Despite several studies designed to evaluate the efficacy of chloroquine and hydroxychloroquine in the treatment of coronavirus disease 2019 (COVID-19), there is still doubt about the effects of these drugs, especially in patients with severe forms of the disease. This randomized, open-label, controlled, phase III trial assessed the efficacy of chloroquine or hydroxychloroquine for five days in combination with standard care compared to standard care alone in patients hospitalized with severe COVID-19. Chloroquine 450 mg BID on day 1 and 450 mg once daily from days 2 to 5 or hydroxychloroquine 400 mg BID on day 1 and 400 mg once daily from days 2 to 5 were administered in the intervention group. Patients were enrolled from April 16 to August 06, 2020, in 6 hospitals in southern Brazil. The primary outcome was the clinical status measured on day 14 after randomization with a 9-point ordinal scale. The main secondary outcomes were all-cause mortality; invasive mechanical ventilation use; the incidence of acute renal dysfunction in 28 days; and the clinical status of patients on days 5, 7, 10 and 28. All patients with a positive RT-PCR result for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were analyzed (modified intention to treat (mITT) population). Arrythmias and cardiovascular complications were assessed as safety outcomes. A total of 105 patients were enrolled and followed for 28 days. The trial was stopped before reaching the planned sample size due to harmful effects. Patients in the intervention group had a worse clinical outcome on the 14th day (odds ratio (OR) 2.45 [1.17 to 4.93], p = 0.016) and on the 28th day (OR 2.47 [1.15 to 5.30], p = 0.020). Moreover, the intervention group had higher incidences of invasive mechanical ventilation use (risk ratio (RR) 2.15 [1.05 to 4.40], p = 0.030) and severe renal dysfunction (KDIGO stage 3) (RR 2.24 [1.01 to 4.99], p = 0.042) until the 28th day of follow-up. No significant arrythmia was noted. In patients with severe COVID-19, the use of chloroquine/hydroxychloroquine added to standard treatment resulted in a significant worsening of clinical status, an increased risk of renal dysfunction and an increased need for invasive mechanical ventilation.Trial Registration: ClinicalTrials.gov, NCT04420247. Registered 09 June 2020—Retrospectively registered, https://www.clinicaltrials.gov/ct2/show/study/NCT04420247.

No abstract

RESUMO Este estudo teve como objetivo conhecer o perfil dos fisioterapeutas paranaenses no ano de 2015, suas características sociodemográficas, tendências na formação e mercado de trabalho, em uma pesquisa quantitativa de caráter transversal. A amostra foi composta por 377 fisioterapeutas, dos 11272 inscritos no Conselho Profissional no ano de 2015, que responderam a um questionário estruturado disponível on-line. Os resultados mostraram que os fisioterapeutas do Paraná constituem-se predominantemente por jovens de 21 a 40 anos (81,7%), do sexo feminino (77,7%), e se concentram na macrorregião de Curitiba (53,6%). A maioria graduou-se nos últimos dez anos (59,9%) e possui pós-graduação lato sensu (73,7%), porém poucos possuem mestrado ou doutorado. A maioria (82,8%) trabalha exclusivamente com a profissão, em um único emprego (53,3%), em instituição privada (59,2%), como autônomos (55,7%), com carga horária de mais de oito horas diárias (35,5%). Com relação a área de atuação, 68,7% trabalham em mais de uma área, sendo Traumato-ortopedia a que apresenta o maior número de profissionais atuantes (59,9%), seguida da Neurofuncional (41,1%) e da Respiratória (38,7%). A maioria dos profissionais tem renda mensal entre o piso e quatro mil reais (42,9%). Assim, foi possível traçar o perfil do fisioterapeuta do Paraná em 2015, vislumbrando a identidade da profissão no estado e a projeção de tendências futuras, o que possibilitará às instituições de ensino superior e às entidades representativas da categoria a criação de estratégias futuras para formação e a regulação do mercado de trabalho.

Resumo A Escala Visual Analógica (EVA), o Questionário de Incapacidade de Roland Morris (RMDQ) e Questionário de Qualidade de Vida SF-36, amplamente utilizados, tiveram seu conteúdo conectado à CIF por regras propostas em 2002 e 2005. Em 2016 foram refinadas e ainda não foram aplicadas. Aplicar as regras de conexão de conteúdo refinadas para os instrumentos EVA, RMDQ e SF-36. Dois profissionais de saúde identificaram os conceitos significativos e vincularam às categorias mais específicas da CIF, um terceiro arbitrou divergências. O grau de concordância foi dado pelo coeficiente kappa. Houve alto grau de concordância (Kappa=0,93 p<0,001). O conceito principal da EVA foi conectado à categoria b280, os 24 conceitos principais do RMDQ, à categoria b28013 e os 27 adicionais a outras categorias. O SF-36 teve 36 conceitos principais e 30 adicionais identificados, do total, 17 não foram definíveis pela CIF. Dos conceitos conectados dos 3 instrumentos 39 referem-se à Funções do Corpo, 57 à Atividades e Participação e 4 à Fatores Ambientais. O refinamento das regras propiciou mais clareza no processo de identificar, relacionar o conteúdo dos instrumentos à CIF e expor os resultado e aumentou o número de conceitos identificados e categorias contempladas pelos instrumentos.

Background. Parkinson’s disease affects approximately 1% of the worldwide population older than 60 years. This number is estimated to double by 2030, increasing the global burden of the disease. Patients with Parkinson’s disease are hospitalized 1.5 times more frequently and for longer periods than those without the disease, increasing health-related costs. Objective. To compare the characteristics and outcome of patients with and without Parkinson’s disease admitted to intensive care units (ICUs). Methods. Historical cohort study of ICU admissions in a Brazilian city over 18 years. All patients with Parkinson’s disease identified were matched for age, sex, year, and place of hospitalization with patients without the disease randomly selected from the same database. Results. The study included 231 patients with Parkinson’s disease (PD group) and 462 controls without the disease (NPD group). Compared with patients in the NPD group, those in the PD group were more frequently admitted with lower level of consciousness and increased APACHE II severity score but required less frequently vasoactive drugs. In total, 42.4% of the patients in the PD group were admitted to the ICUs due to sepsis or trauma. Although these patients had longer hospital stay, the mortality rates were comparable between groups. Parkinson’s disease was not associated with mortality, even when controlled for associated factors of disease severity. Conclusion. Although patients with Parkinson’s disease were admitted with higher severity scores and remained in the ICU for a longer time, their mortality rate was not higher than that in patients without the disease.