Baloxavir vs oseltamivir: reduced utilization and costs in influenza.

OBJECTIVES: To determine whether baloxavir use is associated with lower health care resource utilization (HCRU) and costs for secondary influenza complications post treatment compared with oseltamivir. STUDY DESIGN: Retrospective cohort study. METHODS: Patients filling a prescription for baloxavir or oseltamivir within 48 hours following an influenza-related outpatient visit were identified in the 2018-2019 influenza season from the US Truven MarketScan Research Databases and propensity matched 1:2 (baloxavir:oseltamivir). Outcomes were assessed 15 and 30 days after antiviral treatment and included all-cause, all respiratory-related, and select respiratory-related (influenza, asthma, chronic obstructive pulmonary disease, or infection) HCRU and costs. RESULTS: The study included 5080 baloxavir-treated and 10,160 matched oseltamivir-treated patients. All-cause emergency department (ED) visits and inpatient hospitalizations were lower in baloxavir-treated patients, with a statistically significant difference in the percentage hospitalized at 30 days (0.3% vs 0.5%; P = .04). ED visits for all or select respiratory-related conditions were significantly reduced with baloxavir (P < .01 for all comparisons). Mean per-patient cost savings at day 30 for all-cause, all respiratory-related, and select respiratory-related conditions were $79, $50, and $51, respectively, despite slightly higher prescription costs for baloxavir. In high-risk patients (baloxavir: n = 1958; oseltamivir: n = 3949), the incidence of ED visits was significantly lower for all respiratory-related and select respiratory-related conditions (P < .01); cost savings with baloxavir in the high-risk cohort were substantially greater than in the overall cohort. CONCLUSIONS: Treatment of patients with influenza with single-dose baloxavir was generally associated with lower HCRU and costs post treatment compared with oseltamivir, particularly in high-risk patients.

Burden of influenza in patients with cardiovascular disease who receive antiviral treatment for influenza.

AIMS: Cardiovascular disease (CVD) increases the risk of complications from respiratory viruses, including influenza. Moreover, respiratory viruses may increase the risk of CV events. Antiviral medication may reduce healthcare resource utilization (HRU), but more data is needed in CVD populations to explore relationships between influenza antiviral treatment, CVD-related complications, HRU, and costs. MATERIALS AND METHODS: This retrospective claims analysis examined data extracted from IBM MarketScan Commercial Claims and Encounters and Medicare Supplemental and Coordination of Benefits databases during three influenza seasons: 2016-2017, 2017-2018, or 2018-2019. Propensity score matching was used to compare HRU outcomes and costs among CVD patients treated with influenza antivirals and untreated patients. RESULTS: Across all influenza seasons, patients with CVD and influenza who received antiviral treatment had fewer all-cause emergency department (ED) visits (p < .01), respiratory-related HRU (p < .01), respiratory-related outpatient and ED visits (both p < .01), CVD-related HRU (p < .01), heart failure-related HRU visits (p < .01), and kidney failure-related HRU (p < .01) 180 days post-treatment fill date than CVD patients untreated for influenza. CVD patients treated with antivirals also had a lower mean number of all-cause inpatient, outpatient, and ED visits and days of stay (all p < .01) and fewer mean respiratory-related outpatient and ED visits (both p < .01). HRU patterns were generally consistent over time and across individual influenza seasons. Finally, treated CVD patients incurred lower all-cause outpatient costs 180 days post-treatment fill date (p < .05) than CVD patients untreated for influenza. CONCLUSION: CVD patients who contract influenza and take antiviral medication have fewer short- and long-term influenza-related complications and less overall HRU compared with CVD patients who were not prescribed antiviral treatments. Antiviral treatment may be an important tool in reducing complications in CVD patients with influenza.

People with heart disease are more likely to have complications from respiratory viruses, including influenza (flu). Moreover, respiratory viruses may increase the risk of damage to the heart muscle. We examined whether patients with heart disease who get the flu and take prescription medications called antiviral drugs have fewer short- and long-term flu-related complications and use fewer healthcare services than patients with heart disease who do not take antiviral drugs.We examined commercial and Medicare databases during three influenza seasons (2016­2017, 2017­2018, and 2018­2019), and we compared outcomes and costs among heart disease patients who were treated or not treated with antiviral drugs. Patients with heart disease and the flu who received antiviral drugs had fewer visits to the emergency room, used fewer healthcare services for respiratory-related problems, used fewer heart disease-related healthcare services, and had fewer heart failure-related or kidney failure-related healthcare visits than heart disease patients who were not treated for the flu. Finally, patients with heart disease who were treated with antiviral drugs spent less money on outpatient services than patients with heart disease who were not treated with antiviral drugs.We determined that patients who get the flu and take antiviral drugs have fewer short- and long-term flu-related complications and use fewer healthcare services than heart disease patients who do not receive antiviral drugs. Therefore, it may be important to treat heart disease patients with antiviral drugs in order to reduce the number of flu-related complications in these patients.

