Analysis of the feasibility of early hospital discharge after autologous hematopoietic stem cell transplantation and the implications to nursing care

Autologous hematopoietic stem cell transplantation is a conduct used to treat some hematologic diseases and to consolidate the treatment of others. In the field of nursing, the few published scientific studies on nursing care and early hospital discharge of transplant patients are deficient. Knowledge about the diseases treated using hematopoietic stem cell transplantation, providing guidance to patients and caregivers and patient monitoring are important nursing activities in this process. Guidance may contribute to long-term goals through patients' short-term needs. To analyze the results of early hospital discharge on the treatment of patients submitted to autologous transplantation and the influence of nursing care on this conduct. A retrospective, quantitative, descriptive and transversal study was conducted. The hospital records of 112 consecutive patients submitted to autologous transplantation in the period from January to December 2009 were revisited. Of these, 12 patients, who remained in hospital for more than ten days after transplantation, were excluded from the study. The medical records of 100 patients with a median age of 48.5 years (19-69 years) were analyzed. All patients were mobilized and hematopoietic stem cells were collected by leukapheresis. The most common conditioning regimes were BU12Mel100 and BEAM 400. Toxicity during conditioning was easily managed in the outpatient clinic. Gastrointestinal toxicity, mostly Grades I and II, was seen in 69% of the patients, 62% of patients had diarrhea, 61% of the patients had nausea and vomiting and 58% had Grade I and II mucositis. Ten patients required hospitalization due to the conditioning regimen. Febrile neutropenia was seen in 58% of patients. Two patients died before Day +60 due to infections, one with aplasia. The median times to granulocyte and platelet engraftment were 12 days and 15 days, respectively, with median red blood cell and platelet transfusions until discharge of three and four units, respectively. Twenty-three patients required rehospitalization before being discharged from the outpatient clinic. The median time to granulocyte engraftment was 12 days and during the aplasia phase few patients were hospitalized or suffered infections. The toxicity of the conditioning was the leading cause of rehospitalization. The nursing staff participated by providing guidance to patients and during the mobilization, transplant and outpatient follow-up phases, thus helping to successfully manage toxicity.

Cytologic analysis of the mammary papillar discharge in a canine micropapillary carcinoma

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

The mechanism of 234U 238U activity ratio enhancement in karstic limestone groundwater

Experimental etch/leach of Carboniferous Limestone gravels on a laboratory time-scale has demonstrated that 234U 238U activity ratios (AR's) greater than the radiochemical equilibrium value may be generated on short time-scales. The molar U/Ca and Mg/Ca ratios show that both U and Mg are leached preferentially relative to Ca whereas the molar U/Mg ratio is only slightly greater than that of the rock matrix. The generation of enhanced AR's is attributed to a two-stage process in which the limestone surface is dissolved by zero-order etch and silicate minerals so released are subjected to first-order chemical leach of U and Mg. The implications of these results for the production of enhanced AR's in Carboniferous Limestone groundwater are discussed. It is suggested that chemical leaching or exchange of U between groundwater and its particulate load or at the aquifer fluid-solid interface is an important mechanism controlling AR changes as groundwater migrates beyond a redox boundary. AR's for dissolved U in groundwater are more probably related to chemical equilibria than to groundwater age. © 1993.

Cytological result of in situ ductal carcinoma in nipple discharge: a rare diagnosis

Background: More than half of women present nipple discharge during reproductive age. Case: This case is about a 36 years old woman with unilateral spontaneous hyaline nipple discharge associated with breast pain. The study of scintimammography was compatible with multifocal proliferative lesion in situ. It was performed cytological smear of nipple discharge. It was paucicellular smear represented by cluster of ductal cells in three-dimensional design with hyperchromatic nuclei in the presence of myoepithelial cells. Red cells and signs of necrosis were not observed. The diagnosis of in situ ductal carcinoma was confirmed in biopsy and mastectomy specimen through the expression of calponin in myoepithelial cells at immunohistochemistry. It is known that the cytological examination of nipple discharge has low sensitivity and specificity. However, it is an easy and inexpensive procedure. Suspicious or positive results, may be important for guidance workup of patients in order to perform earlier diagnosis of malignancy. Conclusion: this case demonstrates that in situ ductal carcinoma can be characterized by positive nipple discharge, and cytology sample is an important tool for the diagnosis of suspicion of malignancy and further diagnostic investigation.

