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ABSTRACT Chloroquine and hydroxychloroquine have shown promising preliminary results and have been discussed as therapeutic options for patients with Covid-19. Despite the lack of robust evidence demonstrating the benefits and justifying the use of one of these drugs, the final decision is the responsibility of the attending physician and should be individualized and shared, whenever possible. This position statement recommends dosage adjustment for these drugs in the context of renal impairment.

RESUMO Em razão de resultados preliminares promissores, a hidroxicloroquina e a cloroquina têm sido discutidas como opção terapêutica para pacientes com Covid-19. Apesar da ausência de estudos robustos que evidenciem o benefício e justifiquem o uso de uma dessas drogas, a decisão final compete ao médico assistente, devendo ser individualizada e, sempre que possível, compartilhada. A presente nota pretende orientar o ajuste posológico dessas drogas no contexto da disfunção renal.

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ABSTRACT The Covid-19 pandemic brought several challenges to the healthcare system: diagnosis, treatment and measures to prevent the spread of the disease. With the greater availability and variety of diagnostic tests, it is essential to properly interpret them. This paper intends to help dialysis units concerning the use of clinical criteria and diagnostic tests for decision making regarding the discontinuation of isolation of patients with suspected or confirmed Covid-19, as well as the return to work activities for employees with suspected or confirmed Covid-19.

RESUMO A pandemia da Covid-19 trouxe desafios ao sistema de saúde em diversas esferas: diagnóstico, tratamento e medidas para evitar a disseminação da doença. Com a maior disponibilização e variedades de testes diagnósticos, torna-se fundamental sua adequada interpretação. Este posicionamento pretende orientar unidades de diálise em relação ao uso de critérios clínicos e testes diagnósticos para a tomada de decisão referente à descontinuação do isolamento de pacientes com suspeita ou confirmação de Covid-19, assim como para o retorno às atividades laborais de colaboradores com suspeita ou confirmação de Covid-19.

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Several biosimilar versions of enoxaparin are already approved and in use globally. Analytical characterization can establish good quality control in manufacturing, but they may not assure similarity in clinical outcomes between biosimilar and branded enoxaparin. This study evaluated the efficacy and safety of biosimilar Cristália versus branded Sanofi enoxaparin in venous thromboembolism (VTE) prevention in patients undergoing major abdominal surgery at risk for VTE. In this randomized, prospective single-blind study, we compared Cristália enoxaparin (Ce), a biosimilar version, versus branded Sanofi enoxaparin (Se; at a dose of 40 mg subcutaneously per day postoperatively from 7 to 10 days) in 243 patients submitted to major abdominal surgery at risk for VTE for VTE prevention. The primary efficacy outcome was occurrence of VTE or death related to VTE. The principal safety outcomes were a combination of major bleeding and clinically relevant non-major bleeding. Bilateral duplex scanning of the legs was performed from days 10 to 14, and follow-ups were performed up to 60 days after surgery. The incidence of VTE was 4.9% in the Cristália group and 1.1% in the Sanofi group (absolute risk difference = 3.80%, 95% confidence interval [CI]: -1.4%-9.0%) yielding noninferiority since the 95% CI does not reach the prespecified value Δ = 20%. Clinically significant bleeding occurred in 9.9% in the Cristália group and in 5.5% in the Sanofi group (n.s. ). In conclusion, this study suggests that 40 mg once daily of Ce, a biosimilar enoxaparin, is as effective and safe as the branded Sanofi enoxaparin in the prophylaxis of VTE in patients submitted to major abdominal surgery at risk for VTE.

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INTRODUCTION: One of the biggest challenges in the management of hypertension is adequate blood pressure (BP) control. To achieve this goal, home blood pressure measurement (HBPM) with automated devices has been encouraged. However, part of the medical community still disputes its validity, believing that HBPM may lead to incorrect readings. OBJECTIVE: To evaluate the correspondence between the simultaneous measurements of BP with the auscultatory method and an oscillometric digital method, commonly used in HBPM. METHODS: BP was determined simultaneously in 423 individuals (normotensive and hypertensive) with a validated automated digital device (ONROM 705IT) and with the auscultatory method with a mercury sphygmomanometer. Both devices were connected through a Y-shaped connection to a cuff whose size was adjusted to the arm circumference. RESULTS: The values represent mean ± SD (minimum-maximum values): age 40.8 ± 16.3 years (18-92), arm circumference 28.2 ± 3.7 cm (19-42), systolic BP (SBP) auscultatory 127.6 ± 22.8 mmHg (69-223), SBP automated 129.5 ± 23.0 mmHg (56-226), diastolic BP (DBP) auscultatory 79.5 ± 12.6 mmHg (49-135) DBP automated 79.0 ± 12.6 mmHg (48-123). The mean difference in SBP between the two methods was 1.9 mmHg (-15 to +19) and 0.5 mmHg for DBP (-19 to +13). The Bland-Altman analysis showed clinically acceptable agreement between the methods. CONCLUSION: BP measured with the automated method closely mirrors that determined with the conventional auscultatory method and should be used to improve the diagnosis and control of hypertension.

