Assessment of Human Health Risk Indices Due to Metal Contamination in the Surface Water of the Negro River Sub-Basin, Áncash.

The accelerated loss of glacial cover in the Cordillera Blanca in Áncash, Peru, exposes the underlying rocks with high concentrations of sulfides from the Chicama Formation to oxidation and leaching processes, generating acid rock drainage (ARD) in glacial and periglacial areas. These are transported by surface runoff, contaminating the surface water with high concentrations of metals and sulfates, as well as increasing the acidity, which poses a risk to human health and the ecosystem. Therefore, the risk indices for human health due to metal contamination were evaluated at 19 surface water sampling points distributed in the Río Negro sub-basin. Hydrochemical analyses revealed average metal concentrations in the following order: Fe (28.597 mg/L), Al (3.832 mg/L), Mn (1.085 mg/L), Zn (0.234 mg/L), Ni (0.085 mg/L), Co (0.053 mg/L), Li (0.036 mg/L), Cu (0.005 mg/L), and Pb (0.002 mg/L). The risk was determined by calculating the Heavy Metal Pollution Index (HPI) and the Hazard Index (HI). The average HPI value was 360.959, indicating a high level of contamination (HPI ≥ 150). The human health risk assessment indicated that adverse effects caused by iron, lithium, and cobalt in children and adults should be considered. Through the use of Pearson correlation analysis, principal component analysis, and cluster analysis, it was identified that SO42-, Fe, S, Al, Co, Mn, Ni, Zn, and Li originate from natural sources, associated with the generation of ARD in glacial and periglacial areas.

Desensitizing the autonomic nervous system to mitigate anti-GD2 monoclonal antibody side effects.

Background: Anti-GD2 monoclonal antibodies (mAbs) have shown to improve the overall survival of patients with high-risk neuroblastoma (HR-NB). Serious adverse events (AEs), including pain, within hours of antibody infusion, have limited the development of these therapies. In this study, we provide evidence of Autonomic Nervous System (ANS) activation as the mechanism to explain the main side effects of anti-GD2 mAbs. Methods: Through confocal microscopy and computational super-resolution microscopy experiments we explored GD2 expression in postnatal nerves of infants. In patients we assessed the ANS using the Sympathetic Skin Response (SSR) test. To exploit tachyphylaxis, a novel infusion protocol (the Step-Up) was mathematically modelled and tested. Results: Through confocal microscopy, GD2 expression is clearly visible in the perineurium surrounding the nuclei of nerve cells. By computational super-resolution microscopy experiments we showed the selective expression of GD2 on the cell membranes of human Schwann cells in peripheral nerves (PNs) significantly lower than on NB. In patients, changes in the SSR were observed 4 minutes into the anti-GD2 mAb naxitamab infusion. SSR latency quickly shortened followed by gradual decrease in the amplitude before disappearance. SSR response did not recover for 24 hours consistent with tachyphylaxis and absence of side effects in the clinic. The Step-Up protocol dissociated on-target off-tumor side effects while maintaining serum drug exposure. Conclusion: We provide first evidence of the ANS as the principal non-tumor target of anti-GD2 mAbs in humans. We describe the development and modeling of the Step-Up protocol exploiting the tachyphylaxis phenomenon we demonstrate in patients using the SSR test.

Synthesis and Sensing Response of Magnesium Antimoniate Oxide (MgSb2O6) in the Presence of Propane Atmospheres at Different Operating Voltages.

Nanoparticles of MgSb2O6 were synthesized using a microwave-assisted wet chemistry method, followed by calcination at 700 °C. Their ability to detect different concentrations of propane gas (C3H8) at various operating voltages was evaluated. The material's crystalline phase was identified using X-ray powder diffraction (XRD). The morphology was analyzed by scanning electron microscopy (SEM), finding bar- and polyhedron-type geometries. Through transmission electron microscopy (TEM), we found particle sizes of 8.87-99.85 nm with an average of ~27.63 nm. Employing ultraviolet-visible (UV-Vis) spectroscopy, we found a band gap value of ~3.86 eV. Thick films made with MgSb2O6 powders were exposed to atmospheres containing 150, 300, 400, and 600 ppm of propane gas for dynamic testing. The time-dependent sensitivities were ~61.09, ~88.80, ~97.65, and ~112.81%. In addition, tests were carried out at different operating voltages (5-50 V), finding very short response and recovery times (~57.25 and ~18.45 s, respectively) at 50 V. The excellent dynamic response of the MgSb2O6 is attributed mainly to the synthesis method because it was possible to obtain nanometric-sized particles. Our results show that the trirutile-type oxide MgSb2O6 possesses the ability, efficiency, and thermal stability to be applied as a gas sensor for propane.

