Panorama dos gastos em medicamentos no Brasil (2015-2019)

Introdução: Medicamentos são produtos farmacêuticos tecnicamente obtidos ou elaborados, com finalidade profilática, curativa, paliativa ou para fins de diagnóstico. A dificuldade de acesso a medicamentos pode acarretar em comprometimento da segurança do processo assistencial. Objetivo: apresentar o cenário brasileiro de gastos com medicamento entre os anos de 2015 e 2019, sob a ótica das Contas SHA. Método: Trata-se de um estudo descritivo, a partir da análise de dados secundários, tendo como unidade de investigação as informações sobre gastos em medicamentos no Brasil do setor público e privado. Resultado: Os gastos totais em saúde foram, em média, R$620,2 bilhões por ano no período de 2015 a 2019 o que representa, em média, cerca de 9$ 2,6 bilhões, embora tenha havido uma redução de R$ 800 milhões na série analisada. Conclusão: O fortalecimento e ampliação das políticas públicas de assistência farmacêutica são essenciais para subsidiar a população, ampliando o acesso a medicamentos e reduzindo o comprometimento da renda das famílias.

Calcium pyrophosphate crystals and knee osteoarthritis

Orientador: Adil Muhib SamaraDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias MedicasResumo: No Brasil, a prevalência da osteoartrite é de cerca de 16,2%, sendo que aos 75 anos, 85% das pessoas apresentarão evidências clínica ou radiológica da doença. A condrocalcinose é a segunda principal causa de doença por deposição de cristais. Estudos recentes têm demonstrado uma prevalência de 8-10% de condrocalcinose radiológica em pacientes com 60 anos ou mais. Nosso objetivo é avaliar a influência dos cristais de pirofosfato de cálcio na osteoartrite inflamatória de joelhos. Foram avaliados vinte pacientes do Ambulatório de Ortopedia do Hospital de Clínicas da Unicamp, com critérios diagnóstico de osteoartrite em joelhos. Realizaram-se exames de imagem (radiografia, tomografia computadorizada e ressonância nuclear magnética), colheita do líquido sinovial com posterior análise por microscopia de luz compensada e polarizada, além da dosagem de cálcio no dia da colheita e noventa e seis horas após. Os achados foram correlacionados com a presença ou não de osteoartrite inflamatória. Entre os vinte pacientes estudados, onze apresentavam osteoartrite inflamatória, sendo que a condrocalcinose foi evidenciada na radiografia, tomografia e na ressonância de um paciente e apenas na tomografia de outro. Entre os nove que não apresentavam osteoartrite inflamatória, apenas um apresentou imagem de condrocalcinose na tomografia. Foi dosado o cálcio no LS de quinze pacientes, sendo que não houve diferença significativa entre a média do cálcio 1 e cálcio 2. Não foi possível estabelecer a relação entre a presença de cristais de pirofosfato de cálcio e a osteoartrite inflamatória de joelhosAbstract: Objective: Osteoarthritis prevalence in Brazil is around 16, 2%, and, by the age of 75, 85% of the individuals will present with clinical or radiological signs of the disease. Chondrocalcinosis is the second cause of crystal deposition pathology. Recent studies show 8-10% of radiologic evidence of chondrocalcinosis in people older than 60 years. Our goal is to evaluate the impact of calcium pyrophosphate crystals on inflammatory knee osteoarthritis. Methods: Twenty patients from UNICAMP Clinical Hospital, Orthopedic clinic, with complains of knee joint pain were assessed. Image exams (Radiography, TC scan and Magnetic Resonance Imaging), synovial liquid exam (polarized compensated light microscopy and calcium quantification at the same day of synovial liquid aspiration and after 96 hours) were performed. The diagnosis of inflammatory osteoarthritis was given according to these findings. Results: Eleven patients, among the initial twenty, presented inflammatory osteoarthritis and chondrocalcinosis was observed in two of them. Chondrocalcinosis was detected by Rx, TC scan and MRI in one and just by TC in the other. As for the other nine subjects, just one presented chondrocalcinosis on TC scan. There was no difference regarding synovial liquid calcium measurements. Conclusion: It was not possible to establish a correlation between calcium pyrophosphate crystals and knee osteoarthritisMestradoClinica MedicaMestre em Clinica Medic

Normal anatomy and anatomic variants of vascular foramens in the cervical vertebrae:a paleo-osteological study and review of the literature.

