RESUMO Em 29 de setembro de 2023, a República do Equador convocou uma reunião para tratar do fortalecimento do sistema de atenção cirúrgica e exortar as lideranças políticas a investir em infraestrutura. Participaram da reunião especialistas em diplomacia da saúde, financiamento inovador, estratégia de implementação e planos nacionais de atenção cirúrgica. O evento ocorreu em paralelo ao 60º Conselho Diretor da Organização Pan-Americana da Saúde, 75a Sessão do Comitê Regional da Organização Mundial da Saúde para as Américas. A reunião abordou quatro áreas centrais: (i) capacitação cirúrgica como forma de fazer avançar a atenção universal à saúde e a preparação para emergências; (ii) elaboração de políticas e estratégias para fortalecer os sistemas de atenção cirúrgica; (iii) criação de modelos para financiar, sustentar e melhorar os sistemas de atenção cirúrgica nos países de baixa e média renda; e (iv) avaliação de estratégias de implementação para financiar esses esforços. Ao estabelecer políticas integrais e sustentáveis, os planos nacionais de atenção cirúrgica representam uma oportunidade fundamental para criar sistemas de saúde resilientes. Este artigo destaca as principais mensagens desse evento voltado à América Latina, a fim de informar a comunidade mundial de saúde.

RESUMEN El 29 de septiembre del 2023, República de Ecuador convocó una reunión para abordar el fortalecimiento del sistema quirúrgico e instar a las autoridades políticas a realizar inversiones en infraestructura quirúrgica. En la reunión participaron expertos en diplomacia de la salud, financiamiento innovador, estrategias de implementación y planes quirúrgicos nacionales. El evento se celebró en paralelo con el 60.o Consejo Directivo de la Organización Panamericana de la Salud y la 75.a Sesión del Comité Regional de la Organización Mundial de la Salud para las Américas La reunión se centró en cuatro áreas principales: i) el aumento de la capacidad quirúrgica como medio para avanzar en la atención universal de salud y la preparación para emergencias; ii) la formulación de políticas y estrategias para fortalecer los sistemas quirúrgicos; iii) la elaboración de modelos para financiar, sostener y mejorar los sistemas quirúrgicos en países de ingresos bajos y medianos; y iv) la evaluación de las estrategias de implementación para el financiamiento de estas iniciativas. Los planes quirúrgicos nacionales brindan una oportunidad crucial para la creación de sistemas de atención de salud resilientes mediante el establecimiento de políticas integrales y sostenibles. En este artículo se resaltan los mensajes más destacados del evento, que estuvo centrado en América Latina, a fin de proporcionar información a la comunidad de la salud más amplia a nivel mundial.

ABSTRACT On September 29, 2023, the Republic of Ecuador convened a meeting to address surgical system strengthening and urge political leaders to invest in surgical infrastructure. The meeting included experts in health diplomacy, innovative financing, implementation strategy and national surgical plans. The event occurred in parallel with the Sixtieth Directing Council of the Pan American Health Organization, Seventy-fifth session of the World Health Organization Regional Committee for the Americas. The meeting centered around four major areas: (i) building surgical capacity as a means to develop universal health care and emergency preparedness; (ii) developing policies and strategies for strengthening surgical systems; (iii) developing models for financing, sustaining, and improving surgical systems in low- and middle-income countries; and (iv) evaluating implementation strategies for funding these endeavors. National surgical plans represent a critical opportunity to build resilient health care systems by establishing comprehensive and sustainable policies. This article highlights the key messages from the event, which focused on Latin America, to inform the broader global health community.

Abstract In [4] Wei and Libin defined Quasi normal ring. In this paper we attempt to define Quasi-k-normal ring by using the action of k-potent element. A ring is called Quasi-k-normal ring if ae = 0 ⇒ eaRe = 0 for a ∈ N(R)and e ∈ K(R), where K(R) = {e ∈ R|ek = e}. Several analogous results give in [4] is defined here. we find here that a ring is quasi-k-normal if and only if eR(1 − ek−1)Re = 0 for each e ∈ K(R). Also we get a ring is quasi-k-normal ring if and only if Tn(R, R) is quasi-k-normal ring.

