Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.

Submitted by Simone Souza (simonecgsouza@hotmail.com) on 2017-10-13T15:14:41Z No. of bitstreams: 1 DISS_2014_Lediane Leslie Campos Ramos.pdf: 3409711 bytes, checksum: 0b979d9b033509b0f053399204bcbcc1 (MD5) / Approved for entry into archive by Jordan (jordanbiblio@gmail.com) on 2017-11-07T10:27:32Z (GMT) No. of bitstreams: 1 DISS_2014_Lediane Leslie Campos Ramos.pdf: 3409711 bytes, checksum: 0b979d9b033509b0f053399204bcbcc1 (MD5) / Made available in DSpace on 2017-11-07T10:27:32Z (GMT). No. of bitstreams: 1 DISS_2014_Lediane Leslie Campos Ramos.pdf: 3409711 bytes, checksum: 0b979d9b033509b0f053399204bcbcc1 (MD5) Previous issue date: 2014-02-27 / Devido a precariedade e a falta de rede pública coletora de esgoto na cidade de Cuiabá é grande a procura por serviços das empresas de limpa fossa, o que torna-se um problema, dado que o lodo gerado pelos sistemas de fossas sépticas comporta concentrações expressivas de nutrientes, matéria orgânica, poluentes inorgânicos e organismos patogênicos. O presente estudo tem como objetivo o diagnostico e avaliação da destinação final do lodo de fossa e de tanque séptico em Cuiabá/MT, e propor medidas de adequação de tratamento. Para isso, foram realizadas entrevistas junto às empresas prestadoras deste serviço, e levantamentos junto à Estação de Tratamento de Esgoto Tijucal (ETE Tijucal). A estação é composta por tratamento preliminar (caixa de areia, gradeamento e calha Parshall), dois reatores UASB, uma lagoa anaeróbia, seguida por duas lagoas facultativas em paralelo, e uma lagoa de maturação. Sua capacidade atual de tratamento é de 50 L/s, mas recebe uma vazão diária de 56,23 L/s. Levantamentos realizados neste trabalho indica que a vazão recebida diariamente pode ser maior que a apresentada pela Empresa responsável pela administração da ETE. Além da quantificação do volume de lodo lançado diariamente foi realizado a caracterização com determinação dos seguintes parâmetros: pH, Temperatura, Alcalinidade, Sólidos totais, Sólidos voláteis totais, Sólidos fixos, Sólidos sedimentáveis, Óleos e graxas, DBO, DQO, Fósforo total, Nitrogênio Kjeldahl. De acordo com o resultado da caracterização e comparação com estudos realizados nesta linha de pesquisa identificou-se um possível sistema de tratamento para o lodo de fossas e tanques sépticos. / Due to insecurity and lack of public collector sewer in the city of Cuiabá is great demand for the services of clean fossa companies, which becomes a problem, since the sludge generated by septic tank systems entails significant concentrations of nutrients, organic matter, inorganic pollutants and pathogenic organisms. The present study aims at the diagnosis and evaluation of the final destination of the sludge pit and septic tank in Cuiabá / MT, and proposes measures of adequacy of treatment. For this survey interviews were held with the companies providing this service, and with the Tijucal Sewage Treatment Station (ETE Tijucal). The station consists of preliminary treatment (sandbox, railing and Parshall), two UASB, anaerobic pond, facultative pond followed by two in parallel, and a maturation pond. Your current treatment capacity is 50 L / s, but receives a daily flow of 56.23 L / s. Surveys conducted in this paper indicates that the daily flow received may be higher than that presented by the company responsible for the management of ETE. Besides quantifying the volume of sludge released daily characterization was carried out by determining the following parameters: pH, temperature, alkalinity, total Total solids, volatile solids, fixed solids, settleable solids, oils and grease, BOD, COD, Total Phosphorus, Nitrogen Kjeldahl. According to the results of the characterization and comparison with studies conducted in this research identified a possible treatment system for the sludge pits and septic tanks.