Síndrome de hueso hambriento en pacientes con paratiroidectomía

Introducción: El síndrome de hueso hambriento (SHH) es una complicación asociada a la realización de una paratiroidectomía, definido por la persistencia de más de 4 días de hipocalcemia (Calcio sérico menor a 8,5 mg/dl) con requerimiento de suplementación de calcio endovenoso. Este es el primer estudio realizado en Colombia, que tiene el objetivo de precisar la prevalencia de SHH en un Hospital de referencia en Latinoamérica. Metodología: Se realizó un estudio de corte transversal retrospectivo, se revisaron los registros de historias clínicas de pacientes con antecedente de hiperparatiroidismo primario, secundario y terciario que requirieron paratiroidectomía parcial o total en el Hospital de San José de Bogotá, entre Enero del 2013 y Diciembre de 2021. Resultados: Se identificaron 247 pacientes con diagnóstico de hiperparatiroidismo, la mayoría de los pacientes (65,1%) fueron hombres, con una edad mediana de 50,9 años (rango de 25 a 71 años). La prevalencia del SHH fue del 11,7%, con una relación mujer-hombre de 1.5:1, no hubo casos de patología maligna. Los niveles de hormona paratiroidea séricos preoperatorios tuvieron una correlación estadísticamente significativa con los niveles de hormona paratiroidea postquirúrgica. Conclusiones: El síndrome de hueso hambriento es una complicación que puede presentarse posterior a la realización de una paratiroidectomía. Este estudio presenta una prevalencia más baja que la descrita en la literatura.

Introduction: The Hungry Bone Syndrome (HBS) is a rare complication associated with parathyroidectomy, defined as hypocalcemia (serum calcium less than 8,5 mg/dl) that persist more than 4 days and requires intravenous calcium supplementation. This is the first study made in Colombia with the objective to determine the prevalence of HBS in a reference hospital in Latin America. Methods: A retrospective cross-sectional study was conducted; medical records were reviewed from patients with medical history of primary, secondary, and tertiary hyperparathyroidism that require partial or total parathyroidectomy in San Jose Hospital in Bogota, between January 2013 and December 2021. Results: 247 patients were identified with hyperparathyroidism, most patients were males (65.1%), with a mean age of 50.9 years old (range 25-71 years old). The prevalence of HBS was 11.7%, with a ratio women-men 1.5:1, no malignant pathology was described. Preoperative parathyroid hormone levels and postoperative parathyroid hormone levels were statistically significant. Conclusions: The Hungry Bone Syndrome is a complication that can be present after a parathyroidectomy. This study presents a lower prevalence than the literature described.

Analytical Modeling and Optimization of Cu2ZnSn(S,Se)4 Solar Cells with the Use of Quantum Wells under the Radiative Limit.

In this work, we present a theoretical study on the use of Cu2ZnSn(S,Se)4 quantum wells in Cu2ZnSnS4 solar cells to enhance device efficiency. The role of different well thickness, number, and S/(S + Se) composition values is evaluated. The physical mechanisms governing the optoelectronic parameters are analyzed. The behavior of solar cells based on Cu2ZnSn(S,Se)4 without quantum wells is also considered for comparison. Cu2ZnSn(S,Se)4 quantum wells with a thickness lower than 50 nm present the formation of discretized eigenstates which play a fundamental role in absorption and recombination processes. Results show that well thickness plays a more important role than well number. We found that the use of wells with thicknesses higher than 20 nm allow for better efficiencies than those obtained for a device without nanostructures. A record efficiency of 37.5% is achieved when 36 wells with a width of 50 nm are used, considering an S/(S + Se) well compositional ratio of 0.25.

