Pro and con arguments in using alternative dialysis regimens in the frail and elderly patients.

In the last decade, an increasing number of patients over 75 years of age are starting renal replacement therapy. Frailty is highly prevalent in elderly patients with end-stage renal disease (ESRD) in the context of the increased prevalence of some ESRD-associated conditions: protein-energy wasting, inflammation, anaemia, acidosis or hormonal disturbances. There are currently no hard data to support guidance on the optimal duration of dialysis for frail/elderly ESRD patients. The current debate is not about starting dialysis or managing conservatory frail ESRD patients, but whether a more intensive regimen once dialysis is initiated (for whatever reasons and circumstances) would improve patients' outcome. The most important issue is that all studies performed with extended/alternative dialysis regimens do not specifically address this particular type of patients and therefore all the inferences are derived from the general ESRD population. Care planning should be responsive to end-of-life needs whatever the treatment modality. Care in this setting should focus on symptom control and quality of life rather than life extension. We conclude that, similar to the general dialysed population, extensive application of more intensive dialysis schedules is not based on solid evidence. However, after a thorough clinical evaluation, a limited period of a trial of intensive dialysis could be prescribed in more problematic patients.

Potential blindness in children of patients with hereditary bone disease.

Mono- and bi-allelic mutations in the low-density lipoprotein receptor related protein 5 (LRP5) may cause osteopetrosis, autosomal dominant and recessive exudative vitreoretinopathy, juvenile osteoporosis, or persistent hyperplastic primary vitreous (PHPV). We report on a child affected with PHPV and carrying compound mutations. The father carried the splice mutation and suffered from severe bone fragility since childhood. The mother carried the missense mutation without any clinical manifestations. The genetic diagnosis of their child allowed for appropriate treatment in the father and for the detection of osteopenia in the mother. Mono- and bi-allelic mutations in LRP5 may cause osteopetrosis, autosomal dominant and recessive exudative vitreoretinopathy, juvenile osteoporosis, or PHPV. PHPV is a component of persistent fetal vasculature of the eye, characterized by highly variable expressivity and resulting in a wide spectrum of anterior and/or posterior congenital developmental defects, which may lead to blindness. We evaluated a family diagnosed with PHPV in their only child. The child presented photophobia during the first 3 weeks of life, followed by leukocoria at 2 months of age. Molecular resequencing of NDP, FZD4, and LRP5 was performed in the child and segregation of the observed mutations in the parents. At presentation, fundus examination of the child showed a retrolental mass in the right eye. Ultrasonography revealed retinal detachment in both eyes. Thorough familial analysis revealed that the father suffered from many fractures since childhood without specific fragility bone diagnosis, treatment, or management. The mother was asymptomatic. Molecular analysis in the proband identified two mutations: a c.[2091+2T>C] splice mutation and c.[1682C>T] missense mutation. We report the case of a child affected with PHPV and carrying compound heterozygous LRP5 mutations. This genetic diagnosis allowed the clinical diagnosis of the bone problem to be made in the father, resulting in better management of the family. It also enabled preventive treatment to be prescribed for the mother and accurate genetic counseling to be provided.

Chronic kidney disease in type 2 diabetic patients followed-up by primary care physicians in Switzerland: prevalence and prescription of antidiabetic drugs.

QUESTION UNDER STUDY: The aim of this study was to assess the prevalence of chronic kidney disease (CKD) among type 2 diabetic patients in primary care settings in Switzerland, and to analyse the prescription of antidiabetic drugs in CKD according to the prevailing recommendations. METHODS: In this cross-sectional study, each participating physician was asked to introduce anonymously in a web database the data from up to 15 consecutive diabetic patients attending her/his office between December 2013 and June 2014. Demographic, clinical and biochemical data were analysed. CKD was classified with the KDIGO nomenclature based on estimated glomerular filtration rate (eGFR) and urinary albumin/creatinine ratio. RESULTS: A total of 1 359 patients (mean age 66.5 ± 12.4 years) were included by 109 primary care physicians. CKD stages 3a, 3b and 4 were present in 13.9%, 6.1%, and 2.4% of patients, respectively. Only 30.6% of patients had an entry for urinary albumin/creatinine ratio. Among them, 35.6% were in CKD stage A2, and 4.1% in stage A3. Despite prevailing limitations, metformin and sulfonylureas were prescribed in 53.9% and 16.5%, respectively, of patients with advanced CKD (eGFR <30 ml/min). More than a third of patients were on a dipeptidyl-peptidase-4 inhibitor across all CKD stages. Insulin use increased progressively from 26.8% in CKD stage 1-2 to 50% in stage 4. CONCLUSIONS: CKD is frequent in patients with type 2 diabetes attending Swiss primary care practices, with CKD stage 3 and 4 affecting 22.4% of cases. This emphasizes the importance of routine screening of diabetic nephropathy based on both eGFR and urinary albumin/creatinine ratio, the latter being largely underused by primary care physicians. A careful individual drug risk/benefit balance assessment is mandatory to avoid the frequently observed inappropriate prescription of antidiabetic drugs in CKD patients.

