Comparación entre la administración endovenosa y la administración periarticular de ácido tranexámico en cirugía de reemplazo total de rodilla: estudio de dos cohortes consecutivas / Comparison between intravenous and periarticular administration of tranexamic acid in total knee replacement surgery: a study of two consecutive cohorts

Introducción. Se ha reportado que el ácido tranexámico (AT) es útil en el manejo del sangrado posoperatorio de pacientes sometidos a artroplastia total de rodilla (ATR), pero no hay consenso sobre su dosificación y vía de administración. Objetivo. Evaluar y comparar la eficacia para reducir el sangrado posoperatorio de la administración endovenosa y la administración periarticular de AT en pacientes sometidos a ATR. Metodología. Estudio observacional realizado con 72 pacientes operados entre 2021 y 2022 en un centro hospitalario de segundo nivel de atención en Barcelona (España). Los pacientes se dividieron en 2 grupos según la vía de administración del AT (grupo 1: administración endovenosa de dos dosis, una intraoperatoria de 15mg/kg y una posoperatoria de 10mg/kg; grupo 2: una infiltración periarticular de 2g). Se realizó un análisis bivariado con la prueba t de Student para evaluar las diferencias entre grupos. Resultados. El promedio de edad fue 73,72 años en el grupo 1 y 72,96 años en el grupo 2. Se observó una disminución en los niveles de hemoglobina preoperatorio y a las 24 horas en ambos grupos (grupo 1: 2,1 mg/dL; grupo 2: 2,14 mg/dL). En el grupo 2, un paciente presentó embolia pulmonar y otro requirió de transfusión de glóbulos rojos. Conclusiones. El uso de AT, tanto por vía endovenosa como en administración local, permite reducir el sangrado posoperatorio en pacientes sometidos a ATR. No se evidenciaron diferencias estadísticamente significativas en la disminución de los niveles de hemoglobina posoperatorios entre los grupos.

Introduction: Tranexamic acid (TA) has been reported as useful in the management of postoperative bleeding in patients undergoing total knee arthroplasty (TKA), but there is no consensus on its dosage and route of administration. Objective: To evaluate and compare the efficacy of intravenous and periarticular administration of TA in patients undergoing TKA to reduce postoperative bleeding.Methodology: Observational study conducted with 72 patients operated on between 2021 and 2022 in a secondary care center in Barcelona (Spain). Patients were divided into 2 groups depending on the route of TA administration (group 1: intravenous administration of two doses, an intraoperative dose of 15mg/kg and a postoperative dose of 10mg/kg; group 2: periarticular infiltration of 2g). A bivariate analysis was performed using Student's t-test to evaluate the differences between groups.Results: The mean age of the patients was 73.72 years in group 1 and 72.96 years in group 2. A decrease in preoperative and 24-hour hemoglobin levels was observed in both groups (group 1: 2.1 mg/dL; group 2: 2.14 mg/dL). One patient in group 2 presented pulmonary embolism and another required red blood cell transfusion.Conclusions: The use of TA, both intravenous and locally administered, reduces postoperative bleeding in patients undergoing TKA. There were no statistically significant differences in the decrease of postoperative hemoglobin levels between groups

Comparação da coleta das amostras de sangue na triagem pré-natal, utilizando o papel de filtro e punção venosa na técnica de ELISA para detecção de HIV 1+2 / Comparison of the collection of blood samples in prenatal screening, using the filter paper and venipuncture technique ELISA for the detection of HIV 1+2

