Processing of biomedical waste in plasma gasifier.

The problem of treatment of household and biomedical waste containing toxic substances is becoming increasingly important. In contrast to the conventional incineration, plasma gasification of the waste provides reliable destruction of highly toxic dioxins, benzo(a)pyrene and furans. This article presents the results of thermodynamic analysis and experiments on gasification of the waste of various origins in the plasma reactor. The calculations have shown that the maximum yield of synthesis gas in the waste plasma gasification in the air and steam medium was achieved at a temperature not higher than 1600 K. It is shown that in the process of air-plasma and steam-plasma gasification of bone tissue, it is possible to obtain synthesis gas with concentrations 53.4 and 84.9 vol.% having heat of combustion 3510 and 5664 kJ/kg, respectively. In the air and steam plasma gasification of household waste a high-calorific synthesis gas with concentrations 82.4 and 94.5 vol.%, respectively, can be obtained. Its heat of combustion amounts to 13,620 and 18,497 kJ/kg respectively for air and steam gasification. A comparison between the experiment and the calculations showed a good agreement. According to the results of investigations of the waste plasma gasification, no harmful impurities were detected. From the waste organic and mineral mass, respectively, high-calorific synthesis gas and a neutral slag were obtained.

Clinical application of Ultracontrol®: infusion volume and use with different dialyzers.

INTRODUCTION: Recent studies indicate that the survival benefit with post-dilution on line hemodiafiltration (OL-HDF-post) are achieved if the infusion volume (Vinf) is greater than 20L per session, a goal that is not easily achieved due to hemoconcentration problems. Today we have automated techniques to achieve higher performance minimizing the number of alarms as Ultracontrol® (Ultrac). The objective in the first part of study was to evaluate the UltraC performance (expressed as the filtration fraction (FF) and Vinf) and which problems it presents, and in the second part, to study its performance with four different dialyzers. MATERIAL AND METHODS: 1st period. Nine patients were transferred to OL-HDF-post with UltraC. The first 3 months on OL-HDF all sessions were recorded and compared with hemodialysis sessions in the previous month. 2nd part: 18 patients on chronic OL-HDF-post were dialyzed for a week with each of these dialyser: FX1000, FX800, Elisio210H and Polyflux210. RESULTS: 1st period: In 3 patients, problems associated with inappropriate pressures emerged. In 3 patients there were problems associated with inadequate PTM and Psist that resolved changing to pressure control. Mean values were: maximum Qb 441 (21) (range 350-490) ml/min, Vinf 26.3 (3.3) l/session, FF 30.6 (2.5)%, KT 59.9 (5) l/session. KT increase of 12% compared to HD. 2nd part: Polyflux210 required less UltraC withdrawals than the others. Different PTM or Psist were found and determined the need for removal of the system. The KT was adequate. a) The UltraC system reaches FF of 30% with minimal alarms and Vinf higher than 20 l. b) Structural characteristics of dialysers can limit their use with UltraC although they managed to desirable KT and Vinf in a manual way.

Sistema Ultracontrol® en la clínica diaria de la hemodiafiltración en línea posdilucional: volumen de infusión alcanzado y aplicabilidad con distintos dializadores / Clinical application of Ultracontrol®: infusion volume and use with different dialyzers

Introducción: Estudios recientes indican que los beneficios en la supervivencia con hemodiafiltración en línea posdilucional (HDFOL-post) se logran si el volumen de infusión (Vinf) es superior a 20 l por sesión, cifra que no es fácil lograr por los problemas que genera la hemoconcentración. Hoy día contamos con técnicas automáticas que logran un mayor rendimiento minimizando el número de alarmas como el Ultracontrol® (UltraC). Objetivo: El objetivo ha sido, en una primera parte, evaluar el UltraC para conocer qué rendimiento logra (expresado como la fracción de filtración [FF] y el Vinf) y los problemas que presenta y, en una segunda parte, estudiar su funcionamiento con cuatro dializadores diferentes. Material y métodos: Primera parte. Nueve pacientes fueron transferidos a HDFOL-post con UltraC. Se recogieron todas las sesiones correspondientes a los tres primeros meses con HDF-OL y al mes previo en HD. Segunda parte. 18 pacientes en tratamiento crónico con HDFOL-post fueron sometidos a diálisis una semana con cada uno de estos dializadores: FX1000, FX800, Polyflux210 y Elisio 210H. Resultados: Primera parte. En 3 pacientes surgieron problemas asociados a PTM y Psist inadecuadas que se (..) (AU)

