Correction: Osteoporotic hip fracture-Comorbidities and factors associated with in-hospital mortality in the elderly: A nine-year cohort study in Brazil.

[This corrects the article DOI: 10.1371/journal.pone.0272006.].

Cervical ependymoma en bloc resection.

A 58-year-old male was admitted to the authors' department due to cervicothoracic pain and disequilibrium. Physical examination evidenced sensory and motor deficits in the lower limbs. MRI evidenced an expansive intramedullary lesion compatible with ependymoma. The nuances of this surgical access and the management of intradural tumors are discussed.

A Challenging Case of Oral Ulcers and Gastrointestinal Bleeding: Crohn's or Behçet's Disease.

Introduction. Differentiating Crohn's disease (CD) and Behçet's disease (BD) with gastrointestinal (GI) manifestations can be clinically challenging, as current diagnostic criteria are not clear between both conditions and multiple symptoms could overlap. Case Presentation. The patient is an 8-year-old boy of Brazilian descent, who initially presented with a 1-year history of painful oral ulcers. Before presenting to the hospital, he had been treated for periodic fever, aphthous stomatitis, pharyngitis, and adenitis and placed on steroids, with relapsing symptoms on attempts to wean the doses. The initial workup was largely unremarkable. Buccal biopsies showed no granulomas, and the ophthalmologic exam was normal. Infectious and rheumatological tests were negative. Prometheus IBD sgi testing showed a pattern consistent with CD; however, the patient had multiple negative endoscopies, colonoscopies, and capsule endoscopies. He developed intermittent bloody stools and severe malnutrition and did not respond to infliximab, colchicine, or methotrexate. After a large GI bleed, a 4th colonoscopy was performed, which showed large round ulcers in the terminal ileum, and no granulomas. He was started on ustekinumab with clinical improvement. One month later, he developed bilateral hip effusion and meningismus, being diagnosed with aseptic meningitis secondary to COVID-19. He improved, but in one month developed worsening symptoms, and MRV showed extensive venous sinus thrombosis. The patient was started on enoxaparin, methylprednisolone, and colchicine, with resolution of the thrombus on a 3-month follow-up. The patient's overall symptoms remained controlled with clinical and biochemical remission on monthly ustekinumab. Discussion and Conclusion. Our patient had a challenging clinical course, with nonspecific systemic and intestinal manifestations which proved difficult to differentiate between BD and CD. Given endoscopic findings and the worsening of an auto-inflammatory reaction in the central nervous system after COVID-19 in a patient with controlled GI symptoms, the most likely diagnosis is BD.

Endoscopic endonasal approach for acromegaly: surgical outcomes using 2018 consensus criteria for remission.

Objective: The primary aim is to analyze the endoscopic endonasal surgical results in short-term and two-year follow-ups according to the 11th Acromegaly Consensus statement (2018). Indeed, prognostic factors and complications were analyzed. Subjects and methods: 40 patients who underwent endoscopic endonasal surgery by acromegaly between 2013 to 2020 was analyzed. Patients were considered in remission if an upper limit of normal (ULN) IGF-1 was less than 1.0 at the six-month and two-year follow-ups. Moreover, we assessed the Knosp grade, tumor volumetry, ULN, T2 signal in MRI, reoperation, and complications. Results: The mean age of admission was 46.7 years. Thirty-two patients were in remission after six months of surgery (80%), decreasing to 76.32% at the two-year follow-up. All microadenomas presented remission (n = 6). Regarding the complications, three patients had permanent panhypopituitarism (7.5%); postoperative cerebrospinal fluid (CSF) leaks did not occur in this series. The hyperintense signal on the T2 MRI and a higher tumor volumetry were the single predictor's factors of non-emission in a multivariate regression logistic analysis (p < 0.05). Preoperative hormone levels (GH and IGF-1) were not a prognostic factor for remission. The re-operated patients who presented hypersignal already had a high predictor of clinical-operative failure. Conclusion: The endoscopic endonasal surgery promotes high short-term and two-year remission rates in acromegaly; the tumor's volumetry and the T2 hypersignal were statistically significant prognostic factors in non-remission - the complications presented at similar rates in comparison to the literature. In invasive GH-secreting tumors, we should offer these patients a multi-disciplinary approach to improve acromegalic patients' remission rates.

