Comparison between a fixed bed hybrid membrane bioreactor and a conventional membrane bioreactor for municipal wastewater treatment: a pilot-scale study.

A hybrid membrane bioreactor (HMBR) was developed, by adding biofilm support media into a conventional membrane bioreactor (CMBR), and operated in parallel with a CMBR. Results showed that effluent quality was significantly better with the HMBR. The removal efficiencies of COD, BOD5, NH4(+)-N and TN with the HMBR were 84%, 98%, 97% and 75%, respectively, as compared to 80%, 96%, 93% and 38% with the CMBR. There were no differences in phosphorus removal. The membrane fouling rate in the HMBR was on average only 57% of that in the CMBR. The lower concentration of colloidal biopolymer clusters in the HMBR sludge, probably due to their retention by the biofilm, could be partially responsible for this difference. Filterability and settleability of the sludge were also better in the HMBR. Consequently, it is concluded that the addition of fixed support media for biofilm growth can improve the performance of CMBRs.

Evaluation of a hybrid vertical membrane bioreactor (HVMBR) for wastewater treatment.

A new hybrid membrane bioreactor (HMBR) has been developed to obtain a compact module, with a small footprint and low requirement for aeration. The aim of this research was to assess its performance. The system consists of a single vertical reactor with a filtration membrane unit and, above this, a sponge fixed bed as support medium. The aeration system is located under the membrane unit, allowing for membrane cleaning, oxygenation, biofilm thickness control and bulk liquid mixing. Operated under continuous aeration, a bench-scale reactor (70 L) was fed with pre-treated, raw (unsettled) municipal wastewater. BOD(5) and suspended solids removal efficiencies (96 and 99% respectively) were comparable to those obtained with other membrane bioreactors (MBRs). Total nitrogen removal efficiencies of 80% were achieved, which is better than those obtained in other HMBRs and similar to the values reached using more complex MBRs with extra anoxic tanks, intermittent aeration or internal deflectors.

Evaluación de la eficacia y seguridad del Heberprot-p con dos diluentes en el tratamiento del pie diabético / Evaluation of the eficaccy and safety of the Heberprot P with two dilution in the treatment of the diabetic foot

Introducción. Entre las complicaciones de la Diabetes Mellitus, se encuentran las úlceras del Pie diabético (UPD). ElHeberprot-P es una nueva terapéutica para esta entidad. Objetivo. Evaluar la seguridad y la eficacia del Heberprot-Pcon dos diluentes (agua para inyección o solución salina al 0.9 por ciento) en el tratamiento de las úlceras. Método. Se realizó un estudio abierto, aleatorizado y longitudinal en el servicio de Angiología y Cirugía Vascular del Hospital José R López Tabranes, de marzo a junio del 2010. Se incluyeron 20 pacientes con diagnostico de Úlceras de Pie Diabético (UPD), los que se trataron con Heberprot-P 75 μg tres veces por semana hasta la epitelizacion o un máximo de 8 semanas, aleatorizadosen dos grupos, grupo 1, recibieron el producto diluido en Agua para inyección 10 pacientes (procedimiento habitual) ygrupo 2 diluido en Solución Salina al 0.9 por ciento 10 pacientes. Se estudiaron variables de tipo demográficas, de seguridad y de eficacia. Resultados. De los pacientes analizados, 10 (55.6 por ciento) presentaron eventos adversos, de ellos 9 pertenecieron al grupo 1, por orden de frecuencia se reportaron el dolor en el sitio de administración (60.0 por ciento), escalofríos (50.0 por ciento) y tremor de frio (50.0 por ciento), en el grupo 2 solo un paciente presentó eventos adversos descrito como ardor en el sitio de administración, para lavariable Respuesta Total el grupo 2 tuvo una proporción de pacientes de (90.0 por ciento) con respuesta favorable y en el grupo 1 esta proporción fue de 60.0 por ciento. Conclusiones. La dilución del Heberprot-P® en solución salina al 0,9 por ciento provoca menos eventos adversos que la realizada con agua para inyección(AU)