We investigated 923 cervical vertebrae belonging to late-antiquity and medieval skeletal remains and assessed the qualitative and quantitative structural characteristics of transverse foramens (TF) and additional vascular canals. We also reviewed the pertinent literature. Double TF were chiefly observed in C6 (with a right/left side prevalence of 35.7 and 44.4 %, respectively) and C5 vertebrae (23.6 and 23.9 %, right/left side, respectively), while unclosed TF were mainly documented in C1 vertebrae (8.4 %). Retrotransverse canal and retrotransverse groove were present in 8.5 and 17.8 %, respectively, of C1 vertebrae examined, while arcuate foramens and supertransverse foramens were found in 7.3 and 3.7 % of specimens, respectively. TF diameter decreased from C6 to C2 vertebrae, being smallest in C7 and greatest in C1 vertebrae, with no left/right significant difference. There was a significant correlation between TF diameter and stature, but only on the right side. The mean area of the arcuate foramen was lower than the mean area of the ipsilateral TF (24.5 \ub1 5.7 vs 28.5 \ub1 7.7 mm2, respectively; p = 0.048), possibly causing compression of the vertebral artery within the arcuate foramen. The study of human vertebrae excavated from archaeological sites is a simple and effective way to analyze the morphology and quantitative anatomy of vascular foramens

[churg Strauss Syndrome: A Rare Vasculitis].

The aim of this report is to verify the demographic, clinical, laboratorial and histopathological findings of patients with CSS followed in a University Clinical Hospital. We reviewed the medical records of all patients with the diagnosis of CSS. Only patients who fulfilled ACR criteria were included. Five Caucasian patients were found, with a sex ratio M/F: 3/2. The mean age at disease onset was 46 years old (40 to 55) and the mean time of follow-up was 2.37 years (0.25 to 6). General symptoms, asthma, peripheral neuropathy and skin lesions were the most common clinical findings in all patients. Cardiovascular, gastrointestinal and renal involvement was found in one patient each. All patients presented hypereosinophilia (> 10%) and p-ANCA was present in 3 patients. The chest x-ray showed pulmonary parenchymal infiltrate in 2 cases and in 1 of them an unilateral pleural effusion. Skin biopsies showed extravascular eosinophylia in 3 out of 4. All patients were treated with prednisone and in 3 it was added immunosuppressive drug. No patient died during the follow-up. CSS is a rare disease with a multivisceral involvement and asthma is the main and the earliest symptom. General symptoms and involvement of skin and peripheral nerves were found in all patients. Renal, cardiovascular and gastrointestinal involvement was rare, differently from the literature series where these findings are more frequent. In spite of the CSS being a serious and life-threatening disease, these patients presented adequate response to the treatment and a favorable outcome.44179-8

Síndrome de Churg Strauss: uma vasculite rara

O objetivo deste trabalho é avaliar as características demográficas, clínicas, laboratoriais e histopatológica de pacientes com diagnóstico de síndrome de Churg Strauss (SCS) acompanhados no ambulatório de vasculites do Hospital das Clínicas da Universidade Estadual de Campinas (HC/Unicamp). Foi realizado estudo retrospectivo dos prontuários dos pacientes com vasculite primária, classificados como SCS pelos critérios do American College of Rheumathology (ACR). Foram observados cinco pacientes com diagnóstico de SCS (M/F:3/2, caucasóides). A média de idade do início da doença foi 46 anos (40-55). A média de tempo de seguimento foi de 2,37 anos (0,25-6). Sintomas sistêmicos, asma, neuropatia periférica e lesão cutânea foram observados em todos os pacientes. Envolvimento cardiovascular, renal e de trato gastrintestinal estiveram presentes cada qual em um paciente. Todos os pacientes apresentaram eosinofilia (>10%),e o p-ANCA foi positivo nos três casos investigados. A radiografia de tórax revelou infiltrado pulmonar intersticial em dois casos; em um, associado à derrame pleural. Na histopatologia, evidências de eosinófilos extravascular foram encontradas nas biópsias cutâneas de 3/4 pacientes. Todos os pacientes foram tratados com prednisona. Em 3, houve a necessidade de associar-se imunossupressor. Nenhum paciente evoluiu a óbito. A SCS é uma patologia rara, com acometimento sistêmico, sendo a asma uma das principais e mais precoce manifestação. Todos os pacientes apresentaram sintomas sistêmicos, acometimento de pele e sistema nervoso periférico. Envolvimento renal, cardíaco e gastrointestinal foi observado, cada qual em um único paciente, diferindo de outras séries nas quais esses acometimentos são mais freqüentes. Embora seja uma patologia grave e de prognóstico reservado, observamos evolução favorável com tratamento

