Consensus of the Brazilian Association of Hematology, Hemotherapy and Cellular Therapy (ABHH) and the Brazilian Ministry of Health - General management of blood and blood products on the tests necessary for the release of exceptional medicines for sickle cell disease.

To date, hydroxyurea is the only effective and safe drug that significantly reduces morbidity and mortality of individuals with Sickle cell disease. Twenty years of real-life experience has demonstrated that hydroxyurea reduces pain attacks, vaso-occlusive events, including acute chest syndrome, the number and duration of hospitalizations and the need for transfusion. The therapeutic success of hydroxyurea is directly linked to access to the drug, the dose used and adherence to treatment which, in part, is correlated to the availability of hydroxyurea. This consensus aims to reduce the number of mandatory exams needed to access the drug, prioritizing the requesting physician's report, without affecting patient safety.

Soil-plant transfer models for metals to improve soil screening value guidelines valid for São Paulo, Brazil.

In Brazil, there is a lack of combined soil-plant data attempting to explain the influence of specific climate, soil conditions, and crop management on heavy metal uptake and accumulation by plants. As a consequence, soil-plant relationships to be used in risk assessments or for derivation of soil screening values are not available. Our objective in this study was to develop empirical soil-plant models for Cd, Cu, Pb, Ni, and Zn, in order to derive appropriate soil screening values representative of humid tropical regions such as the state of São Paulo (SP), Brazil. Soil and plant samples from 25 vegetable species in the production areas of SP were collected. The concentrations of metals found in these soil samples were relatively low. Therefore, data from temperate regions were included in our study. The soil-plant relations derived had a good performance for SP conditions for 8 out of 10 combinations of metal and vegetable species. The bioconcentration factor (BCF) values for Cd, Cu, Ni, Pb, and Zn in lettuce and for Cd, Cu, Pb, and Zn in carrot were determined under three exposure scenarios at pH 5 and 6. The application of soil-plant models and the BCFs proposed in this study can be an important tool to derive national soil quality criteria. However, this methodological approach includes data assessed under different climatic conditions and soil types and need to be carefully considered.

Assistência de enfermagem perioperatória aos pacientes com câncer de bexiga / Perioperative nursing care to patients with bladder cancer

Objetivo: O planejamento da assistência de enfermagem perioperatória para pacientes com câncer de bexiga requer conhecimento científico e incorporação tecnológica. Este estudo objetivou caracterizar o perfil de pacientes com câncer de bexiga em uma unidade cirúrgica de um hospital especializado em oncologia do interior paulista e analisar os cuidados de enfermagem realizados para esses pacientes. Metodologia: Estudo exploratório retrospectivo, cujos dados foram coletados em 80 prontuários de pacientes submetidos ao tratamento cirúrgico urológico no período de janeiro a setembro de 2008. Resultados: Houve predomínio do sexo masculino, na faixa etária de 60 a 80 anos, com formação fundamental incompleta, de raça branca, estadiamento I e procedimento cirúrgico de Ressecção Transuretral. A assistência de enfermagem perioperatória abarca intervenções educativas de autocuidado, cuidados procedimentais como soroterapia, preparo colônico, administração de medicamentos, posicionamento do paciente, monitorização de sinais vitais, cuidados com sonda e drenos, controle hídrico, passagem de plantão e encaminhamento de prontuário e exames. No caso específico de pacientes com urostomia, é importante a avaliação clínica e das condições do estoma; ensinar as ações específicas do autocuidado; planejar a alta hospitalar, fornecer equipamentos e encaminhar aos recursos da comunidade. Conclusão: Para prestar assistência perioperatória para esses pacientes é necessário um planejamento fundamentado em conhecimentos científicos, educação permanente da equipe de enfermagem e supervisão do trabalho pelo enfermeiro.

