Seroprevalence of transfusion-transmissible infections among blood donors in the Hohoe Municipality Hospital, Ghana: 2015-2016: a retrospective hospital-based cross-sectional study

Introduction: unsafe blood remains a major threat to the global spread of transfusion transmissible infections (TTIs). Blood is usually tested for four TTIs: Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV), Hepatitis C Virus (HCV) and Syphilis before transfusion. This study determined the trends of transfusion-transmissible infections among blood donors in the Hohoe Municipal Hospital, Ghana from 2015 to 2016. Methods: a total of 3,173 blood donor records were reviewed for the presence of anti-HIV 1/2 IgG/IgM, HBV, anti-HCV IgG/IgM, and anti-Treponema pallidum IgG/IgM/IgA, using commercial ELISA kits following standard protocols. Statistical analysis was performed using Stata version 14.0 at the level 0.05 Results: seroprevalence of HIV, HBV, HCV and Syphilis were 3.9% 5.0%, 4.2% and 5.2% respectively. Females were 30% less likely to be infected with Syphilis (OR=0.3; 95% CI: (0.15-0.69); p=0.004); donors aged 20-29 years were 60% less likely to be infected with HIV than those less than 20 years (OR=0.6; 95% CI: (0.04-0.99); p=0.049), while those aged 30-39 years were 90% more likely to be infected with Syphilis than those less than 20 years (OR=1.9; 95% CI: (1.23-3.20) p=0.005) and those aged 40-49 years were 2 times more likely to get infected with HBV than those less than 20 years (OR=2.2; 95% CI: (1.17-4.04)); p=0.013). Conclusion: males presented higher prevalence of Syphilis and all TTIs were recorded highest among young adults. It is important to continue screening donated blood with highly sensitive tests and to sensitize young adults, especially females on the importance of blood donation

Medical selection effectiveness inassessing the risk of HIV transmission in blood transfusion in Antananarivo Madagascar

Un défi auquel fait face un centre de transfusion en Afrique consiste à assurer une sécurité transfusionnelle optimale. Il est estimé que 25% des dons de sang collectés en Afrique sub-saharienne francophone sont infectés par des agents viraux (HIV, HBV, HCV), parasitaires (Plasmodium spp., microfilaires) et bactériennes. Méthode : Il s'agit d'une étude rétrospective descriptive effectuée au CRTS Analamanga. L'étude concerne tous les dons enregistrés au CRTS Analamanga durant l'année 2013 et l'année 2014. La prévalence du VIH chez les donneurs de sang durant ces deux périodes a été comparée à celle rapportée dans la population générale. Nous avons comparé la prévalence du VIH au niveau du CRTS en utilisant le test de l'écart-réduit avec les données du SE/CNLS 2013 pour l'année 2013 et les données du SE/CNLS 2014 pour l'année 2014. Résultats: Le nombre de total de dons pour l'année 2013 était de 14316. La prévalence du VIH était de 0,78% (112/14316) (ℇ = 5,46). Pour l'année 2014, le nombre total de dons était de 16551 donnant une prévalence du VIH de 0,28% (472/16551) (ℇ = 0,31) Conclusion : La sélection médicale est le seul moyen le plus efficace pour la réduction des IT par le sang en transfusion en Afrique et à Madagascar. La sélection médicale du donneur avec le questionnaire actuel est inefficace pour diminuer le risque de la transmission du VIH par la transfusion sanguine. Une élaboration d'un nouveau questionnaire est urgente. L'adoption des stratégies adaptées aux réalités locales est bénéfique pour le pays

Analysis of economic and social costs of adverse events associated with blood transfusions in Spain / Análisis de costes económicos y sociales asociados a reacciones adversas de transfusiones sanguíneas en España

Objective: To calculate, for the first time, the direct and social costs of transfusion-related adverse events in order to include them in the National Healthcare System's budget, calculation and studies. In Spain more than 1,500 patients yearly are diagnosed with such adverse events. Method: Blood transfusion-related adverse events recorded yearly in Spanish haemovigilance reports were studied retrospectively (2010-2015). The adverse events were coded according to the classification of Diagnosis-Related Groups. The direct healthcare costs were obtained from public information sources. The productivity loss (social cost) associated with adverse events was calculated using the human capital and hedonic salary methodologies. Results: In 2015, 1,588 patients had adverse events that resulted in direct health care costs (4,568,914Euros) and social costs due to hospitalization (200,724Euros). Three adverse reactions resulted in patient death (at a social cost of 1,364,805Euros). In total, the cost of blood transfusion-related adverse events was 6,134,443Euros in Spain. For the period 2010-2015: the trends show a reduction in the total amount of transfusions (2 vs. 1.91MEuros; -4.4%). The number of adverse events increased (822 vs. 1,588; +93%), as well as their related direct healthcare cost (3.22 vs. 4.57MEuros; +42%) and the social cost of hospitalization (110 vs 200MEuros; +83%). Mortality costs decreased (2.65 vs. 1.36MEuros; -48%). Discussion: This is the first time that the costs of post-transfusion adverse events have been calculated in Spain. These new figures and trends should be taken into consideration in any cost-effectiveness study or trial of new surgical techniques or sanitary policies that influence blood transfusion activities

