Situación de los sistemas de sangre de los países andinos del 2013-2020: ORAS-CONHU / Situation of the blood systems of the Andean countries from 2013-2020: ORAS-CONHU

El presente informe sobre la situación del acceso a sangre segura de los países andinos 2013-2020 describe una síntesis de los avances y necesidades de los países andinos para lograr el acceso a sangre segura. Se utilizó como fuente de información los datos disponibles de los programas de sangre reportados a la OPS, durante los años 2013 a 2020. Adicionalmente, se incluyó la información proporcionada por los países al Comité Andino de Sangre Segura del ORAS-CONHU. En este mismo contexto es importante la vigilancia de la calidad, el fortalecimiento del recurso humano, la certificación de los servicios y el análisis continuo de la información

Évaluation des technologies de réduction des agents pathogènes InterceptMC et MirasolMC pour le traitement des produits sanguins labiles au Québec / Assessment of InterceptTM and MirasolTM Pathogen Reduction Technologies for the Treatment of Labile Blood Products in Quebec

MANDAT: L'Institut national d'excellence en santé et en services sociaux (INESSS) a reçu le mandat de la Direction de la biovigilance et de la biologie médicale (DBBM) du ministère de la Santé et des Services sociaux (MSSS) de réévaluer la pertinence de l'introduction des technologies de réduction des agents pathogènes (TRP) InterceptMC et MirasolMC pour le traitement des produits sanguins labiles au Québec. Il s'agit de la deuxième évaluation de ces technologies par l'INESSS à la suite de la recommandation en 2017 de ne pas introduire le procédé InterceptMC dans la chaîne de production des produits sanguins labiles au Québec. DESCRIPTION: Les TRP InterceptMC et MirasolMC sont des processus qui visent à inactiver certains virus, parasites et bactéries par l'utilisation d'agents chimiques ou physiques. Contrairement aux produits sanguins stables, les produits sanguins labiles (culots globulaires, plasma et plaquettes) offerts au Québec ne sont actuellement pas soumis à un tel processus. Advenant leur introduction, ces technologies pourraient s'ajouter aux

