Documento multidisciplinar de consenso sobre el manejo de la hemorragia masiva. Primera actualización 2023 (documento HEMOMAS-II) / Multidisciplinary consensus document on the management of massive haemorrhage. First update 2023 (document HEMOMAS-II)

El presente documento supone una puesta al día del documento multidisciplinar HEMOMAS, publicado en el año 2016 con el aval de las Sociedades Científicas Españolas de Anestesiología y Reanimación (SEDAR), Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) y de Trombosis y Hemostasia (SETH). El objetivo de este documento fue revisar y actualizar las recomendaciones existentes sobre el manejo de la hemorragia masiva (HM). Se siguió una metodología basada en elementos del método ADAPTE (búsqueda y adaptación de guías publicadas en el ámbito específico de la HM desde 2014, más búsqueda bibliográfica en PubMed y EMBASE desde enero-2014 hasta junio-2021). Tras la revisión de nueve guías y 207 artículos seleccionados, se actualizaron las 47 recomendaciones existentes en el artículo original, manteniendo, suprimiendo o modificando cada una de ellas y sus grados de recomendación y evidencia. Consensuadamente, los autores aprobaron la redacción final del artículo y las 41 recomendaciones resultantes.(AU)

This document is an update of the multidisciplinary document HEMOMAS, published in 2016 with the endorsement of the Spanish Scientific Societies of Anaesthesiology (SEDAR), Intensive Care (SEMICYUC) and Thrombosis and Haemostasis (SETH). The aim of this document was to review and update existing recommendations on the management of massive haemorrhage. The methodology of the update was based on several elements of the ADAPTE method by searching and adapting guidelines published in the specific field of massive bleeding since 2014, plus a literature search performed in PubMed and EMBASE from January 2014 to June 2021. Based on the review of 9 guidelines and 207 selected articles, the 47 recommendations in the original article were reviewed, maintaining, deleting, or modifying each of them and the accompanying grades of recommendation and evidence. Following a consensus process, the final wording of the article and the resulting 41 recommendations were approved by all authors.(AU)

Multidisciplinary consensus document on the management of massive haemorrhage. First update 2023 (document HEMOMAS-II).

This document is an update of the multidisciplinary document HEMOMAS, published in 2016 with the endorsement of the Spanish Scientific Societies of Anaesthesiology (SEDAR), Intensive Care (SEMICYUC) and Thrombosis and Haemostasis (SETH). The aim of this document was to review and update existing recommendations on the management of massive haemorrhage. The methodology of the update was based on several elements of the ADAPTE method by searching and adapting guidelines published in the specific field of massive bleeding since 2014, plus a literature search performed in PubMed and EMBASE from January 2014 to June 2021. Based on the review of 9 guidelines and 207 selected articles, the 47 recommendations in the original article were reviewed, maintaining, deleting, or modifying each of them and the accompanying grades of recommendation and evidence. Following a consensus process, the final wording of the article and the resulting 41 recommendations were approved by all authors.

Multidisciplinary consensus document on the management of massive haemorrhage. First update 2023 (document HEMOMAS-II).

This document is an update of the multidisciplinary document HEMOMAS, published in 2016 with the endorsement of the Spanish Scientific Societies of Anaesthesiology (SEDAR), Intensive Care (SEMICYUC) and Thrombosis and Haemostasis (SETH). The aim of this document was to review and update existing recommendations on the management of massive haemorrhage. The methodology of the update was based on several elements of the ADAPTE method by searching and adapting guidelines published in the specific field of massive bleeding since 2014, plus a literature search performed in PubMed and EMBASE from January 2014 to June 2021. Based on the review of 9 guidelines and 207 selected articles, the 47 recommendations in the original article were reviewed, maintaining, deleting, or modifying each of them and the accompanying grades of recommendation and evidence. Following a consensus process, the final wording of the article and the resulting 41 recommendations were approved by all authors.

Documento multidisciplinar de consenso sobre el manejo de la hemorragia masiva. Primera actualización 2023 (documento HEMOMAS-II) / Multidisciplinary consensus document on the management of massive haemorrhage. First update 2023 (document HEMOMAS-II)

El presente documento supone una puesta al día del documento multidisciplinar HEMOMAS, publicado en el año 2016 con el aval de las Sociedades Científicas Españolas de Anestesiología y Reanimación (SEDAR), Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) y de Trombosis y Hemostasia (SETH). El objetivo de este documento fue revisar y actualizar las recomendaciones existentes sobre el manejo de la hemorragia masiva (HM). Se siguió una metodología basada en elementos del método ADAPTE (búsqueda y adaptación de guías publicadas en el ámbito específico de la HM desde 2014, más búsqueda bibliográfica en PubMed y EMBASE desde enero-2014 hasta junio-2021). Tras la revisión de nueve guías y 207 artículos seleccionados, se actualizaron las 47 recomendaciones existentes en el artículo original, manteniendo, suprimiendo o modificando cada una de ellas y sus grados de recomendación y evidencia. Consensuadamente, los autores aprobaron la redacción final del artículo y las 41 recomendaciones resultantes (AU)

This document is an update of the multidisciplinary document HEMOMAS, published in 2016 with the endorsement of the Spanish Scientific Societies of Anaesthesiology (SEDAR), Intensive Care (SEMICYUC) and Thrombosis and Haemostasis (SETH). The aim of this document was to review and update existing recommendations on the management of massive haemorrhage. The methodology of the update was based on several elements of the ADAPTE method by searching and adapting guidelines published in the specific field of massive bleeding since 2014, plus a literature search performed in PubMed and EMBASE from January 2014 to June 2021. Based on the review of 9 guidelines and 207 selected articles, the 47 recommendations in the original article were reviewed, maintaining, deleting, or modifying each of them and the accompanying grades of recommendation and evidence. Following a consensus process, the final wording of the article and the resulting 41 recommendations were approved by all authors (AU)

Does leukocyte-platelet-rich fibrin (L-PRF) cause long term acceleration in the rate of canine retraction? A split-mouth, two-arm parallel group, randomized control trial