Churg strauss Syndrome: a rare vasculitis

The aim of this report is to verify the demographic, clinical, laboratorial and histopathological findings of patients with CSS followed in a University Clinical Hospital. We reviewed the medical records of all patients with the diagnosis of CSS. Only patients who fulfilled ACR criteria were included. Five Caucasian patients were found, with a sex ratio M/F: 3/2. The mean age at disease onset was 46 years old (40 to 55) and the mean time of follow-up was 2.37 years (0.25 to 6). General symptoms, asthma, peripheral neuropathy and skin lesions were the most common clinical findings in all patients. Cardiovascular, gastrointestinal and renal involvement was found in one patient each. All patients presented hypereosinophilia (> 10%) and p-ANCA was present in 3 patients. The chest x-ray showed pulmonary parenchymal infiltrate in 2 cases and in 1 of them an unilateral pleural effusion. Skin biopsies showed extravascular eosinophylia in 3 out of 4. All patients were treated with prednisone and in 3 it was added immunosuppressive drug. No patient died during the follow-up. CSS is a rare disease with a multivisceral involvement and asthma is the main and the earliest symptom. General symptoms and involvement of skin and peripheral nerves were found in all patients. Renal, cardiovascular and gastrointestinal involvement was rare, differently from the literature series where these findings are more frequent. In spite of the CSS being a serious and life-threatening disease, these patients presented adequate response to the treatment and a favorable outcome.O objetivo deste trabalho é avaliar as características demográficas, clínicas, laboratoriais e histopatológica de pacientes com diagnóstico de síndrome de Churg Strauss (SCS) acompanhados no ambulatório de vasculites do Hospital das Clínicas da Universidade Estadual de Campinas (HC/Unicamp). Foi realizado estudo retrospectivo dos prontuários dos pacientes com vasculite primária, classificados como SCS pelos critérios do American College of Rheumathology (ACR). Foram observados cinco pacientes com diagnóstico de SCS (M/F:3/2, caucasóides). A média de idade do início da doença foi 46 anos (40-55). A média de tempo de seguimento foi de 2,37 anos (0,25-6). Sintomas sistêmicos, asma, neuropatia periférica e lesão cutânea foram observados em todos os pacientes. Envolvimento cardiovascular, renal e de trato gastrintestinal estiveram presentes cada qual em um paciente. Todos os pacientes apresentaram eosinofilia (>10%),e o p-ANCA foi positivo nos três casos investigados. A radiografia de tórax revelou infiltrado pulmonar intersticial em dois casos; em um, associado à derrame pleural. Na histopatologia, evidências de eosinófilos extravascular foram encontradas nas biópsias cutâneas de 3/4 pacientes. Todos os pacientes foram tratados com prednisona. Em 3, houve a necessidade de associar-se imunossupressor. Nenhum paciente evoluiu a óbito. A SCS é uma patologia rara, com acometimento sistêmico, sendo a asma uma das principais e mais precoce manifestação. Todos os pacientes apresentaram sintomas sistêmicos, acometimento de pele e sistema nervoso periférico. Envolvimento renal, cardíaco e gastrointestinal foi observado, cada qual em um único paciente, diferindo de outras séries nas quais esses acometimentos são mais freqüentes. Embora seja uma patologia grave e de prognóstico reservado, observamos evolução favorável com tratamento.17918

Brazilian cohort results of the PRECONNECT study: safety and efficacy of trifluridine/tipiracil in metastatic colorectal cancer

PRECONNECT is a multicenter study demonstrating the efficacy and tolerability of trifluridine/tipiracil in adult patients with histologically confirmed adenocarcinoma of the colon or rectum and pretreated metastatic lesions. The current article describes the characteristics and outcomes of the Brazilian cohort of patients who underwent trifluridine/tipiracil therapy within PRECONNECT. Brazilian patients (n=55) received oral trifluridine/tipiracil 35mg/m2 twice daily on days 1-5 and 8-12 of each 28-day cycle. The primary endpoint was safety including time to ECOG (Eastern Cooperative Oncology Group) PS (performance status) deterioration, and the secondary endpoints included progression-free survival (PFS) and quality of life (QoL). Baseline characteristics showed only 34.5% of patients underwent ≥3 lines of treatment, 29.1% presented ≥3 metastatic sites and 52.7% showed an ECOG PS of 0. The disease control rate (DCR) was 32.0% and 28.6% in patients with one and two metastatic sites, respectively, the median PFS was 3.0 months (95%CI: 2.5-3.4), and the time to ECOG PS deterioration (≥2) was 5.4 months. Drug-related treatment-emergent adverse events (TEAE) were observed at least once in 87.3% of patients, and the most common (≥40% of patients) hematological TEAEs were neutropenia and anemia; there was no febrile neutropenia case. The shorter time to ECOG PS deterioration showed in the Brazilian subset of patients is likely due to late diagnosis setting compared to the global population, despite that trifluridine/tipiracil showed good DCR results, including patients with two metastatic sites. In conclusion, safety and efficacy results provide confidence in routine practice use and are in line with the PRECONNECT stud