Peritonitis Due to Appendicitis Related to Mercury Sequestration: An Unusual Peruvian Case Report.

Elemental mercury ingestion caused by folk practices is rare and usually harmless. Nevertheless, some complications related to mercury ingestion have been reported such as appendicitis related to mercury sequestration and poisoning leading to systemic toxicity. Patients usually present with nausea, vomiting, and abdominal tenderness. Mercury sequestration in the appendix depends on its anatomy and mercury physical properties, both of which may lead to appendicitis, resulting in subsequent peritonitis leading to multiple and severe surgical complications. A 26-year-old Peruvian man complaining of vomiting and abdominal pain after ingestion of elemental mercury as part of a folk practice presented to the emergency department. Physical exam was remarkable for rigid abdomen and diffuse rebound sign. A clinical diagnosis of peritonitis was made. The patient was taken to the operating room where an open appendectomy and peritoneal lavage were performed. On gross inspection, a silver foreign body within the perforated appendix was seen by the surgical team. The patient developed multiple surgical complications leading to multiple organ failure and death. Clinicians should be aware that mercury ingestion is usually benign. However, severe complications may develop. Early surgical and medical intervention should be initiated promptly to achieve better outcomes. We present the first case of peritonitis due to appendicitis related to mercury sequestration in the appendix.

Radical cancer treatment is safe during COVID-19: the real-world experience of a large London-based Comprehensive Cancer Centre during the first wave.

BACKGROUND: During the COVID pandemic, there was a paucity of data to support clinical decision-making for anticancer treatments. We evaluated the safety of radical treatments which were delivered whilst mitigating the risks of concurrent COVID-19 infection. METHODS: Using descriptive statistics, we report on the characteristics and short-term clinical outcomes of patients undergoing radical cancer treatment during the first COVID-19 wave compared to a similar pre-pandemic period. RESULTS: Compared to 2019, the number of patients undergoing radical treatment in 2020 reduced by: 28% for surgery; 18% for SACT; and 10% for RT. Within SACT, 36% received combination therapy, 35% systemic chemotherapy, 23% targeted treatments, 5% immunotherapy and 2% biological therapy. A similar proportion of RT was delivered in 2019 and 2020 (53% vs. 52%). Oncological outcomes were also similar to pre-COVID-19. The COVID-19 infection rates were low: 12 patients were positive pre surgery (1%), 7 post surgery (<1%), 17 SACT patients (2%) and 3 RT patients (<1%). No COVID-19-related deaths were reported. CONCLUSIONS: Whilst there were fewer patients receiving radical anticancer treatments, those who did receive treatment were treated in a safe environment. Overall, cancer patients should have the confidence to attend hospitals and be reassured of the safety measures implemented.

Treatment of table olive processing wastewaters using novel photomodified ultrafiltration membranes as first step for recovering phenolic compounds.

Table olive processing wastewaters (TOPW) have high salt concentration and total phenolic content (TPC) causing many environmental problems. To reduce them, ultrafiltration (UF) was applied for treating TOPW. However, NaCl, which is the main responsible of salinity in TOPW, and phenols are small molecules that cannot be separated by conventional UF membranes. They have serious problems caused by fouling, which can be overcome using membrane modification techniques. For these reasons, photomodification may be an effective technique to obtain a stream rich in TPC due to the changes in membrane surface properties. UV-modification in the presence of two hydrophilic compounds (polyethylene glycol and aluminium oxide) was performed to achieve membranes with high reductions of organic matter and to keep the TPC as high as possible. Commercial polyethersulfone (PES) membranes of 30 kDa were used. Surface modification was evaluated using FTIR-ATR spectroscopy and membrane performance was studied by calculating the rejection ratios of colour, chemical oxygen demand (COD) and TPC. Results demonstrated that UF is a useful pre-treatment to reduce organic matter from TOPW, obtaining a permeate rich in TPC. PES/Al2O3 membranes displayed superior antifouling properties and rejection values, keeping high the TPC (>95%). Therefore, UF using modified membranes is an appropriate and sustainable technique for treating TOPW.