The forced adoption of a fast-track appraisal process for a breast cancer treatment in UK

Trastuzumab (Herceptin ®, Roche) is approved in UK for the treatment of the metastatic breast cancer since 2001. As of 2005, concomitantly with the publication of 3 studies that showed it produces a 50% reduction of the recurrence rates of breast cancer, trastuzumab started to be prescribed in the earlt adjuvant treatrnent of this disease. Und June 2006, trastuzumab did not have both: 1) regulatory approval and 2) NICE [National Institute for Health and Clinical Excellence] recommendation for the use in early stages of breast cancer. During the period until June 2006, the trastuzumab use in those patients was not reimbursed and because the cost of trastuzumab is equal with the yearly UK average income, most of patients could not self fund their treatrnent. Before the publication of the final NICE guidance, the new data of trastuzumab in early breast cancer raised enormous patient and professional interest and expectations. A great volume of public and professional pressure was generated to transcend a system by which Primary Care Trusts can reimburse a treatment only after a formal guidance was issued. This paper draw on a case study depicting and analyzing the process by which regulatory approval and NICE recommendations were achieved in a record time and how trastuzumab became a standard treatment on early adjuvant breast cancer. According to the data we gathered in this work we were witnessing one of the fastest processes of adoption of a health care technology since the creation of NICE, in 1999. This study addresses the following research question: How and why does the adoption pattern of trastuzumab differ from the rational decision-making model of the reimbursement process in UK? [Author, p. 4]

Travellers' profile, travel patterns and vaccine practices-a 10-year prospective study in a Swiss Travel Clinic.

BACKGROUND: The travel clinic in Lausanne serves a catchment area of 700 000 of inhabitants and provides pre- and post-travel consultations. This study describes the profile of attendees before departure, their travel patterns and the travel clinic practices in terms of vaccination over time. METHODS: We included all pre-travel first consultation data recorded between November 2002 and December 2012 by a custom-made program DIAMM/G. We analysed client profiles, travel characteristics and vaccinations prescribed over time. RESULTS: Sixty-five thousand and forty-six client-trips were recorded. Fifty-one percent clients were female. Mean age was 32 years. In total, 0.1% were aged <1 year and 0.2% ≥80 years. Forty-six percent of travellers had pre-existing medical conditions. Forty-six percent were travelling to Africa, 35% to Asia, 20% to Latin America and 1% (each) to Oceania and Europe; 19% visited more than one country. India was the most common destination (9.6% of travellers) followed by Thailand (8.6%) and Kenya (6.4%). Seventy-three percent of travellers were planning to travel for ≤ 4 weeks. The main reasons for travel were tourism (75%) and visiting friends and relatives (18%). Sixteen percent were backpackers. Pre-travel advice were sought a median of 29 days before departure. Ninety-nine percent received vaccine(s). The most frequently administered vaccines were hepatitis A (53%), tetanus-diphtheria (46%), yellow fever (39%), poliomyelitis (38%) and typhoid fever (30%). CONCLUSIONS: The profile of travel clinic attendees was younger than the general Swiss population. A significant proportion of travellers received vaccinations that are recommended in the routine national programme. These findings highlight the important role of travel clinics to (i) take care of an age group that has little contact with general practitioners and (ii) update vaccination status. The most commonly prescribed travel-related vaccines were for hepatitis A and yellow fever. The question remains to know whether clients do attend travel clinics because of compulsory vaccinations or because of real travel health concern or both.