MANDATE: The Institut national d'excellence en santé et en services sociaux (INESSS) was mandated by the Direction de la biovigilance et de la biologie médicale (DBBM) of the Ministère de la Santé et des Services sociaux (MSSS) to reassess the relevance of introducing InterceptTM and MirasolTM pathogen reduction technologies (PRTs) for the treatment of labile blood products in Quebec. This is the second assessment of these technologies by INESSS following the recommendation in 2017 not to introduce the InterceptTM Blood System in the labile blood products' production chain in Quebec. DESCRIPTION: Intercept™ and Mirasol™ are PRTs that aim to inactivate certain viruses, parasites, and bacteria through the use of chemical or physical agents. Unlike stable blood products, labile blood products (packed red blood cells, plasma, and platelets) offered in Quebec are not currently subjected to such a process. If introduced, these technologies could be added to the various preventive measures that are already being used to reduce the risks of contamination. ASSESSMENT PROCESS: The assessment used an approach based on the overall value appraisal that the Institute advocates in its Statement of Principles and ethical fondations. A rapid review of the literature was carried out in order to mobilize evidence and reassess the relevance of introducing PRTs in the labile blood products' production chain in Québec. PRT manufacturers were invited to transmit relevant information. Contextual and experiential data was collected from stakeholders through a meeting with Héma-Québec, an expert advisory committee, a focus group with representatives of patient organizations, and a citizen panel. A budget impact analysis (BIA) aiming to quantify the expected financial impact following the introduction of a PRT for the treatment of plasma and platelets was also conducted. The comprehensive scientific, contextual, and experiential data was interpreted using a multidimensional framework to guide certain consultation processes as well as the deliberation process for the development of recommendations by the "Comité délibératif permanent - Remboursement et accès". Socio-CULTURAL DIMENSION: Héma-Québec deploys the preventive measures it deems necessary to ensure the safety of labile blood products distributed in Quebec. Similarly, the Canadian Blood Services (CBS) is implementing preventive measures for the other Canadian provinces and has gradually been rolling out PRTs since January 2022 for the treatment of platelet units in selected hospitals. Some countries that are socially and economically comparable to Canada have taken divergent positions on PRTs, with some being favourable, such as France and Switzerland, and others being unfavourable, such as England. Considering a partial or complete introduction in other countries and Canadian provinces and based on the precautionary principle, the Comité de biovigilance decided that it would be important to consider a strategic introduction of PRTs in order to prepare for the emergence of various pathogens in Quebec. However, the committee has specified that this technology should not replace current preventive measures and should apply only to a small percentage of labile blood products. Although Héma-Québec deems the infectious risks associated with labile blood products to be minimal, it considers the risks associated with the emergence of known pathogen agents (KPAs) and unknown pathogen agents (UPAs) to be legitimate and it regards PRTs as an insurance policy against these intangible and unpredictable risks. Moreover, following the Coronavirus Disease 2019 (COVID-19) pandemic, the potential risk of an emerging pathogen has become more apparent according to the representatives of patient associations that we consulted. Despite the transfusion safety measures in place for labile blood products, this awareness may, for some, have influenced their risk perception. POPULATION DIMENSION: Transfusion safety is a shared responsibility between Héma-Québec, which ensures the safety of blood products, and transfusion hospitals, which are responsible for the quality of the transfusion procedure for patients. Héma-Québec receives nearly 800 orders of labile blood products daily and delivers more than 295,000 of these products annually to hospital centres. Only plasma and platelet units, which represent 22% of the labile blood products distributed, could potentially be treated by PRTs. In order to meet transfusion safety needs, the blood system in Quebec could benefit from better communication on transfusion complications, more preventive measures for noninfectious complications, alternative treatments to transfusions, and increased selfsufficiency in labile blood products. Since the risk of infectious complications associated with transfusions is currently considered low and acceptable by all stakeholders consulted, the main benefit of a PRT occurs during the hypothetical emergence of an UPA. CLINICAL DIMENSION: Intercept™ and Mirasol™ technologies have been shown to be effective on a wide range of viruses, bacteria, and protozoa in laboratory tests. However, the effectiveness of these two PRTs is limited against certain spores, biofilms, residual endotoxins, prions, multidrug-resistant Gram-negative bacteria, and non-enveloped viruses. In addition, there are concerns about the lack of efficacy of Mirasol™ technology against blood-borne viruses such as hepatitis B and cytomegalovirus (CMV). The effects of Intercept™ and Mirasol™ technologies on the biological properties of platelets or plasma are considered acceptable. Both technologies have no effect on bleeding or haemostatic function. However, treatment with both PRTs is accompanied by a statistically significant decrease in post-transfusion platelet recovery, a decrease in the time interval between transfusions, and a statistically significant increase in the number of transfusions per patient. Finally, some studies report a statistically significant increase in the number of transfusion-refractory patients and an increase in alloimmunization rates for platelets treated with Intercept™ compared to conventional platelets. Long-term toxicity or oncogenicity associated with residual amotosalen is also a concern for the Intercept™ technology, especially in pediatrics. ORGANIZATIONAL DIMENSION: Héma-Québec is facing supply chain challenges due to an increase in demand, a constrained pool of donors and a limited shelf life for labile products. PRTs have the potential to reduce the time it takes to make certain labile blood products available if they are accompanied by the withdrawal of bacterial testing. However, compared to untreated products, PRTs lead to an increase in the frequency and number of transfusions per patient, which can thus affect blood product stocks. However, uncertainty remains as to the actual impact of PRTs on plasma or platelet stocks. Moreover, the introduction of these technologies would require changes in the production chain, such as the rapid treatment of collected blood products. According to HémaQuébec, the scale of these changes as well as the resources mobilized would be limited. CBS has made the decision to remove bacterial screening and irradiation from the production chain of products treated with Intercept™ in other Canadian provinces. However, in Quebec, the withdrawal of certain preventive measures that have shown their effectiveness in ensuring the safety of labile products is not unanimous and is not planned by Héma-Québec in the short term. ECONOMIC DIMENSION: A scientific literature update on economic efficiency identified one recently published study specifically assessing Intercept™. According to this analysis, the use of a PRT would have an incremental cost-utility ratio (ICUR) of $9.3 million per QALY gained compared to current preventive measures. This ICUR could see a downturn in the event of the emergence of an UPA, decreasing to $8.6M or approximately $331K per QALY earned, depending on scenario analyses based on rates of infectious transmission of previous pathogens. The conclusions established in the 2017 assessment by INESSS remain unchanged. Uncertainty remains as to the system's willingness to pay for a health intervention such as a PRT according to an insurance principle. Regarding the budgetary impact estimated by INESSS, the uncertainty surrounding certain BIA parameters, in particular the introduction strategy, supported a scenariobased approach. INESSS estimates that the introduction of a PRT to treat only 10% of platelet units, in a partial introduction scenario, would generate a net budget impact of $11.6 million over 10 years. The net budgetary impact is estimated at $157.4 million over 10 years when it is assumed that PRT would treat 100% of platelets and plasma. INESSS Recommendation: Based on the information available to date and given the importance of the uncertainties raised about the added value of PRTs in the production chain of labile blood products in Quebec, INESSS considers that it would not be fair and equitable to implement such a technology. INESSS may reassess the available PRTs, at the request of the Ministère de la Santé et des Services sociaux (MSSS), when new information likely to influence the recommendation becomes available

The Effects of Dietary Clinoptilolite Supplementation on Fattening Performance, Some Blood and Visceral Organ Parameters in Japanese Quails

This study was aimed at determining the effects of dietary zeolite (clinoptilolite) supplementation on fattening performance, slaughter characteristics, and some blood and visceral organ parameters in Japanese quails. For this purpose, 140 (4x35) four-day-old Japanese quail chicks (Coturnix coturnix japonica) were randomly assigned to 4 groups with 4 replicates (9+9+9+8), and the study was continued for a period of 31 days. The groups were fed on a basal diet supplemented with 0% of clinoptilolite (control group), 1.5% of clinoptilolite (Z1.5), 3% of clinoptilolite (Z3) and 6% of clinoptilolite (Z6). For the female quails, the best blood TOS and liver TAS levels were detected in Z3 and Z1.5, respectively. For the male quails, the best blood TAS and liver TOS levels were determined in Z1.5. Histopathological examination demonstrated that dietary supplementation with 1.5% of zeolite had increased the height of the intestinal villi in both male and female quails, and had reduced hepatic lipidosis in female quails. Female quails displayed significantly increased levels of hepatic lipidosis in Z3 and Z6, and liver hepatitis in Z3. In result, it is suggested that zeolite, a hydrated aluminosilicate, in its form containing 90.2% of clinoptilolite, can be incorporated as a feed supplement into quail basal diets at a rate of 3%, owing to its positive effect on fattening performance. Furthermore, the use of zeolite may also contribute to maintaining animal health by reducing humidity in poultry houses and feed.(AU)

