Demora en el inicio del tratamiento biológico o sintético dirigido en pacientes con artritis reumatoidea y factores asociados a la misma / Delayed onset of biologic or targeted synthetic dmards in rheumatoid arthritis patients and associated factors

Introducción: el objetivo del tratamiento de la artritis reumatoidea (AR) es la remisión o baja actividad de la enfermedad. En aquellos pacientes que no logran dicho objetivo con drogas modificadoras de la enfermedad sintéticas convencionales (DMARsc), se indican los agentes biológicos (DMARb) o sintéticos dirigidos (DMARsd). El intervalo de tiempo entre la indicación y hasta que el paciente recibe la primera dosis es variable. Objetivos: describir el tiempo de demora y los motivos relacionados entre la indicación de DMARb o DMARsd y la administración de la primera dosis. Materiales y métodos: estudio observacional, analítico, retrospectivo. Se revisaron historias clínicas de pacientes con diagnóstico de AR, a quienes se les indicó DMARb o DMARsd. Se registraron datos sociodemográficos y características de la enfermedad. Respecto de la indicación de DMARb o DMARsd, se consignó: fecha de indicación, fecha en que el paciente recibió la primera dosis en forma efectiva y motivo de la demora. Resultados: se incluyeron 102 pacientes. La mediana de demora desde la indicación de la droga hasta que el paciente recibió la primera dosis fue de 240 días (RIC 113-504). El principal motivo de demora fue de índole burocrática (47%). Los pacientes con baja actividad de la enfermedad obtuvieron la medicación en menor tiempo (113 días) respecto de aquellos con actividad moderada (242 días) y alta actividad (332 días); p=0,01. Los pacientes en los cuales la demora fue por causas burocráticas, presentaron menor nivel de educación (60% vs 17% con educación superior) y residencia en la Provincia de Buenos Aires (58% vs 31% con residencia en la Ciudad Autónoma de Buenos Aires), siendo estas asociaciones estadísticamente significativas. Conclusiones: la mediana en la demora para el inicio de DMARb o DMARsd fue de aproximadamente 8 meses. El motivo principal de este retraso fue de índole burocrática, evidenciándose la misma con mayor frecuencia en aquellos con menor nivel educativo y en los residentes en la Provincia de Buenos Aires.

Introduction: the goal of rheumatoid arthritis (RA) treatment is to obtain remission or low activity of the disease. In those patients who did not achieve this objective with conventional treatment, biologic or targeted synthetic disease-modifying antirheumatic drugs (bDMARD or tsDMARD, respectively) are indicated. The period of time between the prescription of these medications and its administration is variable. Objectives: to describe the delay time between the prescription of a bDMARD or tsDMARD and the administration of the first dose, and its related reasons. Materials and methods: observational, analytical, retrospective study. Medical records of patients with a diagnosis of RA who were prescribed a bDMARD or tsDMARD were reviewed. Sociodemographic data and characteristics of the disease were recorded. Regarding the indication of bDMARDs or tsDMARs, the following data was collected: prescription date, date on which the patient received the first effective dose and reason for the delay. Results: 102 patients were included. The median delay time from the drug prescription until the patient received the first dose was 240 days (IQR 113-504). The main reason for delay was of bureaucratic nature (47%). Patients with low disease activity obtained the medication with a shorter delay (113 days) compared to those with moderate activity (242 days) and high activity (332 days); p=0.01. Patients with a delay related to bureaucratic causes, presented a lower level of education (60% vs 17% with higher education) and residence in the Province of Buenos Aires (58% vs 31% with residence in Autonomous City of Buenos Aires), and these differences were statistically significant. Conclusions: the median delay time to onset of bDMARDs or tsDMARDs was approximately 8 months. The main reason for this delay was of bureaucratic nature, being more frequent in those with lower educational level and residence in the Province of Buenos Aires.

Avaliação da degradação de formol do efluente gerado no laboratório de anatomia por biorreatores anaeróbios e mapeamento dos pontos críticos de controle / Evaluation of formalin degradation of effluent generated in the anatomy laboratory by anaerobic bioreactors and mapping of critical control points

Diante das estratégias de ensino e aprendizagem adotadas na disciplina de Anatomia da Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo (EERP/USP), que requer a conservação de peças cadavéricas em solução de formol, no Laboratório Multidisciplinar são gerados significantes volumes de efluentes contendo este composto. Considerando as características tóxicas dessa substância, tanto aos seres vivos quanto ao meio ambiente, torna-se imprescindível o gerenciamento e tratamento deste resíduo gerado antes do descarte na rede coletora de esgotos. Embora diferentes métodos, sejam eles químicos ou biológicos, possam ser utilizados para promover o tratamento prévio ao descarte de soluções contendo formol, o uso de tratamentos biológicos, como o reator anaeróbio, possibilita o tratamento de grandes volumes de resíduos, gera menor exposição ocupacional e possui reduzido custo do processo. No ano de 2017 a EERP/USP implementou o Reator Anaeróbio Horizontal de Leito Fixo (RAHLF), dimensionado para atender grandes volumes de efluentes com solução de formol gerados na unidade. Neste contexto, este estudo inédito em escala industrial, além de monitorar a eficiência da remoção da solução de formol dos efluentes gerados do sistema de biorreatores também caracterizamos os pontos críticos de controle do processo de tratamento do RAHLF, durante o período de fevereiro a junho e de setembro a novembro do ano de 2020. Os resultados na entrada do RAHLF apresentaram uma média de 480,19 ± 116,06 mg.L-1, com amplitude amostral de 238,37 mg.L-1 a 774,60 mg.L-1, já na saída do RAHLF demonstraram média de 1,39 ± 0,56 mg.L-1, com amplitude amostral de 0,04 mg.L-1 a 2,32 mg.L-1, evidenciando assim a eficiência na degradação do formol pelos biorreatores em média de 99,70%. A partir dos dados foi evidenciado que além do desempenho satisfatório do RAHLF para o pré-tratamento de água residuária contendo formol, o reator também apresentou estabilidade de operação durante o desenvolvimento do estudo. Com o conhecimento de todas as etapas e dos pontos críticos do processo foi possível a organização do fluxograma do processo, desde o local gerador até a disposição do efluente para a rede coletora de esgoto municipal. A partir do fluxograma, foi possível desenvolver protocolo de operação, visando minimizar ao máximo potenciais ocorrências de falhas durante o processo. Este estudo gerou conhecimento que contribui para melhor compreensão da biotecnologia anaeróbia implantada para alcançar a degradação da solução de formol no efluente do Laboratório Multidisciplinar da EERP/USP. A implantação e funcionamento adequado do biodigestor refletem o compromisso socioambiental da universidade com a sociedade e com o meio ambiente, na busca de ações que promovam tanto a saúde pública quanto a sustentabilidade ambiental. Os resultados constituirão também uma base de dados para outros gestores de biodigestores implantados na universidade, sendo de grande importância para a continuidade de investigações relacionadas com o tratamento dos efluentes em laboratórios de ensino

