Association between inflammatory molecules, nitric oxide metabolites and leg ulcers in individuals with sickle cell anemia

Abstract Introduction Leg ulcers (LUs) are relatively common in patients with sickle cell anemia (SCA). The role of inflammation and nitric oxide (NO) pathways in the pathophysiology of the LU is not understood. Objective The aim of this study was to verify the association between inflammatory molecules and nitric oxide metabolites (NOx) and the occurrence of the LU in patients with SCA. Method It was a cross-sectional study on adult participants with SCA followed at Fundação Hemominas, a public blood center in Brazil. Eligible participants were recruited and included in one of two groups: Group 1, comprised of cases with SCA (Hb SS) and at least one LU at the time of inclusion in the study and Group 2, comprised of controls with SCA without a history of LU, matched by sex and age to cases. Participants were interviewed to obtain sociodemographic data and blood samples were collected. Clinical and laboratory data were abstracted from medical records. Nitric oxide metabolites (NOx) and inflammatory molecules were quantified using an immunoassay and Multiplex xMAP® technology, respectively. Eighty-seven individuals were included, ranging in age from 17 to 61 years (mean 40 ± 10.7 years); 30 had LU and 57 were controls without LU. Results Participants with LU had significantly higher levels of interleukin 8 (IL-8), IL-10, IL-15, NOx and platelet and white blood cell (WBC) counts, when compared to those without LU. Participants with LU had a significantly higher risk of having a history of osteomyelitis and a higher use of antiseptic soap in bathing, when compared to those without LU. Conclusion In conclusion, our results showed that NOx, inflammatory molecules and hematological features were associated with LU in Brazilian adults with SCA.

Test seeking: are healthcare professionals referring people to blood centers for infections marker testing?

ABSTRACT Background: Test-seeking is associated with HIV in Brazilian blood donors. This study sought to investigate the frequency with which three different donor groups: deferred donors, accepted donors who tested HIV positive [HIV (+)], and accepted donors who tested infectious disease markers negative [IDM (−)], came to the blood bank at the suggestion of a health care professional. Study design and methods: Donors deferred for reporting high-risk behaviors and participants in an HIV risk factor case-control study completed a confidential audio computer-assisted self-interview (ACASI) that included two questions related to health care professionals and test-seeking. Results: Of 4013 enrolled deferred donors, 468 (11.8%) reported a health care professional suggested donation as a way to be tested for infection. Of 341 HIV (+) and 791 IDM (−) participants, 43 (12.6%) and 11 (1.4%), respectively, reported a health care professional suggested donation as a way to be tested for infection. Physicians were the most frequently reported source of referral: [(61.5% of deferred, 69.1% of HIV (+), and 9.1% of IDM (−) donors)]. Conclusion: HIV (+) donors and deferred donors were 10 times more likely to report test-seeking behavior by suggestion of health care professional than IDM (−) donors. If true, efforts should be made to educate health care professionals and blood donors on how to safeguard the blood supply, emphasizing that HIV testing should be done at volunteer testing centers rather than at the blood centers.

O ciclo de produção do sangue e a transfusão: o que o médico deve saber / The production cycle of blood and transfusion: what the clinician should know

Desde a história da humanidade, o sangue foi associado ao conceito de vida. Entretanto, o uso inadequado do sangue e produtos sanguíneos aumenta o risco de complicações relacionadas à transfusão e eventos adversos para os destinatários. Também contribui para a escassez de produtos derivados do sangue e a possibilidade de não estarem disponíveis, quando necessário, para outros pacientes que deles realmente necessitem. Objetivo: este estudo visa a descrever o histórico da transfusão de sangue e a maneira correta de se utilizar a hemoterapia, visando esclarecer, aos estudantes de Medicina e residentes, bem como médicos interessados, a importância desse conhecimento ao se prescrever um hemocomponente. Metodologia: os tópicos descritos correspondem ao sumário do conhecimento ministrado durante os estágios oferecidos pela Fundação Hemominas para estudantes e residentes de Medicina. Conclusão: a atuação do médico está inegavelmente ligada à concepção científica de seus fundamentos, obtidos, gradual e continuamente, desde o início da formação médica. Nessa perspectiva, melhor capacitação dos profissionais médicos e a elaboração de currículos educacionais, em conformidade com os mais recentes avanços em hemoterapia, podem melhorar o conhecimento médico relativo à medicina transfusional.

