ABSTRACT
Objetivo. Evaluar la capacidad de inmovilización microbiana de algunos polímeros sintéticos, y establecer su desempeño durante la partida y operación de un reactor biológico híbrido (RBH), aplicado al tratamiento de aguas residuales domésticas. Métodos. Para la evaluación fueron seleccionados cinco polímeros: tereftalato de polietileno (PET), polibutadieno (BD), espuma de poliuretano (EPU), poliestireno expandido (EPS) y polietileno (P). Los materiales con mayor capacidad de inmovilización (expresado como la cantidad de unidades formadoras de colonias contenidas en un gramo de material, UFCg-1), fueron incorporados a un RBH, con volumen operacional de 10,4L, alimentado con agua residual sintética. La eficiencia del sistema fue establecida en términos de remoción de la materia orgánica contenida en el afluente durante 13 días de operación continua. Resultados. Los polímeros que presentaron mayor capacidad de inmovilización fueron: BD (2,2x10(7) UFCg-1) y EPU (4,6x10(7) UFCg-1). El RBH, sometido a una carga orgánica volumétrica de 2,7 Kg DQO m-3d-1, presentó estabilidad operativa en todos los tratamientos evaluados, alcanzando una remoción de materia orgánica de 78% y 94%, al emplear BD y EPU como soportes de inmovilización, respectivamente.
Objective. Evaluate the ability of microbial immobilization of several synthetic polymers, and establish its performance during the start-up and operation of a hybrid biological reactor (HBR), applied to domestic wastewater treatment. Methods. For evaluation we selected five polymers: polyethylene terephthalate (PET), polybutadiene (BD), polyurethane foam (PUF), expanded polystyrene (EPS) and polyethylene (PE). Materials with higher immobilization capacity (expressed as the number of colony forming units contained in one gram of material, CFUg-1) were added to a HBR, with operational volume of 10,4L, fed with synthetic wastewater. The efficiency of the system was established in terms of removal of organic matter contained in the effluent for 13 days of continuous operation. Results. Polymers showing the high immobilization capacity were: BD (2,2x10(7) CFUg-1) and PUF (4,6x10(7) CFUg-1). The HBR, subjected to organic loading rate of 2.7 kg COD m-3d-1, showed operational stability for the treatments evaluated, reaching a removal of organic matter of 78% and 94%, by using BD and PUF as immobilization supports, respectively.
Subject(s)
Humans , Water Microbiology , Water Quality , Water Treatment Plants , WastewaterABSTRACT
The care of the child with a tracheostomy deserves special attention because of the potential devastating airway compromise and because of the need of competent care by caregivers and professionals. The recommendations on tracheostomy care published are few and approaches are inconsistent among different institutions. This clinical consensus statement aims to improve care for children with tracheostomies. A literature search was conducted, reviewed and revised by this group of experts, who concurred with these statements, based on the best evidence available and taking into account the local context.
El cuidado del niño con traqueostomía merece especial atención por el potencial riesgo para la vida que podría ocasionarse con el compromiso súbito de la vía aérea y por la necesidad de contar con cuidadores y profesionales competentes para su cuidado. Los objetivos principales de este consenso son unificar criterios, promover prácticas seguras, fomentar el uso racional de los recursos y contribuir a optimizar la calidad de vida de los niños con traqueostomías y sus familias. Para poder cumplir con estos propósitos, se realizó una búsqueda exhaustiva de la literatura científica; se seleccionó, sobre la base del análisis crítico, la mejor evidencia disponible; y se formularon, por consenso interdisciplinario, una serie de recomendaciones prácticas y adaptables al contexto local.