Background. The Diabetic Foot Ulcer (DFU) is a complication of the Diabetes Mellitus. The Heberprot-P is a new therapy for this pathological condition. Objective. To evaluate the efficacy and safety of the Heberprot-P with two dilutions (waters of injections or normal saline solution 0.9 percent) in the treatment of the DFU. Methods. The design of the investigation is open, aleatorized, and longitudinal in the Angiology and Vascular Surgery Service of the Jose R. Lopez Tabrane Hospital from Matanzas from March to June of 2010. 20 patients with the diagnosis of DFU were included, and treated with Heberprot-P 3 times a week until the epithelisation or a maximum of 8 weeks, aleatorized in two groups, group 1 with the use of waters of injection 10 patients (habitual procedure) and group 2 normal saline solutions 0.9 percent for the dilution with 10 patients. We observe demographic, safety and efficacy variables. Results. Of the patients studied, in 10 (55.6 percent) were presents adverse events, of them 9 are located in the group 1, by order of frequency the pain in the site of the administration (60.0 percent), chills (50.0 percent) and shavering (50.0 percent), are observe and in the group 2 only one patient had adverse events considered like ardour in the place of the administration, for the variable of efficacy Total Answer the group 2 had a proportion of patients of (90.0 percent) with favourable answer and in the group 1 this proportion was of 60.0 percent. Conclusions. The dilution of the Heberprot-P in normal saline solution 0,9 percent caused less adverse events than in case of waters of injection(AU)

Evaluación de la eficacia y seguridad del heberprot-p con dos diluentes en el tratamiento del pie diabético / Evaluation of the eficaccy and safety of the heberprot p with two dilution in the treatment of the diabetic foot

Introducción. Entre las complicaciones de la Diabetes Mellitus, se encuentran las úlceras del Pie diabético (UPD). El Heberprot-P® es una nueva terapéutica para esta entidad. Objetivo. Evaluar la seguridad y la eficacia del Heberprot-P® con dos diluentes (agua para inyección o solución salina al 0.9 %) en el tratamiento de las úlceras. Método. Se realizó un estudio abierto, aleatorizado y longitudinal en el servicio de Angiología y Cirugía Vascular del Hospital José R López Tabranes, de marzo a junio del 2010. Se incluyeron 20 pacientes con diagnostico de Úlceras de Pie Diabético (UPD), los que se trataron con Heberprot-P® 75 μg tres veces por semana hasta la epitelizacion o un máximo de 8 semanas., aleatorizados en dos grupos, grupo 1, recibieron el producto diluido en Agua para inyección 10 pacientes (procedimiento habitual) y grupo 2 diluido en Solución Salina al 0.9% 10 pacientes. Se estudiaron variables de tipo demográficas, de seguridad y de eficacia. Resultados. De los pacientes analizados, 10 (55.6%) presentaron eventos adversos, de ellos 9 pertenecieron al grupo 1, por orden de frecuencia se reportaron el dolor en el sitio de administración (60.0%), escalofríos (50.0%) y tremor de frio (50.0%), en el grupo 2 solo un paciente presentó eventos adversos descrito como ardor en el sitio de administración, para la variable Respuesta Total el grupo 2 tuvo una proporción de pacientes de (90.0%) con respuesta favorable y en el grupo 1 esta proporción fue de 60.0%. Conclusiones. La dilución del Heberprot-P® en solución salina al 0,9% provoca menos eventos adversos que la realizada con agua para inyección (AU)

Background. The Diabetic Foot Ulcer (DFU) is a complication of the Diabetes Mellitus. The Heberprot-P® is a new therapy for this pathological condition. Objective. To evaluate the efficacy and safety of the Heberprot-P® with two dilutions (waters of injections or normal saline solution 0.9%) in the treatment of the DFU. Methods. The design of the investigation is open, aleatorized, and longitudinal in the Angiology and Vascular Surgery Service of the Jose R. Lopez Tabrane Hospital from Matanzas from March to June of 2010. 20 patients with the diagnosis of DFU were included, and treated with Heberprot- P® 3 times a week until the epithelisation or a maximum of 8 weeks, aleatorized in two groups, group 1 with the use of waters of injection 10 patients (habitual procedure) and group 2 normal saline solutions 0.9% for the dilution with 10 patients. We observe demographic, safety and efficacy variables. Results. Of the patients studied, in 10 (55.6%) were presents adverse events, of them 9 are located in the group 1, by order of frequency the pain in the site of the administration (60.0%), chills (50.0%) and shavering (50.0%), are observe and in the group 2 only one patient had adverse events considered like ardour in the place of the administration, for the variable of efficacy Total Answer the group 2 had a proportion of patients of (90.0%) with favourable answer and in the group 1 this proportion was of 60.0%. Conclusions. The dilution of the Heberprot-P® in normal saline solution 0,9% caused less adverse events than in case of waters of injection (AU)