For the development of teaching and learning strategies adopted in the discipline of Anatomy at the University of São Paulo at College of Nursing in Ribeirão Preto (CNRP/USP), which requires the preservation of cadaveric parts in a formaldehyde solution, the Multidisciplinary Laboratory generates significant volumes of effluents containing this compound. Considering the toxic characteristics of this substance, both to living beings and to the environment, it is essential to manage and treat this wastewater before its disposal in the sewage collection system. Although different methods, whether chemical or biological, can be used to promote treatment prior to disposal of solutions containing formaldehyde, the use of biological treatments, such as the anaerobic reactor, allows the treatment of large volumes of waste, generates less occupational exposure and has reduced process cost. In 2017, EERP/USP implemented the Anaerobic Horizontal Fixed Bed Reactor (AHFBR), dimensioned to supply large volumes of wastewater with a formaldehyde solution generated at the unit. In this context, this unprecedented study on an industrial scale, in addition to monitoring the efficiency of the removal of the formaldehyde solution from the effluents generated from the bioreactor system, we also characterized the critical control points of the AHFBR treatment process, during the period from February to June and from September to November of 2020. The results of the affluent of the AHFBR presented an average of 480.19 ± 116.06 mg.L-1, with a sample range of 238.37 mg.L-1 to 774.60 mg. L-1, already in the effluent of the AHFBR obtained average of 1.39 ± 0.56 mg.L-1, with a sample range of 0.04 mg.L-1 to 2.32 mg.L-1, thus evidencing the efficiency in formaldehyde degradation by bioreactors on average of 99.70%. From the data, it evidenced that in addition to the satisfactory performance of the AHFBR for the pre-treatment of wastewater containing formaldehyde, the reactor also showed operating stability during the development of the study. With the knowledge of all the steps and critical points of the process, it was possible to organize the process flowchart, from the generating site to the disposal of the effluent to the municipal sewage collection network. From the flowchart, it was possible to develop an operation protocol, aiming to minimize as many potential occurrences of failures during the process as possible. This study generated knowledge that contributes to a better understanding of the anaerobic biotechnology implemented to achieve the degradation of the formaldehyde solution in the effluent of the Multidisciplinary Laboratory at CNRP/USP. The implantation and proper functioning of the biodigester reflect the university's socio-environmental commitment to society and the environment, in the search for actions that promote both public health and environmental sustainability. The results will also constitute a database for other managers of biodigesters implemented at the university, being of great importance for the continuity of investigations related to the treatment of effluents in teaching laboratories

Evaluar la calidad de vida y funcionalidad en pacientes con espondilitis anquilosante / Evaluate quality of life and the function in patients with ankylosing spondylitis

INTRODUCCIÓN. La Espondilitis Anquilosante compromete la calidad de vida del pacien-te por tratarse de una enfermedad de afectación axial, ocular, gastrointestinal y articular discapacitante que limita actividades básicas de la vida diaria que repercute en su entorno social. OBJETIVO. Evaluar la calidad de vida, funcionalidad y actividad de la enfermedad en pacientes con Espondilitis Anquilosante. MATERIALES Y MÉTODOS. Estudio trans-versal analítico, con una poblacion de 166 pacientes, una muestra de 120 con diagnós-tico de Espondilitis Anquilosante de la Unidad Técnica de Reumatología del Hospital de Especialidades Carlos Andrade Marín. Se aplicó un cuestionario estructurado que midió la actividad fisica, presencia del Antígeno Leucocitario Humano B-27, se utilizó escalas va-lidadas a nivel internacional que evaluaron calidad de vida, funcionalidad y actividad de la enfermedad. El análisis univariado, bivariado y multivariado, se calculó con Chi-cuadrado y Odds Ratios en el programa estadistico SPSS 23.0. RESULTADOS. Se observó un 50% (60; 120) de ligera afectación en calidad de vida, en funcionalidad el 74,2% (89; 120) pre-sentó afectación mientras que en actividad de la enfermedad en la encuesta Ankylosing Spondylitis Disease Activity Score se encontró actividad alta con un 43,3% (52; 120) y en Bath Ankylosing Spondylitis Disease Activity Index 55% (66; 120) de enfermedad activa. El tratamiento combinado presentó mayor riesgo para afectación en la funcionalidad, en actividad de la enfermedad baja, alta y muy alta con valor p= 0,022; 0,014; 0,026 de forma respectiva. CONCLUSIÓN. La calidad de vida se vio afectado en mujeres y quienes no realizaron actividad física; se encontró comprometido la funcionalidad en quienes recibie-ron tratamiento combinado.

INTRODUCTION. Ankylosing Spondylitis compromises the quality of life of the patient as it is a disease of axial, ocular, gastrointestinal and articular disabling affectation that limits basic activities of daily life that affects the social environment. OBJECTIVE. To evaluate the quality of life, functionality and activity of the disease in patients with Ankylosing Spond-ylitis. MATERIALS AND METHODS. Analytical transversal study, with a population of 166 patients, a sample of 120 with a diagnosis of Ankylosing Spondylitis from the "Unidad Téc-nica de Reumatología del Hospital de Especialidades Carlos Andrade Marín". A structured questionnaire was applied to measure physical activity, presence of Human Leukocyte Antigen B-27, using internationally validated scales that evaluated quality of life, functio-nality and disease activity. Univariate, bivariate and multivariate analysis was calculated with Chi-square and Odds Ratios in the statistical program SPSS 23.0. RESULTS. A 50% (60; 120) of slight affectation in quality of life was observed, in functionality 74,2% (89; 120) presented affectation while in disease activity the Ankylosing Spondylitis Disease Activity Score found high activity with 43,3% (52; 120) and in Bath Ankylosing Spondylitis Disease Activity Index 55% (66; 120) of active disease. Combined treatment presented a greater risk of affecting functionality, low, high and very high disease activity with p values of 0,022; 0,014 and 0,026, respectively. CONCLUSION. Quality of life was affected in women and those who did not carry out physical activity; functionality was found to be compromised in those who received combined treatment.