Endoscopic endonasal approach for acromegaly: surgical outcomes using 2018 consensus criteria for remission

ABSTRACT Objective: The primary aim is to analyze the endoscopic endonasal surgical results in short-term and two-year follow-ups according to the 11th Acromegaly Consensus statement (2018). Indeed, prognostic factors and complications were analyzed. Subjects and methods: 40 patients who underwent endoscopic endonasal surgery by acromegaly between 2013 to 2020 was analyzed. Patients were considered in remission if an upper limit of normal (ULN) IGF-1 was less than 1.0 at the six-month and two-year follow-ups. Moreover, we assessed the Knosp grade, tumor volumetry, ULN, T2 signal in MRI, reoperation, and complications. Results: The mean age of admission was 46.7 years. Thirty-two patients were in remission after six months of surgery (80%), decreasing to 76.32% at the two-year follow-up. All microadenomas presented remission (n = 6). Regarding the complications, three patients had permanent panhypopituitarism (7.5%); postoperative cerebrospinal fluid (CSF) leaks did not occur in this series. The hyperintense signal on the T2 MRI and a higher tumor volumetry were the single predictor's factors of non-emission in a multivariate regression logistic analysis (p < 0.05). Preoperative hormone levels (GH and IGF-1) were not a prognostic factor for remission. The re-operated patients who presented hypersignal already had a high predictor of clinical-operative failure. Conclusion: The endoscopic endonasal surgery promotes high short-term and two-year remission rates in acromegaly; the tumor's volumetry and the T2 hypersignal were statistically significant prognostic factors in non-remission - the complications presented at similar rates in comparison to the literature. In invasive GH-secreting tumors, we should offer these patients a multi-disciplinary approach to improve acromegalic patients' remission rates.

Modeling carbonate/bicarbonate and nitrate disturbance during secondary effluent disinfection by UV/H2O2 and UV/ozone.

The disinfection of effluents has been considered the main step to inactivate pathogenic organisms to prevent the spread of waterborne diseases. The variation in the matrix composition can lead to the use of inadequate oxidant dose and disturb a correct treatment. The objective of this study was to develop a simple and practical mathematical model to simulate the disturbance of inorganic anions (CO32-/HCO3- and NO3-) during secondary effluent disinfection by UV/H2O2 and UV/O3. The pathogenic agents chosen for this study were total coliforms and E. coli. To build the mathematical model, a modification of the Chick model (referred to as 'Modified Chick Model') was proposed by employing a weighted average in the calculation of the kinetic constant. Both treatments were affected by the presence of the anions. However, with the highest NO3- concentration, less inhibition of disinfection was observed in the UV/H2O2. The use of the arithmetic means to calculate the value of k, as indicated by the Chick model, demonstrates a lesser precision in the prediction of the microorganisms' concentrations. On the other hand, using the Modified Chick Model, a better prediction of the inactivation of the microorganisms was obtained, which can be confirmed by the validation performed.

Endoscopic endonasal approach for isolated subarachnoid neurocysticercosis in basal cisterns and its complications: illustrative case.

BACKGROUND: Neurocysticercosis (NCC) is an infectious parasitic disease in which humans are the middle host in the life cycle of Taenia solium. It is currently considered to be a neglected tropical disease. According to their location, cysts can cause epilepsy, hydrocephalus, arachnoiditis, and intracranial hypertension. The subarachnoid is the rarest and most morbid form among all forms of NCC presentation. OBSERVATIONS: The authors report an odd case of subarachnoid NCC (SUBNCC). It was treated with expanded endoscopic endonasal surgery. Unfortunately, the patient developed a high-output nasal leak and meningitis after cyst removal, which demanded additional surgical procedures. Nonetheless, the patient showed a good clinical outcome after surgical interventions. LESSONS: Endoscopic endonasal approach of SUBNCC can be safe and curative. Neverthless, the presented report shows that severe complications can arise from the procedure. The authors hypothesized that placing an early cerebrospinal shunt would reduce the patient's morbidity before difficulties arose.

Osteoporotic hip fracture-Comorbidities and factors associated with in-hospital mortality in the elderly: A nine-year cohort study in Brazil.

