Background The absence of specific antivirals to treat COVID-19 leads to the repositioning of candidates’ drugs. Nitazoxanide (NTZ) has a broad antiviral effect. Methods This was a randomized, double-blind pilot clinical trial comparing NTZ 600 mg BID versus Placebo for seven days among 50 individuals (25 each arm) with SARS-COV-2 RT-PCR+ (PCR) that were hospitalized with mild respiratory insufficiency from May 20 th , 2020, to September 21 st , 2020 (ClinicalTrials.gov NCT04348409). Clinical and virologic endpoints and inflammatory biomarkers were evaluated. A five-point scale for disease severity (SSD) was used. Findings Two patients died in the NTZ arm compared to 6 in the placebo arm ( p = 0.564). NTZ was superior to placebo when considering SSD ( p < 0001), the mean time for hospital discharge (6.6 vs. 14 days, p = 0.021), and negative PCR at day 21 ( p = 0.035), whereas the placebo group presented more adverse events ( p = 0.04). Among adverse events likely related to the study drug, 14 were detected in the NTZ group and 22 in placebo ( p = 0.24). Among the 30 adverse events unlikely related, 21 occurred in the placebo group ( p = 0.04). A decrease from baseline was higher in the NTZ group for d -Dimer ( p = 0.001), US-RCP ( p < 0.002), TNF ( p < 0.038), IL-6 ( p < 0.001), IL-8 ( p = 0.014), HLA DR. on CD4 + T lymphocytes ( p < 0.05), CD38 in CD4 + and CD8 + T (both p < 0.05), and CD38 and HLA-DR. on CD4+ ( p < 0.01) Interpretation Compared to placebo in clinical and virologic outcomes and improvement of inflammatory outcomes, the superiority of NTZ warrants further investigation of this drug for moderate COVID-19 in larger clinical trials. A higher incidence of adverse events in the placebo arm might be attributed to COVID-19 related symptoms.

The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize procedures to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.

Introduction: Prostate cancer is the second type of cancer diagnosed and the fifth cause of death in men worldwide. Early diagnosis helps to control disease progression. Currently, prostate specific antigen is the standard biomarker, as it has a broad scope of identification and, thus, new and more specific biomarkers must be studied. Objective: To evaluate the accuracy of engrailed-2 protein (EN2) in urine as a prostate cancer biomarker. Method: A comprehensive search was conducted in the period from January 2005 to July 2016 using the following electronic databases: Medline (PubMed), Embase, Cochrane Library and Lilacs. The keywords used in the databases were: "engrailed-2," "EN2," "prostatic neoplasms." The search was limited to humans and there was no language restriction. Critical appraisal of the included studies was performed according to Quadas-2. Statistical analysis was performed using Meta-DiSc® and RevMan 5.3 softwares. Results: A total of 248 studies were identified. After title and abstract screening, 231 studies were removed. A total of 17 studies were read in full and two studies were included in the meta-analysis. The pooled sensitivity was 66% (95CI 0.56-0.75) and specificity was 89% (95CI 0.86-0.92). The DOR was 15.08 . Conclusion: The EN2 test showed high specificity (89%) and low sensitivity (66%).

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T he Brazilian health system is mixed: public and private. There is a public system-SUS and the system of supplementary health (health insurance companies). The SUS was very well designed and implemented for about 25 years (1988). ANS-National Agency of Supplemental Health is even younger, created in January 2000. ANS is the regulatory agency under the Ministry of Health. The two systems coexist, but do not interact properly. A hundred and fifty million people depend exclusively on SUS and health operators have about 52 million users. Several of these users also use SUS on health demands and, in different ways, all Brazilians use SUS (health surveillance, for example). Public health funding has not been sufficient to meet the demands of the people. The share of spending occurs in three levels, but there is a progressive exemption from federal portion, sacrificing increasingly the federative states and especially the municipal budget. About 12 years the share of federal spending on health was around 60% of the whole. Today only 42%, as around 58% come from states and municipalities. Municipalities must apply at least 12% and states at least 15% of its budget on public health. The supplementary system, which serves about 25% of the population, has more resources than the public system. While we recognize improvements in the public health system, its management is not qualified, because there is predominant political and electoral bias in the choice of the managers; instead of this, we should expect to have strong technical influence. Also, is not used adequately the largest and most qualified efficiency of the supplemental health care sector. Besides not having enough resources, they are badly applied and associated to the rampant corruption that persists in our country, that has good, orderly and worker people. We believe that public-private partnerships and effective prioritization of the health sector could bring more gains to the system, directly benefiting the population, especially the poor and needy, already suffering a lot due to poverty, delays in education, infrastructure and safety. Not only suffers the health care, but also teaching and research. The assistance should prioritize access to quality, ensuring the two main entry points to the system: primary or basic and emergency care. An integrated network should exist, with permanent control and evaluation, with referral and counter-referral of patients using SUS. The teaching in the sector has been less than optimal. Several medical schools were opened, in the majority as private schools and without conditions for functioning: good physical structure for practical activities, as well as current curriculum for Brazilian medical needs and qualified teachers. The federal government claims that our medical schools train few students each year, and insists to authorize new vacancies, 40-50 every year. We need to better educate our doctors and other healthcare professionals. The same happens in postgraduate level where it is also prioritized the quantity, ove...

