Cost-Utility Model of Nirmatrelvir/Ritonavir in Brazil: Analysis of a Vaccinated Population.

OBJECTIVES: The aim of this study is to conduct a cost-utility analysis of the use of the antiviral nirmatrelvir/ritonavir, applied to a vaccinated Brazilian population against COVID-19, from the perspective of the Brazilian Public Health System (SUS). METHODS: A microsimulation model was created with individual-level data and daily cycles, with a 1-year time horizon, to compare the current scenario of standard care with a scenario in which nirmatrelvir/ritonavir is offered to the population. Adults of any age group that received ≥2 doses of the COVID-19 vaccine formed the investigated population. Direct medical costs of the outpatients and inpatients admitted to the ward or intensive care unit were included. The effectiveness of the model was measured in quality-adjusted life-years (QALYs). RESULTS: In all simulations, the use of nirmatrelvir/ritonavir resulted in incremental costs per patient of US dollar (USD)245.86 and incremental effectiveness of 0.009 QALY, over a year. The incremental cost-utility ratio was USD27 220.70/QALY. The relative risk of the vaccinated population was the factor that affected the outcome most, according to the univariate sensitivity analysis. The probabilistic sensitivity analysis resulted in 100% of the simulations being more costly and effective, but that only 4% of them were below the established cost-effectiveness threshold of USD24 000.00/QALY. In the scenario considering only the population over 60 years old and immunosuppressed (of any age), the incremental cost-utility ratio was USD7589.37/QALY. CONCLUSIONS: The use of nirmatrelvir/ritonavir in the treatment of COVID-19 in a vaccinated population was cost-effective only for immunosuppressed individuals and people over 60 years of age.

An analysis of the regulatory program of quality audits in radiotherapy in Brazil from 1995 to 2007.

The Brazilian Institute of Radiation Protection and Dosimetry (IRD/CNEN) carried out quality assurance regulatory audits in Brazilian radiotherapy facilities from 1995 to 2007. In this work, the set of data collected from 195 radiotherapy facilities that use high-energy photon beams are analyzed. They include results from audits in linear electron accelerators and/or Co-60 units. The inspectors of IRD/CNEN performed the dosimetry of high-energy radiotherapy photon beams according to the IAEA dosimetry protocols TRS 277 and TRS 398, and the values of measurements were compared to stated values. Other aspects of radiological protection were checked during on-site audits such as calibration certification of clinical dosimeters and portable monitors, existence and use of check source, use of barometer and thermometer, individual dose registry and training of staff. It was verified that no check source was available in 38% of the visited facilities; the training of personnel was not adequate in 9% of the facilities and the registry of accumulated individual doses was not being done in 6% of the facilities. Measurements of absorbed dose have indicated deviations in the range ± 3% for 67.6% of the cobalt-60 units and 79.6% of medical linear accelerators; 18.5% of Co-60 irradiators and 9.6% of linear accelerators presented deviations in the range 3% < δ ≤ 5%. Finally, 13.9% of Co-60 facilities and 10.8% of linear accelerator facilities presented dosimetry deviations above 5%. The effort in dosimetric quality control performed by IRD/CNEN audits has yielded positive changes that make radiation treatment facilities more reliable.

The negative inotropic action of canrenone is mediated by L-type calcium current blockade and reduced intracellular calcium transients.

BACKGROUND AND PURPOSE: Adding spironolactone to standard therapy in heart failure reduces morbidity and mortality, but the underlying mechanisms are not fully understood. We analysed the effect of canrenone, the major active metabolite of spironolactone, on myocardial contractility and intracellular calcium homeostasis. EXPERIMENTAL APPROACH: Left ventricular papillary muscles and cardiomyocytes were isolated from male Wistar rats. Contractility of papillary muscles was assessed with force transducers, Ca(2+) transients by fluorescence and Ca(2+) fluxes by electrophysiological techniques. KEY RESULTS: Canrenone (300-600 micromol L(-1)) reduced developed tension, maximum rate of tension increase and maximum rate of tension decay of papillary muscles. In cardiomyocytes, canrenone (50 micromol L(-1)) reduced cell shortening and L-type Ca(2+) channel current, whereas steady-state activation and inactivation, and reactivation curves were unchanged. Canrenone also decreased the Ca(2+) content of the sarcoplasmic reticulum, intracellular Ca(2+) transient amplitude and intracellular diastolic Ca(2+) concentration. However, the time course of [Ca(2+)](i) decline during transients evoked by caffeine was not affected by canrenone. CONCLUSION AND IMPLICATIONS: Canrenone reduced L-type Ca(2+) channel current, amplitude of intracellular Ca(2+) transients and Ca(2+) content of sarcoplasmic reticulum in cardiomyocytes. These changes are likely to underlie the negative inotropic effect of canrenone.

