An alternative antimonial schedule to be used in cutaneous leishmaniasis when high doses of antimony are undesirable

Despite more than half a century of use in leishmaniasis, antimony therapy still presents serious problems concerning dosage and toxicity. Low and high doses have been shown to be equally effective. In this paper, the feasibility of injecting one ampoule of meglumine antimoniate intramuscularly every other day until clinical cure is demonstrated, while studying a series of 40 cutaneous leishmaniasis cases. Total dose used varied from 1,822.5 to 12,150mg of pentavalent antimony and total time of treatment varied from 3 to 10 weeks, with 86% efficacy. Thirty-six out of the 40 patients are still on follow-up with a mean time of 10.7 ± 7 months and a median of 9 months. No relapse or mucosal lesions have been noted so far. The schedule showed good tolerance and easy application and its efficacy was comparable to the officially recommended WHO schedule. Therefore, such a schedule represents a valuable alternative for the cases with high toxicicity to antimony or daily injections are an obstacle to the treatment.

An optically coupled power stimulus isolation unit with high voltage and fast rise time output

Recent technological developments have created new devices that could improve and simplify the construction of stimulus isolators. HEXFET transistors can switch large currents and hundreds of volts in nanoseconds. The newer opto-isolators can give a pulse rise time of a few nanoseconds, with output compatible with MOSFET devices, in which delays are reduced to nanoseconds. Integrated DC/DC converters are now available. Using these new resources we developed a new electrical stimulus isolator circuit with selectable constant-current and constant-voltage modes, which are precise and easy to construct. The circuit works like a regulated power supply in both modes with output switched to zero or to free mode through an opto-isolator device. The isolator analyses showed good practical performance. The output to ground resistance was 1011 ohms and capacitance 35 picofarads. The rise time and fall time were identical (5 µs) and constant. The selectable voltage or current output mode made it very convenient to use. The current mode, with higher output resistance values in low current ranges, permits intracellular stimulation even with tip resistances close to 100 megaohms. The high compliance of 200 V guarantees the value of the current stimulus. The very low output resistance in the voltage mode made the device highly suitable for extracellular stimulation with low impedance electrodes. Most importantly, these characteristics were achieved with a circuit that was easy to build and modify and assembled with components available in Brazil.

The decreased oxygen uptake during progressive exercise in ischemia-induced heart failure is due to reduced cardiac output rate

We tested the hypothesis that the inability to increase cardiac output during exercise would explain the decreased rate of oxygen uptake (VO2) in recent onset, ischemia-induced heart failure rats. Nine normal control rats and 6 rats with ischemic heart failure were studied. Myocardial infarction was induced by coronary ligation. VO2 was measured during a ramp protocol test on a treadmill using a metabolic mask. Cardiac output was measured with a flow probe placed around the ascending aorta. Left ventricular end-diastolic pressure was higher in ischemic heart failure rats compared with normal control rats (17 ± 0.4 vs 8 ± 0.8 mmHg, P = 0.0001). Resting cardiac index (CI) tended to be lower in ischemic heart failure rats (P = 0.07). Resting heart rate (HR) and stroke volume index (SVI) did not differ significantly between ischemic heart failure rats and normal control rats. Peak VO2 was lower in ischemic heart failure rats (73.72 ± 7.37 vs 109.02 ± 27.87 mL min-1 kg-1, P = 0.005). The VO2 and CI responses during exercise were significantly lower in ischemic heart failure rats than in normal control rats. The temporal response of SVI, but not of HR, was significantly lower in ischemic heart failure rats than in normal control rats. Peak CI, HR, and SVI were lower in ischemic heart failure rats. The reduction in VO2 response during incremental exercise in an ischemic model of heart failure is due to the decreased cardiac output response, largely caused by depressed stroke volume kinetics.

