Pharmaceutical active compounds in sewage sludge: Degradation improvement and conversion into an organic amendment by bioaugmentation-composting processes.

Around 143,000 chemicals find their fate in wastewater treatment plants in the European Union. Low efficiency on their removal at lab-based studies and even poorer performance at large scale experiments have been reported. Here, a coupled biological technology (bioaugmentation and composting) is proposed and proved for pharmaceutical active compounds degradation and toxicity reduction. The optimization was conducted through in situ inoculation of Penicillium oxalicum XD 3.1 and an enriched consortium (obtained from non-digested sewage sludge), into pilot scale piles of sewage sludge under real conditions. This bioaugmentation-composting system allowed a better performance of micropollutants degradation (21 % from the total pharmaceuticals detected at the beginning of the experiment) than a traditional composting process. Particularly, inoculation with P. oxalicum allowed the degradation of some recalcitrant compounds like carbamazepine, cotinine and methadone, and also produced better stabilization features in the mature compost (significant passivation of copper and zinc, higher macronutrients value, adequate physicochemical conditions for soil direct application and less toxic effect on germination) compared to the control and the enriched culture. These findings provide a feasible, alternative strategy to obtain a safer mature compost and a better removal of micropollutants performance at large scale.

Morphologic Features on MR Imaging Classify Multifocal Glioblastomas in Different Prognostic Groups.

BACKGROUND AND PURPOSE: Multifocal glioblastomas (ie, glioblastomas with multiple foci, unconnected in postcontrast pretreatment T1-weighted images) represent a challenge in clinical practice due to their poor prognosis. We wished to obtain imaging biomarkers with prognostic value that have not been found previously. MATERIALS AND METHODS: A retrospective review of 1155 patients with glioblastomas from 10 local institutions during 2006-2017 provided 97 patients satisfying the inclusion criteria of the study and classified as having multifocal glioblastomas. Tumors were segmented and morphologic features were computed using different methodologies: 1) measured on the largest focus, 2) aggregating the different foci as a whole, and 3) recording the extreme value obtained for each focus. Kaplan-Meier, Cox proportional hazards, correlations, and Harrell concordance indices (c-indices) were used for the statistical analysis. RESULTS: Age (P < .001, hazard ratio = 2.11, c-index = 0.705), surgery (P < .001, hazard ratio = 2.04, c-index = 0.712), contrast-enhancing rim width (P < .001, hazard ratio = 2.15, c-index = 0.704), and surface regularity (P = .021, hazard ratio = 1.66, c-index = 0.639) measured on the largest focus were significant independent predictors of survival. Maximum contrast-enhancing rim width (P = .002, hazard ratio = 2.05, c-index = 0.668) and minimal surface regularity (P = .036, hazard ratio = 1.64, c-index = 0.600) were also significant. A multivariate model using age, surgery, and contrast-enhancing rim width measured on the largest foci classified multifocal glioblastomas into groups with different outcomes (P < .001, hazard ratio = 3.00, c-index = 0.853, median survival difference = 10.55 months). Moreover, quartiles with the highest and lowest individual prognostic scores based on the focus with the largest volume and surgery were identified as extreme groups in terms of survival (P < .001, hazard ratio = 18.67, c-index = 0.967). CONCLUSIONS: A prognostic model incorporating imaging findings on pretreatment postcontrast T1-weighted MRI classified patients with glioblastoma into different prognostic groups.

Valoración de las lesiones oculares producidas en los accidentes de tráfico / Assessment of ocular injuries due to traffic accidents

