Performance Evaluation of Geometrically Different Pediatric Arterial Cannulae in a Pediatric Cardiopulmonary Bypass Model

ABSTRACT Objective: To define a reference chart comparing pressure drop vs. flow generated by a set of arterial cannulae currently utilized in cardiopulmonary bypass conditions in pediatric surgery. Methods: Cannulae from two manufacturers were selected considering their design and outer and inner diameters. Cannula performance was evaluated in terms of pressure drop vs. flow during simulated cardiopulmonary bypass conditions. The experimental circuits consisted of a Jostra HL-20 roller pump, a Quadrox-i pediatric oxygenator (Maquet Cardiopulmonary AG, Rastatt, Germany), and a custom pediatric tubing set. The circuit was primed with lactated Ringer's solution only (first condition) and with human packed red blood cells added (second condition) to achieve a hematocrit of 30%. Cannula sizes 8 to 16 Fr were inserted into the cardiopulmonary bypass circuit with a "Y" connector. The flow was adjusted in 100 ml/min increments within typical flow ranges for each cannula. Pre-cannula and post-cannula pressures were measured to calculate the pressure drop. Results: Utilizing a pressure drop limit of 100 mmHg, our results suggest a recommended flow limit of 500, 900, 1400, 2600, and 3100 mL/min for Braile arterial cannulae sizes 8, 10, 12, 14, and 16 Fr, respectively. For Medtronic DLP arterial cannulae sizes 8, 10, 12, 14, and 16 Fr, the recommended flow limit is 600, 1100, 1700, 2700, and 3300 mL/min, respectively. Conclusion: This study reinforces discrepancies in pressure drop between cannulae of the same diameter supplied by different manufacturers and the importance of independent translational research to evaluate components' performance.

Hemoglobina como predictor del recuento de hematocrito y hematíes según edad y sexo en una población de Villa El Salvador en Lima-Perú

Objetivo: Evaluar el grado de correlación de la hemoglobina como posible predictor del hematócrito y recuento de hematíes según la edad y el sexo en una población del distrito de Villa El Salvador, Lima-Perú. Materiales y métodos: Estudio observacional, analítico, correlacional y prospectivo realizado a 550 hombres y 700 mujeres de todas las edades que acudieron a las campañas de prevención promocionales de salud mensuales, así como a las consultas médicas de rutina, desde enero de 2021 a junio de 2022. El muestreo fue no probabilístico por conveniencia. Las variables fueron sexo, grupo etario, hematocrito y recuento de hematíes; se aplicó la prueba de correlación de Spearman debido a que la prueba de normalidad de Kolmogorov-Smirnov mostró que la distribución no era normal. Se consideró un valor de p significativo menor del 0,05 con un intervalo de confianza al 95 %. Resultados: Hubo mayor prevalencia de anemia en el grupo de mujeres mayores de 11 años (35,10 %), mientras que los niveles de hemoglobina en menores de 11 años fueron, principalmente, normales en la mayoría de los pacientes. Se encontraron correlaciones altas y positivas entre hemoglobina y hematocrito cercanas a 1 en todos los grupos de edad y para ambos sexos. También se halló correlaciones moderadas y positivas entre infantes y niñas (Rho = 0,525), adolescentes y mujeres (Rho = 624), así como infantes y niños (Rho = 0,597). Conclusiones: Los niveles de hemoglobina se correlacionan de forma alta y positiva con el hematocrito. Es posible que el análisis simultáneo de hemoglobina y hematocrito sea clínica y económicamente innecesario en el cribado y en las campañas de prevención promocionales sobre anemia en grandes grupos poblacionales. Asimismo, la hemoglobina se correlaciona de forma moderada y positiva con los hematíes en niños de ambos sexos y adolescentes mujeres. Es necesario ampliar la investigación con estudios que profundicen las razones que causan que la correlación varíe en estos grupos.

Objective: To assess the degree of hemoglobin correlation as a possible predictor of hematocrit and red blood cell count according to age and sex in a population of the district of Villa El Salvador, Lima, Peru. Materials and methods: An observational, analytical, correlational and prospective study carried out with 550 men and 700 women of all ages who attended monthly preventive-promotional health campaigns, as well as routine medical consultations, from January 2021 to June 2022. Collected data consisted of hematocrit, red blood cells and hemoglobin counts. The Spearman's correlation coefficient was used. Results: There was a higher prevalence of anemia in the group of women older than 11 years (35.10 %), while hemoglobin levels in most children younger than 11 years were mainly normal. High and positive correlations between hemoglobin and hematocrit close to one were found in all age groups and both sexes. In addition, moderate and positive correlations were found in female infants and girls (Rho = 0.525), female adolescents (Rho = 624), as well as male infants and boys (Rho = 0.597). Conclusions: Hemoglobin levels are highly and positively correlated with hematocrit. Simultaneous hemoglobin and hematocrit testing may be clinically and economically unnecessary in screening and preventive-promotional campaigns on anemia conducted in large population groups. Likewise, hemoglobin correlates moderately and positively with red blood cell in children of both sexes and female adolescents. Further research is needed to deepen the reasons why correlation varies in these groups.

