Implementación de un programa de reciclaje en pabellón / Performance of a recycling program in the operating room

INTRODUCTION: The waste management of a hospital center affects people both those who receive health care and the environment that receives them. The impact on the environment of the task of peri-operative care has not yet been properly studied. It is known that of the 105 tons of garbage monthly from the health center understudy go to the landfills of the municipality. However, there are different elements, such as low-density plastics (LDP), which can be recycled. OBJECTIVE: implement a clean low-density plastics recycling program in the central Operating Room of the UC-Christus Clinical Hospital. METHODOLOGY: In this report, a prospective longitudinal study was conducted with a sample for convenience, in which an intervention was scheduled in series repeated over time from 2017 to 2018. Residents of anesthesia, anesthesiologists, nurses, nurse technicians, and hospital support personnel participated. RESULTS: In total 200 employees participated. During the pilot phase, 30 kg of plastics were quantified, later increasing to 100 kg of LDP in the subsequent phases. It began with the transfer phase to other pavilions within the healthcare center and to other centers in the metropolitan region. Finally, an alternative was started with the municipalities. CONCLUSIONS: It was possible to quantify the amount of clean LPD for recycling. It was possible to involve the collaborators of the institution. This is the first program reported that involves an intervention for LPD.

INTRODUCCIÓN: El manejo de los desechos de un centro hospitalario afecta a las personas tanto a los que reciben atención de salud como también al medioambiente que recibe éstos. El impacto en el ambiente del quehacer de la atención perioperatoria aún no ha sido estudiado apropiadamente. Se sabe que 105 toneladas de basura mensuales del centro asistencial en estudio van a los vertederos de la municipalidad. Sin embargo, existen distintos elementos, como los plásticos de baja densidad (PBD), limpios los cuales pueden ser reciclados. OBJETIVO: Implementar de un programa de reciclaje de plásticos de baja de densidad limpios en el Servicio de Pabellón Central del Hospital Clínico UC-Christus. MATERIAL Y MÉTODOS: En este reporte se realizó un estudio prospectivo longitudinal con una muestra por conveniencia, en la cual se programó una intervención en series repetidas en el tiempo durante 2017 al 2018. Participaron residentes de anestesia, anestesiólogos, enfermeras, TENS, personal de apoyo del hospital entre otros. RESULTADOS: En total 200 colaboradores participaron. Durante la fase piloto se cuantificó 30 kg de plásticos, posteriormente, se incrementó a 100 kg de PBD en las fases posteriores. Se comenzó con la fase de transferencia hacia otros pabellones dentro del centro asistencial y hacia otros centros de la Región Metropolitana. Finalmente, se comenzó a buscar alternativa con las municipalidades. CONCLUSIONES: Se logró cuantificar la cantidad de PBD limpios para reciclar. Se logró involucrar a los colaboradores de la institución. Este es el primer programa reportado que involucra una intervención para el PBD.

TNF polymorphisms independently predict outcome in patients with B-cell non-hodgkin's lymphoma

Tumour Necrosis Factor alpha [TNF alpha] and Lymphotoxin alpha [LT alpha] have been implicated in the pathogenesis of lymphoproliferative disorders. Patients with B-cell non-Hodgkin's lymphoma [NHL] often have high serum levels of TNF which may be associated with a poor outcome. TNF alpha and LT alpha polymorphisms are known to influence expression of these cytokines and may explain the variable response to therapy. In patients with NHL, serum levels of TNF alpha and LT alpha were measured. DNA was typed using allele specific PCR and restriction fragment length polymorphism for the -308 TNFalpha and +252 LT alpha polymorphisms and comparison was made with clinical outcome. The presence of high producing alleles was significantly associated with high serum levels of TNF alpha and LT alpha. The presence of 2 or more high producing alleles was significantly associated with more advanced disease at presentation [stage III and IV], p = 0.024, a higher International Prognostic Index [IPI] score, p = 0.038, failure to achieve a complete remission [CR] after 1st line therapy [88% vs 33%, p = 0.01] and shorter progression free survival [PFS] [median 24 months compared with 78 months, p = 0.001]. Multivariate analysis confirmed that TNF high-risk haplotype [HRH] was an independent prognostic factor for PFS. These results demonstrate that TNF polymorphisms are independent prognostic factors in NHL. Further study is required to further define the importance of TNF polymorphisms within different lymphoma subtypes and with different therapeutic approaches

Protein Z in beta-thalassemia major adult patients and risk of thrombosis

Recent studies have suggested an association between protein Z [PZ] deficiency and thrombosis. Profound haemostatic changes have been observed in patients with beta-thalassemia major with a higher incidence than normal of Ihromboembolic events, so our present study was carried to asses the role of PZ in hypercoagulable state in beta-thalassemia major with other coagulation factors inhibitors [protein C and S] and to compare the splenectomized versus non-splenectomized patients regarding the risk of thrombosis. The study included 44 patients with beta-thalassemia major [22 splenectomized and 22 non-splenectomized], their age ranged from 20-32 years. All were recruited from hematology department of Kaser ALAini hospital. Fifteen healthy subjects who were age and sex matched were included as controls. Complete blood picture, liver function tests, serum ferritin, PZ antigen, PC and PS activity and FDPs were measured for all participants. Study showed significant reduction of PZ antigen together with reduced PC and PS activity in thalassemic patients compared to controls [p<0.001], FDPs was higher in both thalassemic groups compared with control group [p<0.001]. The reduction of PZ antigen, PC and PS activity was more significant in splenectomized patients compared to non-splenectomized patients together with higher FDPs [All p values <0.001]. An inverse correlation between FDPs and PZ antigen, FDPs and PC and PS activity were detected. Reduced PZ antigen together with PC and PS activity may be a contributing factor for hypercoagulable state in thalassemia major. Splenectomized patients are at higher risk of thrombosis

