use. It serves as a valuable tool to identify PBC patients less likely to respond to UDCA treatment, facilitating early consideration of alternative therapeutic approaches.

100 Deals associated with Irmandade Da SAnta Casa De Misericórdia De Porto Alegre

100 Translational Medicine associated with Irmandade Da SAnta Casa De Misericórdia De Porto Alegre

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