Since the history of mankind, blood has been associated with the concept of life. However, improper use of blood and blood products increases the risk of transfusion-related complications and adverse events to recipients. It also contributes to the shortage of blood products and possibility of unavailability to patients in real need. Objective: this study aims to describe the history of blood transfusion and correct way of using hemotherapy,aiming to clarify to medical students and residents, as well as interested doctors, the importance of this knowledge when prescribing a hemo-component. Methodology: the topics described correspond to the summary of knowledge taught during the training courses offered by the Hemominas Foundation for medical students and residents. Conclusion: the doctor?s performance is undeniably linked to the scientific conception ofhis fundamentals gradually and continuously obtained since the beginning of medical training. In this perspective, a better training of medical professionals and development of educational curricula in accordance with the most recent advances in hematology can improve the medical knowledge related to transfusion medicine.

Teaching transfusion medicine: current situation and proposals for proper medical training

The current curricula in medical schools and hospital residence worldwide lack exposure to blood transfusion medicine, and require the reformulation of academic programs. In many countries, training in blood transfusion is not currently offered to medical students or during residency. Clinical evidence indicates that blood transfusions occur more frequently than recommended, contributing to increased risk due to this procedure. Therefore, the rational use of blood and its components is essential, due to the frequent undesirable reactions, to the increasing demand of blood products and the cost of the process. Significant improvements in knowledge of and skills in transfusion medicine are needed by both students and residents. Improvements are needed in both background knowledge and the practical application of this knowledge to improve safety. Studies prove that hemovigilance has an impact on transfusion safety and helps to prevent the occurrence of transfusion-related adverse effects. To ensure that all these aspects of blood transfusion are being properly addressed, many countries have instituted hospital transfusion committees. From this perspective, the interventions performed during the formation of medical students and residents, even the simplest, have proven effective in the acquisition of knowledge and medical training, thereby leading to a reduction in inappropriate use of blood. Therefore, we would like to emphasize the importance of the exposure of medical students and residents to blood ser- vices and transfusion medicine in order for them to acquire adequate medical training, as well as to discuss some changes in the current medical curricula regarding transfusion medicine that we judge critical.

Contribution of the Retrovirus Epidemiology Donor Study (REDS) to research on blood transfusion safety in Brazil

The Retrovirus Epidemiology Donor Study (REDS) program was established in the United States in 1989 with the purpose of increasing blood transfusion safety in the context of the HIV/AIDS and human T-lymphotropic virus epidemics. REDS and its successor, REDS-II were at first conducted in the US, then expanded in 2006 to include international partnerships with Brazil and China. In 2011, a third wave of REDS renamed the Recipient Epidemiology and Donor Evaluation Study-III (REDS-III) was launched. This seven-year research program focuses on both blood banking and transfusion medicine research in the United States of America, Brazil, China, and South Africa. The main goal of the international programs is to reduce and prevent the transmission of HIV/AIDS and other known and emerging infectious agents through transfusion, and to address research questions aimed at understanding global issues related to the availability of safe blood. This article describes the contribution of REDS-II to transfusion safety in Brazil. Articles published from 2010 to 2013 are summarized, including database analyses to characterize blood donors, deferral rates, and prevalence, incidence and residual risk of the main blood-borne infections. Specific studies were developed to understand donor motivation, the impact of the deferral questions, risk factors and molecular surveillance among HIV-positive donors, and the natural history of Chagas disease. The purpose of this review is to disseminate the acquired knowledge and briefly summarize the findings of the REDS-II studies conducted in Brazil as well as to introduce the scope of the REDS-III program that is now in progress and will continue through 2018.

Uso de hemocomponentes em hospital de médio porte em Belo Horizonte, Minas Gerais / Use of blood in mid-sized hospital in Belo Horizonte, Minas Gerais