Geoquímica de radionuclídeos naturais e biomonitoramento em área de mineração de carvão no sul do Brasil

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Temporal and Spatial Variations of Ions, Isotopes and Agricultural Contaminants in Surface Waters and Groundwater of Nebraska's Rainwater Basin Wetland Region

The wetlands of south-central Nebraska’s Rainwater Basin region are considered of international importance as a habitat for millions of migratory birds, but are being endangered by agricultural practices. The Rainwater Basin extends across 17 counties and covers 4,000 square miles. The purpose of this study was to assemble baseline chemical data for several representative wetlands across the Rainwater Basin region, and determine the use of these chemical data for investigating groundwater recharge. Eight representative wetlands were chosen across the Rainwater Basin to monitor surface and groundwater chemistry. At each site, a shallow well and deep well were installed and sampled once in the summer of 2009 and again in the spring of 2010. Wetland surface water was sampled monthly from April, 2009 to May, 2010. Waters were analyzed for major ions, nutrients, pesticides and oxygen-18 and deuterium isotopes at the University of Nebraska Water Sciences Laboratory. Geochemical analysis of surface waters presents a range of temporal and spatial variations. Wetlands had variable water volumes, isotopic compositions, ion chemistries and agricultural contaminant levels throughout the year and, except for a few trends, theses variations cannot be predicted with certainty year-to-year or wetland-to-wetland. Isotopic compositions showed evaporation was a contributor to water loss, and thus, did impact water chemistry. Surface water nitrate concentrations ranged from <0.10 to 4.04 mg/L. The nitrate levels are much higher in the groundwater, ranging from <0.10 to 18.4 mg/L, and are of concern because they are found above the maximum contaminant level (MCL) of 10 mg/L. Atrazine concentrations in surface waters ranged from <0.05 to 10.3 ppb. Groundwater atrazine concentrations ranged from <0.05 to 0.28 ppb. The high atrazine concentrations in surface waters are of concern as they are above the MCL of 3 ppb, and the highest levels occur during the spring bird migration. Most sampled groundwaters had detectable tritium indicating a mix of modern (<5 to 10 years old) and submodern (older than 1950s) recharge. The groundwater also had differences in chemical and isotope composition, and in some cases, increased nitrate concentrations, between the two sampling periods. Modern groundwater tritium ages and changes in groundwater chemical and isotopic compositions may indicate connections with surface waters in the Rainwater Basin.

The effects of river discharge and seasonal winds on the shelf off southeastern South America

The Rio de la Plata waters form a low salinity tongue that affects the circulation, stratification and the distributions of nutrients and biological species over a wide extent of the adjacent continental shelf. The plume of coastal waters presents a seasonal meridional displacement reaching lower latitudes (28,S) during austral winter and 32 degrees S during summer. Historical data suggests that the wind causes the alongshore shift, with southwesterly (SW) winds forcing the plume to lower latitudes in winter while summer dominant northeasterly (NE) winds force its southward retreat. To establish the connection between wind and outflow variations on the distribution of the coastal waters, we conducted two quasi-synoptic surveys in the region of Plata influence on the continental shelf and slope of southeastern South America, between Mar del Plata, Argentina and the northern coast of Santa Catarina, Brazil. We observed that: (A) SW winds dominating in winter force the northward spreading of the plume to low latitudes even during low river discharge periods; (B) NE winds displace the plume southward and spread the low salinity waters offshore over the entire width of the continental shelf east of the Plata estuary. The southward retreat of the plume in summer leads to a volume decrease of low salinity waters over the shelf. This volume is compensated by an increase of Tropical waters, which dominate the northern shelf. The subsurface transition between Subantarctic and Subtropical Shelf Waters, the Subtropical Shelf Front, and the subsurface water mass distribution, however, present minor seasonal variations. Along shore winds also influence the dynamics and water mass variations along the continental shelf area. In areas under the influence of river discharge, Subtropical Shelf Waters are kept away from the coastal region. When low salinity waters retreat southward, NE winds induce a coastal upwelling system near Santa Marta Cape. In summer, solar radiation promotes the establishment of a strong thermocline that increases buoyancy and further enhances the offshore displacement of low salinity waters under the action of NE winds. (C) 2008 Elsevier Ltd. All rights reserved.

