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Reliable prediction of time-varying pollutant loads in combined sewer systems during storm periods can aid better management of the release of pollution into natural environments as well as enhancing storage tank design. Better understanding of the behaviour of sewer sediments is crucial for the development of models that adequately describe the transport of in-sewer solids and accurately predict the changes in pollutant concentration within combined sewers during storm events. This paper reports on the results of a test programme to examine the erosion of highly organic sewer sediment under the application of time-varying shear stress. The tests were carried out with and without supplying oxygen, and varying simulated dry-weather periods. The aim was to investigate the behaviour of real in-sewer sediment with a high organic content (around 80%) in an attempt to improve prediction of the transport rates under the particular Mediterranean conditions of long dry-period/build-up and intense rainfall/wash-off, and understand how this environment affects the erosional resistance and subsequent sediment release. Results have been compared with previous work on lower organic content sewer sediments and artificial organic sediment. [ABSTRACT FROM AUTHOR]

Background: Antithrombotic prophylaxis in hospitalised patients with SARS-CoV-2 acute infection has increased. Currently, most of the evidence relates to patients in intensive care units; however, there is little information on patients admitted to hospital wards and there is no consensus protocol on thromboprophylaxis during admission and after discharge., Objective: To assess the effectiveness of antithrombotic prophylaxis in patients admitted with COVID-19 and 30 days after discharge., Method: A prospective observational study was conducted of patients admitted with COVID-19 in which the hospital thromboprophylaxis protocol was applied, classifying the patients as having a standard or high risk of thrombosis. Pharmacists performed a daily follow-up and actively intervened during admission and at discharge. The main outcome measure was the global incidence of symptomatic venous thromboembolism (VTE) related to hospitalisation., Results: A total of 113 patients were included, 98.23% of whom were admitted to a hospital ward. The incidence of hospital-acquired VTE was 1.77%. In 75.22% of the subjects, thromboprophylaxis was adjusted to the protocol during admission. A total of 23 pharmaceutical interventions were conducted, with an adherence of 52.17%. At discharge, 94.28% of the patients who had no haemorrhage and ≥4 points on the Padua Prediction Score required thromboprophylaxis, aligning with the protocol. The global incidence of haemorrhagic events during the follow-up period was 0.88%., Conclusion: The incidence of hospital-acquired VTE was lower than that described in the literature. Although it cannot be certain that it is directly related to the instituted protocol, the data can show that the management of prevention of VTE is being optimally performed at the hospital. Long-term studies are needed to evaluate the incidence after discharge, as well as to agree on a specific protocol in the COVID-19 population for the prevention of these events during hospitalisation and post-discharge., Competing Interests: Competing interests: None declared., (© European Association of Hospital Pharmacists 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

To determine the impact of farming over vicuña population in Peru, serum samples were collected from 207 vicuñas (126 captive vicuñas and 81 free-ranging vicuñas) and 614 domestic South American camelids (571 alpacas and 43 llamas), in ten Andean communities at the Salinas y Aguada Blanca reserve, province of Arequipa, southern Peru. Samples were tested for the presence of leptospirosis, foot and mouth disease (FMD), bovine viral diarrhea (BVD), bovine herpesvirus type 1 (BHV-1), brucellosis, bluetongue disease (BT), paratuberculosis, and neosporosis. Serological results showed that 1.9% (4/207) of vicuñas, 18.6% (106/571) of alpacas, and 23.3% (10/43) of llamas were positive to one or more Leptospira serovars. One percent of vicuñas (2/207) and 2.4% of domestic camelids (15/614) had Neospora caninum antibodies tested by ELISA, but only two vicuñas and two alpacas were confirmed by Western blot. Epidemiological evaluation found an association of leptospirosis to sex and age (p < 0.001), with female subjects older than 2.5 years at higher risk of infection. Interestingly, antibodies against Leptospira serovars were only found in captive vicuñas. This is the first study where health status of free-ranging and captive vicuñas has been compared. Results indicate minimal to nil presence of FMD, BVD, BHV-1, brucellosis, BT, paratuberculosis, and neosporosis allied to health disorders in our sample. The detection of seropositive animals against Leptospira, however, unveils the likely significance of leptospirosis in wild and domestic South American camelids, the impact of mixed husbandry over vicuña population and the risk to human health.

