Cost-effectiveness analysis of a state funded programme for control of severe asthma

<p>Abstract</p> <p>Background</p> <p>Asthma is one of the most common chronic diseases and a major economical burden to families and health systems. Whereas efficacy of current therapeutical options has been clearly established, cost-effectiveness analysis of public health interventions for asthma control are scarce.</p> <p>Methods</p> <p>81 patients with severe asthma (12–75 years) joining a programme in a reference clinic providing free asthma medication were asked retrospectively about costs and events in the previous 12 months. During 12 months after joining the programme, information on direct and indirect costs, asthma control by lung function, symptoms and quality of life were collected. The information obtained was used to estimate cost-effectiveness of the intervention as compared to usual public health asthma management. Sensitivity analysis was conducted.</p> <p>Results</p> <p>64 patients concluded the study. During the 12-months follow-up within the programme, patients had 5 fewer days of hospitalization and 68 fewer visits to emergency/non scheduled medical visits per year, on average. Asthma control scores improved by 50% and quality of life by 74%. The annual saving in public resources was US$387 per patient. Family annual income increased US$512, and family costs were reduced by US$733.</p> <p>Conclusion</p> <p>A programme for control of severe asthma in a developing country can reduce morbidity, improve quality of life and save resources from the health system and patients families.</p

Effects of descending positive end-expiratory pressure on lung mechanics and aeration in healthy anaesthetized piglets

INTRODUCTION: Atelectasis and distal airway closure are common clinical entities of general anaesthesia. These two phenomena are expected to reduce the ventilation of dependent lung regions and represent major causes of arterial oxygenation impairment in anaesthetic conditions. The behaviour of the elastance of the respiratory system (E(rs)), as well as the lung aeration assessed by computed tomography (CT) scan, was evaluated during a descendent positive end-expiratory pressure (PEEP) titration. This work sought to evaluate the potential usefulness of E(rs )monitoring to set the PEEP in order to prevent tidal recruitment and hyperinflation of healthy lungs under general anaesthesia. METHODS: PEEP titration (from 16 to 0 cmH(2)O, tidal volume of 8 ml/kg) was performed, and at each PEEP, CT scans were obtained during end-expiratory and end-inspiratory pauses in six healthy, anaesthetized and paralyzed piglets. The distribution of lung aeration was determined and the tidal re-aeration was calculated as the difference between end-expiratory and end-inspiratory poorly aerated and normally aerated areas. Similarly, tidal hyperinflation was obtained as the difference between end-inspiratory and end-expiratory hyperinflated areas. E(rs )was estimated from the equation of motion of the respiratory system during all PEEP titration with the least-squares method. RESULTS: Hyperinflated areas decreased from PEEP 16 to 0 cmH(2)O (ranges decreased from 24–62% to 1–7% at end-expiratory pauses and from 44–73% to 4–17% at end-inspiratory pauses) whereas normally aerated areas increased (from 30–66% to 72–83% at end-expiratory pauses and from 19–48% to 73–77% at end-inspiratory pauses). From 16 to 8 cmH(2)O, E(rs )decreased with a corresponding reduction in tidal hyperinflation. A flat minimum of E(rs )was observed from 8 to 4 cmH(2)O. For PEEP below 4 cmH(2)O, E(rs )increased in association with a rise in tidal re-aeration and a flat maximum of the normally aerated areas. CONCLUSION: In healthy piglets under a descending PEEP protocol, the PEEP at minimum E(rs )presented a compromise between maximizing normally aerated areas and minimizing tidal re-aeration and hyperinflation. High levels of PEEP, greater than 8 cmH(2)O, reduced tidal re-aeration but increased hyperinflation with a concomitant decrease in normally aerated areas

A Paracoccidioides brasiliensis glycan shares serologic and functional properties with cryptococcal glucuronoxylomannan