Objetivo: Calcular por primera vez los costes económicos y sociales relacionados con las reacciones adversas postransfusionales para actualizar estudios e incluirlos en los presupuestos del Sistema Nacional de Salud. En España, anualmente, más de 1500 pacientes sufren dichas reacciones adversas. Método: Se estudiaron retrospectivamente (periodo 2010-2015) las reacciones adversas a la transfusión recopiladas anualmente en los informes nacionales de hemovigilancia. Dichas reacciones se codificaron mediante clasificación de Grupos Relacionados con el Diagnóstico. Los costes directos sanitarios se obtuvieron de fuentes públicas de información. La pérdida en productividad (coste social) asociada a las reacciones adversas se contabilizó utilizando los métodos del capital humano y salarios hedónicos, respectivamente. Resultados: En el año 2015, en España, 1588 pacientes tuvieron reacciones adversas que derivaron en costes sanitarios (4.568.914 Euros) y costes sociales debido a hospitalización (200.724 Euros). Tres reacciones adversas resultaron en muerte del paciente (1.364.805 Euros). Como suma, el coste total de las reacciones adversas a la transfusión fue de 6.134.443 Euros. Periodo 2010-2015: la tendencia refleja una reducción en el número total de transfusiones (2 vs. 1,91 MEuros; -4,4%), un incremento en el número de reacciones adversas (822 vs. 1.588; +93%), en costes sanitarios (3,22 vs. 4,57MEuros; +42%) y en costes sociales (110 vs. 200MEuros; +83%), y un descenso en costes de mortalidad (2,65 vs. 1,36MEuros; -48%). Discusión: Por primera vez se han calculado en España los costes de las reacciones adversas a la transfusión. Los nuevos datos y tendencias deberían ser considerados en estudios de coste-eficiencia sobre técnicas quirúrgicas o políticas sanitarias con repercusión en actividades de transfusión sanguínea

Distrés respiratorio agudo secundario a la transfusión sanguínea / Acute respiratory distress secondary to blood transfusion

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In reply to «Acute respiratory distress secondary to blood transfusion» / En respuesta a «Distrés respiratorio agudo secundario a la transfusión sanguínea»

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A review of blood transfusions in a trauma unit for young children

Background. Trauma is the leading cause of mortality and morbidity worldwide. Blood transfusions play an incremental role in the acute phase, yet practice varies owing to variations in transfusion thresholds and concerns about potential complications, especially in children.Objectives. To evaluate protocol adherence to blood transfusion thresholds in paediatric trauma patients and determine the degree of blood product wastage, as defined by discarded units.Methods. A retrospective, descriptive study of trauma patients (age 0 - 13 years) who received a blood transfusion in the trauma unit at Red Cross War Memorial Children's Hospital, Cape Town, South Africa, over a 5.5-year period (1 January 2009 - 1 July 2014). Haemoglobin (Hb) transfusion thresholds were defined as 10 g/dL for neurotrauma patients and patients requiring skin grafting or a musculocutaneous flap (group 1). All other trauma patients had an Hb transfusion threshold of 7 g/dL (group 2).Results. A total of 144 patients were included (mean age 5.2 years (standard deviation (SD) 3.3), 68.1% male). The mean Hb increase after transfusion was 3.5 g/dL (SD 1.7). Adherence to the transfusion Hb threshold protocol was 96.7% for group 1 v. 34.0% for group 2. No complications were reported. Average blood wastage was 3.5 units per year during the study period.Conclusions. Adherence to paediatric blood transfusion protocol was low in the Hb threshold group <7 g/dL. However, transfusion-related complications and wastage were minimal. Further prospective research is required to determine optimal blood transfusion guidelines for paediatric trauma patients

Resultados de la participación del Departamento de Medicina Transfusional sobre la indicación de sangre desplasmatizada durante el perioperatorio de cirugía cardíaca / Results of the participation of the Transfusion Medicine Department on the indicatio of deplasmatized bloodduring heart surgery preoperative period

