Making surgery safer in an increasingly digital world: the internet-friend or foe?

PURPOSE: The internet has resulted in huge efficiency gains in health care, the ability to deal with massive data accumulation and better manage patient data. However, potential and real pitfalls exist, including breeches in security of data and patient confidentiality, data storage issues, errors, and user interface issues. METHODS: A MEDLINE review was performed using MeSH terms "health care" and "information technology." Cross-referencing was used to explore the different opportunities and challenges the internet has to offer. RESULTS: As health professionals, we are fast adopting technologies at our fingertips, such as WhatsApp and video capabilities, into our clinical practice to increase productivity and improve patient care. However, the potential security breaches are significant for the health professional and health service. Further, electronic medical records have theoretical advantages to improve patient care, reduce medication errors, and expedite referrals. The downside is a less personalized approach to patient care, as well as the potential for these systems to be even more cumbersome. In regard to the acquisition of knowledge, there is no doubt the internet is our friend. Health care professionals as well as patients have unlimited resources for learning, including podcasts videos, apps, simulators, and wearable devices. Unfortunately, this comes with a risk of misinformation and poorly referenced data with little to no regulation of content. CONCLUSION: In this increasing digital world, it is our task as health care providers to embrace these new technologies but develop guidelines and control systems to minimize the pitfalls.

Constructed wetlands for the removal of metals from livestock wastewater - Can the presence of veterinary antibiotics affect removals?

The presence of emergent antibiotics, in livestock wastewater may affect constructed wetlands (CWs) performance in the removal of other pollutants. The main objective of this study was to evaluate the influence of two antibiotics commonly used in livestock industry, enrofloxacin and ceftiofur, on metal removal by CWs. Microcosms (0.4m×0.3m×0.3m), simulating CWs, were constructed with Phragmites australis to treat livestock wastewater spiked or not with 100µg/L of enrofloxacin or ceftiofur (individually or in mixture). Wastewater was treated during 20 one-week cycles. After one-week cycle wastewater was removed and replaced by new wastewater (with or without spiking). At weeks 1, 2, 4, 8, 14, 18 and 20, treated wastewater was analysed to determine the removal rates of metals (Zn, Cu, Fe and Mn) and of each antibiotic. At weeks 1, 8 and 20 portions of the plant root substrate were collected and metals determined. At the end of the experiment metal levels were also determined in plant tissues. Removal rate of Fe from wastewater was 99%. Removal rates of Cu and Zn were higher than 85% and 89%, respectively, whereas for Mn removal rates up to 75% were obtained. In general, no significant differences were observed through time in the removals of the different metals, indicating that the systems maintained their functionality during the experimental period. Antibiotics did not interfere with the system depuration capacity, in terms of metals removals from wastewater, and ceftiofur even promoted metal uptake by P. australis. Therefore, CWs seem to be a valuable alternative to remove pollutants, including antibiotics and metals, from livestock wastewaters, reducing the risk the release of these wastewaters might pose into the environment, although more research should be conducted with other antibiotics in CWs.

Interferences of surfactants during determination of chlorophenols by acetylation coupled to headspace-solid phase microextraction-gas chromatography with an electron capture detector.

The micellar extraction (ME) of chlorophenols (CPs) from solid samples is rapid and avoids the use of organic solvents. The cationic surfactant cetyltrimethylammonium bromide (CTAB) is a powerful agent for ME of CPs. However, CTAB will be an important interference when the extracts are subsequently analyzed by direct solid phase microextraction (SPME) without a previous derivatization step. Therefore, CTAB is usually replaced by the nonionic surfactant polyoxyethylene-10-lauryl ether (POLE), which causes less interference but is less efficient in extracting CPs. In order to assess to what extent the derivatization of CPs with headspace (HS) sampling would be able to reduce surfactant interferences, CPs were measured in the presence of CTAB or POLE using acetylation and HS-SPME coupled to GC with an electron capture detector. Experiments were carried out both in water and in a 0.1 g/mL solution of NaCl (salting out agent). Acetylation and HS-SPME strongly decreased the interference of CTAB for CP determination. Therefore, the application of CTAB followed by SPME determination for an efficient ME of CPs from solid samples should be reconsidered since using CTAB with HS-SPME after acetylation proved to be a potential tool for CP determination in those matrixes after method optimization.

