Critical review of technologies for the on-site treatment of hospital wastewater: From conventional to combined advanced processes.

This review aims to assess different technologies for the on-site treatment of hospital wastewater (HWW) to remove pharmaceutical compounds (PhCs) as sustances of emerging concern at a bench, pilot, and full scales from 2014 to 2020. Moreover, a rough characterisation of hospital effluents is presented. The main detected PhCs are antibiotics and psychiatric drugs, with concentrations up to 1.1 mg/L. On the one hand, regarding the presented technologies, membrane bioreactors (MBRs) are a good alternative for treating HWW with PhCs removal values higher than 80% in removing analgesics, anti-inflammatories, cardiovascular drugs, and some antibiotics. Moreover, this system has been scaled up to the pilot plant scale. However, some target compounds are still present in the treated effluent, such as psychiatric and contrast media drugs and recalcitrant antibiotics (erythromycin and sulfamethoxazole). On the other hand, ozonation effectively removes antibiotics found in the HWW (>93%), and some studies are carried out at the pilot plant scale. Even though, some families, such as the X-ray contrast media, are recalcitrant to ozone. Other advanced oxidation processes (AOPs), such as Fenton-like or UV treatments, seem very effective for removing pharmaceuticals, Antibiotic Resistance Bacteria (ARBs) and Antibiotic Resistance Genes (ARGs). However, they are not implanted at pilot plant or full scale as they usually consider extra reactants such as ozone, iron, or UV-light, making the scale-up of the processes a challenging task to treat high-loading wastewater. Thus, several examples of biological wastewater treatment methods combined with AOPs have been proposed as the better strategy to treat HWW with high removal of PhCs (generally over 98%) and ARGs/ARBs (below the detection limit) and lower spending on reactants. However, it still requires further development and optimisation of the integrated processes.

Un nuevo paradigma para el tratamiento de la osteoartritis de rodilla: el papel del ácido hialurónico, el plasma rico en plaquetas (PRP) y el ozono en la modulación de la inflamación: una revisión / A new paradigm for the treatment of knee osteoarthritis: the role of hyaluronic acid, platelet-rich plasma (prp) and ozone in the modulation of inflammation: a review

Introducción: La osteoartritis (OA) es la causa más común de la artritis. Tradicionalmente, la OA se consideraba como una enfermedad de "desgaste". Sin embargo, los factores metabólicos e inflamatorios se están considerando ahora como los factores patogénicos hasta el punto de que algunos autores están redefiniendo la OA como una enfermedad de "inflamación crónica de bajo grado". Evidencia: En la artrosis de rodilla están involucradas muchas vías de señalización y mediadores inflamatorios. El nuevo paradigma de tratamiento se basa en los tratamientos celulares sobre las vías de señalización de la inflamación, basados en componentes celulares y proteicos para combatir el entorno inflamatorio de la articulación artrósica y regenerar el tejido dañado. Resultados: El enfoque de tratar solo una diana terapéutica (inhibidores de óxido nítrico, nutracéuticos, agentes reductores de uratos y fármacos biológicos) que han demostrado su eficacia en el tratamiento de enfermedades inflamatorias como la artritis reumatoide no se ha traducido en un manejo eficaz de la OA. Un enfoque de tratamiento dirigido simultáneamente a varias dianas sería capaz de manejar la OA de manera más eficiente. Las pautas estándar (AAOS, OARSI, ACR, NICE o EULAR) no consideran el ácido hialurónico, el plasma rico en plaquetas ni el ozono, aunque estas opciones de tratamiento han mostrado propiedades inmunomoduladoras y curativas. En ese escenario, planteamos la hipótesis de que el ácido hialurónico, el plasma rico en plaquetas y el ozono son alternativas prometedoras para el manejo de la OA de rodilla, debido a sus propiedades multidiana, como se observará en esta revisión. Conclusión: En el presente estudio se ha revisado la fisiopatología de la OA, centrándose principalmente en el mecanismo inflamatorio, las vías de señalización implicadas y los posibles objetivos del tratamiento...(AU)

