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1.
Hum Vaccin Immunother ; : 1-11, 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31916905

RESUMO

The vaccination coverage rate has fallen in recent years in Brazil. Although Brazil is a country influenced by social networking and analysis of social media generated content has emerged as an important area of research, this is the first study to investigate how the HPV vaccine is portrayed on the Facebook page of the Ministry of Health and to interpret the user-generated content. Our work evaluated the posts published by the Ministry of Health as well as posted comments, shares and reactions of the population related to the HPV vaccination campaign on the specific Facebook page between January and July 2018.The data were analyzed in three stages: (i) overview of published posts; (ii) analysis of posted comments; and (iii) sub-group analysis of posted comments. This study makes important contributions from the point of view of using social media as a public health communication tool.

3.
Sci Rep ; 9(1): 10400, 2019 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-31320702

RESUMO

The α-carbonic anhydrases (α-CAs) are a large and ancient group of metazoan-specific enzymes. They generate bicarbonate from metabolic carbon dioxide and through calcium carbonate crystal formation play a key role in the regulation of mineralized structures. To better understand how α-CAs contribute to shell mineralization in the marine Mediterranean mussel (Mytilus galloprovincialis) we characterized them in the mantle. Phylogenetic analysis revealed that mollusc α-CA evolution was affected by lineage and species-specific events. Ten α-CAs were found in the Mediterranean mussel mantle and the most abundant form was named, MgNACR, as it grouped with oyster nacreins (NACR). Exposure of the Mediterranean mussel to reduced water salinity (18 vs 37 ppt), caused a significant reduction (p < 0.05) in mantle esterase activity and MgNACR transcript abundance (p < 0.05). Protonograms revealed multiple proteins in the mantle with α-CA hydratase activity and mapped to a protein with a similar size to that deduced for monomeric MgNACR. Our data indicate that MgNACR is a major α-CA enzyme in mantle and that by homology with oyster nacreins likely regulates mussel shell production. We propose that species-dependent α-CA evolution may contribute to explain the diversity of bivalve shell structures and their vulnerability to environmental changes.

5.
Value Health Reg Issues ; 20: 95-102, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31108456

RESUMO

OBJECTIVES: Because of the lack of evidence regarding long-term effectiveness and cost-effectiveness of first-generation direct-acting antivirals for chronic hepatitis C (CHC) treatment in Brazil, we performed a cost-utility analysis comparing standard dual therapy (peginterferon plus ribavirin [pegIFN/RBV]), boceprevir, and telaprevir for CHC patients. METHODS: We developed a state-transition Markov model simulating the progression of CHC. Long-term outcomes included remaining life expectancy in life-years (LYs), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER). Short-term outcomes included sustained virological response rates (SVR). Direct medical costs were obtained from Brazilian databases. A lifelong time horizon was considered and a 5% annual discount rate was applied for costs and clinical outcomes. A willingness-to-pay threshold of approximately $20 000 per QALY was used. We performed multiple sensitivity analyses. RESULTS: For short- and long-term scenarios, therapy with boceprevir was dominated by telaprevir, which was more effective than standard dual therapy (75.0% vs 40.4% SVR rate, 13.47 vs 12.59 LYs, and 9.74 vs 8.49 QALYs, respectively) and was also more expensive ($15 742 vs $5413). The corresponding ICERs were $29 854/SVR, $11 803/LY, and $8277/QALY. Based on our model, triple therapy with telaprevir was the most cost-effective treatment for the Brazilian health system. Despite a lack of data regarding the Brazilian population, we incorporated as many applicable parameters as possible. CONCLUSIONS: Telaprevir is more effective and cost-effective than boceprevir. Our model may be applied for other settings with a few adjustments in the input parameters.

