OBJECTIVES: Quality improvement (QI) initiatives based on data from international registries have been reported previously; however, there is a lack of information on the impact on the costs of medical care associated with the use of these tools. METHODS: Patients admitted due to myocardial infarction (MI), included in the ACTION Registry® and CathPCI Registry®, in a private Brazilian hospital (i.e., the reference hospital) were analyzed. The costs of care of these patients were compared to the costs of MI admissions in nine similar hospitals not included in the same QI program. Regression models were used to analyze the cost change over time between the two groups of hospitals. Readmission rates were compared using logistic regression, adjusting for the same variables as in the cost model. RESULTS: Overall, the annual medical cost inflation in Brazil was higher than the annual cost trend in the reference hospital during the period of analysis. Moreover, the annual in-hospital costs indicate that the reference hospital has a statistically significant 6% lower cost trend for patients with acute MI, compared to patients with the same diagnostic code in the comparison hospitals group, in an adjusted analysis (p-value=0.041). Using multivariable analysis, the readmission rates were also found to be significantly lower in the reference hospital than in the comparison hospitals, with an odds ratio of 0.68 (p-value=0.042). CONCLUSION: The use of the NCDR® as a benchmark to guide QI programs outside the United States was associated with the positive impact of bending the cost curve to below that of national medical inflation and the comparison hospitals’ costs, with a lower incidence of hospital readmission.

RESUMO O nitrogênio é o elemento mais essencial para o crescimento e desenvolvimento das plantas. Os aminoácidos, que servem como principal fonte de nitrogênio orgânico nos meios de cultura de tecidos proporcionam o alongamento da parte aérea e da raiz. A glutamina tem sido amplamente utilizada na cultura de tecidos para processos de desdiferenciação e re-diferenciação. Foram realizados experimentos para avaliar os efeitos da glutamina em comparação com alguns reguladores de crescimento de plantas (PGRs) comumente usados no crescimento de moscheutos de Hibiscus propagados via cultura de tecidos. Um estudo inicial sugeriu que 10 mg L–1 de glutamina em meio basal MS era ideal para o alongamento da parte aérea. Nesta taxa ótima, a glutamina mostrou superioridade sobre os outros PGRs. Nenhuma diferença foi encontrada entre os tratamentos com glutamina e o controle em um estudo posterior. Ao comparar glutamina com arginina, os brotos cultivados em meio com arginina apresentaram um crescimento ligeiramente maior. Com arginina contendo dois grupos extras de nitrogênio em sua estrutura molecular, a maior porcentagem de nitrogênio pode ter resultado em crescimento melhorado.

ABSTRACT Nitrogen is the most essential element for plant growth and development. Amino acids, serving as the main organic nitrogen source in tissue culture media, provide for shoot and root elongation. Glutamine has been widely used in tissue culture for dedifferentiation and re-differentiation processes. Experiments were conducted to assess the effects of glutamine in comparison to some commonly used plant growth regulators (PGRs) on the growth of Hibiscus moscheutos propagated via tissue culture. An initial study suggested that 10 mg L–1 glutamine in MS basal medium was optimal for shoot elongation. At this optimal rate, glutamine showed superiority over other PGRs. No difference was found between glutamine treatments and the control in a later study. When comparing glutamine with arginine, shoots cultured on media with arginine displayed slightly greater growth. With arginine containing two extra nitrogen groups in its molecular structure, the higher percentage of nitrogen may have resulted in improved growth.

Carrapatos e as doenças por eles transmitidas causam grandes perdas econômicas ao gado dos países tropicais. Alternativas não-químicas incluem o uso de raças de gado que sejam resistentes, controle biológico e vacinas. No entanto, o método mais utilizado é a aplicação de diferentes classes químicas de acaricidas e lactonas macrocíclicas. Populações de piolhos de gado, Rhipicephalus (Boophilus) microplus, resistentes aos organofosfatos (OP), piretoides sintéticos (SP), amitraz e fipronil, foram descritas no México. Lactonas macrocíclicas são as drogas antiparasitárias mais vendidas no mercado veterinário mexicano. Populações de R. (B.) microplus resistentes à irvemectina foram relatadas no Brasil, Uruguai e especialmente no México (Veracruz e Yucatan). Embora os níveis de resistência à ivermectina no R. (B.) microplus do México tenha sido relativamente baixa, na maioria dos casos, algumas populações campestres de R. (B.) microplus mostraram altos níveis de resistência à ivermectina. A população CHPAT mostrou uma razão de resistência de 10,23 e 79,6 na concentração letal de 50% e 99%, respectivamente. Muitas populações campestres de R. (B.) microplussão resistentes a múltiplas classes de drogas antiparasitárias, incluindo organofosfatos (clorpirifós, coumafos e diazinon), piretoides (flumetrina, deltametrina e cipermetrina), amitraz e ivermectina. Este artigo relata o estado atual de resistência do R. (B.) microplus aos acaricidas, especialmente ivermectina, no gado mexicano.