INTRODUCTION: The aim of the study was to identify factors associated with the causes of in-hospital morbidity and mortality in an elderly Brazilian population due to osteoporotic hip fractures. METHOD: Retrospective cohort study involving a population over 60 years of age admitted to hospital due to osteoporotic hip fractures and followed up from hospitalization to outcome (discharge or mortality) from 2010 to 2018, in a public hospital in Brasília, the capital of Brazil. Multivariate analysis was performed using the Poisson regression model with a robust variance, observing the hierarchical model proposed and the receiver operating characteristic (ROC) curve to obtain the cutoff point for mortality incidence in relation the total length of hospital stay. Significance level was set as p < 0.05. The analyses were conducted using the SAS 9.4 software. RESULT: The mean hospital mortality rate among the 402 patients involved was 18.4%, and the associations made with the outcome mortality were per relevance: respiratory infection, age over 90 years, high preoperative cardiovascular risk, chronic obstructive pulmonary disease (COPD) as comorbidity, serum hemoglobin level ≤ 10 and other infections. Mortality also showed association with longer total length of hospital stay, as well as with prolonged postoperative period. CONCLUSION: Hip fractures in the elderly due to osteoporosis indicate a relationship between the sicker profile of the aging elderly population and the prevalence of chronic diseases strongly associated with in-hospital infections, contributing to increased mortality. There were fewer early interventions, and mortality was also associated with prolonged postoperative period. The aim of this study was not to compare independent variables with each other, but suggests the relationship between the presence of comorbidities, which predisposes to the development of infections, directly linked to mortality.

Synthesis and Characterization of N and Fe-Doped TiO2 Nanoparticles for 2,4-Dimethylaniline Mineralization.

The present study aimed to evaluate the feasibility of developing low-cost N- and Fe-doped TiO2 photocatalysts for investigating the mineralization of 2,4-dimethylaniline (2,4-DMA). With a single anatase phase, the photocatalysts showed high thermal stability with mass losses of less than 2%. The predominant oxidative state is Ti4+, but there is presence of Ti3+ associated with oxygen vacancies. In materials with N, doping was interstitial in the NH3/NH4+ form and for doping with Fe, there was a presence of Fe-Ti bonds (indicating substitutional occupations). With an improved band gap energy from 3.16 eV to 2.82 eV the photoactivity of the photocatalysts was validated with an 18 W UVA lamp (340-415 nm) with a flux of 8.23 × 10-6 Einstein s-1. With a size of only 14.45 nm and a surface area of 84.73 m2 g-1, the photocatalyst doped with 0.0125% Fe mineralized 92% of the 2,4-DMA in just 180 min. While the 3% N photocatalyst with 12.27 nm had similar performance at only 360 min. Factors such as high surface area, mesoporous structure and improved Ebg, and absence of Fe peak in XPS analysis indicate that doping with 0.0125% Fe caused a modification in TiO2 structure.

Outcomes of Catheter-Related Arterial and Venous Thrombosis After Enoxaparin Therapy in Neonates and Infants With Congenital Heart Disease.

OBJECTIVES: Outcomes of catheter-related arterial and venous thrombosis after enoxaparin therapy in neonates and infants with congenital heart disease. DESIGN: A single-center retrospective cohort study. SETTING: Cardiac ICU. PATIENTS: Patients under 1 year old cared for in the cardiac ICU at Nicklaus Children's Hospital from January 2015 to January 2019 and treated with enoxaparin for central vascular catheter-related arterial and venous thrombosis. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: One-hundred fifty-six events of central catheter-related arterial and venous thrombosis were included in the study. Arterial thrombi accounted for 109 (69.9%) and venous thrombi for 47 (30.1%) of the events. Femoral vessels were the most commonly affected site (88.5%). Therapeutic outcomes were analyzed in 106 events, excluding those without follow-up imaging. The analysis was stratified by age into neonates and infants and catheter types into arterial and venous catheter groups. Therapeutic dose of enoxaparin was higher in neonates (median 1.8 mg/kg/dose) compared with infants (1.6 mg/kg/dose; p = 0.001). Complete resolution was seen in 68%, partial resolution in 19%, nonresolution in 13% of the events. The complete resolution was higher for arterial than venous (85% vs 65.6%; p = 0.032) thrombi with a shorter duration of enoxaparin treatment (23 vs 43 d; p = 0.014). Complete resolution was lowest in neonates with venous thrombosis (42.9%). The median time to complete resolution by Kaplan-Meier analysis was 24.9 days in the overall cohort, 34.3 days in neonates, 24.9 days in infants, 20 days in arterial, and 44.9 days in venous catheter group. CONCLUSIONS: A high proportion of vascular catheter-related thrombi identified in infants with congenital heart disease resolve with enoxaparin treatment. In all patients with thrombosis, arterial versus venous thrombosis is associated with greater odds of resolution.

