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1.
PLoS One ; 14(8): e0220905, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31408484

RESUMO

BACKGROUND: Scrub typhus, an important cause of unexplained fever, is grossly neglected and often misdiagnosed in low and middle income countries like Nepal. The main aim of this study was to report on the clinical profile and complications of scrub typhus and its outcome in Nepalese children. METHODS: A prospective observational study was carried out in children aged 1-16 years, admitted to a tertiary care hospital of central Nepal in between July 2016- Aug 2017. Scrub typhus was diagnosed with IgM ELISA. RESULTS: All cases of scrub typhus (n = 76) presented with fever and commonly had other symptoms such as headache (75%), myalgia (68.4%), vomiting (64.5%), nausea (59.2%), abdominal pain (57.9%), cough (35.5%), shortness of breath (22.4%), altered sensorium (14.5%), rashes (13.2%) and seizures (11.8%). Important clinical signs noticed were lymphadenopathy (60.5%), hepatomegaly (47.4%), edema (26.3%), jaundice (26.3%), and splenomegaly (15.8%). About 12% (n = 9) had necrotic eschar. Similarly, thrombocytopenia, raised liver enzymes and raised creatinine values were seen in 36.9%, 34.2% and 65.8% respectively. The most common complications were myocarditis (72.4%), hypoalbuminemia (71.1%), severe thrombocytopenia (22.4%), renal impairment (65.8%), hyponatremia (48.7%) and hepatitis (34.2%). Over two-thirds (69.70%) of the cases were treated with doxycycline followed by combination with azithromycin in the remaining 18.4%. Overall, mortality rate in this group was 3.9%. CONCLUSIONS: Scrub typhus should be considered as a differential in any community acquired acute undifferentiated febrile illness regardless of the presence of an eschar. Myocarditis and acute kidney injury are important complications which when addressed early can prevent mortality. Use of doxycycline showed a favorable outcome.


Assuntos
Tifo por Ácaros/parasitologia , Adolescente , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Azitromicina/administração & dosagem , Azitromicina/uso terapêutico , Criança , Pré-Escolar , Doxiciclina/administração & dosagem , Doxiciclina/uso terapêutico , Quimioterapia Combinada , Feminino , Humanos , Lactente , Masculino , Nepal/epidemiologia , Estudos Prospectivos , Tifo por Ácaros/complicações , Tifo por Ácaros/tratamento farmacológico , Centros de Atenção Terciária , Resultado do Tratamento
2.
Chemosphere ; 210: 401-416, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30015131

RESUMO

In the operation of biological wastewater treatment processes, fast sludge settling during liquid-solids disengagement is preferred as it affects effluent quality, treatment efficiency and plant operation economy. An important property of fast settling biological sludge is the ability to spontaneously form big and dense flocs (flocculation) that readily separates from water. Therefore, there had been much research to study the conditions that promote biological sludge flocculation. However, reported findings have often been inconsistent and this has possibly been due to the complex nature of the biological flocculation process. Thus, it has been challenging for wastewater treatment plant operators to extract practical information from the literature. The aim of this review is to summarize the current state of understanding of the factors that affect sludge flocculation so that evaluation of such information can be facilitated and strategize for intervention in the sludge flocculation and deflocculation process.


Assuntos
Floculação , Eliminação de Resíduos Líquidos/métodos , Águas Residuárias/química , Esgotos/química , Esgotos/microbiologia , Águas Residuárias/microbiologia
3.
JNMA J Nepal Med Assoc ; 56(209): 510-515, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30058634