Comparative study between the effects of photodynamic therapy and conventional therapy on microbial reduction in ligature-induced peri-implantitis in dogs.

BACKGROUND: Progressive peri-implant bone losses, which are accompanied by inflammatory lesions in the soft tissues, are referred to as peri-implantitis. The aim of this study was to compare the effects of photodynamic therapy (PDT) and conventional technique on microbial reduction in ligature-induced peri-implantitis in dogs. METHODS: Eighteen third premolars from nine Labrador retriever dogs were extracted and the implants were submerged. After osseointegration, peri-implantitis was induced. After 4 months, ligature was removed and natural bacterial plaque was allowed to form for another 4 months. The animals were then randomly divided into two groups. In the conventional group, they were treated using mucoperiosteal flaps for scaling the implant surface and chlorexidine (conventional) irrigation. In the PDT group, only mucoperiosteal scaling was carried out before photodynamic therapy. Inside the peri-implant pocket, a paste-based azulene photosensitizer was placed and then a GaAlAs low-power laser (lambda=660 nm, P=40 mW, E=7.2 J for 3 minutes) was used. Microbiological samples were obtained before and immediately after treatment. Before treatment, one implant was removed and analyzed by scanning electron microscopy to validate the contamination. RESULTS: The results of this study showed that Prevotella sp., Fusobacterium sp., and S. Beta-haemolyticus were significantly reduced for both groups. After treatment, no significant differences were observed between the groups. CONCLUSION: These findings suggest that photodynamic therapy is a non-invasive method that could be used to reduce microorganisms in peri-implantitis.

O emprego da terapia fotodinâmica (PDT) na redução bacteriana em periodontia e implantodontia / Photodinamic therapy in dentistry

A terapia fotodinâmica tem sido utilizada na área da saúde para a destruição seletiva de tumores e redução microbiana. Esta terapia consiste na associação de uma fonte de luz em baixa intesidade associada a um corante. A morte microbiana ocorre quando o corante absorve a energia luminosa, levando a produzir substâncias altamente reativas, que causam danos ao microorganismo ou célula alvo. Na odontologia, sua utilização é bastante indicada, visto que a terapia fotodinâmica se mostra mais eficiente em infecções localizadas, de pouca profundidade e de microflora conhecida. Neste estudo, apresentaremos alguns casos clínicos tanto em periodontite quanto em periimplantite em que foi utilizada a terapia fotodinâmica com um alto índice de sucesso

Estudo da flora bacteriana nasal: estudo preliminar em equipe de enfermagem / Study of the bacteria flora nose: a nursing preliminar study

Há pouca informaçäo sobre o crescimento de microorganismos patogênicos na flora nasal em países tropicais, já que grande parte das pesquisas se realizaram em paises de clima temperado. Neste estudo, identificamos a flora nasal da equipe de enfermagem dos Hospitais universitários de Londrina, correlacionando os resultados com a literatura consultada e disponível

Projeto Áridas - Nordeste: uma estratégia para geraçäo de emprego e renda

Baseia-se no Projeto Áridas. Discorre sobre mudanças no mercado de trabalho, reestruturação produtiva, consequências para o emprego no Brasil e no Nordeste e a heterogeneidade da região e seu mercado de trabalho. Defende que a estratégia de geração de emprego e renda deve envolver um conjunto de ações, políticas e programas ao invés de uma política única de emprego. Mostra a necessidade de se levar em conta as peculiaridades da região e as especificidades de seus subespaços internos. Destaca a importância de três condicões para uma estratégia eficaz: a universalização da educaçao básica e outros investimentos em educação e formação profissional; a criação e consolidação do Sistema Público de Emprego; e investimentos públicos em infra-estrutura social e econômica. Divide a estratégia em: investimentos públicos e privados; programas de geração de emprego e renda, ações específicas voltadas para certas áreas; e outras ações que incluem o desenvolvimento municipal, políticas asseguradoras de direitos sociais e programas de emergência. Observa que a estratégia proposta precisa começar a ser posta em prática na busca da superação do desemprego, da sub-remuneração e da pobreza no Nordeste.