Frequency of autoantibodies and symptoms suggestive of gastrointestinal disease in a group of patients with psoriasis / Frecuencia de autoanticuerpos y síntomas sugestivos de enfermedad gastrointestinal en un grupo de pacientes con psoriasis

ABSTRACT Introduction: Psoriasis is a chronic disease associated with multiple comorbidities including inflammatory intestinal disease. There are no previous studies in Colombia regarding the relationship of gastrointestinal symptoms in patients with psoriasis. Objective: To determine the frequency of symptoms and autoantibodies suggestive of gastrointestinal disease in patients with psoriasis, and to compare the results with healthy controls, as well as their relationship with disease activity. Materials and methods: Cross-sectional study with an analytical component, including a questionnaire on symptoms and serum analysis of antibodies suggestive of gastrointestinal disease in cases and controls. Results: The analysis included 84 individuals, separated into groups of 44 cases and 40 controls. Mild psoriasis was observed in 64% of cases, and the remaining 36% had moderate to severe psoriasis. Topical treatments were given to 71% of cases, with another 16% using oral treatments, and 14% received biological treatment. The main symptoms of gastrointestinal disease were, abdominal distention (45%), constipation (39%), and fatigue (34%). A comparison showed a higher prevalence of gastrointestinal symptoms in cases vs. controls, and fatigue was statistically significant (p = 0.04). Only the antinuclear autoantibodies in the serum analysis were statistically significant (0 vs. 43%; p = 0.01). Conclusions: The prevalence of symptoms and autoantibodies suggestive of gastrointestinal disease in patients with psoriasis is considered important, even although there are no significant differences when compared with healthy controls. Some patients with gastrointestinal symptoms had positive autoantibodies. This suggests that an adequate clinical follow-up should be carried out. Dermatologists have a decisive role in the integral management of patients.

RESUMEN Introducción: La psoriasis es una enfermedad crónica asociada con múltiples comorbilidades, incluida la enfermedad inflamatoria intestinal. Sin embargo, no existen estudios previos en Colombia sobre la relación de los síntomas gastrointestinales en pacientes con psoriasis. Objetivos: Se determinó la frecuencia de síntomas sugestivos de enfermedad gastrointestinal y autoanticuerpos asociados en pacientes con psoriasis, y su relación con la actividad de la misma. Además, se comparó con controles sanos. Materiales y métodos: Estudio transversal con componente analítico que incluyó una encuesta de síntomas y el análisis sérico de autoanticuerpos sugestivos de enfermedad gastrointestinal en casos y controles. Resultados: Ochenta y cuatro individuos analizados, distribuidos en 44 casos y 40 controles. El 64% de los casos tenían psoriasis leve y el 36% presentó psoriasis moderada a severa. El 71, el 16 y el 14% fueron tratados con tratamientos tópicos, orales y biológicos, respectivamente. Los principales síntomas gastrointestinales fueron distensión abdominal (45%), estreñimiento (39%) y fatiga (34%). La comparación arrojó una mayor prevalencia de síntomas gastrointestinales en los casos, y la variable fatiga fue estadísticamente significativa (p: 0,04). Solo el perfil de autoanticuerpos antinucleares fue estadísticamente significativo (0 vs. 43%; p: 0,001). No se encontró asociación con actividad de la enfermedad. Conclusiones: La prevalencia de síntomas y autoanticuerpos sugestivos de enfermedad gastrointestinal en pacientes se considera importante, a pesar de no mostrar diferencias significativas con los controles. Algunos pacientes con síntomas gastrointestinales mostraron autoanticuerpos positivos. Esto sugiere la necesidad de un seguimiento clínico adecuado. El dermatólogo tiene un papel decisivo en el manejo integral de los pacientes.

Consortium of Microalgae for Tannery Effluent Treatment

Abstract Wastewater generated in tanneries have essential elements for microalgae growth, but it has also some toxic compounds that may hinder or restrain the growth of microalgae in this environment. This work tested microalgae consortium growth originating from a deactivated effluent treatment decanter of a complete tannery (beamhouse to finished leather) for the treatment of wastewater of a tannery processing wet-blue leather to finished leather. It was initially evaluated the growth of the microalgae consortium in the three effluents diluted in 50% distilled water: raw effluent (50RE50W), effluent after primary coagulation/flocculation (50PE50W), and effluent after primary and secondary biological treatment (50BE50W). After 16 days of cultivation, the 50PE50W presented the highest biomass concentration (1.77 g L−1). The highest removal values for effluents 50RE50W, 50PE50W and 50BE50W were 51.02%, 99.90%, 82.88%, and 91.75% for chemical oxygen demand (COD), N-NH3, TKN, and P-PO4-, respectively. It was verified low levels of nutrient removal in the raw effluent (100RE), since the consortium was not able to grow in this medium. Finally, at concentrations of 25RE75BE (25% raw effluent diluted with 75% effluent after the biological treatment) and 50RE50B (50% raw effluent diluted with 50% effluent after the biological treatment), effective removal values were reached. Biomass growth concentration up to 1.3 g L-1 and removal values for N-NH3, TKN, P-PO4, COD, total organic carbon (TOC) and biological oxygen demand (BOD5), of 99.90%, 79.36%, 87.82%, 14.26%, 35.82%, and 42.86%, respectively, were reached in 50RE50B.