Sepsis has been defined as a systemic response to an infection. With an incidence of 3 per 1000 population per year or about 750 000 cases a year, this syndrome ranks as the 10th leading cause of death in the United States (1). Increasing severity of sepsis correlates with increasing mortality, which rises from 30-40% for severe sepsis up to 40-60% for septic shock. This thesis examines the effectiveness of adjunctive therapies, including activated protein C, hypercapnia and acidosis, and sodium selenite, in a clinically relevant ovine model of septic shock. The results from these studies can provide valuable information for future clinical trials on sepsis.<p>This thesis is divided into four sections: 1) sepsis overview; 2) an autologous fecal peritonitis model in sheep and its evaluation; 3) the series of studies on adjunctive therapeutics; and 4) ongoing studies and future perspective.<p>In the first section, a broad overview gives a rough introduction to delineate many aspects of sepsis syndrome such as terminology, etiology, epidemiology, pathophysiology and current guidelines for management. Hemodynamics in sepsis are especially elaborated since these are major observations throughout the studies presented later.<p>In the second section, the general characteristics of the sepsis models used in this thesis are elucidated. Data on hemodynamics, lung mechanics, gas exchange, etc. are presented to feature the ovine peritonitis model. The results of laboratory examinations for hematology, coagulation, bacteriology, biochemistry and hormonology are also presented. And then, I review currently used sepsis models with regards to their advantages and disadvantages.<p>The third section discusses three studies with their objectives, the methods used, the major findings, and the potential clinical implications.<p>9<p>1) Beneficial effects of recombinant human activated protein C in experimental septic shock. Activated protein C has a multitude of beneficial effects in severe sepsis and septic shock, including anti-inflammation, anti-coagulation, profibrinolysis, anti-apoptosis and endothelial protection. A clinical Phase III trial demonstrated that the administration of recombinant human activated protein C improved survival in patients with severe sepsis. However, doubts on the protective effects of activated protein C have persisted and been refueled by the recently published negative trials in less severely ill patients and in children. In the light of these ambiguities and uncertainties, we reinvestigated the effects of activated protein C in experimental septic shock.<p>2) Acute hypercapnia improves indices of tissue oxygenation more than dobutamine in septic shock. Hepercapnia has been found to possess beneficial effects in diverse acute inflammatory states independent of protective lung mechanics. To prove the hypothesis that acute hypercapnia has similar or superior hemodynamic effects to those of a dobutamine infusion, which may be particularly relevant in the presence of hemodynamic instability associated with respiratory failure, we investigated the effects of hypercapnia, which induced by inspiring extrinsic carbon dioxide in experimental septic shock.<p>3) High bolus dose of sodium selenite prolongs survival in an ovine model of septic shock. Selenite has both pro- and anti-oxidant effects. The administration of high dose sodium selenite may improve survival in septic shock patients. The benefit may be greater with the administration of a bolus (to achieve higher concentrations) rather than a continuous infusion. To test this hypothesis, we examined the effects of a high dose bolus administration of sodium selenite in experimental septic shock.<p>The fourth and final section talks about currently ongoing studies and offers some perspective on future direction. / Doctorat en Sciences médicales / info:eu-repo/semantics/nonPublished

Diss. (sammanfattning) Stockholm : Karol. inst., 2006. / Härtill 4 uppsatser.

Call number: LD2668 .T4 1984 A43 / Master of Science

Sepsis and its manifestation as a shock state in “septic shock” have long caused medical issues and death worldwide. The disease requires quick identification, diagnosis, and intervention with very high mortality rates prevalent otherwise. Historically this has been due to limited awareness of the disease and misclassification of its prevalence, severity, and incidence. Luckily in the past decade there has been increased interest and therefore resources devoted towards improving care and further understanding a disease that is one of the leading causes of mortality in hospitals worldwide. Over the past handful of years novel interventions and diagnostic techniques have become available. Unfortunately, in many cases these new discoveries have not yet trickled down to many of the providers on the frontline and a large amount of variation in care exists across the country. Because of the time sensitivity of sepsis, it is imperative that individuals working in the areas of healthcare who first come in contact with these patients have a clear understanding of the newest advances and resources available. In this thesis the goal is to first analyze the current protocols and standards of care for sepsis and then secondly consider new developments available both in the hospital and in prehospital emergency medical services (EMS). From the current information, strategies and protocols based on improvement of patient outcomes, can be streamlined and optimized moving forward. As predicted, there is currently an incredibly large amount of variation and knowledge on the subject with some areas implementing very progressive protocols while others still lack a sepsis protocol all together. In general, the current consensus in the field is that rapid identification and initiation of treatment is the most important component to long term survival. Improvement of outcomes therefore relies on standardization of protocols with incorporation of education components for healthcare providers. This aims to raise awareness and encourage utilization of the newest information and suggestions available. Increased interdisciplinary cooperation between prehospital providers in EMS and care providers in the hospital can also lead to improvement of recognition and treatment times for these patients. Future considerations were also examined that may potentially be applicable moving forward to improve these standards even further. There is a much opportunity available in each of these areas currently and progress is key to improving outcomes.

