Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 7 de 7
Filtrar
Mais filtros










Intervalo de ano de publicação
1.
Arq Bras Cardiol ; 118(1): 88-94, 2022 01.
Artigo em Inglês, Português | MEDLINE | ID: mdl-35195214

RESUMO

BACKGROUND: Atrial fibrillation is a public health problem associated with a fivefold increased risk of stroke or death. Analyzing costs is important when introducing new therapies and must be reconsidered in special situations, such as the novel coronavirus pandemic of 2020. OBJECTIVE: This study aimed to evaluate the costs related to anticoagulant therapy in a one-year period, and the quality of life of atrial fibrillation patients treated in a public university hospital. METHODS: Patient costs were those related to the anticoagulation and calculated by the average monthly costs of warfarin or direct oral anticoagulants (DOACs). Patient non-medical costs (eg., food and transportation) were calculated from data obtained by questionnaires. The Brazilian SF-6D was used to measure the quality of life. P-values < 0.05 were considered statistically significant. RESULTS: The study population consisted of 90 patients, 45 in each arm (warfarin vs direct oral anticoagulants). Costs were 20% higher in the DOAC group ($55,532.62 vs $46,385.88), and mainly related to drug price ($23,497.16 vs $1,903.27). Hospital costs were higher in the warfarin group ($31,088.41 vs $24,604.74) and related to outpatient visits. Additionally, non-medical costs were almost twice higher in the warfarin group ($13,394.20 vs $7,430.72). Equivalence of price between the two drugs could be achieved by a 39% reduction in the price of DOACs. There were no significant group differences regarding quality of life. CONCLUSIONS: Total costs were higher in the group of patients taking DOACs than those taking warfarin. However, a nearly 40% reduction in the price of DOACs could make it feasible to incorporate these drugs into the Brazilian public health system.


FUNDAMENTO: A fibrilação atrial é um problema de saúde pública associado com um risco cinco vezes maior de acidente vascular cerebral e mortalidade. A análise de custos é importante para a introdução de novas terapias, e deve ser reconsiderada em situações especiais, tais como a pandemia do coronavírus em 2020. OBJETIVO: Avaliar os custos (em um período de um ano) relacionados à terapia anticoagulante e a qualidade de vida de pacientes com fibrilação atrial tratados em um hospital público universitário. MÉTODOS: Os custos do paciente foram aqueles relacionados à anticoagulação e calculados pela média de custos mensais da varfarina ou de anticoagulantes orais diretos (DOACs). As despesas não médicas, como alimentação e transporte, foram calculadas a partir de dados obtidos de questionários. O questionário brasileiro SF-6D foi usado para medir a qualidade de vida. Valores p<0,05 foram considerados estatisticamente significativos. RESULTADOS: A população do estudo consistiu em 90 pacientes, 45 em cada braço (varfarina vs. DOACs). Os custos foram 20% mais altos no grupo dos DOACs (US$55 532,62 vs. US$46 385,88), e principalmente relacionados ao preço dos medicamentos (US$23 497,16 vs. US$1903,27). Os custos hospitalares foram mais altos no grupo da varfarina (US$31 088,41 vs $24 604,74), e relacionados às visitas ao ambulatório. Ainda, as despesas não médicas foram duas vezes maiores no grupo varfarina ($13 394,20 vs $7 430,72). A equivalência de preço entre os dois medicamentos seria alcançada por uma redução de 39% no preço dos DOACs. Não foram observadas diferenças quanto à qualidade de vida. CONCLUSÕES: Os custos totais foram mais altos no grupo de pacientes tratados com DOACs que no grupo da varfarina. No entanto, uma redução de cerca de 40% no preço dos DOACs tornaria viável a incorporação desses medicamentos no sistema de saúde público brasileiro.