Objetivo: Analizar cómo se realiza, desde el punto de vistapericial, la valoración de las lesiones y secuelas oculares delos accidentes de tráfico en nuestro medio.Método: Hemos realizado un estudio retrospectivo de 127informes sobre lesiones oculares realizados en la Secciónde Oftalmología de la Clínica Médico Forense de Madriddurante cinco años (del 2002 al 2006), analizando lassiguientes variables: la proporción que representan losaccidentes de tráfico (ATF), el tipo de lesión producida enel ATF, la duración media de la baja, las secuelas más frecuentesy la puntuación total media asignada a estassecuelas oculares.Resultados: Los ATF son la causa de la cuarta parte de lassecuelas oculares que vemos. Las lesiones más frecuentementeproducidas son traumatismos cráneo-encefálicos,contusiones oculares directas y esguinces cervicales.Hemos hallado un alto porcentaje de casos (22%), en losque no encontramos lesiones objetivas que justifiquen lasmolestias alegadas por el lesionado, o bien estas no guardanrelación evidente con el accidente de tráfico sufrido.Conclusiones: Que los ATF son una de las causas más frecuentesde secuelas oculares (diplopias, disminuciones deagudeza visual…), con una puntuación media de 15 puntosy una duración media de la baja de 71 días, hay un importanteporcentaje de reclamaciones injustificadas.Considera necesario revisar el actual Baremo de la Ley34/2003, subsanando los errores y deficiencias que presenta,e incluyendo secuelas oculares típicamente postraumáticasque actualmente no recoge, para facilitar la valoraciónde las secuelas oculares

Aim: To analyse how it is performed, from expert evidenceview point, the assessment of ocular injuries and aftereffectsdue to traffic accidents in our area.Method: We have accomplished a retrospective study of127 reports on ocular injuries, carried out in theOphthalmologic Section of the Medical Forensic Clinic ofMadrid for five years –from 2002 to 2006-, analyzing thefollowing variables: the proportion represented by trafficaccidents (TAs); the kind of injury sustained in the TAs; theaverage length of sick leave; the most frequent after-effects;and the overall average punctuation given to these ocularafter-effects.Results: TAs represent the cause of a quarter of the ocularafter-effects we see. The most frequent injuries produced inan accident are cranioencephalic traumatisms, direct ocularcontusions, and cervical sprains. We have met a highpercentage of cases (22%) in which we have not foundobjective injuries that can justify the pains claimed by theinjured, or rather the pains are not evidently connectedwith the TAs suffered.Conclusions: TAs are one of the most frequent causes ofocular after-effects (diplopias, decreases of visualacuity...), with an average punctuation of 15 points and anaverage length of sick leave of 71 days, existing an importantpercentage of unjustified claims. It is considered asnecessary the revision of the present scale of the Law34/2003 rectifying errors and defects that it presents andincluding typically post-traumatic ocular after-effects, whichare not registered presently, to facilitate the assessment of ocular after-effects

[From suspicion to diagnosis. Clinical, epidemiological, radiological and endoscopic aspects of bronchopulmonary cancer in Senegal. Apropos of 700 endoscopies performed at the Principle Hospital of Dakar from 1987 to 1990]. / De la suspicion au diagnostic. Aspects clinique épidémiologique, radiologique et endoscopique du cancer bronchopulmonaire au Sénégal. A propos de 700 endoscopies effectuées à l'Hôpital Principal de Dakar de 1987 à 1990.

700 bronchial endoscopies were performed over a period of three years at the Dakar "Hôpital Principal". 40 bronchopulmonary cancers were identified (34 epidermoid, 4 adenocarcinoma, 2 with "small cells") out of 80 suspect cases. When we examine the clinical, radiological, endoscopic features, we are able to classify the following as the most established facts: 1. Higher radiological frequency of the pulmonary retractile condensation syndrome (40 cases). 2. Main frequency of proximal granulated tumors (45) in comparison with endoscopic bronchial stenosis (22). 3. Identification almost exclusive of bronchial epidermoid cancer in that series (34). 4. Male sex and smoking are two unequivocal elements of that pathology. Bronchial endoscopy, absolutely necessary test easy to perform and to get, enables to visualize a lesion and to bring forward the indisputable histological evidence through the biopsy either alone or associated with endoscopic brushing and alveolar washing.

[Serologic diagnosis of Lyme disease. A pending problem]. / Diagnóstico serológico de la enfermedad de Lyme. Un problema pendiente.