Nitrogen-phosphorus codoped carbon nanotube sponges for detecting volatile organic compounds: experimental and DFT calculations.

The sensing of harmful gases and vapors is of fundamental interest to control the industrial emissions and environmental contamination. Nitrogen/phosphorus codoped carbon nanotube sponges (NP-CNTSs) were used to detect ethanol, acetone, cyclohexane, isopropanol, and methanol. The NP-CNTSs were produced through the aerosol-assisted chemical vapor deposition (AACVD) method using acetonitrile and triphenylphosphine as precursors at 1020 °C. The sensors based on NP-CNTSs were tested with varying operating temperatures (25-100 °C) and gas vapor concentrations (5-50 ppm). For instance, for a gas vapor concentration of 30 ppm and an operating temperature of 65 °C, the sensors showed changes in the electrical resistance of 1.12%, 1.21%, 1.09%, 2.4%, and 1.34% for ethanol, acetone, cyclohexane, isopropanol, and methanol, respectively. We found that the response and recovery times for isopropanol gas vapor are up to 43.7 s and 95 s, respectively. The current sensor outperformed the sensors reported in the literature by at least two times in the response measurement. Additionally, we performed van der Waals density functional theory calculations to elucidate the role of nitrogen and phosphorous codoped single-walled carbon nanotubes (SWCNTs) and their interaction with the considered gas molecule. We analyzed the molecular adsorption energy, optimized structures, and the density of states and calculated the electrostatic potential surface for N-doped, P-doped, NP-codoped, and OH-functionalized NP-codoped metallic SWCNTs-(6,6) and semiconducting SWCNTs-(10,0). Adsorption energy calculations revealed that in most cases the molecules are adsorbed to carbon nanotubes via physisorption. The codoping in SWCNTs-(6,6) promoted structural changes in the surface nanotube and marked chemisorption for acetone molecules.

Enhanced Low-Velocity Impact Properties for Resin Film Infusion-Manufactured Composites by Flow-Control Approach.

The optimization of the mechanical properties of composite materials has been a challenge since these materials were first used, especially in aeronautics. Reduced energy consumption, safety and reliability are mandatory to achieve a sustainable use of composite materials. The mechanical properties of composites are closely related to the amount of defects in the materials. Voids are known as one of the most important defect sources in resin film infusion (RFI)-manufactured composites. Minimizing the defect content leads to maximized mechanical properties and lightweight design. In this paper, a novel methodology based on computer vision is applied to control the impregnation velocity, reduce the void content and enhance the impact properties. Optimized drop-impact properties were found once the impregnation velocity was analyzed and optimized. Its application in both conventional and stitching-reinforced composites concludes with an improvement in the damage threshold load, peak force and damaged area. Although stitching tends to generate additional voids and reduces in-plane properties, the reduction in the damaged area means a positive balance in the mechanical properties. At the same time, the novel methodology provides the RFI process with a noticeable level of automation and control. Consequently, the industrial interest and the range of applications of this process are enhanced.

Barriers and Benefits of the Scheduled Telephone Referral Model (DETELPROG): A Qualitative Approach.

The recently developed scheduled mobile-telephone referral model (DETELPROG) has achieved especially important results in reducing waiting days for patients, but it has been decided to explore what barriers and positive aspects were detected by both primary care physicians (PCPs) and hospital attending physicians (HAPs) regarding its use. For this, a qualitative descriptive study was carried out through six semi-structured interviews and two focus groups in a sample of eleven PCPs and five HAPs. Interviews were carried out from September 2019 to February 2020. Data were analysed by creating the initial categories, recording the sessions, transcribing the information, by doing a comprehensive reading of the texts obtained, and analysing the contents. The results show that DETELPROG gives the PCP greater prominence as a patient's health coordinator by improving their relationship and patient safety; it also improves the relationship between PCP and HAP, avoiding unnecessary face-to-face referrals and providing safety to the PCP when making decisions. The barriers for DETELPROG to be used by PCP were defensive medicine, patients' skepticism in DETELPROG, healthcare burden, and inability to focus on the patient or interpret a sign, symptom, or diagnostic test. For HAP, the barriers were lack of confidence in the PCP and complexity of the patient. As a conclusion, DETELPROG referral model provides a lot of advantages and does not pose any new barrier to face-to-face referral or other non-face-to-face referral models, so it should be implemented in primary care.

