Spectrum of ocular digoxin toxicity in the elderly: A case report

Introduction: We report a case of digoxin intoxication with severe visual symptoms. Patients (or Materials) and Methods: Digoxin 0.25 mg QD for atrial fibrillation was prescribed to a 91-year-old woman with an estimated creatinine clearance of 18 mL/min. Within 2 to 3 weeks, she developed nausea, vomiting, and dysphagia, and began complaining of snowy and blurry vision, photopsia, dyschromatopsia, aggravated bedtime visual and proprioceptive illusions (she felt as being on a boat), and colored hallucinations. She consulted her family doctor twice and visited the eye clinic once until, 1 month after starting digoxin, impaired autonomy led her to be admitted to the emergency department. Results: Digoxin intoxication was confirmed by a high plasma level measured on admission (5.7 μg/L; reference range, 0.8-2 μg/L). After stopping digoxin, general symptoms resolved in a few days, but visual symptoms persisted. Ophtalmologic care and follow-up diagnosed digoxin intoxication superimposed on pre-existing left eye (LE) cataract, dry age-related macular degeneration (DMLA), and Charles Bonnet syndrome. Visual acuity was 0.4 (right eye, RE) and 0.5 (LE). Ocular fundus was physiologic except for bilateral dry DMLA. Dyschromatopsia was confirmed by poor results on Ishihara test (1/13 OU). Computerized visual field results revealed nonspecific diffuse alterations. Full-field electroretinogram (ERG) showed moderate diffuse rod and cone dysfunction. Visual symptoms progressively improved over the next 2 months, but ERG did not. Complete resolution was not expected due to the pre-existing eye disease. The patient was finally discharged home after a 5-week hospital stay. Conclusion: Digoxin intoxication can go unrecognized by clinicians, even in a typical presentation. The range of potential visual symptoms is far greater than isolated xanthopsia (yellow vision) classically described in textbooks. Newly introduced drugs and all symptoms must be actively sought after, because they significantly affect quality of life and global functioning, especially in the elderly population, most liable not to mention them.

How to Improve the Use of Proton Pump Inhibitors

Introduction: Proton pump inhibitors (PPI) are one of the most prescribed medications in the world with proven efficacy. However, several studies showed that their use often doesn't respect indications, leading to over-consumption, thus exposing patients to drug interactions and adverse events (for example pneumonias). Interruption of PPIs can induce a rebound phenomenon. This generates costs for health systems.Methods: This is a prospective interventional study performed in two hospitals: La Chaux-de-Fonds (CDF, cases) and Neucha^tel (NE, control) during two six-month periods, comparing use of PPIs before and after intervention. We elaborated recommendations (PPI doses and treatment duration) based on recent medical literature that we summarized on A6 cards and gave out to all prescribing doctors in the hospital of CDF and held a 30-minute information session for the departments of surgery, medicine and anesthesiology in March 2010. Doctors were asked to apply our recommendations as often as possible, leaving space for their own assessment. No information was given to the doctors of the control hospital. The number of PPI tablets that the pharmacy sent to each careunit in both hospitals was counted and adjusted to the number of patientdays from April to September 2009 (before intervention) and April to September 2010 (after intervention). The number of other antacids that were used in both hospitals was counted during the same periods. General practitioners (GP) in the region around CDF received an explanation letter to avoid re-introduction, after discharge from the hospital, of PPI treatment stopped during the stay. The number of gastro-duodenal ulcers and upper digestive hemorrhages was counted from April to December 2009 and the same period in 2010 in both hospitals.Results: In 2010, in the hospital of CDF, the use of PPIs per 100 patient-days decreased by 36% in the surgical and medical departments compared to 2009. In the control hospital the use of PPIs per 100 patient-days increased by 10% in the surgical department and decreased by 5% in the medical department during the same periods. The decrease from 2009 to 2010 of PPI utilization in CDF comparing to NE is statistically significant: p<0.0001. Use of other antacids didn't change, ulcers or digestive hemorrhages decreased slightly from 2009 to 2010 in both hospitals. Conclusions: The study showed that with a very low-cost intervention, it is possible to decrease considerably the use of PPIs in a hospital, without taking any risk for gastro-intestinal complications.

