Prise en charge de la candidose oesophagienne en médecine de premier recours [Management of the esophageal candidiasis by the primary care physician].

La candidose oesophagienne est l'une des infections opportunistes les plus fréquentes chez les patients infectés par le VIH. Ce diagnostic se rencontre également chez des patients sans immunodéficience manifeste. Certains facteurs de risque sont également associés à cette pathologie, tels que les traitements corticoïdes systémiques et inhalés ou les traitements par inhibiteurs de la pompe à protons et les antihistaminiques H2. En l'absence de facteur de risque identifié, un déficit immunitaire primaire devrait être recherché. La prévention de la candidose oesophagienne est basée en premier lieu sur l'identification des facteurs de risque, ainsi qu'un meilleur contrôle de ceux-ci. Cet article présente en détail la physio-pathologie, la clinique et la prise en charge par le médecin de premier recours de la candidose oesophagienne. Nous aborderons également les moyens de prévention de la candidose oesophagienne quand il y a lieu. Esophageal candidiasis is one of the most common opportunistic infections in patients infected by human immunodeficiency virus (HIV). This pathology is also found in patients without overt immunodeficiency. Other risk factors are known to be associated with this disease like inhaled or systemic corticosteroid treatment or proton-pump inhibitors and H2 receptor antagonists. In the absence of identified risk factors, a primary immune deficiency should be sought. Prevention of esophageal candidiasis is based primarily on the identification of risk factors, and a better control of them. This article presents a review of the physiopathology, clinical presentation and management of esophageal candidiasis by primary care physicians. We will also discuss ways of preventing esophageal candidiasis when necessary.

Ventricularisation of the left atrium: a rare cause of left ventricular dysfunction in a patient with mitral valve prolapse

Case: A 11 yo girl with Marfan syndrome was referred to cardiac MR (CMR) to measure the size of her thoracic aorta. She had a typical phenotype with arachnodactyly, abnormally long arms, and was tall and slim (156 cm, 28 kg, body mass index 11,5 kg/m2). She complained of no symptoms. Cardiac auscultation revealed a prominent mid-systolic click and an end-systolic murmur at the apex. A recent echocardiogram showed a moderately dilated left ventricle with normal function and a mitral valve prolapse with moderate mitral valve regurgitation. CMR showed a dilatation of the aortic root (38 mm, Z-score 8.9) and a severe prolapse of the mitral valve with regurgitation. The ventricular cavity was moderately dilated (116 ml/m2) and its contraction was hyperdynamic (stroke volume (SV): 97 ml; LVEF 72%, with the LV volumes measured by modified Simpson method from the apex to the mitral annulus). In this patient however, the mitral prolapse was characterized by a severe backward movement of the valve toward the left atrium (LA) in systole and the dyskinetic movement of the atrioventricular plane caused a ventricularisation of a part of the LA in systole (Figure). This resulted in a significant reduction of LVEF: more than ¼ of the apparent SV was displaced backwards into the ventricularized LA volume, reducing the effective LVEF to 51% (effective SV 69ml). Moreover, by flow measurement, the SV across the ascending aorta was 30 ml (cardiac index 2.0 l/min/m2) allowing the calculation of a regurgitant fraction across the mitral valve of 56%, which was diagnostic for a severe mitral valve insufficiency. Conclusion: This case illustrates the phenomenon of a ventricularisation of the LA where the severe prolapse gives the illusion of a higher attachement of the mitral leaflets within the atrial wall. Besides the severe mitral regurgitation, this paradoxical backwards movement of the valve causes an intraventricular unloading during systole reducing the apparent LVEF of 72% to an effective LVEF of only 51%. In addition, forward flow fraction is only 22% after accounting for the regurgitant volume, as well. This combined involvement of the mitral valve could explain the discrepancy between a low output state and an apparently hyperdynamic LV contraction. Due to its ability to precisely measure flows and volumes, CMR is particularly suited to detect this phenomenon and to quantify its impact on the LV pump function.

