The drug and vaccine landscape for neglected diseases (2000–11): a systematic assessment

Background In 1975–99, only 1·1% of new therapeutic products had been developed for neglected diseases. Since then, several public and private initiatives have attempted to mitigate this imbalance. We analysed the research and development pipeline of drugs and vaccines for neglected diseases from 2000 to 2011. Methods We searched databases of drug regulatory authorities, WHO, and clinical trial registries for entries made between Jan 1, 2000, and Dec 31, 2011. We defi ned neglected diseases as malaria, tuberculosis, diarrhoeal diseases, neglected tropical diseases (NTDs; WHO defi nition), and other diseases of poverty according to common defi nitions. Findings Of the 850 new therapeutic products registered in 2000–11, 37 (4%) were indicated for neglected diseases, comprising 25 products with a new indication or formulation and eight vaccines or biological products. Only four new chemical entities were approved for neglected diseases (three for malaria, one for diarrhoeal disease), accounting for 1% of the 336 new chemical entities approved during the study period. Of 148 445 clinical trials registered in Dec 31, 2011, only 2016 (1%) were for neglected diseases. Interpretation Our fi ndings show a persistent insuffi ciency in drug and vaccine development for neglected diseases. Nevertheless, these and other data show a slight improvement during the past 12 years in new therapeutics development and registration. However, for many neglected diseases, new therapeutic products urgently need to be developed and delivered to improve control and potentially achieve elimination

PCC21 - Avaliação da presença de disfunção temporomandibular e dor orofacial em indivíduos com mielomeningocele

A mielomeningocele constitui a mais frequente malformaçãocongênita do sistema nervoso variando sua complexidade e acometimento de múltiplos órgãos. Sua etiologia é desconhecida, sugere-se ser uma doença multifatorial. O diagnóstico pode ser feito no período pré-natal através de ultra-sonografia morfológica

Uso do Controle Gerencial e Decisões em Organizações de Saúde Brasileiras: um Estudo Exploratório

This article analyzes the interplay of the use of management control systems, organizational learning, management decisions and the performance of health organizations. In the quantitative step, we collected data on 48 Brazilian hospitals and other health facilities by means of a survey. Principal component analysis identified three dimensions of management decisions (financial, costs and client relationship) and two performance dimensions (economic and non-monetary). Structural equation modeling confirmed the following hypotheses: (i) interactive use of the management control system is positively associated with organizational learning (OL); (ii) OL is positively associated with financial decisions and cost and process decisions; (iii) cost and process decisions and decisions related to clients are positively associated with economic performance; and (iv) cost and process decisions are also positively associated with non-monetary performance. In the qualitative step, we interviewed four key informants to discuss and interpret the results.Nesta pesquisa, foram analisados os relacionamentos entre o uso do sistema de controle gerencial, a aprendizagem organizacional, as decisões gerenciais e o desempenho em organizações hospitalares. Na etapa quantitativa, foram coletados dados de 48 hospitais brasileiros por meio de um survey. A análise de componentes principais identificou três dimensões de decisões gerenciais (financeiras, custos e processos e relacionamento com clientes) e duas dimensões de desempenho (econômico e não monetário). A modelagem de equações estruturais confirmou as seguintes hipóteses: (i) o uso interativo está associado positivamente com a aprendizagem organizacional (AO); (ii) a AO está associada positivamente com decisões financeiras e com decisões de custos e processos; (iii) as decisões de custos e processos e as decisões relacionadas aos clientes estão associadas positivamente com desempenho econômico; e (iv) as decisões de custos e processos também estão associadas positivamente com desempenho não monetário. Na etapa qualitativa, foram entrevistados quatro informantes-chave, com o objetivo de discutir e de interpretar os resultados

Projected Number of People With Onchocerciasis-Loiasis Coinfection in Africa, 1995 to 2025

BACKGROUND: Onchocerciasis elimination through mass drug administration (MDA) is hampered by coendemicity of Loa loa, as people with high L. loa microfilariae (mf) density can develop serious adverse events (SAEs) after ivermectin treatment. We assessed the geographical overlap of onchocerciasis and loiasis prevalence and estimated the number of coinfected individuals at risk of post-ivermectin SAEs in West and Central Africa from 1995 to 2025. METHODS: Focusing on regions with suspected loiasis transmission in 14 countries, we overlaid precontrol maps of loiasis and onchocerciasis prevalence to calculate precontrol prevalence of coinfection by 5 km2 × 5 km2 pixel, distinguishing different categories of L. loa mf intensity. Using statistical and mathematical models, we predicted prevalence of both infections and coinfection for 2015 and 2025, accounting for the impact of MDA with ivermectin. RESULTS: The number of people infected with onchocerciasis was predicted to decline from almost 19 million in 1995 to 4 million in 2025. Of these, 137 000 people were estimated to also have L. loa hypermicrofilaremia (≥20 000 L. loa mf/mL) in 1995, declining to 31 000 in 2025. In 2025, 92.8% of coinfecte

PCC10 - Avaliação de disfunção temporomandibular e dor orofacial em indivíduos com osteogênese imperfeita: série de casos

A osteogênese imperfeita (OI) é uma alteração óssea de origem genética afetando a estrutura e a função do colágeno do tipo I, que representa mais de 90% do colágeno tecidual total. O padrão de herança mais comum é o autossômico dominante, podendo ser, com menor frequência, recessivo. A síntese deficiente leva ao aparecimento de ossos enfraquecidos e quebradiços, sendo outros sinais que acompanham esta doença o tom azulado da esclerótica e a perda de audição

A systematic review and an individual patient data meta-analysis of ivermectin use in children weighing less than fifteen kilograms: Is it time to reconsider the current contraindication?

BACKGROUND: Oral ivermectin is a safe broad spectrum anthelminthic used for treating several neglected tropical diseases (NTDs). Currently, ivermectin use is contraindicated in children weighing less than 15 kg, restricting access to this drug for the treatment of NTDs. Here we provide an updated systematic review of the literature and we conducted an individual-level patient data (IPD) meta-analysis describing the safety of ivermectin in children weighing less than 15 kg. METHODOLOGY/PRINCIPAL FINDINGS: A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for IPD guidelines by searching MEDLINE via PubMed, Web of Science, Ovid Embase, LILACS, Cochrane Database of Systematic Reviews, TOXLINE for all clinical trials, case series, case reports, and database entries for reports on the use of ivermectin in children weighing less than 15 kg that were published between 1 January 1980 to 25 October 2019. The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO): CRD42017056515. A total of 3,730 publications were identified, 97 were selected for potential inclusion, but only 17 sources describing 15 studies met the minimum criteria which consisted of known weights of children less than 15 kg linked to possible adverse events, and provided comprehensive IPD. A total of 1,088 children weighing less than 15 kg were administered oral ivermectin for one of the following indications: scabies, mass drug administration for scabies control, crusted scabies, cutaneous larva migrans, myiasis, pthiriasis, strongyloidiasis, trichuriasis, and parasitic disease of unknown origin. Overall a total of 1.4% (15/1,088) of children experienced 18 adverse events all of which were mild and self-limiting. No serious adverse events were reported. CONCLUSIONS/SIGNIFICANCE: Existing limited data suggest that oral ivermectin in children weighing less than 15 kilograms is safe. Data from well-designed clinical trials are needed to provide further assurance

Enfoques sobre posmodernidad en América Latina

Follari, Roberto y Lanz, Rigoberto(comps): Enfoques sobre posmodernidad en América Latina, edit. Sentido, Caracas, Spetiembre 1998