AVALIAÇÃO DAS DEMANDAS JUDICIAIS POR ACESSO A MEDICAMENTOS NO DISTRITO FEDERAL

Este trabalho investigou as demandas por medicamentos indisponíveis na Secretaria de Saúde do Distrito Federal (SES-DF) e avaliou os aspectos clínicos, processuais e financeiros das ações judiciais interpostas contra o poder público do Distrito Federal de 2009 a 2011. Realizou-se consulta à SES-DF para compreender as possíveis formas de requerimento desses produtos e conhecer os gastos com seu atendimento. Junto à Procuradoria Geral do Distrito Federal, consultaram-se cópias dos processos para traçar o perfil das demandas judiciais por medicamentos. Foram analisadas as evidências científicas disponíveis para as indicações citadas nos processos dos 10 medicamentos mais solicitados em cada ano. Verificou-se que a maioria das solicitações por medicamentos indisponíveis na SES-DF refere-se a ações judiciais, totalizando gasto de aproximadamente 12 milhões de reais em 2011. As características dos autores dos processos sugerem indivíduos menos favorecidos socioeconomicamente, sendo em sua maioria crianças e idosos, predominantemente estudantes e aposentados, representados pela Defensoria Pública. Grande parte dos medicamentos solicitados não está incluída nos elencos da Assistência Farmacêutica e suas evidências científicas sugerem baixo grau de recomendação para as indicações identificadas. Além disso, os processos apresentam poucas justificativas clínicas e quase a totalidade apresenta resultado favorável aos autores

Gene Expression and DNA Methylation Alterations During Non-alcoholic Steatohepatitis-Associated Liver Carcinogenesis

Hepatocellular carcinoma (HCC) is one of the most aggressive human cancers. HCC is characterized by an acquisition of multiple abnormal phenotypes driven by genetic and epigenetic alterations, especially abnormal DNA methylation. Most of the existing clinical and experimental reports provide only a snapshot of abnormal DNA methylation patterns in HCC rather than their dynamic changes. This makes it difficult to elucidate the significance of these changes in the development of HCC. In the present study, we investigated hepatic gene expression and gene-specific DNA methylation alterations in mice using the Stelic Animal Model (STAM) of non-alcoholic steatohepatitis (NASH)-derived liver carcinogenesis. Analysis of the DNA methylation status in aberrantly expressed epigenetically regulated genes showed the accumulation of DNA methylation abnormalities during the development of HCC, with the greatest number of aberrantly methylated genes being found in full-fledged HCC. Among these genes, only one gene, tubulin, beta 2B class IIB (Tubb2b), was increasingly hypomethylated and over-expressed during the progression of the carcinogenic process. Furthermore, the TUBB2B gene was also over-expressed and hypomethylated in poorly differentiated human HepG2 cells as compared to well-differentiated HepaRG cells. The results of this study indicate that unique gene-expression alterations mediated by aberrant DNA methylation of selective genes may contribute to the development of HCC and may have diagnostic value as the disease-specific indicator

Bilateral asymptomatic fibrous-ankylosis of the temporomandibular joint associated with rheumatoid arthritis: a case report

The American Academy of Orofacial Pain (AAOP) defines ankylosis of the temporomandibular joint (TMJ) as a restriction of movements due to intracapsular fibrous adhesions, fibrous changes in capsular ligaments (fibrous-ankylosis) and osseous mass formation resulting in the fusion of the articular components (osseous-ankylosis). The clinical features of the fibrous-ankylosis are severely limited mouth-opening capacity (limited range of motion during the opening), usually no pain and no joint sounds, marked deflection to the affected side and marked limitation of movement to the contralateral side. A variety of factors may cause TMJ ankylosis, such as trauma, local and systemic inflammatory conditions, neoplasms and TMJ infection. Rheumatoid arthritis (RA) is one of the systemic inflammatory conditions that affect the TMJ and can cause ankylosis. The aim of this study is to present a case of a female patient diagnosed with bilateral asymptomatic fibrous-ankylosis of the TMJ associated with asymptomatic rheumatoid arthritis. This case illustrates the importance of a comprehensive clinical examination and correct diagnosis of an unusual condition causing severe mouth opening limitation

Alteração epigenética no gene BDNF, status social e de saúde como preditores da insegurança alimentar e nutricional em cafeicultores familiares