Assuntos
Fibrilação Atrial , COVID-19 , Acidente Vascular Cerebral , Administração Oral , Anticoagulantes , Fibrilação Atrial/complicações , Humanos , Qualidade de Vida , Estudos Retrospectivos , SARS-CoV-2 , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/prevenção & controle
2.
Arq. bras. cardiol ; 118(1): 88-94, jan. 2022. tab
Artigo em Inglês, Português | LILACS | ID: biblio-1360110

RESUMO

Resumo Fundamento: A fibrilação atrial é um problema de saúde pública associado com um risco cinco vezes maior de acidente vascular cerebral e mortalidade. A análise de custos é importante para a introdução de novas terapias, e deve ser reconsiderada em situações especiais, tais como a pandemia do coronavírus em 2020. Objetivo: Avaliar os custos (em um período de um ano) relacionados à terapia anticoagulante e a qualidade de vida de pacientes com fibrilação atrial tratados em um hospital público universitário. Métodos: Os custos do paciente foram aqueles relacionados à anticoagulação e calculados pela média de custos mensais da varfarina ou de anticoagulantes orais diretos (DOACs). As despesas não médicas, como alimentação e transporte, foram calculadas a partir de dados obtidos de questionários. O questionário brasileiro SF-6D foi usado para medir a qualidade de vida. Valores p<0,05 foram considerados estatisticamente significativos. Resultados: A população do estudo consistiu em 90 pacientes, 45 em cada braço (varfarina vs. DOACs). Os custos foram 20% mais altos no grupo dos DOACs (US$55 532,62 vs. US$46 385,88), e principalmente relacionados ao preço dos medicamentos (US$23 497,16 vs. US$1903,27). Os custos hospitalares foram mais altos no grupo da varfarina (US$31 088,41 vs $24 604,74), e relacionados às visitas ao ambulatório. Ainda, as despesas não médicas foram duas vezes maiores no grupo varfarina ($13 394,20 vs $7 430,72). A equivalência de preço entre os dois medicamentos seria alcançada por uma redução de 39% no preço dos DOACs. Não foram observadas diferenças quanto à qualidade de vida. Conclusões: Os custos totais foram mais altos no grupo de pacientes tratados com DOACs que no grupo da varfarina. No entanto, uma redução de cerca de 40% no preço dos DOACs tornaria viável a incorporação desses medicamentos no sistema de saúde público brasileiro.


Abstract Background: Atrial fibrillation is a public health problem associated with a fivefold increased risk of stroke or death. Analyzing costs is important when introducing new therapies and must be reconsidered in special situations, such as the novel coronavirus pandemic of 2020. Objective: This study aimed to evaluate the costs related to anticoagulant therapy in a one-year period, and the quality of life of atrial fibrillation patients treated in a public university hospital. Methods: Patient costs were those related to the anticoagulation and calculated by the average monthly costs of warfarin or direct oral anticoagulants (DOACs). Patient non-medical costs (eg., food and transportation) were calculated from data obtained by questionnaires. The Brazilian SF-6D was used to measure the quality of life. P-values < 0.05 were considered statistically significant. Results: The study population consisted of 90 patients, 45 in each arm (warfarin vs direct oral anticoagulants). Costs were 20% higher in the DOAC group ($55,532.62 vs $46,385.88), and mainly related to drug price ($23,497.16 vs $1,903.27). Hospital costs were higher in the warfarin group ($31,088.41 vs $24,604.74) and related to outpatient visits. Additionally, non-medical costs were almost twice higher in the warfarin group ($13,394.20 vs $7,430.72). Equivalence of price between the two drugs could be achieved by a 39% reduction in the price of DOACs. There were no significant group differences regarding quality of life. Conclusions: Total costs were higher in the group of patients taking DOACs than those taking warfarin. However, a nearly 40% reduction in the price of DOACs could make it feasible to incorporate these drugs into the Brazilian public health system.


Assuntos
Humanos , Fibrilação Atrial/complicações , Acidente Vascular Cerebral/prevenção & controle , Acidente Vascular Cerebral/tratamento farmacológico , COVID-19 , Qualidade de Vida , Administração Oral , Estudos Retrospectivos , SARS-CoV-2 , Anticoagulantes
3.
PLoS One ; 16(4): e0248567, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33793580

