Palmitic acid was the main long chain fatty acids (LCFA) that accumulated onto the anaerobic sludge when oleic acid was fed to an EGSB reactor. The conversion between oleic and palmitic acid was linked to the biological activity. When palmitic acid was fed to an EGSB reactor it represented also the main LCFA that accumulated onto the sludge. The way of palmitic acid accumulation was different in the oleic and in the palmitic acid fed reactors. When oleic acid was fed, the biomass-associated LCFA (83% as palmitic acid) were mainly adsorbed and entrapped in the sludge that became "encapsulated" by an LCFA layer. However, when palmitic acid was fed, the biomass-associated LCFA (the totality as palmitic acid) was mainly precipitated in white spots like precipitates in between the sludge, which remained "non-encapsulated." The two sludges were compared in terms of the specific methanogenic activity (SMA) in the presence of acetate, propionate, butyrate, and H(2)CO(2), before and after the mineralization of similar amounts of biomass-associated LCFA (4.6 and 5.2 g COD-LCFA/g of volatile suspended solids (VSS), for the oleic and palmitic acid fed sludge, respectively). The "non-encapsulated," sludge exhibited a considerable initial methanogenic activity on all the tested substrates, with the single exception of butyrate. However, with the "encapsulated" sludge only methane production from ethanol and H(2)/CO(2) was detected, after a lag phase of about 50 h. After mineralization of the biomass-associated LCFA, both sludges exhibited activities of similar order of magnitude in the presence of the same individual substrates and significantly higher than before. The results evidenced that LCFA accumulation onto the sludge can create a physical barrier and hinder the transfer of substrates and products, inducing a delay on the initial methane production. Whatever the mechanism, metabolic or physical, that is behind this inhibition, it is reversible, being eliminated after the depletion of the biomass-associated LCFA.

The aim of the present work was to study the maximum potential methane production in batch assays of sludge samples taken along the operation of two EGSB reactors (RI inoculated with granular sludge and RII inoculated with suspended sludge) fed with increasing oleic acid concentrations between 2 and 8 gCOD/l (HRT = 1 day). After removing the residual substrate, the sludge was incubated in batch vials without any added carbon source. A maximum methane production rate of 152+/-21 mlCH4(STP)/gVS.day was obtained for the suspended sludge taken on day 70, when oleate at a concentration of 2 g COD/l was fed with a co-substrate (50% COD). The maximum plateau achieved in the methane production curve was 1145+/-307 mlCH4(STP)/gVS, obtained for the suspended sludge taken on day 162, when oleate was fed as the sole carbon source at 6 g COD/I. The methanization rate of the adsorbed substrate was enhanced under stirring conditions and was inhibited by adding oleic acid. Extraction and GC analysis confirmed that the main adsorbed substrate was palmitate, and not oleate. Accumulated palmitate adsorbed onto the sludge and further beta-oxidation was inhibited when in the presence of oleic acid. If oleic acid was removed from the medium beta-oxidation proceeded with methane production. Suspended sludge was more efficient than granular sludge.