The cell wall of the yeast form of the dimorphic fungus Paracoccidioides brasiliensis is enriched with alpha 1,3-glucans. in Cryptococcus neoformans, alpha 1,3-glucans interact with glucuronoxylomannan (GXM), a hetero-polysaccharide that is essential for fungal virulence. in this study, we investigated the occurrence of P. brasiliensis glycans sharing properties with cryptococcal GXM. Protein database searches in P. brasiliensis revealed the presence of sequences homologous to those coding for enzymes involved in the synthesis of GXM and capsular architecture in C. neoformans. in addition, monoclonal antibodies (mAbs) raised to cryptococcal GXM bound to P. brasiliensis cells. Using protocols that were previously established for extraction and analysis of C neoformans GXM, we recovered a P. brasiliensis glycan fraction composed of mannose and galactose, in addition to small amounts of glucose, xylose and rhamnose. in comparison with the C. neoformans GXM, the P. brasiliensis glycan fraction components had smaller molecular dimensions. the P. brasiliensis components, nevertheless, reacted with different GXM-binding mAbs. Extracellular vesicle fractions of P. brasiliensis also reacted with a GXM-binding mAb, suggesting that the polysaccharide-like molecule is exported to the extracellular space in secretory vesicles. An acapsular mutant of C. neoformans incorporated molecules from the P. brasiliensis extract onto the cell wall, resulting in the formation of surface networks that resembled the cryptococcal capsule. Coating the C. neoformans acapsular mutant with the P. brasiliensis glycan fraction resulted in protection against phagocytosis by murine macrophages. These results suggest that P. brasiliensis and C. neoformans share metabolic pathways required for the synthesis of similar polysaccharides and that P. brasiliensis yeast cell walls have molecules that mimic certain aspects of C. neoformans GXM. These findings are important because they provide additional evidence for the sharing of antigenically similar components across phylogenetically distant fungal species. Since GXM has been shown to be important for the pathogenesis of C neoformans and to elicit protective antibodies, the finding of similar molecules in P. brasiliensis raises the possibility that these glycans play similar functions in paracoccidiomycosis. (C) 2012 Elsevier Inc. All rights reserved.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ)NIHCenter for AIDS Research at EinsteinInterhemispheric Research Training Grant in Infectious Diseases, Fogarty International CenterDepartment of EnergyFiocruz MS, CDTS, BR-21040360 Rio de Janeiro, BrazilUniv Fed Rio de Janeiro, Inst Microbiol Prof Paulo de Goes, BR-21941902 Rio de Janeiro, BrazilAlbert Einstein Coll Med, Dept Microbiol & Immunol, Bronx, NY 10461 USAUniversidade Federal de São Paulo, Disciplina Biol Celular, BR-04023062 São Paulo, BrazilUniv Fed Rio de Janeiro, Inst Biofis Carlos Chagas Filho, Lab Ultraestrutura Celular Hertha Meyer, BR-21941903 Rio de Janeiro, BrazilAlbert Einstein Coll Med, Div Infect Dis, Dept Med, Bronx, NY 10461 USAUniversidade Federal de São Paulo, Disciplina Biol Celular, BR-04023062 São Paulo, BrazilNIH: AI033142NIH: AI033774NIH: AI052733NIH: HL059842Interhemispheric Research Training Grant in Infectious Diseases, Fogarty International Center: NIH D43-TW007129Department of Energy: DE-FG-9-93ER-20097Web of Scienc

Síntese de poliestireno sulfonado para aplicações no tratamento de água produzido a partir de copos e bandejas descartadas de poliestireno

In the present paper, the use of poly(styrene sulfonate) (PSS), produced from discarded polystyrene materials through heterogeneous and homogeneous processes, was investigated. The use of PSS for water treatment, using a kaolin suspension as wastewater model, reduced water turbidity for all the employed materials when compared to the blank analysis, without PSS. The most efficient polyelectrolyte was PSS cups obtained by homogeneous route. The same behavior was observed for real system. The homogeneous PSS cups showed a balance between a moderate molecular weight and high anionic character that improved flocks formation and water removal turbidity