Introdução: a transfusão de sangue tem como objetivo restaurar o volume de sangue e manter a concentração de oxigênio. Pode ser um procedimento essencial para a melhoria do estado geral e preservação da vida dos pacientes, mas pode ter efeitos indesejáveis e até mesmo letais. Objetivos: avaliar o perfil de transfusão hospitalar e adesão aos protocolospesquisados. Métodos: estudo descritivo de série de casos com amostra coletada de forma sistemática, a partir dos registros de solicitações de hemocomponentes do ano de 2012. A distribuição dos dados coletados foi analisada após soma do total em número absoluto e cálculo da sensibilidade. Resultados: a proporção de solicitações foi maior para pacientes do sexo masculino (54,6%) e a faixa etária com maior prevalência de solicitações de hemotransfusão foi de 60 anos ou mais (40,4% do total). O concentrado de hemácias (CH) foi o componente do sangue com o maior número de pedidos (72,4%), seguido de plasma congelado fresco (PFC) (22,2%) e de concentrados de plaquetas (CP) (6,2%). Entre as indicações de CH, a anemia foi o mais encontrado, seguido por sangramento. O sangramento também foi a principal indicação clínica do PFC. Outras indicações do PFC foram anemia e terapia de coagulopatias/anticoagulação. Pedidos, transfusões e internações não mostraram relação direta temporal durante o ano estudado. Conclusões: o estudo das características da demanda de sangue pode auxiliar na observação e previsão de tendências e desfechos. Considerando a análise temporal da demanda de sangue, por exemplo, destaca-se a importância de manter o banco de sangue com reservas suficientespara atender às exigências. Além disso, foram encontrados registros de uso acima do esperado de PFC, com indicações não preconizadas pelo hospital e literatura nacional.

Introduction: Blood transfusion is aimed to restore blood volume and maintain the oxygen concentration. It can be an essential procedure for improving the general condition and preserve the lives of patients, but it may have unwanted and even lethal effects. Aims: To evaluate the characteristics and adherence to hospital transfusion protocols surveyed. Methods: Descriptive case series study with samples collected systematically from the records of requests for blood products of the year 2012. The distribution of the collected data was analyzed after the totalsum in absolute numbers and calculation of sensitivity. Results: The proportion of requests was higher for male patients (54.3%) and the age group with the highest prevalence of requests for blood transfusion was 60 years or more (40.4% of the total). The packed red blood cells (RBC)was the blood component with the highest number of requests (72.4%), followed by fresh frozen plasma (FFP) (22.2%) and platelet concentrates (PC) (6.2%). Among the indications for RBC, anemia was most frequently found, followed by bleeding. Bleeding was also the main clinical indication FFP. Other indications of the FFP were anemia and coagulopathies / anticoagulation therapy. Orders, transfusions and hospitalizationsdid not show a direct temporal relationship during the year studied. Conclusions: The study of the characteristics of the demand for blood can aid in the detection and prediction of trends and outcomes. Considering the temporal analysis of the demand for blood, for example, emphasize the importance of maintaining the blood bank with sufficient reserves to meet the requirements. Furthermore, usage records higher than expected FFP, with no indications recommended by the hospital and national literature were found.

Sickle Cell Disease: quality of life in patients with hemoglobin SS and SC disorders

OBJECTIVE Sickle cell disease comprises chronic, genetically determined disorders, presenting significant morbidity and high prevalence in Brazil. The goal of this study was to evaluate the quality of life of sickle cell disease patients (hemoglobin SS and SC) and their sociodemographic and clinical characteristics. METHODS Data was collected from clinical records and semi-structured interviews consisting of clinical questionnaires and the World Health Organization Quality of Life-brief questionnaire. RESULTS Interviews were conducted with 400 patients, aged between 18 and 72, treated in the Fundação HEMOMINAS in Belo Horizonte. The participants predominantly had sickle cell disease hemoglobin SS variant (65.5%), were female (61.8%), single (55.3), with up to 8 years of schooling (49.6%), and self-defined as mulattos (50%). Pain crises, hospitalizations, blood transfusions, and other morbidities of sickle cell disease had a significant impact on the quality of life of these patients. CONCLUSION Within this group, the social profile was that of low income and unemployed with sickle cell disease considered to be a significant impediment to finding a job. Evaluating quality of life as a determining factor of health is essential for the creation of specific policies and measures, appropriate for the specific characteristics and social context of sickle cell disease.

Temporal distribution of blood donations in three Brazilian blood centers and its repercussion on the blood supply

BACKGROUND:Seasonal distribution of blood donation hinders efforts to provide a safe and adequate blood supply leading to chronic and persistent shortages. This study examined whether holidays, geographical area and donation type (community versus replacement) has any impact on the fluctuation of donations. METHODS: The numbers of blood donations from 2007 through 2010 in three Brazilian Retrovirus Epidemiological Donor Study II (REDS-II) participating centers were analyzed according to the week of donation. The weeks were classified as holiday or non-holiday. To compare donations performed during holiday versus non-holiday weeks, tabulations and descriptive statistics for weekly donations by blood center were examined and time series analysis was conducted. RESULTS: The average weekly number of donations varied according to the blood center and type of week. The average number of donations decreased significantly during Carnival and Christmas and increased during the Brazilian National Donor Week. The fluctuation was more pronounced in Recife and Belo Horizonte when compared to São Paulo and higher among community donors. CONCLUSION: National bank holidays affect the blood supply by reducing available blood donations. Blood banks should take into account these oscillations in order to plan local campaigns, aiming at maintaining the blood supply at acceptable levels. .