Comparative analysis of rating curve and ADP estimates of instantaneous water discharge through estuaries in two contrasting Brazilian rivers

This work quantifies, using ADP and rating curve techniques, the instantaneous outflows at estuarine interfaces: higher to middle estuary and middle to lower estuary, in two medium-sized watersheds (72 000 and 66 000 km(2) of area, respectively), the Jaguaribe and Contas Rivers located in the northeastern (semi-arid) and eastern (tropical humid) Brazilian coasts, respectively. Results from ADP showed that the net water balances show the Contas River as a net water exporter, whereas the Jaguaribe River Estuary is a net water importer. At the Jaguaribe Estuary, water retention during flood tide contributes to 58% of the total volume transferred during the ebb tide from the middle to lower estuary. However, 42% of the total water volume (452 m(3) s(-1)) that entered during flood tide is retained in the middle estuary. In the Contas River, 90% of the total water is retained during the flood tide contributing to the volume transported in the ebb tide from the middle to the lower estuary. Outflows obtained with the rating curve method for the Contas and Jaguaribe Rivers were uniform through time due to river flow normalization by dams in both basins. Estimated outflows with this method are about 65% (Contas) and 95% (Jaguaribe) lower compared to outflows obtained with ADP. This suggests that the outflows obtained with the rating curve method underestimate the net water balance in both systems, particularly in the Jaguaribe River under a semi-arid climate. This underestimation is somewhat decreased due to wetter conditions in the Contas River basin. Copyright. (C) 2011 John Wiley & Sons, Ltd.

Body temperature, Aldrete-Kroulik index, and patient discharge from the Post-Anesthetic Recovery Unit

Patient discharge from post-anesthetic recovery (PAR) depends, among other factors, on normothermia and the patient's score on the Aldrete-Kroulik index. The objective of this study was to verify the relationship between the Aldrete-Kroulik index and body temperature in patients. This study was performed at the University of Sao Paulo University Hospital. Convenience sampling was used, and the sample consisted of 60 patients of ages between 18 and 60 years who underwent general anesthesia. The patients' body temperature was obtained by tympanic measurement, and the Aldrete-Kroulik index was measured on admission and at discharge from post-anesthetic recovery. The data were processed using SPSS, considering a significance level of 5%, and the Spearman and Wilcoxon tests were applied. In conclusion, no significant correlation was found between the two parameters for discharge.

TDEM survey in an area of seismicity induced by water wells in Parana sedimentary basin, Northern Sao Paulo State, Brazil

This article presents TDEM results from an area with recent induced shallow seismicity. The purpose was to do a geoelectrical mapping of sedimentary and fractured basaltic aquifers for better understanding of the hydrogeologic setting. The study area is in the Parana basin where flood basalts are overlain by sedimentary units near the city of Bebedouro, northern Sao Paulo State, Brazil. 86 TDEM soundings were acquired in an area of 90 km(2) in the Andes and Botafogo study areas. The soundings were chosen next to wells for calibration, and also along profiles crossing the seismically active areas. 1-D interpretation results showed the general geoelectrical stratigraphy of this part of the Parana basin. The upper geoelectrical layer is the shallow sedimentary aquifer (Adamantina formation) with less than 80 m thickness. The second geoelectrical layer contains the upper basalts of the Serra Geral formation at about 60-80 m depths. A saturated fractured basalt zone between 100 and 300 m depths was identifiable on various TDEM soundings. This depth range corresponds to the range of hypocentral depths for more than 3000 micro-earthquakes in this area. The lower basalt layer was estimated to lie between 400 and 650 m depth. The deepest geoelectrical layer detected by various TDEM soundings corresponds to the Botucatu sandstone (Guarani aquifer). Results suggest that the high-discharge wells are located in the fractured zone in the middle basalt of the Serra Geral formation. There is a good correlation between seismically active areas, high discharge wells (>190 m(3)/h), and fracture zones in the middle basalt. The results reinforce the hypothesis that the shallow seismic activity in the Bebedouro region is being triggered by high rates of groundwater withdrawal. (C) 2012 Elsevier B.V. All rights reserved.

Tracing latitudinal gradient, river discharge and water masses along the Subtropical South American Coast using benthic Foraminifera assemblages

More than 30% of Buccella peruviana (D'Orbigny), Globocassidulina crassa porrecta (Earland & Heron-Allen), Cibicides mackannai (Galloway & Wissler) and C. refulgens (Montfort) indicate the presence of cold Sub Antarctic Shelf Water in winter, from 33.5 to 38.3 degrees S, deeper than 100 m, in the southern part of the study area. In summer, the abundance of this association decreases to less than 15% around 37.5-38.9 degrees S where two species (Globocassidulina subglobosa (Brady), Uvigerina peregrina (Cushman) take over. G. subglobosa, U. peregrina, and Hanzawaia boueana (D'Orbigny) are found at 27-33 degrees S in both seasons in less than 55 m deep in the northern part, and are linked with warm Subtropical Shelf Water and Tropical Water. Freshwater influence was signalized by high silicate concentration and by the presence of Pseudononion atlanticum (Cushman), Bolivina striatula (Cushman), Buliminella elegantissima (D'Orbigny), Bulimina elongata (D'Orbigny), Elphidium excavatum (Terquem), E. poeyanum (D'Orbigny), Ammobaculites exiguus (Cushman & Bronnimann), Arenoparrella mexicana (Kornfeld), Gaudryina exillis (Cushman & Bronnimann), Textularia earlandi (Parker) and thecamoebians in four sectors of the shelf. The presence of Bulimina marginata (D'Orbigny) between 34.1-32.8 degrees S in the winter and 34.2-32.7 degrees S in the summer indicates that the influence of the Subtropical Shelf Front on the sediment does not change seasonally, otherwise, the presence of Angulogerina angulosa (Williamson) in the winter, only in Mar del Plata (38.9 degrees S), show that Malvinas currents are not influencing the sediment in the summer.

