Profiling wastewater characteristics in intra-urban catchments using online monitoring stations

This study aims to investigate the differences in intra-urban catchments with different characteristics through real-time wastewater monitoring. Monitoring stations were installed in three neighbourhoods of Barcelona to measure flow, total chemical oxygen demand (COD), pH, conductivity, temperature, and bisulfide (HS-) for 1 year. Typical wastewater profiles were obtained for weekdays, weekends, and holidays in the summer and winter seasons. The results reveal differences in waking up times and evening routines, commuting behaviour during weekends and holidays, and water consumption. The pollutant profiles contribute to a better understanding of pollution generation in households and catchment activities. Flows and COD correlate well at all stations, but there are differences in conductivity and HS- at the station level. The article concludes by discussing the operational experience of the monitoring stations.

151 Relevance of ESCC Grading and SINS System in the Management of Neurosurgical Patients with MSCC

Introduction

The use of ESCC and SINS scoring in the planning of surgery in Neurosurgical patients is something of mutual habit and standard practise. This project looks at the outcomes of patients referred to the centre via the Metastatic Spinal Cord Compression (MSCC) referral, the relevance of ESCC scoring and SINS scoring in surgical patients as well as the post-operative outcomes between neurosurgical and orthopaedic surgeons when treating the same cohort of patients.

Method

We looked at patients referred to a tertiary centre in the UK between January 2018 and December 2018, and June 2020 and December 2020 via the MSCC coordinator.

Results

The most common cancer that resulted in MSCC were urological malignancies, followed by cancers of the lung. Out of the patients that received radiotherapy, patients with urological malignancies had the best survival rate at 6 months post treatment, while gynaecological malignancies produced the lowest survival numbers.

Conclusions

In the groups that underwent surgery via the neurosurgeons and orthopaedic surgeons, there was no significant difference in outcome between the two, despite the those referred via neurosurgery having worse outcomes as a whole. We noted that there was a statistical significance between ESCC grading and patient’s mobility status in those who had MSCC between C7 and L1 vertebrae (p = 0.0478)- contrary to that mentioned in the literature. A higher ESCC score was associated with better mobility. We also found that the SINS score recommended guidance correlated with management of surgical patients who presented with MSCC within the tertiary centre.

1118 The Role of Emergency Surgery in Diverticular Strictures of Those Who Were Initially Managed Conservatively

Aim

The presence of diverticulosis can lead to several different complications including formation of strictures. However, the literature concerning management of diverticular strictures is poor. The purpose of this study is to evaluate the patients who were initially treated non surgically and had to undergo emergency surgery.

Method

A retrospective study was performed using a cohort of patients between 2016 and 2020 where 84 patients with diverticular strictures were identified and followed up. Data on the management of diverticular stricture was captured using the hospital’s electronic medical records.

Results

Out of 84 patients with diverticular strictures, 9 had elective surgery without any medical treatment while 75 had medical treatment first. Out of the 75 patients who were medically treated, 12 underwent emergency surgery while 2/75 underwent elective surgery after receiving medical treatment due to ongoing symptoms. Out of the 12 patients that underwent emergency surgery, 9 patients presented with obstruction while 3 had a bowel perforation. 6 patients had Hartmann’s procedure, 5 had defunctioning colostomy and 1 patient had adhesiolysis. No patient deaths were recorded at 12 months.

Conclusions

Although medical management remains the preferred method of managing diverticular strictures in the UK, it is not without its complications. 1 in 5 patients had an acute surgical admission requiring emergency surgery. This raises the importance of a good ‘safety net’ in those managed non-surgically, to reduce delays associated with seeking medical advice. We also appreciate the importance of carrying out more extensive studies to establish the best way to manage diverticular strictures.

80 Defunctioning Stomas the Answer to Avoid Anastomotic Leaks – Mere Precaution or A Necessity?

Introduction

Anastomotic leaks account for one of the major complications following Colorectal Surgery. One of the surgical procedures to help avoid this complication include providing a defunctioning stoma. Evidence surrounding the provision of a defunctioning stoma has been supported extensively in the field of Colorectal Surgery.

Method

A retrospective study was performed using a cohort of patients from a single teaching hospital between 2014 and 2019. 559 who had undergone elective bowel resection with primary anastomosis were identified and followed up. Data was captured using the hospital’s electronic medical records; Quadramed and Evolve.