Osakeyhtiömuotoisen maatilan omistajan taloudellinen hyöty verotuksessa

Maatalouden perinteisen harjoittamismuodon, perheviljelmän, rinnalle on viime aikoina noussut yhtiömuotoista maataloutta. Syitä maatilan yhtiöittämiseen on useita, mutta yksi tärkeimmistä lienee osakeyhtiöön sovellettava erilainen verotus. Osakeyhtiömuotoinen maatalous asettaa uusia vaatimuksia erityisesti maatilayhtiön hallinnolle. Etukäteen on mm.selvitettävä viljelijän eläketurvaan liittyvät kysymykset, koska eläkelaki on sidoksissa tulevassa maatilaosakeyhtiössä noudatettavaan verolakiin. Tutkielman tavoitteena on selvittää osakeyhtiömuotoisen maatalouden eroja perinteiseen harjoittamismuotoon verrattuna sekä selvittää, miten tila voidaan toimintamuodon muutoksen kautta yhtiöittää ilman vero-vaikutuksia. Taulukkolaskentaohjelmaan on rakennettu verolaskentamalli ja sen tarkoituksena on toimia tilansa yhtiöittämistä pohtivan viljelijän työkaluna. Malli laskee tilan verorasituksen sekä ammatinharjoittajalle, että osakeyhtiömuotoiselle maataloudelle, ja lopuksi vertaa näitä keskenään. Tutkielmassa on rakennettu myös yksinkertainen malli osakeyhtiö-muotoisen maatalouden avaavasta taseesta, jonka tulee syntyä TVL 24 §:n tasejatkuvuutta ja identtisyyttä noudattaen. Tähän ei ole olemassa selvää ohjetta, vaan on jouduttu käyttämään perusteltuja tulkintoja ja käytäntöjä.

Statin treatment is associated with improved prognosis in patients with AF-related stroke.

BACKGROUND/OBJECTIVES: The most recent ACC/AHA guidelines recommend high-intensity statin therapy in ischemic stroke patients of presumably atherosclerotic origin. On the contrary, there is no specific recommendation for the use of statin in patients with non-atherosclerotic stroke, e.g. strokes related to atrial fibrillation (AF). We investigated whether statin treatment in patients with AF-related stroke is associated with improved survival and reduced risk for stroke recurrence and future cardiovascular events. METHODS: All consecutive patients registered in the Athens Stroke Registry with AF-related stroke and no history of coronary artery disease nor clinically manifest peripheral artery disease were included in the analysis and categorized in two groups depending on whether statin was prescribed at discharge. The primary outcome was overall mortality; the secondary outcomes were stroke recurrence and a composite cardiovascular endpoint comprising of recurrent stroke, myocardial infarction, aortic aneurysm rupture or sudden cardiac death during the 5-year follow-up. RESULTS: Among 1602 stroke patients, 404 (25.2%) with AF-related stroke were included in the analysis, of whom 102 (25.2%) were discharged on statin. On multivariate Cox-proportional-hazards model, statin treatment was independently associated with a lower mortality (hazard-ratio (HR): 0.49, 95%CI:0.26-0.92) and lower risk for the composite cardiovascular endpoint during the median 22months follow-up (HR: 0.44, 95%CI:0.22-0.88), but not with stroke recurrence (HR: 0.47, 95%CI:0.22-1.01, p: 0.053). CONCLUSIONS: In this long-term registry of patients with AF-related stroke, statin treatment was associated with improved survival and reduced risk for future cardiovascular events.

