Revista da Associacao Medica Brasileira (1992)
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Rev Assoc Med Bras (1992) · Jun 2020
Physical and financial participation of teaching hospitals in private care in São Paulo - Brasil.
OBJECTIVE To evaluate the physical and financial participation of private health insurance beneficiaries in the TH located in the State of Sao Paulo, regarding the care of Brazilian Unique Health System patients, in the year 2017. METHODS The research data were obtained from the System of Evaluation of the Teaching Hospitals (SAHE), of the State Department of Health of São Paulo (SES/SP). RESULTS It was observed that, on average, the TH analyzed provide 17% of their operational vacancies for the Supplementary Health System, and that the financial return is better in the philanthropic ones. CONCLUSIONS The health care services provided by TH deserve to be deepened, evaluating the real advantages obtained in the provision of services, given that supplementary health care requires differentiated infrastructure, and mainly the knowledge of operational costs in order to stipulate the procedures' price.
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Rev Assoc Med Bras (1992) · Jun 2020
Meta AnalysisEffects of four types of integrated Chinese and Western medicines for the treatment of COVID-19 in China: a network meta-analysis.
OBJECTIVE Various integrated Chinese and Western medicines might be beneficial for the treatment of Coronavirus disease 2019 (COVID-19). This study aims to evaluate the efficacy of lung computed tomography (CT) of four integrated Chinese and Western medicines in the treatment of COVID-19 using network meta-analysis (NMA). METHODS Multiple databases were consulted to find randomized controlled trials of four different types of integrated Chinese and Western medicines for the treatment of COVID-19. ⋯ A total of 598 cases were included in the study, and the results showed that the four types of integrated Chinese and Western medicines (symptomatic and supportive care with Qingfei Touxie Fuzheng, Lianhua Qingke, and Xuebijing) were significantly superior (P < 0.05) to symptomatic and supportive care alone, except for symptomatic and supportive care with Lianhua Qingwen. The combination of symptomatic and supportive care with Lianhua Qingke had the highest probability of being the most clinically efficacious intervention, with a surface under the cumulative ranking (SUCRA) curve of 85.7. CONCLUSIONS A combination of symptomatic and supportive care with Lianhua Qingke is the best option among the four integrated Chinese and Western medicines considered for the treatment of COVID-19.
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Rev Assoc Med Bras (1992) · Jun 2020
ReviewUse of remdesivir for patients with Covid-19: a review article.
The etiological agent of COVID-19, which causes severe respiratory diseases such as pneumonia and pulmonary insufficiency, has been confirmed as a new coronavirus, now known as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). There is currently no authorized medication for the treatment of COVID-19. No vaccines have been authorized. ⋯ Remdesivir is currently the most promising molecule in the treatment of COVID-19, taking into account its broad antiviral spectrum (considering the genetic sequences of the virus, it is expected to maintain activity against SARS-CoV-2). There is in vitro and in vivo information available for coronaviruses, as well as an extensive clinical safety database (from a clinical trial of the Ebola virus and in the context of the Monitored Emergency Use of Unregistered and Investigational Interventions - MEURI). Further studies are relevant as available data on the efficacy and safety of Remdesivir against SARS-nCoV-2 are limited.
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Rev Assoc Med Bras (1992) · Jun 2020
ReviewFibrinogen and D-dimer variances and anticoagulation recommendations in Covid-19: current literature review.
INTRODUCTION Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a newly described virus responsible for the outbreak of the coronavirus disease 2019 (Covid-19), named by the World Health Organization (WHO) in February/2020. Patients with Covid-19 have an incidence of acute respiratory distress syndrome (ARDS) of 15.9-29% and sepsis is observed in all deceased patients. Moreover, disseminated intravascular coagulation (DIC) is one of the major underlying causes of death among these patients. ⋯ In addition, the current evidence suggests a routine use of anticoagulation, particularly in patients with higher D-dimer levels (> 3.0 μg/mL). CONCLUSION Covid-19 is a systemic, hypercoagulable disease requiring more studies concerning treatment. Aanticoagulation is still an issue to be studied, but D-dimer rise and disease severity are the indicative factors to start treatment as soon as possible.