Ticks and the diseases they transmit cause great economic losses to livestock in tropical countries. Non-chemical control alternatives include the use of resistant cattle breeds, biological control and vaccines. However, the most widely used method is the application of different chemical classes of acaricides and macrocyclic lactones. Populations of the cattle tick, Rhipicephalus (Boophilus) microplus, resistant to organophosphates (OP), synthetic pyrethroids (SP), amitraz and fipronil have been reported in Mexico. Macrocyclic lactones are the most sold antiparasitic drug in the Mexican veterinary market. Ivermectin-resistant populations of R. (B.) microplus have been reported in Brazil, Uruguay and especially in Mexico (Veracruz and Yucatan). Although ivermectin resistance levels in R. (B.) microplus from Mexico were generally low in most cases, some field populations of R. (B.) microplus exhibited high levels of ivermectin resistance. The CHPAT population showed a resistance ratio of 10.23 and 79.6 at lethal concentration of 50% and 99%, respectively. Many field populations of R. (B.) microplus are resistant to multiple classes of antiparasitic drugs, including organophosphates (chlorpyrifos, coumaphos and diazinon), pyrethroids (flumethrin, deltamethrin and cypermethrin), amitraz and ivermectin. This paper reports the current status of the resistance of R. (B.) microplus to acaricides, especially ivermectin, in Mexican cattle.

Aços temperados e revenidos de alta resistência (Q&T) oferecem vantagens econômicas óbvias originadas de sua benéfica razão resistência e custo ou peso. Estes aços são normalmente soldados com consumíveis ferríticos e, por esta causa, apresentam alto risco de trinca de hidrogênio. O uso de consumíveis de aços inoxidáveis austeníticos representa um grande potencial para melhorar este aspecto. Entretanto, não há recomendações técnicas para determinar um nível seguro de temperatura de pré-aquecimento para soldagens de aços ferríticos com consumíveis austeníticos. Por isto, fabricantes adotam para este parâmetro os tirados de procedimentos desenvolvidos para consumíveis ferríticos convencionais, consequentemente reduzindo os benefícios que os consumíveis austeníticos poderiam fornecer. Produtividade poderia ser intensificada pela identificação da temperatura de interpasse, reduzindo os tempos mortos. O objetivo do presente trabalho foi o de desenvolver procedimentos seguros e altamente otimizados para soldagens dos aços temperados e revenidos de alta resistência com consumíveis de aços inoxidáveis austeníticos.

High strength quenched and tempered (Q&T) steels offer obvious economic benefits originating from their advantageous strength to price and weight ratios. These steels are usually welded using ferritic consumables and for this combination the risk of hydrogen assisted cold cracking (HACC) is high. The use of austenitic stainless steel (ASS) consumables has great potential to significantly improve this issue. Yet, there are no guidelines for determination of safe level of preheat for welding ferritic steels with ASS consumables. For this reason manufacturers adopt this parameter from procedures developed for conventional ferritic consumables thus significantly limiting the benefits ASS consumables are capable to deliver. Productivity could be further enhanced by identifying the upper interpass temperature threshold, thus reducing the stand-off times. Aim of this work is to develop safe highly optimised procedures for welding of high strength Q&T steel with ASS consumable.