Perfil hematológico de idoso com dengue internado em unidade de terapia intensiva / Hematological profile of elderly people with dengue hospitalized in an intensive care unit / Perfil hematológico de ancianos con dengue hospitalizados en una unidad de cuidados intensivos

Introdução: A dengue é considerada a arbovirose mais comum no mundo, sendo hoje um problema crescente de saúde pública. Objetivo: Por ser considerada de alta prevalência, foi realizada a avaliação hematológica de um paciente hospitalizado na Unidade de Terapia Intensiva na cidade de Umuarama-PR. Metodologia: Tratou-se de um estudo descritivo retrospectivo, do qual foram analisados os resultados de hemogramas obtidos por um laboratório local, considerando que o paciente constava como sorologia positiva para NS1. Foram avaliados 09 laudos de hemograma emitidos durantes 5 dias de internamento do paciente. Os resultados foram comparados entre os laudos e com os valores de referência disponibilizados pelo próprio laudo. Resultados: Com base na análise dos hemogramas pode-se verificar a redução do hematócrito em 33,33%, macrocitose em 88,9%, leucopenia em 27,3%, trombocitopenia em 27,3%. Conclusão: Conclui-se que através dos laudos avaliados foram encontrados plaquetopenia, leucopenia, linfocitopenia, eosinopenia, neutropenia, monocitopenia. Evidenciando o hemograma como uma ferramenta laboratorial de grande auxílio na avaliação do paciente.

Introduction: Dengue is considered the most common arbovirus in the world, and is now a growing public health problem. Objective: Due to its high prevalence, a hematological evaluation of a patient hospitalized in the Intensive Care Unit in the city of Umuarama-PR was carried out. Methodology: This was a retrospective descriptive study, in which the results of blood counts obtained by a local laboratory were analyzed, considering that the patient had positive serology for NS1. 09 blood count reports issued during the 5 days of the patient's hospitalization were evaluated. The results were compared between the reports and with the reference values provided by the report itself. Results: Based on the analysis of blood counts, it was possible to verify a reduction in hematocrit in 33.33%, macrocytosis in 88.9%, leukopenia in 27.3%, thrombocytopenia in 27.3%. Conclusion: It is concluded that through the evaluated reports, thrombocytopenia, leukopenia, lymphocytopenia, eosinopenia, neutropenia, monocytopenia were found. Evidencing the blood count as a laboratory tool of great help in the evaluation of the patient.

Introducción: El dengue es considerado el arbovirus más común en el mundo, y actualmente es un problema creciente de salud pública. Objetivo: Debido a su alta prevalencia, se realizó una evaluación hematológica de un paciente hospitalizado en la Unidad de Cuidados Intensivos de la ciudad de Umuarama-PR. Metodología: Se trató de un estudio descriptivo retrospectivo, en el cual fueron analizados los resultados de los hemogramas obtenidos por un laboratorio local, considerando que el paciente tenía serología positiva para NS1. Fueron evaluados 09 informes de hemogramas emitidos durante los 5 días de internación del paciente. Los resultados se compararon entre los informes y con los valores de referencia proporcionados por el propio informe. Resultados: A partir del análisis de los hemogramas, fue posible verificar reducción del hematocrito en 33,33%, macrocitosis en 88,9%, leucopenia en 27,3%, trombocitopenia en 27,3%. Conclusiones: Se concluye que a través de los reportes evaluados se encontró trombocitopenia, leucopenia, linfocitopenia, eosinopenia, neutropenia, monocitopenia. Evidenciando el hemograma como una herramienta de laboratorio de gran ayuda en la evaluación del paciente.

The most common inadequacies in red blood cell requests at a reference center in Western Paraná state

Abstract Introduction In the current scenario, in which evidence-based medicine is almost obligatory, therapeutic approaches are increasingly being restricted to measures that are proven to bring benefits to the patient. Transfusion therapy follows the same concept. Even though it can be an essential support procedure in some situations, it must be carefully used, exclusively in situations in which the literature assures scientific support for its usage. Transfusion exposes patients to risks and complications, so it is necessary that we, as doctors, continue working to reduce possible mistakes involving the practice of this type of therapy. Objective To analyze if the red blood cell requests are properly made, analyzing the indication written on them (by the doctor, comparing them to the references in the actual literature. Method In this research, we have analyzed and reviewed the requests for red blood cell concentrates between August and September of 2018 received at the Hematology and Hemotherapy Center studied to find the most common mistakes made by requesters/doctors. Results A total of 397 of the 754 analyzed requests were evaluated as inadequate. Therefore, 1 out of every 2 transfusions performed did not have their requests properly completed in the city of Cascavel, Paraná. Conclusions The number of inappropriate requests was high during the studied period, especially when compared to studies available in the literature. The number of inadequacies suggests that the blood component requests and the subsequent evaluation by the transfusion agency needs to be better addressed in clinical practice.

Cumplimiento de la política transfusional restrictiva en el Instituto de Cardiología y Cirugía Cardiovascular 2019-2021 / Compliance with the restrictive transfusional policy at the Institute of Cardiology and Cardiovascular Surgery 2019-2021

Introducción: A principios del siglo XXI el déficit de sangre y los riesgos de la transfusión, determinaron la adopción de una política transfusional restrictiva, con cifras de hemoglobina entre 70 y 100 g/L para pacientes cardiovasculares en el mundo. En el Instituto de Cardiología y Cirugía Cardiovascular se adoptó esta política, por lo cual es necesario controlar su cumplimiento, para hacer un uso racional y seguro de este recurso. Objetivo: Evaluar el cumplimiento de la política transfusional restrictiva del Instituto de Cardiología y Cirugía Cardiovascular entre 2019 y 2021. Métodos: Se realizó un estudio observacional descriptivo transversal, mediante la revisión del registro de pacientes transfundidos y las órdenes de transfusión, lo que permitió llegar a resultados. Resultados: Se transfundieron 5408 hemocomponentes, 64,1 por ciento concentrados de eritrocitos. Los servicios con mayor consumo fueron: la unidad de cuidados intensivos posquirúrgicos 53,2 por ciento, el salón de operaciones 22,8 por ciento y la unidad de cuidados intensivos de emergencia 10,8 por ciento. La media de las cifras de hematocrito/hemoglobina de los pacientes transfundidos fue 0,24/79,2 g/L, inferior 0,22/72,6 g/L para los operados por valvulopatías cardíacas severas. El 95,9 por ciento de las órdenes de transfusión reunieron los requisitos normados. El principal problema fue la omisión de los antecedentes transfusionales. Conclusiones: Se cumplió la política transfusional restrictiva. La media de las cifras de hematocrito/hemoglobina fue menor a las recomendadas para pacientes cardiovasculares en las guías cubanas. La calidad de las órdenes de transfusión fue adecuada(AU)