The purpose of this study was to examine whether any environmental benefits were obtained when the emptying of sludge from septic tanks were carried out with a dewatering technique using polymers compared to complete pump-out. The mean value of transport distance, fuel consumption, CO2 emissions and the weight of waste per septic tank emptying was calculated for each emptying method. For this, data on transport distance, fuel consumption, CO2 emissions per liter of fuel and number of emptied septic tanks were used. An energy audit over a sewage treatment plant was used to calculate the energy consumption for the treatment of the waste from the two emptying techniques. The environmental impact of the use of polymers and the returning of reject water to the septic tank was examined by studying the literature in the research field. The result showed that emptying with a dewatering technique compared to complete pump-out resulted in shorter transports, less fuel consumption, lower CO2 emissions, less waste and a lower energy consumption for waste treatment. The use of polymers in sludge dewatering should not have any adverse effects on aquatic organisms or health impacts if the dosage and the design of the treatment plant is correct. It is not established whether the return of reject water have any environmental effects. In conclusion this report shows that the emptying of septic tanks with a dewatering technique is better than complete pump-out from an environmental point of view.

Sepse bacteriana é a maior causa de morbimortalidade na faixa etária pediátrica e neonatal. A detecção precoce do quadro séptico é difícil, devido os sinais iniciais da doença serem inespecíficos. A possibilidade da existência de exame laboratorial capaz de identificar precocemente quadros sépticos melhoraria o prognóstico desses pacientes. Várias proteínas de fase aguda foram estudadas como marcadores de infecção sendo a proteína C reativa (PCR) a mais utilizada. A procalcitonina (PCT), um pró-hormônio, encontra-se elevado precocemente em quadros sépticos em crianças e adultos. Estudo prospectivo com 14 crianças submetidas à cirurgia cardíaca com circulação extra-corpórea (CEC), com dosagens seriadas de procalcitonina e proteína C reativa, serviram como modelo de resposta inflamatória sistêmica sem infecção com dosagens antes da CEC, após a CEC no primeiro, segundo e terceiro dia após cirurgia, enquanto 14 crianças com sepse/choque séptico dosagens seriadas de PCT e PCR foram obtidas sequencialmente antes do tratamento antibioticoterápico e a cada dia até o terceiro dia. Em crianças sépticas a PCT demonstrou ser superior a PCR como marcador de sepse assim como para diferenciar quadros inflamatórios sistêmicos. / Bacterial sepsis is a major cause of morbidity and mortality in neonates and children. Early detection of bacterial sepsis is difficult because the first signs of this disease may be minimal or nonspecific. The availability of a laboratory test to accurately and rapidly identify septic neonates and children would be of great value in improving the outcome of these patients. Several acute-phase proteins have been used for the diagnosis of bacterial sepsis and C reactive protein (CRP) is the usual marker. It has been reported that the concentration of procalcitonin (PCT), a pro-hormone, is markedly higher in children and adults with sepsis. In a prospective study, 14 children were enrolled after cardiac surgery with cardiopulmonary bypass (CPB), these group represent the non infected children with inflammatory response. Blood samples were obtained before CPB, after CPB, on the first, second and third day after surgery. Another group with 14 children with sepsis or septic shock were enrolled, and blood samples were obtained before antibiotic start, on the first, second and third days. In septic children PCT concentration is a better diagnostic marker of sepsis and to differentiate inflammatory response than CRP.