Although leprosy is curable with drug treatment, the identification of biomarkers of infection, disease progression and treatment efficacy would greatly help to reduce the overall prevalence of the disease. Reliable biomarkers would also reduce the incidence of grade-2 disability by ensuring that those who are most at risk are diagnosed and treated early or offered repeated treatments in the case of relapse. In this study, we examined the reactivity of sera from lepromatous and tuberculoid leprosy patients (LPs) against a panel of 12 recombinant Mycobacterium leprae proteins and found that six proteins were strongly recognised by multibacillary (MB) patients, while only three were consistently recognised by paucibacillary patients. To better understand the dynamics of patient antibody responses during and after drug therapy, we measured antibody titres to four recombinant proteins, phenolic glycolipid-I and lipoarabinomannan at baseline and up to two years after diagnosis to investigate the temporal changes in the antibody titres. Reactivity patterns to individual antigens and decreases in antibody titres were patient-specific. Antibody titres to proteins declined more rapidly vs. those to carbohydrate and glycolipid antigens. Compared to baseline values, increases in antibody titres were observed during reactional episodes in one individual. Additionally, antibody responses against a subset of antigens that provided a good prognostic indicator of disease progression were analysed in 51 household contacts of MB index cases for up to two years. Although the majority of these contacts showed no change or exhibited decreases in antibody titres, seven individuals developed higher titres towards one or more of these antigens and one individual with progressively higher titres was diagnosed with borderline lepromatous leprosy 19 months after enrolment. The results of this study indicate that antibody titres to specific M. leprae antigens can be used to monitor treatment efficacy in LPs and assess disease progression in those most at risk for developing this disease.

OBJECTIVE: We aimed to determine the burden of bacillary dysentery in China, its cross-regional variations, trends in morbidity and mortality, the causative bacterial species and antimicrobial resistance patterns. METHODS: We extracted and integrated governmental statistics and relevant medical literature published from 1991 to 2000. Data were also collected from one general hospital each for the six provinces and Jin-an district, Shanghai, representative of six geographical regions and a modern city. FINDINGS: In 2000, 0.8-1.7 million episodes of bacillary dysentery occurred of which 0.5 to 0.7 million were treated at health-care facilities and 0.15-0.20 million patients were hospitalized. The highest morbidity and mortality rates were among the youngest and oldest age groups. Bacillary dysentery peaked during the summer months. The major causative species was Shigella flexneri (86%) and the predominant S. flexneri serotype was 2a (80%). About 74-80% of Shigella isolates remained susceptible to fluorinated quinolones. CONCLUSION: We conclude that while morbidity and mortality due to bacillary dysentery has decreased considerably in China in the past decade due to increasing access to affordable health care and antibiotics, a considerable burden exists among the youngest and oldest age groups and in regions with low economic development. We suggest that while a vaccine would be effective for short- and medium-term control of bacillary dysentery, improved water supply, sanitation, and hygiene are likely to be required for long-term control.

OBJETIVO: Decidimos determinar la carga de disentería bacilar en China, las diferencias interregionales en ese sentido, las tendencias de la morbilidad y la mortalidad, las especies bacterianas causantes, y la distribución de la resistencia a los antimicrobianos. MÉTODOS: Procedimos a extraer e integrar estadísticas gubernamentales y publicaciones médicas relacionadas aparecidas entre 1991 y 2000. También obtuvimos datos de un hospital general de cada una de las seis provincias consideradar y del distrito de Jin-an, Shanghai, como información representativa de seis regiones geográficas y una ciudad moderna. RESULTADOS: En 2000 se produjeron entre 0,8 y 1,7 millones de episodios de disentería bacilar, de los cuales 0,5 - 0,7 millones fueron tratados en establecimientos de salud, y 0,15 - 0,20 millones fueron hospitalizados. Las mayores tasas de morbilidad y mortalidad fueron las registradas entre los grupos más jóvenes y en las personas mayores. La disentería bacilar alcanzó la máxima cota en los meses de verano. La principal especie causante fue Shigella flexneri (86%), con la variante 2a como serotipo predominante (80%). Aproximadamente un 74% - 80% de las colonias de Shigella seguían siendo vulnerables a las quinolonas fluoradas. CONCLUSIÓN: Aunque la morbimortalidad por disentería bacilar ha disminuido considerablemente en China durante el último decenio, gracias al mayor acceso a la atención sanitaria y los antibióticos, sigue habiendo una carga considerable de la enfermedad entre los grupos más jóvenes y de mayor edad, así como en las regiones con bajo desarrollo económico. En nuestra opinión, aunque una vacuna sería una opción eficaz para controlar la disentería bacilar a corto y medio plazo, todo control a largo plazo exigirá probablemente mejoras del abastecimiento de agua, el saneamiento y la higiene.

