Are contaminated soil and groundwater remediation with nanoscale zero-valent iron sustainable? An analysis of case studies.

Nanoscale zero valent iron (nZVI) is globally the main nanomaterial used in contaminated site remediation. This study aims to evaluate the sustainability of using nZVI in the nanoremediation of contaminated sites and to determine the factors that affect the sustainability of the use of nZVI in remediation. Five case studies of nZVI use on a pilot scale were selected. Life cycle analysis tools were used to evaluate environmental, economic, social impacts, and sustainability. The functional unit of the life cycle analyses was 1.00 m3 of remediated soil and groundwater. Case study of Brazil was the least sustainable, while case study of United States was the most sustainable. Only the modification of the functional unit results in variations in the sustainability index. Different factors influence the sustainability of nZVI in remediation, the main factor being the amount of nZVI used in the processes. Finally, this work contributes significantly to the state-of-the-art sustainable use of nZVI in remediation. This is a pioneering study in the detailed and comprehensive assessment of the sustainability of the use of nZVI in remediation. Through the analysis of case studies, it is possible to determine the main factors that influence the sustainability of the nZVI remediation life cycle.

Optimization of biocementation responses by artificial neural network and random forest in comparison to response surface methodology.

In this article, the optimization of the specific urease activity (SUA) and the calcium carbonate (CaCO3) using microbially induced calcite precipitation (MICP) was compared to optimization using three algorithms based on machine learning: random forest regressor, artificial neural networks (ANNs), and multivariate linear regression. This study applied the techniques in two existing response surface method (RSM) experiments involving MICP technique. Random forest-based models and artificial neural network-based models were submitted through the optimization of hyperparameters via cross-validation technique and grid search, to select the best-optimized model. For this study, the random forest-based algorithm is aimed at having the best performance of 0.9381 and 0.9463 in comparison to the original r2 of 0.9021 and 0.8530, respectively. This study is aimed at exploring the capability of using machine learning-based models in small datasets for the purpose of optimization of experimental variables in MICP technique and the meaningfulness of the models by their specificities in the small experimental datasets applied to experimental designs. This study is aimed at exploring the capability of using machine learning-based models in small datasets for experimental variable optimization in MICP technique. The use of these techniques can create prerogatives to scale and mitigate costs in future experiments associated to the field.

Social life cycle assessment of the nanoscale zero-valent iron synthesis process for application in contaminated site remediation.

Nanoscale zero-valent iron (nZVI) is the main nanomaterial used in environmental remediation processes. However, as with any remediation technique, the production and the use of nanomaterials can also cause environmental, economic, and social impacts. Thus, the present study investigated the social life cycle analysis (S-LCA) of nZVI production methods applied in environmental remediation. Three production methods of nZVI were selected for analysis: milling, reduction with sodium borohydride, and reduction with hydrogen gas. The social life cycle analysis was developed based on the ISO 14040 standard steps. Limits of the S-LCA system involve the stages of raw material extraction and manufacturing when not considering the use of nZVI postproduction. The analysis of social impact was conducted considering the involved stakeholders, through the application and improvement of an existing methodology and through the following procedures: characterization of social indicators according to a normalized scale, identification of the normalization factor for the indicators, employment of a social questionnaire, calculation of the total points in each impact subcategory (midpoint), calculation of the total points in the impact categories (endpoint), and calculation of the Social Index. The three production methods of nZVI result in significantly equal Social Indices. All methods were classified as socially sustainable according to the implemented methodology. The sensitivity analysis demonstrates the results dependent with the geographic location of the inventory data, while changes in the weighting can affect the Social Index results. Overall, this study significantly contributed to the state-of-the-art application of S-LCA in studies using nanomaterials; however, several limitations were also observed, and thus, steps for future development were suggested to future researches. In addition, this study improved the S-LCA methodology which can be used to assess the social impact of any product.

Global sales and operations planning: A multinational manufacturing company perspective.

