Intrahost Diversity of Feline Coronavirus: A Consensus between the Circulating Virulent/Avirulent Strains and the Internal Mutation Hypotheses?

To evaluate the most controversial issue concerning current feline coronavirus (FCoV) virology, the coexisting hypotheses of the intrahost and interhost origins of feline infectious peritonitis virus (FIPV) in regard to the pathogenesis of feline infectious peritonitis (FIP), this study aimed to assess the molecular diversity of the membrane gene FCoVs in 190 samples from 10 cats with signs of FIP and in 5 faecal samples from cats without signs of FIP. All samples from the non-FIP cats and 25.26% of the samples from the FIP cats were positive for the FCoV membrane (M) gene. Mutations in this gene consisted of SNP changes randomly scattered among the sequences; few mutations resulted in amino acid changes. No geographic pattern was observed. Of the cats without FIP that harboured FECoV, the amino acid sequence identities for the M gene were 100% among cats (Cats 1–3) from the same cattery, and the overall sequence identity for the M gene was ≥91%. In one cat, two different lineages of FCoV, one enteric and one systemic, were found that segregated apart in the M gene tree. In conclusion, the in vivo mutation transition hypothesis and the circulating high virulent-low virulent FCoV hypothesis have been found to be plausible according to the results obtained from sequencing the M gene

Clinical effectiveness and safety of analogue glargine in type 1 diabetes : systematic review and meta-analysis

INTRODUCTION: The use of insulin analogues for the treatment of type 1 diabetes mellitus (T1DM) is widespread; however, the therapeutic benefits still require further evaluation given their higher costs. Objective: To evaluate the effectiveness and safety of Analogue Glargine (AG) compared to Recombinant DNA insulin (rDNA) in patients with DM1 in observational studies, building on previous reviews of RCTs comparing NPH insulin and AG. METHODS: A systematic review (SR) with meta-analysis. The SR included cohort studies and registries available on PUBMED, LILACS, and CENTRAL as well as manual and gray literature searches. The meta-analysis was conducted in Review Manager ® 5.2 software. The primary outcomes were: glycohemoglobin (Hb1Ac), weight gain and hypoglycemia. Methodological quality was assessed using the Newcastle-Ottawa scale. RESULTS: Out of 796 publications, 11 studies were finally included. The meta-analysis favored AG in Hb1Ac outcomes (adult patients) and hypoglycemic episodes (p <0.05), but without reaching glycemic control (Hb1Ac to approximately 7%). The methodological quality of the studies was moderate, noting that 45% of studies were funded by pharmaceutical companies. CONCLUSION: Given the high heterogeneity of the studies, the discrete value presented by the estimated effect on effectiveness and safety, potential conflicts of interest of the studies and the appreciable higher cost of AG, there is still no support for recommending first line therapy with analogues. The role of analogues in the treatment DM1 could be better determined by further observational studies of good methodological quality to assess their long-term effectiveness, safety as well as cost-effectiveness

The impact of metabolic syndrome on metabolic, pro-inflammatory and prothrombotic markers according to the presence of high blood pressure criterion

OBJECTIVES: We explored whether high blood pressure is associated with metabolic, inflammatory and prothrombotic dysregulation in patients with metabolic syndrome. METHODS: We evaluated 135 consecutive overweight/obese patients. From this group, we selected 75 patients who were not under the regular use of medications for metabolic syndrome as defined by the current Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults criteria. The patients were divided into metabolic syndrome with and without high blood pressure criteria (≥130/≥85 mmHg). RESULTS: Compared to the 45 metabolic syndrome patients without high blood pressure, the 30 patients with metabolic syndrome and high blood pressure had significantly higher glucose, insulin, homeostasis model assessment insulin resistance index, total cholesterol, low-density lipoprotein-cholesterol, triglycerides, uric acid and creatinine values; in contrast, these patients had significantly lower high-density lipoprotein-cholesterol values. Metabolic syndrome patients with high blood pressure also had significantly higher levels of retinol-binding protein 4, plasminogen activator inhibitor 1, interleukin 6 and monocyte chemoattractant protein 1 and lower levels of adiponectin. Moreover, patients with metabolic syndrome and high blood pressure had increased surrogate markers of sympathetic activity and decreased baroreflex sensitivity. Logistic regression analysis showed that high-density lipoprotein, retinol-binding protein 4 and plasminogen activator inhibitor-1 levels were independently associated with metabolic syndrome patients with high blood pressure. There is a strong trend for an independent association between metabolic syndrome patients with high blood pressure and glucose levels. CONCLUSIONS: High blood pressure, which may be related to the autonomic dysfunction, is associated with metabolic, inflammatory and prothrombotic dysregulation in patients with metabolic syndrome

Quality of Life of Patients with Type 1 Diabetes Mellitus Using Insulin Analog Glargine Compared with NPH Insulin: A Systematic Review and Policy Implications

