Applying Nightingale charts to evaluate the heterogeneity of biomedical waste in a Hospital / Aplicação de gráficos nightingaleanos para avaliação da heterogeneidade de Resíduos de Serviço de Saúde de um hospital / Aplicación de gráficos Nightingale para la evaluación de la heterogeneidad de los residuos sanitarios en un Hospital

OBJECTIVES: to evaluate the heterogeneity of biomedical waste (BW) using Nightingale charts. METHOD: cross-sectional study consisting of data collection on wastes (direct observation of receptacles, physical characterisation, and gravimetric composition), development of a Management Information System, and creation of statistical charts. RESULTS: the wastes with the greatest degree of heterogeneity are, in order, recyclable, infectious, and organic wastes; chemical waste had the most efficient segregation; Nightingale charts are useful for quick visualisation and systematisation of information on heterogeneity. CONCLUSION: the development of a management information system and the use of Nightingale charts allows for the identification and correction of errors in waste segregation, which increase health risks and contamination by infectious and chemical wastes and reduce the sale and profit from recyclables. .

OBJETIVO: avaliar a heterogeneidade dos Resíduos de Serviço de Saúde por meio da aplicação de gráficos nightingaleanos. MÉTODO: estudo transversal, que consiste na coleta de dados sobre resíduos (observação direta dos locais de armazenamento, caracterização física e composição gravimétrica), desenvolvimento de um Sistema de Informação Gerencial e construção de gráficos estatísticos. RESULTADOS: os resíduos que apresentam maior grau de heterogeneidade são os recicláveis, infectantes e orgânicos, respectivamente; o resíduo químico atingiu maior eficiência na segregação; os gráficos nightingaleanos são úteis na visualização rápida e na sistematização das informações sobre a heterogeneidade. CONCLUSÃO: o desenvolvimento de um sistema de informação gerencial e a utilização dos gráficos nigthingaleanos permite identificar e corrigir erros na segregação dos resíduos que impactam tanto no aumento de riscos à saúde e de contaminação por resíduos infectantes e químicos como na redução da comercialização e receita com os recicláveis. .

OBJETIVO: evaluar la heterogeneidad de los residuos sanitarios (RS) usando gráficos Nightingale. MÉTODO: estudio transversal que consiste en la recopilación de datos sobre los residuos (observación directa de los recipientes, caracterización física y composición gravimétrica), desarrollo de un Sistema de Información para la Gestión y creación de gráficos estadísticos. RESULTADOS: los residuos con el mayor grado de heterogeneidad son los reciclables, infecciosos, y los residuos orgánicos, respectivamente; la segregación de los residuos químicos fue la más eficiente; los gráficos Nightingale son útiles para la visualización rápida y sistematización de la información sobre la heterogeneidad. CONCLUSIÓN: el desarrollo de un sistema de información para la gestión y el uso de gráficos Nightingale permiten la identificación y corrección de errores en la separación de los residuos; dichos errores aumentan los riesgos de salud y la contaminación por residuos infecciosos y químicos, y reducen la venta y beneficio obtenible de los materiales reciclables. .

Tetralogía de fallot con agenesia de sigmoides pulmonares: presentación de 3 pacientes / Tetralogy of fallot with agenesis of pulmonary sigmoid: report of three patients

Se presentan 3 pacientes con tetralogía de Fallot y agenesia de sigmonoides pulmonares correspondiente al grupo II (sin gran dilatación del tronco de la arteria pulmonar y con capacidad fucional entre I y III de la clasificación de la New York Heart Association) (NYHA) cuyas edades fueron 2, 12 y 27 años. Se les realizó cirugía electiva a la niña de 12 años(cierre de comunicación interventricular y liberación de la estenosis infundibuloanular con parche de dacrón); se decidió no hacer reconstrucción por el momento al otro niño por su corta edad y al paciente adulto no aceptó la intervención quirúrgica

Experimental pulmonary fibrosis induced by paraquat plus oxygen in rats: a morphologic and biochemical sequential study.

