The Impact of Intra-Operative Heparin on Thromboembolism and Death in a Matched Cohort of Patients with a Ruptured Abdominal Aortic Aneurysm.

Objective: Portuguese nationwide estimates indicate that 20% of abdominal aortic aneurysms (AAAs) are treated when ruptured. In these cases, intra-operative unfractionated heparin (UFH) usage rates vary widely. Evidence on this topic is scarce and focused on patients treated by open repair (OSR). The aim was to determine the influence of UFH on peri-operative thromboembolic events (TEs) and death in a cohort of ruptured AAA (rAAA). Methods: Retrospective, single-centre, comparative study. From 2011 to April 2023, all consecutive rAAAs (endovascular repair [EVAR] and OSR) were considered. Primary outcomes were 30-day TE free survival and TE rates. The secondary outcome was 30-day death. Safety endpoints were procedural blood loss, blood product requirements, and secondary interventions due to haemorrhage. Using propensity score matching (PSM) each UFH patient was matched with one no UFH patient in a 1:1 ratio. Results: The study included 250 patients. After PSM, 190 patients were analysed (EVAR: 60.0% no-UFH vs. 64.4% UFH). TE free survival estimates favoured the UFH group (67.3% vs. 47.2%, p = .009; UFH adjusted odds ratio [aOR] 2.01, 95% confidence interval [CI] 1.04-4.17). TEs were more frequent in the no UFH group (20.0% vs. 44.2% patients, p < .001; UFH aOR 0.31, 95% CI 0.15-0.65 for any TE), driven by an increase in bowel ischaemia (17.9% no UFH vs. 3.2% UFH, p = .001). Most events occurred in the first 72 hours. EVAR was associated with reduced TE and improved TE free survival (aOR 0.20, 95% CI 0.09-0.45 and aOR 5.54, 95% CI 2.34-13.08, respectively). No significant differences in 30-day survival were noted (75% no-UFH vs. 83% UFH, p = .26; aOR 1.08, 95% CI 0.48-2.43) nor in blood loss, peri-operative red blood cell and fresh frozen plasma requirements, or secondary interventions due to haemorrhage (p = .10; p = .11; p = .13 and p = .18 respectively). Conclusion: In this cohort, intra-operative UFH was safe and associated with improved TE free survival, driven by a reduction in bowel ischaemia. Conversely, mortality remained unaffected. Randomised controlled trials are required to confirm these findings.

Correlation of serological and molecular markers in the screening for hepatitis B virus in blood bank in northern Brazil

ABSTRACT Introduction: In Brazil, the blood donor screening for hepatitis B virus (HBV) includes laboratory testing for serological (HBsAg and Anti-HBc) and molecular (HBV DNA) markers. This study aims to correlate serology reactive results with HBV DNA detection among blood donors with at least one HBV infection marker detected in a blood bank in northern Brazil. Method: A retrospective search for HBV reactive blood donor data from January 2017 to December 2019 was performed. Serological screening was performed by chemiluminescent microparticle immunoassays Architect HBsAg and Architect Anti-HBc, whereas molecular screening was performed by the HBV nucleic acid test (HBV NAT). Main results: A total of 556 HBsAg reactive results were detected, between positive (47.66%) and inconclusive (52.34%). A total of 3,658 Anti-HBc reactive results were detected, between positive (83.71%) and inconclusive (16.29%). None of the inconclusive results were associated with HBV DNA detection. The HBV DNA detection rates were 47.55% among HBsAg positive samples and 4.08% among Anti-HBc positive samples. The signal-to-cutoff (S/CO) ratio median of HBV NAT positive samples was superior in comparison to HBV NAT negative samples (p < 0.0001). The thresholds found to optimize sensitivity and specificity were 404.15 for Architect HBsAg and 7.77 for Architect Anti-HBc. Three blood donors were in the window period and 1 occult HBV infection case was detected. Conclusion: High S/CO ratios were more predictive of HBV DNA detection. However, a number of HBV NAT positive samples gave low values, while some HBV NAT negative samples showed high values, reaffirming the significance of molecular testing to enhance transfusion safety.

Post-Implantation Syndrome Incidence is Higher After Complex Endovascular Aortic Procedures Than After Standard Infrarenal Repair.

OBJECTIVE: Post-implantation syndrome (PIS), characterised by malaise, fever, and increased inflammatory markers, is a common occurrence after endovascular aneurysm repair (EVAR), causing prolonged hospitalisation and increased cost. This study aimed to determine the incidence and short-term outcomes of PIS after fenestrated or branched procedures in aorto-iliac aneurysms compared with standard EVAR. METHODS: A retrospective, comparative study from a tertiary academic institution was undertaken. All patients who underwent elective EVAR with polyester stent grafts from January 2015 to June 2021 were considered. Two groups were defined: standard EVAR (sEVAR) and complex EVAR (cEVAR). The latter included visceral fenestrated and branched or iliac branch and chimney stent grafts. The primary outcome was the incidence of PIS within three days of the index procedure. Secondary outcomes were short-term complications and risk factors for PIS. A multivariable model was constructed to correct for confounders. RESULTS: Overall, 253 patients were included: 165 (65.2%) sEVAR and 88 (34.8%) cEVAR. Complex EVAR patients were younger, with larger aneurysms, had longer procedures, and were more likely to have intra-operative complications. The PIS incidence was 23.7% (n = 60), significantly higher in cEVAR (34.1% vs. 18.2%; p = .005) and increased with the complexity of the procedure (EVAR: 18.2% vs. EVAR + iliac branch device: 25.0% vs. fenestrated and branched EVAR: 36.2%; p = .030). On multivariable analysis, cEVAR (OR 2.833, 95% CI 1.295 - 6.198; p = .009) was associated with a significantly increased risk of PIS. No differences in short term outcomes according to PIS status were noted. Group sub-analysis for cEVAR patients did not reveal any statistically significantly different outcomes according to PIS occurrence. CONCLUSION: In this cohort, cEVAR procedures were associated with a significantly increased risk of developing PIS compared with standard infrarenal repair. Post-implantation syndrome also appears to have a benign course with no major impact on peri-operative outcomes after cEVAR. Further research to confirm these findings is required.

