Cost of Illness in Patients With COVID-19 Admitted in Three Brazilian Public Hospitals.

OBJECTIVES: The severity and transmissibility of COVID-19 justifies the need to identify the factors associated with its cost of illness (CoI). This study aimed to identify CoI, cost predictors, and cost drivers in the management of patients with COVID-19 from hospital and Brazil's Public Health System (SUS) perspectives. METHODS: This is a multicenter study that evaluated the CoI in patients diagnosed of COVID-19 who reached hospital discharge or died before being discharged between March and September 2020. Sociodemographic, clinical, and hospitalization data were collected to characterize and identify predictors of costs per patients and cost drivers per admission. RESULTS: A total of 1084 patients were included in the study. For hospital perspective, being overweight or obese, being between 65 and 74 years old, or being male showed an increased cost of 58.4%, 42.9%, and 42.5%, respectively. From SUS perspective, the same predictors of cost per patient increase were identified. The median cost per admission was estimated at US$359.78 and US$1385.80 for the SUS and hospital perspectives, respectively. In addition, patients who stayed between 1 and 4 days in the intensive care unit (ICU) had 60.9% higher costs than non-ICU patients; these costs significantly increased with the length of stay (LoS). The main cost driver was the ICU-LoS and COVID-19 ICU daily for hospital and SUS perspectives, respectively. CONCLUSIONS: The predictors of increased cost per patient at admission identified were overweight or obesity, advanced age, and male sex, and the main cost driver identified was the ICU-LoS. Time-driven activity-based costing studies, considering outpatient, inpatient, and long COVID-19, are needed to optimize our understanding about cost of COVID-19.

Safety of Treatments for ADHD in Adults: Pairwise and Network Meta-Analyses.

OBJECTIVE: The aim of the study was to analyze evidence comparing the profile of drugs used to treat ADHD in adult patients. METHOD: Systematic searches were conducted in electronic databases. Randomized, double-blind, parallel controlled trials that evaluated the safety of drugs in ADHD were included. The statistical analyses were conducted by pairwise meta-analyses and mixed treatment comparison (MTC). RESULTS: Ten ( n = 3006) trials were included in the analyses. We observed statistical differences for the following outcomes: decreased appetite between atomoxetine and placebo (odds ratio [OR] = 0.15, 95% credibility interval [CrI] = [0.05, 0.38]) and extended-release mixed amphetamine salts and placebo (OR = 0.06, 95% CrI = [0.00, 0.51]); insomnia between atomoxetine and placebo (OR = 0.48, 95% CrI = [0.27, 0.88]) and extended-release mixed amphetamine salts and placebo (OR = 0.23, 95% CrI = [0.06, 0.76]); sleepiness between atomoxetine and methylphenidate OROS (OR = 0.24, 95% CrI = [0.06, 0.97]); and decreased libido between atomoxetine and placebo (OR = 0.28, 95% CrI = [0.08, 0.90]). CONCLUSION: It was possible to generate evidence about the safety profile of different ADHD drugs.

Efficacy and safety of drugs for attention deficit hyperactivity disorder in children and adolescents: a network meta-analysis.

The aim of this study is to gather evidence of head-to-head double-blind randomized-controlled trials on the efficacy and safety of available treatments for attention deficit hyperactivity disorder (ADHD) in children and adolescents. A systematic review was conducted by two independent reviewers in ten electronic databases (PROSPERO register CRD42016043239). Methodological quality of included studies was evaluated according to the Jadad scale. Network meta-analyses were performed including double-blinded head-to-head trials comparing active allopathic drugs in patients (0-18 years old) diagnosed with ADHD. The results of efficacy and safety of atomoxetine (ATX), bupropion, buspirone (BSP), dexamphetamine, edivoxetine (EDX), guanfacine (GXR), lisdexamfetamine (LDX), methylphenidate (MPH), mixed amphetamine salts, modafinil, pindolol (PDL), reboxetine (RBX), selegiline, and venlafaxine were analyzed using ADDIS software v.1.16.5. Forty-eight trials were identified (n = 4169 participants), of which 12 were used for efficacy analysis and 33 for safety analysis. On the CGI-I scale, the analysis revealed that MPH was more effective than ATX and GXR. For the safety outcomes, according to drug ranks, LDX was more likely to cause sleep disorders (39%) as well as loss of appetite (65%) and behavior problems such as irritability (60%). BSP (71%) and EDX (44%) caused less appetite decrease. For behavioral effects, PDL was considered safest (50%). For any adverse events, RBX (89%) was the safest alternative. The lack of head-to-head trials properly reporting outcomes of interest limited some comparisons. Network meta-analysis offered a broader overview on the available treatments for ADHD, especially for safety issues, and contributes towards evidence gathering and clinical practice decisions. A core outcome set for ADHD should be designed to guide the conduction and report of clinical trials.

Efficacy and safety of amphotericin B lipid-based formulations-A systematic review and meta-analysis.

