Lacuna Mozambique : adding an important piece to the African jigsaw puzzle

Reconstructing historical biogeography is similar to assembling a jigsaw puzzle, every piece added reveals a little bit more of the overall picture. In this thesis I present and discuss the diversity of species found on the mountains of northern Mozambique and explore the relationships between assemblages of different mountains. This study reveals a complex history of lineage diversification within species of amphibians and proposes hypotheses to explain the biogeographical patterns observed. The mountains of northern Mozambique are in the crossroads between two faunal groups, Afrotemperate and Afrotropical, which partially explain the complexity of this regions biota. Most of the species found on these mountains are biogeographically related to the lowland forest of East Africa, though some strictly montane species are also present. Furthermore, this thesis provides predictions regarding species potential distributions across other unexplored mountains of this region. Some of the hypotheses and predictions presented in this thesis can potentially be tested in the future. Finally, this thesis adds another piece to the African jigsaw puzzle shedding light on the complex biogeographical history of amphibians

Cost-effectiveness analysis and budgetary impact of anidulafungin treatment for patients with candidemia and other forms of invasive candidiasis in Brazil

Candidemia and other forms of invasive candidiasis (C/IC) are serious conditions, especially for immunosuppressed individuals with prolonged hospitalization in intensive care units (ICU). This study analyzed the incremental cost-effectiveness and budgetary impact (BI) of treatment for IC with anidulafungin compared to amphotericin B lipid complex (ABLC) and amphotericin B deoxycholate (ABD) or conventional amphotericin B (CAB), in the Brazilian Unified Health System (SUS). A decision model was conducted with a time horizon of two weeks from the perspective of SUS. The primary effectiveness endpoints were survival and treatment response rate. All patients were followed up until successful therapy or death. BI analysis was performed based on the measured demand method. A five-year time horizon was adopted based on the number of hospitalizations (per 1,000 hospitalizations). For effectiveness measured in the successful response rate (SRR), anidulafungin dominated the ABLC and ABD formulations. In the results of the analysis with the effectiveness measured according to survival, anidulafungin had a better cost-effectiveness ratio (R$988.26/survival) compared to ABD (R$16,359.50/survival). The BI estimate related to the incorporation of anidulafungin suggests savings of approximately 148 million reais in 5 years when comparing it to ABD. The economic evaluation of anidulafungin and its comparators found it to be cost-effective. The consensus of international scientific societies recommends it as a first-line drug for IC, and its incorporation by SUS would be important

Exploration into the hidden world of Mozambique’s sky island forests:new discoveries of reptiles and amphibians

We carried out a survey of reptiles and amphibians within Afromontane forest and woodland slopes of three inselbergs in northern Mozambique (Mount Mabu, Mount Namuli, and Mount Ribáuè). A total of 56 species (22 amphibians and 34 reptiles) were recorded during the current survey. Our findings substantially increase the number of herpetofaunal species recorded from these mountains (Mount Ribáuè 59%, Mount Mabu 37%, and Mount Namuli 11% of the total species), including one new country record and several putative new species. An updated checklist of the herpetofauna of these mountains is presented

TRASTUZUMAB IN METASTATIC BREAST CANCER: SYSTEMATIC REVIEW OF COST-EFFECTIVENESS ANALYSES

Objective: To conduct a systematic review of cost-effectiveness analyses of trastuzumab in patients with metastatic breast cancer overexpressing human epidermal growth factor receptor 2.Methods: A systematic review for the years 1998 to 2013 was conducted. A survey of the scientific literature was performed using six electronic databases, two search tools on the internet and a manual search of references using search strategies for each database. The selected studies were assessed for quality according to specific methodology. Data analysis was performed by converting the costs and by observations made from the incremental cost-effectiveness ratios of trastuzumab.Results: From a detailed analysis of 521 retrieved articles, 13 articles were selected for this review. The treatment regimens adopted for cost-effectiveness were varied. Eight studies compared treatment with trastuzumab as first line for metastatic disease, and five studies compared treatment with trastuzumab as the second line. All the studies were using trastuzumab as second-line treatment was not considered a cost-effective intervention. The analyses used different thresholds to determine whether treatment with trastuzumab was cost-effective as well as to determine differences in modeling costs, outcomes and treatment patterns.Conclusion: The use of trastuzumab, alone or combined, was cost-effective as first-line treatment. Differences were found in the quality of the included studies. Conducting new cost-effectiveness analyses of trastuzumab in metastatic breast cancer is required, in alliance with political, social and administrative factors, to help decision makers concerning its incorporation

