Proposal of a non-linear model to adjust in vitro gas production at different incubation times

This work aims to propose a new model named Gompertz-Von Bertalanffy bicompartmental (GVB), a combination of the models Gompertz and Von Bertalanffy. The GVB models is applied to fit the kinetic curve of cumulative gas production (CGP) of four foods (SS ­ sunflower silage; CS ­ corn silage; and the mixtures 340SS ­ 660 gkg-1 of corn silage and 340 gkg-1 of sunflower silage; and 660SS ­ 340 gkg-1 of corn silage and 660 gkg-1 of sunflower silage). The GVB fit is compared to models Logistic-Von Bertalanffy bicompartmental (LVB) and bicompartmental logistic (BL). All the process studied employed the semi-automatic "in vitro" technique of producing gases used in ruminant nutrition. The gas production readout was performed at times 2, 4, 6, 8, 10, 12, 15, 19, 24, 30, 48, 72, and 96 h. The data generated were used to estimate the models' parameters by the least squared method with the iterative Gauss-Newton process. The data fit quality of the models was verified using the adjusted coefficient of determination criterion (), mean residual square (MRS), Akaike information criterion (AIC), and mean absolute deviation (MAD). Among the analyzed models, the LVB model presented the best quality of fit evaluators for CS. In contrast, the GVB model showed better quality of fit to describe CGP over time for 340SS, 660SS, and SS, presenting the highest values of () and the lowest values of MSR, AIC, and MAD.

Carboxyhemoglobinemia as a laboratory finding in an outpatient

Resumen El monóxido de carbono (CO) es un gas producido principalmente por combustión incompleta de hidrocarburos. La intoxicación por exposición ambiental puede presentarse con síntomas inespecíficos y constituye la causa más importante de aumento de carboxihemoglobina (COHb). Su nivel en sangre depende de la duración de la exposición, la ventilación minuto y las concentraciones de CO y oxígeno en el ambiente. La elevada toxicidad radica en la hipoxia tisular que se genera. Se presenta el caso de un paciente masculino, 73 años, en seguimiento en el hospital por neumonía intersticial no específica como patología de base. En un control de laboratorio se encontró 11,9% de COHb, sin exposición a tabaco. No utilizaba calefacción a gas sino un panel cerámico eléctrico, recientemente pintado con esmalte sintético. La suspensión del uso del panel normalizó la COHb. El CO, producto de descomposición térmica del esmalte sintético, explica la causa de la intoxicación.

Abstract Carbon monoxide (CO) is a gas produced mainly by incomplete combustion of hydrocarbons. Poisoning from environmental exposure can present with nonspecific symptoms and is the most important cause of increased carboxyhemoglobin (COHb). Its blood level depends on the duration of exposure, minute ventilation, and the concentrations of CO and oxygen in the environment. The high toxicity lies in the tissue hypoxia that is generated. The case of a male patient, 73 years old, under follow-up in the hospital for non-specific interstitial pneumonia as the underlying pathology was presented. In a laboratory control, COHb 11,9% was found. There was no exposure to tobacco and there was no use of gas heating but of an electric ceramic panel, recently painted with synthetic enamel type paint. The suspension of the use of the panel normalised the COHb. The CO product of thermal decomposition of synthetic enamel explains the cause of poisoning.

Resumo O monóxido de carbono (CO) é um gás produzido principalmente pela combustão incompleta de hidrocarbonetos. A intoxicação por exposição ambiental pode se apresentar com sintomas inespecíficos e é a causa mais importante de aumento da carboxihemoglobina (COHb). Seu nível em sangue depende do tempo de exposição, da ventilação minuto e das concentrações de CO e oxigênio no ambiente. A alta toxicidade está na hipóxia tecidual gerada. Apresentamos o caso de um paciente do sexo masculino, 73 anos, em acompanhamento hospitalar por pneumonia intersticial inespecífica como patologia de bas. Em um controle laboratorial, achou-se 11,9% de COHb, sem exposição ao tabaco. Não utilizava aquecimento a gás e sim um painel elétrico cerâmico, recentemente pintado com esmalte sintético. A suspensão do uso do painel normalizou o COHb. O CO produto da decomposição térmica do esmalte sintético explica a causa da intoxicação.

Adding autogenic drainage to chest physiotherapy after upper abdominal surgery: effect on blood gases and pulmonary complications prevention. Randomized controlled trial

ABSTRACT BACKGROUND: Hypoxemia and pulmonary complications are common after upper abdominal surgery (UAS). OBJECTIVE: To examine whether inclusion of autogenic drainage (AD) in chest physiotherapy after UAS confers additional benefits in improving blood gases and reducing postoperative pulmonary complications (PPCs). DESIGN AND SETTING: Randomized controlled study conducted at Kasr Al-Ainy teaching hospital, Egypt. METHODS: A randomized controlled trial was conducted on 48 subjects undergoing elective UAS with high risk of developing PPCs. The study group received AD plus routine chest physiotherapy (deep diaphragmatic breathing, localized breathing and splinted coughing) and the control group received routine chest physiotherapy only. The outcomes included arterial blood gases measured at the first and seventh postoperative days, incidence of PPCs within the first seven days and length of hospital stay. RESULTS: Baseline characteristics were similar between groups. In the AD group, SaO2, PaO2, PaCO2 and HCO3 significantly improved (P < 0.05) while in the physiotherapy group, only SaO2 and PaO2 significantly improved (P < 0.05). Nonetheless, significant differences in post-treatment SaO2 and PaO2 between the groups were observed. The overall incidence of PPCs was 16.66% (12.5% in the AD group and 20.8% in the physiotherapy group) (absolute risk reduction -8.3%; 95% confidence interval, CI, -13.5 to 29.6%), with no significant difference between the groups. The AD group had a significantly shorter hospital stay (P = 0.0001). CONCLUSION: Adding AD to routine chest physiotherapy after UAS provided a favorable blood gas outcome and reduced the length of hospital stay. It tended to reduce the incidence of PPCs. TRIAL REGISTRATION: ClinicalTrials.gov: NCT04446520.

