1/ Colleagues from Manaus reaching out in complete distress:
Covid19 patients that were *improving* are experiencing extreme anguish/panic while dying due to lack of Oxygen!

A system does not colapse out of the blue!

Avoidable catastrophe: Image
2/ NO BEHAVIORAL MEASURE to stop Covid19 was implemented in Manaus (nor anywhere else) in the last 4 weeks.

The population is left to its own luck (or lack of)

The President keeps disencouraging face masks, social distancing, and, BELIEVE ME, vaccination!
3/ If this was not enough, his proposal to address the Covid19 crisis in Brazil is early treatment with hydroxycholoquine, ivermectin, nitazoxanide 😱

Stop this madness!
@ministerpublico @STF_oficial @SenadoFederal @camaradeputados
@RodrigoMaia
Read this!!! 😡
Colleagues sedating *recovering* patients in order to treat their extreme emotional anguish while facing the lack of O2 and hypoxia!

Leiam!!! Irresponsáveis!
@SenadoFederal @camaradeputados @STF_oficial @ministerpublico Image

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More from @leticiakawano

17 Jan
1/ Covid19 is out of control in 🇧🇷 creating chaos & avoidable deaths.

This is the DIRECT result of a political agenda led by the Brazilian Federal Government.

I will provide evidence to help @ministerpublico @STF_oficial @camaradeputados @SenadoFederal do its job. Thread: Image
2/ Early at the beginning of the pandemic, the world knew very little about Covid

It is understandable that, at that time, wrong guidance was temporarily issued to the pop...

The important thing was that these GUIDANCES WERE UPDATED AS WE LEARNED MORE... Image
3/ By January 2021, it is CONSENSUS among the international scientific community that HYDROXICHLOROQUINE has *no* place in the management of Covid19:

WHO: bmj.com/content/370/bm…

NIH: covid19treatmentguidelines.nih.gov

CDC: cdc.gov/coronavirus/20…

In Brazil, various Medical Societies... Image
Read 15 tweets
18 Nov 20
1/ *tweetorial* on how to participate in #ATSchats

Helloooo #Medtwitter , #PCCSM people, and everyone else interested in participating in the #ATSchat s: this 🧵 is for you!

If it's your first time and you don't know how to do it, follow me ;-) @atsearlycareer @atscommunity
2/ At the scheduled date/time:
1.Type #ATSchat in the search bar at the top right of your window.
2.Ensure you click on the “latest” tab: This allows the chronologically most recent tweets to show up allowing you to easily follow the chat!

(see screenshot below)
@SushmaCribbs
3/ @ATSearlycareer will post the questions starting with Q1, Q2, Q3, and so on.

You can answer the question in one of two ways:

a. Below is one way (see screenshot): type in #ATSchat and A1, A2 respectively and answer it ;-)
Read 9 tweets
5 Sep 20
1/ Another result of the collaborative effort, Coalition Covid-19 Brazil, is out!
Kudos at this time to HIAE trial coordination: Otavio Berwanger & Remo Furtado, not on twitter 😕 @JuliaMachline #COVIDー19 @TheLancet @f_g_zampieri @a_serpaneto @FlaviaSepsis @azevedo_lcp
2/ Here the population included in the trial, note that about half of pts were on IMV, ~1/4 shocked. Steroids were being administered to only 15-20% (at that time, early on in the pandemic, steroids were not known to benefit severe covid-19 pts)
3/ At day 15, the use of azythromycin 500mg/d for 19 days did not change health status, look at death (6) and IMV (5) or discharged pts (1)
Read 6 tweets
2 Sep 20
1/ It's out! The Codex trial.
This is the 2nd RCT result published as a result of an unprecedented collaborative research effort, the Coalition Covid19 Brazil 🇧🇷.
Deserve special recognition: @azevedo_lcp @ICURevisited and all HSL team!

jamanetwork.com/journals/jama/… @JAMA_current
2/ In the Codex trial, mod-severe Covid-19 ARDS cases were randomized to Dexa 20mg/d for 5 days followed by 10mg/d for more 5 days.

*Dexa increased the number of days alive & free of mechanical ventilation in 28 days*

PS: for MV-free days, death was penalized as 0 free days
3/ When you breakdown the composite 1ary outcome in its components, note that mortality was the major driver of difference between groups. No short-term difference in AE was noted:
Read 8 tweets
24 Jul 20
1/ Some more information on our study Coalizao 1, on HCQ/Azithro for #Covid19 that explains some issues:

@f_g_zampieri @damiani_petri @tlisboa79 @azevedo_lcp @FlaviaSepsis @a_serpaneto
Before I start, the first thread on the study is here:
2/ Back in March, we knew much less than we know today on Covid19 (and as a consequence v. little information to inform RCT design)
Regulatory agencies & WHO have defined the ordinal scale as an important outcome.

As @f_g_zampieri commented (in Portuguese) elsewhere
3/ We realized, after the trial started, that a clinical status ordinal scale would be potentially problematic given that the level of support offered could differ between countries and local practices not reflecting necessarily dz severity
Read 7 tweets
23 Jul 20
1/ Our study (Coalition I) on HCQ and azithromycin for #Covid19 is out!
This study is the effort of an unprecedented collaboration (Coalition Covid19 Brasil) established between major Brazilian hospitals and research networks/Institutes.

nejm.org/doi/full/10.10…
2/ Coalition I is one of nine RCTs on drug repurposing and long-term consequences of Covid19 being conducted by this research team.
I am honored and humbled to be part of this research effort in Brazil in such daring times.
3/ 667 hospitalized pts w mild to moderate Covid19 (pts on NIV/HF or MV were non-eligible) were randomized 1:1:1 to:
-HCQ + Azithromycin + Standard of care* (SoC)
-HCQ + SoC
-SoC
*SoC: antibiotics (~60%), oseltamivir (~25%), and steroids (~20%) w/o difference between groups.
Read 8 tweets

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