Introduction: At the beginning of the 21st century, the blood deficit and transfusion risks determined the adoption of a restrictive transfusion policy, with hemoglobin levels between 70 and 100 g/L for cardiovascular patients in the world. In the Institute of Cardiology and Cardiovascular Surgery, this policy was adopted for which it is necessary to control compliance, to make a rational and safe use of this resource. Objective: Evaluate compliance with the restrictive transfusion policy of the Institute of Cardiology and Cardiovascular Surgery between 2019 and 2021. Method: An observational descriptive cross-sectional study was carried out by reviewing the records of transfused patients and transfusion orders, which allowed reaching results. Results: 5 408 hem components were transfused, 64,1 percent were packed erythrocytes. The services with the highest consumption were the post-surgical intensive care unit 53,2 percent, the operating room 22,8 percent and the emergency intensive care unit 10,8 percent. The mean of the hematocrit/hemoglobin values of the transfused patients was 0,24/79,2 g/L, lower 0,22/72,6 g/L for those operated on for severe heart valve disease. 95,9 percent of the transfusion orders met the regulatory requirements. The main problem was the omission of transfusion history. Conclusion: The restrictive transfusion policy was complied with. The mean hematocrit/hemoglobin values were lower than those recommended for cardiovascular patients in The Cuban guidelines. The quality of the transfusion orders was adequate(AU)

The value of dynamic changes in hematocrit for early fluid resuscitation and risk of death in septic shock / 中华急诊医学杂志

Objective:To explore the relationship between hematocrit, early fluid therapy, and clinical outcomes in patients with septic shock, and to provide evidence for fluid resuscitation therapy and prognosis assessment in these patients.Methods:The clinical information of patients with septic shock who were diagnosed and treated in the Emergency Intensive Care Unit (EICU) of the First Affiliated Hospital of Wenzhou Medical University from January 1, 2018 to December 31, 2020 were collected. Taking the survival or death of patients 28 days after admission as the end point of clinical research, the patients were divided into the survival and death groups. After analyzing the basic data of the two groups, the univariate and multivariate COX regression analyses were used to analyze the evaluation value of Δ Hematocrit (HCT) d2-d1 and ΔHCT d3-d1 on the prognosis of patients with septic shock. At the same time, the Kaplan-Meier survival curve was used to analyze the overall survival rate of patients with septic shock, and the smooth curve fitting graph was used to verify its relationship with net fluid intake and death. Results:There were 241 cases in the survival group and 67 cases in the death group. Univariate COX analysis showed statistically significant differences between the survival and death groups in acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) ( P=0.0006), red cell volume distribution width (RDW) ( P=0.0043), age ( P=0.0184), ΔHCT d2-d1 ( P=0.0136), ΔHCT d3-d1 ( P=0.0204), and white blood cell (WBC) ( P=0.0444). Multivariate COX analysis showed that ΔHCT d2-d1 ( P=0.0115) and ΔHCT d3-d1 ( P=0.0029) were independent risk factors for death in EICU patients with septic shock. ΔHCT d2-d1 and ΔHCT d3-d1 were divided into three groups according to the three-digit method. The Kaplan-Meier survival curve showed no significant difference among the three groups in the overall survival rate related to ΔHCT d2-d1 ( P=0.16), but there was a statistically significant difference in the overall survival rate among the three groups related to ΔHCT d3-d1 ( P=0.025). The smooth fitting curve of ΔHCT d3-d1, net fluid intake, and prognosis showed that ΔHCT d3-d1 was negatively correlated with net fluid intake, and the middle ΔHCT d3-d1 group had the best prognosis. Conclusions:The value of ΔHCT d3-d1 is related to the net fluid intake of patients with septic shock. An appropriate decrease in HCT on the third day can improve the prognosis of patients with septic shock. The dynamic changes of hematocrit can provide a certain basis for fluid resuscitation and prognosis evaluation in patients with septic shock.

Caracterización de la plaquetopenia, leucopenia y aumento del hematocrito en la evolución y gravedad de los pacientes con diagnóstico de dengue / Characterization of thrombocytopenia, leukopenia and increased hematocrit in the evolution and severity of patients with dengue diagnosis

El virus del dengue (DENV) ha frecuentado nuestro planeta por más de tres siglos. La picadura del Aedes aegypti causa el DENV. El diagnóstico clínico y laboratorial son importantes para el manejo del dengue. Objetivo: caracterizar la presencia de la plaquetopenia, leucopenia y aumento del hematocrito con la evolución y gravedad de los pacientes con Dengue, en el Hospital Univalle, en la ciudad de Cochabamba, Bolivia. Material y métodos: estudio retrospectivo, longitudinal y analítico, desde el 2017 al 2020. Resultados: se identificaron 235 pacientes, 83% el 2020; el 65% entre 19 a 45 años; 54% de sexo masculino, 80% provienen de Cercado-Cochabamba, siendo más del 95% de la zona sud. La prueba de detección de la proteína NS1Ag (AccuBio Tech Co, Ltd.) se usó en 71%; 56% se hospitalizaron; más del 50% presentaron sintomatología entre el 2do y 5to día. Dentro la clasificación del dengue, el 75% perteneció a dengue sin signos de alarma (p= 45% en varones, presentando más de 5 días de hospitalización (p=0,023). Conclusiones: plaquetopenia, leucopenia y el aumento del hematocrito son biomarcadores de severidad clínica y estancia hospitalaria, asociados a un diagnóstico precoz, empleando la sintomatología y pruebas rápidas disponibles; siendo necesario considerar la presencia de pacientes autóctonos de la zona sud de Cochabamba, Cercado.