Complicaciones asociadas a tratamiento biológico en pacientes con artritis reumatoide: consideraciones en relación a un caso clínico / Associated complications with biological treatment in patients with rheumatoid arthritis: considerations in relation to a clinical case

La artritis reumatoide (AR) es una enfermedad inflamatoria sistémica de origen autoinmune, caracterizada por una evolución variable, con remisiones y reacti-vaciones. Se considera que un diagnóstico y tratamiento precoz permiten evitar el daño articular, mejorar el pronóstico y la calidad de vida del paciente. El trata-miento actual está basado en el uso de fármacos antirreumáticos sintéticos mo-dificadores de la enfermedad (sDMARDS), asociado a glucocorticoides en dosis bajas. Frente al fracaso o intolerancia de este tratamiento o bien en casos de una enfermedad inicial muy severa, en especial con manifestaciones extraarticulares, se recomienda el uso de fármacos biológicos modificadores de la enfermedad (bDMARD). Estos fármacos, usados en las condiciones señaladas, han significado un avance importante en el control y pronóstico de la enfermedad. Sin embargo, no están exentos de la presencia de reacciones adversas, por lo que deben ser monitorizados permanentemente.

Rheumatoid arthritis (RA) is a systemic inflammatory disease of autoimmune ori-gin, characterized by a variable evolution, with remissions and reactivations. It is considered that a diagnosis and early treatment allow avoiding the joint damage, improving the prognosis and the quality of life of the patient. The current treat-ment is based on the use of synthetic antirheumatic drugs modifying the disease (sDMARDS), associated with low-dose glucocorticoids. Faced with the failure or intolerance of this treatment or in cases of a very severe initial disease, especially with extra-articular manifestations, the use of biological drugs that modify the disease (bDMARD) is recommended. These drugs, used in the indicated condi-tions, have meant an important advance in the control and prognosis of the dis-ease. However, they are not exempt from the presence of adverse reactions, so they should be monitored permanently.

A análise multicritério de tecnologias utilizadas na gestão de resíduos sólidos urbanos

O presente trabalho analisou a aplicação do método de avalia-ção multicritério como ferramenta de auxilio a escolha de tecnologias de tratamentode RSU, considerando as características, vantagens e desvantagensdas tecnologias disponíveis para tratamento dos RSU; assim como critériospara escolha das tecnologias mais adequadas para tratamento de resíduossegundo a Análise Multicritérios (AHP); além disso, analisou as possíveis combinaçõesde tecnologias para tratamento. Como metodologia de pesquisa, aplicou-sea revisão bibliográfica, e para a aplicação do método de analise multicritério,consultaram-se especialistas na área de gestão de resíduos sólidos urbanos.Esta consulta se realizou através do preenchimento de formulários (apêndiceII) por especialistas da área, sem que suas identidades e formações fossemde conhecimento do pesquisador, de modo a evitar que suas respectivasformações pudessem influenciar a interpretação dos dados. Todavia, comoforma de considerar a experiência de cada especialista, houve outra forma deconsultá-los, de modo paralelo a análise AHP. Desta forma, tornou-se comparara aplicação do método AHP com uma consulta direta. As possibilidades detratamento de resíduos sólidos urbanos foram organizadas segundo os custosprincipais envolvidos, que são os custos de coleta (com ou sem segregação deresíduos na fonte geradora), custos internos do empreendimento e custos externos.As tecnologias consideradas foram o uso de aterros sanitários, a incineraçãocombinada com o tratamento biológico dos resíduos e a incineração indissociadadestes mesmos resíduos. Como resultados, evidenciou-se que nãohá um consenso entre os especialistas quanto ao uso de tecnologias de tratamentode resíduos sólidos urbanos.

The present work analyzed the application of the multicriteriaevaluation method as a tool to assist in the selection of MSW treatment technologies,considering the characteristics, advantages and disadvantages of theavailable technologies for MSW treatment; as well as criteria for choosing themost appropriate technologies for waste treatment according to MulticriteriaAnalysis (AHP); in addition, analyzed the possible combinations of technologiesfor treatment. As a research methodology, the literature review was applied,and for the application of the multicriteria analysis method, specialists wereconsulted in the area of urban solid waste management. This consultation wascarried out by filling in forms (appendix II) by experts in the field, without theiridentities and formations being known to the researcher, in order to avoid thattheir respective formations could influence the interpretation of the data. However,as a way of considering the experience of each specialist, there was anotherway of consulting them, in parallel to the AHP analysis. In this way, it becamepossible to compare the application of the AHP method with a directquery. The possibilities of urban solid waste treatment were organized accordingto the main costs involved, which are collection costs (with or without segregationof waste at the generating source), internal costs of the project andexternal costs. The technologies considered were the use of landfills, incinerationcombined with the biological treatment of waste and the incineration withoutthe associated waste. As results, it was evidenced that there is no consensusamong the experts regarding the use of urban solid waste treatment technologies.

A presença de fármacos nos esgotos domésticos e sua remoção pelos processos de lodo ativado com oxigênio puro, lagoa aerada e reator anaeróbio de fluxo ascendente / Pharmaceuticals in domestic sewage and their removal by pure oxygen activated sludge, aerated basin and upflow anaerobic sludge blanket

Processos biológicos de tratamento de esgotos são largamente utilizados mundialmente e, apesar de serem eficientes na remoção de matéria orgânica, têm capacidades limitadas na remoção de poluentes orgânios emergentes, principalmente fármacos. Este trabalho avaliou a eficiência dos processos de tratamento de esgotos por lodos ativados com oxigênio puro, lagoas aeradas e reator anaeróbio de fluxo ascendente (RAFA) na remoção de seis fármacos selecionados - paracetamol, ibuprofeno, atenolol, sinvastatina, carbamazepina e clonazepam, com altos índices de utilização pela população. Para isto, foram analisadas amostras de esgoto bruto e de esgoto tratado oriundas de três estações de tratamento de esgotos em operação no Estado de São Paulo, sendo realizadas quatro campanhas de coleta, durante dois anos, em períodos hidrológicos de seca e chuva. A técnica analítica utilizada foi a cromatografia líquida de alta eficiência acoplada à espectrometria de massas (LC-MS/MS), através de método estabelecido e validado para a execução desta pesquisa. Ibuprofeno, sinvastatina e clonazepam não foram identificados em nenhuma das amostras analisadas. Atenolol, paracetamol e carbamazepina foram detectados em todas as estações estudadas, observando-se remoção e liberação deles durante todos os processos de tratamento. A estação que adota o processo por lagoas aeradas mostrou maior eficiência na remoção de paracetamol e atenolol, sendo que um elevado tempo de detenção hidráulica empregado nela parece ter influenciado positivamente na eficácia de remoção destas subtâncias. A estação que utiliza lodos ativados com oxigênio puro apresentou remoções inferiores e maiores taxas de liberação dos fármacos paracetamol e carbamazepina. Já a estação que adota RAFA apresentou discreta superioridade na remoção de carbamazepina, e eficiências intermediárias para paracetamol e atenolol. A carbamazepina mostrou resistência à degradaçào pelos processos avaliados, porém a desinfecção do efluente final, por cloração, aparentemente elevou a remoção deste composto

