Effectiveness of Two Targeted Temperature Management Methods After Pediatric Postcardiac Arrest: A Multicenter International Study.

OBJECTIVES: It is currently recommended that after return of spontaneous circulation following cardiac arrest, fever should be prevented using TTM through a servo-controlled system. This technology is not yet available in many global settings, where manual physical measures without servo-control is the only option. Our aim was to compare feasibility, safety and quality assurance of servo-controlled system versus no servo-controlled system cooling, TTM protocols for cooling, maintenance and rewarming following return of spontaneous circulation after cardiac arrest in children. DESIGN: Prospective, multicenter, nonrandomized, study. SETTING: PICUs of 20 hospitals in South America, Spain, and Italy, 2012-2014. PATIENTS: Under 18 years old with a cardiac arrest longer than 2 minutes, in coma and surviving to PICU admission requiring mechanical ventilation were included. METHODS: TTM to 32-34°C was performed by prospectively designed protocol across 20 centers, with either servo-controlled system or no servo-controlled system methods, depending on servo-controlled system availability. We analyzed clinical data, cardiac arrest, temperature, mechanical ventilation duration, length of hospitalization, complications, survival, and neurologic outcomes at 6 months. PRIMARY OUTCOME: feasibility, safety and quality assurance of the cooling technique and secondary outcome: survival and Pediatric Cerebral Performance Category at 6 months. MEASUREMENTS AND MAIN RESULTS: Seventy patients were recruited, 51 of 70 TTM (72.8%) with servo-controlled system. TTM induction, maintenance, and rewarming were feasible in both groups. Servo-controlled system was more effective than no servo-controlled system in maintaining TTM (69 vs 60%; p = 0.004). Servo-controlled system had fewer temperatures above 38.1°C during the 5 days of TTM (0.1% vs 2.9%; p < 0.001). No differences in mortality, complications, length of mechanical ventilation and of stay, or neurologic sequelae were found between the two groups. CONCLUSIONS: TTM protocol (for cooling, maintenance and rewarming) following return of spontaneous circulation after cardiac arrest in children was feasible and safe with both servo-controlled system and no servo-controlled system techniques. Achieving, maintaining, and rewarming within protocol targets were more effective with servo-controlled system versus no servo-controlled system techniques.

Are urology residents ready to treat premature ejaculation after their training?

INTRODUCTION: The management of premature ejaculation (PE) among urology residents (URs) in the era of standard definition and new treatments is unknown. AIM: To determine how future urologists currently address PE and to review their adherence to guidelines. METHODS: A specifically designed survey on the preferred approaches to the treatment of PE was given to residents during the Eighth European Urology Education Programme. The results were tabled, and descriptive statistics were used to analyze differences in practice patterns. MAIN OUTCOMES MEASURES: The responses are compared with clinical guidelines and recommendations. RESULTS: A total of 360 URs attended the recommendation course, and 140 answered the survey (response rate: 38.8%). Seventeen (12.1%) of the respondents considered PE to be a very common sexual dysfunction, 62 (44.3%) considered PE to be frequent, 33 (23.6%) considered this condition uncommon, and 28 (20%) did not consider PE to be a dysfunction. Regarding incidents, 67 residents (47.9%) treated one patient per week. To assess PE, 132 (94.3%) used sexual history, 37 (26.4%) used physical examination, 38 (27.1%) used questionnaires, and 4 (2.9%) used laboratory testing. The preferred initial management strategy for PE was psychological/behavioral therapy for 65 (46.4%) residents. Topical anesthetic, andrological referral, and prescription of selective serotonin reuptake inhibitors (SSRIs) on demand were favored by 34 (24.3%), 19 (13.6%), and 8 (12.9%) of the respondents, respectively. Other options were psychiatric referral, which was preferred by two (1.4%) respondents, and prescription of daily SSRIs, which was preferred by two (1.4%) respondents. The preferred secondary treatment for patients who did not improve initially was prescription of SSRIs for on demand, which was 46 (32.9%) respondents. In cases where patients had concomitant erectile dysfunction (ED), 16 (11.4%) URs treated only the ED and 60 (42.9%) treated both conditions. CONCLUSIONS: The majority of URs follow the established guidelines for diagnosis of PE, but not for treatment. The URs have an insufficient medical education in sexual medicine.