Objetivo: El planeamiento de la asistencia de enfermería perioperatoria para los pacientes con cáncer de vejiga requiere del conocimiento científico y de la incorporación tecnológica. El objetivo de este estudio fue caracterizar el perfil de los pacientes con cáncer de vejiga en una unidad quirúrgica de un hospital especializado en oncología del interior de São Paulo y analizar los cuidados de enfermería realizados para estos pacientes. Metodología: Estudio exploratorio retrospectivo, cuyos datos fueron recolectados en 80 prontuarios de pacientes sometidos a tratamiento quirúrgico urológico en el periodo enero-septiembre de 2008. Resultados: Hubo predominio del género masculino en la franja etaria de 60 a 80 años, con formación fundamental incompleta, de raza blanca, estadiamiento I y procedimiento quirúrgico de Resección Transuretral. La asistencia de enfermería perioperatoria abarca intervenciones educativas de autocuidado y cuidados procedimentales como sueroterapia, preparación colónica, administración de medicamentos, posicionamiento del paciente, monitorización de signos vitales, cuidados con sonda y drenaje, control hídrico, cambio de turno, envío de historia clínica y exámenes. En el caso específico de los pacientes con ostomía urológica, es importante tener en cuenta la evaluación clínica y de las condiciones del estoma; enseñar las acciones específicas del autocuidado; planear la alta hospitalaria proporcionar equipos y enviarlos a los recursos de la comunidad. Conclusión: Para brindarle asistencia quirúrgica a los pacientes, es necesario un planeamiento fundamentado en conocimientos científicos, educación permanente del equipo de enfermería y supervisión del trabajo realizado por el enfermero.

Objective: The perioperative nursing care planning for patients with bladder cancer needs scientific knowledge and incorporation of technology. Our study aimed to characterize the profile of bladder cancer population in a surgical unit of a hospital specializing in oncology in São Paulo State, and to analyze the nursing care made for this population. Methodology: Retrospective exploratory study, whose data were collected in 80 medical records of patients undergoing urology surgical treatment from January to September of 2008. Results: There were prevalence of male gender, in the age group from 60 to 80 years-old, with incomplete elementary school education, white people, staging cancer I and tumor resection. The perioperative nursing care includes educational interventions of self-care, procedural care as antivenin therapy, bowel's prepare, patient position, administration of drugs, monitoring of vital signs, care with catheters and drains, water control, change of shift, and routing of medical records and exams. In the specific case of patients with urostomy it is important to evaluate clinical situation and ostomy conditions; to teach the specific action of self-care, to plan hospital discharge; and to give equipment routing it to community resources. Conclusion: To give perioperative care to this population, it is necessary a planning based on scientific knowledge, permanent education and job supervision by a nurse.

Bioconcentration factors and the risk concentrations of potentially toxic elements in garden soils.

Empirical models describe soil-plant transfers to explain the variations in the occurrence of potentially toxic elements (PTE) in soils and to estimate the Bioconcentration Factor (BCF). In this study, results were selected based on data in the literature on soils of humid tropical and temperate regions to evaluate soil-plant transfer models, to calculate the BCF and to derive risk concentrations of Cu, Cr, Pb, Ni and Zn present in the exposure pathway leading to the consumption of contaminated vegetables. The Cetesb (Environmental Agency of the State of Sao Paulo, Brazil) mathematical model was used to derive the risk posed by soil concentrations in urban and rural exposure scenarios. The results of the pseudo total contents of PTE in the soil and the contents absorbed by plants were compared and the BCFs were calculated by the use of geometric means, including a correction factor appropriate to each particular type of soil. Differences were observed between BCFs calculated for each climate region: humid tropical (HTR) and temperate (TE), which the first one presented the highest values to BCF in leaves and the lowest BCF values for root, except Ni, compared to second one. The soil concentrations with the highest risk were found in humid tropical regions as compared with those found in temperate regions, except for Ni. The obtained BCFs may contribute to any future revisions of guideline values as well as help other state environmental agencies to establish their own guideline values.

Peat-assisted phytoremediation of waste foundry sands: plant growth, metal accumulation and fertility aspects.

