Optimización del Acueducto Cabecera Urbana del Municipio de Guapi

El proyecto Optimización del Acueducto de la cabecera Municipal de Guapi -Cauca, contempla la construcción de un pozo profundo ubicado dentro de la cabecera municipal, para esto es necesario la realización de unos estudios geo eléctricos que permitirán conocer el potencial hídrico de la zona, se usará una bomba tipo lapicero sumergible capaz de captar 37.17 L/s, esta estructura permitirá captar el agua necesaria para atender las necesidades de la comunidad. Para garantizar la calidad del agua para el consumo humano se optimizará la Planta de Tratamiento de Agua Potable (PTAP) existente, la cual fue construida en 1988, actualmente sus procesos de tratamiento son ineficientes y requieren una optimización, por lo que se implementaran tecnologías novedosas. Las estructuras nuevas de la PTAP serán, un (1) tanque de almacenamiento para una capacidad de 700 M3, un (1) centro de bombeo de agua tratada con capacidad de bombeo de 114.17 L/s. Los equipos de tratamiento instalados serán una (1) torre de aireación, un (1) sistema de cloración de agua y un (1) laboratorio para medición de los parámetros de calidad. Esta optimización de la planta permitirá asegurar la calidad del agua a la comunidad. Por último, se construirán las redes de distribución que garanticen el 100% de la cobertura, en total se instalaran cerca de 24 km de redes entre los diámetros de 1” a 10” pulgadas, y el material de las tuberías será Polietileno de alta densidad (PEAD). El método de instalación de las redes será a zanja abierta y las uniones entre las tuberías se realizará por la tecnología de termofusión

Thyroid Storm and Hypoparathyroidism Caused by Anaplastic Thyroid Carcinoma

Anaplastic Thyroid Carcinoma (ATC) has an incidence of ≤ 2/1,000,000 and mean diagnosis age of 65 years (1). Fewer than 10% are \u3c50 years (2,3). Hypoparathyroidism secondary to destruction of the gland from malignant invasion is rare, accounting for ≤0.7% of all cases (4). The estimated incidence of thyroid storm is \u3c0.2/100,000 per year (5). A 48-year-old woman presents with odynophagia, night sweats, exertional dyspnea, diarrhea and swelling of the neck. A CT shows a large solid mass with cystic pockets in the thyroid measuring 12.5 cm, and multiple lung nodules consistent with metastatic cancer. She is admitted with an initial Burch HB-Wartofsky Score (BWS) of 10. TSH is \u3c0.01 mIU/L; free T4, 2.91 ng/dL; and T3, 6.44 pg/mL. Thyroid fine needle aspiration biopsy shows malignancy with a differential diagnosis of ATC versus metastatic squamous cell carcinoma. A subsequent core thyroid biopsy confirms ATC. The patient developed compressive dyspnea that resulted in hypoxic cardiac arrest followed by atrial fibrillation. She experienced persistent tachycardia, hyperthermia (101.7 F), and coma. She is diagnosed with thyroid storm (BWS of 50). Thyroid antibodies were negative. She responds to high-dose glucocorticoids, beta blockers, and propylthiouracil. Three days later, thyroid function tests, tachycardia, and fever improves, but coma persists. The ATC continues to enlarge rapidly. Fourteen days after admission, she develops hypocalcemia (5.2 mg/dL), and intact Parathyroid Hormone (iPTH) was 6.3 pg/mL. Phosphorus and magnesium are normal. Hypoparathyroidism is attributed to malignant infiltration and destruction of the parathyroid glands. She responds to enteral calcitriol and calcium citrate. Her family opts for comfort measures after 19 days of coma. Conclusion: ATC may present with thyrotoxicosis and progress to thyroid storm. Hypoparathyroidism may occur due to invasion of the parathyroid glands. References: 1. Burke JP, Hay ID, Dignan F, et al. Long-term trends in thyroid carcinoma: a population-based study in Olmsted County, Minnesota, 1935-1999. Mayo Clin Proc 2005; 80:753. 2. Kebebew E, Greenspan FS, Clark OH, et al. Anaplastic thyroid carcinoma. Treatment outcome and prognostic factors. Cancer 2005; 103:1330. 3. Nagaiah G, Hossain A, Mooney CJ, et al. Anaplastic thyroid cancer: a review of epidemiology, pathogenesis, and treatment. J Oncol 2011; 2011:542358. 4. Marcucci G, et al. HypoparaNet: A Database of Chronic Hypoparathyroidism Based on Expert Medical-Surgical Centers in Italy