ABSTRACT Objective: The present study was conducted to investigate the effects of leukocyte-platelet-rich fibrin (L-PRF) on the rate of maxillary canine retraction for a period of 5 months. Methods: A split-mouth study was conducted on 16 subjects (9 males and 7 females; age range 17-25 years; mean age, 21.85±2.45 years) who required therapeutic extraction of bilateral maxillary first premolars. After the initial leveling and alignment, L-PRF plugs were placed in a randomly selected extraction socket (Experimental Group), and the other side served as a control (Control Group). Canine retraction was carried out by the activation of nickel-titanium (NiTi) closed-coil springs delivering 150 g of force. The rates of canine movement, canine rotation, tipping, root resorption, and molar movement were assessed at monthly intervals for five months (T0-T5). Pain, swelling and discomfort accompanying the procedure were assessed using a Likert scale. Results: The study revealed a significant increase in the rate of canine movement on the experimental side in the first two months, and significant molar anchorage loss was observed only in the first month for control side. There were no statistically significant differences between the groups regarding canine rotation, tipping, probing depth, root resorption, and pain perception. Conclusions: The use of L-PRF plugs in extraction sockets considerably enhanced the rate of canine movement only in the first two months, and long-term efficacy was not observed in this study.

RESUMO Objetivo: O presente estudo foi realizado para investigar os efeitos da fibrina rica em leucócitos e plaquetas (L-PRF) na taxa de retração do canino superior, durante um período de cinco meses. Métodos: Um estudo de boca dividida foi realizado em 16 indivíduos (9 homens e 7 mulheres; faixa etária de 17 a 25 anos; idade média de 21,85 ± 2,45 anos) que precisavam de extração terapêutica dos primeiros pré-molares superiores de ambos os lados. Após o nivelamento e o alinhamento iniciais, os plugs de L-PRF foram colocados em um alvéolo pós-extração, selecionado aleatoriamente (Grupo Experimental), e o outro lado serviu como controle (Grupo Controle). A retração do canino foi realizada pela ativação de molas fechadas de níquel-titânio (NiTi) com 150 g de força. As taxas de movimentação do canino, rotação, inclinação e reabsorção radicular do canino e movimentação do molar foram avaliadas em intervalos mensais durante cinco meses (T0-T5). A dor, o inchaço e o desconforto após o procedimento foram avaliados por meio de uma escala de Likert. Resultados: O estudo revelou um aumento significativo na taxa de movimentação do canino no lado experimental nos dois primeiros meses, e uma perda significativa de ancoragem do molar foi observada apenas no primeiro mês no lado controle. Não houve diferenças estatisticamente significativas entre os grupos, com relação à percepção da dor e rotação, inclinação, profundidade de sondagem e reabsorção radicular do canino. Conclusões: O uso de plugs de L-PRF em alvéolos pós-extração aumentou consideravelmente a taxa de movimentação do canino apenas nos dois primeiros meses, não sendo observada uma eficácia em longo prazo.

Analysis of different platelet-rich fibrin processing / Análise de diferentes processamentos da fibrina rica em plaquetas

Introduction: Platelet-rich fibrin (PRF) is formed by an autologous blood concentrate, with properties that promote cell proliferation and regenerationof bone, gingival and epithelial tissue. Objective: To compare four different procedures for processing as well as obtaining PRF, and analyzing their formation through laboratory techniques. The purpose of the study is to validate a method that produces higher quality PRF for oral surgery use in different branches of dentistry. Material and method: The experiment consisted of collecting blood from 12 volunteers, and processing each patient's sample in 4 different ways. In the following two-stage process analysis, the first, quantitative, step was to analyze the samples' platelet-poor plasma (PPP),with a Neubauer Hemocytometer to count blood components. In the second, qualitative step, the sample's PRF were analyzed under microscopy using histological slides. Result: The statistical analysis of the leukocyte, red blood cell and platelet count did not show any significant distinction when comparing different processes. Histological analysis of the PRF showed fibrin network with platelet aggregation, several leukocytes and presence of red blood cells, with double centrifuged samples presenting more white blood cells than the others. Conclusion: Among the analyzed procedures, the sample centrifuged once at 3000 RPM (1900 G) for 10 min showed the best quality PRF.

Introdução: A fibrina rica em plaquetas (FRP) é formada por um concentrado sanguíneo autólogo, com propriedades de promover a proliferação celular, regeneração de tecido, dentre eles tecido ósseo, gengival e epitelial. Objetivo: Comparar quatro tipos diferentes de processamento e obtenção de FRP, analisando a sua formação através de técnicas laboratoriais. A finalidade do estudo é validar um método que obtenha maior qualidade para o uso em cirurgias nas diversas áreas da odontologia. Material e método: O experimento foi constituído de uma coleta de sangue de 12 voluntários, onde a amostra de cada paciente foi processada de 4 formas. A análise dos processamentos se deu em duas etapas, onde na primeira, quantitativa, foi analisado o plasma pobre em plaquetas (PPP), através de contagem de constituintes sanguíneos em câmara de Neubauer. Na segunda etapa, qualitativa, foram analisadas as FRP em microscopia através de lâminas histológicas. Resultado: A análise estatística da contagem de leucócitos, hemácias e plaquetas não mostraram diferença significativa entre os distintos processamentos. As análises histológicas do FRP mostraram redes de fibrina com agregação plaquetária, inúmeros leucócitos e presença de hemácias, sendo que as amostras de dupla centrifugação apresentaram mais leucócitos que nas demais. Conclusão: Dos procedimentos analisados, a amostra centrifugada a 1 única vez a 3000 RPM (1900 G) por 10 min mostrou-se a melhor qualidade de FRP.