Influenza Management During the COVID-19 Pandemic: A Review of Recent Innovations in Antiviral Therapy and Relevance to Primary Care Practice.

Seasonal influenza requires appropriate management to protect public health and resources. Decreasing the burden of influenza will depend primarily on increasing vaccination rates as well as prompt initiation of antiviral therapy within 48 hours of symptom onset, especially in the context of the current coronavirus disease 2019 pandemic. A careful approach is required to prevent health services from being overwhelmed by a surge in demand that could exceed capacity. This review highlights the societal burden of influenza and discusses the prevention, diagnosis, and treatment of influenza as a complicating addition to the challenges of the coronavirus disease 2019 pandemic. The importance of vaccination for seasonal influenza and the role of antiviral therapy in the treatment and prophylaxis of seasonal influenza, including the most up-to-date recommendations from the Centers for Disease Control and Prevention for influenza management, will also be reviewed.

Sotagliflozin Added to Optimized Insulin Therapy Leads to Lower Rates of Clinically Relevant Hypoglycemic Events at Any HbA1c at 52 Weeks in Adults with Type 1 Diabetes.

Background: Hypoglycemia rates usually increase when insulin treatment is intensified to improve glycemic control. We evaluated (post hoc) hypoglycemic rates in adult patients with type 1 diabetes (T1D) on sotagliflozin (a dual sodium-glucose cotransporter [SGLT] 1 and 2 inhibitor) in two phase 3, 52-week clinical trials (inTandem 1 and 2; NCT02384941 and NCT02421510). Materials and Methods: We analyzed rates of documented hypoglycemia (level 1, blood glucose ≥54 to <70 mg/dL) and clinically important hypoglycemia (level 2, glucose <54 mg/dL) in a patient-level pooled analysis (n = 1362) using a negative binomial model adjusted for hemoglobin A1c (HbA1c) at 52 weeks in patients receiving placebo, sotagliflozin 200 mg, and sotagliflozin 400 mg. Results: Rates of level 1 hypoglycemia events per patient-year were 58.25 (95% confidence interval: 50.26-67.50) with placebo, 44.86 (38.83-51.82; P = 0.0138 vs. placebo) with sotagliflozin 200 mg, and 45.68 (39.52-52.81; P = 0.0220) with sotagliflozin 400 mg. Sotagliflozin was also associated with lower rates of level 2 hypoglycemia: 15.95 (14.37-17.70), 11.51 (10.39-12.76; P < 0.0001), and 11.13 (10.03-12.35; P < 0.0001) for placebo and sotagliflozin 200 and 400 mg, respectively. The difference in rates of hypoglycemia with sotagliflozin versus placebo became more pronounced as HbA1c decreased. Conclusions: At week 52, level 1 and 2 hypoglycemia events were 22% to 30% less frequent with sotagliflozin added to optimized insulin therapy versus placebo in adults with T1D at any HbA1c level, with greater differences at lower HbA1c values. These findings support the use of sotagliflozin as an insulin adjunct in T1D.

O valor do sulfato de desidroepiandrosterona sérico como teste de triagem das formas deinício tardio da hiperplasia congênita da supra-renal / The value of serum levels of dehydroepiandrosterone sulfate as a screening test for late-onset congenital adrenal hyperplasia

O objetivo deste trabalho foi Avaliar o uso do nível sérico de sulfato de desidroepiandrosterona como teste de triagem para as formas de início tardioda hiperplasia congênita da supra-renal. Foram selecionadas 14 mulheres hirsutas com níveis séricos elevadosde sulfato de desidroepiandrosterona, 17 mulheres hirsutas com níveis normais de sulfato de desidroepiandrosterona e 12 mulheresovulatórias não-hirsutas. Foram coletadas amostras de sangueantes do teste de estímulo com o hormônio adrenocorticotrófico euma hora após o teste. Os níveis séricos de sulfato de desidroepiandrosterona foram dosados antes do teste de estímulo com o hormônio adrenocorticotrófico. Os níveis séricos de 17- hidroxiprogesterona, composto S, 17-hidroxipregnenolona,desidroepiandrosterona, androstenediona e cortisol foram dosados uma hora após o teste de estímulo com o hormônio adrenocorticotrófico. Duas mulheres hirsutas comníveis séricos elevados de sulfato de desidroepiandrosterona preenchiam o critério para a hiperplasia congênita da supra-renal devido a deficiência da 21-hidroxilase, isto é, nível sérico de 17-hidroxiprogesterona >1000 ng/dL após o teste de estímulo com o hormônio adrenocorticotrófico. Nenhuma mulher hirsuta tinha deficiência da 11b-hidroxilase ou da 3b-hidroxiesteróidedesidrogenase. O nível sérico de sulfato de desidroepiandrosterona é útil como teste de triagem para as formas de início tardio da hiperplasia congênita da supra-renal. Os níveis séricos elevados de sulfato de desidroepiandrosterona não significam necessariamente um defeito enzimático da supra-renal,enquanto o nível normal exclui a possibilidade da forma de início tardio da hiperplasia congênita da supra-renal.