Dynamic mechanical analysis (DMA) and drilling performance of the polypropylene (PP) composites reinforced with different volume fractions (0, 10, 20, 30, 40 and 50 vol.%) of untreated and alkali treated novel Alstonia macrophylla (AS) fiber were investigated. DMA reports showed that 40 vol.% fiber loaded PP composites imparted good thermomechanical properties in terms of storage modulus (E’), and loss modulus (E”) with a remarkable 366% and 331% improvement than virgin PP laminates respectively. In addition, study also disclosed that, alkali treated composites exhibited higher DMA properties than untreated PP composites owing to strong interfacial bonding of fiber and matrix as result of alkali treatment. Drilling study was also performed to investigate the effect of chemical treatment and drill parameters viz., drill point angle (90°, 118°, and 130°) and feed rate (20, 40, and 60 mm/min) on machinability property of PP/AS composites. Drilling outcomes conveyed that alkali treated PP/AS composites showed slight resistance to drilling than untreated composites owing to strong interfacial strength which played a vital role in resisting thrust force. Field emission scanning electron microscopy (FESEM) was used to capture the images of the drilled surface to understand the morphology of the PP/AS composite.

RESUMO Objetivo. Determinar a prevalência e a resistência a antimicrobianos de Escherichia coli e Salmonela spp. em amostras de ração animal coletadas entre 2018 e 2021 na Colômbia. Métodos. Estudo transversal de base laboratorial, usando dados de rotina do programa de inspeção, vigilância e controle de ração animal do Instituto Colombiano de Agricultura. Amostras de ração animal para as espécies suína, avícola, canina, felina, leporina, piscina e equina foram processadas para detecção de E. coli e Salmonella spp., usando métodos de enriquecimento e cultura seletiva. Os isolados foram testados quanto à suscetibilidade a antimicrobianos usando um método automatizado de microdiluição. Resultados. Das 1.748 amostras de ração animal analisadas, 83 (4,7%) foram positivas para E. coli e 66 (3,8%) para Salmonella spp. A presença de E. coli e Salmonella spp. foi maior em rações para aves (6,4% e 5,5%) e suínos (6,1% e 4,3%). O teste de resistência a antimicrobianos foi realizado em 27 (33%) isolados de E. coli e 26 (39%) isolados de Salmonella. Em E. coli, a resistência observada com maior frequência foi à ampicilina (44,5%), seguida da cefazolina (33,3%), ciprofloxacino (29,6%), ampicilina/sulbactam (26%) e ceftriaxona (11,1%). Os maiores níveis de resistência em isolados de Salmonella spp. foram contra cefazolina (7,7%) e piperacilina/tazobactam (7,7%). Conclusões. Este é o primeiro estudo da Colômbia a notificar a prevalência e resistência a antimicrobianos de E. coli e Salmonella spp. em amostras de ração animal. Os resultados estabelecem uma linha de base com ampla distribuição geográfica na Colômbia. Destaca-se a necessidade de integrar a vigilância da resistência a antimicrobianos na ração animal, devido ao surgimento de bactérias resistentes nesta importante etapa da cadeia de abastecimento.

RESUMEN Objetivo. Determinar la prevalencia y resistencia a los antimicrobianos de Escherichia coli y Salmonella spp. en muestras de piensos para animales tomadas entre el 2018 y el 2021 en Colombia. Métodos. Se trata de un estudio transversal realizado en el laboratorio a partir de los datos regulares del programa de inspección, vigilancia y control de alimentos para animales del Instituto Colombiano Agropecuario. Se procesaron muestras de alimentos utilizados en la cría de cerdos, aves de corral, cánidos, félidos, lepóridos, peces y equinos con el fin de detectar E. coli y Salmonella spp. por medio de métodos de enriquecimiento y cultivo selectivo. Se analizó la sensibilidad a los antimicrobianos de las cepas aisladas mediante microdilución automatizada. Resultados. De 1748 muestras de alimentos analizadas, 83 (4,7%) resultaron positivas para E. coli y 66 (3,8%) para Salmonella spp. La presencia de E. coli y Salmonella spp. fue mayor en los alimentos para aves de corral (6,4% y 5,5%) y cerdos (6,1% y 4,3%). Se realizaron pruebas de resistencia a los antimicrobianos en 27 (33%) cepas de E. coli y 26 (39%) de Salmonella. En las cepas de E. coli, se observó una mayor resistencia a la ampicilina (44,5%), seguida de la resistencia a la cefazolina (33,3%), la ciprofloxacina (29,6%), la ampicilina/sulbactam (26%) y la ceftriaxona (11,1%). En el caso de las cepas de Salmonella spp., los niveles de resistencia más elevados fueron para la cefazolina (7,7%) y piperacilina/tazobactam (7,7%). Conclusiones. Este es el primer estudio realizado en Colombia en el que se informa sobre la prevalencia y la resistencia a los antimicrobianos de E. coli y Salmonella spp. en muestras de alimentos para animales. Sus resultados establecen una línea de base para una zona geográfica mucho mayor dentro de Colombia. Se subraya la necesidad de integrar la vigilancia de la resistencia a los antimicrobianos en los alimentos para animales debido a la aparición de bacterias resistentes en esta importante etapa de la cadena de suministro.