Thyroid Storm and Hypoparathyroidism Caused by Anaplastic Thyroid Carcinoma

Anaplastic Thyroid Carcinoma (ATC) has an incidence of ≤ 2/1,000,000 and mean diagnosis age of 65 years (1). Fewer than 10% are \u3c50 years (2,3). Hypoparathyroidism secondary to destruction of the gland from malignant invasion is rare, accounting for ≤0.7% of all cases (4). The estimated incidence of thyroid storm is \u3c0.2/100,000 per year (5). A 48-year-old woman presents with odynophagia, night sweats, exertional dyspnea, diarrhea and swelling of the neck. A CT shows a large solid mass with cystic pockets in the thyroid measuring 12.5 cm, and multiple lung nodules consistent with metastatic cancer. She is admitted with an initial Burch HB-Wartofsky Score (BWS) of 10. TSH is \u3c0.01 mIU/L; free T4, 2.91 ng/dL; and T3, 6.44 pg/mL. Thyroid fine needle aspiration biopsy shows malignancy with a differential diagnosis of ATC versus metastatic squamous cell carcinoma. A subsequent core thyroid biopsy confirms ATC. The patient developed compressive dyspnea that resulted in hypoxic cardiac arrest followed by atrial fibrillation. She experienced persistent tachycardia, hyperthermia (101.7 F), and coma. She is diagnosed with thyroid storm (BWS of 50). Thyroid antibodies were negative. She responds to high-dose glucocorticoids, beta blockers, and propylthiouracil. Three days later, thyroid function tests, tachycardia, and fever improves, but coma persists. The ATC continues to enlarge rapidly. Fourteen days after admission, she develops hypocalcemia (5.2 mg/dL), and intact Parathyroid Hormone (iPTH) was 6.3 pg/mL. Phosphorus and magnesium are normal. Hypoparathyroidism is attributed to malignant infiltration and destruction of the parathyroid glands. She responds to enteral calcitriol and calcium citrate. Her family opts for comfort measures after 19 days of coma. Conclusion: ATC may present with thyrotoxicosis and progress to thyroid storm. Hypoparathyroidism may occur due to invasion of the parathyroid glands. References: 1. Burke JP, Hay ID, Dignan F, et al. Long-term trends in thyroid carcinoma: a population-based study in Olmsted County, Minnesota, 1935-1999. Mayo Clin Proc 2005; 80:753. 2. Kebebew E, Greenspan FS, Clark OH, et al. Anaplastic thyroid carcinoma. Treatment outcome and prognostic factors. Cancer 2005; 103:1330. 3. Nagaiah G, Hossain A, Mooney CJ, et al. Anaplastic thyroid cancer: a review of epidemiology, pathogenesis, and treatment. J Oncol 2011; 2011:542358. 4. Marcucci G, et al. HypoparaNet: A Database of Chronic Hypoparathyroidism Based on Expert Medical-Surgical Centers in Italy

Fall Prevention in the Emergency Department

https://scholarlycommons.baptisthealth.net/cohort-6-ebp-showcase/1021/thumbnail.jp

