Incorporated antivirals for chronic hepatitis B in Brazil: a cost-effectiveness analysis.

OBJECTIVE: To evaluate the cost-effectiveness of different drug therapies for chronic hepatitis B in adult patients. METHODS: Using a Markov model, a hypothetical cohort of 40 years for HBeAg-positive or HBeAg-negative patients was constructed. Adefovir, entecavir, tenofovir and lamivudine (with rescue therapy in cases of viral resistance) were compared for treating adult patients with chronic hepatitis B undergoing treatment for the first time, with high levels of alanine aminotransferase, no evidence of cirrhosis and without HIV co-infection. Values for cost and effect were obtained from the literature, and expressed in effect on life years (LY). A discount rate of 5% was applied. Univariate sensitivity analysis was conducted to assess model uncertainties. RESULTS: Initial treatment with entecavir or tenofovir showed better clinical outcomes. The lowest cost-effectiveness ratio was for entecavir in HBeAg-positive patients (R$ 4,010.84/LY) and lamivudine for HBeAg-negative patients (R$ 6,205.08/LY). For HBeAg-negative patients, the incremental cost-effectiveness ratio of entecavir (R$ 14,101.05/LY) is below the threshold recommended by the World Health Organization. Sensitivity analysis showed that variation in the cost of drugs may make tenofovir a cost-effective alternative for both HBeAg-positive and HBeAg-negative patients. CONCLUSIONS: Entecavir is the recommended alternative to start treating patients with chronic hepatitis B in Brazil. However, if there is a reduction in the cost of tenofovir, it can become a cost-effective alternative.

Análise de custo-efetividade dos imunossupressores utilizados no tratamento de manutenção do transplante renal em pacientes adultos no Brasil / Cost-effectiveness analysis of immunosuppressive drugs in post-renal transplantation maintenance therapy in adult patients in Brazil / Coste-efectividad de los inmunosupresores utilizados en el tratamiento de mantenimiento por trasplante renal en pacientes adultos de Brasil

O objetivo do estudo foi realizar análise custoefetividade de imunossupressores utilizados na terapia de manutenção pós-transplante renal. Coorte hipotética de adultos transplantados foi acompanhada por 20 anos, empregando-se modelo de Markov. Os 10 esquemas terapêuticos avaliados continham prednisona (P). O custo médio dos medicamentos foi obtido na Câmara de Regulação do Mercado de Medicamentos. Outros custos assistenciais compuseram cada estágio da doença. O custo foi expresso em reais, a efetividade em anos de vida ganhos e adotou-se a perspectiva do sistema público de saúde. Ao fim do acompanhamento, a análise com desconto mostrou que todos os esquemas foram dominados por ciclosporina(CSA)+azatioprina(AZA) +P. Nas demais análises, tacrolimo+AZA+P não foi dominado, mas a relação custo-efetividade incremental entre estes dois esquemas foi de R$ 156.732,07/ anos de vida ganhos, na análise sem desconto, valor que ultrapassa o limiar de três vezes o PIB per capita brasileiro. Nenhuma alteração qualitativa foi demonstrada pela análise de sensibilidade e a probabilidade do esquema CSA+AZA+P ser o mais custo-efetivo é superior a 85%.

The aim of the study was to perform cost-effectiveness analysis of immunosuppressive drugs in post-renal transplantation maintenance therapy. A hypothetical cohort of transplanted adults was followed for 20 years, using the Markov model. The 10 evaluated therapeutic regimens contained prednisone (P). Average cost of the medicines was obtained from CMED (Câmara de Regulação do Mercado de Medicamentos). Other patient care costs were included in each disease stage. Costs were expressed in Brazilian reais, effectiveness was measured as years of life gained, and the study adopted a public health system perspective. At the end of follow-up, the analysis with discount showed that all the regimens were dominated by cyclosporine (CSA)+azathioprine (AZA)+P. In the remaining analyses, tacrolimus+AZA+P was not dominated, but the incremental cost-effectiveness ratio between these two regimens was R$ 156,732.07/ years of life gained, a value that exceeds the threshold of three times the Brazilian per capita GDP. In the sensitivity analysis, no qualitative change was observed and the probability of CSA+AZA+P being the most cost-effective regimen was greater than 85%.