RESUMO

INTRODUCTION: To understand and report the prevalence of meconium aspiration syndrome and the clinico-radiological features in a tertiary care hospital of western Nepal. METHODS: An observational study carried out for a year in 2014-15 in all babies with MAS. Clinical and radiological profiles of MAS in relation to gender, gestational age, mode of delivery, birth weight, Apgar score, thickness of meconium, age at admission and the immediate outcome were studied. RESULTS: Out of 584 admitted newborns (male=389; female=186) during the study period, 78 (13.4%) had meconium aspiration syndrome with male: female ratio of 1.2:1. Majority of babies admitted to NICU had thick meconium [n=52 (66.7%)]. There was no statistical significant difference in various parameters such as Apgar score at 1 and 5 minutes, respiratory distress, birth asphyxia, duration of oxygen use, MAS severity and chest x-ray in those with thick MAS compared to thin. Among all newborns with MAS, 59% (n=46) had abnormal radiological findings with over two-folds in those with thick MAS (71.7%)] compared to thin (28%). Hyperinflation (47.8%), diffuse patchy infiltration (37%), consolidation (21.7%) collapse (8.7%), right lung fissure (6.5%) and pneumothorax (8.7%) were the abnormal radiological findings seen in MAS babies. The odds of having APGAR score at 1 minute at least 7 or more was twice unlikely in those having thick meconium compared to thin (P=0.02) Conclusions: Thick meconium is relatively common with more significant abnormal radiological findings and low Apgar score.


Assuntos
Síndrome de Aspiração de Mecônio , Radiografia Torácica , Índice de Apgar , Asfixia Neonatal/epidemiologia , Peso ao Nascer , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Masculino , Mecônio , Síndrome de Aspiração de Mecônio/diagnóstico , Síndrome de Aspiração de Mecônio/epidemiologia , Nepal/epidemiologia , Radiografia Torácica/métodos , Radiografia Torácica/estatística & dados numéricos , Fatores de Risco
4.
Int J Pediatr ; 2018: 1030878, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29951102

RESUMO

Background: Neurocysticercosis (NCC), a common cause of seizures in children from low and middle income countries (LMICs), if not diagnosed and treated early enough may lead to considerable morbidity and mortality. There is a lack of data on the prevalence of NCC and its clinical characteristics among those with seizure in South-Western Nepal. Aims and Objectives: To study the prevalence and clinical characteristics of NCC in children with seizures. Material and Methods: All children admitted to Universal College of Medical Sciences, a tertiary hospital in South-Western Nepal with seizures during 2014-16, were tested for NCC. NCC was diagnosed by neuroimaging [computerized tomography (CT) scan or magnetic resonance imaging (MRI)]. We used logistic regression to test the association between NCC with participants' characteristics and clinical symptoms. Results: Among 4962 in-patient children, 168 (104 boys and 64 girls) had seizures (138 with generalized tonic clonic seizures (GTCS) and 30 with focal seizures). 43% of children with seizures had CT scan confirmed NCC. The prevalence of NCC in the oldest children (13-16 years) was significantly greater (57.1% versus 15.6%) compared to the youngest (0-4 years) one (p < 0.001). Among 72 children with NCC, the proportions of children with vesicular, calcified, and colloidal stages were 76% (n = 35), 18% (n = 13), and 6% (n = 2), respectively. Children with focal seizures had 13% more NCC compared to those with GTCS but the result was statistically not significant. The adjusted odds of having NCC among 5-8 years, 9-12 years, and 13-16 years children were 6.6 (1.78-24.60), 11.06 (2.74-44.60), and 14.47 (3.13-66.96), respectively, compared to 0-4-year-old children. Reoccurrence of seizures within the first 3 months of taking antiepileptic drug in those with NCC was approximately 3 times higher compared to those without NCC (11% versus 4%, p = 0.084). Conclusions: This study shows that NCC contributes significantly to higher prevalence of seizures in children in South-Western region of Nepal.

