Experimental and modeling of potassium diclofenac uptake on activated carbon.

The presence of pharmaceuticals in wastewater resulting from human activities has driven researchers to explore effective treatment methods such as adsorption using activated carbon (AC). While AC shows promise as an adsorbent, further studies are essential to comprehend its entire interaction with pharmaceuticals. This article investigates the adsorption of potassium diclofenac (PD) onto AC using experimental and modeling approaches. Batch adsorption studies coupled with Fourier transform infrared spectroscopy (FTIR) were employed to clarify the adsorption mechanism of PD on AC. Various kinetic and isotherm adsorption models were applied to analyze the adsorbent-adsorbate interaction. The kinetics were best described by Avrami's fractional order (AFO) nonlinear model. Also, the intraparticle diffusion (IP) model reveals a three-stage adsorption process. The experimental equilibrium data fitted well with the three-parameter nonlinear Liu model, indicating a maximum adsorption capacity (Qmax) of 88.45 mg g-1 and suggesting monolayer or multilayer adsorption. Thermodynamic analysis showed favorable adsorption (ΔG° < 0), with an enthalpy change (ΔH° = -30.85 kJ mol-1) characteristic of physisorption involving hydrogen bonds and π-π interactions. The adsorption mechanism was attributed to forming a double layer (adsorbate-adsorbent and adsorbate-adsorbate).

Insights from the EQUALS4COVID19 study on migrant mental health in Portugal: a cross-sectional mixed-methods approach.

BACKGROUND: The COVID-19 pandemic and related disruptive consequences in the economic, health, and educational sectors have impacted people's lives, contributing to a context of increased economic and social vulnerability. The pandemic has revealed and accentuated social inequalities and discrimination based on racial or ethnic origin. This study aimed to contribute to the promotion of the mental health and well-being of migrant populations living in Portugal via the definition of an analytical framework and recommendations emerging from the EQUALS4COVID19 project. METHODS: To gather information on the impact of the COVID-19 pandemic and resilience determinants among immigrants, a mixed-methods approach was implemented in 2022, combining a cross-sectional survey targeting immigrant adults in Portugal, focus groups with immigrants, focus groups with healthcare professionals, and in-depth individual interviews with stakeholders involved in the implementation of measures related to mental health and well-being during the pandemic. The analysis followed an integrated framework; quantitative data informed the script of qualitative data collection methods, and qualitative analysis informed the reinterpretation of quantitative data. RESULTS: The survey with 604 Brazilian and Cape Verdean immigrants revealed that gender (being a woman) was associated with both psychological distress and depression-related symptomatology and that the perception of discrimination was a major risk factor for psychological suffering, while perceived social support and individuals' resilience characteristics were protective factors. Qualitative data provided deeper insights into these findings, revealing the ways mental health is affected by social structures, such as gender and ethnic hierarchies. Migrants tend to work in precarious jobs requiring physical presence, which, together with dense housing conditions, puts them at higher risk of infection. The deterioration of the economic conditions of the general population has also increased the perception of ethnic-racial discrimination, which was found to be related to the increase in insecurity and anxiety-related symptomatology among the migrant population. Newly arrived migrants, with reduced support networks, experienced a greater sense of insecurity as well as concern and anguish regarding relatives who live far away, in their home country. Migrant women reported greater family-related distress, including work-life balance problems. CONCLUSIONS: Proposals to address mental health inequalities should be considered in the context of the necessary global changes both at the societal level and in the delivery of mental health services. Additionally, they should be considered with the active involvement of migrants, families, and communities in the design and delivery of mental health promotion and care processes.

Comprehensive adsorption and spectroscopic studies on the interaction of magnetic biochar from black wattle sawdust with beta-blocker metoprolol.

The rise of contaminants of emerging concern in water-resources due to human activities has driven research toward wastewater treatment, specifically adsorption. The utilization of woody biomass for biochar production in adsorption has shown promise due to its high availability. This study shows the preparation of magnetic biochars (MB) from waste black wattle sawdust, utilizing ZnCl2 and NiCl2 (proportions: 1:0.5:0.5 = MB-0.5 and 1:1:1 = MB-1) as activating and magnetic agents. Synthesized via microwave-assisted-pyrolysis, MB boasts a high surface area (up to 765 m2.g-1) and functional groups, enhancing metoprolol medicine adsorption. Nonlinear kinetic and isothermal models were tested; the Avrami fractional-order kinetic model and Liu's isothermal model provided the best fits for experimental data. Thermodynamics and spectroscopic studies revealed spontaneous and exothermic adsorption processes, with physisorption magnitude and dominance of hydrogen-bond and π-π-interactions. MB can be easily extracted from an aqueous medium using magnetic fields, while adsorption capacity could be regenerated through green solvent elution.

