Level of activity, night and day alternation, and well being measured in a smart hospital suite

The present paper reports a study on the daily activity of elderly people in a hospital suite, with presence infrared sensors. It is an attempt to produce parameters and indicators for the predictive analysis of the daily activity of fragile persons. A relationship is proposed between well being of the patient and the night and day activities alternation.

Ozonation strategies to reduce sludge production of a seafood industry WWTP

In this work, several alternatives related to the application of ozone in different streams of a seafood industry WWTP were evaluated to minimize the production of waste sludge. The WWTP was composed of two coagulation-flocculation units and a biological unit and generated around of 6550 kg/d of sludge. Ozone was applied to sludge coming from flotation units (110 g TSS/L) at doses up to 0.03 g O(3)/g TSS during batch tests, no solids solubilization being observed. Ozone doses ranging from 0.007 to 0.02 g O(3)/g TSS were also applied to the raw wastewater in a bubble column reaching a 6.8% of TSS removal for the highest ozone dose. Finally, the effect of the pre-ozonation (0.05 g O(3)/g TSS) of wastewater coming from the first flotation unit was tested in two activated sludge systems during 70 days. Ozonation caused a reduction of the observed yield coefficient of biomass from 0.14 to 0.07g TSS/g COD(Tremoved) and a slight improvement of COD removal efficiencies. On the basis of the capacity for ozone production available in the industry, a maximum reduction of sludge generated by the WWTP of 7.5% could be expected.

Photocatalytic decolorization of methylene blue in the presence of TiO2/ZnS nanocomposites

The synthesis of distinct nanocrystalline TiO2 capped ZnS samples was carried out using a chemical deposition method. The materials characterization showed that the presence of ZnS onto TiO2 surface results in a red shift of the material band edge when compared with the initial semiconductor. The photocatalytic activity of the prepared nanocomposites was tested on the decolorization of methylene blue (MB) aqueous solutions. The dye photodecolorization process was studied considering the influence of experimental parameters such as catalyst concentration, TiO2/ZnS ratio, pH and methylene blue adsorption rate. The material with the best catalytic activity towards the methylene blue photodecolorization was the TiO2 doped with 0.2% of ZnS. The complete photodecolorization of a 20ppm methylene blue solution, at natural pH was achieved in less than 20min, nearly 70min faster than the TiO2 photoassisted process.

Limited approach to a thoracic spine osteoblastoma

Osteoblastoma (OB) is a rare primary benign bone tumor. It generally occurs in the axial skeleton, where it preferentially involves the neural arch. The peak incidence of this neoplasm is in the first two decades of life. Female/male ratio is 2:1. It is important to differentiate OB from osteoid osteoma, a very similar bone tumor. Neuroradiological imaging are diagnostics in most of the cases. This article describes a 18-year-old female affected from a thoracic osteoblastoma stemming from T9 lamina and extending to T11, with a diameter of about 2.5 cm. The patient complained of dorsal pain with progressive weakness to lower limbs. A dorsal approach was performed with a right partial T9 and T11 right laminectomy with total T10 right laminectomy. The mass was totally removed by a limited approach, with no consequent instability and no reason for any stabilization. OB is rare benign bone neoplasm that generally affect the posterior elements of the spine. Surgery is the treatment of choice in this kind of lesions: total removal is effective with no recurrence. When the lesion is placed in the cervical and thoracic spine the goal is to decompress spinal cord and reach the stability of the spine.