Uso de concentrados de fibrinógeno para el tratamiento de la hipofibrinogenemia adquirida / Use of Fibrinogen Concentrates for the Treatment of Acquired Hypofibrinogenemia

Resumen Introducción: Un adecuado manejo del sangrado debe incluir la correcta valoración y eventual reposición de fibrinógeno. Las fuentes tradicionales de este elemento hemostático incluyen el plasma fresco congelado y los crioprecipitados. Los concentrados liofilizados de fibrinógeno humano (CFH) son una alternativa terapéutica novedosa en el mercado chileno. Objetivo: Este estudio describe el curso clínico de los primeros pacientes en nuestra institución requirentes de CFH, dentro de un algoritmo de reposición hemostática por metas. Materiales y Método: Serie de pacientes con hipofibrinogenemia secundaria a sangrado perioperatorio severo, en los que se utilizó CFH como método de reposición de fibrinógeno. Se utilizó tromboelastometría para definir dosis. Se registraron variables demográficas, operatorias, complicaciones y seguimiento hasta los 3 meses. Resultados: Se utilizaron CFH en 18 pacientes. La mediana de edad fue 40,7 (56,5-63) años y dos tercios de los pacientes fueron de sexo masculino. Fallecieron 5 pacientes de la serie. Todos los pacientes requirieron manejo posoperatorio en una unidad de cuidados intensivos. Ocho pacientes fueron sometidos a cirugía cardiaca. El uso de hemocomponentes y concentrados liofilizados fue heterogéneo, pero en todos los casos su uso fue determinado por tromboelastometría. Ningún paciente fue reintervenido a causa de sangrado posoperatorio. Conclusión: El uso de concentrados de fibrinógeno humano dentro de un algoritmo de manejo de sangrado guiado por tromboelastometría, es un recurso hemostático factible en la realidad nacional. El impacto clínico de esta intervención requiere una subsiguiente evaluación basada en la evidencia.

Introduction: An adequate bleeding management should include a proper assessment of fibrinogen values and consequent replacement. Traditional sources for this hemostatic element include fresh frozen plasma and cryoprecipitates. Lyophilized human fibrinogen concentrates are a novel therapeutic alternative for the chilean market. Aim: This study aims to describe the clinical course of the first patients in our institution receiving fibrinogen concentrates, included in a goal directed hemostatic management algorithm. Materials and Method: Case series of patients with hypofibrinogenemia secondary to severe perioperative bleeding, in which fibrinogen concentrate was used for fibrinogen replacement. Thromboelastometry was used to define dose regimens. Demographic and surgical variables, complications and follow-up up to 3 months were registered. Results: Fibrinogen concentrate was used in 18 patients. Median age was 40.7 (56.5-63) years, and two thirds of the patients were male. Five patients died. All of the cases required postoperative intensive care. Eight patients underwent cardiac surgery. There was a heterogenic use of blood derived products and lyophilized concentrates, but in all cases its use was guided by thromboelastometry. No patients needed a secondary exploration due to bleeding. Conclusion: The use of human fibrinogen concentrate included in a bleeding management algorithm is a feasible hemostatic resource in the chilean current situation. The clinical impact of this intervention requires further evidence-based evaluation.

Optimized broad-range real-time PCR-based method for bacterial screening of platelet concentrates / Otimização de um método baseado em PCR em tempo real para rastreamento de bactérias em concentrados de plaquetas

Abstract Bacterial contamination of blood components remains a major challenge in transfusion medicine, particularly, platelet concentrates (PCs) due to the storage conditions that support bacterial proliferation. In this study, we develop a rapid, sensitive and specific real-time PCR protocol for bacterial screening of PCs. An internally controlled real-time PCR-based method was optimized and validated with our proprietary 16S Universal PCR Master Mix (IBMP/Fiocruz), which targets a conserved region of the bacterial 16S rRNA gene. Nonspecific background DNA was completely eliminated by treating the PCR Master Mix with ethidium monoazide (EMA). A lower limit of detection was observed for 10 genome equivalents with an observed Ct value of 34±1.07 in calibration curve generated with 10-fold serial dilutions of E. coli DNA. The turnaround time for processing, including microbial DNA purification, was approximately 4 hours. The developed method showed a high sensitivity with no non-specific amplification and a lower time-to-detection than traditional microbiological methods, demonstrating it to be an efficient means of screening pre-transfusion PCs.

Resumo A contaminação bacteriana dos componentes sanguíneos é um grande desafio na medicina transfusional, principalmente nos concentrados de plaquetas (PCs) devido às condições de armazenamento que favorecem a proliferação bacteriana. Neste estudo, desenvolvemos um protocolo de PCR em tempo real rápido, sensível e específico para a triagem bacteriana de PCs. Um método baseado em PCR em tempo real, controlado internamente, foi otimizado e validado com um Master Mix Universal PCR 16S (IBMP / Fiocruz), que detecta uma região conservada do gene 16S rRNA bacteriano. O background de DNA não específico foi completamente eliminado tratando a PCR Master Mix com monoazida de etídio (EMA). O limite de detecção inferior observado foi de 10 cópias equivalentes do genoma com um valor de Ct 34 ± 1,07, a curva de calibração foi gerada com diluições seriada de 10 vezes do DNA de E. coli. O tempo de processamento, incluindo a purificação microbiana do DNA, foi de aproximadamente 4 horas. O método desenvolvido mostrou alta sensibilidade sem amplificação inespecífica e menor tempo de detecção do que os métodos microbiológicos tradicionais, demonstrando ser um meio eficiente de triagem de PCs pré-transfusionais.

Beneficial effects of a calf starter versus forage on rumen development and bacteria populations in beef calves / Efeitos benéficos de um concentrado de bezerro versus forragem no desenvolvimento ruminal e na população de bactérias em bezerros

ABSTRACT: Rumen development depends on the intake of solid food that is fermented into volatile fatty acids that stimulate the development of the rumen papillae in calves. The starter feeding can promote the growth of papillae in the rumen and as a consequence an earlier weaning. We evaluated the effects of calf starter on ruminal development, and productive response of lactating bull calves raised for meat in the tropics. Twelve male Brahman × Swiss American cross beef calves from a dual-purpose system were randomly assigned two treatments with six animals per treatment: milk-fed calves + Taiwan grass (Pennisetum purpureum, MT) and MT + calf starter, (MTS). Feed intake and growth were measured at 7-day intervals throughout until 210 d of age. At 90 days old, three calves from each treatment were harvested, and fluid and ruminal tissues were collected from the cranial, ventral, dorsal, and dorsal blind ruminal sacs for measurements of many papillaes per cm2 (NP), papillae length (LP) and papillae width (WP). Ruminal bacterial genotype identification was determined by amplicon generation with the Illumina platform. Calf starter-improved weight (Live weight, LW) and average weight gain (ADG) and NP, but, LP and WP was similar in both treatments (p < 0.05). In calves with starter feed treatment, we observed the bacteria Desulfonauticus autotrophicus sp. nov.that was not previously reported in ruminants. Use of calf starter showed benefit for calves with improved feed intake and rumen development because promoted a greater number of rumen papillae.

