Prevalência da esclerose múltipla em pacientes tratados com medicamentos modificadores do curso da doença utilizando dados do Sistema Único de Saúde brasileiro / Prevalence of multiple sclerosis in patients treated with disease-modifying drugs using data from the Brazilian Unified Health System

Objetivo: Compreender o cenário da esclerose múltipla (EM) em relação aos aspectos epidemiológicos, diagnósticos, progressão, tratamento e comorbidades no sistema público brasileiro. Métodos: Trata-se de um estudo retrospectivo e observacional utilizando os sistemas de dados do Departamento de Informática do Sistema Único de Saúde (DataSUS). Os dados utilizados foram obtidos por meio da base de dados do Sistema Ambulatorial/Sistema de Procedimentos de Alta Complexidade (SIA/SUS). Nessa base, o vínculo de registros foi por meio do Cadastro Nacional de Saúde (CNS). Para a quantificação de dados epidemiológicos, foram coletados os dados do Código de Endereçamento Postal (CEP), sexo e data de nascimento, além das bases de geolocalização dos pacientes. Considerou-se como desfecho primário a descrição epidemiológica da população de pacientes em uso ou que usaram MMCD para o tratamento da EM. Como desfecho secundário, consideraram-se as características dos pacientes (gênero, idade, idade ao diagnóstico e comorbidades). Resultados: Foram incluídos na análise 45.011 pacientes. Identificou-se predominância de pacientes do gênero feminino (72,9%) e com idade entre 31 e 60 anos (61,23%) diagnosticados com CID G35 no primeiro registro. A taxa de incidência de pacientes com EM foi maior (2,7 pacientes/100 mil habitantes) na região Sudeste, seguida pela região Sul (2,2 pacientes/100 mil). A prevalência na região Sul teve a maior taxa (18 pacientes/100 mil), seguida pelo Sudeste (16,7 pacientes/100 mil). As betainterferonas e o acetato de glatirâmer foram os medicamentos mais utilizados no primeiro tratamento. O acetato de glatirâmer foi o mais utilizado para o segundo tratamento no período de 2011 até 2017. Em 2018, os MMCD mais utilizados como segundo tratamento foram fingolimode e natalizumabe. A partir de 2019, fingolimode, fumarato de dimetila e natalizumabe foram os medicamentos mais utilizados como segundo tratamento, permanecendo nessa ordem até 2021. Para o terceiro tratamento, o natalizumabe foi o medicamento mais utilizado até 2017. Após esse período, o fingolimode passou a ser mais usado. Desde 2019, com o acesso ao fumarato de dimetila, os medicamentos mais prescritos foram, em ordem decrescente, fingolimode, natalizumabe e fumarato de dimetila. Conclusão: Estabelecer uma análise epidemiológica dos pacientes que usam MMCD para o tratamento da EM no Brasil, além do padrão de tratamento, são dados essenciais para a promoção do tratamento da EM de forma adequada, bem como para a implementação de políticas públicas locais, regionais e nacionais.

Objective: To understand the multiple sclerosis (MS) setting in relation to epidemiological aspects, diagnoses, progression, treatment and comorbidities in the Brazilian public system. Methods: This is a retrospective, observational study using the Unified Health System's Informatics Department [Departamento de Informática do Sistema Único de Saúde] data systems (DataSUS). The data used were obtained by means of the outpatient system/high-complexity procedure system (SIA/SUS) database. In this database, the association of entries was via the National Health Registration [Cadastro Nacional de Saúde] (CNS). For epidemiological data quantification, Zip Code, sex and date of birth information was collected, as well as data from patient geolocation databases. The epidemiological description of the patient population using or having used DMTs for MS treatment was considered as the primary endpoint. Patient characteristics (gender, age, age at diagnosis and comorbidities) were considered as the secondary endpoint. Results: 45,011 patients were included in the analysis. A predominance of female patients (72.9%) aged between 31 and 60 years (61.23%) and diagnosed with ICD code G35 in the first entry was identified. The incidence rate of patients with MS was higher (2.7 patients/100 thousand inhabitants) in the Southeast region, followed by the South region (2.2 patients/100 thousand). Prevalence in the South region had the highest rate (18 patients/100 thousand), followed by the Southeast region (16.7 patients/100 thousand). Interferons beta and glatiramer acetate were the most used drugs in the first treatment. Glatiramer acetate was the most used drug for the second treatment within the period from 2011 to 2017. In 2018, the most common DMTs used as second treatment were fingolimod and natalizumab. From 2019, fingolimod, dimethyl fumarate and natalizumab were the most used drugs as second treatment, remaining in this order until 2021. For the third treatment, natalizumab was the most used drug until 2017. After this period, fingolimod became more widely used. Since 2019, with access to dimethyl fumarate, the most prescribed drugs were, in decreasing order, fingolimod, natalizumab and dimethyl fumarate. Conclusion: Establishing an epidemiological analysis of patients using DMTs for MS treatment in Brazil, in addition to standard of care, results in critical data for adequately promoting MS treatment, as well as for implementing local, regional and national public policies.

