BackgroundCetuximab and panitumumab are monoclonal antibodies targeting the epidermal growth factor receptor. Both drugs are active against RAS wild type metastatic colorectal cancer after chemotherapy failure, with similar efficacy and toxicity profiles. However, their cost and limited survival benefits may compromise incorporation in the Brazilian public healthcare system, the Unified Heath System (Sistema Único de Saúde) (SUS).MethodsA cost-effectiveness analysis was conducted using a Markov model from the Brazilian Public health perspective and a lifetime horizon in patients with RAS -wt mCRC. Transition probabilities and mortality rates were extracted from randomized studies. Treatment costs were obtained from price tables regulated by the Brazilian Health Ministry. The World Health Organization recommendation of three times GDP per capita was used to define the cost-effectiveness threshold.ResultsThe use of cetuximab or panitumumab for chemotherapy-refractory mCRC patients resulted in 0.22 additional life-years relative to BSC, with incremental cost-effectiveness ratios (ICERs) of $58,240 and $52,772 per LY, respectively. That exceeds the pre-specified threshold for cost-effectiveness. Acquisition of biological agents was the major driver of increased costs.ConclusionsOur economic evaluation demonstrates that both cetuximab and panitumumab are not a cost-effective approach in RAS-wt mCRC patients. Discussion about drug price should be prioritized to enable incorporation of these monoclonal antibodies in the SUS.

Blister formation and eccrine sweat gland necrosis is a cutaneous manifestation associated with states of impaired consciousness, most frequently reported after overdoses of central nervous system depressants, particularly phenobarbital. The case of a 45-year-old woman who developed "coma blisters" at six distinct anatomic sites after confirmed (laboratory) phenobarbital poisoning, associated with other central nervous system depressants (clonazepam, promethazine, oxcarbazepine and quetiapine), is presented. A biopsy from the left thumb blister taken on day 4 revealed focal necrosis of the epidermis and necrosis of sweat gland epithelial cells; direct immunofluorescence was strongly positive for IgG in superficial blood vessel walls but negative for IgM, IgA, C3 and C1q. The patient was discharged on day 21 with no sequelae. Keywords: Coma; Fluorescent antibody technique; Microscopy, fluorescence; Phenobarbital; Toxicology Resumo: Formação de bolhas e necrose de glândula sudoríparas écrinas é uma manifestação cutânea associada com estados de diminuição da consciência, mais frequentemente relatada após superdosagens de depressores do sistema nervoso central, particularmente fenobabital. Relatamos o caso de uma paciente de 45 anos que desenvolveu "bolhas do coma" após tentativa de suicídio por fenobarbital (confirmada laboratorialmente), associada a outros depressores do sistema nervoso central (clonazepam, prometazina, oxcarbazepina e quetiapina). Biópsia da bolha do 1o quirodáctilo esquerdo no 4o dia de internação revelou necrose focal da epiderme e necrose de células epiteliais de glândula sudorípara; a imunofluorescência direta foi fortemente positiva para IgG na parede superficial dos vasos sanguíneos, mas negativa para IgM, IgA, C3 e C1q. A paciente teve alta no 21o dia, sem seqüelas.

Objectives: To evaluate plasmatic arginine vasopressin (AVP) levels in patients undergoing scheduled conventional abdominal aortic aneurysm (AAA) repair.Methods: Plasmatic AVP concentrations were measured by radioimmunoassay in 22 non-consecutive adult patients undergoing infra-renal AAA repair. They were under combined general and epidural anesthesia at the following time frames: 1 -pre-operative (T0); 2 -2h (T1) and 6h (T2) after the surgical procedure; 3 -in the morning at the first (T3), second (T4) and third (T5) post-operative days. Some clinical and laboratory variables were also recorded.Results: The mean age of patients was 68±10 years; 17 were males. Plasmatic AVP (mean±SD; pg/mL) was within the normal range at T0 (1.4±0.7; baseline), increasing significantly at T1 (62.6±62.9; P<0.001) and at T2 (31.5±49.7; P<0.001), with a progressive fall, returning to basal levels at T5 (2.1±3.8; P=NS). Positive and statistically significant correlations were found between AVP and glycemia, serum lactate and white blood cells counts, but not with systemic arterial pressure or plasma osmolarity during the postoperative period.Conclusions: Considering that no correlations were found between AVP levels and hemodynamic or plasmatic osmolarity variations in AAA repair, it seems that stress response is mainly secondary to noxious stimulation mediated by the autonomic nervous system that is not completely blocked by anesthetics. Descriptors: Intensive care units. Cardiovascular abnormalities. Receptors, vasopressin. Resumo Objetivos: Avaliar os níveis plasmáticos de vasopressina (AVP) em pacientes submetidos à correção convencional de aneurisma de aorta abdominal (AAA).Métodos: A AVP plasmática foi mensurada por radioimunoensaio em 22 pacientes não-consecutivos submetidos à correção eletiva de AAA infrarrenal sob anestesia geral + epidural nos seguintes momentos: pré-operatório (T0); 2h (T1) e 6h (T2) após a cirurgia; e nas manhãs do primeiro (T3), segundo (T4) e terceiro (T5) dia pós-operatório (PO). Variáveis clínicas e laboratoriais de interesse também foram anotadas.Resultados: A média de idade dos pacientes foi de 68±10 anos, sendo 17 homens. A AVP plasmática (média±DP; pg/ mL) estava dentro de limites normais no T0 (1,4±0,7; basal), aumentando no T1 (62,6±62,9; P<0,001) e no T2 (31,5±49,7; P<0,001), e retornando aos valores basais no T5 (2,1±3,8; RBCCV 44205-1296

