Resumo Fundamento Apesar da ausência de evidência mostrando benefícios da hidroxicloroquina e da cloroquina combinadas ou não à azitromicina no tratamento da covid-19, esses medicamentos têm sido amplamente prescritos no Brasil. Objetivos Avaliar desfechos, incluindo moralidade hospitalar, alterações eletrocardiográficas, tempo de internação, admissão na unidade de terapia intensiva, e necessidade de diálise e de ventilação mecânica em pacientes hospitalizados com covid-19 que receberam cloroquina ou hidroxicloroquina, e comparar os desfechos entre aqueles pacientes e seus controles pareados. Métodos Estudo multicêntrico retrospectivo do tipo coorte que incluiu pacientes com diagnóstico laboratorial de covid-19 de 37 hospitais no Brasil de março a setembro de 2020. Escore de propensão foi usado para selecionar controles pareados quanto a idade, sexo, comorbidades cardiovasculares, e uso de corticosteroides durante a internação. Um valor de p<0,05 foi considerado estatisticamente significativo. Resultados Dos 7850 pacientes com covid-19, 673 (8,6%) receberam hidroxicloroquina e 67 (0,9%) cloroquina. A idade mediana no grupo de estudo foi 60 (46-71) anos e 59,1% eram mulheres. Durante a internação, 3,2% dos pacientes apresentaram efeitos adversos e 2,2% necessitaram de interromper o tratamento. Alterações eletrocardiográficas foram mais prevalentes no grupo hidroxicloroquina/cloroquina (13,2% vs. 8,2%, p=0,01), e o prolongamento do intervalo QT corrigido foi a principal diferença (3,6% vs. 0,4%, p<0,001). O tempo mediano de internação hospitalar foi maior no grupo usando CQ/HCQ em relação aos controles (9,0 [5,0-18,0] vs. 8,0 [4,0-14,0] dias). Não houve diferenças estatisticamente significativas entre os grupos quanto a admissão na unidade de terapia intensiva (35,1% vs. 32,0%; p=0,282), ventilação mecânica invasiva (27,0% vs. 22,3%; p=0,074) ou mortalidade (18,9% vs. 18,0%; p=0,682). Conclusão Pacientes com covid-19 tratados com cloroquina ou hidroxicloroquina apresentaram maior tempo de internação hospitalar, em comparação aos controles. Não houve diferença em relação a admissão em unidade de terapia intensiva, necessidade de ventilação mecânica e mortalidade hospitalar. covid19, covid19 covid 19, 19 covid-1 3 2020 sexo cardiovasculares p005 p 0 05 p<0,0 significativo 785 8,6% 86 8 6 (8,6% 0,9% 09 9 (0,9% 4671 46 71 (46-71 591 59 1 59,1 mulheres 32 2 3,2 22 2,2 hidroxicloroquinacloroquina 13,2% 132 13 (13,2 vs 82 8,2% p=0,01, p001 p=0,01 , 01 p=0,01) 3,6% 36 (3,6 04 4 0,4% p<0,001. p0001 p<0,001 . 001 p<0,001) CQHCQ CQ HCQ 9,0 90 (9, 5,018,0 50180 5,0 18,0 5 18 [5,0-18,0 80 8, 4,014,0 40140 4,0 14,0 14 [4,0-14,0 dias. dias dias) 35,1% 351 35 (35,1 32,0% 320 p=0,282, p0282 p=0,282 282 p=0,282) 27,0% 270 27 (27,0 22,3% 223 p=0,074 p0074 074 18,9% 189 (18,9 18,0% 180 p=0,682. p0682 p=0,682 682 p=0,682) covid1 covid- 202 p00 p<0, 78 8,6 (8,6 0,9 (0,9 467 7 (46-7 59, 3, 2, 13,2 (13, 8,2 p=0,0 3,6 (3, 0,4 p000 p<0,00 00 9, (9 018 5,018, 5018 50 5, 18, [5,0-18, 014 4,014, 4014 40 4, 140 14, [4,0-14, 35,1 (35, 32,0 p028 p=0,28 28 27,0 (27, 22,3 p=0,07 p007 07 18,9 (18, p068 p=0,68 68 20 p0 p<0 (8, 0, (0, (46- 13, (13 p=0, (3 ( 5,018 501 [5,0-18 4,014 401 [4,0-14 35, (35 32, p02 p=0,2 27, (27 22, (18 p06 p=0,6 p< (8 (0 (46 (1 p=0 5,01 [5,0-1 4,01 [4,0-1 (2 (4 p= [5,0- [4,0- [5,0 [4,0 [5, [4, [5 [4 [

