RESUMEN En general, los programas de control de la hipertensión son costo-eficaces, incluso en los países de ingresos bajos y medios. Aun así, es poco probable que los gobiernos nacionales y la sociedad civil apoyen los programas de control de la hipertensión a menos que se demuestre su valor en términos de beneficios para la salud pública, impacto presupuestario y valor de la inversión para el contexto individual del país. La Organización Mundial de la Salud (OMS) y la Organización Panamericana de la Salud (OPS) implementaron la iniciativa HEARTS, un enfoque mundial estandarizado y simplificado para el control de la hipertensión, que incluye los medicamentos antihipertensivos y los dispositivos de medición de la presión arterial de preferencia. El objetivo de este estudio es informar sobre los estudios en el ámbito de la economía de la salud relativos al costo de las medidas de control de la hipertensión previstas en HEARTS (especialmente, de los medicamentos), la costo-efectividad y el impacto presupuestario, así como describir los modelos matemáticos diseñados para traducir los datos de este programa en un enfoque óptimo para la prestación y el financiamiento de los servicios de atención de la hipertensión, especialmente en países de ingresos medianos y bajos. Los primeros resultados indican que las intervenciones de HEARTS para el control de la hipertensión son de bajo costo o costo-eficaces, que el conjunto de medidas HEARTS es asequible, a un precio que oscila entre US$ 18 y US$ 44 al año por paciente tratado, y que los medicamentos antihipertensivos podrían tener un precio lo suficientemente bajo como para alcanzar un estándar medio mundial de <US$ 5 por paciente al año en el sector público. Estos datos del ámbito de la economía de la salud serán argumentos convincentes para que los gobiernos se involucren en los programas de control de la hipertensión a escala nacional y les brinden apoyo financiero.

RESUMO Geralmente, os programas de controle de hipertensão são custo-efetivos, inclusive em países de baixa e média renda, mas os governos dos países e a sociedade civil provavelmente não apoiarão tais programas a menos que demonstrem valor em termos de benefícios à saúde pública, impacto orçamentário e retorno sobre o investimento no contexto individual do país. A Organização Mundial da Saúde (OMS) e a Organização Pan-Americana da Saúde (OPAS) criaram a Global HEARTS, uma abordagem padrão e simplificada ao controle da hipertensão arterial, que inclui medicamentos anti-hipertensivos preferidos e dispositivos para aferição da pressão arterial preferidos. O objetivo deste estudo é relatar os estudos de economia em saúde que analisaram o custo (especialmente custos de medicamentos), custo-benefício e impacto orçamentário do pacote HEARTS para controle da hipertensão e descrever modelos matemáticos elaborados para traduzir os dados do programa de controle de hipertensão em uma abordagem ideal para a prestação e financiamento de serviços de atenção às pessoas com hipertensão, especialmente em países de baixa e média renda. Os primeiros resultados sugerem que as intervenções HEARTS para controle da hipertensão são de baixo custo ou custo-efetivas, que o pacote HEARTS é acessível (custando de US$ 18 a 44 por pessoa tratada por ano) e que o preço dos medicamentos anti-hipertensivos poderia ser baixo o suficiente para atingir uma média global de <US$ 18 por paciente por ano no setor público. Estas evidências do campo da economia em saúde serão um argumento convincente para que os governos se responsabilizem por programas de controle de hipertensão em escala nacional e os dotem de recursos financeiros.