El objetivo del estudio fue el análisis del coste-efectividad de los inmunosupresores utilizados en el tratamiento de mantenimiento por trasplante renal. Una cohorte hipotética de adultos trasplantados tuvo un seguimiento durante 20 años, utilizando el modelo de Markov. Los 10 regímenes terapéuticos evaluados contienen prednisona (P). El coste promedio de los medicamentos se obtuvo de la CMED (Cámara de Regulación del Mercado de Medicamentos), asimismo, se incluyeron otros costes sanitarios. El coste se expresó en reales, eficacia en los años de vida ganados y adoptó la perspectiva del sistema sanitario público. Al final del periodo de seguimiento, el análisis demostró que todos los regímenes terapéuticos fueron dominados por cic losporina(CSA)+azatioprina(AZA)+P. En otros análisis, tacrolimus+AZA+P no fue dominante, pero la ratio coste-efectividad incremental entre estos dos regímenes fue de R$ 156.732,07/ años de vida ganados. Un valor que supera el umbral de tres veces el PIB per cápita brasileño. Análisis de sensibilidad: no se demostró ningún cambio cualitativo y la probabilidad de régimen CSA + AZA + P reflejó la mejor relación coste-beneficio (superior al 85%).

Antivirais incorporados no Brasil para hepatite B cronica: analise de custo-efetividade / Antivirales incorporados en Brasil para hepatitis B cronica: analisis de costo-efectividad / Incorporated antivirals for chronic hepatitis B in Brazil: a cost-effectiveness analysis

OBJETIVO Avaliar o custo-efetividade de diferentes tratamentos medicamentosos para hepatite B crônica entre pacientes adultos. MÉTODOS Utilizando modelo de Markov, construiu-se coorte hipotética de 40 anos para pacientes HBeAg-positivo ou HBeAg-negativo. Foram comparados os usos de adefovir, entecavir, tenofovir e lamivudina (com terapia de resgate em caso de resistência viral) para tratamento de pacientes adultos com hepatite B crônica, virgens de tratamento, com elevados níveis de alanina aminotransferase, sem evidência de cirrose e sem coinfecção por HIV. Valores para custo e efeito foram obtidos da literatura. A medida do efeito foi expressa em anos de vida ganhos (AVG). Taxa de desconto de 5% foi aplicada. Análise de sensibilidade univariada foi conduzida para avaliar incertezas do modelo. RESULTADOS O tratamento inicial com entecavir ou tenofovir apresentou melhores resultados clínicos. As menores razões custo-efetividade foram de entecavir para pacientes HBeAg-positivo (R$ 4.010,84/AVG) e lamivudina para pacientes HBeAg-negativo (R$ 6.205,08/AVG). Para pacientes HBeAg-negativo, a razão custo-efetividade incremental de entecavir (R$ 14.101,05/AVG) está abaixo do limiar recomendado pela Organização Mundial da Saúde. Análise de sensibilidade mostrou que variação nos custos dos medicamentos pode tornar tenofovir alternativa custo-efetiva tanto para pacientes HBeAg-positivo quanto para HBeAg-negativo. CONCLUSÕES Entecavir é alternativa recomendada para iniciar o tratamento de pacientes com hepatite B crônica no Brasil. Contudo, se houver redução no custo de tenofovir, esta pode se tornar alternativa mais custo-efetiva. .