Introduction: state of Food and Nutritional Security (FNS) is one that should guarantee the right of permanent access to quality food and in sufficient quantity without prejudicing access to other basic rights. In Brazil, rural family farming establishments represent 84.4% of total agricultural establishments and contribute to more than 70% of all food consumed by Brazilians. In this context, the production of the coffee commodity stands out. However, despite being food producers, they do not earn a good income. Slow economic activity can lead to loss of wages and income, illness, as well as food insecurity (FNiS). In addition, the molecular effects of FNiS are poorly studied, especially epigenetic. Objective: the objective of the present study is to analyze the association between Brain-Derived Neurotrophic Factor (BDNF) DNA methylation and socio demographic, lifestyle, and epigenetic factors, among coffee farmers in the Caparaó zone, in Espirito Santo, Southeast Brazil. Methods: the study was carried out in 22 randomly selected coffee producing communities in Zona Caparaó, an area that produces coffee of recognized quality. A total of 570 coffee farming households, 18 to 60 years of age, were included in the study by answering a questionnaire about socioeconomic characteristics, land use and ownership, behavior, health, and working conditions. FNiS evaluation was carried out using the Brazilian Food Insecurity Scale. BDNF exon I methylation was examined by methylation-specific PCR. Body mass index and biochemical analyses were performed. Logistic regression models were used to verify factors associated with FNiS (p<0.05). Data were analyzed using the Stata® statistical software package version 14. Results: the FNiS prevalence found was 23.68%. In multivariable logistic regression, the occurrence of FNiS was associated with hypermethylation of exon I of the BDNF promoter exon I [ORa = 5.03 (95% (1.98, 12.82)] when compared to the unmethylated gene. Moreover, FNiS was associated with excessive workload [ORa = 3.36 (1.23, 9.22)], possession of less land (hectares) [ORa = 0.77 (0.67, 0.90)] and greater number symptoms and / or illnesses in real life [ORa = 1.12 (1.04.1.20)]. Conclusion: there is a high prevalence of Food Insecurity in the studied region. This phenomenon was associated with epigenetic factors (BDNF methylation), excessive workload, small land ownership and a greater number of diseases / symptoms. Food insecurity is a psychosocial stressor that can lead to epigenetic changes in the BDNF gene, responsible for regulating cognitive functions, neuronal survival and involved in the genesis of psychiatric diseases.Introdução: o Estado de Segurança Alimentar e Nutricional (SAN) é aquele que deve garantir o direito de acesso permanente à alimentação de qualidade e em quantidade suficiente sem prejudicar o acesso a outros direitos básicos. No Brasil, os estabelecimentos de agricultura familiar rural representam 84,4% do total de estabelecimentos agropecuários e contribuem com mais de 70% de todos os alimentos consumidos pelos brasileiros. Nesse contexto, destaca-se a produção da commodity café. No entanto, apesar de serem produtores de alimentos, não auferem bons rendimentos. A lenta atividade econômica pode levar à perda de salários e renda, doenças e insegurança alimentar (INSAN). Além disso, os efeitos moleculares da INSAN são pouco estudados, sobretudo epigenéticos. Objetivos: o objetivo do presente estudo é analisar a associação entre a metilação do promotor do BDNF e a INSAN e a associação da INSAN com fatores sociodemográficos, de estilo de vida e epigenéticos, em cafeicultores da zona do Caparaó, no Espírito Santo, Sudeste do Brasil. Método: o estudo foi realizado em 22 comunidades cafeeiras selecionadas aleatoriamente na Zona do Caparaó, área que produz café de reconhecida qualidade. Um total de 570 famílias de cafeicultores, entre 18 a 60 anos, foram incluídos no estudo e responderam a um questionário sobre características socioeconômicas, uso e posse da terra, hábitos de vida, saúde e condições de trabalho. A avaliação da INSAN foi realizada por meio da Escala Brasileira de Insegurança Alimentar. A metilação do éxon I do BDNF foi examinada por PCR específica para metilação. Índice de massa corporal e análises bioquímicas foram realizadas. Modelos de regressão logística foram utilizados para verificar os fatores associados à INSAN (p<0,05). Os dados foram analisados usando o software estatístico Stata® versão 14. Resultados: a prevalência de INSAN encontrada foi de 23,68%. Na regressão logística multivariada, a ocorrência de INSAN foi associada a hipermetilação do éxon I do promotor do gene BDNF [ORa = 5,03 (95% (1,98, 12,82)] quando comparado ao gene não metilado. Além disso, a INSAN foi associada a carga de trabalho excessiva [ORa = 3,36 (1,23, 9,22)], posse de menos hectares de terra [ORa = 0,77 (0,67, 0,90)] e maior número de sintomas e/ou doenças da vida real [ORa = 1,12 (1.04.1.20)]. Conclusão: o estudo mostrou uma alta prevalência de Insegurança Alimentar na região analisada. Esse fenômeno foi associado a fatores epigenéticos (metilação do gene BDNF), carga horária excessiva, pequena propriedade de terra e maior número de doenças/sintomas. A INSAN pode ser um estressor capaz de promover alterações epigenéticas no gene BDNF, importante gene regulador da cognição, crescimento e sobrevivência neuronal e envolvido com doenças psiquiátricas

