Effectiveness of three configurations of membrane bioreactors on the removal of priority and emergent organic compounds from wastewater: comparison with conventional wastewater treatments

In this work the effectiveness of membrane bioreactors as advanced treatment on the removal of emergent and priority organic compounds in wastewater treatment plants has been evaluated during a one-year monitoring study. The studied wastewater treatment plant operates with flat sheet and hollow fibre membranes in two parallel lines. Moreover, a reverse osmosis module connected in series after the hollow fibre membrane was evaluated for one month. Comparison of membrane bioreactor and conventional activated sludge treatment was also investigated, as well as the influence of the physicochemical properties of the compounds on the removal rates achieved. Sixteen pharmaceutical compounds belonging to seven therapeutic groups and eight priority organic pollutants, including linear alkylbenzene sulfonates, nonylphenol and its ethoxylates and phthalate, were monitored. The highest mean concentrations corresponded to priority organic pollutants (309 μg L(-1) of linear alkylbenzene sulfonate C(12)) followed by pharmaceutical compounds (24.5 μg L(-1) of ibuprofen). No significant difference of effectiveness was found among flat sheet and hollow fibre membranes. However, an improvement was obtained with the addition of a reverse osmosis module for most of the compounds. Biodegradation has been shown as the main route involved in the removal of organic compounds during both technologies.

[Emotional climate and internal communication in a clinical management unit compared with two traditional hospital services]

BACKGROUND AND OBJECTIVE

The aim of this study is to compare the emotional climate, quality of communication and performance indicators in a clinical management unit and two traditional hospital services.

MATERIAL AND METHODS

Quantitative study.

INSTRUMENT

questionnaire of 94 questions.

PARTICIPANTS

83 health professionals (63 responders) from the clinical management unit of breast pathology and the hospital services of medical oncology and radiation oncology.

ANALYSIS

descriptive statistics, comparison of means, correlation and linear regression models.

RESULTS

The clinical management unit reaches higher values compared with the hospital services about: performance indicators, emotional climate, internal communication and evaluation of the leadership. An important gap between existing and desired sources, channels, media and subjects of communication appear, in both clinical management unit and traditional services.

CONCLUSIONS

The clinical management organization promotes better internal communication and interpersonal relations, leading to improved performance indicators.

Sources and behaviour of polybrominated diphenyl ethers (PBDEs), polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) in Spanish sewage sludge

Presence, sources and behaviour of polybrominated diphenyl ethers (PBDEs) and polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) were evaluated in Spanish sewage sludge. A total of 120 samples were seasonally collected from October 2005 to September 2006 at 31 urban wastewater treatment plants (WWTPs). Concentrations of PBDEs (ranging between 57.5 and 2606 ng/g dry weight) were two to three orders of magnitude higher than those obtained for PCDDs (0.17-5.03 ng/g d.w.) and PCDFs (0.05-3.07 ng/g d.w.). All the samples presented International Toxicity Equivalents (I-TEQ) levels (ranging between 2.06 and 44.4 ng/kg d.w.) below the limit values proposed by European Union for land application. Congener patterns evaluation revealed that the use of Deca-BDE commercial mixture seems to be the major source of PBDEs in the sludge. Nevertheless, origin of PCDD/Fs should be related to atmospheric deposition, faeces and presence of PCDD/Fs precursors such as pentachlorophenol in the sludge. No correlations (p>0.05) were found between pollutant concentrations (PBDEs and PCDD/Fs) and wastewater treatment plant (WWTP) characteristics (capacity nor sludge rate). Lower levels of PBDEs and PCDFs were found in WWTPs using biological nitrogen and phosphorous elimination, suggesting that these compounds are susceptible of microbial elimination. According to our knowledge, this is the first work comparing together both PBDEs and PCDD/Fs sludge patterns.

Oral desensitization as a useful treatment in 2-year-old children with cow's milk allergy

BACKGROUND

Limited published evidence shows oral desensitization to be a potential intervention option for cow's milk protein (CMPs) allergy.

OBJECTIVE

The aim of this study was to evaluate the safety and efficacy of oral desensitization in 2-year-old children with cow's milk allergy, as a treatment alternative to elimination diet.

METHODS

A total of 60 children aged 24-36 months with IgE-mediated allergy to CMPs were included in this multi-center study and were randomized into two groups. Thirty children (group A: treatment group) began oral desensitization immediately, whereas the remaining 30 (group B: control group) were kept on a milk-free diet and followed-up for 1 year.