Human T-lymphotropic virus 2 (HTLV-2) prevalence of blood donors in the state of Pará, Brazil.

INTRODUCTION: The present study had the objective to describe the molecular prevalence and epidemiological aspects of the human T-lymphotropic virus 2 (HTLV-2) infection in the blood donor population of the Pará state. METHODS: The present study is a descriptive, retrospective, and cross-sectional review of epidemiological, serological, and molecular data on inapt blood donors in the State Center for Hematology and Hemotherapy from January 2015 to December 2021. The data were digitalized to create a database using the Statistical Package for Social Sciences program. The prevalence of HTLV-2 was calculated based on the total number of donations during the study period. Descriptive frequency was used to analyze the qualitative data. RESULTS: A total of 665,568 blood donations were made. Out of these, 1884 (0.2%) samples presented serological detection to HTLV and further were evaluated using molecular confirmatory tests. Out of these, 36 samples were positive for HTLV-2 using qPCR Taqman assay based on pol gene region (0.005%). The HTLV-2 was found to be more prevalent in women (63.9%); aged between 39 and 59 years (55.6%); residents of the metropolitan region of Belém (80.6%); with self-declared race as brown (80.6%); individuals who had completed high school (58.6%); and first-time donors (58.3%) CONCLUSION: The present study identified the presence of HTLV-2 (1 HTLV-2 case/20,000 donations; 0.005%) in the specific population of blood donors in Pará state. These findings can contribute to the existing literature on the subject both for specific population groups under study and for understanding the prevalence of HTLV-2 in the general population.

Seroprevalence of Trypanosoma cruzi infection among blood donors in the state of Pará, Brazil.

INTRODUCTION: Chagas disease (CD) is a neglected pathology worldwide, considered a public health problem due to the high morbidity and mortality rate and its social impact. Thus, the objective was to estimate the prevalence of reactive serology for T. cruzi in blood donors in the units of the public blood network in the state of Pará (Brazil), as well as to describe the epidemiological profile of these donors. METHODS: This is a retrospective and descriptive study carried out at the Pará State Center for Hematology and Hemotherapy (HEMOPA) between 2016 and 2021, with analysis of secondary data (epidemiological and serological) of inapt blood donors for CD. RESULTS: Among the 533,674 screened samples, the reactivity for anti-T. cruzi was detected in 0.1% (548), of which 0.03% (166) were inconclusive and 0.07% (382) were positive. The hemonucleus of the city of Abaetetuba had the highest seroprevalence (0.6%). Regarding epidemiological characteristics, most blood donors were men (63.7%), aged between 31 and 45 (44.7%), racially mixed (79.2%), high school graduate (45.8%), single/widowed/divorced (62%), first-time donors (69%), spontaneous donations (58%) and from the state's countryside (69.9%). CONCLUSION: Over the years analyzed, we observed an increase in seroprevalence for T. cruzi emphasizing the need to maintain epidemiological control in the region and the application of more accurate serological tests in the screening of donor blood bags.

Correlation of serological and molecular markers in the screening for hepatitis B virus in blood bank in northern Brazil.

INTRODUCTION: In Brazil, the blood donor screening for hepatitis B virus (HBV) includes laboratory testing for serological (HBsAg and Anti-HBc) and molecular (HBV DNA) markers. This study aims to correlate serology reactive results with HBV DNA detection among blood donors with at least one HBV infection marker detected in a blood bank in northern Brazil. METHOD: A retrospective search for HBV reactive blood donor data from January 2017 to December 2019 was performed. Serological screening was performed by chemiluminescent microparticle immunoassays Architect HBsAg and Architect Anti-HBc, whereas molecular screening was performed by the HBV nucleic acid test (HBV NAT). MAIN RESULTS: A total of 556 HBsAg reactive results were detected, between positive (47.66%) and inconclusive (52.34%). A total of 3,658 Anti-HBc reactive results were detected, between positive (83.71%) and inconclusive (16.29%). None of the inconclusive results were associated with HBV DNA detection. The HBV DNA detection rates were 47.55% among HBsAg positive samples and 4.08% among Anti-HBc positive samples. The signal-to-cutoff (S/CO) ratio median of HBV NAT positive samples was superior in comparison to HBV NAT negative samples (p < 0.0001). The thresholds found to optimize sensitivity and specificity were 404.15 for Architect HBsAg and 7.77 for Architect Anti-HBc. Three blood donors were in the window period and 1 occult HBV infection case was detected. CONCLUSION: High S/CO ratios were more predictive of HBV DNA detection. However, a number of HBV NAT positive samples gave low values, while some HBV NAT negative samples showed high values, reaffirming the significance of molecular testing to enhance transfusion safety.

