Gestión de calidad en equipos de gases en sangre POCT. Expandiendo las fronteras del laboratorio / Quality management in POCT blood gas equipment. Expanding the frontiers of the laboratory

La realización de pruebas de laboratorio en el lugar de atención del paciente (POCT) de equipos de gases en sangre representa un desafío continuo tanto para los usuarios como para el laboratorio. La vulnerabilidad al error y la amenaza del riesgo que rodea esta forma de trabajo obliga a establecer un sistema de trabajo robusto para la obtención de un "resultado confiable" cerca del paciente crítico. La formación de un grupo interdisciplinario, la capacitación de usuarios externos al laboratorio, el aseguramiento de la calidad analítica y la conectividad, son los cuatro pilares sobre los cuales se sostiene el éxito de esta nueva era de laboratorio clínico. Además es necesaria la reinvención de la imagen bioquímica, asumiendo un rol de líder, comunicador, asesor e integrado al sistema de salud (AU)

Point of care laboratory testing (POCT) with blood gas equipment is an ongoing challenge for both the users and the laboratory. The vulnerability to error and the threat of risk that surrounds this way of working necessitates the establishment of a robust working system to obtain "reliable results" for the critically ill patient. The creation of an interdisciplinary group, the training of external users, analytical quality assurance, and connectivity are the four pillars on which the success of this new era of clinical laboratories is based. It is also necessary to reinvent the biochemical image, assuming the role of leader, communicator, and advisor integrated into the health system (AU)

Cognitive Ability in Midlife and Labor Market Participation Among Older Workers: Prospective Cohort Study With Register Follow-up

Background@#The study aimed to determine the association of individual cognitive ability in late midlife with labor market participation among older workers. @*Methods@#This prospective cohort study estimates the risk of long-term sickness absence, disability pension, early retirement, and unemployment from scores on the Intelligenz-Struktur-Test 2000R by combining data from 5076 workers from the Copenhagen Aging and Midlife Biobank with a register on social transfer payments. Analyses were stepwise adjusted for age, gender, physical and psychosocial work environment, health behaviors, occupational social class, education, and chronic diseases. @*Results@#In the fully adjusted model, low cognitive ability (≥1 standard deviation below the mean for each gender) and high cognitive ability (≥1 standard deviation above the mean for each gender) were not associated with risk of any of the four labor market outcomes. @*Conclusion@#Individual cognitive ability in late midlife was not associated with risk of long-term sickness absence, disability pension, early retirement, and unemployment in the fully adjusted model. Thus, no direct effect of individual cognitive ability in late midlife was observed on the risk of permanently or temporarily leaving the labor market.

Colostomy closure: risk factors for complications / Fechamento de colostomia: fatores de risco para complicações

ABSTRACT Background : The restoration of intestinal continuity is an elective procedure that is not free of complications; on the contrary, many studies have proven a high level of morbidity and mortality. It is multifactorial, and has factors inherent to the patients and to the surgical technique. Aim : To identify epidemiological features of patients that underwent ostomy closure analyzing the information about the surgical procedure and its arising complications. Method : It was realized a retrospective analysis of medical records of patients who underwent ostomy closure over a period of seven years (2009-2015). Results : A total of 39 patients were included, 53.8% male and 46.2% female, with mean age of 52.4 years. Hartmann´s procedure and ileostomy were the mainly reasons for restoration of intestinal continuity, representing together 87%. Termino-terminal anastomosis was performed in 71.8% of cases, by using mainly the manual technique. 25.6% developed complications, highlighting anastomotic leakage; there were three deaths (7.6%). The surgical time, the necessity of ICU and blood transfusion significantly related to post-operative complications. Conclusion : It was found that the majority of the patients were male, with an average age of 52 years. It was observed that the surgical time, the necessity of blood transfusion and ICU were factors significantly associated with complications.