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INTRODUÇÃO: Um dos maiores desafios no manejo da hipertensão arterial é o adequado controle pressórico. Para se alcançar esse objetivo tem se difundido a medida residencial da pressão arterial (MRPA) com aparelhos automáticos. Entretanto, parte da comunidade médico-científica ainda discute sua validade, acreditando que as medidas pressóricas domiciliares podem ser incorretas. OBJETIVO: Avaliar a correspondência entre as medidas simultâneas da pressão arterial (PA) pelo método auscultatório convencional e método digital automático, habitualmente utilizado na MRPA. MÉTODOS: Através de uma conexão em "Y" acoplamos um manguito a um aparelho digital automático validado (ONROM 705IT) e a um esfigmomanômetro de coluna de mercúrio, permitindo aferir simultaneamente a PA pelos dois métodos. Determinamos a PA em 423 indivíduos (normotensos e hipertensos), adequando o tamanho do manguito à circunferência braquial. RESULTADOS: Os valores representam média ± desvio padrão (DP) (valores mínimo-máximo): Idade 40,8 ± 16,3 anos (18-92), circunferência braquial 28,2 ± 3,7 cm (19-42), PA sistólica (PAS) auscultatório 127,6 ± 22,8 mmHg (69-223), PAS automático 129,5 ± 23,0 mmHg (56-226), PA diastólica (PAD) auscultatório 79,5 ± 12,6 mmHg (49-135), PAD automático 79,0 ± 12,6 mmHg (48-123). A diferença média da PAS entre os dois métodos foi de 1,9 mmHg (-15 a +19) e a diferença da PAD de 0,5 mmHg (-19 a +13). Os índices de correlação de Pearson entre os métodos são para a PAS (r = 0,97), e PAD (r = 0,91). A análise de Bland-Altman mostrou concordância clinicamente aceitável entre os métodos. CONCLUSÃO: A PA aferida pelo método digital automático apresenta boa concordância com o método auscultatório convencional, devendo ser usada no auxílio do diagnóstico e controle da hipertensão arterial (HA).

INTRODUCTION: One of the biggest challenges in the management of hypertension is adequate blood pressure (BP) control. To achieve this goal, home blood pressure measurement (HBPM) with automated devices has been encouraged. However, part of the medical community still disputes its validity, believing that HBPM may lead to incorrect readings. OBJECTIVE: To evaluate the correspondence between the simultaneous measurements of BP with the auscultatory method and an oscillometric digital method, commonly used in HBPM. METHODS: BP was determined simultaneously in 423 individuals (normotensive and hypertensive) with a validated automated digital device (ONROM 705IT) and with the auscultatory method with a mercury sphygmomanometer. Both devices were connected through a Y-shaped connection to a cuff whose size was adjusted to the arm circumference. RESULTS: The values represent mean ± SD (minimum-maximum values): age 40.8 ± 16.3 years (18-92), arm circumference 28.2 ± 3.7 cm (19-42), systolic BP (SBP) auscultatory 127.6 ± 22.8 mmHg (69-223), SBP automated 129.5 ± 23.0 mmHg (56-226), diastolic BP (DBP) auscultatory 79.5 ± 12.6 mmHg (49-135) DBP automated 79.0 ± 12.6 mmHg (48-123). The mean difference in SBP between the two methods was 1.9 mmHg (-15 to +19) and 0.5 mmHg for DBP (-19 to +13). The Bland-Altman analysis showed clinically acceptable agreement between the methods. CONCLUSION: BP measured with the automated method closely mirrors that determined with the conventional auscultatory method and should be used to improve the diagnosis and control of hypertension.

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