Disparity in the use of Alzheimer's disease treatment in Southern Brazil

Alzheimer's disease (AD) treatment is freely available in the Brazilian public health system. However, the prescription pattern and its associated factors have been poorly studied in our country. We reviewed all granted requests for AD treatment in the public health system in October 2021 in the Rio Grande do Sul (RS) state, Southern Brazil. We performed a spatial autocorrelation analysis with the population-adjusted patients receiving any AD medication as the outcome and correlated it with several socioeconomic variables. 2382 patients with AD were being treated during the period analyzed. The distribution of the outcome variable was not random (Moran's I 0.17562, P <.0001), with the most developed regions having a higher number of patients/100,000 receiving any AD medication. We show that although AD medications are available through the public health system, there is a clear disparity between regions of RS state. Factors related to socioeconomic development partly explain this finding

Modeling biomass and nutrients in a eucalyptus stand in the cerrado

The prediction of biological processes, which involve growth and plant development, is possible via the adjustment of mathematical models. In forest areas, these models assist in management practices, silviculture, harvesting, and soil fertility. Diameter, basal area, and height are predictors of volume and biomass estimates in forest stands. This study utilized different non-linear models for estimating biomass and nutrient values in the aerial biomass and roots of an unmanaged eucalypt stand in Cerrado dystrophic soil. It was hypothesized that the models would estimate the nutrients of the aboveground biomass and roots after meeting the selection and validation criteria. By statistical analysis of the parameters and subsequent validation, the Schumacher–Hall model was presented to be the best fit for biomass and nutrients. This result confirmed the ability of different variables, including diameter, basal area, and height, to be predicted. Estimating the nutrient values in the aboveground biomass and roots allowed a better understanding of the quality of the vegetal residues that remained in the soil. For dystrophic soils, which occur in the Cerrado, these estimates become even more relevant

Disparidade na distribuição dos medicamentos para doença de Alzheimer pelo SUS no Rio Grande do Sul