OBJETIVO Evaluar el costo-efectividad de diferentes tratamientos medicamentosos para hepatitis B crónica entre pacientes adultos. MÉTODOS Utilizando el modelo de Markov, se construyó cohorte hipotética de 40 años para pacientes HBeAg-positivo o HBeAg-negativo. Se compararon los usos de adefovir, entecavir, tenofovir y lamivudina (con terapia de rescate en caso de resistencia viral) para tratamiento de pacientes adultos con hepatitis B crónica, vírgenes de tratamiento, con elevados niveles de alanina aminotransferasa, sin evidencia de cirrosis y sin coinfección por VIH. Valores para costo y efecto fueron obtenidos de la literatura y efecto en años de vida ganados (AVG). Tasa de descuento de 5% fue aplicada. Análisis de sensibilidad univariado fue conducido para evaluar incertidumbres del modelo. RESULTADOS El tratamiento inicial con entecavir o tenofovir presentó mejores resultados clínicos. Los menores cocientes costo-efectividad fueron de entecavir para pacientes HBeAg-positivo (R.010,84/AVG) y lamivudina para pacientes HBeAg-negativo (R.205,08/AVG).Para pacientes HBeAg-negativo, el cociente costo-efectividad incrementado de entecavir (R.101,05/AVG) está por debajo del límite recomendado por la Organización Mundial de la Salud. El análisis de sensibilidad mostró que la variación en los costos de los medicamentos puede tornar tenofovir una alternativa costo-efectiva tanto para pacientes HBeAg-positivo como para los HBeAg-negativo. CONCLUSIONES Entecavir es una alternativa recomendada para iniciar el tratamiento de pacientes con hepatitis B crónica en Brasil. Sin embargo, al haber reducción en el costo de tenofovir, éste puede convertirse en una alternativa más costo-efectiva. .

OBJECTIVE To evaluate the cost-effectiveness of different drug therapies for chronic hepatitis B in adult patients. METHODS Using a Markov model, a hypothetical cohort of 40 years for HBeAg-positive or HBeAg-negative patients was constructed. Adefovir, entecavir, tenofovir and lamivudine (with rescue therapy in cases of viral resistance) were compared for treating adult patients with chronic hepatitis B undergoing treatment for the first time, with high levels of alanine aminotransferase, no evidence of cirrhosis and without HIV co-infection. Values for cost and effect were obtained from the literature, and expressed in effect on life years (LY). A discount rate of 5% was applied. Univariate sensitivity analysis was conducted to assess model uncertainties. RESULTS Initial treatment with entecavir or tenofovir showed better clinical outcomes. The lowest cost-effectiveness ratio was for entecavir in HBeAg-positive patients (R$ 4,010.84/LY) and lamivudine for HBeAg-negative patients (R$ 6,205.08/LY). For HBeAg-negative patients, the incremental cost-effectiveness ratio of entecavir (R$ 14,101.05/LY) is below the threshold recommended by the World Health Organization. Sensitivity analysis showed that variation in the cost of drugs may make tenofovir a cost-effective alternative for both HBeAg-positive and HBeAg-negative patients. CONCLUSIONS Entecavir is the recommended alternative to start treating patients with chronic hepatitis B in Brazil. However, if there is a reduction in the cost of tenofovir, it can become a cost-effective alternative. .

[Cost-effectiveness analysis of immunosuppressive drugs in post-renal transplantation maintenance therapy in adult patients in Brazil]. / Análise de custo-efetividade dos imunossupressores utilizados no tratamento de manutenção do transplante renal em pacientes adultos no Brasil.

The aim of the study was to perform cost-effectiveness analysis of immunosuppressive drugs in post-renal transplantation maintenance therapy. A hypothetical cohort of transplanted adults was followed for 20 years, using the Markov model. The 10 evaluated therapeutic regimens contained prednisone (P). Average cost of the medicines was obtained from CMED (Câmara de Regulação do Mercado de Medicamentos). Other patient care costs were included in each disease stage. Costs were expressed in Brazilian reais, effectiveness was measured as years of life gained, and the study adopted a public health system perspective. At the end of follow-up, the analysis with discount showed that all the regimens were dominated by cyclosporine (CSA)+azathioprine (AZA)+P. In the remaining analyses, tacrolimus+AZA+P was not dominated, but the incremental cost-effectiveness ratio between these two regimens was R$ 156,732.07/ years of life gained, a value that exceeds the threshold of three times the Brazilian per capita GDP. In the sensitivity analysis, no qualitative change was observed and the probability of CSA+AZA+P being the most cost-effective regimen was greater than 85%.

Custo-efetividade dos análogos de nucleosídeos/nucleotídeos para hepatite crônica B / Cost-effectiveness of nucleoside/nucleotide analogues in chronic hepatitis B / Costo-efectividad de los análogos de nucleósidos/nucleótidos para hepatitis crónica B

.

