Cerebellious abscesses caused by Nocardia farcinica in an immunocompromised patient

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"CAPA in Progress": A New Real-Life Approach for the Management of Critically Ill COVID-19 Patients.

(1) Background: COVID-19-associated pulmonary aspergillosis (CAPA) has worsened the prognosis of patients with pneumonia and acute respiratory distress syndrome admitted to the intensive care unit (ICU). The lack of specific diagnosis criteria is an obstacle to the timely initiation of appropriate antifungal therapy. Tracheal aspirate (TA) has been employed under special pandemic conditions. Galactomannan (GM) antigens are released during active fungal growth. (2) Methods: We proposed the term "CAPA in progress" (CAPA-IP) for diagnosis at an earlier stage by GM testing on TA in a specific population admitted to ICU presenting with clinical deterioration. A GM threshold ≥0.5 was set as the mycological inclusion criterion. This was followed by a pre-emptive short-course antifungal. (3) Results: We prospectively enrolled 200 ICU patients with COVID-19. Of these, 164 patients (82%) initially required invasive mechanical ventilation and GM was tested in TA in 93 patients. A subset of 19 patients (11.5%) fulfilled the CAPA-IP criteria at a median of 9 days after ICU admittance. The median GM value was 3.25 ± 2.82. CAPA-IP cases showed significantly higher ICU mortality [52.6% (10/19) vs. 34.5% (50/145), p = 0.036], as well as a much longer median ICU stay than those with a normal GM index [27 (7-64) vs. 11 (9-81) days, p = 0.008]. All cases were treated with a pre-emptive systemic antifungal for a median time of 19 (3-39) days. (4) Conclusions: CAPA-IP highlights a new real-life early approach in the field of fungal stewardship in ICU programs.

SURFWET: A biokinetic model for surface flow constructed wetlands.

Constructed wetlands are an alternative biotechnology for wastewater treatment that have several advantages over conventional systems. In this work, a biokinetic model for surface flow constructed wetlands is presented (SURFWET). SURFWET belongs to a class of models that are not only interesting from a theoretical viewpoint, as they allow to improve the understanding of the underlying processes; but also from a practical viewpoint, because they can be useful for optimal designs of constructed wetlands, complementing current empirical methods. The proposed model is centered on the intervening physical and biochemical processes involved in pollutant removal in wastewater (organic matter, nitrogen, phosphorus, suspended solids), capturing the interplay of the main agents on contaminant removal (bacteria, macrophytes and phytoplankton). Furthermore, the hydraulic model considers water volume as a variable depending on the outlet hydraulic capacity, and dissolved oxygen has also been introduced as a key driver of reaction kinetics of wetlands. Beyond putting forward a theoretical framework, SURFWET has been applied to simulate a specific case to demonstrate its robustness, in a 12-year-interval simulation. The results show the typical seasonality of this biotechnology, highlighting the importance of dissolved oxygen, which is a key limiting factor on a large number of biochemical processes.

Effects of flooding regime and meteorological variability on the removal efficiency of treatment wetlands under a Mediterranean climate.

The modeling of free-water surface constructed wetlands (FWS-CWs) provides an improved understanding of their processes and constitutes a useful tool for the design and management of these systems. In this work, a dynamic simulation model for FWS-CWs was developed and used to simulate the operation of a FWS-CW proposed for improving the treatment of sewage effluents entering the Tablas de Daimiel National Park in central Spain. The process-based model simulates carbon, nitrogen and phosphorus dynamics, including key hydrological processes for wetlands under a fluctuating Mediterranean semiarid climate. The model allows for the simulation of the operation of FWS-CWs with variable flooding regimes, relating the surface water level to the flooded area and the water outflow. Simulations of the proposed FWS-CW under different water management schemes and scenarios were run, and the consequences of those management strategies on the treatment efficiency were analyzed. Under the Mediterranean climate and geology of the study area, namely, high water losses through evapotranspiration and infiltration, the decrease in nutrient concentrations was higher when the flooded area was reduced in summer than when a constant flooded area was maintained. Moreover, the meteorological variability introduced in different scenarios produced different results in terms of water outflow, but differences in terms of nutrient concentrations were not significant. The ability of the model to simulate different hydrological scenarios and their consequences on water quality makes it a useful decision-support tool.

Effect of key design parameters on bacteria community and effluent pollutant concentrations in constructed wetlands using mathematical models.

Constructed wetlands are currently recognized as an effective environmental biotechnology for wastewater treatment, but the influence of their design parameters on internal functioning and contaminant removal efficiency is still under discussion. In this work, the effect of aspect ratio and water depth on bacteria communities as well as treatment efficiency of horizontal subsurface flow constructed wetlands (HSSF) under the Mediterranean climate was evaluated, using a mathematical model. For this purpose, experimental results from four pilot-scale wetlands of equal surface area but different aspect ratios and water depth were used. The HSSF system was fed with municipal wastewater. The experimental data were simulated using the BIO_PORE model, developed in the COMSOL Multiphysics™ platform. Simulations with the BIO_PORE model fitted well to the experimental results, showing a higher removal efficiency for the shallower HSSF for COD (93.7% removal efficiency) and ammonia nitrogen (73.8%). The aspect ratio had a weak relationship with the bacteria distribution and the removal efficiency. In contrast, the water depth was a factor. The results of the present study confirm a previous hypothesis in which depth has an important impact on the biochemical reactions causing contaminants transformation and degradation.

Changes in water quality of treated sewage effluents by their receiving environments in Tablas de Daimiel National Park, Spain.

The Tablas de Daimiel National Park (TDNP), a floodplain wetland located in the Upper Guadiana Basin (central Spain), receives pollution from wastewater treatment plants (WWTPs) discharging their treated sewage effluents (TSEs) to tributary channels to the wetland. The TSEs suffer transformations on their way to the TDNP, but the water quality is controlled only at the point of discharge. In this work, we analyse the change in water quality of the TSE from four urban WWTPs in the surroundings of the TDNP (Alcázar de San Juan, Daimiel, Manzanares and Villarrubia de los Ojos towns). The water samples were taken at the outlet of the plants and in the receiving environments, to analyse the water quality transformation of the TSE. The different discharge configurations of each WWTP have been related with the water quality transformation of their TSE, to interpret the influence of the hydro-geomorphology in the improvement or deterioration of the water quality of TSE. We found that the discharge of TSE into slow flow channels with macrophyte vegetation facilitates water self-purification but, with time, the accumulation of sludge in the beds of the effluents tends to be the cause of the deterioration of the water quality.