RESUMO Racional: A reconstrução de trânsito intestinal é procedimento realizado eletivamente que não é isento de complicações, pelo contrário, muitos estudos evidenciam alto grau de morbimortalidade, dependendo de fatores inerentes ao paciente, bem como da própria técnica operatória. Objetivo: Identificar as características epidemiológicas dos pacientes submetidos à reconstrução intestinal, além de analisar as informações a respeito do procedimento cirúrgico e as complicações decorrentes. Método: Foi realizado análise retrospectiva dos prontuários dos pacientes submetidos à reconstrução intestinal no período de sete anos (2009-2015). Resultado: Foram incluídos 39 pacientes, sendo 53,8% homens e 46,2% mulheres, com idade média de 52 anos. As operações tipo Hartmann e ileostomia foram os motivos para a reconstrução do trânsito intestinal, representando juntas 87% dos pacientes. A anastomose terminoterminal foi realizada em 71,8% dos casos, utilizando principalmente a técnica manual. 25,6% dos pacientes apresentaram complicações, destacando-se a fístula de anastomose. Três (7,6%) morreram. O tempo operatório, necessidade de UTI e transfusão sanguínea apresentaram significância estatística com as complicações pós-operatórias. Conclusão: Verificou-se que a maioria foi de homens, com média de idade de 52 anos. Entre as variáveis estudadas, observou-se que a duração da operação, a necessidade de transfusão sanguínea e de UTI foram fatores complicadores com significância estatística.

Pork carcass injury in slaughterhouse waiting area and nutrient addition in pre-slaughter fasting / Lesión en la carne y adicción de nutrientes en el ayuno antes del sacrificio de cerdos

ABSTRACT Objective. Two experiments were conducted on a slaughterhouse located in Brazil, which the first aimed at evaluating the injuries on pig skin and carcass resulting from slaughterhouse waiting area management and the second aimed at assessing how glucose (G), sodium bicarbonate (SB) and vitamin E (VE) added to water during pre-slaughter fasting may affect carcass yield, organ relative weight and pork meat quality characteristics. Materials and methods. First trial included 1000 pigs, which were observed in the slaughterhouse resting area until the moment they entered the stunning process area. In the second trial were used 500 animals distributed on the last pre-slaughter day in a completely randomized design, including ten treatments and ten replicates. The treatments were: water; 50 g/L G; 50 g/L G + 200 mg/L of VE; 75 g/L of G; 75 g/L of G + 200 mg VE; 0.45% SB; 0.45% SB + 200 mg/L of VE; 0.55% SB; 0.55% SB + 200 mg/L of VE; 200 mg/L of VE. Results. Carcass yield and relative organ weight were not affected by treatments. The addition of 0.55% SB + 200 mg VE reduced the final pH of meat, and of 0.45% SB reduced the red pigment intensity. Conclusions. The main occurrences of injuries to the skin and carcass of pigs are due to fights. Also, adding glucose, sodium bicarbonate, and vitamin E to diet did not affect the carcass and viscera yield and meat quality.

RESUMEN Objetivo. Se realizaron dos experimentos en un beneficiadero en Brasil, dirigido a la evaluación de las lesiones en la piel de cerdo y la canal en la área de espera del beneficiadero y destinado a evaluar los efectos de glucosa (G), bicarbonato de sodio (SB) y vitamina E (VE) añadida al agua durante el ayuno antes de la masacre en el rendimiento de la canal, de órganos y la calidad de la carne. Materiales y métodos. En primer ensayo incluyó a 1.000 cerdos, observados en la zona de descanso del beneficiadero hasta la entrada en el área del aturdimiento. En el segundo ensayo se utilizaron 500 animales en el último día antes del beneficio, en un diseño experimental incluyendo diez repeticiones. Los tratamientos fueron: agua; 50 g/L G; 50 g/L G + 200 mg/L VE; 75 g/L G; 75 g/L G + 200 mg VE; 0.45% SB; 0.45% SB + 200 mg/L VE; 0.55% SB; 0.55% SB + 200 mg/L VE; 200 mg/L of VE. Resultados. Los rendimiento de la canal y de órganos no se vieron afectados por los tratamientos. La adición de 0.55 % SB + 200 mg VE redujo el pH final de la carne, y de 0.45 % SB reduce el valor de pigmento rojo. Conclusiones. Los principales casos de lesiones en la piel y la canal de cerdos se deben a peleas. La adición de los nutrientes en el agua de bebida no afectó a la carcasa, el rendimiento vísceras y calidad de la carne.