OBJECTIVE: To conduct a cost-effectiveness analysis of drug alternatives with rescue therapy in case of relapse due to viral resistance for the treatment of patients with chronic hepatitis B (CHB). METHODS: Hypothetical cohort of patients with CHB, HBeAg-negative, without clinical or histological evidence of cirrhosis, detectable HBV DNA, histological diagnosis of the disease, positive serum HBsAg for longer than six months, high levels of alanine aminotransferase (ALT) (twice as high as the upper limit of normality) and mean age of 40 years. A Markov model was developed for chronic hepatitis B (HBeAg- negative) with a 40-year time horizon. Costs and benefits were discounted at 5%. Annual rates of disease progression, costs due to complications and the efficacy of medicines were obtained from the literature. One-way and probabilistic sensitivity analysis evaluated uncertainties. RESULTS: Initiation of treatments with entecavir resulted in an increase of 0.35 discounted life-years gained compared to lamivudine. The incremental cost-effectiveness ratio was R$16,416.08 per life-years gained. In the sensitivity analysis, the incremental cost-effectiveness ratio was more sensitive to variation in the probability of transition from chronic hepatitis B to compensated cirrhosis, discount rate and medicine prices (± 10%). In the probabilistic sensitivity analysis, the acceptability curve showed that beginning treatment with entecavir was the most cost-effective alternative in comparison with the use of lamivudine. CONCLUSIONS: The availability of entecavir is economically attractive as part of early treatment for patients with chronic hepatitis B without HIV co-infection.

.

[Use of medications by elderly Brazilians according to age: a postal survey]. / Utilização de medicamentos por idosos brasileiros, de acordo com a faixa etária: um inquérito postal.

The objective of this study was to evaluate factors associated with use of medicines by the elderly. A national postal survey was conducted with a random sample of 3,000 elderly individuals selected from the registry of the Brazilian National Social Security Institute. The study estimated the prevalence and average number of medicines used in the 15 days prior to the survey, according to age bracket. Prevalence of use of medication was 83.0%: 78.8% in the 60-69 year bracket and 87.3% in individuals 70 years or older (p < 0.05). Older elders had taken an average of 4.4 drugs, as compared to 3.3 among younger elders. Drugs for the cardiovascular system were the most widely used. Age 70 years and older, female gender, poor self-rated health, interruption of routine daily activities, six or more medical visits in the previous year, private health insurance, and reporting of four or more illnesses were independently associated with use of medications (p < 0.05). The results expand the knowledge on use of medications among elderly Brazilians, emphasizing the need to improve pharmaceutical care focused on this subgroup of the population.

Utilização de medicamentos por idosos brasileiros, de acordo com a faixa etária: um inquérito postal / Use of medications by elderly Brazilians according to age: a postal survey

O objetivo deste estudo foi avaliar fatores associados ao uso de medicamentos por idosos. Foi realizado um inquérito postal nacional, com 3 mil idosos, selecionados com base no cadastro do Instituto Nacional do Seguro Social. Foram estimadas a prevalência e a média de medicamentos utilizados nos 15 dias anteriores à pesquisa, segundo faixas etárias. A prevalência de uso de medicamentos foi de 83%, sendo de 87,3% no grupo de 70 anos ou mais, e de 78,8% no de 60-69 anos (p < 0,05). Os idosos com 70 anos ou mais usaram em média 4,4 medicamentos, os mais jovens 3,3. Os medicamentos mais utilizados pertenciam ao sistema cardiovascular. Idade de 70 ou mais anos, sexo feminino, pior percepção de saúde, interrupção de atividades habituais, mais de 6 consultas médicas no último ano, filiação a plano de saúde e relato de 4 ou mais doenças estavam associados ao uso de medicamentos (p < 0,05) entre os participantes. Os resultados ampliam o conhecimento a respeito da utilização de medicamentos pelos idosos brasileiros, evidenciando a necessidade de aprimoramento da assistência farmacêutica voltada para esse subgrupo da população.