Neumatosis quística intestinal en un adulto joven sin antecedentes clínicos: reporte de caso / Cystic intestinal pneumatosis in a young adult with no clinical history: Case report

Resumen La neumatosis quística intestinal se refiere a la presencia de gas dentro de la pared del intestino delgado o grueso, puede ser asintomática y potencialmente mortal cuando se presentan complicaciones. Las causas de esta entidad incluyen enfermedades pulmonares, sistémicas, intestinales, medicamentosas, causas iatrogénicas y traumáticas. Se presenta el caso de un hombre de 35 años de edad sin antecedentes de importancia que consultó por dolor en el hemiabdomen inferior, con un diagnóstico imagenológico de neumatosis quística intestinal, neumoperitoneo y peritonitis, complicación secundaria a esta patología, por lo que se realizó el manejo quirúrgico, laparotomía y resección de segmento colónico, que se analizó histopatológicamente y se confirmó el diagnostico; finalmente, fue dado de alta después de finalizar el tratamiento antibiótico.

Abstract Cystic intestinal pneumatosis refers to the presence of gas within the wall of the small or large intestine. It can be asymptomatic and life-threatening when complications occur. The causes of this entity include pulmonary, systemic, intestinal, drug, iatrogenic and traumatic factors. The following is the case of a 35-year-old man who presented with pain in his lower hemiabdomen and had no previous medical history. Imaging scans showed intestinal cystic pneumatosis and secondary pneumoperitoneum and peritonitis. The patient was taken to laparotomy, and a colonic segment was resected and sent to pathology. The diagnosis was confirmed by a biopsy. The patient was discharged after completing antibiotic treatment.

Nutritive value of elephant grass hay ammoniated by urea / Valor nutritivo do feno de capim elefante amonizado por uréia

The aim of this study was to evaluate the effect of ammoniation by urea on the nutritional value of elephant grass hay harvested after flowering. A completely randomized design, in double factorial designs with an additional treatment: 4 urea doses (2, 4, 6 and 8%) x 2 treatment periods (30 and 45 days) + 1 (Control) with four replicates each, was employed. Dry matter, ash, ether extract, neutral detergent fiber, acid detergent fiber, cellulose, lignin, neutral detergent fiber corrected for the ash and the protein, total nitrogen, acid detergent insoluble nitrogen, neutral detergent insoluble nitrogen, non-protein nitrogen, in vitro gas production and carbohydrates fractionation were analyzed. The treatments influenced the contents of DM, EE, NDF, ADF, lignin, cellulose, NDFap, fraction A + B1, fraction B2, fraction C, TN, NPN, ADIN, NDIN, L and Vf2. There was a positive linear effect of urea dose for NDF, ADIN, NDIN and L, positive linear effect on fraction A + B1, NT and NPN, and positive quadratic effect for Vf2, with absolute maximum point of 4.5%. Elephant grass hay harvested after flowering has its nutritional value improved, with a minimum dose of 4.5% urea on a dry matter basis.(AU)

Objetivou-se avaliar o efeito da amonização com ureia sobre o valor nutritivo do feno de capim elefante colheitado após florescimento. O estudo foi delineado, em esquema fatorial duplo com um tratamento adicional: 4 doses de ureia (2, 4, 6 e 8%) x 2 período de tratamento (30 e 45 dias) + 1 tratamento controle, com 4 repetições cada. As variáveis analisadas foram: matéria seca (MS), cinzas, extrato etéreo (EE), fibra em detergente neutro (FDN) e ácido (FDA), FDN corrigida para cinzas e proteínas (FDNcp), celulose, lignina, nitrogênio total (NT), nitrogênio insolúvel em detergente ácido (NIDA) e neutro (NIDN), nitrogênio não proteico (NNP). Produção de gases in vitro proveniente dos carboidratos não fibrosos (Vf1) e fibrosos (Vf2), taxa de fermentação dos carboidratos não fibrosos (k1) e fibrosos (k2) e tempo de colonização bacteriana do substrato (L), além do fracionamento de carboidratos. Os tratamentos influenciaram os teores de MS, EE, FDN, FDA, lignina, celulose, FDNcp, fração A + B1, fração B2, fração C dos carboidratos, NT, NNP, NIDA, NIDN, L e Vf2. Houve efeito linear decrescente de dose de ureia para FDNcp, NIDA, NIDN e L, crescente para fração A+B1, NT e NNP, e, quadrático crescente de dose de ureia para Vf2, com ponto máximo absoluto de 4,5% de ureia obtido após derivar a equação de regressão aos 45 dias de tratamento do feno. Concluindo que feno de capim elefante colheitado após florescimento tem seu valor nutricional melhorado, com dose mínima de 4,5% de ureia em base da matéria seca.(AU)

Comparación de dos tipos de recipientes para analizar gases en sangre y otras mediciones relacionadas contra jeringas con heparinato de litio liofilizado / Comparison of two types of containers to analyze blood gases and other related measurements against syringes with lyophilized lithium heparinate / Comparação de dois tipos de recipientes para analisar gases em sangue e outras medições relacionadas contra seringas com heparinato de lítio liofilizado

El estudio de gases en sangre involucra pruebas relacionadas con el equilibrio ácido-base y estado de oxigenación (pH, pO2, SO2, pCO2, HCO3 -). Además, en los equipos multiparamétricos se realizan otras determinaciones (mediciones relacionadas) como: Na+, K+, Cl-, Ca2+, glucosa y lactato. El objetivo de este trabajo fue comparar los resultados de medición de dos tipos de recipientes (tipo 2: jeringa preparada en el laboratorio con heparinato de Na+ líquido diluido y tipo 3: microtubo con heparinato de Li líquido) contra el recipiente recomendado por el CLSI en su guía 46-A2 (tipo 1: jeringa con heparinato de Li liofilizado balanceado con zinc). El análisis se hizo desde un punto de vista estadístico y clínico para establecer la posibilidad de usar indistintamente estos tres tipos de recipientes. Se analizaron un total de 254 muestras. Para evaluar la aceptación clínica de los resultados se tomó como estándar de calidad la variabilidad biológica. No se encontraron diferencias clínicamente significativas en los analitos del recipiente tipo 2 respecto del tipo 1, excepto para Ca2+. Se rechazaron desde el punto de vista clínico varios analitos del recipiente tipo 3. En conclusión, el uso del recipiente tipo 3 fue inapropiado. Sin embargo, el recipiente tipo 2 sería apto para el análisis de este tipo de muestras.