An approach for the application of the Ecological Footprint as environmental indicator in the textile sector

The Ecological Footprint (EF) is a recent concept which has widely been used as an indicator of environmental sustainability applied to individual lifestyles, regions, nations or even the world. Recently, its application to enterprises has been proposed. In the present study, a textile tailoring plant has been analysed. The overall purpose of this study was to develop a tool useful for evaluating the environmental impact evolution due to the performance of the plant, as well as for comparing the environmental behaviour of different tailoring processes. Therefore, the selected data were those from the manufacturing work. Data were divided in three main categories: energy, resources and waste. The principal contribution to the final EF (expressed in hectares of land) was the resources category, mainly due to the high value associated to the cloth. The consumed energy was the second contributor, while the waste category remained in third place. The final outcomes were divided by the production rates to obtain a comparable relative index, easy to be interpreted by the different stakeholders. This is of special importance for a Company involved in Corporate Social Responsibility and thus meant to have a general communication strategy.

Use of resorbable implants for symptomatic cervical spondylosis: experience on 16 consecutive patients

AIM

The aim of this study was to evaluate the results of a consecutive series of 16 patients affected by degenerative cervical spondylosis and operated on by anterior cervical discectomy and fusion (ACFD) by means of anterior bioresorbable plate and screws. Further, the authors compared the results in these patients with a series of 13 patients also affected by degenerative cervical spondylosis in whom arthrodesis was obtained by means of cages without plates.\

METHODS

The series included 8 males and 8 females aging from 37 to 69 years, operated from June 2003 to September 2004. They showed signs of cervical myelopathy, radiculopathy or both. The ACDF was performed with the insertion of dense cancellous allograft and application of anterior bioresorbable plate and screws (group A). The group B series included 9 males and 4 females aging from 50 to 77 years, all affected by the same pathology of group A patients and operated on in the same period of time. In these cases the ACDF was followed by the insertion of cages without anterior plates.

RESULTS

The retrospective analysis of our series showed lack of soft tissue reaction, with safeguarding of the vertebral body and disc space height. The degree of alignment of the cervical spine was also preserved, with a good rate of fusion and a good clinical outcome in both series of patients.

CONCLUSION

The use of a cervical plate increase stability and rate of fusion when added to the interbody device; while the use of a metallic plate may be responsible for several shortcomings, a resorbable plate may overcome these problems.

Gastrointestinal complications in renal transplant recipients: MITOS study

INTRODUCTION AND METHODS

An epidemiologic multicenter study was performed to evaluate the prevalence and management of gastrointestinal (GI) complications in solid organ transplant patients. A total of 1788 recipients were included, 1132 of which corresponded to renal transplanted patients.

RESULTS

The mean age for the renal transplanted patients was 52 +/- 13.2 years. The mean time from the transplantation was 5.4 +/- 5.4 years. 17.7% showed some pretransplant GI disease, while 53% presented this type of complication in the posttransplant period. Diarrhea was the most prevalent GI complication (51.5%) and digestive perforation was the GI disorder that affected the patients daily living the most. From the patients with GI complications, 71% received pharmacological treatment, using gastric protectors in 91.3% of the cases. Regarding immunosuppressive drugs, in 30.9% of the cases the dose of the drug was reduced, in 9.3% discontinued temporarily and in 7.5% discontinued permanently. These changes mainly affected the MMF (89%, 83% and 74% for dose change, temporary and permanent discontinuation, respectively).

CONCLUSIONS

The prevalence of GI complications in renal transplant exceeded 50%, and affected patients' daily living. The management of these complications was based on treatment with gastric protectors, dose reduction and/or partial or definitive MMF discontinuation.

[Evaluation of pulmonary function in the elderly. Intergroupe Pneumo Gériatrie SPLF-SFGG]

