Use of Low-Dose Platelets in Actively Bleeding Patients: A Retrospective Analysis of a Cardiac Surgery Cohort.

CONTEXT.­: During platelet shortages, many hospitals produce low-dose platelets by splitting a standard platelet unit (>3 × 1011 platelets in the United States) in 2, then providing these low-dose units to patients. While low-dose units were previously found to be effective for prophylactic purposes in patients undergoing chemotherapy in the Prophylactic Platelet Dose (PLADO) trial, their use in actively bleeding patients has not yet been assessed. OBJECTIVE.­: To assess the use and safety of low-dose platelets in actively bleeding patients. DESIGN.­: We performed a retrospective review of cardiac surgery cases receiving platelet units for 18 months at 1 hospital. Two cohorts, those receiving only whole-dose platelets (37 cases) and those receiving only low-dose platelets (38 cases), were compared during the intraoperative and the 24-hour perioperative period. Mean number of platelet transfusions, dose of other blood products, estimated blood loss, bleeding complications in index cases, and all-cause mortality within 30 days of discharge were compared. RESULTS.­: There was no significant difference in mean number of intraoperative platelet transfusions between the cohorts (1.61 versus 1.53, P = .57). There was no significant increase in the transfusion of other blood products, estimated blood loss, bleeding complications in index cases, or all-cause mortality within 30 days of discharge in the low-dose platelet cohort, apart from a small increase in requirement for fresh frozen plasma in the perioperative period. CONCLUSIONS.­: These results suggest that low-dose platelets are tentatively equivalent to whole-dose platelets in cardiac surgery during shortages, with similar transfusion requirements and clinical outcomes between groups. Future multicenter studies are needed to confirm these findings.

How many mislabelled samples go unidentified? Results of a pilot study to determine the occult mislabelled sample rate.

BACKGROUND: Specimens with incorrect patient information are both a critical safety error and difficult to identify. Estimates of sample mislabelling rely on subjective identification of mislabelling, with the possibility that not all mislabelled samples are being caught. METHODS: We determined the blood type of two or more complete blood count specimens with the same patient label and assessed for discrepancies. We additionally determined the rate of identified sample mislabelling for the study period. RESULTS: We found a rate of 3.17 per 1000 discrepancies over the study period. These discrepancies most likely represent occult, or unidentified, mislabelled samples. In contrast, the rate of identified sample mislabelling was 1.15 per 1000. CONCLUSIONS: This study suggests that specimens identified as, or known to be, mislabelled represent only a fraction of those mislabelled. These findings are currently being confirmed in our laboratory and are likely generalisable to other institutions.

Comparison of the effects of platelet concentrates produced by high and low-speed centrifugation protocols on the healing of critical-size defects in rat calvaria: a microtomographic and histomorphometric study.

The current study evaluated the healing of critical-size defects (CSD) created in rat calvaria treated with platelet concentrates produced by high-speed (Leukocyte- and Platelet-Rich Fibrin - L-PRF) and low-speed (Advanced Platelet-Rich Fibrin - A-PRF) protocols of centrifugation. Twenty-four rats were distributed into three groups: Control, L-PRF, and A-PRF. Five mm diameter CSD were created on the animals' calvaria. The defects of the L-PRF and A-PRF groups were filled with 0.01 ml of L-PRF and A-PRF, respectively. The control group defects were filled with a blood clot only. All animals were euthanized on the 35th postoperative day. Histomorphometric and microtomographic analyses were then performed. The L-PRF and A-PRF groups had significantly higher bone volume and neoformed bone area than those of the control group and lowered bone porosity values (p < .05). No significant differences were observed between A-PRF and L-PRF groups for the analyzed parameters. Therefore, it can be concluded that i) L-PRF and A-PRF potentiated the healing of CSD in rat calvaria; ii) high and low-speed centrifugation protocols did not produce PRF matrices with different biological impacts on the amount of bone neoformation.

Characterisation of exposure to non-ionising electromagnetic fields in the Spanish INMA birth cohort: study protocol.

BACKGROUND: Analysis of the association between exposure to electromagnetic fields of non-ionising radiation (EMF-NIR) and health in children and adolescents is hindered by the limited availability of data, mainly due to the difficulties on the exposure assessment. This study protocol describes the methodologies used for characterising exposure of children to EMF-NIR in the INMA (INfancia y Medio Ambiente- Environment and Childhood) Project, a prospective cohort study. METHODS/DESIGN: Indirect (proximity to emission sources, questionnaires on sources use and geospatial propagation models) and direct methods (spot and fixed longer-term measurements and personal measurements) were conducted in order to assess exposure levels of study participants aged between 7 and 18 years old. The methodology used varies depending on the frequency of the EMF-NIR and the environment (homes, schools and parks). Questionnaires assessed the use of sources contributing both to Extremely Low Frequency (ELF) and Radiofrequency (RF) exposure levels. Geospatial propagation models (NISMap) are implemented and validated for environmental outdoor sources of RFs using spot measurements. Spot and fixed longer-term ELF and RF measurements were done in the environments where children spend most of the time. Moreover, personal measurements were taken in order to assess individual exposure to RF. The exposure data are used to explore their relationships with proximity and/or use of EMF-NIR sources. DISCUSSION: Characterisation of the EMF-NIR exposure by this combination of methods is intended to overcome problems encountered in other research. The assessment of exposure of INMA cohort children and adolescents living in different regions of Spain to the full frequency range of EMF-NIR extends the characterisation of environmental exposures in this cohort. Together with other data obtained in the project, on socioeconomic and family characteristics and development of the children and adolescents, this will enable to evaluate the complex interaction between health outcomes in children and adolescents and the various environmental factors that surround them.