Changes in lung structure and collagen metabolism were studied at 1, 2, 3, 4, 6, and 8 weeks in a model of pulmonary fibrosis induced in rats with paraquat plus hyperoxia. Morphologic examination of the lungs revealed that the earliest lesions consisted of severe and irreversible endothelial and alveolar epithelial cell damage. Afterward, an inflammatory process took place, initially dominated by polymorphonuclear leukocytes and then by mononuclear cells, but with the constant presence of granulocytes. From the fourth week on there were fibroblast proliferation and a moderate increase of mast cells. In the early stages alveolitis was focal, but from the second week the lungs were diffusely affected with severe distortion of the architecture. Collagen content was moderately increased in the first 2 weeks and then showed a progressive increment until the end of the experiment. Collagen synthesis was significantly elevated from the fourth week, coinciding with interstitial fibroblast proliferation, although there were some animals that showed increased collagen production from the first week. Collagenolytic activity occurred in 3 stages: at 2 weeks there was increased collagen degradation, at 3, 4, and 6 weeks the values showed a trimodal behavior, and at 8 weeks almost all experimental rats presented an important decrease of collagenolysis. Thus, the development of lung fibrosis was associated first with increased rates of collagen synthesis and later with a decrease of collagen degradation.

Posttransplant lymphoproliferative disorders in heart-lung transplant recipients: primary presentation in the allograft.

Heart-lung transplant recipients are predisposed to acute rejection episodes, bronchiolitis obliterans, and opportunistic infections. In 9.4% of recipients at the University of Pittsburgh, a posttransplant lymphoproliferative disorder (PTLD) developed, and in 60% of cases, it presented in the allografted lungs and was associated with primary infection by Epstein-Barr virus (EBV). The PTLD is histologically indistinguishable from a primary pulmonary lymphoma and consists of a mixed population of large lymphoid cells, immunoblasts, and plasma cells. Two cases of PTLD were monoclonal with immunohistochemical and Southern blot analysis. Despite this, there was clinical recovery with reduced immunosuppression and acyclovir. We discuss the role of EBV in the development of PTLD and the pathogenesis of primary presentation in the allograft.

Polyunsaturated fatty acids and protection of newborn rats from oxygen toxicity.

To test whether polyunsaturated fatty acids (PUFA) might be associated with protection against oxygen toxicity in newborn experimental animals, we performed two series of experiments. In the first series, adult female rats were fed one of three diets--regular Rat Chow, a high-PUFA (safflower oil-based) diet, or a low-PUFA (palm oil-based) diet--for several weeks before and throughout pregnancy and lactation. Newborn offspring of the three diet groups had similar antioxidant enzyme activities and surfactant development. Offspring of dams fed the high-PUFA diet had total lung lipid fatty acids characterized by increased linoleic acid (18:2 omega 6) and arachidonic acid (20:4 omega 6) and a significantly increased PUFA/saturated fatty acid ratio, compared with offspring of dams fed the regular diet or low-PUFA diet; associated with this increased PUFA pattern was markedly superior survival (80 of 84 (95%) vs 56 of 84 (67%) for regular-diet offspring, P less than 0.01) after 7 days in greater than 95% oxygen. Conversely, offspring born to dams fed the low-PUFA diet had decreased lung PUFA content and inferior tolerance to prolonged high O2 exposure (survival 38 of 84 (45%)). In the second experimental series, the postnatal provision of high PUFA rat milk to offspring born to dams fed the low-PUFA diet (via "cross-nurturing" by high-PUFA diet dams) rapidly increased their lung lipid PUFA and improved their hyperoxic survival (44 of 50 vs 25 of 50 for low-PUFA diet newborn animals kept with their low-PUFA mother rats, P less than 0.01). These studies suggest that increasing lung lipid PUFA can confer a protective effect against the toxic effects of hyperoxia on the newborn animal lung.

Assessment of lung water by magnetic resonance in three types of pulmonary edema.