Mental Health and Well-Being of Migrant Populations in Portugal Two Years after the COVID-19 Pandemic.

In Portugal, like in other European countries, the COVID-19 pandemic aggravated the risk of poverty and social exclusion faced by migrants. This study aimed to assess mental health and well-being, and their social determinants, among Brazilian and Cape Verdean immigrant populations two years after the COVID-19 pandemic while exploring the role of positive psychological factors such as resilience and perceived social support. We conducted a cross-sectional survey combining online and face-to-face questionnaires for data collection between February and November 2022 on dimensions of mental health considered potentially relevant to the post-pandemic context: psychological distress, anxiety, and depression. Overall, 604 immigrants were included (322 Brazilian and 282 Cape Verdean); 58.5% of those surveyed were women and 41.5% were men. The results revealed that gender (being a woman) was associated with both psychological distress and depression, higher education was associated with anxiety, and that, for the three mental health dimensions under analysis, the perception of discrimination and resilience were negative and positive predictors, respectively. Findings can inform the design and implementation of relevant public mental health promotion programs with a focus on equity targeted to the general population. Such programs would help to address the psychological and social impacts of this long-term, insidious global pandemic that has challenged governments, health care systems, health care professionals, individuals, families, and communities worldwide.

Brilliant blue FCF dye adsorption using magnetic activated carbon from Sapelli wood sawdust.

Sapelli wood sawdust-derived magnetic activated carbon (SWSMAC) was produced by single-step pyrolysis using KOH and NiCl2 as activating and magnetization agents. SWSMAC was characterized by several techniques (SEM/EDS, N2 adsorption/desorption isotherms, FTIR, XRD, VSM, and pHPZC) and applied in the brilliant blue FCF dye adsorption from an aqueous medium. The obtained SWSMAC was a mesoporous material and showed good textural properties. Metallic nanostructured Ni particles were observed. Also, SWSMAC exhibited ferromagnetic properties. In the adsorption experiments, adequate conditions were an adsorbent dosage of 0.75 g L-1 and a solution pH of 4. The adsorption was fast, and the pseudo-second-order demonstrated greater suitability to the kinetic data. The Sips model fitted the equilibrium data well, and the maximum adsorption capacity predicted by this model was 105.88 mg g-1 (at 55 °C). The thermodynamic study revealed that the adsorption was spontaneous, favorable, and endothermic. Besides, the mechanistic elucidation suggested that electrostatic interactions, hydrogen bonding, π-π interactions, and n-π interactions were involved in the brilliant blue FCF dye adsorption onto SWSMAC. In summary, an advanced adsorbent material was developed from waste by single-step pyrolysis, and this material effectively adsorbs brilliant blue FCF dye.

Hibiscus Tea and its Therapeutic Potential in Weight Reduction: Integrative Review / Chá de Hibiscus e seu Potencial Terapêutico na Redução de Peso: Revisão Integrativa

The calyx of the Hibiscus plant are used in the form of an infusion in popular medicine with the purpose of contributing to the weight loss of its users. Therefore, the objective of this work was to verify in the literature the therapeutic potential of Hibiscus sabdariffa tea for weight loss. This is an integrative review done in the following databases: Scopus, PubMed, Science Direct, Web of Science. The final sample consisted of 6 articles. Half of the selected articles had the clear objective of evaluating weight loss, the others evaluated anti-metabolic and anti-stress properties, obesity-related adipogenesis and control of lipid indicators. In the selected studies, the most used part of the plant was the calyx, being fresh and dry. Factors such as the concentration and form of supply of the Hibiscus sabdariffa extract seem to be points to be taken into account in experiments that have food intake as an influence on the other variables. The studies brought evidence that Hibiscus sabdariffa extracts contribute to weight loss and to the suppression of weight gain in human and animal groups with metabolic disorders, without change for the healthy human/animal group. However, studies on the long-term maintenance of weight loss, once achieved, the efficacy and safety of its use, are still insufficient according to the collected evidence.(AU)

