Efficacy assessment of peracetic acid in the removal of synthetic 17α-ethinyl estradiol contraceptive hormone in wastewater.

Increasing concerns have been raised on endocrine disrupting chemicals like the sex hormone 17α-ethinylestradiol (EE2), the more since traditional wastewater (WW) treatments appear to be ineffective for their removal. The efficacy of the relatively novel disinfectant peracetic acid (PAA) in EE2 removal was evaluated, as well as its potential effects on WW quality parameters. The treatments tested for EE2 removal were also evaluated in terms of toxicity, through the determination of biochemical responses (antioxidant enzymes, lipid peroxidation and vitellogenin induction) using zebrafish (Danio rerio) as a biological model. PAA contact times less than 20 min appeared insufficient regardless of the PAA dose tested, but a 100% EE2 removal was attained at a PAA concentration of 15 mg/L with a contact time of 20 min. Total suspended solids, chemical oxygen demand and pH in PAA treatments remained well within levels set in European legislation for WW discharge. EE2 induced significant increased vitellogenin (VTG) levels in both female and male fish, indicating increased estrogenic activity, especially in males suggesting an endocrine disruption effect. With the addition of PAA (15 mg/L), however, VTG levels in both sexes returned to control values. Although this PAA treatment showed increased levels of the antioxidant enzyme catalase, the lipid peroxidation levels were similar or even lower than in controls. Overall the results suggest that the use of PAA appears a promising way forward as a less toxic alternative to chlorine disinfection with high efficiency in the removal of EDC like EE2.

Spontaneous pneumomediastinum: case report.

OBJECTIVE: The description of this case is due to the rarity of this clinical entity and its semiotic diversity, which implies a high level of suspicion for a correct diagnosis. METHODS: Description of a clinical case, based on the data referred to in the clinical process. RESULTS: The case describes a young male patient, attended to at the emergency room due to right chest pain, which further investigation revealed to be consistent with spontaneous pneumomediastinum. He underwent medical treatment, with favorable outcome. CONCLUSION: The clinical course is usually benign, self-limited, involves only conservative treatment, and use of drugs is recommended only in symptomatic patients.

Thirteen square centimetre mass causing syncope in a patient with device related infective endocarditis.

A 68-year-old man presented with anorexia, weight loss and severe asthenia starting 2 months before and fever lasting over 2 weeks. Analytical study revealed increased C reactive protein and sedimentation velocity. While thoracic x-ray and urinalysis were unremarkable, blood cultures were consistently positive for Enterococcus faecalis. A thoracic echocardiogram revealed a very large vegetation adherent to the ventricular electrocatheter of the patient's pacemaker, so parenteral antibiotics were started. During his stay at the internal medicine ward, patient suffered three syncopal episodes and maintained intermittent fever. A transesophageal ECG performed at a tertiary centre on the 14th day unmasked a 9-12 cm(2) organised mass, ovoid and with regular borders, adherent to the ventricular electrocatheter at right atrium level and protruding to the ventricle at systole. Patient was referred for cardiothoracic surgery and a 13 cm(2) mass was removed alongside the ventricular electrocatheter. Two weeks following surgery, patient remains stable and asymptomatic.

Pneumomediastino espontâneo: relato de um caso / Spontaneous pneumomediastinum: case report

OBJETIVO: A descrição deste caso é motivada pela não frequência desta entidade clínica e sua diversidade semiológica, o que implica elevado nível de suspeição para o diagnóstico correto. MÉTODOS: Descrição de um caso clínico, com base nos dados referidos no processo clínico. RESULTADO: O caso refere-se a um jovem do sexo masculino, observado no serviço de urgência por apresentar dor torácica à direita, cuja investigação complementar foi compatível com pneumomediastino espontâneo. Ele, então, foi submetido a terapêutica médica, com evolução favorável. CONCLUSÃO: Habitualmente o curso clínico é benigno, autolimitado, o que implica em apenas um tratamento conservador, sendo o uso de fármacos recomendado somente nos doentes sintomáticos.

OBJECTIVE: The description of this case is due to the rarity of this clinical entity and its semiotic diversity, which implies a high level of suspicion for a correct diagnosis. METHODS: Description of a clinical case, based on the data referred to in the clinical process. RESULTS: The case describes a young male patient, attended to at the emergency room due to right chest pain, which further investigation revealed to be consistent with spontaneous pneumomediastinum. He underwent medical treatment, with favorable outcome. CONCLUSION: The clinical course is usually benign, self-limited, involves only conservative treatment, and use of drugs is recommended only in symptomatic patients.