Blood gas analysis involves tests related to the acid-base balance and oxygenation state (pH, pO2, SO2, pCO2, HCO3 -). In multiparametric equipment, some ion and metabolite (related measurements) are performed: Na+, K+, Cl-, Ca²+, glucose and lactate. The objective of this study was to compare two types of containers (type 2: syringe prepared in the laboratory with diluted liquid sodium heparinate and type 3: microtube with liquid lithium heparinate) against the container recommended by CLSI in its guide 46-A2 (type 1: syringe with lyophilized lithium heparinate balanced with inc). The analysis was made from a statistical and clinical point of view to establish the possibility of indiscriminately using these three types of containers. A total of 254 samples were analyzed. To establish the clinical acceptance of the results, the biological variability quality standard was used. No clinically significant differences were found in the analytes of the type 2 container compared to type 1, except for Ca+. Several analytes of the type 3 container were rejected from the clinical point of view. In conclusion, the use of the type 3 container is inappropriate; however, the type 2 container would be suitable for the analysis of this type of samples.

O estudo de gases em sangue envolve testes relacionados com o equilíbrio ácido-base e estado de oxigenação (pH, pO2, SO2, pCO2, HCO3 -). Além disso, nos equipamentos multiparâmetros, outras determinações (medições relacionadas) como: Na+ , K+, Cl-, Ca2+, glicose e lactato são realizadas. O objetivo deste trabalho foi comparar os resultados de medição de dois tipos de recipientes (tipo 2: seringa preparada no laboratório com heparinato de Na+ líquido diluído e tipo 3: microtubo com heparinato de Li líquido) contra o recipiente recomendado pelo CLSI em seu guia 46-A2 (tipo 1: seringa com heparinato de Li liofilizado equilibrado com zinco). A análise foi feita do ponto de vista estatístico e clínico, para estabelecer a possibilidade de utilização indiscriminada desses três tipos de recipientes. Um total de 254 amostras foram analisadas. Para avaliar a aceitação clínica dos resultados, a variabilidade biológica foi tomada como padrão de qualidade. Não foram encontradas diferenças clinicamente significativas nos analitos do recipiente tipo 2 em relação ao tipo 1, exceto para Ca²+. Vários analitos do recipiente tipo 3 foram rejeitados do ponto de vista clínico. Em conclusão, o uso do contêiner tipo 3 foi inadequado. No entanto, o recipiente tipo 2 seria apto para a análise deste tipo de amostras.

Efecto de gas de formalina sobre el recuento de mesófilos en nailon comercial destinado a procedimientos quirúrgicos / Effect of formaline gas on the counting of mesophiles in commercial nylon destined to surgical procedures

RESUMEN La investigación se realizó a fin de evaluar el efecto del gas de formalina sobre el recuento de mesófilos en nailon comercial (poliamida) destinado a procedimientos quirúrgicos. En primer lugar, se evaluó la contaminación de una muestra del material comercial de 1 g expuesta al ambiente de quirófano por 72 horas, a través de la técnica de recuento en placa para mesófilos; se obtuvieron 850 UFC/g. Una vez comprobada la contaminación de la poliamida comercial, esta se sometió a gases de formalina en comprimidos. Se colocaron 5 muestras (n=5) de nailon de 1 g cada una en 5 recipientes herméticos de 1 litro con 1 gramo de formalina cada uno; estos recipientes se almacenaron en un mueble en sala de esterilización a un metro de altura del piso y posteriormente, fueron abiertos y cultivados a través de la técnica de recuento en placa para mesófilos, uno por día a lo largo de 5 días a intervalos de 24 horas. Los resultados obtenidos no registraron crecimientos de microorganismos a partir de las 24 horas y durante los 5 días posteriores y se encontraron diferencias estadísticamente significativas (p < 0,05). Se concluye que bajo las condiciones del presente estudio el tiempo de esterilización de la formalina sobre nailon comercial es de 24 horas.

ABSTRACT Hie present research work was carried out with the purpose of evaluating the effect of formalin gas on the count of mesophiles in commercial nylon (polyamide) destined to surgical procedures. Firstly, the contamination of a 1 g commercial nylon sample, exposed to the operating room environment for 72 hours, was evaluated through the plate counting technique for mesophiles; it yielded a result of 850 CFU / gram. Once the contamination of the commercial polyamide was checked, it was subjected to formalin gases in tablets. Five nylon samples (n=5) of 1 gram each were placed in 5 1 liter airtight containers containing 1 gram of formalin; Hese containers were stored in a cabinet in the sterilization room one meter above the floor, and later opened and cultivated through the plate counting technique for mesophiles, one per day for 5 days at 24 hour intervals. The results obtained after being exposed to formalin gases in tablets did not register growths of microorganisms after 24 hours and during the 5 days after the study, finding statistically significant differences (p < 0.05) in relation to the studied times concluding under the conditions of the present study that the sterilization time of the formalin on commercial nylon is equal to 24 hours.