Introduction: Osteoarthritis (OA) is the most common cause of arthritis. Traditionally, OA was viewed as a "wear and tear" disease. However, metabolic and inflammatory factors are now being considered as pathogenic factors to the point that some authors are redefining OA as a "chronic low-grade inflammation" disease. Evidence: In knee osteoarthritis, many inflammatory signaling pathways and mediators are involved. The new treatment paradigm is based on cellular treatments on the signaling pathways of inflammation, based on cellular and protein components to combat the inflammatory environment of the arthritic joint and regenerate damaged tissue. Results: The approach of treating only one therapeutic target (nitric oxide inhibitors, nutraceuticals, urate reducing agents, and biologics) that have demonstrated their efficacy in the treatment of inflammatory diseases such as rheumatoid arthritis has not been translated into effective management in OA. A treatment approach aimed simultaneously at multiple targets would be able to manage OA more efficiently. The standard guidelines (AAOS, OARSI, ACR, NICE, or EULAR) do not consider hyaluronic acid, platelet-rich plasma, or ozone, although these treatment options have shown immunomodulatory and healing properties. In this scenario, we hypothesized that hyaluronic acid, platelet-rich plasma, and ozone are promising alternatives for the management of knee OA, due to their multidial properties, as will be seen in this review. Conclusion: In the present study the pathophysiology of OA has been reviewed, focusing mainly on the inflammatory mechanism, the signaling pathways involved and the possible goals of treatment. Hyaluronic acid, platelet-rich plasma and ozone are proposed as multi-target options for the treatment of knee osteoarthritis.

Investigation of the photocatalytic transformation of acesulfame K in the presence of different TiO2-based materials.

The photocatalytic transformation of acesulfame K - an artificial sweetener that has gained popularity over the last decades for being a calorie-free additive in food, beverages and several pharmaceutical products - was studied using three different photocatalysts, the benchmark TiO2-P25 and two other forms of synthetized titanium oxides named TiO2-SG1 and TiO2-SG2. The two latter materials were synthesized by a sol gel process in which the hydrolysis rate of titanium n-butoxide was controlled by the water formed in situ through an esterification reaction between ethanol and acetic acid. The investigation included monitoring the sweetener disappearance, identifying its intermediate compounds, assessing mineralization and evaluating toxicity. The analyses were carried out using high-performance liquid chromatography (HPLC) coupled with a LTQ-Orbitrap analyzer via an electrospray ionization (ESI) in the negative ion mode. This is a powerful tool for the identification, characterization and measurement of the transformation products (TPs); overall 13 species were identified. The use of several semiconductors has pointed out differences in terms of both photocatalytic efficiency and mechanism: the assessment of the evolution kinetics of each species (TPs, total organic carbon and inorganic ions) has brought to the elaboration of a general transformation pathway of acesulfame K. TiO2-SG2 proved to be the most efficient material in degrading the artificial sweetener and leads to the complete mineralization within 6 h of irradiation, while up to 16 h are required for TiO2-P25.

Dolor irruptivo oncológico inducido por radioterapia: ¿es posible optimizar su tratamiento? / Radiotherapy-induced breakthrough cancer pain: is it possible to optimize its treatment?

Introducción: en el contexto de la radioterapia, el control del dolor irruptivo oncológico (DIO) supone un reto especial. El DIO ha sido definido por la Sociedad Española del Dolor (SED), la Sociedad Española de Oncología Médica (SEOM) y la Sociedad Española de Cuidados Paliativos (SECPAL) como una exacerbación del dolor súbita y transitoria, de gran intensidad (EVA > 7) y de corta duración (inferior a 20-30 minutos), que aparece sobre la base de un dolor persistente estable cuando este se encuentra reducido a un nivel tolerable (EVA < 5) mediante el uso de opioides mayores. Objetivos: el objetivo principal de este estudio fue evaluar la intensidad del DIO inducido por tratamientos oncológicos que incluyeran radioterapia (RT), tanto exclusiva como asociada a quimioterapia (RT/QT). Secundariamente, se evaluó la eficacia del tratamiento con fentanilo sublingual pautado para el control del DIO. Material y métodos: estudio observacional retrospectivo realizado en 110 pacientes reclutados en 19 Servicios de Radioterapia españoles. Los pacientes debían presentar DIO inducido por RT o RT/QT, con o sin medicación pautada y cuya intensidad fuera de una EVA > 6 en las últimas 24-48 h. Se establecieron controles en el momento basal, y a los 3, 7, 15 y 30 días. Resultados: se apreció un descenso en la media de los valores en la escala EVA según avanzó el estudio (EVA = 6 en el control 0 a EVA = 3 en el control 3), y las diferencias fueron significativas (p < 0,0001). La satisfacción con el tratamiento fue calificada como buena o excelente por el 85,3% de los pacientes y por el 92,7% de los investigadores. Conclusiones: los resultados de este estudio demuestran la eficacia del tratamiento del DIO con fentanilo sublingual en el contexto del tratamiento oncológico radioterápico, con un descenso significativo en los valores EVA frente al valor basal. La elevada satisfacción de los médicos y pacientes con este tratamiento refleja la eficacia y la comodidad del fentanilo sublingual en el control del DIO (AU)

