Prescribing patterns of tramadol in hemodialysis patients

Background: Pain is the most common complaint in hemodialysis patients. Tramadol had become analgesic of choice in these patients, and its prescription is increasing day by day. With this background, we evaluated the prescribing trends of tramadol in patients undergoing maintenance hemodialysis.Methods: A total of 70 prescriptions were audited to assess the prescribing trends of tramadol (usually prescribed as a combination of 37.5 mg tramadol and 325 mg of paracetamol two times a day). Included prescriptions were from both male and female patients above 18 years of age undergoing maintenance hemodialysis. Demographic, clinical and medication use were recorded from the patients.Results: The mean age of patients was 48±11.7 years, duration of dialysis 2.2±1.4 years. Tramadol consumptions were observed in 40/70 (56%) of patients. Majority of tramadol consumption was found in 30/40 (75%) males, 23/40 (59%) between 40-59 years and 28/40 (70%) undergoing two dialyses per week and 13/40 (32.5) were diabetics. During our exploratory analysis, we found that 15/40 (38%) of tramadol users, were concurrently prescribed with clonidine as add on antihypertensive. We noticed that the tramadol pill count during the preceding week was 81 in patients concurrently using clonidine and 139 in the patients who were not using clonidine (p>0.05).Conclusions: In our study, tramadol consumptions were observed in 56% of patients. We also noticed analgesic interaction between clonidine and tramadol

La microflore de boues aérobies acclimatées à des teneurs élevées en graisse

Le travail présenté dans cet article a pour but d'isoler les principaux micro-organismes impliqués dans la biodégradation des lipides concentrés dans des réacteurs spécifiques de stations d'épuration des eaux et d'étudier leur action sur ce type de substrat.La microflore d'une boue activée « classique » est comparée à celle de boues acclimatées à des teneurs élevées en lipides selon un nouveau procédé « BIOMASTER® G ». Cela montre un enrichissement en bactéries fortement lipolytiques dans le système à l'équilibre. En effet, la boue activée « classique » ne contient aucun microorganisme fortement lipolytique alors qu'à partir de la boue acclimatée du même site on a pu en isoler, Acinetobacter calcoaceticus et Pseudomonas putida étant les constituants les plus actifs. L'utilisation de bioadditifs du commerce pour l'ensemencement des pilotes au lancement du système ne semble pas apporter d'avantages décisifs puisqu'on ne retrouve pas à l'équilibre les micro-organismes contenus dans ces bioadditifs. Par contre, d'autres microorganismes à pouvoir lipolytique élevé sont détectés tels que Pseudomonas sp., Aeromonas hydrophila et Staphylococcus sp . Le genre Pseudomonas est par ailleurs presque toujours rencontré quelle que soit la boue acclimatée examinée. De même, on peut noter la quasi absence de bactéries Gram positif.Tous les isolats Gram négatif dégradent plus ou moins les acides gras de longueur de chaîne variée. Le seul isolat Gram positif est inhibé ou même tué par les acides gras à chaîne moyenne ou courte et cela peut contribuer à la pauvreté en bactéries Gram positif dans les boues acclimatées. Les genres principaux que nous avons rencontrés, Pseudomonas, Acinetobacter et Aeromonas, sont capables d'assurer à la fois la lipolyse (libération des acides gras) et l'oxydation subséquente des acides gras. L'enrichissement naturel de la microflore lipolytique des boues activées dans le procédé aboutit à une microflore acclimatée capable d'assurer la biodégradation complète des lipides.In this study, the main microorganisms involved in lipid biodegradation in activated sludge sewage treatment plants were isolated and their action on triglycerides and on fatty acids was investigated.Six different sludge samples were studied. An activated sludge of the usual type (A) was used as reference. At the same site, activated sludge was adapted to higher lipid levels, through separation of fats reaching the sewage treatment plant, followed by their addition in higher proportion to activated sludge. In experiment B, adaptation took place in a « BIOMASTER® G » reactor, which is a new process for the elimination of fats by an aerobic treatment. Experiments C and D used the same original sludge plus lipid mixture, but with the addition of commercial bioadditives containing lipolytic bacteria. Finally, microorganisms isolated from two other systems, located at two other sites, were also studied (experiments E and F).The control activated sludge, A, did not contain any strongly lipolytic microorganisms. On the other hand, in the new system at equilibrium, after adaptation, bacteria with a strong lipolytic potential such as Acinetobacter calcoaceticus and, Pseudomonas putida were isolated. The use of bioadditives at the start of the incubation did not afford any notable advantage, since at equilibrium microorganisms contained in these additives were not reisolated. However, other microorganisms with high lipolytic power (activity higher than 0.1 µmole acid liberated per minute and per ml of culture broth) were isolated, such as Pseudomorns sp., Aeromonas hydrophila and Staphylococcus sp. The genus Pseudomozas was almost always detected, regardless of the acclimated sludge studied. Conversely, Gram positive bacteria were virtually absent.All Gram negative isolates were more or less capable of degrading fatty acids with various chain lengths. The only Gram positive isolate was inhibited, even killed, by short and medium chain fatty acids. In the present study, this might contribute to the paucity of Gram positive bacteria in the adapted sludges. The main genera encountered, Pseudomonas, Acinetobacter and Aeromonas, were able to perform both lipolysis (liberation of fatty acids) and the subsequent oxidation of the liberated fatty acids. The natural enrichment of the lipolltic microflora of activated sludges in the process leads to an acclimated microflora, able to completely biodegrade lipids