RESUMO

OBJECTIVES: To determine whether the generic and branded warfarins used as anticoagulants in Brazil are therapeutic equivalents based on their international normalized ratio (INR) results. METHODS: This crossover randomized controlled trial had four periods. We used the branded Marevan and two generic versions of warfarin sodium tablets, manufactured by União Química and Teuto laboratories, all purchased from retail drugstores. Eligible participants were outpatients from an anticoagulation clinic at a university hospital in São Paulo, Brazil. They had atrial fibrillation or flutter and had been using warfarin for at least 2 months with an INR therapeutic range of 2.0-3.0. Randomization was by numbered, opaque, sealed envelopes. Healthcare personnel and outcome assessors were blinded to treatments, but patients were not. The primary outcome was the variability in the INR (ΔINR) and secondary outcomes included mean INR. We accepted formulations as equivalent if the 95% confidence interval (CI) of the comparison of ΔINR between branded and generic formulations was within the limit of ±0.49. RESULTS: One hundred patients were recruited and randomized to six sequences of treatment (four sequences with n = 17 and two sequences with n = 16). União Química generic warfarin had equivalent variability in the INR to Marevan (ΔINR +0.09 [95% CI -0.29 to +0.46], n = 84). Comparison between Teuto generic warfarin and Marevan was inconclusive (ΔINR +0.29 [95% CI -0.09 to +0.68], n = 84). CONCLUSIONS: Marevan and União Química warfarin had equivalent therapeutic effectiveness and both could be confidently used for anticoagulation. The comparison between Marevan and TW was inconclusive and does not warrant a statement of equivalence. Our methods are especially important for comparing generic and branded drugs that raise concerns and may be subject of future investigations by regulatory agents. TRIAL REGISTRATION: ClinicalTrials.gov NCT02017197.


Assuntos
Fibrilação Atrial/tratamento farmacológico , Coagulação Sanguínea/efeitos dos fármacos , Monitoramento de Medicamentos/métodos , Medicamentos Genéricos/uso terapêutico , Coeficiente Internacional Normatizado/métodos , Varfarina/uso terapêutico , Idoso , Anticoagulantes/uso terapêutico , Fibrilação Atrial/patologia , Brasil , Estudos Cross-Over , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Equivalência Terapêutica , Resultado do Tratamento
4.
World J Surg ; 42(5): 1458-1462, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29134307

RESUMO

BACKGROUND: Atrial fibrillation (AF) is the most common cardiac arrhythmia. Some evidence shows that gastroesophageal reflux disease (GERD) may be a trigger for paroxysmal AF (PAF). Most of the previous studies that correlated GERD and AF used questionnaires to diagnose GERD, not an objective evaluation. This study aims to evaluate in patients with PAF: (a) accuracy of symptoms to diagnose GERD; (b) prevalence of GERD; and (c) temporal correlation between cardiac arrhythmia and reflux. METHODS: Twenty-two patients (59% females, mean age 68 years) with PAF underwent esophageal manometry followed by ambulatory pH monitoring and concurrent Holter. Eight (36%) patients had GERD symptoms. Patients were grouped as GERD+ or GERD- based on the DeMeester score. Temporal correlation between arrhythmia and reflux was recorded. RESULTS: Six (27%) patients were GERD+. Symptoms had sensitivity and specificity of 50 and 70%, respectively, for the diagnosis of GERD. Episodic AF occurred in one patient only (GERD-). There were 23 episodes of AF during the test with 14% correlation with reflux. Persistent AF during the period of the test was found in five patients (60% GERD+). CONCLUSIONS: Our results show: (a) Symptoms have a low accuracy for the diagnosis of GERD; (b) the prevalence of GERD in patients with PAF is low; and


Assuntos
Fibrilação Atrial/complicações , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/diagnóstico , Idoso , Eletrocardiografia Ambulatorial , Monitoramento do pH Esofágico , Feminino , Humanos , Masculino , Manometria , Sensibilidade e Especificidade
5.
J Fluoresc ; 18(6): 1163-8, 2008 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-18488145

RESUMO

Protoporphyrin IX (PpIX) is a porphyrin derivative that is accumulated in cancerous tissue in consequence of the tumor-specific metabolic alterations. The aim of this study was to evaluate the accumulation of PpIX in mice bearing renal cell carcinoma by spectroscopy analysis. A total of 24 male Balb/c mice, 6 weeks old, were divided into six groups: Normal (without inoculation of tumor cells) and 4, 8, 13, 16, and 20 days after inoculation of tumor cells. The orthotopic tumor model of renal cancer was used. Murine renal cell carcinoma (Renca cells) were inoculated into the subcapsular space of the kidney. Normal and tumor-bearing kidneys in different progression stages were removed and analyzed by ex-vivo spectroscopy and by microscopy, for tumor histometric analysis. Emission spectra were obtained by exciting the samples at 405 nm. Significant differences between normal and tumor-bearing kidneys in autofluorescence shape occurred in the 600-700 nm spectral region. A good correlation was found between emission band intensity at 635 nm and the tumor area.