ABSTRACT Objective. To determine the prevalence and antimicrobial resistance of Escherichia coli and Salmonella spp. in animal feed samples collected between 2018 and 2021 in Colombia. Methods. This was a laboratory-based cross-sectional study using routine data from the program for inspection, surveillance, and control of animal feed at the Colombian Agriculture Institute. Samples of animal feed for swine, poultry, canine, feline, leporine, piscine, and equine species were processed for detection of E. coli and Salmonella spp. using enrichment and selective culture methods. Isolates were tested for antimicrobial susceptibility using an automated microdilution method. Results. Of 1 748 animal feed samples analyzed, 83 (4.7%) were positive for E. coli and 66 (3.8%) for Salmonella spp. The presence of E. coli and Salmonella spp. was highest in feed for poultry (6.4% and 5.5%) and swine (6.1% and 4.3%). Antimicrobial resistance testing was performed in 27 (33%) E. coli isolates and 26 (39%) Salmonella isolates. Among E. coli, resistance was most frequently observed to ampicillin (44.5%) followed by cefazolin (33.3%), ciprofloxacin (29.6%), ampicillin/sulbactam (26%), and ceftriaxone (11.1%). The highest resistance levels in Salmonella spp. isolates were against cefazolin (7.7%) and piperacillin/tazobactam (7.7%). Conclusions. This is the first study from Colombia reporting on the prevalence and antimicrobial resistance of E. coli and Salmonella spp. in animal feed samples. Its results establish a baseline over a wide geographical distribution in Colombia. It highlights the need to integrate antimicrobial resistance surveillance in animal feed due to the emergence of resistant bacteria in this important stage of the supply chain.

Abstract In this study, we explain the impact of nonlinearity and wave dispersion parameters on the soliton pulses of the (2+1)-dimensional Kundu-Mukherjee-Naskar equation. In this regard, some new optical solitons are received via the unified method to the aforesaid equation to explain such impact on the soliton pulses. The presented optical solitons are expressed by the dark, bright, periodic, bell, kink, and singular soliton solutions. Considering both effects help stabilize the soliton pulses during their propagation by generating new dynamics depending upon the nonlinearity and the wave dispersion parameters of the studied equation. All the characteristics of the soliton pulses are exhibited graphically. It is found from the graphical outputs that the soliton profiles are decreasing and increasing with the increase of nonlinearity and dispersion parameters, respectively. The outcomes reveal that the soliton pulses are balanced due to the influences of nonlinearity and wave dispersion parameters of the aforementioned equation. It is mentioned that the impact of wave dispersion and nonlinearity parameters on the soliton pulses has not been discussed before. Therefore, the applied method permits the explanation of the various wave dynamics by analyzing the attained soliton solutions in nonlinear optical fibers systems, which can be used for further studies.