RESUMO: O desenvolvimento dorumen depende da ingestão de alimentos sólidos fermentados em ácidos graxos voláteis que estimulam o desenvolvimento das papilas de rúmen em bezerros. A alimentação inicial pode promover o crescimento das papilas no rúmen e, como consequência, um desmame mais cedo. Avaliamos os efeitos da concentrado de bezerros no desenvolvimento ruminal, e a resposta produtiva dos bezerros lactantes criados para carne nos trópicos. Doze bezerros de carne bovina cruza Brahman × suíço-americano machos de de um sistema de dupla finalidade foram aleatoriamente atribuídos adois tratamentos, com seis animais por tratamento: bezerros alimentados com leite + grama taiwanesa (Pennisetumpurpureum, MT) e MT+ concentrado de bezerro, (MTS). A ingestão de ração e o crescimento foram medidos. Aos 90 dias de idade, três bezerros de cada tratamento foi amostrado, e foram coletados tecidos fluidos dos sacos ruminais cranianos, ventral, dorsal e dorsal cegos para medições do número de papilas por cm2 (NP), comprimento das papilas (LP) e largura da papila (PM). A identificação do genótipo das bactérias ruminais foi determinada pela geração de amplicon com a plataforma de ilumine. Oconcentrado de bezerro melhorou o peso (LW) e o ganho diário médio (AGD) e NP, mas, LP e WP foram semelhantes nos dois tratamentos. Bezerros em MTS uma bactéria não encontrada anteriormente em ruminantes Desulfonauticus autotrophicus sp. nov. foi detectado. O uso de concentrado de bezerro mostrou benefício para bezerros com melhor ingestão de ração e desenvolvimento de rúmen, pois promove um maior número de papilas de rúmen.

Em busca do melhor aproveitamento de bolsas de concentrado de hemácia de baixo volume / In search of the best use of bags low-volume red blood cells concentrate

RESUMO: Introdução: A produção de bolsas de sangue total com volume inferior ao esperado é prevista na Portaria de Consolidação no 05/2017, porém, a sua dispensação hoje leva em consideração apenas o teor de hemoglobinas e hematócrito da bolsa. Objetivo: Determinar, a partir dos parâmetros técnicos brasileiros existentes, os critérios para o melhor aproveitamento para bolsas de concentrados de hemácias de baixo volume (CHBV) produzidas na Fundação HEMOPA. Material e métodos: Foram analisados volume, teor de hemoglobina e hematócrito de 525 bolsas de CHBV provenientes de bolsas duplas sem adição de conservante; triplas convencional com adição de SAG-M (soro fisiológico, adenina, glicose e manitol); triplas top and bottom (TAB) com adição de SAG-M; e quádruplas TAB com filtro "in line" e adição de SAG-M. Resultados: Foi observado que 71,43% (375/525) das bolsas de CHBV, independente do tipo da bolsa, apresentavam-se em conformidade para hematócrito e teor de hemoglobina em relação à legislação. As bolsas duplas e triplas convencionais apresentaram os maiores valores de teor de hemoglobina. Observou-se ainda que as bolsas de sangue total coletadas com volumes entre 350 e 404 ml geraram bolsas de CHBV com os menores índices de descarte. O maior descarte das bolsas de CHBV ocorreu quando o volume final ≤250 mL e hemoglobina ≤ 16 g/dL. Conclusão: Observou-se que o melhor aproveitamento das bolsas de CHBV ocorreu quando as bolsas de sangue total se encontravam com volumes entre 350 e 404 mL e as bolsas de CHBV apresentavam volume final ≥ 250 mL e hemoglobina ≥ 16g/dL.(AU)

ABSTRACT: Introduction: The production of whole blood bags with a lower volume than expected is approved in the Consolidation Ordinance number 05/2017; however, its dispensation today takes into account only the hemoglobin and hematocrit content of the bag. Objective: From the existing Brazilian technical parameters, determine the criteria for the best clinical use for low-volume red cell concentrate (LVRCC) bags produced at the HEMOPA Foundation. Material and methods: We analyzed volume, hemoglobin content, and hematocrit of 525 LVRCC bags from double bags without addition of preservative; conventional triple bags with the addition of SAG-M (saline, adenine, glucose, and mannitol); triples bags top and bottom (TAB) with the addition of SAG-M, and quadruple bags TAB with "in line" filter and the addition of SAG-M. Results: It was observed that 71.43% (375/525) of bags of LVRCC, regardless of bag type, were in conformance with hematocrit and hemoglobin content concerning Brazilian legislation. With the double and conventional triple bags, they had the highest values of hemoglobin content. It was also observed that the bags of whole blood collected with volumes between 350 and 404 mL generated LVRCC bags with the lowest rate of discard. The greatest discard of LVRCC bags occurred when the final volume ≤ 250 mL and hemoglobin ≤ 16 g/dL. Conclusion: It was observed that the best use of LVRCC bags occurred when the whole blood bags were between 350 and 404 mL and the LVRCC bags had a final volume ≥ 250 mL and hemoglobin ≥ 16 g/dL. (AU)

Determinación de la viabilidad de los concentrados plaquetarios obtenidos de capa leucocitaria (buffy coat) durante siete días de almacenamiento / Monitoring of the Viability of Platelet Concentrates Obtained from Buffy Coat during Seven Days of Storage / Determinação da viabilidade de concentrados de plaquetas obtidos de camada leucocitária (buffy coat) durante sete dias de armazenamento