Prevalence of COVID-19 in children, adolescents and adults in remote education situations in the city of Fortaleza, Brazil.

OBJECTIVES: A retrospective study was conducted to identify the prevalence of COVID-19 through serology and RT-PCR in children, adolescents and adults. A database of the COVID-19 Tracking Program in school children was used. METHODS: The data comprised sociodemographic and clinical variables, results of serological tests (IgM and IgG), and real-time-polymerase chain reaction (RT-PCR) results of IgM-positive individuals. The statistical analysis was performed with a 5% significance level. RESULTS: Among 423 children, 107 (25.3%) exhibited seroprevalence with IgG, IgM or IgG/IgM; among 854 adolescents, 250 (29.2%) had positive serology; and among 282 adults, 59 (20.9%) were positive. The frequency of positivity on RT-PCR for SARS-CoV-2 was 3.5%, 3.6% and 6.0% in children, adolescents and adults, respectively. Children had a lower incidence of symptoms than adolescents (p = 0.001) and adults (p = 0.003); the most frequent were fever, ageusia, anosmia, headache, dry cough, sore throat, muscle pain, runny nose, dyspnoea, and diarrhoea. CONCLUSIONS: The prevalence rate for all groups was 26.7% in serology and 4.04% in RT-PCR. Children had lower rates of IgM and fewer symptoms compared with adolescents and adults. The data suggest the potential for transmissibility in all age groups.

Bioacessibility of phenolic compounds and antioxidant capacity in organic peppermint leaves

ABSTRACT The objective of this study was to analyze the chemical composition and bioaccessibility of phenolic compounds as well as their antioxidant capabilities of organic peppermint leaves after each phase of simulated digestion. Moisture was determined until a constant weight was obtained in an oven at 105 °C; ash was determined after sample calcination in a muffle furnace at 550 °C. The protein concentration was determined by the Macro-Kjeldahl method and lipid content by hot-extraction in a Soxhlet apparatus. Carbohydrates were calculated from differences and energy values based on the Atwater conversion factors. Total phenolic, flavonoid content, and antioxidant activity were determined by spectrophotometry. A four-step procedure was used for in vitro digestion. Organic peppermint was found to contain the following: 78% moisture, 1.7% ash, 1.5% lipids, 0.3% proteins, 17.7% carbohydrates, and a total of 85.5 kcal/100 g. Values of 705 mg GAE/100 g of phenolic, 918 mg QE/100 g of flavonoids, and 58.8 mg/g of vitamin C were also measured. It was discovered that total phenolics had the highest bioaccessible fraction relative to flavonoids; the salivary phase was identified as that with the highest release of these compounds and thus the phase in which peppermint showed significant antioxidant activity (1509 μmol TEAC/100g). This study demonstrated that organic peppermint has a high content of phenolic compounds that can be extracted from the alimentary matrix in the salivary and intestinal phases of the digestive system. Because of the antioxidant activity of these compounds, the use of this aromatic plant as seasonings and spices is relevant.

RESUMEN El objetivo de este estudio fue analizar la composición química de hojas de menta orgánica y la bioaccesibilidad de los compuestos fenólicos así como su capacidad antioxidante. Se determinó la humedad hasta obtener un peso constante en el horno a 105 °C, la ceniza se determinó en un horno de mufla a 550 °C. La concentración de proteína se determinó mediante el método Macro-Kjeldahl y los lípidos mediante extracción en un aparato Soxhlet. Los carbohidratos se calcularon por diferencia y energía basadas en los factores de conversión de Atwater. El contenido fenólico y la actividad antioxidante se determinaron por espectrofotometría. Se usó un procedimiento de cuatro pasos para la digestión in vitro. La menta orgánica contiene 78% de humedad, 1,7% de cenizas, 1,5% de lípidos, 0,3% de proteínas, 17,7% de carbohidratos y 85,5 kcal/100 g. También se midieron valores de 705 mg GAE/100g de fenólico, 918 mg QE/100 g de flavonoides y 58,8 mg/g de vitamina C. Se descubrió que los fenólicos tenían la fracción bioaccesible más alta en relación con los flavonoides; la fase salival se identificó como aquella con la mayor liberación de estos compuestos y, por lo tanto, la menta mostró una actividad antioxidante significativa (1509 μmol de TEAC/100 g). La menta orgánica tiene un alto contenido de fenólicos que se pueden extraer en las fases salival e intestinal. Debido a la actividad antioxidante de estos compuestos, el uso de esta planta como condimentos y especias es relevante.