Gasificación de carbones colombianos en lecho fluidizado

IP 1118-06-192-95gasificacion de carbon / Alonso Ocampo O., Jaime Aguirre C. yCarlos Londoño G. -- En: Carbon : factor de;desarrollo integral siglo XXI. Memorias / Congreso Nacional yInternacional de Ciencia y Tecnologia del;Carbon. (4 y 2 : 1998 mayo 19-22 : Paipa (Boyaca) Colombia. --[s.l. : s.n.], 1998. -- p. -- Balance de masa y;energia de un gasificador basado en equilibrio quimico / E. Arenas ... [etal.]. -- En: Carbon : factor de;desarrollo integral siglo XXI. Memorias / Congreso Nacional yInternacional de Ciencia y Tecnologia del;Carbon. (4 y 2 : 1998 mayo 19-22 : Paipa (Boyaca) Colombia. --[s.l. : s.n.], 1998. -- p. -- Effect of;pyrolysis conditions on the CO2 catalytic gasification ofchar/A. Molina... [et al.]. -- En: Proceedings /;International Conference on Coal Science (9 : 1997 Sept. 7-12:Essen, Germany). -- Essen : [s.n.], 1997. --;p. -- ARTICULO(S) EN REVISTA: Reactivity of coal gasificationwith steam and CO2 / Alejandro Molina and Fanor;Mondragon. -- En: Fuel. -- Vol. 77, no. 15 (1998); p. 1831-1839.-- ISSN 00162361 -- CO2 strong chemisorption;as an estimate of coal char gasification reactivity / AlejandroMolina, Alejandro Montoya, Fanor Mondragon.; En: Fuel. -- Vol. 78 (1999); p. 971-977. -- ISSN 001623-61-Prediccionde los principales productos de la;gasificacion del carbon / Erika Arenas Castiblanco ... [etal.].'-- en: energia y computacion. -- Vol. 8, no.;1 (ene.-jun. 1999); p. 62-66. -- ISSN 01215299.;and Alejandro Molina. -- En: Prospects for coal science in21stcentury ed. Pekin (Beijing) : Shanxi Science &;Technology Press, 1999. -- p. -- PONENCIA(S) EN CONGRESO:Actividad catalitica de hierro y niquel en la;gasificacion con CO2 de semicoques de Amaga y Titiribi / A. Montoya ... [et al.]. -- En: Carbon : factor de;desarrollo integral siglo XXI. Memorias / Congreso Nacional yInternacional de Ciencia y Tecnologia del;Carbon. (4 y 2 : 1998 mayo 19-22 : Paipa (Boyaca) Colombia. --[s.l. : s.n.], 1998. -- p. -- Efecto de las;condiciones de pirolisis en la gasificacion de CO2 de semicoquescon K como catalizador / A. Molina, F.;Mondragon. -- En: Carbon : factor de desarrollo integral sigloXXI. Memorias / Congreso Nacional y;Internacional de Ciencia y Tecnologia del Carbon. (4 y 2 :1998mayo 19-22: Paipa (Boyaca) Colombia. -- [s.l.;: s.n.], 1998. -- p. -- Utilizacion de la quimisorcion deCO2,en el estudio de la reactividad de semicoques;durante la gasificacion con CO2 / A. Molina, F. Mondragon.--En: Carbon :factor de desarrollo integral siglo;XXI. Memorias / Congreso Nacional y Internacional de Ciencia yTecnologiadel Carbon. (4 y 2 : 1998 mayo 19-22;: Paipa (Boyaca) Colombia. -- [s.l. : s.n.], 1998. -- p. -'- Simulacion y diseño de una planta piloto de;CAPITULO(S) EN LIBRO: Evolution of pore structure and surfacearea duringgasification of coal char with CO2;and H2O / Alejandro Montoya, Elizabeth Florez and Fanor Mondragon. -- En:Prospects for coal science in 21st;century ed. Pekin (Beijing) : Shanxi Science & TechnologyPress,1999. --p. -- CO2 chemisorption on chars;loaded with K, Fe and Ni and its relation to CO2 gasificationreactivity /Fanor Mondragon, Alejandro Montoy

