Avaliação econômica das anticitocinas adalimumabe, etanercepte e infliximabe no tratamento da artrite reumatoide no Estado do Paraná

Este estudo objetivou realizar uma avaliação econômica das anticitocinas adalimumabe (ADA), etanercepte (ETA) e infliximabe (IFX) para o tratamento da artrite reumatoide no Estado do Paraná, sob a perspectiva do SUS. Os dados de eficácia e segurança dos tratamentos foram buscados na literatura, e os custos foram calculados com valores gastos pelo SUS para cada um dos tratamentos. Foi elaborado o modelo de Markov para obter a relação custo-efetividade de cada tratamento. A relação custo-efetividade incremental (ICER) comparado ao tratamento padrão também foi calculada para cada anticitocina. Análises de sensibilidade e taxas de desconto foram aplicadas. Na avaliação custo-efetividade, encontraram-se custos por QALY de R$511.633,00, R$ 437.486,00 e R$657.593,00 para ADA, ETA e IFX, respectivamente. O ICER por QALY foi R$ 628.124,00, R$509.974,00 e R$ 965.927,00 para ADA, ETA e IFX, respectivamente. Nas análises de sensibilidade, o ETA e o ADA apresentaram valores próximos. Cabe aos gestores públicos e aos médicos prescritores a escolha adequada para cada paciente, entre os tratamentos disponibilizados.This study aimed to perform an economic evaluation of anticytokines adalimumab (ADA), etanercept (ETA) and infliximab (IFX) for the treatment of rheumatoid arthritis in the State of Parana, in Brazil, in the perspective of the Brazilian Unified Health System. Data on efficacy and safety of treatment were collected in literature, and costs were calculated on the amounts spent by the Government for each treatment. A Markov model was performed to get the cost-effectiveness of each treatment. The incremental cost-effectiveness relationship (ICER) compared to a standard treatment was also calculated for each anticytokine. Sensitivity analysis and discount rates were applied. In assessing cost-effectiveness we found the following values (cost at R$per QALY): 511,633.00, 437,486.00 and 657,593.00 (respectively for ADA, ETA and IFX). The ICER (R$ per QALY) was 628,124.00, 509,974.00 and 965,927.00 (for ADA, ETA and IFX). In the sensitivity analysis, ETA and ADA showed similar values. It is for public managers and physicians the choice for each patient, among the treatments available

Goodbye Hartmann trial: a prospective, international, multicenter, observational study on the current use of a surgical procedure developed a century ago

Background: Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann's procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA. Methods: This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up. Results: 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6 years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P < 0.001). 30-day mortality was higher in HP patients (13.7%), especially in case of bowel perforation and diffused peritonitis. 1-year follow-up showed no differences on ostomy reversal rate between HP and RPA. (P = 0.127). A backward likelihood logistic regression model showed that RPA was preferred in younger patients, having low ASA score (≤ 3), in case of large bowel obstruction, absence of colonic ischemia, longer time from admission to surgery, operating early at the day working hours, by a surgeon who performed more than 50 colorectal resections. Conclusions: After 100 years since the first Hartmann's procedure, HP remains the most common treatment for left-sided colorectal emergencies. Treatment's choice depends on patient characteristics, the time of surgery and the experience of the surgeon. RPA should be considered as the gold standard for surgery, with HP being an exception

Laterally stretched flap with connective tissue graft: a novel approach to treat deep/narrow gingival recessions in lower incisors

EuroPerio 9 Congress. European Federation of Periodontology. Amsterdam, Holland Poster Presentation PD171 Background: Different alternatives of treatment of deep/narrow gingival recessions with connective tissue grafts have been proposed: Tunneling procedures1 leave a considerable area of the graft exposed conditioning its nutrition.2,3 Coronally advancing the flap to cover the graft requires extensive repositioning of a -mostly mucosal- flap and the mucogingival junction; while lateral displacement4 is generally achieved by placing vertical incisions, potentially leaving visible scars. The aim of this case series is to present the technical description, and the results obtained with 21 gingival recessions treated with a recently published novel approach: the laterally stretched flap (LSF) with connective tissue graft (CTG).5 Technical variants, and keys to success will be reviewed. Clinical Procedure: 17 patients with 21 deep/narrow Miller class II and III gingival recessions were treated and followed-up between 6 months and 4 years. Recession depth (Rec) and keratinized tissue (KT) were registered at baseline and at final evaluation (Table 1). Mean % root coverage (MRC) and complete root coverage (CRC) were calculated. Briefly, the recipient site was prepared with intracrevicular incisions and a partial thickness envelope performed with tunneling instruments until ample tissue elasticity was obtained.5 A connective tissue graft was harvested from the palate with a modified single incision technique utilizing a parallel blade scalpel.6 The graft was inserted into the envelope and held with sutures at both lateral ends.7,8 The lateral edges of the recession were finally approximated with sutures to cover the graft. Outcomes: Clinical Outcomes: Class I and II recessions gained 99.2% of MRC and 88.5% of sites achieved CRC. Miller class III showed 79.2% of MRC and 23.1% of the sites reached CRC. KT was increased in all cases (Table 1). Conclusions: Laterally stretching the flap to cover the graft improved revascularization of the graft and wound stability rendering excellent esthetic outcomes with minimal patient discomfort

Honey produced by apini and meliponini in Brazil: multivariate analysis of physicochemical parameters, sugar and metabolite profiles

The objective of this study was to investigate honey samples from two bee tribes grouped in Meliponini (stingless bee) and Apini (Apis mellifera) honeys from Brazil, in order to compare their chemical composition. Thirty-four honey samples were collected and evaluated by proton NMR spectroscopy, HPLC and physicochemical parameters, using chemometric methods. Principal component analysis (PCA) was able to discriminate Apini and Meliponini goups. Additionally, the partial least squares discriminant analysis (PLS-DA) models were able to predict the Apini and Meliponini honey samples with sensitivity, specificity and accuracy values close to 100%. Frequency values between 4.00 − 3.00 ppm, corresponding to the sugar region, were important for the classification by the PLS-DA model using NMR data. For the PLS-DA model using physicochemical data, the main parameters for classification were water activity, reducing sugar, moisture, refractive index, total soluble solids, maltose and glucose. Since stingless honeys have no regulation, the data presented in this study can compose a database to assist in the establishment of regulatory criteria. Moreover, the chemometric models proposed can be used as a tool for the quality control of honey, especially for authentication purposes.</p