Changes on emitter discharge under different water temperature and pressure

The study was conducted at the Research Laboratory of Hydraulic and Irrigation Group in the Rural Engineering Department, Technical University of Madrid (Universidad Politecnica de Madrid), Madrid, Spain. Water temperatures of 20, 30, 40 degrees C and system pressures often encountered in irrigation practices of 80, 90, 100, 110, 120, 130, 140, 150, 160, 170, 180, 190 and 200 k Pa were applied to determine the effects of different water temperatures and pressures on emitter discharge. Non-pressure compensating in-line emitter which has turbulent flow regime with a long-path (labyrinth), emitter discharge was 4 L h(-1) at system pressure of 100 kPa according to the manufacturer recommended, was used. Emitters were spaced 20 cm along the drip laterals with 16 mm diameter. Discharge equations and coefficients of variation related to temperatures of 20, 30 and 40 degrees C were obtained as q = 0.375H(0.51), q = 0.358H(0.52), q = 0.346H(0.53) and 2.68, 2.09, 3.65, respectively. Discharge of the emitter was affected by different system pressures and increased as potentially (R = 0993-0996). In general. the emitter discharge increased with increasing temperature. However, especially in the common system pressures of 90-120 k Pa, differences of obtained emitter discharges between the different water temperatures were not significant (1%).

Lower third molar infection with purulent discharge through the external auditory meatus. Case report and review of literature

This manuscript reports an uncommon case of inferior third molar facial abscess with purulent secretion drainage through the left external acoustic meatus. The patient's left external acoustic meatus was filled with a purulent secretion observed on a CT scan. He underwent surgery to drain the facial abscess. Despite facial abscesses being routine occurrences, the literature does not contain many case reports of odontogenic facial abscesses with drainage via the external acoustic meatus. These situations occur in two possible ways: multiple fissures in the anterior wall of the cartilaginous portion of the external acoustic meatus; and congenital defects that are occasionally present in the anterior-superior aspect of the external acoustic meatus, known as the foramen of Huschke, which allow communication between the external acoustic meatus and mandibular fossa. These defects may also predispose the patient to the spread of the infection or tumour from the external auditory canal to the infratemporal fossa and vice versa. No otological sequelae were observed in this case. The authors conclude that the hypothesis of bone malformation cannot be excluded, and affirm that any facial abscess requires appropriate and immediate treatment for adequate resolution, by removing the causal factor and providing systemic support.

Failure to reduce C-reactive protein levels more than 25% in the last 24 hours before intensive care unit discharge predicts higher in-hospital mortality: A cohort study

Purpose: To discharge a patient from the intensive care unit (ICU) is a complex decision-making process because in-hospital mortality after critical illness may be as high as up to 27%. Static C-reactive protein (CRP) values have been previously evaluated as a predictor of post-ICU mortality with conflicting results. Therefore, we evaluated the CRP ratio in the last 24 hours before ICU discharge as a predictor of in-hospital outcomes. Methods: A retrospective cohort study was performed in 409 patients from a 6-bed ICU of a university hospital. Data were prospectively collected during a 4-year period. Only patients discharged alive from the ICU with at least 72 hours of ICU length of stay were evaluated. Results: In-hospital mortality was 18.3% (75/409). Patients with reduction less than 25% in CRP concentrations at 24 hours as compared with 48 hours before ICU discharge had a worse prognosis, with increased mortality (23% vs 11%, P = .002) and post-ICU length of stay (26 [7-43] vs 11 [5-27] days, P = .036). Moreover, among hospital survivors (n = 334), patients with CRP reduction less than 25% were discharged later (hazard ratio, 0.750; 95% confidence interval, 0.602-0.935; P = .011). Conclusions: In this large cohort of critically ill patients, failure to reduce CRP values more than 25% in the last 24 hours of ICU stay is a strong predictor of worse in-hospital outcomes. (C) 2012 Elsevier Inc. All rights reserved.