Colorectal resection in emergency general surgery: An EAST multicenter trial

OBJECTIVE Evidence comparing stoma creation (STM) versus anastomosis after urgent or emergent colorectal resection is limited. This study examined outcomes after colorectal resection in emergency general surgery patients. METHODS This was an Eastern Association for the Surgery of Trauma-sponsored prospective observational multicenter study of patients undergoing urgent/emergent colorectal resection. Twenty-one centers enrolled patients for 11 months. Preoperative, intraoperative, and postoperative variables were recorded. ?2, Mann-Whitney U test, and multivariable logistic regression models were used to describe outcomes and risk factors for surgical complication/mortality. RESULTS A total of 439 patients were enrolled (ANST, 184; STM, 255). The median (interquartile range) age was 62 (53-71) years, and the median Charlson Comorbidity Index (CCI) was 4 (1-6). The most common indication for surgery was diverticulitis (28%). Stoma group was older (64 vs. 58 years, p \u3c 0.001), had a higher CCI, and were more likely to be immunosuppressed. Preoperatively, STM patients were more likely to be intubated (57 vs. 15, p \u3c 0.001), on vasopressors (61 vs. 13, p \u3c 0.001), have pneumoperitoneum (131 vs. 41, p \u3c 0.001) or fecal contamination (114 vs. 33, p \u3c 0.001), and had a higher incidence of elevated lactate (149 vs. 67, p \u3c 0.001). Overall mortality was 13%, which was higher in STM patients (18% vs. 8%, p = 0.02). Surgical complications were more common in STM patients (35% vs. 25%, p = 0.02). On multivariable analysis, management with an open abdomen, intraoperative blood transfusion, and larger hospital size were associated with development of a surgical complication, while CCI, preoperative vasopressor use, steroid use, open abdomen, and intraoperative blood transfusion were independently associated with mortality. CONCLUSION This study highlights a tendency to perform fecal diversion in patients who are acutely ill at presentation. There is a higher morbidity and mortality rate in STM patients. Independent predictors of mortality include CCI, preoperative vasopressor use, steroid use, open abdomen, and intraoperative blood transfusion. Following adjustment by clinical factors, method of colon management was not associated with surgical complications or mortality. LEVEL OF EVIDENCE Therapeutic study, level IV

Validation of the American Association for the Surgery of Trauma Emergency General Surgery Grading System for Colorectal Resection: An EAST Multicenter Study

BACKGROUND: The American Association for the Surgery of Trauma (AAST) has developed a grading system for emergency general surgery (EGS) conditions. We sought to validate the AAST EGS grades for patients undergoing urgent/emergent colorectal resection. METHODS: Patients enrolled in the Eastern Association for the Surgery of Trauma Multicenter Colorectal Resection in EGS-to anastomose or not to anastomose study undergoing urgent/emergent surgery for obstruction, ischemia, or diverticulitis were included. Baseline demographics, comorbidity severity as defined by Charlson comorbidity index (CCI), procedure type, and AAST grade were prospectively collected. Outcomes included length of stay (LOS) in-hospital mortality, and surgical complications (superficial/deep/organ-space surgical site infection, anastomotic leak, stoma complication, fascial dehiscence, and need for further intervention). Multivariable logistic regression models were used to describe outcomes and risk factors for surgical complication or mortality. RESULTS: There were 367 patients, with a mean (± SD) age of 62 ± 15 years. 39% were women. The median interquartile range (IQR) CCI was 4 (2-6). Overall, the pathologies encompassed the following AAST EGS grades: I (17, 5%), II (54, 15%), III (115, 31%), IV (95, 26%), and V (86, 23%). Management included laparoscopic (24, 7%), open (319, 87%), and laparoscopy converted to laparotomy (24, 6%). Higher AAST grade was associated with laparotomy ( = .01). The median LOS was 13 days (8-22). At least 1 surgical complication occurred in 33% of patients and the mortality rate was 14%. Development of at least 1 surgical complication, need for unplanned intervention, mortality, and increased LOS were associated with increasing AAST severity grade. On multivariable analysis, factors predictive of in-hospital mortality included AAST organ grade, CCI, and preoperative vasopressor use (odds ratio (OR) 1.9, 1.6, 3.1, respectively). The American Association for the Surgery of Trauma emergency general surgery grade was also associated with the development of at least 1 surgical complication (OR 2.5), while CCI, preoperative vasopressor use, respiratory failure, and pneumoperitoneum were not. CONCLUSION: The American Association for the Surgery of Trauma emergency general surgery grading systems display construct validity for mortality and surgical complications after urgent/emergent colorectal resection. These results support incorporation of AAST EGS grades for quality benchmarking and surgical outcomes research

Validation of the American Association for the Surgery of Trauma Emergency General Surgery Grading System for Colorectal Resection: An EAST Multicenter Study