Hepatitis C: geographical diversity and temporal trends of seropositivity in brazilian blood donors from Minas Gerais state, Brazil

Introduction: Hepatitis C virus (HCV) is transmissible through blood products and is a public health problem in Brazil. Monitoring blood donors may help to understand its trends in the general population. The evolution of HCV antibody prevalence in blood donors from Minas Gerais, south-eastern Brazil, and its distribution in first-time donors are shown. Methodology: From 1993 to 2007, 3,249,944 blood donors were screened for HCV-Ab with ELISAs. Results: Of the donors tested, 8,107 were reactive for HCV-Ab (0.25 por cento CI=0.2441-0.2549). The total prevalence decreased from a maximum of 0.91 por cento in 1993 to 0.098 por cento in 2007. Among 1,283,970 first-time donors in the 2003 to 2007 period, there were 1,792 (0.51 por cento) reactive for HCV-Ab. The cities of Sete Lagoas and Passos had the highest prevalence (0.76 por cento), followed by Uberaba (0.62 por cento) and Belo Horizonte (0.60 por cento). Betim, Diamantina and Ituiutaba had the lowest rates (< 0.4 por cento). Discussion: The decrease in the prevalence of HCV-Ab in blood donors may be due to improved tests, better donor selection and deferral of the repeat donors. The asymmetrical distribution may reflect different profiles of exposure to HCV and may help elicit public health measures that, in turn, will help foster a safer donor population...

Introdução: O vírus da hepatite C (HCV) é transmissível por meio de produtos sanguíneos e consiste em um problema de saúde pública no Brasil. O monitoramento de doadores pode contribuir 2013para o entendimento da tendência desta infecção na população geral. Neste estudo, mostramos a evolução da prevalência de HCV em doadores de Minas Gerais, no sudoeste do Brasil e sua distribuição em doadores de primeira vez, que apresentam maior semelhança com a população. Metodologia: De 1993 a 2007, 3.249.944 doadores de sangue foram triados para HCV usando a metodologia de ELISA. Resultados: Dos doadores testados, 8.107 foram reativos para HCV (0,25 por cento CI=0,2441-0,2549). A prevalência total caiu de um máximo de 0,91 por cento in 1993 para 0,098 por cento em 2007. Dentre os 1.283.970 doadores de primeira vez no período de 2003 a 2007 havia 1.792 (0,51 por cento) indivíduos reativos para HCV. As cidades de Sete Lagoas e Passos tiveram a prevalência mais elevada (0,76 por cento), seguidos por Uberaba (0,62 por cento) e Belo Horizonte (0,60 por cento). Betim, Diamantina e Ituiutaba apresentaram as taxas mais baixas (< 0,4 por cento). Discussão: Redução da prevalência de HCV em doadores é significativa para a segurança do estoque de sangue e pode ser devida à melhoria dos testes, à melhor seleção de doadores e a retirada do grupo de doadores daqueles de repetição que ainda não haviam sido testados. A distribuição assimétrica no estado pode refletir os diferentes perfis de exposição ao HCV e podem auxiliar na elaboração de medidas de saúde pública que poderão, por sua vez, contribuir para uma população de doadores mais saudável...

Grupo Cooperativo Iberoamericano de Medicina Transfusional. Programa Consulta al Experto. El uso adecuado de la sangre y sus alternativas en cirugía / Ibero-American Cooperative Group on Transfusion Medicine. Consulting the Expert. Appropiate use of blood products and its alternatives in surgical procedures

