Objective This study describes epidemiological and clinical features of patients with confirmed infection by SARS-CoV-2 diagnosed and treated at Hospital Israelita Albert Einstein , which admitted the first patients with this condition in Brazil. Methods In this retrospective, single-center study, we included all laboratory confirmed COVID-19 cases at Hospital Israelita Albert Einstein , São Paulo, Brazil, from February until March 2020. Demographic, clinical, laboratory and radiological data were analyzed. Results A total of 510 patients with a confirmed diagnosis of COVID-19 were included in this study. Most patients were male (56.9%) with a mean age of 40 years. A history of a close contact with a positive/suspected case was reported by 61.1% of patients and 34.4% had a history of recent international travel. The most common symptoms upon presentation were fever (67.5%), nasal congestion (42.4%), cough (41.6%) and myalgia/arthralgia (36.3%). Chest computed tomography was performed in 78 (15.3%) patients, and 93.6% of those showed abnormal results. Hospitalization was required for 72 (14%) patients and 20 (27.8%) were admitted to the Intensive Care Unit. Regarding clinical treatment, the most often used medicines were intravenous antibiotics (84.7%), chloroquine (45.8%) and oseltamivir (31.9%). Invasive mechanical ventilation was required by 65% of Intensive Care Unit patients. The mean length of stay was 9 days for all patients (22 and 7 days for patients requiring or not intensive care, respectively). Only one patient (1.38%) died during follow-up. Conclusion These results may be relevant for Brazil and other countries with similar characteristics, which are starting to deal with this pandemic.

RESUMOObjetivo: Arboviroses são motivo de preocupação para a saúde pública, com impactos clínicos e econômicos negativos. Este estudo teve o objetivo de avaliar custos de combate ao vetor, custos médicos diretos e custos indiretos associados à dengue clássica, dengue hemorrágica, chikungunya e infecção pelo Zika vírus (ZIKV) no Brasil, para o ano de 2016. Métodos: As análises quantificaram custos relacionados ao combate ao vetor, como repasses de recursos federais e aquisição de pesticidas, custos médicos diretos para tratamento das doenças por meio de condutas de manejo ambulatorial e hospitalar e custos indiretos relacionados ao absenteísmo, calculados com base em estudos publicados ou de estimativa de anos de vida ajustados por incapacidade (AVAIs). Resultados: O investimento para combate ao vetor foi de R$ 1,5 bilhão no Brasil e o custo reportado pelo governo federal para aquisição de inseticidas e larvicidas foi de R$ 78,6 milhões. Custos médicos diretos geraram gasto total de R$ 374 milhões. Febre chikungunya apresentou o maior número de AVAIs perdidos por episódio da doença (0,036 AVAI), seguido pela infecção por ZIKV (0,005 AVAI). O custo indireto total foi estimado em R$ 431 milhões. Custos totais com o manejo das arboviroses atingiram impacto de R$ 2,3 bilhões no Brasil, em 2016. Minas Gerais, São Paulo, Bahia e Rio de Janeiro apresentaram os maiores custos. Conclusões: Arboviroses geram consideráveis impactos econômico e social ao Brasil. Custos de combate ao vetor, custos médicos diretos e custos indiretos representaram 2% do orçamento previsto para a saúde no País, em 2016. ABSTRACTObjective: Arboviruses are a cause of concern for public health, with negative clinical and economic impacts. The objective of this study was to evaluate costs of vector control, direct medical costs and indirect costs associated with classical dengue fever, dengue hemorrhagic fever, chikungunya and Zika virus infection in Brazil for the year 2016. Methods: The analyzes quantified costs related to vector control, such as federal resource transfers and acquisition of pesticides, direct medical costs related to diseases treatment through outpatient and hospital management, and indirect costs related to absenteeism, calculated from published studies or estimates of disability-adjusted life years (DALYs). Results: The investment for vector combat was R$ 1.5 billion in Brazil and the cost reported by federal government for the acquisition of insecticides and larvicides was R$ 78.6 million. Direct medical costs generated total expenses of R$ 374 million. Fever chikungunya presented the highest number of DALYs lost per episode of disease (0.036 DALYs), followed by Zika virus infection (0.005 DALYs). Total indirect cost was estimated at R$ 431 million. Total costs with the management of arboviroses reached an impact of R$ 2.3 billion in Brazil for 2016. Minas Gerais, São Paulo, Bahia and Rio de Janeiro presented the highest costs. Conclusions: Arboviroses generate considerable economic and social impact to Brazil. Vector combat c...