Antioxidant response of Phragmites australis to Cu and Cd contamination.

Metals are known to induce oxidative stress in plant cells. Antioxidant thiolic compounds are known to play an important role in plants׳ defence mechanisms against metal toxicity but, regarding salt marsh plants, their role is still very poorly understood. In this work, the involvement of non-protein thiols (NPT), such as cysteine (Cys), reduced glutathione (GSH), oxidised glutathione (GSSG) and total acid-soluble SH compounds (total thiols), in the tolerance mechanisms of the marsh plant Phragmites australis against Cu and Cd toxicity was assessed. Specimens of this plant, freshly harvested in an estuarine salt marsh, were exposed, for 7 days, to rhizosediment soaked with the respective elutriate contaminated with Cu (0, 10 and 100 mg/L) or Cd (0, 1, 10 mg/L). In terms of NPT production, Cu and Cd contamination induced different responses in P. australis. The content of Cys increased in plant tissue after plant exposure to Cu, whereas Cd contamination led to a decrease in GSSG levels. In general, metal contamination did not cause a significant variation on GSH levels. Both metals influenced, to some extent, the production of other thiolic compounds. Despite the accumulation of considerable amounts of Cu and Cd in belowground tissues, no visible toxicity signs were observed. So, antioxidant thiolic compounds were probably involved in the mechanisms used by P. australis to alleviate metal toxicity. As P. australis is considered suitable for phytostabilising metal-contaminated sediments, understanding its tolerance mechanisms to toxic metals is important to optimise the conditions for applying this plant in phytoremediation procedures.

Stability of chlorophenols and their acetylated derivatives in water: sample storage procedures.

The determination of chlorophenols (CPs) in water samples is a subject of increasing interest. Reduction of sample storage space and the stability of CPs when present at very low levels are still problems that deserve research. The stability of CPs at ng/L levels at different temperatures and in the presence or absence of sodium carbonate and acetic anhydride was studied for up to 39 days. Stable and reproducible CP concentrations for about a month of storage in both river and wastewater were achieved in two storage conditions as follows: at -18 degrees C with addition of 10% sodium chloride; and at 4 degrees C with addition of both 10% sodium chloride and 10 mglmL sodium carbonate. These sample treatments are good alternatives to the immobilization of CPs on SPE cartridges in terms of both analyte stability and saving of storage space.

Comparing T1-weighted and T2-weighted three-point Dixon technique with conventional T1-weighted fat-saturation and short-tau inversion recovery (STIR) techniques for the study of the lumbar spine in a short-bore MRI machine.

AIM: To compare T1-weighted (W) fat-water separation (Dixon's technique) with T1W fat-saturation (FS) and T2W Dixon with short-tau inversion recovery (STIR) images for fat suppression in a short-bore MRI machine. MATERIALS AND METHODS: Thirteen patients with lumbar disease were studied on using 1.5 T MRI machine. The protocol included T1 FS (with contrast medium administration) and/or STIR and T1W and/or T2W Dixon, for comparison. Three neuroradiologists scored the images from the two-pairs of techniques for fat suppression uniformity and lesion conspicuity. Clinical usefulness of fat-only images was also evaluated. RESULTS: Regarding uniformity of fat suppression, mean scores were 2.28 (±0.49), 3.06 (±0.49), 2.39 (±0.49), and 3.15 (±0.35) for T1W FS, T1W Dixon, STIR, and T2W Dixon sequences, respectively. For the same pulse sequences, lesion conspicuity scores were 2.78 (±0.50), 2.78 (±0.27), 2.76 (±0.47), and 2.91 (±0.4), respectively. Both T1W and T2W Dixon sequences showed more homogeneous fat-suppression when compared to T1W FS (p = 0.026) and STIR (p = 0.008) techniques, but no significant difference was found for lesion conspicuity. Mean scores for the diagnostic utility of fat-only maps were, respectively, 1.72 (±0.39) and 2.48 (±0.50) for T1W and T2W Dixon. CONCLUSION: Fat suppression quality was superior with Dixon when compared to the conventional sequences, but not lesion conspicuity, suggesting that both techniques are reliable for diagnosis. Dixon may be advantageous in cases where inhomogeneity artefacts are an issue. Water-only maps appear to be useful in the clinical setting.