Apesar de o papel de filtro (PF) ter sido introduzido desde o século passado, (1963) por Guthrie e Susi, nas triagens neonatais, como alternativa para a coleta da amostra do sangue, seus benefícios na aplicação da prática médica laboratorial não foram aproveitados com eficiência nestes anos, comexceção dos recentes resultados obtidos nos trabalhos para a triagem pré-natal. O diagnóstico precoce do HIV em mulheres grávidas é de fundamental importância, sendo o aporte mais destacado para neutralizar a transmissão vertical (TV) do HIV-aids, pois ao ser detectada a presença de anticorpos anti--HIV, aplica-se o Protocolo ACTG 076 (Pediatric AIDS Clinical Trials Group Study Group), que é o tratamento das gestantes HIV-positivo no pré, intra e pós-parto. Objetivo: comparar a coleta das amostras de sangue no papel de filtro (PF) e no plasma (padrão-ouro) na triagem pré-natal, utilizando anticorposanti-HIV 1+2 no procedimento imunoquímico ELISA (Imunoscreen HIV 1+2 SS), da firma Mbiolog. Métodos: foram estudadas 1.142 grávidas de quatromunicípios do Estado do Rio de Janeiro: Itaboraí (N = 131), Itaguaí (N = 597), Niterói (N = 377) e São João de Meriti (N = 37), a partir do mês de novembro de 2008 até fevereiro de 2009. As grávidas foram submetidas a punção digital e venosa para a rotina da triagem pré-natal, sendo a primeira aplicada em PF. Foram calculados os limites de especificidade, sensibilidade, e valores preditivos positivos e negativos para o estudo. Resultados: os resultados da absorbância (homogeneização das variâncias) encontrados para as amostras não reativas e reativas, em ambas as técnicas, não mostraram diferenças significativas (P > 0,05) quando aplicado o teste T de Student no estudo de repetitividade. Os estudos de reprodutibilidade em ambas as técnicas não resultaram coeficientes de variação superiores a 10%. Conclusão: os resultados da sorologia para HIV no sangue seco coletado em PF foram semelhantes aos da coleta por punção venosa, validando esta técnica.

Although the filter paper (FP) have been introduced since the last century (1963) by Guthrie and Susi, in neonatal screening as an alternative to blood sample collection, its benefits in the application of medical laboratory practice not were used effectively in recent years, with the exception of the recent results obtained in the works for the prenatal screening. Early diagnosis of HIV in pregnant women is of paramount importance, being the most out standing support to counteract the vertical transmission (VT) of HIV-AIDS, because the determination of the presence of HIV antibodies, it applies to the ACTG 076 Protocol (Pediatric AIDS Clinical Trials Group Study Group), which is the treatment of pregnant HIV-positive in the pre-,intra and post-parto.Objetive: compare the collection of blood samples on filter paper (FP) and plasma (standard gold) in prenatal screening, using antibodies against HIV 1+2 ELISA immunochemical procedure (Imunoscreen HIV 1 +2 SS), the firm Mbiolog. Methods: we studied 1,142 pregnant women in four counties of the State of Rio de Janeiro: Itaboraí (N = 131), Itaguaí (N = 597), Niterói (N = 377) and St. John Meriti (N = 37), from November 2008 until February 2009.The pregnant women underwent fingerstick and venous for routine prenatal screening, the first being applied in PF. We calculated the limits of sensitivity,specificity and positive predictive value and negative for the study. Results: the results of absorbance (homogeneity of variances) for the samples foundnon-reactive and reactive in both techniques, showed no significant differences (P > 0.05) when using the Student's T test in the study of repeatability.Reproducibility studies for both techniques did not result in coefficients of variation above 10%. Conclusion: the results of serological tests for HIV in driedblood collected in PF were similar to the collection by venipuncture, validating this technique.

Comparação da coleta das amostras de sangue na triagem pré-natal, utilizando o papel de filtro e punção venosana técnica de ELISA para detecção de sífilis / Comparison of the collection of blood samples in prenatal screening, using the filter paperand venipuncture technique ELISA for the detection of syphilis

A sífilis é uma doença infecciosa sistêmica, de evolução crônica e causada pelo Treponema pallidum, um espiroqueta de transmissão sexuale vertical, que pode produzir, respectivamente, as formas adquirida e congênita da doença. No Brasil, segundo o Ministério da Saúde (MS), embora a subnotificação de casos de sífilis seja alta, alguns dados disponíveis indicam a elevada magnitude deste problema infeccioso. Objetivo: comparar a coletadas amostras de sangue no papel de filtro (PF) e no plasma (padrão-ouro) na triagem pré-natal, utilizando anticorpos antitreponêmicos totais (IgG + IgM) no procedimento imunoquímico ELISA, registrado pelo Imunoscreen, da firma MBiolog. Métodos: foram estudadas 1.142 grávidas de quatro municípiosdo Estado de Rio de Janeiro: Itaboraí (N = 131), Itaguaí (N = 597), Niterói (N = 377) e São João de Meriti (N = 37) a partir do mês de novembro de 2008 até fevereiro de 2009. As grávidas foram submetidas a punção venosa e digital para a rotina da triagem pré-natal, sendo a última aplicada em PF. Foram calculados os limites de especificidade, sensibilidade e valores preditivos positivo e negativo para o estudo. Resultados: os resultados da sorologia parasífilis nas amostras do município de Itaboraí apresentaram ELISA positivo em 4,58%, os municípios de Itaguaí, Niterói e São João de Meriti mostraram positividade em 3,18%, 2,65% e 0%, respectivamente. Os procedimentos realizados tiveram uma sensibilidade e especificidade de 100% e os critérios preditivos positivos e negativos para todas as grávidas, estudados nas 1.142 amostras, foram de 100%. Conclusão: os resultados da sorologia para sífilis no sangue seco coletado em PF foram semelhantes aos da coleta por punção venosa, validando esta técnica.