Sewage biological treatment processes are the most used worldwide and, in general, they show organic matter removal high efficiency, however their pharmaceuticals removal capacity were quite limited. The aim of this study is verify the efficiency of sewage biological treatment processes per pure oxygen activated sludge, aerated basin and upflow anaerobic sludge blanket (UASB), in removal of six selected drugs acetaminophen, ibuprofen, atenolol, simvastatin, carbamazepine and clonazepam, most frequently used by population. For this purpose, it was analyzed raw sewage and treated sewage samples from three sewage treatment plants localized at Sao Paulo, Brazil, in four collection stages, during two years, at dry and wet periods. The analytical technique of choice was high performance liquid chromatography tandem mass spectrometry (LC-MS/MS), by developed and validated method for this study. Ibuprofen, simvastatin and clonazepam were not detected at any samples collected. Atenolol, acetaminophen and carbamazepine were identified at all plants investigated, with removal and production during all treatment processes here considered. Aerated basin plant was most efficient in acetaminophen and atenolol removal, and a high hydraulic detention time seem be better to remove these compounds. Pure oxygen activated sludge plant showed lower removal rates and higher production of acetaminophen and carbamazepine. Already the UASB plant revealed a little superiority in carbamazepine removal, and intermediary efficacy to acetaminophen and atenolol removal. Carbamazepine showed persistence in treatment processes evaluated, however final effluent disinfection, with chlorination, apparently raised this compound removal

Avaliação de um sistema descentralizado de tratamento de esgotos domésticos em escala real composto por tanque séptico e wetland construída híbrida / Evaluation of a decentralized system of domestic sewage treatment in real scale composed of septic tank and hybrid constructed wetland

A concentração demográfica e de sistemas coletivos de esgotamento sanitário dentro do perímetro urbano da maioria dos municípios brasileiros, dificulta a viabilização do fornecimento de serviços de tratamento de esgotos domésticos à habitações e núcleos habitacionais isolados situados em áreas periurbanas e rurais, intensificando os danos provocados pela poluição de origem antrópica ao meio ambiente e à preservação da saúde pública. Para contribuir no equacionamento deste problema, o presente estudo teve por finalidade avaliar uma wetland construída híbrida em escala real, composta por uma unidade com fluxo contínuo subsuperficial vertical seguida por uma unidade de fluxo contínuo subsuperficial horizontal, cultivadas com capim Vetiver, para o tratamento de efluente proveniente de tanque séptico. A presente configuração experimental busca uma solução de baixo custo e simplificada para o tratamento descentralizado de esgotos domésticos. A estação experimental de tratamento de esgotos, parte integrante e um dos produtos da Rede Nacional de Tratamento de Esgotos Descentralizados RENTED, foi construída no Centro Tecnológico de Hidráulica CTH - Escola Politécnica EPUSP, campus Butantã da USP, em São Paulo. O esgoto bruto foi proveniente do Conjunto Residencial da USP e do restaurante central da Cidade Universitária

The demographic concentration and collective systems of sanitation inside the urban perimeter of most Brazilian municipalities, hampers the feasibility of providing sewage treatment services to domestic dwellings and housing isolated nuclei located in peri-urban and rural areas, intensifying the damage caused by pollution of human origin to the environment and to the preservation of public health. For help in solving this problem, the present study had the purpose to evaluate a hybrid constructed wetland full-scale, composed of a unit with continuous vertical subsurface flow followed by a continuous horizontal subsurface flow unit, grown with Vetiver grass, for the treatment of effluent from septic tank. This experimental search setting a low-cost and simplified solution for decentralized treatment of household sewage. The experimental sewage treatment station, integral and one of the products of the Rede Nacional de Tratamento de Esgotos Descentralizados RENTED, was built on the Centro Tecnológico de Hidráulica CTH / Escola Politécnica EPUSP, campus Butantã of USP, in São Paulo. The raw sewage was coming from the residential condominium of the USP and the central restaurant of the University City

Características de los tratamientos biológicos en enfermedades reumáticas en Argentina: quinto informe del registro BIOBADASAR / Features of rheumatic diseases biological treatments in Argentina: BIOBADASAR fifth report

Introducción: El proyecto BIOBADASAR (Registro argentino deeventos adversos con tratamientos biológicos en reumatología)comenzó en agosto de 2010, para recabar información a largo plazosobre los eventos adversos en tratamientos biológicos en pacientescon enfermedades reumáticas en la práctica clínica cotidiana enArgentina.Pacientes y método: Se registraron datos de cada paciente,tratamientos y acontecimientos adversos relevantes o importantes.Los pacientes debían tener enfermedad diagnosticada y tratadacon un agente biológico. Cada caso se comparó con un control:un paciente con tratamiento no biológico con característicasdemográficas similares. Se analizaron los datos con análisis de lavarianza, con test de t de Student, Mann Whitney, test chi2, o testexacto de Fisher. El análisis de supervivencia de los tratamientoshasta su discontinuación o interrupción se realizó con el método deKaplan-Meier y test log-rank...

Background: BIOBADASAR (Argentine Registry of Adverse Eventsin Biological Treatments in Rheumatology) was started in August2010 to obtain long-term information of patients with rheumatic diseases,treatments and adverse events in everyday clinical practice.Patients and methods: Data on patients’ demographics,treatments and adverse events were collected. Patients had a diagnosisof a rheumatic disease and were treated with biological agent.To compare information, a control group was included, consisting ofpatients treated with similar demographic characteristics but treatedwith a non-biological agent. Data were analysed with Anova,Student´s t, Mann Whitney, chi2, Fisher´s exact tests, as appropriate.Survival analysis of treatments was performed with Kaplan-Meiercurves and log-rank test...