La transfusión de productos sanguíneos tiene como objetivo restaurar o mantener la capacidad de transportar oxígeno, y la homeostasis del volumen sanguíneo. En los últimos años se han introducido mejoras en las indicaciones de los productos sanguíneos ya que se ha demostrado que su uso supone un riesgo para el paciente y también es costoso para el sistema de salud. Hay grupos que están trabajando con la práctica de la "cirugía sin sangre". El propósito principal de realizar intervenciones utilizando poca sangre ("cirugía sin sangre") está enfocada en minimizar las pérdidas y reducir o eliminar la exposición a los componentes sanguíneos alogeneicos. Los riesgos asociados con las transfusiones de sangre han sido bien documentados, y el objetivo de los centros de "cirugía sin sangre" es evitar complicaciones y el uso innecesario de las transfusiones. Hay una estrategia universal de uso conservador de la sangre que es aplicable a todos los pacientes y poblaciones. Factores tales como las condiciones preexistentes van a cambiar el enfoque en casos específicos. Un protocolo de cirugía exitosa con poca pérdida de sangre requiere trabajo en equipo y la cooperación entre el banco de sangre, hematólogos, cirujanos y anestesiólogos, para asegurar que se cumplan los objetivos de minimizar la pérdida de sangre y evitar las transfusiones, sin poner en riesgo la vida y el bienestar del paciente.

Evaluation of rapid tests for human immunodeficiency virus as a tool to detect recent seroconversion

The identification of recent HIV infection is important for epidemiological studies and to monitor the epidemic. The objective of this study was to evaluate two rapid tests that are easily available to the Brazilian scientific community for using as markers of recent HIV infection. The Rapid Test - HIV-1/2 Bio-Manguinhos (Bio-Manguinhos/Fiocruz, Brazil) and the Rapid Check HIV 1&2 (NDI-UFES, Center for Infectious Diseases, Universidade Federal do Espírito Santo) were tested, using 489 samples with HIV positive serology, from blood donors, previously classified as recent or long-term infection by serological testing algorithm for recent HIV seroconversion (STARHS) or LS-HIV Vitros assay methods. The samples were diluted prior to testing (1:50 and 1:100 for the Rapid Test - HIV-1/2 Bio-Manguinhos, and 1:500 and 1:600 for the Rapid Check HIV 1&2). Negative samples were considered recent infection, whereas those showing any color intensity were associated with long-term infection. The best dilutions were 1:100 for HIV-1/2 Bio-Manguinhos test (Kappa = 0.840; overall agreement = 0.93), and 1:500 for the Rapid Check HIV 1&2 (Kappa = 0.867; overall agreement = 0.94). The results suggest that both rapid tests can be used to detect recent seroconversion.

Thrombospondin-1 expression in human T-lymphotropic virus 1 asymptomatic carriers and patients with HTLV-associated myelopathy/tropical spastic paraparesis / Expressão de Trombospondina-1 em indivíduos infectados pelo HTLV-1 assintomáticos e pacientes portadores da mielopatia associada ao HTLV/Paraparesia Espástica Tropical

O Vírus Linfotrópico de células T humanas tipo 1 (HTLV-1) está associado a uma mielopatia (chamada mielopatia associada ao HTLV - HAM/TSP). A trombospondina-1 (TSP-1) é uma proteína da matriz que interfere com a adesão, a motilidade, e a proliferação celular. Níveis deexpressão de RNA mensageiro (mRNA) da trombospondina-1 foram avaliados em indivíduos infectados por HTLV-1: 11 pacientes assintomáticos, 18 com mielopatia ou oligossintomáticos, e 13participantes não-infectados. O RNA de células mononucleares do sangue periférico foi submetido à análise de RT-PCR para trombospondina-1. O número de indivíduos que expressaram esta proteína foi maior no grupo com mielopatia/sintomas (14/18, p igual 0,007). Em geral, a tendência para valores mais elevados de mRNA de trombospondina-1 foi observada no grupo de infectados pelo vírus (p igual 0,062). Os níveis mais elevados de expressão do mRNA foram detectados no início dos sintomas clínicos da HAM/TSP. Estudos adicionais com maior número de amostras são necessários para elucidar melhor o papel desta proteína da matriz na rede inflamatória relacionada à HAM/TSP.