Survey of management of first-ever seizures in a hospital based community

Résumé Contexte: Bon nombre d'études épidémiologiques concernant les premières crises comitiales ont été effectuées principalement sur des populations générales. Cependant, les patients admis dans un hôpital peuvent présenter des éléments cliniques différents. Nous avons donc mené une étude prospective auprès de sujets dans une population hospitalière ayant subi une première crise d'épilepsie, afin d'étudier leur pronostic et le rôle des examens complémentaires (examen neurologique, imagerie cérébrale, examens sanguins, EEG) dans le choix de l'administration d'une médication antiépileptique. Méthodes : Sur une période d'une année, nous avons suivi 177 patients adultes, admis consécutivement, ayant présenté une crise d'épilepsie dont l'évaluation aiguë a été effectuée dans notre hôpital. Pendant 6 mois, nous avons pratiqué pour chaque patient un suivi du traitement antiépileptique, des récidives de crises et d'un éventuel décès. Résultats : L'examen neurologique était anormal dans 72.3% des cas, l'imagerie cérébrale dans 54.8% et les examens sanguins dans 57.1%. L'EEG a montré des éléments épileptiformes dans 33.9% des cas. L'étiologie la plus fréquemment représentée était constituée par des intoxications. Un traitement antiépileptique a été prescrit chez 51% des patients. 31.6% des sujets suivis à six mois ont subi une récidive ; la mortalité s'est élevée à 17.8%. Statistiquement, l'imagerie cérébrale, l'EEG et l'examen neurologique étaient des facteurs prédictifs indépendants pour l'administration d'antiépileptiques, et l'imagerie cérébrale le seul facteur associé au pronostic. Conclusions : Les patients évalués en aigu dans un hôpital pour une première crise comitiale présentent un profil médical sous-jacent, qui explique probablement leur mauvais pronostic. L'imagerie cérébrale s'est avérée être le test paraclinique le plus important dans la prévention du traitement et du pronostic. Mots-clés : première crise d'épilepsie, étiologie, pronostic, récidive, médication antiépileptique, population hospitalière Summary Background: Epidemiological studies focusing on first-ever seizures have been carried out mainly on community based populations. However, since hospital populations may display varying clinical features, we prospectively analysed patients with first-ever seizure in a hospital based community to evaluate prognosis and the role of complementary investigations in the decision to administer antiepileptic drugs (AED). Methods: Over one year, we recruited 177 consecutive adult patients with a first seizure acutely evaluated in our hospital. During six months' follow-up data relating to AED treatment, recurrence of seizures and death were collected for each patient. Results:. Neurological examination was abnormal in 72.3%, neuroimaging in 54.8% and biochemical tests in 57.1%. Electroencephalogram (EEG) showed epileptiform features in 33.9%. Toxicity represented the most common aetiology. AED was prescribed in 51% of patients. Seizure recurrence at six months involved 31.6% of patients completing the follow-up; mortality was 17.8%. Statistical analysis showed that brain CT, EEG and neurological examination are independent predictive factors for AED administration, but only CT scan is associated with outcome. Conclusions: Patients evaluated acutely for first- ever seizure in a hospital setting have severe underlying clinical conditions apparently related to their relatively poor prognosis. Neuroimaging represents the most important paraclinical test in predicting both treatment administration and outcome.

Formation and Control of Trace Metal Emissions in Co-Firing of Biomass, Peat, and Wastes in Fluidised Bed Combustors