We analyze the experience in serologic diagnosis of Lyme's borreliosis. From a total of 551 patients studied from 1987 to 1989, we further evaluate 80 cases with erythema chronicum migrans or a clinical diagnosis of Lyme's disease and positive serological tests. The techniques used were IFI, ELISA1 (Whittaker Bioproducts) and ELISA2 (MarDx Diagnostics). Serological tests results were evaluated in relation to clinical data. Five cases were excluded because of no-specific symptoms. There were 20 false-positive results, mainly due to other infections (HIV infection, tuberculosis, Mediterranean spotted fever and syphilis). Fifty-five patients were considered clinically of having Lyme's disease. IFI test was positive in 81.8% of all the 55 cases, ELISA2 in 58.4% of 53 cases tested and ELISA1 in 23% of 43 cases tested. Correlation between IFI and ELISA2 positive test was seen in 45% of cases. Specificity of all tests was higher than 97%. The study shows that sensitivity for all three techniques used was not optimal, and also there are some differences in their results. However, specificity was adequate.

HIV-2 and HIV-1 AIDS cases in Senegal: clinical patterns and immunological perturbations.

The serological and immunological parameters, disease patterns, and social characteristics of 39 human immunodeficiency virus type 2 (HIV-2) seropositive CDCIV cases seen in Dakar, Senegal were studied. These data were compared with those obtained from 48 HIV-1 seropositive CDC stage IV patients. Social characteristics of populations infected with HIV-1 or HIV-2 were clearly different. A patient sex ratio of three men to one woman was found for both viruses. In addition, the immune status of nonsymptomatic HIV-1 and HIV-2 seropositive people was evaluated. The correlation between abnormalities of the immune system and clinical status was similar for the two infections. Clinical symptoms of both diseases were the same, but this cross-sectional study could not address the questions of differences between the two infections in latency and development of disease or specific manifestations of HIV-2 infection. This study suggests that HIV-2 infection may contribute to the present AIDS epidemic in West Africa.

[Continent esoduodenal intubation after total gastrectomy for cancer. An African experience apropos of an initial series of 17 cases]. / L'intubation oeso-duodénale continente après gastrectomie totale pour cancer. Expérience africaine à propos d'une série préliminaire de 17 cas.

On the basis of a series of 17 cases in which GI continuity was restored by a containing esoduodenal intubation, the authors describe the technique, which consists in the approximation of the duodenum opposite the diaphragm. Esophageal intubation in the duodenum, the margins of which have been everted, allows preserving the physiological circuit, producing a new container within 3 months and ensuring an effective protection against reflux. The 17 patients had undergone total gastrectomy for advanced cancer, Gutman's stage II in 80% of all cases and stage III or more in the other 20%. 88% of the tumors were adenocarcinomas. There were no clinical or radiological signs of reflux, and no esophagitis was noted on repeated endoscopies. The postoperative mortality rate was 5.8%. The shortest time lapse is 1 year.

[Tumor-like focal nodular hyperplasia. Apropos of 3 cases observed at the Dakar Central Hospital from 1986 to 1989]. / Hyperplasie nodulaire focale à forme tumorale. A propos de 3 cas observés à l'Hôpital Principal de Dakar de 1986 à 1989.

Authors report three observations of Focal Nodular Hyperplasia, Tumor-like on two: senegalese female patients, 16 years and 37 years old, and a young senegalese man, 24 Years old. The mean age is about 25.5 years and oestro progestative intake has bean noted once. Diagnosis of Focal Nodular Hyperplasia was difficult and has been done twice after surgical intervention for chronic cholecystitis and blood peritonitis. The only complication reported, has been a rupture of nodular, causing the death of a patient. This benign tumor that never degenerates, does not need any particular treatment unless a stopping of oral contraception.

[Highly malignant tumors of the uterine corpus at the Hospital Principal in Dakar. Apropos of 8 cases in 1986-1987]. / Tumeurs corporéo-utérines de haute malignité à l'Hôpital Principal de Dakar. A propos de 8 cas en 1986-1987.

8 observations of corporeo-uterine tumors, observed during 2 years (1986-1987) at the Hospital Principal of Dakar (Senegal), are expounded. Their connected chemical, surgical and evolutive expression allowed us to gather 4 "Carcinoma" (epithelial malignant tumours), 2 sarcomas (conjunctival malignant tumours) and 2 uterine corpus extensive choriocarcinoma (trophoblastic tumours). Late detected, unfortunately developed, these tumours are characterized by their high seriousness and the appalling prognosis they mean (the victim doesn't generally survive more than 10 months).