Biochemical and hormonal parameters of goats kept in a controlled environment consuming water with different levels of salinity / [Parâmetros bioquímicos e hormonais de caprinos consumindo água com diferentes níveis de salinidade mantidos em ambiente controlado]

The objective of this work was to evaluate the biochemical and hormonal variables of Moxotó and Canindé goats submitted to two temperatures - 26.0±0.6 (thermoneutral) and 32.0±1.2°C (above thermal comfort zone) - and consuming water with three levels of salinity (1.0, 6.0 and 12.0 dSm-1). Thirty-six animals (18 of each breed) were used, with an average age of 5.0±0.6months and an average weight of 20.0±2.3kg, housed in metabolic cages inside a climate chamber. The animals were distributed in a completely randomized design with a 2 × 2 × 3 factorial scheme (2 breeds, 2 temperatures and 3 levels of salinity) and three replications. The glucose and urea had a significant effect (P>0.05) according to water salinity. Glucose, cholesterol, protein, albumin, globulin, aspartate aminotransferase and hormones (T4, T3 and cortisol) varied according to temperature (P<0.05). There was a significant effect of time on hormonal variables (P<0.05). Biochemical and hormonal variables changed according to temperature and day shift, so that metabolism was reduced in the animals under thermal stress and accelerated when animals were in the thermal comfort zone.(AU)

O objetivo do trabalho foi avaliar as variáveis bioquímicas e hormonais de caprinos das raças Moxotó e Canindé, submetidos a duas temperaturas (26,0±0,6ºC e 32,0±1,2ºC), termoneutra e acima da zona de conforto térmico, respectivamente), consumindo água com três níveis de salinidade (1,0, 6,0 e 12,0dSm-1), utilizando-se 36 animais (18 de cada raça), com idade média de 5,0±0,6 meses e peso médio de 20,0±2,3kg, alojados em gaiolas metabólicas no interior de uma câmara climática. Os animais foram distribuídos em um delineamento inteiramente ao acaso, com esquema fatorial de 2 x 2 x 3 (2 raças, 2 temperaturas e 3 níveis de salinidade) e três repetições. A glicose e a ureia apresentaram efeito significativo (P<0,05) em função da salinidade da água. Glicose, colesterol, proteína, albumina, globulina, AST e hormônios (T4, T3 e cortisol) variaram conforme as temperaturas (P<0,05). Observou-se efeito significativo do horário sobre as variáveis hormonais (P<0,05). As variáveis bioquímicas e hormonais sofrem alterações em função da temperatura e do turno do dia, de modo que o metabolismo é reduzido em animais sob estresse térmico e acelerado quando os animais encontram-se na zona de conforto térmico.(AU)

Falsely Increased Plasma Lactate Dehydrogenase without Hemolysis Following Transport through Pneumatic Tube System.

BACKGROUND: Lactate dehydrogenase (LDH) is a nonspecific biomarker for diseases including lymphoma. Serum and plasma are generally considered interchangeable for LDH testing. Investigation into falsely increased plasma LDH concentration results led to the hypothesis that a workflow change that included pneumatic tube system (PTS) transportation caused the errors. The following study was conducted to test the hypothesis. METHODS: Plasma and serum separator tube samples were each drawn in duplicate, centrifuged, transported either through the PTS or by hand courier, and evaluated by means of clinical chemistry and hematology assays. Smear slides were made out of the plasma and examined. Aggregate patient results before and after the PTS workflow change were compared. RESULTS: In post-PTS plasma samples, LDH activity was 26%-149% higher. Similarly, white blood cells (WBCs) were 14- to 156-fold higher and platelets were 1- to 13-fold higher. Smear examination revealed dramatically more cells and cell fragments. No significant hemolysis was observed in plasma by chemistry hemolysis indices or hemoglobin testing. These effects were not observed in similarly transported serum samples in gel separator tubes. Aggregate LDH patient results, including moving medians, demonstrated dramatic changes following PTS workflow implementation. CONCLUSIONS: PTS transportation led to falsely increased LDH concentration in plasma. These LDH concentration elevations are not heralded by standard indicators of hemolysis. These errors can be prevented by restricting LDH concentration testing to serum collected in gel separator tubes. Moving patient statistics can effectively detect important testing process changes not revealed by external QC or indices.