Classification of chronic obstructive pulmonary disease based on chest radiography

Objective Quantitative analysis of chest radiographs of patients with and without chronic obstructive pulmonary disease (COPD) determining if the data obtained from such radiographic images could classify such individuals according to the presence or absence of disease. Materials and Methods For such a purpose, three groups of chest radiographic images were utilized, namely: group 1, including 25 individuals with COPD; group 2, including 27 individuals without COPD; and group 3 (utilized for the reclassification /validation of the analysis), including 15 individuals with COPD. The COPD classification was based on spirometry. The variables normalized by retrosternal height were the following: pulmonary width (LARGP); levels of right (ALBDIR) and left (ALBESQ) diaphragmatic eventration; costophrenic angle (ANGCF); and right (DISDIR) and left (DISESQ) intercostal distances. Results As the radiographic images of patients with and without COPD were compared, statistically significant differences were observed between the two groups on the variables related to the diaphragm. In the COPD reclassification the following variables presented the highest indices of correct classification: ANGCF (80%), ALBDIR (73.3%), ALBESQ (86.7%). Conclusion The radiographic assessment of the chest demonstrated that the variables related to the diaphragm allow a better differentiation between individuals with and without COPD.

Developing the environmental marketing of an industrial company

The objective of this study was to examine how the customers of Larox Flowsys value environmental issues and how environmental issues affect their purchasing behaviour. A comparison between Larox peristaltic pumps and competing pump brands and types was also made in order to find out whether LPP pumps possess some more environmentally beneficial features that other pumps do not have. Finally, if the answers to the first two research questions show that a need for a new marketing message does exist, then the final stage is to select the most appropriate environmental arguments for Larox Flowsys. The empirical data in the study was collected from several different sources, but the main sources were the customer interviews and the outsourced market research. The data was analysed mainly by using content analysis, but theme formation and quantification were also utilized. The results showed that the customers do not consider environmental issues as a main purchasing criterion, but they may well be the criterion that differentiates the product from competing ones. The comparison proved that LPP pumps do possess some significant environmental benefits over competing pumps and therefore, the prerequisite for the use of environmental arguments exists. The final stage in the study was to select the proper environmental arguments for Larox Flowsys.

Syrjäytystilavuuspumpun toiminnallisen välyksen säätömekanismin kehitys

Syrjäytystilavuuspumppua käytetään kuluttavien, syövyttävien, jähmeiden ja kiteytyvien väliaineiden pumppaukseen. Sähkömoottorin pyörittämä akseli puristaa rullan välityksellä letkun tiiviisti rungon sisäpintaa vasten työntäen samalla väliainetta edellään kulkiessaan letkua pitkin. Puristuksen jälkeen letku palautuu pyöreään muotoonsa muodostaen alipaineen pumpun imupuolelle. Nykyisen konstruktion iskunsäätö on toteutettu ruuvi-epäkeskomekanismilla, jolle haetaan vaihtoehtoja. Tässä työssä on tavoitteena kehittää syrjäytystilavuuspumpun iskunsäätömekanismista nykyistä konstruktiota yksinkertaisempi ja halvempi vaihtoehto. Työssä ideoidaan koneensuunnittelun perinteisin keinoin uusia ratkaisuvaihtoehtoja, joista kaksi valitaan jatkokehitykseen. Näistä kahdesta valitaan nykyiseen konstruktioon tehdyn vertailun jälkeen toinen lopulliseksi vaihtoehdoksi.

Substâncias húmicas: sistema de fracionamento sequencial por ultrafiltração com base no tamanho molecular

A sequential system for fractionation by ultrafiltration (SSFU) equipped with advanced membranes filters (molecular size cut-off: 5, 10, 30, 50 and 100 kDalton) of the polyethersulfone type was developed for analytical fractionation of humic substances (HS) extracted from aquatic systems or soils. The device consists of five membrane filters (Sartocon® Micro) operated by a multi-channel peristaltic pump, enabling an easy handling, working in a closed system and with simple collection of the six obtained fractions (F1>100; F2: 100-50; F3: 50-30; F4:30-10; F5: 10-5 and F6 <5 kDalton). Then, the HS sample (250 mL solution 1.0 mg/mL, pH 5.0 to 6.0) to be fractionated is pumped by pump through the series of membrane filters with a tangential flow of 85 mL/min, initial pressure 0.2 to 0.3 bar and permeation flux through the membranes of 0.8 to 1.4 mL/min. The overall time for fractionation and cleaning of the device is about 10 h and 25 mL of each fraction is obtained.