Dengue virus (DENV) has haunted our planet for more than three centuries. The Aedes aegypti bite causes DENV. Clinical and laboratory diagnosis are important for the management of dengue. Objective: to characterize the presence of plaquetopenia, leukopenia and increased hematocrit with the evolution and severity of patients with Dengue, Hospital Univalle. Material and methods: retrospective, longitudinal and analytical study, 2017 to 2020. Results: 235 patients were identified, 83% in 2020; 65% between 19 to 45 years old; the male sex with 54%. 80% come from Cercado-Cochabamba, of these more than 95% from the southern area. The test with the detection of the NS1Ag protein (AccuBio Tech Co, Ltd.) was used in 71%; 56% were hospitalized; more than 50% presented symptoms between the 2nd and 5th day; Within the dengue classification, 75% belonged to dengue without warning signs (p = 45% in men and represented more than 5 days of hospitalization (p = 0,023). Conclusions: Plaquetopenia, leukopenia and increased hematocrit are biomarkers of clinical severity, hospital stay, associated with an early diagnosis, using the symptoms and rapid tests available; finally, consider the presence of autochthonous patients from the southern area of Cochabamba, Cercado.

Anemia in cardiac surgery - can something bad get worse?

Abstract Introduction: Anemia and blood transfusion are risk factors for morbidity/mortality in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). The objective of this study is to analyze the association of blood transfusion with morbidity/mortality in patients undergoing coronary artery bypass grafting (CABG) under CPB in the state of São Paulo, Brazil. Methods: This is a retrospective analysis using the State of São Paulo Registry of Cardiovascular Surgery from November 2013 to August 2014. Blood transfusion was only considered during surgery or within six hours after surgery. Anemia was defined as hematocrit ≤ 37.5%. Patients < 18 years old were excluded. The sample was divided in four groups - Group I (851, no anemia), Group II (200, anemia without blood transfusion), Group III (181, no anemia and transfusion), and Group IV (258, anemia and transfusion). Results: A total of 1,490 patients were included; 639 (42.9%) were anemic and 439 (29.5%) underwent blood transfusion. Group II showed lower composite morbidity (odds ratio [OR] −0.05; confidence interval [CI] −0.27-0.17; P=0.81) than Group III (OR 0.41; CI 0.23-0.59; P=0.018) or Group IV (OR 0.54; CI 0.31-0.77; P=0.016). Group III was at greater risk of mortality (OR 0.73; CI 0.43-1.03; P=0.02) than Group II, which was exposed only to anemia (OR −0.13; CI −0.55-0.29; P=0.75), or Group IV (OR 0.29; CI −0.13-0.71; P=0.539). Conclusion: Anemia in patients undergoing CABG with CPB is bad, but blood transfusion can be worse, increasing at least 50% the risk for mortality and/or morbidity.

The effect of dialectic behavioral counseling on depression, anxiety, and postpartum hematocrit levelprotocolo 20210073553284 prefeitura

Abstract Objective Childbirth is a biological, psychological, and sociological event that can be a positive or negative experience, and, without support, this period may be potentially damaging. Parturition may distort maternal emotions and lead to short- or long-term disorders such as postpartum depression and anxiety. The present research aims to study the effects of dialectic behavioral therapy-based counseling on depression, anxiety symptoms, and postpartum hematocrit level. Methods The current research is a clinical trial study, and the sample was selected using parturients who were referred to the Health General Center with a diagnosis of postpartum depression and anxiety. The sample size consisted of 116 subjects who agreed to participate in the study. The patients in intervention group underwent group dialectic behavioral counseling (10 sessions/one session per week) and the control group did not receive any type of intervention. The patients were assessed in the first and last sessions as well as 2 months after the end of the sessions, using the Beck depression scale and Spielberg anxiety scale as well as the results of hematocrit tests. Data were analyzed using the IBMSPSS Statistics for Windows, Version 21.0 (IBMCorp., Armonk, NY, USA) Results The results implied the effectiveness of dialectic behavioral therapy on reduction of the depression score, anxiety symptoms (p-value ≤ 0.0001), and hematocrit level (p-value=0.04). The participants' depression, anxiety, and hematocrit levels decreased in the experiment group compared to the control group, and this decrease has remained until the 2-month follow-up. Conclusion It seems that dialectic behavioral counseling reduces the levels of postpartum depression, anxiety, and hematocrits.