Optimization of a saccharin molecularly imprinted solid-phase extraction procedure and evaluation by MIR hyperspectral imaging for analysis of diet tea by HPLC.

Saccharin was determined based on a new molecularly imprinted solid-phase extraction (MISPE) procedure. The polymer was synthesized with a hybrid monomer of metacrylic acid and 3-amino propril tetraethoxysilane and saccharin as template. After the synthesis, the saccharin removal from the MIP was verified by the UV analysis of the solutions used in the template removal procedure, as well as by the direct MIP analysis using FTIR hyperspectral image and chemometrics. The residual saccharin concentrations observed in the image analysis revealed a narrow concentration distribution consistent with a homogenous material. The MISPE was performed with homemade cartridges containing 200 mg of the MIP. The results obtained with standards and diet tea samples confirmed high affinity, adsorption capacity and selectivity of the MIP. The MISPE cartridge exhibited recoveries of 100 ± 3% in six extraction cycles. The diet tea analysis showed a significant reduction of the interferences, which can considerable simplifies the HPLC-UV analysis.

Healthcare resource utilization of spinal muscular atrophy in the Brazilian Unified Health System: a retrospective database study / Utilização de Recursos em Saúde para pacientes de atrofia muscula espinhal (AME 5q) no Sistema de Saúde Público brasileiro: um estudo retrospectivo em base de dados

Objective: To describe the healthcare resource utilization (HCRU) related to patients with spinal muscular atrophy (SMA) treated at the Brazilian Unified Health System (SUS) since 2015 according to age-groups. Methods: This study analyzed outpatient and inpatient data for SMA patients from the Brazilian Unified Health System database (DATASUS) from January 2015 to September 2020. Data were collected from patients with ICD-10 codes G12.0 (Infantile spinal muscular atrophy, type I [Werdnig-Hoffman]) or G12.1 (Other inherited spinal muscular atrophy), plus with at least one claim of nusinersen OR at least one claim of any SMA-related procedure groups codes since 2010. SMA-related procedures were defined based on collaborative work involving authors from medical boarding composed by physicians from SUS. Results: In total, 3,775 patients with SMA fulfilled the eligibility criteria. Physiotherapy changed from 11.34 (2.49 ­ 24.40) procedures PPPY in the 0 - 6-month old group to 3.30 (0.84 ­ 11.76) procedures PPPY in the > 36-month old group. The median of orthosis was 1.64 (0.66 ­ 3.41) procedures PPPY in the 0 ­ 6-month old group and 0.63 (0.34 ­ 1.33) PPPY in the > 36-month-old group. Exams were primarily performed for younger groups (0 ­ 6 months and > 6 ­ 18 months). The percentage of patients that needed some ventilatory care seems greater, and the speech therapy and the use of nusinersen seem lower along with age. Conclusion: This study has demonstrated important HCRU at the SUS setting with SMA patients. In addition, our results highlight the need to implement evidence-based strategies to manage SMA patients and drive cost savings for the health care system.

Objetivo: Descrever a utilização de recursos em saúde de pacientes com atrofia muscular espinhal (AME) no Sistema Público de Saúde Brasileiro (SUS) desde 2015, de acordo com a faixa etária. Métodos: Analisaram-se os dados hospitalares e ambulatoriais de pacientes com AME no DATASUS de janeiro de 2015 a setembro de 2020. Foram incluídos pacientes com código de CID-10 G12.0 (atrofia muscular espinhal infantil tipo I ­ Werdning-Hoffman) ou G12.1 (outras atrofias medulares espinhais hereditárias) com pelo menos um registro utilizando o código de nusinersena ou o código de procedimento relacionado à doença desde 2010. Os procedimentos relacionados à doença foram definidos por meio de trabalho colaborativo entre autores, incluindo três autores médicos que atuam no SUS. Resultados: No total, 3.775 pacientes com AME preencheram os critérios de elegibilidade. Procedimentos de fisioterapia passaram de 11,34 (2,49 ­ 24,40) por paciente por ano (PPPY) no grupo 0 ­ 6 meses para 3,30 (0,84 ­ 11,76) PPPY no grupo > 36 meses. A mediada de procedimentos de órteses foi de 1,64 (0,66 ­ 3,41) PPPY no grupo 0 ­ 6 meses para 0,63 (0,34­ 1,33) PPPY no grupo > 36 meses. Exames foram realizados principalmente por pacientes mais jovens (0 ­ 6 meses e > 6 ­ 18 meses). A porcentagem de pacientes que realizaram procedimentos ventilatórios parece aumentar ao longo da idade, já a fonoterapia e o uso de nusinersena parecem reduzir. Conclusão: Este estudo demonstra uma importante utilização de recursos em saúde no SUS pelos pacientes com AME e destaca a necessidade de implementação de estratégias baseadas em evidência para gerenciar esses pacientes e o uso de recursos no sistema de saúde

Ergatoid reproductives in the Neotropical termite Nasutitermes aquilinus (Holmgren) (Blattaria: Isoptera: Termitidae): developmental origin, fecundity, and genetics.

