Outcomes of surgical bleb revision for complications of trabeculectomy.

OBJECTIVE: To describe the results of revision surgery for complications of trabeculectomy in a case series from an academic glaucoma service. DESIGN: Retrospective case series. PARTICIPANTS: A total of 177 eyes of 167 adult patients who underwent revision of trabeculectomy at the Wilmer Eye Institute between 1994 and 2007. METHODS: Three indications for surgery were identified: hypotony without leak, bleb leak, and bleb dysesthesia. Revision was deemed successful when all of the following were true: the primary indication was eliminated, further intraocular pressure (IOP)-lowering surgery was not required, no major complication occurred, and a new bleb-related problem did not develop. Patients with less than 3 months of follow-up were excluded unless failure occurred earlier. Surgical procedures included variations on excision of thin or leaking conjunctiva with advancement. MAIN OUTCOME MEASURES: Change in IOP, change in visual acuity, need for further IOP-lowering surgery, and complications after bleb revision. RESULTS: Subjects' mean age was 67+/-14 years, 54% were female, and mean follow-up was 2.8+/-2.7 years, with a mean interval from trabeculectomy to revision of 3.5+/-3.7 years. Overall success rate was 63% (112/177), which was slightly higher for leak repair (65%; 64/98) and hypotony (63%; 32/51) than for dysesthesia (57%; 16/28) indications. By Kaplan-Meier analysis, overall cumulative success rates at 1, 2, 5, and 10 years after bleb revision were 80%, 75%, 50%, and 41%, respectively. IOP and visual acuity improved significantly in both hypotony and leak groups (P values ranging from 0.004 to <0.0001). Additional IOP-lowering surgery was required in 9%. In multivariate regression analysis adjusting for age, gender, and number of prior surgeries, patients with glaucoma other than primary open-angle glaucoma were twice as likely to have failed bleb revision. CONCLUSIONS: Surgical bleb revision often provides successful resolution of bleb-related complications. Most patients maintain IOP control without need for further IOP-lowering surgery. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

Cataract surgical outcomes, visual function and quality of life in four rural districts in Vietnam.

BACKGROUND: To evaluate cataract surgical outcomes in four rural districts of Ha Tinh Province, Vietnam. DESIGN: Cross-sectional study. PARTICIPANTS: Post-cataract surgery patients sampled randomly from facilities in four rural districts of Ha Tinh Province >3 months after surgery. MAIN OUTCOME MEASURES: Postoperative visual acuity (VA), visual function and quality of life. RESULTS: Among 412 patients, the mean age was 74.5 ± 9.4 years, 67% (276) were female, and 377 (91.5%) received intraocular lenses (IOL). Nearly two-thirds of patients had no postoperative visits after discharge. Postoperatively, more than 40% of eyes had presenting VA <6/18, while 20% remained <6/60. The mean self-reported visual function and quality of life for all patients were 68.7 ± 23.8 and 73.8 ± 21.6, respectively. Most patients (89.5%) were satisfied with surgery and the majority (94.4%) would recommend surgery to others. One-third of patients paid ≥$US50 for surgery. In multiple regression modelling, older age (P < 0.01), intraoperative complications (P < 0.01) and failure to receive an IOL (P < 0.01) were associated with postoperative VA <6/60. CONCLUSION: Satisfaction with surgery was high, and many patients were willing to pay for their operations. Poor visual outcomes were common; however, and better surgical training is needed to reduce complications and their impact on visual outcomes. More intensive postoperative follow-up may also be beneficial. © 2011 The Authors. Clinical and Experimental Ophthalmology © 2011 Royal Australian and New Zealand College of Ophthalmologists.

Willingness to pay for potential enhancements to a low-cost cataract surgical package in rural southern China.

PURPOSE: To assess determinants of patients' willingness to pay (WTP) for potential components of a multi-tiered cataract surgical package offered by a non-governmental organization (NGO) in rural China. DESIGN: Cross-sectional study. METHODS: Demographic and clinical data were collected from 505 patients presenting for cataract screening or surgery in Yangjiang, China. Willingness to pay for potential enhancements to the current surgery package was assessed using a bidding format with random payment cards. RESULTS: Among 426 subjects (84.4%) completing interviews, the mean age was 73.9 ± 7.3 years, 67.6% were women and 73% (n = 310) would pay for at least one offering, with 33-38% WTP for each item. Among those who would pay, the mean WTP for food was US$1.68 ± 0.13, transportation US$3.24 ± 0.25, senior surgeon US$50.0 ± 3.36 and US$89.4 ± 4.19 for an imported intra-ocular lens (IOL). The estimated total recovery from these enhancements under various assumptions would be US$20-50 (compared to the current programme price of US$65). In multivariate models, WTP for the senior surgeon increased with knowledge of a person previously operated for cataract (OR = 2.13, 95% CI 1.42-3.18, p < 0.001). Willingness to pay for the imported IOL increased with knowledge of a previously operated person (OR = 1.85, 95% CI 1.24-2.75, p < 0.01) and decreased with age >75 years (OR = 0.61, 0.40-0.93, p < 0.05). CONCLUSIONS: Opportunities exist to increase cataract programme revenues through multi-tiered offerings in this setting, allowing greater subsidization of low-income patients. Personal familiarity with cataract surgery is important in determining WTP. © 2011 The Authors. Acta Ophthalmologica © 2011 Acta Ophthalmologica Scandinavica Foundation.