Abstract Background Despite no evidence showing benefits of hydroxychloroquine and chloroquine with or without azithromycin for COVID-19 treatment, these medications have been largely prescribed in Brazil. Objectives To assess outcomes, including in-hospital mortality, electrocardiographic abnormalities, hospital length-of-stay, admission to the intensive care unit, and need for dialysis and mechanical ventilation, in hospitalized COVID-19 patients who received chloroquine or hydroxychloroquine, and to compare outcomes between those patients and their matched controls. Methods A retrospective multicenter cohort study that included consecutive laboratory-confirmed COVID-19 patients from 37 Brazilian hospitals from March to September 2020. Propensity score was used to select matching controls by age, sex, cardiovascular comorbidities, and in-hospital use of corticosteroid. A p-value <0.05 was considered statistically significant. Results From 7,850 COVID-19 patients, 673 (8.6%) received hydroxychloroquine and 67 (0.9%) chloroquine. The median age in the study group was 60 years (46 - 71) and 59.1% were women. During hospitalization, 3.2% of patients presented side effects and 2.2% required therapy discontinuation. Electrocardiographic abnormalities were more prevalent in the chloroquine/hydroxychloroquine group (13.2% vs. 8.2%, p=0.01), and the long corrected QT interval was the main difference (3.6% vs. 0.4%, p<0.001). The median hospital length of stay was longer in the HCQ/CQ + AZT group than in controls (9.0 [5.0, 18.0] vs. 8.0 [4.0, 14.0] days). There was no statistical differences between groups in intensive care unit admission (35.1% vs. 32.0%; p=0.282), invasive mechanical ventilation support (27.0% vs. 22.3%; p=0.074) or mortality (18.9% vs. 18.0%; p=0.682). Conclusion COVID-19 patients treated with chloroquine or hydroxychloroquine had a longer hospital length of stay, when compared to matched controls. Intensive care unit admission, invasive mechanical ventilation, dialysis and in-hospital mortality were similar. COVID19 COVID 19 COVID-1 treatment Brazil inhospital lengthofstay, lengthofstay length-of-stay laboratoryconfirmed laboratory confirmed 3 2020 sex comorbidities corticosteroid pvalue p value 005 0 05 <0.0 significant 7850 7 850 7,85 8.6% 86 8 6 (8.6% 0.9% 09 9 (0.9% 46 (4 71 591 59 1 59.1 women hospitalization 32 2 3.2 22 2.2 discontinuation chloroquinehydroxychloroquine 13.2% 132 13 (13.2 vs 82 8.2% p=0.01, p001 p=0.01 , 01 p=0.01) 3.6% 36 (3.6 04 4 0.4% p<0.001. p0001 p<0.001 . 001 p<0.001) HCQCQ HCQ CQ 9.0 90 (9. 5.0, 50 5 [5.0 18.0 180 18 80 8. 4.0, 40 [4.0 14.0 140 14 days. days days) 35.1% 351 35 (35.1 32.0% 320 p=0.282, p0282 p=0.282 282 p=0.282) 27.0% 270 27 (27.0 22.3% 223 p=0.074 p0074 074 18.9% 189 (18.9 18.0% p=0.682. p0682 p=0.682 682 p=0.682) similar COVID1 COVID- 202 00 <0. 785 85 7,8 8.6 (8.6 0.9 (0.9 ( 59. 3. 2. 13.2 (13. 8.2 p00 p=0.0 3.6 (3. 0.4 p000 p<0.00 9. (9 5.0 [5. 18. 4.0 [4. 14. 35.1 (35. 32.0 p028 p=0.28 28 27.0 (27. 22.3 p=0.07 p007 07 18.9 (18. p068 p=0.68 68 20 <0 78 7, (8. 0. (0. 13. (13 p0 p=0. (3 p<0.0 5. [5 4. [4 35. (35 32. p02 p=0.2 27. (27 22. (18 p06 p=0.6 < (8 (0 (1 p=0 p<0. [ (2 p= p<0 p<

ABSTRACT Objective to identify chronic renal failure patients’ perceptions of the everyday implications of hemodialysis therapy. Methodology this qualitative, observational, descriptive, cross-sectional study was conducted with 20 patients with chronic renal failure (CRF) in Montes Claros, Minas Gerais, Brazil. Results the analysis generated the categories: “the influence of hemodialysis on the life of CRF patients”, in which adaptation to a new lifestyle affects biopsychosocial factors, and restricts the patient’s activities; and “nutritional restrictions: personal and social repercussions for the person with CRF”, which is an important factor in treatment efficiency, but leads to social isolation and deprivation of leisure. Conclusion understanding these changes leads to new strategies to improve the quality of care provided. Therefore, education, “embracement”, motivation and including the family/community constitute strategies for strengthening coping with hemodialysis.

RESUMEN Objetivo identificar la percepción del portador de insuficiencia renal crónica respecto a las implicaciones del tratamiento de hemodiálisis en su cotidiano. Metodología estudio descriptivo, con enfoque cualitativo, realizado en Montes Claros, Minas Gerais, junto a 20 pacientes con insuficiencia renal crónica en tratamiento hemodialítico. Se recolectaron los datos por medio de entrevista semiestructurada y se analizaron a través de la técnica de análisis de contenido. Resultados el análisis generó las categorías: “la influencia de la hemodiálisis en la vida de los portadores de IRC”, en la que la adaptación a un nuevo estilo de vida afecta los factores biopsicosociales restringiendo las actividades del paciente; y “restricciones nutricionales: repercusiones personales y sociales para el portador de IRC”, siendo éste un importante factor en la eficiencia del tratamiento, pero proporcionando el aislamiento social y la privación al ocio. Conclusión el entendimiento de esas alteraciones tras nuevas estrategias de mejoría de la calidad a la asistencia proporcionada. Siendo así, educar, acoger, motivar e incluir a la familia/comunidad constituyen estrategias de fortalecimiento para enfrentar la hemodiálisis.