Subject(s)
Tracheostomy , Child , Consensus , Humans , Practice Guidelines as TopicABSTRACT
INTRODUCTION: Diagnosis of acute appendicitis is difficult in nearly 30% of patients with pain in low right quadrant. Diagnostic imaging may provide a means of a more accurate diagnosis. OBJECTIVE: The cost-effectiveness of diagnostic image tests was calculated for comparison with routine physical examination in patients with abdominal pain suspected to be appendicitis. MATERIALS AND METHODS: A cost-effectiveness protocol was designed, using a decision analysis model. The standard case was a patient with abdominal pain in right lower quadrant and suspicion of appendicitis. Three independent diagnostic alternatives were selected--ultrasonography, abdominal tomography and physical exam in hospital with the subject under observation less than six hours. Operative characteristics, study design and costs of interventions and outcomes were assessed. The main outcome consisted of a confirmed diagnosis of appendicitis. The point of view taken was that of health maintenance organizations. Direct and indirect medical costs were measured. Time horizon used was three months. A one way sensitivity analysis was made. RESULTS: For a prepaid system, the most cost-effective strategy was abdominal tomography, with a cost-effectiveness ratio of US$965/diagnosed patient. For public system, the most cost-effective strategy was abdominal tomography, with a cost-effectiveness ratio of US$492/diagnosed patient. CONCLUSIONS: Imaging diagnostic methods, in cases of abdominal pain suspected to be appendicitis, are more cost-effective than physical exam to make accurate diagnostic decisions. Tomography offers the best cost-effectiveness in prepaid system and in public health system.
Subject(s)
Appendicitis/diagnosis , Appendicitis/economics , Cost-Benefit Analysis/economics , Tomography, X-Ray Computed/economics , Ultrasonography/economics , Abdominal Pain/diagnosis , Abdominal Pain/diagnostic imaging , Abdominal Pain/economics , Appendicitis/diagnostic imaging , Decision Support Techniques , Health Care Costs , Humans , Models, Economic , Treatment OutcomeABSTRACT
Introduction. Diagnosis of acute appendicitis is difficult in nearly 30 percent of patients with pain inlow right quadrant. Diagnostic imaging may provide a means of a more accurate diagnosis. Objective. The cost-effectiveness of diagnostic image tests was calculated for comparison with routine physical examination in patients with abdominal pain suspected to be appendicitis. Materials and methods. A cost-effectiveness protocol was designed, using a decision analysis model. The standard case was a patient with abdominal pain in right lower quadrant and suspicion of appendicitis. Three independent diagnostic alternatives were selected ultrasonography, abdominal tomography and physical exam in hospital with the subject under observation less than six hours. Operative characteristics, study design and costs of interventions and outcomes were assessed. The main outcome consisted of a confirmed diagnosis of appendicitis. The point of view taken was that of health maintenance organizations. Direct and indirect medical costs were measured. Time horizon used was three months. A one way sensitivity analysis was made. Results. For a prepaid system, the most cost-effective strategy was abdominal tomography, with a cost-effectiveness ratio of US$965/diagnosed patient. For public system, the most cost-effective strategy was abdominal tomography, with a cost-effectiveness ratio of US$492/ diagnosed patient. Conclusions. Imaging diagnostic methods, in cases of abdominal pain suspected to be appendicitis, are more cost-effective than physical exam to make accurate diagnostic decisions. Tomography offers the best cost-effectiveness in prepaid system and in public health system.