Elimination de la matière organique biodégradable par ultrafiltration

Les installations de production de la Compagnie des Eaux de banlieue (CEB) au Mont Valérien traitent l'eau de Seine en aval de Paris sur 2 filières de potabilisation comprenant pour la première (50 000 m3/J) une préozonation, une coagulation au sels d'Aluminium (Aqualenc), une décantation (super pulsator Degrémont), une filtration sur sable, une ozonation, une filtration sur charbon actif en grains (CAG) et une désinfection finale au bioxyde de chlore, et pour la deuxième, une filtration lente sur sable (80 000 m3/j) dite filtration "Chabale".Dans le cadre du remplacement de la filière "Chabale", une unité de démonstration (8 m3/h) eomprenaut une addition de charbon actif en poudre (CAP) avant ultrafiltration sur membrane a été mise en route.Dans cette étude, une comparaison du traitement conventionnel physico-chimique de l'usine et du nouveau procédé d'ultrafiltration a été effectuée. Pour cela, un suivi du carbone organique total et une évaluation du potentiel de reviviscence ont été réalisés en différents points des chaînes de traitement. La matière organique biodégradable (MOB) a été mesurée par la méthode Werner (1980).Les premiers résultats montrent :- l'élimination des MOB est comparable pour les différents procédés;- toutefois, la nature des MOB est sensiblement affectée à chaque type de traitement (ozonation, addition de CAP, filtration sur sable ou sur CAG)."Compagnie des Eaux de Banlieue" water facilities located at the Mont-Valérien treat the Seine river water downstream Paris. A first facility (5000 m3/day) includes the following processes : preozonation, coagulation, settling, sand filtration, postozonalion, GAC filtration and a final desinfection (CIO2). A second one consists in a biological sand filtration (80000 m3/day). An ultrafiltration demonstration plant including a CAP addition into the recirculation loop is currently tested on a small scale (8 m3/h) to compare the conventional treatments with new ultrafiltration process.In this study, the TOC removal as well as the biodegradable organic matter (BOM) removal are evaluated on the different processes. The BOM has been assessed by the Werner methodology (1980).During the cool season (october-january) all the biodegradable organic matter were removed by the clarification process (preozonation + coagulation decantation + sand filtration). More than 90 % of the BOM were also removed by the ultrafiltration demonstration plant (including granular activated carbon) although the addition of preozonation slightly increases the effluent BOM concentrations and modifies its composition. 80 % of the dissolved organic compounds were removed by the preozonation + ultrafiltration + powder treatment line. This performance should be compared with the 70 % removal obtained with conventional treatments.This study demonstrate that the combination 03 + UF + CAP can advantageously replace traditional treatment such as preozonation + coagulation clarification + ozonation + granular activated carbon + desinfection

Influence of dissolved oxygen on the nitrification kinetics in a circulating bed biofilm reactor