Blood parameters and hepatic histopathology of broilers fed rations supplemented with essential oils

This study aimed to evaluate the hematological profile, hepatic function, and histopathology of mixed-sex broilers fed rations supplemented with microencapsulated essential oils from Cymbopogon flexuosus (lemon grass) and Lippia rotundifolia (chá-de-pedestre). One hundred and fifty Cobb chicks were housed in cages from 1 to 42 days of age in a completely randomized design, with six replicates with five chickens in each of five treatments (150 total chicks): basal diet without antibiotic growth promoter (negative control), diet with enramicina and salinomycin (positive control), diet with lemon grass essential oil, diet with L. rotundifolia essential oil, and diet with a mixture of lemon grass and L. rotundifolia essential oils. Mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH) were significantly lower in untreated broilers (negative control group). Gender was not associated with erythrogram values, but aspartate aminotransferase activity (AST) was higher in females. Gamma-glutamyl transferase (GGT) was higher in chicks in the group that received rations with lemon grass oil. Broilers that received L. rotundifolia oil developed more hepatic lesions, although no effect of sex was observed related to the lesion score. Biliary hyperplasia and fibroplasias were observed in all groups, with higher histopathology scores in broilers that received diets containing L. rotundifolia oil. Mixed-sex broilers fed rations supplemented with lemon grass and L. rotundifolia essential oils have normal complete blood counts and unspecific hepatic lesions and are characterized by lipidosis, hyperplasia of the bile ducts, and fibroplasia.(AU)

Blood parameters of Angus and Nellore young bulls fed diets with or without forage

We evaluated blood parameters of Angus and Nellore bulls fed diets with and without forage. Forty animals with initial body weight (BW) of 380±16.2 kg were housed in individual stalls. Eight bulls of each breed were fed a whole shelled corn (WSC) diet [850 g kg−1 of WCS and 150 g kg−1 of a pellet based on soybean meal, dry mater (DM) basis] or a ground corn with silage (GC) diet (300 g kg−1 of silage and 700 g kg−1 of a concentrate based on corn and soybean meal, DM basis), ad libitum, and four animals of each breed were limited-fed the GC diet [feed restriction (FR), 55% of the DM intake of bulls fed ad libitum, adjusted for the metabolic BW]. Intake was measured daily, and a metabolism trial was conducted with total collection of feces and urine to estimate the ruminally degraded and undegraded protein (intake and nitrogen balance). Blood samples for determination of hormones and metabolites were collected. The data were analyzed using the GLM procedure of SAS adopting a significance level of 0.05. The diet affected only the serum concentrations of triglycerides, HDL, and VLDL, with limited-fed animals presenting smaller concentrations than ad libitum-fed bulls. No difference in blood parameters was observed between animals fed WSC or GC diets. Nellore bulls presented greater T4, cholesterol, HDL, LDL, and serum urea nitrogen concentrations than Angus. Feeding finishing beef cattle with no-roughage diets does not alter their blood parameters. Also, our results support that Zebu cattle might have lower serum removal of nutrients due to a lesser demand for fat and protein deposition than Bos taurus taurus.(AU)

In vitro effect of uremic serum on barrier function and inflammation in human colonocytes / Efeito in vitro do soro urêmico sobre a função de barreira e inflamação em colonócitos humanos

ABSTRACT Introduction: In chronic kidney disease (CKD), it has been suggested that alterations within the gut are associated with an inflammatory state and uremic toxicity. Studies suggest that uremia may impair the function of the intestinal barrier via the promotion of increased intestinal permeability. To understand the mechanisms that are involved in intestinal barrier damage in the setting of uremia, we evaluated the in vitro effect of uremic serum on transepithelial electrical resistance (TER), inflammation, and apoptosis in intestinal epithelial cells (T84). Methods: Pools of serum from healthy individuals, patients not on dialysis, and patients on hemodialysis (Pre-HD and Post-HD) were prepared. T84 cells were incubated for 24 h in medium, of which 10% consisted of the pooled serum from each group. After incubation, the TER was measured and the following parameters were determined by flow cytometry: expression of toll-like receptors (TLRs), production of reactive oxygen species (ROS), and apoptosis. The level of IL-6 in the culture supernatant was determined by ELISA. Results: No difference was observed among the groups with respect to TER, apoptosis, and ROS or the expression of TLR-2, TLR-4, and TLR-9. IL-6 secretion was higher (p < 0.001) in cells that were incubated with pre- and post-HD serum. Conclusion: The results that were obtained from this model suggest that uremic serum per se does not seem to impair the integrity of intestinal epithelial cells. The increased IL-6 secretion by cells that were incubated with HD serum suggests a potential effect of uremia in the intestinal inflammatory response.

RESUMO Introdução: Tem sido sugerido que na doença renal crônica (DRC) a uremia pode causar alterações intestinais, tais como modificações na microbiota e danos à barreira intestinal, e que estas possíveis alterações podem ter uma relação importante com o estado inflamatório e a toxicidade urêmica apresentadas por pacientes com DRC. Objetivos: Avaliar o efeito in vitro do soro urêmico sobre a permeabilidade da monocamada de células epiteliais do intestino, inflamação e apoptose. Métodos: Pools de soro foram preparados a partir de soros de indivíduos saudáveis, pacientes em tratamento conservador e em hemodiálise (Pré e Pós-HD). As células T84 foram incubadas por 24 horas com os diferentes pools. Em seguida a TER foi medida e as células foram submetidas às seguintes análises: apoptose, produção de espécies reativas de oxigênio (EROs) e expressão de receptores toll-like (TLR) por citometria de fluxo e detecção de IL-6 no sobrenadante da cultura por ELISA. Resultados: Não foram encontradas diferenças, entre os grupos, com relação a TER, apoptose, EROs e expressão de TLR-2, TLR-4 e TLR-9. Já a secreção de IL-6 foi maior (p < 0,001) pelas células incubadas com soro pré-HD e pós-HD. Conclusão: Os resultados obtidos a partir deste modelo sugerem que a uremia per se parece não comprometer a integridade das células epiteliais do intestino. O aumento da secreção de IL-6 pelas células incubadas com soro HD (pré e pós) sugere um potencial efeito da uremia sobre a resposta inflamatória intestinal.