Frequency of antigen Dia on the blood donor population of the Hemocenter coordinator of the Hemopa Foundation

ABSTRACT Introduction: Erythrocyte phenotyping is a very important test in the adoption of prophylactic measures to reduce transfusion reactions/alloimmunizations in polytransfused patients. The blood group Diego, in its current, form has 22 antigens, of which 4 are immunogenic, being Dia/Dib and Wra/Wrb, while the others are less expressive. The antigen Dia is of low incidence among whites and blacks, however, it is common in the South American indigenous and Asian Mongolian populations. It is also considered a system of clinical importance for its immunogenicity. Method: The present study aimed to carry out a retrospective and descriptive survey of the frequency of the Dia antigen in the blood donor population at the HEMOPA Foundation Coordinating Blood Center from 12/2018 to 1/2000. The data obtained were from the HEMOPA Foundation SBS Progress and SBS WEB Systems databases. Results: During this period, 941,744 blood bags were collected and, of these, 930 bags were phenotyped for the Dia antigen, of which 842 were negative and 88 (9.7%) positive. The research showed that, among the positive donors for the antigen Dia, 88.6% were brown, 3.4%, black and 8%, white. In the statistical analysis, the frequency observed was higher in browns. Conclusion: In the present investigation, we concluded that our region has a relatively higher frequency of the Dia antigen, when compared to the rest of Brazil, and it occurs more often in browns.

O impacto da automação da fenotipagem eritrocitária estendida na rotina de um serviço de hemoterapia / The impact of automation of extended erythrocyte phenotyping in the routine of a blood transfusion center

Objetivos. Avaliar o impacto da automação na fenotipagem eritrocitária expandida e o nível de concordância dessa com a metodologia manual em amostras de doadores de sangue atendidos no hemocentro coordenador da Fundação HEMOPA no período de janeiro a dezembro de 2019. Material e Métodos. Foram analisadas 2.700 fenotipagens eritrocitárias realizadas por metodologia manual e automatizada através do equipamento IH500 da BioRad®. Os resultados foram testados quanto ao nível de concordância através do teste de Coeficiente Kappa. Resultados. Das amostras fenotipadas 98,6% (2.662/2.700) foram concordantes em ambas as metodologias e apenas 1,4% (38/2700) foram discordantes. Das 38 amostras discordantes 31,6% referiram-se ao fenótipo Lu(b); 15,8% ao fenótipo Lu(a); 13,1% ao fenótipo Fy(b); 7,9% aos fenótipos Le(b), E, c; 5,3% aos fenótipos N, S, s, Kp(a), P1; e 2,6% aos fenótipos M, Jk(a), Jk(b), Fy(a). Conclusões. O nível de concordância entre os dados obtidos através das técnicas de fenotipagem eritrocitária manual e automatizada foi de 98,6%. Já a implantação dessa metodologia teve um impacto positivo com o aumento em 1.649 amostras processadas a mais em relação ao mesmo período do ano anterior. [au]

Objective. Evaluate the impact of automation on expanded erythrocyte phenotyping and the level of agreement between it and the manual methodology in samples from blood donors treated at the blood center coordinating the Fundação HEMOPA from january to december 2019. Material and Methods. 2,700 erythrocyte phenotyping performed by manual and automated methodology using BioRad® IH500 equipment was analyzed. The results were tested for the level of agreement using the Kappa Coefficient test. Results. Of the phenotyped samples, 98,6% (2,662 / 2,700) were in agreement in both methodologies and only 1,4% (38/2700) were in disagreement. Of the 38 discordant samples, 31,6% referred to the Lu(b) phenotype; 15,8% to the Lu(a) phenotype; 13,1% to the Fy phenotype (b); 7,9% to Le(b), E, c phenotypes; 5,3% to N, S, s, Kp (a), P1 phenotypes; and 2,6% for phenotypes M, Jk(a), Jk(b), Fy(a). Conclusions. The level of agreement between data obtained through manual and automated erythrocyte phenotyping techniques was 98.6%. The implementation of this methodology had a positive impact, with an increase of 1,649 more processed samples compared to the same period of the previous year. [au]

Paclitaxel in real-life data is not associated with reduced survival but has limited benefit in preventing amputation.

BACKGROUND: Recent meta-analysis of randomized-controlled trials reported an increased risk of long-term mortality in patients treated with paclitaxel-coated devices (PCD) for femoropopliteal arteries (FP) lesions. However, real-life data on the subject is contradictory and data from CLTI patients is missing. The authors aim to evaluate the impact of PCD for the treatment of FP lesions on long-term mortality and amputation on a real-life cohort up to 5 years. METHODS: All patients treated for FP lesions with endovascular devices from January 2013 to December 2016 were included, irrespective of clinical presentation. Primary endpoint is overall survival. Secondary endpoints are freedom-from major amputation and amputation-free survival. Survival estimates were obtained using Kaplan-Meier plots and a multivariable model was constructed to correct for relevant baseline differences. RESULTS: From 2013 to 2016, 351 patients with FP lesions were treated, 250 with uncoated devices (nPCD) and 101 with PCD. Patients treated with nPCD were significantly older, more often female and with more severe degrees of ischemia. Median follow-up was 55(20-71) months. Overall survival and amputation-free survival were significantly higher in patients treated with PCD. Survival at one-year was 79% vs. 92%, at two-years 69% vs. 79% and at five-years 50% vs. 65% (P=0.02). AFS was 43% vs. 57% at 5-years (P=0.016). Freedom-from major amputation was similar between groups. After correction for relevant baseline differences on multivariable analysis, the survival advantage for patients treated with PCD was lost at 2 and 5 years. CONCLUSIONS: Our results do not confirm the findings of increased mortality associated with PCD. However, no improvement in amputation rate was found. For the time, our institutional data does not support withholding PCD to reduce mortality but suggests that the benefit in preventing amputation is not significant.

