Hybrid Process of Adsorption/Coagulation/Ceramic MF for Removing Pesticides in Drinking Water Treatment-Inline vs. Contact Tank PAC Dosing.

Two pilot trials of powdered activated carbon (PAC)/(coagulation)/ceramic microfiltration were conducted to compare continuous 10-12 mg/L PAC inline dosing with 8-10 mg/L dosing to a 2 h-contact tank. Two low turbidity/low natural organic matter (NOM, total organic carbon <2 mg C/L) surface waters spiked with 7.2-10.3 µg/L total-pesticides were tested and the dosing options were compared towards operational performance, average removal of pesticides and NOM and costs. Removal differences between the two PAC dosing options depended on pesticides' amenability to adsorption and NOM characteristics (254 nm absorbance, A254). Waters containing low A254-absorbing NOM and only pesticides amenable to adsorption showed very high removals (all pesticides ≥93%) and no significant differences between the two PAC dosing options. Waters containing higher A254-absorbing NOM and high loads of pesticides less amenable to adsorption (dimethoate, bentazone) required higher inline PAC dose. Those or more severe conditions may require PAC doses higher than tested to comply with the Drinking Water Directive limits for pesticides. Cost analysis showed PAC inline dosing is more cost-effective than PAC dosing to the contact tank when identical PAC dose is sufficient or when the doses are low, even if 50% higher for inline dosing, and the plant is small.

Adsorption/Coagulation/Ceramic Microfiltration for Treating Challenging Waters for Drinking Water Production.

Pressurized powdered activated carbon/coagulation/ceramic microfiltration (PAC/Alum/MF) was investigated at pilot scale for treating low turbidity and low natural organic matter (NOM) surface waters spiked with organic microcontaminants. A total of 11 trials with clarified or non-clarified waters spiked with pesticides, pharmaceutical compounds, or microcystins were conducted to assess the removal of microcontaminants, NOM (as 254 nm absorbance, A254, and dissolved organic carbon, DOC), trihalomethane formation potential (THMFP), aerobic endospores as protozoan (oo)cysts indicators, bacteriophages as viruses indicators, and regular drinking water quality parameters. PAC/(Alum)/MF achieved 75% to complete removal of total microcontaminants with 4-18 mg/L of a mesoporous PAC and 2 h contact time, with a reliable particle separation (turbidity < 0.03 NTU) and low aluminium residuals. Microcontaminants showed different amenabilities to PAC adsorption, depending on their charge, hydrophobicity (Log Kow), polar surface area and aromatic rings count. Compounds less amenable to adsorption showed higher vulnerability to NOM competition (higher A254 waters), greatly benefiting from DOC-normalized PAC dose increase. PAC/Alum/MF also attained 29-47% NOM median removal, decreasing THMFP by 26%. PAC complemented NOM removal by coagulation (+15-19%), though with no substantial improvement towards THMFP and membrane fouling. Furthermore, PAC/Alum/MF was a full barrier against aerobic endospores, and PAC dosing was crucial for ≥1.1-log reduction in bacteriophages.

Bromate removal by anaerobic bacterial community: mechanism and phylogenetic characterization.

A highly bromate resistant bacterial community and with ability for bromate removal was obtained from a sulphate-reducing bacteria enrichment consortium. This community was able to remove 96% of bromate and 99% of sulphate from an aqueous solution containing 40 µM bromate and 10 mM sulphate. Moreover, 93% of bromate was removed in the absence of sulphate. Under this condition bromate was reduced stoichiometrically to bromide. However, in the presence of sulphate only 88% of bromate was reduced to bromide. Although, bromate removal was not affected by the absence of sulphate, this anion promoted a modification on the structure of the bacterial community. Phylogenetic analysis of 16S rRNA gene showed that the community grown in the presence of bromate and sulphate was mainly composed by bacteria closely to Clostridium and Citrobacter genera, while the community grown in the absence of sulphate was predominantly composed by Clostridium genus. It is the first time that Clostridium and Citrobacter genera are reported as having bromate removal ability. Furthermore, bromate removal by the consortium predominantly composed by Clostridium and Citrobacter genera occurred by enzymatic reduction and by extracellular metabolic products, while the enzymatic process was the only mechanism involved in bromate removal by the consortium mainly composed by Clostridium genus.

Recommendations for the diagnosis and treatment of latent and active tuberculosis in inflammatory joint diseases for candidates for therapy with tumor necrosis factor alpha inhibitors--March 2008 update.

