Manual de procesos y procedimientos para la gestión de la sangre, inmunohematología y hemoterapia / Manual of processes and procedures for blood management, immunohematology and hemotherapy

El presente manual de procesos y procedimientos documenta los servicios que se ofrecen en la atención al usuario interno y externo para la gestión de la sangre, inmunohematología y hemoterapia como parte del proceso de atención en salud integral e integrada a la persona en el curso de vida con enfoque de atención primaria en salud, describe el sistema de operación ofrecido en los establecimientos de salud, mediante el enfoque por procesos, fomentando así el desarrollo organizacional y el mejoramiento continuo para el cumplimiento de la misión institucional. Establece las bases para la ejecución de los procedimientos como parte de los procesos institucionales, unificando criterios de contenido que permite la sistematización de las actividades y la definición de la metodología para efectuarlas. Esta herramienta táctica y operativa, permite integrar las actividades y tareas de manera oportuna, para el logro de la prestación de servicios con calidad en los establecimientos de salud que lo necesiten, facilitando el cumplimiento de las normativas y lineamientos de programas especiales o por ciclo de vida vigentes en el Ministerio de Salud, así como la armonización con la sistematización y uso de herramientas tecnológicas que sea necesario implementar para volver más eficaz el trabajo del talento humano en salud

This manual of processes and procedures documents the services offered in the care of internal and external users for blood management, immunohematology and hemotherapy as part of the process of comprehensive and integrated health care for the person throughout the life course. With a focus on primary health care, it describes the operation system offered in health establishments, through the process approach, thus promoting organizational development and continuous improvement to fulfill the institutional mission. Establishes the bases for the execution of procedures as part of institutional processes, unifying content criteria that allows the systematization of activities and the definition of the methodology to carry them out. This tactical and operational tool allows the integration of activities and tasks in a timely manner, to achieve the provision of quality services in the health establishments that need it, facilitating compliance with the regulations and guidelines of special programs or by cycle of life in force in the Ministry of Health, as well as harmonization with the systematization and use of technological tools that need to be implemented to make the work of human talent in health more effective

Profil lipidique associé à l'obésité chez les adolescents à Brazzaville, Congo / Lipid profile among obese adolescents in Brazzaville, Congo

Contexte & objectif. Les modifications lipidiques chez les enfants obèses en Afrique noire sont peu documentées. Les objectifs de la présente étude étaient de déterminer chez les adolescents obèses le profil lipidique, et analyser les associations entre quelques paramètres anthropométriques et lipidiques. Méthodes. L'étude transversale a été réalisée à Brazzaville auprès de 82 adolescents âgés de 11 à 18 ans, répartis en 45 sujets obèses, 17 en état de surpoids et 20 poids normal. Des mesures de la taille, du poids, du tour de taille, des plis cutanés sous-scapulaire et tricipital ont été effectuées. Des prélèvements sanguins ont permis de déterminer les concentrations en cholestérol total, cholestérol-LDL, cholestérol-HDL et triglycérides. Résultats. Les concentrations lipidiques notées chez les adolescents obèses étaient significativement supérieures à celles des sujets de poids normal : cholestérol total, 1,70 vs 1,59g/L ; cholestérol-LDL, 1,03 vs 0,88g/L ; triglycérides, 1,18 vs 0,86. Par contre, celles du cholestérol-HDL étaient significativement inférieures : 0,42 vs 0,51g/L. Une corrélation positive a été retrouvée entre le rapport tour de taille/taille et le cholestérol-HDL (r=0,75 ; p=0,031). Conclusion. Nos résultats soulignent la nécessité de renforcer la prise en charge des enfants obèses afin de prévenir les facteurs de risque potentiels des maladies cardiovasculaires à l'âge adulte

Influencia de ácidos grasos en parámetros sanguíneos y adipogénesis. Estudio experimental en pollos eclosionados / Influence of fatty acids on blood parameters and formation of adipocytes at early age

Introducción: La alimentación en la primera infancia influencia la instauración del tejido adiposo y el desarrollo de diversas patologías en la edad adulta. Objetivo: Evaluar la influencia del consumo de tres fuentes de ácidos grasos sobre parámetros sanguíneos y tejido adiposo en pollos recién eclosionados. Materiales y métodos: Se utilizaron 76 pollitos Cobb 500 distribuidos aleatoriamente en cuatro tratamientos, que fueron alimentados durante siete días con una de las cuatro dietas (T1: 97% Dieta basal (DB); T2: DB +3% de manteca vegetal parcialmente hidrogenada; T3: DB +3% de aceite de quinua y T4: DB +3% de aceite de pescado). Al finalizar, se evaluó en sangre glucosa, colesterol, triglicéridos y tamaño de adipocitos del tejido adiposo subcutáneo y visceral. Se aplicó ANOVA considerando 0,05 de significancia y en el caso de variables no distribuidas normalmente, se aplicó el test no paramétrico de Kruskal-Wallis mediante el programa R-Studio. Resultados: Se obtuvieron diferencias significativas con disminución de los niveles de glucosa y colesterol en animales suplementados con elevada proporción de aceites insaturados (T3 y T4) en comparación a T2. Los tratamientos T3 y T4 promovieron una formación hiperplásica de adipocitos, diferenciándose significativamente de T2, que promovió la hipertrofia en dichas células, esta respuesta fue similar en ambos depósitos subcutáneos. Conclusiones: El consumo de aceite de quinua y aceite de pescado promueve la formación de tejido adiposo saludable, y reducen los niveles de glucosa y colesterol. Contrariamente el consumo de manteca vegetal propicia la hipertrofia de adipocitos de gran tamaño e incrementa los parámetros bioquímicos evaluados(AU)

