Luana Lenzi

Influenza pandêmica A (H1N1) 2009: fatores de risco para o internamento

Objective: To evaluate pandemic influenza A (H1N1) 2009 in hospitalized patients in order to identify risk factors for hospitalization and, consequently, for the worsening of the disease. Methods: This retrospective observational study was conducted between March and December of 2010. The data were collected from the Brazilian Ministry of Health National Case Registry Database. We included only patients (inpatients and outpatients) in whom H1N1 infection was confirmed (via laboratory testing) during the study period. The variables regarding demographic and clinical characteristics were statistically evaluated in order to compare the hospitalization rates in the presence or absence of these factors. Risk factors were identified by logistic regression analysis. Results: We included 4,740 patients with laboratory confirmation of H1N1 infection. Of these, 1,911 individuals were hospitalized, and 258 (13.5%) died. The risk factors for hospitalization were age (20-29 years), African or Indigenous ethnicity, presence of specific comorbidities (heart disease, lung disease, kidney disease, hemoglobinopathy, immunosuppression, diabetes, obesity, puerperium, and smoking), a high number of comorbidities, and specific symptoms (dyspnea, diarrhea, vomiting, chest pain, hemoptysis, pneumonia, and wheezing). Higher levels of education and early use of oseltamivir were found to be protective factors. Hospitalization contributed to an increase in survival. Conclusions: Knowledge of the epidemiological characteristics that can be associated with hospitalization, disease severity, and mortality can be helpful in the adoption of preventive measures, as well as in the early diagnosis and treatment of disease, which might contribute to the reduction in the numbers of hospitalizations and deaths.

Comparative efficacy of oral nucleoside or nucleotide analog monotherapy used in chronic hepatitis B: a mixed-treatment comparison meta-analysis.

To compare the efficacy of nucleoside or nucleotide analog monotherapy for the treatment of chronic hepatitis virus B (HBV) with adefovir dipivoxil, entecavir, lamivudine, telbivudine, and tenofovir disoproxil fumarate.

Evaluation of adverse events associated with antiretroviral therapy and the relationship to treatment adherence.

Despite the effectiveness of highly active antiretroviral therapy (HAART), many adverse events (AEs) are associated with the use of these drugs, thus affecting treatment adherence. The aim of this study was to evaluate AE incidence with the use of HAART and the relationship to treatment adherence. This was a retrospective observational study conducted with patients who experienced serious AEs related to HAART, resulting in the need to change the therapeutic regimen. To calculate adherence, the dates the patients received HAART were used. From January 2009 to December 2011, 168 AE cases associated with antiretroviral drugs were observed. Of the total study population, 58% of the patients were male. The side effects were associated with 12 drugs, of which 58.3% were nucleoside analogues reverse transcriptase inhibitors (NRTIs). In addition, 16.7% were non-nucleoside reversetranscriptase inhibitors (NNRTIs), and 25% were protease inhibitors (PIs). The NRTIs and PIs presented similar numbers of AEs, whereas the NNRTIs resulted in less than 50% of the reported AEs compared to other drug classes. The low adherence observed in patients with severe AEs that force treatment regimen change suggests that the occurrence of side effects could be one of the obstacles affecting the adherence and thus the effectiveness of HAART.

Economic evaluation of treatments for chronic hepatitis B

The aim of this study was to conduct a cost-utility study of adefovir, entecavir, interferon alpha, pegylated interferon alpha, lamivudine and tenofovir for chronic hepatitis B in the context of Brazilian Public Health Care System. A systematic review was carried out for efficacy and safety. Another review was performed to collect utility data and transition probabilities between health states. A Markov model was developed in a time horizon of 40 years with annual cycles for three groups of: HBeAg positive, HBeAg negative, and all patients. These strategies were compared to a fourth group that received no treatment. Discount rates of 5% were applied and sensitivity analyses were performed. Tenofovir offered the best cost-utility ratio for the three evaluated models: U

Study of the relationship between socio-demographic characteristics and new influenza A (H1N1)

397, U

The characteristics, clinical manifestations and outcomes of pandemic influenza A (H1N1) 2009 in the elderly

385 and U

Evaluation of the Effectiveness of Oseltamivir for the Treatment of 2009 Pandemic Influenza A (H1N1)

384 (per QALY, respectively, for HBeAg positive, negative, and all patients). All other strategies were completely dominated because they showed higher costs and lower effectiveness than tenofovir. The sequence of cost-utility in the three models was: tenofovir, entecavir, lamivudine, adefovir, telbivudine, pegylated interferon alpha, and interferon alpha. In the sensitivity analysis, adefovir showed lower cost-utility than telbivudine in some situations. The study has some limitations, primarily related to the creation of scenarios and modeling. In this study, tenofovir presented the best cost-utility ratio. The results obtained in this study will be valuable in decision-making and in the review of the clinical protocol, mainly involving the allocation of available resources for health care.

