Quality of life of patients with diabetes mellitus types 1 and 2 from a regerral health care center in Minas Gerais, Brazil

Quality of life (QoL) characteristics are important in patients with diabetes mellitus (DM 1 and 2). Aim: Evaluate QoL and DM-associated factors among diabetic patients. Methods: Patients attending a University Hospital interviewed about sociodemographic, clinical and QoL characteristics, with QoL measured via the EQ-5D. Descriptive analysis, correlation, linear regression, univariate and multivariate analysis were performed. Results: 346 patients took part, comprising 67% women, 59% with DM2, and 32% DM1. DM 1 patients had a mean QoL of 0.7369, with retinopathy, depression, dyslipidemia and a serious hypoglycemic crisis significantly reducing QoL. Patients with DM type 2 had mean QoL 0.6582, with hypertension, neuropathy, depression, cancer and dyslipidemia significantly reducing QoL. Reduced QoL also correlated with a lack of physical exercise. Males with both DM1 and 2 had a better QoL. Conclusion: Need for better disease monitoring and control combined with effective activities to improve self-care, reduce complications and improve patients’ QoL

Comparative effectiveness and safety of monoclonal antibodies for mCRC

Introduction: Biological medicines are increasingly used in combination with chemotherapy for patients with metastatic colorectal cancer (mCRC), resulting in increased progression-free survival (PFS). However, concerns remain over the extent of their effect on overall survival (OS) given the high costs of these monoclonal antibodies (MoAbs) (bevacizumab, cetuximab and panitumumab) and their safety. Published studies suggest no major differences in effectiveness and safety between the MoAbs; however, differences in costs with cetuximab more expensive than bevacizumab by 127% in Brazil and more expensive than panitumumab by 112%, with panitumumab more expensive than bevacizumab by 6%. Since there is rising litigation in Brazil in order to access these 3 MoAbs as they are not currently reimbursed, we wanted to compare their effectiveness and safety associated with chemotherapy or chemotherapy alone in patients with mCRC to provide future guidance to the judiciary and the healthcare system. Method: A systematic review and meta-analysis based on cohort studies published in databases up to November 2017. Effectiveness measures include PFS, post-progression survival (PPS), RECIST (Response Evaluation Criteria In Solid Tumors), response rates, metastasectomy rates, OS and safety. We also evaluated the methodological quality of the studies. Results: Overall, 21 observational cohort studies were included in the review. There were statistically significant and clinically relevant benefits in patients treated with bevacizumab versus those not treated with bevacizumab (no bevacizumab arm) mainly around PFS, PPS, metastasectomy rates and OS, but not for disease control rates. However, bevacizumab increased toxicities and there were concerns with the heterogeneity of the studies. Conclusion: The results suggested an advantage in favour of bevacizumab for a number of outcome measures and costs in patients with mCRC. However, this advantage may be only clinically modest for bevacizumab. This though has to be weighed against the serious adverse events associated with bevacizumab, especially severe hypertension and gastrointestinal perforation

Comparative Effectiveness and Safety of Monoclonal Antibodies (Bevacizumab, Cetuximab, and Panitumumab) in Combination with Chemotherapy for Metastatic Colorectal Cancer: A Systematic Review and Meta-Analysis

Background: The last decade has seen the increasing use of biological medicines in combination with chemotherapy containing 5- Fluorouracil/oxaliplatin or irinotecan for the treatment of metastatic colorectal cancer (mCRC). These combinations have resulted in increased progression-free survival (PFS) in patients with mCRC; however, there are remaining concerns over the extent of their effect on overall survival (OS). Published studies to date suggest no major differences between the three currently available monoclonal antibodies (MoAbs); however, there are differences in costs. In addition, there is rising litigation in Brazil in order to access these medicines as they are currently not reimbursed. Objective: To compare the effectiveness and safety of three MoAbs (bevacizumab, cetuximab and panitumumab) associated with fluoropyrimidine-based chemotherapy regimens or compared to fluoropyrimidine-based chemotherapy alone in patients with mCRC through an updated systematic review and meta-analysis with concurrent or non concurrent observational cohort studies to guide the authorities and judiciary. Method: A systematic review and meta-analysis was performed based on cohort studies published in databases up to November 2017. Effectiveness measures include OS, PFS, post-progression survival (PPS), RECIST (Response Evaluation Criteria In Solid Tumors), response rate, metastasectomy and safety. The methodological quality of the studies was also evaluated. Results: 21 observational cohort studies were included. There were statistically significant and clinically relevant benefits in patients treated with bevacizumab versus no bevacizumab mainly around OS, PFS, PPS and the metastasectomy rate, but not for the disease control rates. However, there was an increase in treatment-related toxicities, and concerns with the heterogeneity of the studies. Conclusion: The results pointed to an advantage in favor of bevacizumab for OS, PFS, PPS, and metastasectomy. Although this advantage may be considered clinically modest, bevacizumab represents a hope for increased survival and a chance of metastasectomy for patients with mCRC. However, there are serious adverse events associated with its use, especially severe hypertension and gastrointestinal perforation that need to be considered

Biological therapy in psoriatic arthritis patients with and without previous biologic experience