Results of a sample-to-cutoff ratio using Abbott Architect rHTLV-I/II assay allow to predict detection of HTLV-1 and HTLV-2 proviral DNA by real-time PCR / Resultados da razão sinal da amostra sobre o cutoff da reação no ensaio Abbott Architect rHTLV-I/II permite prever a detecção de DNA proviral por PCR em tempo real

The present study aims to correlate the sample-to-cutoff ratios (S/CO) distributions of reactive results for HTLV-1/2 antibodies with the detection of proviral DNA in a population of blood donor candidates. It was carried out a retrospective data search of 632 HTLV-1/2 reactive samples, submitted to confirmatory testing from January 2015 to December 2019. Serological screening was performed by chemiluminescent microparticle immunoassay Architect rHTLV-I/II, whereas confirmatory testing was performed by in-house real-time polymerase chain reaction method. 496 out of 632 samples (78%) had undetectable HTLV-1/2 proviral DNA and 136 (22%) had detectable proviral DNA. HTLV infection was not confirmed in any individual for whom the S/CO ratio value was <4, and proviral DNA detection rates gradually escalated as S/CO ratio values increased. The sensitivity and predictive positive value found for the Architect rHTLV-I/II was 100% and 22%, respectively. The receiver operating characteristic (ROC) curve analysis showed that the optimal S/CO ratio value for predicting the presence of HTLV-1/2 was 18.11. High S/CO ratios were more associated with the detection of proviral DNA. The S/CO ratio value <4 suggests excluding true HTLV infection and the risk of blood transmission (AU).

O estudo tem como objetivo correlacionar às distribuições das razões sample-to-cutoff (S/CO) de resultados reagentes para anticorpos HTLV-1/2 com a detecção de DNA proviral em uma população de candidatos à doação de sangue. Realizou-se uma busca retrospectiva de dados de 632 amostras reagentes para HTLV-1/2 submetidas à testagem confirmatória entre janeiro de 2015 a dezembro de 2019. A triagem sorológica foi realizada pelo imunoensaio quimioluminescente de micropartículas Architect rHTLV-I/II, enquanto o teste confirmatório foi realizado pelo método de PCR em tempo real in-house. 496 de 632 amostras (78%) apresentaram DNA proviral indetectável e 136 (22%) apresentaram DNA proviral detectável. A infecção por HTLV não foi confirmada em nenhum indivíduo com valor de S/CO <4 e as taxas de detecção de DNA proviral escalonaram gradualmente à medida que as razões S/CO aumentaram. A sensibilidade e valor preditivo positivo encontrados para o Architect rHTLV-I/II foram 100% e 22%, respectivamente. Utilizando análise de curva ROC, o valor de razão S/CO ideal para predizer a presença de DNA proviral foi de 18,11. Razões S/CO elevadas foram mais associadas à detecção de DNA proviral. Em suma, o valor de S/CO <4 sugere a exclusão de infecção por HTLV e o risco de transmissão pelo sangue (AU).

Frequency of antigen Dia on the blood donor population of the Hemocenter coordinator of the Hemopa Foundation.

INTRODUCTION: Erythrocyte phenotyping is a very important test in the adoption of prophylactic measures to reduce transfusion reactions/alloimmunizations in polytransfused patients. The blood group Diego, in its current, form has 22 antigens, of which 4 are immunogenic, being Diª/Dib and Wra/Wrb, while the others are less expressive. The antigen Diª is of low incidence among whites and blacks, however, it is common in the South American indigenous and Asian Mongolian populations. It is also considered a system of clinical importance for its immunogenicity. METHOD: The present study aimed to carry out a retrospective and descriptive survey of the frequency of the Diª antigen in the blood donor population at the HEMOPA Foundation Coordinating Blood Center from 12/2018 to 1/2000. The data obtained were from the HEMOPA Foundation SBS Progress and SBS WEB Systems databases. RESULTS: During this period, 941,744 blood bags were collected and, of these, 930 bags were phenotyped for the Diª antigen, of which 842 were negative and 88 (9.7%) positive. The research showed that, among the positive donors for the antigen Diª, 88.6% were brown, 3.4%, black and 8%, white. In the statistical analysis, the frequency observed was higher in browns. CONCLUSION: In the present investigation, we concluded that our region has a relatively higher frequency of the Diª antigen, when compared to the rest of Brazil, and it occurs more often in browns.

Prevalence of Dengue, Chikungunya and Zika Viruses in Blood Donors in the State of Pará, Northern Brazil: 2018-2020.