Introduction: Recent studies indicate that the survival benefit with post-dilution on line hemodiafiltration (OL-HDF-post) are achieved if the infusion volume (Vinf) is greater than 20L per session, a goal that is not easily achieved due to hemoconcentration problems. Today we have automated techniques to achieve higher performance minimizing the number of alarms as Ultracontrol® (Ultrac). The objective in the first part of study was to evaluate the UltraC performance (expressed as the filtration fraction (FF) and Vinf) and which problems it presents, and in the second part, to study its performance with four different dialyzers. Material and methods: 1st period. Nine patients were transferred to OL-HDF-post with UltraC. The first 3 months on OL-HDF all sessions were recorded and compared with hemodialysis sessions in the previous month. 2nd part: 18 patients on chronic OL-HDF-post were dialyzed for a week with each of these dialyser: FX1000, FX800, Elisio210H and Polyflux210. Results: 1st period: In 3 patients, problems associated with inappropriate pressures emerged. In 3 patients there (..) (AU)

Assessment of Clients' Satisfaction with Health Service Deliveries at Jimma University Specialized Hospital

BACKGROUND: Client satisfaction is considered as one of the desired outcomes of health care and it is directly related with utilization of health services. Nonetheless; there is no adequate information on users' perception about the service provided in the hospital after the implementation of Business process re-engineering reform. Hence; the objective of this study was to assess the perceived levels of clients' satisfaction with health services rendered at Jimma University Specialized Hospital. METHODS: A cross sectional study was conducted from March 1-8; 2010 on a sample of 422 service users of the hospital using systematic random sampling technique. Data was collected using structured questionnaire and analyzed by SPSS for windows version 16.0. Statistical tests were employed where necessary at 0.05 level of significance. RESULT: The questionnaire was administered to a total of 422 clients ; of which; 51.7were male; about 33.4of the respondents were between the age group 25-34; 41.of the clients were illiterates; 60were from the rural areas and 57.8received the service free of charge. The findings of the study showed that the overall client satisfaction level with the health services rendered at the hospital was 77. Satisfaction was reported to be highest (82.7) with the way the doctors examined them and on the other hand dissatisfaction was reported to be highest (46.9) by respondents with the time spent to see a doctor. Furthermore; satisfaction with the health care was found to have a significant association with the age of the respondents (p=0.034) and educational level of the respondents (p=0.003). CONCLUSION: This study showed higher clients' satisfaction level in the University Specialized Hospital when compared to previous studies in the same hospital as well as other similar studies in the country. Lack of drugs and supplies; poor information provision; long waiting time; poor cleanliness; lack of privacy and inadequate visiting hours; were found to be the major causes of dissatisfaction. Therefore; the Hospital management should understand these weak service areas and plan for a better service delivery

¿Hemos olvidado lo más importante para prevenir las bacteriemias en pacientes portadores de catéteres para hemodiálisis? / Have we forgotten the most important thing to prevent bacteremias associated with tunneled hemodialysis catheters?