Brachial plexus avulsion neuropathic refractory pain: association of spinal cord stimulation and DREZotomy for complex pain.

A 52-year-old male was involved in a car accident 30 years ago. He presented with complete motor paralysis of the left upper limb. This evolved into severe neuropathic pain (mainly shocking and burning sensation) distributed from C5 to T1 dermatomes. He was first treated with spinal cord stimulation (SCS), which did not show efficacy for pain control, maintaining high visual analog scale (VAS) scores. He then received complementary treatment with left cervical DREZotomy to mitigate suffering and preserve SCS function to control "mirror pain." The video can be found here: https://youtu.be/iTvbLAZ3odM.

Photoelectrocatalytic Degradation of Methylene Blue Using ZnO Nanorods Fabricated on Silicon Substrates.

ZnO nanorods were grown on silicon (Si) substrates by two techniques: (i) Chemical Bath Deposition (CBD) and (ii) a CBD seed layer combined with Carbothermal Reduction Vapor Phase Transport (CTR-VPT). The structured ZnO nanorods were characterized by scanning electron microscopy (SEM), X-ray diffraction (XRD), X-ray photoelectron spectroscopy (XPS), and contact angle measurments. The photoelectrochemical property of ZnO nanorods were analyzed by linear voltammetry under UV-ABC light excitation. Using the ZnO nanorod samples as photoanodes, the removal of methylene blue (MB) as a representative organic compound was studied by the photoelectrocatalytic (PEC) technique applying a potential (E) of 0.6 V. For comparison purposes, experiments were performed under the same conditions using photocatalysis (PC), direct photolysis and using samples of pure Si (support material) as working electrodes in PEC. XRD analyses of ZnO prepared by both methods showed the expected ZnO wurtzite phase and a preferred c-axial orientation in the growth of the nanorods. The presence of ZnO was further confirmed by XPS and contact angle measurements showed that ZnO grown by CBD (ZnO/CBD) had a slightly hydrophobic behavior while ZnO grown by CTR-VPT (ZnO/CTR-VPT) is hydrophilic. Both ZnO sample types were shown to be photoactive, with ZnO/CBD showing higher resultant photocurrent compared to ZnO/CTRVPT. For the degradation of MB 53% of the compound was removed using ZnO/CBD as a working electrode, while using the ZnO/CTR-VPT electrode led to a removal of 43% of MB. However, direct photolysis alone removed 39% of the MB. The lower removal of MB using ZnO/CTR-VPT samples was related to surface dissociation during the degradation process. The results show that ZnO nanorods prepared by the CBD techique are a promising photoelectrode for PEC applications. Our data also indicate that CTR-VPT-grown nanorods produce uniform nanorod arrays, but this uniform nanostructure deposit does not lead to any increase in PEC activity.

Identification of intermediates, acute toxicity removal, and kinetics investigation to the Ametryn treatment by direct photolysis (UV254), UV254/H2O2, Fenton, and photo-Fenton processes.

This paper reports the degradation of 10 mg L-1 Ametryn solution with different advanced oxidation processes and by ultraviolet (UV254) irradiation alone with the main objective of reducing acute toxicity and increase biodegradability. The investigated factors included Fe2+ and H2O2 concentrations. The effectiveness of the UV254 and UV254/H2O2 processes were investigated using a low-pressure mercury UV lamp (254 nm). Photo-Fenton process was explored using a blacklight blue lamp (BLB, λ = 365 nm). The UV254 irradiation process achieved complete degradation of Ametryn solution after 60 min. The degradation time of Ametryn was greatly improved by the addition of H2O2. It is worth pointing out that a high rate of Ametryn removal was attained even at low concentrations of H2O2. The kinetic constant of the reaction between Ametryn and HO● for UV254/H2O2 was 3.53 × 108 L mol-1 s-1. The complete Ametryn degradation by the Fenton and photo-Fenton processes was observed following 10 min of reaction for various combinations of Fe2+ and H2O2 under investigation. Working with the highest concentration (150 mg L-1 H2O2 and 10 mg L-1 Fe2+), around 30 and 70% of TOC removal were reached within 120 min of treatment by Fenton and photo-Fenton processes, respectively. Although it did not obtain complete mineralization, the intermediates formed in the degradation processes were hydroxylated and did not promote acute toxicity of Vibrio fischeri. Furthermore, a substantial improvement of biodegradability was obtained for all studied processes.

