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- Acute kidney injury: Dosing of antibioticsPublication . Gonçalves-Pereira, J
- Antibioterapia: Utilização de antibióticos e risco de infeçãoPublication . Gonçalves-Pereira, J
- Antibiotic dosing in the obese patientPublication . Gonçalves-Pereira, J
- Antibiotics and extracorporeal circulation – one size does not fit allPublication . Gonçalves-Pereira, J; Oliveira, B
- Antibiotics The When and the HowPublication . Gonçalves-Pereira, J
- Artificial Intelligence to Close the Gap between Pharmacokinetic/Pharmacodynamic Targets and Clinical Outcomes in Critically Ill Patients: A Narrative Review on Beta LactamsPublication . Gonçalves Pereira, João; Fernandes, Joana; Mendes, Tânia; Gonzalez, Filipe André; Fernandes, Susana M.Abstract: Antimicrobial dosing can be a complex challenge. Although a solid rationale exists for a link between antibiotic exposure and outcome, conflicting data suggest a poor correlation between pharmacokinetic/pharmacodynamic targets and infection control. Different reasons may lead to this discrepancy: poor tissue penetration by β-lactams due to inflammation and inadequate tissue perfusion; different bacterial response to antibiotics and biofilms; heterogeneity of the host’s immune response and drug metabolism; bacterial tolerance and acquisition of resistance during therapy. Consequently, either a fixed dose of antibiotics or a fixed target concentration may be doomed to fail. The role of biomarkers in understanding and monitoring host response to infection is also incompletely defined. Nowadays, with the ever-growing stream of data collected in hospitals, utilizing the most efficient analytical tools may lead to better personalization of therapy. The rise of artificial intelligence and machine learning has allowed large amounts of data to be rapidly accessed and analyzed. These unsupervised learning models can apprehend the data structure and identify homogeneous subgroups, facilitating the individualization of medical interventions. This review aims to discuss the challenges of β-lactam dosing, focusing on its pharmacodynamics and the new challenges and opportunities arising from integrating machine learning algorithms to personalize patient treatment.
- Atrial Fibrillation in critically ill patients: incidence and outcomesPublication . Paula, Sofia B.; Oliveira, André; Melo e Silva, João; Simões, André F.; Gonçalves Pereira, JoãoAbstract Background: Atrial fibrillation (AF), either chronic or new onset, is common in critically ill patients. Its epidemiology and relationship with clinical outcomes are poorly known. Objective: To understand the burden of AF in patients admitted to ICU and its impact on patients’ outcomes. Methods: Single-center retrospective, cohort study, evaluating all patients with AF admitted to a non cardiac intensive care unit over the course of 54 months. Clinical outcomes were evaluated in the short (hospital discharge) and long-term (2-year follow-up). The hazard ratio (HR) with 95% CI was computed for the whole population as well as for propensity score-matched patients, with or without AF. Results: A total of 1357 patients were screened (59.1% male), with a mean age of 75±15.2 years, length of intensive care unit stay of 4.7±5.1 days, and hospital mortality of 26%. A diagnosis of AF was found in 215 patients (15.8%), 142 of which had chronic AF. The hospital all-cause mortality was similar in patients with chronic or new-onset AF (31% vs. 28.8%, p=0.779). Patients with AF had higher in-hospital, 1-year, and 2-year mortality (30.2%, 47.9%, and 52.6% vs. 22.9%, 35.3%, and 38.4%, respectively). However, after propensity score matching (N=213), this difference was no longer significant, neither in-hospital mortality (Odds Ratio 1.10; 95% CI 0.72-1.66), 1-year mortality (OR 1.16; 95% CI 0.79-1.70) or 2-years mortality, (Odds Ratio 1.16; 95% CI 0.79-1.70). Conclusions: In ICU patients AF was common, either chronic or new-onset, being diagnosed in 15.8%. Patients with AF had higher mortality but no significant differences were found in the short- and long-term mortality after adjustment for severity on admission.
- Biofilmes Da investigação à clínicaPublication . Pereira, João Gonçalves
- C-reactive Protein Variation and Its Usefulness in the Prognostication and Monitoring of Patients With Pneumococcal PneumoniaPublication . Gomes, André; Ribeiro, Rui; Froes, Filipe; Mergulhão, Paulo; Gonçalves Pereira, JoãoCommunity-acquired pneumonia (CAP) is a prevalent and life-threatening infection that causes significant morbidity and mortality. Biomarkers, such as C-reactive protein (CRP), can help to diagnose, monitor, and prognose patients with this condition. This study aimed to analyze the disease course, the CRP peak concentration, its relationship with prognosis, and its variation in hospitalized patients with pneumococcal CAP.
- A Case Report of Hemophagocytic SyndromePublication . Mendes, Tânia F.; Oliveira, Ana Isabel; Gomes, Carolina; Sousa, Nuno A.; Gonçalves Pereira, JoãoAbstract Hemophagocytic syndrome (HPS) represents a critical and often overlooked hyperinflammatory condition that can lead to rapid multi-organ failure and high mortality rates, particularly in adults. This article presents a compelling case study of a 45-year-old male with a complex clinical presentation, highlighting the diagnostic challenges posed by HPS, including its nonspecific symptoms and the necessity for a high index of suspicion. We underscore the paramount importance of early recognition, thorough differential diagnosis, and prompt initiation of treatment to improve patient outcomes. This case not only illustrates the intricacies of diagnosing HPS but also advocates for increased awareness among healthcare providers to mitigate the risks associated with this life-threatening syndrome.