High prevalence of HTLV-1 and 2 viruses in pregnant women in São Luis, state of Maranhão, Brazil / Alta prevalência dos vírus HTLV-1 e 2 em gestantes de São Luis, estado do Maranhão, Brasil

INTRODUCTION: Human T cell lymphotropic virus type 1 (HTLV-1) is endemic in the Caribbean, Japan, South America and regions of Africa. HTLV-2 is present in Native American populations and associated with IV drug use in Europe and North America. In Brazil, it is estimated that 1.5 million people are infected with HTLV-1/2. The study objective was to determine HTLV-1/2 prevalence in pregnant women in the prenatal care from three public services in São Luis, State of Maranhão, Brazil, and to counsel seropositive women to reduce viral transmission. METHODS: A cross-sectional study was conducted from February to December 2008; women with age of 18 to 45 years, with low risk for sexually transmitted disease (STD) were invited to participate. Blood samples were collected in filter paper, and HTLV-1/2 immunoenzymatic test (ELISA) was performed as a screening test. Women with reactive results were submitted to peripheral venous blood collection for ELISA repetition, followed by Western blot (WB) and real-time PCR to confirm and discriminate the infection between virus types 1 and 2. RESULTS: Of the 2,044 women tested, seven (0.3%) were ELISA reactive and confirmed positive (four were HTLV-1, and three were HTLV-2). All positive women were oriented not to breastfeed their newborns. CONCLUSIONS: This study showed that the virus is present in high prevalence in that population. Further studies covering other segments of the population are necessary to better characterize the presence of HTLV-1/2 in Maranhão and to elicit measures to prevent its spread.

INTRODUÇÃO: O vírus linfotrópico de células T humanas tipo 1 (HTLV-1) é endêmico no Caribe, Japão, América do sul e regiões da África. O HTLV-2 está presente em populações indígenas das Américas e usuários de drogas injetáveis na Europa e América do Norte. No Brasil, estimase que 1,5 milhões de pessoas estejam infectadas pelo HTLV-1/2. O objetivo deste estudo foi de determinar a prevalência do HTLV-1/2 em gestantes atendidas no pré-natal de três serviços públicos em São Luis, Maranhão, e orientar as mulheres soropositivas para reduzir a transmissão viral. MÉTODOS: Foi realizado um estudo transversal, de fevereiro a dezembro de 2008, com gestantes de 18 a 45 anos, com baixo risco de doença sexualmente transmissível (DST). Amostras de sangue foram coletadas em papel filtro e submetidas à técnica de ensaio imunoenzimático (ELISA) como teste de triagem para HTLV-1/2. As gestantes com resultado ELISA reativo foram submetidas à coleta de sangue venoso periférico para repetição do ELISA, seguido por WB e PCR em tempo real para confirmar e discriminar a infecção pelos tipos virais. RESULTADOS: Das 2.044 mulheres examinadas, sete (0.3%)tiveram resultados reativos e foram confirmadas soropositivas (quatro para HTLV-1 e três para HTLV-2). Todas as sete gestantes foram orientadas a não dar leite materno aos filhos. CONCLUSÕES: Este estudo mostrou que o HTLV-1/2 está presente em alta prevalência na população das mulheres grávidas estudadas. São necessários outros estudos contemplando diferentes segmentos populacionais para caracterizar a presença do HTLV-1/2 no Maranhão, e permitirmedidas preventivas contra a disseminação viral.

Confidential donation confirmation as an alternative to confidential unit exclusion: 15 months experience of the HEMOMINAS foundation

BACKGROUND: Confidential unit exclusion remains a controversial strategy to reduce the residual risk of transfusion-transmitted infections. OBJECTIVE: This study aimed to analyze confidential unit exclusion from its development in a large institution in light of confidential donation confirmation. METHODS: Data of individuals who donated from October 1, 2008 to December 31, 2009 were analyzed in a case-control study. The serological results and sociodemographic characteristics of donors who did not confirm their donations were compared to those who did. Variables with p-values < 0.20 in univariate analysis were included in a logistic multivariate analysis. RESULTS: In the univariate analysis there was a statically significant association between positive serological results and response to confidential donation confirmation of "No". Donation type, (firsttime or return donor - OR 1.69, CI 1.37-2.09), gender (OR 1.66, CI 1.35-2.04), education level (OR 2.82, CI 2.30-3.47) and ethnic background (OR 0.67, CI 0.55-0.82) were included in the final logistic regression model. In all logistic regression models analyzed, the serological suitability and confidential donation confirmation were not found to be statistically associated. The adoption of new measures of clinical classification such as audiovisual touch-screen computer-assisted self-administered interviews might be more effective than confidential unit exclusion in the identification of donor risk behavior. The requirement that transfusion services continue to use confidential unit exclusion needs to be debated in countries where more specific and sensitive clinical and serological screening methods are available. CONCLUSION: Our findings suggest that there are not enough benefits to justify continued use of confidential donation confirmation in the analyzed institution.