Arboviruses have been reported over the years as constant threats to blood transfusion recipients, given the high occurrence of asymptomatic cases and the fact that the presence of viremia precedes the onset of symptoms, making it possible that infected blood from donors act as a source of dissemination. This work aims to identify the prevalence of dengue virus (DENV), Zika virus (ZIKV) and Chikungunya virus (CHIKV) infection in blood donors during epidemic and non-epidemic periods; classify the donor as symptomatic or asymptomatic; and verify the need to include DENV, CHIKV and ZIKV in the nucleic acid test (NAT) platform in northern Brazil. We investigated 36,133 thousand donations in two years of collection in Northern Brazil. One donor was positive for DENV and one for CHIKV (0.002% prevalence). As the prevalence for arboviruses was low in this study, it would not justify the individual screening of samples from donors in a blood bank. Thus, DENV- and CHIKV-positive samples were simulated in different amounts of sample pools, and both were safely detected by molecular biology even in a pool of 14 samples, which would meet the need to include these three viruses in the routine of blood centers in endemic countries such as Brazil.

Morphometric study of the c6 and c7 pedicle: a computerized tomography analysis / Estudo morfométrico do pedículo de c6 e c7: uma análise por tomografia computadorizada / Estudio morfométrico del pedículo c6 y c7: análisis por tomografía computarizada

ABSTRACT Objective: Measure the diameter and thickness of the C6 and C7 pedicles using computed tomography, to analyze the security of the act surgery and the difference between males and females. Methods: This is a retrospective study. Two hundred computerized tomography scans of the cervical spine, one hundred male and one hundred female, from the Hospital Santa Teresa Radiology sector were evaluated. The pedicle thickness was measured in the axial plane, and the height was measured in sagittal slices. The student's t-test was used to compare differences between the sexes, and a p-value lower than 0.05 was considered significant. Results: The mean age of the individuals included in the sample was 35±9 years. The mean height of the C6 and C7 pedicles were 7.1±0.9 mm and 7.8±0.9 mm, respectively. The mean thickness of the C6 and C7 pedicles were 5.2±0.7 mm and 5.9±0.8 mm, respectively. The statistical test showed that the values were significantly lower for female patients. Conclusions: The present study demonstrated parameters that can be used and can be the rule for preoperative planning of transpedicular cervical fixation surgeries, both in C6 and C7. As it is a procedure that can cause iatrogenic damage to important structures, the screw size must be chosen with care in pre-operative planning to avoid vessel rupture or damage to adjacent nerves. Level of Evidence III; retrospective study.

RESUMO Objetivo: Mensurar o diâmetro e a espessura do pedículo de C6 e C7 por meio de tomografia computadorizada para analisar a segurança no ato cirúrgico e a diferença entre o sexo masculino e feminino. Métodos: Trata-se de um estudo retrospectivo. Foram avaliadas 200 tomografias computadorizadas da coluna cervical, sendo 100 do sexo masculino e 100 do sexo feminino, provenientes do setor de Radiologia do Hospital Santa Teresa. Foram inclusos exames de pacientes acima de 18 anos e menores que 70 anos. A espessura do pedículo foi mensurada no plano axial e a altura foi mensurada em cortes sagitais. O teste t de Student foi utilizado para comparar diferenças entre os sexos, e um valor de p menor que 0,05 foi considerado significante. Resultados: A média de idade dos indivíduos incluídos na amostra foi de 35±9 anos. Em geral, a média da altura dos pedículos de C6 e C7 foram de 7,1±0,9 mm e 7,8±0,9 mm, respectivamente. A média da espessura dos pedículos de C6 e C7 foram de 5,2±0,7 mm e 5,9±0,8 mm, respectivamente. Os valores foram significativamente menores para pacientes do sexo feminino. Conclusões: O presente trabalho demonstrou parâmetros que podem ser utilizados para o planejamento préoperatório de cirurgias de fixação transpedicular cervical, tanto em C6 quanto em C7. Como é um procedimento que pode acarretar lesão iatrogênica em estruturas importantes, o tamanho do parafuso deve ser escolhido com cautela, dentro de um planejamento minucioso pré-operatório de modo à evitar ruptura de vasos ou lesões em nervos adjacentes. Nível de evidência III; Estudo retrospectivo.

RESUMEN Objetivo: Medir el diámetro y grosor del pedículo C6 y C7 mediante tomografía computarizada para analizar la seguridad en el procedimiento quirúrgico y la diferencia entre hombres y mujeres. Métodos: Este es un estudio retrospectivo. Se evaluaron un total de 200 tomografías computarizadas de columna cervical, 100 del sexo masculino y 100 del femenino, del sector de Radiología del Hospital Santa Teresa. Se incluyeron exámenes de pacientes mayores de 18 años y menores de 70 años. El grosor del pedículo se midió en el plano axial y la altura en cortes sagitales. Se utilizó la prueba de la t de Student para comparar las diferencias entre sexos, y se consideró significativo un valor de p inferior a 0,05. Resultados: La edad media de los individuos incluidos en la muestra fue de 35±9 años. En general, la altura media de los pedículos C6 y C7 fue de 7,1±0,9 mm y 7,8±0,9 mm, respectivamente. El grosor medio de los pedículos de C6 y C7 fue de 5,2±0,7 mm y 5,9±0,8 mm, respectivamente. Los valores fueron significativamente más bajos para las pacientes femeninas. Conclusiones: El presente estudio demostró parámetros que pueden ser utilizados para la planificación preoperatoria de cirugías de fijación cervical transpedicular, tanto en C6 como en C7. Al ser un procedimiento que puede causar lesiones iatrogénicas en estructuras importantes, el tamaño del tornillo debe elegirse cuidadosamente, dentro de una minuciosa planificación preoperatoria para evitar la ruptura de vasos o daño de nervios adyacentes. Nivel de Evidencia III; Estudio retrospectivo.