Os cálices da planta Hibiscus são utilizados na forma de infusão na medicina popular com o propósito de contribuir na perda ponderal de seus usuários. Diante disto, o trabalho teve como objetivo verificar na literatura o potencial terapêutico do chá de Hibiscus sabdariffa para a perda ponderal. Trata-se de uma revisão integrativa realizada nas bases: Scopus, PubMed, Science Direct, Web of Science. A amostra final foi formada por 6 artigos. Metade dos artigos selecionados tinham como objetivo claro avaliar a perda de peso, os demais avaliavam as propriedades antimetabólicas e antiestresse, adipogênese relacionada à obesidade e controle dos indicadores lipídicos. Nos estudos selecionados, a parte da planta mais utilizada foi o cálice, sendo eles frescos e secos. Fatores como a concentração e a forma de fornecimento do extrato do Hibiscus sabdariffa parecem ser pontos a serem levados em consideração em experimentos que tenham a ingestão alimentar como influência sobre as demais variáveis. Os estudos trouxeram evidencias de que os extratos de Hibiscus sabdariffa contribuem para a perda de peso e para a supressão do ganho de peso em grupos humanos e animais com disfunções metabólicas, sem alteração para o grupo de humanos/animais saudáveis. No entanto, estudos sobre a manutenção a longo prazo da perda de peso, uma vez alcançada, a eficácia e segurança de seu uso, ainda são insuficientes de acordo com as evidências coletadas.(AU)

Adsorptive Features of Magnetic Activated Carbons Prepared by a One-Step Process towards Brilliant Blue Dye.

Water pollution by dyes has been a major environmental problem to be tackled, and magnetic adsorbents appear as promising alternatives to solve it. Herein, magnetic activated carbons were prepared by the single-step method from Sapelli wood sawdust, properly characterized, and applied as adsorbents for brilliant blue dye removal. In particular, two magnetic activated carbons, MAC1105 and MAC111, were prepared using the proportion of biomass KOH of 1:1 and varying the proportion of NiCl2 of 0.5 and 1. The characterization results demonstrated that the different proportions of NiCl2 mainly influenced the textural characteristics of the adsorbents. An increase in the surface area from 260.0 to 331.5 m2 g-1 and in the total pore volume from 0.075 to 0.095 cm3 g-1 was observed with the weight ratio of NiCl2. Both adsorbents exhibit ferromagnetic properties and the presence of nanostructured Ni particles. The different properties of the materials influenced the adsorption kinetics and equilibrium of brilliant blue dye. MAC111 showed faster kinetics, reaching the equilibrium in around 10 min, while for MAC1105, it took 60 min for the equilibrium to be reached. In addition, based on the Sips isotherm, the maximum adsorption capacity was 98.12 mg g-1 for MAC111, while for MAC1105, it was 60.73 mg g-1. Furthermore, MAC111 presented the potential to be reused in more adsorption cycles than MAC1105, and the use of the adsorbents in the treatment of a simulated effluent exhibited high effectiveness, with removal efficiencies of up to 90%.

Opciones terapéuticas para la colecistitis aguda: de las guías de Tokio 2018 a la práctica clínica / Therapeutic options for acute cholecystitis: from the Tokyo guidelines 2018 to clinical practice / Opções terapêuticas para colecistite aguda: das diretrizes de Tóquio 2018 à prática clínica