Neumatosis intestinal: Rara presentación de abdomen agudo / Pneumatosis intestinalis: a rare presentation of acute abdomen

La neumatosis intestinal es una entidad poco frecuente. Se caracteriza por la presencia de gas en la subserosa o submucosa, o en ambas, a través del tracto gastrointestinal. Presentamos dos casos en los cuales el motivo de consulta fue dolor abdominal generalizado asociado a reacción peritoneal. Se realizó tomografía computarizada (TC) en ambos casos, donde se evidenciaron distensión intestinal, neumatosis intestinal y neumatosis portal. Posteriormente se llevó acabo laparotomía de urgencia y se encontró necrosis intestinal con isquemia mesentérica, hallazgo compatible con imágenes tomográficas. Ambos pacientes fallecieron (uno durante el acto quirúrgico y el otro en el posquirúrgico inmediato).

Pneumatosis intestinalis is a rare condition characterized by the presence of gas in the submucosa or subserosa of the intestinal wall. We report two cases associated with generalized abdominal pain and rebound tenderness. The computed tomography (CT) scans in both cases showed bowel distention, pneumatosis intestinalis and portal venous gas. Both patients underwent emergency surgery which demonstrated bowel necrosis with mesenteric ischemia, consistent with the CT images. Both patients died (one during surgery and the other in the immediate postoperative period).

Sargazo: la irrupción atípica de un ecosistema milenario / Sargassum: the atypical irruption of an ancient ecosystem

Resumen El sargazo es un ecosistema marino milenario que circula en el sentido de las manecillas del reloj en el Océano Atlántico. A partir de 2011, el alga flotante que lo compone ha comenzado a recalar en playas de 19 países del Caribe, con consecuencias ambientales, sanitarias y económicas que deben atenderse con urgencia.

Abstract Sargassum constitutes an ancient marine ecosystem that circulates clockwise on the Atlantic Ocean. Upon 2011, the pelagic seaweed which is the main component of sargassum started to reach beaches on 19 Caribbean countries, with environmental, health and economic impacts that need to be addressed urgently.

Aplicación del ozono interescalénico en la radiculopatía cervical por hernia discal / Application of intercalenic ozone in cervical radiculopathy due to herniated disc

Introducción: el ozono es un gas médico descrito desde el siglo XIX que ha tenido su evolución hasta a la fecha en cuanto a sus aplicaciones y su utilidad en diversas enfermedades por su actuación a nivel molecular y en disímiles enfermedades asociadas a procesos dolorosos de origen inflamatorio como los presentes en las hernia discales de la columna vertebral. Método: estudio retrospectivo con 20 pacientes atendidos en la consulta externa de Neurocirugía del Hospital Miguel Enríquez desde de Diciembre 2016 hasta Abril 2017 con el diagnostico de una radiculopatía cervical por hernia discal. Se le aplicó 10 ML de ozono con una concentración 22 mg/litro tres veces en la semana durante 10 semanas solamente se utilizó este tipo de terapia; obteniendo mejoría en 15 pacientes. Resultados: predominando los mayores de 51 años para un 50 por ciento, en nuestra serie predominó el sexo femenino para un 80 por ciento. En cuanto al cuadro clínico prevaleció la disminución de la fuerza muscular para un 60 por ciento en 12 pacientes, seguidos del dolor cervical y el interescapular para un 75 por ciento y 55 por ciento respectivamente. Se halló mejoría en 15 pacientes para un 75 por ciento y en los otros 5, en tres pacientes no continuaron el tratamiento y en dos no se obtuvo mejoría. Conclusiones: tenemos otra alternativa en la aplicación del ozono por el espacio interescalénico como tratamiento analgésicos y antiinflamatorio en las radiculopatía por hernia discales cervicales(AU)

Introduction: Ozone is a medical gas described since the nineteenth century that has had its evolution up to date in terms of its applications and its usefulness in various diseases for its performance at the molecular level and dissimilar diseases associated with painful processes of inflammatory origin such as those present in herniated discs of the spine. Method: Retrospective study with 20 patients assisted in the outpatient consultation of the Miguel Enríquez Hospital from December 2016 to April 2017 with the diagnosis of a cervical radiculopathy by herniated disc. 10 ML of ozone applied with a concentration of 22 mg/liter three times in the week for 10 weeks only this type of therapy used getting improvement in 15 patients. Results: predominating the older than 51 years for 50 percent, in our series predominated the female sex for 80 percent .As for the clinical picture, decreased muscle strength was prevailed for 60 percent in 12 patients, followed by cervical pain and interescapular for 75 percent and 55 percent respectively. We found improvement in 15 patients for 75 percent and in the other 5, in 3 patients did not continue the treatment and in two, no improvement obtained. Conclusions: We have another alternative in the application of ozone by the intercalenic space as analgesic and anti-inflammatory treatment in cervical herniated discus radiculopathy(AU)

Intoxicación por monóxido de carbono / Carbon monoxide poisoning

Introducción: A nivel mundial, existe un incremento de las intoxicaciones por monóxido de carbono recibidas en los servicios de urgencia. En Cuba no es frecuente este tipo de intoxicación y existe desconocimiento para su diagnóstico precoz. El monóxido de carbono es un gas inodoro, incoloro, no irritante a las mucosas y altamente tóxico para el hombre. Es un contaminante de la atmósfera terrestre y el agente causal más frecuente de la intoxicación por gases. Objetivo: Describir la intoxicación por monóxido de carbono en un paciente atendido en el Hospital Militar;Dr. Mario Muñoz Monroy de Matanzas, Cuba. Caso clínico: Paciente masculino de 19 años de edad que inhala en un área cerrada, de forma accidental, los gases de la combustión de un vehículo durante 30 minutos. Permaneció en el lugar de la exposición sin medios de protección individual por un período de tres horas y comenzó con síntomas correspondientes a una intoxicación moderada por monóxido de carbono. Ingresó en la sala de cuidados intermedios para tratamiento. Conclusiones: El paciente tuvo una evolución favorable, tratado con oxígeno normobárico e hiperbárico(AU)