La bacteriemia relacionada con el catéter (BRC) en pacientes en hemodiálisis (HD) es una complicación grave. Existen múltiples publicaciones que abogan por el uso de diferentes medidas farmacológicas para su prevención, pero muy pocas sobre la importancia de las medidas de precaución universal . El objetivo de este trabajo es mostrar la baja tasa de incidencia de BRC obtenida con la aplicación estricta de un protocolo de cuidados de catéter tunelizado (CT) por un personal bien entrenado en una nueva unidad de HD. Durante20 meses se aplicó un protocolo de manejo de CT por personal de enfermería cual i f i cado. Se ut i l izaron un total de 42 CT en 32 pacientes . El tiempo total de seguimiento fue de 8.372 días en los que ocurrieron dos episodios de BRC: 0,24 eventos /1.000 días - catéter. El trabajo muestra cómo sólo con medidas de precaución universal pueden lograr se tasas de BRC dentro de la excelencia (AU)

Bacteremia associated with tunneled central venous catheters (CVC) is a major complication in hemodialysis patients. Strategies that aim to prevent catheter-related bacteremia (CRB),ranging from the application of topical antibiotics to the use of different catheter-lock solutions, have been studied, but limited interest has been shown about following standardization of aseptic care and maintenance of CVC by experienced staff. This study reports CRB incidence obtained with astrict infection prophylaxis protocol based on universal precautions against infection adopted in our Unit by qualified nursing hemodialysis staff. During a period of 20 months, 32 patients received 42 CVC. There were 2 CRB, with an incidence of 0.24CRB/1000 days-catheter. This study shows that an optimal catheter-use management reduces the incidence of CRB to excellent rates. The use of a protocol directed to vigorously protect the catheter at the time of usage by specialized teams is critically important and is highly recommended (AU)

[Have we forgotten the most important thing to prevent bacteremias associated with tunneled hemodialysis catheters?]. / ¿Hemos olvidado lo más importante para prevenirlas bacteriemias en pacientes portadores de catéterespara hemodiálisis?

Bacteremia associated with tunneled central venous catheters (CVC) is a major complication in hemodialysis patients. Strategies that aim to prevent catheter-related bacteremia (CRB), ranging from the application of topical antibiotics to the use of different catheter-lock solutions, have been studied, but limited interest has been shown about following standardization of aseptic care and maintenance of CVC by experienced staff. This study reports CRB incidence obtained with a strict infection prophylaxis protocol based on universal precautions against infection adopted in our Unit by qualified nursing hemodialysis staff. During a period of 20 months, 32 patients received 42 CVC. There were 2 CRB, with an incidence of 0.24 CRB/1000 days-catheter. This study shows that an optimal catheter-use management reduces the incidence of CRB to excellent rates. The use of a protocol directed to vigorously protect the catheter at the time of usage by specialized teams is critically important and is highly recommended.

[Calciphylaxis: fatal complication of cardiometabolic syndrome in patients with end stage kidney disease]. / Calcifilaxis: complicación grave del síndrome cardio-metabólico en pacientes con enfermedad renal crónica terminal (ERCT).

UNLABELLED: Calciphylaxis characterized by schemic skin ulceration due to subcutaneous small arterioles calcification, is a rare disease but usually fatal. Disorders of calcium metabolism and vascular calcifications are common in dialysis patients but calciphylaxis prevalence is low in patients with end stage renal disease. So we proposed other emergent factors implicated in calciphylaxis development. METHODS: We studied retrospective 8 patients who developed calciphylaxis in our service from january 2001 to december 2006. RESULTS: All patients were female with mean age at diagnosis 68.5+/-6.7 years. All patients were receiving hemodialysis therapy and 6 patients had been receiving hemodialysis less than four months. Six patients had diabetes mellitus type II and all patients were obese (BMI >25 kg/m2). All patients had metabolic syndrome (APTIII) with bad control hypertension and 6 (75%) were receiving anticoagulation therapy with warfarin. Patients didn t have severe alterations of calcium metabolism, all had product calcium-phosphorus <55. All patients developed low blood pressure at the beginning of dialysis treatment (98.3+/-22.7/60+/-18,29 mmHg). 7 patients present proximal lesions in fatty regions like abdomen and thighs. Histopathologic examination reveals calcium deposits in arteriole-sized and small vessels with vascular thrombosis. Prognosis was poor, seven patients died secondary to a sepsis originated in infected cutaneous ulcers. CONCLUSIONS: calciphylaxis is a disease with poor prognosis and high mortality, without specific treatment actually. Female gender, obesity associated with diabetes mellitus and cardiometabolic syndrome, anticoagulant therapy with warfarin and low blood pressure associated with hemodialysis therapy, are risk factors to develop calciphylaxis, in absence of severe disorders of calcium metabolism. In these patients is important to avoid hypotension episodes during dialysis, dialysis hypotension appears to be an important risk factor who promotes ischemia of subcutaneous adipose tissue.