OBJECTIF: L'étude visait à déterminer la charge de dysenterie bacillaire en Chine, les variations interrégionales, les tendances de la morbidité et de la mortalité, les agents étiologiques bactériens et les schémas de résistance aux antimicrobiens. MÉTHODES: Les statistiques publiques et les documents médicaux pertinents publiés de 1991 à 2000 ont été extraits et pris en compte dans l'étude. On a également recueilli des données auprès d'un hôpital général de chacune des six provinces considérées et du district de Jin an à Shanghai, ces hôpitaux étant représentatifs de six régions géographiques et d'une ville moderne. RÉSULTATS: En 2000, 0,8 à 1,7 million d'épisodes de dysenterie bacillaire on été enregistrés, dont 0,5 à 0,7 million ont été traités dans des établissements de soins et 150 000 à 200 000 ont donné lieu à des hospitalisations. Les taux de morbidité et de mortalité les plus élevés ont été relevés parmi les classes d'âge correspondant aux plus jeunes et aux plus âgés. La dysenterie bacillaire a atteint un pic au cours des mois d'été. Le principal agent étiologique était Shigella flexneri (86 %) et le sérotype prédominant de S. flexneri était le sérotype 2a (80 %). De 74 % à 80 % des isolements de Shigella étaient sensibles aux quinolones fluorés. CONCLUSION: Malgré une baisse considérable de la morbidité et de la mortalité dues à la dysenterie bacillaire en Chine au cours de la dernière décennie, imputable à l'amélioration de l'accès à des soins de santé et à des antibiotiques à des prix abordables, une importante charge de morbidité subsiste chez les classes d'âge extrêmes et dans les régions faiblement développées sur le plan économique. Si un vaccin constituerait un moyen efficace à court et à moyen terme pour lutter contre la dysenterie bacillaire, il est probable que la lutte à long terme contre cette maladie exige une amélioration de l'approvisionnement en eau, des installations d'assainissement et de l'hygiène.

The crystal and molecular structure of N-2-pyridylethyl-N'-3- tolylthiourea, 1, was determined. 1 crystallizes as triclinic, P-1, a = 9.024(2) Å, b = 9.718(3) Å, c = 9.765(4) Å, α = 102.26(3)°, β = 114.18(3)°, γ = 103.12(2)°, V = 714.4(4) ų, Z = 2. Both thiourea N-H groups form intermolecular hydrogen bonds, N'H with the thione sulfur atom and the NH with the pyridine nitrogen. When compared with other N-2-pyridylethyl-N'-arylthioureas it is observed that the centro-symmetric N'H⋯S hydrogen bond is always present and the NH⋯N always H-bonds to the pyridine N atom but in some cases as an intramolecular H-bond and in the other as an intermolecular H-bond. This difference may be due to variables introduced by the flexibility of the molecules, whose effects on the crystal packing can not be predicted.

La estructura molecular y cristalina de la N-2-piridiletill-N'-3-toliltiourea, 1, fue determinada. 1 cristaliza como triclinico, P-1, a = 9.024(2)Å, b = 9.718(3)Å, c = 9.765(4)Å, α = 102.26(3)°, β = 114.18(3)°, γ = 103.12(2)°, V = 714.4(4) ų, Z = 2. Los dos hidrógenos de N-H en 1 forman enlaces de hidrógeno, uno intramolecular con el átomo de nitrógeno de la piridina, y el otro intermolecular con el átomo de azufre. Un análisis comparativo con otras N-2-piridiletil-N'-ariltioureas muestra que el enlace de hidógeno N'H⋯S siempre está presente y el N-H siempre forma enlaces de hidrógeno con el átomo nitrógeno de la piridina, este último es en algunas ocasiones intramolecular y otras intermolecular. Esta diferencia puede deberse a que la flexibilidad de las moléculas introduce variables cuyos efectos sobre la red cristalina son difíciles de predecir.