Assuntos
Carcinoma de Células Renais/patologia , Fluorescência , Neoplasias Renais/patologia , Rim/patologia , Animais , Progressão da Doença , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Microscopia de Fluorescência/métodos , Protoporfirinas/química , Espectrometria de Fluorescência/métodos , Células Tumorais Cultivadas
6.
FASEB J ; 21(12): 3153-61, 2007 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17513560

RESUMO

We investigated whether transfer of the gene encoding the angiogenesis inhibitor endostatin into the NIH/3T3 fibroblast cell line could inhibit renal tumor growth in vivo. NIH/3T3 cells were transduced with retroviral vectors containing the murine endostatin (ES) gene. SCID mice bearing CaKi-1 derived tumors were given a subcutaneous injection of either ES-transduced cells or control cells and were monitored for tumor growth. At the end of the in vivo experiment, the mean tumor volume of treated mice was 51.6 +/- 2.4 mm3, while the tumor volume of control was 234.5 +/- 14.8 mm3. Microvascular density was significantly decreased on treatment (control 9.79 vs. ES 2.53%, <0.001) accompanied by a 23-fold increase in intratumoral necrotic area and a 2.94-fold increase in the apoptotic index, determined by immunohistochemistry with anti-activated caspase-3. Apoptotic cells were found in foci enriched in infiltrating leukocytes. In conclusion, retroviral endostatin gene transfer led to secretion of functional endostatin that was sufficiently active to inhibit tumor angiogenesis and tumor growth. A second mechanism may also be implied in endostatin-dependent tumor regression, associated with tumor infiltration of leukocytes. Besides its antiangiogenic properties, endostatin may be a promising adjuvant to immunotherapy.


Assuntos
Inibidores da Angiogênese/metabolismo , Antineoplásicos/metabolismo , Carcinoma de Células Renais/metabolismo , Endostatinas , Técnicas de Transferência de Genes , Retroviridae , Animais , Apoptose/fisiologia , Carcinoma de Células Renais/patologia , Carcinoma de Células Renais/terapia , Linhagem Celular Tumoral , Endostatinas/genética , Endostatinas/metabolismo , Humanos , Masculino , Camundongos , Camundongos SCID , Células NIH 3T3 , Transplante de Neoplasias , Retroviridae/genética , Retroviridae/metabolismo , Transdução Genética , Transplante Heterólogo
7.
J Fluoresc ; 17(3): 289-92, 2007 May.
Artigo em Inglês | MEDLINE | ID: mdl-17393286

RESUMO

Renal cell carcinoma (RCC) accounts for approximately 3% of new cancer incidence and mortality in the United States. Unfortunately many RCC masses remain asymptomatic and nonpalpable until they are advanced. Diagnosis and localization of early carcinoma play an important role in the prevention and curative treatment of RCC. The autofluorescence of blood porphyrin of healthy and tumor induced in male SCID mice was analyzed using fluorescence and excitation spectroscopy. A significant contrast between normal and tumor blood could be established. Blood porphyrin fluorophore showed enhanced fluorescence band (around 630 nm) in function of the tumor growth. This indicates that either the autofluorescence intensity of the blood fluorescence may provide a good parameter for the "first approximation" characterization of the tumor stage.


Assuntos
Neoplasias/diagnóstico , Porfirinas/sangue , Animais , Carcinoma de Células Renais/sangue , Carcinoma de Células Renais/diagnóstico , Carcinoma de Células Renais/patologia , Linhagem Celular Tumoral , Modelos Animais de Doenças , Progressão da Doença , Humanos , Masculino , Camundongos , Camundongos SCID , Estadiamento de Neoplasias/métodos , Neoplasias/sangue , Neoplasias/patologia , Porfirinas/química , Protoporfirinas/sangue , Protoporfirinas/química , Espectrometria de Fluorescência , Espectrofotometria Ultravioleta
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...