Pulmonary edema was produced in nine mongrel dogs by: (a) saline lavage; (b) intravenous injection of oleic acid; and (c) intravenous injection of propranolol followed by ureteral ligation. The resulting effect could be characterized by varying the protein concentration in the pulmonary edema fluid. After induction, all dogs were killed and 20 samples from each passively deflated lung were obtained. Proton T1 and T2 values were measured on a Praxis II NMR spectrometer operated at 10.7 MHz and 37 degrees C. The water content of all samples was determined gravimetrically. Correlation between T1 or T2 measured in vitro and the ratio of wet to dry weight was highly significant (r greater than 0.95, P less than 0.001) in each pathological state. Regression curves indicate that although all three types of pulmonary edema can be characterized by slightly different slopes, the differences are statistically insignificant. Moreover, the slopes of previous studies, when recast in the same format, are very similar to our findings despite the use of different magnetic field strengths and different animal models. This study indicates that quantitation of pulmonary edema is possible, but in vitro measurements do not give useful information for characterizing the etiology of pulmonary edema.

Postmortem findings of the victims of the Jonestown tragedy.

The procedure for processing and identifying the victims of the Jonestown, Guyana tragedy is outlined. Autopsies were performed on seven of the victims, and the autopsy anatomic and toxicologic findings are presented. Problems encountered in the interpretation of the autopsy findings are noted.

Pulmonary involvement in schistosomiasis mansoni.

The post-treatment pulmonary alterations were evaluated in patients (Study 1) and in mice (Study 2) infected with Schistosoma mansoni. Study 1: the patients were examined pre and post-treatment (with ora oxamniquine) and the following exams were performed: sputum for eosinophils and chest x-ray. Study 2: four groups of mice (total = 64) were studied; Group I (infected and treated with oxamniquine); II (infected and not treated); III (not infected and treated) and IV (not infected and not treated). All were x-rayed to check for pulmonary abnormalities pre and post-treatment and lung specimens were studied by optical microscopy and immunofluorescence. We have found abnormalities in the parameters checked in both studies and the results suggest an immunological reaction, probably due to deposition of immune complexes in the lungs, with subsequent activation of the complement system. The experimental study showed that the alterations are not dependent of the presence of eggs and/or worms of S. mansoni in the lungs, thus corroborating the hypothesis of deposition of circulating material.

Pulmonary structure and extravascular lung water after cardiopulmonary bypass.

1. This paper describes the pulmonary alterations that occur after cardiopulmonary bypass (CPB) when a bubble oxygenator is used. 2. Two groups of patients who underwent myocardial revascularization were studied before and after CPB. The first group (7 patients with a bypass time of 130 +/- 17 min), when examined by light and electron microscopy showed platelet/neutrophil accumulation in the pulmonary parenchyma, endothelial lesions and interstitial edema. In the second group (10 patients with a bypass time of 123 +/- 37 min), extravascular lung water (EVLW) was measured by the thermal and green-dye dilution technique, and showed a significant increase immediately after CPB which lasted through the 1st and 2nd post-operative days. 3. No statistical correlation was found between the increase in EVLW and the plasma colloid oncotic pressure/pulmonary artery wedge pressure gradient, CPB time or intra-operative fluid balance. 4. Our results indicate an increase in pulmonary endothelium permeability after CPB when a bubble oxygenator is used.

Fosfilípidos pulmonares y asfixia al nacer: su relación con el síndrome de dificultad respiratoria en neonatos de pretérmino / Pulmonary phospholipidos and birth asphyxia: it relation with respiratory distress syndrome in newborn infants

En 23 neonatos de pretérmino se estudió prospectivamente la relación existente entre el perfil de los fosfolípidos pulmonares (relación L/E y FG) y el pH de sangre de cordón y la aparición y gravedad del síndrome de dificuldad respiratoria (SDR). Los fosfolípidos pulmonares se determinaron a partir de muestras tomadas al nacimiento por medio de la técnica de cromatografía bidimensional en capa fina. En los neonatos con depleción de fosfolípidos (relación L/E menor de 2 y/o FG negativo) se produjo SDR en todos los casos. En cambio, en presencia de una relación L/E mayor de 2 (13 casos) aconteció SDR en 8 neonatos y entre los 9 neonatos con FG positivo hubo 5 casos de SDR. Entre los neonatos con perfil de fosfolípidos maduro los que presentaron SDR tuvieron un pH de cordón más hajo (7,14 + ou - 0,15) que el observado en los casos sin SDR (7,26 + ou - 0,10). No hubo relación entre la magnitud de la inmadurez pulmonar estimada por el perfil de fosfolípidos y la gravedad del SDR. En cambio, el pH de cordón fue significativamente más hajo (p menor de 0,01) en los neonatos que requieron ARM (7,06 + ou - 0,11) comparando al observado en los casos de SDR tratados sólo con aumento de la FiO2 (7,28 + ou - 0,07)