COST-EFFECTIVENESS ANALYSIS OF TRASTUZUMAB EMTANSINE IN THE TREATMENT OF METASTATIC BREAST CANCER

Objective: To investigate the cost-effectiveness of second-line pharmacological treatments for metastatic breast cancer (MBC) by comparing trastuzumab emtansine (T-DM1) versus a combination of lapatinib and capecitabine (LAP+CAP) from the perspective of the Brazilian health system, the Unified Health System (Sistema Único de Saúde–SUS).Methods: The results of each treatment were simulated based on a three-state Markov decision model applied to a hypothetical cohort of 1,000 women, aged 50 y old or older, with MBC and HER2 (human epidermal growth factor receptor 2) overexpression. The data on the effectiveness of treatments were taken from reports in the literature. The period considered for simulation was three years subdivided into monthly cycles of transition between health states. A discount rate of 5% per year was applied to costs and outcomes. Possible uncertainty was assessed by means of a sensitivity analysis.Results: Chemotherapy for women with refractory MBC using T-DM1 monotherapy was ruled out by extended dominance. Treatment with LAP+CAP proved to be the most efficient strategy because the cost in relation to the overall survival (BRL 72,035.43/quality-adjusted life year–QALY) was the lowest and fell within the acceptability threshold, BRL 86,628.00.Conclusion: T-DM1 demonstrated pharmacological superiority over other agents used for the treatment of MBC in clinical studies. However, the price set for T-DM1 in Brazil is the determinant variable that contraindicates its inclusion in the SUS, in agreement with other international assessments

CALIDAD DE VIDA RELACIONADA CON SALUD, ANSIEDAD, DEPRESIÓN Y VARIABLES CARDIOMETABÓLICAS EN PERSONAS CON DIABETES TIPO 2

Type 2 diabetes Mellitus is related to the increase prevalence of mental health problems. The aim of this study was to a) verify the anxiety and health-related quality of life (HRQoL) of diabetics with and without symptoms of depression; b) correlate HRQoL with blood glucose levels and abdominal adiposity and c) investigate if there is difference between genders. Ninety-six individuals, with an average age of 56.2 ± 9.6 years, men and women, carried out anthropometric measure: waist circumference (WC), body mass index, evaluation of blood pressure (BP), heart rate (HR) and fasting blood glucose. The Beck Depression Inventory, the Trait-State Anxiety Inventory and the SF-36 Questionnaire verified the presence of depressive symptoms, the anxiety level and the HRQoL respectively. Most individuals were overweight (78%) and altered WC (72.9%). The depression’s prevalence was 34.1%, and the levels of trait and state anxiety were 63.3% and 77%. Individuals with depression had worse HRQoL, anxiety (trait) and altered WC, but without differences in HR and BP. Men had better HRQoL and lower levels of depression than women. Cardiometabolic variables (abdominal adiposity and blood glucose) correlated with altered HRQoL, despite gender. In men, correlations between glycemia and functional capacity, and HR with mental health were observed. In women, anxiety levels correlated with functional capacity and abdominal adiposity. Diabetes is directly related to biopsychosocial factors, mainly HRQoL and depression. In addition, depressive diabetics have worse HRQoL, more anxiety and, in men, changes in body composition.O diabetes Mellitus tipo 2 está relacionado ao aumento da prevalência de problemas de saúde mental. O objetivo deste estudo foi a) verificar a ansiedade e a qualidade de vida relacionada à saúde (QVRS) de diabéticos com e sem sintomas de depressão; b) correlacionar QVRS com glicemia e adiposidade abdominal ec) investigar se há diferença entre os sexos. Noventa e seis indivíduos, com idade média de 56,2 ± 9,6 anos, homens e mulheres, realizaram medidas antropométricas: circunferência da cintura (CC), índice de massa corporal, avaliação da pressão arterial (PA), frequência cardíaca (FC) e glicemia de jejum. O Inventário de Depressão de Beck, o Inventário de Ansiedade Trait-State e o Questionário SF-36 verificaram a presença de sintomas depressivos, o nível de ansiedade e a QVRS respectivamente. A maioria dos indivíduos apresentava excesso de peso (78%) e CC alterada (72,9%). A prevalência de depressão foi de 34,1%, e os níveis de ansiedade traço e estado foram de 63,3% e 77%. Indivíduos com depressão apresentaram pior QVRS, ansiedade (traço) e CC alterada, mas sem diferenças na FC e PA. Os homens apresentaram melhor QVRS e menores níveis de depressão do que as mulheres. Variáveis cardiometabólicas (adiposidade abdominal e glicemia) correlacionaram-se com alteração da QVRS, independente do sexo. Nos homens, foram observadas correlações entre glicemia e capacidade funcional e FC com saúde mental. Nas mulheres, os níveis de ansiedade correlacionaram-se com a capacidade funcional e adiposidade abdominal. O diabetes está diretamente relacionado a fatores biopsicossociais, principalmente QVRS e depressão. Além disso, diabéticos depressivos apresentam pior QVRS, mais ansiedade e, nos homens, alterações na composição corporal.La diabetes mellitus tipo 2 se relaciona con una mayor prevalencia de problemas de salud mental. El objetivo de este estudio fue a) verificar la ansiedad y la calidad de vida relacionada con la salud (CVRS) de diabéticos con y sin síntomas de depresión; b) correlacionar la CVRS con la glucemia y la adiposidad abdominal yc) investigar si existe diferencia entre sexos. A 96 individuos, con una edad media de 56,2 ± 9,6 años, hombres y mujeres, se les realizaron mediciones antropométricas: circunferencia de cintura (CC), índice de masa corporal, presión arterial (PA), frecuencia cardíaca (FC) y glucemia en ayunas. El Inventario de Depresión de Beck, el Inventario de Ansiedad Rasgo-Estado y el Cuestionario SF-36 verificaron la presencia de síntomas depresivos, el nivel de ansiedad y la CVRS respectivamente. La mayoría de los individuos tenían sobrepeso (78%) y CC alterada (72,9%). La prevalencia de depresión fue del 34,1%, y los niveles de ansiedad rasgo y estado fueron del 63,3% y 77%. Los individuos con depresión tenían peor CVRS, ansiedad (rasgo) y CC alterada, pero sin diferencias en FC y PA. Los hombres tenían mejor CVRS y niveles más bajos de depresión que las mujeres. Las variables cardiometabólicas (adiposidad abdominal y glucemia) se correlacionaron con cambios en la CVRS, independientemente del sexo. En los hombres se observaron correlaciones entre la glucemia y la capacidad funcional y la FC con la salud mental. En las mujeres, los niveles de ansiedad se correlacionaron con la capacidad funcional y la adiposidad abdominal. La diabetes está directamente relacionada con factores biopsicosociales, principalmente la CVRS y la depresión. Además, los diabéticos depresivos tienen peor CVRS, más ansiedad y, en los hombres, cambios en la composición corporal