Biological phosphorus removal during high-rate, low-temperature, anaerobic digestion of wastewater.

We report, for the first time, extensive biologically-mediated phosphate removal from wastewater during high-rate anaerobic digestion (AD). A hybrid sludge bed/fixed-film (packed pumice stone) reactor was employed for low-temperature (12°C) anaerobic treatment of synthetic sewage wastewater. Successful phosphate removal from the wastewater (up to 78% of influent phosphate) was observed, mediated by biofilms in the reactor. Scanning electron microscopy and energy dispersive X-ray analysis revealed the accumulation of elemental phosphorus (~2%) within the sludge bed and fixed-film biofilms. 4’, 6-diamidino-2-phenylindole (DAPI) staining indicated phosphorus accumulation was biological in nature and mediated through the formation of intracellular inorganic polyphosphate (polyP) granules within these biofilms. DAPI staining further indicated that polyP accumulation was rarely associated with free cells. Efficient and consistent chemical oxygen demand (COD) removal was recorded, throughout the 732-day trial, at applied organic loading rates between 0.4-1.5 kg COD m-3 d-1 and hydraulic retention times of 8-24 hours, while phosphate removal efficiency ranged from 28-78% on average per phase. Analysis of protein hydrolysis kinetics and the methanogenic activity profiles of the biomass revealed the development, at 12˚C, of active hydrolytic and methanogenic populations. Temporal microbial changes were monitored using Illumina Miseq analysis of bacterial and archaeal 16S rRNA gene sequences. The dominant bacterial phyla present in the biomass at the conclusion of the trial were the Proteobacteria and Firmicutes and the dominant archaeal genus was Methanosaeta. Trichococcus and Flavobacterium populations, previously associated with low temperature protein degradation, developed in the reactor biomass. The presence of previously characterised polyphosphate accumulating organisms (PAOs) such as Rhodocyclus, Chromatiales, Actinobacter and Acinetobacter was recorded at low numbers. However, it is unknown as yet if these were responsible for the luxury polyP uptake observed in this system. The possibility of efficient phosphate removal and recovery from wastewater during AD would represent a major advance in the scope for widespread application of anaerobic wastewater treatment technologies.

Continuing the fight in reducing the risk of surgical site infections in the perioperative environment

Assessing risk has become part of the process of supporting patients andmaintaining safety in the healthcare setting. The risk of healthcare associatedinfections (HCAIs) has long been well documented and surgical site infection (SSI)is recognised as one of the most prevalent (Tanner & Khan 2008, Wilson 2013a).

Design, production and characterisation of granular adsorbent material for arsenic removal from contaminated wastewater

The objective of this research was to design granulated iron oxide for the adsorption of heavy metals from wastewater. Polyvinyl acetate (PVAc) was chosen as a suitable binder; as it is water insoluble. Initial experiments on selection of suitable solvent of the polymer were carried out using three solvents namely; methanol, acetone and toluene. Based on the initial tests on product yield and mechanical strength, acetone was selected as the solvent for the polyvinyl acetate binder. Design of experiment was then used to investigate the influence of granulation process variables; impeller speed, binder concentration and liquid to solid ratio on the properties of the granular materials. The response variables in the study were granules mean size, stability in water and granule strength. The results showed that the combination of high impeller speed and high binder concentration favour the formation of strong and stable granules. Results also showed that leaching of the binder into the simulated was water was negligible. Trial adsorption experiments carried out using the strongest and most stable iron oxide granules produced in this work showed removal efficiency of around 70% of synthetic arsenic solutions with initial concentration of 1000 ppb.