Introduction: Feeding in early childhood influences the establishment of adipose tissue, and therefore also in the development of various pathologies in adulthood. Objective: To evaluate the influence of the consumption of three sources of fatty acids on blood parameters and adipose tissue at an early age. Materials and methods: 76 Cobb 500 chicks randomly distributed in four treatments were used, who were fed for seven days with one of the four diets (T1: Basal diet; T2: DB +1.0% vegetable shortening partially hydrogenated; T3: DB +1.0% quinoa oil and DB +1.0% fish oil) until the seventh day of life. At the end, glucose, cholesterol, triglycerides and adipocyte size of the subcutaneous and visceral adipose tissue were evaluated. A completely randomized design with ANOVA considering 0.05 significance was applied and in the case of non-normally distributed variables, the non-parametric Kruskal-Wallis test was applied using the R-Studio program. Results: Significant differences were obtained with a decrease in glucose and cholesterol levels in animals supplemented with unsaturated oils (T3 and T4) compared to T2. Regarding the size of adipocytes, treatments T3 and T4 promoted a hyperplastic formation of adipocytes, differing significantly from T2, which promoted hypertrophy in these cells, this response was similar in both subcutaneous deposits. Conclusions: The consumption of quinoa oil and fish oil promote the formation of healthy adipose tissue, in addition to reducing glucose and cholesterol levels. In contrast, the consumption of vegetable shortening favors the hypertrophy of large adipocytes and increases the biochemical parameters evaluated(AU)

Análisis de la problemática resultante de los tipos de donación de sangre, producida en el Banco de Sangre de la Seguridad Social en La Paz durante la gestión 2020 / Analysis of the problems resulting from the types of blood donation, produced at the social security Blood Bank in La Paz during the 2020 administration

INTRODUCCIÓN: actualmente la sangre continúa siendo un elemento vital para la vida, su fabricación aún no ha sido optimizada, por lo tanto, solo puede obtenerse a través de donaciones humanas. Por ello, para los Bancos de Sangre, contar con personas de confianza que aporten sangre constituye uno de los principales problemas éticos. Actualmente existen tres tipos de donación de sangre: la donación voluntaria y altruista, la donación de reposición o familiar y la donación remunerada, siendo esta última inaceptable en términos económicos y sanitarios, además de estar prohibida en el marco legal vigente en nuestro país. OBJETIVOS: analizar la problemática de la donación de sangre, haciendo énfasis en los tipos de donaciones que existen en nuestro país, considerando cuál es el tipo de donación más seguro para el receptor y cuáles son los menores de las pruebas de tamizaje inmunoserológico. MATERIALES Y MÉTODOS: se realizó un estudio transversal analítico, retrospectivo, en el que se revisaron las historias clínicas y los formularios electrónicos de trabajo utilizados en la recolección de datos de las donaciones de sangre obtenidas en el Banco de Sangre. de la seguridad social. Para el análisis estadístico se realizó la media y la varianza. RESULTADOS: de un total de 7787 personas que se presentaron a donar sangre, solo 5166 realizaron una donación efectiva. El resto fueron diferidos temporalmente por causas subsanables, 147 fueron diferidos definitivamente por enfermedades e infecciones que pudieran suponer un riesgo para el receptor y en 19 de ellos la extracción de sangre fue difícil por dificultad de acceso venoso. Según el tipo de donaciones, el 52,8 % fueron donaciones solidarias de reposición, el 43,3 % donación exijida y el 3,71 % donación voluntaria. Finalmente, el 68 % del total de las donaciones de sangre provino de hombres. CONCLUIONES: los datos obtenidos demuestran porcentajes muy bajos de donantes voluntarios y valores altos de donantes obligados a donar, muy en relación a países con programas deficientes de donación voluntaria y altruista de sangre.

INTRODUCTION: currently blood is a vital element for life, its manufacture has not yet been optimized, therefore, it can only be obtained through human donations. For this reason, for Blood Banks, having reliable people who provide blood constitutes one of the main ethical problems. There are currently three types of blood donation: voluntary and altruistic donation, replacement or family donation, and paid donation, the latter being unacceptable in economic and health terms, as well as being prohibited under the current legal framework in our country. OBJECTIVES: analyze the problem of blood donation, emphasizing the types of donations that exist in our country, considering what is the safest type of donation for the recipient and what are the minors of immunoserological screening tests. MATERIALS AND METHODS: this was a retrospective, analytical cross-sectional study, in which, we reviewed clinical histories and electronic work forms used in the collection of data on blood donations obtained in the Blood Bank. of social security. For statistical analysis we performed the mean and variance. RESULTS: in a total of 7787 people who presented themselves to donate blood, only 5166 made an effective donation. The rest were temporarily deferred for rectifiable reasons, 147 were permanently deferred due to diseases and infections that could cause a risk to the recipient and in 19 of them it was difficult to draw blood due to difficult venous access. According to the type of donations, 52.8 % were solidarity replacement donations, 43.3 % required donation, and 3.71 % voluntary donation. Finally, 68 % of the total blood donations came from men. CONCLUSIONS: the data obtained show very low percentages of voluntary donors and high values of required donors, these results are in accordance with countries with deficient voluntary and altruistic blood donation programs.

Evaluación de los niveles de anticuerpos para COVID-19 en pacientes que concurrieron a un laboratorio de la Ciudad Autónoma de Buenos Aires / Evaluation of antibody levels for COVID-19 patients who attended a laboratory in Buenos Aires city

Resumen A fines de 2019 se describieron en China los primeros casos de neumonía asociada a SARS-CoV-2. La OMS la llamó COVID-19 y declaró emergencia sanitaria internacional en enero de 2020, ante la rápida diseminación de la infección a nivel mundial. En la Argentina los primeros casos se detectaron en marzo de 2020 y casi inmediatamente comenzaron a utilizarse métodos directos para detección de SARS-CoV-2 (RT PCR, LAMP, entre otros). Los métodos para detección de anticuerpos fueron aprobados posteriormente y no son de elección para realizar el diagnóstico de la enfermedad. En este laboratorio estos últimos comenzaron a utilizarse durante la primera ola de COVID-19 y con estos datos se realizó un estudio observacional retrospectivo de una serie de pacientes con resultados de anticuerpos IgG positivos. Se calculó la tasa de notificación al Sistema Integrado de Información Sanitaria Argentino (SISA) y se evaluaron los niveles de anticuerpos, agrupándolos de acuerdo a: si estaban notificados y si tenían resultado de RT PCR/LAMP, los síntomas presentados y el tiempo transcurrido post RT PCR/LAMP. No fue posible demostrar diferencias entre los pacientes con RT PCR/LAMP detectable y no detectable, tampoco con el tipo de síntomas declarados ni con respecto a los días transcurridos posinfección. Sin embargo, se observó que existía una diferencia significativa entre el grupo de pacientes notificados y no notificados y una alta tasa de pacientes con anticuerpos positivos que no fueron declarados en SISA, por lo que su detección podría considerarse como marcador subrogante de contacto cuando no fuera posible arribar al diagnóstico por métodos moleculares.

