Thermal evaluation of plant biomass from the phytostabilisation of soils contaminated by potentially toxic elements.

The combination of phytoremediation of soils contaminated by potentially toxic elements with energy production by combustion of the generated biomass can be a sustainable land management option, combining the production of renewable bioenergy with soil restoration while minimising energy consumption and CO2 emission. In this work, plant biomass from phytoremediation of soils contaminated by potentially toxic elements was studied as solid biofuel for combustion by thermal analysis and biomass composition. Six plant species were grown in two soils with differing degrees of contamination: Brassica juncea, Cynara cardunculus, Atriplex halimus, Nicotiana glauca, Dittrichia viscosa, Retama sphaerocarpa and Salvia rosmarinus. The composition of the plant biomass was characterised chemically and thermogravimetric analyses were performed for the mass loss (TG), derivative curves of mass loss (DTG) and temperature difference (DTA) signal. The cellulose concentration correlated with the parameters of the thermal analysis in the low temperature range (150-350 °C), while lignin correlated with the thermal parameters of the second peak in the high temperature range. Salvia rosmarinus and R. sphaerocarpa showed the best combustion characteristics according to the thermal profile and mineral residue results. The accumulation of potentially toxic elements in B. juncea grown in heavily contaminated soil led to a higher amount of residue at 750 °C, with a global activation energy lower than the one obtained when this species was grown in a soil with lower contamination. Therefore, the most beneficial combination of soil phytoremediation and energy production (combustion) that can be suggested would depend on the level of soil contamination: in heavily contaminated soil, phytostabilisation using R. sphaerocarpa and S. rosmarinus; in slightly contaminated soil, B. juncea due to its high energy of activation, although the concentrations of potentially toxic elements in the residue must be controlled, as well as possible particulate matter emissions during combustion.

Acalasia en obesos mórbidos: reporte de casos / Achalasia in morbidly obese patients: report of two cases

Achalasia is uncommon in morbidly obese patients. We report two patients with both conditions. A 71 years old diabetic male with a body mass Índex (BMI) of 36 kg/m . He consulted for dysphagia and a manometry showed a lack of relaxation of the lower esophageal sphincter. He was subjected to unsuccessful pneumatic dilatations in two occasions. Finally the patient was subjected to a total gastrectomy and Roux en Y esophago-jejunal anastomosis. Eight months after surgery the patient reports slight dysphagia and lost 24 kg. A 66 years old male with a BMI of 44 kg/m² consulting for regurgitation. Manometry confirmed the diagnosis of achalasia. The patient was subjected to a esophagomyotomy, subtotal gastrectomy and Roux en Y gastro jejunal and jejuno-jejunal anastomosis. Two years after surgery the patient had a slight dysphagia and lost 20 kg.

La acalasia es un trastorno de la motilidad esofágica que tiende a producir baja de peso, siendo rara su presentación en obesos mórbidos. Existen pocos reportes de casos en la literatura. Se presentan 2 casos de pacientes con el diagnóstico de acalasia y obesidad mórbida, uno de ellos tratado con Gastrectomía total y el otro con Esofagomiotomía asociada a Bypass gástrico. Ambos pacientes evolucionaron en buenas condiciones. Finalmente se realiza un análisis de la literatura.

Demencia, una enfermedad evolutiva: demencia severa. Identificación de demencia terminal / Dementia, a progressive disease: severe dementia. Identification of end-stage dementia

El envejecimiento de la población determina un aumento de la prevalencia e incidencia de las personas afectadas de demencia. La enfermedad de Alzheimer es la demencia más frecuente y en la presente revisión nos referimos a ella cuando se evalúa el curso evolutivo y el pronóstico de ésta, a pesar de que muchos aspectos pueden ser extrapolables a otros tipos de demencia. A pesar del gran despliegue en los últimos años de educación pública sobre la demencia, ésta continúa siendo responsable de un gran impacto sobre el paciente, el cuidador principal y/o familia y la sociedad en general. El diagnóstico de demencia acorta la esperanza de vida. Si bien en general se estima que el tiempo medio de supervivencia se sitúa alrededor de los 10 años, éste varía de una persona a otra en función de diferentes factores. A través de diferentes escalas, como la Global Deterioration Scale (GDS), complementada con la Functional Assessment Staging (FAST), es posible monitorizar la progresión de la enfermedad e identificar aquellos pacientes que se encuentran en fase terminal, en ausencia de factores pronósticos de mala evolución, a fin de aplicar todos aquellos cuidados que aseguren un adecuado final de vida en pacientes con demencia (AU)

Because of the aging population, the incidence and prevalence of dementia has increased. The most common form of dementia is Alzheimer's disease. The present review focusses on the progression and prognosis of this disease, although many of the issues discussed can be extrapolated to other types of dementia. Despite public education efforts in recent years, dementia continues to have a tremendous impact on the patient, the primary caregiver and/or family and society in general. A diagnosis of dementia shortens life expectancy. Mean survival time is generally about 10 years but varies from person to person, depending on several factors. Through various scales, such as the Global Deterioration Scale (GDS), complemented by Functional Assessment Staging (FAST), disease progression can be monitored and patients who are terminally ill can be identified in the absence of factors of poor outcome. Thus, the correct measures can be implemented to ensure an appropriate end of life in patients with dementia (AU)

[Dementia, a progressive disease: severe dementia. Identification of end-stage dementia]. / Demencia, una enfermedad evolutiva: demencia severa. Identificación de demencia terminal.