Pediatric SMA patients with complex spinal anatomy: Implementation and evaluation of a decision-tree algorithm for administration of nusinersen.

The approval of nusinersen for the treatment of spinal muscular atrophy (SMA) has significantly changed the natural history of the disease. Nevertheless, scoliosis secondary to axial muscle weakness occurs at some point in most of patients with SMA and a conventional posterior interlaminar approach for intrathecal administration of nusinersen can be particularly challenging to perform in patients with severe scoliosis and/or previous spine fusion surgeries. We developed a protocol for the administration of nusinersen in pediatric patients, which includes a decision-tree algorithm that categorizes patients according to the estimated technical difficulty for the intrathecal administration. Complex spine patients were defined as those with a Cobb angle greater than 50° and/or a history of spinal surgery, while the rest of patients were considered non-complex. Nusinersen was successfully administered through a conventional non-CT-guided lumbar puncture in all 14 non-complex spine patients (110 out of 110 procedures; 100%). The feasibility of the intrathecal injection in the 15 complex spine patients was assessed by 3D CT. Administration was considered unfeasible in 7 out of these 15 patients according to imaging. In the 8 complex spine patients in whom the administration was considered feasible, conventional non-CT-guided lumbar punctures were successful only in 19 out of 53 procedures (36%). The remaining 34 procedures (64%) were guided by CT scan, all successful. Our work demonstrates that a cut-off point of 50° in Cobb angle and history of spinal surgery can reliably be used to anticipate the need for CT guidance in nusinersen administration.

Treatment of tequila vinasse and elimination of phenol by coagulation-flocculation process coupled with heterogeneous photocatalysis using titanium dioxide nanoparticles.

In this research, we are reporting the treatment of tequila vinasse by a coagulation-flocculation process coupled with heterogeneous photocatalysis using two types of titanium dioxide nanoparticles, i.e. (1) commercial nanoparticles, and (2) nanoparticles synthesized by sol-gel. The efficiency in the elimination of phenol, which is one of the most harmful contaminants in tequila vinasse, was also included in the evaluation of the treatment process. The synthesized titanium dioxide nanoparticles were annealed in air at 400°C for 1 h and were characterized by X-ray diffraction, transmission electron microscopy, ultraviolet-visible and Raman spectroscopy. Anatase phase was observed in both samples, with a crystallite size of 22.5 and 9.8 nm for commercial and synthesized nanoparticles respectively. Tequila vinasse was characterized before and after the treatments by measuring physicochemical parameters such as pH, chemical oxygen demand (COD), colour, total suspended solids (TSS), as well as using ultraviolet-visible spectroscopy and Raman spectroscopy to identify the presence of organic compounds, and gas chromatography (GC) for phenol quantification. Raw vinasse was treated initially by coagulation-flocculation producing clarified vinasse, which in turn was treated by photocatalysis for 3 h using hydrogen peroxide as oxidizing agent. The use of synthesized titanium dioxide nanoparticles allowed the highest efficiencies, reaching reductions of 99.4%, 86.0%, and 70.0% for TSS, colour, and COD respectively. GC results showed the reduction of phenol concentrations in 89.7% with our synthesized nanoparticles in contrast to 82.7% reduction, with commercial titanium dioxide nanoparticles.

Postpartum Bilateral Tension Pneumothoraces.

We report the first case report of postpartum bilateral tension pneumothoraces. A 31-year-old primigravida presented with obstructive shock and respiratory failure five days following a normal spontaneous vaginal delivery. Bilateral surgical chest drains were inserted and following computed tomography suggestive of an underlying interstitial lung disease she was transferred to a tertiary cardiothoracic centre. Video-assisted thoracic surgery was carried out with left apicectomy and parietal pleurectomy. Histopathology supported a diagnosis of pulmonary lymphangioleiomyomatosis. We discuss the pathophysiology of labour-induced barotrauma and examine pertinent elements of the acute management of this case.

Effectiveness of high-flow nasal oxygen therapy in management of acute hypoxemic and hypercapnic respiratory failure.