Calcifilaxis: complicación grave del síndrome cardio-metabólico en pacientes con enfermedad renal crónica terminal (ERCT) / Calciphylaxis: fatal complication of cardio-metabolic syndrome in patients with end stage kidney disease

La calcifilaxis, caracterizada por la ulceración isquémica de la piel secundaria a la calcificación de las pequeñas arteriolas subcutáneas, es una enfermedad poco frecuente pero con mal pronóstico. Los pacientes con ERCT tienen un riesgo alto de calcificaciones patológicas debido a las alteraciones del metabolismo calcio-fósforo, pero solo un pequeño número desarrollan esta enfermedad. Por ello es lógico pensar que hay otros factores que condicionan el desarrollo de la calcifilaxis. Métodos: Con el fin de identificar estos posibles factores implicados en su génesis, hemos analizado de forma retrospectiva las características de los 8 pacientes con ERCT que presentaron calcifilaxis en nuestro hospital entre de enero 2001 a diciembre 2006. Resultados: Los 8 pacientes eran mujeres con edad media de 68,5 ± 6,7 años. Todas presentaban ERCT en hemodiálisis periódica (HD) y en 6 casos la cacifilaxis apareció en los primeros 4 meses del inicio del tratamiento con HD. Seis de las pacientes eran diabéticas tipo 2 y todas eran obesas (IMC > 25 kg/m2), 3 con obesidad grado 4 o mórbida. Todas cumplían criterios de síndrome metabólico (APT III), habían sido hipertensas mal controladas y en un 75% de los casos recibían tratamiento con anticoagulantes cumarínicos por distintas causas. No presentaban alteraciones severas del metabolismo calcio-fósforo: todas tenían un producto CaxP < 55. En todos los casos se controló estrictamente la Presión arterial (PA) con el tratamiento con HD manteniendo cifras medias de PA de 98,3 ± 22,7/60 ± 18,29 mmHg en el momento de la aparición de los síntomas. La mayoría de las pacientes (7/8), presentaron las lesiones a nivel proximal en las zonas con mayor depósito graso como muslos y abdomen. El estudio histológico de las lesiones en todos los casos demostró calcificación de pequeñas arteriolas subcutáneas asociada a paniculitis y trombosis de pequeños vasos. La evolución clínica fue mala ya que siete de las ocho pacientes murieron como consecuencia de una sepsis de origen cutáneo. La exéresis quirúrgica de los nódulos no modificó la mala evolución. En conclusión: La paniculitis calcificante en pacientes con ERCT es una enfermedad rara pero de mal pronóstico y elevada mortalidad. El sexo mujer, la obesidad asociada a Diabetes y Síndrome metabólico, el tratamiento anticoagulante y el excesivo control de la presión arterial al inicio del tratamiento con HD pueden favorecer su aparición incluso en ausencia de alteraciones relevantes del metabolismo Ca-P-PTH. Debido a la epidemia actual de DM, obesidad y síndrome metabólico es de esperar que el número de pacientes con estas características que desarrollen ERCT y calcifilaxis vaya en aumento (AU)

