Chronic Hepatitis C treatment for genotype 2 or 3 in Brazil: cost effectiveness analysis of peginterferon plus ribavirin as first choice treatment

Brazilian Guidelines to HCV treatment (2007) recommended that the first choice treatment for patients with chronic hepatitis C (CHC) and genotype 2 or 3 is interferon alpha (IFN) plus ribavirin (RBV) for 24 weeks. The aim of this study is compare the cost and effectiveness to Hepatitis C treatment in patients with genotype 2 or 3 of peginterferon alpha (PEG) as the first choice of treatment within PEG for those that do not respond to IFN. The target population is CHC patients with genotype 2 or 3 in Brazil. The interventions are: PEG-SEC (first IFN plus RBV for 24 weeks, after, for non-responders and relapsers subsequently PEG plus RBV for 48 weeks); PEG-FIRST24 (PEG+RBV for 24 weeks). The type of the study is cost-effectiveness analysis. The data sources are: Effectiveness data from meta-analysis conducted on the Brazilian population. Treatment cost from Brazilian micro costing study is converted into USD (2010). The perspective is the Public Health System. The outcome measurements are Sustained Viral Response (SVR) and costs. PEG-FIRST24 (SVR: 87.8%, costs: USD 8,338.27) was more effective and more costly than PEG-SEC (SVR: 79.2%, costs: USD 5,852.99). The sensitivity analyses are: When SVR rates with IFN was less than 30% PEG-FIRST is dominant. On the other hand, when SVR with IFN was more then 75% PEG-SEC is dominant (SVR=88.2% and costs USD $ 3,753.00). PEG-SEC is also dominant when SVR to PEG24 weeks was less than 54%. In the Brazilian context, PEG-FIRST is more effective and more expensive than PEG-SEC. PEG-SEC could be dominant when rates of IFN therapy are higher than 75% or rates of PEG24 therapy are lower than 54%

Sustained virological response to treatment of chronic hepatitis C with peginterferon alfa and ribavirin

This study aimed to evaluate the rate of sustained virological response (SVR) and the clinical and treatment characteristics of patients with chronic hepatitis C (CHC). A retrospective uncontrolled cohort study was conducted among patients who received treatment for CHC between 2005 and 2008 attended at the Center for the Application and Monitoring of Injectable Medications, in Florianopolis, SC, Brazil. The inclusion criteria were: patients over 18 years of age, with a confirmed diagnosis of chronic hepatitis C according to Brazilian guidelines, treated with PEG-IFN alfa-2a or 2b associated with RBV. A total of 188 patients were included in the study: 70% men, 59% genotype 1, 27% coinfected with HIV, 31% with cirrhosis. The SVR rate, calculated by probability theory, was determined as 26% (max=57.4% and min=12.8%) and the intention to treat was 12.8%. Associations between Sustained Virological Response (SVR) and the variables sex (p=0.017), age (p=0.003), genotype (p=0.648) and cirrhosis (p=0.275), were determined in the bivariate analysis and only sex and age were significantly associated with SVR. The SVR rate was considered low, which can be partially explained by patients' unfavorable pretreatment characteristics.O objetivo do estudo foi avaliar a taxa de resposta viral sustentada (RVS) e as características clínicas e do tratamento dos pacientes portadores de hepatite C crônica. Realizou-se uma coorte retrospectiva não controlada com recorte temporal dos anos de 2005 a 2008, dos pacientes atendidos no Polo de Aplicação e Monitoramento de Medicamentos Injetáveis, em Florianópolis, SC. Os critérios de inclusão foram: pacientes maiores de 18 anos, com diagnóstico confirmado de hepatite C crônica de acordo com o protocolo brasileiro, tratados com PEG-IFN alfa-2a ou 2b associado a ribavirina. Total de 188 pacientes foi incluído no estudo, 70% homens, 59% genótipo 1, 27% co-infectados com o HIV e 31% apresentando cirrose. A taxa de RVS calculada através da teoria das probabilidades foi de 26% (max=57,4% and min=12,8%) e por intenção de tratamento de 12,8%. Verificou-se a associação da RVS com as variáveis: sexo (p=0,017), idade (p=0,003), genótipo (p=0,648) e presença de cirrose (p=0,275). Somente sexo e idade foram associados significativamente com a RVS. A taxa de RVS foi considerada baixa e, em parte, pode ser explicada pelas características desfavoráveis dos pacientes para a obtenção de RVS

Quantum Computing with Trapped Ion Hyperfine Qubits

We discuss the basic aspects of quantum information processing with trapped ions, including the principles of ion trapping, preparation and detection of hyperfine qubits, single-qubit operations and multi-qubit entanglement protocols. Recent experimental advances and future research directions are outlined.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45527/1/11128_2004_Article_489417.pd

Evaluation of a screening technique for manganese toxicity in relation to leaf manganese distribution and interaction with silicon.

A screening technique utilizing a flowing nutrient culture was used to evaluate 20 lettuce cultivars differing in the severity of the toxicity symptoms marginal yellowing and necrosis in older leaves. Growth, leaf and root Mn contents and toxicity ratings (1 = no symptoms to 5 = high toxicity) were recorded over six Mn and two Si concentrations. A test solution of 0.5-1.0 mg/l Mn produced consistent toxicity ratings and the ratings for tolerant and sensitive cultivars were similar to ratings for the same cultivars grown under glasshouse conditions. Total Mn content in leaves was not a useful index for Mn sensitivity. Increased Si resulted in a repression of toxicity symptoms and decreased shoot/root Mn ratios in 12 cultivars. ADDITIONAL ABSTRACT: A screening technique was developed to evaluate lettuce cultivars for manganese tolerance in flowing nutrient culture. Considerable variation in the sensitivity of 20 cultivars was observed, as shown by visible symptoms. However there was no correlation between accumulation of Mn in leaves and roots and the degree of Mn tolerance. Increasing silicon in the solution repressed Mn toxicity symptoms, but had variable effects on the Mn content of leaves and roots. (Abstract retrieved from CAB Abstracts by CABI’s permission)</jats:p