INTRODUCTION: Insulin analogue glargine (GLA) has been available as one of the therapeutic options for patients with type 1 diabetes mellitus to enhance glycemic control. Studies have shown that a decrease in the frequency of hypoglycemia episodes improves the Quality of Life (QoL) of diabetic patients. However, there are appreciable acquisition cost differences between different insulins. Consequently, a need to assess their impact on QoL to provide future guidance to health authorities. METHOD: A Systematic review (SR) of multiple databases including Medline, LILACS, Cochrane and EMBASE databases with several combinations of agreed terms involving randomized controlled trials (RCTs) and cohorts, as well as manual searches and gray literature was undertaken. The primary outcome measure was a change in QoL. The quality of the studies and the risk of bias was also assessed. RESULTS: Eight studies were eventually included in the systematic review out of 634 publications. Eight different QoL instruments were used (2 generic, 2 mixed and 4 specific), in which the Diabetes Treatment Satisfaction Questionnaire (DTSQs) was the most used. The systematic review did not consistently show any significant difference overall in QoL scores whether as part of subsets or combined into a single score with the use of GLA versus NPH insulin. Only in patients’ satisfaction measured by DTSQ was a better result consistently seen with GLA versus NPH insulin but not using the WED scale. However, none of the cohort studies scored a maximum on the Newcastle-Ottawa scale for quality and they generally were of moderate quality with bias in the studies. CONCLUSION: There was no consistent difference in QoL or patient reported outcomes when the findings from the eight studies were collated. In view of this, we believe the current price differential between GLA and NPH insulin in Brazil cannot be justified by these findings

Strategies to improve the availability of medicines in primary health care in Brazil : findings and implications

Aim: Access to essential medicines is a key component of managing patients in ambulatory care. In 2008, the State of Minas Gerais, Brazil, created the Pharmacy Network of Minas (Rede Farmácia de Minas [RFM]) program to improve access to medicines, increasing availability and restructuring the infrastructures. The aim was to assess the current situation, comparing municipalities with and without RFM. Materials & methods: Descriptive survey study, data collected from 2014 July to May 2015. Availability was verified by stock levels. Results: The drug availability index was 61.0%, higher in municipalities with RFM. Most physicians considered the pharmaceutical services as good/very good. The main reasons for medicines shortage were ‘financial transference problems’, ‘insufficient financial resources’ and ‘budget’. Conclusion: Strategies, such as the RFM can promote improvements in medicine availability

Deposición de capas funcionales sobre esmaltes cerámicos mediante la técnica sol-gel (revisión)

Functionalized enamels for the ceramic tile industry has been a research topic since the past 15 years. Different researchers have focused their efforts on achieving surfaces with functional attributes that increase product value and provide technical solutions for the technological needs of our times. This article presents a review of the scientific literature dedicated to obtaining functional surfaces by means of a sol gel technique, that provides a means for deposition and formation of thin layers on traditional ceramic enamels in order to provide functional characteristics. The document presents: typical used alcoxidic solutions, the different deposition techniques emphasizing the experimental findings obtained by the authors, and presents a synthesis of the functional effects obtained by means of the technique.La funcionalización de esmaltes para la industria de las baldosas cerámicas ha sido un frente de investigación importante en los últimos 15 años. Diferentes investigadores han centrado sus esfuerzos en conseguir superficies con atributos funcionales que incrementen el valor agregado del producto y a su vez aporten respuestas a las necesidades tecnológicas de nuestros tiempos. El presente artículo se concentra en hacer una revisión de la literatura científica dedicada a la obtención de superficies funcionales por medio de la técnica de sol-gel, la cual es apta para la fabricación de soluciones que se depositan formando capas finas sobre los esmaltes de cerámica tradicional con el fin de aportar características funcionales al mismo. El documento presenta las principales soluciones alcóxidicas usualmente empleadas, las diferentes técnicas de deposición haciendo énfasis en los hallazgos experimentales obtenidos por los diferentes autores, y presenta una síntesis de los efectos funcionales hasta la fecha obtenidos por medio de la técnica

Access to medicines in the Brazilian Unified Health System's primary health care : assessment of a public policy

In 2008, the Programa Rede Farmácia de Minas (RFM, literally translated: ‘Minas Gerais Pharmacy Network’ program) was created as a strategy to expand access to medicines. Aim: Measure access to medicines in public pharmacies through comparison between municipalities that joined or not the RFM. Materials & methods: Cross-sectional, evaluative study, gathering information from a representative sample of the municipalities in Minas Gerais between July 2014 and May 2015. The Poisson regression results were obtained by calculating the prevalence ratios. Results: Adequate access to medicines in Minas Gerais was 69.9%, being 75.8% in municipalities with and 69.2% without the RFM. The municipalities with the RFM showed statistically higher percentages in the Availability, Adequacy/Accommodation, and Acceptability dimensions. Conclusion: RFM appears an efficient strategy for promoting access to medicines

The clinical effectiveness of insulin glargine in patients with Type I diabetes in Brazil: findings and implications