Determinação dos hidrocarbonetos saturados e policíclicos aromáticos presentes no material particulado da atmosfera amazônica

It was identified and quantified several organic compounds in the atmosphere of a site into Amazon Basin with high impact of biomass burning emission. It was important to know the particulate matter composition with respect to n-alkanes and PAH associated with the particulate matter because they provided indication on the main sources contributing to airborne particles, the contribution of natural vs. man-made emission and the aging of the particles. The main classes of compounds observed were n-alkanes, PAH and nitro-PAH. It was observed the formation of nitro-PAH from photochemical reactions. The aerosol mass concentration is mainly associated with fluoranthene, pyrene and benzo(ghi)perylene. Environmental and direct emissions samples (flaming and smoldering) were collected and analysed.

Ciência de espumas - aplicação na extinção de incêndios

The structural characteristics of foams are responsible for a broad range of applications of this system. Foams produced by aqueous solutions of surfactant concentrates are used in fire-fighting due to their special properties as extinguishing agents. In the present paper we discuss the main aspects involved in fire-fighting, based on some properties of foams. Thermal and chemical stability, good wetting of surfaces, cooling effect by water drained from the bubbles, isolation of the air from the burning surface and suppression of flammable vapors are some of the factors involved in the extinguishment of fire by foams.

Eletrocatálise e poluição ambiental

This work considers mainly the problem of environmental pollution due to the production of energy by burning fossil fuels, particularly in urban vehicles. Electrochemical energy conversion is proposed as a partial solution to this problem, through the use of hydrogen in fuel cells. In both the production of hydrogen by electrolysis and in the electrochemical processes in fuel cells, the key factor is electrocatalysis. The concept of electrocatalysis, the production of catalysts and supported catalysts and their use in practical systems for the conversion of energy is discussed.

O renascimento de um fármaco: talidomida

Thalidomide, first synthesized in 1953, was widely prescribed for morning sickness of pregnant women from 1957 to 1961, when it was found to be seriously teratogenic, having caused serious birth defect. Nowadays, a quarter of a century later, it appears that it may be a miracle drug for such diseases as leprosy, AIDS, cancer and tuberculosis.

Caracterização de cinza de casca de arroz para uso como matéria-prima na fabricação de refratários de sílica

The characterization of rice husk ash, a deriving by-product of the burning of the rice husk during the rice processing is the object of this study. This by-product, for being rich in silica, can be an important raw material for the production of siliceous ceramics, such as thermal insulators and refractory. A combination of surface analysis, thermal analysis and microscopy analysis techniques was used for the characterization. The characterized by-product presented as main component the silica, under amorphous form, with a maximum content of alkalis around 1%, features that become it potentially interesting for the production of ceramic materials.

Integration of a Bioethanol Process to a Pulp Mill

Tässä diplomityössä tutkittiin puuhakkeen esihydrolyysi- ja hakkuujätteen hydrolyysiprosessien integroimista sellutehtaaseen bioetanolin tuottamiseksi. Tällaisesta ns. biojalostamosta luotiin WinGEMS-simulointiohjelmalla simulointimalli, jonka avulla tutkittiin bioetanoliprosessin vaikutusta sellutehtaan massa- ja energiataseisiin sekä alustavaa biojalostamon kannattavuutta. Simuloinnissa tarkasteltiin kolmea eri tapausta, joissa mäntysellun tuotannon ajateltiin olevan 1000 tonnia päivässä ja hakkuujätettä käytettävän 10 % tarvittavan kuitupuun määrästä: 1) Puuhakkeen esihydrolyysi ja hakkuujätteen hydrolyysi etanolin tuottamiseksi 2) Puuhakkeen esihydrolyysi, hakkuujäte kuorikattilaan poltettavaksi 3) Ei esihydrolyysiä, hakkuujäte kuorikattilaan poltettavaksi Verrattuna tapaukseen 3, puun kulutus kasvaa 16 % esihydrolysoitaessa puuhake ennen keittoa tapauksissa 1 ja 2. Kasvaneella puun kulutuksella tuotetaan tapauksessa 1 149 tonnia etanolia ja 240 MWh enemmän ylimääräsähköä päivässä. Tapauksessa 2 tuotetaan 68 tonnia etanolia ja 460 MWh enemmän ylimääräsähköä päivässä. Tämä tuottaisi vuotuista lisäkassavirtaa 18,8 miljoonaa euroa tapauksessa 1 ja 9,4 miljoonaa euroa tapauksessa 2. Hydrolyysin tuoteliuoksen, hydrolysaatin, haihduttaminen sekä hydrolyysiprosessien orgaanisten jäännöstuotteiden haihduttaminen ja polttaminen kasvattavat haihduttamon ja soodakattilan kuormitusta. Verrattuna tapaukseen 3, tapauksissa 1 ja 2 haihduttamon vaiheiden määrä on kasvatettava viidestä seitsemään ja tarvittavat lämmönsiirtopinta-alat lähes kaksinkertaistettava. Soodakattilan kuormitus kasvaa 39 % tapauksessa 1 ja 26 % tapauksessa 2.