No abstract

BackgroundThe objective of this study was to estimate costs to society and patients’ quality of life (QoL) at all levels of disease severity (measured with the Expanded Disability Status Scale, EDSS) in Brazil.MethodsThe study was part of an international, cross-sectional burden-of-illness study carried out in collaboration with national MS patient organizations. All information was collected directly from patients using a validated questionnaire. Direct costs were estimated both from societal and payer perspectives, while total costs are presented as societal costs.ResultsThe survey included 694 patients (response rate 21%; mean age 40.8 years). 95% of patients were of working age, and around half were working. The mean EDSS score was 3.2 (62.5% of patients with EDSS <3). Relapses were reported by 18.9% of patients. Fatigue affected almost all patients (94%) regardless of EDSS level, and cognitive difficulties were reported by 69.1% of patients. Mean utility ranged from 0.77 at EDSS 0 to negative values at EDSS 9, with a mean score of 0.58; utility was affected by relapses. Total mean annual cost was R$33,872 (€ 8,000) per patient in the societal perspective, with direct costs representing 81% (R$ 27,355, € 6,500). Direct costs for the payer amounted to R$ 16,793 (€ 4,000)/patient.ConclusionsThis study included a population with relatively mild and early disease, with a majority of patients with relapsing disease and thus on DMD treatment. It is not possible to conclude directly on the total cost of MS in Brazil. Nevertheless, resource quantities used, QoL and MS symptoms are very similar to what was seen in the European survey.

IntroductionDetrusor sphincter dyssynergia affects 70% to 80% of all spinal cord injury patients, resulting in increased risk of urinary tract infections (UTIs) and potential exposure to antimicrobial resistance. In Brazil, local guidelines recommend intermittent catheterization as the best method for bladder emptying, and two catheter types are available: the conventional uncoated PVC and the hydrophilic coated catheters.ObjectiveTo evaluate the cost-effectiveness of two types of catheters for intermittent catheterization from the perspective of the Brazilian public healthcare system.Materials and MethodsA Markov model was used to evaluate cost-effectiveness in those with spinal cord injuries. A primary analysis was conducted on all possible adverse events, and a secondary analysis was performed with urinary tract infections as the only relevant parameter. The results were presented as cost per life years gained (LYG), per quality-adjusted life years (QALY) and per number of urinary tract infections (UTIs) avoided.ResultsThe base scenario of all adverse events shows a cost-effective result of hydrophilic coated catheters compared to uncoated PVC catheters at 57,432 BRL (Brazilian Reais) per LYG and 122,330 BRL per QALY. The secondary scenario showed that the use of hydrophilic coated catheters reduces the total number of UTIs, indicating that an additional cost of hydrophilic coated catheters of 31,240 BRL over a lifetime will reduce lifetime UTIs by 6%.ConclusionsDespite the higher unit value, the use of hydrophilic coated catheters is a cost-effective treatment from the perspective of the Brazilian public healthcare system.

No abstract

The implementation of the rapid response team may have caused a significant reduction in the number of cardiorespiratory arrests. It was estimated that during the period from March 2007 to September 2008, the intervention probably saved 67 lives.

A simple adjustment in vial size may reduce the waste of bortezomib by 36% to 62% and can also reduce the cost of treatment.