BACKGROUND: High-flow nasal oxygen therapy (HFNOT) therapy has been increasingly used in patients with acute hypoxemic (Type I) respiratory failure (RF). Meanwhile indications and clinical effectiveness of HFNOT in patients with hypercapnic (Type II) RF remain controversial. The aim of our study was to evaluate the outcomes of primary HFTNOT in patients with hypoxemic and hypercapnic RF. MATERIALS AND METHODS: We conducted a retrospective observational study of patients diagnosed with severe community acquired pneumonia (CAP), who required HFNC oxygen therapy for hypoxemia. Primary end-point was intubation or escalation to NIV rate after HFNOT. The secondary endpoint was the 30-day mortality after an admission regardless of the cause. RESULTS: Analysis was conducted on all 51 (n = 51) patients. Of these, 32 (63%) were diagnosed with Type I RF and 19 (37%) with Type II RF. The partial pressure of arterial carbon dioxide (PaCO2) in Type I RF patients was 34.05 mmHg at admission and decreased to 33.07 mmHg after 1 hour of HFNOT. In patients with Type II RF PaCO2 decreased from 56.47 to 54.97 mmHg. In Type I RF successful outcome was achieved in 25 patients (78%) compared to 11 patients (58%) with Type II RF. Escalation was required in seven patients with Type I RF and eight patients in Type II group. There were no mortalities in our population group. CONCLUSIONS: Our data suggest that HFNOT can be effectively used in Type I and Type II RF. Clinicians should be cautious identifying patients at risk of escalation. A larger population group study is needed to identify predictors of HFNOT failure.

Metformin poisoning treated with high dose insulin dextrose therapy: a case series.

PURPOSE: We describe the compassionate use of high dose insulin dextrose (HID) for life threatening metformin associated lactic acidosis (MALA) in four patients admitted to intensive care. METHODS: Patients presenting with refractory lactic acidosis believed to be secondary to metformin poisoning were included.High dose insulin dextrose at 0.5units/kg/hour was infused in 50% dextrose. Frequent blood gas analysis allowed titration of therapy. All patients also received continuous veno-venous haemofiltration. RESULTS: All four patients recovered to normal or near normal lactate and pH between 10 and 24 hours of therapy. Two patients had significant separation in time between initiation of HID and haemofiltration to suggest an independent effect of HID on improving pH and lactate.All patients had at least one episode of hypoglycaemia below 4.0 mmol/L with the lowest glucose in any patient during therapy being 3.0 mmol/L. All episodes were corrected with a dextrose infusion without sequelae. CONCLUSIONS: Our study demonstrates that HID therapy appears to be safe in patients with suspected metformin poisoning. It also appears to work to drive down lactate, improve pH and patients' clinical condition. Further evidence is required to assess the effectiveness of HID therapy in the context of MALA.

Identification and prioritisation of risks in a hospital pharmacy using healthcare failure mode and effect analysis.

OBJECTIVES: The goals of this project included identifying the processes and subprocesses performed in hospital pharmacies, identifying potential adverse events, detecting failure modes and the causes of errors, prioritising the risks identified and designing a map of risks for hospital pharmacies. METHODS: A task force composed of hospital pharmacy staff was committed to update the diagram of processes and design a map of processes performed in hospital pharmacies. Risks were identified by failure mode and effect analysis annd prioritised according to their risk priority index (RPI) and criticality. A risk map of adverse events was designed based on the diagram of processes and/or primary activities where the prioritised failure modes were most frequent. RESULTS: In total, 99 failure modes associated with 80 adverse events and 129 causes were identified in eight hospital pharmacy areas/subprocesses. The three areas with the highest percentages of failure modes were inpatient pharmaceutical care, pharmacy laboratory and pharmaceutical technology, and medication management. The 25 failure modes (first quartile) with the highest RPI scores (RPI≥20) and the 25 failure modes with the highest frequency and criticality scores were classified as priority. CONCLUSIONS: According to their RPI, priority failure modes mostly occurred in the area of inpatient pharmaceutical care (92%). However, according to their criticality, priority failure modes were found to homogeneously occur across all pharmaceutical care areas. As general recommendations pharmacists should assume responsibility and leadership in the implementation of safe medication use practices in healthcare centres.