RESULTS

After 1-year follow-up period, 90% of the children in group A had become completely tolerant vs. 23% of the children in group B. In group A, cow's milk skin reactivity and serum-specific IgE to milk and casein decreased significantly from the initial assessment, whereas group B showed no significant change after 1 year of follow-up. Twenty-four patients (80%) developed some reaction during the treatment period: 14 children developed moderate reaction (47%) and 10 mild reaction (33%). The most common manifestations were urticaria-angioedema, followed by cough.

CONCLUSIONS AND CLINICAL RELEVANCE

In this study, oral desensitization was found to be effective in a significant percentage of 2-year-old children with cow's milk allergy. Oral desensitization appears to be efficacious as an alternative to elimination diet in the treatment of 2-year-old children with cow's milk allergy. The side-effect profile appears acceptable but requires further study.

Calcium oscillations induced by gambierol in cerebellar granule cells

Gambierol is a marine polyether ladder toxin derived from the dinoflagellate Gambierdiscus toxicus. To date, gambierol has been reported to act either as a partial agonist or as an antagonist of sodium channels or as a blocker of voltage-dependent potassium channels. In this work, we examined the cellular effect of gambierol on cytosolic calcium concentration, membrane potential and sodium and potassium membrane currents in primary cultures of cerebellar granule cells. We found that at concentrations ranging from 0.1 to 30 microM, gambierol-evoked [Ca(2+)]c oscillations that were dependent on the presence of extracellular calcium, irreversible and highly synchronous. Gambierol-evoked [Ca(2+)]c oscillations were completely eliminated by the NMDA receptor antagonist APV and by riluzole and delayed by CNQX. In addition, the K(+) channel blocker 4-aminopyridine (4-AP)-evoked cytosolic calcium oscillations in this neuronal system that were blocked by APV and delayed in the presence of CNQX. Electrophysiological recordings indicated that gambierol caused membrane potential oscillations, decreased inward sodium current amplitude and decreased also outward IA and IK current amplitude. The results presented here point to a common mechanism of action for gambierol and 4-AP and indicate that gambierol-induced oscillations in cerebellar neurons are most likely secondary to a blocking action of the toxin on voltage-dependent potassium channels and hyperpolarization of sodium current activation.

Presence of pharmaceutically active compounds in Doñana Park (Spain) main watersheds

Among the emerging environmental contaminants, pharmaceutically active compounds have become a growing public concern because of their potential to cause undesirable ecological and human health effects. Doñana Park (South of Spain) includes a mosaic of unique ecosystems known around the world which is particularly affected by the quality of the incoming flowing water. This study reports the presence of a number of priority pharmaceuticals in wastewater and surface water samples from Doñana watersheds. In general, ibuprofen, naproxen, salicylic acid, propranolol, caffeine and gemfibrozil were the compounds most frequently found in all locations, in the range of ng/L to microg/L. Carbamazepine, with high potential risk to the environment, was also detected, although only in a few water samples. The main results are: (i) pharmaceuticals, as water pollutants, are continually discharged into Doñana water bodies and, owing to their biological activity, could lead to adverse effects in this outstanding aquatic ecosystem; (ii) wastewater treatments implemented in the area are insufficient to remove pharmaceuticals; and (iii) therefore, there is a requirement for better wastewater treatments in this natural area to reduce or avoid the presence of organic pollutants in general and pharmaceutical active compounds in particular. To the best of our knowledge, these data constitute the first measurements of pharmaceutical compounds in water not only from the protected area of Doñana Park but also from other Natural or National Parks in the world.

[Treating severe acute anemia due to vaginal bleeding in the Jehovah's Witness: a report of 2 cases]

For reasons of religious belief, Jehova's Witnesses do not accept blood transfusions or the infusion of blood products. In situations in which severe, life-threatening anemia develops, patient refusal to receive a transfusion can create serious ethical and legal problems. The principle of patient autonomy, which implies the freedom to accept or reject treatment, comes into conflict with the physician's obligation to safeguard the patient's life using all means possible. We report 2 cases of severe anemia in Jehova's Witnesses. One was due to menorrhagia and the other to postpartum bleeding. The physician should be aware of alternatives to infusion of blood products and know how to cope with an unexpected critical event in these patients. The measures we took were effective in our patients. In the case of menorrhagia, hormone treatment is effective when the woman wishes to preserve the ability to conceive and avoid surgery (endometrial ablation and hysterectomy). In postpartum bleeding refractory to conservative treatment, selective embolization of bleeding vessels may make it unnecessary to resort to more aggressive treatment, such as obstetric hysterectomy.