Syphilis is a systemic disease of chronic evolution and caused by Treponema pallidum, a spirochete of sexual and vertical transmission,which can produce, respectively, the form of acquired and congenital disease. In Brazil, according to the Ministry of Health (MoH), although the underreporting of cases of congenital syphilis is high, some available data indicate the high magnitude of this problem that especially affects the weakness of pregnant women. Congenital syphilis causes great social impact, which results in deterioration of quality of life on a important stratum of the population,and indirect costs to the economy of the country, which, added to the direct costs resulting from hospitalizations and procedures for the treatment of its complications, increasing the total costs of care of public health. Objective: to compare the collection of blood samples on filter paper (FP) and plasma(gold standard) in prenatal screening, using anti-treponema total (IgG + IgM) in ELISA immunochemical. Methods: we studied 1,142 pregnant of the following cities: Itaboraí (N = 131), Itaguaí (N = 597), Niterói (N = 377) and St. João de Meriti (N = 37). Blood samples were collected from the finger and venipuncture of pregnant women in stations of collection of these counties, calculating elapsed time from sample collection to delivery of the report to thecouncil. We calculated the limits of sensitivity, specificity, positive predictive value and negative for the study. Results: Itaboraí showed positive ELISA in4.58%, in Itaguai, Niterói and St. João de Meriti showed, respectively, 3.18%, 2.65% and 0%. The procedures performed had a sensitivity and specificity of 100%, and the positive and negative predictive criteria for all pregnant women studied in 1,142 samples were 100%. All positive cases were reported to the Municipality within 10 days of sample collection. Conclusion: we conclude that the implementation of collection of dried blood on filter paper in pregnantwomen screening, was similar to that collected by venipuncture, validating this technology.

Síndrome de celulitis-adenitis inguinal por Streptococcus agalactiae / Cellulitis-adenitis syndrome inguinal Streptococcus agalactiae

Las infecciones de tejidos blandos en la infancia son producidas habitualmente por el Staphylococcus aureus pero, en los primeros meses de vida, el Streptococcus agalactiae (SGB) puede ser responsable de celulitis con afectación sistémica. El síndrome de celulitis-adenitis por SGB constituye una presentación infrecuente de la infección tardía causada por este germen. Las manifestaciones clínicas consisten en fiebre, mal estado general y signos inflamatorios locales. La localización más frecuente es la submaxilar, siendo excepcional la inguinal. Aportamos el caso de un paciente de 30 días de vida con fiebre, con una placa eritematosa y adenopatías en la zona inguinal derecha. En el hemocultivo se aisló SGB. El tratamiento inicial fue cloxacilina y cefotaxima parenterales cambiándose a las 48 horas, tras la recepción del hemocultivo, por cefotaxima y ampicilina. La evolución fue favorable. En niños menores de 3 meses, ante la presencia de celulitis y adenitis regional, debemos considerar al SGB como posible agente etiológico y contemplar la posibilidad de bacteriemia y afectación del sistema nervioso central para no diferir el tratamiento adecuado.

Soft-tissue infections in children are most often caused by Staphylococcus aureus but, in the first months of life, group B streptococcus (GBS) can be the etiologic agent of cellulitis with systemic involvement. Group B streptococcus cellulitis-adenitis syndrome is a rare form of late-onset disease for this germen. Clinical manifestations include fever and local inflammatory signs. Typical localization is submandibular but the inguinal form is exceptional. We present a case of a 30-day-old infant with fever, an erythematous plaque and lymphadenopathy in the right inguinal area. Blood culture was positive for GBS. Evolution was good with initial parenteral therapy with oxacylin and cefotaxime that was changed at 48 hours of treatment, after the blood culture reception, to ampicilin and cefotaxime. In cases of cellulitis and adenitis in infants during the first 3 months of life, GBS has to be considered the probable etiologic agent, and severe invasive disease has to be ruled-out in order to establish the appropriate antimicrobial therapy.