Base teórica: As transformações demográficas ocorridas nas últimas décadas determinaram um aumento significativo da proporção de idosos na população brasileira, e consequentemente, as doenças neurodegenerativas associadas com o envelhecimento também aumentaram em frequência, em particular as demências, cujo impacto pode ser considerado um problema de saúde pública. Dentre as possíveis etiologias de demência, a doença de Alzheimer (DA) é a forma mais comum, respondendo por 60 a 70% dos casos na maioria das séries. O tratamento farmacológico da DA inclui quatro fármacos que apresentam efeito sintomático modesto, aliviando os sintomas da doença: três Inibidores da acetilcolinesterase (IAChE), donepezila, rivastigmina e galantamina; e um inibidor de receptores N-metil-D-aspartato (NMDA), memantina. Apesar de esses medicamentos estarem disponíveis gratuitamente para todos os pacientes com o diagnóstico de DA que preencham os critérios de inclusão preconizados no Protocolo Clínico e Diretrizes Terapêuticas do Ministério da Saúde (PCDT/MS), o acesso a esses medicamentos pode apresentar distribuição irregular. Dessa forma, realizou-se um estudo para avaliar a disparidade na distribuição de medicamentos para o tratamento da DA no estado do RS, e correlacionar quantidade de medicamentos dispensados em um determinado período de tempo com dados sociodemográficos. Objetivo: Avaliar o padrão de distribuição do fornecimento dos medicamentos do componente especial de assistência farmacêutica para DA no estado do Rio Grande do Sul (RS). Métodos: Realizou-se um estudo com dois delineamentos diferentes. O estudo transversal, o qual analisou o perfil dos pacientes que receberam medicamentos para DA em outubro de 2021 no Estado do RS, Brasil. Também se realizou-se um estudo ecológico, onde analisou-se o perfil de prescrição de medicamentos para DA em todos os municípios do RS neste período. Avaliamos as solicitações dos quatro medicamentos disponíveis na rede pública de saúde, em qualquer formulação ou dose: donepezila, rivastigmina, galantamina e memantina. No estado do RS, as solicitações de medicamentos para DA na rede pública são inicialmente realizadas pelo médico assistente por meio de um sistema web denominado AME (Administração de Medicamentos Especiais), administrado pela Secretaria Estadual 6 de Saúde (SES) do RS. Resultados: Em outubro de 2021, no estado do RS, Brasil, 2.382 pacientes com DA faziam uso de qualquer um dos quatro medicamentos fornecidos pelo sistema público de saúde brasileiro. A maioria, 65,6% (1.562), era do sexo feminino, com idade mediana de 79 [73-84] anos e 71,7% (1.036) com ensino fundamental incompleto. A mediana do MEEM foi de 15 [12-18] e a maioria apresentou CDR = 2 (55,2%, 1133). A medicação mais prescrita foi donepezila, 42,9% (1.014), de forma concomitante ou em combinação com memantina. Verificou-se que a distribuição da variável paciente/100.000/município teve distribuição em cluster, com I de Moran de 0,17562 (p<0,001). Como a distribuição dessa variável não foi aleatória, correlacionou-se com as variáveis sociodemográficas dos municípios. Diversas variáveis tiveram correlação fraca com pacientes/100.000/município como IDH (Rho = 0,32), PIB (Rho = 0,21), médicos/100.000 (Rho = 0,17) e % de analfabetismo (Rho = - 0,16). Conclusão: Mostrou-se que a distribuição de medicamentos para DA pelo sistema público de saúde no estado do RS apresenta um padrão desigual e regiões mais desenvolvidas socioeconomicamente têm maior frequência de prescrições. Avaliar as raízes dessa disparidade pode levar a mudanças nas políticas públicas que levem a um melhor diagnóstico e tratamento de pacientes com doença de Alzheimer.Background: The demographic transformations that have occurred in recent decades have determined a significant increase in the proportion of elderly people in the Brazilian population, and consequently, neurodegenerative diseases associated with aging have also increased in frequency, in particular dementia, whose impact can be considered a public health problem. Among the possible etiologies of dementia, Alzheimer's disease (AD) is the most common form, accounting for 60 to 70% of cases in most series. The pharmacological treatment of AD includes four drugs that have a modest symptomatic effect, which alleviate the symptoms of the disease: three acetylcholinesterase inhibitors (IAChE), donepezil, rivastigmine and galantamine; and an N-methyl-D-aspartate (NMDA) receptor inhibitor, memantine. Although these drugs are available free of charge to all patients diagnosed with AD who meet the inclusion criteria recommended in the Clinical Protocol and Therapeutic Guidelines of the Ministry of Health (PCDT/MS), access to these drugs may be unevenly distributed. Thus, a study was carried out to evaluate the disparity in the distribution of medication for the treatment of AD in the state of RS and to correlate the amount of medication dispensed in a given period of time with sociodemographic data. Objective: Evaluate the pattern of distribution of the supply of medicines of the special component of pharmaceutical assistance for AD in the state of Rio Grande do Sul (RS). Methods: A study with two different designs was performed. The cross-sectional study, which analyzed the profile of patients who received medication for AD in October 2021 in the State of RS, Brazil. And an ecological study, in which the profile of drug prescription for AD in all municipalities in RS during this period was analyzed. We evaluated requests for the four drugs available in the public health system, in any formulation or dose: donepezil, rivastigmine, galantamine and memantine. Results: In October 2021, in the state of RS, Brazil, 2,382 AD patients were using any of the four medications provided by the Brazilian public health system. The 8 majority, 65.6% (1,562), were female, with a median age of 79 [73-84] years and 71.7% (1,036) had incomplete primary education. The median MMSE was 15 [12-18] and the majority had a CDR = 2 (55.2%, 1133). The most prescribed medication was donepezil, 42.9% (1.014), concomitantly or in combination with memantine. It was verified that the distribution of the variable patient/100,000/city was grouped, with Moran's I of 0.17562 (p<0.001) (Figures 1 and 2). As the distribution of this variable was not random, it correlated with the sociodemographic variables of the municipalities. Several variables had weak correlation with patients/100,000/municipality such as HDI (Rho = 0.32), GDP (Rho = 0.21), physicians/100,000 (Rho = 0.17) and % of illiteracy (Rho = - 0.16). Conclusion: It was shown that the distribution of medications for AD by the public health system in the state of RS, Brazil presents an uneven pattern and more socioeconomically developed regions have higher frequency of prescriptions. Assessing the roots of this disparity can lead to public policy changes that lead to better diagnosis and treatment of patients with Alzheimer's disease

The theoretical analysis on the cost of buying biological drugs for rheumatoid arthritis in the state of Rio Grande do Sul