Taajuusmuuttajaohjatun pumppukäytön simulointimallin kehittäminen ja testaus

Pumppukäytöt vastaavat noin neljänneksestä Euroopan sähkömoottoreissa kulutettavasta sähkötehosta. Energian kallistumisen vuoksi energian säästämisestä ja energiatehokkuudesta on tullut yhä tärkeämpää. Taajuusmuuttajat ovat tuoneet yksinkertaisen säätötavan, jolla suurimmassa osassa pumppukäyttöjä voidaan saada huomattavia energiasäästöjä. Koko energiansäästöpotentiaalin hyödyntämiseksi täytyy kuitenkin pumppujen toimintaa tarkkailla. Tarkkailu voidaan toteuttaa käyttämällä taajuusmuuttajan sisäisiä mittauksia pumpun toimintapisteen määrittämiseen. Tässä työssä muodostetaan kaksi simulointimallia, joilla voidaan tutkia pumppukäytön toimintapistettä ja energiatehokkuutta. Pumpattavan nesteen ominaisuuksien vaikutusta malleihin tutkitaan ja tapoja korjata virhettä selvitetään. Mallien tuottamia estimaatteja verrataan laboratorio ja pilot-kohteiden mittauksiin. Pilot-kohteiden avulla tutkitaan voidaanko simulointimalleja käyttää teollisuuden energiansäästöpotentiaalia omaavien pumppukäyttöjen havaitsemiseen.

Propulsor pneumático versátil e isento de pulsação para sistemas de análise em fluxo

Aquarium air pumps are proposed and evaluated as pneumatic liquid propulsion devices for flow injection and continuos flow analysis (FIA and CFA) systems. This kind of pump is widely available at a very low cost and it can sustain a pressure around of 4 psi (0.28 bar) indefinitely. By applying this air pressure onto a solution contained in a reservoir flask, it is possible to reach flow rates of up to 12.5 mL min-1 for circuits comprising reactors, made from 0.8 i.d. tubing with a length of 100 cm. The precise adjustment of flow rate below the maximum one can be made with a simplified needle valve or inserting in series a short length of capillary tube. The absence of flow pulsation is a definite advantage in comparison with peristaltic pumps, especially when amperometric detection is elected, as confirmed experimentally in FIA and CF applications.

Pientalojen ilmalämpöpumput sähköverkossa

Työssä tutkitaan ilmalämpöpumppujen kokonaisvaltaista vaikutusta sähköverkkoon. Tarkastelu aloitetaan lämpöpumppujen toiminnasta ja rakenteesta, josta jatketaan laitteen käytettävyyteen ja muiden lämmitysmenetelmien vertailuun. Sähköisten ominaisuuksien tarkastelussa pohditaan ilmalämpöpumppujen vaikutusta suomalaiseen sähköverkkoon muun muassa yleissähkötekniikan, taloudellisuuden ja energiatehokkuuden sekä häiriöiden kannalta. Tämä tutkielma rajoittuu pientaloihin, ja niihin asennettuihin ilma-ilmalämpöpumppuihin. Työn loppupäätelmänä on, että ilmalämpöpumppujen käytöstä ei juuri aiheudu vaikutuksia suomalaiseen sähköverkkoon. Suurimmat ilmalämpöpumppujen käytöstä syntyvät seuraukset kohdistuvat sähköverkkoyhtiöihin, joihin ilmalämpöpumput aiheuttavat taloudellisia menetyksiä. Suuret ja tulevaisuudessa kasvavat ilmalämpöpumppumäärät aiheuttavat sähköntuotantoon lisätehontarvetta huippukuorman aikaan. Toisaalta välitehoalueella tehontarve sekä energiankulutus pienenevät. Sähköverkoissa ei ole toistaiseksi havaittu ilmalämpöpumpuista johtuvia häiriöitä.

Sistema de alimentação gás-líquido para medidas de atividade catalítica

This note has as objective to present the advantages of the use of syringe-type pumps for the feeding of liquid reactants, together with mass flow controllers for gases, instead of the saturators, as it is generally accomplished. Among the advantages, the system with syringe pumps presents a greater flexibility in flow control as well as in composition compared with the system that uses saturator. In addition, the flow of the liquid reactants is known with precision in the syringe pump system.

Energy efficiency parameters in variable speed drives

The main purpose of this thesis is to measure and evaluate how accurately the current energy saving calculation in ABB’s new variable speed drive ACS850 works. The main topic of this thesis is energy-efficiency parameters. At the beginning of this thesis centrifugal pump, squirrel cage motor and variable speed drive, including some equations related to them, are being introduced. Also methods of throttling control and variable speed drive control of centrifugal pumps are being introduced. These subjects are introduced because the energy saving calculation in ACS850 is related to the centrifugal pumps usually driven by squirrel cage motors. The theory also includes short section about specific energy of pumping. Before measurements the current energy saving calculation of ACS850 is being introduced and analyzed. The measurements part includes introduction of measuring equipment, measurement results, summary and analysis of the measurements. At the end of this thesis a proposal for an improvement to the current energy saving calculation is being introduced and few proposals are made for new energy-efficiency parameters, which could be added to variable speed drives. At the end are also thoughts