Introducción: la transfusión de sangre desplasmatizada es una de las intervenciones más frecuente y variable durante la cirugía cardiaca. Esta puede ser beneficiosa, pero también puede provocar resultados adversos. La mayoría de los estudios en los últimos años han relacionado su administración con un aumento de la morbimortalidad. Material y métodos: realizamos un estudio retrospectivo, observacional, de casos y controles que analizó la asociación de la transfusión de sangre desplasmatizada con la aplicación de un protocolo de atención para optimizar la terapia transfusional en el perioperatorio de cirugía cardíaca. Resultados y conclusiones: mediante la aplicación de este protocolo se observó una disminución en la transfusión de sangre en el intraoperatorio sin producirse cambios en la mortalidad ni en los días de internación.

Abstract Deplasmatized blood transfusion is one of the most frequent and variable interventions during cardiac surgery. It might be beneficial, although it may also cause adverse results. Most recent studies have associated them with an increase in morbimortality. We conducted a study that analysed the association of deplasmatized blood transfusion with the application of a protocol for care to optimize transfusional therapy in the perioperative stages of cardiac surgery. A decrease in blood transfusion in the perioperative stage with no impact in mortality or days of hospitalization was observed upon the application of this protocol.

Resumo A transfusão de sangue desplasmatizada é uma das intervenções mais frequentes e variáveis durante uma cirurgia cardíaca. Esta pode trazer benéficos, mas também pode provocar resultados adversos. A maioria dos estudos nos últimos anos relaciona sua administração com um aumento da morbimortalidade. Realizamos um estudo que analisou a associação da transfusão de sangue desplasmatizada com a aplicação de um protocolo de atendimento para otimizar a terapia transfusional no período perioperatorio de cirurgia cardíaca. A aplicação deste protocolo mostrou uma redução da transfusão de sangue no período intraoperatorio sem que se observassem alterações na mortalidade ou nos dias de internação.

Hemolisina e aglutinina como teste para pesquisa de doadores “O” Perigosos

Atualmente os bancos de sangue produzem hemocompoentes sanguíneos específicos, ondesão transfundidos conforme a necessidade de cada receptor. A rotatividade e o curto períododo tempo de estocagem das plaquetas tornam a sua disponibilidade muitas vezes prejudicada,sendo comum encontrar estoques de serviços de hemoterapia com quantidade baixas deplaqueta, de modo que muitas vezes se faz necessário a transfusão de plaquetas do tipo O empacientes não O, ocasionando a transferência passiva de anticorpos anti-A e anti-B para oreceptor (gerando incompatibilidade ABO menor). Para prevenir possíveis reaçõeshemolíticas decorrentes de transfusões por incompatibilidade menor, há técnicas de pesquisade aglutinina e/ou o teste de hemolisina como medida profilática. Assim, foi realizada umarevisão bibliográfica das técnicas de hemolisina e aglutinina, técnicas empregadas paradiagnosticar doadores de sangue “O” perigosos, na rotina de bancos de sangue, como medidaprofilática para prevenção de reações hemolítica agudas em transfusões de plaquetas nãoisogrupo. A bibliografia foi construída mediante a base de dados PUBMED e BVS-BRASILonde foi selecionado estudos que abordavam testes com hemolisina e ou aglutinina,associados ou não com a pesquisa de antiglobulina direto (TAD). Com a realização doreferente estudo foi possível verificar que atualmente há discordâncias na literatura em seutilizar testes de pesquisa do título de isoaglutinina ou pesquisa de hemolisina para identificardoadores “O” perigosos, pois os resultados do teste de hemolisina e aglutinina não secorrelacionam e que ainda há poucos estudos que possam avaliar as técnicas empregadas paraidentificar doadores “O” perigosos

Currently blood banks produce specific blood blood components, which are transfused asneeded for each receiver. The turnover and short period platelet storage time make itsavailability often impaired, is common to find transfusion service inventories with lowamount of platelets, so that often it is necessary transfusion type platelets in the patients werenot, causing the passive transfer of anti-a and anti-B for the receiver (generating less ABOincompatibility). To prevent possible hemolytic transfusion reactions due to for minorincompatibilities, there agglutinin search techniques and / or hemolysin test as a prophylacticmeasure. Thus, a literature review of the techniques of hemolysin and agglutinin employedtechniques used to diagnose blood donors was carried out "O" dangerous in routine bloodbanks, as a prophylactic measure to prevent acute hemolytic reactions not isogrupo platelettransfusions. The bibliography was built by the database PUBMED and BVS-BRAZIL wherehe was selected studies that addressed tests and hemolysin or agglutinin, associated or notwith the direct antiglobulin search (TAD). With the completion of the referent study weobserved that currently there are disagreements in the literature using isoaglutinina title searchtests or hemolysin research to identify donors "O" dangerous, because the results of thehemolysin and agglutinin test did not correlate and that there are few studies to evaluate thetechniques used to identify donors "the" dangerous