Levantamento retrospectivo de casos de escabiose canina e felina, atendidos na Faculdade de Medicina Veterinária e Zootecnia da Universidade de São / Paulo, no período compreendido entre 1984 e 2002 / Canine and feline scabies in São Paulo – Brasil – Faculdade de Medicina Veterinária e Zootecnia da Universidade de São Paulo (1984-2002)

Em levantamento retrospectivo de 19 anos (1984-2002), envolvendo a totalidade de 39524 casos dermatopáticos, de caninos e felinos, atendidos no Serviço de Dermatologia do VCM-HOVET /FMVZUSP, identificou-se um total de 2907 (7,3%) casos de escabiose. Respectivamente, 2283 (78,5%) e 624 (21,5%) animais, eram das espécies canina e felina. A frequência de ocorrência da sarna sarcóptica (6,4%) foi inferior aquela da sarna notoédrica (15,7%), esta última, duas e meia vezes mais freqüente que a congênere canina, sendo tal diferença significativa (p<0,05). Relativamente, à predisposição sexual, os machos apresentaram maior suscetibilidade à infecção do que as fêmeas, em ambas as espécies. Quando da comparação dos sexos, entre caninos e felinos, observou-se que os animais da espécie felina são os atingidos com maior freqüência pela escabiose (p<0,05). Ao se considerar a predisposição racial, apenas na espécie canina, constatou-se maior tendência de acometimento de animais de raça definida (58,0%). As raças caninas (poodle, Cocker Spaniel e Pastor Alemão) de pelame longo (74,2%) e felina (Siamês) de pelo curto (81,3%) foram as mais acometidas (p<0,05). Animais com faixa etária inferior a um ano foram aqueles mais freqüentemente infectados (caninos 54,7%, felinos 63,5%) e dentre estes, foram os felinos os mais atingidos (p<0,05). Não houve influência sazonal na ocorrência de escabiose, canina e felina.

Hipoglicemia factícia: avaliaçäo dos testes laboratoriais utilizados no diagnóstico diferencial / Factidious hypoglycemia: evaluation of laboratory tests used in differential diagnosis

O presente trabalho descreve um caso de hipoglicemia espontânea em uma paciente diabética devido ao uso escondido de insulina. O diagnóstico diferencial com insulinoma foi difícil. A presença de anticorpos anti-insulina no soro era sugestiva de hipoglicemia factícia. O diagnóstico correto foi feito pela presença de altos níveis de insulina total com níveis indetectáveis de peptídeo C. A confirmaçäo foi feita pelo encontro de insulina no fundo falso da bolsa da paciente. Embora rara em diabéticos, a hipoglicemia factícia pode apresentar problemas no seu diagnóstico

Tratamento do hirsutismo com acetado de ciproterona e etinilestradiol / Treatment of hirsutism with cyproterone acetate and ethinyloestradiol

Doze mulheres hirsutas de causa idiopática ou com a síndrome dos ovários policísticos foram tratadas com 100 mg de acetato de ciproterona (ACP) e 30 µg de etinilestradiol (EE2) no esquema seqüencial inverso de hammerstein modificado, por um período de quatro meses. Todas apresentaram melhora importante do hirsutismo, avaliado subjetivamente pela paciente e também de maneira objetiva através do índice de Ferriman Gallwey. Como efeito colateral observou-se um aumento de peso, em média de 2 kg. O tratamento com ACP EE2 produziu normalizaçÝo dos níveis séricos de LH, FSH, testosterona total, testoterona livre e sulfato de dehidroepiandrosterona já a partir do 2§ mês de tratamento. Conclui-se que a terapêutica com ACP, segundo o esquema seqüencial inverso de Hammerstein modificado mostrou-se eficiente no tratamento do hirsutismo, sendo bem tolerado e apresentando poucos efeitos colaterias

Puberdade precoce em tumor de sistema nervoso central: relato de um caso / Precocious puberty in central nervous system neoplasm: report of a case

Os autores apresentam um caso de puberdade precoce em um menino de sete anos, em que após investigaçäo clínica, radiológica, tomográfica e laboratorial foi feita a hipotese diagnóstica de tumor de pineal. Após realizaçäo da cirurgia para ressecçäo tumoral, diagnosticou-se germinoma com áreas de coriocarcinoma em pineal. Os autores mostram a evoluçäo, exames laboratoriais incluindo dosagens hormonais e marcadores biológico, e também os tratamentos cirúrgico e quimioterápico.