Comparación de calidade del pepel de filtro hahnemuehle 2992 con el schleicher & schuell 903 en la conservación de la sangre seca para el estudio poblacional de anticuerpos igm e igg de la sífilis / Comparison of quality between hahnemuehle 2992 and schleucher & schuell 903 filter paper, in the preservation of dried blood for the population study of igm and igg antbodies to syphilis

Introducción: la alternativa para la colecta de las muestras de sangre en el papel de filtro (PF) muestra cada día mayor interés en los investigadores yasistentes de salud que buscan mejorar los programas de pesquisaje masivo de la población. Muchos autores desde la apertura esta posibilidad en el siglo pasado iniciaron sus proyectos con la conservación de la muestra de sangre seca para estudios masivos neonatales. . Objetivo: valorar la calidad del papel de filtro (Hahnemuehle, 2992) para la colecta de muestras de sangre para el tamisaje de sífilis, como alternativa en la conservación de sangre seca en los laboratorios que usan esta alternativa y estrategia en los estudios de terreno. Métodos: fue realizadoun diseño para el estudio comparativo de calidad entre el PF Schleicher & Schuell 903 que sirvió como patrón de oro y el PF Hahnemuehle 2992, para a coleta e almacenamiento de muestras de sangre para el estudio de anticuerpos totales (IgM e IgG) contra el Treponema pallidum con una técnica ELISA tipo Sándwich. Se compararon 140 señales de absorbancia del mismo número de muestras de mujeres embarazadas, previo consentimiento escrito, para registrar su semejanza estadísticamente según los procedimientos estadísticos del Test de Fisher y Student (Test T) con un valor de seguridad de P > 0,05. Resultados: se encontró correspondencia entre los valores de especificidad, sensibilidad y valor predictivo positivo entre el procedimiento usando con los dos PF en el universo estudiado, así como los valores de T = 0,344331 para el análisis de comparación de medias entre la absorbancia obtenida con los dos PF para de P < 0,001. Conclusión: se concluye que la comparación del PF Hahnemuehle 2992 con el Schleicher & Schuell 903 para el estudio de muestras de sangre seca para la detección de anticuerpos totales del Treponema pallidum por ensayo ELISA es significativamente semejante y cuentan con la misma calidad.

Introduction: the filter paper (dried blood spot DBS) as an alternative of blood sample collection shows an increased interest of scientific investigators and health assistants that search to improve massive research programs of the population. Since the opening of this possibility in the last century, many authors started their projects using dried blood spots for massive neonatal studies. Objective: to assess the filter paper quality (Hahnemuehle, 2992) for collecting blood samples for sifilis screening as an alternative to the conservation of dry blood in the laboratory using this alternative strategyand in camp studies. Methods: a design for a comparative study of quality between Schleicher and Schuell 903 paper used as golden standard- andHahnemuehle 2992 paper was realized, for the collection and storage of dried blood for the totals antibodies (IgM and IgG) against the Treponema pallidum study, using ELISA assay (sandwich type). A hundred and forty (140) signals of absorbance of the same number of pregnant samples, with previous written consent, to register their similarity, using statistic procedures of the Test of Fisher and Student (test T) with a security value of P > 0,05. It was also compared the absorbance values of the positive cases (according a settled cut off for each plate) and sensitivity,specificity and predictive value criteria were calculatedon a total of 604 pregnant of the study. Results: it was detected correspondence of sensitivity, specificity and positive predictive values, in the procedures using the two types of fi lter papers, as well as the value of T = 0,344331 for the analysis of the average comparison between the obtained absorbance with the two types to P < 0,001. Conclusion: it was concluded that Hahnemuehle 2992 fi lter paper compared with Schleicher and Schuell 903 shows signifi cantly similar and have the same quality for the detection of totals antibodies Treponema pallidum of using ELISA test.