6.
Water Sci Technol ; 79(4): 699-708, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30975936

RESUMO

The possibility of using the first stage of the French System (FS) of vertical wetlands composed of only two units in parallel requires hydraulic investigations to allow a better understanding of its operation under tropical climatic environments. This study evaluated the pattern of the outflow hydrograph along an extended cycle of operation (seven days of feeding) and the influence of the sludge deposit, rainfall occurrence and duration of pulse application on the outflow hydrograph in a modified full-scale FS in Brazil. The results indicated that, as the feeding cycle days increased, there was an increase in the time of filtration and the internal storage of the liquid volume, probably due to a reduction in the filter permeability. Greater hydraulic gradient favoured the infiltration velocity, decreased the amount of liquid stored within the system, and delayed the loss of permeability. The sludge layer contributed to a momentary liquid retention, and also allowed greater evapotranspiration, reducing the liquid volume to be treated. The sludge deposit seemed to hinder the liquid percolation, especially at the end of the cycle, modifying the hydraulic conductivity of the filter as a whole. Intense rainfall events demonstrated that precipitation could modify the flow dynamics within the system.


Assuntos
Eliminação de Resíduos Líquidos/métodos , Áreas Alagadas , Brasil , Filtração , Esgotos
7.
Endocrine ; 63(1): 18-26, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30145746

RESUMO

PURPOSE: Acromegaly is a rare disease that often requires drug treatment to achieve control, with pegvisomant being one of the most widely used therapies. In the present paper, we aimed to obtain evidence regarding the effectiveness and safety of pegvisomant by reviewing real-world observational longitudinal studies. METHODS: A systematic review was performed with a meta-analysis of event rates (95% confidence interval (CI)) using a random effects model. Sensitivity and subgroup analyses were performed (comprehensive meta-analysis 2.0). The systematic review was performed in accordance to preferred reporting items for systematic reviews and meta-analyses, meta-analysis of observational studies in epidemiology, and Cochrane recommendations (PROSPERO register CRD 42017059880). PubMed, Scopus, Web of Science, and SciELO were used to search for literature. Observational studies in patients using pegvisomant for the treatment of acromegaly were included. RESULTS: Initially, 552 papers were retrieved from the databases; and 31 articles were included in the qualitative analysis and 14 in the quantitative analysis. Eight primary meta-analyses were performed. The overall rate of patients with disease control was of 60.9% (51.8-69.3%; 95% CI). When considering patients under monotherapy, the control rate was 71.7% (64.0-78.4%; 95% CI). Tumor growth was estimated in 7.3% (4.7-11.1%; 95% CI) and elevation of transaminases in 3.0% (1.7-5.2%; 95% CI). CONCLUSIONS: The real-world data showed that the effectiveness of pegvisomant is not as high as reported in interventional studies. Acromegaly appears to be better controlled when pegvisomant is used as a monotherapy. No serious adverse events were associated with the use of pegvisomant; however, given the high cost of this drug, further studies are required.


Assuntos
Acromegalia/tratamento farmacológico , Hormônio do Crescimento Humano/análogos & derivados , Hormônio do Crescimento Humano/efeitos adversos , Hormônio do Crescimento Humano/uso terapêutico , Humanos , Estudos Longitudinais , Estudos Observacionais como Assunto
8.
Artigo em Inglês | MEDLINE | ID: mdl-32039047

RESUMO

In this study, we generated a transgenic strain of Leishmania braziliensis, an etiological agent associated with a diversity of clinical manifestations of leishmaniasis ranging from localized cutaneous to mucocutaneous to disseminated disease. Transgenic parasites expressing reporter proteins are valuable tools for studies of parasite biology, host-pathogen interactions, and anti-parasitic drug development. To this end, we constructed an L. braziliensis line stably expressing the reporters eGFP and luciferase (eGFP-LUC L. braziliensis). The integration cassette co-expressing the two reporters was targeted to the ribosomal locus (SSU) of the parasite genome. Transgenic parasites were characterized for their infectivity and stability both in vitro and in vivo. Parasite maintenance in axenic long-term culture in the absence of selective drugs did not alter expression of the two reporters or infection of BALB/c mice, indicating stability of the integrated cassette. Infectivity of eGFP-LUC, L. braziliensis, both in vivo and in vitro was similar to that obtained with the parental wild type strain. The possibility of L. braziliensis tracking and quantification using fluorescence and luminescence broadens the scope of research involving this neglected species, despite its importance in terms of public health concerning the leishmaniasis burden.