Lipidomic Analysis of Extracellular Vesicles from the Pathogenic Phase of Paracoccidioides brasiliensis

Background: Fungal extracellular vesicles are able to cross the cell wall and transport molecules that help in nutrient acquisition, cell defense, and modulation of the host defense machinery.Methodology/Principal Findings: Here we present a detailed lipidomic analysis of extracellular vesicles released by Paracoccidioides brasiliensis at the yeast pathogenic phase. We compared data of two representative isolates, Pb3 and Pb18, which have distinct virulence profiles and phylogenetic background. Vesicle lipids were fractionated into different classes and analyzed by either electrospray ionization- or gas chromatography-mass spectrometry. We found two species of monohexosylceramide and 33 phospholipid species, including phosphatidylcholine, phosphatidylethanolamine, phosphatidic acid, phosphatidylserine, phosphatidylinositol, and phosphatidylglycerol. Among the phospholipid-bound fatty acids in extracellular vesicles, C181 predominated in Pb3, whereas C18:2 prevailed in Pb18. the prevalent sterol in Pb3 and Pb18 vesicles was brassicasterol, followed by ergosterol and lanosterol. Inter-isolate differences in sterol composition were observed, and also between extracellular vesicles and whole cells.Conclusions/Significance: the extensive lipidomic analysis of extracellular vesicles from two P. brasiliensis isolates will help to understand the composition of these fungal components/organelles and will hopefully be useful to study their biogenesis and role in host-pathogen interactions.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)National Institutes of Health (NIH)Universidade Federal de São Paulo, UNIFESP, Dept Microbiol Imunol & Parasitol, São Paulo, BrazilUniv Texas El Paso, Dept Biol Sci, Border Biomed Res Ctr, El Paso, TX 79968 USAUniversidade Federal de São Paulo, UNIFESP, Dept Microbiol Imunol & Parasitol, São Paulo, BrazilFAPESP: 06/05095-6FAPESP: 07/04757-8FAPESP: 07/59768-4CNPq: 301666/2010-5National Institutes of Health (NIH): 5G12RR008124-16A1National Institutes of Health (NIH): 5G12RR008124-16A1S1National Institutes of Health (NIH): G12MD007592Web of Scienc

Angiotensin II Facilitates Breast Cancer Cell Migration and Metastasis

Breast cancer metastasis is a leading cause of death by malignancy in women worldwide. Efforts are being made to further characterize the rate-limiting steps of cancer metastasis, i.e. extravasation of circulating tumor cells and colonization of secondary organs. In this study, we investigated whether angiotensin II, a major vasoactive peptide both produced locally and released in the bloodstream, may trigger activating signals that contribute to cancer cell extravasation and metastasis. We used an experimental in vivo model of cancer metastasis in which bioluminescent breast tumor cells (D3H2LN) were injected intra-cardiacally into nude mice in order to recapitulate the late and essential steps of metastatic dissemination. Real-time intravital imaging studies revealed that angiotensin II accelerates the formation of metastatic foci at secondary sites. Pre-treatment of cancer cells with the peptide increases the number of mice with metastases, as well as the number and size of metastases per mouse. In vitro, angiotensin II contributes to each sequential step of cancer metastasis by promoting cancer cell adhesion to endothelial cells, trans-endothelial migration and tumor cell migration across extracellular matrix. At the molecular level, a total of 102 genes differentially expressed following angiotensin II pre-treatment were identified by comparative DNA microarray. Angiotensin II regulates two groups of connected genes related to its precursor angiotensinogen. Among those, up-regulated MMP2/MMP9 and ICAM1 stand at the crossroad of a network of genes involved in cell adhesion, migration and invasion. Our data suggest that targeting angiotensin II production or action may represent a valuable therapeutic option to prevent metastatic progression of invasive breast tumors