Bioenergiaa ja ravinteita kasvi- ja eläinperäisistä sivuainevirroista Parikkalassa

Euroopan unionissa pyritään lisäämään uusiutuvien energialähteiden käyttöä. Tämän työn tavoitteena oli selvittää Parikkalan kunnan alueella muodostuvat biomassat sekä tutkia niiden hyötykäyttömahdollisuuksia sähkön, lämmön sekä lannoitteiden tuotannossa. Käsiteltäviä biomassoja ovat eläintilojen lietteet ja lannat, biojätteet ja yhdyskuntalietteet, vesistöjen kunnostuksessa syntyvät biomassat sekä peltobiomassat ja metsäbiomassa. Mädätyksen kannalta olennaisinta on materiaalien kosteus ja haihtuvan orgaanisen aineksen pitoisuus sekä siitä saatava biokaasumäärä. Poltossa polttoaineen kuiva-aineen lämpöarvo ja kosteus määrittelevät saadun hyödyn. Kompostoinnissa on tärkeää huolehtia riittävästä ilman saannista ja riittävästä viipymäajasta. Hyödynnettäessä biokaasua sähkön ja lämmön yhteistuotannossa on tärkeää löytää hyötykäyttö myös muodostuvalle lämmölle. Poltosta saatavan tuhkan hyötykäyttö onnistuu metsälannoitteena, kun poltetaan turvetta tai puuta. Kompostia voidaan hyödyntää maanparannusaineena. Parikkalan alueella tarkasteltiin biomassojen nykyistä ja mahdollista tulevaa hyötykäyttöä. Tarkastelu tehtiin skenaarioiden avulla. Skenaarioihin kuuluvat mädätyksen ja polton maksimipotentiaalit sekä keskitetyn ja hajautetun käsittelyn skenaariot. Alueelta on saatavissa paljon biomassoja, joista massaltaan suurin on eläintilojen lannat. Alueella on hankaluutena löytää sopiva kulutuskohde biokaasusta tuotetulle lämmölle, mutta sopivana kohteena voisi toimia alueella oleva suuri sikala tai lämpökeskukset.

Determinação de As em amostras orgânicas de interesse ambiental por espectrometria de absorção atômica com atomização eletrotérmica após combustão em bomba de O2

The toxicity of the major As species present in the environment justifies the effort for quantifying the element in environmental organic samples, which can vary from animal and vegetal tissues to coal and industrial residues. This paper comments about the applicability of the O2 bomb digestion, as a general procedure for all environmental organic materials. A rapid and straightforward method is suggested, which consists in burning the sample in the bomb at high O2 pressure, dissolving the vapours in diluted HNO3 and determining As in the resulting solution by atomic absorption spectrometry with electrothermal atomization. The method was applied to certified materials and plant samples.

Aplicabilidade das cinzas da casca de arroz

Currently, the accumulation of rice husk is a serious environmental problem. The burning of rice husk generates a considerable volume of ash, that falls to the ground and gets into the air and the rivers, causing a disequilibrium in the ecosystem. This motived research into solutions that aim to exploit the husks for energy generation and the ashes for developing diverse technological products. This work presents the possibilities of using rice husks and their ashes after burning.

Emissão de mercúrio para a atmosfera pela queima de gás natural no Brasil

Increasing natural gas use in Brazil triggered a discussion of its role as a Hg source. We show that Hg emissions to the atmosphere from fossil fuel combustion for power generation in Brazil contribute with 6.2% (4.2 t yr-1) to the total anthropogenic Hg atmospheric emissions, with coal combustion and biomass burning as major sources. Natural gas contributes with 0.04 t yr-1, mostly from electricity generation (88%) and industrial uses (7.6%). Preliminary results on Hg concentrations in natural gas suggest that a large fraction of it is trapped during refining and transport, which may create Hg point sources between extraction and consumption.