Calciphylaxis characterized by schemic skin ulceration due to subcutaneous small arterioles calcification, is a rare disease but usually fatal. Disorders of calcium metabolism and vascular calcifications are common in dialysis patients but calciphylaxis prevalence is low in patients with end stage renal disease. So we proposed other emergent factors implicated in calciphylaxis development. Methods: We studied retrospective 8 patients who developed calciphylaxis in our service from january 2001 to december 2006. Results: All patients were female with mean age at diagnosis 68.5 ± 6.7 years. All patients were receiving hemodialysis therapy and 6 patients had been receiving hemodialysis less than four months. Six patients had diabetes mellitus type II and all patients were obese (BMI > 25 kg/m2). All patients had metabolic syndrome (APTIII) with bad control hypertension and 6 (75%) were receiving anticoagulation therapy with warfarin. Patients didn´t have severe alterations of calcium metabolism, all had product calcium-phosphorus < 55. All patients developed low blood pressure at the beginning of dialysis treatment (98.3 ± 22.7/60 ± 18,29 mmHg). 7 patients present proximal lesions in fatty regions like abdomen and thighs. Histopathologic examination reveals calcium deposits in arteriole-sized and small vessels with vascular thrombosis. Prognosis was poor, seven patients died secondary to a sepsis originated in infected cutaneous ulcers. Conclusions: calciphylaxis is a disease with poor prognosis and high mortality, without specific treatment actually. Female gender, obesity associated with diabetes mellitus and cardiometabolic syndrome, anticoagulant therapy with warfarin and low blood pressure associated with hemodialysis therapy, are risk factors to develop calciphylaxis, in absence of severe disorders of calcium metabolism. In these patients is important to avoid hypotension episodes during dialysis, dialysis hypotension appears to be an important risk factor who promotes ischemia of subcutaneous adipose tissue (AU)

Inhibition of in-stent restenosis in rabbit iliac arteries with photodynamic therapy.

OBJECTIVES: Photodynamic therapy (PDT, the combination of light with a photosensitising drug in the presence of oxygen) inhibits restenosis after angioplasty without stenting. This study assesses the potential of PDT for prevention of in-stent re-stenosis. DESIGN AND METHODS: Normal rabbits were given the photosensitising agent 5-aminolaevulinic acid (ALA) 60 mg/kg, 3 h prior to endovascular illumination of the iliac artery (635 nm at 50 J/cm(2)) either immediately before or after deployment of an oversized (3 mm diameter) stent. PDT treated arteries were retrieved 3 or 28 days later and assessed for cell counts and vascular morphometry. Control arteries (stent but no PDT) were examined at 28 days. RESULTS: There were no adverse events and all vessels were patent at the end of the study. At 3 days there was almost complete medial cell ablation when light was delivered before stent deployment (17+/-1 cells/hpf), with little effect when illumination followed stent deployment (184+/-17 cells/hpf, p<0.0001). Twenty-eight days after PDT, the neointimal areas were 1.41+/-0.52 mm(2) (stent with no PDT), 1.24+/-0.54 mm(2) (light after stent) and 0.60+/-0.21 mm(2) (light before stent) (p=0.004). CONCLUSIONS: PDT before stent deployment caused almost complete medial cell ablation at 3 days with inhibition of in-stent restenosis at 28 days. PDT is worthy of further study as an adjuvant to percutaneous intervention in patients with vascular disease.

[Long-term treatment of Cushing's disease using ketoconazole. Possibility of therapeutic escape]. / Traitement prolongé de la maladie de Cushing par le kétoconazole. Possibilité d'un échappement thérapeutique.

Five women suffering from Cushing's disease were treated with ketoconazole 800 mg per day for 2 to 28 months (mean 12.4 months). Four of them had full clinical and biochemical regression. However, after 8 months of therapy the disease failed to respond in three of these four women. Increasing the ketoconazole dosage up to 1,200 mg per day was ineffective in two patients. Such an escape phenomenon, not described until now, will restrict the use of ketoconazole in the treatment of Cushing's disease, although the drug is easy to administer and well tolerated globally and by the liver in most cases.

[A comparative study of cephalometric variation of the skeletal and dentoalveolar structures after treatment with the Begg, Ricketts and edgewise technic in cases of Class I and Class II malocclusions treated with and without extractions]. / Etude comparative des variations céphalométriques des structures squelettiques et alvéolo-dentaires après traitement en technique de Begg, de Ricketts et d'edgewise dans les cas de Classe I et de Classe II squelettiques traités avec ou sans extractions.

