Evaluación económica de costos de la línea de cuidado de la hipoacusia prelingual en Argentina / Economic evaluation of costs related to prelingual hearing loss care in Argentina

INTRODUCCIÓN Se estima que la prevalencia de la hipoacusia en Argentina oscila entre 1 a 3 casos por cada 1000 nacidos vivos y que existen alrededor de un millón de hipoacúsicos de diverso grado y edad. Ello pone de relieve la magnitud de la problemática en el país. OBJETIVOS Objetivo general Estimar los costos económicos asociados a la línea de cuidado de la hipoacusia bilateral profunda prelingual en Argentina, con y sin implementación de la política pública de atención. Objetivos específicos 1) Describir la línea de cuidados de la hipoacusia prelingual implementada por el subsector público. 2) Identificar y describir las implicancias sociales asociadas a la hipoacusia bilateral profunda prelingual. 3) Estimar los costos (médicos y no médicos) asociados a la línea de cuidado de la hipoacusia bilateral profunda prelingual frente a su ausencia. 4) Identificar parámetros de comparación con el subsector privado y la seguridad social. MÉTODOS Se estimaron los costos médicos y no médicos utilizando una perspectiva de análisis social. Se estudió un caso tipo de hipoacusia infantil, sin encontrarse aún en etapa de oralización. El relevamiento de información involucró la implementación de la técnica del microcosteo, la revisión de registros administrativos y la realización de entrevistas. RESULTADOS El escenario sin intervención presentó una variación estimada del 45% ($537 420) respecto al escenario de intervención con audífono más implante, y del 70% ($710 490) respecto a la intervención con audífono. DISCUSIÓN Para un caso "tipo" de hipoacusia bilateral profunda, la falta de intervención oportuna podría implicar mayores costos para la sociedad, reflejados en la productividad que resigna, en la pensión no contributiva otorgada por el Estado y en los costos diferenciales de educación.

An environmentally sustainable decision model for urban solid waste management.

The aim of this work is to present the structure and the application of a decision support system (DSS) designed to help decision makers of a municipality in the development of incineration, disposal, treatment and recycling integrated programs. Specifically, within a MSW management system, several treatment plants and facilities can generally be found: separators, plants for production of refuse derived fuel (RDF), incinerators with energy recovery, plants for treatment of organic material, and sanitary landfills. The main goal of the DSS is to plan the MSW management, defining the refuse flows that have to be sent to recycling or to different treatment or disposal plants, and suggesting the optimal number, the kinds, and the localization of the plants that have to be active. The DSS is based on a decision model that requires the solution of a constrained non-linear optimization problem, where some decision variables are binary and other ones are continuous. The objective function takes into account all possible economic costs, whereas constraints arise from technical, normative, and environmental issues. Specifically, pollution and impacts, induced by the overall solid waste management system, are considered through the formalization of constraints on incineration emissions and on negative effects produced by disposal or other particular treatments.

Synthesis of cone, partial-cone, and 1,3-alternate 25, 27-Bis

The preparation of 25,27-bis[1-(2-ethyl)hexyl]- and 25, 27-bis[1-(2-tert-butoxy)ethyl]calix[4]arene-crown-6 combining one polyether crown-6 and one alkylchain O-attached on each side of a calix[4]arene in the cone, partial-cone, and 1,3-alternate conformations are reported. The control over 25, 27-bisalkylcalix[4]arene-crown-6 conformation via varying specific reaction conditions was studied. The series of calix[4]arenes have been prepared by two routes, which differ in the order in which the alkyl or polyether groups were introduced. Moreover, methods have been developed to selectively prepare the cone and partial-cone conformers by using an appropriate base in the alkylation reactions. The conformations of these new derivatives have been probed by (1)H NMR analysis and X-ray crystallography. The (1)H and (13)C NMR spectra of 25,27-bis[1-(2-ethyl)hexyl]calix[4]arene-crown-6, 1, 3-alternate 1, cone 2, and partial-cone 3 are also discussed.

Synthesis and evaluation of the CNS activity of new 4-alkoxyphenylimidazolidin-2-ones.

Various 4-alkoxyphenylimidazolidin-2-ones were prepared from benzaldehydes via a Curtius rearrangement and were evaluated for their anticonvulsant activities.

Amide derivatives with H1-antihistaminic effect.