Resumen: Introducción: el tratamiento "gold standard" de la colecistitis aguda es la colecistectomía laparoscópica temprana. En pacientes añosos de alto riesgo anestésico-quirúrgico, con cuadros de evolución subaguda y/o con repercusión sistémica, es alternativa el tratamiento médico exclusivo o asociado al drenaje vesicular percutáneo. Objetivo: analizar y comparar las recomendaciones internacionales con las conductas terapéuticas en dos centros asistenciales de tercer nivel para pacientes con colecistitis aguda. Método: trabajo descriptivo, prospectivo de 161 pacientes con colecistitis aguda litiásica asistidos en los departamentos de emergencia del Hospital de Clínicas y el Hospital Español entre mayo de 2018 y mayo de 2019. Resultados: la colecistectomía laparoscópica temprana fue indicada en el 88% de los pacientes, con 3% de conversión y 9% de morbilidad. 12% recibieron manejo no operatorio, asociándose en el 65% colecistostomía percutánea. La edad avanzada, comorbilidades, discrasias y la severidad del cuadro presentaron asociación significativa con la modalidad terapéutica (p <0,05). El 40% de los pacientes en los que se realizó manejo no operatorio presentó recurrencias sintomáticas. A todos se les realizó la colecistectomía en diferido. Conclusiones: la colecistectomía laparoscópica temprana es la conducta terapéutica más frecuente. Las principales indicaciones de manejo no operatorio en nuestro medio son las características sistémicas desfavorables. El mismo presenta altas tasas de éxito y escasa morbilidad con una recurrencia sintomática del 40%.

Abstract: Introduction: early laparoscopic cholecystectomy is the gold standard treatment for acute cholecystitis. However, exclusive medical treatment (EMC) or medical treatment associated with percutaneous gallbladder drainage is the treatment of choice in elderly patients given their high surgical and anesthetic risk and upon the subacute course of the condition and/or its systemic repercussions. Objective: to analyze and compare international guidelines to the therapeutic behavior for patients with acute cholecystectomy in two third-level hospitals. Methodology: descriptive, prospective study of 161 patients with litiasic acute cholecystitis treated in the ER of Hospital de Clínicas and Hospital Español between May 2018 and May 2019. Results: early laparoscopic cholecystectomy was indicated in 88% of patients, conversion being 3% and morbidity 9%. Twelve percent of patients received non-surgical treatment, 65% of which evidenced percutaneous cholecystostomy. Old age, comorbidities, dyscrasias, and severity of the condition were closely related to the therapeutic modality (p < 0.05). Forty percent of patients who received non-surgical treatment presented symptomatic repercussions. They all underwent delayed cholecystectomy. Conclusions: early laparoscopic cholecystectomy is the most frequent treatment of choice. Unfavorable systemic characteristics are the main indications for non-surgical management in our country. This surgical treatment evidences high success rates and scarce morbidity with 40% of systemic repercussions.

Resumo: Introdução: o tratamento padrão ouro da colecistite aguda é a colecistectomia laparoscópica precoce. Em pacientes idosos com alto risco anestésico-cirúrgico, com evolução subaguda e/ou repercussão sistêmica, o tratamento clínico isolado ou associado à drenagem percutânea da vesícula biliar é uma alternativa. Objetivo: analisar e comparar recomendações internacionais com condutas terapêuticas em dois centros terciários para pacientes com colecistite aguda. Método: estudo descritivo e prospectivo de 161 pacientes com colecistite aguda de cálculos atendidos nos serviços de emergência do Hospital de Clínicas e Hospital Español no período maio de 2018 - maio de 2019. Resultados: a colecistectomia laparoscópica precoce foi indicada em 88% dos pacientes, com 3% de conversão e 9% de morbidade. 12% receberam tratamento não operatório, associado a 65% colecistostomia percutânea. Idade avançada, comorbidades, discrasias e gravidade do quadro apresentaram associação significativa com a modalidade terapêutica (p < 0,05). 40% dos pacientes nos quais o manejo não operatório foi realizado apresentaram recidivas sintomáticas. Todos foram submetidos à colecistectomia diferida. Conclusões: a colecistectomia laparoscópica precoce é a abordagem terapêutica mais frequente. As principais indicações para o manejo não operatório em nosso meio são as características sistêmicas desfavoráveis. Apresentando altas taxas de sucesso e baixa morbidade com recorrência sintomática de 40%.

Anacardic Acid Derivatives Affect the in Vitro Reactions of Photosynthesis.

The dichloromethane extract of the cashew nuts from Anacardium occidentale was fractionated by rotation locular countercurrent chromatography aimed at discovering metabolites that could be useful as new models for photosynthesis inhibitors. The chemical fractionation afforded a complex mixture of anacardic acids, which upon catalytic hydrogenation yielded anacardic acid (1). Methylation of 1 via reaction with diazomethane afforded an ester 2. Both compounds were evaluated using polarographic approaches and fluorescence studies of chlorophyll a (ChL a). The in vitro assays informed the decision for the classification of 1 and 2 as Hill reaction inhibitors. Besides that, 1 inhibited the donor side of the PSII, while 2 acted as an energy transfer inhibitor. Therefore, this study is important for the development of herbicides.