Environmentally harmful consequences of fossil fuel utilisation andthe landfilling of wastes have increased the interest among the energy producers to consider the use of alternative fuels like wood fuels and Refuse-Derived Fuels, RDFs. The fluidised bed technology that allows the flexible use of a variety of different fuels is commonly used at small- and medium-sized power plants ofmunicipalities and industry in Finland. Since there is only one mass-burn plantcurrently in operation in the country and no intention to build new ones, the co-firing of pre-processed wastes in fluidised bed boilers has become the most generally applied waste-to-energy concept in Finland. The recently validated EU Directive on Incineration of Wastes aims to mitigate environmentally harmful pollutants of waste incineration and co-incineration of wastes with conventional fuels. Apart from gaseous flue gas pollutants and dust, the emissions of toxic tracemetals are limited. The implementation of the Directive's restrictions in the Finnish legislation is assumed to limit the co-firing of waste fuels, due to the insufficient reduction of the regulated air pollutants in the existing flue gas cleaning devices. Trace metals emission formation and reduction in the ESP, the condensing wet scrubber, the fabric filter, and the humidification reactor were studied, experimentally, in full- and pilot-scale combustors utilising the bubbling fluidised bed technology, and, theoretically, by means of reactor model calculations. The core of the model is a thermodynamic equilibrium analysis. The experiments were carried out with wood chips, sawdust, and peat, and their refuse-derived fuel, RDF, blends. In all, ten different fuels or fuel blends were tested. Relatively high concentrations of trace metals in RDFs compared to the concentrations of these metals in wood fuels increased the trace metal concentrations in the flue gas after the boiler ten- to hundred-folds, when RDF was co-fired with sawdust in a full-scale BFB boiler. In the case of peat, lesser increase in trace metal concentrations was observed, due to the higher initial trace metal concentrations of peat compared to sawdust. Despite the high removal rate of most of the trace metals in the ESP, the Directive emission limits for trace metals were exceeded in each of the RDF co-firing tests. The dominat trace metals in fluegas after the ESP were Cu, Pb and Mn. In the condensing wet scrubber, the flue gas trace metal emissions were reduced below the Directive emission limits, whenRDF pellet was used as a co-firing fuel together with sawdust and peat. High chlorine content of the RDFs enhanced the mercuric chloride formation and hence the mercury removal in the ESP and scrubber. Mercury emissions were lower than theDirective emission limit for total Hg, 0.05 mg/Nm3, in all full-scale co-firingtests already in the flue gas after the ESP. The pilot-scale experiments with aBFB combustor equipped with a fabric filter revealed that the fabric filter alone is able to reduce the trace metal concentrations, including mercury, in the flue gas during the RDF co-firing approximately to the same level as they are during the wood chip firing. Lower trace metal emissions than the Directive limits were easily reached even with a 40% thermal share of RDF co-firing with sawdust.Enrichment of trace metals in the submicron fly ash particle fraction because of RDF co-firing was not observed in the test runs where sawdust was used as the main fuel. The combustion of RDF pellets with peat caused an enrichment of As, Cd, Co, Pb, Sb, and V in the submicron particle mode. Accumulation and release oftrace metals in the bed material was examined by means of a bed material analysis, mass balance calculations and a reactor model. Lead, zinc and copper were found to have a tendency to be accumulated in the bed material but also to have a tendency to be released from the bed material into the combustion gases, if the combustion conditions were changed. The concentration of the trace metal in the combustion gases of the bubbling fluidised bed boiler was found to be a summary of trace metal fluxes from three main sources. They were (1) the trace metal flux from the burning fuel particle (2) the trace metal flux from the ash in the bed, and (3) the trace metal flux from the active alkali metal layer on the sand (and ash) particles in the bed. The amount of chlorine in the system, the combustion temperature, the fuel ash composition and the saturation state of the bed material in regard to trace metals were discovered to be key factors affecting therelease process. During the co-firing of waste fuels with variable amounts of e.g. ash and chlorine, it is extremely important to consider the possible ongoingaccumulation and/or release of the trace metals in the bed, when determining the flue gas trace metal emissions. If the state of the combustion process in regard to trace metals accumulation and/or release in the bed material is not known,it may happen that emissions from the bed material rather than the combustion of the fuel in question are measured and reported.

Ash Particle Erosion on Steam Boiler Convective Section

In this study, equations for the calculation of erosion wear caused by ash particles on convective heat exchanger tubes of steam boilers are presented. Anew, three-dimensional test arrangement was used in the testing of the erosion wear of convective heat exchanger tubes of steam boilers. When using the sleeve-method, three different tube materials and three tube constructions could be tested. New results were obtained from the analyses. The main mechanisms of erosionwear phenomena and erosion wear as a function of collision conditions and material properties have been studied. Properties of fossil fuels have also been presented. When burning solid fuels, such as pulverized coal and peat in steam boilers, most of the ash is entrained by the flue gas in the furnace. In bubbling andcirculating fluidized bed boilers, particle concentration in the flue gas is high because of bed material entrained in the flue gas. Hard particles, such as sharp edged quartz crystals, cause erosion wear when colliding on convective heat exchanger tubes and on the rear wall of the steam boiler. The most important ways to reduce erosion wear in steam boilers is to keep the velocity of the flue gas moderate and prevent channelling of the ash flow in a certain part of the cross section of the flue gas channel, especially near the back wall. One can do this by constructing the boiler with the following components. Screen plates can beused to make the velocity and ash flow distributions more even at the cross-section of the channel. Shield plates and plate type constructions in superheaters can also be used. Erosion testing was conducted with three types of tube constructions: a one tube row, an inline tube bank with six tube rows, and a staggered tube bank with six tube rows. Three flow velocities and two particle concentrations were used in the tests, which were carried out at room temperature. Three particle materials were used: quartz, coal ash and peat ash particles. Mass loss, diameter loss and wall thickness loss measurements of the test sleeves were taken. Erosion wear as a function of flow conditions, tube material and tube construction was analyzed by single-variable linear regression analysis. In developing the erosion wear calculation equations, multi-variable linear regression analysis was used. In the staggered tube bank, erosion wear had a maximum value in a tube row 2 and a local maximum in row 5. In rows 3, 4 and 6, the erosion rate was low. On the other hand, in the in-line tube bank the minimum erosion rate occurred in tube row 2 and in further rows the erosion had an increasing value, so that in a six row tube bank, the maximum value occurred in row 6.