Resumo Introdução: Mais de 50% das mulheres grávidas apresentam tonturas frequentes nos primeiros dois trimestres da gravidez. Durante a gestação, as mudanças no metabolismo dos hormônios são responsáveis pelo ciclo ovariano, resultam em alterações vestibulares periféricas ou centrais. A necessidade do estudo é enfocar o efeito das mudanças durante a gravidez sobre o potencial evocado miogênico vestibular, uma medida eletrofisiológica que investiga as funções das estruturas otolíticas. Objetivo: Investigar as respostas do potencial evocado miogênico vestibular no primeiro trimestre da gravidez. Método: Participaram deste estudo 17 mulheres grávidas e 17 não grávidas com idades pareadas. O potencial evocado miogênico vestibular cervical foi registrado a partir do músculo esternocleidomastóideo ipsilateral e o potencial evocado miogênico vestibular ocular foi registrado a partir do músculo extraocular contralateral em ambos os grupos. Resultados: A amplitude pico a pico do potencial evocado miogênico vestibular cervical e do potencial evocado miogênico vestibular ocular estava significativamente reduzida nas respostas obtidas de mulheres grávidas no primeiro trimestre de gestação quando comparadas a de mulheres não grávidas. Conclusão: Os testes de potencial evocado miogênico vestibular mostram uma redução clinicamente significativa na amplitude pico a pico no primeiro trimestre da gravidez, o que indica disfunção na via otolítica reflexa.

Abstract Introduction: More than 50% of pregnant women experience dizziness frequently in the first two gestational trimesters. During pregnancy, the changes in the metabolism of hormones are responsible for the ovarian cycle resulting in either peripheral or central vestibular alterations. The need for the study is to focus on the effect of changes during pregnancy on the vestibular evoked myogenic potential, an electrophysiological measure that investigates functions of the otolith structures. Objectives: The aim is to investigate the vestibular evoked myogenic potential responses during the first trimester of pregnancy. Methods: A total of 17 pregnant women and 17 non-pregnant women with age matched took part in this study. The cervical vestibular evoked myogenic potential were recorded from the ipsilateral sternocleridomastoid muscle and the ocular vestibular evoked myogenic potential were recorded from contralateral extraocular muscle in both groups. Results: Peak to peak amplitude of cervical vestibular evoked myogenic potential and ocular vestibular evoked myogenic potential was found to be significantly reduced in the responses obtained from first-trimester pregnant women when compared to that of non-pregnant women. Conclusions: Vestibular evoked myogenic potential tests exhibits a clinically significant reduced peak to peak amplitude in the first trimester of pregnancy, which indicates dysfunction in the otolith reflex pathway.

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.

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.

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.

We have prepared several pyrazolyl palladium and nickel complexes ([(L1)PdCl2](1), [(L2) PdCl2](2), [(L3) PdCl2](3), [(L1) NiBr2](4), [(L2) NiBr2](5) and [(L3) NiBr2](6)) by reacting 3,5-dimethyMH-pyrazole (L1), 3,5-di-ferf-butyl-1ZÏ-pyrazole (L2) and 5-ferrocenyl-1Zf-pyrazole(L3) with [PdCl2(NCMe)2] or [NiBr2(DME)] to afford mononuclear palladium and nickel complexes, respectively. These complexes were then investigated as pre-catalysts in the hydrogenation of 2,4-hexadienoic acid (sorbic acid). The active catalysts from these complexes demonstrate significant activities under mild experimental conditions. Additionally, the active catalysts show that the hydrogenation of sorbic acid proceeds in a sequential manner, where the less hindered C=C bond (4-hexenoic acid) is preferentially reduced over the more hindered C=C bond (2-hexenoic acid).

Polyvinylpyrrolidone Oxime (PVPO) was synthesized and studied for mild steel (MS) corrosion inhibition in 1 M H2SO4, at different concentrations and temperatures. The corrosion inhibition efficiency was studied using weight loss method, polarization technique, electrochemical impedance spectroscopy (EIS), scanning electron microscopy (SEM) and quantum chemical calculations. The results from weight loss, potentiodynamic polarization and EIS showed that the inhibition efficiency (I. E.) increased with gradual increments in the inhibitor concentration, and decreased at higher temperatures. The polarization study also revealed that PVPO acted as a mixed type inhibitor, and Langmuir adsorption isotherm fitted well for the adsorption behavior. The highest corrosion efficiency was found to be 88.39%, with a concentration of 1000 ppm, and a temperature of 303 K. The corrosion inhibition mechanism has been further proposed, including the support from the theoretical study. SEM images also verified the MS surface smoothening in PVPO presence, and, hence, it has shown to be a good corrosion inhibitor.