Aging is associated with a progressive decrease in lung function. As a consequence of aging, individual's reserve is diminished, but this decrease is heterogeneous between individual subjects. Many factors are involved in the overall decline in lung function. The prevalence of asthma in the elderly is estimated between 6 and 10%. Mortality due to COPD is increasing, especially among older subjects. Older subjects are at an increased risk of developing chronic diseases such as Parkinson's disease, which can have consequences for lung function. Under-nutrition is also common in the elderly and can produce sarcopenia and skeletal muscle dysfunction. The presentation of respiratory disorders may differ in the elderly, especially because of a lack of perception of symptoms such as dyspnea. The impact of bronchodilatators or corticosteroids on respiratory function has not been studied in the elderly. Drugs usually used for the treatment of hypertension or arrhythmias, which are often observed with aging, can have pulmonary toxicity. There is no difference between functional evaluation in younger and older subjects but it is more difficult to find predicted values for older patients. Performing pulmonary function tests in older patients is often difficult because of a higher prevalence of cognitive impairment and/or poor coordination. When assessing pulmonary function in the elderly, the choice of tests will be depend on the circumstances, with the use of voluntary manoeuvres dependent on the condition of the patient.

Successful use of bivalirudin for cardiopulmonary bypass in a patient with heparin allergy

Heparin-induced IgE-mediated hypersensitivity and anaphylactoid reactions, although rare, can pose a serious clinical problem for patients requiring cardiopulmonary bypass (CPB). Bivalirudin is a bivalent reversible direct thrombin inhibitor, with a half-life of 25 min, eliminated mostly by proteolytic cleavage. There are some reports on the use of bivalirudin for cardiac surgery, particularly for heparin-induced thrombocytopenia (HIT), but none on cases of heparin allergy. We report a case of heparin allergy successfully managed for CPB with bivalirudin anticoagulation.

Clinical, haematological, biochemical and economic impacts of Trichinella spiralis infection in pigs

The purpose of this work was to assess the clinical, haematological and biochemical responses of pigs experimentally inoculated with Trichinella spiralis. Groups of three pigs were inoculated per os with 100, 500 and 5000 T. spiralis muscle larvae, two pigs were used as control. Clinical evaluation of disease in pigs included daily examination, rectal temperature measurements and cardiac and respiration rates. Haematological studies included: hematocrit (%), hemoglobin (g/dl), and white cell, neutrophil, lymphocyte and eosinophil counts. Blood biochemistry included: bun (mg/dl), creatinine (mg/dl), AST (UI/l), ALT (UI/l), CPK (UI/l) and ALP (UI/l). No significant differences were observed in rectal temperature and in cardiac and respiration rates between inoculated animals and the control group (p> or =0.05). Significant differences were detected (p< or =0.05) in the values of % hemoglobin, and eosinophils, as well as in the values of CK, ALP, AST and ALT. The variations observed in some cases were related to the number of T. spiralis larvae inoculated and varied with the number of days post-infection. Inoculated pigs showed significant differences (p< or =0.05) in weight gain when compared with uninoculated controls. This study has clinical, haematological, and enzyme alterations in Trichinella infected pigs provides a better understanding of acute and chronic trichinellosis in pigs.

[Anesthesia in urology: notes on its history and development in Spain, 1847 to 1950]

This review of the historical course of anesthesia performed in the context of urology in Spain relies on primary sources: doctoral theses, dissertations, published articles, inaugural addresses, conference proceedings, and books belonging to various archives and libraries. We collected a large number of documents relating to urology and of particular interest regarding anesthesia, classified them, and subjected them to critical analysis. This allowed us to carefully follow the development of anesthesia and urology itself, both of which attained notable clinical and scientific importance in Spain. Anesthesia with chloroform and incomplete anesthesia were the norm during the second half of the 19th century. However, during the first half of the 20th century, the most widely used techniques were the application of ether or spinal or local infusions, although epidural and intravenous techniques were also mentioned.

The outcome of patients requiring emergency conversion from off-pump to on-pump coronary artery bypass grafting

BACKGROUND AND OBJECTIVE

Patients undergoing off-pump coronary artery bypass grafting (CABG) may need emergent institution of cardiopulmonary bypass (CPB) for circulatory collapse during the operation. Our aim was to evaluate outcome in such patients and identify preoperative and intraoperative risk factors.