Comparison of the consumption of antidepressants in the immigrant and native populations in a Spanish health region: an observational study

BACKGROUND: Health professionals and organizations in developed countries adapt slowly to the increase of ethnically diverse populations attending health care centres. Several studies report that attention to immigrant mental health comes up with barriers in access, diagnosis and therapeutics, threatening equity. This study analyzes differences in exposure to antidepressant drugs between the immigrant and the native population of a Spanish health region. METHODS: Cross-sectional study of the dispensation of antidepressant drugs to the population aged 15 years or older attending the public primary health centres of a health region, 232,717 autochthonous and 33,361 immigrants, during 2008. Data were obtained from computerized medical records and pharmaceutical records of medications dispensed in pharmacies. Age, sex, country of origin, visits, date of entry in the regional health system, generic drugs and active ingredients were considered. Statistical analysis expressed the percentage of persons exposed to antidepressants stratified by age, gender, and country of origin and prevalence ratios of antidepressant exposition were calculated. RESULTS: Antidepressants were dispensed to 11% of native population and 2.6% of immigrants. Depending on age, native women were prescribed antidepressants between 1.9 and 2.7 times more than immigrant women, and native men 2.5 and 3.1 times more than their immigrant counterparts. Among immigrant females, the highest rate was found in the Latin Americans (6.6%) and the lowest in the sub-Saharans (1.4%). Among males, the highest use was also found in the Latin Americans (1.6%) and the lowest in the sub-Saharans (0.7%). The percentage of immigrants prescribed antidepressants increased significantly in relation to the number of years registered with the local health system. Significant differences were found for the new antidepressants, prescribed 8% more in the native population than in immigrants, both in men and in women. CONCLUSIONS: All the immigrants, regardless of the country of origin, had lower antidepressant consumption than the native population of the same age and sex. Latin American women presented the highest levels of consumption, and the sub-Saharan men the lowest. The prescription profiles also differed, since immigrants consumed more generics and fewer recently commercialized active ingredients.

Ischemic heart disease and primary care: identifying gender-related differences. An observational study

Background: Gender-related differences are seen in multiple aspects of both health and illness. Ischemic heart disease (IHD) is a pathology in which diagnostic, treatment and prognostic differences are seen between sexes, especially in the acute phase and in the hospital setting. The objective of the present study is to analyze whether there are differences between men and women when examining associated cardiovascular risk factors and secondary pharmacological prevention in the primary care setting. Methods: Retrospective descriptive observational study from January to December of 2006, including 1907 patients diagnosed with ischemic heart disease in the city of Lleida, Spain. The clinical data were obtained from computerized medical records and pharmaceutical records of medications dispensed in pharmacies with official prescriptions. Data was analyzed using bivariate descriptive statistical analysis as well as logistic regression. Results: There were no gender-related differences in screening percentages for arterial hypertension, diabetes, obesity, dyslipemia, and smoking. A greater percentage of women were hypertensive, obese and diabetic compared to men. However, men showed a tendency to achieve control targets more easily than women, with no statistically significant differences. In both sexes cardiovascular risk factors control was inadequate, between 10 and 50%. For secondary pharmaceutical prevention, the percentages of prescriptions were greater in men for anticoagulants, beta-blockers, lipid-lowering agents and angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, with age group variations up to 10%. When adjusting by age and specific diagnoses, differences were maintained for anticoagulants and lipid-lowering agents. Conclusion: Screening of cardiovascular risk factors was similar in men and women with IHD. Although a greater percentage of women were hypertensive, diabetic or obese, their management of risk factors tended to be worse than men. Overall, a poor control of cardiovascular risk factors was noted. Taken as a whole, more men were prescribed secondary prevention drugs, with differences varying by age group and IHD diagnosis.