Introducción: los concentrados plaquetarios (CPG) son hemocomponentes lábiles afectados por varios factores, desde el método de obtención hasta las condiciones de almacenamiento, que provocan una paulatina pérdida de funcionalidad, por lo que es necesario evaluar parámetros de calidad que garanticen la viabilidad de las plaquetas durante los días de almacenamiento, con el propósito de monitorear el mantenimiento de las características funcionales de las plaquetas. Materiales y métodos: estudio descriptivo transversal, con un tamaño muestral de 64 cpq, evaluados a los 3, 5 y 7 días de almacenamiento. Los parámetros monitoreados fueron físicos, de almacenamiento y porcentaje de la activación plaquetaria mediante la medición de P-selectina (cd62) por citometría de flujo. Se aplicó el estadístico de chi cuadrado, Anova de un factor, Kruskall-Wallis y correlación de Pearson. Resultados: existen diferencias significativas al séptimo día con relación al tercer y quinto día de almacenamiento, especialmente en el parámetro de formación de remolino plaquetario o swirling (p < 0.005) y agregados plaquetarios (p = 0.001). La activación plaquetaria aumentó significativamente (p = 0.001) desde el quinto día. Conclusiones: la viabilidad de los cpq difiere con los días de almacenamiento, por lo que es necesario evaluar pH, formación de remo-linos y agregados a todos los cpq antes de ser transfundidos como indicativos de activación plaquetaria y disminución de su funcionalidad

Introduction: Platelet concentrates (cpq) are labile blood components affected by several factors from the method of production to storage conditions that cause a gradual loss of functionality. For this reason, it is necessary to evaluate the platelet quality parameters that guarantee the viability during the storage days, with the purpose of monitoring the maintenance of the functional characteristics of the platelets. Materials and methods: This cross-sectional descriptive study had a sample size of 64 platelet concen-trates, evaluated at 3, 5, and 7 days of storage. The monitored parameters were the physical storage parameters and percentage of platelet activation by measuring P-selectin (cd62) via flow cytometry. The chi-square statistic, one-way Anova, Kruskal­Wallis test, and Pearson correlation were applied. Results: Significant differences were observed on the 7th day in relation to the 3rd and 5th day of storage, espe-cially in the swirling parameter (p < 0.005) and platelet aggregates (p = 0.001). The platelet activation increased significantly (p = 0.001) on the 5th day. Conclusions: Based on the findings of this study, the viability of the platelet concentrates differs with the days of storage. For this reason, it is necessary to evaluate the swirling, pH, and aggregates to all platelet concentrates before being transfused as an indication of platelet activation and decreased functionality

Introdução: os concentrados de plaquetas (cpq) são hemocomponentes lábeis afetados por diversos fato-res, desde o método de obtenção até as condições de armazenamento que ocasionam uma perda grada-tiva de funcionalidade, sendo necessário avaliar os parâmetros de qualidade que garantem a viabilidade das plaquetas ao longo dos dias de armazenamento, a fim de monitorar a manutenção das características funcionais das plaquetas. Materiais e métodos: estudo descritivo transversal, com tamanho de amostra de 64 cpq, avaliados aos três, cinco e sete dias de armazenamento. Os parâmetros monitorados foram físicos, de armazenamento e porcentagem de ativação plaquetária pela dosagem de P-selectin (cd62) por citometria de fluxo. Os testes estatísticos aplicados incluíram o teste qui-quadrado, anovade um fator, teste de Kruskall-Wallis e correlação de Pearson. Resultados: há diferenças significativas no sétimo dia em relação ao terceiro e quinto dia de armazenamento, principalmente no parâmetro formação de rede-moinhos ou swirling de plaquetas (p < 0.005) e agregados plaquetários (p = 0.001). A ativação plaquetária aumentou significativamente (p = 0.001) a partir do quinto dia. Conclusões: a viabilidade dos concentra-dos de plaquetas difere com os dias de armazenamento, por isso é necessário avaliar o pH, a formação de redemoinhos e agregados a todos os concentrados de plaquetas antes de serem transfundidos como indicativo de ativação plaquetária e diminuição de sua funcionalidade

Impacto económico de emicizumab en pacientes con hemofilia a con inhibidor en un hospital de tercer nivel / Economic impact of emicizumab in patients with haemophilia a with inhibitor in a third level hospital

Objetivo: Estimar el impacto económico del emicizumab en pacientes con hemofilia A (HA) e inhibidor en un hospital de tercer nivel, comparándolo con las alternativas terapéuticas. Métodos: Se estimó el coste anual del tratamiento de la HA e inhibidor con complejo protrombínico activado (aPCC), factor VII recombinante (rFVIIa) y emicizumab, y varias estrategias terapéuticas: profiláctica, a demanda e inmunotolerancia (ITI). Las dosis utilizadas, localización, frecuencia y gravedad de los sangrados se obtuvieron de la literatura. Resultados: El coste medio anual de la estrategia a demanda con aPCC/rFVIIa y de la estrategia profiláctica fueron 309.523 € y 354.866 €, en un paciente pediátrico y 808.928 € y 926.574 € en un adulto, respectivamente. El coste de la ITI fue 619.644 € y 1.029.399 € en el paciente pediátrico y adulto, respectivamente. Respecto a la estrategia profiláctica, el coste del tratamiento con emicizumab fue un 27,7% menor en el paciente pediátrico (240.255 €) y un 50,8% menor en el adulto (427.266 €).Conclusiones: Emicizumab, además de aportar mejoras clínicas y de calidad de vida a los pacientes con HA, ofrece ventajas económicas frente a los agentes “bypass”. (AU)

Purpose: Estimate the economic impact of the use of emicizumab in patients with hemophilia A (HA) and inhibitor in a third level hospital, comparing it with the different therapeutic alternatives.Methods: HA and inhibitor annual cost treatment with activated prothrombin complex (aPCC), recombinant factor VII (rFVIIa) and emicizumab was estimated. The patients were stratified in pediatrics (<14 years) and adults (>14 years). Several strategies were considered: prophylactic, on demand and immune tolerance induced (ITI). The dose used and the bleeding location, frequency and severity were obtained from the literature.Results: The average annual cost of on demand strategy with aPCC and rFVIIa and prophylactic strategy in a pediatric patient was 309,523 € and 354,866 € respectively, and 808,928 € and 926,574 € in an adult patient, respectively. ITI cost was 619,644 € and 1,029,399 € in pediatric and adult patient respectively. Regard prophylactic strategy, the treatment cost with emicizumab was 27.7% lower in pediatric patients (240,255 €) and 50.8% lower in adult patients (427,266 €). (AU)

Avaliação morfológica do concentrado autólogo de plaquetas em cães sob refrigeração e criopreservação em DMSO 6% / [Morphological evaluation of the autologous platelet concentrate in dogs under refrigeration and criopreservation in 6% DMSO]

