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Leticia Kawano-Dourado Profile picture
Leticia Kawano-Dourado
@leticiakawano
Pulmonologist & Researcher Tweeting on: methodology, RCTs, ILD, #Brazil #Portugal, #womenInMedicine, Metabolic health, #HumanRights, #meditation
Jul 10, 2021 • 5 tweets • 5 min read
1/ Olá @TwitterBrasil ,📢:
Venho aqui protestar contra a INDIFERENÇA do @instagram @Facebook frente à pandemia COVID-19 no Brasil🇧🇷:

A plataforma deles vem sendo usada para comunicar informação 😃 instagram.com/p/CRDsdt5qmki/

e desinformação 😖em COVID-19🦠

Mas... 2/ @instagram se recusa a assumir a responsabilidade social frente à COVID-19:

❌ recusa-se a verificar perfis alinhados com o consenso cientifico internacional de alto padrão (como o @Twitter fez por ex.)

⚠️ Mas verifica 😱perfis que comunicam desinformaçao em Covid (!!) +
Jul 9, 2021 • 7 tweets • 3 min read
1/Hello colleagues in 🇬🇧, why do you do that?
You probably know how to evaluate the quality of evidence, why rating HIGH quality 2 RCTs that are not HIGH quality? And then yielding biased net results?
It probably doesn't change much in your country BUT+ academic.oup.com/ofid/advance-a… 2/ Are you aware that these publications fuels widespread off-label use of Ivermectin in Brazil, where the pandemic has NO scientific guidance?

Do you know that there are young people going into liver transplantation bc of Ivermectin in Brazil?
saude.ig.com.br/2021-03-24/ao-…
Jul 8, 2021 • 6 tweets • 7 min read
1/ Hello @Twitter community, coming here to protest against the INDIFFERENCE of @instagram when it comes to the COVID-19 pandemic in Brazil 🇧🇷

Their platform has been widely used to disseminate information & fake news on COVID-19

But,

instagram.com/p/CRDsdt5qmki/
@Facebook Image 2/ @instagram refuses to assume responsibility for the content posted on its platform

(probably bc it is profitable to let things run wild as it is going. In 2019 they made USD $69.7 billion in advertising fees)

@ChanZuckerberg
investopedia.com/articles/perso…
Jul 8, 2021 • 10 tweets • 4 min read
1/ 💥Effectiveness of Coronavac (Sinovac's vaccine) in Chile - prospective national cohort (Nordic research style, Chile? 😎)
Just out in the @NEJM!

Thread 🧵 Image 2/ Estimates of vaccine effectiveness in Covid-19 are essential 💥 bc they reflect real-world challenges (logistics, cold chains, vaccination schedules, and also involve more diverse populations 🧓🧒👩‍🦰👲🧕 than those selected in RCTs)

sample in this study: > 10 million people Image
Mar 8, 2021 • 14 tweets • 11 min read
1/ A 🧵 on the #pandemicide in 🇧🇷

* Pandemicide: The willful act of ignoring pandemic spread to selectively eliminate those who it will affect most..low and middle-income folks and racialized persons @DrBarbKing

Bolsonaro: "Only the weak dye of Covid19"
euronews.com/2020/04/06/a-l… 2/ The word pandemicide seems to have been used for the first time by @Laurie_Garrett to describe the 🇺🇸 Covid19 situation under the Trump administration
#pandemicide

I do like the term, but let's not forget that pandemicide, at least in 🇧🇷, refers to...

Mar 5, 2021 • 4 tweets • 2 min read
Covid-19 in Brazil: the government has failed to prevent the spread of covid-19 disq.us/t/3vbqfgd Image 2/ The report, now in English, by Prof @Deisy_Ventura and Prof Aith clearly demonstrates the deliberate intention to push the population towards Covid-19:
+
conectas.org/wp/wp-content/… Image
Jan 21, 2021 • 7 tweets • 3 min read
1/ Our study is out on the @bmj_latest 🤩

TOCILIZUMAB added to the standard of care did not improve clinical outcomes in hospitalized pts with severe Covid19

Let me walk you through the results 2/ Baseline characteristics: ~57yo, around 1/2 of the patients on low flow O2, ~15% on IMV; 20-40% on NIV/HF (random imbalance between groups)

70% of the patients were using steroids at baseline

These pts had high CRP (higher in the control), high LDH, high ferritin:
Jan 20, 2021 • 4 tweets • 5 min read
1/Hoje lembrei de vocês aqui, cientistas de dados:

Tentando entender o endurecimento das medidas restritivas em Paris 🤔 quando "estamos tão bem há semanas", descobri que a decisão foi tomada com base na vigilância genômica da variante B117 e 2/ na tendência de ⬆️ no n. de casos novos.