Subject(s)
Appendicitis/diagnosis , Cost-Benefit Analysis , Physical Examination , Tomography , Ultrasonography , Decision Support TechniquesABSTRACT
La meningitis por Listeria monocytogenes es una enfermedad infrecuente en la población pediátrica y más aún en pacientes inmunocompetentes. Presentamos un niño de cuatro años, previamente sano, que se internó con diagnóstico de síndrome meníngeo con líquido cefalorraquídeo patológico. Inicialmente se trató con cefotaxima y dexametasona, pero al persistir la fiebre, a las 48 horas se agregó vancomicina y aciclovir al tratamiento anterior. A las 72 horas se recibió el informe del líquido cefalorraquídeo(LCR) que mostró bacilos grampositivos, el cultivo informó Listeria monocytogenes, por lo cual se inició tratamiento con ampicilina y se suspendieron los antibióticos indicados previamente. Como complicaciones presentó estado epiléptico por hiponatremia con osmolaridad plasmática normal, a los 20 días evolucionó a una hidrocefalia aguda que requirió colocación de un sistema dederivación ventriculo peritoneal. Ponemos énfasis en la importancia de la tinción de Gram del LCR para orientar el tratamiento empírico inicial y en la observación del equilibrio hidroelectrolítico para disminuir la morbimortalidad en esta enfermedad grave
Subject(s)
Child, Preschool , Listeria monocytogenes , Meningitis/complications , Meningitis/diagnosis , Meningitis/therapyABSTRACT
La meningitis por Listeria monocytogenes es una enfermedad infrecuente en la población pediátrica y más aún en pacientes inmunocompetentes. Presentamos un niño de cuatro años, previamente sano, que se internó con diagnóstico de síndrome meníngeo con líquido cefalorraquídeo patológico. Inicialmente se trató con cefotaxima y dexametasona, pero al persistir la fiebre, a las 48 horas se agregó vancomicina y aciclovir al tratamiento anterior. A las 72 horas se recibió el informe del líquido cefalorraquídeo(LCR) que mostró bacilos grampositivos, el cultivo informó Listeria monocytogenes, por lo cual se inició tratamiento con ampicilina y se suspendieron los antibióticos indicados previamente. Como complicaciones presentó estado epiléptico por hiponatremia con osmolaridad plasmática normal, a los 20 días evolucionó a una hidrocefalia aguda que requirió colocación de un sistema dederivación ventriculo peritoneal. Ponemos énfasis en la importancia de la tinción de Gram del LCR para orientar el tratamiento empírico inicial y en la observación del equilibrio hidroelectrolítico para disminuir la morbimortalidad en esta enfermedad grave(AU)
Subject(s)
Child, Preschool , Meningitis/complications , Meningitis/diagnosis , Meningitis/therapy , Listeria monocytogenesABSTRACT
OBJECTIVE: Describe modes of death and factors involved in decision-making together with life support limitation (LSL) procedures. DESIGN: Prospective, descriptive, longitudinal, and noninterventional study. SETTING: Sixteen pediatric intensive care units in Argentina. PATIENTS: Every patient who died during a 1-yr period was included. MEASUREMENTS AND MAIN RESULTS: Age, sex, length of stay (LOS), primary and admission diagnosis, underlying chronic disease (CD), postoperative condition (PO). Deaths were classified in four groups: a) failed cardiopulmonary resuscitation (CPR); b) do-not-resuscitate (DNR) status; c) withholding or withdrawing life-sustaining treatment (WH/WD); and d) brain death (BD). Justifications were classified as a) imminent death; b) poor long-term prognosis; c) poor quality of life; and d) family request. Data were collected from medical records and interviews with the attending physicians. Descriptive statistics were performed. Differences among groups were analyzed through contingency tables and analysis of variance when required. Relative risks and confidence intervals of variables potentially related to LSL were analyzed, and logistic regression was performed. There were 6358 admissions and 457 deaths. CPR was performed in 52%, DNR in 16%, WH/WD in 20%, and BD in 11% of dead patients. BD patients were older, LOS and CD prevalence were higher in the WH/WD group. Inotropic drugs were the most frequently limited treatment in 110 patients (55%), CPR in 72 (35.6%), and mechanical ventilation in 63 (31%). Imminent death was the most frequently reported justification for LSL. CD and more staff were associated with a higher probability of LSL. CONCLUSIONS: Most of the patients in Argentina underwent CPR before their death. We have a high proportion of patients with CD (65%) and low BD diagnosis. PO condition decreased LSL probability in chronically ill patients. Do-not-resuscitate orders and withholding new treatments were the most common LSL. Active withdrawal was exceptional. The Ethics Committee was consulted in 5% of the LSL population.