RESUMEN Las precipitaciones convectivas asociadas a tormentas ocurren frecuentemente en los Andes Centrales del Perú. Para estudiar estos eventos se determinaron estimadores estadísticos de la reflectividad tri-dimensional, la intensidad de lluvia y parámetros microfísicos usando la información de radares abordo en los satélites del TRMM y el núcleo GPM. Como resultado se encontró que en las regiones de los Andes ocurren sistemas de nubes más profundas que en la región de transición Amazonia-Andes. De tal manera la diferencia del promedio vertical de la reflectividad presenta valores de alrededor de 5 dBZ entre ambas regiones. El ciclo diurno de la lluvia también es diferente, ya que llueve preferentemente en los intervalos 13-23 horas local y 18-06 hora local respectivamente. Los porcentajes de ocurrencia de precipitación convectiva y estratiforme en las áreas de los Andes son 30% y 70% respectivamente y sus contribuciones acumulativas a la lluvia son 63.3% y 36.7% respectivamente; en cambio en la región de transición Amazonia-Andes, los porcentajes de ocurrencia son 31% y 69% y sus contribuciones acumulativas a la lluvia son equivalentes. Se concluye que la precipitación convectiva en las áreas de Andes se intensifica con el mecanismo de forzamiento orográfico, lo que fortalece el crecimiento de los hidrometeoros por encima de la altura del nivel de congelación entre 6 y 12 km de altura y propicia mayores acumulados de lluvia.

ABSTRACT Convective precipitations associated with storms frequently occur in the Central Andes of Peru. To study these events, statistical estimators of three-dimensional reflectivity, rainfall intensity and microphysical parameters were determined using radar information onboard in the TRMM satellites and the GPM core. As a result, it was found that deeper cloud systems occur in the Andes regions than in the Amazon-Andes transition region. Thus, the difference of the vertical average of reflectivity is around 5 dBZ between both regions. The diurnal rainfall cycle is also different, since it rains preferably at the intervals of 13-23 LST and 18-06 LST respectively. The percentages of occurrence of convective and stratiform precipitation in the areas of the Andes are 30% and 70% respectively and their cumulative contributions to rainfall are 63.3% and 36.7% respectively; however, in the Amazon-Andes transition region, the percentages of occurrence are 31% and 69% and their cumulative contributions to rain are equivalent. It is concluded that convective precipitation in the Andes areas is intensified by the orographic forcing mechanism, which strengthens the growth of hydrometeors above the height of the freezing level between 6 and 12 km of height and leads to greater cumulative rainfall.

South Africa is among the countries with the highest prevalence of debilitating diseases such as HIV/Aids and diabetes. In this context, the emergence of vancomycin-resistant enterococci (VREs) in most South African ecological niches is quite disturbing, taking into consideration the fact that therapeutic options in a case of resistant-enterococci infection would be limited. Agricultural practices coupled with the misuse of antibiotics in intensive animal rearing and in hospital facilities have led to the creation of reservoirs of VREs in the environment. VREs can cause serious health problems by transmitting their resistance genes to susceptible pathogens; they are transmitted to humans by direct or indirect contact and through the food chain. We screened thoroughly the AJOL and the PubMed databases for studies on VRE incidence in South Africa. This review gives insight into the current status of antimicrobial resistance management in South Africa; it explores the different pathways involved in the spread of VREs and proposes possible solutions to tackle the issue of VREs and antimicrobial resistance in South Africa and other parts of the world. Significance: • The recent detection of vancomycin-resistant enterococci in most South African ecological niches poses a serious threat to public health and is therefore an issue of great concern. • This study not only addresses the causes and patterns of resistance to antimicrobial agents, particularly in South Africa, but also outlines a holistic approach to potential strategies to tackle antimicrobial resistance in South Africa and the world at large.

Abstract Escalating burden of antibiotic resistance that has reached new heights present a grave concern to mankind. As the problem is no longer confined to clinics, we hereby report identification of a pandrug resistant Escherichia coli isolate from heavily polluted Delhi stretch of river Yamuna, India. E. coli MRC11 was found sensitive only to tobramycin against 21 antibiotics tested, with minimum inhibitory concentration values >256 µg/mL for amoxicillin, carbenicillin, aztreonam, ceftazidime and cefotaxime. Addition of certain heavy metals at higher concentrations were ineffective in increasing susceptibility of E. coli MRC11 to antibiotics. Withstanding sub-optimal concentration of cefotaxime (10 µg/mL) and mercuric chloride (2 µg/mL), and also resistance to their combinatorial use, indicates better adaptability in heavily polluted environment through clustering and expression of resistance genes. Interestingly, E. coli MRC11 harbours two different variants of blaTEM (blaTEM-116 and blaTEM-1 with and without extended-spectrum activity, respectively), in addition to mer operon (merB, merP and merT) genes. Studies employing conjugation, confirmed localization of blaTEM-116, merP and merT genes on the conjugative plasmid. Understanding potentialities of such isolates will help in determining risk factors attributing pandrug resistance and strengthening strategic development of new and effective antimicrobial agents.