The influence of dissolved oxygen concentration on the nitrification kinetics was studied in the circulating bed reactor (CBR). The study was partly performed at laboratory scale with synthetic water, and partly at pilot scale with secondary effluent as feed water. The nitrifi- cation kinetics of the laboratory CBR as a function of the oxygen concentration can be described according to the half order and zero order rate equations of the diffusion-reaction model applied to porous catalysts. When oxygen was the rate limiting substrate, the nitrification rate was close to a half order function of the oxygen concentration. The average oxygen diffusion coefficient estimated by fitting the diffusion-reaction model to the experimental results was around 66% of the respective value in water. The experimental results showed that either the ammonia or the oxygen concentration could be limiting for the nitri fication kinetics. The latter occurred for an oxygen to ammonia concentration ratio below 1.5-2 gO2/gN-NH4+ for both laboratory and pilot scale reactors. The volumetric oxygen mass transfer coefficient (kLa) determined in the laboratory scale reactor was 0.017 sˉ¹ for a superficial air velocity of 0.02 m sˉ¹, and the one determined in the pilot scale reactor was 0.040 sˉ¹ for a superficial air velocity of 0.031 m sˉ¹. The kLa for the pilot scale reactor did not change significantly after biofilm development, compared to the value measured without biofilm.Fundação para a Ciência e a Tecnologia (FCT) - PRAXIS XXI, project 2/2.1/Bio/37/94.INTERREG

Mathematical Modeling of Secondary Malignancies and Associated Treatment Strategies

Several scientific and technological advancements in radiation oncology have resulted in dramatic improvements in dose conformity and delivery to the target volumes using external beam radiation therapy (EBRT). However, radiation therapy acts as a double-edged sword leading to drastic side-effects, one of them being secondary malignant neoplasms in cancer survivors. The latency time for the occurrence of second cancers is around $10$-$20$ years. Therefore, it is very important to evaluate the risks associated with various types of clinically relevant radiation treatment protocols, to minimize the second cancer risks to critical structures without impairing treatment to the primary tumor volume. A widely used biologically motivated model (known as the initiation-inactivation-proliferation model) with heterogeneous dose volume distributions of Hodgkin's lymphoma survivors is used to evaluate the excess relative risks (ERR). There has been a paradigm shift in radiation therapy from purely photon therapy to other particle therapies in cancer treatments. The extension of the model to include the dependence of linear energy transfer (LET) on the radio-biological parameters and mutation rate for charged particle therapy is discussed. Due to the increase in the use of combined modality regimens to treat several cancers, it is extremely important to evaluate the second cancer risks associated with these anti-cancer therapies. The extension of the model to include chemotherapy induced effects is also discussed. There have been several clinical studies on early and late relapses of cancerous tumors. A tumor control probability (TCP) model with recurrence dynamics in conjunction with the second cancer model is developed in order to enable design of efficient radiation regimens to increase the tumor control probability and relapse time, and at the same time decrease secondary cancer risks. Evolutionary dynamics has played an important role in modeling cancer progression of primary cancers. Spatial models of evolutionary dynamics are considered to be more appropriate to understand cancer progression for obvious reasons. In this context, a spatial evolutionary framework on lattices and unstructured meshes is developed to investigate the effect of cellular motility on the fixation probability. In the later part of this work, this model is extended to incorporate random fitness distributions into the lattices to explore the dynamics of invasion probability in the presence and absence of migration.1 yea

Enhanced method to detect spammers in social network

We present a hybrid methodology for recognizing computerized spammers by amalgamating network based highlights with other element classifications, specifically metadata-, content-, and collaboration based highlights. The curiosity of the proposed methodology lies in the portrayal of clients dependent on their associations with their devotees given that a client can sidestep includes that are identified with his/her own exercises, however sidestepping those dependent on the adherents is troublesome. Nineteen different features, including six newly defined features and two redefined features, are identified for learning three classifiers, namely, random forest, decision tree, and Bayesian network, on a real dataset that comprises benign users and spammers. The separation intensity of various element classes is likewise broke down, and association and network based highlights are resolved to be the best for spam recognition, though metadata-based highlights are ended up being to be the least viabl

Reimagining Creolization: the deep history of cultural interactions in the Windward Islands, Lesser Antilles, through the lens of material culture

Seventh Framework Programme (FP7)Archaeology of the America