METHODS

This is an observational study in a University Hospital setting. In the period June 2001-July 2003, data from 988 consecutive patients undergoing CABG in our institution were prospectively collected. No interventions were made. Prolonged hospital stay (>7 days), hospital mortality, temporal trends and risk factors for conversion from off-pump to on-pump surgery were studied.

RESULTS

Fifty-four patients with emergency operations and six with associated carotid artery surgery were excluded. Of the remaining 928 patients, 450 (48.5%) were planned for off-pump surgery. Thirty-seven (8.2%) of them required conversion to CPB on an emergency basis. These patients had higher mortality (5.4%) than the off-pump group (1.5%) and the CPB group (0.4%), P = 0.02. The incidence of prolonged hospital stay was also higher (conversion group = 27%, off-pump group = 12.3%, CPB group = 17.6%; P = 0.02). We did not identify any perioperative characteristics significantly associated with the risk of requiring conversion. The conversion rate was uniformly distributed over the study period.

CONCLUSIONS

Patients who are emergently converted to CPB during attempted off-pump procedures are at higher risk of death and prolonged hospital stay; this population should be included in comparative studies as "intention to treat" in the off-pump group.

ACTIDOM--a microsystem based on MEMS for activity monitoring of the frail elderly in their daily life

A "ambulatory activity recorder" was developed, with 3 accelerometers and 3 magnetometers, to detect and qualify the elementary activities of a person, such as walking and transfers. The signal processing is explained, along with the preliminary results obtained on young and older healthy subjects. This work open the way to continuous and automatic monitoring of the level of mobility.

[Evaluation of viral load and antigenemia as markers for relapse cytomegalovirus infection in renal transplant recipients]

Cytomegalovirus (CMV) is a pathogen, commonly found in the donors and recipients of solid organ transplantation. CMV is one of the major causes of morbidity and mortality in these patients. Relapsing episodes of CMV infection occur in 23-33% of transplant patients which is likely a reflection of incomplete suppression of viral replication following antiviral treatment with intravenous ganciclovir. We have studied CMV DNA load and antigenemia as markers for relapse of CMV infection in 49 renal transplant patients out of 68 with CMV infection who received a course of intravenous ganciclovir among 300 transplants carried out between January of 2001 and June of 2005. Viral load and antigenemia were measured in blood samples obtained before, during and at the completion of treatment. We also studied different viral load as predictors of relapse CMV infection. Twelve (24.5%) of 49 recipients developed relapsing CMV infection. The relapsing group had higher viral loads after treatment than the no relapsing group. There was no difference in antigenemia level between both groups. The viral loads before and during the treatment, the age and sex of donors and recipients, inmunosupresión, percentage of seronegative recipients with seropositive donors, duration of the therapy and the percentage of patients with heavy immunosuppression were similar in the two groups, but the incidence of acute rejection was higher in the relapsing group. We also evaluated the range of viral load after treatment which is able to trigger the relapse of CMV infection. We conclude that CMV DNA load after treatment is a useful marker for individualizing antiviral treatment of CMV infection in renal transplant recipients. Acute rejection is a risk factor to the relapsing CMV infection.

Redo coronary artery bypass grafting on the beating heart and transfusion needs

AIM

Reoperative coronary artery bypass grafting is associated with significant morbidity and a difficult perioperative management; in particular, important bleeding is observed. Off pump technique may give specific advantages in redo coronary operations since it is associated to decreased interactions of blood with foreign surfaces. We investigated our 5-year database to evaluate the role of off pump technique in reducing transfusion needs.

METHODS

The present single centre case control study was carried out in a university tertiary care hospital on 132 consecutive patients undergoing reoperative coronary artery bypass grafting off pump (OP group, 41 patients) or with cardiopulmonary bypass (CPB group, 91 patients). Univariate and multivariate analysis were performed.