Clinical research of the differences between hematocrit and serum albumin for evaluating the severity of acute paraquat poisoning / 中华危重病急救医学

Objective:To investigate the clinical values of the differences between hematocrit and serum albumin (HCT-ALB) for evaluating the severity of patients with acute paraquat (PQ) poisoning.Methods:Patients with acute PQ poisoning admitted to the Second People's Hospital of Yunnan Province from January 2018 to December 2019 were enrolled, and healthy voluteers during the same period were selected as the control. The general information, poisoning dose and poisoning time of patients, as well as the HCT and serum ALB levels before blood product infusion, intravenous infusion, or hemopurification at admission were collected, and the HCT-ALB was calculated. According to the results of rapid semiquantitative test of PQ in urine at admission, the patients were divided into PQ low concentration group (0-10 mg/L) and PQ high concentration group (30-100 mg/L). The relationship between poisoning time, poisoning dose, HCT-ALB and the degree of acute PQ poisoning were analyzed, and Spearman method was used to analyze the grade correlation.Results:A total of 295 patients with acute PQ poisoning were enrolled, including 118 cases in PQ low concentration group and 177 cases in PQ high concentration group, and another 200 healthy persons matched with PQ patients in gender and age (healthy control group). The poisoning time of PQ low concentration group was significantly longer than that of PQ high concentration group [hours: 11.0 (6.0, 60.0) vs. 8.0 (5.0, 20.5), P < 0.01], but the poisoning dose was significantly lower than that of PQ high concentration group [mL: 10.0 (5.8, 15.0) vs. 40.0 (20.0, 80.0), P < 0.01]. The HCT and HCT-ALB in PQ low and high concentration groups were significantly higher than those of the healthy control group [HCT: (43.14±4.41)%, (43.54±5.40)% vs. (42.14±2.15)%, HCT-ALB: 3.59±6.26, 5.94±7.80 vs. -7.26±3.55, all P < 0.01], but ALB was significantly lower than that of the healthy control group (g/L: 39.54±5.74, 37.60±7.15 vs. 49.40±3.41, both P < 0.01). With the increase of urine PQ concentration, the HCT and HCT-ALB further increased, and ALB further decreased. There were significant differences between PQ high concentration group and PQ low concentration group [HCT: (43.54±5.40)% vs. (43.14±4.41)%, HCT-ALB: 5.94±7.80 vs. 3.59±6.26, ALB (g/L): 37.60±7.15 vs. 39.54±5.74, all P < 0.05]. The poisoning severity of patients with acute PQ poisoning were negatively correlated with poisoning time and ALB ( r values were -0.195 and -0.695, respectively, both P < 0.01), there were positively correlated with poisoning dose, HCT, and HCT-ALB ( r values were 0.650, 0.256, 0.737, respectively, all P < 0.01), and the correlation between HCT-ALB and poisoning severity was the strongest. Conclusion:The HCT-ALB can reflect the poisoning severity of patients with acute PQ poisoning and indirectly reveal the pathological changes of microvessels in patients with acute PQ poisoning.

Comparison of efficacy of two blood transfusion methods in cesarean delivery / 中国基层医药

Objective:To explore the application value and complications of two blood transfusion methods used for cesarean delivery.Methods:Sixty parturients undergoing cesarean delivery in Yiwu Central Hospital from January 2013 to December 2019 were included in this study. They were divided into autogenic blood transfusion and allogeneic blood transfusion groups ( n = 30/group) according to different blood transfusion methods used. In the autogenic blood transfusion group, self-storage blood transfusion scheme was used, while in the allogeneic blood transfusion group, allogeneic blood transfusion scheme was used. The amount of postpartum blood loss, amount of autogenic blood transfused, amount of allogeneic blood transfused, hemoglobin, hematocrit and coagulation index before and 3 days after surgery, complications were compared between autogenic blood transfusion and allogeneic blood transfusion groups. Results:Postoperative blood loss in the autogenic blood transfusion group was significantly less than that in the allogeneic blood transfusion group [(9 897.42 ± 215.37) mL vs. (23 081.87 ± 546.23) mL, t = 122.990, P < 0.05]. The amount of autogenic blood transfused in the autogenic blood transfusion group was less than that in the allogenic blood transfusion group [(954.32 ± 143.42) mL vs. (10 474.18 ± 376.87) mL, t = 129.310, P < 0.05). Hemoglobin level and hematocrit at 3 days after surgery in the autogenic blood transfusion group were (106.32 ± 12.19) g/L and (0.39 ± 0.19), which were significantly higher than those in the allogenic blood transfusion group [(86.18 ± 3.25) g/L, 0.34 ± 0.14, t = 8.744, 11.633, both P < 0.05]. D-Dimer and fibrin degradation product levels in the autogenic blood transfusion group were (5.45 ± 1.29) mg/L and (13.42 ± 2.41) mg/L, respectively, which were significantly lower than those in the allogenic blood transfusion group [(8.56 ± 1.47) mg/L, (21.30 ± 3.64) mg/L, t = 8.710, 9.887, P < 0.05]. The incidence of complications in the autogenic blood transfusion group was significantly lower than that in the allogenic blood transfusion group [6.67% (2/30) vs. 36.67% (11/30), χ2 = 7.954, P < 0.05]. Conclusion:Autogenic blood transfusion is highly effective for cesarean delivery of dangerous placenta previa, and it has few complications.