Determination of gaseous polycyclic aromatic hydrocarbons by a simple direct method using thermal desorption-gas chromatography-mass spectrometry.

In the last decade, the development of novel analytical methodologies enabled the identification of several environmental pollutants responsible for health problems associated with indoor exposure. Polycyclic aromatic hydrocarbons (PAHs) are among the potential hazardous chemicals present in ambient air. Due to their bioaccumulation potential and carcinogenic/mutagenic effects, 16 PAHs are currently listed as priority air pollutants. The main goal of this work was to implement a new and simple method for sampling and determination of PAHs in air by using a thermal desorption (TD) technique followed by gas chromatography coupled with mass spectrometry analysis. A detailed study was carried out to optimise the experimental method in each of its phases, including (active) sampling, TD and chromatographic analysis. The results demonstrate that this approach allowed the detection and quantification of the six more volatile PAHs, namely, naphthalene, acenaphthylene, acenaphthene, fluorene, phenanthrene, and anthracene. Acceptable precision and good linearity over the explored range were obtained. No carry-over was observed during experimental tests and the method provided a reproducible answer. The applicability of the novel methodology was tested in real environment, namely, on the roof of a building in an urban area, in a domestic kitchen and in a collective car garage. The method enabled the identification of two PAHs in the field samples, specifically, naphthalene (two rings) and phenanthrene (three rings). With regard to PAHs sample composition, the most abundant PAH found, in the three different locations, was naphthalene, accounting for about 84-100 % of the total PAH mass detected.

Simultaneous determination of several veterinary pharmaceuticals in effluents from urban, livestock and slaughterhouse wastewater treatment plants using a simple chromatographic method.

Minocycline, oxytetracycline, tetracycline, enrofloxacin and ceftiofur, commonly used veterinary pharmaceuticals, were searched in four urban, two livestock and two slaughterhouse effluents from wastewater treatment plants (WWTPs) in the north of Portugal. A simple method that includes solid-phase extraction followed with analysis by high-performance liquid chromatography with diode array detector was established and applied to the simultaneous determination of the five pharmaceuticals in WWTP effluents. This method, which is expeditious, inexpensive and available in most laboratories, showed to be useful for screening for problematic levels of drugs in WWTP effluents. It is known that several livestock and slaughterhouse effluents (pre-treated or treated) are discharged to the urban network before discharge into the environment. The presence of these drugs in such effluents can constitute a significant environmental problem that should be addressed, by the monitoring of these drugs and by implementation of methodologies that contribute to their decrease/elimination from wastewaters. Minocycline (≤6 µg L(-1)), oxytetracycline (≤7 µg L(-1)), tetracycline (≤6 µg L(-1)) and enrofloxacin (<2 µg L(-1)) could be detected and/or quantified in three urban effluents. Detectable levels of enrofloxacin (<2 µg L(-1)) and quantifiable levels of tetracycline (≤15 µg L(-1)) were found in the slaughterhouse effluents.

Role of natural attenuation, phytoremediation and hybrid technologies in the remediation of a refinery soil with old/recent petroleum hydrocarbons contamination.

