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Abstract Background Hypoglycemia is a barrier to optimal glucose control in the treatment of both type 1 (T1DM) and type 2 diabetes mellitus (T2DM). Blood glucose monitoring is essential in diabetes management. Inappropriate glucose management is associated with high mortality and morbidity. FreeStyle Libre® (FSL) is a continuous glucose monitoring (CGM) system that provides effective, safe, and convenient glucose monitoring, without routine finger pricking. This study aims to estimate the incremental cost-effectiveness ratio (ICER) of the FSL system in comparison to conventional Self-monitoring of blood glucose (SMBG) in T1DM and T2DM patients that require intensive insulin therapy. Methods A decision-tree model was developed to compare the cost-effectiveness ratio between FSL and conventional SMBG from the perspective of the Brazilian Public Healthcare System (SUS). The model captures the cumulative rates of acute complications such as severe hypoglicemia and diabetic ketoacidosis, per-event costs, and quality-adjusted life-years (QALYs) gained over a 1-year time horizon in adult and pediatric patients (≥ 4 years old) with T1DM or T2DM. Inputs from the Brazilian health databases, clinical trials, and real-world data were used in the study. Results The results demonstrated that, regarding solely severe hypoglicemia and diabetic ketoacidosis events, T1DM have a QALY difference of 0.276, a cost difference of R$ 7.255, and an ICER of R$ 26,267.69 per QALY gained for CGM with FSL, when compared to conventional SMBG. T2DM results demonstrated equally a QALY difference of 0.184, a cost difference of R$ 7290, and an ICER of R$ 39,692.67 per QALY gained, in favour of CGM with FSL. Conclusion Our findings demonstrated that FSL is cost-effective in T1DM and T2DM for acute diabetic complications, from a SUS perspective. CGM with FSL can promote safe, convenient, and cost-effective glucose monitoring, therefore contributing to the improvement of the incidence of complications and quality of life.

O tratamento da infecção latente por Mycobacterium tuberculosis (ILTB) é uma prioridade estratégica para eliminar a tuberculose em países com alta incidência, como o Brasil. Esquemas mais curtos têm sido recomendados para estimular a adesão e a conclusão do tratamento pelos pacientes. Esta revisão examina as evidências da eficácia e segurança da combinação de rifapentina com isoniazida por três meses (3HP) em comparação com isoniazida isolada por nove meses (9H) no tratamento da ILTB. Uma revisão sistemática com meta-análise foi conduzida seguindo as diretrizes de redação do checklist PRISMA. Buscas estruturadas nas plataformas Medline (PUBMED), EMBASE, Cochrane Library, LILACS, Scopus e Web of Science foram realizadas em agosto de 2020. Foram encontradas 586 publicações e incluídos sete estudos completos na análise. Os resultados mostram que o 3HP foi superior ao 9H no desfecho de conclusão do tratamento, com significância estatística (OR = 2,92; IC95% = 2,07-4,12). Menos casos de tuberculose ativa ocorreram em pacientes tratados com 3HP, porém o risco relativo não evidenciou diferença estatisticamente significativa (RR = 0,47; IC95% = 0,2-1,12). As taxas de hepatotoxicidade clinicamente relevante variaram de 0% a 1,5% no 3HP e entre 1,2% a 5,3% no 9H. Não houve mortalidade atribuída aos medicamentos. Os resultados dessa revisão indicam que o regime 3HP é tão seguro e eficaz quanto o 9H e promove taxas de conclusão de tratamento significativamente mais altas. A adoção do 3HP no tratamento da ILTB pode contribuir nos esforços do país em eliminar a tuberculose como um problema de saúde pública.

Resumo Em todo paciente submetido a reparo endovascular do aneurisma de aorta abdominal (REVA) que se apresente subitamente com quadro de dor abdominal ou sinais de choque, a hipótese de endoleak ou vazamento, com expansão do aneurisma e ruptura deve ser aventada. Apresentamos o caso de um paciente em pós-operatório de REVA que apresentou uma neoplasia de duodeno mimetizando um endoleak.

Lactic acid is the monomer unit of the bioplastic poly-lactic acid (PLA). One candidate organism for lactic acid production is Pichia pastoris, a yeast widely used for heterologous protein production. Nevertheless, this yeast has a poor fermentative capability that can be modulated by controlling oxygen levels. In a previous study, lactate dehydrogenase (LDH) activity was introduced into P. pastoris, enabling this yeast to produce lactic acid. The present study aimed to increase the flow of pyruvate towards the production of lactic acid in P. pastoris. To this end, a strain designated GLp was constructed by inserting the bovine lactic acid dehydrogenase gene (LDHb) concomitantly with the interruption of the gene encoding pyruvate decarboxylase (PDC). Aerobic fermentation, followed by micro-aerophilic culture two-phase fermentations, showed that the GLp strain achieved a lactic acid yield of 0.65 g/g. The distribution of fermentation products demonstrated that the acetate titer was reduced by 20% in the GLp strain with a concomitant increase in arabitol production: arabitol increased from 0.025 g/g to 0.174 g/g when compared to the GS115 strain. Taken together, the results show a significant potential for P. pastoris in producing lactic acid. Moreover, for the first time, physiological data regarding co-product formation have indicated the redox balance limitations of this yeast.

