Objective: To perform a cost-effectiveness analysis of donepezil and rivastigmine therapy for mild and moderate Alzheimer’s disease (AD) from the perspective of the Brazilian Unified Health System. Method: A hypothetical cohort of 1,000 individuals of both sexes, aged >65 years, and diagnosed with AD was simulated using a Markov model. The time horizon was 10 years, with 1-year cycles. A deterministic and probabilistic sensitivity analysis was performed. Results: For mild AD, the study showed an increase in quality-adjusted life years (QALYs) of 0.61 QALY/21,907.38 Brazilian reais (BRL) for patients treated with donepezil and 0.58 QALY/BRL 24,683.33 for patients treated with rivastigmine. In the moderate AD group, QALY increases of 0.05/BRL 27,414.96 were observed for patients treated with donepezil and 0.06/BRL 34,222.96 for patients treated with rivastigmine. Conclusions: The findings of this study contradict the standard of care for mild and moderate AD in Brazil, which is based on rivastigmine. A pharmacological treatment option based on current Brazilian clinical practice guidelines for AD suggests that rivastigmine is less cost-effective (0.39 QALY/BRL 32,685.77) than donepezil. Probabilistic analysis indicates that donepezil is the most cost-effective treatment for mild and moderate AD.

Foi avaliada neste estudo a presença de caspase-3-clivada no coração de ratos irradiados durante o declínio da função ventricular. Ratas Wistar foram irradiadas com uma dose única de radiação (15 Gy) diretamente no coração e as análises molecular, histológica e fisiológica foram realizadas treze meses pós a irradiação dos animais. As expressões de procolágeno tipo I, TGF-ß1 e caspase-3-clivada foram analisadas usando Western blotting. Alterações cardíacas estruturais e funcionais foram investigadas por meio de ecocardiografia e microscopia eletrônica. No grupo irradiado, os níveis de procolágeno tipo I, TGF-ß1 e caspase-3-clivada estão aumentados Alterações histológicas importantes (degeneração do tecido cardíaco e deposição de colágeno) e funcionais (fração de ejeção reduzida) foram observadas. Dados sugerem que o declínio da função cardíaca após a exposição à radiação ionizante está relacionado, em parte, com aumento do colágeno e da caspase-3-clivada.

The caspase-3-cleaved presence was evaluated in this study in the heart of irradiated rats, during the decline of ventricular function. Female Wistar rats were irradiated with a single dose of radiation (15 Gy) delivered directly to the heart and the molecular, histological and physiological evaluations were performed at thirteen months post-irradiation. The expressions of procollagen type I, TGF-ß1 and caspase-3-cleaved were analyzed using Western blotting. Cardiac structural and functional alterations were investigated by echocardiography and electron microscopy. In the irradiated group, the levels of procollagen type I, TGF-ß1 and caspase-3-cleaved are increased. Significant histological changes (degeneration of heart tissue and collagen deposition) and functional (reduced ejection fraction) were observed. Data suggest that the cardiac function decline after exposure to ionizing radiation is related, in part, to increased collagen and increased caspase-3-cleaved.