Introduction: Worldwide, there is an increase in poisonings by carbon monoxide received in emergency services. In Cuba this type of intoxication is not frequent and there is ignorance for its early diagnosis. Carbon monoxide is an odorless, colorless gas, not irritating to mucous membranes and highly toxic to man. It is a pollutant of the Earth's atmosphere and the most frequent causative agent of gas poisoning. Objective: To describe carbon monoxide poisoning in a patient treated at the Military Hospital Dr. Mario Muñoz Monroy from Matanzas, Cuba. Clinical case: A 19-year-old male patient inhaled in a closed area, accidentally, the combustion gases of a vehicle for 30 minutes. He remained in the place of exposure without means of individual protection for a period of three hours and began with symptoms corresponding to moderate intoxication by carbon monoxide. He was admitted at intermediate care ward for treatment. Conclusions: The patient had a favorable evolution, treated with normobaric and hyperbaric oxygen(AU)

Successful medical drainage and surgical treatment for vertebral osteomyelitis and bilateral psoas abscess with gas formation caused by klebsiella pneumoniae in a diabetic patient

SUMMARY OBJECTIVE: We describe the case of a diabetic patient who developed vertebral osteomyelitis and bilateral psoas abscess with gas formation due to klebsiella pneumoniae. METHODS: A 64-year-old woman with a 4-year history of type-2 diabetes mellitus was admitted to the Emergency Department. The subject had a 2-day history of high-grade fever associated with chills and a 5-hour history of consciousness. She received empirical treatment with febrifuge, after which her fever decreased. RESULTS: Her fever recurred after an interval of three hours. A computed tomography scan of the abdomen revealed vertebral osteomyelitis and bilateral psoas muscle abscess with gas formation. Blood culture and purulent fluid described the growth of the Klebsiella pneumoniae. The patient received antibiotic therapy and bilateral drainage therapy after the drainage catheter was placed into the abscess cavity by CT-guidance. Due to the serious damage to the vertebral column and permanent pain, the patient underwent minimally invasive internal spinal fixation and recovered successfully. CONCLUSION: A case of vertebral osteomyelitis and bilateral psoas abscess with gas formation caused by Klebsiella pneumoniae in a diabetic patient. Antibiotic therapy, drainage, and minimally invasive internal spinal fixation were performed, which enabled a good outcome.

RESUMO OBJETIVO: Descrever o caso de uma paciente diabética que desenvolveu osteomielite vertebral e abcesso bilateral do psoas com formação de gás causada por klebsiella pneumoniae. MÉTODOS: Uma mulher de 64 anos de idade, com 4 anos de histórico de diabetes mellitus tipo 2, foi admitida no Serviço de Emergência. A paciente apresentava um quadro de dias de febre alta acompanhada de calafrios e um histórico de 5 horas de consciência. Ela recebeu tratamento empírico com antitérmico, após o qual a febre diminuiu. RESULTADOS: A febre retornou após um intervalo de três horas. Uma tomografia computadorizada do abdome revelou osteomielite vertebral e abcesso bilateral do músculo psoas com formação de gás. A cultura do sangue e o fluido purulento revelaram o crescimento de Klebsiella pneumoniae. A paciente recebeu antibióticos e terapia de drenagem bilateral após o cateter de drenagem ser posicionado na cavidade do abscesso com auxílio de TC. Devido a sérios danos à coluna vertebral e a dor permanente, a paciente foi submetida à fixação vertebral interna minimamente invasiva e recuperou-se com sucesso. CONCLUSÃO: Um caso de osteomielite vertebral e abscesso do psoas bilateral com a formação de gás causada por Klebsiella pneumoniae em uma paciente diabética. Antibioticoterapia, drenagem e fixação vertebral interna minimamente invasiva foram realizadas, o que permitiu um bom resultado.

Identificación de microorganismos en archivos coloniales del archivo y bibliotecas nacionales previamente desinfectados en cámara de gas inerte / Identification of microorganisms in colonial archives of the archive and national libraries previously disinfected in the inerts gas chamber

Sucre ciudad turística que alberga una gran riqueza cultural distribuida en los diferentes museos e instituciones que contienen información de Bolivia como sucede con los Archivos y Biblioteca Nacionales de Bolivia que cuentan con una amplia colección en archivos con documentos que datan desde tiempos de la colonia e incluso libros que conllevan más de mil años de antigüedad cuyas características motivaron la presente investigación que con base en otra desarrollada el 2016 donde se identificaron microorganismos causantes del deterioro en archivos coloniales del Archivo y Biblioteca Nacionales de Bolivia, tiene el objetivo de identificar microorganismos presentes en archivos coloniales del Archivo y Biblioteca Nacionales de Bolivia previamente desinfectados en cámara de gas inerte; la investigación se realizó entre octubre del 2017 y mayo del 2018. Para su desarrollo se adoptó un estudio descriptivo, observacional y de corte transversal tomando como objeto de estudio 20 archivos coloniales ya estudiados que contienen microorganismos degradantes, mismos que fueron previamente desinfectados en la cámara de gas inerte para la toma de muestra y posterior análisis laboratorial destinado a validar la efectividad de la cámara. Se encontró mayor porcentaje de bacterias con relación a los hongos, por lo que la eficacia de cámara de gas inerte es mayor contra los hongos, quedando así validada la cámara. Los resultados alcanzados servirán para proponer alternativas de tratamiento no solo a los archivos sino a todos los documentos contenidos en el Archivo y Bibliotecas Nacionales de Bolivia a fin de preservar nuestra Historia hacia futuras generaciones y no perder nuestra riqueza cultural de Bolivia y el Mundo.

Sucre tourist city that houses a great cultural wealth distributed in the different museums and institutions that contain information from Bolivia as it happens with the National Archives and Library of Bolivia that have an extensive collection in archives with documents dating from colonial times and even books that carry more than a thousand years old whose characteristics motivated the present investigation that based on another one developed in 2016 where microorganisms causing the deterioration in colonial archives of the National Archive and Library of Bolivia were identified, have the objective of identifying microorganisms present in archives Colonial National Archives and Library of Bolivia previously disinfected in inert gas chamber; the investigation was conducted between October 2017 and May 2018 For its development, a descriptive, observational and cross-sectional study was adopted, taking as an object of study 20 colonial archives already studied that contain degrading microorganisms, which were previously disinfected in the inert gas chamber for sampling and subsequent laboratory analysis. to validate the effectiveness of the camera. A higher percentage of bacteria was found in relation to fungi, so the efficiency of the inert gas chamber is higher against fungi, thus validating the chamber. The results achieved will serve to propose treatment alternatives not only to the archives but to all the documents contained in the Archive and National Libraries of Bolivia in order to preserve our History towards future generations and not lose our cultural wealth of Bolivia and the World.