Abstract At the end of 2019 the first cases of SARS-CoV-2-associated pneumonia were reported in China. Consequently, the World Health Organization (WHO) named it COVID-19 and in January 2020, it declared the international health emergency due to the worldwide rapid spread of the infection. The first cases in Argentina were detected in early March 2020. Molecular tests like RT PCR and LAMP were immediately used. Serological tests for antibody detection were approved a few months later; however, these are still not the preferred evidiagnostic method for the disease. In our laboratory, the latter began to be used during the first wave of COVID-19. With the results obtained in that moment, an observational retrospective study in a cohort of patients who came voluntarily to test for SARS-CoV-2 IgG antibodies and whose results were positive was performed. The notification rate to the Argentine Integrated System for Health Information (SISA for its acronym in Spanish) was calculated and antibody levels were evaluated, clustering them according to the following facts: if the event had been notified to the SISA and if they had a previous RT PCR/LAMP result, the symptoms experienced by these patients and the time elapsed between RT PCR/LAMP and antibody test results. It was not possible to demonstrate differences between patients with detectable and undetectable RT PCR/LAMP, neither with the type of declared symptoms nor with respect to the days elapsed post-infection. However, it was found that there was a significant difference between notified and non-notified patients, and a high rate of non-notified patients with positive antibodies. Therefore, antibodies level might be considered as a surrogate marker of SARS-CoV-2 contact when a diagnosis through molecular methods is not available.

Resumo No final de 2019 foram reportados na China os primeiros casos de pneumonia associados a SARS-CoV-2. A Organização Mundial da Saúde (OMS) chamou-a de COVID-19 e declarou emergência sanitária internacional em janeiro de 2020, frente à rápida disseminação da infecção em nível mundial. Na Argentina os primeiros casos foram detectados no início de março de 2020 e de forma quase imediata, começaram a ser utilizados métodos diretos para detectar SARS-CoV-2 (RT PCR, LAMP, entre outros). Os métodos para detectar anticorpos foram posteriormente aprovados e não são de eleição para realizar o diagnóstico da doença. Em nosso laboratório, a utilização destes últimos começou durante a primeira onda de COVID-19 e com os resultados obtidos nesse momento foi realizado um estudo observacional retrospectivo de uma série de pacientes com resultados de anticorpos IgG positivos. Foi calculada a taxa de notificação ao Sistema Integrado de Informação em Saúde da Argentina (SISA) e foram avaliados os níveis de anticorpos agrupando- os de acordo a: se estavam notificados e se eles tinham resultado de RT PCR/LAMP, os sintomas apresentados e o tempo decorrido pós RT PCR/LAMP. Não foi possível demonstrar diferenças entre pacientes com RT PCR/LAMP detectável e não detectável, nem com o tipo de sintomas declarados nem com relação aos dias decorridos após a infecção. No entanto, verificou-se que existia uma diferença significativa entre o grupo de pacientes notificados e não notificados, e uma alta taxa de pacientes com anticorpos positivos que não foram declarados no SISA, portanto, sua detecção poderia ser considerada como um marcador substituto de contato quando não fosse possível chegar ao diagnóstico por métodos moleculares.

El valor de la palabra, el valor de la glucemia / The value of the word, the value of blood glucose

La glucemia es una palabra de fácil definición, glucosa en sangre, pero deja de ser simple cuando quiere entenderse el significado de determinado resultado. El desafío es interpretar correctamente el valor hallado.

Niveles séricos de la isoenzima creatina quinasa-MB y lactato deshidrogenasa como indicadores de daño miocárdico en perros con enfermedad valvular degenerativa / Serum levels of the isoenzyme creatine kinase-MB and lactate dehydrogenase as indicators of myocardial damage in dogs with degenerative valve disease

RESUMEN Se analizaron los niveles séricos de creatina quinasa-MB (CK-MB) y lactato deshidrogenasa (LDH) en 10 perros diagnosticados con enfermedad valvular degenerativa y en seis perros clinicamente sanos, con el objetivo de evaluar si sus niveles séricos indican daño miocárdico. Las muestras de suero se analizaron mediante el método UV. Se utilizó la prueba de diferenciación de medias para determinar diferencias entre medias, y la prueba de correlación de Pearson para determinar si existe correlación entre los niveles séricos de ambas enzimas. Los valores de CK-MB y de LDH fueron significativamente diferentes entre los dos grupos de pacientes. Los niveles de CK-MB y LDH tuvieron correlación positiva, pero no significativa.

ABSTRACT Serum levels of creatine kinase-MB (CK-MB) and lactate dehydrogenase (LDH) were analyzed in 10 dogs diagnosed with degenerative valvular disease and in six clinically healthy dogs with the objective of evaluating whether their serum levels indicate myocardial damage. Serum samples were analyzed by UV method. The mean differentiation test was used to determine differences between means and the Pearson correlation test was performed to determine if there was a correlation between the serum levels of both enzymes. The CK-MB and LDH values were significantly different between the two groups of patients. The levels of CK-MB and LDH had a positive but not significant correlation.

Carboxyhemoglobinemia as a laboratory finding in an outpatient

Resumen El monóxido de carbono (CO) es un gas producido principalmente por combustión incompleta de hidrocarburos. La intoxicación por exposición ambiental puede presentarse con síntomas inespecíficos y constituye la causa más importante de aumento de carboxihemoglobina (COHb). Su nivel en sangre depende de la duración de la exposición, la ventilación minuto y las concentraciones de CO y oxígeno en el ambiente. La elevada toxicidad radica en la hipoxia tisular que se genera. Se presenta el caso de un paciente masculino, 73 años, en seguimiento en el hospital por neumonía intersticial no específica como patología de base. En un control de laboratorio se encontró 11,9% de COHb, sin exposición a tabaco. No utilizaba calefacción a gas sino un panel cerámico eléctrico, recientemente pintado con esmalte sintético. La suspensión del uso del panel normalizó la COHb. El CO, producto de descomposición térmica del esmalte sintético, explica la causa de la intoxicación.

