Sewage surveillance can be used as an effective complementary tool for detecting pathogens in local communities, providing insights into emerging threats and aiding in the monitoring of outbreaks. In this study using qPCR and whole genomic sewage surveillance, we detected the Mpox virus along with other viruses, in municipal and hospital wastewaters in Belo Horizonte, Brazil over a 9-month period (from July 2022 until March 2023). MPXV DNA detection rates varied in our study, with 19.6% (11 out of 56 samples) detected through the hybrid capture method of whole-genome sequencing and 20% (12 out of 60 samples) through qPCR. In hospital wastewaters, the detection rate was higher, at 40% (12 out of 30 samples) compared to 13.3% (4 out of 30 samples) in municipal wastewaters. This variation could be attributed to the relatively low number of MPXV cases reported in the city, which ranged from 106 to 341 cases during the study period, and the dilution effects, given that each of the two wastewater treatment plants (WWTP) investigated serves approximately 1.1 million inhabitants. Additionally, nine other virus families were identified in both hospitals and municipal wastewaters, including Adenoviridade, Astroviridae, Caliciviridae, Picornaviridade, Polyomaviridae, Coronaviridae (which includes SARS-CoV-2), Herspesviridae, Papillomaviridae and Flaviviridae (notably including Dengue). These findings underscore the potential of genomic sewage surveillance as a robust public health tool for monitoring a wide range of viruses circulating in both community and hospitals environments, including MPXV.

Background: Gaucher’s disease (GD), a lysosomal storage disorder, poses significant treatment challenges. This 23-year study assesses survival rates and treatment efficacy in Brazilian GD patients, integrating data from a 16-year cohort (2000–2015) and the TABNET/DATASUS medicines distribution data (1999–2022).Objective: To investigate the survival of GD patients in Brazil, identifying key risk factors and evaluating the impact of treatments funded by the Brazilian National Health System (SUS).Methodology: A 16-year retrospective cohort study was conducted using the National Database of SUS. Patients diagnosed with GD and treated with Enzyme Replacement Therapy (ERT) or Substrate Synthesis Inhibition (SSI) from 2000 to 2015 were included. Survival analysis was performed using Kaplan-Meier method and Cox proportional hazards model. The data from TABNET/DATASUS system from 1999 to 2022 was used to assess the trend in drug distribution beyond the main cohort.Results: The study included 1,234 patients. Survival rates at 5 and 10 years were 93.2% and 88.5%, respectively, with age and comorbidities like diabetes, cardiovascular diseases, and Parkinson’s disease significantly affecting survival. Patients who received doses lower than DDD (n = 880) demonstrated a survival probability of 91.8%. In contrast, those with doses equal to the DDD (n = 15) showed a 100% survival probability, as no events were observed in this group. The greater than DDD group (n = 339) exhibited a survival probability of 81%. A log-rank test indicated a borderline statistical significance (p = 0.058) in the survival distributions among the different DDD adherence, with the lower dose group showing a favorable trend.Conclusion: This study provides insights into the survival rates and associated risk factors for GD patients in Brazil, contributing to the global understanding of GD and its management. While we acknowledge the inherent limitations of relying largely on electronic medical records and categorical codes, our findings underscore the need for early diagnosis, timely initiation of treatment, effective management of comorbidities, and personalized dosing strategies to improve patient outcomes. Future studies should aim to incorporate clinical verification of electronic data to further enhance the reliability and applicability of these findings.