Experimental study for evaluation of a low-cost spray cryotherapy system / Estudo experimental para avaliação de um sistema de baixo custo para crioterapia em spray

ABSTRACT Objective To evaluate the feasibility and applicability of a low-cost cryotherapy system. Methods Experimental study with 25kg Landrace pigs submitted to a longitudinal cervico-thoraco-abdominal incision for exposure of the trachea, thorax and abdomen. The tissues were frozen by continuous spray application at different periods of time (5, 10 and 15 seconds). Spray cryotherapy was performed using a fluorinated gas (tetrafluorethane) delivered at - 47°C temperature (DermaFreeze®, Emdutos; ANVISA registration 80409950001; price R$ 394,00). via an adapted, disposable 1.8mm cholangiography catheter (Olympus; price R$ 280,00). The specimens were resected for histopathological analysis. Results Thirty samples were obtained from ten different organs and divided according to spray cryotherapy application time. System activation for 5, 10 or 15 seconds led to consumption of 14g, 27g and 40g of gas respectively (average gas consumption, 2.7g/s using a 1.8mm catheter). The system comprising a spray tube and catheter proved user-friendly and effective, with constant gas dispersion and adequate tissue freezing. In spite of effective freezing, microscopy failed to reveal tissue changes. This may have reflected methodological constraints precluding evaluation at tissue damage peak time (48 hours). Conclusion The low-cost spray cryotherapy system proved feasible and safe.

RESUMO Objetivo Avaliar a exequibilidade e a aplicação de um sistema de baixo custo de crioterapia. Métodos Estudo experimental realizado com um suíno da raça Landrace, 25kg, submetido à cervicotoracolaparotomia longitudinal, com exposição de traqueia, tórax e abdome. Procedemos ao congelamento das estruturas em tempos diferentes (5, 10 e 15 segundos) com jato contínuo. A crioterapia foi realizada com gás fluoretado (tetrafluoretano), na forma de spray em tubo, que atinge a temperatura de -47°C (DermaFreeze®, Emdutos; registro ANVISA 80409950001; preço R$ 394,00). A este tubo, adaptamos um cateter descartável de colangiografia de 1,8mm (Olympus; preço R$ 280,00). As peças foram ressecadas para análise histopatológica. Resultados Foram obtidas 30 amostras em 10 órgãos diferentes, divididos em três intervalos de tempo distintos. Quando o sistema foi acionado por 5 segundos, gastaram-se 14g de gás; por 10 segundos, 27g; e por 15 segundos, 40g; o gasto médio foi de 2,7g/s pelo cateter de 1,8mm. O sistema confeccionado com tubo de gás e cateter proporcionou resultado efetivo, com dispersão adequada e constante do gás, congelamento adequado e de fácil execução. Apesar da técnica evidenciar congelamento efetivo, na microscopia não houve alteração tecidual. Isso ocorreu porque o pico de lesão tecidual por congelamento ocorre após 48 horas, o que não foi possível avaliar por este método proposto. Conclusão O sistema de crioterapia em spray de baixo custo foi exequível e seguro.

Huella de carbono en el Hospital Base de Puerto Montt / Measurement of the carbon footprint at a regional hospital

Background: Measuring the carbon footprint (CF) makes it possible to estimate the contribution of clinical activity to global warming. Aim: To measure the emitter components of CO2 equivalents (CO2e) at the Hospital Base, Puerto Montt (HBPM). Material and methods: Descriptive study with data collected retrospectively between January and December 2016 from the HBPM database. The data analyzes direct and indirect emissions as well as other indirect emissions beyond the organizational limits. Results: Of the 9,660.3 tons of CO2e emitted by the HBPM in 2016, 46% were derived from consumption of electricity, 29% derived from the generation of residues, and 10% from clinical gas consumption, of which Sevoflurane was the greatest contributor. Conclusions: Clinical gases are a significant source of CO2e emissions. Sevoflurane alone is in fourth place in CO2e emissions at the HBPM. Estimating the CF produced by HBPM is the first step in the discussion of measures to reduce the environmental impact of our activity.

Modelación de riesgos hacia los trabajadores y comunidad por emisiones de gas licuado de petróleo, utilizando software Slab View en la ciudad de Los Ángeles, Chile / Risks modeling to workers and the community for releases of petroleum liquid gas, using software slab view in los angeles city, Chile

RESUMEN: 21. Con el software SLAB VIEW se realizaron modelaciones para determi nar cuantitativamente los riesgos hacia los trabajadores y comunidad por emisiones accidentales de gas licuado de petróleo, desde fuentes de uso y almacenamiento, dentro del radio urbano de Los Ángeles (Chile). Se modelaron 23 fuentes con categoría de riesgo grave, clase "C" y las 3 fuentes con categoría muy grave, clase "D", identificadas con la meto dología APELL, aplicada en el estudio de Silva et. al (2016). 22. 23. Se evaluó el comportamiento espacial y temporal de las fugas de gas para estanques identificados con capacidades de 2 m3, 4 m3, 11 m3 y 49 m3 utilizando promedios estacionales de variables meteorológicas consideradas en un periodo de evaluación de cinco años. Se utiliza ron variables de tiempo de fuga evaluando su comportamiento en 1, 3 y 5 minutos, con el fin de identificar las condiciones del peor escenario. Como resultado se obtiene que el comportamiento de la nube depende de la estabilidad atmosférica, siendo la condición esta ble donde concentraciones de interés permanecen por más tiempo alcanzando mayores distancias y que el peor escenario para una fuga son las bajas temperaturas y las condiciones atmosféricas estables. Como conclusión, puede establecerse que en la zona de estudio exis ten estanques que son potencialmente peligrosos por deflagración para trabajadores y la comunidad; sin embargo, los tiempos de expo sición no generan peligros por exposición aguda.