DETELPROG Study. Effectiveness of a New Model of Scheduled Telephone Referral from Primary Care to Internal Medicine. A Randomised Controlled Study.

In Spain, the average waiting time for a specialist consultation is 58 days. A determinant factor that contributes to this situation is the poor communication between primary care and specialised care, which is mainly due to the waiting days for a consultation, number of avoided/avoidable face-to-face referrals, and waiting days for the resolution of the process. DETELPROG is a referral system in which the family physician requests a scheduled outpatient internal medicine consultation, integrated into the usual consultations agenda of both physicians, the family, and the outpatient clinic physician, in order to have a telephone consultation. A randomized controlled clinical trial has been carried out to assess the effectiveness of DELTELPROG. In a sample of 255 patients, the experimental group was referred via a scheduled telephone call, and those in the control group, by face-to-face hospital consultation area. The results showed statistically significant differences between both groups of 27 days (95% confidence interval (CI): 20-33) regarding specialised consultation, 47 days (95% CI: 17-74) as for the resolution of the process, and 91.7% for avoided face-to-face consultations. The DETELPROG resulted as a low coverage system (53%), which makes it a complementary referral model. It is necessary to make an in-depth analysis of the causes that have led to this technologically low coverage.

Efectividad de un nuevo modelo de derivación telefónica compartida entre atención primaria y atención hospitalaria / Effectiveness of a new model of telephone derivation shared between primary care and hospital care

Objetivo: Averiguar si la derivación telefónica desde Atención Primaria a consultas externas de Medicina Interna (CCEE de MI) reduce días de espera, con respecto a la derivación presencial. Averiguar la aceptación de la consulta telefónica por parte de los médicos de familia (MF) de Atención Primaria y de sus pacientes. Diseño: Ensayo clínico controlado aleatorizado sin enmascaramiento. Emplazamiento: Área de Gestión Sanitaria Norte de Huelva. Participantes: Ciento cincuenta y cuatro pacientes. Intervenciones: Los pacientes de los MF del grupo experimental fueron derivados vía telefónica (salvo cumplimiento criterios exclusión) y los del grupo control vía presencial. Mediciones: Número de días desde la solicitud de derivación hasta la consulta en MI. Número de derivaciones telefónicas y presenciales. Número de médicos y de pacientes rechazados. Causas de los rechazos. Resultados: Diferencia estadísticamente significativa, estimándose en 27 (21-34) días entre ambos grupos. De los 58 MF, 8 prealeatorización, y 6 de los 20 asignados al grupo experimental rechazaron participar por «suponer consumo excesivo de tiempo y esfuerzo». Para un 50% de los pacientes derivados por los 14 MF que quedaron finalmente en el grupo experimental se rechazó la vía telefónica, siendo la complejidad de los pacientes la principal causa. Conclusiones: La derivación telefónica reduce considerablemente los días de espera para CCEE de MI, elimina las principales barreras de la consulta telefónica a tiempo real, no supuso un mayor gasto de tiempo ni de esfuerzo para los médicos y no se consideró tan beneficiosa en pacientes complejo

Aim: The purpose of this study is to find out whether telephone referral from Primary Health Care to Internal Medicine Consult manages to reduce waiting days as compared to traditional referral. This study also aims to know how acceptable is the telephone referral to general practitioners and their patients. Design: No blind randomized controlled clinical trial. Setting: Northern Huelva Health District. Participants: 154 patients. Interventions: Patients referrals from intervention clinicians were sent via telephone consultation, whereas patients referrals from control clinicians were sent by traditional via. Measurements: Number of days from referral request to Internal Medicine Consult. Number of telephone and traditional referrals. Number of doctors and patients denied. Denial reasons. Results: A statistically significant difference was found between groups, with an average of 27 (21-34) days. Among General Practitioners, 8 of the first 58 total doctors after randomization and, subsequently, 6 of the 20 doctors of the test group refused to engage in the trial because they considered "excessive time and effort consuming". 50% of patients referred by the 14 General Practitioners finally randomized to the intervention group were denied referral by telephone due to patient's complexity. Conclusions: Telephone referral significantly reduces waiting days for Internal Medicine consult. This type of referral did not mean an "excessive time and effort consuming" to General Practitioners and was not all that beneficial to complex patients