The pharmaceutical landscape has undergone a transformative shift due to emerging technologies, leading to a projected value of USD 405.52 billion for the global pharmaceutical manufacturing market in 2020. Brazil, representing 2% of the global pharmaceutical market, boasts a comprehensive public health system called Sistema Único de Saúde (SUS), ensuring universal health coverage. However, the public and private health sectors in Brazil operate independently, with 23% of Brazilians possessing private health insurance plans. Regulated by the Brazilian Drug Market Regulation Chamber (CMED), which controls drug prices based on international retail prices and other factors, the pharmaceutical market in Brazil faces significant challenges in maintaining the sustainability of the Brazilian health-care system, particularly due to the high costs of cancer medications, such as pembrolizumab and trastuzumab deruxtecan. This study aims to assess the budgetary impact of expanding indications for pembrolizumab and trastuzumab deruxtecan in Brazil after their initial registration by the Brazilian Health Regulatory Agency. Utilizing epidemiological data from the National Cancer Institute (INCA) and clinical trial data, we estimated the eligible patient populations and associated costs for these medications. Trastuzumab deruxtecan’s eligible patient population increased from 383 to 23,000 across various indications, resulting in a total cost increase from USD 90.6 million to USD 5.0 billion. Similarly, pembrolizumab’s eligible patient population expanded from 1796 to 99,544 for multiple indications, causing the total cost increase from USD 121.1 million to USD 6.7 billion. The study highlights the substantial expansions in indications and patient eligibility for trastuzumab deruxtecan and pembrolizumab in Brazil, with significant budgetary implications potentially jeopardizing the health-care system’s sustainability. To ensure the long-term sustainability of health-care systems and to provide equitable access to optimal treatments, it is crucial for policymakers to monitor and adjust drug prices following their initial registration. Policymakers must be aware of these challenges and consider them in health-care policy development and decision-making processes.

Objectives: In Brazil, specialty medicines for rheumatoid arthritis (RA) treatment are provided by the national health system (NHS) according to mandatory protocols. Knowing the rules for prescription of these biological agents is crucial to ensuring patient access to treatment. This study aims to evaluate the feasibility of an academic detailing strategy to promote the quality use of the medicines available in NHS among prescribers. Methods: Forty-three specialists and general practitioners were visited by researchers to perform an academic detailing of the Clinical Protocols and Therapeutic Guidelines (PCDT) for RA adopted by NHS. After the visits, a survey was performed with prescribers to measure their perception in terms of satisfaction and information reliability with the academic visits. At the end, we perform a cost analysis to permit comparisons of this strategy with other educational activities. Key findings: From 43 physicians that were visited, 28 responded to the telephone survey. Of these, 68% were very satisfied with the visit, 50% rated the content of the visit relevant to their practice, 64.3% agreed the duration of the visit did not affect their work, 60.7% agreed the distributed material would be useful for their professional practice, and 57.1% agreed that the visits added to their knowledge. A total of USDPPP 162.96 per prescriber (USDPPP 7,007.20, BRL14,185.00) were spent on the program. Conclusion: The prescribers visited represent a large number of deferrals for the Specialized Component of Pharmaceutical Care (CEAF) drug applications. Therefore, the total amount spent on the implementation of this program and its potential for improving access to these medicines has the possibility to have a positive impact on the targeting of public expenditures and avoiding litigation against NHS. Academic detailing has the capability to become an effective strategy for PCDT dissemination and implementation.

Down syndrome regression disorder (DSRD) is characterized by an acute or subacute neurocognitive regression that severely impacts the autonomy and quality of life of individuals with Down syndrome (DS). Despite its growing recognition, understanding of the condition remains limited, particularly regarding its etiology and the factors contributing to its development. Objective The aim of this study was to systematically map the available evidence regarding the potential causes of DSRD and the factors that may contribute to its development. Methods Following the Joanna Briggs Institute (JBI) methodology for scoping reviews, a comprehensive three-step search strategy was conducted across MEDLINE (PubMed), Embase, Cochrane, and Lilacs. Studies published in any language were considered, with no restrictions on publication date. Results In total, 14 studies met the eligibility criteria. The findings consistently point to chronic autoimmunity and immune dysregulation as potential causes of DSRD. Additionally, the contribution of genetic variants associated with the type 1 interferon inflammatory response has been suggested. Finally, the role of psychosocial and environmental stressors was highlighted, as these are considered potential triggers that precede the onset of DSRD manifestations. Conclusion The hypothesis that DSRD is a multifactorial condition seems reasonable. Nevertheless, the immune system may play a central role in its development, as the identified causes converge toward a neuroinflammatory process. Furthermore, the contribution of genetic variants associated with the inflammatory response and the role of psychosocial stressors as triggers for DSRD also appear plausible.