In vitro effect of uremic serum on barrier function and inflammation in human colonocytes.

INTRODUCTION: In chronic kidney disease (CKD), it has been suggested that alterations within the gut are associated with an inflammatory state and uremic toxicity. Studies suggest that uremia may impair the function of the intestinal barrier via the promotion of increased intestinal permeability. To understand the mechanisms that are involved in intestinal barrier damage in the setting of uremia, we evaluated the in vitro effect of uremic serum on transepithelial electrical resistance (TER), inflammation, and apoptosis in intestinal epithelial cells (T84). METHODS: Pools of serum from healthy individuals, patients not on dialysis, and patients on hemodialysis (Pre-HD and Post-HD) were prepared. T84 cells were incubated for 24 h in medium, of which 10% consisted of the pooled serum from each group. After incubation, the TER was measured and the following parameters were determined by flow cytometry: expression of toll-like receptors (TLRs), production of reactive oxygen species (ROS), and apoptosis. The level of IL-6 in the culture supernatant was determined by ELISA. RESULTS: No difference was observed among the groups with respect to TER, apoptosis, and ROS or the expression of TLR-2, TLR-4, and TLR-9. IL-6 secretion was higher (p < 0.001) in cells that were incubated with pre- and post-HD serum. CONCLUSION: The results that were obtained from this model suggest that uremic serum per se does not seem to impair the integrity of intestinal epithelial cells. The increased IL-6 secretion by cells that were incubated with HD serum suggests a potential effect of uremia in the intestinal inflammatory response.

Clinical responses to acute blood loss in goats / Respostas clínicas à perda sanguínea aguda em caprinos

The response to blood loss is directly related to the degree of hemorrhage, but for the caprine species some aspects still need to be investigated. Therefore, the present study aimed to assess the clinical and hemodynamic effects of acute blood loss in goats. Eight healthy, adult male crossbred goats were subjected to external jugular puncture to remove 30% of the total blood volume. A physical examination and blood gas, biochemical, and hematologic analyses were performed at baseline, before blood loss (T0), and after one (T1h), six (T6h), 12 (T12h), 24 (T24h) and 72 (T72h) hours, and eight (T8d), 16 (T16d), 24 (T24d) and 32 (T32d) days after the acute blood loss event. The goats presented with tachycardia, tachypnea, and hyperthermia one hour after blood loss with a return to normal physiological values at T6h. Packed cell volume was decreased at T1h and red cell counts at T12h, both returning to baseline at T24d. There was a reduction in total protein and albumin levels at T1h, both remained below baseline levels until T16d and T8d, respectively. The serum calcium concentration decreased over the period T1h to T24h and glucose increased over the period T1h to T6h. The values of pH, TCO2 , bicarbonate, and base excess were lower at T1h, while lactate increased markedly at this time. The pCO2 value only was reduced at T24h. Systolic (PS), diastolic (PD), and mean (PM) pressures were decreased at T1h. Acute loss of 30% of blood volume in goats caused changes in clinical, blood gas, and biochemical parameters, which were restored over a six-hour period, while hematologic changes were more persistent, with baseline values restored only after 24 days.

A resposta clínica à perda de sangue está diretamente relacionada ao grau de hemorragia, mas para a espécie caprinas alguns aspectos ainda precisam ser investigados. Deste modo o presente estudo teve como objetivo avaliar os efeitos clínicos e hemodinâmicos da perda aguda de sangue em caprinos. Oito caprinos adultos, mestiços, hígidos, foram submetidas a punção jugular externa para remoção de 30% do volume total de sangue. Foi realizado exame clínico e análises hematológicas, hemogasométricas e bioquímicas no momento basal, antes da perda de sangue (T0), e uma (T1h), seis (T6h), 12 (T12h), 24 (T24h) e 72 (T72h) horas e oito (T8d), 16 (T16d), 24 (T24d) e 32 (T32d) dias após. As cabras apresentaram taquicardia, taquipneia e hipertermia uma hora após a perda de sangue com retorno aos valores fisiológicos em T6h. O volume globular diminuiu em T1h e a contagem de células vermelhas em T12h, ambos retornando valores basais em T24d. Houve uma redução nos níveis de proteína totais e albumina em T1h, e ambos permaneceram abaixo dos níveis basais até T16d e T8d, respectivamente. A concentração sérica de cálcio diminuiu durante o período T1h para T24h e a glicose aumentou no período T1h a T6h. Os valores de pH, TCO2, bicarbonato e excesso de base foram menores em T1h, enquanto o lactato aumentou acentuadamente neste momento. O pCO2 foi reduzida somente em T24h. As pressões sistólica (PS), diastólica (PD) e média (PM) diminuíram em T1h. A perda aguda de 30% do volume sangüíneo em cabras causou alterações nos parâmetros clínicos, hemogasométricos e bioquímicos, que foram restaurados ao longo de um período de seis horas, enquanto que as alterações hematológicas foram mais persistentes, com valores basais restaurados somente após 24 dias.

