Cost-Effectiveness of Molecular Method Diagnostic for Rapid Detection of Antibiotic-Resistant Bacteria.

OBJECTIVES: This study aimed to perform a cost-effectiveness analysis (CEA) of the molecular diagnostic method (MM) associated with conventional diagnostic method (CM) compared with the CM alone, for the detection of resistant profile in bacteremia, from the perspective of the Brazilian Public Health System, in intensive care units setting. METHODS: The clinical parameters regarding methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Gram-negative bacteria (CRGNB), and vancomycin-resistant Enterococcus spp. (VRE) infections were collected from searches on PubMed, Scopus, and SciELO, using specific keywords. Data on direct medical costs to treat these infections were collected according to Brazilian Public Health System perspective from Brazilian databases, in tables of 2018 to 2019. CEA was performed after building a dynamic model, which was calibrated and validated according to international recommendations. The incremental cost-effectiveness ratio of the MM + CM compared with the CM was calculated using the outcomes "avoided death" and "avoided resistant infections." One-way sensitivity analyses were performed. RESULTS: This CEA demonstrated that the MM + CM was dominant in all scenarios. Estimates showed that for MRSA, CRGNB, and VRE infections, every avoided death would lead to savings of Brazilian real (R$) 4.9 million ($937 301), R$2.2 million ($419 899), and R$1.3 million ($248 919), respectively. The same infections assessed by avoided resistant infections savings were projected to be R$24 964 ($4686), R$40 260 ($7558), and R$23 867 ($4480). CONCLUSIONS: MM leads to cost reduction and increased benefits, optimizing the use of financial resources on the health system in the intensive care unit setting, in bacteremia caused by MRSA, CRGNB, and VRE.

Responses of marine zooplankton indicators after five years of a dam rupture in the Doce River, Southeastern Brazil.

Since November of 2015, when ore tailings from a dam rupture reached the Atlantic Ocean, researchers are trying to assess the degree of impact across the Doce River and adjacent coastal area. This study aims to use the zooplankton dynamics as a tool to evaluate the environmental impact in the coastal region, five years after the rupture, during periods of low and high river flow. Doce River flow varied from 49 to 5179 m3/s and structured the zooplankton community between periods of low and high river flow, but salinity and chlorophyll-a had stronger correlation with depth (r = 0.40 and - 0.40 respectively) than with the Doce River discharge variation along the sampling period (r < 0.2). On the other hand, inorganic particles in the water and total metal concentration (dissolved + particulate), used as tracers of the iron enriched tailing (Al, Cd, Cr, Cu, Fe, V), were correlated with fluvial discharge and showed to be the main factor driving the zooplankton community dynamics. For assessing the degree of environmental impact, we tested the ecological indexes for the zooplankton community. Margalef Richness, Pielou Evenness and Shannon-Wiener Diversity varied from 2.52, 0.40 and 1.39 (all registered during high river flow period) to 9.02, 0.85 and 3.44 (all registered during low river flow period), respectively. Along with those community indicators, we evaluated the response of representative taxonomical genera such as Paracalanus, Oikopleura and Temora, regarding the Doce River flow, and found population patterns that established a baseline for future monitoring in the region. Our results showed that the zooplankton community is more fragile when the river discharge is stronger, and this pattern is confirmed by all indicators tested.

The Tentacular Strike Behavior in Squid: Functional Interdependency of Morphology and Predatory Behaviors During Ontogeny.

This study examines the relationship between morphology and predatory behaviors to evaluate the ontogeny of the specialized tentacular strike (TS) in Doryteuthis opalescens squid reared under laboratory conditions [hatching to 80 day-old; 2-16 mm mantle length (ML)]. Ontogenetic morphological changes in the arm-crown and the role played by the arms and tentacles during predatory behavior was correlated with prey types captured and revealed interconnected morphological and behavior traits that enabled paralarvae to perform the TS. Hatchlings have a poorly developed arm-crown and tentacles that resemble and function as arms, in which tentacular clubs (suckerfull non-contractile portion) and stalks (suckerless contractile portion) have not yet formed. Only a basic attack (BA) behavior was observed, involving arms and tentacles, which were not ejected during prey capture. A more elaborated behavior, the arm-net (AN) was first employed by 30 day-old (>4.7 mm ML) paralarvae, in which the tentacles were eject down, but not toward the prey. The TS was first observed in 40-50 day-old (6.7-7.8 mm ML) squid, which stay stationary by sustainable swimming prior to ejecting the tentacles toward the prey. Thus, the ability to perform sustainable swimming and acquisition of swimming coordination (schooling behavior) are prerequisites for the expression of the TS. The arms played the same roles after prey was captured: hold, subdue and manipulate the prey, while the actions performed by the tentacles truly defined each behavior. Prey size captured increased with increasing squid size. Morphometric data showed that hatchlings have little ability of elongating their tentacles, but this ability increases significantly with size. Squid older than 40 days could elongate their tentacles up to 61% of their ML, whereas early paralarvae 13% on average. Paralarvae were frequently observed elongating and contracting their tentacles, while not attempting to capture prey, which could perhaps serve to adjust muscle activity and development, while specializations for the strike - stalks, clubs, muscle fibers, arm-crown and swimming coordination - are still being developed. The expression of the TS is constrained by development in early paralarvae as it involves interdependency of morphology and behavior and as such, represents a major developmental milestone in the early life history of squid.