Duration and compliance with antidepressant treatment in immigrant and native-born populations in Spain: a four year follow-up descriptive study

Background: Non-compliance with antidepressant treatment continues to be a complex problem in mental health care. In immigrant populations non-compliance is one of several barriers to adequate management of mental illness; some data suggest greater difficulties in adhering to pharmacological treatment in these groups and an increased risk of therapeutic failure. The aim of this study is to assess differences in the duration and compliance with antidepressant treatment among immigrants and natives in a Spanish health region. Methods: Population-based (n = 206,603), retrospective cohort study including all subjects prescribed ADT between 2007 and 2009 and recorded in the national pharmacy claims database. Compliance was considered adequate when the duration was longer than 4 months and when patients withdrew more than 80% of the packs required. Results: 5334 subjects (8.5% of them being immigrants) initiated ADT. Half of the immigrants abandoned treatment during the second month (median for natives = 3 months). Of the immigrants who continued, only 29.5% presented good compliance (compared with 38.8% in natives). The estimated risk of abandoning/ending treatment in the immigrant group compared with the native group, adjusted for age and sex, was 1.28 (95%CI 1.16-1.42). Conclusions: In the region under study, immigrants of all origins present higher percentages of early discontinuation of ADT and lower median treatment durations than the native population. Although this is a complex, multifactor situation, the finding of differences between natives and immigrants in the same region suggests the need to investigate the causes in greater depth and to introduce new strategies and interventions in this population group.

Patterns and factors associated with low adherence to psychotropic medications during pregnancy-a cross-sectional, multinational web-based study.

BACKGROUND: No previous studies have explored how closely women follow their psychotropic drug regimens during pregnancy. This study aimed to explore patterns of and factors associated with low adherence to psychotropic medication during pregnancy. METHODS: Multinational web-based study was performed in 18 countries in Europe, North America, and Australia. Uniform data collection was ensured via an electronic questionnaire. Pregnant women were eligible to participate. Adherence was measured via the 8-item Morisky Medication Adherence Scale (MMAS-8). The Beliefs about Prescribed Medicines Questionnaire (BMQ-specific), the Edinburgh Postnatal Depression Scale (EPDS), and a numeric rating scale were utilized to measure women's beliefs, depressive symptoms, and antidepressant risk perception, respectively. Participants reporting use of psychotropic medication during pregnancy (n = 160) were included in the analysis. RESULTS: On the basis of the MMAS-8, 78 of 160 women (48.8%, 95% CI: 41.1-56.4%) demonstrated low adherence during pregnancy. The rates of low adherence were 51.3% for medication for anxiety, 47.2% for depression, and 42.9% for other psychiatric disorders. Smoking during pregnancy, elevated antidepressant risk perception (risk≥6), and depressive symptoms were associated with a significant 3.9-, 2.3-, and 2.5-fold increased likelihood of low medication adherence, respectively. Women on psychotropic polytherapy were less likely to demonstrate low adherence. The belief that the benefit of pharmacotherapy outweighed the risks positively correlated (r = .282) with higher medication adherence. CONCLUSIONS: Approximately one of two pregnant women using psychotropic medication demonstrated low adherence in pregnancy. Life-style factors, risk perception, depressive symptoms, and individual beliefs are important factors related to adherence to psychotropic medication in pregnancy.

Seospellettien pienpoltto

This work is a part of Vapos research over mixed pellets. In this work combustion of ten different mixed pellets are examined. This is done by two kinds of tests, burning tests and ash melting tests. First there is a short review how different bio fuels burn and what kind of problems they cause. After this burning characteristics and flue gas calculation methods are acquainted. In test part burning tests and ash melting tests and their results are reported. Lastly conclusions and considerations over further study are done.

Statins are associated with decreased mortality risk after status epilepticus.

BACKGROUND AND PURPOSE: Statins display anti-inflammatory and anti-epileptogenic properties in animal models, and may reduce the epilepsy risk in elderly humans; however, a possible modulating role on outcome in patients with status epilepticus (SE) has not been assessed. METHODS: This cohort study was based on a prospective registry including all consecutive adults with incident SE treated in our center between April 2006 and September 2012. SE outcome was categorized at hospital discharge into 'return to baseline', 'new disability' and 'mortality'. The role of potential predictors, including statins treatment on admission, was evaluated using a multinomial logistic regression model. RESULTS: Amongst 427 patients identified, information on statins was available in 413 (97%). Mean age was 60.9 (±17.8) years; 201 (49%) were women; 211 (51%) had a potentially fatal SE etiology; and 191 (46%) experienced generalized-convulsive or non-convulsive SE in coma. Statins (simvastatin, atorvastatin or pravastatin) were prescribed prior to admission in 76 (18%) subjects, mostly elderly. Whilst 208 (50.4%) patients returned to baseline, 58 (14%) died. After adjustment for established SE outcome predictors (age, etiology, SE severity score), statins correlated significantly with lower mortality (relative risk ratio 0.38, P = 0.046). CONCLUSION: This study suggests for the first time that exposure to statins before an SE episode is related to its outcome, involving a possible anti-epileptogenic role. Other studies are needed to confirm this intriguing finding.