A oclusão aguda de stent fêmoro-poplíteo pode ser causa de isquemia crítica dos membros inferiores. A terapia fibrinolítica pode não ser a forma de tratamento mais indicada para o grupo de pacientes com esse quadro clínico. Neste artigo, apresentamos um caso em que a retirada de um fragmento de stent por endarterectomia tornou possível a revascularização do membro.Femoropopliteal stent obstruction may be responsible for acute lower limb ischemia. Fibrinolytic treatment may not be the best therapeutic approach in this group of patients. We report a clinical case in which stent fragmentation and endarterectomy enabled femoropopliteal below knee bypass and limb revascularization.

PURPOSE: To compare the healing of abdominal wall aponeurosis of rats after incision with either cold scalpel or electrocautery. METHODS: Twelve male adults Wistar inbreed rats weightin 258-362g entered the experiment. They were randomly divided in two groups, control group (N= 6) and experimental group (N= 6). All animals underwent anesthesia followed abdominal wall incision with either cold scalpel (controls) or electrocautery (experimental group). The animals were killed on the 10th day and necropsied. Tissue samples containig the abdominal wall aponeurosis were sent for both histological study and hydroxyproline content assay. RESULTS: The histological study showed no significant difference between the two groups. Hydroxiproline content in experimenral group (128,56 [78,98-198,92] µg /100m) was not significantly different from control group (140,27 [116,20-166,59] mg /100ml; p = 0.53). CONCLUSION: Healing of abdominal wall after dieresis with either cold scalpel or electrocautery are equivalent and do not differ.OBJETIVO: Comparar a cicatrização da aponeurose abdominal de ratos submetidos à dierese com o uso de eletrocautério e de bisturi de lâmina. MÉTODOS: Utilizou-se 12 ratos Wistar, machos, adultos, com peso entre 258-362g. Os animais foram divididos aleatoriamente em dois grupos: controle (N= 6) e experimental (N= 6). Sob anestesia parenteral, realizou-se no grupo controle a abertura da aponeurose abdominal utilizando-se o bisturi de lâmina e no experimental abertura com o uso do eletrocautério. Os animais foram sacrificados no 10° PO, a aponeurose foi ressecada e enviada para estudo histológico e dosagem de hidroxiprolina. RESULTADOS: Não houve diferença na avaliação histológica entre os grupos. O conteúdo de hidroxiprolina no grupo experimental (128,56 [78,98-198,92] mg /100m) não foi diferente do grupo controle (140,27 [116,20-166,59] µg /100ml; p = 0.53). CONCLUSÃO: A cicatrização da aponeurose da parede abdominal de ratos submetidos à diérese com bisturi de lâmina e eletrocautério se equivalem e não diferem entre si.

Introduction Iontophoresis is a noninvasive technique used to increase transdermal penetration of substances through the skin layer (epidermis, dermis and hypodermis) in a controlled manner. Technological advance in recent decades have provided reduced cost of equipment needed for implementation, which allowed for the expansion of this technique. Objective The aim of this paper is to present the state of the art on iontophoresis, ranging from the atomic characteristics of the ion formation to the current applications of the technique. Methods Were researched papers from databases: IOP publishing, ScienceDirect, Pubmed, Springer, IEEE Xplore, Google Scholar and books with keywords iontophoresis, ions, topical applications between 1967 and 2010. Results Were selected (number of papers and database) 1 IOP Publishing, 1 from ScienceDirect, Central, 1 from Springer, 2 from PubMed, 11 from IEEE Xplore, 35 from Google Scholar, and 15 books, totaling 66 references and websites with nationally marketed electrotherapy products. Conclusion Iontophoresis is suitable for applications such as acetic acid (calcific tendinitis and myositis ossificans), calcium chloride and magnesium sulfate (control of musculoskeletal spasms), dexamethasone (inflammation), lidocaine (inflammation of soft tissues), zinc oxide (rheumatoid arthritis). It is also used in cosmetic applications with devices attached to the skin and for eye treatment aimed at specific tissues of the eye, providing a treatment option for various eye diseases, reducing the complications secondary to traditional methods of treatment. The advantages are the significant increase in the release and control of therapeutic agents, including drugs with high molecular weight. The disadvantages of iontophoresis are the complexity of the drug release system and prolonged exposure of the skin to an electrical current.

Whenever a patient who has undergone endovascular repair of an abdominal aortic aneurysm (EVAR) presents with sudden onset abdominal pains or signs of shock, the hypothesis of endoleak with aneurysm expansion and rupture should be considered. We present the case of an EVAR patient in whom a tumor of the duodenum mimicked an endoleak during the postoperative period. [ABSTRACT FROM AUTHOR]