Clinical responses to acute blood loss in goats / Respostas clínicas à perda sanguínea aguda em caprinos

The response to blood loss is directly related to the degree of hemorrhage, but for the caprine species some aspects still need to be investigated. Therefore, the present study aimed to assess the clinical and hemodynamic effects of acute blood loss in goats. Eight healthy, adult male crossbred goats were subjected to external jugular puncture to remove 30% of the total blood volume. A physical examination and blood gas, biochemical, and hematologic analyses were performed at baseline, before blood loss (T0), and after one (T1h), six (T6h), 12 (T12h), 24 (T24h) and 72 (T72h) hours, and eight (T8d), 16 (T16d), 24 (T24d) and 32 (T32d) days after the acute blood loss event. The goats presented with tachycardia, tachypnea, and hyperthermia one hour after blood loss with a return to normal physiological values at T6h. Packed cell volume was decreased at T1h and red cell counts at T12h, both returning to baseline at T24d. There was a reduction in total protein and albumin levels at T1h, both remained below baseline levels until T16d and T8d, respectively. The serum calcium concentration decreased over the period T1h to T24h and glucose increased over the period T1h to T6h. The values of pH, TCO2 , bicarbonate, and base excess were lower at T1h, while lactate increased markedly at this time. The pCO2 value only was reduced at T24h. Systolic (PS), diastolic (PD), and mean (PM) pressures were decreased at T1h. Acute loss of 30% of blood volume in goats caused changes in clinical, blood gas, and biochemical parameters, which were restored over a six-hour period, while hematologic changes were more persistent, with baseline values restored only after 24 days.(AU)

A resposta clínica à perda de sangue está diretamente relacionada ao grau de hemorragia, mas para a espécie caprinas alguns aspectos ainda precisam ser investigados. Deste modo o presente estudo teve como objetivo avaliar os efeitos clínicos e hemodinâmicos da perda aguda de sangue em caprinos. Oito caprinos adultos, mestiços, hígidos, foram submetidas a punção jugular externa para remoção de 30% do volume total de sangue. Foi realizado exame clínico e análises hematológicas, hemogasométricas e bioquímicas no momento basal, antes da perda de sangue (T0), e uma (T1h), seis (T6h), 12 (T12h), 24 (T24h) e 72 (T72h) horas e oito (T8d), 16 (T16d), 24 (T24d) e 32 (T32d) dias após. As cabras apresentaram taquicardia, taquipneia e hipertermia uma hora após a perda de sangue com retorno aos valores fisiológicos em T6h. O volume globular diminuiu em T1h e a contagem de células vermelhas em T12h, ambos retornando valores basais em T24d. Houve uma redução nos níveis de proteína totais e albumina em T1h, e ambos permaneceram abaixo dos níveis basais até T16d e T8d, respectivamente. A concentração sérica de cálcio diminuiu durante o período T1h para T24h e a glicose aumentou no período T1h a T6h. Os valores de pH, TCO2, bicarbonato e excesso de base foram menores em T1h, enquanto o lactato aumentou acentuadamente neste momento. O pCO2 foi reduzida somente em T24h. As pressões sistólica (PS), diastólica (PD) e média (PM) diminuíram em T1h. A perda aguda de 30% do volume sangüíneo em cabras causou alterações nos parâmetros clínicos, hemogasométricos e bioquímicos, que foram restaurados ao longo de um período de seis horas, enquanto que as alterações hematológicas foram mais persistentes, com valores basais restaurados somente após 24 dias.(AU)

Effects of two sources of Mexican oregano oil on performance, blood profile, carcass variables, and meat of broilers

The current study was conducted to investigate the effects of Mexican oregano essential oil (MOO) extracts from Lippia berlandieri Schauer (LBS) and Poliomintha longiflora Gray (PLG) on performance, blood profiles, carcass variables, and meat composition of broilers at slaugther. A total of 360 one-day-old Ross broilers were randomly distributed into four dietary treatments with six replicate pens per treatment and 15 birds per pen. The dietary treatments were: a basal diet (control), control + 0.40 g of LBS/kg of feed, control + 0.40 g of PLG/kg, and control + 0.40 g of LBS/kg + 0.40 g of PLG/kg. Results showed that linear, quadratic, and cubic effects of days were significant in the performance variables of broilers. The treatments with LBS and PLG maintained the broiler body weight without increasing feed intake and water intake when compared with the control group. Broilers given LBS+PLG and PLG had increased blood leukocytes, lymphocytes, low-density lipoprotein, and hot carcass yields. In meat composition, treatments with PLG and LBS+PLG presented similar breast protein content compared with the control treatment. Supplementation with these two MOO exhibits positive effects on broiler performance, blood profiles, carcass traits, and meat composition. These two MOO may be promising feed supplements as growth promoters and enhancers of meat quality in broiler production.(AU)