Aims: Published studies have challenged the cost-effectiveness of insulin glargine versus NPH insulins in Brazil with limited evidence of increased effectiveness despite considerably higher acquisition costs. However, still a controversy. Consequently, a need to address this. Methods: Retrospective cohort study of type 1 diabetes patients receiving insulin glargine in Brazil following NPH insulin who met the criteria. Results: 580 patients were enrolled. HbA1c varied from 8.80 ± 1.98% in NPH insulin users to 8.54 ± 1.88% after insulin glargine for six months, which is not clinically significant. Frequency of glycemic control varied from 22.6% with NPH insulin to 26.2% with insulin glargine. No statistically significant difference was observed between controlled and still uncontrolled groups for all analyzed factors including type and frequency of insulin use and carbohydrate counting. Conclusions: Limited differences between NPH insulins and insulin analogues in routine clinical care does not justify an appreciable cost difference

ENRAIZAMENTO DE MINIESTACAS E PRODUTIVIDADE DE MINICEPAS DE CEDRO AUSTRALIANO MANEJADAS EM CANALET 5ES E TUBETES

The planted forest stands aim to supply the growing demand for wood, especially for the sawing and veneer industries, that exclusively used wood from native forests. The Australian cedar ( Toona ciliata ) belongs to the family Meliaceae, is the species of interest for this sector. Studies with the Australian cedar propagation have carried out in latest years, mainly involving the use of mini-cuttings due to the need for high quality cuttings. The objectives of this paper were to evaluate the rooting and the productive capacity of Australian cedar mini-strains, managed in lifted seedbeds and 180 cm3 plastic tubes systems. So, two mini-clone gardens were set up. The mini-strains of both gardens were grown from cut-off seedlings originated from seeds. Successive collections of sprouts were carried out to get the mini-cuttings. Afterwards, they remained in the rooting area under intermittent mist. Thirty days later the rooting characteristics of the cuttings originated from both mini-gardens were evaluated. The period of permanence of the cuttings in the gardens was seven-month long. During this period, six collections from the lifted seedbed and four from the plastic tubes were carried out. The mini-strains in the two systems showed 100 % of survival rate. At the end of this seven-month period, an increasing tendency of the average number of mini-cutting was found out in both systems. Those from the lifted seedbed showed more productivity than those ones from the tubes. The plants from the mini-cuttings of the tube showed higher number and length of adventitious roots at the end rooting stage.Os povoamentos florestais plantados buscam atender \ue0 demanda crescente por madeira, principalmente, para as ind\ufastrias de serraria e de lamina\ue7\ue3o, que utilizavam madeira exclusivamente de matas nativas. O cedro australiano ( Toona ciliata ), pertencente \ue0 fam\uedlia Meliaceae, \ue9 uma das esp\ue9cies de interesse desse setor. Pela necessidade cada vez maior por mudas de alta qualidade, estudos sobre propaga\ue7\ue3o de cedro australiano t\ueam sido realizados nos \ufaltimos anos, principalmente envolvendo o uso da miniestaquia. Os objetivos deste trabalho foram avaliar o enraizamento e a capacidade produtiva das minicepas de cedro australiano, manejadas em sistemas de canalet\uf5es e em tubetes de 180 cm3. Assim, estabeleceram-se dois minijardins de minicepas formadas a partir de mudas recepadas, produzidas por sementes. Nestes dois sistemas, foram realizadas coletas sucessivas de brota\ue7\uf5es para confec\ue7\ue3o de miniestacas, que permaneceram por 30 dias no setor de enraizamento, em c\ue2mara com nebuliza\ue7\ue3o intermitente. Ap\uf3s este per\uedodo, foram avaliadas as caracter\uedsticas do enraizamento das mudas originadas nos dois sistemas de minijardins testados, que foram conduzidos por sete meses e, durante este per\uedodo, foram realizadas seis coletas no minijardim de canalet\ue3o e quatro, no de tubetes. As minicepas dos dois sistemas apresentam 100 % de sobreviv\ueancia. Ao final do per\uedodo observou-se tend\ueancia no aumento do n\ufamero m\ue9dio de miniestacas em ambos os sistemas. As minicepas do sistema de minijardim em canalet\ue3o s\ue3o mais produtivas que as do sistema conduzido em tubetes. As mudas originadas de miniestacas do sistema de tubetes apresentam maior n\ufamero e comprimento de ra\uedzes advent\uedcias na expedi\ue7\ue3o do setor de enraizamento

Budget impact analysis of medicines : updated systematic review and implications

This evaluation determines whether published studies to date meet the key characteristics identified for budget impact analyses (BIA) for medicines, accomplished through a systematic review and assessment against identified key characteristics. Studies from 2001 to 2015 on "budget impact analysis" with "drug" interventions were assessed, selected based on their titles/abstracts and full texts, with their characteristics checked according to key criteria. Out of 1984 studies, 92 were identified. Of these, 95% were published in Europe and the USA. 2012 saw the largest number of publications (16%) with a decline thereafter. 48% met up to 6 or 7 out of the 9 key characteristics. Only 22% stated no conflict of interest. The results indicate low adherence to the key characteristics that should be considered for BIAs and strong conflict of interest. This is an issue since BIAs can be of fundamental importance in managing the entry of new medicines including reimbursement decisions