Abstract Carbon monoxide (CO) is a gas produced mainly by incomplete combustion of hydrocarbons. Poisoning from environmental exposure can present with nonspecific symptoms and is the most important cause of increased carboxyhemoglobin (COHb). Its blood level depends on the duration of exposure, minute ventilation, and the concentrations of CO and oxygen in the environment. The high toxicity lies in the tissue hypoxia that is generated. The case of a male patient, 73 years old, under follow-up in the hospital for non-specific interstitial pneumonia as the underlying pathology was presented. In a laboratory control, COHb 11,9% was found. There was no exposure to tobacco and there was no use of gas heating but of an electric ceramic panel, recently painted with synthetic enamel type paint. The suspension of the use of the panel normalised the COHb. The CO product of thermal decomposition of synthetic enamel explains the cause of poisoning.

Resumo O monóxido de carbono (CO) é um gás produzido principalmente pela combustão incompleta de hidrocarbonetos. A intoxicação por exposição ambiental pode se apresentar com sintomas inespecíficos e é a causa mais importante de aumento da carboxihemoglobina (COHb). Seu nível em sangue depende do tempo de exposição, da ventilação minuto e das concentrações de CO e oxigênio no ambiente. A alta toxicidade está na hipóxia tecidual gerada. Apresentamos o caso de um paciente do sexo masculino, 73 anos, em acompanhamento hospitalar por pneumonia intersticial inespecífica como patologia de bas. Em um controle laboratorial, achou-se 11,9% de COHb, sem exposição ao tabaco. Não utilizava aquecimento a gás e sim um painel elétrico cerâmico, recentemente pintado com esmalte sintético. A suspensão do uso do painel normalizou o COHb. O CO produto da decomposição térmica do esmalte sintético explica a causa da intoxicação.

Dose-ranging effects of SGLT2 inhibitors in patients with type 2 diabetes: a systematic review and meta-analysis

ABSTRACT The lowest dosage of empagliflozin (10 mg) showed similar benefits on glycated hemoglobin (HbA1c) level, body weight, blood pressure, and total and cardiovascular mortality in comparison with the highest available dose (25 mg) in the EMPAREG trial. These findings have not been clearly demonstrated for canagliflozin and dapagliflozin. The objective was to compare the effect of different doses of SGLT2 inhibitors commercially available in Brazil on HbA1c and body weight of patients with type 2 diabetes. MEDLINE, Cochrane and Embase databases were searched from inception until 11th October 2021 for randomized controlled trials of SGLT2 inhibitors in type 2 diabetes patients, lasting at least 12 weeks. HbA1c and body weight variations were described using standard mean difference. We performed direct and indirect meta-analysis, as well as a meta-regression with medication doses as covariates. Eighteen studies were included, comprising 16,095 patients. In the direct meta-analysis, SGLT2 inhibitors reduced HbA1c by 0.62% (95% CI −0.66 to −0.59) and body weight by 0.60 kg (95% CI −0.64 to −0.55). In the indirect meta-analysis, canagliflozin 300 mg ranked the highest regarding reductions in HbA1c and body weight. The remaining medications and dosages were clinically similar, despite some statistically significant differences among them. Canagliflozin 300 mg seems to be more potent in reducing HbA1c and body weight in patients with type 2 diabetes. The remaining SGLT2 inhibitors at different doses lead to similar effects for both outcomes. Whether these glycemic and weight effects are reflected in lower mortality and cardiovascular events is still uncertain and may be a topic for further studies.

Aspectos epidemiológicos da infecção por Ehrlichia canis, Anaplasma platys e Mycoplasma spp. em gatos domésticos / Epidemiological aspects of infection by Ehrlichia canis, Anaplasma platys and Mycoplasma spp. in domestic cats

Hemoparasitoses vêm se tornando cada vez mais importantes na clínica médica de pequenos animais. Dentre os agentes causadores encontramos Ehrlichiacanis, Anaplasmaplatys., e Mycoplasma spp., torna-se de grande importância conhecer a epidemiologia nos gatos domésticos. Objetivou-se com esta pesquisa fazer um levantamento retrospectivo de fichas de gatos advindos de consultas no Hospital Veterinário Mário Dias Teixeira (HOVET) que realizaram exame de Reação de Cadeia da polimerase (PCR) no laboratório de biologia molecular, na Universidade Federal Rural da Amazônia, no ano de 2018 e 2019. No total foram 72 amostras de gatos domésticos processadas, sendo 33 machos e 39 fêmeas, 70 animais SRD e 2 Siameses, todos com trombocitopenia, além de outros sinais clínicos que os levaram a precisar de atendimento veterinário, foram categorizados os meses de entrada e processamento das amostras, bairros dos animais e grupos etários. De todos os animais testados, 34,7% obtiveram diagnóstico positivo para uma das enfermidades, sendo o gênero Mycoplasma spp. o que mais prevaleceu em amostras positivas, com maior frequência em fêmeas adultas, bem como foi descrita ocorrência de E. canis apenas nesse sexo, já A. platysfoi descrito com maior frequência em machos, além de achados de infecções concomitantes observado entre os agentes Anaplasmae Mycoplasma. Concluímos que os gatos atendidos no HOVET possuíam parasitismo por diferentes agentes infecciosos.

Hemoparasitosis have become increasingly important in the small animals' internal medicine. Among the causal agents, there are Ehrlichiacanis, Anaplasmaplatys. and Mycoplasma spp., which give the understanding of the epidemiology in domestic cats a great significance. This research aimed to make a retrospective survey of records from cats that came from appointments at the Veterinary Hospital Mário Dias Teixeira (HOVET) and underwent the Polymerase Chain Reaction (PCR) test at the molecular biology laboratory, at the Amazônia Federal Rural University (UFRA), in the years of 2018 and 2019. In total, 72 samples of domestic cats were processed, from which 33 were males and 39 females, 70 of them were mongrel cats and 2 siamese, all of them showed thrombocytopenia amongst other clinical signs that led them to need a veterinary appointment, the months of admission, processing of the samples, districts the animals came from and age group were categorized. 34,7% of all the animals tested showed positive results for one of the diseases, with the genus Mycoplasma spp. being the most prevalent in positive samples, showing a higher rate in adult females, as the occurrence of E. canis was reported only in females, while A. platys was reported with a higher rate in males, as well as concomitant infections following the observation of the agents Anaplasma and Mycoplasma. In conclusion, the cats admitted at HOVET showed parasitism by different infectious agents.

