Performance of a modified MASCC index score for identifying low-risk febrile neutropenic cancer patients

GOALS OF WORK: This is a prospective and observational study comparing the efficacy of risk-assessment models in patients with neutropenic fever in a reference treatment center. The meaning of the complex infection was evaluated. MATERIALS AND METHODS: Patients were recruited throughout a 9-month period. Inclusion criteria were histologic diagnosis of malignancy, neutropenic febrile secondary to chemotherapy and/or radiotherapy (absolute neutrophil count of <500/microl and axillary temperature > or = 38 degrees C), and > or = 18 years of age. MAIN RESULTS: Fifty-three febrile neutropenic patients were included. Twenty one of them were classified as low risk by the Multinational Association of Supportive Care in Cancer (MASCC) risk-index score. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of the MASCC risk-index scores were, respectively 87.9, 85.0, 90.6, 80.9, and 86.8%. None of the low-risk patients died, but four patients classified as low risk by the MASCC model developed serious medical complications during febrile neutropenic episodes. When we subtracted patients with complex infections from the group of patients with the MASCC risk-index score of > or = 21, we got 15 patients that were classified as low risk by a proposed adjustment by complex infection (PACI) model. None of them developed serious medical complications. The sensitivity, specificity, PPV, NPV, and the accuracy of this new model were, respectively, 100, 75.0, 86.8, 100, and 90.6%. CONCLUSION: The MASCC risk-index score had high sensitivity and specificity to predict the absence of complications, but the PACI model was better than MASCC for predicting the absence of complications in this febrile neutropenic patients.     

Plasma oxidative parameters and mortality in patients with severe burn injury

OBJECTIVE: To determine xanthine oxidase and superoxide dismutase activities, lipid peroxidation, protein carbonylation, and total radical-trapping antioxidant parameter in survivors and nonsurvivors patients with severe burn injury. DESIGN AND SETTING: Prospective, comparative observational study in an intensive care unit, burn division, in a trauma hospital. PATIENTS: Twenty-five consecutive patients who met the established criteria for severe burn injury (total burn surface area of more than 30%). MEASUREMENTS AND RESULTS: Plasma thiobarbituric acid reactive species and protein carbonyls levels were significantly higher in nonsurvivors than in survivors at 0 and 6 h. Elevated xanthine oxidase activity at 0 h was associated with adverse outcome after burn injury. In contrast, plasma superoxide dismutase activity and total radical-trapping antioxidant parameter did not differ significantly between nonsurvivors and survivors at any time point. CONCLUSIONS: For the first time we demonstrate the value of oxidative parameters, namely thiobarbituric acid reactive species, protein carbonyls, and xanthine oxidase activity, in identifying burn patients with a poor prognosis. Whether these parameters are merely markers of clinical course, or whether they signal specific deleterious effects of oxidative stress during the burn injury remains to be elucidated.     

Influence of scapular position on the pressure pain threshold of the upper trapezius muscle region

A position of scapula depression will maintain the upper trapezius muscle region in a lengthened position, causing excessive strain. This strain could lead to peripheral nociceptive nerves sensitization in the affected area, changing the pressure pain threshold (PPT). Thus, people with a faulty alignment of scapular depression may have lower PPT levels in the upper trapezius region when compared to subjects with normal vertical scapular position. The purpose of this double‐blind study was to assess the influence of scapular position on the PPT of the upper trapezius region in a young healthy population. Fifty two physical therapy students of the Catholic University of Minas Gerais – PUC‐Minas, Brazil, with normal shoulder (NS group, n=26, 6 men and 20 women) or depressed shoulder (DS group, n=26, 6 men and 20 women) volunteered to participate in this study. An electronic pressure algometer was used to measure the PPT on the upper trapezius muscle region. The results showed a significant difference between groups, with the DS group (19.0±9.0N/cm²) demonstrated lower mean PPT values when compared to NS group (26.1±9.6N/cm²) (p<0.01). Our results showed that healthy young subjects with depressed scapula position had significant lower upper trapezius PPT values when compared to subjects with normal scapula position.     

Dimensioning nursing staff: analysis of the nurse's work at the pediatric ICU of HU-USP

The purposes of this study were to evaluate effective time of the nurse's work during the morning shift at the Pediatric ICU of HU-USP, to identify percentage of effective time of work of these nurses dedicated to direct and indirect assistance and to determine the index of productivity of the professionals doing a retrospective analysis of daily activities records. The mean of the effective time a month of these nurses' work corresponded to 275.5 minutes, of which 49.9% were related to indirect and 50.1% to direct assistance. According to the evaluation criterion available in the literature, the productivity index found is between satisfactory and excellent.     