Laser diopexy for peripheral Retinal Ablation in proliferative diabetic retinopathy

To assess the effect and efficacy of the diopexy [contact transscleral retinal photocoagulation with a diode laser] in the peripheral areas of the retina not accessible by standard slit-lamp laser, after full scatter PRP +/- macular treatment in eyes with PDR. The objective is to induce regression of neovascularization in cases with persistent new vessels as an alternative to anterior retinal cryoablation. Diopexy was performed on 35 eyes in patients with PDR associated with NVD +/- NVE's +/- subtotal localized subhyaloid hemorrhage +/- rubeosis irides. Out of the 35 eyes that underwent diopexy, 4 had initial subtotal vitreous hemorrhage, 3 initial rubeosis. In 21/35 eyes stabilization of the neovascularization occurred after diopexy. 7/36 eyes developed vitreous hemorrhage after diopexy [9ms, 3ms, 1 week, 5ms, 2 weeks, 10ms and 3 1/2ms later]. 3 underwent vitrectomy, and in 4 vitreous hemorrhage absorbed, 1/35 eye developed increase in lenticular changes I week after diopexy. Out of the 4 eyes with initial subtotal hemorrhage, 2/4 had recurrent vitreous hemorrhage attacks [1 month and 4 months later], but ultimately vitreous hemorrhage absorbed in all cases within 4 months. Out of the 3 eyes with initial rubeosis, in 2/3 rubeosis regressed 1 week later, and 1/3 rubeosis regressed 1 month later then recurrent rubeosis occurred after another month and later needed vitrectomy for the initial unabsorbed total vitreous hemorrhage. Results showed that diopexy is useful in stabilizing the PDR eyes, help in regression of rubeosis, and in cases of recurrent vitreous hemorrhage, help reabsorption of hemorrhage. Patients with persistent vitreous hemorrhage who underwent vitrectomy later had a better prognosis than those who did not have diopexy. To conclude, diopexy is an intermediate option between laser treatment and vitrectomy in the sequence of PDR treatment

Acute Hepatitis E. virus infection in Egypt

Hepatitis E virus [HEV] is largely responsible for water borne epidemics in many developing countries. The principle mode of HEV transmission is the fecal oral route in epidemic and sporadic forms with a high case fatality ratio in pregnant women. Serum samples from 50 healthy subjects and from 435 acute viral hepatitis patients, 4-75 years old, were screened for markers of acute viral hepatitis. These included [HBsAg, anti-HBc [IgM], anti- HDV [IgM], HAV [IgM], anti-HCV [IgG], and anti-HEV [IgG], and [IgM] tests by enzyme- linked immunoassays [EIA]. Furthermore isolation of HEV from peripheral blood lymphocytes and from stools belonging to anti-HEV IgG-positive patients was attempted by inoculation of HepG2 and Vero cell line cultures. The inoculated cell cultures were examined after immunoperoxidase staining for the detection of HEV antigen. Plasma, lymphocytes and stool samples from anti-HEV IgM positive patients were examined for HEV RNA by PCR.Anti-HEV IgG was found in 144/435 [33%] of these acute hepatitis patients. Anti-HEV [IgM] was detected in 8/52 [15.4%] out of 52 chosen from the 144 sera that were anti-HEV IgG positive cases. HEV was isolated in HepG2 from 32.6% of lymphocyte and from 34.9% of stools from patients positive for anti-HEV [IgG]. While it was isolated from 71.4% of lymphocytes and from 100% of stools from patients positive for anti-HEV [IgM]. In Vero cell cultures there was no HEV isolation from stools but HEV was isolated from 50% of lymphocytes. HEV RNA was detected by PCR in 85.7% of stools, 62.5% of plasma, and in 37.5% of lymphocyte samples belonging to anti-HEV IgM positive cases. Analysis of these diagnostic tests indicated that virus isolation from peripheral blood lymphocytes and stools by inoculation of HepG2 cell cultures is more sensitive than virus-RNA detection by PCR

Factors affecting variations in exposure to infections by Leishmania donovani in eastern Sudan

A cross-sectional survey was carried out in Gedaref state, eastern Sudan to investigate the prevalence of positive leishmanin skin tests and environmental factors related to Leishmania donovani infection. A total of 3835 people living in 11 villages in 3 regions were screened. Soil types and tree densities were determined in 33 villages inhabited by 44 different tribes. The highest rates of positive skin tests were in Rahad region [33.9%], Atbara [21.6%] and Gedaref [10.6%], with an average of 21.1% for the state. Risk of infection by L. donovani varied significantly between different tribes. Higher densities of Acacia and Balanites spp. trees were in Masaleet villages, suggesting that the relatively high risk of L. donovani exposure in this tribe is due to environmental factors

influence of dietary changes in diabetic patients on their plaque cariogenic potential

The aim of this study was to elucidate the influence of diabetes mellitus on the cardiogenicity of dental plaque. 20 patients aged 35-45 years old were selected. 10 of them were insulin dependent diabetic patients while, the other 10 were normal patients. Quantitative and qualitative acid production, its rate, protein content and colony forming units counts of plaque samples were determined. No apparent statistical significant differences were found between the patients and controls for quantitative and qualitative acid production, its rate and protein content. However, the only difference appeared was the colony forming units counts within the plaque samples of the diabetic and normal group of patents