Cholesterolemia and triglyceridemia changes in adult with malaria in a hypo-endemic malaria region, Butembo-DR Congo

changes occur commonly among patients affected with malaria. This study aimed to assess lipid changes in blood among patients with malaria in Butembo, a hypoendemic region. Methods: This cross-sectional study, conducted in the Departments of Internal and Parasitology of Matanda Hospital, located in Butembo, from July 1st, 2020, to November 2, 2020; involved 100 patients diagnosed with malaria. Biochemical analyses carried out by three lab technicians were performed among patients who had positive malaria using positive thick film. Plasmodial species, the parasite density, the triglycerides, the total cholesterol, the HDL-cholesterol, the LDL-cholesterol were assessed. Results: Cholesteroleamia and HDLemia demonstrated a low level in 93% and in 61% of participants respectively; whereas 73% of cases showed an increased level of triglycerides in the blood. Lipidemia profile was independently associated with parasite density among patients with malaria. Conclusion: Although the lipid changes in the blood are not specific in the diagnosis of malaria, this study highlighted their status among patients with malaria. Further researches should be conducted to determine their impact on malaria outcomes. Therefore, dyslipidemia could be used in malaria screening.

Sero-molecular Epidemiology of Hepatitis E Virus in Blood Donors, Gezira State, Sudan: A Cross-sectional Study

Background: Hepatitis E virus (HEV) is a hepatotropic pathogen that causes significant morbidity and mortality in humans. It is an important causative agent of viral hepatitis outbreaks. This study investigates the serological and molecular prevalence of HEV in blood donors attending the Central Blood Bank in Wad Medani City in Gezira State, Sudan. Methods: The study adopted a cross-sectional descriptive design. A structured questionnaire was used to collect data concerning demographic information and risk factors associated with HEV transmission. All enrolled participants (N = 300) were screened for HEV IgG antibodies using commercial ELISA kits, then strong positive samples (N = 84) were selected and rescreened for HEV IgM and HEV RNA by RT PCR. SPSS version 24.0 was used for analysis. Results: Out of 300 male participants, 36.3% (109/300) were positive for HEV IgG. However, only one participant was IgM positive, while the HEV RNA was negative. The highest prevalence rates of the virus were 42 (44.6%) among the age group of 31­40 years, 20 (48.8%) in those who consumed food from outside, 13 (50%) in three to four multiple blood donations, and 5 (62.5%) in those who consumed water from the river source. A significant association of HEV IgG prevalence concerning the occupation of the participants being students or farmers was detected using univariate and multivariate analysis (P-value = 0.007).

PCR em tempo real no diagnóstico da toxoplasmose congênita / Real-time PCR in the diagnosis of congenital toxoplasmosis

O diagnóstico da toxoplasmose congênita apresenta limitações sendo, portanto, necessárias novas opções de exames. A análise do líquido aminiótico pela PCR em tempo real já se mostrou eficaz para confirmação da infecção fetal. No entanto, o seu desempenho em outras amostras biológicas ainda não está claro. O objetivo deste estudo é avaliar a PCR em tempo real no sangue da mãe e do recém-nascido assim como no líquido amniótico e placenta, no diagnóstico da toxoplasmose congênita. Esse é um estudo descritivo de gestantes com toxoplasmose acompanhadas no Rio de Janeiro, Brasil. Foi realizada PCR em tempo real em amostras de sangue materno, líquido amniótico, placenta e sangue dos recém-nascidos e o exame histopatológico das placentas. Também foram coletados dados clínicos e laboratoriais dos recém-nascidos. Foram acompanhadas 116 gestantes e analisadas 298 amostras. Uma (0,9%) gestante apresentou PCR positiva no sangue, três (3,5%) no líquido amniótico, uma (2,3%) na placenta e nenhum recém-nascido apresentou PCR positiva no sangue. O estudo histopatológico foi sugestivo de infecção por toxoplasmose em 24 (49%) placentas. Seis (5,2%) recém-nascidos foram diagnosticados com toxoplasmose congênita e apenas os casos com PCR positiva no líquido amniótico tinham associação do resultado da PCR com o diagnóstico de infecção congênita. Tanto as amostras de sangue materno quanto as de sangue dos recém-nascidos e placenta, não demonstraram ser promissoras no diagnóstico da toxoplasmose congênita. Novos estudos são necessários para avaliar o real papel do diagnóstico molecular em outros materiais biológicos que não o líquido amniótico.

The diagnosis of congenital toxoplasmosis has limitations so new options are needed. Real-time PCR analysis of amniotic fluid has proven effective for confirming fetal infection. However, its performance in other biological samples still needs to be determined. This study aims to evaluate the real-time PCR role in the blood of the mother and newborn as well as in the amniotic fluid and placenta, in congenital toxoplasmosis diagnosis. It is a descriptive study of pregnant women with toxoplasmosis followed in Rio de Janeiro, Brazil. Real-time PCR was performed on maternal blood, amniotic fluid, placenta, and newborn blood samples. In addition, a histopathological examination of the placentas was performed and data from the babies were collected. One hundred and sixteen pregnant women were followed and 298 samples were analyzed. One (0.9%) pregnant woman had positive PCR in the blood, three (3.5%) in the amniotic fluid, one (2.3%) in the placenta, and any newborn had positive PCR in the blood. The histopathological study suggested toxoplasmosis infection in 24 (49%) placentas. Six (5.2%) newborns were diagnosed with congenital toxoplasmosis and only the cases with positive PCR in amniotic fluid associated with the diagnosis of congenital infection. Neither maternal nor newborn blood and placenta samples have not shown promise in diagnosing congenital toxoplasmosis. Further studies are needed to evaluate the fundamental role of molecular diagnostics in others biological materials than amniotic fluid.