H2O2-assisted photoelectrocatalytic degradation of Mitoxantrone using CuO nanostructured films: Identification of by-products and toxicity.

CuO nanostructured thin films supported on silicon with 6.5 cm2 area (geometric area greater than the studies reported in the literature) were synthesized by a chemical bath deposition technique. The electrodes were characterized by MEV, XRD, XPS, contact angle, cyclic voltammetry and electrochemical impedance spectroscopy analyses. To evaluate the photoelectrochemical properties of the CuO films, photocurrent-voltage measurements were performed using linear voltammetry. The catalytic activities of CuO nanostructures were evaluated by monitoring photodegradation of Mitoxantrone (MTX) under UV-A light irradiation. The method of photoelectrocatalysis (PEC), applying a voltage of 1.5 V and assisted by adding H2O2, was undertaken. To the best of our knowledge, no studies on the degradation of anticancer agents using PEC process have been found in the literature. For comparison purposes, experiments were performed under the same conditions by assisted photocatalysis (PC) with H2O2 and direct photolysis. CuO deposits consist of a needle-like morphology. The presence of CuO in the tenorite phase was evidenced by XRD and the XPS spectra showed the presence of copper(II) oxide. The increase in current under illumination shows that CuO exhibits photoactivity. The PEC system showed a 75% level of MTX degradation, while the level achieved using PC was 50%. Under UV-A light alone only 3% removal was obtained after 180 min. Up to 10 by-products were identified by chromatography-mass spectrometry (LC-MS) with m/z values ranging between 521 and 285 and a plausible degradation route has been proposed. It is worth mentioning that 9 by-products identified in this work, were not found in the literature in other studies of degradation or products generated as metabolites. The toxicity tests of MTX before and after PEC treatment with Artemia Salina and Allium cepa showed a decrease in the acute toxicity of the medium as the antineoplastic was degraded.

Optimization of nimesulide oxidation via a UV-ABC/H2O2 treatment process: Degradation products, ecotoxicological effects, and their dependence on the water matrix.

Nimesulide (Nim) degradation in ultrapure water (UW) and municipal sewage (MS) via UV-ABC/H2O2 was investigated. The variables included in the experimental design were time, initial Nim, and initial H2O2 concentrations. Resulting decreases in Nim concentration (monitored by high performance liquid chromatography (HPLC) using a photodiode array detector operating at a maximum UV absorbance of 300 nm), mineralization (from total organic carbon (TOC) measurements), and ecotoxicity (assays employing the bioindicators Daphnia similis, Artemia salina, and Allium cepa) were also studied. Degradation rates of 90% or higher were found for 15-20 min reaction times, employing combinations of [H2O2] = 50-150 mg L-1 and [Nim] = 8.5-15 mg L-1 prepared with MS. Mineralization rates of 70% and higher were attained within 60 min of reaction for [Nim] = 15 mg L-1 prepared in MS with [H2O2] = 100 mg L-1. Nim by-products were detected and possible degradation pathways proposed. Ecotoxicity evaluation using A. salina, D. similis, and A. cepa revealed that the treated samples had significantly lower toxicity. Exposure to treated samples resulted in survival rates of 79% for A. salina and over 90% for D. similis. No root growth inhibition was observed in A. cepa exposed to treated samples, whereas exposure to untreated samples inhibited root growth by 60%. Statistical analysis revealed elimination of cytotoxicity and reduction of genotoxicity against A. cepa. The results showed that the UV-ABC/H2O2 process can be employed as a pre- or post-treatment method to remove Nim from contaminated wastewater.

Mineralization of humic acids (HAs) by a solar photo-Fenton reaction mediated by ferrioxalate complexes: commercial HAs vs extracted from leachates.