La saturación venosa central de oxígeno es un factor predictor de mortalidad en el paciente con choque séptico / Central venous oxygen saturation is a predictor of mortality in patients with septic shock

Objetivo: determinar si la saturación venosa central de oxigeno inicial (SvCO2) anormal (alta o baja) es un factor predictor de mortalidad en los pacientes con choque séptico que ingresan al área critica de emergencia del hospital "Carlos Andrade Marín". Diseño y lugar: estudio analítico, observacional, prospectivo sobre una cohorte de pacientes que ingresaron al área crítica de emergencia de este hospital. Pacientes: 107 sujetos ingresaron en los meses de junio a septiembre del 2015, con seguimiento para la mortalidad a 28 días. Medidas y resultados: se midió la SvcO2 inicial a través de un catéter venoso central al momento del diagnóstico de choque. La mortalidad a los 28 días fue de 46,2%. Solo los valores de APACHE II (OR:1,11; IC: 1,04 a 1,19 p=< 0,01); la asistencia ventilatoria mecánica (OR:0,19; IC: 0,05 a 0,62, p=<0,01) tuvieron un valor estadístico significativo en regresión logística. APACHE II fue el factor individual más importante, en el modelo CART, el pH arterial y procalcitonina fueron útiles. Conclusiones: la saturación venosa central de O2 inicial (SvcO2) anormal alta o baja no mostró tener utilidad para predecir mortalidad a los 28 días. La medición de la SvcO2 es un método simple que refleja de manera indirecta la oxigenación tisular. El APACHE II es un predictor independiente de mortalidad a 28 días y la ventilación mecánica tuvo una relación inversa con la mortalidad. (AU)

Objective: to determine the central venous saturation of abnormal initial oxygen (SvCO2) (high or low) as a predictor of mortality in patients with septic shock admitted to the emergency area of Carlos Andrade Marín Hospital. Design and location: this is an analytical, observational, prospective study on a cohort of patients admitted to the critical area of emergency of this health unit. Subjects: 107 patients admitted in the months of June to September 2015, with a mortality follow-up of 28-day. Measurements and results: initial SvcO2 was measured by central venous catheter at the time of shock diagnosis. Mortality at 28 days was 46.2%. Only APACHE II values (OR 1.11, CI 1.04-1.19 p = <0.01) and mechanical ventilation (OR 0.19, CI 0.05-0.62, p = 0.01) had significant statistical value in the logistic regression. APACHE II was the most important single factor, in the CART model arterial pH and procalcitonin were useful. Conclusion: Central venous saturation of abnormal or high initial O2 (SvcO2) was not found to be useful in predicting mortality at 28 days of follow-up. Measurement of SvcO2 is a simple method that indirectly reflects tissue oxygenation. The APACHE II is an independent predictor of mortality at 28 days and the use of mechanical ventilation had an inverse relationship with mortality. (AU)

Measuring the Physiologic Properties of Oral Lesions Receiving Fractionated Photodynamic Therapy.

Photodynamic therapy (PDT) can treat superficial, early-stage disease with minimal damage to underlying tissues and without cumulative dose-limiting toxicity. Treatment efficacy is affected by disease physiologic properties, but these properties are not routinely measured. We assessed diffuse reflectance spectroscopy (DRS) for the noninvasive, contact measurement of tissue hemoglobin oxygen saturation (St O2 ) and total hemoglobin concentration ([tHb]) in the premalignant or superficial microinvasive oral lesions of patients treated with 5-aminolevulinic acid (ALA)-PDT. Patients were enrolled on a Phase 1 study of ALA-PDT that evaluated fluences of 50, 100, 150 or 200 J cm(-2) delivered at 100 mW cm(-2) . To test the feasibility of incorporating DRS measurements within the illumination period, studies were performed in patients who received fractionated (two-part) illumination that included a dark interval of 90-180 s. Using DRS, tissue oxygenation at different depths within the lesion could also be assessed. DRS could be performed concurrently with contact measurements of photosensitizer levels by fluorescence spectroscopy, but a separate noncontact fluorescence spectroscopy system provided continuous assessment of photobleaching during illumination to greater tissue depths. Results establish that the integration of DRS into PDT of early-stage oral disease is feasible, and motivates further studies to evaluate its predictive and dosimetric value.

Uremic serum inhibits in vitro expression of chemokine SDF-1: impact of uremic toxicity on endothelial injury.