Introdução: Artrite reumatoide (AR) é uma doença crônica, de etiologia desconhecida que acomete principalmente mulheres. Causa comorbidades afetando diretamente a vida do paciente e também a sociedade. A terapia biológica Anti-Fator de Necrose Tumoral Alfa (anti-TNFα) transformou o tratamento dos pacientes, apresentando melhores resultados terapêuticos, melhorando a qualidade de vida e diminuindo as comorbidades dos mesmos. Devido ao alto custo destes medicamentos os pacientes recorrem ao sistema público de saúde para terem acesso ao tratamento. O Componente Especializado da Assistência Farmacêutica (CEAF) é responsável por disponibilizar esses medicamentos de alto custo, promovendo o acesso integral ao tratamento. Métodos: Estudo quantitativo, de caráter exploratório e descritivo sobre a estimativa do custo dos Medicamentos Modificadores do Curso da Doença (MMCD) anti-TNF usados no tratamento da AR por aquisição pelo Ministério da Saúde, e diretamente pelo usuário em farmácias privadas do estado do Rio Grande do Sul (RS). O método baseia-se no uso de dados de incidência e prevalência de doenças e os esquemas terapêuticos preconizados para os medicamentos indicados no tratamento dessas doenças. Resultados e discussão: Entre os MMCD biológicos o que apresentou maior custo para aquisição foi o adalimumabe, seguido do etanercepte, infliximabe e golimumabe, e o que apresentou menor custo foi o certolizumabe pegol, tanto para o setor público quanto para o privado. Devido ao alto custo de aquisição desses medicamentos é importante seguir o correto escalonamento proposto pelo Protocolo Clínico de Diretrizes Terapêuticas do Ministério da Saúde (PCDT/MS) para AR a fim de proporcionar um tratamento de menor custo-minimização para o paciente. Considerações finais: Apesar do tratamento com MMCD biológicos para AR apresentar alto custo, a longo prazo o tratamento proporciona benefícios para os paciente e para a sociedade, pois os MMCD biológicos reduzem as comorbidades causadas pela AR melhorando a qualidade de vida dos pacientes, e consequentemente diminuindo os custos indiretos causados pela doença.Introduction: Rheumatoid arthritis (RA) is a chronic disease of unknown etiology that affects mainly women. It causes comorbidities directly affecting the life of the patient and also the society. Anti tumor necrosis fator alpha therapy (anti-TNFα) transformed the treatment of the patients, demonstrating better therapeutic results, improving the quality of life and reducing their comorbidities. Due to the high cost of these drugs, patients use the public health system to access treatment. The Specialized Component of Pharmaceutical Assistance (CEAF) is responsible for making these high-cost medicines available, promoting full access to treatment. Methods: A quantitative, exploratory and descriptive study on the cost estimate anti-TNF terapy of medicine modifying the course of the disease (MMCD) drugs used in the treatment of RA by the Ministry of Health and directly by the user in private pharmacies in the state of Rio Grande do Sul (RS). The method is based on the use of disease incidence and prevalence and the recommended therapeutic regimens for the drugs indicated in the treatment of these diseases. Results and discussion: Among the biological MMCDs, the most costly for acquisition was adalimumab, followed by etanercept, infliximab and golimumab, and the lowest cost was certolizumab pegol, both for the public and private sectors. Due to the high cost of purchasing these drugs, it is important to follow the correct scheduling proposed by the Ministry of Health's Clinical Protocol on Therapeutic Guidelines (PCDT / MS) for RA in order to provide a lower cost-minimization treatment for the patient. Final considerations: Although treatment with biological MMCD for RA is costly, in the long term treatment provides benefits for patients and for society, since the biological MMCDs reduce comorbidities caused by RA, improving patients' quality of life, and consequently reducing costs caused by the disease

Chumbo e zinco em águas e sedimentos de área de mineração e metalurgia de metais

Lead metallurgy at Adrianópolis is the largest environmental problem of Paraná, Brazil. The objective of this study was to determine Pb and Zn levels in water and sediment in two catchments by different extraction methods. The high levels of lead in water in most of samples do not allow the human use. Total Pb concentration as high as 795.3 µg L-1 was observed in Ribeira River bank, in a pluvial water stream flowering from a abandoned factory. Due to the high Pb levels in sediments from some sites (maximum of 24,300 mg kg-1) is recommended to avoid the water turbulence

Pharmacokinetic And Pharmacodynamic Evaluation Of A Nanotechnological Topical Formulation Of Lidocaine/prilocaine (nanorap) In Healthy Volunteers.

Nanorap is a new nanotechnological formulation for topical anesthesia composed of lidocaine (2.5%) and prilocaine (2.5%). The present study evaluated the pharmacokinetics (PK) of Nanorap. For the determination of lidocaine and prilocaine in human plasma a new method using high-performance liquid-chromatography coupled to tandem mass spectrometry was developed. Nanorap pharmacodynamic (PD) and its physical proprieties were also evaluated. Nanorap was administered by topical application of 2g to healthy volunteers and blood samples were collected for the PK analysis. The drugs were extracted from plasma by liquid-liquid extraction with ether/hexane (80/20, v/v). The chromatography separation was performed on a Genesis C18 analytical column 4 µm (100 x 2.1 mm i.d.) with a mobile phase of methanol/acetonitrile/water (40/30/30, for lidocaine, and 50/30/20, for prilocaine, v/v/v) + 2 mM of ammonium acetate and ropivacaine as internal standard. The drugs were quantified using a mass spectrometer with an electrospray source in the ESI positive mode (ES+) configured for multiple reaction monitoring. The PD of Nanorap was evaluated with the use of a visual analogue scale. Nanorap was characterized by cryofracture. The chromatography run time was 5.5 min for lidocaine and 3.3 min for prilocaine and the lower limit of quantification was 0.05 ng/mL for both drugs. Mean Cmax was 6.62 and 1.72 ng/mL for lidocaine and prilocaine, respectively. Median Tmax was 6.5 hours for both drugs. Nanocapsules had a mean size of 88nm and mean drug association of 92.5% and 89% for lidocaine and prilocaine, respectively. The PD study showed that Nanorap has a sufficient analgesic effect (>30% reduction in pain) after 10 minutes of application. A new simple, selective and sensitive method for determination of lidocaine and prilocaine in human plasma was developed. Nanorap generated safe plasma levels of the drugs and satisfactory analgesic effect