The purpose of this paper is to analyse the global Sales and Operations Planning (S&OP) process and investigate the steps to support consolidated business planning in worldwide operations and large-scale supply chains. The paper conducts a case study at a multinational manufacturing company applying an abductive approach. It combines the deductive logic from theory and the inductive logic from field observation in an attempt to elaborate further on theory on global S&OP. The analysis is structured and guided by a novel framework for global S&OP, which is developed based on the theoretical background and the case study findings. The research findings characterise the S&OP process for global operations and identify challenges related to the need to synchronise the subsidiaries' S&OP efforts worldwide to deal with different contingencies of these subsidiaries, and to manage and analyse a large amount of information gathered. The research reveals how the subsidiaries' performance is analysed by top executives along the global S&OP process, feeding strategic initiatives in the organisation and identifying business opportunities like benchmarking among subsidiaries, synergies with other management practices, and global gains. This paper offers a novel investigation of the global steps on S&OP in a real-life setting, offering a well-documented characterisation of the process that goes beyond the traditional local approach. Moreover, it is the first study to reveal challenges and expected outcomes of such a global perspective for S&OP. The theoretical advancements of S&OP research offered herein aid scholars, opening avenues for middle-range theorising, highlighting the cross-disciplinary nature of the domain, and discussing the use of concepts from related disciplines like Economics, Psychology, and Information Systems. The research findings can also assist executives, especially from multinational manufacturers, in their efforts to consolidate global planning.

Improving the Bioremediation and in situ Production of Biocompounds of a Biodiesel-Contaminated Soil.

We aimed to produce simultaneously biosurfactants and lipases in solid state fermentation (SSF) using Aspergillus niger, followed by the use of the fermented media on the bioremediation of oily contaminated soil, in order to valuate agro industrial residuals and reduce the contamination. The biocompounds were produced using wheat bran and corncob (80:20), 5% of soybean oil and 0.5% of sugar cane molasses in SSF for 4 d, producing 4.58 ± 0.69 UE of emulsifying activity and 7.77 ± 1.52 U of lipolytic activity. This fermented media was used in the bioremediation of a 20% biodiesel contaminated soil, evaluating for 90 d microbial growth, contaminant degradation, and production of lipases and biosurfactants in soils. Six experimental strategies (natural attenuation; biostimulation + bioaugmentation + biocompounds; biostimulation + biosurfactant; biocompounds extract; biostimulation; adsorption of contaminant) were realized. The highest degradation of contaminant was verified in 90 d, of 74.40 ± 1.76%, and the production of biosurfactants and lipases in situ in the soil was found in 30 d (6.02 ± 0.24% of reduction in surface tension and 6.62 ± 0.17 UL of lipid activity in soil) for the same experiment (biostimulation + bioaugmentation + biocompounds). The addition of biostimulation + biosurfactant promotes higher biodegradation (66.00 ± 0.92%) of the contaminant than the biocompounds extract (59.58 ± 0.34%). The use of a solid fermented culture medium containing both biocompounds was feasible for the treatment of contaminants, demonstrating the potential for environmental application without the need for purification processes.

Bacterial biosurfactant increases ex situ biodiesel bioremediation in clayey soil.

The contamination of soils by oily compounds has several environmental impacts, which can be reversed through bioremediation, using biosurfactants as auxiliaries in the biodegradation process. In this study, we aimed to perform ex situ bioremediation of biodiesel-contaminated soil using biosurfactants produced by Bacillus methylotrophicus. A crude biosurfactant was produced in a whey-based culture medium supplemented with nutrients and was later added to biodiesel-contaminated clayey soil. The produced lipopeptide biosurfactant could reduce the surface tension of the fermentation broth to 30.2 mN/m. An increase in the microbial population was observed in the contaminated soil; this finding can be corroborated by the finding of increased CO2 release over days of bioremediation. Compared with natural attenuation, the addition of a lower concentration of the biosurfactant (0.5% w/w in relation to the mass of diesel oil) to the soil increased biodiesel removal by about 16% after 90 days. The added biosurfactant did not affect the retention of the contaminant in the soil, which is an important factor to be considered when applying in situ bioremediation technologies.

Use of Nanoscale Zero-Valent Iron for Remediation of Clayey Soil Contaminated with Hexavalent Chromium: Batch and Column Tests.

This study investigated the reduction of hexavalent chromium (Cr(VI)) in a clayey residual soil using nanoscale zero-valent iron (nZVI). Five different ratios between nZVI and Cr(VI) were tested in batch tests (1000/11; 1000/23; 1000/35; 1000/70, and 1000/140 mg/mg) with the soil. With the selected proportion resulting best efficiency, the column tests were conducted, with molded specimens of 5 cm in diameter and 5 cm in height, with different nZVI injection pressures (10, 30, and 100 kPa). The soil was contaminated with 800 mg/kg of Cr(VI). The Cr(VI) and Cr(III) analyses were performed following the USEPA 3060A and USEPA 7196A standards. The results show that the reduction of Cr(VI) is dependent on the ratio between nZVI and Cr(VI), reaching 98% of efficiency. In column tests, the pressure of 30 kPa was the most efficient. As pressure increased, contaminant leaching increased. The permeability decreased over time due to the gradual increase in filtration and formation of oxyhydroxides, limiting nZVI mobility. Overall, nZVI is efficient for soil remediation with Cr(VI), but the injection process can spread the contaminated if not properly controlled during in situ application.