ECMO respiratorio como opción terapéutica en falla respiratoria refractaria en la edad pediátrica / Respiratory ECMO as treatment of choice for refractory respiratory failure in pediatric patients

Resumen La oxigenación con membrana extracorpórea (ECMO), es una alternativa terapéutica útil en el manejo de la falla respiratoria refractaria en la edad pediátrica. La infección por virus sincitial respiratorio es una patología prevalente en nuestra ciudad con una carga de la enfermedad que supone el 75% de las hospitalizaciones en menores de 2 años diagnosticados con bronquiolitis. Un índice de oxigenación mayor a 40 predice una mortalidad mayor del 80% en estos pacientes, asimismo, se ha encontrado que un pH menor de 7.29 es un factor de riesgo independiente para la mortalidad en el mismo grupo. La ECMO es una terapia que desde el año 1985 ha mostrado tener una sobrevida del 53% en este grupo, llegando a niveles del 63% en los últimos años, particularmente, si la etiología es el virus sincitial respiratorio. Se reportan dos casos de pacientes lactantes menores con falla respiratoria refractaria en quienes se decidió iniciar la ECMO logrando la sobrevida de ambos.

Abstract Extracorporeal membrane oxygenation (ECMO) is a useful alternative therapy when managing refractory respiratory failure in pediatric patients. An infection caused by respiratory syncytial virus is a prevalent condition in our city, with a disease burden that accounts for 75% of hospital admissions in children under to years of age who have been diagnosed of bronchiolitis. An oxygenation index above 40 predicts a mortality of over 80% for these patients; likewise, it has been found that a pH below 7.29 is an independent mortality risk factor for this same group. ECMO is a therapy that has shown survival rates of 53% in this patient group since 1985, reaching a level of 63% over recent years, particularly when the aetiology is respiratory syncytial virus. Two cases of infants with refractory respiratory failure where ECMO therapy was chosen and achieved survival of both children are reported.

Factors influencing colostrum yield by sows / Fatores que influenciam a produção de colostro em porcas

An adequate colostrum intake, in order to ensure the survival and weight gain of piglets, depends on the sow's ability to produce enough colostrum for the whole litter. The aim of this study was to evaluate factors involved in colostrum yield (CY) variability related to the sow, the litter and the farrowing process. The experiment was conducted with 96 Camborough 25(r) sows of parities one to seven, whose farrowing was spontaneous. Colostrum production of each sow was estimated by summing up the colostrum intake of each piglet in the litter, estimated by an equation that takes into account the birth weight and weight gain during the first 24h of life. The multiple regression model explained 28% of variation in CY, with 24% and 4% respectively of variation being explained by the litter birth weight and the width of the first mammary glands. Litter birth weight was positively correlated with the number of total born (r= 0.73) and born alive piglets (r= 0.83). When categorised into two groups of colostrum yield (LOWCY; ≤3.4kg; n= 46 vs HIGHCY; >3.4kg; n= 50), LOWCY sows had fewer total born and born alive piglets and lighter litters (P<0.05). The logistic regression analysis showed that sows from parities 1, 2 and >3 had greater odds (P≤0.05) of belonging to the LOWCY group than parity 3 sows. Sows with two or more obstetrical interventions had higher odds (P<0.05) of belonging to the LOWCY group than sows without interventions during farrowing. The higher colostrum yield observed in sows of parity 3 and sows with less than two obstetrical interventions during farrowing was associated with a greater number of nursed piglets. This study showed that total birth weight of born alive piglets is the most important factor involved in colostrum yield variability, indirectly representing the number of piglets nursed by the sow.(AU)