The mineralization of bio-recalcitrant humic acids (HAs) by a solar photo-Fenton (SPF) process was investigated in aqueous system, in order to understand its abatement in real high-HA content matrices, such as sanitary landfill leachates. SPF reactions were performed in tubular photoreactors with CPCs at lab-scale (simulated solar light) and pilot-scale (natural sunlight). Considering the experimental conditions selected for this work, the formation of insoluble HA-Fe3+ complexes was observed. Thus, to avoid HA precipitation, oxalic acid (Ox) was added, since Fe3+-Ox complexes present a higher stability constant. The effect of different process variables on the performance of SPF reaction mediated by ferrioxalate complexes (SPFF) was assessed with excess of H2O2 (50-250 mg L-1), at lab-scale: (i) pH (2.8-4.0); (ii) initial iron concentration (20-60 mg Fe3+ L-1); (iii) iron-oxalate molar ratio (Fe3+-Ox of 1:3 and 1:6); (iv) temperature (20-40 °C); (v) UV irradiance (21-58 WUV m-2); and (vi) commercial-HA concentration (50-200 mg C L-1). At the best lab conditions (40 mg Fe3+ L-1, pH 2.8, 30 °C, 1.6 Fe3+-Ox molar ratio, 41 WUV m-2), commercial HAs' mineralization profile was also compared with HAs extracted from a sanitary landfill leachate, achieving 88 and 91% of dissolved organic carbon removal, respectively, after 3-h irradiation (8.7 kJUV L-1). Both reactions followed the same trend, although a 2.1-fold increase in the reaction rate was observed for the leachate-HA experiment, due to its lower humification degree. At pilot-scale, under natural sunlight, 95% HA mineralization was obtained, consuming 42 mM of H2O2 and 5.9 kJUV L-1 of accumulated UV energy. However, a pre-oxidation during 2.8 kJUV L-1 (12 mM H2O2) was enough to obtain a biodegradability index of 89%, showing the strong feasibility to couple the SPFF process to a downstream biological oxidation, with low chemicals and energetic demands. Graphical abstract ᅟ.

Is there a correlation between the spinal instability neoplastic score and mechanical pain in patients with metastatic spinal cord compression? A prospective cohort study.

INTRODUCTION: The decision for selecting patients for surgical treatment of metastatic spinal cord compression (MSCC) is challenging even for experienced surgeons. Recently, the spinal instability neoplastic score (SINS) has been proposed to help surgeons in the evaluation of spinal stability in the setting of spinal metastases. This study aimed to evaluate the correlation between SINS and preoperative visual analog scale (VAS), as well as the pre- and post-operative association of the VAS and neurological function. METHODS: A prospective cohort study was conducted in a tertiary referral cancer center. Seventy-nine patients with MSCC were surgically treated from June 2012 to March 2015. Pain status before and after surgery was assessed using VAS score, and neurological status was evaluated using the American Spine Injury Association Impairment Scale (AIS) before and after surgery. Pain was classified as VAS (0-4) none or mild pain; VAS (5-8) moderate pain; and VAS (9-10) as severe pain. Neurological function was scored as AIS A: Complete deficits, AIS B-D: Incomplete deficits, AIS E: Neurologically intact. SINS degrees were classified as 0-6-stable; 7-12 potentially unstable, and 13-18-unstable. Spearman's correlation coefficient test was utilized for correlation between pain and SINS; Chi-square association test was utilized for evaluating pre- and post-operative pain and AIS, as well as the association between SINS and tumor types. RESULTS: A higher SINS correlates with severe mechanical pain preoperatively (ρ = 0.38, P = 0.001); surgical procedure improved neurological function (P = 0.0001), and decrease pain (P = 0.84). Finally, a higher SINS was also associated with osteolytic tumors (P = 0.03). CONCLUSIONS: The SINS correlates with mechanical pain. Surgery provides a significant improvement in pain and neurological status, especially in patients who presented higher SINS scores and some degree of preoperative neurological function.

Prevalência e Fatores Associados ao Consumo de Álcool e Tabaco entre Estudantes de Medicina no Nordeste do Brasil / Prevalence and Associated Factors of Alcohol Consumption and Smoking among Medical Students in Northeastern Brazil