The Portuguese Society of Rheumatology and the Portuguese Society of Pulmonology have updated the guidelines for the diagnosis and treatment of latent tuberculosis infection (LTBI) and active tuberculosis (ATB) in patients with inflammatory joint diseases (IJD) that are candidates to therapy with tumour necrosis factor alpha (TNFalpha) antagonists. In order to reduce the risk of tuberculosis (TB) reactivation and the incidence of new infections, TB screening is recommended to be done as soon as possible, ideally at the moment of IJD diagnosis, and patient assessment repeated before starting anti-TNFalpha therapy. Treatment for ATB and LTBI must be done under the care of a TB specialist. When TB treatment is indicated, it should be completed prior to starting anti-TNFalpha therapy. If the IJD activity justifies the need for immediate treatment, anti-TNFalpha therapy can be started two months after antituberculous therapy has been initiated, in the case of ATB, and one month after in the case of LTBI; healed lesions require the exclusion of ATB. In cases of suspected active lesions, ATB should be excluded/confirmed and adequate therapy initiated. Tuberculin skin test, with two units of RT23, should be performed in all patients. If the duration is < 5 mm, the test should be repeated within 1 to 2 weeks, on the opposite forearm, and will be considered negative only if the result is again < 5 mm. Positive TST implicates LTBI treatment, unless previous proper treatment was provided. If TST is performed in immunossuppressed IJD patients, LTBI treatment should be offered to the patient before starting anti-TNFalpha therapy, even in the presence of a negative test, after risk/benefit assessment.

Recommendations for the diagnosis and treatment of latent and active tuberculosis in inflammatory joint diseases candidates for therapy with tumor necrosis factor alpha inhibitors: March 2008 update.

The Portuguese Society of Rheumatology and the Portuguese Society of Pulmonology have updated the guidelines for the diagnosis and treatment of latent tuberculosis infection (LTBI) and active tuberculosis (ATB) in patients with inflammatory joint diseases (IJD) that are candidates to therapy with tumour necrosis factor alpha (TNFalpha) antagonists. In order to reduce the risk of tuberculosis (TB) reactivation and the incidence of new infections, TB screening is recommended to be done as soon as possible, ideally at the moment of IJD diagnosis, and patient assessment repeated before starting anti-TNFalpha therapy. Treatment for ATB and LTBI must be done under the care of a TB specialist. When TB treatment is indicated, it should be completed prior to starting anti-TNFalpha therapy. If the IJD activity justifies the need for immediate treatment, anti-TNFalpha therapy can be started two months after antituberculous therapy has been initiated, in the case of ATB, and one month after in the case of LTBI. Chest X-ray is mandatory for all patients. If Gohn s complex is present, the patient should be treated for LTBI; healed lesions require the exclusion of ATB. In cases of suspected active lesions ATB should be excluded/confirmed and adequate therapy initiated. Tuberculin skin test, with two units of RT23, should be performed in all patients. If the induration is <5 mm, the test should be repeated within 1 to 2 weeks, on the opposite forearm, and will be considered negative only if the result is again <5 mm. Positive TST implicates LTBI treatment, unless previous proper treatment was provided. If TST is performed in immunossuppressed IJD patients, LTBI treatment should be offered to the patient before starting anti-TNFalpha therapy, even in the presence of a negative test, after risk/benefit assessment.

Recommendations for the diagnosis and treatment of latent and active tuberculosis in inflammatory joint diseases candidates for therapy with tumor necrosis factor alpha inhibitors - March 2008 update. / Recomendações para o diagnóstico e tratamento das tuberculoses latente e activa nas doenças inflamatórias articulares candidatas a terapêutica com fármacos inibidores do factor de necrose tumoral alfa. Revisão de Março de 2008.

The Portuguese Society of Rheumatology and the Portuguese Society of Pulmonology have updated the guidelines for the diagnosis and treatment of latent tuberculosis infection (LTBI) and active tuberculosis (ATB) in patients with inflammatory joint diseases (IJD) that are candidates to therapy with tumour necrosis factor alpha (TNFα) antagonists. In order to reduce the risk of tuberculosis (TB) reactivation and the incidence of new infections, TB screening is recommended to be done as soon as possible, ideally at the moment of IJD diagnosis, and patient assessment repeated before starting anti-TNFα therapy. Treatment for ATB and LTBI must be done under the care of a TB specialist. When TB treatment is indicated, it should be completed prior to starting anti-TNFα therapy. If the IJD activity justifies the need for immediate treatment, anti-TNFα therapy can be started two months after antituberculous therapy has been initiated, in the case of ATB, and one month after in the case of LTBI. Chest X-ray is mandatory for all patients. If Gohn's complex is present, the patient should be treated for LTBI; healed lesions require the exclusion of ATB. In cases of suspected active lesions, ATB should be excluded/confirmed and adequate therapy initiated. Tuberculin skin test, with two units of RT23, should be performed in all patients. If the induration is <5 mm, the test should be repeated within 1 to 2 weeks, on the opposite forearm, and will be considered negative only if the result is again <5 mm. Positive TST implicates LTBI treatment, unless previous proper treatment was provided. If TST is performed in immunossuppressed IJD patients, LTBI treatment should be offered to the patient before starting anti-TNF-α therapy, even in the presence of a negative test, after risk / benefit assessment. Rev Port Pneumol 2007; XIV (2): 271-283.