The objective of this study was to evaluate factors associated with use of medicines by the elderly. A national postal survey was conducted with a random sample of 3,000 elderly individuals selected from the registry of the Brazilian National Social Security Institute. The study estimated the prevalence and average number of medicines used in the 15 days prior to the survey, according to age bracket. Prevalence of use of medication was 83.0%: 78.8% in the 60-69 year bracket and 87.3% in individuals 70 years or older (p < 0.05). Older elders had taken an average of 4.4 drugs, as compared to 3.3 among younger elders. Drugs for the cardiovascular system were the most widely used. Age 70 years and older, female gender, poor self-rated health, interruption of routine daily activities, six or more medical visits in the previous year, private health insurance, and reporting of four or more illnesses were independently associated with use of medications (p < 0.05). The results expand the knowledge on use of medications among elderly Brazilians, emphasizing the need to improve pharmaceutical care focused on this subgroup of the population.

[Cost-effectiveness of nucleoside/nucleotide analogues in chronic hepatitis B]. / Custo-efetividade dos análogos de nucleosídeos/nucleotídeos para hepatite crônica B.

OBJECTIVE: To conduct a cost-effectiveness analysis of drug alternatives with rescue therapy in case of relapse due to viral resistance for the treatment of patients with chronic hepatitis B (CHB). METHODS: Hypothetical cohort of patients with CHB, HBeAg-negative, without clinical or histological evidence of cirrhosis, detectable HBV DNA, histological diagnosis of the disease, positive serum HBsAg for longer than six months, high levels of alanine aminotransferase (ALT) (twice as high as the upper limit of normality) and mean age of 40 years. A Markov model was developed for chronic hepatitis B (HBeAg- negative) with a 40-year time horizon. Costs and benefits were discounted at 5%. Annual rates of disease progression, costs due to complications and the efficacy of medicines were obtained from the literature. One-way and probabilistic sensitivity analysis evaluated uncertainties. RESULTS: Initiation of treatments with entecavir resulted in an increase of 0.35 discounted life-years gained compared to lamivudine. The incremental cost-effectiveness ratio was R$16,416.08 per life-years gained. In the sensitivity analysis, the incremental cost-effectiveness ratio was more sensitive to variation in the probability of transition from chronic hepatitis B to compensated cirrhosis, discount rate and medicine prices (± 10%). In the probabilistic sensitivity analysis, the acceptability curve showed that beginning treatment with entecavir was the most cost-effective alternative in comparison with the use of lamivudine. CONCLUSIONS: The availability of entecavir is economically attractive as part of early treatment for patients with chronic hepatitis B without HIV co-infection.

[Complexity of therapeutic regimens prescribed for elderly retirees, Belo Horizonte/MG, Brazil]. / Complexidade do regime terapêutico prescrito para idosos.

OBJECTIVE: To examine factors associated with therapeutic regimen complexity of drug prescriptions for elderly people in Belo Horizonte, Minas Gerais, Brazil. METHODS: A household survey of elderly people selected by simple random sampling from Brazil's social security register. The medication complexity index (MCI), a direct measurement of actions required to administer medication, was derived from information in the latest prescription. Univariate and bivariate analyses were performed to identify factors associated with the MCI. RESULTS: Of the 667 interviewees, 56.5% had prescriptions meeting the inclusion criteria; most (69.2%) were females aged 72.4 years (mean); 35.5% self-rated their health good or very good; and 37.4% reported five or more diseases. In the 15 days prior to interview, 1873 drugs were used (mean=5.1), of which 942 appeared on the prescriptions examined (mean=2.5). Over the same period, 22.3% of interviewees failed to use some prescribed drug. The MCI ranged from 1 to 24 (mean=6.1). Number of drugs prescribed (>2), less schooling, worse perception of health and a lower benefit payment associated positively with greater complexity (p<0.05). An association was observed between regimen complexity and failure to use some drug in the preceding 15 days (p=0.034). CONCLUSION: Elderly people in worse socio-economic and health conditions seem more likely to receive more complex therapeutic regimens, which are associated with non-compliance to the proposed treatment. This is an important consideration in the healthcare of elderly. Simplification of therapy could aid self-care among the elderly.