5.
Artigo em Inglês | MEDLINE | ID: mdl-29344531

RESUMO

Background: In Nepal, the maternal mortality ratio is 281 per thousand live births, among which 40% mortality occurs during home delivery. Home delivery increases the risk of maternal and neonatal mortality and morbidity due to the birth not assisted by skilled attendant. This study was carried out to determine the factors affecting the place of delivery among the mothers residing in Jhorahat VDC, Morang district, Nepal. Methods: A mixed method study using interviews based on semi-structured questionnaire (n=93) among mothers and two focus group discussion among decision makers of the house and female community health volunteers was conducted between November to December 2012. For quantitative data, Chi-square test and Fischer's Exact test were used to examine the association between the selected variables and place of delivery. Results: More than half (58.1%) of the mothers had institutional delivery and 41.9% of them had home delivery. The most common reason for home delivery was easy and convenient environment (66.7%) and that for institutional delivery was safety (77.8%). There was a significant association between caste, education of mothers, education of spouse, occupation of spouse, per capita income, time to reach the nearest health center, parity, previous place of delivery, number of antenatal visit, knowledge about place of delivery, planned place of delivery, and place of delivery. Conclusion: Maternal health services, such as prenatal care, skilled assistance during delivery and post-natal care, along with adequately equipped health institutions, play a major role in the reduction of maternal morbidity and mortality. Concerted efforts should be made both at community and government levels to increase institutional delivery.

7.
JNMA J Nepal Med Assoc ; 56(207): 325-30, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29255314

RESUMO

INTRODUCTION: Measurement of birth weight, crown-heel length, head circumference and chest circumference used to assess the intrauterine growth of a baby vary with altitude, race, gender, socioeconomic status, maternal size, and maternal diseases. The study aimed to construct centile charts for birth weight, crown-heel length and head circumference for new born at different gestational ages in Western Nepal. METHODS: This was a descriptive cross-sectional study done over a period of 15 months in a tertiary care hospital of Western Nepal. Birth weight, length, head circumference and chest circumference were measured within 12-24 hours of birth. Gestational age was estimated from the first day of last menstrual period and New Ballard's scoring system. Microsoft 2007 Excel and SPSS-16 was used for data analysis. Cole's Lambda Mu Sigma method was used for constructing centile curves. RESULTS: Out of 2000 babies analysed, 1910 samples were used to construct smoothed intrauterine growth curve of birth weight, crown-heel length, and head circumference from 33-42 weeks of gestation. Among all, 1147 (57.35%) were male and 853 (42.65%) were female, mean gestational age was 38.13±2.44 weeks. The means of birth weight, crown-heel length, head and chest circumference were 2744.78 gm, 47.80 cm, 33.18 cm, and 30.20 cm with standard deviations of 528.29, 3.124, 1.78, and 2.35 respectively. CONCLUSIONS: This necessitates the update in the existing growth charts and development in different geographical regions of a country.


Assuntos
Altitude , Peso ao Nascer , Estatura , Desenvolvimento Fetal , Idade Gestacional , Gráficos de Crescimento , Cabeça/anatomia & histologia , Tórax/anatomia & histologia , Adulto , Antropometria , Cefalometria , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Masculino , Nepal , Gravidez , Valores de Referência , Centros de Atenção Terciária , Ultrassonografia Pré-Natal , Adulto Jovem
8.
Neurol Res Int ; 2017: 1524548, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28713592

RESUMO

Seizures are one of the common causes for hospital admissions in children with significant mortality and morbidity. This study was conducted to study the prevalence and clinicodemographic profile of children with seizures in a tertiary care hospital of western Nepal. This prospective cross-sectional study conducted over a period of 2 years included all admitted children (2 months-16 years) with seizures. Among 4962 admitted children, seizures were present in 3.4% (n = 168) of children, with male preponderance. 138 (82.1%) children had generalized tonic-clonic seizures (GTCS) and 30 (17.9%) children had partial seizures. GTCS were more common than partial seizures in both sexes (male = 82.7%; female = 81.2%) and age groups. There was no statistical significance in the distribution of seizures (GTCS and partial seizures) with sexes (P = 0.813) and age groups (P = 0.955). Mean ages of children having GTCS and partial seizures were 8.2 ± 4.6 years and 8.2 ± 4.2 years, respectively. Loss of consciousness (55.4%), fever (39.9%), vomiting (35.1%), and headache (16.1%) were common complaints in seizure patients. Significant number of GTCS cases had fever (P = 0.041) and neurocysticercosis (n = 72; 43%) was the most common etiology in seizure patients. Idiopathic epilepsy (38 (22.6%)), meningoencephalitis (26 (15.5%)), and febrile convulsions (14 (8.33%)) were other leading disorders in children with seizures.