Within a search for a biological remediation technology to remove petroleum hydrocarbons (PHC) from a contaminated soil from a refinery, the potential of monitored natural attenuation (MNA) was compared with the use of transplants of Cortaderia selloana both in the absence and in the presence of soil amendments. After 31 months of experiments, MNA was effective in removing most of the recent PHC contamination (50% of the initial total contamination) at 5-20 cm depth. The presence of weathered contamination explains the existence of an established community of PHC degraders, as can be inferred by the most probable number technique. C. selloana, in its turn, showed capacity to mobilize the most recalcitrant fraction of PHC to its roots, nevertheless masking its remediation capacity. The use of a hybrid technology (C. selloana together with treatments with a surfactant and a bioaugmentation product) improved the removal of PHC at 15-20 cm depth, the presence of C. selloana facilitating the migration of additives into the deeper layers of soil, which can be considered a secondary but positive role of the plant. In the surface soil layer, which was exposed to both microorganisms and the atmosphere, a further 20% of weathered PHC contamination disappeared (70% total removal) as a result of photo- and chemical degradation. Periodic revolving of the soil, like tillage, to expose all the contaminated soil to the atmosphere will therefore be a reliable option for reducing the contamination of the refinery soil if conditions (space and equipment) permit this operation.

A headspace SPME-GC-ECD method suitable for determination of chlorophenols in water samples.

A headspace solid phase microextraction coupled to gas chromatography with electron capture detector (HS-SPME-GC-ECD) method was optimized for the determination of seven chlorophenols (CPs) with different levels of chlorination. This is the first time that HS-SPME-GC-ECD with acetylation of the analytes is used for the simultaneous determination of CPs in water samples. The influence of fibre type, derivatization conditions, salt addition, temperature and time of extraction and temperature of desorption was checked. Possible sources of contamination and analyte losses were considered. The best results were obtained with the polydimethylsiloxane/divinylbenzene fibre, derivatization by acetylation using 100 µL of acetic anhydride and 0.1 g of anhydrous sodium carbonate per 10 mL of sample, salt addition of 100 g L(-1) sodium chloride, extraction at 70 °C for 60 min and desorption in the GC injector at 260 °C for 6 min. The limits of detection (LOD) for monochlorophenols were 12 and 122 ng L(-1) for 2-chlorophenol and 4-chlorophenol, respectively. For polychlorinated CPs, the LODs were lower than 6 ng L(-1), values similar to the existing methods that use SPME with derivatization for CPs determination in water samples. The method is suitable for the determination of CPs in most environmental aqueous samples. Repeatability and reproducibility were less than 16.8% and 11.7%, respectively. The optimized method was successfully applied for the analysis of waters with complex matrices such as river and estuarine water samples.

Effects of minocycline and its degradation products on the growth of Microcystis aeruginosa.

This work aimed to investigate the influence of Microcystis aeruginosa on the rate of minocycline (MNC) removal (abiotic degradation, physical binding or chemical transformation by cells) and the toxicity of MNC and its degradation products to the cyanobacterium. Most of the work was carried out in culture media in the presence or in the absence of M. aeruginosa. The rate of the MNC abiotic degradation in culture media strongly decreased with the increase of the MNC initial concentration. The exudates did not influence the rate of MNC degradation in the media. For concentrations ≥0.48 µM, the rate of the MNC removal from the media was faster in the presence of M. aeruginosa. Biotic MNC removal occurs by both physical binding by the cells (10%) and chemical transformations. EC(50) and EC(20) for MNC on the growth of M. aeruginosa were 0.92 and 0.13 µM, respectively. Interestingly, MNC degradation products might promote M. aeruginosa growth.

Transient disabling dyskinesias: a predictor of good outcome in subthalamic nucleus deep brain stimulation in Parkinson's disease.

We report 5 of 75 (6.6%) patients with Parkinson's disease (PD) submitted to subthalamic nucleus deep brain stimulation (STN-DBS) who developed transient disabling dyskinesias immediately after surgery. Dyskinesias persisted despite levodopa withdrawal, cessation or reduction of stimulation, and resolved spontaneously in a maximum period of 12 weeks without the need to change stimulation active contact. Compared to the rest of our PD patients submitted to STN-DBS, the dyskinesia group needed a lower levodopa-equivalent daily dosage (LEDD) over the time of follow-up. A microlesion in the STN, probably concealed in cerebral MRI by the electrode-related artifact, could have been involved in the etiopathology of our patients' symptoms. The presence of transient disabling dyskinesia in PD patients immediately after STN-DBS might be a predictor of good outcome as measured by a decrease in the LEDD needed.

