Shortened first-line TB treatment in Brazil: potential cost savings for patients and health services.

BACKGROUND: Shortened treatment regimens for tuberculosis are under development to improve treatment outcomes and reduce costs. We estimated potential savings from a societal perspective in Brazil following the introduction of a hypothetical four-month regimen for tuberculosis treatment. METHODS: Data were gathered in ten randomly selected health facilities in Rio de Janeiro. Health service costs were estimated using an ingredient approach. Patient costs were estimated from a questionnaire administered to 126 patients. Costs per visits and per case treated were analysed according to the type of therapy: self-administered treatment (SAT), community- and facility-directly observed treatment (community-DOT, facility-DOT). RESULTS: During the last 2 months of treatment, the largest savings could be expected for community-DOT; on average USD 17,351-18,203 and USD 43,660-45,856 (bottom-up and top-down estimates) per clinic. Savings to patients could also be expected as the median (interquartile range) patient-related costs during the two last months were USD 108 (13-291), USD 93 (36-239) and USD 11 (7-126), respectively for SAT, facility-DOT and community-DOT. CONCLUSION: Introducing a four-month regimen may result in significant cost savings for both the health service and patients, especially the poorest. In particular, a community-DOT strategy, including treatment at home, could maximise health services savings while limiting patient costs. Our cost estimates are likely to be conservative because a 4-month regimen could hypothetically increase the proportion of patients cured by reducing the number of patients defaulting and we did not include the possible cost benefits from the subsequent prevention of costs due to downstream transmission averted and rapid clinical improvement with less side effects in the last two months

EFICÁCIA DAS ENTEROCINAS NO DESENVOLVIMENTO DO CÂNCER COLORRETAL: UMA ANÁLISE EXPERIMENTAL

The objective of this study was to evaluate the efficacy of enterocins produced by Enterococcus faecium 141v and 137v, probiotics, from artisanal rennet cheese from Pernambuco on the development of colorectal cancer in an in vivo study. As a methodology, protease sensitivity tests were carried out in order to prove its protein properties, in addition to its biological activity as an antimicrobial. Ultrasonography was used to evaluate the effect of Enterocins on colorectal cancer induced by 1,2 Dimethylhydrazine (DMH) in Wistar rats. The results obtained in vitro demonstrated the peptide nature of the Enterocins as well as their effectiveness in terms of antimicrobial activity. As for the in vivo results evaluated on ultrasound, it was possible to observe the decrease in the thickness of the intestinal wall of the rats that underwent colorectal cancer induction and treated with Enterocins, which can be explained by the possible apoptotic stimulation, aiming at the inhibition of cancer cells. This study provided important aspects regarding the use of enterocins for therapeutic purposes, especially in the prevention and control of colorectal cancer in an animal model. Also highlighted the use of ultrasound to evaluate the effect of enterocins on disease development, showing that a method that considers the animal welfare to be less invasive and effective. The results of this study reinforce the need for studies to further investigate the issue. In addition, they add knowledge in several areas such as biotechnology, microbiology, medicine, nutrition and pharmacology.El objetivo de este estudio fue evaluar la eficacia de enterocinas producidas por Enterococcus faecium 141v y 137v, probióticos, a partir de queso cuajo artesanal de Pernambuco sobre el desarrollo de cáncer colorrectal en un estudio in vivo. Las pruebas de sensibilidad a la proteasa se realizaron como metodología para demostrar sus propiedades proteicas, además de su actividad biológica como antimicrobiano. La ultrasonografía se utilizó para evaluar el efecto de las enterocinas en el cáncer colorrectal inducido por 1,2 dimetilhidrazina (DMH) en ratas Wistar. Los resultados obtenidos in vitro demostraron la naturaleza péptido de las enterocinas, así como su eficacia en la actividad antimicrobiana. En cuanto a los resultados in vivo evaluados en ultrasonido, fue posible observar la disminución en el grosor de la pared intestinal de ratas que se sometieron a la inducción por cáncer colorrectal y se trataron con enterocinas, y se pueden explicar por una posible estimulación apoptótica, con el objetivo de inhibir las células cancerosas. Los resultados obtenidos en este estudio fueron positivos para el uso de enterocinas producidas por E137v y E141v a partir de queso de cuajo artesanal de Pernambuco, como una suplementación prometedora en la prevención y tratamiento contra el cáncer colorrectal, pero se necesitan más estudios, con un aumento en el número de animales para proporcionar una mayor seguridad.Objetivou-se com este estudo avaliar a eficácia das enterocinas produzidas pela Enterococcus faecium 141v e 137v, probióticos, oriundos do queijo de coalho artesanal de Pernambuco sobre o desenvolvimento do câncer colorretal em estudo in vivo. Como metodologia foram realizados testes de sensibilidade a protease com a finalidade de comprovar suas propriedades proteicas, além de sua atividade biológica como antimicrobiano. A ultrassonografia foi utilizada para avaliar o efeito das enterocinas sobre o câncer colorretal induzido por 1,2 Dimetilhidrazina (DMH ) em ratos Wistar. Os resultados obtidos in vitro demonstraram a natureza peptídica das enterocinas bem como sua eficácia quanto à atividade antimicrobiana. Quanto aos resultados in vivo avaliados na ultrassonografia, foi possível observar a diminuição na espessura da parede intestinal dos ratos que foram submetidos a indução do câncer colorretal e tratados com as enterocinas, podendo ser explicada pela possível estimulação apoptótica, visando a inibição de células cancerígenas. O presente estudo trouxe aspectos importantes a respeito da utilização das enterocinas para fins terapêuticos, sobretudo na prevenção e controle do câncer colorretal em modelo animal. Também destacou o uso da ultrassonografia para avaliar o efeito das enterocinas sobre o desenvolvimento da doença, mostrando ser um método que considera o bem-estar animal por ser menos invasivo e eficaz. Os resultados obtidos neste trabalho reforçam a necessidade de estudos que aprofundem o tema. Além disso, agregam conhecimentos em diversas áreas como biotecnologia, microbiologia, medicina, nutrição e farmacologia