[Epidemiology of cancer of the digestive tract in Senegal. Review of 18,000 endoscopies performed at the Principal Hospital of Dakar]. / Epidémiologie des cancers du tube digestif au Sénégal. Apport de 18.000 endoscopies effectuées à l'Hôpital Principal de Dakar.

314 alimentary tract cancers were discovered in 219 black males and 95 black females at the occasion of 18.000 endoscopies (high or low) performed during the 5 past years at the Principal Hospital (Dakar-Senegal). Mean age of the patients was 50, gastric cancer (170 cases) was the most frequent localization, then rectocolonic one (71 cases) and oesophageal one (61 cases). The more frequent utilization of endoscopy and may be a modification of diet in urban milieu might explain such a high frequency of discovery of alimentary tract cancers in Dakar.

[Crohn's disease. Apropos of 2 recent cases collected at the Dakar Central Hospital]. / Maladie de Crohn. A propos de deux observations récentes recueillies à l'Hôpital Principal de Dakar.

This report covers two cases of Crohn's Disease, one in a 27 year old Senegalese woman, the other in a 38 year old Senegalese man, both presenting abdominal pain, diarrhoea and loss of weight over several months. The ulcerated lesions were staged on the colon, respecting the rectum, and reached the ileum in one patient and the esophagus in the other. Following X-rays, endoscopy and consideration of the history, Crohn's Disease was diagnosed. Treatment with corticoids produced rapid improvement with the ulcers healing after one month. The unusualness of Crohn's Disease in Black Africans adds interest to these two observations.

[Epidemiology of digestive tube cancers in Senegal. Apropos of 18,000 endoscopies carried out at the Hospital Principal of Dakar]. / Epidémiologie des cancers du tube digestif au Sénégal. A propos de 18,000 endoscopies effectuées à l'Hôpital Principal de Dakar.

314 bowel cancers were discovered in 219 men and 95 women of negroid race in the course of 18,000 upper and lower endoscopies taken over the past 5 years at Dakar's Main Hospital. The average age of the sick persons is 50 years. Gastric cancer (170 cases) is the most frequent, followed by recto-colic cancer (71 cases) and oesophagian cancer (61 cases). The use of endoscopy and perhaps dietetic changes in the urban area, explain the large number of bowel cancers discovered in Dakar.

[Diagnostic suspicion. Clinical, epidemiological, radiological, and endoscopic aspects of bronchopulmonary cancer in Senegal. Apropos of 700 endoscopies performed at the Hôpital Principal de Dakar from 1987 to 1990]. / De la suspicion au diagnostic. Aspects clinique, épidémiologique, radiologique et endoscopique du cancer bronchopulmonaire au Sénégal. A propos de 700 endoscopies effectuées à l'Hôpital Principal de Dakar de 1987 à 1990.

700 bronchial fiber endoscopies were performed at Dakar Main Hospital over a period of 3 consecutive years. 40 broncho-pulmonary cancers were identified (34 epidermoids, 4 adeno-cancers, 2 small cell cancers) among the 80 suspect cases. Comparison of clinical, radiological and endoscopic data revealed the following information: 1. most frequently radiology showed retractile, pulmonary condensation syndrome (40 cases); 2. a large predominance of close, bulging tumours (45 times) in relation to endoscopic bronchial stenosis (22 times); 3. almost exclusive identification of bronchial epidermoid cancer in this series (34 times); 4. the masculine sex and use of tobacco remain 2 unavoidable elements in this pathology. Bronchial endoscopy, a simple, indispensible examination, allows the lesion to be visualized, and a biopsy, on its own or associated with endoscopic cysto-brushing and alveolus washing, can then furnish conclusive histological proof.

[The value of laparoscopy. Results of 600 studies performed in an internal medicine department at the General Hospital of Dakar]. / Intérét de la laparoscopie. Résultats de 600 examens effectués dans un service de Médecine interne à l'Hôpital Principal de Dakar.