The morphological characteristics of the autologous platelet concentrate (APC) of 31 dogs were evaluated after cooling and freezing in 6% DMSO. Blood from the jugular vein of each patient was collected and centrifuged at 191g for six minutes to obtain APC. In the fresh sample, the platelet count, MPV, PDW and cell morphology were evaluated. Four samples of each animal were sent for storage, one refrigerated at 4°C for seven days, another for 30 days and two more stored in a freezer at -80°C in the same time interval, using 6% DMSO as cryoprotectant. The conserved samples were submitted to the same laboratory analysis as the fresh sample. There was a difference between fresh and preserved samples for platelet count, cell concentration, MPV and PDW (P<0.05), except in the 30-day refrigerated group, which showed severe morphological changes. In the frozen group for seven days, no difference was observed in the percentage of activation (P>0.05). The results obtained lead to the conclusion that cryopreservation with 6% DMSO at -80°C for seven days is a favorable option for the maintenance of platelet concentrations and the morphological characteristics of APC in dogs.(AU)

Contribution of environmental factors in the formation of biofilms by Alicyclobacillus acidoterrestris on surfaces of the orange juice industry / Contribuição de fatores ambientais na formação de biofilmes por Alicyclobacillus acidoterrestris em superfícies da indústria de suco de laranja

ABSTRACT: The objective of this study was to evaluate the effect of the initial microbial load, temperature and contact time on the biofilm formation of Alicyclobacillus acidoterrestris on stainless steel and natural food-grade rubber using orange juice as culture medium. The low initial load of A. acidoterrestris (2 log CFU/mL) led to biofilm formation on the stainless steel surface after 48 h of contact at 28 ºC and after 24 h at 45 ºC, and on natural food-grade rubber surface after 48 h of contact at both temperatures. The high initial microbial load (5 log CFU/mL) led to biofilm formation on stainless steel after 4 h of contact at 28 °C and 45 °C, while biofilm was formed on natural food-grade rubber after 8 h of contact at 28 °C and 4 h at 45 °C. The microbial load also affected the presence of spores in biofilm, which was observed on both surfaces only at high initial loads of A. acidoterrestris.

RESUMO: O objetivo deste estudo foi avaliar o efeito da carga microbiana inicial, temperatura e tempo de contato na formação de biofilme de Alicyclobacillus acidoterrestris em aço inoxidável e borracha natural de qualidade alimentar utilizando suco de laranja como meio de cultura. A baixa carga inicial de A. acidoterrestris (2 log UFC/mL) levou à formação de biofilme na superfície do aço inoxidável após 48 h de contato a 28 ºC e após 24 h a 45 ºC, e na superfície natural de borracha de qualidade alimentar após 48 h de contato nas duas temperaturas. A alta carga microbiana inicial (5 log UFC/mL) levou à formação de biofilme em aço inoxidável após 4 h de contato a 28 °C e 45 °C, enquanto o biofilme foi formado em borracha natural de qualidade alimentar após 8 h de contato a 28 °C e 4 h a 45 °C. A carga microbiana também afetou a presença de esporos no biofilme, o que foi observado em ambas as superfícies apenas com altas cargas iniciais de A. acidoterrestris.

Aplicación de la terapia regenerativa en la enfermedad arterial periférica y el pie diabético isquémico / Use of regenerative therapy in the peripheral arterial disease and the ischemic diabetic foot

Introducción: El pie diabético isquémico y la enfermedad arterial periférica, son dos enfermedades que ocasionan dolor por isquemia crítica y ponen en peligro la viabilidad de las extremidades inferiores. Objetivo: Demostrar la efectividad de la terapia regenerativa con plasma rico en plaquetas en pacientes con las enfermedades citadas. Métodos: Estudio longitudinal, prospectivo y aleatorizado realizado en el Servicio de Angiología del Hospital: Julio Trigo López, entre enero 2016-diciembre 2017. Se incluyeron 26 pacientes en dos grupos de estudios, 10 pacientes no diabéticos con claudicación intermitente y 16 pacientes con lesiones isquémicas en el pie del diabético. Se aplicó plasma rico en plaquetas por vía intramuscular en la pierna afectada, en el primer grupo y de forma intra- y perilesional en el pie del diabético isquémico. Resultados: Se obtuvo alivio del dolor y mejoría en más del 70 por ciento de los pacientes en la distancia de claudicación por encima o cerca de los 200 metros. En los pacientes con pie diabético isquémico, alivio del dolor y cierre de las lesiones isquémicas en el 81,3 por ciento, solo 3 pacientes requirieron amputaciones mayores de los miembros inferiores. Conclusiones: La terapia regenerativa resulta efectiva en el salvataje de las extremidades inferiores en los pacientes estudiados, asociada a los procedimientos convencionales empleados en la cirugía revascularizadora; disminuye la amputación mayor de miembros inferiores y es una posibilidad terapéutica más en manos de especialistas entrenados, por su impacto social y en la calidad de vida de pacientes y familiares(AU)

Introduction: Ischemic diabetic foot and peripheral arterial disease are two conditions that cause pain and put in danger the functionality of lower limbs. Objective: To demonstrate the effectiveness of regenerative therapy with platelet-rich plasma in patients with the above mentioned diseases. Methods: Longitudinal, prospective and randomized study that was conducted in the Angiology Service of Julio Trigo López Hospital, from January 2016 to December 2017. There were 26 patients included in 2 groups: 10 non-diabetic patients with intermittent claudication and 16 patients with ischemic lesions in the diabetic foot. Platelet-rich plasma was used instramuscularly in an affected legs of the first group, and intraperilesional and perilesional in the diabetic foot. Results: There was pain relief and improvement in more than 70 percent of patients in the claudication distance higher or near to 200 meters. In the patients presenting ischemic diabetic foot, pain relief and closing of ischemic lesions in the 81,3 percent , just 3 patients required major amputations of lower limbs. Conclusions: Regenerative therapy results effective in the rescue of lower limbs in patients presenting peripheral arterial disease and ischemic diabetic foot. It also reduces major amputations of lower limbs and it is another therapeutic option in the hands of trained specialists due to its social impact and in the life quality of patients and their families(AU)