Reducción de las amputaciones con Heberprot P en la terapia local del pie diabético / Reduction in the amputation rate with Heberprot P in the local treatment of diabetic foot

INTRODUCCIÓN. El síndrome de Pie diabético, se ha convertido en un problema sanitario mundial, por su alta frecuencia, recidiva y costos, a su vez, la frecuencia de ulceración y amputación aumenta progresivamente. Pretendemos a través de la siguiente investigación demostrar el impacto en la reducción de las tasa de amputaciones por Pie diabético asociada al uso del Heberprot P. MÉTODOS. Diseñamos un estudio analítico retrospectivo con los pacientes ingresados con el diagnóstico de Pie diabético en el Servicio Provincial de Angiología y Cirugía Vascular del Hospital Clínico-Quirúrgico Docente de Matanzas José R López Tabrane, entre enero del 2007 y septiembre del 2010 incluyendo ambos. De ellos seleccionamos nuestra muestra consistente en 2 grupos: Grupo A En los cuáles se empleo la terapia convencional aplicada a esta entidad y Grupo B en los cuales además de la terapia convencional, se utilizó localmente el heberprot P. RESULTADOS. Se aprecia una significativa reducción de la frecuencia de amputaciones en el grupo tratado con heberprot P encomparación con la terapia convencional, demostrando su utilidad en los grados 3,4 y 5 de Wagner y en las lesiones tanto neuropáticas como neuroisquémicas, observándose a su vez una marcada reducción en el tiempo de granulación y epitelización con el empleo del mismo. Hechos todos que avalan la importancia de su empleo local en el pie diabético(AU)

BACKGROUND. The diabetic foot syndrome (DFS), has become in a world sanitary problem, by its high frequency and cost, is important also for the increase in the prevalence of ulceration and amputation. Is objective of this investigation to demonstrate the impact in the reduction of the amputation rate for DFS associated with the use of the heberprot P. METHODS. The design of the investigation is retrospective, analytic with the patients admitted with the diagnosis of DFS in the provincial service of vascular surgery of the University Clinical Surgical Hospital of Matanzas Jose R. Lopez Tabrane, from January 2007 to September of 2010, including both. From this we select our population that consist of 2 groups. Group A that use conventional therapy and Group B in witch associated to the conventional therapy we use local treatment withheberprot P. RESULTS. We obtain a significative reduction in the amputation rate in the group that received local treatment with heberprotP when a comparison is established with a conventional treatment, the effectiveness is observe for the groups 3,4 and 5 of the Wagner classification and in the neuropatic and euroischemics ulcers, with a reduction in the granulation and epithelisation time. Facts that show the importance of this local treatment in the wound healing of the DFS(AU)

Reducción de las amputaciones con heberprot p en la terapia local del pie diabético / Reduction in the amputation rate with heberprot p in the local treatment of diabetic foot

INTRODUCCIÓN. El síndrome de Pie diabético, se ha convertido en un problema sanitario mundial, por su alta frecuencia, recidiva y costos, a su vez, la frecuencia de ulceración y amputación aumenta progresivamente. Pretendemos a través de la siguiente investigación demostrar el impacto en la reducción de las tasa de amputaciones por Pie diabético asociada al uso del Heberprot P. MÉTODOS. Diseñamos un estudio analítico retrospectivo con los pacientes ingresados con el diagnóstico de Pie diabético en el Servicio Provincial de Angiología y Cirugía Vascular del Hospital Clínico-Quirúrgico Docente de Matanzas José R. López Tabrane, entre enero del 2007 y septiembre del 2010 incluyendo ambos. De ellos seleccionamos nuestra muestra consistente en 2 grupos: Grupo A En los cuáles se empleo la terapia convencional aplicada a esta entidad y Grupo B en los cuales además de la terapia convencional, se utilizó localmente el heberprot P. RESULTADOS. Se aprecia una significativa reducción de la frecuencia de amputaciones en el grupo tratado con heberprot P en comparación con la terapia convencional, demostrando su utilidad en los grados 3,4 y 5 de Wagner y en las lesiones tanto neuropáticas como neuroisquémicas, observándose a su vez una marcada reducción en el tiempo de granulación y epitelización con el empleo del mismo. Hechos todos que avalan la importancia de su empleo local en el pie diabético (AU)