Termite colonies are usually headed by primary reproductives, which establish nests during the swarming season. However, secondary reproductives may develop in some species and become supplementary or replacement breeders, extending colony lifespan. Here we investigate the developmental origin, fecundity and genetic characterization of ergatoid reproductives in the Neotropical termite Nasutitermes aquilinus (Holmgren), using morphometrical and histological techniques, five microsatellite loci and the COI mitochondrial DNA. Twelve measurements performed on 208 apterous individuals of N. aquilinus revealed 10 groups, including ergatoid females, which developed from major workers through two successive molts, and were characterized by the presence of imaginal features such as eyes and wing buds. The differentiation of these features was correlated to physogastric development in these ergatoids. Histology revealed oocytes in all maturation stages in worker-derived reproductives of N. aquilinus, presence of nonflagellate spermatozoa inside the spermatheca, and royal fat body. Thus, ergatoid reproductives were reproductively functional. According to the genotypes of 221 individuals from 11 nests, and mitochondrial haplotypes of 43 ergatoids, 73% of the colonies were simple families, whereas 27% were extended families. Despite the occurrence of related reproductives, low inbreeding rates were detected within and among colonies. Such values could be explained given that sib mating itself cannot result in a higher inbreeding rate but depend on several factors discussed in detail. This is the first study to investigate the genetic structure of termite colonies influenced by the development of ergatoids, and further investigations are encouraged to understand the influence of these reproductives on colony lifespan.

Chemical communication in isoptera.

The semiochemicals produced by termites have been little studied compared to those of ants and bees. Among the limiting factors are the cryptic habits of termites, together with the difficulty in maintaining many species in the laboratory. The semiochemicals of Isoptera include trail, sex and alarm pheromones and a complex mixture of substances responsible for the recognition of nestmates. Although little is known about the semiochemicals of termites, available data indicate a strategy of pheromonal parsimony in the chemistry communication of these insects, i.e., the same compound is sometimes secreted by different glands, different species and for different functions.

Chemical communication in isoptera / Comunicação química em isoptera

The semiochemicals produced by termites have been little studied compared to those of ants and bees. Among the limiting factors are the cryptic habits of termites, together with the difficulty in maintaining many species in the laboratory. The semiochemicals of Isoptera include trail, sex and alarm pheromones and a complex mixture of substances responsible for the recognition of nestmates. Although little is known about the semiochemicals of termites, available data indicate a strategy of pheromonal parsimony in the chemistry communication of these insects, i.e., the same compound is sometimes secreted by different glands, different species and for different functions.

Os semioquímicos dos cupins têm sido pouco estudados quando comparados aos de formigas e abelhas. Um dos fatores limitantes é o hábito críptico dos térmitas, aliado à dificuldade de manutenção de muitas espécies em laboratório. Entre os semioquímicos de Isoptera destacam-se os feromônios sexuais, de trilha, de alarme e uma mistura complexa de substâncias responsável pelo reconhecimento dos companheiros de ninho. Apesar de os semioquímicos dos cupins serem pouco conhecidos, os dados disponíveis indicam uma estratégia de parcimônia feromonal na comunicação química desses insetos, ou seja, algumas vezes o mesmo composto é secretado por diferentes glândulas, diferentes espécies e para diferentes funções.

Soldiers initiate foraging activities in the subterranean termite, Heterotermes tenuis.

Caste polyethism has been recorded in some termite species, however the foraging behavior of subterranean termites remains poorly known. Heterotermes tenuis Hagen (Isoptera: Rhinotermitidae) is a subterranean termite that is native to Brazil and is an agricultural and urban pest. The aim of this study was to investigate which caste acts as scouts when searching for food sources and determinate the percentages of each caste present in the foraging territories of field colonies of H. tenuis. Our results showed no significant differences among the caste proportions present in the foraging territories of the three colonies studied in the field. Laboratory experiments showed that minor soldiers were the most frequent initiators of foraging activities. This result suggests that the exploratory phase of the foraging behavior may be regulated by the number of soldiers present in the foraging territories of each colony.

Record of a gregarine (Apicomplexa: Neogregarinida) in the abdomen of the termite Coptotermes gestroi (Isoptera, Rhinotermitidae).