We investigated the potential of peat additions to improve plant growth and fertility and to reduce plant metal uptake in waste foundry sands (WFS) landfills. The WFS contains 78211 mg kg(-1) and 371 mg kg(-1) concentrations of Cr and Ni, respectively, and varied metal concentrations. The experiment investigated the growth of Brassica juncea plants on fertilized WFS mixed with peat at concentrations of 0, 2.5, 5, and 10% (w/w). The highest peat treatment allowed substantial plant growth and increased Ni mass in shoots, which was positively correlated to shoot biomass increments. On a concentration basis, peat additions did not increase shoot Ni values, thus suggesting that plants grown on peat-treated WFS may not increase risks to human and ecological receptors. Chromium was below detection levels in shoots for all peat treatments. Peat-treated substrates also promoted increased CEC values and higher water holding capacity, therefore improving the WFS agronomical properties. These results indicate that peat can be used as an amendment to assist in the phytoremediation of WFS landfill areas. However, there was evidence for increased mobilization of Cr and Ni in the substrate solution which can pose a threat to local groundwater.

Analysis of Mercury-Rich plants and mine tailings using the Hydride-Generation AAS method

A hydride-generation atomic absorption spectroscopy (AAS) method was developed for the analysis of total Hg in liquid matrices of mercury-rich plants and mine tailings samples. The detection limit for this method was as low as 11.4 ng/mL. The reproducibility of the mercury signals (in terms of relative standard deviation) was 4.6 percent. Accuracy of the method was verified by analyses of deionised water samples spiked with HgCl2 and HgNO3. Recovery values for total mercury ranged from 88.5 to 94.3 percent for both mercury species added. An external certified laboratory validated the analytical method with a maximum discrepancy of 15 percent. Optimal analytical response of the equipment for Hg analysis of plant samples was achieved when the sample volume added to the reaction vessel was 0.25 mL.

Um protocolo para análise do mercúrio (Hg) em amostras líquidas de solo e tecidos vegetais enriquecidos com Hg foi desenvolvido com base na técnica de geração de hidretos. O limite de detecção para este método foi de 11.4 ng/mL. A reproducibilidade do método (calculado com base no desvio padrão relativo) foi de 4.6 por cento. A precisão do método foi verificada pela análise de amostras de água deionizada contendo HgCl2 and HgNO3. Os valores de mercúrio total recuperados variaram de 88.5 a 94.3 por cento para ambas as espécies testadas. O método analítico foi validado por um laboratório externo certificado com discrepância máxima de 15 por cento. O desempenho analítico do equipamento para análise do mercúrio em tecidos vegetais foi considerado ótimo para volumes de amostra de até 0.25 mL.

Protocols for in vitro culture and phytochemical analysis of Phyllanthus species (euphorbiaceae).

We developed reproducible protocols for micropropagation, callus culture, and root culture of the medicinal plant Phyllanthus urinaria, P. niruri, P. tenellus, P. corcovadensis, P. caroliniensis, P. stipulatus, and P. fraternus by using single node explants. Genotype-linked differences are visible among the Phyllanthus species concerning shoot culture, callus culture, and root culture growth. The protocols developed for phytochemical screening of callus and root extracts of P. urinaria, P. caroliniensis, P. stipulatus, and P. fraternus have shown the production of sterols and triterpenes. Both compounds are known to account for the antinociceptive activity of the methanolic extracts as glochidone and stigmasterol have strong activity against neurogenic and inflammatory pain. Similarly, methanolic callus extracts of P. tenellus, P. niruri and P. corcovadensis have potent analgesic properties, however phenolics are major compounds isolated from these species. The optimized micropropagation, callus culture, and root culture protocols offer the possibility to use cell/root culture techniques for vegetative propagation and secondary metabolite studies.

Viral hepatitis: An alternative teaching method.