Öljyvahinkojätteiden käsittely alusonnettomuuden jälkeen Kymenlaakson alueen näkökulmasta

Työn tavoitteena oli selvittää Suomenlahden rannalta merkittävän suuruisen alusöljyvahingon jälkeen kerättävän öljyisen jätteen käsittelymahdollisuudet ja -kapasiteetit sekä loppusijoitusmahdollisuudet ja -kapasiteetit Kymenlaakson alueen näkökulmasta. Tarkoituksena oli selvittää, missä jätteiden käsittely voidaan toteuttaa sekä, miten öljyisiä jätteitä voidaan esikäsitellä välivarastoinnin aikana puhdistuksen ja loppusijoituksen tehostamiseksi. Tutkimuksen kohteena oli sekä rannalta kerättävät kiinteät öljyiset ainekset että öljyinen merivesi. Työn alussa on perehdytty jätehuoltovastuuseen, eli kenen vastuulla öljyalusonnettomuuksissa syntyvät öljyiset jätteet ovat. Työssä on esitelty lyhyesti öljyvahinkojätteille teknisesti soveltuvien käsittelymenetelmien periaatteet ja menetelmien rajoituksia käsitellä öljyvahinkojätetteitä. Työssä on myös mainittu aiemmin Suomea koskettaneiden tai maailmalla tapahtuneiden alusöljyvahinkojen jätemääriä ja tapauksissa käytettyjä jätteiden käsittelymenetelmiä. Työ painottuu esittelemään Kymenlaakson alueen laitosten, Riihimäen Ekokem Oy Ab:n ja siirrettävien laitteistojen mahdollisuuksia käsitellä öljyisiä jätteitä. Lisäksi on esitelty öljyisen meriveden käsittelyyn soveltuvia laitoksia Kymenlaakson alueen näkökulmasta. Tietoja on kerätty puhelimitse ja sähköpostitse yritysten edustajilta vuoden 2007 aikana. Kymenlaakson alueella voidaan polttaa voimalaitosten leijupedeissä puhtaaseen polttoaineeseen sekoitettuja öljyisiä orgaanisia aineksia ja murskautuvia puhdistustyössä käytettyjä varusteita noin 10 000 t/a, homogenoitua öljyistä orgaanista ainesta voidaan polttaa Leca-soratehtaan rumpu-uunissa noin 1 200 t/a. Alueen polttokapasiteetti kasvaa, kun työn aikana rakenteilla oleva jätteenpolttolaitos valmistuu ja jätettä voidaan polttaa laitoksen arinalla. Haihtuvilla öljy-yhdisteillä pilaantuneita maa-aineksia voidaan alipainekäsitellä, jos yhdisteet eivät ole haihtuneet jo merellä. Erityisesti öljyiset maaainekset voidaan käsitellä alhaisilla öljypitoisuuksilla (öljypitoisuus noin alle 1-2 %) bitumistabiloimalla, aumakompostoimalla tai pesemällä siirrettävällä pesulaitteistolla. Kymenlaakson alueelle voidaan tuoda myös alueen ulkopuolelta siirrettäviä laitteistoja. Siirrettävät termodesorptiolaitteistot on tehty pilaantuneen maa-aineksen ensisijaiseen käsittelyyn, mutta samalla voidaan käsitellä myös muita jätejakeita, joilla on pieni partikkelikoko (alle 5-10 cm). Savaterra Oy:n siirrettävän termodesorptiolaitteiston kapasiteettiarvio on 100 000 t/a. Myös Niska & Nyyssönen Oy:llä on siirrettävä termodesorptiolaitteisto. Doranova Oy:n siirrettävän pesulaitteiston kapasiteettiarvio on 30 000- 50 000 t/a öljyistä maa-ainesta. Tutkimuksessa on ollut mukana myös Riihimäen Ekokem Oy Ab:n jätevoimala, jonka kapasiteettiarvio on 40 000-45 000 t/a erityisesti öljyisille orgaanisille aineksille, varusteille ja kuolleille eläimille. Riihimäen Ekokem Oy Ab:n ongelmajätelaitoksen rumpuuuneissa voidaan käsitellä arviolta 80 000-100 000 t/a öljyisiä maa-aineksia eli kiinteitä jätteitä, joiden partikkelikoko on suunnilleen alle 10 cm, ja 20 000 t/a nestemäisiä öljyisiä jätteitä. Työn loppupuolella on esitelty myös öljyisen meriveden käsittelyyn soveltuvia laitoksia ja niiden rajoituksia käsitellä kyseistä jätettä. Kyseisten laitosten kapasiteetit selviävät usein vasta onnettomuuden sattuessa. Kaikkiin annettuihin kapasiteettiarvioihin vaikuttaa merkittävästi jätteen koostumus. Raportin lopussa on esitelty alustava toimintasuunnitelma öljyvahinkojätteen käsittelemiseksi. Suunnitelmaan sisältyvät eri jätejakeille laaditut kaaviot, joista voi nähdä muun muassa eri jätekoostumuksille teknisesti soveltuvat käsittelymenetelmät ja käsittelymenetelmiä suorittavat yritykset. Öljyalusonnettomuuden sattuessa soveltuviin yrityksiin tulee ottaa yhteyttä ja selvittää kyseisellä hetkellä vapaana oleva käsittelykapasiteetti. Raportissa on myös esitelty käsittelykustannuksiin vaikuttavia tekijöitä ja arvioitu aiheutuvia kuljetuskustannuksia. Saadut tutkimustulokset ovat hyödynnettävissä erityisesti Kymenlaakson alueella. Tiedot käsittelymenetelmistä ja niiden rajoitteista ovat hyödynnettävissä valtakunnallisesti.