More Powerful Twistron Carbon Nanotube Yarn Mechanical Energy Harvesters.

Stretching a coiled carbon nanotube (CNT) yarn can provide large, reversible electrochemical capacitance changes, which convert mechanical energy to electricity. Here, it is shown that the performance of these "twistron" harvesters can be increased by optimizing the alignment of precursor CNT forests, plastically stretching the precursor twisted yarn, applying much higher tensile loads during precoiling twist than for coiling, using electrothermal pulse annealing under tension, and incorporating reduced graphene oxide nanoplates. The peak output power for a 1 and a 30 Hz sinusoidal deformation are 0.73 and 3.19 kW kg-1 , respectively, which are 24- and 13-fold that of previous twistron harvesters at these respective frequencies. This performance at 30 Hz is over 12-fold that of other prior-art mechanical energy harvesters for frequencies between 0.1 and 600 Hz. The maximum energy conversion efficiency is 7.2-fold that for previous twistrons. Twistron anode and cathode yarn arrays are stretched 180° out-of-phase by locating them in the negative and positive compressibility directions of hinged wine-rack frames, thereby doubling the output voltage and reducing the input mechanical energy.

Low-Cost Ka-Band Satellite Receiver Data Preprocessing for Tropospheric Propagation Studies.

Satellite tropospheric propagation studies strongly rely on beacon receiver measurements. We were interested in performing a measurement campaign to characterize rain attenuation statistics. In this article, we outline some of the characteristics and drawbacks one faces when trying to perform a radio wave satellite beacon propagation experiment at the Ka-band with low-cost measurement equipment. We used an affordable beacon receiver consisting of a commercial low-noise block down-converter, an outdoor dual-reflector antenna, and a software-defined radio unit. To measure rain attenuation events, we needed to work out where the reference signal level was at all times. However, as we did not have a radiometer to remove the impact of gases and clouds, since it is a very expensive device, we used a procedure that involved the subtraction of a stable and reliable reference level (template) from the raw received beacon level. This template was extracted from observations during non-rainy periods. The procedure implemented for extracting the template was based on the same data processing methodology used by other authors in this field. Here, we describe through specific examples the main characteristics of the templates extracted on non-rainy days, as well as the impact of some meteorological parameters and unavoidable, but small antenna pointing errors.

BRASH Syndrome: A Case Report.

BACKGROUND BRASH syndrome is a newly recognized clinical entity characterized by bradycardia, renal failure, atrioventricular blockade, shock, and hyperkalemia. Patients with BRASH syndrome often have severe bradycardia that is refractory to antidotes and chronotropic medications. In these situations, transvenous pacemaker and renal replacement therapy may be necessary. Therefore, rapid diagnosis and correct management of this entity are crucial to reduce mortality. We report a case and the management of BRASH syndrome in the Emergency Department. CASE REPORT A 76-year-old man with chronic kidney disease stage 3, essential hypertension and psoriasis, and receiving atenolol presented to the Emergency Department with lethargy and weakness that started 3 days ago, with rapid deterioration into shock. His initial laboratory tests revealed hyperkalemia, metabolic acidosis, and acute kidney injury. His initial electrocardiogram was remarkable for sinus bradycardia with junctional escape rhythm with ventricular rate of 26 bpm. A chest X-ray was normal. Transthoracic echocardiogram showed normal systolic and diastolic function. Atenolol was immediately held. He was treated with potassium-lowering agents and vasoactive drugs. Due to the persistence of bradycardia, even after reversal of hyperkalemia, a temporary transvenous pacemaker was placed. Renal replacement therapy was not required. Renal function improved and heart rate stabilized at 80 bpm. The patient was discharged and advised to avoid atrioventricular-blocking agents, with Cardiology follow-up. CONCLUSIONS BRASH syndrome is a serious complication due to a combination of hyperkalemia, hypotension, and bradycardia in the setting of kidney dysfunction and medications that block the atrioventricular node. Hemodynamic support and temporary pacemaker use may be needed to manage this entity.