In the present work we have studied in Neospra caninum aborted bovine foetuses the influence of foetal age (first, second and third gestational periods) on parasite distribution by nested PCR, parasite loads by real-time PCR and N. caninum associated lesions. For this purpose, a total of 220 aborted foetuses were analysed and detection of N. caninum infection was accomplished by nested-PCR in brain, heart and liver, detecting the presence of the parasite in 72 (32.7%) bovine foetuses. When the different age classes were compared, parasite DNA-detectability in heart and liver was reduced over time of gestation (P < 0.05, Fisher F-test). N. caninum distribution, parasite loads and lesions were studied on 34 out of 72 N. caninum-infected foetuses selected according to the stage of pregnancy and organs recovered. A higher number of positive-PCR tissue samples were observed in the foetuses corresponding to the first and second pregnancy periods. In the last trimester, the parasite could only be detected in the brain and, sporadically, in the diaphragm, heart and lymph nodes. The parasite loads decreased during pregnancy and the foetuses from the first period had higher parasite burdens in brain, heart, kidney and lung (P < 0.05, Kruskal-Wallis H-test) than in those corresponding to the other two trimesters of pregnancy. In addition, the observed lesions were more severe in foetuses from the first and second pregnancy periods than those from the third period (P > 0.05, Kruskal-Wallis H-test). Our results confirm the influence of N. caninum foetal age on pathogenesis in natural N. caninum infections.

Simple closure followed by Helicobacter pylori (Hp) eradication has become the most used procedure in perforated ulcer treatment. However, its efficacy and safety are still to be determined. To assess recurrence and re-perforation rates, and as a secondary objective, to analyze Hp infection rates in perforated ulcer patients and controls, we conducted a prospective study. Ninety-two consecutive patients (ages: 19-96 years) were operated on between 1996 and 2002, and treated by simple closure followed by Hp eradication and NSAID avoidance. The data were prospectively collected in a database. Hp infection was diagnosed in 68 patients (73.9%). Thirty-four patients (37%) consumed nonsteroidal anti-inflammatory drugs (NSAIDs), and 23 (25%) had both Hp infection and NSAID antecedents. The perforation was gastric in 4 cases and pre-pyloric, pyloric or duodenal in 88. There were postoperative complications in 24 patients (26%) and 4 patients died (4.3%). Hp eradication was shown in 46 patients. There was clinical ulcer recurrence in 4 (4.3%); in 3 of them recurrence manifested as re-perforation, all in gastric locations. Overall relapse and re-perforation 1-year crude rates were 6.1% and 4.1%, respectively. Crude rates for non-gastric ulcer recurrence were 0 at 1 year and 2.6% at 2 years and for non-gastric ulcer re-perforation rates were 0 at 1 and 2 years. This therapeutic strategy is associated with a low rate of recurrence and no re-perforations in case of duodenal, pyloric, or pre-pyloric perforated ulcers, but it is not acceptable for perforated gastric ulcers.

The reconfiguration of an existing five-stage bleaching D0E1D1E2D2 sequence is proposed to ensure the minimal formation of organochlorine compounds, expressed as AOX, in the bleach plant of a kraft pulp mill processing Eucalyptus globulus wood. This reduction of the load of AOX in the effluents can be achieved without introducing new and expensive technologies in the bleaching process. In practice, this goal can be achieved by eliminating the washing step between the D0 and the E1 stages. With this strategy, the total AOX in the liquid effluent of the bleach plant can be reduced by almost 65% while maintaining a level of 90% ISO brightness of the pulp and even diminishing the degradation of its polysaccharides. With this process redesign, the total AOX discharge from the bleach plant can be decreased from 1.2 to 0.42 kg/t prior to any biological treatment. Furthermore, the proposed modified (D0E1)D1E2D2 sequence enables the reduction of the total flow rate of effluent to be treated and also the total consumption of water, which is quite critical in these types of plants. Moreover, with this strategy, one is able to move the first drum washer of a conventional bleaching sequence to the entrance of the bleach plant. This gives rise to a cleaner pulp and therefore to lower requirements of chlorine dioxide, which in turn will enable further reductions in the global AOX generation.