Background Digital inclusion and literacy facilitate access to health information and can contribute to self-care behaviors and informed decision-making. However, digital literacy is not an innate skill, but rather requires knowledge acquisition. Objective The present study aimed to develop, conduct, and measure the impact, on digital and health literacy, of a digital inclusion program aimed at community dwellers. Methods The program targeted the recruitment of people aged 55 and older that owned mobile devices with an internet connection in 3 cities in northern Portugal (Paredes de Coura, Guimarães, and Barcelos). The program was titled the Workshops for Online Technological Inclusion (OITO) project and, in each city, was promoted by the coordinator of municipal projects and organized as an in-person 8-workshop program, using mobile devices, smartphones, or tablets. A quasi-experimental design was used with a nonrandomized allocation of participants in each set of 8 workshops. Sociodemographic, health status, and mobile use information were collected at baseline. Digital and health literacy were measured via the Mobile Device Proficiency Questionnaire and the Health Literacy Scale questionnaires, respectively, at baseline (T1), program completion (T2), and a 1-month follow-up (T3). A self-reported measure of autonomy was evaluated at T1 and T2 using a visual scale. Results Most participants were women with primary schooling (up to 4 years) aged between 65 and 74 years and retired. The intervention had an 81% (97/120) recruitment rate, 53% (43/81) adherence, and 94% (67/71) satisfaction rate, with 81 participants completing the entire 8-workshop program. Most participants had owned their mobile device for more than one year (64/81, 79%), were frequent daily users (70/81, 86%), and had received their mobile device from someone else (33/64, 52%). Over 80% (71/81) of the participants who completed the intervention used Android smartphones. At baseline, participants had low baseline scores in digital literacy, but medium-high baseline scores in health literacy. They showed significant improvement in digital literacy at T2 and T3 compared to T1, but without a significant difference between T2 and T3, regardless of sex, age, or schooling. A significant improvement in self-reported autonomy was observed at T3 compared with baseline. Regarding health literacy, no significant differences were found at T2 or T3 compared to the baseline. Conclusions The feasibility indicators showed that the OITO project methodology had a substantial rate of recruitment and satisfaction. Program participants had significant improvement in digital literacy after 8 workshops and maintained their score 1 month after completing the intervention. There was no significant change in health literacy during the project period.

BACKGROUND Digital inclusion and literacy facilitates access to health information and can contribute to self-care behaviours and informed decision-making. However, digital literacy is not an innate skill, rather it requires knowledge acquisition. OBJECTIVE The present study aimed to develop, conduct, and measure the impact, on digital and health literacy, of a digital inclusion program (termed “OITO Project”) aimed at community-dwellers aged 55 years old and above. METHODS The digital intervention was organized as an in-person, 8-workshop based, guided digital inclusion program, using mobile devices. Sociodemographic, health status, and mobile use information, was collected at baseline, and digital and health literacy measured at baseline (T1), program completion (T2), and 1-month (T3) thereafter, via the Mobile Device Proficiency Questionnaire and the Health Literacy Scale questionnaires, respectively. RESULTS The intervention had 81% recruitment rate, 53% adherence, and 94% satisfaction, with a total of 81 participants completing of the workshops. Most study participants were women, with primary schooling (up to 4 years), aged between 65 to 74 years, and retired. Participants had a low baseline score in digital literacy and a medium/high baseline score in health literacy, with a significant improvement in digital literacy at T2 and T3, compared to T1, but without significant differences between T2 and T3, regardless of sex, age, and schooling. A significant improvement in self-reported autonomy was observed at T3 compared with baseline. Regarding health literacy, no significant differences were found at T2 or T3 compared to the baseline. CONCLUSIONS The feasibility Indicators were satisfactory, showing that the methodology of the workshops had a substantial rate of recruitment and satisfaction. The study showed significant improvement in digital literacy in 8 workshops, with score maintenance one month after the intervention end.

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