A pandemic recap: lessons we have learned.

On January 2020, the WHO Director General declared that the outbreak constitutes a Public Health Emergency of International Concern. The world has faced a worldwide spread crisis and is still dealing with it. The present paper represents a white paper concerning the tough lessons we have learned from the COVID-19 pandemic. Thus, an international and heterogenous multidisciplinary panel of very differentiated people would like to share global experiences and lessons with all interested and especially those responsible for future healthcare decision making. With the present paper, international and heterogenous multidisciplinary panel of very differentiated people would like to share global experiences and lessons with all interested and especially those responsible for future healthcare decision making.

Reducing Sexual and Reproductive Health Inequities Between Natives and Migrants: A Delphi Consensus for Sustainable Cross-Cultural Healthcare Pathways.

The increasing number of international migrants (ranging from 153 million in 1990 to ~272 million in 2019) brought to attention the wide variation of national contexts concerning the policy measures to protect migrants' rights and ensuring their equal access to basic and essential services, namely in health. Sexual and Reproductive Health (SRH) is a key component to the overall health and quality of life and is impacted by power inequities inherent to society's institutions, environment, economics, and culture. In Portugal, guidelines for intervention in SRH are insufficient, a gap that is more pronounced with migrant populations due to the absence of culturally sensitive indicators to assess and monitor SRH. The aim of this work was 2-fold: to identify good practices in the SRH field, with a particular focus, whenever possible, on migrant populations, and to identify relevant and inclusive indicators to monitor SRH in Portugal. A Delphi panel (via online survey) with 66 experts (researchers, teachers, and health professionals) and 16 stakeholders (non-governmental organizations, civil society, and governmental organizations) was implemented in two rounds. Panelists were asked to state their level of agreement (5-point Likert-type scale) regarding four different SRH areas: Sexual Health, Reproductive Health, Social-Structural Factors, and Good Practices. Items were based on literature review and a World Café with 15 experts and stakeholders. Participation rate was 68% and response rate was 97% on the first round. From the initial list of 142 items, a total of 118 (83%) items were approved by consensus. Findings may provide extended opportunities for the healthcare system to engage in better informed decisions and more inclusive and integrative strategies regarding SRH, contributing to build political measures toward sexual and reproductive justice.

Médico como arquiteto da escolha: paternalismo e respeito à autonomia / Physicians as choice architects: paternalism and respect for autonomy / El médico como arquitecto de elección: paternalismo y respeto por la autonomía

Resumo A relação médico-paciente difere significativamente das demais interações sociais. Não por acaso, cresce expressivamente o número de estudos voltados exclusivamente à referida área. O fortalecimento da concepção de autonomia passou também a abranger a figura do paciente, com notória ampliação de sua esfera de participação e de influência na tomada de decisão em tratamentos e em procedimentos clínicos, mitigando aquela concepção exacerbadamente paternalista que recaía sobre a figura do profissional médico. Porém, daí insurge grave problemática: quais são os limites dessa autonomia? Acredita-se que a solução se encontra na ideia do paternalismo libertário, tese de Richard Thaler e Cass Sunstein, em que o médico atua como arquiteto da escolha do paciente. A partir do método hipotético-dedutivo, o objetivo do presente ensaio é verificar a possibilidade de adequar o método do paternalismo libertário à prática médica, mormente em relação aos hard cases , estabelecendo o alcance e os limites da autonomia do paciente.

Abstract The doctor-patient relationship differs significantly from other social interactions, and in the last years studies on this subject have grown significantly. The concept of autonomy now also encompasses patients, with notable expansion of their sphere of participation and influence in decision-making in treatments and clinical procedures, mitigating that overly paternalistic role of the physician. But this change poses a serious question: what are the limits of this autonomy? This article believes in the solution of libertarian paternalism, an idea proposed by Richard Thaler and Cass Sunstein, in which the doctor acts as a choice architect for the patient. Based on the hypothetico-deductive method, this study verifies the possibility of adapting libertarian paternalism to current medical practices, mainly in hard cases, establishing the scope and limits of patient autonomy.