ABSTRACT: 28. With the SLAB VIEW software, modeling wasperformed to determine quantitatively the risks to workers and the community from acciden tal releases of liquefied petroleum gas, from sources use and storage, within the urban radius of Los Angeles (Chile). 23 sources with a severe risk category class "C" and the 3 very severe risk category class "D" identified with the APELL methodology, applied in the study by Silva et al. (2016), were modeled. 29. 30. The spatial and temporal behavior of the gas leaking for tanks iden tified with capacities of 2m3, 4m3, 11m3 and 49m3 were evaluated using seasonal averages of meteorological variables considered in a five - year evaluation period. Leakage time variables were used evaluating their behavior in 1, 3 and 5 minutes in order to identify worst-case conditions. As a result it is obtained that the behavior of the cloud depends on the atmospheric stability, being the stable condition where concentrations of interest remain longer reaching greater distances and that the worst scenario for a leak is the low temperatures and the stable atmospheric conditions. As a conclusion, it can be established that in the study area, there are ponds that are potentially dangerous due to deflagration for workers and the com munity, however, exposure times do not generate hazards due to acute exposure.

Validación del método para la cuantificación de alcohol en sangre por cromatografía gaseosa con detector de ionización de llama y espacio de cabeza y correlación con el método enzimático / Validation of the method for the quantification of blood alcohol by gaseous chromatography with flame ionization detector and head and correlation space with the enzymatic method

El presente estudio describe la estandarización del método para la cuantificación de alcohol en sangre por Cromatografía Gaseosa con Detector de Ionización de llama y espacio de cabeza. La separación del alcohol de una matriz compleja como la sangre fue llevada a cabo de manera exitosa utilizando una columna ELITE-1, la fase móvil o gas de arrastre es una mezcla de hidrógeno y aire, inyector split y detector de ionización de llama. El método fue validado con los siguientes parámetros: especificidad, linealidad, precisión, exactitud, límite de detección y límite de cuantificación. También se realizó la prueba de aptitud del sistema. El método fue específico para el alcohol, la respuesta fue lineal en el rango de 0,125 ­ 1,0 mg/mL de concentración del analito. El valor del coeficiente de variación o desviación estándar relativa (C.V. o DSR) para la precisión fue óptimo. La recuperación media fue de 99,06%. Y el límite de detección y cuantificación resultaron óptimos para la cuantificación de alcohol en sangre en el rango definido. Finalmente el método cromatográfico fue correlacionado con el método analítico (previamente validado) actualmente utilizado en la División de Dosage Etílico del Instituto de Investigaciones Técnicas de la Universidad Policial Mariscal Antonio José de Sucre, mediante el análisis estadístico de las respuestas analíticas de ambos métodos se obtuvo una muy buena correlación por lo que se concluye que el método cromatográfico puede ser utilizado para los fines consiguientes.

The present study describes the standardization of the method for the quantification of alcohol in blood by Gas Chromatography with Flame Ionization Detector and headspace. The separation of the alcohol from a complex matrix such as blood was successfully carried out using an ELITE-1 column, the mobile phase or entrainment gas is a mixture of hydrogen and air, split injector and flame ionization detector. The method was validated with the following parameters: specificity, linearity, precision, accuracy, limit of detection and limit of quantification. The system fitness test was also performed. The method was alcohol specific, the response was linear in the range of 0.125 - 1.0 mg / mL analyte concentration. The value of the coefficient of variation or relative standard deviation (C.V. or DSR) for precision was optimal. The mean recovery was 99.06%. And the limit of detection and quantification were optimal for the quantification of blood alcohol in the defined range. Finally the chromatographic method was correlated with the enzymatic method (previously validated) currently used in the Ethical Dosage Division of the Institute of Technical Investigations of the Mariscal Antonio José de Sucre Police University, through the statistical analysis of the analytical responses of both methods a very good correlation was obtained by which it is concluded that the chromatographic method can be used for the consequent purposes.

Anesthesia of Epinephelus marginatus with essential oil of Aloysia polystachya: an approach on blood parameters

ABSTRACT This study investigated the anesthetic potential of the essential oil (EO) of Aloysia polystachya in juveniles of dusky grouper (Epinephelus marginatus). Fish were exposed to different concentrations of EO of A. polystachya to evaluate time of induction and recovery from anesthesia. In the second experiment, fish were divided into four groups: control, ethanol and 50 or 300 µL L−1 EO of A. polystachya, and each group was submitted to induction for 3.5 min and recovery for 5 or 10 min. The blood gases and glucose levels showed alterations as a function of the recovery times, but Na+ and K+ levels did not show any alteration. In conclusion, the EO from leaves of A. polystachya is an effective anesthetic for dusky grouper, because anesthesia was reached within the recommended time at EO concentrations of 300 and 400 µL L−1. However, most evaluated blood parameters showed compensatory responses due to EO exposure.

Pancreatic Necrosis and Gas in the Retroperitoneum: Treatment with Antibiotics Alone

OBJECTIVE: To present our experience in the management of patients with infected pancreatic necrosis without drainage. METHODS: The records of patients with pancreatic necrosis admitted to our facility from 2011 to 2015 were retrospectively reviewed. RESULTS: We identified 61 patients with pancreatic necrosis. Six patients with pancreatic necrosis and gas in the retroperitoneum were treated exclusively with clinical support without any type of drainage. Only 2 patients had an APACHE II score >8. The first computed tomography scan revealed the presence of gas in 5 patients. The Balthazar computed tomography severity index score was >9 in 5 of the 6 patients. All patients were treated with antibiotics for at least 3 weeks. Blood cultures were positive in only 2 patients. Parenteral nutrition was not used in these patients. The length of hospital stay exceeded three weeks for 5 patients; 3 patients had to be readmitted. A cholecystectomy was performed after necrosis was completely resolved; pancreatitis recurred in 2 patients before the operation. No patients died. CONCLUSIONS: In selected patients, infected pancreatic necrosis (gas in the retroperitoneum) can be treated without percutaneous drainage or any additional surgical intervention. Intervention procedures should be performed for patients who exhibit clinical and laboratory deterioration.