Um consumo adequado de colostro, para assegurar a sobrevivência e o ganho de peso, dos leitões, depende da capacidade da porca em produzir colostro suficiente para toda a leitegada. O objetivo deste estudo foi determinar fatores relacionados com a porca, com a leitegada ou com o parto que possam influenciar a produção de colostro (PC). O experimento foi conduzido com 96 porcas Camborough 25, de ordem de parto (OP) 1 a 7, cujo parto foi espontâneo. A produção de colostro das porcas foi estimada pela soma do consumo individual de colostro pelos leitões, o qual foi estimado por equação que considera o peso ao nascimento e o ganho de peso nas primeiras 24h de vida. Por meio de modelo de regressão múltipla, 28% da variação na PC foi explicada pelo peso da leitegada (24%) e pela largura do primeiro par de glândulas mamárias (4%). O peso da leitegada foi positivamente correlacionado com o número total de leitões nascidos (r= 0.73) e com o número de leitões nascidos vivos (r= 0.83). Quando separadas em dois grupos de PC (BAIXAPC; ≤3.4kg; n=46 e ALTAPC; >3.4kg; n=50), as porcas do grupo BAIXAPC tiveram menor número total de leitões nascidos, menor número de leitões nascidos vivos e leitegadas mais leves (P<0.05). Por regressão logística, foi observado que porcas da OP 1, 2 e >3 tiveram maior chance (P≤0.05) de pertencer ao grupo BAIXAPC do que porcas de OP 3. Porcas com duas ou mais intervenções obstétricas tiveram maior chance (P<0.05) de pertencer ao grupo BAIXAPC do que as porcas sem intervenção durante o parto. A maior PC observada nas porcas de OP 3 e nas porcas com menos intervenções obstétricas foi associada com um maior número de leitões amamentados. Foi mostrado, neste estudo, que o peso total da leitegada viva, o qual indiretamente representa o número de leitões amamentados pela porca, é o fator mais importante envolvido na produção de colostro.(AU)

Antecedentes históricos de nuestra Revista. La exanguinotransfusión en la enfermedad hemolítica del recién nacido / Historical background of our journal. Blood exchange in the hemolytic disease of the newborn

1.Se relatan diez casos de enfermedad hemolítica del recién nacido: ocho por incompatibilidad RH; uno por isoinmunización anti-B; uno por causa aún desconocida. Todos tratados favorablemente por exanguinotransfusión, cuyas técnicas se detallan. 2. Se aconseja como técnica de elección, la transfusión gota a gota por punción venosa en dorso de mano y extracción por vena umbilical o arteriotomía radial. 3. Se recomienda la transfusión lenta y la sangría lenta (duración de la operación 3 a 5 horas) con el objeto de asegurarse mejor contra bruscos desniveles en la volemia. 4. Con el fin de limitar el aporte inicial de "conglutinina" y de disminuir la dosis total de citrato de sodio, se considera útil comenzar la transfusión con glóbulos privados del plasma y resuspendidos en soluciones isotónicas: se termina con sangre total. 5. La práctica de repetidos hematocritos en la sangre que se va extrayendo, resulta de suma utilidad para controlar la marcha de la operación. 6. Se fundamentan las ventajas que, sobre la operación cesárea, tiene la inducción médica del parto (preferentemente desde el octavo mes en adelante y valorando el peso del feto in útero) para el tratamiento de la madre isoinmunizada, supeditando la terapéutica del niño al examen de la sangre del cordón. 7. Se considera que la exanguinotransfusión es actualmente, en los casos graves, el tratamiento más completo de la enfermedad hemolítica del recién nacido.