The coexistence of a pancreatic papillary cystic tumor with hairy cell leukemia is reported. To the best of our knowledge this association has never been published. A 41-year-old man diagnosed with hairy cell leukemia developed a second malignancy that corresponded to a papillary cystic pancreatic tumor. The patient underwent splenectomy and a tumoral surgical resection, and is currently well at 21 months follow-up. A pathogenetic relationship between the two malignancies was not demonstrated. Hairy cell leukemia has been reported to be associated to a great number of different second malignancies. In contrast, only two papillary cystic tumors of the pancreas have been described associated to a second neoplasm, a papillary thyroid carcinoma and a colonic carcinoma. This unusual benign or low-grade malignant pancreatic tumor more commonly occurs in the tail of the pancreas of young women. We want to stress the unusual presentation of this pancreatic tumor affecting the head of the gland in a male patient as well as its coexistence with a hairy cell leukemia.

Purpose: The aim of this study was to analyze the diagnostic accuracy of C-reactive protein and its possible advantage, if any, over leukocyte counts in acute appendicitis in children., Methods: We performed a retrospective study of 124 children (72 males) with a mean age of 9.3 (range, 2-14) years operated on under a clinical diagnosis of acute appendicitis. The diagnosis of acute appendicitis, confirmed by pathologic examination of the removed appendix, was then correlated with C-reactive protein, leukocyte count, and a combination of both C-reactive protein and leukocyte count, with a logistic regression model. C-reactive protein serum measurements were performed by an immunoturbidimetric test. The patients were divided into two groups according to the pathologic features of the removed appendix: Group A (n = 104), patients with acute appendicitis, and Group B (n = 20), patients without acute appendicitis. To assess the accuracy of C-reactive protein, leukocyte counts, and a combination of both parameters, receiver operating characteristic curves were used. The areas under the curve were compared using the maximum likelihood estimation method., Results: There were 95 cases (76.6 percent) of nonperforated appendicitis, 9 cases (7.3 percent) of perforated appendicitis and 20 cases (16.1 percent) of normal appendix. Mean C-reactive protein in Group A was 4.3 (standard deviation, 6.6) and in Group B was 1.2 (standard deviation, 1.7; P = 0.03). The C-reactive protein and leukocyte count values were correlated with the pathologic diagnosis of acute appendicitis. Mean C-reactive protein values increase as the pathologic inflammation type progresses (P = 0.007). The C-reactive protein receiver operating characteristic curve shows that the C-reactive protein value with highest accuracy was 1.7 mg/dl. The sensitivity, specificity, and accuracy rates calculated in the 1.7 cutoff were 58, 80, and 83.8 percent, respectively. A comparison of the respective receiver operating characteristic curves demonstrates that C-reactive protein, leukocyte count, and the combination of both tests all have a good diagnostic value but without any significant difference (P = 0.2)., Conclusions: In children, 1) serum C-reactive protein is increased in acute appendicitis; 2) such increase is related to the severity of the appendiceal inflammation; and 3) although serum C-reactive protein has an adequate diagnostic accuracy, neither individually nor in combination with the leukocyte count is it significantly better than the leukocyte count alone.

Objective: To study changes in arterial-venous PCO2 pressures (Da-vPCO2) and in pH (Da-vpH) in an experimental dog model of acute bleeding. To emphasize the utility of monitoring these variables in situations of acute bleeding. ANIMALS AND METHOD: Eighteen dogs were anesthesized and monitored while being subjected to gradual bleeding. Gasometric and hemodynamic variables were recorded at the following moments: baseline, stage I (15% of volemic loss), stage Ib (20%), stage II (25%), stage IIb (30%) and stage III (35%)., Results: No significant differences in pH or PCO2 in either arterial or mixed venous blood were found. Bleeding induced a constant and progressive increase in Da-vPCO2 that correlated with changes in volume (r = -0.56, p < 0.001), SvO2 (r = 0.71; p < 0.001), Da-vO2 gradient (r = 0.62; p < 0.001) and cardiac output (r = 0.63; p < 0.001)., Conclusions: Gradual bleeding caused a constant and significant increase of Da-vPCO2. Monitoring such changes in states of circulatory insufficiency may be useful for evaluating tissue ischemia.