Effect of alprostadil on acute cerebral infarction in 150 cases / 中国基层医药

Objective:To investigate the clinical efficacy of alprostadil injection in the treatment of acute cerebral infarction.Methods:A total of 300 patients with acute cerebral infarction who received treatment in The First People's Hospital of Jiashan, China between August 2016 and August 2018 were included in this study. They were randomly divided into a control group and an observation group ( n = 150/group). Based on conventional treatment, patients in the control group received Xueshuantong power injection treatment and those in the observation group received alprostadil injection treatment. All patients were treated for 14 days. Clinical efficacy was compared between the control and observation groups. Results:In the observation group, infarct volume, plaque area, lumen area, intima-media thickness of the common carotid artery, Crouse score, recanalization rate, Barthel Index, National Institutes of Health Stroke Scale (NIHSS) score, hematocrit and plasma viscosity in the observation group were (3.16 ± 1.19) cm 3, (0.21 ± 0.05) mm 2, (0.30 ± 0.06) mm 2, (1.05 ± 0.23) mm, (2.18 ± 0.61) points, 98.67% (148/150), (96.38 ± 1.75) points, (6.31 ± 1.08) points, (41.03 ± 4.28)%, (1.12 ± 0.03) mPa/s, respectively, which were superior to those in the control group [ (2.25 ± 1.37) cm 3, (0.68 ± 0.46) mm 2, (0.89 ± 0.54) mm 2, (1.76 ± 0.85) mm, (3.29 ± 0.78) points, 72.00% (108/150), (85.22 ± 1.56) points, (10.18 ± 1.43) points, (50.76 ± 5.31)%, (1.54 ± 0.34) mPa/s, t = 1.869, 1.231, 1.452, 1.326, 2.285, χ2 = 12.528, t = 11.428, 4.28, 17.473, 15.071, all P < 0.05]. Conclusion:Based on conventional treatment, alprostadil injection exhibits good clinical efficacy in the treatment of acute cerebral infarction.

Preparation and clinical application of 0.7~0.8 hematocrit concentrated washed red blood cells in intrauterine blood transfusion for fetal anemia / 中国输血杂志

【Objective】 To develop a new approach for the preparation of 0.7~0.8 hematocrit concentrated washed red blood cells(RBCs) for fetal anemia in utero transfusion and apply it in clinical. 【Methods】 The erythrocyte suspension and frozen stored erythrocytes within expiry date in Guangzhou Blood Center from March 2020 to February 2021 were taken to prepare concentrated washed RBCs. According to the derivation formula, corresponding weight of RBC preservation solution was added to obtain 0.7~0.8 hematocrit concentrated washed RBCs. Routine blood test data were statistically analyzed by single-sample t test, and P<0.05 was considered statistically significant. Qualified Rh-negative/ O-type 0.7~0.8 hematocrit concentrated RBCs within expiry date were used in clinical intrauterine blood transfusion. 【Results】 The hematocrit of concentrated washing RBCs prepared by the new approach could reach 0.7~0.8. The RBCs count (8.389 ±0.808)×1 012/ L and hemoglobin content(233.730±15.498)g/L were higher while the erythrocyte count (0.732±0.469)×109 /L and platelets count(26.000±26.276)×109/L were lower than the normal values of adults. The mean erythrocyte volume(fL), hemoglobin content(pg) and concentration(g/L )were 88.123±6.359, 30.004±2.809 and 339.980±11.865, respectively, which were normal values of adults. Fetal anemia was significantly improved and the prognosis was good after intrauterine blood transfusion. 【Conclusion】 The 0.7~0.8 hematocrit concentrated washed RBCs prepared by the new approach is consistent with the special blood requirements during fetal anaemia transfusion, meets the clinical treatment standards, and can be applied in clinical.

Clinical and laboratory profile of dengue fever in children in a tertiary care hospital of Navi Mumbai, India

Background: Dengue fever is a mosquito born arboviral illness endemic in tropical countries and causes significant mortality and morbidity due to lack of definitive treatment. The objective of this study was to assess the clinical and laboratory profile of confirmed cases of dengue in children up to 12 years of age and also to charactrise the risk factors for severe dengue.Methods: This is a descriptive, observational, retrospective study done in the Department of Pediatrics, Terna Medical College, Nerul, Navi Mumbai, India.   Medical records of all children up to 12 years of age diagnosed to have dengue   were reviewed.  Their clinical and laboratory profile were recorded in a pro forma and analyzed. All cases were classified as per WHO guidelines into non severe and severe dengue cases.Results: Among the 117 confirmed dengue cases, (84.6%) had non severe dengue and (15.4%) had severe dengue. The most common age group affected was 9-12 years (45.3%) with a male to female ratio of 2.4:1. Fever was the most common clinical feature seen in all cases followed by headache (83%), myalgia (81%), ascites (24.7%), vomiting (17.9%). Clinical signs of ascitis, hepatomegally, gastrointestinal bleeding, pleural effusion and shock were predominantly associated with severe dengue cases. Laboratory parameters showed leukopenia in 58.1% and thrombocytopenia (platelet counts <20,000/cumm3) in16.2% cases. Elevated liver enzymes, raised hematocrit (36.3%) and coagulation abnormalities were seen in over 50% dengue cases and were significantly associated with severe dengue dengue.Conclusions: Knowledge of clinical   and laboratory profile of dengue cases of a particular area will help in early prediction of risk factors for severe dengue resulting in favourable outcome of such cases.

Comparison of glucose measurement on dried blood spots versus plasma samples in pregnant women with and without anemia

ABSTRACT Objective Compare the concordance degree between plasma glucose and glucose measurements on Dried Blood Spots (DBS) during pregnancy. Subjects and methods Glucose measurement was performed in pregnant women after a fast of 8-12 hours. Venous blood was collected with sodium fluoride, the plasma was separated, and glucose measured by the enzymatic oxidase glucose method. Capillary blood samples were collected and analyzed by DBS. For statistics, the paired Student's t test, interclass correlation coefficient (ICC), graphic approach of Altman and Bland, and survival - concordance plot were used. Results 307 pregnant women were evaluated, 88.6% without diabetes and 11.4% with previous diabetes. The glucose ranged from 66 to 190 mg/dL [3.66 to 10.55 mmol/L] in plasma and from 53 to 166 mg/dL [2.94 to 9.21 mmol/L] in DBS. The glucose average values were 88.1 ± 12 mg/dL [4.98 ± 0.67 mmol/L] in plasma and 89.2 ±11,5 mg/dL, [4.95 ± 0.64 mmol/L] in DBS - p-value = 0.084. The ICC value was moderate (0.510), and Pearson's correlation coefficient was r = 0.507 p < 0.001. Altman and Bland's graph showed that difference between the values obtained by both methods is -24.62 to 22.3 mg/dL [-1.37 to 1.24 mmol/L]. Significant fixed bias (-1,16 average difference) and proportional bias (r = 0.056; p = 0.33) were not observed. Anemia was associated with differences between plasma glucose and DBS measurements (p = 0.031). Conclusion Capillary glucose in DBS correlates with plasma glucose; however, the methods do not present good concordance. The presence of anemia worsens this result.