ABSTRACT Generally, hypertension control programs are cost-effective, including in low- and middle-income countries, but country governments and civil society are not likely to support hypertension control programs unless value is demonstrated in terms of public health benefits, budget impact, and value-for-investment for the individual country context. The World Health Organization (WHO) and the Pan American Health Organization (PAHO) established a standard, simplified Global HEARTS approach to hypertension control, including preferred antihypertensive medicines and blood pressure measurement devices. The objective of this study is to report on health economic studies of HEARTS hypertension control package cost (especially medication costs), cost-effectiveness, and budget impact and describe mathematical models designed to translate hypertension control program data into the optimal approach to hypertension care service delivery and financing, especially in low- and middle-income countries. Early results suggest that HEARTS hypertension control interventions are either cost-saving or cost-effective, that the HEARTS package is affordable at between US$ 18-44 per person treated per year, and that antihypertensive medicines could be priced low enough to reach a global standard of an average <US$ 5 per patient per year in the public sector. This health economic evidence will make a compelling case for government ownership and financial support for national scale hypertension control programs.

Abstract Objective: To determine the frequency and characteristics of mesiodens in Indian school children. Material and Methods: 1232 radiographs of patients attending the Department of Oral Medicine and Radiology of the age group of 4-15 years studied for the present retrospective study. The intraoral periapical radiographs and occlusal radiographs of the premaxilla were examined to determine the presence of mesiodens. The data regarding the presence of mesiodens, number, position, location on the arch, shape and associated complications were recorded. Results: Eleven patients had 14 mesiodens, with a frequency of 0.8%. The ratio of boys to girls was 1.2:1. Maximum mesiodens observed in the age group of 7-9 years. Most of the mesiodens were conical in shape and found on the palatal side. Fifty percent of the mesiodens were unerupted. The majority of patients (57.1%) had vertically positioned mesiodens. Midline diastema was the most common complication due to mesiodens (66.7%). Conclusion: Routine check-up during the primary dentition and mixed dentition stages helps for early detection of mesiodens and thus preventing complications. Early identification is useful for planning comprehensive management, initiating proper consultation and referral for evaluation and treatment.

Abstract We present evidence of the generation of radical ion formation during the oxidation of iodide on a fluorine doped tin oxide (FTO) electrode in acetonitrile. The cyclic voltammograms for the oxidation of iodide and triiodide on FTO are significantly different as in the case of the oxidation on Pt electrode. The distinct voltammetric behavior is assigned to kinetic differences on the FTO surface that require significant over potentials to drive the oxidation of iodide and triiodide. We propose that at the highly positive potentials the iodine radical intermediate, I(, becomes thermodynamically stable at FTO. The radical nature of the intermediate was verified by the formation of radicals of the usual traps of 5,5-dimethyl-1-pyrroline N-oxide (DMPO) and 2,2,5,5 tetramethyl-1-pyrroline N-oxide (TMPO) when these were added to an electrolyzed solution. Irradiation of an iodine solution causes the homolytic cleavage of I2 and yields the same radical intermediate with TMPO as in the electrolysis experiment. Similar results were obtained from the electrolysis of bromide solutions upon addition of TMPO. Short term electrolysis (< 1 h) gives triiodide as a final product while long-term electrolysis (> 17 h) yields additional byproducts. Byproducts were determined to be organoiodines by gas chromatography-mass spectrometry (GC-MS). Overall, our results are consistent with iodine atoms reacting with the electrolyte during electrolysis at the FTO electrode and with a sequential two-electron transfer process.

Resumen Presentamos evidencia de la generación de iones radicales durante la oxidación de ioduro sobre un electrodo de óxido de estaño dopado con flúor (FTO por sus siglas en inglés) en acetonitrilo. Los voltamogramas cíclicos para la oxidación de ioduro y triioduro en FTO son siginificativamente diferentes como es el caso de la oxidación en electrodo de platino. Éstas discrepancias son asignadas a diferencias cinéticas sobre la superficie del FTO, las cuales requieren sobrepotenciales para la oxidación de ioduro y triioduro. Proponemos que, a potenciales altmente positivos, el intermediario radical ioduro, I•, se vuelve termodinámicamente estable en FTO. La naturaleza radical del intermediario fue verificada por la formación de radicales con las trampas usuales 5,5-dimetil-1-pirrolina N-óxido (DMPO) y 2,2,5,5-tetrametil-1-pirrolina N-óxido (TMPO) cuando éstas fueron añadidas a una solución electrolizada. La irradiación de una solución de ioduro causa la ruptura homolítica de I2, y resulta en el mismo radical con TMPO que en el experimento de electrólisis. Resultados similares son obtenidos de la electrólisis de soluciones de bromuro con TMPO. La electrólisis por corto tiempo (< 1 h) da triioduro como producto final, mientras que la electrólisis por largo tiempo (> 17 h) resulta en productos adicionales. Se determinó que los productos adicionales son organoiodos por cromatografía de gases-espectrometría de masas (GC-MS por sus siglas en inglés). En general, nuestros resultados son consistentes con la reacción de átomos de iodo con el electrolito durante la electrólisis sobre FTO, seguido por doble transferencia de electrones.