Sangre total leucorreducida y filtro ahorrador de plaquetas preserva su función hemostática por 21 días: ¿La resucitación hemostática podría ser una realidad en Colombia? / Leukoreduced whole blood and platelet-sparing filter preserves its hemostatic function for 21 days: Could hemostatic resuscitation become a reality in Colombia?

Introducción. La resucitación hemostática es una estrategia para compensar la pérdida sanguínea y disminuir el impacto de la coagulación inducida por trauma. Debido a que la disponibilidad de transfundir una razón equilibrada de hemocomponentes es difícil de lograr en el entorno clínico, la sangre total ha reaparecido como una estrategia fisiológica, con ventajas logísticas, que le permiten ser accesible para iniciar tempranamente la resucitación hemostática. El objetivo de este estudio fue evaluar las propiedades celulares, coagulantes y viscoelásticas de la sangre total almacenada por 21 días. Métodos. Las unidades de sangre total fueron obtenidas de 20 donantes voluntarios sanos. Se procesaron mediante un sistema de leucorreducción ahorrador de plaquetas y fueron almacenadas en refrigeración (1-6°C) sin agitación. Se analizaron los días 0, 6, 11 y 21. Las bolsas fueron analizadas para evaluar las líneas celulares, niveles de factores de coagulación y propiedades viscoelásticas mediante tromboelastografía. Resultados. El conteo eritrocitario y la hemoglobina se mantuvieron estables. El conteo de plaquetas tuvo una reducción del 50 % al sexto día, pero se mantuvo estable el resto del seguimiento. Los factores de coagulación II-V-VII-X, fibrinógeno y proteína C se mantuvieron dentro del rango normal. La tromboelastografía mostró una prolongación en el tiempo del inicio de la formación del coágulo, pero sin alterar la formación final de un coágulo estable. Conclusiones. La sangre total leucorreducida y con filtro ahorrador de plaquetas conserva sus propiedades hemostáticas por 21 días. Este es el primer paso en Colombia para la evaluación clínica de esta opción, que permita hacer una realidad universal la resucitación hemostática del paciente con trauma severo.

Background. Hemostatic resuscitation is a strategy to compensate blood loss and reduce the impact of trauma-induced coagulopathy. However, balanced resuscitation presents challenges in its application in the clinical setting. Whole blood has re-emerged as a physiologic strategy with logistical advantages that offer the opportunity for early initiation of hemostatic resuscitation. The study aims to evaluate the cellular, coagulation, and viscoelastic properties of whole blood preserved for 21 days. Methods. Whole blood units were donated by 20 healthy volunteers. These units were processed using a platelet-sparing leukoreduction filtration system. Units were stored under refrigeration (1-6°C) without agitation and were sampled on days 0, 6, 11, 16, and 21. The units were tested to assess its cellular properties and coagulation factors levels. In addition, viscoelastic features were tested using tromboelastography.Results. Red blood cells count and hemoglobin levels remained stables. Platelet count had a 50% reduction on day 6, and then remained stable for 21 days. Factors II-V-VII-X, fibrinogen, and protein C remained within normal range. Tromboelastrography test showed that the reaction time of clot formation is prolonged, but the final clot formation is not altered. Conclusion. Whole blood retains its hemostatic properties for 21 days. This is the first step to evaluate the use of whole blood in the resuscitation protocols for Colombia allowing hemostatic resuscitation become a universal reality.

Blood culture contamination in the departments of paediatrics and child health at two tertiary training hospitals in central South Africa

Background. Bloodstream infections are an important cause of mortality in children. Blood cultures (BCs) remain the primary means of identifying organisms and their antibiotic susceptibility profiles. A shortcoming of BCs is that up to 56% of positive cultures will represent contaminants. Poor adherence to standard practices applicable to BC sampling could explain an unacceptable contamination rate. Objectives. To determine: (i) the BC contamination rate in the departments of paediatrics and child health at two tertiary hospitals in central South Africa; and (ii) BC sampling practices among paediatric clinicians. Methods. The author determined the prevalence of BC contamination by analysis of laboratory data for the period 1 May - 27 August 2019, and assessed possible factors contributing to BC contamination by surveying paediatric medical staff with a self-administered BC practices questionnaire. Results. Of the 244 BCs reviewed, 25.4% were positive. The most commonly isolated pathogens were coagulase-negative staphylococci (CoNS) (33.3%), Escherichia coli (22.2%), Enterococcus faecium (16.7%) and Acinetobacter baumannii (11.1%). In total, 15.2% of the BCs yielded contaminants and 2.9% had polymicrobial growth. The most common contaminant was CoNS. Approximately 68% of clinicians were not aware of BC sampling guidelines, and even among those who were aware of the guidelines, non-compliance was reported. Conclusions. The BC contamination rate was higher than internationally accepted rates. Educating clinicians on specific BC sampling guidelines is strongly recommended to decrease the high rate of contamination observed in this study.

Comparación de dos sistemas de medición de glucosa en sangre en pacientes adultos internados en una unidad de cuidados intensivos / Comparison of two blood glucose measurement systems in adult patients hospitalised in an intensive care unit

Resumen El desempeño analítico de la determinación de glucosa es crucial para el manejo del paciente crítico. El objetivo del presente estudio fue establecer si los valores de glucosa determinados por un sistema point of care (POC) eran comparables con el sistema de uso habitual del laboratorio. Se analizaron 60 muestras de pacientes críticamente enfermos. La medición de la glucosa en suero y sangre entera se realizó en el analizador modular Cobas c 501 y, en el POC, Cobas b 221, respectivamente. Se estudió la correlación y concordancia entre los métodos, se compararon los resultados con requerimientos de calidad internacionales y se realizó el análisis de exactitud clínica en planillas de vigilancia de errores (Surveillance Error Grid). La glucemia media en el equipo Cobas b 221 fue 149,96 mg/dL, mientras que la glucemia media en suero en el equipo Cobas c 501 fue 148,37 mg/dL. El coeficiente de correlación obtenido fue 0,95. Mediante el análisis de concordancia se observó que un 5% de los valores superaban las 2 desviaciones estándar. En base a las especificaciones de los requerimientos internacionales, los resultados obtenidos no alcanzaron el desempeño óptimo. El análisis mediante planillas de vigilancia de errores determinó que el 90% de las mediciones se encontraron en la clasificación de grado de riesgo A, y el resto en grado de riesgo B. El analizador Cobas b 221 presenta las características metrológicas adecuadas para suplir al sistema de referencia en situaciones de urgencia o avería.