Granulomatous infectious disease in an immunosuppressed patient: a case report with radiological and pathological correlation.

We report here on a case of disseminated aspergillosis in an immunocompromised patient with Wegener's granulomatosis to illustrate the complexity of brain imaging diagnosis in the presence of concomitant infectious, immunological and ischemic diseases.

Butyltin levels in several Portuguese coastal areas.

This work aimed to report present levels (2007-2008 sampling) of tri- (TBT), di- (DBT), and monobutyltin (MBT) in surface sediments from 11 Portuguese coastal sites and discuss the evolution of BTs contamination in the last two decades. All the samples revealed quantifiable values of TBT, DBT, and MBT with total butyltin concentrations between 1 and 565 ng/g (of Sn in dry sediment). Maximum level of TBT, 66 ng/g, was observed in Sado estuary, at Lisnave site, in the proximity of a big shipyard. MBT decreased site by site by the same order as DBT and TBT did, but its concentrations were much higher in many cases, denoting that TBT contamination was much higher in the past. A comparison with the available previous data confirmed a marked decrease of TBT contamination all over the last years, indicating that the main sources of TBT in Portuguese coastwise stopped effectively.

Application of SPME to the determination of alkylphenols and bisphenol A in cyanobacteria culture media.

In order to survey the influence of estrogenic compounds on cyanobacteria, solid-phase microextraction (SPME) with a carbowax-divinylbenzene fibre was used for the determination of tert-octylphenol (tert-OP), n-nonylphenol (n-NP), technical nonylphenol (tech-NP) and bisphenol A (BPA) in cyanobacteria culture media by gas chromatography with flame ionization detection. Determinations were carried out without derivatization in deionized water and filtered culture media. A comparison between f2 and Fraquil culture media was performed, which showed that only f2 allowed quantitative recoveries. Headspace SPME with salting out, requiring only 10 mL of sample, was suitable for tert-OP, n-NP, and tech-NP determination with limits of detection (LOD) of <0.05 microg L(-1). For BPA, direct immersion SPME could provide a LOD of 1 microg L(-1). Automated sampling allowed reproducible extraction. No exudate substances overlapped with the studied compounds during the chromatographic separation and no matrix effects were observed. Ecotoxicity tests can be performed by single spiking of tert-OP and tech-NP and multiple spiking of n-NP due to its lower stability.

Multiple regression analysis to assess the role of plankton on the distribution and speciation of mercury in water of a contaminated lagoon.

Spatial and seasonal variation of mercury species aqueous concentrations and distributions was carried out during six sampling campaigns at four locations within Laranjo Bay, the most mercury-contaminated area of the Aveiro Lagoon (Portugal). Inorganic mercury (IHg(II)) and methylmercury (MeHg) were determined in filter-retained (IHgPART, MeHgPART) and filtered (<0.45µm) fractions (IHg(II)DISS, MeHgDISS). The concentrations of IHgPART depended on site and on dilution with downstream particles. Similar processes were evidenced for MeHgPART, however, its concentrations increased for particles rich in phaeophytin (Pha). The concentrations of MeHgDISS, and especially those of IHg(II)DISS, increased with Pha concentrations in the water. Multiple regression models are able to depict MeHgPART, IHg(II)DISS and MeHgDISS concentrations with salinity and Pha concentrations exhibiting additive statistical effects and allowing separation of possible addition and removal processes. A link between phytoplankton/algae and consumers' grazing pressure in the contaminated area can be involved to increase concentrations of IHg(II)DISS and MeHgPART. These processes could lead to suspended particles enriched with MeHg and to the enhancement of IHg(II) and MeHg availability in surface waters and higher transfer to the food web.

Response of a salt marsh microbial community to antibiotic contamination.