9.
Zookeys ; (792): 69-89, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30386160

RESUMO

The Neotropical genus Lycinella Gorham, 1884 is revised. Lycinellaopaca Gorham, 1884 and Lycinellaparvula Gorham, 1884 are redescribed and illustrated. Six new species are described for the genus: Lycinellaadamantis sp. n., L.hansoni sp. n., L.milleri sp. n., L.cidaoi sp. n., L.marshalli sp. n. and L.pugliesae sp. n.. Lycinellahumeralis Pic, 1933 is moved to Ceratoprionhumerale (Pic, 1933), comb. n. A key to the species of Lycinella, illustrations and a distribution map is provided.

10.
Rev Inst Med Trop Sao Paulo ; 60: e72, 2018 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-30462795

RESUMO

Due to the severity of chronic hepatitis C, there are multiple factors that can negatively affect the quality of life of infected patients. The aim of this study was to evaluate changes in the health-related quality of life (HRQoL) in patients under second-generation direct-acting antiviral (DAA) (interferon-free) therapies and to assess treatment effectiveness. This was an observational study conducted in Curitiba (Brazil) using two instruments (a generic and a specific) for measuring the quality of life in patients with chronic hepatitis C, the Short Form-36 (SF-36) and the Chronic Liver Disease Questionnaire (CLDQ) for liver disease evaluation. The study included patients receiving any interferon-free therapy for hepatitis C treatment during 2016 and 2017. Data were collected before, during, and after treatment regarding the two questionnaires, effectiveness and safety. Fifty-six patients fulfilled all eligibility criteria and were included for analysis. Sustained virological response was obtained in 88% of the patients. They were mainly genotype 1, cirrhotic and treated with sofosbuvir combined with daclatasvir or sofosbuvir with simeprevir. Improvement in the quality of life was observed for several domains in both questionnaires (p < 0.05) in the comparison before and after treatment. Patients receiving sofosbuvir with daclatasvir had significantly lower scores compared to the group receiving sofosbuvir with simeprevir. Second-generation DAA therapies were effective and have considerably increased the HRQoL of patients with chronic hepatitis C virus.


Assuntos
Antivirais/administração & dosagem , Hepatite C Crônica/tratamento farmacológico , Imidazóis/administração & dosagem , Qualidade de Vida , Simeprevir/administração & dosagem , Sofosbuvir/administração & dosagem , Quimioterapia Combinada , Feminino , Genótipo , Hepatite C Crônica/psicologia , Hepatite C Crônica/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores Socioeconômicos , Inquéritos e Questionários , Resposta Viral Sustentada , Resultado do Tratamento
11.
Cad Saude Publica ; 34(9): e00184317, 2018 09 06.
Artigo em Português | MEDLINE | ID: mdl-30208182

RESUMO

Administrative data show high vaccination coverage rates in Brazil, but there is no assessment of the validity and timeliness of dose administration, or whether the vaccination schedule is complete. This study assessed timely and updated coverage rates in children 12 to 24 months of age. This was a longitudinal population-based study in Araraquara, São Paulo State, a predominantly urban medium-sized municipality, using the Juarez System, an electronic immunization registry (EIR). Coverage rates were assessed in 49,741 children born from 1998 to 2013, a period in which five different vaccination schedules were used. Trends were estimated with the Prais-Winsten linear regression method. Updated coverage of the complete schedule varied from 79.5% to 91.3% at 12 months and from 75.8% to 86.9%, at 24 months. Timely coverage (all doses applied at the recommended ages, with no delays) ranged from 53.3% to 74% at 12 months and from 36.7% to 53.8% at 24 months. There was an upward trend in updated coverage at 24 months. The delays in relation to recommended age increased starting at six months and appeared to relate more to age than to the number of doses in the schedule. The proportion of invalid and late doses was lower than in other studies. Despite the increase in the number of doses in the vaccination schedule, the study showed high updated coverage rates and higher timely coverage than reported in the national and international literature; however, more effort is needed to increase timeliness. EIR proved relevant for assessing and monitoring vaccination coverage with more accurate analyses.