Occurrence and risk assessment of nonylphenol and nonylphenol ethoxylates in sewage sludge from different conventional treatment processes

In the present work, the concentrations of the organic pollutants nonylphenol (NP) and nonylphenol mono- and diethoxylates (NP1EO and NP2EO, respectively) in primary, secondary, mixed, aerobically-digested, anaerobically-digested, dehydrated, compost and lagoon sludge samples from different sludge treatments have been evaluated. Toxicological risk assessment of these compounds in sludge and sludge-amended soil has also been reported. NP, NP1EO and NP2EO were monitored in sludge samples obtained from treatment plants located in Andalusia (south of Spain) based on anaerobic treatments (11 anaerobic-digestion wastewater treatment plants and 3 anaerobic wastewater stabilization ponds) or on aerobic treatments (3 aerobic-digestion wastewater treatment plants, 1 dehydration treatment plant and 2 composting plants). The sum of NP, NP1EO and NP2EO (NPE) concentrations has been evaluated in relation to the limit value of 50 mg/kg set by the European Union Sludge Directive draft published in April 2000 (Working Document on Sludge). In most of the samples, NP was present at higher concentration levels (mean value 88.0 mg/kg dm) than NP1EO (mean value 33.8 mg/kg dm) and NP2EO (mean value 14.0 mg/kg dm). The most contaminated samples were compost, anaerobically-digested sludge, lagoon sludge and aerobically-digested sludge samples, which contained NPE concentrations in the ranges 44-962 mg/kg dm, 8-669 mg/kg dm, 27-319 mg/kg dm and 61-282 mg/kg dm, respectively. Risk quotients, expressed as the ratios between environmental concentrations and the predicted no-effect concentrations, were higher than 1 for NP, NP1EO and NP2EO in the 99%, 92% and 36% of the studied samples, respectively; and higher than 1 in the 86%, 6% and 2%, respectively, after sludge application to soil, leading to a significant ecotoxicological risk mainly due to the presence of NP.

[Lymphoma of the pituitary stalk]

INTRODUCTION

Tumors of the pituitary stalk are rare and their diagnosis is sometimes difficult.

CASE REPORT

We report a case of a primary lymphoma of the pituitary stalk in a 78-year-old patient. To our knowledge, only seven similar cases have been previously published: prominent symptoms were headache, fatigue and diplopia; biologically, anterior pituitary low secretion or hyperprolactinemia were found in the majority of cases; regarding the imaging, only three patients presented an initial and isolated lesion of the stalk; histological evidence was obtained by a trans-sphenoidal biopsy in case of hypothalamic or pituitary associated lesion or by a trans-cranial biopsy in the event of an isolated lesion. As an alternative, a lumbar puncture could be performed; although less invasive, its diagnostic performance is lower.

CONCLUSION

Current treatment relies on chemotherapy with intravenous methotrexate associated with intrathecal methotrexate infusion if cerebrospinal showed abnormal cells. Unfortunately, the results remain poor with a median survival of 9 months.

Occurrence of pharmaceutically active compounds during 1-year period in wastewaters from four wastewater treatment plants in Seville (Spain)

Several pharmaceutically active compounds have been monitored during 1-year period in influent and effluent wastewater from wastewater treatment plants (WWTPs) to evaluate their temporal evolution and removal from wastewater and to know which variables have influence in their removal rates. Pharmaceutical compounds monitored were four antiinflammatory drugs (diclofenac, ibuprofen, ketoprofen and naproxen), an antiepileptic drug (carbamazepine) and a nervous stimulant (caffeine). All of the pharmaceutically active compounds monitored, except diclofenac, were detected in influent and effluent wastewater. Mean concentrations measured in influent wastewater were 6.17, 0.48, 93.6, 1.83 and 5.41 microg/L for caffeine, carbamazepine, ibuprofen, ketoprofen and naproxen, respectively. Mean concentrations measured in effluent wastewater were 2.02, 0.56, 8.20, 0.84 and 2.10 microg/L for caffeine, carbamazepine, ibuprofen, ketoprofen and naproxen, respectively. Mean removal rates of the pharmaceuticals varied from 8.1% (carbamazepine) to 87.5% (ibuprofen). The existence of relationships between the concentrations of the pharmaceutical compounds, their removal rates, the characterization parameters of influent wastewaters and the WWTP control design parameters has been studied by means of statistical analysis (correlation and principal component analysis). With both statistical analyses, high correlations were obtained between the concentration of the pharmaceutical compounds and the characterization parameters of influent wastewaters; and between the removal rates of the pharmaceutical compounds, the removal rates of the characterization parameters of influent wastewaters and the WWTP hydraulic retention times. Principal component analysis showed the existence of two main components accounting for 76% of the total variability.