The synthesis and the structure-activity correlation of a series of N-aminoalkylacetamides as H1-antihistaminic agents have been carried out. The compounds were tested in vitro by measurement of the inhibition of histamine-induced contractions on isolated guinea pig ileum; the results are expressed as pA2.

In Vivo Nitric Oxide Synthase Inhibitors Can Be Deprived of This Activity: Unexpected Influence of the Tetrachloroplatinate(II) Counteranion. Crystal Structures of Bis(S-Methyl-Isothiouronium)-N,N'-Bis(3-Guanidinopropyl)Piperazinium and Hexamidinium Tetrachloroplatinates(II) Salts.

The synthesis and crystal structures of bis(S-methylisothiouronium) (MSTUH)(+), N,N'-bis((3- guanidinopropyl)piperazinium (PipeC3GuaH4)(4+) and hexamidinium (HexaH2)(2+) tetrachloro platinate(ll) salts ( called hereafter PtMSTU, PtPipeC3Gua and PtHexa respectively ) were investigated. These compounds contain the "amidine" function ( - C(=NH)NH(2) ) in which the H atoms supplied by the acid have become attached to the imino group of each terminal amidino function. Moreover, in PtPipeC3Gua, the nitrogen atoms of the chair-piperazine moiety are also protonated. The influence of tetrachloroplatinate(ll) counteranion ( versus sulfate, nitrate and diisethionate ) in the in vivo nitrite inhibition by the (MSTUH)(+), (PipeC3GuaH4)(4+) and (HexaH2)(2+) cations was investigated. The three tetrachloroplatinate(ll) salts, unexpectedly, do not inhibit significantly the in vivo nitrite production in comparison with the other salts (sulfate, nitrate and diisethionate and their corresponding previous countercations) which exhibit NO synthase inhibition, especially bis(S-methylisothiouronium) sulfate, a selective and potent inducible NO synthase (iNOS) inhibitor commonly used as standard.

Synthesis, Crystal Structure and Interaction With DNA of N,N'-(Butane-1,4-Diyl)Bis(Guanidinium) Tetrachloroplatinate (II).

The design, synthesis, crystal structure and interaction with DNA of the N,N'-(butane-1,4-diyl)bis(guanidinium) tetrachloroplatinate(ll) are described. Crystal data: a = 8.152(1), b = 8.889(4), c = 10.700(3) A , alpha = 81.59(3), beta = 87.99(5), gamma = 78.48(6) degrees , V = 752(1) A(3), Z = 2 , space group P-1. The structure was refined to R = 0.039 and Rw = 0.046 from 1853 reflections (I > 3sigma(I)). This compound, named PtC(4)Gua, does not exhibit a center of symmetry and the center linker chain C(2) - C(3) - C(4) - C(5) is in gauche conformation. The cation is bisprotonated with the H(+) attached to the imine group of each terminal guanidinium function. The presence of the platinum moiety reinforces the binding of the butane(bis)guanidinium structure with double stranded DNA as judged from thermal denaturation studies and DNA unwinding experiments.

A new class of pyrrolidin-2-ones: synthesis and pharmacological study. II.

The anticonvulsant activity of a second series of pyrrolidin-2-ones (1-2a, 1-4b, 1-9c) was tested on pentylenetetrazole (PTZ) treated mice. The compounds were obtained by acylation of N-(3'-aminopropyl)-2-pyrrolidinone with the suitable acid chloride.

Novel and selective partial agonists of 5-HT3 receptors. 2. Synthesis and biological evaluation of piperazinopyridopyrrolopyrazines, piperazinopyrroloquinoxalines, and piperazinopyridopyrroloquinoxalines.

In continuation of our previous work on piperazinopyrrolothienopyrazine derivatives, three series of piperazinopyridopyrrolopyrazines, piperazinopyrroloquinoxalines, and piperazinopyridopyrroloquinoxalines were prepared and evaluated as 5-HT3 receptor ligands. The chemical modifications performed within these new series led to structure-activity relationships regarding both high affinity and selectivity for the 5-HT3 receptors that are in agreement with those established previously for the pyrrolothienopyrazine series. The best compound (8a) obtained in these new series is in the picomolar range of affinity for 5-HT3 receptors with a selectivity higher than 10(6). Four of the high-affinity 5-HT3 ligands (8a, 15a,b, and 16d) were selected in both the pyridopyrrolopyrazine and the pyrroloquinoxaline series and were characterized in vitro and in vivo as agonists or partial agonists. Compound 8a was also evaluated in the light/dark test where it showed potential anxiolytic-like activity at very low doses per os.