Resumen La relación médico-paciente difiere significativamente de otras interacciones sociales. No es coincidencia que haya un aumento expresivo de estudios centrados exclusivamente en esta área. El fortalecimiento del concepto de autonomía ha abarcado también la figura del paciente, con una notable ampliación de su esfera de participación y influencia en las decisiones sobre tratamientos y procedimientos clínicos, mitigando la concepción extremadamente paternalista que recae en la figura del profesional médico. Sin embargo, esto plantea un problema grave: ¿dónde están los límites de esta autonomía? El artículo argumenta que la solución radica en la idea de paternalismo libertario propuesta por Richard Thaler y Cass Sunstein, según la cual el médico actuaría como el arquitecto de elección del paciente. Con base en el método hipotético-deductivo, el objetivo de este estudio fue verificar la posibilidad de adaptar la metodología del paternalismo libertario a la práctica médica, especialmente con relación a los casos difíciles ( hard cases ), para establecer el alcance y los límites de la autonomía del paciente.

Perforación esofágica espontánea: síndrome de Boerhaave. Caso clínico y revisión de la literatura / Boerhaave síndrome: spontaneous esophageal perforation. A clinical case and review of literature / Perfuração esofágica espontânea: síndrome de Boerhaave. Relato de caso e revisão bibliográfica

Resumen: La perforación esofágica espontánea o síndrome de Boerhaave es una entidad poco frecuente. Se define como la rotura del esófago no relacionada con traumatismos, exploraciones invasivas, patología esofágica previa o cuerpos extraños. Las roturas esofágicas se consideran como la perforación más grave del tracto digestivo, con una alta tasa de morbimortalidad relacionada principalmente con el desarrollo de mediastinitis posterior. Presentamos un paciente de sexo masculino de 63 años, que postingesta copiosa presenta esfuerzo de vómito inefectivo y posteriormente intenso dolor epigástrico, acompañado de enfisema subcutáneo. Se realiza tomografía de tórax que evidencia colección de contraste paraesofágica. Con planteo de síndrome de Boerhaave se decide cirugía de urgencia. Destacamos que el principal elemento pronóstico es el tiempo de resolución quirúrgica, por lo que debemos considerar esta patología como diagnóstico diferencial en pacientes con dolor torácico de inicio agudo.

Summary: Spontaneous esophageal perforation or Boerhaave syndrome is rather an unusual condition. It may be defined as the rupture of the esophagus that is not associated to trauma, invasive explorations, previous esophagus pathology or foreign bodies. Esophageal ruptures are considered as the most severe perforations of the digestive tract, with high morbimortality rates which are mainly associated to the development of subsequent mediastinitis. The study presents a 63-year-old patient who, after copious food intake, evidences unsuccessful effort to vomit effort and subsequent intense epigastric pain, accompanied by subcutaneous emphysema. Abdominal contrast scan reveals paraesophageal collection and a decision is made to perform an emergency surgery upon the suspicion of Boerhaave syndrome. It is worth pointing out that time for surgical resolution is the main prognostic element, and thus, this condition is to be considered as differential diagnosis in patients with acute thoracic pain.

Resumo: A perfuração esofágica espontânea ou síndrome de Boerhaave é uma entidade rara. É definida como ruptura do esôfago não relacionada a trauma, exames invasivos, patologia esofágica prévia ou corpos estranhos. As rupturas esofágicas são consideradas as perfurações mais graves do trato digestivo, com alto índice de morbimortalidade principalmente relacionado ao desenvolvimento de mediastinite posterior. Apresentamos um paciente do sexo masculino, 63 anos, que após ingestão abundante apresentou esforço ineficaz de vômito e, posteriormente, dor epigástrica intensa, acompanhada de enfisema subcutâneo. Foi realizada tomografia de tórax que evidenciou coleção de contraste paraesofágico. Com diagnóstico de síndrome de Boerhaave, a cirurgia de emergência foi decidida. Ressaltamos que o principal elemento prognóstico é o tempo de resolução cirúrgica, portanto, devemos considerar essa patologia como um diagnóstico diferencial em pacientes com dor torácica de início agudo.

Adsorption of amoxicillin onto high surface area-activated carbons based on olive biomass: kinetic and equilibrium studies.