Silage of rehydrated corn grain / Silagem de grão de milho reidratado

The objective with this study was to evaluate the effect of different levels of water inclusion on the chemical composition and fermentation profiles of reconstituted corn grain silage. The experiment was carried out in a factorial arrangement in a completely randomized design, with three replicates per treatment. Five treatments were evaluated with different levels of water inclusion (% of the natural matter): dry corn grain (control); 90% dry corn grain (DCG) and 10% water; 80% DCG and 20% water; 70% DGC and 30% water; and 60% DCG and 40% water, totaling 45 experimental silos. Inclusion of water in the silage of reconstituted corn grain promoted a reduction in the CP (%) and NDF (%) contents. However, the water increase elevated the NPN/TN contents and the amount of effluent, gas and dry matter (%) losses. The treatment with inclusion of 30% water in the natural matter leads to a better fermentation profile and fewer losses of effluent and dry matter, so it is recommended for ensiling dry ground corn grain.(AU)

Objetivou-se avaliar o efeito de diferentes níveis de inclusão de água na composição química e no perfil fermentativo de silagem de grão de milho reidratado. O experimento foi conduzido em esquema fatorial, em um delineamento inteiramente ao acaso. Cinco tratamentos com diferentes níveis de inclusão de água (% da matéria natural) foram avaliados: milho grão seco (controle); 90% de milho grão seco (MGS) e 10% de água; 80% de MGS e 20% de água; 70% de MGS e 30% de água e 60% de MGS e 40% de água, totalizando 45 silos experimentais. A inclusão de água na silagem do grão de milho reconstituído promoveu redução nos conteúdos de PB (% MS) e FDN (% MS). Contudo, o incremento de água aumentou os teores de NNP/NT e as perdas por efluente, gás e matéria seca. O tratamento com a inclusão de 30% de água na matéria natural propicia um melhor perfil fermentativo e menores perdas por efluente e matéria seca, sendo recomendado para a ensilagem de grão de milho seco moído.(AU)

Substituição da farinha e do óleo de peixe por farinha e óleo de origem vegetal em rações utilizadas na fase de engorda do camarão-branco-do-pacífico Litopenaeus vannamei, em sistemas de bioflocos / Replacement of fishmeal and fish oil with vegetable meal and oil in feedstuffs used in the growing phase of the Pacific white shrimp Litopenaeus vannamei, in biofloc systems

Este trabalho teve como objetivo avaliar o efeito da substituição da farinha e do óleo de peixe pelo concentrado proteico de soja e óleo de soja, na sobrevivência, no crescimento e na composição corporal dos camarões (Litopenaeus vannamei) produzidos em sistema de bioflocos (BFT). Foram formuladas cinco dietas, isoproteicas e isoenergéticas, com diferentes níveis de substituição da farinha e do óleo de peixe por concentrado proteico de soja e óleo de soja, sendo os tratamentos designados como: 0% (sem substituição), 25%, 50%, 75% e 100%. As rações foram elaboradas para conter aproximadamente 35% de proteína e 8% de lipídios. O experimento foi conduzido durante 49 dias, com juvenis com peso inicial de 2,93±0,83g, em sistema de bioflocos (BFT). Não foram encontradas diferenças significativas entre os tratamentos até 75% de substituição para as variáveis de ganho de peso, conversão alimentar e sobrevivência. O tratamento de 100% de substituição apresentou menor taxa de crescimento específico. O presente resultado sugere que, nas dietas para camarões criados em sistema bioflocos, a farinha e o óleo de peixe possam ser substituídos em até 75% por concentrado proteico de soja e óleo de soja, sem prejudicar o desenvolvimento dos animais.(AU)

The objective of this work was to evaluate the effect of the substitution of fishmeal and fish oil with soy protein concentrate and soybean oil on survival, growth and body composition of shrimp (Litopenaeus vannamei) produced in biofloc system (BFT). Five diets were formulated to be isoproteic and isoenergetic with different levels of substitution of fishmeal and fish oil with soy protein concentrate and soybean oil. The treatments were named as: 0% (without substitution), 25%, 50%, 75% and 100%. The diets were formulated to contain approximately 35% protein and 8% lipids. The experiment was conducted for 49 days, with juveniles with initial weight of (2.93±0.83g) in a biofloc system (BFT). No significant differences were found between treatments up to 75% of substitution for the variables of weight gain, feed conversion ratio, and survival. The 100% substitution treatment showed a lower specific growth rate. The present study suggests fish meal and fish oil can be substituted in up to 75% for soy protein concentrate and soybean oil, without harming the development of the shrimps when reared in biofloc system.(AU)

Influence of calcium concentration in haemodialysis fluid on blood pressure control. / Influencia de la concentración de calcio en el líquido de hemodiálisis sobre el control de la tensión arterial.

BACKGROUND: Hypertension is a highly prevalent disorder among patients undergoing haemodialysis. It contributes to greater cardiovascular risk and must be controlled. However, despite dietary measures, haemodialysis regimen optimisation and pharmacological treatment, some patients in our units continue to maintain high blood pressure levels. The objective of the study is to demonstrate that reducing calcium in dialysis fluid can help treat hypertension patients undergoing haemodialysis. MATERIAL AND METHODS: We selected all of the hypertensive patients from our haemodialysis unit. We checked their normovolemic status by means of bioimpedance spectroscopy, decreasing the haemodialysis fluid's calcium concentration to 2.5mEq/l, with a follow-up period of 12 months. RESULTS: A total of 24 patients met the non-volume dependent hypertension criteria (age 61±15 years, males 48%, diabetes 43%). A significant systolic and diastolic blood pressure decrease was observed at 6 and 12 months as a result of reducing the dialysis calcium concentration; this was not accompanied by greater haemodynamic instability (baseline systolic blood pressure: 162±14 mmHg; at 6 months: 146±18 mmHg; at 12 months: 141±21 mmHg; P=.001) (baseline diastolic blood pressure: 76±14 mmHg; at 6 months: 70±12 mmHg; at 12 months: 65±11 mmHg; P=.005). A non-significant increase in plasma parathyroid hormone levels was also found. No side effects were observed. CONCLUSIONS: Adding 2.5mEq/l of calcium to dialysis fluid is a safe and effective therapeutic alternative to control hard-to-manage hypertension among haemodialysis patients.

