Estimate of Effectiveness of Palivizumab in the Prevention of Respiratory Syncytial Virus-Related Hospitalizations in a Cohort of Premature Children

As recomendações da Secção de Neonatologia da Sociedade Portuguesa de Pediatria (SNN-SPP) prevêem a profilaxia medicamentosa da infecção por vírus sincicial respiratório (VSR) com palivizumab em idades gestacionais (IG)inferiores a 30 semanas. Alguns Hospitais de Apoio Perinatal Diferenciado seguem práticas mais restritas, limitando o seu uso à extrema prematuridade e/ou a prematuros com doença pulmonar crónica da prematuridade. Objectivos. Estimar a relação custo-eficácia da profilaxia com palivizumab segundo as recomendações da SNN-SPP, através da aplicação de um modelo teórico a uma coorte real de prematuros. Metodologia. Estudo prospectivo histórico. Coorte de crianças nascidas num Hospital de Apoio Perinatal Diferenciado entre 1/10/2002 e 30/04/2005 com IG ² 35 semanas. Considerou- se caso o internamento no mesmo hospital por bronquiolite por VSR nas épocas 2003/04 e 2004/05. Baseando-nos nas recomendações SNN-SPP e no Number Needed to Treat dos estudos IMpact e IRIS, estimámos a redução prevista nas taxas de hospitalização caso a profilaxia fosse efectuada, comparando os seus custos com a redução de custos de hospitalização. Resultados. Dos 356 recém-nascidos elegíveis, nove foram excluídos por óbito e dois por administração de palivizumab. A taxa de hospitalização por bronquiolite por VSR nas 345 crianças incluídas foi 9,3%. No subgrupo com indicação para profilaxia (26 crianças) a taxa de hospitalização foi 15,4%, com uma estimativa de custo médio de hospitalização de Û 6.542,35. Não ocorreu nenhuma morte por infecção por VSR. A redução estimável no número de hospitalizações sob profilaxia seria de 1,5 (IMpact) ou 2,4 (IRIS). O custo necessário para prevenir um internamento seria de Û 26.263,11 na melhor estimativa e Û 57.716,26 na pior estimativa. Conclusão. Com o modelo desenvolvido, não conseguimos demonstrar nesta coorte uma estimativa de relação custo-eficácia favorável à administração de Palivizumab segundo recomendações da SNN-SPP

Advanced ultra-light multifunctional metallic-glass wave springs

We show that, using thermo -elastic processing, metallic -glass foils can be shaped, without being embrittled, into linear and annular wave springs. These springs exhibit an undulatory behaviour, unique to metallic -glass foils, in which under compression the number of arcs in the spring increases, increasing the load -bearing capacity and the spring constant. We evaluate the performance limits of the metallic -glass wave springs, and consider how the undulatory behaviour can be exploited. The metallic -glass springs can operate over the same load -ranges as commercially available crystalline wave springs, but have material volumes (and therefore weights) that are one to two orders of magnitude less. Their energy storage per unit material volume is as high as 2600 kJ m – 3 . We suggest that the undulatory behaviour is important in rendering the springs fail -safe in case of overload. We discuss the range of applicability of thermo -elastic processing, the likely working limit of metallic -glass wave springs, and the potential for application of metallic -glass springs in MEMS devices

Micro-costing analysis of guideline-based treatment by direct-acting agents: the real-life case of hepatitis C management in Brazil

Background Eradication of hepatitis C virus (HCV) using direct-acting agents (DAA) has been associated with a financial burden to health authorities worldwide. We aimed to evaluate the guideline-based treatment costs by DAAs from the perspective of the Brazilian Ministry of Health (BMoH). Methods The activity based costing method was used to estimate the cost for monitoring/treatment of genotype-1 (GT1) HCV patients by the following strategies: peg-interferon (PEG-IFN)/ribavirin (RBV) for 48 weeks, PEG-IFN/RBV plus boceprevir (BOC) or telaprevir (TEL) for 48 weeks, and sofosbuvir (SOF) plus daclastavir (DCV) or simeprevir (SIM) for 12 weeks. Costs were reported in United States Dollars without (US$) and with adjustment for purchasing power parity (PPP$). Drug costs were collected at the National Database of Health Prices and an overview of the literature was performed to assess effectiveness of SOF/DCV and SOF/SIM regimens in real-world cohorts. Results Treatment costs of GT1-HCV patients were PPP$43,176.28 (US$ 24,020.16) for PEG-IFN/RBV, PPP$71,196.03 (US$ 39,578.23) for PEG-IFN/RBV/BOC and PPP$86,250.33 (US$ 47,946.92) for PEG-IFN/RBV/TEL. Treatment by all-oral interferon-free regimens were the less expensive approach: PPP$19,761.72 (US$ 10,985.90) for SOF/DCV and PPP$21,590.91 (US$ 12,002.75) for SOF/SIM. The overview reported HCV eradication in up to 98% for SOF/DCV and 96% for SOF/SIM. Conclusion Strategies with all oral interferon-free might lead to lower costs for management of GT1-HCV patients compared to IFN-based regimens in Brazil. This occurred mainly because of high discounts over international DAA prices due to negotiation between BMoH and pharmaceutical industries