Influence of nanoscale zero-valent iron on hydraulic conductivity of a residual clayey soil and modeling of the filtration parameter.

Contaminated clay soils pose problems to public health and the environment in several parts of the world. Very little is known about the transport of decontaminating agents used in remediation process under natural, undisturbed conditions. Nanomaterials, especially those made of nanoscale zero-valent iron (nZVI), have been most frequently used for remediation of contaminated soils because of their higher reactivity, lower toxicity, and lower cost than other metallic nanoparticles. Even though the nanoparticle size is smaller than soil pores, clogging may occur over time due to agglomeration of nanoparticles, which could reduce the soil's natural permeability and thereby cause filtration of the nanoparticles. The use of a stabilizer in the nanoparticles can modify the reactivity but improves their mobility in the soil system. Thus, the objective of this work was to evaluate the hydraulic conductivity of residual clay soil under the injection of different types and concentrations of nZVI with and without surfactant stabilizer (NANOFER 25, NANOFER 25S, and NANOFER STAR in powder at 1 g/L, 4 g/L, 7 g/L, and 10 g/L concentrations), and to model transport of these nZVI suspensions in this soil system. Undisturbed cylindrical soil samples collected from the field were used, and hydraulic conductivity tests were performed using a column apparatus. The results showed that the presence of the stabilizer in the nZVI influenced the nanoparticles' mobility. The nZVI concentrations of 1 and 4 g/L did not affect the natural soil hydraulic conductivity. However, higher concentrations reduced the hydraulic conductivity value, which retarded the migration of nZVI as reflected in the value of filtration parameter.

Proposal for an optimized method for sustainable remediation evaluation and application: implementation of a multi-criteria process.

As sustainable remediation methods do not yet have a consolidated approach, a detailed assessment of the level of satisfaction for sustainability prospects is necessary. So, this study aims to evaluate the sustainability level of sustainable remediation methods according to the visions of decision makers in this field, in order to propose an optimized method that best represents its approach. We considered eight methods applied to sustainable remediation and nine decision criteria for evaluation. The analytical hierarchy process (AHP) of multi-criteria decision analysis (MCDA) was applied to judge and weigh the criteria by stakeholders. These weights were used to calculate the degrees of sustainability for all the methods, to classify these within a ranking, and to optimize the one that obtained the best performance. The results indicated that when the criteria were weighted, the criterion (C7), protection of human health and the environment in general, obtained the best placement, and the degree of sustainability achieved by each method indicates that ITRC (Interstate Technology and Regulatory Council) had the best performance. Finally, the proposal method resulted in an explicit approach of all the considered criteria. This article presents a new approach compared with those already applied in this context and provides more robust resources to examine to what extent the methods integrate the premises of sustainable remediation. Graphical Abstract .

Quantitative Assessment of Life Cycle Sustainability (QUALICS): Framework and its application to assess electrokinetic remediation.

In recent years, the broader environmental impacts of remediation that arise from different remediation activities has drawn attention of practitioners, remediation design professionals and academicians to evaluate the net environmental benefit of environmental remediation projects. The main objective of this paper is to describe the Quantitative Assessment of Life Cycle Sustainability (QUALICS) framework, a new tool developed to strengthen decision-making in the selection of sustainable remedial technologies for the clean-up of contaminated sites. The proposed framework is a combination of two multi-criteria evaluation methods namely, the Integrated Value Model for Sustainable Assessment (MIVES) and Analytic Hierarchy Process (AHP). The QUALICS uses a multi-criteria assessment framework to support decision-making in remediation projects. A description of the methodology adopted for sustainability assessment of alternative remedial strategies using QUALICS framework is presented in this study. In addition, a case study is discussed to demonstrate the application of the QUALICS framework for the sustainability assessment of different remediation options for clean-up of a contaminated site. The case study involves sustainability assessment of different remediation options namely, electrokinetic remediation (EKR), excavation/disposal, and phytoremediation for remediation of a contaminated site. A sensitivity analysis was also performed for the EKR option by varying different parameters including electrode materials, energy source, electrolyte used, to analyze their influence on the sustainability of the alternative remedial options. The proposed framework can also be applied to any project in general to quantify and compare the sustainability indices of each of the alternative options considered and thereby identify the most sustainable option.