The wide use and the incomplete metabolism of antibiotics, along with the poor removal efficiency of current treatment systems, results in the introduction of large quantities of antibiotics to the environment through the discharge of treated and untreated wastewater. If not treated or attenuated near the source of discharge, the antibiotics can be distributed widely in the environment. In this research, sulfamethoxazole (SMX), a common sulfonamide antibiotic, was selected as a model compound due to its presence in the environment and its resistance to remediation and natural attenuation. Among the various entry routes, discharges from on-site disposal systems are of particular interest due to the wide use of these systems. The complex nature of subsurface transport downstream of these systems adds difficulties to the removal of SMX from subsurface discharges. For this research, two processes that impact SMX removal, biodegradation and sorption, were examined to determine the primary factors governing the elimination of SMX from septic effluent discharges in the subsurface. To characterize the biodegradation of SMX, batch experiments were conducted with SMX in the presence of septic effluent and soil for both aerobic and anoxic conditions. Results showed that SMX removal was limited in the septic effluent but increased in the presence of soil, demonstrating the important role of the soil in SMX removal in both aerobic and anoxic conditions. Addition of external nutrients (ammonium and sulfate) had small effects on SMX removal, although SMX removal was enhanced under aerobic condition with increased dissolved organic carbon. To overcome the limited sorption of SMX on soil, soil amendments were developed and evaluated using biochar, a green and cost-effective adsorbent. Biochars produced from different types of feedstock were characterized for different pyrolysis temperatures, and their adsorption behaviors were examined and compared with commercial biochar and activated carbon (AC). Adsorption isotherms were developed and adsorption kinetics of soil, biochar and AC were studied. Results showed that adsorption on soil, biochar and AC followed three different kinetics models and their equilibrium isotherms followed the Freunlich model. Higher adsorption rates were achieved with biochars prepared at the higher temperature. A lab-engineered biochar with pine sawdust at 500 °C achieved comparable sorption capacity to AC. SMX transport in subsurface was also explored with saturated soil columns filled with soil that was mixed with biochar at different percentages. Significant SMX removal (including complete elimination at a low flowrate and over 90 % elimination at a high flowrate) for all cases was primarily attributed to biodegradation. These results provide insight into the transport and transformations affecting SMX, and then provide a basis for developing low-cost approaches for the mitigation of SMX.

Le choc septique est défini par une hypotension persistante malgré un remplissage vasculaire adéquat en présence d’une réponse inflammatoire systémique suite à une infection. Il est responsable de 10% des admissions en réanimation et malgré des progrès thérapeutiques constants, la mortalité liée au sepsis varie entre 30% et 60% dans les cas de choc septique. Dans 50% des cas, le choc septique est associé à une insuffisance surrénale relative ce qui diminue la probabilité de survie des patients. Les patients sont alors traités avec de l’hydrocortisone et de la fludrocortisone, mais ce traitement est très controversé. Pour la première fois, nous avons pu mettre au point et valider une technique de quantification de la fludrocortisone plasmatique après une prise de 50 μg. Cette technique a pu ensuite être utilisée pour l’obtention de l’étude pharmacocinétique/pharmacodynamique de la fludrocortisone chez le volontaire sain et le patient septique avec insuffisance surrénale relative. Enfin, nous avons étudié la distribution et l’élimination de cette molécule chez la souris saine et deux modèles de sepsis. Les paramètres pharmacocinétiques montrent que la demi-vie de la fludrocortisone est d’environ 1 h, avec un délai d’absorption d’environ 50 minutes. Nos travaux ont permis de mettre en évidence qu’il existe deux populations de patients : les absorbants et les non-absorbants la fludrocortisone, qui représentent 30 % des patients testés, ce qui pourrait être à l’origine de la controverse sur les effets bénéfiques de cette molécule sur la survie des patients. Cependant nous n’avons pu mettre en évidence aucun effet hémodynamique de cette molécule sur les patients septiques. / The septic shock is defined by persistent hypotension despite fluid resuscitation with systemic inflammation due to infection. This is the cause of 10% of the admission in intensive care unit. Despite steady progress in therapeutics, the mortality of patients with sepsis varies between 30% to 60% for a septic shock. In 50%, the septic shock is associated to relative adrenal insufficiency which decrease survival probability of the patients. The patients receive hydrocortisone and fludrocortisone but this treatment is still controversial. For the first time, we developped and validated a quantification method of low concentration fludrocortisone in plasma. This method were used for the pharmacokinetic/pharmacodynamic study of fludrocortisone in healthy volunteers and patients with septic shock associated with relative adrenal insufficiency. Then we studied the distribution and elimination of this molecule in two mice models of sepsis. The pharmacokinetic parameters show that the half-life of fludrocortisone is about 1h and the delay of absorption is about 50min. Our study shows two groups of patients : absorbent patients and non-absorbent patients which have no detectable fludrocortisone concentrations in plasma. This population represents 30% of the population. This could be the reason of the controversial results. No hemodynamic effetc were found in patients with septic shock due to fludrocortisone after low-dosage administration.