Metsäteollisuuden lietteiden bioterminen kuivaus

Työssä tarkastellaan kompostointiin perustuvaa biotermistä kuivausprosessia, prosessiin vaikuttavia tekijöitä sekä sen soveltuvuutta metsäteollisuuden mekaanisesti kuivatun jätevesilietteen lisäkuivaukseen polttoa varten. Tutkimukseen kuuluvien paperitehtaiden lietteillä suoritettavien biotermisten kuivauskokeiden avulla tutkitaan tehtaiden lietteiden sopivuutta biotermiseen kuivaukseen. Lisäksi tehtaille suunnitellaan kuivauskokeiden ja paperitehtailla tehtävien selvitysten perusteella bioterminen kuivauslaitos. Suomen metsäteollisuus tuottaa nykyisin noin 400 000 – 500 000 kuiva-ainetonnia jätevedenpuhdistamolietteitä vuosittain. Tutkimukseen kuuluvan kahden tehdasintegraatin biologisilla puhdistamoilla syntyvien jätevesilietteiden määrät ovat keskimäärin 33 000 ja 15 000 kuiva-ainetonnia vuodessa. Ongelmana metsäteollisuudessa on jätevesilietteen alhainen kuiva-ainepitoisuus lietteen mekaanisen kuivauksen jälkeen. Tämä vaikeuttaa lietteen polttamista voimalaitoskattilassa ja lietteen poltosta talteen saatavan energian määrä jää vähäiseksi. Mekaanisesti kuivatun sekalietteen käsittely biotermisesti kuivaamalla mahdollistaa lietteen kuiva-ainepitoisuuden nostamisen yli 55 %:in kuiva-ainepitoisuuteen. Tämä helpottaa lietteen polton ongelmia ja kasvattaa lietteen poltosta talteen saatavan energian määrää. Bioterminen kuivaus soveltuu hyvin tutkimukseen kuuluvien tehtaiden sekalietteen kuivaukseen. Suositeltava sekalietteen lähtökuiva-ainepitoisuuden arvo on välillä 30 – 35 % ja tukiaineeksi lisättävän kuoren määrä noin 0,5 m3 yhtä lietekuutiota kohden. Kuivausprosessin kesto on tällöin 10 – 14 vuorokautta, kun haluttu lietepolttoaineen kuiva-ainepitoisuus on vähintään 55 %. Tehtaille suunnitelluissa laitoksissa käsiteltävä lietemäärä on noin 40 000 märkätonnia vuodessa. Tutkimukseen kuuluvalle paperitehtaalle yhdistetyn lietteenkuivausprosessin kustannukset ovat edullisimmat kun liete kuivataan ennen biotermistä kuivausta mekaanisesti 35 %:in kuiva-ainepitoisuuteen. Tällöin lietteenkäsittelyn hinnaksi tulee noin 150 mk/t.