Caracterização fenotípica de famílias com hipodontia no Hospital Universitário de Brasíia, Brasília-DF

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Ciências da Saúde, 2008.A odontogênese é o processo de formação dentária, resultado de interações epitélioectomesenquimais. Em seres humanos, alterações no processo de desenvolvimento dentário são denominadas anomalias dentárias. Dentre essas, uma das mais comuns é a agenesia dentária, uma alteração de número, que é resultado da ausência de formação do germe dentário. Quando a agenesia envolve até seis dentes, excluindo os terceiros molares, essa condição é denominada de hipodontia. O objetivo do presente estudo foi descrever as manifestações bucais e dentárias de pacientes e familiares com hipodontia atendidos e em acompanhamento na Clínica de Anomalias Dentárias da Divisão de Odontologia do Hospital Universitário de Brasília (HUB), da Universidade de Brasília (UnB). Foram estudadas nove famílias, compreendendo 60 indivíduos examinados. O modo de herança autossômico dominante foi sugerido para sete famílias, sendo que em seis a expressividade foi variável, e nas outras duas não foi possível se determinar o modo de herança. Foi verificada a associação da hipodontia com outras anomalias dentárias, sendo estas: dente conóide, dente supranumerário, taurodontia, erupção dentária ectópica e defeito de desenvolvimento do esmalte. Na Família I, com diagnóstico de anquiloglossia e anomalias de número associadas, foi investigada a presença de mutação no gene LGR-5 (leucinerich repeat-containing G protein-coupled receptor 5) e não foi encontrada mutação na região codificante desse gene. __________________________________________________________________________________________ ABSTRACTOdontogenesis is the process of tooth development, resulting from epithelialectomesenchymal interactions. In humans, alterations in the dental development process are called dental anomalies. One of the most common of these is tooth agenesis, which is a change in number, due to the absence of dental germ formation. When agenesis involves up to six teeth, excluding the third molars, this condition is known as hypodontia. The aim of the present study was to describe the dental and oral cavity manifestations of patients and family members with hypodontia treated or undergoing treatment at the Dental Anomaly Clinic of the Dentistry Division of the Brasília University Hospital (HUB), of the University of Brasília (UnB). Nine families were studied, comprising a total of 60 individuals examined. The dominant form of autossomic inheritance was suggested for seven families; in six of the families expressiveness varied; in two others it was not possible to determine the form of inheritance. Also verified was the association of hypodontia with other dental anomalies, such as conoid teeth, supernumerary teeth, taurodontism, ectopic dental eruptions, and defective enamel development. Family I, diagnosed with ankyloglossy and number anomaly association, was investigated for the presence of a mutation in gene LGR-5 (leucine-rich repeat-containing G protein-coupled receptor 5). However, no mutation was found in the coding region of this gene

Impact of enamel defects on early caries development in preschool children.

Quantitative defects of the enamel are considered risk factors for caries development at the cavitated level. Since caries risk assessment and control should be implemented as early as possible in order to prevent operative treatment, it seemed interesting to investigate the relationship between enamel defects and caries development in the stages of progression that precede cavitation. The impact of enamel defects and selected child-mother indicators on early caries development was investigated in a cohort of Brazilian preschool children. The null hypothesis that developmental defects of the enamel and dental caries are independent and that an association between them occurs by chance was tested. The sample (n = 1,718) was made up of 2- to 5-year-olds. Developmental defects of enamel and caries on buccal surfaces were identified in 48 and 26% of the children, respectively. Bivariate analyses at the surface level showed neither an association between demarcated/diffuse opacity and caries experience (p ≥ 0.64, GLM), nor between the presence of hypoplastic surfaces and non-cavitated lesions (p = 0.29, GLM). The multivariate analyses indicated that in the mouths of individual children, hypoplastic surfaces were more likely to present filled surfaces and non-cavitated/cavitated lesions than non-hypoplastic surfaces (within-child p = 0.03, GEE). However, children having teeth with hypoplastic surfaces were not at higher caries risk than those children who did not present hypoplastic surfaces (between-child p = 0.23, GEE). The null hypothesis could not be accepted for quantitative defects such as hypoplasia, since they had a significant impact on the within-child prevalence of filled surfaces and non-cavitated/cavitated lesions

Dental caries and Developmental Defects of Enamel in Brazilian Preschool Children

The risk of developing dental caries may be increased by the presence of developmental defects of the enamel (DDE). The aim of the study was to investigate whether a correlation existed between dental caries and DDE in a sample of Brazilian preschool children. 1,836 2–5-year-old children attending public nursery in the Federal District of Brazil (0.8 mg/l F water supply) in 2006 were clinically examined. […