Usefulness of bladder-prostate ultrasound in the diagnosis of obstruction/hyperactivity in males with BPH.

OBJECTIVE: To determine the utility of prostate ultrasound in the diagnosis of infravesical obstruction (IVO) and detrusor hyperactivity(DH). METHODS: Prospective study with 39 patients consulting for LUTS. Clinical history was compiled, IPSS was determined, a digital rectal exam was performed, abdominal ultrasound was used to calculate detrusor thickness/weight, prostate volume, and middle lobe length (MLL). Urodynamic study (UD) was performed with determination of the Abrams-Griffiths number and ICS nomogram. Mean values were compared with Mann-Whitney U-test, and ROC curves were plotted determining the cutoff points for optimum sensitivity/specificity. RESULTS: Mean age was 63.1 years (SD: 7.8), with a mean IPSS score of 14 (SD: 6). 53.8% of the patients presented IVO at UD evaluation, and 43.6% DH. The differences between free flowmetry Qmax(p=0.015) and MLL (p=0.003) between patients with and without IVO proved significant. The ROC curves yielded an AUC for middle lobe length of 0.772, with a maximum sensitivity and specificity cutoff point at 10.5 mm (sensitivity 90%, specificity 73%, PPV 76%, NPV 85%). There were no significant differences in any parameter between patients with and without DH. CONCLUSION: Ultrasound MLL measurement in patients with LUTS offers high sensitivity/specificity in diagnosing IVO, with a cutoff point of 10.5 mm. In our study it wasn't effective in the noninvasive diagnosis of DH.

Removal of nutrients from Organic Liquid Agricultural Waste using filamentous algae.

A feasibility analysis of tertiary treatment for Organic Liquid Agricultural Waste is presented using filamentous algae belonging to the genus Cladophora sp. as an alternative to chemical tertiary treatment. The main advantages of tertiary treatments that use biological systems are the low cost investment and the minimal dependence on environmental variables. In this work we demonstrate that filamentous algae reduces the nutrient load of nitrate (circa 75%) and phosphate (circa 86%) from the organic waste effluents coming from dairy farms after nine days of culture, with the added advantage being that after the treatment period, algae removal can be achieved by simple procedures. Currently, the organic wastewater is discarded into fields and local streams. However, the algae can acquire value as a by-product since it has various uses as compost, cellulose, and biogas. A disadvantage of this system is that clean water must be used to achieve enough water transparency to allow algae growth. Even so, the nutrient reduction system of the organic effluents proposed is friendly to the ecosystem, compared to tertiary treatments that use chemicals to precipitate and collect nutrients such as nitrates and phosphates.

Removal of nutrients from Organic Liquid Agricultural Waste using filamentous algae / Remoção de nutrientes de Resíduos Agrícolas Líquidos Orgânicos utilizando algas filamentosas

Abstract A feasibility analysis of tertiary treatment for Organic Liquid Agricultural Waste is presented using filamentous algae belonging to the genus Cladophora sp. as an alternative to chemical tertiary treatment. The main advantages of tertiary treatments that use biological systems are the low cost investment and the minimal dependence on environmental variables. In this work we demonstrate that filamentous algae reduces the nutrient load of nitrate (circa 75%) and phosphate (circa 86%) from the organic waste effluents coming from dairy farms after nine days of culture, with the added advantage being that after the treatment period, algae removal can be achieved by simple procedures. Currently, the organic wastewater is discarded into fields and local streams. However, the algae can acquire value as a by-product since it has various uses as compost, cellulose, and biogas. A disadvantage of this system is that clean water must be used to achieve enough water transparency to allow algae growth. Even so, the nutrient reduction system of the organic effluents proposed is friendly to the ecosystem, compared to tertiary treatments that use chemicals to precipitate and collect nutrients such as nitrates and phosphates.

