"H" is not for hydroxychloroquine-"H" is for heparin: lack of efficacy of hydroxychloroquine and the role of heparin in COVID-19-preliminary data of a prospective and interventional study from Brazil.

BACKGROUND: COVID-19 pandemic is the major public health problem in the world actually. It's associated with high morbidity and mortality. To date, no therapeutic measure has a curative potential. Hydroxychloroquine (HCQ) is a drug with immunomodulatory properties that has demonstrated antiviral efficacy in in vitro experiments, with conflicting results in in vivo studies. METHODS: A single-center, prospective and interventional study, that evaluates the impact on mortality of the HCQ use in 154 patients hospitalized with COVID-19 in a Brazilian public hospital. The study also aims to determine prognostic factors that predict mortality, ICU admission and endotracheal intubation in this population. RESULTS: 154 patients diagnosed with COVID-19 confirmed by RT-PCR and hospitalized were included. There was a male predominance (87/154, 56.5%), median age 60 years and 88% (136/154) had comorbidities. Among these, 76% (117/154) were admitted to the ICU and 29.2% (45/154) experienced EOT. The OMR was 51.3% (79/154). There was no difference in mortality between patients treated with HCQ (N = 95) and non-HCQ (N = 59) (44.1% × 55.8%, p = 0.758). In univariate analysis, age ≥ 60 years (HR 3.62, p < 0.001), need for mechanical ventilation (HR 2.17, p = 0.001), ≥ 2 comorbidities (HR 1.83, p = 0.049), SAH (HR: 1.56, p = 0.054) were predictors of mortality, as well as no use of prophylactic or therapeutic heparin (HR 3.60, p = 0.02). Multivariate analysis identified admission to the ICU (HR 8.98, p = 0.002) and advanced age (HR 3.37, p < 0.01) as independent predictors of mortality, although, use of heparin (HR 0.25, p = 0.001) was independently associated with a favorable outcome. CONCLUSION: This study confirmed the absence of a benefit associated with the use of HCQ in Brazilian patients hospitalized with COVID-19. However, prophylactic or therapeutic heparin was an independent predictor for reducing mortality in this population.

A importância de um programa de assistência multidisciplinar no controle de pressão arterial no idoso hipertenso / The importance of a multidisciplinary assistance program in the control of blood pressure in hypertensive elderly patients

Objetivo: Verificar se o fato de ser inserido em um programa de assistência geriátrica multidisciplinar contribui para um melhor controle da pressão arterial. Métodos: Estudo transversal. Local: um centro terciário de ensino de um Hospital de São Paulo, Brasil. Participantes:110 pacientes hipertensos com mais de 60 anos. Medidas: apressão arterial de idosos foi verificada em um serviço denominado“grupo de referência”. Posteriormente foi feito o controle da pressão arterial do mesmo grupo de idosos depois de serem inseridos no programa multidisciplinar de exercícios. Resultados: Encontrou-se uma diferença significativa entre o “grupo de referência” e o “grupomultidisciplinar” em relação à proporção de pacientes que estavamem controle da pressão arterial (p = 0,021). No “grupo de referência”,24,7% dos pacientes tiveram pressão arterial controlada e no “grupomultidisciplinar”, essa proporção foi de 41,1%. Conclusão: O fato de ser inserido em um grupo geriátrico com assistência multidisciplinar para exercícios mostrou um significativo controle da pressão arterial no idoso hipertenso.