1.Ten cases of hemolytic disease of the newborn infant are reported: eight with Rh incompatibility; one with anti-B isoimmunization and one case where unable to determine the cause. All were successfully treated by exchange transfusion. The technic is explained. 2. Drop by drop transfusion technic through one of the veins of the back of the hand, is advised. Extraction is perfomed through the umbilical vein or by radial arteriotomy. 3. Slow bleeding and transfusion are recommended (the whole procedure lasts form 3 to 5 hours) to avoid sudden changes in blood volume. 4. With the purpose of restricting the initial amount of "conglutinin" and to diminish te total dosis of sodium citrate it is advisable to start the transfusion with blood cells wothout plasma and resuspended in isotonic solutions; whole blood is used to finish the operation. 5. The habit of performing several hematocrits through the procedure results in great usefulness in controling the patient's condition. 6. The advantanges of medical induction versus cesarean operation are established (preferably from the eigth month onward and determining the weight of the fetus in utero) for the treatment of the isoimmunized mother, reducing the therapeutics of the child on examining the umbilical blood cord. 7. In serious cases of hemolytic disease of the newborn infant exchange transfusion is considered the best treatment.

Trabalho de consenso de força-tarefa da WFSBP sobre marcadores biológicos das demências: contribuição da análise do LCR e do sangue para o diagnóstico precoce e diferencial das demências / Consensus Paper of the WFSBP Task Force on Biological Markers of Dementia: The role of CSF and blood analysis in the early and differential diagnosis of dementiaWorld J Biol Psychiatry

O envelhecimento da população e o aumento da expectativa de vida resultam em um número cada vez maior de pacientes com demência. Os déficits cognitivos podem ser manifestações de uma doença curável do sistema nervoso central (por exemplo, neuroinflamação), como também de uma doença atualmente considerada irreversível, como a doença de Alzheimer (DA). Tendo em vista as novas abordagens terapêuticas para a DA, em que se avalia o potencial modificador da patogenia, torna-se necessário o estabelecimento de um diagnóstico confiável em vida. Embora a análise do líquido cefalorraquidiano (LCR) e do soro seja realização de rotina em doenças neuroinflamatórias, ainda necessita de padronização para ser usada como instrumento auxiliar no diagnóstico clínico da DA. Vários parâmetros relacionados à DA (tau total, formas fosforiladas de tau, peptídeos Aβ, genótipo ApoE, p97 etc.) podem ser determinados no LCR. A combinação de alguns desses parâmetros proporciona sensibilidade e especificidade na faixa de 85 por cento para o diagnóstico da DA, um valor usualmente atribuído a um bom instrumento de diagnóstico. Nesta revisão, são discutidas as publicações mais recentes sobre os marcadores neuroquímicos para o diagnóstico clínico das demências, com ênfase no diagnóstico precoce e diferencial da DA. Discutem-se brevemente as novas perspectivas oferecidas por tecnologias recentes, tais como a FCS (fluorescence correlation spectroscopy) e a técnica de espectrometria de massa pelo método SELDI-TOF (surface enhanced laser desorption/ionization time-of-flight mass spectrometry).

Aging of population, and increasing life expectancy result in an increasing number of patients with dementia. This symptom can be a part of a completely curable disease of the central nervous system (e.g, neuroinflammation), or a disease currently considered irreversible (e.g, Alzheimer's disease, AD). In the latter case, several potentially successful treatment approaches are being tested now, demanding reasonable standards of pre-mortem diagnosis. Cerebrospinal fluid and serum analysis (CSF/serum analysis), whereas routinely performed in neuroinflammatory diseases, still requires standardization to be used as an aid to the clinically based diagnosis of AD. Several AD-related CSF parameters (total tau, phosphorylated forms of tau, Aß peptides, ApoE genotype, p97, etc.) tested separately or in a combination provide sensitivity and specificity in the range of 85 percent, the figure commonly expected from a good diagnostic tool. In this review, recently published reports regarding progress in neurochemical pre-mortem diagnosis of dementias are discussed with a focus on an early and differential diagnosis of AD. Novel perspectives offered by recently introduced technologies, e.g, fluorescence correlation spectroscopy (FCS) and surface enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF MS) are briefly discussed.