OBJECTIVES: Our teaching experience has shown that dealing with the immunological aspects of viral hepatitis poses several difficulties. Therefore, we developed a game to verify whether or not this active-learning exercise could enhance students' learning and arouse their interest in subjects that are basically complex. METHODS: Fifteen cards with clinical cases of hepatitis A, B, C, D, and E, and 50 explanatory cards with the description of epidemiological, clinical, and immunological aspects of the hepatitis mentioned above. The objective of the game was to match the explanatory cards with the respective clinical case. Pre- and post-tests were used to assess students' grade improvement. FINDINGS: One-hundred-and-forty students participated in the activity. The overall response of the students to the game was very positive: 129 (92.1%) found the game encouraged clinical thinking, and 105 (75%) regarded the game as an important way of consolidating learning. The students' grades significantly improved (p < 0.05). CONCLUSION: Games allow understanding the subject matter through global knowledge. They also foster the student-professor relationship, simplifying the solution to the questions that may arise from a more comprehensive study.

Induced plant uptake and transport of mercury in the presence of sulphur-containing ligands and humic acid.

The induced accumulation of mercury (Hg) by plants was investigated for the species Phaseolus vulgaris (Bush bean), Brassica juncea (Indian mustard), and Vicia villosa (Hairy vetch). All plants were grown in modified Hg-contaminated mine tailings and were treated with sulphur-containing ligands to induce Hg accumulation. The effects of varied substrate Hg concentration and humic acid (HA) level on the induced plant-Hg accumulation for B. juncea were examined. Thiosulphate salts (ammonium and sodium) mobilised Hg in the substrates and caused an increase in the Hg concentration of roots and shoots of all tested plant species. Root Hg accumulation was positively correlated to extractable Hg for (NH4)2S2O3-treated B. juncea plants grown in HA-amended substrates. However, shoot Hg translocation for this species was inhibited at 1.25 g HA kg(-1) of substrate. Mercury-thiosulphate complexes could be translocated and accumulated in the upper parts of the plants up to 25 times the Hg concentration in the substrate. We conclude that shoot Hg accumulation in the presence of thiosulphate salts is dependent upon plant species characteristics (e.g. root surface area) and humic acid content.

Mercury volatilisation and phytoextraction from base-metal mine tailings.

Experiments were carried out in plant growth chambers and in the field to investigate plant-mercury accumulation and volatilisation in the presence of thiosulphate (S2O3)-containing solutions. Brassica juncea (Indian mustard) plants grown in Hg-contaminated Tui mine tailings (New Zealand) were enclosed in gastight volatilisation chambers to investigate the effect of ammonium thiosulphate ([NH4]2 S2O3) on the plant-Hg volatilisation process. Application of (NH4)2 S2O3 to substrates increased up to 6 times the Hg concentration in shoots and roots of B. juncea relative to controls. Volatilisation rates were significantly higher in plants irrigated only with water (control) when compared to plants treated with (NH4)2 S2O3. Volatilisation from barren pots (without plants) indicated that Hg in tailings is subject to biological and photochemical reactions. Addition of sodium thiosulphate (Na2S2O3) at 5 g/kg of substrate to B. juncea plants grown at the Tui mine site confirmed the plant growth chambers studies showing the effectiveness of thio-solutions at enhancing shoot Hg concentrations. Mercury extraction from the field plots yielded a maximum value of 25 g/ha. Mass balance studies revealed that volatilisation is a dominant pathway for Hg removal from the Tui mine site. A preliminary assessment of the risks of volatilisation indicated that enhanced Hg emissions by plants would not harm the local population and the regional environment.