Coptotermes gestroi is an exotic species of termite that is a pest of great economical importance in Brazil. This paper relates the occurrence of a coelomic gregarine (Apicomplexa: Neogregarinida) in the abdomen of the foraging workers recently collected from field colonies of this termite. The termite hosts presented large, white abdomens because they carried 1 up to 3 cysts of gregarines filled with numerous lemon-shaped spores. Earlier developmental stages of this gregarine were not observed in the scanning microscope preparations nor in the histological slides of the infected termites. However, the lemon-shaped spores suggest a parasite gregarine of Mattesia genus, family Lipotrophidae.

[Visual and olfactory factors interaction in resource-location by the blowfly, Chrysomya megacephala (Fabricius) (Diptera: Calliphoridae), in natural conditions]. / Interação entre fatores visuais e olfativo em localização de recursos pela mosca-varejeira, Chrysomya megacephala (Fabricius) (Diptera: Calliphoridae), em condições naturais.

The interaction between olfactory and visual cues in the landing responses of Chrysomya megacephala (Fabricius) was analyzed in a natural environment (grass) using three plain cardboard circles with the colors white, black and other being the own grass (control) with 30 cm in diameter. The circles were divided in four quadrants and five sectors using as bait 80 mg of carcass of fish and minced flesh put in the center. To check the interaction between visual and olfactory factors, we analyzed the relation among the direction of wind and the sectors, the quadrants and the color of circle where C. megacephala adults landed. In the presence of the black and white circles, flies landed closer to the central release point of the bait when the wind was present compared with the other control circle. The results show that while odor cues may enhance the induction of landing by C. megacephala, visual cues are important when selecting a final landing site. Improved understanding of this interaction may allow the development of more effective traps or targets, enhancing the control efficiency of these control devices.

Interação entre fatores visuais e olfativo em localização de recursos pela mosca-varejeira, Chrysomya megacephala (Fabricius) (Diptera: Calliphoridae), em condições naturais / Visual and olfactory factors interaction in resource-location by the blowfly, Chrysomya megacephala (Fabricius) (Diptera: Calliphoridae), in natural conditions

A interação entre pistas visuais e olfativa na resposta de pouso de Chrysomya megacephala (Fabricius) foi analisada em ambiente natural. Para isso, foram utilizados três círculos planos de cartolina de cor branca, preta e outro com a própria grama (controle) com 30 cm de diâmetro. Os círculos foram divididos em quatro quadrantes e cinco setores circulares, tendo como isca 80 mg de carcaça de peixe e carne moída colocada no centro. Para verificar a interação entre as pistas visuais e a olfativa, foi analisada a relação entre a direção do vento e os setores, os quadrantes e a cor do círculo em que os adultos de C. megacephala pousavam. Na presença dos círculos preto e branco, as moscas pousaram mais próximo do ponto de liberação do odor das iscas quando o vento estava presente, em comparação com o círculo controle. Os resultados mostraram que a existência de odor pode melhorar a indução do pouso de C. megacephala e que pistas visuais são importantes para selecionar o local de pouso final. O entendimento dessa interação pode permitir o desenvolvimento de iscas e alvos mais efetivos, fortalecendo a eficiência de estratégias de controle.

The interaction between olfactory and visual cues in the landing responses of Chrysomya megacephala (Fabricius) was analyzed in a natural environment (grass) using three plain cardboard circles with the colors white, black and other being the own grass (control) with 30 cm in diameter. The circles were divided in four quadrants and five sectors using as bait 80 mg of carcass of fish and minced flesh put in the center. To check the interaction between visual and olfactory factors, we analyzed the relation among the direction of wind and the sectors, the quadrants and the color of circle where C. megacephala adults landed. In the presence of the black and white circles, flies landed closer to the central release point of the bait when the wind was present compared with the other control circle. The results show that while odor cues may enhance the induction of landing by C. megacephala, visual cues are important when selecting a final landing site. Improved understanding of this interaction may allow the development of more effective traps or targets, enhancing the control efficiency of these control devices.

Neotenic formation in laboratory colonies of the termite Coptotermes gestroi after orphaning.

The termite Coptotermes gestroi (Wasmann 1896) (Rhinotermitidae: Coptotermitinae) is an exotic species in Brazil and information concerning its reproductive developmental biology is scarce. We induced the formation of neotenics in laboratory colonies through orphaning experiments. Orphaning experiments were conducted in three-year old colonies of C. gestroi kept under laboratory conditions. After three months, eight nymphoid neotenics were observed in one colony after queen removal. Histological analysis showed that these neotenics were non-functional. The results suggest that these individuals may have arisen from the first nymphal instar (N1) or from an early N1 instar after one or two larval moults. Neotenics also were recorded on two incipient colonies of C. gestroi that lost the queen naturally.