9.
Dermatol Res Pract ; 2016: 6306404, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27247564

RESUMO

Pediatric dermatoses are one of the most common presentations in a dermatology clinic and reflect the health and hygiene status of children. The incidence and severity of these skin lesions are influenced by geographical area, seasonal and cultural factors, and socioeconomic status. This study was done to show the prevalence of different pediatric dermatoses in a tertiary care hospital of Western Nepal. Chart reviews of children aged one day to 17 years, presenting to Universal Medical College Teaching Hospital, Nepal, from 1 September 2014 to 30 august 2015, were done. Descriptive analysis and two-sided chi-square test were done. Among 23992 patients visiting the dermatology outpatient department (OPD), 5398 (22.5%) were of pediatric age groups (male/female: 1.2/1); most of them belonged to young teens and teenagers (n = 3308; 61.3%). Three most common dermatoses were fungal infections (18.5%), eczema (14.4%), and acne (10.1%). Fungal infections (n = 653; 65.4%) and acne (n = 284; 51.9%) were common in males, whereas eczema (n = 402; 51.7%) was more common in females. Fungal infection (P < 0.001), eczema (P < 0.001), pigmentation disorders (P < 0.001), and acne (P < 0.01) were significantly more during summer, while scabies was more in winter (P < 0.001). Dermatophytosis, pyoderma, and warts comprised frequently occurring fungal, bacterial, and viral infections, respectively.

10.
Case Rep Pediatr ; 2016: 6937465, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27213068

RESUMO

Cerebral salt wasting (CSW) syndrome is an important cause of hyponatremia in head injuries apart from syndrome of inappropriate antidiuretic hormone (SIADH). Proper diagnosis and differentiation between these two entities are necessary for management as the treatment is quite opposite in both conditions. Fludrocortisone can help in managing CSW where alone saline infusion does not work. We report a 17-month-old female child with head injury managed successfully with saline infusion and fludrocortisone.

11.
Bioresour Technol ; 200: 579-86, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26546787

RESUMO

This study investigates alkali-solubilized dissolved organic matter (DOM) and its fate in the anaerobic treatment process. DOM was fractionated into high molecular weight (HMW) protein-like substances (PL), HMW saccharide-like substances (SL), low molecular weight (LMW) PL, LMW SL, and humic acid-like substances (HAL). The results indicate alkali-solubilized DOM is primarily composed of LMW PL, HMW SL, and HAL. Alkaline pretreatment improved the overall anaerobic degradability of DOM in sludge (removal efficiency of total DOM increased by 28.4%). However, certain DOM fractions (mainly HMW PL and HAL) exhibited low degradability during anaerobic treatment, primarily caused by the low degradability of aromatic groups (such as aromatic amine groups from tryptophan-like PL). Alkaline pretreatment also resulted in an increase of residual DOM, which is mainly composed of HAL (52.9%) and HMW SL (49.9%).


Assuntos
Álcalis/química , Substâncias Húmicas/análise , Compostos Orgânicos/química , Eliminação de Resíduos/métodos , Esgotos , Anaerobiose , Carbono/química , Cromatografia , Peso Molecular , Nitrogênio/química , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz , Espectrofotometria , Espectroscopia de Infravermelho com Transformada de Fourier
12.
J Clin Diagn Res ; 9(2): SD01-3, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25859496

RESUMO

Neurocysticercosis (NCC) is one of the most common parasitic infestations (Taenia solium) of central nervous system (CNS) in children. Seizures are the common presenting symptoms. Hydrocephalus and optic atrophy are rare complications which may require neurosurgical interventions. We report a case of NCC with hydrocephalus and bilateral optic atrophy associated with vision loss in a Nepalese patient who improved with anti-parasitic therapy followed by ventriculo-peritoneal (VP) shunting.