Because of the aging population, the incidence and prevalence of dementia has increased. The most common form of dementia is Alzheimer's disease. The present review focuses on the progression and prognosis of this disease, although many of the issues discussed can be extrapolated to other types of dementia. Despite public education efforts in recent years, dementia continues to have a tremendous impact on the patient, the primary caregiver and/or family and society in general. A diagnosis of dementia shortens life expectancy. Mean survival time is generally about 10 years but varies from person to person, depending on several factors. Through various scales, such as the Global Deterioration Scale (GDS), complemented by Functional Assessment Staging (FAST), disease progression can be monitored and patients who are terminally ill can be identified in the absence of factors of poor outcome. Thus, the correct measures can be implemented to ensure an appropriate end of life in patients with dementia.

Uso de antibióticos profilácticos en pancreatitis aguda grave: ¿es útil? / Prophylactic antibiotics in severe acute pancreatitis: are they useful?

The use in intravenous antibiotics in prophylaxis of acute necrotizing pancreatitis is still an issue under active debate, and consensus have not been accomplished yet. The main goal of this prophylaxis is the impregnation of pancreatic tissue with antibiotics, in order to prevent the bacterial colonization, ensuing the microbial translocation from the gut. Different experts have developed different approaches to this issue, each one with argumentation for the defense or the rejection of prophylactic use of antibiotics. Our review reveled strong evidence that nobody has demonstrated yet a real benefit, in terms of lower mortality or decreased rate of infections, with the prophylactic use of antibiotics in pancreatic necrosis. Many groups have reported a decrease in numbers of infections or mortality, but without statistical significance. In some series the use of prophylactic antibiotics decreased the length of stay, but no correlation with changes in mortality or infection rate in pancreatic necrosis was established. The indication of antibiotic prophylaxis in a sterile necrotic pancreatic tissue is a decision that involves several factors as: the individual clinical assessment of every case, the knowledge about the pathogenic flora and of the bacterial spectrum and tissue penetration of the antimicrobial agent, and, also, its cost-effectiveness and toxicity. The criteria used by some hospitals in the country is the antibioprophylaxis is a cases whose pancreatic necrosis exceeds 30 percent in abdominal CT scan with contrast medium, as in these cases severity increases twofold, but there has not been shown significant reduction of morbility in these cases corresponding to an evidence type II. Consequently and according to the available reports we dont't recommend the prophylactic use of antibiotics in pancreatic necrosis. A promising field, shown in a dutch study by Luiten & cols is the selective decontamination of the gut with non absorbable antibiotics...

El uso de antibióticos endovenosos en la profilaxis de la pancreatitis aguda necrótica, es un tema vigente en plena discusión. No existe un consenso con respecto a su utilidad. La profilaxis antibiótica tiene como objetivo primordial impregnar el tejido pancreático con antibióticos que prevengan luego la colonización a partir de la translocación bacteriana del tubo digestivo. Distintos grupos de expertos han tomado diferentes posturas al respecto, utilizando diversos argumentos para defenderse, o rechazar el uso de antibióticos profilácticos. Nuestra revisión muestra de manera bastante contundente que ningún grupo ha logrado demostrar que el uso de antibióticos entregue beneficios en cuanto a prevenir la mortalidad o disminuir la infección de la necrosis pancreática o de su mortalidad. En algunas series el uso de antibióticos disminuyó la permanencia hospitalaria, pero esto no se relacionó con cambios en la mortalidad ni en la infección de la necrosis. La indicación de antibioprofilaxis en tejido pancreático necrótico estériles es una decisión que implica considerar varios factores tales como: evaluación clínica individual de cada caso; conocimiento de la flora patógena así como del espectro y penetración del antimicrobiano, pero también su costo-efectividad y su toxicidad. Una conducta utilizada en algunos centros hospitalarios del país consiste en la indicación de antibióticos profilácticos en necrosis pancreática mayores del 30 por ciento estimadas al TAC abdominal con contraste, valor sobre el cual la gravedad se duplica, pero la experiencia no avala una reducción significativa de la mortalidad en estos casos que corresponden a un nivel de evidencia tipo II. En consecuencia y en base a los estudios disponibles no recomendamos el uso de antibióticos profilácticos en la necrosis pancreática. Un aspecto promisorio, demostrado por el estudio holandés de Luiten y cols es el uso de la descontaminación selectiva del tracto digestivo con antibióticos...