Introduction: In the context of radiotherapy, control of breakthrough cancer pain (BTPc) is particularly challenging. BTPc has been defined by the Spanish Society of Pain (SED), the Spanish Society of Medical Oncology (SEOM) and the Spanish Society for Palliative Care (SECPAL) as a sudden and transient exacerbation of pain of great intensity (VAS > 7) and short (less than 20-30 minutes), which appears on the basis of a stable persistent pain when it is reduced to a tolerable level (VAS < 5) by using major opioids. Objectives: The main objective of this study was to assess the intensity of BTPc induced by cancer treatments that included radiotherapy (RT), both exclusive and associated with chemotherapy (RT/CT). Secondly, the efficacy of treatment was evaluated with fentanyl sublingual scheduled for BTPc control. Material and methods: Retrospective, observational study in 110 patients recruited in 19 Spanish Radiotherapy Services. Patients must have BTPc induced by RT or RT/CT, with or without medication prescribed and with an intensity outside a VAS > 6 in the last 24-48 h. Controls were established at baseline and at 3, 7, 15 and 30 days. Results: There was a decrease in mean values on the VAS scale as the study progressed (VAS = 6 in the control 0 to VAS = 3 in the control 3) and the differences were significant (p < 0.0001). Treatment satisfaction was rated as good or excellent by 85.3% of patients and 92.7% of researches. Conclusions: The results of this study demonstrate the efficacy of BTPc treatment with sublingual fentanyl in the context of the radiotherapy cancer treatment, with a significant decrease in VAS from baseline values . The high satisfaction among physicians and patients with this treatment reflects the efficacy and convenience of sublingual fentanyl in controlling BTPc (AU)

Coupling membrane separation and photocatalytic oxidation processes for the degradation of pharmaceutical pollutants.

The coupling of membrane separation and photocatalytic oxidation has been studied for the removal of pharmaceutical pollutants. The retention properties of two different membranes (nanofiltration and reverse osmosis) were assessed. Comparable selectivity on the separation of pharmaceuticals were observed for both membranes, obtaining a permeate stream with concentrations of each pharmaceutical below 0.5 mg L(-)(1) and a rejected flux highly concentrated (in the range of 16-25 mg L(-)(1) and 18-32 mg L(-)(1) of each pharmaceutical for NF-90 and BW-30 membranes, respectively), when an initial stream of six pharmaceuticals was feeding to the membrane system (10 mg L(-)(1) of each pharmaceutical). The abatement of concentrated pharmaceuticals of the rejected stream was evaluated by means of heterogeneous photocatalytic oxidation using TiO2 and Fe2O3/SBA-15 in presence of hydrogen peroxide as photo-Fenton system. Both photocatalytic treatments showed remarkable removals of pharmaceutical compounds, achieving values between 80 and 100%. The nicotine was the most refractory pollutant of all the studied pharmaceuticals. Photo-Fenton treatment seems to be more effective than TiO2 photocatalysis, as high mineralization degree and increased nicotine removal were attested. This work can be considered an interesting approach of coupling membrane separation and heterogeneous photocatalytic technologies for the successful abatement of pharmaceutical compounds in effluents of wastewater treatment plants.

Una visión histórica de las drogas de abuso desde la perspectiva criminológica (Parte II) / An historical vision of drugs of abuse from the criminological perspective (Part II)

En la primera parte de este trabajo se analizó la historia de las principales drogas de abuso desde la vertiente criminológica y el desarrollo de la normativa legal para combatir estos problemas. En esta segunda parte, se analiza el vínculo entre el uso/abuso de drogas y la delictogénesis, que puede ser clasificado según una triple tipología: delincuencia inducida o delitos cometidos bajo el efecto de las drogas (delitos contra las personas y contra la seguridad del tráfico); delincuencia funcional/instrumental o delitos relacionados con las conductas encaminadas a financiar la propia dependencia (delitos contra la propiedad, como robos, asaltos); delincuencia relacional o delitos englobados en el concepto legal de narcotráfico (cultivo, elaboración y distribución de drogas de abuso) (AU)

