RESUMO

The first-line treatment for mild-to-moderate bleeding episodes in patients with haemophilia and inhibitors in Brazil is currently activated prothrombin complex concentrate (aPCC), with recombinant activated factor VII (rFVIIa) used as second-line therapy or as a last resort. The aim of this study was to determine the cost and effectiveness of these treatments from the perspective of the Brazilian National Health Service. A decision analysis model was constructed to assess total direct medical costs (including drug costs, costs of outpatient or inpatient care, ambulance transportation and cost of concomitant medications) of first-line treatment with aPCC or rFVIIa. Clinical outcome and resource utilization data were obtained both retrospectively and prospectively and validated by the consensus of an expert panel of Brazilian haematologists. A total of 103 bleeds in 25 patients were included in the analysis. rFVIIa resolved bleeds more quickly (4.4 h) than aPCC (62.6 h) and was more effective (100% vs. 56.7% respectively). Mean total direct medical costs (from initiation to cessation of bleed) were estimated to be US$13 500 (aPCC) and US$7590 (rFVIIa). Extensive sensitivity analyses confirmed the cost-effectiveness of rFVIIa. Compared with aPCC, rFVIIa was more effective and less expensive when used as first-line treatment for mild-to-moderate bleeding episodes in patients with haemophilia and inhibitors in Brazil. rFVIIa should be considered a first-line treatment for the management of these patients.

Assuntos

Fator VII/uso terapêutico , Hemofilia A/tratamento farmacológico , Hemorragia/prevenção & controle , Adolescente , Adulto , Brasil , Criança , Estudos de Coortes , Efeitos Psicossociais da Doença , Fator VII/economia , Fator VIIa , Feminino , Hemofilia A/economia , Hemorragia/economia , Humanos , Masculino , Estudos Prospectivos , Proteínas Recombinantes/economia , Proteínas Recombinantes/uso terapêutico , Estudos Retrospectivos , Resultado do Tratamento

RESUMO

Because gastrointestinal dysfunction is a major problem in children with human immunodeficiency virus (HIV) infection, we utilized breath hydrogen measurements to determine the relationship between disaccharide malabsorption and gastrointestinal dysfunction in HIV-infected children. We found a strong association between lactose intolerance and persistent diarrheal disease in this population (p less than 0.007, Mann-Whitney U test). We also found evidence of sucrose malabsorption and persistent diarrheal disease in three of the children. Extensive microbiologic evaluations failed to reveal an etiologic agent related to the occurrence of gastrointestinal symptoms. Our findings indicate that disaccharide intolerance is a common occurrence in HIV-infected children with persistent diarrheal disease. Careful attention to dietary intake may be required to ameliorate clinical symptoms and to maintain adequate nutrition.

Assuntos

Dissacarídeos/farmacocinética , Infecções por HIV/metabolismo , Absorção Intestinal/fisiologia , Síndromes de Malabsorção/metabolismo , Testes Respiratórios/métodos , Criança , Pré-Escolar , Diarreia/complicações , Diarreia/metabolismo , Duodeno/metabolismo , Duodeno/patologia , Fezes/química , Infecções por HIV/complicações , Humanos , Hidrogênio/análise , Lactente , Lactose/farmacocinética , Intolerância à Lactose/complicações , Intolerância à Lactose/metabolismo , Síndromes de Malabsorção/complicações , Síndromes de Malabsorção/patologia , Estudos Prospectivos , Sacarose/farmacocinética

RESUMO

The behavioral responses of male and female Mexican fruit flies elicited by male abdominal extracts were measured in laboratory cages where pheromone was applied to the undersides of some leaves on a treated tree but to none of the leaves on a control tree. After arrival to the treated tree, females came directly to pheromone sources. Females on the treated tree visited leaves and fought other females at higher rates than on the control tree. Females stayed on treated leaves and trees longer than on control leaves and trees. In separate experiments, the number of males on pheromone-treated trees and leaves was higher than on controls, but other behavior was unchanged. The results indicate that the pheromone stimulates a complex of behavior involved in the mating ecology of the species.