Abstract An actinobacterial strain VL-RK_09 having potential antimicrobial activities was isolated from a mango orchard in Krishna District, Andhra Pradesh (India) and was identified as Arthrobacter kerguelensis. The strain A. kerguelensis VL-RK_09 exhibited a broad spectrum of in vitro antimicrobial activity against bacteria and fungi. Production of bioactive metabolites by the strain was the highest in modified yeast extract malt extract dextrose broth, as compared to other media tested. Lactose (1%) and peptone (0.5%) were found to be the most suitable carbon and nitrogen sources, respectively, for the optimum production of the bioactive metabolites. The maximum production of the bioactive metabolites was detected in the culture medium with an initial pH of 7, in which the strain was incubated for five days at 30 °C under shaking conditions. Screening of secondary metabolites obtained from the culture broth led to the isolation of a compound active against a wide variety of Gram-positive and negative bacteria and fungi. The structure of the first active fraction was elucidated using Fourier transform infrared spectroscopy, electrospray ionization mass spectrometry, 1H and 13C nuclear magnetic resonance spectroscopy. The compound was identified as S,S-dipropyl carbonodithioate. This study is the first report of the occurrence of this compound in the genus Arthrobacter.

Mesoscale atmospheric circulations play an important role in the transport of air pollution and local air quality issues. The planetary boundary layer (PBL), the thermo-dynamical structure and the flow field play an important role in air pollution dispersion. Hence, the PBL parameters over Nagpur, India are simulated using the ARW v. 3.6.1 mesoscale model. High-resolution simulations are conducted with triple nested domains having a horizontal resolution of 27, 9 and 3 km, as well as 27 vertical levels by using the 1 x 1° NCEP Final Analysis meteorological fields for initial and boundary conditions. Eight fair-weather days in winter and summer (January and April 2009) with no significant synoptic activity were chosen for the study. Sensitivity experiments of the ARW model were conducted with two non-local (Yonsei University [YSU], and Asymmetric Convective Model v. 2 [ACM2]) and three local turbulence kinetic energy (TKE) closure (Mellor-Yamada Nakanishi and Niino Level 2.5 PBL [MYNN2], Mellor-Yamada-Janjic [MYJ], and quasi-normal scale elimination [QNSE]) turbulence diffusion parameterizations, to study the evolution of PBL parameters and the thermodynamical structure during the study period. After validation of the simulated parameters with the available in situ data, it was revealed that the non-local PBL scheme YSU, followed by local scheme MYNN2, could be able to capture the characteristic variations of surface meteorological variables and the thermodynamical structure of the atmosphere. The present results suggest that PBL schemes, namely YSU and MYNN2, performed better in representing the boundary-layer parameters and are useful for air pollution dispersion studies.

