Early-onset effluvium secondary to COVID-19: Clinical and histologic characterizationTo the Editor: As telogen effluvium (TE) is the most common manifestation of postacute COVID-19 syndrome, we read with keen interest the publication by Abrantes et al 1 reporting the clinical characteristics of 30 patients with post-COVIDe19 acute TE. We would like to commend the authors and bring some other elements to this relevant discussion.TE is a heterogeneous condition that can be elicited by multiple stimuli. 2 Headington 3 proposed 5 functional types of TE based on alternations in particular phases of the follicular cycle. Infections are thought to induce TE through the mechanism of immediate anagen release. According to this model, an acute inflammatory state converts the follicles from anagen to catagen, leading to the shedding of telogen hairs around 90 days after the infection. Interestingly, the median time for the onset of hair shedding observed by Abrantes et al 1 was 45 days after infection; in the most precocious case, it started 18 days after COVID-19.This early onset was also observed in 2 multicentric studies. Moreno-Arrones et al 4 evaluated 214 cases of acute TE after COVID-19 and noted the onset of hair shedding, on average, 57.1 days after the infection. Starace et al 5 observed early onset especially when TE was associated with trichodynia. In these cases, the latency from the infection to hair shedding occurred at an average of 3 (range, 2-7.5) weeks. 5 We recently assessed 203 hospitalized patients with confirmed COVID-19, of whom 11 (5.4%) reported hair loss with onset early during hospitalization, \30 days after the infection. Seven of them were assessed using trichoscopy, a trichogram, and a histologic evaluation. The detailed information of these cases is presented in Supplementary Table I (available via Mendeley at https://data.mendeley.com/datasets/p254jbh356/1).Clinically, all the cases presented a positive pull test result. Trichoscopy did not reveal broken hairs, anisotrichosis, or yellow dots, but it did reveal some empty follicles. The trichogram obtained from the vertex revealed[10% dystrophic anagen hairs (Fig 1) and [20% telogen hairs in all the cases. Histologically, there was predominance of anagen terminal follicles, no relevant miniaturization ([10%), and no cases showing [25% telogen follicles. No

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This study evaluated hypertensive patients assisted in twelve health facilities, in Alfenas city-Minas Gerais, Brazil, in order to verify medication adherence and make a situational analysis of these patients. Data collection was carried out through home visits to patients, who answered a questionnaire and had their blood pressure (BP) measured. Medication adherence was assessed in the questionnaire by using the "Morisky" test, and following adaptations of "MINICHAL", life quality of the hypertensive patients under antihypertensive therapy, was observed. Among 196 hypertensive patients interviewed (52.04% female and 47.96% male), the age group with the highest number of hypertensive patients was the elderly (≥60 years), accounting by 68.36% of the interviewed, being that most of the interviewed declared having low education. Only 48.98% of the interviewed were considered adherent to antihypertensive treatment and 55.10% of the patients complained of dry mouth, 26.53% reported chest pain without physical effort, and 36.23% reported the occurrence of numbness or tingling. As for the BP measurement, 58.67% of the patients had between normal BP and ideal-high, and 41.32% between stage 1 and isolated systolic hypertension. Due to age group, biological, socioeconomic status, sociocultural context, and educational differences among the interviewed, can be inferred that there is a lack in more effective and individualized care in the healthcare facilities assessed, greatly contributing the high prevalence of antihypertensive treatment non-adherence found in this study (51.02%). Therefore, these data should be considered to increase the adherence rates to antihypertensive treatment by the users.