SUMMARY BACKGROUND. The diabetic foot syndrome (DFS), has become in a world sanitary problem, by its high frequency and cost, is important also for the increase in the prevalence of ulceration and amputation. Is objective of this investigation to demonstrate the impact in the reduction of the amputation rate for DFS associated with the use of the heberprot P. METHODS. The design of the investigation is retrospective, analytic with the patients admitted with the diagnosis of DFS in the provincial service of vascular surgery of the University Clinical Surgical Hospital of Matanzas Jose R. Lopez Tabrane, from January 2007 to September of 2010, including both. From this we select our population that consist of 2 groups. Group A that use conventional therapy and Group B in witch associated to the conventional therapy we use local treatment with heberprot P. RESULTS. We obtain a significative reduction in the amputation rate in the group that received local treatment with heberprot P when a comparison is established with a conventional treatment, the effectiveness is observe for the groups 3,4 and 5 of the Wagner classification and in the neuropatic and neuroischemics ulcers, with a reduction in the granulation and epithelisation time. Facts that show the importance of this local treatment in the wound healing of the DFS (AU)

[Hemodynamic and angiocardiographic assessment of thoracopagus twins for surgical separation purposes]. / Evaluación hemodinámica y angiocardiográfica de gemelos toracópagos con finalidad de separación quirúrgica.

The rate of conjoined twins is 1 in 50,000 births. These patients usually have a common pericardial sac (90%) and conjoined hearts (75%). In case of shared heart there is a communication by a vascular channel between both atria and ventricles. If there is not ventricular communication, surgical separation is possible. We describe such a case in whom in spite that interventricular connections were present; surgical separation was decided because of the critical conditions of twin A in an effort to preserve the survival of twin B.

[Blade auricular septostomy]. / Septostomía auricular con navaja.

We describe the first case of BAS in our country in a three months old child with transposition of the great arteries, restrictive atrial septal defect (RASD) and intact interventricular septum. When he was 15 days old, we performed a balloon atrial septostomy. He had temporal improvement and six weeks later his cyanosis increased, and a new catheterization showed systemic arterial oxygen saturation of 30%, RASD and an interatrial pressure gradient of 2.1 mmHg (left atrium LA: 3.9 and right atrium RA: 1.8). We decided to perform a new septostomy with Park's blade atrial septostomy catheter. After the procedure the interatrial pressure gradient decreased to 0.2 mmHg (RA: 4.3 and LA: 4.5), the angiography shunt and atrial pressures increased. Five months later the child is alive and the systemic arterial oxygen saturation is 51.3%. The technique, advantages and complications are described.

[Transcatheter percutaneous commissurotomy in rheumatic mitral stenosis]. / Comisurotomía percutánea transcateterismo en la estenosis mitral reumática.

Percutaneous transcatheter balloon mitral commissurotomy was performed in an 11 year old girl. The atrial septum was perforated and an 8 mm angioplasty balloon was advanced the atrial septal perforation was then dilated to allow passage of 25 mm balloon valvuloplasty catheter across the mitral annulus. Transmitral balloon inflation acutely decreased the end diastolic transmitral gradient (23 mm Hg to 2 mm Hg). Immediate gradient reduction was associated with increases in cardiac output (3.4 to 5.3 L/min). Murmur intensity diminished immediately post-commissurotomy. Balloon commissurotomy did not produced mitral regurgitation. Five weeks later, follow-up catheterization was performed and did not show change in mitral valvular gradient (2 mmHg). Clinical improvement was evident.