Assuntos
Registros Eletrônicos de Saúde/estatística & dados numéricos , Programas de Imunização/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde/métodos , Cobertura Vacinal/estatística & dados numéricos , Fatores Etários , Brasil , Pré-Escolar , Cidades , Feminino , Humanos , Esquemas de Imunização , Lactente , Estimativa de Kaplan-Meier , Masculino , Valores de Referência , Sistema de Registros/estatística & dados numéricos , Fatores de Tempo
12.
Nat Commun ; 9(1): 3706, 2018 09 12.
Artigo em Inglês | MEDLINE | ID: mdl-30209270

RESUMO

Embedding tunable quantum emitters in a photonic bandgap structure enables control of dissipative and dispersive interactions between emitters and their photonic bath. Operation in the transmission band, outside the gap, allows for studying waveguide quantum electrodynamics in the slow-light regime. Alternatively, tuning the emitter into the bandgap results in finite-range emitter-emitter interactions via bound photonic states. Here, we couple a transmon qubit to a superconducting metamaterial with a deep sub-wavelength lattice constant (λ/60). The metamaterial is formed by periodically loading a transmission line with compact, low-loss, low-disorder lumped-element microwave resonators. Tuning the qubit frequency in the vicinity of a band-edge with a group index of ng = 450, we observe an anomalous Lamb shift of -28 MHz accompanied by a 24-fold enhancement in the qubit lifetime. In addition, we demonstrate selective enhancement and inhibition of spontaneous emission of different transmon transitions, which provide simultaneous access to short-lived radiatively damped and long-lived metastable qubit states.

13.
Pituitary ; 21(6): 642-652, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30159696

RESUMO

PURPOSE: Acromegaly is a rare disease that results in the enlargement of body extremities and in organomegaly. Treatments include surgery, drugs, and radiotherapy, which are all onerous. Therefore, well-conducted cost-analyses are crucial in the decision-making process. METHODS: A systematic review of cost-effectiveness studies on acromegaly therapies was performed following PRISMA and Cochrane recommendations. The search for records was conducted in PubMed, Scopus, and Web of Science (May 2018). The quality of the included studies was assessed using the Joana Briggs Institute Tool. RESULTS: From initial 547 records, 16 studies were included in the review. The studies could present more than one economic evaluation, and encompassed cost-effectiveness (n = 13), cost-utility (n = 5), and cost-consequence (n = 1) analyses. All studies were model-based and evaluated only direct medical costs. Eleven records did not mention discounting and only 10 performed sensitivity analyses. The characteristic of the studies, the cost-effectiveness results and the studies' conclusions are described and commented upon. The main limitation of the studies was discussed and aspects to improve in future studies were pointed out. CONCLUSIONS: Cost-effectiveness studies on acromegaly have been performed in several scenarios, evaluating different phases of treatment. However, the studies present limitations and, overall, were considered of moderate quality. Further economic models should be developed following health economics guidelines recommendations, and must improve transparency.


Assuntos
Acromegalia/tratamento farmacológico , Acromegalia/economia , Análise Custo-Benefício , Hormônio do Crescimento Humano/análogos & derivados , Hormônio do Crescimento Humano/uso terapêutico , Humanos , Octreotida/uso terapêutico , Peptídeos Cíclicos/uso terapêutico , Somatostatina/análogos & derivados , Somatostatina/uso terapêutico
14.
Value Health ; 21(7): 874-880, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-30005760