600 laparoscopic examinations were performed in an Internal Medicine Department of the general Hospital Dakar (Senegal) from 1984 to 1989 in 402 males and 198 females aged from 7 to 82 years. This examination of simple and quick procedure well tolerated under simple premedication, should be performed only after diffusion of the pneumoperitoneum, per- foration being the major risk. Even if liver cell carcinoma and cirrhosis represent more than an half of the examined cases (52%) due to their high frequency, exploration of peritoneal pathology is the best indication for laparoscopy. Thanks to laparoscopy, 68 tuberculosis, 28 peritoneal carcinomatosis and 11 infectious peri-hepatitis were diagnosed. It remains a major examination perfectly adapted to studies of the so-frequent hepato-peritoneal pathology in Black Africa]

[Importance of laparoscopy. Results of 600 examinations performed in the Internal Medicine Department of the Hôpital Principal of Dakar]. / Intérêt de la laparoscopie. Résultats de 600 examens effectués dans un service de Médecine Interne à l'Hôpital Principal de Dakar.

At Dakar General Hospital between 1984 and 1989, 402 men and 198 women aged between 7 and 82 years were examined by laparoscopy. This simple, rapid examination, well tolerated after simple premedication, should only be undertaken after complete diffusion of the pneumoperitoneum because of a major perforation risk: 2 deaths unfortunately occurred during the above series. CPF's and cirrhosis account for more than half the cases (52%) and Laparoscopy is most useful in exploring the peritoneal pathology. Laparoscopy led to 68 cases of tuberculosis, 28 of peritoneum carcinomatosis, and 11 of infectious peri-hepatitis being diagnosed, and remains a major examination method perfectly adapted to the hepato-peritoneal pathology so common in Black Africa.

[Campylobacter pylori and the gastric mucosa. Apropos of the detection of Campylobacter pylori in 12 patients with gastric mucosa lesions]. / Campylobacter pylori et muqueuse gastrique. A propos de la mise en évidence de Campylobacter pylori chez 12 patients porteurs de lésions muqueuses gastriques.

The authors report the results of systematic research on Campylobacter pylori during high endoscopy. Of the 60 patients examined, 12 were found to have the germ in their antral, gastric mucosa. All these patients had a history of chronic gastritis. They recall the role of this germ in creating chronic gastritis, and evoke the hypothesis that the mucosa becomes fragile facilitating the appearance of an ulcer.

[Pseudomembranous colitis after antibiotic therapy associated with the presence of Entamoeba histolytica histolytica. Apropos of 2 cases]. / Colites pseudo-membraneuses post-antibiotiques associées à la présence d'Entamoeba histolytica histolytica. A propos de deux observations.

The authors report on two cases of pseudomembranous colitis (P.M.C.) developed in two Senegalese women of 38 and 36 years, and discovered at the 4th and 5th day respectively of an antibiotherapy based on ampicillin. In these two observations, cysts of Entamoeba histolytica histolytica were found in both feces and biopsies. They recall the circumstances of the occurrence, diagnosis techniques and treatment. They underline the unfrequency of this disease in Africa south of Sahara and they discuss the correlation with amoebiasis colitis. One has to keep in mind the possibility of a P.M.C. during any antibiotherapy, and consequently to have a rectoscopy to perform. Such an exploration is enough to pose a diagnosis. In day to day practice it is not necessary to show clearly the specific germ Clostridium difficile or its entero-toxin. To stop any antibiotherapy is required and beneficial. Metronidazole or Vancomycin are the best drugs in this case.

[Rectocolonic polyps in Senegal. Results of 1500 lower endoscopies carried out at the Dakar General Hospital]. / Les polypes recto-coliques au Sénegal. Résultat de 1,500 endoscopies basses effectuées à l'Hôpital Principal de Dakar.

57 polyps were discovered during 1,500 low endoscopies, and 24 of them were adenoma. In the same period of time, 26 proctocolitic adenocarcinomas were found. Adenomatous polyps appear to be 5 times less frequent in Senegal than in industrialized countries and frequency of colitic cancer should be of the same frequency, that is far less negligible. Even if proctocolitic cancer does not set up any Public Health problems one could envisage systematic screening of polyadenoma in every patient aged more than 40. Proctosigmoid being the seat of most adenoma, fibrosigmoidoscopy appears well adapted to this kind of screening because it does not require any preparation, it is easy to perform and well accepted.