Comparison of pupil diameter and tear production in dogs treated with acepromazine, tramadol and their combination

Some ophthalmic surgeries require induction of mydriasis, however, drugs traditionally used for this purpose significantly reduces tear production. To evaluate the effect of acepromazine and tramadol, used alone or in combination, on pupil diameter, tear production, heart and respiratory rate, systolic blood pressure and rectal temperature, these drugs were administered to seven clinically normal dogs divided into three experimental groups (G1 - acepromazine; G2 - tramadol; G3 - tramadol + acepromazine) that differed only in the sedation protocol. Parameters were measured in four experimental moments. Miosis occurred in G1, in addition to reduced tear production and respiratory rate. No significant changes were found in the parameters assessed in G2, whereas in G3, there was decrease in tear production of the right eye, decrease in the respiratory rate and rectal temperature. Tramadol proved to be a drug suitable for pre-anesthetic procedures that require the maintenance of pupil diameter and keeps the tear production within normal parameters. However, the use of acepromazine alone or in combination with tramadol requires protection of the patient's eye surface to prevent the occurrence of undesirable ophthalmic changes.

Eficiência dos gastos municipais em saúde e educação: uma investigação através da análise envoltória no estado do Rio de Janeiro

Este artigo analisa a eficiência dos gastos públicos nos municípios fluminenses no período 1999/2000, por meio da aplicação da análise envoltória de dados. O estudo adota os indicadores sociais e de gastos municipais das seguintes áreas temáticas da realidade social: educação e cultura; saúde e saneamento. O artigo apresenta uma revisão de várias aplicações de DEA no campo das políticas públicas e, em seguida, os indicadores e modelos propostos para análise da eficiência dos gastos sociais. Aplicou-se o modelo BCC da DEA, com orientação output, isto é, visando maximizar os outputs sem diminuir os inputs. Foram selecionados indicadores de despesas per capita com educação e cultura e com saúde e saneamento como inputs do modelo em questão. Já as variáveis "candidatas" a outputs foram definidas como: taxa de alfabetização de 10 a 14 anos; proporção de domicílios particulares permanentes com esgotamento sanitário adequado; proporção de domicílios particulares permanentes com saneamento adequado; o inverso da taxa de mortalidade por causas hídricas; a proporção de crianças de dois a cinco anos matriculadas em creches ou escolas de educação infantil. O artigo destaca como "boas práticas", no que se refere à eficiência das políticas públicas, pelos resultados que alcançam em termos do que alocam como recursos ou pelas condições de renda média, os municípios de São Gonçalo, Japeri, Queimados, Cantagalo, São João de Meriti e Resende.

Movimentação financeira: a base de uma contribuição para o INSS em substituição à folha de pagamentos

Em média, os salários no Brasil são onerados em 42,5% do seu valor bruto, somando-se a parte que é descontada do salário do trabalhador com a que incide sobre a folha de pagamentos das empresas. Isso torna o país uma das economias que mais tributam rendimentos do trabalho assalariado no mundo. O maior ônus sobre os salários recai sobre as empresas, estimulando práticas como a contratação de empregados sem carteira de trabalho assinada e a terceirização, fazendo da informalidade um dos elementos determinantes dos crescentes déficits do INSS. A folha de pagamentos é tributada em média em 35%, sendo a contribuição previdenciária o tributo de maior peso. Após diagnosticar o problema, este texto discute aspectos relacionados aos regimes previdenciários e as bases de incidência adequadas a cada um deles. Mostra ainda que o regime geral da previdência no Brasil assumiu conotação de política pública de renda complementar. Nesse sentido, propõe-se a substituição do INSS patronal, uma base restrita, por uma contribuição de 0,61% sobre as movimentações nas contas-correntes bancárias, uma base universal, e compara os efeitos sobre a economia de um tributo cumulativo com os produzidos por um imposto sobre o valor agregado. Utilizando o modelo de input-output de Leontief como mecanismo de análise, o trabalho revela que uma contribuição sobre as transações bancárias implica menor carga tributária sobre os preços setoriais e menor distorção alocativa que os 20% cobrados sobre a folha de salários das empresas para o INSS. Por fim, o texto procura desmistificar a crítica envolvendo a cumulatividade tributária.