Sequence-selective binding to DNA of bis(amidinophenoxy)alkanes related to propamidine and pentamidine.

The DNA sequences targeted by a complete homologous series of aromatic diamidines have been determined at single-nucleotide resolution via protection from cutting by the endonucleases DNase I, DNase II and micrococcal nuclease. Propamidine, pentamidine and to a lesser extent hexamidine bind selectively to nucleotide sequences composed of at least four consecutive A-T base pairs. In contrast, the binding to DNA of butamidine, heptamidine, octamidine and nonamidine is poorly sequence-selective. Sequences composed of only three consecutive A-T base pairs do not afford a potential binding site for propamidine or the longer homologues, and none of the drugs tolerate the presence of a G-C base pair within the binding site. Experiments with DNA molecules containing inosine in place of guanosine and 2,6-diaminopurine in place of adenine reveal that the lack of binding of propamidine to GC-containing sites is attributable to an obstructive effect of the exocyclic 2-amino group of guanosine. The present data support the view that the local conformation of the double helix (in particular the width of the minor groove) plays a dominant role in the binding reaction and that the capacity of diamidines to recognize AT-rich sequences selectively varies considerably depending on the length of the alkyl chain. The evidence indicates that binding to AT-tracts in DNA must play a role in the biological activity of these diamidines, but there is no simple correlation between binding and pharmacological efficacy.

Synthesis and pharmacological activities of some 2,3,4,5-tetrahydro[1,5]benzo[f]thiazepines.

In search of new biological active agents in the series of [1,5]benzothiazepines, some 2,3,4,5-tetrahydro-N-(5-morpholinopentanoyl)-[1,5]benzo[f] thiazepines were synthesized and examined in vitro for their calcium antagonist activity compared to the Diltiazem one.

In vitro effects of Celiptium and MR 14504 on mature rat Leydig cell testosterone production.

Percoll-purified mature rat Leydig cells have been used to evaluate the testicular toxicity of two highly potent intercalating agents (Celiptium and MR 14505). Testosterone secretion in the absence and in the presence of human chorionic gonadotropin (hCG) was measured to assess Leydig cell function. Celiptium and MR 14504 induce time- and dose-related inhibitory effects on the production of testosterone by Leydig cells, both in the presence and in the absence of hCG, whatever the concentration of hCG used. We have observed that MR 14504 is about 5 times more potent as an inhibitor of rat Leydig cell steroidogenesis than Celiptium without inducing any cell toxicity. The present study indicates that the Leydig cell is an additional potential site for the primary toxic effects of these drugs in the adult rat testis.

Novel selective and partial agonists of 5-HT3 receptors. Part 1. Synthesis and biological evaluation of piperazinopyrrolothienopyrazines.

A series of piperazinopyrrolo[1,2-a]thieno[3,2-e]- and -[2,3-e]pyrazine derivatives were prepared and evaluated in order to determine the necessary requirements for high affinity on the 5-HT3 receptors and high selectivity versus other 5-HT receptor subtypes. Various substitutions on the piperazine and the thiophene ring of the pyrrolothienopyrazine moieties were systematically explored as well as replacement of the piperazine by other cyclic amines. The best compounds are in the nanomolar range of affinity of 5-HT3 receptors with high to very high selectivity (up to 10,000 for 14b). These high-affinity compounds have in common a benzyl- or allylpiperazine substituent with no substitutions on the thiophene ring. Five of these compounds (1a, 4b, 13a,b, and 14b) have been evaluated on the Von Bezold-Jarisch reflex and were characterized as partial agonists. One of them, 13a, has shown in vivo at very low dose a potent anxiolytic-like activity in the light/dark test.

Applicability of CoMFA in ecotoxicology: a critical study on chlorophenols.