Biosurfactants during in situ bioremediation: factors that influence the production and challenges in evalution.

Research on the influence of biosurfactants on the efficiency of in situ bioremediation of contaminated soil is continuously growing. Despite the constant progress in understanding the mechanisms involved in the effects of biosurfactants, there are still many factors that are not sufficiently elucidated. There is a lack of research on autochthonous or exogenous microbial metabolism when biostimulation or bioaugmentation is carried out to produce biosurfactants at contaminated sites. In addition, studies on the application of techniques that measure the biosurfactants produced in situ are needed. This is important because, although the positive influence of biosurfactants is often reported, there are also studies where no effect or negative effects have been observed. This review aimed to examine some studies on factors that can improve the production of biosurfactants in soils during in situ bioremediation. Moreover, this work reviews the methodologies that can be used for measuring the production of these biocomposts. We reviewed studies on the potential of biosurfactants to improve the bioremediation of hydrocarbons, as well as the limitations of methods for the production of these biomolecules by microorganisms in soil.

Biostimulation and rainfall infiltration: influence on retention of biodiesel in residual clayey soil.

This study investigates the retention of biodiesel in residual clayey soil during biostimulation by nutrients (nitrogen, phosphorus, and potassium) under conditions of rainfall infiltration. Several column tests were conducted in a laboratory under different void ratios (1.14, 1.24, and 1.34), varying moisture contents (15, 25, and 35%), and in both the presence and absence of biostimulation. The volume of biodiesel (which was equivalent to the volume of voids in the soil) was placed atop the soil and allowed to percolate for a period of 15 days. The soil was subjected to different rainfall infiltration conditions (0.30 or 60 mm). The greatest reductions in residual contaminants occurred after 60 mm of rain simulation, at values of up to 74% less than in samples with the same conditions but no precipitation. However, the residual contamination decay rate was greater with 0-30 mm (0.29 g/mm) of precipitation than with 30-60 mm (0.075 g/mm). Statistical assessment revealed that increased moisture and the presence of nutrients were the factors with the most powerful effect on contaminant retention in the soil. The residual contaminant level was 21 g/kg at a moisture content of 15% and no precipitation, decreasing to 12 g/kg at 35% moisture and no precipitation. Accordingly, it is possible to conclude that biostimulation and rainfall infiltration conditions can decrease the retention of contaminants in soil and allow a greater leaching or spreading of the contamination. All of these phenomena are worthy of careful examination for the in situ bioremediation of organic contamination. HIGHLIGHTS: • The higher moisture in the soil, due to a high initial moisture content and/or infiltration of rainfall, can reduce contaminant retention, • The use of biostimulation through the addition of nutrients to accelerate the biodegradation of toxic organic contaminants may induce inadvertent undesirable interactions between the soil and the contaminant. • When adopting biostimulation for bioremediation, the effects of rainfall should be addressed; ideally, it should be prevented from entering the affected site, in order to avoid increased contaminant leaching and potential spreading.

Potential of Live Spirulina platensis on Biosorption of Hexavalent Chromium and Its Conversion to Trivalent Chromium.

Microalga biomass has been described worldwide according their capacity to realize biosorption of toxic metals. Chromium is one of the most toxic metals that could contaminate superficial and underground water. Considering the importance of Spirulina biomass in production of supplements for humans and for animal feed we assessed the biosorption of hexavalent chromium by living Spirulina platensis and its capacity to convert hexavalent chromium to trivalent chromium, less toxic, through its metabolism during growth. The active biomass was grown in Zarrouk medium diluted to 50% with distilled water, keeping the experiments under controlled conditions of aeration, temperature of 30°C and lighting of 1,800 lux. Hexavalent chromium was added using a potassium dichromate solution in fed-batch mode with the aim of evaluate the effect of several additions contaminant in the kinetic parameters of the culture. Cell growth was affected by the presence of chromium added at the beginning of cultures, and the best growth rates were obtained at lower metal concentrations in the medium. The biomass removed until 65.2% of hexavalent chromium added to the media, being 90.4% converted into trivalent chromium in the media and 9.6% retained in the biomass as trivalent chromium (0.931 mg.g(-1)).