Diagnostic value of surgical lung biopsy: comparison with clinical and radiological diagnosis

OBJECTIVE: To determine overall and disease-related accuracy of the clinical/imagiological evaluation for pulmonary infiltrates of unknown aetiology, compared with the pathological result of the surgical lung biopsy (SLB) and to evaluate the need for the latter in this setting. METHODS: We conducted a retrospective review of the experiences of SLB in 366 consecutive patients during the past 5 years. The presumptive diagnosis was based on clinical, imagiological and non-invasive or minimally invasive diagnostic procedures and compared with the gold standard of histological diagnosis by SLB. We considered five major pathological groups: diffuse parenchymal lung disease (DPLD), primitive neoplasms, metastases, infectious disease and other lesions. Patients with previous histological diagnosis were excluded. RESULTS: In 56.0% of patients (n=205) clinical evaluation reached a correct diagnosis, in 42.6% a new diagnosis was established (n=156) by the SLB, which was inconclusive in 1.4% (n=5). The pre-test probability for each disease was 85% for DPLD, 75% for infectious disease, 64% for primitive neoplasms and 60% for metastases. Overall sensitivity, specificity, positive and negative predictive values for the clinical/radiological diagnosis were 70%, 90%, 62% and 92%, respectively. For DPLD: 67%, 90%, 76% and 85%; primitive neoplasms: 47%, 90%, 46% and 90%; metastases: 99%, 79%, 60% and 99%; infectious disease 38%, 98%, 53% and 96%. CONCLUSIONS: Despite a high sensitivity and specificity of the clinical and imagiological diagnosis, the positive predictive value was low, particularly in the malignancy group. SLB should be performed in pulmonary infiltrates of unknown aetiology because the clinical/imagiological assessment missed and/or misdiagnosed an important number of patients.

Mercury (II) removal from aqueous solutions by microporous materials

O Mercúrio é um dos metais pesados mais tóxicos existentes no meio ambiente, é persistente e caracteriza-se por bioamplificar e bioacumular ao longo da cadeia trófica. A poluição com mercúrio é um problema à escala global devido à combinação de emissões naturais e emissões antropogénicas, o que obriga a políticas ambientais mais restritivas sobre a descarga de metais pesados. Consequentemente o desenvolvimento de novos e eficientes materiais e de novas tecnologias para remover mercúrio de efluentes é necessário e urgente. Neste contexto, alguns materiais microporosos provenientes de duas famílias, titanossilicatos e zirconossilicatos, foram investigados com o objectivo de avaliar a sua capacidade para remover iões Hg2+ de soluções aquosas. De um modo geral, quase todos os materiais estudados apresentaram elevadas percentagens de remoção, confirmando que são bons permutadores iónicos e que têm capacidade para serem utilizados como agentes descontaminantes. O titanossilicato ETS-4 foi o material mais estudado devido à sua elevada eficiência de remoção (>98%), aliada à pequena quantidade de massa necessária para atingir essa elevada percentagem de remoção. Com apenas 4 mg⋅dm-3 de ETS-4 foi possível tratar uma solução com uma concentração igual ao valor máximo admissível para descargas de efluentes em cursos de água (50 μg⋅dm-3) e obter água com qualidade para consumo humano (<1.0 μg⋅dm-3), de acordo com a legislação Portuguesa (DL 236/98). Tal como para outros adsorbentes, a capacidade de remoção de Hg2+ do ETS- 4 depende de várias condições experimentais, tais como o tempo de contacto, a massa, a concentração inicial de mercúrio, o pH e a temperatura. Do ponto de vista industrial as condições óptimas para a aplicação do ETS-4 são bastante atractivas, uma vez que não requerem grandes quantidades de material e o tratamento da solução pode ser feito à temperatura ambiente. A aplicação do ETS-4 torna-se ainda mais interessante no caso de efluentes hospitalares, de processos de electro-deposição com níquel, metalúrgica, extracção de minérios, especialmente ouro, e indústrias de fabrico de cloro e soda cáustica, uma vez que estes efluentes apresentam valores de pH semelhantes ao valor de pH óptimo para a aplicação do ETS-4. A cinética do processo de troca iónica é bem descrita pelo modelo Nernst-Planck, enquanto que os dados de equilíbrio são bem ajustados pelas isotérmicas de Langmuir e de Freundlich. Os parâmetros termodinâmicos, ΔG° and ΔH° indicam que a remoção de Hg2+ pelo ETS-4 é um processo espontâneo e exotérmico. A elevada eficiência do ETS-4 é confirmada pelos valores da capacidade de remoção de outros materiais para os iões Hg2+, descritos na literatura. A utilização de coluna de ETS-4 preparada no nosso laboratório, para a remoção em contínuo de Hg2+ confirma que este material apresenta um grande potencial para ser utilizado no tratamento de águas. ABSTRACT: Mercury is one of the most toxic heavy metals, exhibiting a persistent character in the environment and biota as well as bioamplification and bioaccumulation along the food chain. Natural inputs combined with the global anthropogenic sources make mercury pollution a planetary-scale problem, and strict environmental policies on metal discharges have been enforced. The development of efficient new materials and clean-up technologies for removing mercury from effluents is, thus, timely. In this context, in my study, several microporous materials from two families, titanosilicates and zirconosilicates were investigated in order to assess their Hg2+ sorption capacity and removal efficiency, under different operating conditions. In general, almost all microporous materials studied exhibited high removal efficiencies, confirming that they are good ion exchangers and have potential to be used as Hg2+ decontaminant agents. Titanosilicate ETS-4 was the material most studied here, by its highest removal efficiency (>98%) and lowest mass necessary to attain it. Moreover, according with the Portuguese legislation (DL 236/98) it is possible to attain drinking water quality (i.e. [Hg2+]< 1.0 μg⋅dm-3) by treating a solution with a Hg2+ concentration equal to the maximum value admissible for effluents discharges into water bodies (50 μg⋅dm-3), using only 4 mg⋅dm-3 of ETS-4. Even in the presence of major freshwater cations, ETS-4 removal efficiency remains high. Like for other adsorbents, the sorption capacity of ETS-4 for Hg2+ ions is strongly dependent on the operating conditions, such as contact time, mass, initial Hg2+ concentration and solution pH and, to a lesser extent, temperature. The optimum operating conditions found for ETS-4 are very attractive from the industrial point of view because the application of ETS-4 for the treatment of wastewater and/or industrial effluents will not require larges amounts of adsorbent, neither energy supply for temperature adjustments becoming the removal process economically competitive. These conditions become even more interesting in the case of medical institutions liquid, nickel electroplating process, copper smelter, gold ore tailings and chlor-alkali effluents, since no significant pH adjustments to the effluent are necessary. The ion exchange kinetics of Hg2+ uptake is successfully described by the Nernst-Planck based model, while the ion exchange equilibrium is well fitted by both Langmuir and Freundlich isotherms. Moreover, the feasibility of the removal process was confirmed by the thermodynamic parameters (ΔG° and ΔH°) which indicate that the Hg2+ sorption by ETS-4 is spontaneous and exothermic. The higher efficiency of ETS-4 for Hg2+ ions is corroborate by the values reported in literature for the sorption capacity of other adsorbents for Hg2+ ions. The use of an ETS-4 fixed-bed ion exchange column, manufactured in our laboratory, in the continuous removal of Hg2+ ions from solutions confirms that this titanosilicate has potential to be used in industrial water treatment.