[Treatment of latent tuberculosis infection: update of guidelines, 2006]. / Tratamento da tuberculose latente: revisão das normas, 2006.

The Tuberculosis Working Group of the Portuguese Society of Pulmonology, feeling the need to develop guidelines for the diagnosis and treatment of latent tuberculosis infection, compiled a set of recommendations, in view to standardize procedures on this area. This document was prepared in collaboration with the Portuguese Societies of Internal Medicine, Pediatrics and Infectious Diseases, A review and update of guidelines for tracing and treatment of latent tuberculosis infection was made, concerning immunocompetent children and adults, as well as immunocompromised children and adults due to HIV infection. It is understood that these guidelines are to be used as general recommendations, and they should not replace the individual analysis of each case.

[Recommendations for the diagnosis and treatment of latent and active tuberculosis in patients with inflammatory joint diseases treated with tumour necrosis factor alpha inhibitors]. / Recomendações para diagnóstico e tratamento da tuberculose latente e activa nas doenças inflamatórias articulares candidatas a tratamento com fármacos inibidores do factor de necrose tumoral alfa.

The Portuguese Society of Rheumatology (SPR) and the Portuguese Society of Pulmonology (SPP) have developed guidelines for the diagnosis and treatment of latent tuberculosis infection (LTBI) and active tuberculosis (AT) in patients with inflammatory joint diseases (IJD), namely rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis, treated with tumour necrosis factor alpha (TNF-alpha) antagonists. Due to the high risk of tuberculosis (TB) in patients with IJD, LTBI and AT screening should be performed as soon as possible, ideally at the moment of IJD diagnosis. Even if TB screening was performed at the beginning of the disease, the evaluation should be repeated before starting anti-TNF-alpha therapy. When TB (LTBI orAT) treatment is indicated, it should be performed before the beginning of anti-TNF-alpha therapy. If the IJD activity requires urgent anti-TNF-alpha therapy, these drugs can be started after two months of antituberculosis therapy in AT cases, or after one month in LTBI cases. Chest X-ray is mandatory for all patients. If abnormal, e.g. Gohn complex, the patient should be treated as LTBI; residual lesions require the exclusion of AT and patients with history of untreated or incomplete TB treatment should be treated as LTBI. In cases of suspected active lesions, AT diagnosis should be confirmed and adequate therapy initiated. Tuberculin skin test (TST), with two units of RT23, should be performed in all patients. If induration is less than 5 mm, the test should be repeated after 1 to 2 weeks, on the opposite forearm, and should be considered negative if the result is again inferior to 5 mm. Positive TST implicates LTBI treatment. IfTST is performed in immunosupressed IJD patients, LTBI treatment should be offered to the patient before starting anti-TNFalpha therapy, even in the presence of a negative test.

[Guidelines for the diagnosis and treatment of latent tuberculosis infection and active tuberculosis in patients with inflammatory joint diseases proposed for treatment with tumour necrosis factor alpha antagonist drugs]. / Recomendações para diagnóstico e tratamento da tuberculose latente e activa nas doenças inflamatórias articulares candidatas a tratamento com fármacos inibidores do factor de necrose tumoral alfa.

The Portuguese Society of Rheumatology (SPR) and the Portuguese Society of Pulmonology (SPP) have developed guidelines for the diagnosis and treatment of latent tuberculosis infection (LTBI) and active tuberculosis (AT) in patients with inflammatory joint diseases (IJD), namely rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis, treated with tumour necrosis factor alpha (TNF-a) antagonists. Due to the high risk of tuberculosis (TB) in patients with IJD, LTBI and AT screening should be performed as soon as possible, ideally at the moment of IJD diagnosis. Even if TB screening was performed at the beginning of the disease, the evaluation should be repeated before starting anti-TNF-a therapy. When TB (LTBI or AT) treatment is indicated, it should be performed before the beginning of anti-TNF-a therapy. If the IJD activity requires urgent anti-TNF-a therapy, these drugs can be started after two months of antituberculosis therapy in AT cases, or after one month in LTBI cases. Chest X-ray is mandatory for all patients. If abnormal, e.g. Gohn complex, the patient should be treated as LTBI; residual lesions require the exclusion of AT and patients with history of untreated or incomplete TB treatment should be treated as LTBI. In cases of suspected active lesions, AT diagnosis should be confirmed and adequate therapy initiated. Tuberculin skin test (TST), with two units of RT23, should be performed in all patients. If induration is less than 5 mm, the test should be repeated after 1 to 2 weeks, on the opposite forearm, and should be considered negative if the result is again inferior to 5 mm. Positive TST implicates LTBI treatment. If TST is performed in immunosuppressed IJD patients, LTBI treatment should be offered to the patient before starting anti-TNF-a therapy, even in the presence of a negative test.