Neoplasia escamosa de la superficie ocular en pacientes con pterigión en Perú / Squamous neoplasia of the ocular surface in patients with pterygium in Peru

Objetivos. Estimar la frecuencia de neoplasia escamosa de la superficie ocular (NESO) no sospechada en pterigión, la precisión del diagnóstico clínico y las características demográficas y clínicas asociadas. Materiales y métodos. Se examinaron los informes histopatológicos de los pacientes con diagnóstico clínico de pterigión y/o NESO que fueron quirúrgicamente tratados entre marzo de 2009 y diciembre de 2012 en el Instituto Nacional de Oftalmología en Lima, Perú. La precisión del diagnóstico clínico para identificar la NESO se evaluó mediante la sensibilidad, especificidad y los cocientes de probabilidad. Se realizaron modelos de regresión log-log negativos para identificar las características demográficas y clínicas asociadas con un aumento de las probabilidades de diagnosticar NESO. Resultados. Se examinaron 3021 informes de histopatología. La frecuencia de NESO no sospechada en pterigión fue de 0,65%. El diagnóstico clínico presentó una sensibilidad del 85%, una especificidad del 99%, un cociente de probabilidad positiva de 111,89 y un cociente probabilidad negativa de 0,15. Las características asociadas fueron el sexo masculino (OR 1,15; IC 95%:1,01-1,30), pacientes de 61 a 80 años (OR 1,54; IC 95%: 1,28-1,85), ≥ de 81 años (OR 3,10; IC 95%: 2,09-4,58), pacientes con lesiones recurrentes (OR 1,59; IC 95%: 1,03-2,46) y lesiones en el lado temporal (OR 3,57; IC 95%: 2,63-4,85) presentaron mayor probabilidad de NESO. Conclusiones. Se encontró una baja frecuencia de NESO no sospechada, sin embargo, es recomendable realizar el estudio histopatológico de forma rutinaria para evitar diagnósticos erróneos de NESO como pterigión.

Objectives. To estimate the frequency of unsuspected ocular surface squamous neoplasia (OSSN) in pterygium, the accuracy of clinical diagnosis, and associated demographic and clinical characteristics. Materials and methods. We reviewed histopathological reports of patients with a clinical diagnosis of pterygium and/or OSSN who were surgically treated between March 2009 and December 2012 at the National Eye Institute in Lima, Peru. The accuracy of the clinical diagnosis of OSSN was assessed by sensitivity, specificity, and likelihood ratios. Models of negative log-log regression were performed to identify demographic and clinical characteristics associated with increased odds of diagnosing OSSN. Results. 3,021 histopathological reports were reviewed. The frequency of unsuspected OSSN in pterygium was 0.65%. Clinical diagnosis had a sensitivity of 85%, a specificity of 99%, a positive likelihood ratio of 111.89, and a negative likelihood ratio of 0.15. Associated characteristics were male gender (OR =1.15; 95% CI: 1.01 to 1.30), age group of 61- 80 years (OR = 1.54, 95% CI: 1.28 to 1.85) ≥ 81 years (OR = 3.10; 95% CI: 2.09 to 4.58), presence of recurrent lesions (OR = 1.59; 95% CI: 1.03 to 2.46) and temporal location lesions (OR = 3.57; 95% CI: 2.63 to 4.85). These characteristics were associated with a greater likelihood of OSSN. Conclusions. A low frequency of unsuspected OSSN was found; however, it is recommended to routinely perform histopathology studies to avoid misdiagnosis of OSSN as pterygium.

Study of the behaviour of different NF membranes for the reclamation of a secondary textile effluent in rinsing processes.

More demanding legal regulations for the wastewater disposal and water scarcity make necessary wastewater reuse in the industry. In particular, textile industry generates large amounts of wastewater with a high concentration of pollutants. Even though present biological or physical-chemical treatments are broadly in place, the quality of the final effluent is not good enough to allow its direct reuse. Consequently, a complementary membrane process is required in order to improve wastewater characteristics. In this work, six NF membranes were tested at different volume concentration factors in order to select the most appropriate one. The main studied criteria were the permeate quality for its reuse in the textile processes and the minimum membrane fouling effect. The different results obtained for the tested membranes were explained by membrane characterization parameters as contact angle, roughness and size exclusion. Taking these factors into consideration, TFC-SR2 has shown the overall best results because of the high permeate flux and the minimum fouling (in terms of the normalised flux reduction).