RESUMO Objetivo identificar a percepção do portador de insuficiência renal crônica quanto às implicações da terapia hemodialítica no seu cotidiano. Metodologia estudo descritivo, com abordagem qualitativa, realizado em Montes Claros/MG, com 20 pacientes com insuficiência renal crônica em tratamento hemodialítico. Os dados foram coletados por entrevista semiestruturada e analisados pela técnica de análise de conteúdo. Resultados a análise gerou as categorias: “a influência da hemodiálise na vida dos portadores de IRC”, na qual a adaptação a um novo estilo de vida afeta os fatores biopsicossociais restringindo as atividades do paciente; e “restrições nutricionais: repercussões pessoais e sociais para o portador de IRC”, sendo este um importante fator na eficiência do tratamento, porém proporcionando o isolamento social e a privação ao lazer. Conclusão o entendimento dessas alterações traz novas estratégias de melhoria da qualidade à assistência prestada. Sendo assim, educar, acolher, motivar e incluir a família/comunidade constituem estratégias de fortalecimento para o enfrentamento da hemodiálise.

The influence of oral infections, especially periodontal disease, on systemic diseases has been extensively discussed in the literature. Because periodontal disease is a persistent infection, it promotes an inflammatory response. C-reactive protein is a marker for inflammatory reactions that is frequently studied, since elevated levels of this protein are related to coronary events. OBJECTIVE: The aim of this study was to investigate the effect of periodontal therapy on reducing the serum levels of C-reactive protein, by means of a systematic review of the literature and meta-analysis. MATERIAL AND METHODS: A systematic review of the English-language literature was conducted in the PUBMED-MEDLINE database, using the key words "periodontal disease", "C-reactive protein", "periodontal therapy" and "periodontal treatment", in accordance with the terms for Medical Subject Headings (MeSH), to evaluate the effect of periodontal therapy on C-reactive protein levels. A qualitative analysis of studies of randomized clinical trial design was performed using CONSORT, with subsequent meta-analysis. RESULTS: The literature search initially retrieved 46 potentially relevant studies available in the databases. From these, in accordance with the inclusion criteria, only 11 were selected, of which only 4 fulfilled the criteria of randomized clinical trial design. According to CONSORT, the studies evaluated generally presented good quality with regard to the criteria analyzed. Through meta-analysis, the reduction in mean levels of C-reactive protein (-0.231; p=0.000) after introducing periodontal treatment was estimated. The result was statistically significant, without evidence of heterogeneity between the studies (p=0.311). CONCLUSIONS: The findings indicated that non-surgical periodontal treatment had a positive effect with regard to reduction of the serum levels of C-reactive protein.

A produção de espécies reativas de oxigênio (EROs) por leucócitos polimorfonucleares (LPMNs) durante a fagocitose é essencial para a defesa do organismo contra microrganismos invasores. Entretanto, em algumas doenças ocorre a deposição de imunocomplexos, o que leva à produção e liberação excessiva dessas EROs, e conseqüente lesão nos tecidos hospedeiro. Neste trabalho avaliamos o efeito de substâncias naturais (quercetina e 7-aliloxicumarina) sobre a produção de EROs por LPMNs de coelho, estimulados com imunocomplexos de imunoglobulina G (ICIgG), empregando o ensaio de quimioluminescência (QL) dependente de luminol (QL lum) e de QL dependente de lucigenina (QL luc). A interação entre ICIgG e LPMNs, mediada pelo receptor de membrana Fcgama, foi observada por microscopia eletrônica de transmissão, pela intensa marcação dos ICIgG com partículas de ouro coloidal. Os resultados obtidos indicaram que as substâncias analisadas inibiram a QL lum e a QL luc e que tais efeitos não parecem estar relacionados com a inibição da fagocitose, conforme observado no ensaio por microscopia eletrônica.

The generation of reactive oxygen species (EROs) by polymorphonuclear leukocytes (LPMNs) during phagocytosis plays a key role in the organism defense against invading microorganisms. However, in some diseases the immune complexes deposition occurs, that causes an increase in the production and release of EROs. Consequently, the host tissue is damaged. In this work we studied the effect of natural compounds (quercetin and 7-allyloxycoumarin) on EROs generation by rabbit (LPMNs) stimulated with immunecomplexes (IC) of chicken egg albumin (antigen) and class G immuneglobulins (IgG) - ICIgG. The EROs production was measured by chemiluminescence assay (QL) enhanced by luminol (QL lum) or by lucigenin (QL luc). The interaction between ICIgG (conjugated with colloidal gold) e LPMNs, mediated by Fcgamma membrane receptor, was observed by transmission electron microscopy. The results indicated that the studied compounds inhibited QL lum and QL luc. They also suggest that such effects are not related to phagocytosis inhibition, as observed by the electron microscopy assay.