Limitation of the concentration of organic pollutants in sewage sludge for agricultural purposes: A case study in South Spain

In 2000, the EU published the third draft of a future sludge directive entitled "Working document on sludge" where limit values for some organic compounds, including di-(2-ethyhexyl)phthalate (DEHP), sum of nonylphenol (NP), nonyphenol mono-(NP1EO) and diethoxylates (NP2EO), seven polychlorinated biphenyl congeners (PCB), polycyclic aromatic hydrocarbons (PAH) and linear alkylbenzene sulphonates (LAS), are fixed. In the present work, the monitoring of these organic compounds in sludge samples from four wastewater treatment plants (WWTPs) is reported. All WWTPs use anaerobic biological stabilization of sludge. The highest concentration levels were found for LAS, NPE and DEHP, in this order, with, in general, anaerobically-digested dehydrated sludge and compost samples being the most contaminated samples. DEHP, NPE, LAS and PAH were found at concentration levels above the limit values fixed in the third draft of the future EU sludge directive in the 44%, 88%, 13% and 6% of the analyzed anaerobically-digested dehydrated sludge and compost samples.

Sewage sludge applied to agricultural soil: Ecotoxicological effects on representative soil organisms

Application of sewage sludge to agricultural lands is a current practice in EU. European legislation permits its use when concentrations of metals in soil do not increase above the maximum permissible limits. In order to assess the fate and the effects on representative soil organisms of sewage sludge amendments on agricultural lands, a soil microcosm (multi-species soil system-MS3) experiment was performed. The MS3 columns were filled with spiked soil at three different doses: 30, 60 and 120tha(-1) fresh wt. Seed plants (Triticum aestivum, Vicia sativa and Brassica rapa) and earthworms (Eisenia fetida) were introduced into the systems. After a 21-d exposure period, a statistically significant increase for Cd, Cu, Zn and Hg concentrations was found for the soils treated with the highest application rate. Dose-related increase was observed for nickel concentrations in leachates. Plants and earthworm metal body burden offer much more information than metal concentrations and help to understand the potential for metal accumulation. Bioaccumulation factor (BAF(plant-soil)) presented a different behavior among species and large differences for BAF(earthworm-soil), from control or sewage-amended soil, for Cd and Hg were found. B. rapa seed germination was reduced. Statistically significant decrease in fresh biomass was observed for T. aestivum and V. sativa at the highest application rate, whereas B. rapa biomass decreased at any application rate. Enzymatic activities (dehydrogenase and phosphatase) as well as respiration rate on soil microorganisms were enlarged.

Observational study of continuous spinal anesthesia with the catheter-over-needle technique for cesarean delivery

BACKGROUND

Few studies have assessed the efficacy and safety of continuous spinal anesthesia in obstetrics, although placement of a catheter in the intrathecal space theoretically offers advantages in these patients.

METHODS

Ninety-two women scheduled for elective cesarean delivery using continuous spinal anesthesia with the catheter-over-needle technique (22- or 24-gauge Spinocath) were included in the study. The doses of local anesthetic used, hemodynamic variables, use of ephedrine and other drugs, and incidence of complications such as technical failure and postdural puncture headache (PDPH) were recorded.

RESULTS

The mean (+/-SD) dose of hyperbaric bupivacaine used was 8.2+/-1.8 mg. The incidence of hypotension was 30% and the mean total dose of ephedrine was 4+/-7 mg. The continuous spinal anesthetic technique failed in 18 women (20%). The overall incidence of post-dural-puncture headache was 29%; 18% of patients with post-dural-puncture headache required a blood patch.

CONCLUSIONS

Compared to previous reports, the incidence of block failure and PDPH in this study was unacceptably high and therefore the risks of the technique appear to outweigh the advantages of continuous spinal anesthesia in obstetric practice.