Improvement of the viability of probiotics (Lactobacillus acidophilus) by multilayer encapsulation / Melhoramento da viabilidade de probióticos (Lactobacillus acidophilus) por encapsulação em multicamadas

ABSTRACT: This study produced pectin microcapsules containing Lactobacillus acidophilus by external ionic gelation, followed by the adsorption of whey protein and pectin to form multilayers. The viability of free and microencapsulated lactobacilli was evaluated after in vitro exposure to gastrointestinal conditions. They were also assessed by heat treatment, and stability was examined at -18 °C, 5 °C and 25 °C for 120 days. Exposure to different pHs, simulating passage through the gastrointestinal tract, showed that treatment of the microcapsules with only pectin (LA/P0) and with one and two layers of whey protein (treatments LA/P1 and LA/P3, respectively), were able to protect Lactobacillus acidophilus , with microcapsules increasing the release of probiotics from the stomach into the intestines. Free cells showed a decrease in their counts over the course of the simulated gastrointestinal system. Regarding heat treatments, microcapsules with a layer of whey protein (LA/P1) maintained the viability of their encapsulated Lactobacillus acidophilus (9.57 log CFU/g-1). The best storage viability was at -18 °C, with a count of 7.86 log CFU/g-1at 120 days for microcapsule LA/P1,with those consisting of two layers of whey protein (LA/P3)having a 6.55 log CFU/g-1 at 105 days. This study indicated that external ionic gelation was effective and could be used for the production of pectin microcapsules, with multilayer whey protein promoting greater protection and viability of Lactobacillus acidophilus.

RESUMO: O objetivo deste trabalho foi produzir microcápsulas de pectina, contendo Lactobacillus acidophilus por gelificação iônica externa, seguida da adsorção de proteína de soro de leite e multicamadas formadoras de pectina. Além disso, a viabilidade de lactobacilos livres e microencapsulados, após exposição in vitro a condições gastrintestinais, foi avaliada após simulação de tratamentos térmicos e, finalmente, estabilidade a -18 ºC, 5 ºC e 25 ºC durante 120 dias de armazenamento. A exposição a diferentes pHs, simulando a passagem pelo trato gastrointestinal, mostrou que os tratamentos das microcápsulas com apenas pectina (LA/P0) e com uma e duas camadas proteína do soro (tratamentos LA/P1 e LA/P3, respectivamente), foram capazes de proteger o Lactobacillus acidophilus , enquanto as microcápsulas aumentaram a liberação de probióticos do estômago para o intestino. As células livres diminuíram suas contagens no curso do sistema. Em relação aos tratamentos térmicos aplicados, pode-se afirmar que a microcápsula com uma camada de proteína do soro (LA/P1) resistiu e manteve a viabilidade de Lactobacillus acidophilus (9,57 log CFU / g-1). A melhor viabilidade foi obtida no armazenamento a -18 ° C, com uma contagem de 7,86 log CFU / g-1 para essa mesma microcápsula (LA/P1) no final do armazenamento (120 dias) e 6,55 log CFU / g-1 para as microcápsulas com duas camadas de proteína do soro (LA/P3) por 105 dias. Este estudo indica que a gelificação iônica externa é eficaz e pode ser usada para a produção de microcápsulas de pectina com multicamadas de proteína de soro para promover maior proteção e viabilidade ao Lactobacillus acidophilus.

Maíz nixtamalizado suplementado con un concentrado de proteínas de sardina para mejorar el valor biológico de las tortillas.

INTRODUCCIÓN: La mayor parte de la población rural en México adquiere casi la mitad de su energía de la tortilla de maíz y sus fuentes de proteína son principalmente de origen vegetal. OBJETIVO: Obtener un concentrado de proteína de sardina para adicionar harina de maíz e identificar la concentración que proporcione la mejor calidad biológica de las tortillas sin modificar sus características físicas y sensoriales. MÉTODO: Obtención de un concentrado de proteína de sardina y elaboración de tortillas con harina de maíz suplementada con diferentes concentraciones de proteína. Las características físicas y sensoriales de las tortillas fueron evaluadas por panelistas no entrenados. La calidad biológica de las tortillas se analizó en un modelo murino (crecimiento y la relación de eficiencia de proteína, PER). Para el análisis se utilizó estadística paramétrica. RESULTADOS: Se obtuvo un concentrado de proteína con 70.48 g/100 g. La suavidad, inflado, doblado y calidad de las tortillas preparadas con las mezclas con 0.63-3.75 % de proteínas de sardina fueron comparables con los de las tortillas elaboradas con harina no adicionada. El crecimiento de las ratas alimentadas con tortillas adicionadas fue mayor que el de las alimentadas con harina no adicionada; la diferencia fue significativa a partir de la concentración de 3.75 % (p < 0.05). El PER de las tortillas con 3.75 % de proteínas de sardina fue de 2.41, comparable al de la proteína de referencia (caseína). CONCLUSIÓN: La harina de maíz adicionada con proteínas de sardina en una proporción de 96.25:3.75 % mejora el valor biológico de las tortillas sin alterar sus características físicas y sensoriales. INTRODUCTION: Most part of the rural population in Mexico obtains almost half its energy from corn tortilla, and its sources of protein are mainly of vegetal origin. OBJECTIVE: To obtain a concentrate of sardine protein (SP) to supplement corn flour, and to identify which concentration provides corn tortillas with a better biological value, without modifying its physical and sensorial characteristics. METHOD: Obtainment of the SP concentrate, preparation of tortillas with corn flour and different SP concentrations, assessment of tortillas physical and sensorial characteristics by untrained panelists, assessment of biological quality in a murine model (growth and protein efficiency ratio [PER]). Parametric statistics was used. RESULTS: A protein concentrate of 70.48 g/100 g was obtained. Smoothness, blistering, foldability and quality of the tortillas prepared with mixtures containing 0.63-3.75% of SP were comparable to those of tortillas prepared with non-supplemented flour. The growth of rats fed supplemented tortillas was superior; the difference was significant with ≥ 3.75% concentrations (p < 0.05). The PER of tortillas with 3.75% of SP was 2.41, which was comparable to that of the reference protein (casein). CONCLUSION: SP-supplemented corn flour at a 96.25:3.75% ratio improves the biological value of tortillas without modifying their physical and sensorial characteristics.