RESULTS

There was no preoperative difference between the 2 groups; mean number of grafts per patient differed between groups (OP: 1.4+/-0.7, CPB: 2.5+/-1.0). The frequency of patients transfused with blood products was significantly (P=0.004) higher in the CPB group (47.3%) than in the OP group (19.5%). The only independent predictors of transfusions, determined by stepwise multivariate logistic regression analysis, was the use of cardiopulmonary bypass (OR: 4.1, CI: 1.6 - 10.1), and female gender (OR: 7.0, CI: 2.1 - 16.1).

CONCLUSION

In our centre, off pump coronary surgery is associated with reduced transfusion of blood products.

Prevalence of Toxocara cati and other parasites in cats’ faeces collected from the open spaces of public institutions: Buenos Aires, Argentina

Toxocarosis is a worldwide parasitic infection that affects both cats and dogs. Toxocara cati (Schrank, 1788) syn. Toxocara mystax (Zeder, 1800) prevalence was studied in faeces from stray cats collected from the open spaces of public institutions of Buenos Aires city, both building and surrounding open spaces are fenced off. Of the 465 samples obtained from March to June of 2005, 58.3% were found to have parasite eggs. The following parasites were identified from the 271 positive samples: T. cati (61.2%), Cystoisospora spp. (20.3%), Trichuris spp. (17.0%), Toxascaris leonina (15.1%), Ancylostoma spp. (14%) and Aelurostrongylus abstrusus (2.6%). T. cati prevalence was 35.7% (95% confidence interval: 31.2-40.1), with a 42.2% single isolations. The most frequent combination was T. cati and Cystoisospora spp. (9%). More than half the areas studied showed over 40% prevalence. Seventy-one percent of the collected samples were fresh with a variable moist consistency and 29% were older with a dry consistency. A statistically significant association was found between sample consistency and presence of parasites (chi2 = 10.81; p = 0.001) as also between sample consistency and presence of T. cati (chi2 = 11.27; p = 0.0007). Moist consistencies were significantly different from the rest: consistency (wet or dry) versus parasites (z = 1.95; p = 0.02) (95% confidence interval: 0.004-0.203); consistency (wet or dry) versus T. cati (z = 3.25; p = 0.0006) (95% confidence interval: 0.075-0.254). The cat population that inhabits these public green spaces contaminates the environment, thus transforming them into dangerous spaces with a variable rate for the human population that spends time in these places.

[How can psychological help be provided for the patient/caregiver tandem home?]

INTRODUCTION

Elderly people and their family helpers are often isolated at home and do not have access to the professional psychological help that they require. For an elderly population, the trips to consulting rooms are difficult, tedious and expensive. Besides, maintaining a patient at home is heavy to manage for close relatives because of the organization, financial issues and above all the risk of psychological burnout. The literature shows us that psychological assistance is more common at distance from home, in hospitals, in special institutions or specific organizations. However, there is a clear need of help at home. We propose to develop psychological assistance at home for the patient/helper tandem in cases of dementia. This prospective study reports three different cases.

METHOD

This study is a qualitative pilot study. Participants characteristics: patients were diagnosed with severe dementia, assistance showed deep fatigue of the helper, both members of the tandem lived at home, age above 69 years, the eed for nursing care at home. THERAPEUTIC ASSESSMENT: The psychological clinician acts after proposing his helpand not on a clear request from the patient. He will meet his patient 7 times during 4 months. The meetings always take place in the same place and last 45 minutes. Confidentiality during the meeting is explained and guaranteed so the patient can speak openly.

EVALUATION

An independent psychologist assessed the monitoring in the hospital. Our methodology included two assessments: the first, assessing the task of the helper before the evaluation and the second taking into account a new measurent of the task and the opinions of the participants following a semi-directed interview. The evaluation of the task was performed using Zarit's scale. The evaluation was also based on the clinical observation of the psychologist.