Results

From the 559 patients 167 received a defunctioning stoma, out of which 114 were successfully reversed. 2 patients out of the 114 were deceased at 6 months following the reversal (p = 0.332). Furthermore, 15 patients of the 167 went on to develop complications at the anastomotic site (chi-square 25.37, p = <0.00001). 8 patients had anastomotic leaks and 9 patients developed strictures of which 2 patients developed both strictures and leaks.

Conclusions

Although written literature points in favour of providing a defunctioning stoma; it is important to consider such a decision in a case-by-case manner, due to the complications involved instead of routinely providing a stoma as a prophylactic measure.

[Usefulness of transcutaneous carbon dioxide pressure monitoring to measure blood gases in adults hospitalized for respiratory disease]

OBJECTIVE

To evaluate the usefulness of transcutaneous carbon dioxide pressure (TcPCO2) monitoring in patients hospitalized for respiratory disease.

PATIENTS AND METHODS

We used a SenTec TcPCO2 monitor that also determines transcutaneous oxygen saturation (SpO2) by means of a sensor placed behind the ear lobe at a temperature of 42 degrees C. We compared arterial blood gas measurements--PaCO2 and arterial oxygen saturation (SaO2)--with transcutaneous measurements and analyzed the correlation, regression line, and agreement between the 2 methods.

RESULTS

Thirty patients (20 men and 10 women) with various respiratory diseases and a mean (SD) age of 71 (13) years were included in the study. The median TcPCO2 was 43.25 mm Hg and the median PaCO2 was 42.6 mm Hg with no significant differences between the 2 measurements. The correlation was significant (rho=0.979; P< .0001) and the corresponding regression equation was TcPCO2=-2.475+1.058 PaCO2. The mean difference was 0.16 mm Hg (95% confidence interval [CI], --0.74 to 1.06). The lower limit of agreement (mean -1.96 SD) was -4.64 mm Hg, and the upper limit (mean +1.96 SD) was 4.96 mm Hg. For SaO2, the median was 94% and for SpO2, 95%. The difference between the 2 medians was significant (P< .004). The correlation was also significant (rho=0.822; P< .0001) with SpO2=4.427+0.97 SaO2. The mean difference was 1.14% (95% CI, 0.381% to 1.899%). The lower limit of agreement (mean -1.96 SD) was --2.93% and the upper limit (mean +1.96 SD) was 5.21%

CONCLUSIONS

Transcutaneous determination of carbon dioxide pressure and oxygen saturation is useful for patients hospitalized for respiratory disease in view of its good correlation and agreement, although SpO2 does tend to overestimate SaO2.

Online chat rooms: virtual spaces of interaction for socially oriented people

The internet has opened a new social space for communication. The present work studies interpersonal relationships in cyberspace using the chat channel as an interaction medium. Data obtained have outlined the sociodemographic and personality profile of internet users who engage in online chats as well as group self-perception, chatters' use habits, motivations to interact online, and the chatters' network of virtual and face-to-face relationships. Results suggests that relationships developed online are healthy and a complement to face-to-face relationships. These data are confirmed by personality studies. The theoretical and methodological implications of data are discussed.

Differences in airway responsiveness to acetaldehyde and methacholine in asthma and chronic bronchitis

Inhaled acetaldehyde may induce bronchoconstriction in asthmatic subjects and provides a new method to investigate airway responsiveness. The objective of the study was to determine whether acetaldehyde was a more specific stimulus than methacholine in differentiating asthma from chronic bronchitis with or without airflow limitation. Bronchial provocation challenges with methacholine and acetaldehyde were performed in 62 asthmatics and in 59 smokers with chronic bronchitis (32 with chronic bronchitis alone and 27 with chronic bronchitis and coexisting chronic obstructive pulmonary disease (COPD)). The response to both bronchoconstrictor agents was measured by the provocative concentration required to produce a 20% fall in forced expiratory volume in one second (FEV1; PC20). The two types of challenge yielded a similarly high level of sensitivity (100% for methacholine and 92% for acetaldehyde) in revealing airway hyperresponsiveness in asthma. However, bronchoprovocation with acetaldehyde yielded considerably greater specificity (95%) than bronchoprovocation with methacholine (24%) in separating asthma from chronic bronchitis. In subjects with asthma, methacholine and acetaldehyde responsiveness were weakly but significantly correlated (r=0.42, p=0.001) but no correlation was found between airway responsiveness to acetaldehyde and baseline FEV1 (r=0.13, p=0.33). These findings suggest that the demonstration of bronchoconstriction in response to acetaldehyde may be a more specific test than methacholine in the differentiation of asthma from chronic bronchitis. Furthermore, methacholine and acetaldehyde hyperresponsiveness are not reflecting the same pathophysiological process in the airways.