Removal of cyanobacteria and cyanotoxins from drinking water by powdered activated carbon adsorption/ultrafiltration

Tese dout., Ciências e Tecnologias do Ambiente, Universidade do Algarve, 2009

Bio-removal of toxic metals by metal resistant anaerobic bacteria: molecular characterization and performance studies

Tese de dout., Ciências Biotecnológicas (Biotecnologia Ambiental), Faculdade de Ciências e Tecnologia, Univ. do Algarve, 2010

Development of new technologies for the selective removal of volatile compounds with applications in forensic science and natural aromas

Tese de doutoramento, Farmácia (Química Farmacêutica e Terapêutica), Universidade de Lisboa, Faculdade de Farmácia, 2015

Nanoporous carbons from sisal residues and their application in hybrid TiO2/carbon photocatalysts for the removal and degradation of phenol in solution

Tese de doutoramento, Química (Química Tecnológica), Universidade de Lisboa, Faculdade de Ciências, 2016

Post-surgical wound infections involving Enterobacteriaceae with reduced susceptibility to ß-lactams in two Portuguese hospitals

The post-surgical period is often critical for infection acquisition. The combination of patient injury and environmental exposure through breached skin add risk to pre-existing conditions such as drug or depressed immunity. Several factors such as the period of hospital staying after surgery, base disease, age, immune system condition, hygiene policies, careless prophylactic drug administration and physical conditions of the healthcare centre may contribute to the acquisition of a nosocomial infection. A purulent wound can become complicated whenever antimicrobial therapy becomes compromised. In this pilot study, we analysed Enterobacteriaceae strains, the most significant gram-negative rods that may occur in post-surgical skin and soft tissue infections (SSTI) presenting reduced β-lactam susceptibility and those presenting extended-spectrum β-lactamases (ESBL). There is little information in our country regarding the relationship between β-lactam susceptibility, ESBL and development of resistant strains of microorganisms in SSTI. Our main results indicate Escherichia coli and Klebsiella spp. are among the most frequent enterobacteria (46% and 30% respectively) with ESBL production in 72% of Enterobacteriaceae isolates from SSTI. Moreover, coinfection occurred extensively, mainly with Pseudomonas aeruginosa and Methicillin-resistant Staphylococcus aureus (18% and 13%, respectively). These results suggest future research to explore if and how these associations are involved in the development of antibiotic resistance.