Decline in prevalence and asymmetric distribution of human T cell lymphotropic virus 1 and 2 in blood donors, State of Minas Gerais, Brazil, 1993 to 2007 / Declínio na prevalência e distribuição assimétrica do vírus linfotrópico de células T humanas em doadores de sangue, Estado de Minas Gerais, Brasil, 1993 a 2007

INTRODUCTION: Human T cell lymphotropic virus types 1 and 2 (HTLV-1/2) are endemic in Brazil and are screened for in transfusion services since 1993. This study evaluated the evolution of the prevalence of HTLV-1 and 2 in blood donors of the Hemominas Foundation from 1993 to 2007, and its geographical distribution in State of Minas Gerais, Brazil. METHODS: The Hemominas Foundation is a centralized blood center in Minas Gerais, Brazil. The sources of data were the Hemominas Foundation Technical Bulletin and files from the centralized serological laboratory. Donors were tested in the period using enzyme linked immuno sorbent assays (ELISA), followed by Western blot, when repeatedly reactive. The data were analyzed by EPIINFO 6.2 and TABWIN 3.5 softwares. RESULTS: The average seroprevalence in the period 1993-2007 was 0.1 percent. A steady decline occurred from 0.4 percent in 1993 to below 0.1 percent in 2002 and later, with a transient peak of 0.5 percent in 1994. HTLV reactivity distribution was asymmetrical in the state, with regions of higher prevalence, interspersed with low prevalence areas. Comparison of positive and negative donors verified that increasing age was proportional to virus positivity. Odds ratio for age ranged from 1.43 (30 to 39 years-old) to 3.09 (50 to 65 years-old). Women had a greater chance of being positive (OR-1.64), as previously described. CONCLUSIONS: Possible explanations for HTLV-1/2 prevalence decline are the exclusion of positive donors from the donor pool, an increase in repeat donors and ELISA test improvement, with reduction in the number of false positive results.

INTRODUÇÃO: Os vírus linfotrópicos de células T humanas 1 e 2 (HTLV-1/2) são endêmicos no Brasil e são testados nos serviços de transfusão desde 1993. Este estudo avaliou a evolução da prevalência do HTLV-1 e 2 em doadores de sangue da Hemominas, de 1993 a 2007, bem como sua distribuição geográfica no Estado de Minas Gerais, Brasil. MÉTODOS: A Hemominas é um serviço transfusional centralizado em Minas Gerais, Brasil. As fontes de dados foram o Boletim Técnico da Fundação Hemominas, e os dados informatizados do laboratório central de sorologia. Os doadores foram testados no período utilizando ensaio enzimático (ELISA), seguido de Western blot, para confirmação, se repetidamente reagentes. Os dados foram analisados utilizando EPIINFO 6.2 e TABWIN 3.5. RESULTADOS: A prevalência media no período 1993-2007 foi de 0,1 por cento. Houve declínio contínuo de 0,4 por cento em 1993 para menos de 0,1 por cento de 2002 em diante, com um pico transitório de 0,5 por cento em 1994. A distribuição do HTLV foi assimétrica, com alternância de regiões de alta e baixa prevalências. A comparação entre doadores positivos e negativos mostrou que a idade aumenta a positividade para o vírus. A OR para idade variou de 1,43 (30 a 39 anos) a 3,09 (50 a 65 anos). As mulheres tiveram chance maior de ser positivas (OR-1,64), como descrito anteriormente. CONCLUSÕES: As possíveis explicações para o declínio do HTLV-1/2 foram a exclusão de doadores positivos, aumento nos doadores de repetição, e melhora nos testes de ELISA, com redução do número de testes falso positivos.

HTLV-1 associated myelopathy diagnosed during lepromatous leprosy reaction treatment: a case report / Mielopatia associada ao HTLV-1 diagnosticada durante tratamento de hanseníase virchowiana reacional: relato de caso

Leprosy and human T cell lymphotropic virus type 1 infection are prevalent in Brazil. Coinfection by Mycobacterium leprae and HTLV-1 is reviewed and a case is reported. A 59 year-old woman was followed and HTLV-1 associated myelopathy was diagnosed during leprosy treatment. The clinical and neurological aspects of this unusual association were initially reviewed. Immunological markers and the possible prognoses due to the association of the diseases were discussed. The unexpected association of leprosy and HTLV-1 associated myelopathy may occur in endemic areas and causes difficulties in determining the correct diagnosis and adequate management of the neurological manifestations.