Invasive fungal infections, an important cause of mortality, are primarily treated using amphotericin B, which is available in different formulations, both conventional and lipid-based (liposomal, lipid complex, colloidal dispersion and Intralipid® infusion). The aim of our study was to determine the efficacy and safety of conventional amphotericin B vs its lipid-based formulations. A systematic review followed by pairwise meta-analysis was performed, including randomised controlled trials (RCTs) that evaluated the use of lipid-based amphotericin B in patients with any degree of immunosuppression and susceptibility to invasive fungal infection. An electronic search was conducted using PubMed, Scopus, Web of Science and Scielo databases. Extracted outcomes were related to efficacy (cure) and safety (incidence of adverse events). Results were evaluated and meta-analyses were performed. Twenty-three RCTs were identified (n=2677 participants) for meta-analysis. No significant differences between conventional amphotericin B and any of the five formulations evaluated were observed, with regard to the efficacy analysis. With respect to the adverse events of nephrotoxicity, fever, chills and vomiting, all lipid formulations presented better profiles than the conventional formulation. The present systematic review and meta-analysis showed that conventional amphotericin B presents the same efficacy profile as lipid-based formulations, although the latter were associated with a safer profile.

Atividade antibacteriana de Cereus jamacaru DC, Cactaceae / Screening antimicrobial activity of Cereus jamacaru DC, Cactaceae

A procura por novos agentes antimicrobianos a partir de plantas vem sendo intensificada e não existem estudos direcionados à avaliação da atividade antimicrobiana de C. jamacaru frente a microrganismos prejudiciais ao homem. Em vista disso, avaliou-se o efeito antimicrobiano do extrato bruto etanólico do lenho (EBLE) e do córtex (EBCO) desta espécie frente a colônias puras de oito microrganismos patogênicos. Neste estudo foram utilizados os métodos difusão em ágar (meio sólido) e CIM (concentração inibitória mínima). Os resultados obtidos neste ensaio preliminar mostraram que EBCO apresentou atividade antimicrobiana mais pronunciada que EBCE e que os microrganismos cujo crescimento foi mais influenciado por EBCO foram Streptococcus epidermidis, Staphylococcus aureus, Pseudomonas aeruginosa e Escherichia coli.

The search for new antibiotic agents from plants is growing, and no study regarding the activity of C. jamacaru pathological microorganisms has been carried out. This research evaluates the antibiotic effect of crude ethanolic extracts of the cortex (EBCO) and wood (EBLE) of the species over eight microorganisms. Two methods were used: agar diffusion and MIC (minimal inhibitory concentration). EBCO showed better inhibition results than EBLE. Streptococcus epidermidis, Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia coli are the microorganisms that were better inhibited by EBCO.

Contribuição ao estudo alelopático de Erythrina velutina Willd., Fabaceae / Contribution to the allelopatic study of Erythrina velutina Willd., Fabaceae

Este trabalho utilizou extrato etanólico e respectivas frações de Erythrina velutina em ensaio alelopático com sementes de Lactuca sativa. Observou-se que, com exceção da fração acetato de etila, o extrato etanólico e frações foram capazes de influenciar a germinação e crescimento das sementes de L. sativa.

This work has used ethanol extract and respective fractions from Erythrina velutina in allelophatic rehearsal with seeds from Lactuca sativa. It was observed that, except for the ethyl acetate fraction, the ethanol extract and fractions has been capable to influence the germination and growth of the seeds from L. sativa.

Atividade antibacteriana e antifúngica de extratos etanólicos de Aster lanceolatus Willd., Asteraceae / Antibacterial and antifungal activity of ethanolics extracts from Aster lanceolatus Willd., Asteraceae

Conhecida popularmente como áster-arbustiva, margarida-de-são-miguel e monte-cassino, Aster lanceolatus é uma planta ornamental de corte. Sabendo-se que não existem estudos que atestem a atividade biológica desta espécie, procurou-se neste trabalho atividades antibacteriana e antifúngica. Para tanto se utilizaram extratos brutos etanólicos de duas porções distintas, das flores e dos caules com folhas. Para a atividade antibacteriana, oito bactérias patogênicas foram submetidas a ensaio de difusão em gel e concentração inibitória mínima. Demonstrou-se atividade do extrato bruto etanólico de flores contra Streptococcus pyogenes, em difusão em gel e atividade de extrato bruto etanólico de caules e folhas contra Salmonella typhimurium e Streptococcus pyogenes em concentração inibitória mínima. Para a atividade antifúngica, utilizaram-se três fungos patogênicos em ensaios de crescimento micelial em placas e bioautografia direta. No ensaio de crescimento micelial em placas verificou-se a inibição de Fusarium oxysporum e na bioautografia direta, inibição do Cylindrocladium spathulatum. Os resultados delinearam uma nova fonte de pesquisa, as plantas ornamentais. Estas podem ser fonte de constituintes químicos capazes de servirem como protótipos para novos agentes terapêuticos e para tratamento sanitário de plantas medicinais.

Popularly known as aster-arbustiva, margarida-de-são-miguel and monte-cassino, Aster lanceolatus is an ornamental plant. Having the knowledge that there is no studies on the biological activity of this species, this work aimed to check the antibacterial and antifungal activities. The ethanol extracts of the flowers and of the stems with leaves were used. For the antibacterial activity eight pathogenic bacteria were submitted to the diffusion test in gel and minimal inhibitory concentration. The activity of the ethanolic extract of the flowers has been demonstrated against Streptococcus pyogenes in diffusion in gel and the activity of the ethanol extract of the stems and leaves against Salmonella typhimurium and Streptococcus pyogenes in minimal inhibitory concentration. For the antifungal activity, three pathogenic yeasts have been used in the micelial growth tests in plates and direct bioautography. In the micelial growth tests in plates the inhibition of Fusarium oxysporum has been verified and in the direct bioautography, inhibition of the Cylindrocladium spathulatum. The results indicated a new research source, the ornamental plants. These can be the source of chemicals capable of serving as prototypes for new therapeutic agents and for sanitary treatment of medicinal plants.