RESUMO

BACKGROUND: Acromegaly results from the hypersecretion of growth hormone. Because of the low incidence rates of this disease worldwide, few clinical trials evaluating drug treatments have been conducted. OBJECTIVES: To conduct the first network meta-analysis simultaneously comparing all available drugs used in acromegaly treatment so as to provide more robust evidence in this field. METHODS: A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Cochrane Collaboration recommendations (PROSPERO database under the registration number CRD42017059880). The electronic searches were conducted in PubMed (MEDLINE), Scopus, and Web of Science databases. Randomized controlled trials comparing any drug for the treatment of acromegaly head-to-head or versus placebo were included. Outcomes concerning the efficacy and safety of treatments were evaluated. The statistical analyses were performed using Aggregate Data Drug Information System version 1.16.8 (drugis.org, Groningen, The Netherlands). RESULTS: The initial search retrieved 2059 articles. Of these, 10 randomized controlled trials were included in a qualitative analysis and 7 in a quantitative analysis. The network meta-analysis for the efficacy outcome (number of patients achieving insulinlike growth factor 1 control) showed that pegvisomant and lanreotide autogel were statistically superior to placebo (odds ratio [95% credible interval] 0.06 [0.00-0.55] and 0.09 [0.01-0.88]). No further differences were found. The probability rank indicated that pegvisomant and pasireotide have the highest probabilities (33% and 34%, respectively) of being the best therapeutic options. No major side effects were noted. CONCLUSIONS: Pegvisomant is still a good option for acromegaly treatment, but pasireotide seems to be a promising alternative. Nevertheless, other important key factors such as drug costs and effectiveness (real-world results) should be taken into account when selecting acromegaly treatment.


Assuntos
Acromegalia/tratamento farmacológico , Antagonistas de Hormônios/uso terapêutico , Hormônio do Crescimento Humano/análogos & derivados , Hormônio do Crescimento Humano/metabolismo , Peptídeos Cíclicos/uso terapêutico , Receptores da Somatotropina/antagonistas & inibidores , Somatostatina/análogos & derivados , Acromegalia/metabolismo , Acromegalia/fisiopatologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Antagonistas de Hormônios/efeitos adversos , Hormônio do Crescimento Humano/efeitos adversos , Hormônio do Crescimento Humano/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Peptídeos Cíclicos/efeitos adversos , Receptores da Somatotropina/metabolismo , Somatostatina/efeitos adversos , Somatostatina/uso terapêutico , Resultado do Tratamento , Adulto Jovem
15.
Eur J Clin Pharmacol ; 74(11): 1513-1521, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30022333

RESUMO

PURPOSE: Although randomized controlled trials (RCTs) are the gold standard for the assessment of clinical outcomes, long-term extension trials (LTEs) and observational cohorts may help generate evidence. Our goal was to compare the discontinuation rates of abatacept, rituximab, and tocilizumab in rheumatoid arthritis (RA) reported in different study designs. METHODS: A systematic review was conducted with searches in PubMed, Scopus, and the Cochrane Library, plus a manual search, for RCTs, LTEs, and observational cohorts reporting discontinuation rates by any of three causes (all-cause, inefficacy, adverse events). Meta-analyses with sensitivity analyses and meta-regressions were conducted. RESULTS: Of the 111 studies included, 74 were RCTs (n = 55) or LTEs (n = 17) reporting data on abatacept (n = 33), rituximab (n = 10), and tocilizumab (n = 31) and 37 were observational cohort studies (abatacept = 11, rituximab = 8, tocilizumab = 18). The follow-up duration did not differ among the study designs. Discontinuation rates were similar among the drugs but varied among the study designs. Discontinuation rates were significantly higher in cohort studies than those in interventional studies for the three drugs. Sensitivity analyses could not identify patient characteristics associated with these differences. Meta-regression analyses demonstrated no correlation between study follow-up duration and discontinuation rates. CONCLUSIONS: The discontinuation rates reported for non-anti-TNF drugs varied relative to the study design in which they were investigated. Regulatory agencies, price-setting entities, and evidence-gathering researchers should consider the effect of the real-life environment in their decisions and conclusions.


Assuntos
Antirreumáticos/administração & dosagem , Artrite Reumatoide/tratamento farmacológico , Projetos de Pesquisa , Abatacepte/administração & dosagem , Anticorpos Monoclonais Humanizados/administração & dosagem , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Rituximab/administração & dosagem
16.
CNS Drugs ; 32(9): 813-826, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30014314

RESUMO

BACKGROUND: A broad range of disease-modifying therapies (DMTs) for relapsing-remitting multiple sclerosis (RRMS) is available. However, the efficacy and safety of traditional DMTs compared with the recently developed DMTs remain unclear. OBJECTIVE: Therefore, we have synthesised available evidence of clinical outcomes for DMTs in adults with RRMS. METHODS: PubMed, Scopus and a manual search were performed. Bayesian network meta-analyses of randomised clinical trials assessing DMTs as monotherapies were conducted. SUCRA and GRADE were used to rank therapies and to assess quality of general evidence, respectively. RESULTS: Thirty-three studies were included in the meta-analyses. The most effective therapies for the outcome of annualised relapse rate were alemtuzumab (96% probability), natalizumab (96%) and ocrelizumab (85%), compared with all other therapies (hazard ratio versus placebo, 0.31, 0.31 and 0.37, respectively; p < 0.05 for all comparisons) (high-quality evidence). However, no significant differences among these three therapies were found. Discontinuation due to adverse events revealed similarity across all therapies, except for alemtuzumab, which showed less discontinuation when compared with interferon-1a intramuscular (relative risk 0.37; p < 0.05). CONCLUSION: High-quality evidence shows that alemtuzumab, natalizumab and ocrelizumab present the highest efficacy among DMTs, and other meta-analyses are required regarding adverse events frequency, to better understand the safety of therapies. Based on efficacy profile, guidelines should consider a three-category classification (i.e. high, intermediate and low efficacy).


Assuntos
Fatores Imunológicos/uso terapêutico , Esclerose Múltipla Recidivante-Remitente/tratamento farmacológico , Meta-Análise em Rede , Teorema de Bayes , Humanos
17.
Mycoses ; 61(10): 754-763, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29893450

RESUMO

Amphotericin formulations, indicated for invasive fungal infections (IFIs), vary in effectiveness, safety and costs. In Brazil, only the conventional formulation is provided by the Public Health System. The aim of this study was to perform a cost-effectiveness analysis comparing conventional amphotericin B (CAB), liposomal amphotericin B (LAB) and amphotericin B lipid complex (ABLC). Therefore, a decision tree was developed. The model began with high-risking patients on suspicion or confirmation of IFI. The analysis was conducted under the perspective of the Brazilian Public Health System. Model health states were defined according to medication use and clinical evolution. Clinical efficacy (cure) and transition probabilities were derived from the literature. Resource use was estimated from Brazilian data. Time horizon followed the maximum treatment time determined in the patient information leaflets (3 or 6 weeks). One-way and probabilistic-sensitivity analyses were conducted. The conventional formulation was the most cost-effective. No dominance was observed; however, high incremental cost-effectiveness ratios were obtained for LAB (USD 313 130) and ABLC (USD 1 711 280). Sensitivity analyses demonstrated the robustness of the results. CAB is the most cost-effective treatment, followed by LAB and ABLC. Although CAB presents critical safety aspects, the high acquisition costs of the other formulations prevent their large-scale use in Brazil.


Assuntos
Anfotericina B/economia , Anfotericina B/uso terapêutico , Antifúngicos/economia , Antifúngicos/uso terapêutico , Análise Custo-Benefício , Infecções Fúngicas Invasivas/tratamento farmacológico , Brasil , Humanos
18.
Braz. j. infect. dis ; 22(3): 186-192, May-June 2018. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-974205