BACKGROUND: Treatment of severe acute respiratory distress syndrome coronavirus 2 (SARSCoV-2) remains a significant challenge in the face of increased worldwide morbidity and mortality. The acute illness caused by SARS-CoV-2 is initiated by a viral phase, followed by an inflammatory phase. Numerous anti-inflammatory and anti-viral therapies, with a relatively minor clinical effect, have been applied. Developing a safe and efficient direct anti-viral treatment is essential as it can block disease progression before significant complications ensue and potentially prevent transmission. AIM: The present phase 1 study aimed to determine the safety of Codivir, a newly developed anti-viral agent, and to preliminarily assess its anti-viral activity in patients infected by COVID-19. METHODS: In vitro studies were conducted to determine the direct anti-viral effect of Codivir using an immunofluorescence-based assay and to assess its cytotoxic effect by tetrazolium assay (MTT). In a phase I clinical trial, Codivir was administered for ten days in 12 patients who were followed for its safety. Patients were followed for clinical manifestations during administration. Sequential nasal viral PCR titers (Cycle Threshold, CT) were determined preceding and during treatment. RESULTS: In vitro, Codivir showed activity against SARS-CoV-2 with 90% viral replication suppression and minimal cytotoxicity. The anti-viral activity was demonstrated at the early stages of infection, postentry of the virus in the cell. Codivir was safe in all 12 patients in phase I clinical trial and significantly suppressed viral replication in 5/7 fully assessed patients, with an anti-viral effect noted as early as three days. SUMMARY: The present study's data support the safety of Codivir administration in humans and suggest its significant anti-COVID-19 effect. These results support the testing of the drug in more extensive controlled trials in patients with SARSCoV-2.

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It is with great satisfaction that we speak to everyone, to account for our mandate (2011)(2012)(2013)(2014) ahead of the Brazilian Medical Association (AMB), a leading and thriving entity that fights bravely for the causes of health and medicine in Brazil.We began our management putting things in the right place, from a managerial and administrative standpoint. We organized processes, flows, responsibilities and values , after receiving the report of a consulting firm (Ernst & Young, hired for this purpose). Getting started was not easy because the problems included a financial deficit that hindered the implementation of several activities. We adopted the motto "only spend what you have, and the resources of the institution belong to the AMB."We launched, together with the Brazilian Bar Association (OAB) and the National Medicine Academy, a successful project leading to a Bill called More Health (or Health +10), aiming at improving public health funding, forcing the federal government to allocate 10% of its gross current revenue (equivalent to approximately 18% of net current revenues) to the sector. The project was successful because, jointly with many other prominent medical organizations and agencies from other sectors, such as the National Conference of Catholic Bishops of Brazil (CNBB), we managed to gather over 2.5 million signatures to pass the bill (the minimum required was about 1.4 million). The state of Minas Gerais gave a great example, getting over 700 thousand signatures, and we also emphasize the commitment of the Legislative Assembly and the Medical Association of Minas Gerais. We visited many states (Pará, Ceará, Rio Grande do Norte, Minas Gerais, Rio de Janeiro, Paraná, Santa Catarina, Rio Grande do Sul, etc.). And even with that number of signatures, the project "sleeps" in the national congress, because the "powerful hand of the government" is not interested in securing health financing. In recent years, the federal government has invested a smaller proportion of funds compared to the resources provided by states and municipalities.We focus on an increasingly closer relationship with federated associations and specialty societies, notably for the stubborn defense of quality medical education, either at undergraduate or postgraduate level. We strengthened our title of specialist, which has quality, and we do not turn a blind eye to the political and electoral follies of quantity superseding quality. We advocate an adequate number of physicians according to our demand, distributed in different regions, states and cities in the country, based on the need of specialists according to technical and epidemiological criteria. Never training without quality. Furthermore, we preach exhaustively that health is achieved not only with doctors. Medical residency is our flag, along with the specialty societies. There is harmony among the medical societies and the struggle for quality in medical education prevails.We sat down with everyone who came to us and is involved with health and medicine: governments...