Neutrophil-lymphocyte and hematocrit scoring in acute pancreatitis as an early predictor of severity and outcome

Background: The management of acute pancreatitis (AP) is determined by an accurate assessment of severity of disease. Numerous severity indicators have been described till date, most of which require reassessment after admission and resuscitation. Authors propose a novel indicator, the neutrophil-lymphocyte and hematocrit (NLH) scoring as a predictor of acute pancreatitis at the initial time of diagnosis. NLH may have a role in predicting the length of hospital stay and intensive care unit admission and also to predict adverse manifestations of severe acute pancreatitis (SAP).Methods: A retrospective analysis of 107 patients done who diagnosed with acute pancreatitis based on Atlanta 2012 definitions, who were admitted and treated between August 2018 and November 2019. NLH score calculated by adding NLR (neutrophil lymphocyte ratio) and Ht (hematocrit) i.e., NLH=NLR+Ht. NLH was also compared with APACHE II score as a standard predictor of prognosis in acute pancreatitis.Results: Median NLH score among the severe group is significantly higher compared to mild and moderate group. NLH score significantly correlated with length of hospital stay and also had a statistically significant correlation with ICU stay. NLH scoring is comparable with APACHE II scoring system in predicting prognosis in acute pancreatitis.Conclusions: NLH score can be used as a predictor of severity of acute pancreatitis, right at the time of initial diagnosis. Further it may predict adverse outcomes, need for ICU care as well as the length of hospital stay. NLH score can be used as a tool to refer at risk patients to tertiary center needing ICU admission.

Avaliação da prevalência de anemia pós-parto e fatores associados em uma maternidade terciária do estado do Piauí / Prevalence of postpartum anemia and associated factors in a tertiary maternity hospital of the state of Piaui

Este trabalho avaliou a prevalência de anemia puerperal por meio das dosagens de hemoglobina (Hb) e hematócrito (Ht) numa maternidade pública terciária do estado do Piauí e os fatores de risco associados à presença de anemia. No total, 198 puérperas internadas na maternidade foram submetidas a entrevista e análise do prontuário e do cartão pré-natal. Foram feitas coletas de amostra de sangue venoso periférico antes do parto, 24 horas após o parto vaginal e 48 horas após o parto cesariano. A prevalência de anemia pós-parto encontrada na maternidade estudada foi de 27,27%. A presença de anemia pré-parto e gemelaridade e o ganho de peso foram os fatores de risco significativamente associados à anemia pós-parto.(AU)

This study evaluated the prevalence of puerperal anemia using hemoglobin (Hb) and hematocrit (Ht) measurements in a public tertiary maternity hospital in the state of Piauí and the risk factors associated with the presence of anemia. In total, 198 puerperal women admitted to the maternity hospital were interviewed, analyzed the medical record and the prenatal card. A peripheral venous blood sample was collected before delivery, 24 hours after vaginal delivery and 48 hours after cesarean delivery. The prevalence of postpartum anemia found in the maternity studied was 27.27%. The presence of pre-delivery anemia, twinning and weight gain were the risk factors significantly associated with postpartum anemia.(AU)

Influencia de la dieta vegetariana y carnívora en relación a la hemoglobina y hematocrito / Influence of the vegetarian and carnivore diets on hemoglobin and hematocrit levels

RESUMEN El presente identifica el grado de influencia de la dieta vegetariana y carnívora en relación con la hemoglobina y hematocrito de los estudiantes de medicina humana de la Universidad Peruana Unión, Lima, 2018. El problema planteado es descubrir si las personas con dieta vegetariana y carnívora presentan deficiencia de hematocrito y hemoglobina. En relación a las personas que llevan una dieta vegetariana, 23 participantes practican diferentes tipos de vegetarianismo. Se consideraron los siguientes rangos, hemoglobina (12 - 16 g/dl) y hematocrito (36-48 %). Se concluye que, en relación a dieta y hemoglobina/hematocrito, la mayoría de los encuestados están en los rangos normales de dichas variables y que las personas que mantienen una dieta vegetariana no presentan un alto grado de deficiencia en los niveles de hematocrito y hemoglobina, y presentan un mejor nivel nutricional que los de dieta carnívora.

ABSTRACT The present study establishes the degree of influence of the vegetarian and carnivore diets on the hemoglobin and hematocrit levels of students of human medicine of the Universidad Peruana Unión, Lima, 2018. The goal was to find out if people who follow a vegetarian or carnivore diet are deficient in hematocrit and hemoglobin. Out of the vegetarians, 23 followed different types of vegetarianism. The following ranges were considered: hemoglobin (12 - 16 g/dL) and hematocrit (36 - 48 %). It is concluded that, regarding the diet and hemoglobin/hematocrit levels, most respondents show normal ranges, and people who follow a vegetarian diet do not present highly-deficient hematocrit and hemoglobin levels, and have a better nutritional level than those who follow a carnivore diet.