RESUMO

ABSTRACT Background This study aimed to evaluate the clinical effectiveness in terms of sustained virological response and tolerability of available second generation direct-acting antivirals in Brazilian patients. Methods This was a retrospective observational study conducted in six centers in Southern Brazil. The sample comprised adult patients who were chronically infected with hepatitis C virus, regardless of virus genotype, fibrosis stage, or prior treatment. Statistical analysis was performed to compare the effectiveness among the treatments, and also to uncover the factors influencing the achievement of sustained virological response. Results A total of 296 patients were included in the study, with the majority receiving sofosbuvir with daclatasvir (59%) or sofosbuvir with simeprevir (26%). Overall sustained virological response rates were approximately 91.6%. For genotype 1, sofosbuvir with daclatasvir had an sustained virological response rate of approximately 95%, while the sustained virological response rate of sofosbuvir with simeprevir was 92%; this difference was statistically significant only for subtype 1b. The only treatment used for genotype 3 patients was sofosbuvir with daclatasvir, and lower rates of sustained virological response were observed for this group, compared to genotype 1 (84% versus 95%, p < 0.05). Apart from this difference between genotypes, and a difference between patients who achieved rapid virologic response compared with those who did not, there were no other statistically significant factors associated with sustained virological response. Conclusions The results point to the effectiveness of second-generation direct-acting antivirals in hepatitis C virus Brazilian patients, especially those with genotype 1. Furthermore, that patients with genotype 3 need more attention and adjustments in available treatment options.

19.
Radiol Bras ; 51(2): 102-105, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29743737

RESUMO

Objective: To describe the technique of injecting hemostatic matrix, as well as the experience of our interventional radiology department in its application. Materials and Methods: We conducted a single-center study with retrospective analysis of the experience of our group in the use of hemostatic gelatin matrix in percutaneous biopsies. Results: In a total of 73 biopsies in different organs, such as the liver, kidney, and spleen, hemostatic gelatin matrix was introduced into the coaxial needle. The only complication observed was migration of the hemostatic matrix to the left kidney collecting system, and that was resolved with clinical treatment. There were no cases of bleeding after the injection of hemostatic matrix. Conclusion: The use of hemostatic matrices in the path of percutaneous biopsies is another tool available for consideration in minimally invasive procedures.

20.
Braz J Infect Dis ; 22(3): 186-192, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29752891

RESUMO

BACKGROUND: This study aimed to evaluate the clinical effectiveness in terms of sustained virological response and tolerability of available second generation direct-acting antivirals in Brazilian patients. METHODS: This was a retrospective observational study conducted in six centers in Southern Brazil. The sample comprised adult patients who were chronically infected with hepatitis C virus, regardless of virus genotype, fibrosis stage, or prior treatment. Statistical analysis was performed to compare the effectiveness among the treatments, and also to uncover the factors influencing the achievement of sustained virological response. RESULTS: A total of 296 patients were included in the study, with the majority receiving sofosbuvir with daclatasvir (59%) or sofosbuvir with simeprevir (26%). Overall sustained virological response rates were approximately 91.6%. For genotype 1, sofosbuvir with daclatasvir had an sustained virological response rate of approximately 95%, while the sustained virological response rate of sofosbuvir with simeprevir was 92%; this difference was statistically significant only for subtype 1b. The only treatment used for genotype 3 patients was sofosbuvir with daclatasvir, and lower rates of sustained virological response were observed for this group, compared to genotype 1 (84% versus 95%, p<0.05). Apart from this difference between genotypes, and a difference between patients who achieved rapid virologic response compared with those who did not, there were no other statistically significant factors associated with sustained virological response. CONCLUSIONS: The results point to the effectiveness of second-generation direct-acting antivirals in hepatitis C virus Brazilian patients, especially those with genotype 1. Furthermore, that patients with genotype 3 need more attention and adjustments in available treatment options.


Assuntos
Antivirais/farmacologia , Hepatite C Crônica/tratamento farmacológico , Idoso , Brasil , Relação Dose-Resposta a Droga , Feminino , Hepatite C Crônica/complicações , Humanos , Imidazóis/farmacologia , Cirrose Hepática/virologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Valores de Referência , Estudos Retrospectivos , Ribavirina/farmacologia , Simeprevir/farmacologia , Sofosbuvir/farmacologia , Resposta Viral Sustentada , Fatores de Tempo , Carga Viral
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