Eliminating, in a first step, the growth effect on the modifications of the skeletal and alveolo-dental structures thanks to the cephalometric analysis of cases not treated, we study the therapeutic control of skeletal Classes I and II (treated with or without extraction) successively in the BEGG, RICKETTS and EDGEWISE technics. For that, we analyse statistically the cephalometrics variations comparing the differents angles and measurements of the RICKETTS, TWEED and STEINER analyses before and after treatment. Thus, we evaluate the bi-dimensionnals, antero-posterior and vertical modifications that an take place during the treatment respectively in the three technics.

[Improvement of the prognosis of Basedow's disease by using high doses of carbimazole]. / Amélioration du pronostic de la maladie de Basedow par utilisation de fortes doses de carbimazole.

The influence of synthetic antithyroid drug dosage on the course of Graves' disease was evaluated by comparing two groups of matched patients treated with carbimazole. Thirty-seven patients received a rapidly degressive treatment (60 mg/day initially rapidly reduced without replacement thyroid hormone therapy), and 36 patients received a prolonged treatment in high doses (60 mg daily for 6 months with progressive reduction of dosage over 5 months and replacement therapy). There was a highly significant difference in the actuarial curves of patients without relapse during 36 months: 82 per cent in patients with high doses, as against 38 per cent in patients with rapidly degressive treatment (log rank: chi 2 = 7.67, P less than 0.01). The anti-TSH receptor antibody titers decreased more rapidly in patients under prolonged treatment with high doses than in those with the rapidly degressive treatment. It is concluded that carbimazole in high doses is more immunosuppressive than in rapidly degressive doses and that it improves the prognosis of Graves' disease.

The effect of subcutaneous infusion versus subcutaneous injections of a somatostatin analogue (SMS 201-995) on the diurnal GH profile in acromegaly.

Multiple sc injections of a long-acting somatostatin analogue (SMS 201-995) are currently used in the treatment of acromegaly. However, plasma GH concentration often reaches a pathological level (less than 5 micrograms/l) between two injections. In seven patients with active acromegaly we compared, in a short-term trial, the effect of SMS 201-995 administered by continuous sc infusion (50 micrograms and 100 micrograms a day) and by three sc injections (100 micrograms each). In six patients, plasma GH levels were significantly reduced regardless of the mode and dose of treatment (P less than 0.05). However, comparing diurnal profiles, 100 micrograms continuous sc infusion was more effective than discontinuous administration in reducing the number of GH levels above 5 micrograms/l (P less than 0.01). In two patients, continuous infusion was the only way to decrease all plasma GH values below 5 micrograms/l during the diurnal profile determination. Moreover, even when, in a long-term study, the dose of multiple injections was progressively increased to 500 micrograms three times a day, GH levels remained consistently elevated in one of these patients. Thus, in some acromegalic patients continuous sc injection seems currently the most efficient way of treatment with SMS 201-995.

Thymulin (Zn-facteur thymique serique) activity in anorexia nervosa patients.

Thymulin (or FTS-Zn) a well-defined thymic hormone was studied in fifteen female patients hospitalized for anorexia nervosa. The circulating hormone was measured together with the plasma levels of thyroid hormones, cortisol and zinc. Thymulin activity determined by the rosette assay was significantly reduced in the anorexia nervosa patients compared to sex- and age-matched healthy control subjects. The patients were characterized by very depressed plasma levels of triiodothyronine (T3) but exhibited normal concentrations of thyroxine (T4), thyroxine-binding globulin (TBG), cortisol and zinc. The distribution of their peripheral lymphocyte cells into several subsets was not affected. The observed decrease of thymulin activity in this illness might be the consequence of thymic atrophy secondary to malnutrition and/or hormonal disturbances. Our results suggested that the fall in thymulin level might explain the variability of cellular immune responses in anorexia nervosa patients and occurrence of energy when their weight loss is far advanced.