Carcinogenicity of cobalt, antimony compounds, and weapons-grade tungsten alloy

The complete evaluation of the carcinogenicity of cobalt, antimony compounds, and weapons-grade tungsten alloy will be published in Volume 131 of the IARC Monographs.[Excerpt] In March, 2022, a Working Group of 31 scientists from 13 countries met remotely at the invitation of the International Agency for Research on Cancer (IARC) to finalise their evaluation of the carcinogenicity of nine agents: cobalt metal (without tungsten carbide or other metal alloys), soluble cobalt(II) salts, cobalt(II) oxide, cobalt(II,III) oxide, cobalt(II) sulfide, other cobalt(II) compounds, trivalent antimony, pentavalent antimony, and weapons-grade tungsten (with nickel and cobalt) alloy. For cobalt metal and the cobalt compounds, particles of all sizes were included in the evaluation. These assessments will be published in Volume 131 of the IARC Monographs.1 Cobalt metal and soluble cobalt(II) salts were classified as “probably carcinogenic to humans” (Group 2A) based on “sufficient” evidence for cancer in experimental animals and “strong” mechanistic evidence in human primary cells. Cobalt(II) oxide and weapons-grade tungsten alloy were classified as “possibly carcinogenic to humans” (Group 2B) based on “sufficient” evidence in experimental animals. Trivalent antimony was classified as “probably carcinogenic to humans” (Group 2A), based on “limited” evidence for cancer in humans, “sufficient” evidence for cancer in experimental animals, and “strong” mechanistic evidence in human primary cells and in experimental systems. Cobalt(II,III) oxide, cobalt(II) sulfide, other cobalt(II) compounds, and pentavalent antimony were each evaluated as “not classifiable as to its carcinogenicity to humans” (Group 3).[...

DECREASING PREVALENCE OF THE ACUTE/SUBACUTE CLINICAL FORM OF PARACOCCIDIOIDOMYCOSIS IN MATO GROSSO DO SUL STATE, BRAZIL

With the objective to evaluate the behavior of paracoccidioidomycosis in the last three decades, clinical and epidemiological data of 595 patients admitted to clinical services of the Federal University of Mato Grosso do Sul from 1980 to 2009 were investigated. Gender, age distribution, clinical form, comorbidity with tuberculosis or AIDS, and mortality were compared by decades of clinical admission. It was shown that during the three decades there was a decrease in women percentage, and the same manner occurred a reduction in participants in the age group of 20 to 39 years. Moreover, the acute/subacute forms have been diminished in the period. These fluctuations are closely related and can be simultaneously analyzed. Increased AIDS co-infection prevalence from the first to the second decade was also revealed, coinciding with the appearance of the retroviral epidemic and stabilizing during the third decade. No change in the tuberculosis co-infection rate was observed (overall = 6.9%). It reinforces the importance of this co-morbidity. The overall mortality rate remained steady at 6.7%, not varying significantly from one decade to another. The persistent mortality rate calls attention to the importance of this neglected disease

LongITools: Dynamic longitudinal exposome trajectories in cardiovascular and metabolic noncommunicable diseases

The current epidemics of cardiovascular and metabolic noncommunicable diseases have emerged alongside dramatic modifications in lifestyle and living environments. These correspond to changes in our “modern” postwar societies globally characterized by rural-to-urban migration, modernization of agricultural practices, and transportation, climate change, and aging. Evidence suggests that these changes are related to each other, although the social and biological mechanisms as well as their interactions have yet to be uncovered. LongITools, as one of the 9 projects included in the European Human Exposome Network, will tackle this environmental health equation linking multidimensional environmental exposures to the occurrence of cardiovascular and metabolic noncommunicable diseases.</p

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries