Impacto orçamental de medicamentos anti retrovíricos para a infecção pelo VIH/SIDA em 2030 no Centro Hospitalar Universitário de S. João, EPE: Estudo de caso

Em Portugal, a prestação de cuidados de saúde à imagem do preconizado na Constituição da República Portuguesa é levada a cabo pelo Estado através do Serviço Nacional de Saúde, que suporta elevados custos com o setor do medicamento, não só devido ao aumento da esperança média de vida da população, como devido ao aumento das doenças crónicas e ao aparecimento de medicamentos inovadores. Segundo a Organização Mundial de Saúde o Vírus da Imunodeficiência Humana continua a ser um grande problema de saúde pública global, sendo uma doença crónica e com necessidades de cuidados de saúde permanentes. Aproximadamente 36,7 milhões de pessoas eram portadoras de VIH no final de 2016, das quais 1,8 milhões foram infetadas nesse mesmo ano. A Organização das Nações Unidas, em 2016, estabeleceu como meta para 2030 erradicar a doença como um problema de saúde pública (meta 95-95-95), visto que outras metas estão a ser alcançadas com sucesso. A determinação dos custos financeiros associados ao tratamento dos indivíduos com infeção por VIH é importante para que se possa tomar decisões quer a curto, quer a longo prazo. De tal modo que se possa determinar como poderão ser aplicados os recursos apropriados no tratamento e controlo desta infeção. A presente dissertação pretende estimar o impacto orçamental que os medicamentos anti retrovíricos terão na despesa total com medicamentos com a elaboração de cenários prospetivos até 2030, caso se cumpra a meta estabelecida pela Organização das Nações Unidas, através da realização de um estudo de caso no Centro Hospitalar Universitário S. João, EPE. As projeções obtidas mostram que a nível nacional estarão em tratamento 58 372 pessoas, sendo que 4 237 pessoas serão tratadas no Centro Hospitalar Universitário S. João, EPE. Quanto ao valor total gasto com medicamentos anti retrovíricos para a infeção pelo VIH/SIDA, em 2030 pode variar no Centro Hospitalar Universitário S. João, EPE entre 26 501 765 € e 27 583 470 € e a nível nacional entre 419 991 562 € e 437 134 075 €.In Portugal, the provision of health care as advocated in the Constitution of the Portuguese Republic is carried out by the State through the National Health Service, which endures high costs with the drug industry, not only due to the increase in the average life expectancy of the population, but also because of the increase in chronic diseases and the emergence of innovative medicines. According to the World Health Organization, the Human Immunodeficiency Virus continues to be a major global public health problem, being a chronic disease and needing permanent health care. Approximately 36.7 million people had HIV at the end of 2016, of which 1.8 million were infected in that same year. In 2016, the United Nations, set 2030 as the target for the eradication of the disease as a public health problem (goal 95-95-95), as other goals are being successfully achieved. Determining the financial costs associated with treating the individuals with HIV infection is important so that decisions can be made, both in the short and long term. In such a way that it can be determined how the appropriate resources can be applied in the treatment and control of this infection. The present dissertation intends to estimate the budgetary impact that antiretroviral drugs will have on total drug expenditure with the elaboration of prospective scenarios by 2030, if the goal established by the United Nations is met, by conducting a case study in the Centro Hospitalar Universitário de S. João, EPE. The projections obtained show that at the national level, 58 372 people will be undergoing treatment, and 4 237 people will be treated at the Centro Hospitalar Universitário de S. João, EPE. As for the total amount spent on drugs for HIV/AIDS, in 2030 it can vary at the Centro Hospitalar Universitário de S. João, EPE between 26 501 765 € and 27 583 470 €, and at national level between 419 991 562 € and 437 134 075 €

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved

NEOTROPICAL CARNIVORES: a data set on carnivore distribution in the Neotropics

Mammalian carnivores are considered a key group in maintaining ecological health and can indicate potential ecological integrity in landscapes where they occur. Carnivores also hold high conservation value and their habitat requirements can guide management and conservation plans. The order Carnivora has 84 species from 8 families in the Neotropical region: Canidae; Felidae; Mephitidae; Mustelidae; Otariidae; Phocidae; Procyonidae; and Ursidae. Herein, we include published and unpublished data on native terrestrial Neotropical carnivores (Canidae; Felidae; Mephitidae; Mustelidae; Procyonidae; and Ursidae). NEOTROPICAL CARNIVORES is a publicly available data set that includes 99,605 data entries from 35,511 unique georeferenced coordinates. Detection/non-detection and quantitative data were obtained from 1818 to 2018 by researchers, governmental agencies, non-governmental organizations, and private consultants. Data were collected using several methods including camera trapping, museum collections, roadkill, line transect, and opportunistic records. Literature (peer-reviewed and grey literature) from Portuguese, Spanish and English were incorporated in this compilation. Most of the data set consists of detection data entries (n = 79,343; 79.7%) but also includes non-detection data (n = 20,262; 20.3%). Of those, 43.3% also include count data (n = 43,151). The information available in NEOTROPICAL CARNIVORES will contribute to macroecological, ecological, and conservation questions in multiple spatio-temporal perspectives. As carnivores play key roles in trophic interactions, a better understanding of their distribution and habitat requirements are essential to establish conservation management plans and safeguard the future ecological health of Neotropical ecosystems. Our data paper, combined with other large-scale data sets, has great potential to clarify species distribution and related ecological processes within the Neotropics. There are no copyright restrictions and no restriction for using data from this data paper, as long as the data paper is cited as the source of the information used. We also request that users inform us of how they intend to use the data

Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR): a multicentre, prospective observational study

Background Results from retrospective studies suggest that use of neuromuscular blocking agents during general anaesthesia might be linked to postoperative pulmonary complications. We therefore aimed to assess whether the use of neuromuscular blocking agents is associated with postoperative pulmonary complications. Methods We did a multicentre, prospective observational cohort study. Patients were recruited from 211 hospitals in 28 European countries. We included patients (aged ≥18 years) who received general anaesthesia for any in-hospital procedure except cardiac surgery. Patient characteristics, surgical and anaesthetic details, and chart review at discharge were prospectively collected over 2 weeks. Additionally, each patient underwent postoperative physical examination within 3 days of surgery to check for adverse pulmonary events. The study outcome was the incidence of postoperative pulmonary complications from the end of surgery up to postoperative day 28. Logistic regression analyses were adjusted for surgical factors and patients’ preoperative physical status, providing adjusted odds ratios (ORadj) and adjusted absolute risk reduction (ARRadj). This study is registered with ClinicalTrials.gov, number NCT01865513. Findings Between June 16, 2014, and April 29, 2015, data from 22803 patients were collected. The use of neuromuscular blocking agents was associated with an increased incidence of postoperative pulmonary complications in patients who had undergone general anaesthesia (1658 [7·6%] of 21694); ORadj 1·86, 95% CI 1·53–2·26; ARRadj –4·4%, 95% CI –5·5 to –3·2). Only 2·3% of high-risk surgical patients and those with adverse respiratory profiles were anaesthetised without neuromuscular blocking agents. The use of neuromuscular monitoring (ORadj 1·31, 95% CI 1·15–1·49; ARRadj –2·6%, 95% CI –3·9 to –1·4) and the administration of reversal agents (1·23, 1·07–1·41; –1·9%, –3·2 to –0·7) were not associated with a decreased risk of postoperative pulmonary complications. Neither the choice of sugammadex instead of neostigmine for reversal (ORadj 1·03, 95% CI 0·85–1·25; ARRadj –0·3%, 95% CI –2·4 to 1·5) nor extubation at a train-of-four ratio of 0·9 or more (1·03, 0·82–1·31; –0·4%, –3·5 to 2·2) was associated with better pulmonary outcomes. Interpretation We showed that the use of neuromuscular blocking drugs in general anaesthesia is associated with an increased risk of postoperative pulmonary complications. Anaesthetists must balance the potential benefits of neuromuscular blockade against the increased risk of postoperative pulmonary complications

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference -1·69 [-9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5-8] vs 6 [5-8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52-23·52]; p<0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75-0·86]; p<0·0001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status

Erratum to: Guidelines for the use and interpretation of assays for monitoring autophagy (3rd edition) (Autophagy, 12, 1, 1-222, 10.1080/15548627.2015.1100356

non present