COST-EFFECTIVENESS ANALYSIS OF TRASTUZUMAB IN THE TREATMENT OF METASTATIC BREAST CANCER

Objective: To perform a cost-effectiveness analysis of pharmacological treatments for MBC in the context of the Brazilian Unified Health System (Sistema Único de Saúde - SUS) by comparing the drugs docetaxel and paclitaxel in isolation and in combination with trastuzumab. Methods: The results for each treatment were simulated using a Markov model and a hypothetical cohort of 1000 women aged 50 years diagnosed with MBC with overexpression of HER2. The progression of MBC was simulated for 48 months and the transitions between health states occurred monthly. A sensitivity analysis was performed. The discount rate considered was 5% per year. Results: The addition of trastuzumab allowed a gain of eight to ten months in the average lifespan after a four-year treatment. The increased threshold allows the increased use of trastuzumab combined with paclitaxel in the treatment of MBC. The combination of trastuzumabwith docetaxel and paclitaxel achieved an effective gain in the survival of patients with MBC, and the average survival time doubled compared with monotherapy. Conclusion: Considering that the costs per quality-adjusted life year (QALY) of these treatment strategies were below the threshold of 3 times the per capita GDP recommended by WHO, both strategies can be considered cost-effective

Perda de Produtividade Atribuída a Neoplasias na América do Sul

Introdução: A carga da doença tem sido empregada em estimativas do impacto das neoplasias, mas a perda de produtividade em razão dessas enfermidades ainda não foi tão explorada. Objetivo: Estimar os anos de vida produtiva perdidos (AVPP) e a perda de produtividade por conta da mortalidade prematura relacionada ao câncer em países da América do Sul em 2019. Método: Dados de mortalidade disponíveis no Global Burden of Disease (GBD) Study 2019 foram usados para estimar a carga de doença atribuível a neoplasias. A perda de produtividade em termos monetários foi calculada usando um proxy da abordagem do capital humano (ACH). Os cálculos foram realizados por sexo, nas faixas etárias de trabalho. Resultados: O total de óbitos foi de 192.240 e o de AVPP, 2.463.155. A perda total de produtividade permanente foi de US$4,4 bilhões e US$ 9,4 bilhões em purchasing power parity (PPP) – 0,13% do produto interno bruto (PIB) da região. O custo total por morte foi de US$ 23.617. Houve diferenças significativas entre os países, mas a variação dos cenários mostra robustez das estimativas. Conclusão: O câncer impõe um ônus econômico significativo à América do Sul tanto em termos de saúde quanto de produtividade. Sua caracterização pode subsidiar os governos na alocação de recursos destinados ao planejamento de políticas e execução de intervenções de saúde

Oral myiasis in a patient with neurological deficit - Case report / Miíase oral em paciente com déficit neurológico - Relato de caso

The term "myiasis" refers to human and animal parasites caused by fly larvae. The clinical manifestations of myiasis are not specific, they vary according to the area of the body involved and the species of fly. It is strongly associated with poor oral hygiene and is seen in people with predisposing conditions, such as lack of lip sealing due to malocclusion, tooth extraction, decreased body resistance, malnutrition, open-mouth breathing (especially during sleep), alcoholism, senility, neurological disorder, hemiplegia and facial trauma. The present work describes the particularities of diagnosis and treatment of a case of oral myiasis. A 17-year-old male patient with neurological deficit, totally dependent on his daily life activities. Oral examination revealed poor oral hygiene, presence of periodontitis and lesions in the palate and gingival regions, with swelling and presence of large numbers of larvae. Surgery under local anaesthesia was performed. After exposure of the affected region, the larvae were removed. Sixty-two larvae of various sizes were observed. Early and correct diagnosis of oral myiasis can be easily treated by the dentist by mechanical removal of the larvae with or without the use of local chemicals, with a favourable prognosis