This study presents the extraction of antibiotic amoxicillin (AMX) from aqueous solution employing activated carbons (AC) from olive biomass (OB). Two AC were prepared using ZnCl2 (activator agent), and a conventional muffle furnace (ACF) or microwave oven (ACMW). The structure, morphology, and textural properties from both AC were analyzed by scanning electron microscope (SEM), pH of point-zero-charge (pHPZC), infrared spectroscopy (FTIR), and N2 adsorption/desorption isotherms. AC with mesoporous structures rich in oxygenated groups and high specific area (as high as 1742 m2 g-1) were helpful for the efficient and fast adsorption of AMX. The Avrami kinetic nonlinear equation showed the best fitting for the empirical data when related to the pseudo-1st and pseudo-2nd order. The isothermal experimental data followed the Liu nonlinear model, displaying at 25 °C the maximum sorption capacity of 237.02 and 166.96 mg g-1 for the ACF and ACMW, respectively. An adsorption test with synthetic hospital effluent was carried out to evaluate the possibility of applying both adsorbents in wastewater purification. The purification efficiency was up to 94.4% and 91.96% for ACF and ACMW, respectively. Therefore, the AC obtained from OB (containing a mixture of seed, pulp, and olive peel) has a high potential for application in removing emerging contaminants from the wastewater.

Single-step pyrolysis for producing magnetic activated carbon from tucumã (Astrocaryum aculeatum) seed and nickel(II) chloride and zinc(II) chloride. Application for removal of nicotinamide and propanolol.

The present research describes the synthesis of new nanomagnetic activated carbon material with high magnetization, and high surface area prepared in a single pyrolysis step that is used for the carbonization, activation, and magnetization of the produced material. The pyrolysis step of tucumã seed was carried out in a conventional tubular oven at 600 °C under N2-flow. It was prepared three magnetic carbons MT-1.5, MT-2.0, MT-2.5, that corresponds to the proportion of biomass: ZnCl2 always 1:1 and varying the proportion of NiCl2 of 1.5, 2.0, and 2.5, respectively. These magnetic nanocomposites were characterized by Vibrating Sample Magnetometer (VSM), X-ray diffraction, scanning electron microscopy, thermogravimetric analysis, hydrophobic/hydrophilic balance, CHN/O elemental analysis, modified Boehm titration, N2 adsorption-desorption isotherms; and pHpzc. All the materials obtained presented Ni particles with an average crystallite size of less than 33 nm. The MT-2.0 was employed for the removal of nicotinamide and propranolol from aqueous solutions. Based on Liu isotherm, the Qmax was 199.3 and 335.4 mg g-1 for nicotinamide and propranolol, respectively. MT-2.0 was used to treat simulated pharmaceutical industry effluents attaining removal of all organic compounds attaining up to 99.1 % of removal.

Neuropsychiatric feature profiles of patients with Lewy body dementia.

OBJECTIVE: Differential diagnosis between Parkinson's disease (PD) dementia and dementia with Lewy bodies (DLB) is difficult due to common features, whereas management decisions and research endpoints depend upon knowledge of dementia severity. We aimed to assess risk factors for age at dementia onset, as well as which neuropsychiatric features are associated with pharmacotherapy and signs and symptoms of Lewy body dementia. PATIENTS AND METHODS: Patients with PD dementia or DLB were evaluated for age at disease onset, education, sanitation, anthropometric measures, alcohol use, smoking, history of infections or head trauma with unconsciousness, family history of neurodegenerative diseases, functional independence, cognition, behavior, motor features, caregiver burden and pharmacotherapy. RESULTS: Fifty-one patients were recruited (37 with DLB, 14 with PD dementia). Cumulative alcohol use and married status were associated with earlier dementia onset, whereas history of treated systemic infections and cumulative family history of primary neurodegenerative diseases led to later dementia onset. The length of dementia was shorter only for severely impaired patients who used anti-depressants, but not for users of cholinesterase inhibitors, while no behavioral symptom was associated with dopaminergic therapy. Night-time behavior disturbances were inversely associated with sleep satisfaction, while caregiver burden was more affected by depression and motor features. Non-motor symptoms were more burdensome for patients with DLB, while in PD dementia anxiety and dysphoria occurred when motor features were less burdensome. CONCLUSIONS: PD dementia and DLB are two phenotypes of the same pathological entity, differing mostly by the occurrence of parkinsonian signs. Predictors of dementia onset differ from other neurodegenerative diseases.