Antecipa-se que, por conta da B117, via modelagem matemática, é possível que a França precise de um 3o confinamento em breve 😐

Sonhando com o dia em que nossos cientistas serão igualmente ouvidos no Brasil. #Quediferenca
Jan 19, 2021 • 7 tweets • 4 min read
1/ Awesome 🤩: RCTs coming out answering important questions on Covid19!

A trial designed/coordinated by 🇧🇷 trialists @RenatoDLopes1 @damiani_petri Pedro Barros

DSMB chaired by Alexandre Biasi, who I luckily can call a friend

thread:

jamanetwork.com/journals/jama/… @JAMA_current Image 2/ Why this trial was needed? 🧐

ACE2 is the receptor for SARS-CoV-2

Select preclinical investigations have shown upregulation of ACE2 by RAAS inhibitors (such as ACEIs and ARBs), raising concerns about their safety in patients with COVID-19

science.sciencemag.org/content/367/64… Image
Jan 17, 2021 • 15 tweets • 11 min read
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: 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...
Jan 14, 2021 • 4 tweets • 3 min read
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!
Nov 18, 2020 • 9 tweets • 7 min read
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
Sep 5, 2020 • 6 tweets • 4 min read
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)
Sep 2, 2020 • 8 tweets • 6 min read
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
Jul 24, 2020 • 7 tweets • 4 min read
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
Jul 23, 2020 • 8 tweets • 4 min read
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.
May 29, 2020 • 6 tweets • 4 min read
1/ How is it, on a personal level, to be a Respiratory physician & #Covid_19 researcher in the epicenter of the #coronavirus pandemic, in Sao Paulo, 🇧🇷:

I receive phone calls and whatsapp messages almost every day from colleagues & friends all over 🇧🇷 asking for advice/help 2/ Delicate/tender situations happen all the time, as for ex, when a physician friend from another State called me telling me he/she had covid19... he/she was deteriorating & he/she wanted me to help him/her decide on steroids yes/no #ThisIsTough 💔 ...
May 24, 2020 • 7 tweets • 4 min read
1/ ACTT-1 preliminary results
🔴1:1 randomization stratified by dz severity & center - Remdesivir vs placebo (total sample: 1,063)
🔴1ary outcome: *time* to recovery (time frame: 28d)

nejm.org/doi/full/10.10… @NEJM 2/
🔴By the time the DSMB recommended for the end of the study, recruitment had finished. Only 391/340 pts in the Remdesivir/placebo group had 28d complete data.
🔴But the analysis of the population included 1,059 for whom researchers had at least some postbaseline data
May 23, 2020 • 4 tweets • 4 min read
1/ #coronavirusbrasil 🇧🇷is killing far more young people around here.

The reason for that:
Lack of access to proper hospital life support. That is a major problem especially for the poor who rely on a burdened public healthcare system (burdened b4 covid)
wapo.st/3d0EghN 2/ let´s remember that the age range that most get infected by #covid19 is between 20 - 59yo. Some do need hospital admission but in general do well. What if you don´t have access to proper healthcare when you need? weekly.chinacdc.cn/en/article/id/…
May 18, 2020 • 6 tweets • 4 min read
1/ Multicentric chinese randomized open label trial on HCQ + SoC vs SoC for mild-mod #COVID19
1:1 randomization - stratification on dz severity
Intervention: loading dose of 1200mg/d for 3d HCQ > 800mg/d for 11d.
bmj.com/content/369/bm…
@bmj_latest 2/
The primary outcome was changed throughout the study conduction:
Final 1ary outcome: negative SARS-CoV PCR conversion by 28d AND, if severe #covid19, whether clinical improvement had occurred by 28d #BadChoice ?
Oct 12, 2019 • 8 tweets • 5 min read
1/ [ 5th AMIB-ESICM Symposium]:
I talked about the physiological rationale of the #HFNC for hypercapnic ARF.
So not all hypercapnic ARF are the same. There are those due to Central hypoventilation / neuromuscular disorders & those due to V/Q mismatch
@israelmaia16 @RENOVATEtrial 2/ In the V/Q mismatch category, airway diseases such as #COPD commonly presents a mismatch due to ⬆️Vd/Vt. And how that happens can be easily appreciated in these two slides:
#RENOVATEtrial