Abstract The analytical performance of glucose determination is crucial for the management of critical patients. The objective of this research was to establish whether the glucose values determined by a point of care (POC) system were comparable with the laboratory's usual use system. Sixty samples from critically ill patients were analysed. The measurement of serum glucose and whole blood was performed on the Cobas c 501 modular analyser and, at the POC, Cobas b 221, respectively. The correlation and agreement between the different methods was studied and the results compared with the international quality requirements. The analysis of clinical accuracy was performed in ways to monitor errors (Surveillance Error Grid). The average blood glucose in the Cobas b 221 was 149.96 mg/dL, while the average blood glucose in the Cobas c 501 was 148.37 mg/dL. The correlation coefficient obtained was 0.95. The concordance analysis showed that 5% of the values exceeded the two standard deviations. Based on the specifications of the international requirements, the results obtained did not reach the optimum performance. The analysis using error monitoring forms determined that 90% of the measurements were in the classification of risk grade A, while the rest were in risk grade B. The Cobas b 221 analyser presents the appropriate clinical characteristics to be used to replace in case of emergency in relation to the Cobas c 501 measurement system.

Resumo O desempenho analítico da determinação da glicose é crucial para o manejo do paciente crítico. O objetivo da presente pesquisa foi estabelecer se os valores de glicose determinados por um sistema point of care (POC) eram comparáveis com o sistema de uso habitual do laboratório. Foram analisadas 60 amostras de pacientes criticamente doentes. A medição da glicose em soro e sangue total foi realizada no analisador modular Cobas c 501 e no POC Cobas b 221, respectivamente. A correlação e concordância entre os diferentes métodos foram estudadas, os resultados foram comparados com os requisitos de qualidade internacionais. A análise de precisão clínica foi realizada em formulários de monitoramento de erros (Surveillance Error Grid). A glicemia média no equipamento Cobas b 221 foi de 149,96 mg/dL, enquanto que a glicemia sérica média no equipamento Cobas c 501 foi de 148,37 mg/dL. O coeficiente de correlação obtido foi de 0,95. A análise de concordância mostrou que 5% dos valores superavam os dois desvios-padrão. Com base nas especificações dos requisitos internacionais, os resultados obtidos não atingiram o desempenho ideal. A análise por meio de formulários de monitoramento de erros determinou que 90% das medições foram encontradas na classificação do grau de risco A, enquanto que o restante estava no grau de risco B. O analisador Cobas b 221 apresenta as características metrológicas apropriadas para suprir o sistema de referência em situações de emergência ou avaria.

Survey of Maximum Blood Ordering for Surgery (MSBOS) in elective general surgery, neurosurgery and orthopedic surgery at the Poursina Hospital in Rasht, Iran, 2017

ABSTRACT Introduction: Blood is a valuable life resource that depends on the donation of blood by the community. As a result, it is crucial that the manner in which this expensive resource is used be correct and reasonable. Objective: The purpose of this study was to investigate the Maximum Blood Ordering for Surgery (MSBOS) in general, orthopedic and neurosurgical elective surgeries at the Poursina Hospital in Rasht in 2017. Methods: According to the patient file number information, such as gender, age, type of surgery, number of blood units requested, number of cross-matched blood units, number of blood units transfusion, number of patients undergoing transfusion, number of patients who were cross-matched, initial hemoglobin and the underlying disease, was extracted from the HIS (Hospital Information System). Based on the collected data, a descriptive report of the cross-match to transfusion ratio (C/T), transfusion index (TI) and transfusion probability (%T) was performed, using average and standard deviation, by using the SPSS 16. Results: In the present study, 914 patients from the neurosurgery, orthopedic and general surgery wards of the Poursina Hospital were studied. Of these, 544 were male (59.5%) and 370 were female (40.5%), aged 1-99 years, with a mean age of 43 years. The frequency distribution of C/T in this study was 1.29 in neurosurgery, 1.95 in orthopedic surgery and 1.96 in general surgery. This study indicated that the C/T index was above the normal standard level in four different kinds of surgery, including leg fracture (2.71), cholecystectomy(2.71), forearm fracture (2.70), and skin graft (2.62).The C/T index was at the maximum normal level in thyroidectomy surgery (2.5). The other surgeries had the normal C/T index. Conclusion: Overall, all of the MSBOS indices were at the standard level in this study, although C/T indices were higher than the standard level in the surgeries for cholecystectomy, leg fracture, forearm fracture, hand fracture and skin graft.

Blood components use at two private hospitals in Belo Horizonte, Minas Gerais between July 2017 and June 2019

ABSTRACT Introduction: A retrospective ecological longitudinal study was carried out with data on blood components use from two private hospital units that belong to the same organization located in Belo Horizonte between July 2017 and June 2019. Objectives: To describe the monthly series of red blood cells, platelets and plasma use and the rate of blood components use for general hospitalizations in the health network, from the perspective of time series. Methods: A total of 15 time series were created with monthly data related to the use of blood components. The stationarity of the series was verified by the unit root test, the trend, by the Cox-Stuart test and seasonality, by the Fisher test (significance levels of 10% for the first test and 5% for the last two). Results: All series tested positive for the trend component and showed an increasing trend for the use of blood components. Ten series showed statistically significant seasonality and eight series were identified as non-stationary. The percentage of transfusions of blood components due to hospitalization at hospitals 1 and 2 was 29% (22% at hospital 1 and 38.9% at hospital 2). Conclusion: This study was able to describe the components of blood components use dynamics, from the perspective of time series at hospitals. Due to the growing trend in demand for blood components and their high cost, we propose the reduction of blood components use and the expanded use of alternative blood transfusion strategies.