INTRODUCTION: Endothelial dysfunction is important in the pathogenesis of cardiovascular disease (CVD) related to chronic kidney disease (CKD). Stromal cell-derived factor-1 (SDF-1) is a chemokine which mobilizes endothelial progenitor cells (EPC) and together with interleukin-8 (IL-8) may be used as markers of tissue injury and repair. OBJECTIVE: This study investigated in vivo and in vitro the effect of uremic media on SDF-1 and IL-8 expression. METHODS: Systemic inflammation was assessed by C-reactive protein (CRP) and interleukin-6 (IL-6). IL-8 and SDF-1 were measured as markers of endothelial dysfunction and tissue repair, respectively, by ELISA. In vitro studies were performed on human umbilical vein endothelial cells (HUVEC) exposed to healthy or uremic media. RESULTS: The study included 26 hemodialysis (HD) patients (17 ± 3 months on dialysis, 52 ± 2 years, 38% men and 11% diabetic). Serum concentrations of CRP, IL-6, SDF-1 and IL-8 were 4.9 ± 4.8 mg/ml, 6.7 ± 8.1 pg/ml, 2625.9 ± 1288.6 pg/ml and 128.2 ± 206.2 pg/ml, respectively. There was a positive correlation between CRP and IL-6 (ρ = 0.57, p < 0.005) and between SDF-1 and IL-8 (ρ = 0.45, p < 0.05). In vitro results showed that after 6 hours treatment, SDF-1 expression by HUVEC treated with uremic media is lower compared to cells treated with healthy media (p < 0.05). After 12 hours of treatment there was an increase in IL-8 when HUVECs were exposed to uremic media (p < 0.005). CONCLUSION: We suggest that SDF-1 and IL-8 in HD patients can be used to measure the extent of damage and subsequent vascular activation in uremia.

Soro urêmico inibe a expressão in vitro da quimiocina SDF-1: possível impacto da toxicidade urêmica na lesão endotelial / Uremic serum inhibits in vitro expression of chemokine SDF-1: impact of uremic toxicity on endothelial injury

Introdução: A disfunção endotelial é importante na patogênese da doença cardiovascular (DCV) relacionada à doença renal crônica (DRC). Stromal cell-derived factor-1 (SDF-1) é uma quimiocina que mobiliza células endoteliais progenitoras (EPC) e em conjunto com a interleucina-8 (IL-8) podem ser usadas como marcadores de reparo e lesão tecidual. Objetivo: Neste trabalho, foi investigado o efeito do meio urêmico na expressão de SDF-1 e IL-8 in vivo e in vitro. Métodos: A inflamação sistêmica foi avaliada por meio da proteína C-reativa (PCR) e interleucina-6 (IL-6). IL-8 e SDF-1 foram avaliados por ELISA como marcadores de disfunção endotelial e reparo tecidual, respectivamente. Os estudos in vitro foram realizados em células endoteliais umbilicais humanas (HUVEC) expostas ao meio urêmico ou saudável. Resultados: Foram incluídos nesse estudo 26 pacientes em hemodiálise (HD) (17 ± 3 meses em diálise, 52 ± 2 anos, 38% homens e 11% diabéticos). As concentrações séricas de PCR, IL-6, SDF-1 e IL-8 foram 4,9 ± 4,8 mg/ml, 6,7 ± 8,1 pg/ml, 2625,9 ± 1288,6 pg/ml e 128,2 ± 206,2 pg/ml, respectivamente. Houve correlação positiva entre PCR e IL-6 (ρ = 0,57; p < 0,005) e entre SDF-1 e IL-8 (ρ = 0,45; p < 0,05). Os resultados in vitro demonstraram que a expressão de SDF-1 pelas HUVEC após 6 horas de tratamento com meio urêmico é menor comparada ao tratamento com meio saudável (p < 0,05). Após 12 horas de tratamento, ocorreu aumento de IL-8 quando as HUVECs foram expostas ao meio urêmico (p < 0,005). Conclusão: Sugerimos que SDF-1 e IL-8 nos pacientes em HD podem ser usados para mensurar a extensão do dano e consequente ativação vascular na uremia. .

Introduction: Endothelial dysfunction is important in the pathogenesis of cardiovascular disease (CVD) related to chronic kidney disease (CKD). Stromal cell-derived factor-1 (SDF-1) is a chemokine which mobilizes endothelial progenitor cells (EPC) and together with interleukin-8 (IL-8) may be used as markers of tissue injury and repair. Objective: This study investigated in vivo and in vitro the effect of uremic media on SDF-1 and IL-8 expression. Methods: Systemic inflammation was assessed by C-reactive protein (CRP) and interleukin-6 (IL-6). IL-8 and SDF-1 were measured as markers of endothelial dysfunction and tissue repair, respectively, by ELISA. In vitro studies were performed on human umbilical vein endothelial cells (HUVEC) exposed to healthy or uremic media. Results: The study included 26 hemodialysis (HD) patients (17 ± 3 months on dialysis, 52 ± 2 years, 38% men and 11% diabetic). Serum concentrations of CRP, IL-6, SDF-1 and IL-8 were 4.9 ± 4.8 mg/ml, 6.7 ± 8.1 pg/ml, 2625.9 ± 1288.6 pg/ml and 128.2 ± 206.2 pg/ml, respectively. There was a positive correlation between CRP and IL-6 (ρ = 0.57, p < 0.005) and between SDF-1 and IL-8 (ρ = 0.45, p < 0.05). In vitro results showed that after 6 hours treatment, SDF-1 expression by HUVEC treated with uremic media is lower compared to cells treated with healthy media (p < 0.05). After 12 hours of treatment there was an increase in IL-8 when HUVECs were exposed to uremic media (p < 0.005). Conclusion: We suggest that SDF-1 and IL-8 in HD patients can be used to measure the extent of damage and subsequent vascular activation in uremia. .