Pressure and time dependence of the cardiopulmonary reflex response in patients with hypertensive cardiomyopathy

The first minutes of the time course of cardiopulmonary reflex control evoked by lower body negative pressure (LBNP) in patients with hypertensive cardiomyopathy have not been investigated in detail. We studied 15 hypertensive patients with left ventricular dysfunction (LVD) and 15 matched normal controls to observe the time course response of the forearm vascular resistance (FVR) during 3 min of LBNP at -10, -15, and -40 mmHg in unloading the cardiopulmonary receptors. Analysis of the average of 3-min intervals of FVR showed a blunted response of the LVD patients at -10 mmHg (P = 0.03), but a similar response in both groups at -15 and -40 mmHg. However, using a minute-to-minute analysis of the FVR at -15 and -40 mmHg, we observed a similar response in both groups at the 1st min, but a marked decrease of FVR in the LVD group at the 3rd min of LBNP at -15 mmHg (P = 0.017), and -40 mmHg (P = 0.004). Plasma norepinephrine levels were analyzed as another neurohumoral measurement of cardiopulmonary receptor response to LBNP, and showed a blunted response in the LVD group at -10 (P = 0.013), -15 (P = 0.032) and -40 mmHg (P = 0.004). We concluded that the cardiopulmonary reflex response in patients with hypertensive cardiomyopathy is blunted at lower levels of LBNP. However, at higher levels, the cardiopulmonary reflex has a normal initial response that decreases progressively with time. As a consequence of the time-dependent response, the cardiopulmonary reflex response should be measured over small intervals of time in clinical studies.

Ethical Standards for the Occupational Health-Nursing Practitioner Regarding the HIV Positive Person in the Workplace

The occcupational health-nursing practitioner often becomes involved in ethical dilemmas with regard to the handling of HIV-positive people in the workplace in that the interests of the HIV-positive people conflict with the interests of the employer. Therefore; the occupational health-nursing practitioner could find himself ? Herself acting as mediator between the two parties. Despite the existence of legal norms ancl ethicirl standards to regulate the interests of the HN-positive person in the workplace; no guidelines exist as to how these norms and standards should be operrationalised during interaction between the HN-positive person; the occcupational health-nursing practitioner and the employer: The occupational health-nursing practitioner is therefore rrncertain us to the manner in which to act professionally within the laid-ilown ethical standards for HN positive people in the workplace.The purpose of this study is to provide guidelines and criteria for the operationalisation of ethical standards for the occupational health-nursing practitioner regarcling the HN-positive person in the workplace. This is done through a literatrrre study with specific reference to current ethical frameworks within the occupational health-nursing context; after which the research is focused on two target groups; namely the occupational haalth-nursing practitioners and HIV-positive persons in the workplace. The design of the research is qualitative; explorative and descriptive. In order to assist the occupational health-nursing practitioner to handle the HIVpositive person in the workplace in an ethical manner guidelines and criteria were compiled for the operationalisation of the standards

Mortalidad neonatal; Hospital San Juan de Dios, 1984 / Neonatal mortality at the Hospital San Juan de Dios

Los objetivos del trabajo fueron determinar la tasa de mortalidad neonatal y sus variaciones según sexo, peso de nacimiento y edad del fallecido estableciendo las causas de muerte. Se analizó la mortalidad neonatal durante 1984, revisando las fichas de 90 recién nacidos fallecidos en un total de 6.950 nacidos vivos. La tasa de mortalidad neonatal fue de 12,9 por 1.000 nacidos vivos, la precoz de 11,3 y la tardía de 1,6. El 58% de la precoz ocurrió el primer día de vida. Las tasas según peso de nacimiento fueron de 523, para los de 1.500 gramos o menos; de 139 para los de 1.500 a 2.500 gramos y de 3,4 para los de más de 2.500 gramos. Las causas agrupadas de muerte neonatal fueron: condiciones asociadas a inmadurez (41%); condiciones específicas (28%); malformaciones congénitas (21%) y condiciones asociadas a hipoxia perinatal y traumatismos de parto (10%)