Fatores relacionados ao óbito pela Influenza Pandêmica A (H1N1) 2009 em pacientes tratados com Oseltamivir

OBJECTIVE The pandemic of new influenza A (H1N1) has spread rapidly throughout the world, characterized by high transmissibility, but low pathogenicity and virulence. The aim of this study was to understand the pandemic event and available technologies for disease surveillance, prevention, control and management. METHODS In this retrospective study, we used data from patients in the State of Paraná who had been diagnosed with the disease during the 2009 pandemic. Data were collected from the disease notification form and the study only included patients with confirmed laboratory diagnosis by RT-PCR. RESULTS We present the epidemiological profile of 4,740 patients that met the inclusion criteria. The variables age, level of schooling and gestational age were shown to be associated with mortality due to the infection. Gender and race/ethnicity were not associated with the outcome of the infection. CONCLUSION These results underscore the importance of knowing the variables associated with unfavorable outcomes of pandemic influenza infection in order to minimize the health related consequences. Attention should be given to its forms of transmission and to the frailty of certain age groups that have no cross-immunity.

Profile of users of drugs for the treatment of chronic hepatitis B available through the Brazilian Public Health System

INTRODUCTION The objective of this study was to evaluate the 2009 Pandemic Influenza A (H1N1) in the elderly and identify the clinical characteristics, mortality and prognostic factors of the infection in these patients. METHODS This was an observational, retrospective study. Data were collected from the National Notifiable Diseases (SINAN), from the Brazilian Ministry of Health. Only patients 60 years old or more that had laboratory confirmed infections were included. The socio-demographic and clinical variables and outcomes were evaluated to compare mortality rates in the presence or absence of these factors. RESULTS We included 93 patients in the study, 16.1% of whom died. The symptoms of cough and dyspnea, the use of the antiviral oseltamivir, influenza vaccine and comorbidities influenced the outcomes of cure or death. Chest radiography can aid in diagnosis. CONCLUSIONS Although relatively few elderly people were infected, this population presented high lethality that can be justified by the sum of clinical, physical and immunological factors in this population. Treatment with oseltamivir and vaccination against seasonal influenza have significantly reduced rates of hospitalization and mortality.

Safety of Biologics Approved for the Treatment of Rheumatoid Arthritis and Other Autoimmune Diseases: A Disproportionality Analysis from the FDA Adverse Event Reporting System (FAERS)

Aims: Evaluate retrospectively the effectiveness of treatment with oseltamivir in a Brazilian subpopulation infected during the 2009 pandemic influenza A(H1N1) and compare drug activity based on the presence or absence of other disease risk factors and also the time from onset of symptoms to initiation of treatment. Study Design: Observational and retrospective. Place and Duration of Study: Federal University of Parana and Parana State Secretary of Health, between April 2009 and December 2010. Methodology: 1,917 patients were included (842 men, 1,075 women; age range 0-90 years) with positive diagnosis for the 2009 influenza virus A (H1N1) characterized by RTPCR, whose notification forms were available at the time of data collection and that contained information of the use or not of oseltamivir. The patients were categorized by age, gender, symptoms, presence or absence of co morbidities, outcomes (cure or death) and treated or untreated with oseltamivir. The odds ratio (OR) was estimated using a multivariate logistic regression analysis. Kaplan-Meier method was used to determine if differences existed between the survival of untreated patients and oseltamivir treated patients. Results: Out of 1,917 patients, 1,644 had cleared the infection and 273 patients died. Age, education level, cardiopathies, nephropathies, immunodepression, smoking, diabetes, systemic arterial hypertension, obesity, diarrhea, dyspnea, hemoptysis and pneumonia were considered risk factors. The use of oseltamivir provided about 32.3 Research Article