Real-world effectiveness and safety of insulin glargine 300 U/ml in insulin-naïve people with type 2 diabetes in the Latin America region: A subgroup analysis of the ATOS.

AIM: To evaluate the real-world effectiveness and safety of insulin glargine 300 U/ml (Gla-300) in achieving glycaemic goals in insulin-naïve people with type 2 diabetes (T2D) in Mexico, Colombia and Peru (Latin America region) in the A Toujeo Observational Study (ATOS). MATERIALS AND METHODS: ATOS was a multicentre, prospective, 12-month observational study, which included 4422 insulin-naïve adults (age ≥ 18 years) with T2D uncontrolled (HbA1c > 7% and ≤11%) on at least one oral antidiabetic drug (OAD) who initiated Gla-300 treatment as per routine practice. The primary endpoint was the percentage of participants achieving their predefined individualized HbA1c goal at month 6. Key secondary endpoints included change from baseline in HbA1c, fasting plasma glucose (FPG), fasting self-monitored blood glucose (SMBG), body weight and incidence of hypoglycaemia. RESULTS: In this subgroup analysis, a total of 314 participants with T2D received Gla-300. At baseline, mean ± SD age was 56.0 ± 11.6 years, duration of diabetes was 9.7 ± 6.6 years and 65.9% of participants were on at least two OADs. The individualized HbA1c target was achieved by 25.8% of participants (95% confidence interval [CI]: 20.3-31.9) at month 6 and by 35.3% (95% CI: 28.5-42.5) at month 12. Gla-300 treatment improved glycaemic control with meaningful reductions in mean HbA1c, FPG and fasting SMBG. The incidence of hypoglycaemia reported was low and body weight remained stable. CONCLUSIONS: In a real-world setting in the Latin America region, the initiation of Gla-300 in people with T2D uncontrolled on OADs resulted in improved glycaemic control with a low incidence of hypoglycaemia and no change in body weight.

Model-based design of a software sensor for real-time diagnosis of the stability conditions in high-rate anaerobic reactors - Full-scale application to Internal Circulation technology.

Internal Circulation (IC) anaerobic systems are especially suitable when plant designs that involve both small footprints and high organic loading rates (>25 kg COD m-3 d-1) are required. However, given that operating anaerobic processes at high organic loads increases their vulnerability to external disturbances, real-time indicators of the stability conditions become particularly pertinent for IC reactors. This paper addresses the design and full-scale validation of a software sensor that uses only feeding flow-rate and biogas flow-rate measurements to classify the operating conditions of the reactor as "strongly", "moderately" or "weakly" stable. A simulation-based procedure was used to design the software sensor and configure its parameters. Then, the performance of the software sensor was tested under real conditions in a full-scale IC reactor of 1679 m3 installed in a recycled paper mill (RPM).

Model-based methodology for the design of optimal control strategies in MBR plants.

This paper proposes a model-based methodology that allows synthesising the most appropriate strategies for optimising the operation of wastewater treatment plants (WWTPs). The methodology is applied with the aim of maximising the nitrogen removal in membrane bioreactors (MBRs). The proposed procedure is based on a systematic approach composed of four steps. First, a sensitivity analysis of the input variables is carried out in order to obtain a first assessment of the potential for operational improvements. Then, the optimum input variable values are calculated by a model-based optimisation algorithm that minimises a cost function associated with the effluent total nitrogen at different temperatures. Then, the optimum operational strategies are identified. Finally, these operational strategies form the conceptual knowledge base for designing automatic control laws. The obtained optimal control strategies have shown a significant improvement in performance in comparison with fixed operation for the studied case, reducing the total nitrogen by 40%.

Advanced data management for optimising the operation of a full-scale WWTP.

The lack of appropriate data management tools is presently a limiting factor for a broader implementation and a more efficient use of sensors and analysers, monitoring systems and process controllers in wastewater treatment plants (WWTPs). This paper presents a technical solution for advanced data management of a full-scale WWTP. The solution is based on an efficient and intelligent use of the plant data by a standard centralisation of the heterogeneous data acquired from different sources, effective data processing to extract adequate information, and a straightforward connection to other emerging tools focused on the operational optimisation of the plant such as advanced monitoring and control or dynamic simulators. A pilot study of the advanced data manager tool was designed and implemented in the Galindo-Bilbao WWTP. The results of the pilot study showed its potential for agile and intelligent plant data management by generating new enriched information combining data from different plant sources, facilitating the connection of operational support systems, and developing automatic plots and trends of simulated results and actual data for plant performance and diagnosis.

El primer uso en Venezuela de OKT3 para el tratamiento del rechazo agudo del trasplante renal / The first use in Venezuela of OKT3 for treatment of acute refection of kidney transplantation

Nosotros descubrimos a continuación el primer caso en Venezuela de rechazo agudo resistente a corticosteroides tratado con la globulina antilinfocítica monoclonal Muromonab CD3 Orthoclone OKT3. (OKT3) contra el receptor linfocítico CD3. Nuestro paciente presentó un rechazo agudo intersticial y vascular resistente a los coricosteroides que respondió a OKT3 sin las complicaciones normalmente descritas con este tratamiento. Recomendamos la terapia monoclonal en pacientes con rechazo agudo resistente al tratamiento convencional y sugerimos que la administración de las primeras 2 a 3 dosis sea bajo estricta supervisión, posiblemente en una unidad de terapia intensiva, para evitar las complicaciones asociadas a la administración del tratamiento