Salt marsh plants and associated microorganisms can have an important role in contaminant removal from estuaries, through bioremediation processes. Nevertheless, the interaction between emerging contaminants, namely antibiotics, and plant-microorganism associations in estuarine environment are still scarcely known. In this vein, the aim of the present study was to evaluate, in controlled conditions, the response of a salt marsh plant-microorganism association to a contamination with a veterinary antibiotic. For that a salt marsh plant (Phragmites australis) and its respective rhizosediment were collected in a temperate estuary (Lima estuary, NW Portugal) and exposed for 7 days to enrofloxacin (ENR) under different nutritional conditions in sediment elutriates. Response was evaluated in terms of ENR removal and changes in microbial community structure (evaluated by ARISA) and abundance (estimated by DAPI). In general, no significant changes were observed in microbial abundance. Changes in bacterial richness and diversity were observed but only in unplanted systems. However, multivariate analysis of ARISA profiles showed significant effect of both the presence of plant and type of treatment on the microbial community structure, with significant differences among all treatment groups. In addition, plants and associated microorganisms presented a potential for antibiotic removal that, although highly dependent on their nutritional status, can be a valuable asset to recover impacted areas such as estuarine ones.

Microbial community dynamics associated with veterinary antibiotics removal in constructed wetlands microcosms.

This study aimed to evaluate the response of the microbial community from CWs microcosms tested for the removal of two veterinary antibiotics, enrofloxacin (ENR) and tetracycline (TET), from livestock industry wastewater. Three treatments were tested (control, ENR or TET (100 µg L(-1))) over 12 weeks in microcosms unplanted and planted with Phragmites australis. CWs removal efficiency was relatively stable along time, with removals higher than 98% for ENR and 94% for TET. In addition, CWs were able to reduce wastewater toxicity, independently of antibiotics presence. Despite no significant differences were observed in terms of microbial abundance, bacterial richness or diversity, analysis of similarities (two-way crossed ANOSIM) showed a significant effect of both time and treatments in bacterial community structure. This study points to CWs applicability for veterinary antibiotics removal from livestock wastewaters, showing that CWs microbial communities were able to adapt without significant changes in their diversity or depuration capacity.

[The initial loss of consciousness in spontaneous subarachnoid hemorrhage. What does it mean?]. / Perda de consciência inicial na hemorragia subaracnoideia espontânea. O que significa?

BACKGROUND AND PURPOSE: Poor outcome and rebleeding, after admission to hospital of patients with spontaneous subarachnoid hemorrhage (SAH) has been found to be predicted by loss of consciousness at ictus (LOCi). In this study, we assessed the clinical and neuro-radiological significance of the LOCi in non-traumatic SAH. PATIENTS AND METHODS: The authors retrospectively studied 102 patients with SAH admitted to S. João Hospital between January 1, 1989 and December 31, 1992, who were divided into two groups with and without LOCi and compared according to clinical and imaging features. RESULTS: Loss of consciousness at ictus was statistically associated with an age over 52 years (odds ratio, 2.9; 95% confidence interval, 1.1-7.8); a Hunt and Hess Scale score > ou = 3 (4.4; 1.6-12.3); finding of subarachnoid blood on initial cranial CT scan (5.5; 1.4-26.3); existence of aneurysm (3.4; 1.3-8.9); a Glasgow Outcome Scale score > ou = 3 (4.69; 1.6-14.1). A poor clinical condition on admission (5.2;1.8-14.5) and existence of aneurysm (4.1; 1.6-10.6) were the only two findings shown to have an independent power of significant association with loss of consciousness at ictus, using logistic regression analysis, with LOCi as a dependent variable. CONCLUSIONS: In this study, LOCi has independent predictive power for a poor neurologic condition on admission and for the finding of aneurysm on angiogram. Loss of consciousness at ictus may be explained by the direct impact of the initial hemorrhage on the brain from a large tear in the aneurysmal wall, causing a quick rise in intracranial pressure (with LOCi) but a relatively short bleeding time.

[What do nurses do to promote population's health?]. / Cosa fanno gli infermieri per promuovere la salute della popolazione?

It is interest of the profession to theorize on this matter to direct and to reorganize the education. This article describes the phase of study developed up to today.