Hoping for the future child: the father's experience in the intensive care unit

This study was intended to analyse the experience of the father who have a child in an Intensive Care Unit, by applying the qualitative research under the phenomenological perspective of Martin Heidegger, it was to identify three themes which figured that experience: Transforming the fear into hope, Perceiving himself as the person who decides and Acting for his child benefit. These themes unveiled the phenomenon SEARCHING A CHANCE FOR THE CHILD TO BECOME, who reveals that submits his child to risks and to essential treatments while continuously unchanging overcomes his own feelings in order to offer to his child an opportunity of full living.     

Effect of acute swimming exercise at different intensities but equal total load over metabolic and molecular responses in swimming rats

Journal of Muscle Research and Cell Motility - Acute metabolic and molecular response to exercise may vary according to exercise’s intensity and duration. However, there is a lack regarding...     

Effect of cholecalciferol supplementation on blood glucose in an experimental model of type 2 diabetes mellitus in spontaneously hypertensive rats and Wistar rats

BACKGROUND: Vitamin D might have an influence on glucose concentrations, due to the presence of VDR receptors on the pancreas. We established an experimental model of type 2 diabetes in spontaneously hypertensive rats (SHR) and Wistar rats in order to investigate the glycemic response. METHODS: SHR males (n=6) and Wistar rats (n=6) weighing approximately 89+/-5.5 g and 123.5+/-6.5 g, respectively, after 7 days of basal period, had the chow pattern substituted (350 kcal/100 g) for a hypercaloric/hyperlipidic (HC/HL) diet (490 kcal/100g) and then injected with 40 mg/kg (SHR) and 20 mg/kg (Wistar) streptozotocin I.P. After the creation of diabetes, the rats suffered daily gavage of cholecalciferol (12.5 microg/kg(-) (1)) for 14 days. The blood glucose was assessed twice a week with a glucometer. The data were analyzed by ANOVA. RESULTS: SHR and Wistar rats fed on a HC/HL diet gained 60 g and 32 g in once week, vs. the basal period, where they only gained 23 g and 13 g, respectively. The cholecalciferol supplementation did not change the glucose concentration in all of the SHR animals. About 40% of the group responded by treatment with reduction of about 60% in glucose concentrations. We did find a 40% of the blood glucose levels in all Wistar rats. CONCLUSIONS: Cholecalciferol is able to reduce blood glucose in this experimental diabetes model.     

1H-NMR detectable fatty acyl chain unsaturation in excised leiomyosarcoma correlate with grade and mitotic activity.

We report on the use of 1H-NMR two-dimensional total correlated spectroscopy (2D TOCSY) at 600 MHz for an ex vivo analysis of fatty acyl chain lipid in normal smooth muscle and a series of primary retroperitoneal leiomyosarcomas. These TOCSY spectra were used to identify and quantitate the methylene protons situated between unsaturated site protons (D) to those bordered by only one unsaturated site proton (C). The D/C cross-peak volume ratios determined for oleic (18:1), linoleic (18:2), linolenic (18:3), and arachidonic (20:4) acids were 0.0, 1.3, 2.7, and 4.0, respectively, suggesting that this ratio can be a measure of the degree of unsaturation for fatty acyl chains of lipids. The D/C cross-peak volume ratio was found to be proportional to the mean mitotic activity (r = 0.94) in nine smooth muscle tissues. These results suggest, that for leiomyosarcoma, the degree of fatty acyl unsaturation may be an important determinant of the metastatic potential of these tumors. Furthermore, application of TOCSY for the ex vivo study of smooth muscle tumors would potentially serve as a pathologist-independent and quantitative method for assessment of leiomyosarcoma grade and mitotic activity thereby rendering a more accurate staging of patients.     

Effect of a peroxysomal proliferator agent on intracellular cholesterol accumulation in cultured fibroblasts from Niemann-Pick type C disease patients

BACKGROUND: Niemann-Pick type C (NP-C) disease is a lysosomal storage disorder. It is possible that peroxisomes are also modified and their alterations can be an early event in the process of the disease. As the use of peroxisomal inducers restores the original function of the organelle, the importance of peroxisomes is further emphasized and can suggest future therapeutic interventions. METHODS: We treated fibroblast cultures from NP-C patients and normal individuals with 200 and 400 micromol/l clofibrate and evaluated its action on intracellular cholesterol content that was determined by filipin staining and quantitative measurement of unesterified cholesterol. RESULTS: The fibroblasts from NP-C patients that did not receive any drug presented a pattern of intense perinuclear fluorescence associated with the accumulation of unesterified cholesterol which was not observed in normal fibroblasts. Comparing the NP-C fibroblasts that were incubated with clofibrate and the same cells without this treatment, there were no changes in cholesterol content by filipin staining, but normal fibroblasts after incubation with this drug showed a slight increase in its cholesterol content. However, unesterified cholesterol was significantly increased in both cells treated with clofibrate when compared to untreated cells. CONCLUSIONS: Clofibrate is probably not useful for treatment of NP-C patients because it seems to contribute to an increase the cholesterol in the cells of these individuals.