Objetivo: avaliar os efeitos da terapia biológica sobre a atividade da doença, funcionalidade, qualidade de vida, persistência no tratamento e segurança em pacientes com artrite psoriásica sem experiência e com experiência prévia em terapia biológica. Métodos: um estudo observacional prospectivo de um ano foi realizado. Os desfechos avaliados foram a persistência no tratamento, atividade da doença, funcionalidade, qualidade de vida e segurança. Um modelo de regressão linear múltipla foi utilizado para avaliar os fatores preditores de resposta clínica. Resultados: foram incluídos 205 pacientes, dos quais 155 não tinham e 50 tinham experiência prévia com medicamentos biológicos. As taxas de persistência no tratamento foram maiores para pacientes sem experiência prévia em comparação aos experientes em seis meses de acompanhamento, mas não em 12 meses. As taxas de persistência no tratamento foram 71,5% em pacientes sem experiência prévia e 70% em pacientes com experiência prévia em 12 meses. Todos os desfechos clínicos avaliados melhoraram em ambos os grupos de pacientes. Aos 12 meses, 63% dos pacientes sem experiência prévia e 52% dos pacientes com experiência prévia apresentaram melhora na qualidade de vida. Além disso, 48% dos pacientes sem experiência prévia e 42% dos pacientes com experiência prévia apresentaram melhora na funcionalidade. A doença axial melhorou em 67% dos pacientes sem experiência prévia e em 56% dos pacientes com experiência prévia. Um bom controle da doença articular periférica foi observado em 49% dos pacientes sem experiência prévia e em 44% dos pacientes com experiência prévia. Os principais fatores preditores de pior resposta clínica foram sexo feminino, uso de etanercepte ou infliximabe, bem como pior funcionalidade e qualidade de vida no início do estudo. Conclusão: a saúde dos pacientes melhorou após o início do tratamento com os medicamentos biológicos. Em geral, pacientes com experiência prévia com medicamentos biológicos apresentaram mais reações adversas e menor efetividade.Objective: this study evaluated the biological therapy effects on disease activity, functionality, quality of life, drug survival, and safety of patients with psoriatic arthritis naïve and experienced in biological therapy. Methods: a oneyear prospective observational study was performed. The outcomes assessed were drug survival, disease activity, functionality, quality of life, and safety. Multiple linear regression was used to assess predictive factors for clinical response.Results: a total of 205 patients were included, 155 of whom were biologic naïve and 50 biologic experienced. Drug survival rate was greater for naïve patients than experienced patients at 6 months, but not at 12 months. Drug survival rates were 71.5% for naïve patients and 70.0% for experienced patients at 12 months. All clinical parameters improved for both biologic naïve and experienced patients. At 12 months, 63% of naïve patients and 52% of experienced patients had an improvement in their quality of life. Besides, 48% of naïve patients and 42% of experienced patients had an improvement in functionality. The axial disease improved in 67% of naïve individuals and 56% of experienced patients. Good control of peripheral disease was achieved by 49% of naïve patients and 44% of experiencedpatients. Female sex, use of etanercept or infliximab, and lower functionality or quality of life at baseline were the main predictors of poor clinical response. Conclusion: Patients’ health improved after starting biological therapy. In general, biologic experienced patients had more adverse reactions and lesser effectiveness

Use of medicinal plants during COVID-19 pandemic in Brazil

Abstract Medicinal plants are an integrative and complementary health practice widely used by the population. However, its use is not without risks. This study assessed the profile and associated factors with the traditional use of medicinal plants. To this end, a cross-sectional survey study was conducted in a southeastern Brazilian city. Descriptive analysis was performed by frequency distribution and median and interquartile range. Associated factors with the use of medicinal plants were analyzed using Poisson regression with robust variance. A total of 641 people were interviewed, of whom 258 (40.2%) reported using medicinal plants. A total of 79 distinct plants were identified, of whom Melissa officinalis (31.0%), Peumus boldus (24.4%), Mentha spicata (20.9%), Matricaria recutita L. (18.2%), Rosmarinus officinalis (17.0%), and Foeniculum vulgare (14.7%) were the most used. There were no reports of medicinal plants used to treat COVID-19. However, anxiety was the most frequently cited indication for using medicinal plants, a health condition exacerbated by the COVID-19 pandemic. Furthermore, the use of medicinal plants for treating respiratory and gastrointestinal symptoms similar to those in COVID-19 has been identified. There was an association between the use of medicinal plants and females, non-white, lower schooling, higher income, and comorbidities

Comparative persistence of anti-tumor necrosis factor therapy in ankylosing spondylitis patients : a multicenter international study

Objective. To evaluate persistence on conventional DMARDs (cDMARDs) and anti-TNF therapies, and to identify potential determinants of discontinuation among individuals with ankylosing spondylitis(AS) living in Brazil and Quebec, Canada. Methods. We conducted a cohort study of AS patients using health administrative data (2010-2015). One-year and 2-year persistence rates were assessed. Cox regression was used to identify potential determinants of therapy discontinuation. Results. One-year persistence was less likely in Brazil for both anti-TNF and cDMARDs (Brazil: 62.1% and 30.7%, Quebec: 66.9% and 67.0%). The 2-year persistence rates were lower for both anti-TNF and cDMARD, but remained higher in Quebec (Brazil: 47.9% and 18.1%, Quebec: 51.5% and 53.5%). In multivariate Cox regression analysis, age, sex and comorbidities were associated with persistence in both countries. In Quebec, persistence did not differ between rural and urban regions or with socioeconomic status. While in Brazil, patients in regions with higher Human Development Index and those in cities with lower Gini index were less likely to discontinue therapy. Conclusions. Canadian AS patients were more likely to persist on therapy compared to Brazilian patients, although rates were lower at 2 years in both countries. Socioeconomic disparity in persistence was found in Brazil, but not in Quebec