IntroductionThe purpose of this study was to evaluate the clinical relevance of high values of central venous-to-arterial carbon dioxide difference (PCO2 gap) in high-risk surgical patients admitted to a postoperative ICU. We hypothesized that PCO2 gap could serve as a useful tool to identify patients still requiring hemodynamic optimization at ICU admission.MethodsOne hundred and fifteen patients were included in this prospective single-center observational study during a 1-year period. High-risk surgical inclusion criteria were adapted from Schoemaker and colleagues. Demographic and biological data, PCO2 gap, central venous oxygen saturation, lactate level and postoperative complications were recorded for all patients at ICU admission, and 6 hours and 12 hours after admission.ResultsA total of 78 (68%) patients developed postoperative complications, of whom 54 (47%) developed organ failure. From admission to 12 hours after admission, there was a significant difference in mean PCO2 gap (8.7 ± 2.8 mmHg versus 5.1 ± 2.6 mmHg; P = 0.001) and median lactate values (1.54 (1.1-3.2) mmol/l versus 1.06 (0.8-1.8) mmol/l; P = 0.003) between patients who developed postoperative complications and those who did not. These differences were maximal at admission to the ICU. At ICU admission, the area under the receiver operating characteristic curve for occurrence of postoperative complications was 0.86 for the PCO2 gap compared to Sequential Organ Failure Assessment score (0.82), Simplified Acute Physiology Score II score (0.67), and lactate level (0.67). The threshold value for PCO2 gap was 5.8 mmHg. Multivariate analysis showed that only a high PCO2 gap and a high Sequential Organ Failure Assessment score were independently associated with the occurrence of postoperative complications. A high PCO2 gap (≥6 mmHg) was associated with more organ failure, an increase in duration of mechanical ventilation and length of hospital stay.ConclusionA high PCO2 gap at admission in the postoperative ICU was significantly associated with increased postoperative complications in high-risk surgical patients. If the increase in PCO2 gap is secondary to tissue hypoperfusion then the PCO2 gap might be a useful tool complementary to central venous oxygen saturation as a therapeutic target.

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BACKGROUND AND OBJECTIVES: Drug administration to children is a widely spread practice, however it may lead to several health problems, because in addition to medical guidance it requires attention of parents and caregivers. This study aimed at identifying the prevalence of drug administration in children by their tutors, before medical assistance. METHODS: This is a quantitative descriptive research involving adults who were escorting children, before medical assistance in a Children's First Aid Unit of a medium-sized city of the Vale do Paraíba Paulista in the months of June, July and August 2011, being data recorded by means of a specific form. RESULTS: Participated in the study 105 adults responsible for the children who reported that 71.42% of children were medicated before medical assistance and only 28.58% have not adopted such practice. Most frequent symptom was fever, present in 40% of participants, and drugs used were paracetamol and dipirone. CONCLUSION: Our results allow concluding that there has been a high rate of drug administration to children before medical assistance, with predominance of non-steroid antiinflammatory drugs, which may be noxious to health. It is clear the need for the adoption of measures which favor the access to health services, in addition to the awareness about the risk of administering drugs without medical prescription. Keywords: Analgesics, Anti-inflammatory drugs, Children, Self-medication. Use of analgesic and anti-inflammatory drugs before assistance in a children's first aid unit* O uso de fármacos analgésicos e anti-inflamatórios prévio ao atendimento em pronto socorro infantil RESUMO JUSTIFICATIVA E OBJETIVOS:A administração de fármacos na criança é uma prática amplamente difundida, porém pode levar a inúmeros prejuízos à saúde, pois além da orientação médica, exige atenção dos pais e cuidadores. O objetivo deste estudo foi identificar a prevalência da administração de fármacos na criança, por seus responsáveis, previamente ao atendimento médico. MÉTODOS: Trata-se de uma pesquisa quantitativa descritiva, envolvendo adultos que acompanhavam as crianças antes do atendimento médico em um Pronto Socorro Infantil de um município de médio porte do Vale do Paraíba Paulista, nos meses de junho, julho e agosto de 2011, sendo os dados registrados por meio de um formulário específico. RESULTADOS: Participaram do estudo 105 adultos responsáveis pelas crianças que relataram que 71,42% das crianças foram medicadas previamente ao atendimento médico e apenas 28,58% não adotaram essa prática. O principal sintoma citado foi febre, presente em 40% dos participantes, e os fármacos mais utilizados foram o paracetamol e a dipirona. CONCLUSÃO: Os resultados obtidos permitem concluir que houve um alto índice de administração de fármacos nas crianças previamente ao atendimento médico, com predomínio dos anti-inflamatórios não esteroides, fármacos esses que podem causar lesões à saúde. Evidencia-se a necessidade de adoção de medidas que favoreçam o acesso aos serviços de saúde, alé...