Las circulaciones atmosféricas de mesoescala desempeñan un papel importante en el transporte de la contaminación del aire y en cuestiones relacionadas con la calidad del aire a nivel local. La estructura termodinámica de la capa limítrofe planetaria (PBL, por sus siglas en inglés) y el campo de flujo también desempeñan un papel importante en la dispersión de contaminantes en la atmósfera. Por lo tanto, se simularon los parámetros de la PBL sobre Naigpur, India, utilizando el modelo de mesoescala ARW v. 3.6.1. Las simulaciones de alta resolución se llevaron a cabo por medio de dominios anidados con resolución horizontal de 27, 9 y 3 km, y 27 niveles verticales obtenidos mediante la utilización de los campos meteorológicos de 1 x 1° del análisis final del NCEP, para las condiciones iniciales y limítrofes. Para estudiar la evolución de los parámetros de la PBL y la estructura termodinámica durante el periodo de estudio, se eligieron ocho días de invierno y verano (enero y abril) con buen tiempo y ausencia de actividad sinóptica significativa. Se realizaron experimentos de sensibilidad del modelo ARW con dos parametrizaciones de la difusión turbulenta del cierre de energía cinética (TKE, por sus siglas en inglés) no locales (Yonsei University [YSU] y el Modelo Convectivo Asimétrico v. 2 [ACM2, por sus siglas en inglés]) y tres locales (Mellor-Yamada-Nakanishi and Niino Level 2.5 PBL [MYNN2], Mellor-Yamada-Janjic [MYJ] y eliminación de escala casi normal [QNSE, por sus siglas en inglés]). La validación de los parámetros simulados mediante el modelo con los datos in situ disponibles reveló que el esquema PBL no local YSU seguido del esquema local MYNN2 podrían reproducir las variables meteorológicas superficiales y la estructura termodinámica de la atmósfera. Los resultados del estudio sugieren que los esquemas PBL, en especial YSU y MYNN2, tuvieron un mejor desempeño para representar los parámetros de la capa limítrofe y son útiles en estudios de dispersión de contaminantes atmosféricos.

Objetivou-se com este trabalho avaliar o efeito da interação entre salinidade e espaçamento de plantio em plantas de milho (Zea mays L.) Híbrido AG 1051. Utilizou-se o delineamento em blocos ao acaso, em arranjo fatorial 3 x 2, sendo três espaçamentos entre fileiras (0,5, 0,7 e 0,9 m) e dois níveis de salinidade da água de irrigação (0,8 e 5,0 dS m-1), com 5 repetições. As variáveis analisadas foram: fotossíntese (A), radiação fotossinteticamente ativa (RFA), altura da planta, massa seca da parte aérea (MSPA), índice de área foliar (IAF), área foliar (AF), e teores foliares de carboidratos, N-aminossolúveis, Na+ e K+. As taxas de fotossíntese líquida não diferiram significativamente em decorrência dos espaçamentos nem da salinidade da água de irrigação. A RFA interceptada pelas folhas basais do milho foi maior no espaçamento com 0,9 m, porém não houve diferença entre as plantas estressadas e não estressadas, com relação à radiação interceptada pelas folhas e as taxas fotossintéticas. Embora a salinidade tenha afetado os níveis de carboidrato e de sódio nas folhas, as maiores diferenças foram relacionadas ao espaçamento de plantio e à idade da folha avaliada. De modo geral, o adensamento do cultivo de milho não minimizou os efeitos deletérios da salinidade no crescimento das plantas.

The objective of this work was to evaluate the effect of interaction between salinity and plant spacing on maize (Zea mays L.) hybrid AG 1051. A randomized block in a 3 x 2 factorial was used, with three row spacings (0.5, 0.7 and 0.9 m) and two levels of salinity of irrigation water (0.8 and 5.0 dS m-1), with five replications. The variables analyzed were: photosynthesis (A), photosynthetically active radiation (PAR), plant height, shoot dry mass (SDM), leaf area index (LAI), leaf area (LA), content of carbohydrate, soluble N-amines, Na+ and K+. The rates of net photosynthesis did not differ significantly neither as a result of plant spacings nor the salinity of irrigation water. The PAR intercepted by the basal leaves of maize was higher in the spacing of 0.9 m, but no difference between stressed and unstressed plants in relation to the radiation intercepted by leaves and photosynthetic rates was observed. Although salinity affected the levels of carbohydrates and sodium in leaves, the greatest differences were related to plant spacing and leaf age evaluated. In general, the densification of maize cultivation did not minimize the deleterious effects of salinity on plant growth.