Serious Adverse Transfusion Reactions Reported in the National Recipient-Triggered Trace Back System in Korea (2006-2014)

BACKGROUND: Adverse transfusion reactions (ATRs) are clinically relevant to patients with significant morbidity and mortality. This study aimed to review the cases of ATR reported in the recipient-triggered trace back system for a recent nine-year period in Korea. METHODS: Nine-year data obtained from 2006 to 2014 by the trace back system at the Division of Human Blood Safety Surveillance of the Korean Centers for Disease Control (KCDC) were reviewed. The suspected cases were assessed according to six categories: (i) related to, (ii) probably related to, (iii) probably not related to, (iv) not related to transfusion, (v) unable to investigate, and (vi) under investigation. RESULTS: Since 2006, 199 suspected serious ATRs were reported in hospitals and medical institutions in Korea, and these ATRs were reassessed by the division of Human Blood Safety Surveillance of the KCDC. Among the reported 193 cases as transfusion related infections, hepatitis C virus (HCV) infection (135, 67.8%) was reported most frequently, followed by hepatitis B virus (HBV) infection (27, 13.6%), HIV infection (13, 6.5%), syphilis (9, 4.5%), malarial infection (4, 2.0%), other bacterial infections (3, 1.5%), HTLV infection (1, 0.5%), and scrub typhus infection (1, 0.5%), respectively. Of the 199 cases, 13 (6.5%) cases were confirmed as transfusion-related (3 HCV infections, 3 malarial infections, 1 HBV infection, 2 Staphylococcus aureus sepsis, 3 transfusion-related acute lung injuries, and 1 hemolytic transfusion reaction). CONCLUSIONS: This is the first nationwide data regarding serious ATRs in Korea and could contribute to the implementation of an effective hemovigilance system.

Possible Transfusion-Related Acute Lung Injury Following Convalescent Plasma Transfusion in a Patient With Middle East Respiratory Syndrome

No abstract available.

Frequency and Pattern of Noninfectious Adverse Transfusion Reactions at a Tertiary Care Hospital in Korea

BACKGROUND: Although transfusion is a paramount life-saving therapy, there are multiple potential significant risks. Therefore, all adverse transfusion reaction (ATR) episodes require close monitoring. Using the computerized reporting system, we assessed the frequency and pattern of non-infectious ATRs. METHODS: We analyzed two-year transfusion data from electronic medical records retrospectively. From March 2013 to February 2015, 364,569 units of blood were transfused. Of them, 334,582 (91.8%) records were identified from electronic nursing records. For the confirmation of ATRs by blood bank physicians, patients' electronic medical records were further evaluated. RESULTS: According to the nursing records, the frequency of all possible transfusion-related events was 3.1%. After the blood bank physicians' review, the frequency was found to be 1.2%. The overall frequency of febrile non-hemolytic transfusion reactions (FNHTRs) to red blood cells (RBCs), platelet (PLT) components, and fresh frozen plasmas (FFPs) were 0.9%, 0.3%, and 0.2%, respectively, and allergic reactions represented 0.3% (RBCs), 0.9% (PLTs), and 0.9% (FFPs), respectively. The pre-storage leukocyte reduction significantly decreased the frequency of FNHTRs during the transfusion of RBCs (P<0.01) or PLTs (Pfalling dots0.01). CONCLUSIONS: The frequency of FNHTRs, allergic reactions, and "no reactions" were 22.0%, 17.0%, and 60.7%, respectively. Leukocyte-reduction was associated with a lower rate of FNHTRs, but not with that of allergic reactions. The development of an effective electronic reporting system of ATRs is important in quantifying transfusion-related adverse events. This type of reporting system can also accurately identify the underlying problems and risk factors to further the quality of transfusion care for patients.