Programa de Transplante Hepático Infantil do Hospital de Clínicas de Porto Alegre: resultados dos doze primeiros transplantes hepáticos intervivos / Pediatric liver transplantation program: results of living liver transplantation

Introdução: O Hospital de Clínicas de Porto Alegre (HCPA) é pioneiro na realização de transplante hepático infantil (THI) no RS. A menor oferta de doadores falecidos tem estimulado a realização de transplante hepático (TxH) intervivos. Objetivo: Descrever os resultados do THI intervivos do programa THI-HCPA. Método: Estudo descritivo. Incluídos: receptores de TxH intervivos, 18 anos, ambos os sexos e respectivos doadores, voluntários, ambos os sexos. Excluídos: insufi ciência hepática aguda. Variáveis: receptores: características clínico-demográficas, antropométricas; sorologias para Citomegalovírus (CMV) e Epstein-Barr (EBV); incidência de complicações pós-operatórias, tempo de internação, sobrevida 12 meses; doadores: características clínico-demográficas, sobrevida 12 meses. Todas as cirurgias foram realizadas pelo mesmo cirurgião e os dados, coletados prospectivamente. Estudo aprovado pelo Comitê de Ética em Pesquisa do HCPA (13-0208). Resultados: Doze TxH intervivos incluídos. Idade dos receptores: mediana=2 anos (sexo feminino:7). Espera em lista: 141,4±10,3d. Indicação de TxH: 83,3% atresia biliar. IMC normal: 100%. Child- -Pugh: C:7/12(58%). PELD: mediana=11,9a. Pré-TxH:IgG+CMV (10); IgG+EBV(4); ascite (7); peritonite bacteriana espontânea (3), hiponatremia dilucional (7); encefalopatia hepática (2); varizes esofágicas (4); hemorragia digestiva alta (3). Idade dos doadores: 31,8±8,4a. Sexo feminino=50%; 92% aparentado. Pesos receptor/doador: 19,2±8,9%. Implante do segmento hepático lateral esquerdo: 100%. Tempo de isquemia total: 1,34±0,67h. Duração da cirurgia: 5,94±2,58h. Duração da internação (receptores): 30,6 ± 25,2d. Complicações receptores: vascular (4), biliar (3), steal syndrome (1), small for size (2), sepse (1). Reintervenções cirúrgicas: 5. Tempo de permanência em UTI: mediana=9d. Primo-infecção: CMV (1), EBV (3). Rejeição celular aguda (4). Sobrevida em 1 ano: 76,7%. Tempo de internação(doadores): 8,1±4,0 d. Complicações ao doador: dor pós-operatória (80%). Conclusão: Os nossos resultados se assemelham àqueles da literatura no que se refere à incidência de complicações. A cirurgia tem se mostrado segura para o doador (AU)

Introduction: Hospital de Clínicas de Porto Alegre (HCPA) is a pioneer in conducting child liver transplantation (CLT) in RS. The lower supply of deceased donors has stimulated living liver transplant (LTx). Aim: To describe the results of living CLT in the THI-HCPA program. Methods: A descriptive study that included: LTx recipients from living donor, ≤ 18 years old, both sexes and their donors, volunteers, both sexes; and excluded: acute liver failure. Variables: Receptors: clinical, demographic and anthropometric characteristics, serology for cytomegalovirus (CMV) and Epstein-Barr virus (EBV) infection, incidence of postoperative complications, length of stay, 12-month survival; Donors: demographic and clinical characteristics, 12-month survival. All surgeries were performed by the same surgeon and the data were collected prospectively. This study was approved by the Research Ethics Committee of the HCPA (13-0208). Results: Twelve LTx from living donors were included. Age of recipients: median = 2 years (female: 7). Waiting in list: 141.4 ± 10.3 d. Indication for liver transplantation: 83.3% biliary atresia. Normal BMI: 100%. Child-Pugh C:7/12 (58%). PELD: median = 11.9a. Pre-LTx: CMV+IgG (10), EBV+IgG (4), ascites (7), spontaneous bacterial peritonitis (3), dilutional hyponatremia (7), hepatic encephalopathy (2), esophageal varices (4), high gastrointestinal bleeding (3). Donor age: 31.8 ± 8.4. Female = 50%, 92% related. Receiver/giver weights: 19.2 ± 8.9%. Implantation of left lateral hepatic segment: 100%. Total ischemic time: 1.34 ± 0.67 h. Length of surgery: 5.94 ± 2.58 h. Duration of hospitalization (receivers): 30.6 ± 25.2 d. Complications in receptors: vascular (4), bile (3), steal syndrome (1), small for size (2), sepsis (1). Surgical re-interventions: 5. Time in ICU: median = 9d. Primary infection: CMV (1), EBV (3). Acute cellular rejection (4). 1-year survival: 76.7%. Length of hospital stay (donors): 8.1 ± 4.0d. Donor complications: postoperative pain (80%). Conclusion: The results resemble those of the literature regarding the incidence of complications. The surgery has been shown to be safe for the donor (AU)