Emergence of multi and pan-drug resistant Gram-negative bacteria causing nosocomial infections in intensive care settings has become a challenge for clinicians. The mortality rate of ventilator-associated pneumonia (VAP) is known to increase when the initial microbiological diagnosis and antimicrobial therapy are inappropriate. We present a case of a 18-year-old man, who after being admitted following an accident, had developed VAP due to multi-drug resistant Pseudomonas aeruginosa and Acinetobacter spp. and had a downhill clinical course despite broad-spectrum antibiotic treatment. The strains were found to be Col-S, as the susceptibility was tested. Colistin was instituted, with remarkable recovery. It is imperative to diagnose VAP with multi-drug resistant strains as early as possible; colistin, the 'last resort' antibiotic, if instituted with proper monitoring at the right time, can be life saving.

Por meio de revisão da literatura pertinente foram coligidos e são apresentados os principais dados relativos à intoxicação por selênio em animais domésticos. Foram abordados e discutidos os aspectos epidemiológicos, clínicos, anátomo e histopatológicos e patogenéticos atribuídos a Alkali Disease, Blind Staggers, intoxicação aguda e poliomielomalácia simétrica focal dos suínos. O trabalho tem como objetivo esclarecer pontos obscuros relativos à intoxicação por selênio, bem como alertar para os riscos que a suplementação com esse elemento pode representar.

Trough a critical literature review, the main data of selenium poisoning in domestic animals are presented. Epidemiological, clinical, anatomic and histopathological aspects attributed to Alkali Disease, Blind Staggers, acute poisoning and focal symmetrical poliomielomalacia of swine are discussed. The main objective of the paper is to clarify obscure points of selenium poisoning, as well to point out the risks that supplementation with this element can represent.

The causes of luteal phase progesterone deficiency in polycystic ovary syndrome (PCOS) are not known. To determine the possible involvement of hyperinsulinemia in luteal phase progesterone deficiency in women with PCOS, we examined the relationship between progesterone, luteinizing hormone (LH) and insulin during the luteal phase and studied the effect of metformin on luteal progesterone levels in PCOS. Patients with PCOS (19 women aged 18-35 years) were treated with metformin (500 mg three times daily) for 4 weeks prior to the test cycle and throughout the study period, and submitted to ovulation induction with clomiphene citrate. Blood samples were collected from control (N = 5, same age range as PCOS women) and PCOS women during the late follicular (one sample) and luteal (3 samples) phases and LH, insulin and progesterone concentrations were determined. Results were analyzed by one-way analysis of variance (ANOVA), Duncan's test and Karl Pearson's coefficient of correlation (r). The endocrine study showed low progesterone level (4.9 ng/ml) during luteal phase in the PCOS women as compared with control (21.6 ng/ml). A significant negative correlation was observed between insulin and progesterone (r = -0.60; P < 0.01) and between progesterone and LH (r = -0.56; P < 0.05) concentrations, and a positive correlation (r = 0.83; P < 0.001) was observed between LH and insulin. The study further demonstrated a significant enhancement in luteal progesterone concentration (16.97 ng/ml) in PCOS women treated with metformin. The results suggest that hyperinsulinemia/insulin resistance may be responsible for low progesterone levels during the luteal phase in PCOS. The luteal progesterone level may be enhanced in PCOS by decreasing insulin secretion with metformin.