Safety of mannitol use in bowel preparation: a prospective assessment of intestinal methane (CH4) levels during colonoscopy after mannitol and sodium phosphate (NaP) bowel cleansing / Segurança do uso do manitol no preparo para colonoscopia: avaliação prospectiva do nível de metano (CH4) intestinal durante colonoscopia após preparo com manitol e fosfato de sódio (NaP)

ABSTRACT Background - Adequate bowel preparation is critical for the quality of colonoscopy. Despite reported occurrence of colonic explosion due to methane and hydrogen production by bacterial fermentation during colonoscopy, gas exchange during the procedure is believed to be effective in lowering existing methane concentration, allowing for safe utilization of mannitol for bowel preparation. Thus, mannitol is widely used for bowel cleansing prior to colonoscopy, considering its low cost and effectiveness for bowel preparation. Objective - The aim of this study was to assess the safety of mannitol for bowel preparation, when compared to sodium phosphate (NaP). Methods - We conducted a prospective observational study in which 250 patients undergoing colonoscopy at Universidade Federal de São Paulo and Hospital Albert Einstein (São Paulo, Brazil) were approached for inclusion in the study. Patients received either mannitol (n=50) or NaP (n=200) for bowel preparation, based on physician indication. Study was conducted from August 2009 to December 2009. The main outcome of interest was presence of detectable levels of methane (CH4) during colonoscopy and reduction in such levels after gas exchange during the procedure. Methane concentrations were measured in three intestinal segments during scope introduction and withdrawal. Safety was assessed as the absence of high levels of methane, defined as 5%. Measurements were made using a multi-gas monitor (X-am 7000, Dräger Safety AG & Co. KGaA, Lübeck, Germany) connected to a plastic catheter introduced into the working channel of the colonoscope. Additional outcomes of interest included levels of O2. Methane and O2 levels are reported as ppm. Mean, difference and standard deviation of levels of gas measured in both moments were calculated and compared in both groups. Proportions of patients with detectable or high levels of methane in both groups were compared. Continuous variables were analyzed using t test and categorical variables using qui-square tests. The Ethics Committee in both study sites approved the study protocol. Results - Patients in both groups were similar regarding demographics, colonoscopy indication, ASA status and quality of bowel preparation. Seven (3.5%) patients in the NaP group had methane detected during introduction of the endoscope. Methane levels became undetectable during withdrawal of the scope. None of the patients in the mannitol group had detectable levels of methane. O2 levels did not differ in the groups. Conclusion - This is the largest study to assess the safety of mannitol for bowel preparation, considering methane measurements. Our results indicate that mannitol use is as safe as NaP, and gas exchange was efficient in reducing methane concentrations.

RESUMO Contexto - Preparo adequado é fundamental para garantia de boa qualidade em colonoscopia. Apesar de relatos de explosão do cólon durante colonoscopia, secundários à produção de metano e hidrogênio pela fermentação bacteriana, acredita-se que a troca gasosa durante o procedimento diminua a concentração existente de metano, permitindo a utilização com segurança, de manitol para o preparo de cólon. Assim, manitol é largamente utilizado para limpeza dos cólons antes da colonoscopia, especialmente devido ao seu baixo custo e eficácia. Objetivo - O objetivo do estudo foi avaliar a segurança do uso de manitol no preparo dos cólons, quando comparado ao uso de fosfo-soda (NaP). Métodos - Este foi um estudo observacional retrospectivo no qual foram incluídos 250 pacientes submetidos a colonoscopia na Universidade Federal de São Paulo e Hospital Albert Einstein (São Paulo - Brasil). Os pacientes receberam preparo de cólon com manitol (n=50) ou NaP (n=200), de acordo com preferências dos médicos que encaminharam os pacientes. O estudo foi realizado entre agosto e dezembro de 2009. O principal resultado pesquisado foi a presença de níveis detectáveis de metano (CH4) durante a colonoscopia, e a redução nestes níveis após troca gasosa durante o procedimento. As concentrações de metano foram dosadas com detector multi-gas (X-am 7000, Dräger Safety AG & Co., KGaA, Lübeck, Alemanha) conectado a um cateter plástico que foi introduzido no canal de instrumentação do colonoscópio. Outro achado de interesse foram níveis de O2. Níveis de metano e O2 foram relatados em ppm. Média, diferença entre as médias e desvio padrão nos níveis dos gases em ambos momentos foram comparados nos dois grupos. A proporção de pacientes com níveis detectáveis ou altos de metano em ambos os grupos foram comparados. Variáveis contínuas foram analisadas com teste t e variáveis categóricas com o teste do qui-quadrado. Os Comitês de Ética de ambas instituições aprovaram o protocolo do estudo. Resultados - Pacientes nos dois grupos foram comparáveis quanto aos dados demográficos, indicação para colonoscopia, classificação ASA e qualidade do preparo do cólon. Sete (3,5%) pacientes no grupo NaP tinham níveis detectáveis de metano durante a introdução do colonoscópio. Os níveis de metano se tornaram indetectáveis durante a retirada do aparelho. Nenhum dos pacientes no grupo manitol tinha níveis detectáveis de metano. Níveis de O2 foram semelhantes nos dois grupos. Conclusão - Este é o estudo com maior casuística que avaliou a segurança do uso de manitol para preparo de cólon, no que diz respeito a dosagem de metano. Nossos resultados indicam que o emprego do manitol é tão seguro quanto o NaP, e que a troca gasosa é eficaz na redução da concentração de metano.