Estratégias de tratamento de lixiviado de aterro sanitário com foco na matéria orgânica biodegradável e nitrogênio amoniacal / Strategies of landfill leachate treatment focused on biodegradable organic matter and ammonia nitrogen

Sistemas de tratamento de esgotos, quando aplicados ao tratamento de lixiviado de aterro sanitário, não têm apresentado bons resultados. Por conta disso, faz-se necessário o desenvolvimento de alternativas para o tratamento de lixiviado. Objetivo avaliar o pós-tratamento de lixiviado de aterro sanitário por wetland construído de fluxo subsuperficial horizontal e reator biológico de leito móvel (RBLM). Materiais e métodos foram realizados dois experimentos com tratamento de lixiviado após remoção de amônia por dessorção. No experimento 1 utilizou-se wetlands construídos de fluxo horizontal em escala de bancada (volume total de 30,8 L), plantados com Cyperus papyrus, Heliconia psittacorum e Gynerium sagittatum, e um controle sem vegetação, preenchidos com pedrisco calcário. O sistema foi alimentado com lixiviado diluído em água em diferentes proporções (entre 10 por cento e 30 por cento ) com concentração média de DQO entre 336 e 750 mg.L-1 e nitrogênio amoniacal (N-NH4) entre 47 e 199 mg.L-1. A operação ocorreu em três etapas: (1ª) alimentação contínua e TDH médio entre 2,7 e 5,3 d; (2ª) regime de ciclos de recirculação do efluente, para avaliar o efeito do aumento de TDH para 21 dias; (3ª) alimentação contínua de duas unidades wetlands em série, visando elevar o TDH (entre 8,1 e 9,9 d) sem recirculação. O experimento 2 foi implantado em escala piloto, com uma unidade de dessorção de amônia seguida de um Reator Biológico de Leito Móvel (RBLM) e um biofiltro anóxico. O RBLM (volume efetivo de 380 L) foi preenchido em 50 por cento com anel pall. Resultados e discussão No experimento 1, obteve-se baixa remoção de DQO com médias inferiores a 40 por cento e concentração final entre 270 e 750 mg.L-1...

sewage treatment systems, when applied to the treatment of landfill leachate, have not shown good results. Thus it is necessary to develop alternatives for the treatment of leachate. Objective To assess the post-treatment of landfill leachate by horizontal subsurface flow constructed wetland and moving bed biofilm reactor (MBBR). Materials and methods Two experiments were conducted with treatment of the leachate after removal of ammonia by stripping. In experiment 1, horizontal flow constructed wetlands, at bench scale (total volume of 30.8 L), planted with Cyperus papyrus, Heliconia psittacorum and Gynerium sagittatum, and a control without vegetation, were filled with calcareous gravel. The system was fed with leachate diluted in water with different proportions (between 10 per cent and 30 per cent ) with mean COD concentration of between 336 and 750 mg.L-1 and ammonia nitrogen (NH4-N) between 47 and 199 mg L-1. The operation was divided in three stages: (1st) continuous feeding with mean HRT between 2.7 and 5.3 d; (2nd) regime of effluent recirculation to evaluate the effect of increasing the HRT to 21 days; (3rd) continuous feeding with two wetlands units in series, aimed HRT increasing (between 8.1 and 9.9 d) without recirculation. Experiment 2 was implemented on a pilot scale, with a unit of ammonia stripping followed by MBBR and an anoxic biofilter. The MBBR (380 L working volume) was filled 50 per cent with pall ring. Results and discussion In experiment 1, the COD removal was low, with averages below 40 per cent , with effluent concentration between 270 and 750 mg.L-1...

Nitrógeno en aguas residuales: orígenes, efectos y mecanismos de remoción para preservar el ambiente y la salud pública / Nitrogen in wastewater: origins, effects and removal mechanisms to preserve the environment and public health

El tratamiento de aguas residuales (AR), centrado tradicionalmente en la remoción de sólidos, patógenos y materia orgánica, ha puesto especial interés en la remoción de nutrientes, principalmente del nitrógeno debido a las consecuencias ambientales y sanitarias de su presencia en el recurso hídrico como aumento de la acidez, eutrofización y toxicidad de los ecosistemas acuáticos, que afectan sobrevivencia, crecimiento y capacidad reproductiva de algunos animales. Ciertas formas de nitrógeno en el agua establecen riesgos para el hombre por su ingesta o por contacto directo con compuestos como toxinas, liberadas por floraciones de cianobacterias en ambientes eutrofizados. La presente revisión, trata sobre los tipos de compuestos nitrogenados en el agua; sus orígenes e impactos sobre el recurso hídrico, algunas especies hidrobiológicas y la salud humana; describe brevemente las opciones tradicionales para transformación o remoción de compuestos nitrogenados en AR, enfatizando en las relativas a la eliminación biológica, pues pueden remover completamente el contaminante y no lo traslada hacia otros sistemas. La información presentada es de gran importancia para la selecciónde sistemas de tratamiento y remoción del nitrógeno de AR para reducir sus impactos sobre los cuerpos de agua y preservar la salud pública.

The wastewater treatment, traditionally based on removal of solids, pathogens and organic matter, have focused specially on nutrient removal, mainly of nitrogen due to the environmental and sanitary consequences of its presence on water resources such increased acidity, eutrophication and toxicity of aquatic ecosystems, that affect the survival, growing and reproductive capacity of some animals. Certain forms of nitrogen on water establish risks for humans through its ingestion or direct contact with compounds as toxins released by cyanobacteria blooms on eutrophic environments. This review deals with the forms of nitrogen compounds on water; their origins and impacts on water resources, some hydro biological species and public health. It also briefly describes the conventional options for nitrogen compounds transformation or removal in wastewater. The biological elimination alternatives are emphasized because they can completely remove the contaminant and not transfer it to other systems. The presented information is important for the selection of wastewater treatment systems and nitrogen removal of wastewater in order to reduce their impacts on water bodies and preserve the public health.