13.
Environ Technol ; 36(17): 2239-48, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25800403

RESUMO

In this study, low-energy ultrasonic (3 and 6 kJ/g volatile solids of feed biomass (FB) which was lower than the heat value of the FB), alkaline, and ultrasonic-alkaline pretreatments were applied on FB, a biosludge from secondary industrial wastewater treatment. Biochemical methane potential (BMP), particle size distribution, Biomass Stress Index (BSI™), soluble chemical oxygen demand (SCOD), protein, carbohydrate, and size-exclusion chromatography (SEC) fingerprints were used to comparatively study the mechanisms of these pretreatment methods. The results indicated that low-energy ultrasonication and alkali exhibited significantly different impacts on the FB. After ultrasonication with energy input of 6 kJ/g-VS, the average particle size of FB was reduced from 102.6 to 19.4 µm. However, ultrasonication had no obvious effect on microbial cells rupture, solubilization of protein and carbohydrate, and SEC fingerprint. Consequently, low-energy ultrasonication could not enhance methane generation. However, after alkaline pretreatment with dosage of 0.3 g-NaOH/g-VS, SCOD, soluble protein, and soluble carbohydrate concentration of FB increased from 0.66, 0.00, 0.07 to 2.83, 0.83, 0.47 g/L, respectively. At the same time, BSI™ increased from 5.3% to 96.8%, and the SEC fingerprint changed significantly. Consequently, the methane generation in the BMP test increased from 68.9 to 135.0 mL. Ultrasonic-alkaline pretreatment was similar to alkaline pretreatment in terms of methane generation. Based on this study, alkaline pretreatment is recommended over both low-energy ultrasonic and low-energy ultrasonic-alkaline pretreatment to enhance the biodegradability of FB.


Assuntos
Álcalis/química , Esgotos/análise , Esgotos/microbiologia , Ultrassom/métodos , Eliminação de Resíduos Líquidos/métodos , Anaerobiose , Análise da Demanda Biológica de Oxigênio , Biomassa , Carboidratos/análise , Cromatografia em Gel , Metano/análise , Tamanho da Partícula , Proteínas/análise , Purificação da Água/métodos
14.
Chemosphere ; 140: 159-66, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25541534

RESUMO

In this paper, a linear state space model for the two-phase anaerobic reactor system was developed based on historical data. Subsequently, the model was used to predict its future behavior. The state space model developed involved correlation analysis and model development. The model would be updated at every time point when a new data set became available, giving it an "adaptive" feature. The model was then applied to monitor two-phase anaerobic co-digestion of a feed comprising 2 industrial secondary sludges and 2 industrial wastewaters. The case study showed the proposed model was able to provide good predictions of various process parameters. In addition, it also predicted impending process failure and this would have allowed the operator to take necessary measures to prevent or reduce impact of such failure during plant operation.


Assuntos
Reatores Biológicos/estatística & dados numéricos , Modelos Teóricos , Eliminação de Resíduos Líquidos/métodos , Anaerobiose , Bactérias Anaeróbias , Esgotos , Eliminação de Resíduos Líquidos/estatística & dados numéricos
15.
J Environ Sci (China) ; 26(4): 875-84, 2014 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-25079418

RESUMO

A high strength chemical industry wastewater was assessed for its impact on anaerobic microbial community dynamics and consequently mesophilic methane generation. Cumulative methane production was 251 mL/g total chemical oxygen demand removed at standard temperature and pressure at the end of 30 days experimental period with a highest recorded methane percentage of 80.6% of total biogas volume. Volatile fatty acids (VFAs) analysis revealed that acetic acid was the major intermediate VFAs produced with propionic acid accumulating over the experimental period. Quantitative analysis of microbial communities in the test and control groups with quantitative real time polymerase chain reaction highlighted that in the test group, Eubacteria (96.3%) was dominant in comparison with methanogens (3.7%). The latter were dominated by Methanomicrobiales and Methanobacteriales while Methanosarcinaceae in test groups increased over the experimental period, reaching a maximum on day 30. Denaturing gradient gel electrophoresis profile was performed, targeting the 16S rRNA gene of Eubacteria and Archaea, with the DNA samples extracted at 3 different time points from the test groups. A phylogenetic tree was constructed for the sequences using the neighborhood joining method. The analysis revealed that the presence of organisms resembling Syntrophomonadaceae could have contributed to increased production of acetic and propionic acid intermediates while decrease of organisms resembling Pelotomaculum sp. could have most likely contributed to accumulation of propionic acid. This study suggested that the degradation of organic components within the high strength industrial wastewater is closely linked with the activity of certain niche microbial communities within eubacteria and methanogens.