Fosfilípidos pulmonares y asfixia al nacer: su relación con el síndrome de dificultad respiratoria en neonatos de pretérmino / Pulmonary phospholipidos and birth asphyxia: it relation with respiratory distress syndrome in newborn infants

En 23 neonatos de pretérmino se estudió prospectivamente la relación existente entre el perfil de los fosfolípidos pulmonares (relación L/E y FG) y el pH de sangre de cordón y la aparición y gravedad del síndrome de dificuldad respiratoria (SDR). Los fosfolípidos pulmonares se determinaron a partir de muestras tomadas al nacimiento por medio de la técnica de cromatografía bidimensional en capa fina. En los neonatos con depleción de fosfolípidos (relación L/E menor de 2 y/o FG negativo) se produjo SDR en todos los casos. En cambio, en presencia de una relación L/E mayor de 2 (13 casos) aconteció SDR en 8 neonatos y entre los 9 neonatos con FG positivo hubo 5 casos de SDR. Entre los neonatos con perfil de fosfolípidos maduro los que presentaron SDR tuvieron un pH de cordón más hajo (7,14 + ou - 0,15) que el observado en los casos sin SDR (7,26 + ou - 0,10). No hubo relación entre la magnitud de la inmadurez pulmonar estimada por el perfil de fosfolípidos y la gravedad del SDR. En cambio, el pH de cordón fue significativamente más hajo (p menor de 0,01) en los neonatos que requieron ARM (7,06 + ou - 0,11) comparando al observado en los casos de SDR tratados sólo con aumento de la FiO2 (7,28 + ou - 0,07) (AU)

alpha-Tocopherol (vitamin E) content of lung, liver, and blood in the newborn rat and human infant: influence of hyperoxia.

Increases in liver and lung alpha-tocopherol (vitamin E) content occur concurrent with birth and the onset of suckling in the newborn rat and are prevented by denying pups access to dams. Liver alpha-tocopherol concentration peaks at 24 hours of age and then declines, whereas the lung concentration of alpha-tocopherol continues to increase in the early neonatal period. These tissue changes are not reflected by changes in the blood alpha-tocopherol concentration. Significant increases in lung alpha-tocopherol result from administering alpha-tocopherol (100 mg/kg body weight, sc) on days 0, 2, and 4 of age. Studies of lung alpha-tocopherol concentrations in infants with varying histories of alpha-tocopherol exposure confirm the findings in the rat, and suggest that increases in lung alpha-tocopherol concentration result from administration of alpha-tocopherol in the immediate newborn period. Studies of alpha-tocopherol values in alpha-tocopherol-treated and control newborn rats reveal no significant changes in lung tocopherol concentration resulting from exposure to hyperoxia.

Electrofocusing of heparin: Presence of 21 monomeric and dimeric molecular species in heparin preparations.

Electrofocusing of heparins and subsequent polyacrylamide gel electrophoresis has shown that two types of heparins are present in different tissues. One of the types (from beef lung tissues) gives only a single band in agarose gel electrophoresis and 21 molecular species after electrofocusing and polyacrylamide gel electrophoresis. The other type of heparin (from pork intestinal mucosa) gives two bands in agarose gel electrophoresis and 42 molecular species after electrofocusing and polyacrylamide. Ascorbic acid treatment of the pork intestinal mucosa heparin reduced the number of molecular species to 21. A suggestion is made that some heparins exist as monomeric or dimeric molecular species forming single or double helixes.