Correlation between low back pain due to fatty degeneration and sex and age: study by mri / Correlação entre lombalgia por degeneração gordurosa e sexo e idade: estudo por irm / Correlación entre el dolor lumbar por degeneración grasa y el sexo y la edad: estudio por irm

ABSTRACT Objective: To correlate low back pain caused by fatty degeneration, visualized by magnetic resonance imaging (MRI), with sex and age. Methods: With a timeframe of 2015 to 2020, data on sex and age of fifty symptomatic patients with low back pain were collected from medical records and correlated with MRI analyses showing the occurrence of fatty infiltration in the paraspinal and erector muscles. Three trained observers, using the classification of Goutallier et al. (1994), analyzed five lumbar levels and the degree of injury. The Kolmogorov-Smirnov, Shapiro Wilk, Student's t, Mann-Whitney and Spearman correlation tests were used, all with a 5% significance level. Results: Among the cases, the L5-S1 level was found in all the images, with a prevalence of 46% of grades 1 and 2 and 24% in the five lumbar levels. Severity was present in a small portion (8%) of the injuries. There was a predominance of 78% women, with significantly more severe injuries in relation to the number of levels (p < 0.001) and injuries of a higher degree (p < 0.001). The age range was 14 to 38 years (mean = 26.70 ± 5.70 years), showing a significant and moderate correlation between the number of levels reached and a greater degree of degeneration (p < 0.001). Conclusion: Fatty degeneration as a cause of low back pain was significantly more severe in women in terms to the number of levels and the higher degree of injury. The number of levels and the severity of fatty degeneration were not correlated with the patient's age. Level of evidence II; Retrospective Study.

RESUMO Objetivo: Correlacionar a lombalgia por degeneração gordurosa visualizada em imagens de ressonância magnética (IRM) com sexo e idade. Métodos: Com um recorte temporal de 2015 a 2020, sexo e idade de cinquenta pacientes sintomáticos com lombalgia foram coletados em prontuários e correlacionados com análises de IRM com ocorrência de infiltração gordurosa nos músculos paraespinhais e eretores. Três observadores treinados que usaram a classificação de Goutallier et al. (1994) analisaram cinco níveis lombares e o grau das lesões. Empregaram-se os testes estatísticos de Kolmogorov-Smirnov, Shapiro-Wilk, t de Student, Mann-Whitney e correlação de Spearman, todos com nível de significância de 5%. Resultados: Dentre os casos, o nível L5-S1 foi encontrado em todas as imagens, com prevalência de 46% dos graus 1 e 2 e de 24% nos cinco níveis lombares. A gravidade esteve presente em pequena parcela (8%) de lesões. Houve predomínio de 78% em mulheres com lesões significativamente mais graves com relação ao número de níveis (p < 0,001) e ao maior grau (p < 0,001). A faixa etária foi de 14 a 38 anos (média = 26,70 ± 5,70 anos), demonstrando correlações significativa e moderada entre número de níveis atingidos e maior grau de degeneração (p < 0,001), respectivamente. Conclusões: A degeneração gordurosa como causa de lombalgia foi significativamente mais grave em mulheres com relação ao número de níveis e ao maior grau da lesão. O número de níveis e a gravidade da degeneração gordurosa não se correlacionaram com idade dos pacientes. Nível de evidência II; Estudo Retrospectivo.

RESUMEN Objetivo: Correlacionar el dolor lumbar por degeneración grasa, visualizada en imágenes de resonancia magnética (IRM) con el sexo y la edad. Métodos: En un período de tiempo de 2015 a 2020, se recopilaron en historias clínicas, datos de sexo y edad de cincuenta pacientes sintomáticos con dolor lumbar y se correlacionaron con análisis de IRM para determinar la aparición de infiltración grasa en los músculos paraespinales y erectores. Tres observadores entrenados, utilizando la clasificación de Goutallier et al. (1994), analizaron cinco niveles lumbares y el grado de las lesiones. Se utilizaron las pruebas estadísticas de Kolmogorov-Smirnov, Shapiro-Wilk, t de Student, Mann-Whitney y correlación de Spearman, todas con un nivel de significancia del 5%. Resultados: Entre los casos, el nivel L5-S1 estuvo presente en todas las imágenes, siendo prevalente con 46% para los grados 1 y 2 y con 24% en los cinco niveles lumbares. La severidad estuvo presente en una pequeña parte (8%) de las lesiones. Hubo predominio del 78% en mujeres con lesiones significativamente más graves en relación al número de niveles (p < 0,001) y al grado más alto (p < 0,001). El rango de edad fue de 14 a 38 años (media = 26,7 ± 5,7 años), demostrando una correlación significativa y moderada con el número de niveles alcanzados y un mayor grado de degeneración (p < 0,001). Conclusión: La degeneración grasa como causa de dolor lumbar fue significativamente más grave en las mujeres con respecto al número de niveles y al mayor grado de lesión. El número de niveles y la gravedad de la degeneración grasa no se correlacionaron con la edad de los pacientes. Nivel de evidencia II; Estudio Retrospectivo.