Epidemia de intoxicação por chumbo em empresa de fundição secundária / Occupational lead poisoning epidemic in a secondary melting facility

A intoxicação por chumbo constitui importante problema de saúde dos trabalhadores em nosso meio, sendo causada principalmente pela montagem, reforma e reciclagem de baterias automotivas. Neste artigo, são apresentados os resultados de uma investigação realizada em uma empresa de fundição secundária de chumbo localizada na região metropolitana de Belo Horizonte. A empresa foi inspecionada para estudo dos riscos à saúde dos trabalhadores. Foi ainda realizada revisão bibliográfica e estudo dos prontuários médicos dos trabalhadores atendidos no Centro de Referência Estadual em Saúde dos Trabalhadores- CEREST/MG ,no período de janeiro de 2005 a setembro de 2007. Os 18 trabalhadores do setor produtivo da empresa são homens e estavam expostos e intoxicados pelo chumbo. A idade média era de 33,6 anos. Quanto à escolaridade, 61,1% possuíam primeiro grau incompleto. O tempo médio de exposição ao chumbo metálico foi de 17,8 meses. Constatou-se que 66,7% dos trabalhadores mostraram níveis séricos de chumbo acima de 60µg/dl, e 33,3% mostraram níveis entre 40 e 60µg/dl. Os sintomas mais frequentes foram parestesias (72,2%), dor nas pernas (66,7%), fraqueza (55.6%), cefaleia (50%), irritabilidade (50%) e dor abdominal (44,4%). Dentre os pacientes, 61.1% foram submetidos à terapia quelante com versenato de sódio. O tempo médio de afastamento do trabalho dos pacientes que concluíram o tratamento foi de 14,3 meses. Os autores alertam para a gravidade do problema e enfatizam a necessidade de maior integração entre as agências públicas que implementam ações de proteção ambiental e saúde do trabalhador visando melhorar as condições de trabalho e eliminar a intoxicação por chumbo nas empresas de fundição secundária de chumbo.

Lead intoxication remains a significant occupational health concern in our environment, being primarily caused by the process of assembly, restoration, and recycling of automotive batteries. This paper presents research data collected from an automotive battery board recycling facility in greater Belo Horizonte, Minas Gerais, and points out inappropriate workplace conditions. The facility was visited for researching workplace processes and identifying all risks to the workers’ health, a bibliographical review was conducted, as well as a study of facility's workers medical records from their visits to the Centro de Referência Estadual em Saúde dos Trabalhadores de Minas Gerais - CEREST/MG. All the 18 workers practically performed the same activities and were poisoned by lead. The mean age was 33.6 years and 100% of them were male. The mean time of metallic lead exposure was 17,8months. 66,7% of workers showed serum lead levels above 60µg/ dl, and 33,3% between 40 and 60µg/dl . The main symptoms were leg pain, paresthesia (72,2%), leg ache (66,7%),faintness (55,6%), headache (50%), irritation (50%) and abdominal pain (44,4%). Chelation therapy with calcium versenate was the treatment in 61,1% of them. The mean time sickleaves of patients that concluded the treatment was 14,3 months. The authors stress the need of institutional integration among public agencies that implemented occupational health andenvironmental protection actions, in order to improve the work conditions in secondary melting facilites.

Aspectos anatómicos de la disposición y anastomosis de las ramas terminales del plexo braquial: (nervus mediano, ulnar, radial y musculocutáneo) / Anatomical aspects of the disposition and anastomosis of the braquial plexus: (median nerve urnal, radial and musclecutaneous)

En los tiempos modernos, los múltiples traumatismos que ocurren en el miembro superior, exigen de los profesionales de la salud conocimiento preciso de la disposición del pedículo y sus posibles variaciones. Se estudiaron 40 miembros superiores de cadáveres adultos previamente tratados con solución de formol al 5 por ciento, glicerina y fenos durante al menos tres meses en el Instituto Anatómico José Izquierdo de la Escuela Luis Razetti de la Facultad de Medicina de la Universidad Central de Venezuela. Los resultados fueron registrados en un protocolo, tras lo cual se obtuvo un 47,5 por ciento de variabilidad (19 variaciones), de las cuales el 35 por ciento correspondían al nervio mediano, 7,5 por ciento al nervio ulnar, y 5 por ciento al nervio musculocutáneo. Por otro lado se encontró mayor variabilidad en el miembro derecho (57,9 por ciento) y en el sexo masculino (84,2 por ciento)

Aspectos anatomo-quirúrgicos de la irrigación muscular / Aspect anatomical surgical of the muscle irrigation

En los últimos tiempos las modernas técnicas de cirugía plásticas y recostructivas han utilizado colgajos musculares y músculos cutáneos para reparar las perdidas de las sustancias superficiales de origen traumático o quirúrgico. El presente trabajo tiene por objeto estudiar las características anatómicas de la irrigación de los músculos glúteos maximus, tensor de la fasciae latae, rectus femoris y vastus laterales. Presentamos las conclusiones correspondientes a 56 miembros inferiores que corresponden a igual número de músculos estudiados. Se clasifican los músculos según su tipo de irrigación y se establece la correlación anatomo quirúrgica con las ventajas y desventajas para la utilización de los musculares y sus áreas de aplicación