Comparative molecular field analysis (CoMFA) is used to relate ecotoxicological data with steric and electrostatic fields of chemicals forming an intentionally selected homogeneous set, the chlorophenols, for which reliable data are abundant in literature. Among these data, those concerning 16 different biological systems were selected, leading to predictive CoMFA QSAR in 14 of the cases. This is attested by cross-validation and bootstrapping, which also authorize the prediction of the chlorophenols toxicity values, when they are missing. The quality of obtained CoMFA models and the applicability of the method are discussed. The results are very promising, and they encourage further investigation into CoMFA in ecotoxicology.

[Anti-AIDS thienopyrimidine nucleosides]. / Nucléosides thiénopyrimidiniques à visée anti-sida.

In response to the AIDS epidemic, the discovery of antiviral agents has been focused on the synthesis of nucleoside analogues. The basis moiety of these pyrimidine nucleosides were thieno and thiano[3,2-d]pyrimidine-2,4-dione possibly substituted on 7 position by methyl or aryl groups, 6,7-dihydrothieno[3,2-d]pyrimidin-4-one, bicyclic heterocycles including an uracil moiety. The first part of organic chemistry work has provided cyclic and acyclic N-nucleosides after adaptation of Vorbrüggen and Niedballa method. The carbohydrate fraction of these nucleosides included either a cyclic sugar yielding uridine, ARA U and IDU analogues or an hydroxylated chain that allowed access to aciclovir, ganciclovir and EBPU analogues. The second part has been devoted to functional arrangements beta-D-ribonucleoside respectively on carbohydrate and aglycon moieties carrying into reduction (synthesis of an unsaturated dideoxynucleoside, a d4T analogue) and amination reactions (cytidine analogue). Several compounds were tested against HIV1 in CEM cl 13 cell cultures, but none of them exhibited significant activity against this virus.

Amoebicidal efficiencies of various diamidines against two strains of Acanthamoeba polyphaga.

The first medical cure of Acanthamoeba keratitis was obtained by use of propamidine isethionate. Since then, it has been the basic drug recommended for use in treatment. Because some Acanthamoeba strains have been reported to be resistant to propamidine and propamidine was found to be only weakly cysticidal, superior homologs such as butamidine, pentamidine, hexamidine, heptamidine, octamidine, and nonamidine were tested for their amoebicidal effects on two Acanthamoeba strains isolated from patients with keratitis. Trophozoicidal and cysticidal efficiencies were found to be increased from propamidine to nonamidine; i.e., when the alkyl chain connecting the two benzene rings in their molecular structures was elongated, in comparison with propamidine, hexamidine and octamidine were the most amoebicidal molecules. As a result of these data, a kinetic study carried out on propamidine, hexamidine, and octamidine demonstrated that the amoebicidal effects resulted from two events: the diffusion of molecules through the plasma membrane or the double wall of trophozoites or cysts, respectively, and the lethal effects of molecules on amoebic protoplasm. The diffusion kinetics were increased when the alkyl chain was elongated, i.e., with an increase in the lipophilic properties of molecules. In contrast, the lethal effect kinetics were found to be unchanged by this elongation, indicating that they originated from the cationic surface-active properties induced by the protonated amidine groups attached to each benzene ring, which themselves remained unchanged from one molecule to the other. These results strongly advocate the immediate replacement of propamidine by hexamidine in the medical treatment of Acanthamoeba keratitis; in France, 0.1% hexamidine eyedrops are available (Desomedine). The results also advocate clinical investigations on the efficiency and toxicity of octamidine, which appears to be the most amoebicidal diamidine in vitro.

Mass spectral study of chlorofluorocarbons (CFCs) and potential alternatives (HCFCs and HFCs).

Owing to high ozone depletion potential of the chlorofluorocarbons (CFCs), the production of such substances has been regulated worldwide by the Montreal Protocol in 1987. There is an urgent need to find other suitable products to replace them and hydrochlorofluorocarbons (HCFCs) and hydrofluorocarbons (HFCs) are considered to be the most probable candidates as CFC alternatives. The HCFCs and HFCs are more susceptible to decomposition during use than CFCs because they contain hydrogen. Toxicological data on these alternative fluorocarbons are being developed. A systematic investigation of these compounds has been undertaken to establish the fragmentation patterns. Electron impact mass spectra are reported for HCFCs and HFCs. Fragmentation mechanisms are presented and discussed on the basis of variable energy (11 to 30 eV) spectra. At low ionization energy, it is possible to describe an order of fragmentation for each compound. This may lead to the possibility of classifying them according to characteristic behaviors.