Epidemiology of transfusion-transmitted infections among multi-transfused patients in seven hospitals in Peru.

BACKGROUND: Transfusion-transmitted infections (TTIs) constitute a major health problem worldwide where routine screening of blood or blood products is improperly done, and where non-medical injecting medications and/or drug use are prevalent. Prevalence and risk factors vary by geographic location and by the specific TTI (including HIV-1, HBV, HCV and HTLV-I). OBJECTIVE: To determine the prevalence and risk factors associated with TTIs among a sample of multi-transfused adult patients in Peru. STUDY DESIGN: A cross-sectional multi-center study was conducted across seven major hospitals in Peru from February 2003 to September 2004. Self-reported behavior information (medical procedures, number of sexual partners, and drug use history) was analyzed, along with a review of exposure history from hospital medical records. Prevalences were calculated by TTI for different exposures, along with unadjusted and adjusted odds ratios for infection risk. RESULTS: Overall, 192 (54.7%) of 351 multi-transfused patients were found infected with one or more TTIs. Number of transfusion units, years of transfusion history (6 or more), and number of treatment facilities (2 or more) were associated with HCV infection. Hemodialysis history was a common risk factor associated with HBV, HCV and HTLV-I infection. HIV infection was associated only with total number of transfusion units received. CONCLUSIONS: High prevalences of HBV and HCV infection were found among Peruvian multi-transfused patients and were associated with a past history and number of blood transfusions, as well as with past hemodialysis procedures. TTIs continue to represent a significant public health problem in Peru. Continued vigilant attention to blood safety procedures, including universal screening and health care provider education, is recommended.

Field validation of a milk-line sampling device for monitoring milk component data.

The objective of this study was to investigate the ability of a milk-line sampling device to obtain a representative sample under field conditions by comparing the milk component composition between milk-line and bulk-tank samples, for milk harvested from the same group of cows at the same milking. A total of 42 paired milk-line and bulk-tank samples were collected at separate milking events from 21 different dairy herds. Samples were analyzed for milk fat (%), true protein (%), and milk urea nitrogen (mg/dl). Concordance correlation coefficients showed a very high level of agreement between the two sample types, with values ranging between 0.82 and 0.95 for the components measured. ANOVA showed that milk component data derived from milk-line samples were neither statistically nor numerically different from milk component data derived from bulk-tank samples. The strategy of monitoring milk component data through milk line sampling should provide dairy producers with inexpensive, timely, and accurate information that will help to improve ongoing nutritional monitoring programs for individual groups of cows within the dairy herd.

Field validation of a milk line sampling device for monitoring milk quality and udder health.

The objective of this study was to investigate the ability of a milk line sampling device to obtain a representative sample by comparing SCC and bacterial culture results between milk line and bulk tank samples for milk harvested from the same group of cows at the same milking. A total of 42 paired milk line and bulk tank samples were collected at separate milking events from 21 different herds. Concordance correlation coefficients showed a high level of agreement between the two sample types, with values ranging between 0.74 and 0.99 for all parameters and bacterial species measured. ANOVA showed that SCC and bacterial culture results for Streptococcus agalactiae, Staphylococcus aureus, Streptococcus non-agalactiae, Coliforms, and coagulase-negative staphylococci were neither numerically or statistically different between milk line and bulk tank samples. KAPPA analysis showed that overall agreement beyond chance between milk line and bulk tank samples in determining whether a herd was positive or negative for either Strep. agalactiae or Staph. aureus were 100 and 75%, respectively. While further research is needed to fully assess the utility of this tool for the purpose of bacterial culture, the results of this study suggest that the strategy of milk line sampling is a very promising monitoring tool. This sampling strategy should provide producers with inexpensive and timely information that will help to improve programs for monitoring milk quality and udder health in commercial dairy herds.

Tru-cut needle biopsy of subcutaneous fat in the diagnosis of secondary amyloidosis in rheumatoid arthritis

In order to investigate the presence of secondary amyloidosis in patients with rheumatoid artritis (RA), we performed and abdominal subcutaneous fat biopsy with a truc-cut needle in 50 patients. The tissue was stained with Congo red and was observed with polarized light microscopy. We found amyloid deposits in 78 percent of our patientas. We randomly selected ten patients with a positive biopsy and a second procedure was performed. Tissues were studied with electron microscopy. We found unbranced fibrils characteristic of amyloid in all of them. We found a direct correlation with rheumatoid factor titers: the more intense the amyloid deposit, the higher the rheumatoid factor titers (p< 0.001). We did not find any correlation betwen amyloid deposits and clinical manifestations of disease. Amyloid deposits in RA are more frequent than previously thought, and their clinical importance remains to be determined