The American Association for the Surgery of Trauma (AAST) has developed a grading system for emergency general surgery (EGS) conditions. We sought to validate the AAST EGS grades for patients undergoing urgent/emergent colorectal resection. Patients enrolled in the "Eastern Association for the Surgery of Trauma Multicenter Colorectal Resection in EGS-to anastomose or not to anastomose" study undergoing urgent/emergent surgery for obstruction, ischemia, or diverticulitis were included. Baseline demographics, comorbidity severity as defined by Charlson comorbidity index (CCI), procedure type, and AAST grade were prospectively collected. Outcomes included length of stay (LOS) in-hospital mortality, and surgical complications (superficial/deep/organ-space surgical site infection, anastomotic leak, stoma complication, fascial dehiscence, and need for further intervention). Multivariable logistic regression models were used to describe outcomes and risk factors for surgical complication or mortality. There were 367 patients, with a mean (± SD) age of 62 ± 15 years. 39% were women. The median interquartile range (IQR) CCI was 4 (2-6). Overall, the pathologies encompassed the following AAST EGS grades: I (17, 5%), II (54, 15%), III (115, 31%), IV (95, 26%), and V (86, 23%). Management included laparoscopic (24, 7%), open (319, 87%), and laparoscopy converted to laparotomy (24, 6%). Higher AAST grade was associated with laparotomy ( = .01). The median LOS was 13 days (8-22). At least 1 surgical complication occurred in 33% of patients and the mortality rate was 14%. Development of at least 1 surgical complication, need for unplanned intervention, mortality, and increased LOS were associated with increasing AAST severity grade. On multivariable analysis, factors predictive of in-hospital mortality included AAST organ grade, CCI, and preoperative vasopressor use (odds ratio (OR) 1.9, 1.6, 3.1, respectively). The American Association for the Surgery of Trauma emergency general surgery grade was also associated with the development of at least 1 surgical complication (OR 2.5), while CCI, preoperative vasopressor use, respiratory failure, and pneumoperitoneum were not. The American Association for the Surgery of Trauma emergency general surgery grading systems display construct validity for mortality and surgical complications after urgent/emergent colorectal resection. These results support incorporation of AAST EGS grades for quality benchmarking and surgical outcomes research

Colorectal resection in emergency general surgery: An EAST multicenter trial.

ObjectiveEvidence comparing stoma creation (STM) versus anastomosis after urgent or emergent colorectal resection is limited. This study examined outcomes after colorectal resection in emergency general surgery patients.MethodsThis was an Eastern Association for the Surgery of Trauma-sponsored prospective observational multicenter study of patients undergoing urgent/emergent colorectal resection. Twenty-one centers enrolled patients for 11 months. Preoperative, intraoperative, and postoperative variables were recorded. χ, Mann-Whitney U test, and multivariable logistic regression models were used to describe outcomes and risk factors for surgical complication/mortality.ResultsA total of 439 patients were enrolled (ANST, 184; STM, 255). The median (interquartile range) age was 62 (53-71) years, and the median Charlson Comorbidity Index (CCI) was 4 (1-6). The most common indication for surgery was diverticulitis (28%). Stoma group was older (64 vs. 58 years, p < 0.001), had a higher CCI, and were more likely to be immunosuppressed. Preoperatively, STM patients were more likely to be intubated (57 vs. 15, p < 0.001), on vasopressors (61 vs. 13, p < 0.001), have pneumoperitoneum (131 vs. 41, p < 0.001) or fecal contamination (114 vs. 33, p < 0.001), and had a higher incidence of elevated lactate (149 vs. 67, p < 0.001). Overall mortality was 13%, which was higher in STM patients (18% vs. 8%, p = 0.02). Surgical complications were more common in STM patients (35% vs. 25%, p = 0.02). On multivariable analysis, management with an open abdomen, intraoperative blood transfusion, and larger hospital size were associated with development of a surgical complication, while CCI, preoperative vasopressor use, steroid use, open abdomen, and intraoperative blood transfusion were independently associated with mortality.ConclusionThis study highlights a tendency to perform fecal diversion in patients who are acutely ill at presentation. There is a higher morbidity and mortality rate in STM patients. Independent predictors of mortality include CCI, preoperative vasopressor use, steroid use, open abdomen, and intraoperative blood transfusion. Following adjustment by clinical factors, method of colon management was not associated with surgical complications or mortality.Level of evidenceTherapeutic study, level IV