Phylogeny, ultrastructure, histopathology and prevalence of Myxobolus oliveirai sp. nov., a parasite of Brycon hilarii (Characidae) in the Pantanal wetland, Brazil

This paper presents the morphological, histological and ultrastructural characteristics of Myxobolus oliveirai sp. nov., a parasite of the gill filaments in Brycon hilarii from the Brazilian Pantanal. Out of 216 B. hilariispecimens examined (126 wild and 90 cultivated), 38.1% of wild specimens (n = 48) were infected. The parasites form elongated plasmodia primarily in the tip of gill filaments, reaching about 3 mm in length. A thorough comparison with all the Myxobolus species described from South American hosts, as well as nearly all the Myxobolus species described so far is provided. Partial sequencing of the 18S rDNA gene revealed a total of 1,527 bp. The Myxobolus species parasite of B. hilarii did not match any of the Myxozoa available in GenBank. In the phylogenetic analysis, M. oliveirai sp. nov. composed a monophyletic group with eight other species: five species of Myxobolus parasites of mugilid fishes, two parasites of pangasiid and one of centrarchid. Infection prevalence values of the parasite revealed no significant differences between wet and dry seasons or between males and females. The importance of the infection to the farming of the host species is emphasized.FAPESPCEPTA - ICMBioCoordenacao de Aperfeicoamento de Pessoal de Nivel Superior (CAPES

An Evaluation of Prediction Equations for the 6 Minute Walk Test in Healthy European Adults Aged 50-85 Years

This study compared actual 6 minute walk test (6MWT) performance with predicted 6MWT using previously validated equations and then determined whether allometric modelling offers a sounder alternative to estimating 6MWT in adults aged 50-80 years.We compared actual 6MWT performance against predicted 6MWT in 125 adults aged 50-85 years (62 male, 63 female). In a second sample of 246 adults aged 50-85 years (74 male, 172 female), a new prediction equation for 6MWT performance was developed using allometric modelling. This equation was then cross validated using the same sample that the other prediction equations were compared with.Significant relationships were evident between 6MWT actual and 6MWT predicted using all of the commonly available prediction equations (all P<0.05 or better) with the exception of the Alameri et al prediction equation (P>0.05). A series of paired t-tests indicated significant differences between 6MWT actual and 6MWT predicted for all available prediction equations (all P<0.05 or better) with the exception of the Iwama et al equation (P = .540). The Iwama et al equation also had similar bias (79.8m) and a coefficient of variation of over 15%. Using sample 2, a log-linear model significantly predicted 6MWT from the log of body mass and height and age (P = 0.001, adjusted R2 = .526), predicting 52.6% of the variance in actual 6MWT. When this allometric equation was applied to the original sample, the relationship between 6MWT actual and 6MWT predicted was in excess of values reported for the other previously validated prediction equations (r = .706, P = 0.001). There was a significant difference between actual 6MWT and 6MWT predicted using this new equation (P = 0.001) but the bias, standard deviation of differences and coefficient of variation were all less than for the other equations.Where actual assessment of the 6MWT is not possible, the allometrically derived equation presented in the current study, offers a viable alternative which has been cross validated and has the least SD of differences and smallest coefficient of variation compared to any of the previously validated equations for the 6MWT

Time to harmonize dengue nomenclature and classification

Dengue virus (DENV) is estimated to cause 390 million infections per year worldwide. A quarter of these infections manifest clinically and are associated with a morbidity and mortality that put a significant burden on the affected regions. Reports of increased frequency, intensity, and extended geographical range of outbreaks highlight the virus's ongoing global spread. Persistent transmission in endemic areas and the emergence in territories formerly devoid of transmission have shaped DENV's current genetic diversity and divergence. This genetic layout is hierarchically organized in serotypes, genotypes, and sub-genotypic clades. While serotypes are well defined, the genotype nomenclature and classification system lack consistency, which complicates a broader analysis of their clinical and epidemiological characteristics. We identify five key challenges: (1) Currently, there is no formal definition of a DENV genotype; (2) Two different nomenclature systems are used in parallel, which causes significant confusion; (3) A standardized classification procedure is lacking so far; (4) No formal definition of sub-genotypic clades is in place; (5) There is no consensus on how to report antigenic diversity. Therefore, we believe that the time is right to re-evaluate DENV genetic diversity in an essential effort to provide harmonization across DENV studies.publishersversionpublishe