Resumo Uma análise de viabilidade do tratamento terciário para Resíduos Agrícola Líquidos Orgânicos é apresentada usando algas filamentosas pertencentes ao gênero Cladophora sp. como alternativa ao tratamento químico terciário. Os tratamentos terciários que utilizam sistemas biológicos têm baixo custo de investimento e a dependência de variáveis ​​ambientais é mínima. Neste trabalho, é demonstrado que essas algas filamentosas reduzem a carga nutricional de nitrato (circa 75%) e fosfato (circa 86%) dos efluentes de resíduos orgânicos provenientes de fazendas de leite em nove dias de cultura e tem a vantagem de que as algas podem ser facilmente coletadas posteriormente. Atualmente, as águas residuais orgânicas são descartadas nos campos e córregos locais. Posteriormente, as algas podem ser consideradas como matéria prima, uma vez que possuem várias utilidades como composto, celulose e biogás. Uma desvantagem desse sistema é que água limpa deve ser usada para obter transparência de água suficiente para permitir o crescimento de algas. Mesmo assim, o sistema de redução de nutrientes dos efluentes orgânicos propostos e amigável ao ecossistema, comparado aos tratamentos terciários que utilizam produtos químicos para precipitar e coletar nutrientes como nitratos e fosfatos.

Removal of nutrients from Organic Liquid Agricultural Waste using filamentous algae

Abstract A feasibility analysis of tertiary treatment for Organic Liquid Agricultural Waste is presented using filamentous algae belonging to the genus Cladophora sp. as an alternative to chemical tertiary treatment. The main advantages of tertiary treatments that use biological systems are the low cost investment and the minimal dependence on environmental variables. In this work we demonstrate that filamentous algae reduces the nutrient load of nitrate (circa 75%) and phosphate (circa 86%) from the organic waste effluents coming from dairy farms after nine days of culture, with the added advantage being that after the treatment period, algae removal can be achieved by simple procedures. Currently, the organic wastewater is discarded into fields and local streams. However, the algae can acquire value as a by-product since it has various uses as compost, cellulose, and biogas. A disadvantage of this system is that clean water must be used to achieve enough water transparency to allow algae growth. Even so, the nutrient reduction system of the organic effluents proposed is friendly to the ecosystem, compared to tertiary treatments that use chemicals to precipitate and collect nutrients such as nitrates and phosphates.

Resumo Uma análise de viabilidade do tratamento terciário para Resíduos Agrícola Líquidos Orgânicos é apresentada usando algas filamentosas pertencentes ao gênero Cladophora sp. como alternativa ao tratamento químico terciário. Os tratamentos terciários que utilizam sistemas biológicos têm baixo custo de investimento e a dependência de variáveis ambientais é mínima. Neste trabalho, é demonstrado que essas algas filamentosas reduzem a carga nutricional de nitrato (circa 75%) e fosfato (circa 86%) dos efluentes de resíduos orgânicos provenientes de fazendas de leite em nove dias de cultura e tem a vantagem de que as algas podem ser facilmente coletadas posteriormente. Atualmente, as águas residuais orgânicas são descartadas nos campos e córregos locais. Posteriormente, as algas podem ser consideradas como matéria prima, uma vez que possuem várias utilidades como composto, celulose e biogás. Uma desvantagem desse sistema é que água limpa deve ser usada para obter transparência de água suficiente para permitir o crescimento de algas. Mesmo assim, o sistema de redução de nutrientes dos efluentes orgânicos propostos e amigável ao ecossistema, comparado aos tratamentos terciários que utilizam produtos químicos para precipitar e coletar nutrientes como nitratos e fosfatos.

Tratamiento de infecciones intraabdominales

El presente estudio se realizó para evaluar la eficacia y tolerancia de sulbactam/ampicilina parenteral (IM/IV) en infecciones intraabdominales. Treinta pacientes de ambos sexos fueron tratados con una aombinación de 500 mg de sulbactam y 1 g de ampicilina IM/IV cada 12 horas, por un período de 7 a 14 días. La respuesta clínica bacteriológica demostró la efectividad de la droga en 27 pacientes (90 por ciento). NO se observó ningún efecto adverso en el 100 por ciento de los casos. sulbactam/ampicilina fue efectivo y bién tolerado en el tratamiento de las infecciones intraabdominales.