Comparación de calidad del papel de filtro hahnemuehel fp 2992 con el whatman (S& S) 903 en la conservación de la sangre seca para el estudio poblacional de anticuerpos HIV 1+2 / Comparison of quality between hahnemuehle 2992 and schleicher & amp; schuell 903 filter paper, in preservation of dried blood for the population study of HIV 1+2 antibodies

Intoducción: el papel de fi ltro (PF) como alternativa para la colecta de las muestras de sangre muestra cada día mayor interés en los investigadores y asistentes de salud que buscan mejorar los programas de pesquisaje masivo de la población. Muchos autores desde la apertura esta posibilidad en el siglo pasado iniciaron sus proyectos con la conservación de la muestra de sangre seca para estudios masivos neonatales. Desde los inicios desde siglo se han acrecentando los estudios y posibilidades para ampliar los estudios epidemiológicos de apoyo a la atención primaria de salud. Objetivo: valorar la calidad del papel de fi ltro (Hahnemuehle 2992) para la colecta de muestras de sangre para el tamisaje de anticuerpos HIV 1+2, como alternativa en la conservación de sangre seca en los laboratorios que usan esta alternativa y estrategia en los estudios de terreno. Métodos: fue realizado un diseño para el estudio comparativo de calidad entre el PF Schleicher & Schuell 903 que sirvió como patrón de Oro y el PF Hahnemuehle 2992, para la coleta y almacenamiento de muestras de sangre para el estudio de anticuerpos del virus HIV 1 y 2 con una técnica ELISA tipo Sándwich del subtipo O. Se compararon 150 señalesde absorbancia del mismo número de muestras de mujeres embarazadas, previo consentimiento escrito, para registrar su semejanza stadísticamentesegún los procedimientos estadísticos del Test de Fisher y Student (Test T) con un valor de seguridad de P > 0,05. También se compararon los valores de absorbancia de los casos que resultaron positivos según el cutt off acertado para cada placa realizada y la infl uencia del hematocrito en los resultados en PF. Se calcularon los criterios de sensibilidad, especifi cidad y valor predictivo del universo total de 604 embarazadas incluidas en el estudio. Resultados: se encontró correspondencia entre los valores de especifi cidad, sensibilidad y valor predictivo positivo entre el procedimiento usando con los dos PF en el universo estudiado, así como los valores de T = 0,008 para el análisis de comparación de medias entre la absorbancia obtenida con los dos PF para de P < 0,0001. Conclusión: se concluye que la comparación del PF Hahnemuehle 2992 con el Schleicher & Schuell 903 para el estudio de muestras de sangre seca para la detección de anticuerpos de HIV 1+2 por ensayo ELISA es signifi cativamente semejante y cuentan con la misma calidad.

Introduction: the fi lter paper (dried blood spot- DBS) as an alternative for blood sample collection shows an increased interest of scientifi c investigators and health assistants that search to improve massive research programs of the population. Since the opening of this possibility in the last century, many authors started their projects using dried blood spots for massive neonatal studies. Since the beginning of this century, studies and possibilities are being increased using this alternative, enlarging the epidemiologic studies that support basic care on health. Objective: to assess the fi lter paper quality (Hahnemuehle 2992)for collecting blood samples for HIV 1+2 antibodies screening as an alternative to the conservation of dry blood in the laboratory using this alternative strategy and in camp studies. Methods: a design for a comparative study of quality between Schleicher and Schuell 903 paper- used as golden standard- and Hahnemuehle 2992 paper was realized, for the collection and storage of dried blood for the HIV 1+2 antibody study, using ELISA assay (sandwich, subtype O). A hundred and fi fty (150) signals of absorbance of the same number of pregnant samples, with previous written consent, to register their similarity, using statistic procedures of the Test of Fisher and Student (test T) with a security value of P > 0,05. The absorbance values of the positive cases (accordinga settled cut off for each plate) and sensitivity were also compared, specifi city and predictive value criteria were calculated on a total of 604 pregnant of the study. Results: it was detected correspondence of sensitivity, specifi city and positive predictive values, in the procedures using the two types of filter papers, as well as the value of T = 0,008 for the analysis of the average comparison between the obtained absorbance with the two types to P < 0,0001. It was concluded that Hahnemuehle 2992 fi lter paper compared with Schleicher and Schuell 903 shows signifi cantly similar and have the same quality for the detection of HIV 1+2 antibodies using ELISA test. Conclusion: it was concluded that Hahnemuehle 2992 fi lter paper compared with Schleicher and Schuell903 shows signifi cantly similar and have the same quality for the detection of total antibodies HIV 1 + 2 of using ELISA test.