In the first part of this paper we analyzed the history of the main drugs of abuse from the criminological perspective and the development of legal norms to fight against these problems. In this second part, we analyze the link between drug use/abuse and the crime genesis, which can be classified according to a triple typology: induced crime, or crimes committed under the influence of drugs (crimes against the persons and traffic security); functional/instrumental crime, or crimes related to the behavior directed to pay for their dependency (crimes against property, such as robberies and assaults); relational crime, or crimes included in the legal concept of drug trafficking (cultivation, manufacture and distribution of drugs of abuse) (AU)

Disociación clinicorradiológica en la encefalopatía hipertensiva con afectación predomimanante de troncoencéfalo y cerebelo / Primary involvement of brainstem and cerebellum in hypertensive encephalopathy

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[Multiple sclerosis and neurocysticercosis: a diagnostic dilemma]. / Esclerosis múltiple y neurocisticercosis. dilema diagnóstico.

INTRODUCTION: Both Multiple Sclerosis (MS) and Neurocysticercosis (NC) are two entities in which clinical manifestations, neuroimaging findings and immunoserologic assays are neither pathognomonic nor specific requiring for their diagnosis an accurate examination of the clinical history of patients and an adequate follow up. CASE REPORTS: Two patients who consulted non neurologists about focal neurological symptoms. Neuroimaging findings revealed multiple lesions, some of them contrast enhanced. A diagnosis of neurocysticercosis was established, supported in one of the patients by positive serologic assays for cysticerci and antihelmintic therapy began to be administered. Observing the clinical evolution of the patients, monitoring their clinical history and considering the diagnostic criteria proposed by McDonald for MS and by Del Brutto for NC the patients were finally diagnosed of MS. CONCLUSION: The first step to reach a diagnosis of MS is to consider such a possibility. The diagnosis is mainly based on clinical grounds and it is necessary to prove that symptoms disseminate or that alterations occur in neuroimaging findings both in time and space. It is of the utmost importance to establish a differential diagnosis with other conditions presenting with similar clinical manifestations, neuroimaging findings and cerebrospinal fluid tests results. Even with the latest criteria proposed for the diagnosis of MS and NC we may have doubts making it fundamental to cautiously interpret the clinical manifestations and tests results.

[Intervention to improve the quality of continuing drug prescription at a primary care center]. / Intervención de mejora de la calidad de la prescripción farmacológica continuada en un centro de atención primaria.

An evaluation study has been done on the quality of long-term drugs prescription. The aim was to check the effectiveness of certain corrective measures agreed by the professionals working in a primary care centre. Using the results of a first evaluation made in 1989, a series of recommendations were made to reduce the prescription of drugs with a low intrinsic value (LIV). A further evaluation took place 9 months later. A relative reduction of 20.2% in LIV drugs was obtained. This represented a reduction from 25% to 20.8% of the total number of prescriptions. In the relevant pharmacological subgroups a reduction of 77.9% in the prescription of nitrites linked to barbiturites was obtained; of 60% in LIV antacids; of 50.3% in antivaricose drugs; of 36.1% in LIV laxatives; and of 30.1% in Dipiridamol. There was no improvement in the prescription of external LIVs nor cerebral vasodilators. It is concluded that the intervention has proved its usefulness in the improvement of long-term drugs prescription.

[The indicators of the quality of the prescription for chronic pathologies]. / Indicadores de la calidad de la prescripción por patologías crónicas.

To assess the qualitative characteristics of the prescription for chronic diseases and to select the most appropriate quality indicator, we evaluated 1588 drugs recorded in 549 forms for chronic prescription. 64.9% of the drugs were included in the Index Farmacològic, and the same rate in the Essential Drugs list of the WHO, 73.4% had a high intrinsic value (IV) and 80.7% were monocomponents. The male patients received more drugs included in the WHO list and with high IV, while patients older than age 65 years received more drugs with absent or unacceptable IV. A higher quality in the four indicators was found in the prescriptions from the CAP physicians than in those from specialists. The drug preparations with a not high IV more commonly prescribed belonged to the categories of cerebral and peripheral vascular therapy (16.2%), antacids and antiflatulents (9.3%), oral antidiabetics (8.4%), and antivaricose and antihemorrhoidal drugs (8.4%). It is concluded that the intrinsic value in the most adequate quality indicator for the prescription studies in primary care.