Tercer reporte de eventos adversos con tratamientos biológicos en Argentina. Informe de registro biobadasar / Thrid report of adverse events with biologics in Argentina. Report from biobadasar registry

Introducción: BIOBADASAR (Registro Argentino de Eventos Adversos con Tratamientos Biológicos en Reumatología) comenzó en agosto de 2010. La importancia de este registro es mostrar datos locales que, probablemente, puedan diferir de otros registros. El objetivo es comunicar los resultados del tercer reporte de BIOBADASAR. Métodos: Todos los pacientes con enfermedades reumáticas que requirieron tratamiento con agentes biológicos y pacientes controles sin estos tratamientos fueron incluidos en la base de datos provenientes de 32 centros participando a lo largo de la Argentina. Tres áreas de datos son analizados: características de los pacientes, tratamientos y eventos adversos...

Introduction: BIOBADASAR (Argentine Registry of Adverse Events with Biological Treatments in Rheumatology) began in August 2010. The importance of this registry is to show local data that may probably differ from other registries. The objective is to communicate the results of the third BIOBADASAR report. Methods: All patients with rheumatic diseases who required treatment with biological agents and control patients without these treatments were included in the database from 32 participating centers throughout Argentina. Three areas of data are analyzed: patient characteristics, treatments and adverse events...

Adherencia al tratamiento de pacientes con artritis reumatoidea que reciben medicamentos biológicos / Treatment adherence in patients with rheumatoid arthritis receiving biologics

Introducción: Al igual que en otras enfermedades crónicas, la adherencia al régimen terapéutico de los pacientes con artritis reumatoidea (AR) es baja (entre 30 y 80%), dependiendo de la definición de adherencia y de la metodología empleada para medirla. En este estudio se propone determinar el nivel de adherencia al tratamiento en pacientes con AR que reciben DMAR biológicas e identificar factores asociados a la falta de cumplimiento a la terapia. Material y métodos: Se realizó un estudio analítico, observacional de corte transversal en donde se incluyeron pacientes consecutivos con AR según criterios de clasificación (ACR’87) que se encontraban recibiendo fármacos biológicos para el tratamiento de su enfermedad en los últimos seis meses y que asistieron a la consulta ambulatoria. Para la valoración de la adherencia a DMAR se utilizaron los cuestionarios CQR (Compliance Questionnaire on Rheumatology) y el cuestionario SMAQ (Simplified Medication Adherence Questionnaire). Resultados: Se encuestaron 345 pacientes. Mediante el cuestionario SMAQ se observó una adherencia del 50% (159 pacientes). El Cuestionario CQR tuvo un puntaje mediano de 78 puntos (RIC 67-86). El 47% (147 pacientes) fueron adherentes (CQR >80). Sobre los pacientes incluidos, 151 (48%) refirieron no haber tenido ningún retraso, pérdida o adelanto de la dosis del biológico en los últimos 6 meses de tratamiento. El 52% no adherentes tuvo como causas: 146 (46%) pérdida de al menos una dosis del biológico con una mediana de dosis perdidas de 2 (RIQ: 1-3); 117 (37%) tuvo al menos un retraso en las dosis del biológico y 8 (2%) delantó la dosis. Los factores asociados al no cumplimiento de la terapia biológica fueron el tipo de cobertura médica, que el paciente no haya notado mejoría y la esperanza de una rápida respuesta al tratamiento, y la falta de adherencia a DMAR

Introduction: As in other chronic diseases, adherence to the therapeutic regimen of patients with rheumatoid arthritis (RA) is low (between 30 and 80%), depending on the definition of adherence and the methodology used to measure it. This study aims to determine the level of adherence to treatment in patients with RA who receive biological DMARs and to identify factors associated with non-compliance with therapy. MATERIAL AND METHODS: An observational, cross-sectional, observational study was performed in which consecutive patients with RA according to classification criteria (ACR'87) who were receiving biological drugs for the treatment of their disease in the last six months were included Attended the outpatient appointment. The CQR (Compliance Questionnaire on Rheumatology) and SMAQ (Simplified Medication Adherence Questionnaire) questionnaires were used to assess adherence to DMAR. Results: A total of 345 patients were surveyed. A 50% adherence (159 patients) was observed through the SMAQ questionnaire. The CQR Questionnaire had a median score of 78 points (RIC 67-86). 47% (147 patients) were adherent (CQR> 80). Regarding the patients included, 151 (48%) reported not having had any delay, loss or advancement of the biological dose in the last 6 months of treatment. The 52% of non-adherents had as causes: 146 (46%) loss of at least one dose of the biological with a median of doses lost of 2 (RIQ: 1-3); 117 (37%) had at least one biological dose delay and 8 (2%) delayed the dose. Factors associated with non-compliance with biological therapy were the type of medical coverage, the patient's perceived improvement and the expectation of a rapid response to treatment, and lack of adherence to DMAR.

Monoterapia biológica en pacientes con artritis reumatoidea en Argentina / Biological monotherapy in patients with rheumatoid arthritis in Argentina

Introducción: La utilización de agentes biológicos para el tratamiento de la Artritis Reumatoidea (AR) es habitualmente usada en aquellos pacientes con enfermedad activa que no hayan respondido al tratamiento con drogas modificadoras de la Artritis Reumatoidea convencionales (DMARD, por sus siglas en inglés) o que hayan presentado intolerancia a las mismas. Al estado actual de la evidencia, la terapia combinada de agentes biológicos más un DMARD convencional (principalmente metotrexato) constituye el estándar de tratamiento. Sin embargo existen algunos escenarios como la intolerancia, la falta de adherencia y la aparición de eventos adversos a las DMARDs convencionales donde la monoterapia biológica emerge como una opción terapéutica válida. Según los distintos registros a nivel internacional, la frecuencia de utilización de agentes biológicos en monoterapia oscila entre 12 a 39%. Debido a la ausencia de estos datos a nivel local decidimos realizar este estudio para conocer el porcentaje de pacientes que se encuentran en monoterapia biológica y analizar las causas que llevaron a este tipo de tratamiento. Materiales y métodos: Estudio de tipo corte transversal donde se invitó a participar a diferentes centros reumatológicos distribuidos a lo largo de Argentina. Cada centro revisó las historias clínicas de los últimos 30 a 50 pacientes consecutivos vistos con AR, mayores de 18 años, que habían presentado inadecuada respuesta al tratamiento con DMARDs y que estaban bajo tratamiento biológico. Se completaba una ficha por cada paciente incluido, registrando datos demográficos, de la enfermedad y tratamientos previos. Resultados: Se incluyeron 32 centros y se evaluaron 1148 historias clínicas de pacientes con AR durante el mes de octubre y noviembre del 2012. Un 21,4% (246) de los pacientes al momento del estudio se encontraba bajo tratamiento biológico en monoterapia...