Epidemiological and molecular profile of blood donors infected with HTLV-1/2 in the state of Pará, northern Brazil.

BACKGROUND: The Human T-lymphotropic virus (HTLV) is a retrovirus of the genus Deltaretrovirus, which belongs to the family Retroviridae. The most important types are HTLV-1 and HTLV-2. It is estimated that between five and 10 million individuals are infected with HTLV-1, worldwide. Studies in the state of Pará indicate that it has the third highest prevalence of HTLV infections of any Brazilian state. The present study describes the epidemiological, serological, and molecular profile of blood donors from the state of Pará that were classified as unfit due to infection by HTLV-1 and 2. METHODS: The present study is based on a descriptive, retrospective, and cross-sectional review of the epidemiological, serological, and molecular data on blood donations, between January 2015 and December 2019. The data were obtained from the blood bank system and were digitalized to form a database in the Statistical Package for Social Sciences program, version 20. Descriptive statistics were used to determine the absolute and relative frequencies of the qualitative variables. For the quantitative variables, the mean, standard deviation, and minimum and maximum values were calculated. A p < 0.05 significance level was adopted for all analyses. RESULTS: A total of 632 samples were analyzed, of which 496 (78%) had no detectable proviral DNA and 136 (22%) had detectable HTLV. The HTLV-1 was detected in most (78%; 106/136) of these samples, while only 30 (22%) were detected for HTLV-2. The HTLV proviral DNA was detected primarily in females (69.1%), with a mean age of 40 years, with the highest frequencies of detection being recorded in single individuals (66.2%), first-time donors (74.3%), and individuals that had graduated high school (44.1%). The molecular confirmation of HTLV showed that three-quarters (78%) of the serologically reactive individuals were negative for either types 1 or 2, so the epidemiological profile of these individuals was significantly different from their detectable profile. CONCLUSIONS: The HTLV is neglected in Brazil; there is thus a clear need for further research in the area of regional hemotherapy and hematology services, in order to contribute to the definition of regional infection profiles, that will be fundamental to the development of effective prophylactic practices for the prevention of the infection and the dissemination of knowledge on the dangers of HTLV in the community.

Estimated exposure of spine surgeons to radiation / Estimativa da exposição de cirurgiões de coluna vertebral à radiação / Estimativa de la exposición de cirujanos de columna vertebral a la radiación

ABSTRACT Objective To estimate the amount of radiation received and accumulated in the bodies of two surgeons, one being the responsible surgeon and the other the assistant, performing spine surgery procedures over a period of 25 years. Methods Seventy-two spinal surgeries were performed during a seven-month period and the radiation loads were measured in both surgeons. The measurement of radiation was captured in fluoroscopy in anteroposterior and lateral incidences. The surgeon and the assistant used two dosimeters, one in the cervical region protecting the thyroid and the other on the lead apron in the genital region. The radioactive loads were measured in millisieverts and the accumulated charges were recorded monthly in both regions of the body in the two surgeons for seven months and the means for the work periods (1, 5, 10, 15, 20 and 25 years) were estimated. Results It was observed that in the surgeon the average accumulated radiation loads were 131.9% and 176.92% higher than those of the assistant in the cervical and genital regions, respectively. Conclusion While the use of X-rays is indispensable in routine orthopedic surgery, we have to consider the development of techniques of protection, rigor and discipline in the use of safety materials for surgeons. Preventive exposure reduction measures such as using thyroid protection equipment and turning the head away from the patient during fluoroscopy, among others, should be mandatory to promote less radiation exposure. Level of evidence II; Comparative prospective study.

RESUMO Objetivo Estimar a quantidade de radiação recebida e acumulada no corpo de dois cirurgiões, durante período de 25 anos de trabalho, sendo um o cirurgião responsável e outro, assistente, nos procedimentos de cirurgia da coluna vertebral. Métodos Foram realizadas 72 cirurgias de coluna vertebral em um período de sete meses, e as cargas de radiação foram medidas nos dois cirurgiões. A medição da radiação foi captada em fluoroscópio nas incidências anteroposterior e de perfil. O cirurgião e o auxiliar utilizaram dois dosímetros, sendo um na região cervical protegendo a tireoide e outro sobre o avental de chumbo, na região genital. As cargas radioativas foram medidas em milisievert e as cargas acumuladas foram registradas mensalmente em ambas as regiões do corpo nos dois cirurgiões, durante sete meses, foram estimadas as médias no período (1, 5, 10, 15, 20 e 25 anos) de trabalho. Resultados Observou-se que no cirurgião as médias das cargas de radiação acumulada foram 131,9% e 176,92% superiores às do assistente nas regiões cervical e genital, respectivamente. Conclusão Enquanto o uso dos raios X for indispensável na rotina da cirurgia ortopédica, há de se considerar o desenvolvimento de técnicas de proteção, rigor e disciplina no uso materiais de segurança para os cirurgiões. Medidas preventivas de redução da exposição, como uso de equipamento para proteção da tireoide e girar a cabeça para se afastar do paciente durante a fluoroscopia, entre outras, devem ser obrigatórias para promover menor exposição à radiação. Nível de evidência II; Estudo prospectivo comparativo.