The psychosocial and economic burden of genital warts among women assisted in sixsexual and reproductive health clinics in Brazil / A carga psicossocial e econômica de verrugas genitais em mulheres atendidas em seis clínicas de saúde sexual e reprodutiva no Brasil

Introduction: World Health Organization estimates that 291 million women worldwide will have a human papillomavirus infection. Treatment for genital warts brings discomfort and may be stressful. Objective: The objectives are to estimate the psychological burden of genital warts and to estimate its economic and burden in six reproductive health clinics in Brazil. Methods: Women visiting BEMFAM'S Clinics form January 2012 until March 2013 filled a self-administrated questionnaire based on psychometric scale. The economic burden was measured with a retrospective study of medical chart review of patients assisted from January 2009 to December 2010. Results: A total of 122 individuals filled the psychosocial questionnaire. Women with normal Pap smear presented lower scores of worries and concerns about gynecological health than women with cervical intraepithelial neoplasia (CIN) or GW and higher scores of satisfaction with sexual life than women with CIN or GW. Feelings of anxiety and surprise with the the last exam were higher in GW group than for normal Pap smear and CIN goups. Each GW episode lasted on average 132 days, had 6 medical visits and costs US$139. Conclusion: The economic burden of GW is closely related to psychosocial burden, and the use of health services after a GW episode should be considered in future resaech. The study of indirect costs is important, considering the number if visits per episode of GW. Additional studies are needed and can help in the advocacy efforts for a comprehensive prevention programs in Brazil.

Introdução: A Organização Mundial de Saúde estima que 291 milhões de mulheres serão infectadas pelo Papilomavírus humano. O tratamento das verrugas genitais pode ser desconfortável e estressante. Objetivo: Estimar a carga psicossocial das verrugas genitais (VG); e estimar a carga econômica das verrugas genitais entre mulheres atendidas em seis clínicas de saúde reprodutiva. Métodos: Voluntárias atendidas nas Clínicas da BEMFAM entre 2010 e 1013 preencheram um questionário baseado na escala psicométrica. A carga econômica foi medida através da análise de prontuários de pacientes atendidas entre 2009 e 2010. Resultados: O questionário psicossocial foi preenchido por 122 sujeitos. Mulheres com Papanicolaou normal apresentaram menores índices de preocupação quanto à saúde ginecológica e maiores índices de satisfação com a vida sexual do que mulheres com neoplasia intraepitelial (CIN) ou VG. Sentimentos de ansiedade e surpresa com o resultado dos exames foram mais observados entre mulheres com verrugas genitais do que nas com Papanicolaou normal ou CIN. Em média, cada episódio de verruga genital durou 132 dias, demandou seis visitas médicas, e custou US$139. Conclusão: Houve relação entre a carga econômica das VG. O presente estudo reforça a importância da análise dos custos indiretos, considerando o número de visitas por episódio de VG. Estudos adicionais podem fortalecer os esforços para programas abrangentes de prevenção no Brasil.

Tosse na criança / Cough in children

A tosse crônica é um problema bastante freqüente no consultório do pediatra generalista. A tosse näo é uma doença, mas apenas um sintoma de alguma patologia subjacente e a busca de um diagnóstico etiológico específico é de vital importância nesses casos. Os autores propöem uma abordagem eminentemente clínica que facilita a elucidaçäo diagnóstica e o tratamento específico de causa básica, enfatizando o papel limitado dos medicamentos sintomáticos

Reidrataçäo oral: tópicos importantes / Oral rehydration: important topics

Desidrataçäo, devido a diarréia aguda, é uma causa comum de morbidade e de mortalidade nos países em desenvolvimento. O conhecimento da terapêutica e dos cuidados iniciais com esses pacientes säo muito importantes para todo o pessoal médico. Este trabalho pretende demonstrar as indicaçöes, complicaçöes mais freqüentes e crenças a respeito da terapia de reidrataçäo oral