Um novo modelo para os sítios de interação dos antagonistas H2, baseado na caracterização química dos sítios primário e secundário por QSAR- 3D

A new model for the H2 antagonists binding site is postulated based on adsorption coefficient values of sixteen antagonists, in the affinities constants of the primary and secondary binding sites, and in the chemical characterization of these sites by 3D-QSAR. All study compounds are in the extended conformation and deprotonated form. The lateral validation of the QSARs, CoMFA analysis, affinity constants and chemical similarity data suggest that the antagonists block the proton pump in the H2 receptor interacting with two tyrosines - one in the helix 5, and other in the helix 6.

Thermal-Hydraulic Studies on the Safety Of VVER-440 Type Nuclear Power Plants

This thesis includes several thermal hydraulic analyses related to the Loviisa WER 440 nuclear power plant units. The work consists of experimental studies, analysis of the experiments, analysis of some plant transits and development of a calculational model for calculation of boric acid concentrations in the reactor. In the first part of the thesis, in the case of won of boric acid solution behaviour during long term cooling period of LOCAs, experiments were performed in scaled down test facilities. The experimental data together with the results of RELAPS/MOD3 simulations were used to develop a model for calculations of boric acid concentrations in the reactor during LOCAs. The results of calculations showed that margins to critical concentrations that would lead to boric acid crystallization were large, both in the reactor core and in the lower plenum. This was mainly caused by the fact that water in the primary cooling circuit includes borax (Na)BsO,.IOHZO), which enters the reactor when ECC water is taken from the sump and greatly increases boric acid solubility in water. In the second part, in the case of simulation of horizontal steam generators, experiments were performed with PACTEL integral test loop to simulate loss of feedwater transients. The PACTEL experiments, as well as earlier REWET III natural circulation tests, were analyzed with RELAPS/MOD3 Version Sm5 code. The analysis showed that the code was capable of simulating the main events during the experiments. However, in the case of loss of secondary side feedwater the code was not completely capable to simulate steam superheating in the secondary side of the steam generators. The third part of the work consists of simulations of Loviisa VVER reactor pump trip transients with RELAPSlMODI Eur, RELAPS/MOD3 and CATHARE codes. All three codes were capable to simulate the two selected pump trip transients and no significant differences were found between the results of different codes. Comparison of the calculated results with the data measured in the Loviisa plant also showed good agreement.

Acoplamento de cela de difusão gasosa a sistema de análise por injeção seqüencial visando a determinação espectrofotométrica de sulfeto

A new configuration for coupling a gas diffusion cell to a sequential injection system is presented. The matrix exchange is made without the need for additional rotary injection valves or peristaltic pumps, keeping the original mechanical components of the sequential injection apparatus: one syringe pump (or peristaltic pump) and one selection valve. The system was tested constructing analytical curves for sulfide exploring the formation of the methylene blue dye. The proposed method has a detection limit of 60 µg L-1 S2-, with a linear dynamic range between 0.10 and 4.0 mg L-1 S2- concentrations, with a sampling frequency of 20 h-1.

Espectrofotometría de absorción atómica con tubo en la llama: aplicación en la determinación total de cadmio, plomo y zinc en aguas frescas, agua de mar y sedimentos marinos

Thermospray flame furnace Atomic Absorption Spectrometry (TS-FF-AAS) was used for the total determination of Cd, Pb and Zn in fresh water and seawater samples at µg L-1 levels, and in marine sediment samples at µg g-1 levels. Using a sample loop of 50 µL and a peristaltic pump the samples were transported into the metallic tube placed over an air/acetylene flame, through a ceramic capillary (o.d. = 3.2 mm) containing two parallel internal orifices (i.d = 0.5 mm). The detection limits determined for Cd, Pb and Zn using a synthetic water matrix (2.5% m/v NaCl, 0.5% m/v MgCl2 and 0.8% m/v CaCl2) were 0.32 µg L-1; 2.6 µg L-1 and 0.21 µg L-1 respectively. The methodology by TS-FF-AAS was validated by determination of Cd, Pb and Zn in certified reference materials of water and marine sediment, and the t-test for differences between means was applied. No statistically significant differences were established in fresh water and seawater (p>0.05), whereas differences became apparent in marine sediment (p<0.03).