Conservation of both hematocrit and liver regeneration in hepatectomies: a vascular occlusion approach in rats / Hepatectomia hemoconservadora no rato: preservação do hematócrito e da regeneração hepática

ABSTRACT Background: Hepatectomies promote considerable amount of blood loss and the need to administrate blood products, which are directly linked to higher morbimortality rates. The blood-conserving hepatectomy (BCH) is a modification of the selective vascular occlusion technique. It could be a surgical maneuver in order to avoid or to reduce the blood products utilization in the perioperative period. Aim: To evaluate in rats the BCH effects on the hematocrit (HT) variation, hemoglobin serum concentration (HB), and on liver regeneration. Methods: Twelve Wistar rats were divided into two groups: control (n=6) and intervention (n=6). The ones in the control group had their livers partially removed according to the Higgins and Anderson technique, while the rats in the treatment group were submitted to BCH technique. HT and HB levels were measured at day D0, D1 and D7. The rate between the liver and rat weights was calculated in D0 and D7. Liver regeneration was quantitatively and qualitatively evaluated. Results: The HT and HB levels were lower in the control group as of D1 onwards, reaching an 18% gap at D7 (p=0.01 and p=0.008, respectively); BCH resulted in the preservation of HT and HB levels to the intervention group rats. BCH did not alter liver regeneration in rats. Conclusion: The BCH led to beneficial effects over the postoperative HT and serum HB levels with no setbacks to liver regeneration. These data are the necessary proof of evidence for translational research into the surgical practice.

RESUMO Racional: As hepatectomias compreendem considerável perda sanguínea e utilização de hemoderivados, o que diretamente estão relacionados com maior morbimortalidade. A hepatectomia hemoconservadora (HH) é modificação da técnica de oclusão vascular seletiva em hepatectomia. Ela pode ser alternativa cirúrgica para evitar ou diminuir o uso de hemoderivados no perioperatório. Objetivo: Avaliar os efeitos da HH sobre o volume globular (VG), concentração de hemoglobina (HB) e sobre a regeneração hepática em ratos. Métodos: Dois grupos de ratos Wistar foram constituídos: controle (n=6) e intervenção (n=6). Os do grupo controle foram submetidos à hepatectomia parcial de Higgins e Anderson e os do grupo Intervenção à HH. VG e HB foram medidos nos dias D0, D1 e D7. A relação peso do fígado/peso do rato foi calculada em D0 e D7. A regeneração hepática foi analisada qualitativamente e quantitativamente. Resultados: Houve diminuição dos níveis de VG e HB nos ratos do grupo controle a partir de D1, atingindo decréscimo de 18% em D7 (p=0,01 e p=0,008 respectivamente); a HH permitiu a manutenção dos níveis de VG e HB nos ratos do grupo intervenção. A HH não alterou a regeneração hepática. Conclusão: HH resultou em níveis maiores de VG e HB pós-operatórios sem alterar a regeneração hepática. Pode-se considerar estes dados como a prova necessária para a translação à pesquisa clinicocirúrgica.

Hemoperitoneo secundario a la ruptura espontánea de una variz uterina en una paciente con embarazo a término: reporte de un caso y revisión bibliográfica / Hemoperitoneum secondary to spontaneous rupture of a uterine varice in a patient with a full-term pregnancy: A case report and literature review

Resumen: ANTECEDENTES: La ruptura de una variz útero-ovárica durante el embarazo es un evento poco frecuente, pero con importantes implicaciones en la morbilidad y mortalidad materna y neonatal. Puede acontecer en cualquier momento del embarazo, aunque su frecuencia se incrementa en el tercer trimestre y durante el parto. CASO CLÍNICO: Paciente de 32 años, con 39 semanas de embarazo, en control prenatal, sin contratiempos, que acudió al servicio de Urgencias debido a un dolor abdominal generalizado e intenso, de dos horas de evolución. A la exploración física se encontraron: hipotensión, taquicardia y anemia moderada; hemoglobina de 8.9 g/dL y hematócrito de 35%. La evaluación fetal reportó: taquicardia y posterior bradicardia. Se decidió finalizar el embarazo por cesárea urgente, donde se objetivó hemoperitoneo de aproximadamente 1 L y sangrado activo procedente de la ruptura de un vaso en la parte posterior de la pared uterina que se suturó con puntos dobles. El desenlace materno y neonatal fue favorable. CONCLUSIONES: La rotura de las várices útero-ováricas puede originarse por hemoperitoneo masivo y resultar en consecuencias graves para la madre y el feto. La sospecha diagnóstica y la laparotomía de urgencia son decisivas para cohibir el sangrado y lograr un desenlace materno y fetal satisfactorios.

Abstract: BACKGROUND: The rupture of an utero-ovarian varicose vein during pregnancy is an infrequent event but it can have important implications for maternal and neonatal morbidity and mortality. It can occur at any time during pregnancy, although its frequency is increased in the third trimester and during labor. CLINICAL CASE: A single gestation of 39 weeks, with regular monitoring without incidents, who went to the emergency department for intense and generalized abdominal pain of two hours of evolution. The patient presented hypotension and tachycardia and moderate anemia with a hemoglobin of 8.9 g/dL and a hematocrit of 35%. Fetal monitoring showed fetal tachycardia with decreased variability and subsequent bradycardia. It was decided to end the pregnancy by an urgent caesarean section where a hemoperitoneum of approximately 1 liter was observed. As well, and active bleeding resulting from the rupture of a posterior uterine wall vein was noted and controlled with hemostatic sutures. The maternal and neonatal results were favorable. CONCLUSIONS: Spontaneous rupture of utero-ovarian varicose veins can be the cause of massive hemoperitoneum and can maternal and fetal serious consequences. A promptly suspected diagnosis and an urgent laparotomy are vital to restrain bleeding and achieve a good maternal and fetal result.