Enfermedades hematológicas y no hematológicas relacionadas con el fenotipo ABO en pacientes de una unidad hospitalaria de Medellín / Hematological and non-hematological diseases related to the ABO phenotype in patients at a Medellín hospital unit

Resumen Introducción. El sistema sanguíneo ABO está compuesto por los antígenos A y B, los cuales varían de acuerdo a las sustituciones de nucleótidos, que determinan la especificidad de la enzima para la cual codifican. Su importancia clínica se extiende más allá de los procesos transfusionales, aparentemente está involucrado en la fisiopatología de varias enfermedades, como cáncer, infecciones, alteraciones cardiovasculares, entre otras. Metodología. estudio descriptivo retrospectivo, con 2708 datos de clasificación de grupo sanguíneo ABO en pacientes hospitalizados. Se realizó la prueba de Chi2 de independencia para determinar la relación entre enfermedades hematológicas y no hematológicas y el grupo sanguíneo. Resultados. El grupo sanguíneo O se presentó en el 59,2% y el AB en el 18% de los pacientes; las entidades clínicas que predominaron fueron las no hematológicas; entre ellas las más frecuentes la hemorragia gastrointestinal, diabetes mellitus y las fracturas tanto para el grupo A como el B. En el grupo AB se presentó la tuberculosis y hemorragia gastrointestinal. Para las enfermedades de la sangre y de los órganos hematopoyéticos, en los grupos sanguíneos A, AB y O predominó la anemia de tipo no especificada, por su parte en el grupo B se presentó la anemia falciforme en crisis. Conclusión. en el presente estudio no se pudo establecer desde el análisis estadístico la relación entre los antígenos de grupo sanguíneo y el desarrollo de una entidad clínica en particular, pero desde el punto de vista clínico si se pudo notar la tendencia de una frecuencia más alta de una enfermedad en un grupo sanguíneo específico.

Abstract Introduction. The ABO blood system is composed of A and B antigens, which vary according to nucleotide substitutions, which determine the specificity of the enzyme for which they code. Its clinical importance extends beyond transfusion processes, apparently it is involved in the pathophysiology of various diseases, such as cancer, infections, cardiovascular disorders, among others. Methodology. retrospective descriptive study, with 2708 ABO blood group classification data in hospitalized patients. The Chi2 test of independence was performed to determine the relationship between hematological and non-hematological diseases and blood group. Results. Blood group O was present in 59.2% and AB in 18% of the patients; the clinical entities that predominated were non-hematological ones; Among them the most frequent were gastrointestinal bleeding, diabetes mellitus and fractures for both group A and B. In group AB, tuberculosis and gastrointestinal bleeding occurred. For diseases of the blood and hematopoietic organs, anemia of unspecified type predominated in blood groups A, AB and O, while in group B there was sickle cell anemia in crisis. Conclusion. in the present study, the relationship between blood group antigens and the development of a particular clinical entity could not be established from the statistical analysis, but from the clinical point of view, the trend of a higher frequency could be observed. of a disease in a specific blood group.

Prevalencia de Infección por Trypanosoma Cruzi en donantes de un banco de sangre de Boyacá, Colombia / Prevalence of Trypanosoma cruzi infection in donors from a blood bank in Boyacá, Colombia

Resumen Introducción: La Enfermedad de Chagas también conocida como Tripanosomiasis americana es un problema de salud pública. Se calcula que en el mundo hay entre 6 y 7 millones de personas infectadas por Trypanosoma cruzi, la mayoría de ellas en América Latina. Objetivo: Identificar la prevalencia de infección por Trypanosoma cruzi en donantes de un banco de sangre del departamento de Boyacá 2016-2018. Materiales y métodos: Estudio descriptivo retrospectivo realizado en 25.920 donantes de sangre del departamento de Boyacá. La fuente de información fue secundaria. Se determinó la prevalencia de la infección por Trypanosoma cruzi y se compararon según sexo, grupo etario y tipo de donante a través de análisis de frecuencias. Resultados: Se evaluaron 9187 donantes durante el año 2016; 8517 en el 2017 y 8216 en el 2018, de los cuales 56,1% eran de sexo femenino y 43,9% masculino. La prevalencia de la infección por Trypanosoma cruzi fue 0,17 % en la tamización y 0,08 % con las pruebas confirmatorias de las cuales el 70,0% eran mujeres, el 85,0% donantes voluntarios por primera vez, el rango de edad en el que se presentó mayor prevalencia de este marcador serológico fue de 41 a 50 y de 51 a 65 años con un 35,0% cada uno . La prevalencia de la infección de Chagas presentó asociación estadísticamente significativa con la edad (p < 0,05). Conclusiones: Los bancos de sangre resultan ser una de las fuentes de información disponibles para monitorear el comportamiento de la enfermedad de Chagas y evaluar la toma de decisiones en salud pública, teniendo en cuenta que la enfermedad se caracteriza de manera asintomática y sin compromiso clínico en la mayoría de los casos.

Abstract Introduction: Chagas Disease, also known as American Trypanosomiasis, is a public health problem. It is estimated that in the world there are between 6 and 7 million people infected with Trypanosoma cruzi, most of them in Latin America. Objectives: To identify the prevalence of Trypanosoma cruzi infection in donors from a blood bank in the department of Boyacá 2016-2018. Materials and methods: Retrospective-descriptive study carried out in 25,920 blood donors from the department of Boyacá (Colombia). The source of information was secondary. The prevalence of Trypanosoma cruzi infection was determined and compared according to sex, age group and type of donor through frequency analysis. Results: 9187 donors were evaluated during 2016; 8,517 in 2017 and 8,216 in 2018, of which 56.1% were female and 43.9% male. The prevalence of Trypanosoma cruzi infection was 0.17% in screening and 0.08% with confirmatory tests of which 70.0% were women, 85.0% first-time volunteer donors, the range of The age at which the highest prevalence of this serological marker was found was 41 to 50 and 51 to 65 years with 35.0% each. The prevalence of Chagas infection showed a statistically significant association with age (p <0.05). Conclusions: Blood banks turn out to be one of the sources of information available to monitor the behavior of Chagas disease and evaluate decision-making in public health, taking into account the characteristics of the disease in which the majority of cases they are asymptomatic and without clinical compromise.