Introduction: The use of biological agents for the treatment of rheumatoid arthritis (RA) is commonly used in patients with active disease who have not responded to treatment with conventional rheumatoid arthritis-modifying drugs (DMARDs) or Who have presented intolerance to them. At the present state of evidence, combined therapy of biological agents plus conventional DMARD (mainly methotrexate) is the standard of treatment. However, there are some scenarios such as intolerance, lack of adherence and the appearance of adverse events to conventional DMARDs where biological monotherapy emerges as a valid therapeutic option. According to different international registries, the frequency of use of biological agents in monotherapy ranges from 12 to 39%. Due to the absence of these data at the local level we decided to carry out this study to know the percentage of patients who are in biological monotherapy and to analyze the causes that led to this type of treatment. Materials and methods: A cross-sectional study where different rheumatologic centers throughout Argentina were invited to participate. Each center reviewed the medical records of the last 30 to 50 consecutive patients seen with RA, older than 18 years, who had inadequate response to treatment with DMARDs and who were under biological treatment. One card was completed for each patient included, recording demographic, disease and previous treatment data. Results: Thirty-two centers were included and 1148 clinical records of patients with RA were evaluated during October and November 2012. A total of 244 patients (246) at the time of the study were under monotherapy...

Tratamiento de la artritis reumatoidea con AntiTNF. Experiencia en Uruguay / Treating rheumatoid arthritis with Anti-TNF. Experience in Uruguay

La artritis reumatoidea (AR) es una enfermedad sistémica autoinmune, que se asocia a afectación en la calidad de vida y a un incremento de la morbimortalidad. Los tratamientos remisivos de la AR incluyen fármacos antiartríticos modificadores de le enfermedad (FAME) y terapias con biológicos. En marzo 2010 se incorpora a las prestaciones del Fondo Nacional de Recursos (FNR) el tratamiento con Antifactor de necrosis tumoral (Anti-TNF) se realiza evaluación de la cohorte de pacientes que iniciaron tratamiento antes del 01/05/2011. Objetivos: caracterizar la población y evaluar resultado de la eficacia del tratamiento, según evolución de puntuación de DAS 28. Resultados: se incluyeron 69 pacientes. Las medias de DAs 28 pre y postratamiento evidenciaron una mejoría (p < 0,05). Criterio de mejoría en 76,4% (bajo grado de actividad 37,3% y remisión 14,9%). Efectos adversos en 20 pacientes (en 3 casos motivó suspensión de la terapia). Cambio de droga, principal causa: falla de tratamiento (8/9). Conclusiones: más de 70% obtiene criterio de mejoría por lo cual los resultados en esta primera evaluación de respuesta pueden calificarse como buenos, aunque deberán monitorizarse en el tiempo.

Adaptación de bacterias a diferentes concentraciones de fenol en el laboratorio: aspectos esenciales para un proceso de biodegradación / Adaptation of bacteria to different concentrations of phenol in the laboratory: essentials for biodegradation process

En el presente trabajo se determino la carga bacteriana de muestras de agua y suelo contaminadas con diferentes concentraciones de fenol. Se hizo seguimiento en medio mineralizado con concentraciones de 200 a 10000mg/L y variaciones de inoculo. Se evidenciaron cambios en crecimiento bacteriano, encontrándose mayor carga en suelo con fase de adaptación al segundo día y fase de crecimiento en cuarto día. Comparando variaciones del inoculo (directa, adaptado y preenriquecimiento) el directo puede aplicarse para muestras de carga alta (suelo); el preenriquecimiento no es práctico por el estrés bacteriano y adaptado permite ser usado hasta 500mg/L sin problemas. En repiques sobre agares (mineralizados y nutritivo) hubo crecimiento hasta 1000mg/L. Es importante para depurar aguas residuales, encontrar bacterias de diferentes fuentes que resistan altas concentraciones de fenol y permitan efectividad en bioprocesos al estudiar comportamientos de pre adaptación, tiempos y tratamientos adecuados para la preparación del inóculo.

Agentes biológicos en el tratamiento de la artritis reumatoide / Biological agents in the treatment of rheumatoid arthritis

El mayor conocimiento inmuno-patológico de la artritis reumatoide permitió mediante una sofisticada tecnología molecular elaborar antagonistas contra blancos específicos en diversos pasos de la inmuno patogenia de la enfermedad. Existe una amplia evidencia sobre la eficacia, tolerabilidad y seguridad de estos agentes en diferentes escenarios clínicos de la artritis reumatoide. La introducción de estos agentes biológicos en el arsenal terapéutico de la artritis reumatoide ha marcado un hito en su evolución y pronóstico artritis reumatoide.

Evaluación de la utilización del duckweed como alternativa de pos-tratamiento de aguas residuales domesticas en efluentes de lagunas de oxidación / Evaluation of the use of duckweed as an alternative for post-treatment of domestic wastewater effluent from oxidation ponds

En el presente estudio se trabajó a escala de laboratorio un sistema de pos-tratamiento de agua residual doméstica en reactores tipo batch con el fin de evaluar la potencialidad del duckweed para remover materia orgánica, nutrientes y coliformes, utilizando como sustrato aguas residuales provenientes de las lagunas de oxidación del sistema de tratamiento de aguas residuales del Municipio de Valledupar. Las lemnáceas que sirvieron como inóculo para desarrollar la investigación fueron tomadas de jagüeyes ubicados a las afueras de Valledupar. En esta investigación se analizaron los siguientes parámetros: demanda química de oxígeno, nitrógeno total kjeldalh, fósforo, coliformes, conteo de frondas, determinación de la biomasa.