RESUMEN Objetivo Estimar la cantidad de radiación recibida y acumulada en el cuerpo de dos cirujanos, durante 25 años de trabajo, siendo uno el cirujano responsable y el otro, asistente, en los procedimientos de cirugía de columna vertebral. Métodos Se realizaron 72 cirugías de columna vertebral en un período de siete meses, y las cargas de radiación fueron medidas en los dos cirujanos. La medición de la radiación fue captada en fluoroscopio en las incidencias anteroposterior y de perfil. El cirujano y el auxiliar usaron dos dosímetros, siendo uno en la región cervical protegiendo la tiroides y otro sobre el delantal de plomo, en la región genital. Las cargas radiactivas se midieron en milisievert, y las cargas acumuladas se registraron mensualmente en ambas regiones del cuerpo, en los dos cirujanos, durante siete meses, y se estimaron los promedios durante el período (1, 5, 10, 15, 20 y 25 años) de trabajo. Resultados Se observó que en el cirujano los promedios de las cargas de radiación acumulada fueron de 131,9% y 176,92% superiores a las del asistente en las regiones cervical y genital, respectivamente. Conclusión Mientras el uso de rayos X sea indispensable en la rutina de la cirugía ortopédica, hay que considerar el desarrollo de técnicas de protección, rigor y disciplina en el uso de materiales de seguridad para los cirujanos. Las medidas preventivas de reducción de la exposición, como uso de equipamiento para protección de la tiroides y girar la cabeza para alejarse del paciente durante la fluoroscopia, entre otras, deben ser obligatorias para promover menor exposición a la radiación. Nivel de evidencia II; Estudio prospectivo comparativo.

Correlação entre os métodos sorológico e molecular para detecção do HIV na triagem de doadores de sangue na Fundação HEMOPA / Correlation between sorological and molecular methods for HIV detection in blood donor screening in HEMOPA Foundation

Objetivo: Buscar a correlação entre os métodos sorológico e molecular para detecção do HIV na triagem de doadores de sangue na Fundação HEMOPA. Métodos: Realizou-se a busca das amostras reagentes para HIV, referente aos anos de 2015 a 2019 no Sistema de Banco de Sangue da Fundação HEMOPA. Para análise estatística, utilizou-se o programa SPSS para a comparação das medianas dos valores de S/CO com NAT detectável e indetectável. O teste de X² foi utilizado para apontar a correlação dos valores de S/CO com a presença do RNA viral. Resultados: Obtiveram-se para o estudo 910 amostras reagentes, na qual 75,60% (688/910) positivas (S/CO >1,2) e 24,40% (222/910) inconclusivas (S/CO 0,8-1,2). A mediana de S/CO das amostras detectáveis foi de 503,93 e das indetectáveis foi de 1,22 no NAT. Conclusão: Estabelecemos que na triagem sorológica-molecular há uma correlação estatisticamente significante, na qual a presença de anticorpos e/ou antígenos no teste ARCHITECH HIV Ag/Ab Combo orienta a predição de viremia no NAT.

Objective: Search for the correlation between serological and molecular methods of HIV detection in screening blood donors at the HEMOPA Foundation. Methods: The HIV reagent samples were searched for the years 2015 to 2019 in the Blood Bank System of the HEMOPA Foundation. For statistical analysis, the SPSS program was used to compare the medians of the S / CO values with detectable and undetectable NAT. The X² test was used to point out the correlation between S / CO values and the presence of viral RNA. Results: 910 reagent samples were obtained for the study, in which 75.60% (688/910) positive (S / CO> 1.2) and 24.40% (222/910) inconclusive (S / CO 0.8) -1.2). The median S / CO of the detectable samples was 503.93 and the undetectable was 1.22 in NAT. Conclusion: We established that in serological-molecular screening there is a statistically significant correlation, in which the presence of antibodies and / or antigens in the ARCHITECH HIV Ag / Ab Combo test guides the prediction of viremia in NAT.

Effects of anodal multichannel transcranial direct current stimulation (tDCS) on social-cognitive performance in healthy subjects: A randomized sham-controlled crossover pilot study.

Recent studies suggest that temporoparietal junction (TPJ) modulation can influence attention and social cognition performance. Nevertheless, no studies have used multichannel transcranial direct current stimulation (tDCS) over bilateral TPJ to estimate the effects on these neuropsychological functions. The project STIPED is using optimized multichannel stimulation as an innovative treatment approach for chronic pediatric neurodevelopmental disorders, namely in children/adolescents with Autism Spectrum Disorder (ASD). In this pilot study, we aim to explore whether anodal multichannel tDCS coupled with a Joint Attention Task (JAT) influences social-cognitive task performance relative to sham stimulation, both in an Emotion Recognition Task (ERT) and in a Mooney Faces Detection Task (MFDT), as well as to evaluate this technique's safety and tolerability. Twenty healthy adults were enrolled in a randomized, single-blinded, sham-controlled, crossover study. During two sessions, participants completed the ERT and the MFDT before and after 20min of sham or anodal tDCS over bilateral TPJ. No significant differences on performance accuracy and reaction time were found between stimulation conditions for all tasks, including the JAT. A significant main time effect for overall accuracy and reaction time was found for the MFDT. Itching was the most common side effect and stimulation conditions detection was at chance level. Results suggest that multichannel tDCS over bilateral TPJ does not affect performance of low-level emotional recognition tasks in healthy adults. Although preliminary safety and tolerability are demonstrated, further studies over longer periods will be pursued to investigate the clinical efficacy in children/adolescents with ASD, where social cognition impairments are preponderant.