Abstract Introduction Eustachian tube (ET) dysfunction plays an important role not only in the pathophysiology of various middle ear disorders, but also in predicting the outcome of the treatment. As there is no single test that assesses both the anatomic and physiological functions of the ET, a combination of tympanometry and dynamic slow motion video endoscopy may improve the sensitivity of ET function assessment. Objective To find out if there is any correlation between dynamic slow motion nasal video endoscopy and impedance audiometry in assessing ET function in patients with middle ear diseases. Methods Ours was a descriptive study performed with 106 patients attending the Ear, Nose and Throat (ENT) Outpatient Department of a tertiary care center in South India with features suggestive ofmiddle ear disease. All patients underwent impedance audiometry and dynamic slow motion nasal video endoscopy, and were graded based on the severity of the ET pathology. Results A total of 47 out of 97 patients with abnormal endoscopy findings also had abnormal impedance audiometry. The correlation was greater among the patients with higher grades of ET dysfunction. The endoscopy findings of 106 cases, when correlated with middle ear manometry, revealed that 56 cases showed complete agreement, and 50 cases showed disagreement. The nasal endoscopy results, when correlated with middle ear manometry studies by using McNemar’s chi-squared (χ2) test, showed a significant association between the 2 tests (p = 0.017). Conclusion There is a significant alteration in middle ear pressure as the severity of the ET tube dysfunction increases. Impedance audiometry and nasal endoscopy provide a better measure of ET function.

Abstract: Background: Varicose veins and the complications of venous disease are common disorders in humans. Objective: To study the effects of bleomycin as a potential new sclerosing agent and its adverse events in treating varicose veins. Methods: Bleomycin-loaded liposomes 0.1ml was injected in the dorsal ear veins of white New Zealand rabbits. Sodium tetradecyl sulfate was used as a positive control. Normal saline was used as negative control. The blood vessels of the treated ears were photographed before and at one hour and two, eight and 45 days after treatment. Biopsies from the treated areas were obtained for histological examination. Blood samples were collected to determine any possible toxicity. Results: Bleomycin by itself was ineffective; therefore, liposomes were used as a vector to deliver bleomycin to the vein lumen. Subsequently, bleomycin started showing its sclerosing effects. Toxicity monitoring showed no apparent hematologic, pulmonary, hepatic or renal toxicities. This study revealed that bleomycin induced vasculitis, which led to vascular occlusion, which was observed on day 1 and day 8. No bleomycin-related injury was noted by histopathological examination of lung sections. The calculation of the lung/body weight coefficient indicated that edema was present in the experimental groups compared with the negative and positive controls. Study limitations: Relatively small number of experimental animals used. Conclusions: This study showed that bleomycin-loaded liposomes were able to induce vasculitis and vascular occlusion without any toxicity or complications. It might be useful, hence, to treat patients suffering from Varicose veins and other ectatic vascular diseases with this agent.

A methodology is proposed to develop an optimization model to understand the impact of transporting minerals, from mines to the final destination, on air quality. Recently, there has been increasing concern about the combined effects of multiple activities over many years, and the regional environmental changes brought about by a single project. Environmental issues in the iron ore industry have highlighted the need to broaden the cumulative impact assessment. In this study, we simulated the optimal routes and quantity of materials needed to meet the destination plant demand based upon environment constraints (level of air pollution), as well as the cost of transportation and availability of materials. Multiple scenarios were developed to analyse the effects of changes in routes, alternative transport system (or multi-modal split), traffic congestion, and the cumulative impacts on air quality. The air quality impact zones of the study area were demarcated using a GIS technique. The expected outcome of the study is the selection of a suitable transport system for a particular site with the least impact on air quality, including the transportation route, relative to the minimum cost of transportation of the minerals from the mines to their final destination. The proposed methodology is evaluated with a case study.