Abstract Objective To evaluate clinical characteristics and outcomes of COVID-19 patients infected with HIV, and to compare with a paired sample without HIV infection. Methods This is a substudy of a Brazilian multicentric cohort that comprised two periods (2020 and 2021). Data was obtained through the retrospective review of medical records. Primary outcomes were admission to the intensive care unit, invasive mechanical ventilation, and death. Patients with HIV and controls were matched for age, sex, number of comorbidities, and hospital of origin using the technique of propensity score matching (up to 4:1). They were compared using the Chi-Square or Fisher's Exact tests for categorical variables and the Wilcoxon for numerical variables. Results Throughout the study, 17,101 COVID-19 patients were hospitalized, and 130 (0.76%) of those were infected with HIV. The median age was 54 (IQR: 43.0;64.0) years in 2020 and 53 (IQR: 46.0;63.5) years in 2021, with a predominance of females in both periods. People Living with HIV (PLHIV) and their controls showed similar prevalence for admission to the ICU and invasive mechanical ventilation requirement in the two periods, with no significant differences. In 2020, in-hospital mortality was higher in the PLHIV compared to the controls (27.9% vs. 17.7%; p = 0.049), but there was no difference in mortality between groups in 2021 (25.0% vs. 25.1%; p > 0.999). Conclusions Our results reiterate that PLHIV were at higher risk of COVID-19 mortality in the early stages of the pandemic, however, this finding did not sustain in 2021, when the mortality rate is similar to the control group. COVID19 COVID 19 COVID-1 infection (202 2021. . 2021) records unit death sex comorbidities up 41. 41 4 1 4:1) ChiSquare Chi Square Fishers Fisher s study 17101 17 101 17,10 hospitalized 13 0.76% 076 0 76 (0.76% 5 IQR (IQR 43.064.0 430640 43.0 64.0 43 64 43.0;64.0 202 46.063.5 460635 46.0 63.5 46 63 46.0;63.5 (PLHIV differences inhospital 27.9% 279 27 9 (27.9 vs 17.7% 177 7 0.049, 0049 0.049 , 049 0.049) 25.0% 250 25 (25.0 25.1% 251 0.999. 0999 0.999 999 0.999) pandemic however group COVID1 COVID- (20 4:1 1710 10 17,1 0.76 07 (0.76 064 43.064. 43064 430 43. 640 64. 6 43.0;64. 20 063 46.063. 46063 460 46. 635 63. 46.0;63. 27.9 2 (27. 17.7 004 0.04 04 25.0 (25. 25.1 099 0.99 99 (2 4: 171 17, 0.7 (0.7 06 43.064 4306 43.0;64 46.063 4606 46.0;63 27. (27 17. 00 0.0 25. (25 09 0.9 ( 0. (0. 43.06 43.0;6 46.06 46.0;6 (0 43.0; 46.0;

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 BACKGROUND: Instant messaging services (IMS) are widely used in medical practice. OBJECTIVE: To evaluate perceptions regarding use and usability of IMS within clinical practice and assess users’ knowledge of the ethical and legal context involved in using IMS within medical practice. DESIGN AND SETTING: Cross-sectional study conducted in different hospitals and medical institutions in Minas Gerais, Brazil. METHODS: Medical students, medical residents, primary care physicians and specialist doctors answered an online questionnaire regarding epidemiological data, graduation level and use of IMS for medical communication. Responses were collected over a five-month period and data were assessed using the IBM-SPSS software. RESULTS: 484 people answered the questionnaire: 97.0% declared that they were using IMS for medical-related purposes; 42.0%, to elucidate medical concerns every week; 75.0%, to share imaging or laboratory tests and patients’ medical records; and 90.5%, to participate in clinical case-study private groups. Moreover, only 37.0% declared that they had knowledge of the legislative aspects of use of smartphones within clinical practice. Differences in the frequency of discussion of medical concerns within the daily routine between student/residents and general practitioners/specialists, and in the frequency of image-sharing and patient-guiding/assistance between students and medical doctors, were observed. CONCLUSIONS: Our results provide reliable proof that medical doctors and students use IMS, as a tool for clinical case discussions, interactions between healthcare providers and patients, or dissemination of knowledge and information. Nonetheless, because of limitations to the ethical and legal regulations, evidence-based discussions between authorities, academics and medical institutions are needed in order to fully achieve positive outcomes from such platforms.

Abstract Background: The knowledge on the management of patients with acute coronary syndrome (ACS) is essential to reduce the gap between evidence and practice. Objective: To describe a simulation training strategy for emergency healthcare professionals and provide preliminary data on knowledge acquisition, learners' confidence and prescription of medications after training. Methods: The training was part of the implementation of two myocardial infarction systems of care. It comprehended lectures and simulation-based learning using high and low-fidelity mannequins and actors. It was tested in two phases: the first one in Belo Horizonte and the second one in Montes Claros, both in the state of Minas Gerais. A test was applied before and after training to assess knowledge acquisition. Confidence to perform thrombolysis in ST-elevation myocardial infarction (STEMI) patients was assessed using a questionnaire, and the impact on medication prescription analyzed STEMI patients admitted to hospitals in Montes Claros. Results: In the first phase, 156 professionals answered both tests: 70% of them improved their results and the median number of right answers increased (6, interquartile range [IQR] 5-7; vs 7 ([IQR] 6-9; p < 0.05). In the second phase, 242 professionals answered both tests: 58% of the physicians and 83% of the nurses obtained better test scores. Participants referred a positive impact on their clinical practice, 95% reported feeling very secure when perform fibrinolysis after the training, and there was also an impact on medication prescription. Conclusions: There was an impact on the learners' knowledge acquisition and confidence using our two-phase training model, with evidence of impact on performance.

ABSTRACT BACKGROUND: Electrocardiograms (ECGs) are an essential examination for identification and management of cardiovascular emergencies.The aim of this study was to report on the frequency and recognition of cardiovascular emergencies in primary care units. DESIGN AND SETTING: Observational retrospective study assessing consecutive patients whose digital ECGs were sent for analysis to the team of the Telehealth Network of Minas Gerais. METHODS: Data from patients diagnosed with cardiological emergencies in the primary care setting of 750 municipalities in Minas Gerais, Brazil, between March and September 2015, were collected via telephone contact with the healthcare practitioner who performed the ECG. After collection, the data were subjected to statistical analysis. RESULTS: Over the study period, 304 patients with cardiovascular emergencies were diagnosed within primary care. Only 73.4% of these were recognized by the local physicians. Overall, the most frequent ECG abnormalities were acute ischemic patterns (44.7%) and the frequency of such patterns was higher among the ECGs assigned as emergency priority (P = 0.03). It was possible to obtain complete information on 231 patients (75.9%). Among these, the mean age was 65 ± 14.4 years, 57.1% were men and the most prevalent comorbidity was hypertension (68.4%). In total, 77.9% were referred to a unit caring for cases of higher complexity and 11.7% of the patients died. CONCLUSION: In this study, cardiovascular emergencies were misdiagnosed in primary care settings, acute myocardial ischemia was the most frequent emergency and the mortality rate was high.