[Epidemiologic outbreak of Legionnaire's disease in an open community: 10 years later]

AIM

The aim of this study was to describe an outbreak of pneumonia due to L. pneumophila in Llutxent (Valencia) and to know the evolution of these patients 10 years after.

METHODS

The definition and identification of cases was carried out with the use of IFI techniques. An environmental and epidemiological study was performed for determining the origin and route of disease dissemination. The patients were clinically, functionally and serologically reviewed 10 years after.

RESULTS

From July to August 1983, 35 cases of pneumonia were reported in Llutxent (rate = 1.5%). L. pneumophila serotype 1 was serologically identified and was also found in shower heads and toilet tanks (in the context of the entry of sand into the drinking water supply). Ten years after, the patients had no respiratory symptoms with titers of antibodies versus Legionella sp. being under 1/64.

CONCLUSIONS

The authors emphasize the involvement of the distribution system for drinking water to the population in this first outbreak of Legionnaires disease in an open community. The health care measures taken were effective as demonstrated by no further pneumonias being recorded and after normalization of the rate of antibodies on a 10 year review.

[The primary ciliary dyskinesia syndrome. A frequent pathology]

The prevalence of primary ciliary dyskinesia syndrome (PCDS) in Western countries is of 1/40,000 but is 13% in patients with bronchiectasis. The aim of this study was to determine the prevalence of PCDS in patients with bronchiectasis and sinusitis, including whether or not these patients present specific clinical signs. Eighteen patients with these two conditions from an area with 750,000 inhabitants in Valencia (Spain), were studied for 2 years. Radiologic and clinical information was recorded and mucociliary motility was measured with albumin marked with radioactive technetium. The structure of the nasal mucosa cilia was also studied. In 14 patients (77%) mucociliary motility was suppressed and in 13 ultrastructural changes typical of PCDS were observed. Only male infertility and situs inversus were more frequent in patients with PCDS; other clinical signs were equally severe and frequent in patients with PCDS and in those in whom no cause for bronchiectasis and sinusitis could be found. We conclude that 1) the prevalence of PCDS in patients with bronchiectasis and sinusitis is 77%; 2) in these patients a test of mucociliary motility is sufficient for diagnosis (structural study not being required); 3) the prevalence of PCDS in our population seems to be greater than that described; and 4) clinical signs are similar in patients with PCDS and in those with bronchiectasis of unknown genesis.

Quality of death certificates in Valencia, Spain

Certificates of 1,454 deaths occurring over 11 months were retrieved from the Civil Register in Valencia, Spain. Relevant medical information was systematically gathered from hospital records, questionnaires, and Coroner reports. We compared the underlying cause of death (UCD) from the original death certificate, and a reference cause of death (RCD) determined by a panel of experts based on all available information. Overall, 80.2 percent of the certificates were concordant for disease category, but there was a great disparity among some specific disease categories.

[Microsurgery applied to surgery of Vater's ampulla]

Microsurgery, applied to surgery of Vater's papilla, does not represent a new development in surgical technique, but rather propounds the possibility of a new view of infundibular papilla which is of great diagnostic value of biliar disease. We see it as being indicated in all those cases in which surgery of papilla is undertaken. In papilla microsurgery technique exists a first period of diagnosis in which a study is made of the infundibula mucous membrane, allowing one to ascertain the state of the wall and possible affectation of the distal parts of the choledochus and of Wirsung ducts. In the second period, or the strictly surgical, microsurgery constantly achieves control of the papilla and its elements, at the same time being antitraumatic and more objective.

[Problem oriented pediatric record (author's transl)]

The object of this paper is the presentation of the problem griented medical record now in use at the Department of Pediatrics of the Faculty of Medicine of the University of Valencia. The main documents of this medical record (problem list, discharge summary, anamnesis and physical examination summary, and medical record summary) are given describing the characteristics of format and the rules for its completion. The relationships between the main documents are shown.