RESUMO Introdução O consumo de derivados de tabaco e álcool é apontado como importante causa de doenças e agravos no mundo. No Brasil, há um aumento no consumo dessas drogas entre os jovens, principalmente estudantes universitários. Objetivo Conhecer a prevalência e os fatores associados ao tabagismo e consumo de bebidas alcoólicas entre estudantes de Medicina, além do nível de conhecimento acerca das técnicas de cessação do hábito tabagista em diferentes momentos da vida acadêmica. Métodos Estudo analítico, de prevalência, envolvendo estudantes de Medicina de Fortaleza, Ceará, Brasil. Foram selecionadas todas as escolas médicas e os estudantes do primeiro ano (S1/S2), quarto ano (S7/S8) e aqueles do último ano do internato (I3/I4). A amostra foi calculada considerando uma frequência esperada de 10% de pessoas fumantes, com um erro de 3%, estimando 726 estudantes das quatro instituições. Foi aplicado um questionário estruturado, com 46 perguntas. Os dados foram analisados pelo software Stata 11.2. Resultados Foram entrevistados 1.035 estudantes, distribuídos proporcionalmente nos três períodos, 392 (37,9%) do primeiro ano (S1-S2), 319 (30,8%) do quarto ano (S7-S8) e 324 (31,3%) do internato (I3-I4). Quinhentos e cinquenta e três (53,4%) eram do sexo feminino, a maioria era solteira (993; 96,3%), nascidos em Fortaleza (748; 72,4%), residiam com os pais (896; 86,8%) e com renda familiar acima de dez salários mínimos (652; 61,8%). Ao todo, 533 (51,5%) eram alunos de instituições particulares. Do total, 254 (24,6%) já haviam fumado. Esse consumo foi significativamente maior entre o sexo masculino (p = 0,025), sem diferença em relação ao estado civil (p = 0,247) ou renda familiar (p = 0,191). Todos os acadêmicos que experimentaram alguma substância derivada do tabaco já haviam ingerido bebida alcoólica alguma vez na vida (p < 0,000). O consumo de álcool foi referido por mais de 80% dos estudantes, sendo maior entre aqueles cuja família apresentou renda superior a nove salários mínimos (p = 0,001). Houve relato de embriaguez em mais de 70% dos estudantes, tendo esse fato ocorrido antes dos 18 anos. Cerveja e vodca são as bebidas mais consumidas. Apenas 39,5% afirmaram estar aptos a aconselhar um paciente a não ingerir bebidas alcoólicas e apenas 28,4% receberam algum treinamento sobre o assunto em sua universidade. Conclusão A prevalência do consumo de álcool é muito elevada entre os estudantes de Medicina, principalmente entre aqueles que relataram fumar. Esses temas são abordados de forma incipiente em sua formação. É preciso reforçar esses aspectos na formação desses futuros profissionais de saúde.

ABSTRACT Introduction Tobacco and alcohol consumption is considered a major cause of diseases and disorders in the world. In Brazil, there has been increased consumption of these drugs among young people, especially university students. Objective To discover the prevalence of and factors associated to smoking and alcohol consumption among medical students, as well as their level of knowledge about techniques to stop smoking at different times of their academic life. Methods Analytical study of prevalence among medical students in Fortaleza, Ceará, Brazil. The study sample included all the city's medical schools and their first year (S1/S2) and fourth year (S7/S8) students and students in the final year of their internship (I3/I4). The sample was calculated considering an expected smoker frequency of 10%, with a 3% margin of error, estimating 726 students in the four institutions. A structured questionnaire containing 46 questions was applied. Data were analyzed using Stata 11.2 software. Results 1,035 students were interviewed, distributed proportionally in the three periods: 392 (37.87%) from the first year (S1 / S2), 319 (30.82%) from the fourth year (S7/S8) and 324 (31.30%) interns (I3/I4). 553 students (53.4%) were female; most of the students were single (993; 96.3%), born in Fortaleza (748; 72.4%), living with their parents (896; 86.8%) and with a household income of more than 10 minimum wages (652; 61.8%). In total, 533 (51.5%) were students at private institutions. Of the total, 254 (24.6%) had smoked. This consumption was significantly higher among males (p = 0.025), with no difference in relation to marital status (p = 0.247) or household income (p = 0.191). All the students who reported having experienced any tobacco derivative also reported using alcohol in their lifetime (p < 0.000). Alcohol consumption was reported by more than 80% of the students, and was higher among those whose family income was more than nine times the minimum wage (p = 0.001). Alcoholic intoxication was reported by over 70% of the students - where this had occurred before the age of 18 years. Beer and vodka are the most consumed beverages. Only 39.5% said they were inclined to advise a patient to avoid alcoholic beverages and only 28.4% had received training on the subject at their university. Conclusion The prevalence of alcohol consumption is very high among medical students, especially among those who reported smoking. These issues are addressed in a primitive manner in their training. We must strengthen these aspects in the training of future health professionals.