Hanseníase e infecção pelo HTLV-1 são prevalentes no Brasil. A associação de hanseníase e infecção por HTLV-1 é revista e é relatado um caso de coinfecção. Paciente feminina de 59 anos teve diagnóstico de mielopatia associada ao HTLV-1 durante o tratamento para hanseníase. Aspectos clínicos e neurológicos desta associação, ainda não descrita, são revistos e os marcadores imunológicos e possíveis evoluções relacionadas com a associação dessas doenças discutidos. A associação de hanseníase e mielopatia associada ao HTLV-1, aparentemente pouco usual, pode ocorrer em áreas endêmicas e trazer dificuldades para o diagnóstico e tratamento das manifestações neurológicas.

Geographic distribution of human T-lymphotropic virus types 1 and 2 among mothers of newborns tested during neonatal screening, Minas Gerais, Brazil / Distribución geográfica del virus linfotrópico de células T humanas tipos 1 y 2 en madres de recién nacidos estudiados en el tamizaje neonatal en Minas Gerais, Brasil

OBJECTIVE: To evaluate the geographic distribution of human T-lymphotropic virus types 1 and 2 (HTLV-1/2) in the State of Minas Gerais, Brazil, in puerperal women whose newborns were tested for HTLV-1/2 during neonatal screening, and to overlap seropositivity with social and economic status determinants. METHODS: During September-November 2007, the dry-blood samples taken from newborns on filter paper for routine screening were also tested for maternal IgG anti-HTLV-1/2 antibodies. For reactive samples, the mothers of the newborns had blood drawn to test for these viruses. RESULTS: The study analyzed 55 293 specimens taken from newborns. Of these, 52 (9.4 per 10 000) were reactive and 42 mothers (7.6 per 10 000) were confirmed with HTLV-1/2 infection. HTLV-1/2 geographic distribution was heterogeneous, with a tendency to be higher in the North and North-East parts of Minas Gerais. The highest rates of seropositivity were observed in Vale do Mucuri (55.9 per 10 000) and in Jequitinhonha (16.0 per 10 000), overlapping with the State's worst social and economic indicators. CONCLUSIONS: To our knowledge this was the first time that neonatal screening for HTLV-1/2 was performed in Brazil. This model could be used in other areas with high HTLV-1/2 prevalence rates. The detection of carrier mothers can enable intervention measures, such as providing infant formula to newborns, to be implemented expeditiously to reduce vertical transmission.

OBJETIVOS: Evaluar la distribución geográfica del virus linfotrópico de células T humanas tipos 1 y 2 (HTLV-1/2) en el estado de Minas Gerais (Brasil), en mujeres puérperas en cuyos recién nacidos se analizó la presencia del HTLV-1/2 durante las pruebas neonatales de detección sistemática, y superponer la seropositividad con determinantes del estado socioeconómico. MÉTODOS: Entre septiembre y noviembre de 2007, en las muestras de sangre seca extraída a los recién nacidos en papel de filtro para un tamizaje sistemático, se analizaron también los anticuerpos maternos de tipo IgG anti-HTLV-1/2. En el caso de las muestras reactivas, se extrajo la sangre de las madres de los recién nacidos para realizar pruebas de detección de estos virus. RESULTADOS: En el estudio se analizaron 55 293 muestras extraídas de los recién nacidos. De estas, 52 (9,4 por 10 000) fueron reactivas y en 42 madres (7,6 por 10 000) se confirmó la infección por el HTLV-1/2. La distribución geográfica del HTLV-1/2 fue heterogénea, con una tendencia a ser mayor en el norte y el noreste de Minas Gerais. Las tasas más elevadas de seropositividad se observaron en Vale do Mucuri (55,9 por 10 000) y en Jequitinhonha (16,0 por 10 000), superponiéndose con los peores indicadores socioeconómicos del estado. CONCLUSIONES: Esta fue la primera vez que se realizó un tamizaje neonatal para el HTLV-1/2 en Brasil. Este modelo podría usarse en otras regiones con tasas de prevalencia altas del HTLV-1/2. La detección de las madres portadoras puede permitir la aplicación rápida de medidas de intervención, como por ejemplo, el suministro de leche maternizada a los recién nacidos, a fin de reducir la transmisión vertical.