RESULTS

Organization of the monitoring: one meeting per week was sufficient for all participants with a minimal duration of 45 minutes. The fact that the meetingsrook place at home was appreciated, because of their simple and convenient organization. The patient/helper tandems in those suffering from advanced dementia could only have taken place in the home because transport any where else would have beent too difficult for them. The sessions during this research study were free of charge. Two out of three participants were ready to pay so long as the study could continue. The managers were bothered a few times by phone calls and/or unexpected visits, invitations for a cup of tea and requests for a small service (like mailing a letter). Assistance for the caregiver: all the caregivers declared that assistance was a personal improvement in a period of doubt, loss of self-confidence and isolation. Furthermore, clinical observation of the therapeutic assistance appears to show that psychological help at home could lead to the improved psychological function of the helper. This was emphasized when we established the limits of the caregiver/patient relationship. We observed a better balance in the input of investing and de-investing and better acceptance of the identity modifications which were required for the caregiver. Assistance for the patient: we believe that this sort of intervention has positive effects on the patients themselves. This care at home protects the destructurated identity of the patients and their intimity. Moreover, intrapsychic tension can be lowered by being shared with the psychologist. Assessment of the burden: among the three patients who wete studied, the burden was unaltered in one case (43/88; 43/88), significantly improved in one case (41/88; 24/88) and remained light in one case (18/88; 16/88).

DISCUSSION

We discovered that Zarit's test showed some limits. The time to complete the test is quite long and tedious for caregivers. Some questions are too direct and can put the caregivers in a guilty position. The mini Zarit version with only seven items, appears more satisfactory because it's shorter and provokes less guilt. The other point concerns the therapeutic frame at home. The usually represents all the constants of the therapeutic process including the role of the psychologist and all the items that refer to space, time, management of the timetable, payement and interruptions in care. Could the fact of being at home be harmful for the therapeutic process? Of course, the place of residence is less neutral than a office in an institution and the superposition of the frame of life and of the therapeutic frame raises lots of questions for the psychologist: entering a private house is like entering a private life, which is not without consequences on the follow-up. We are here far from a classical frame of therapeutic interviews, so the frame must be clearly defined.

CONCLUSION

This prospective study leads us to the conclusion that the superposition of the frame of life and of the therapeutic frame represents a limit to psychotherapy but is not exclusive of psychological support at home. As a supplement to this face to face follow up at home, we could imagine other ways of providing such psychological support, by phone or by telemedicine for instance. Could the new technologies of communication help to compensate the lack of means in favour of the caregivers at home? Although these new technologies are more dedicated to institutions than to providing care at home, could they not be helpful for organizing psychological help at home? However, in order to validate such devices, they need to be fried and assessed at home.

Granulation in high-load denitrifying upflow sludge bed (USB) pulsed reactors

In this work, the effect of the application of a pulse system to anoxic upflow sludge bed (USB) denitrifying reactors for enhancing sludge granulation was studied. In all, three 0.8 L reactors (two operated with flow pulsation, P1 with effluent recycling and P2 without recycling, and one without pulsation and effluent recycling, no pulsation (NP)) were fed with a mixture of NaNO3 and glucose and inoculated with methanogenic granular sludge. The organic loading rate (OLR) and the nitrogen loading rate (NLR) were progressively increased and, at the end of the experiment, extremely high values were obtained (67.5 kgCOD/m3d and 11.25 kgN-NO3-/m3 d). Ammonia and nitrite accumulation in reactor NP were important in the maturation stage, decreasing the denitrification efficiency to 90%, while in reactor P1 only low nitrite values were obtained in the last few days of the experiment. In reactor P2, nitrogen removal was 100% most of the time. Several operational problems (flotation and the subsequent wash out of biomass) appeared in the NP reactor when working at high denitrifying loading rates, while in reactors P1 and P2 there were no notable problems, mainly due to the good characteristics of the sludge developed and the efficient degasification produced by the pulsing flow. The sludge formed in the NP reactor presented a flocculent structure and a total disintegration of the initial methanogenic granules occurred, while a small-sized granular biomass with a high specific density was developed in the pulsed reactors due to the shear stress produced.