Complexidade do regime terapêutico prescrito para idosos / Complexity of therapeutic regimens prescribed for elderly retirees, Belo Horizonte/MG, Brazil

OBJETIVO: Analisar fatores associados à complexidade do esquema terapêutico em prescrições de medicamentos para idosos, em Belo Horizonte (MG). MÉTODOS: Inquérito domiciliar, com idosos selecionados por amostragem aleatória simples, a partir do cadastro do INSS. O Índice de Complexidade Terapêutica (ICT), medida direta das ações necessárias para administrar o medicamento, foi obtido de informações contidas na última prescrição. Foram realizadas análises univariada e bivariada dos dados para identificar fatores associados ao ICT. RESULTADOS: Dos 667 entrevistados, 56,5 por cento apresentaram prescrição que atendia aos critérios de inclusão. A maioria (69,2 por cento) era do sexo feminino com idade média de 72,4 anos. 35,5 por cento consideravam seu estado de saúde bom ou muito bom e 37,4 por cento relataram cinco ou mais doenças. Nos 15 dias anteriores à entrevista, foram utilizados 1873 medicamentos (média=5,1), desses, 942 constavam nas prescrições analisadas (média=2,5). Para o mesmo período, 22,3 por cento dos entrevistados deixaram de usar algum medicamento prescrito. O ICT encontrado variou de 1 a 24 (média=6,1). Número de medicamentos prescritos (>2), menor escolaridade, pior percepção de saúde e menor valor do benefício recebido foram associados positivamente à maior complexidade (p<0,05). Observou-se associação entre maior complexidade do regime e não uso de algum medicamento nos últimos 15 dias (p=0,034) CONCLUSÃO: Idosos com piores condições socioeconômicas e de saúde parecem mais propensos a receber esquemas terapêuticos mais complexos. Terapias mais complexas estão associadas ao menor cumprimento do tratamento proposto, sendo um importante aspecto a se considerar na atenção à saúde do idoso. A simplificação da terapia pode melhorar o autocuidado entre idosos.

OBJECTIVE: To examine factors associated with therapeutic regimen complexity of drug prescriptions for elderly people in Belo Horizonte, Minas Gerais, Brazil. METHODS: A household survey of elderly people selected by simple random sampling from Brazil's social security register. The medication complexity index (MCI), a direct measurement of actions required to administer medication, was derived from information in the latest prescription. Univariate and bivariate analyses were performed to identify factors associated with the MCI. RESULTS: Of the 667 interviewees, 56.5 percent had prescriptions meeting the inclusion criteria; most (69.2 percent) were females aged 72.4 years (mean); 35.5 percent self-rated their health good or very good; and 37.4 percent reported five or more diseases. In the 15 days prior to interview, 1873 drugs were used (mean=5.1), of which 942 appeared on the prescriptions examined (mean=2.5). Over the same period, 22.3 percent of interviewees failed to use some prescribed drug. The MCI ranged from 1 to 24 (mean=6.1). Number of drugs prescribed (>2), less schooling, worse perception of health and a lower benefit payment associated positively with greater complexity (p<0.05). An association was observed between regimen complexity and failure to use some drug in the preceding 15 days (p=0.034). CONCLUSION: Elderly people in worse socio-economic and health conditions seem more likely to receive more complex therapeutic regimens, which are associated with non-compliance to the proposed treatment. This is an important consideration in the healthcare of elderly. Simplification of therapy could aid self-care among the elderly.

Treatment of postmenopausal osteoporosis in women: a systematic review.

Osteoporosis, a typical disease of the elderly, has become a frequent and relevant public health problem. Several drugs are available for treatment of osteoporosis, some of which are currently dispensed by the Brazilian Unified National Health System. The objective of this study was to present a systematic review of drugs for treatment of osteoporosis, focusing on the adequacy of clinical protocols based on existing evidence in the scientific literature. We conducted a search for randomized clinical trials in PubMed and LILACS that presented results for bone mineral density, incidence of vertebral fractures, and adverse effects. 32 articles met the review's inclusion criteria. Bisphosphonates were reported to have consistently reduced the risk of vertebral fractures. Hormone replacement therapy showed positive outcomes, but its use has been found to increase the risk of cardiovascular disease and breast cancer. Teriparatide and monofluorophosphate also showed efficacy against osteoporosis. Calcium and vitamin D were given to patients as food supplements.