Assuntos
Metano/análise , Consórcios Microbianos , Águas Residuárias/microbiologia , Microbiologia da Água , Anaerobiose , Biocombustíveis/análise , Análise da Demanda Biológica de Oxigênio , Indústria Química , Eletroforese em Gel de Gradiente Desnaturante , Resíduos Industriais , Filogenia , Reação em Cadeia da Polimerase
16.
Environ Technol ; 30(4): 337-44, 2009 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-19492545

RESUMO

This study evaluated the potential of an extracellular, novel biopolymeric flocculant produced by a strain of Klebsiella terrigena for removal of Salmonella, a potent pathogen prevalent in poultry wastewater. The purified biopolymer was applied to poultry wastewater containing 3 log CFU cells of Salmonella. An optimized dosage of 2 mg L(-1) of the purified bioflocculant was sufficient to remove 80.3% Salmonella spp. within 30 min, at ambient temperature. Also this bioflocculant showed high flocculating activity (90%) against kaolin particles and proved to be far more effective than the other synthetic flocculants used in this study. Fluorescent in situ hybridization (FISH) with the genus specific Sal3 probe hybridized with the Salmonella present in the agglomerated matrix of the bioflocculant. Confocal laser scanning micrographs (CLSM) allowed a clear visualization of the spatial distribution of the total flocculated bacterial population (with DAPI and Eub338 probe) as well as Salmonella (with the Sal3 probe), indicating that the removed Salmonella remained bound and embedded within the flocculant matrix. Scanning electron microscopic (SEM) analysis exhibited a porous surface morphology. The bioflocculant was characterized to be a polysaccharide by FTIR, HPLC, CHN and chemical analysis. A viable alternative treatment technology of poultry wastewater using this novel bioflocculant is suggested.


Assuntos
Biopolímeros/química , Klebsiella/química , Aves Domésticas , Salmonella/isolamento & purificação , Eliminação de Resíduos Líquidos/métodos , Microbiologia da Água , Agricultura , Compostos de Alúmen/química , Animais , Reatores Biológicos , Fenômenos Químicos , Floculação , Hibridização in Situ Fluorescente , Microscopia Eletrônica de Varredura , Tamanho da Partícula , Espectrofotometria Infravermelho
17.
Water Environ Res ; 81(2): 160-4, 2009 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19323286

RESUMO

Extracellular biopolymer produced from Klebsiella terrigena was found to have excellent flocculating ability over a wide range of colloid particles (0.5 to 25micro). The biopolymer was thermostable, with an optimum temperature for flocculation of 30 degrees C. Analysis with Fourier transform infrared spectrophotometry (FT-IR) shows that the biopolymer mainly possesses hydroxyl, carboxyl, and methoxyl groups, with neutral sugar and uronic acid as its major and minor components, and the structure of a polysaccharide. The average molecular weight of the biopolymer was greater than 2 x 10(3) kilodalton (KDa), as determined by gel permeation chromatography. Scanning electron microscopy indicated a porous morphology of the biopolymer. At a dosage of 2 mg/L, the purified biopolymer could remove 62.3% of Cryptosporidium oocysts (1 x 10(6)) spiked in tap water samples. Calcium (5mM) was required for effective removal. The removal efficiency of Cryptosporidium oocysts by the biopolymer remained unaltered over a pH range of 6 to 8. The results of this study indicates a possible utility of the Klebsiella terrigena biopolymer as an alternative to typically used chemical flocculants for removal of Cryptosporidium oocysts from water.


Assuntos
Cryptosporidium parvum/isolamento & purificação , Polissacarídeos Bacterianos/química , Purificação da Água/métodos , Animais , Biodegradação Ambiental , Biopolímeros , Floculação , Humanos , Klebsiella/metabolismo , Polissacarídeos Bacterianos/isolamento & purificação
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