Labelling of scorpion (Mesobuthus tamulus concanesis Pocock) venom was successfully achieved with Tc 99m using direct tin reduction procedure. Biodistribution studies were carried out in Wistar rats at different time intervals after i.v. administration of the labelled venom. Scintiimages were obtained after scorpion envenoming using a large field of view gamma camera to ascertain the pharmacological action of venom in the body. Within 5 min of administration, labelled venom was found in the blood (27.7%), muscle (30.11%), bone (13.3%), kidneys (11.5%), liver (10.4%), and other organs. The level of venom in the kidneys was higher than in the liver. The labelled venom was excreted through renal and hepatobiliary pathways. An immunoreactivity study was carried out in rabbits after i.v. injection of labelled scorpion venom followed by the injection of the species specific antivenom. A threefold increase in uptake by the kidneys was observed compared with that seen with scorpion venom alone. The neutralisation of the venom in the kidneys was higher than in the liver.

The efficacy of insulin-glucose infusion in reversing myocardial damage, haemodynamic changes, peripheral circulatory failure, and pulmonary oedema was evaluated in 25 victims of venomous scorpion stings from the Rayalaseema region in the south of India. Myocardial damage with peripheral circulatory failure was seen in all scorpion sting victims. Ten of these victims also had pulmonary oedema. All the patients received continuous infusion of regular crystalline insulin at the rate of 0.3 U/g of glucose and glucose at the rate of 0.1 g/kg/h with supplementary potassium as needed, inotropic agents, oxygen, as well as maintenance of fluid, electrolytes and acid-base balance. Insulin-glucose infusion was associated with reversal of cardiovascular and haemodynamic changes, and pulmonary oedema in 24 of the 25 victims. One severely envenomed victim admitted 72 hours after the sting died. The scorpion envenoming syndrome with myocardial damage, cardiovascular disturbances, peripheral circulatory failure, pulmonary oedema, and many other clinical manifestations may cause multi-system organ failure (MSOF). It is characterised by a massive release of catecholamines, angiotensin II, glucagon, cortisol, and inhibition of insulin secretion. Under these altered conditions in the hormonal milieu, scorpion envenoming essentially results in a syndrome of fuel-energy deficits and an inability to use the existing metabolic substrates by vital organs, causing MSOF and death. Administration of insulin-glucose infusion to scorpion sting victims appears to be the physiological basis for the control of the metabolic response when that has become a determinant to survival.

O objetivo do presente estudo foi comparar as mudanças na glândula tireóide com o ciclo reprodutivo de S. heathi. A tireóide mostrou variação sazonal marcada em peso, quantidade de colóide e altura do epitélio folicular, sugerindo que esta glândula está inativa durante a quiescência e o torpor de inverno e ativa durante o tempo de recrudescência e acasalamento, similarmente ao ciclo testicular. A concentração de tiroxina (T4) do plasma mostrou significantes mudanças sazonais com alta concentração durante o acasalamento e pós-acasalamento e baixa concentração durante a quiescência. Entretanto, a concentração plasmática de T4 aumentou da fase reprodutiva à pós-reprodutiva, quando o peso dos testículos estava se reduzindo. Sugere-se que, em S. heathi, a estreita correlação entre os ciclos testicular e tireóideo durante algumas fases do ciclo reprodutivo esteja relacionada à sensibilidade aumentada no período reprodutivo e à atividade metabólica.

The aim of present study was to compare the changes in thyroid gland with the reproductive cycle of S. heathi. Thyroid showed marked seasonal variation in weight, quantity of colloid and follicular epithelial height, suggesting the thyroid gland to be inactive during quiescence and winter dormancy and active during the time of recrudescence and breeding similarly to the testicular cycle. Plasma thyroxin (T4) concentration showed a significant seasonal change with high concentration during breeding and post-breeding and low concentration during quiescence. However, the T4 concentration increased from breeding to post-breeding phase, when the testes weight was declining. It is suggested that in S. heathi the positive correlation between thyroid and testicular cycles occurs only during the phases of the reproductive cycle when the body weight and testicular activity are also closely correlated.