Improved purification process of β- and α-trypsin isoforms by ion-exchange chromatography

The purpose of this work was to improve the separation and yield of pure β- and α-trypsin isoforms by ion-exchange chromatography and to characterize some physical-chemical properties of these isoforms. Purification of trypsin isoforms was performed by ion-exchange chromatography in 0.1 mol/L tris-HC buffer, pH 7.10 at 4ºC. The sample loading, salt concentration, flow rate and pH of mobile phase were varied to determine their effects on the resolution of the separation. The resolution was optimized mainly between β- and α-trypsin. Pure isoforms were obtained by chromatographying 100 mg of commercial trypsin during seven days, yielding 51 mg of high purity β-trypsin and 13 mg of α-trypsin partially pure, with small amounts of contaminating of ψ-trypsin. Thus, time and resolution of purification were optimized yielding large amounts of pure active enzymes that are useful for several research areas and biotechnology.

O propósito deste trabalho foi melhorar a separação e o rendimento das isoformas puras β- e α-tripsina por meio de cromatografia de troca iônica e caracterizar algumas propriedades físico-químicas dessas isoformas. A purificação de isoformas de tripsina foi realizada em SE Sephadex, com tampão tris-HCl, pH 7,10 a 4ºC. A quantidade de amostra, a concentração salina, o fluxo e o pH da fase móvel foram variados para determinar o efeito sobre a resolução da separação. A resolução foi otimizada principalmente entre β- e α-tripsina, utilizando o pH 7,10 a 4ºC. Isoformas puras foram obtidas a partir de 100 mg de tripsina comercial bovina depois de sete dias de cromatografia, fornecendo 51,0 mg de β-tripsina totalmente pura e 13,0 mg de α-tripsina parcialmente pura, com quantidades pequenas de contaminação por ψ-Tripsina. Assim, tempo e resolução da purificação foram otimizados redendo grandes quantidades de enzimas puras e ativas que são úteis em várias áreas de pesquisa e ciências biotecnológicas.

Treatment of postmenopausal osteoporosis in women: a systematic review / Tratamento da osteoporose em mulheres na pós-menopausa: uma revisão sistemática

Osteoporosis, a typical disease of the elderly, has become a frequent and relevant public health problem. Several drugs are available for treatment of osteoporosis, some of which are currently dispensed by the Brazilian Unified National Health System. The objective of this study was to present a systematic review of drugs for treatment of osteoporosis, focusing on the adequacy of clinical protocols based on existing evidence in the scientific literature. We conducted a search for randomized clinical trials in PubMed and LILACS that presented results for bone mineral density, incidence of vertebral fractures, and adverse effects. 32 articles met the review's inclusion criteria. Bisphosphonates were reported to have consistently reduced the risk of vertebral fractures. Hormone replacement therapy showed positive outcomes, but its use has been found to increase the risk of cardiovascular disease and breast cancer. Teriparatide and monofluorophosphate also showed efficacy against osteoporosis. Calcium and vitamin D were given to patients as food supplements.

A osteoporose, doença típica dos idosos, vem se tornando um dos problemas mais freqüentes e relevantes no âmbito da saúde pública. Vários medicamentos estão disponíveis para o seu tratamento, alguns disponibilizados pelo SUS. Este estudo apresenta uma revisão sistemática dos medicamentos destinados ao tratamento da osteoporose, buscando subsidiar as discussões a respeito dos protocolos clínicos, com base em evidências científicas na literatura. Foi realizada busca de ensaios clínicos randomizados na base de dados PubMed e LILACS que apresentavam resultados de densidade mineral óssea, incidência de fraturas vertebrais e reações adversas aos medicamentos. Nos 32 artigos revisados, a classe de medicamentos bifosfonados foi a mais freqüente e a que melhor tem demonstrado sua eficácia clínica, principalmente o alendronato e o ibandronato via endovenosa. A terapia de reposição hormonal demonstrou efeito, mas seu uso tem sido associado ao aumento de risco de doenças cardiovasculares e outras. Teriparatida e monofluorfosfato apresentaram eficácia antiosteoporótica. Cálcio e vitamina D foram dados aos pacientes como suplemento alimentar.