Leucemia Mielóide Agura: perfil de duas décadas do Serviço de Hematologia do Hospital das Clínicas de Porto Alegre - RS / Acute Myelogenous Leukemia: two decades overview - Hematology Service Hospital de Clínicas de Porto Alegre - RS

Nos últimos vinte anos, nosso serviço recebeu os pacientes com a suspeita de Leucemia Mielóide Aguda (LMA) provenientes de todas as regiões do estado. Entre março de 1980 e dezembro de 1999 analisamos 195 pacientes com idades superior a 12 e inferior a 70 anos, apresentando LMA "de novo" excetuando o subtipo M3. Na década de 80 foram registrados 102 pacientes: 47 homens e 55 mulheres. Destes, 84 receberam quimioterapia de indução com Citarabina e Daunorrubicina (esquema "7+3"), resultando no índice de remissão de 51 por cento (43/84). As médias de sobrevidas livre de doença e global foram dez meses em 35 por cento e 12 meses em 13 por cento respectivamente. De jan/90 a dez/93 houve 41 novos diagnósticos e todos foram submetidos à quimioterapia com esquema "7+3" atingindo a taxa de 66 por cento de remissão. As sobrevidas livre de doença e global foram estatisticamente (p<0.001) superiores com 17,6 meses em 41 por cento e 22 meses em 17,5 por cento dos pacientes. Em 1994 foi instituído novo protocolo orientado pelo grupo cooperativo brasileiro de estudos de leucemia (CBEL), preconizando a indução com Citarabina +Idarrubicina, seguido dos ciclos de consolidação e dois ciclos de intensificação com altas doses. Entre 1994-99 foram incluídos 52 pacientes neste protocolo, cujo índice de remissão foi 73 por cento (p=0,002). Em 50 por cento destes pacientes, a sobrevida livre de doença alcançou 23,3 meses, enquanto a sobrevida global foi de 26 meses em 25 por cento. As sobrevidas livre de doença e global, neste último período, tiveram diferenças estatisticamente significativas comparadas aos anos anteriores. Observamos uma melhora nas taxas de remissão e de sobrevida na última década, mesmo assim a sobrevida longa livre de eventos permanece inferior a 30 por cento. Nossos resultados são equivalentes aos demais centros nacionais que tratam LMA e corroboram os dados da literatura

We have treated many AML patients in the last twenty years. We followed, between March 1980 andDecember 1999, 195 patients with ages ranging from 12 to 70 years and presenting “de novo” AML,excluding the M3 subtype. In the eighties, 102 patientsare on record: 47 males and 55 females. Among these,84 received induction chemotherapy with Cytarabinplus Daunorrubicin (7+3), resulting in a 51% (43/84) remission rate. The average disease-free andoverall survival was 35% at ten months and 13% at 12 months. Forty-one new diagnoses were performedfrom January 1990 and December 1993, all patients were submitted to the “7+3” chemotherapy protocoland a 66% remission rate was obtained. The disease free and overall survival rates were statistically (p <0.001) higher with 41% of the patients at 7.6 months and 17.5% at 22 months. In 1994 a new protocol wasintroduced under the guidance of the Brazilian Cooperative Group on Leukemia Studies (GCBEL). Itrecommended induction with Cytarabin +Idarrubicin followed by consolidation and two intensification cycles with high doses of Cytarabin................................................... We observed a progressive improvement in remission and survival rates in the last decades, however the prolonged eventfree survival stayed below 30%. Our results are similar to the national centers that treat AML and inaccordance with the literature data.

Fitorremediacion de acuiferos contaminados por benceno y etanol utiliando "sauce lloron" (Salix babylonica)

El objetivo del trabajo fue investigar el potencial del sauce lloron (salix babylonica-Familia Salicaceae) en el proceso de adsorcion directa por las raices de etanol y benceno,como una etapa inicial en el estudio de la fitorremediacion.Los resultados obtenidos indicaron reducciones de hasta un 99 por ciento para ambos contaminantes,tanto a nivel balance de masa como a nivel de concentracion

Fitorremediacion de acuiferos contaminados por benceno y etanol utiliando "sauce lloron" (Salix babylonica)

El objetivo del trabajo fue investigar el potencial del sauce lloron (salix babylonica-Familia Salicaceae) en el proceso de adsorcion directa por las raices de etanol y benceno,como una etapa inicial en el estudio de la fitorremediacion.Los resultados obtenidos indicaron reducciones de hasta un 99 por ciento para ambos contaminantes,tanto a nivel balance de masa como a nivel de concentracion