Risk Factors for Hepatitis C Virus (HCV) Infection in Areas with a High Prevalence of HCV in the Republic of Korea in 2013

BACKGROUND/AIMS: The prevalence of hepatitis C virus (HCV) infection in Busan, Gyeongnam, and Jeonnam Provinces in Korea is more than twice the national average. This study aimed to examine whether demographic and lifestyle characteristics are associated with HCV infection in these areas. METHODS: A case control study was performed at three study hospitals. HCV cases were matched with two controls for sex and age. Patient controls were selected from non-HCV patients at the same hospital. Healthy controls were subjects participating in medical checkups. Conditional logistic regression models were used. RESULTS: A total of 234 matched-case and patient- and healthy-control pairs were analyzed. The significant risk factors for both controls were sharing razors (adjusted odds ratio [aOR], 2.39 and 3.29, respectively) and having more than four lifetime sexual partners (aOR, 2.15 and 6.89, respectively). Contact dockworkers (aOR, 1.91) and tattoos (aOR, 2.20) were significant risk factors for the patient controls. Transfusion (aOR, 5.38), a bloody operation (aOR, 5.02), acupuncture (aOR, 2.08), and piercing (aOR, 5.95) were significant risk factors for the healthy controls. Needle stick injuries and intravenous drug abuse were significant in the univariate analysis. CONCLUSIONS: More education concerning the dangers of sharing razors, tattoos and piercings is required to prevent HCV infection. More attention should be paid to needle stick injuries in hospitals and the community.

TRALI, una amenaza enmascarada: biología y fisiopatología / TRALI, a masked menace: biology and pathophysiology

El daño pulmonar agudo ocasionado por la transfusión o TRALI (por sus siglas en inglés), definido como la aparición de un distrés respiratorio agudo en un paciente recién transfundido, pasó de ser considerado una complicación infrecuente de la terapia transfusional a ser actualmente la principal causa de mortalidad por transfusión, según sistemas de hemovigilancia de Europa y Norteamérica. Su desarrollo en forma clínicamente reconocible se atribuye a la interacción entre factores dependientes de la unidad transfundida (tipo de componente, presencia de sustancias biológicamente activas, etc.) y el estado de las respuestas celulares en el receptor. La heterogeneidad en cuanto al cuadro clínico de los pacientes afectados, la variación en el volumen infundido, el tipo de componente implicado y el tiempo desde el inicio de la transfusión hasta la aparición de los síntomas, ha hecho evolucionar la explicación a la génesis de este evento adverso, en el afán de incluir los casos sin explicación mediante las distintas hipótesis. Dos interesantes acercamientos patogénicos resultan la teoría de dos golpes y el modelo basado en el umbral que impone la relación entre los distintos factores de riesgo. La naturaleza multicausal del TRALI y el sinnúmero de variables que pueden influir en su aparición y reconocimiento, continúan haciendo de este un reto médico importante en el contexto de la medicina transfusional, donde su mejor enfoque terapéutico sigue siendo el preventivo(AU)

Transfusion-related acute lung injury (TRALI) defined as the onset of an acute respiratory distress in a recently transfused patient, has passed from been considered a rare complication of transfusion therapy to be the leading cause of transfusion-associated death, as reported by hemovigilance systems in Europe and America. In a previous paper definition, epidemiology and some clinical aspects of TRALI are reviewed. Now we focused our efforts in reviewing the incompletely understood world of its pathogenesis. Clinically recognizable TRALI´s development depends on the interaction between risk factors from both the transfused component unit (as the kind of component and substances within it) and receiver patient´s cellular response. Heterogeneity of clinical features, transfused volumes, component type and time elapsed from the beginning of transfusion to the onset of symptoms have pushed the explanations for its genesis to evolve in an effort to include as much cases as the different hypotheses allowed. Two interesting approaches to TRALI´s pathogenesis are the “two hit” theory and the “threshold” model imposed by risk factors interactions. The large diversity of variables and causes which can influence its onset and clinical recognition continue to make it a real challenge for clinicians, mainly within transfusion medicine, where the best therapeutic approach available is prevention(AU)

Efectos adversos en la cadena transfusional en el Instituto de Hematología e Inmunología / Adverse effects of transfusion chain at the Institute of Hematology and Immunology

Introducción: la hemovigilancia requiere de un control organizado sobre los efectos o reacciones adversas que se manifiestan en donantes y receptores de sangre, así como su seguimiento epidemiológico durante toda la cadena transfusional.Objetivo: determinar el estado del reporte de las reacciones adversas en los procesos de donación y transfusión como base a la implantación de un sistema de hemovigilancia.Métodos: se realizó un estudio descriptivo con datos obtenidos de los registros de donaciones y transfusiones de sangre del periodo 2009 -2011 del Departamento de Medicina Transfusional del Instituto de Hematología e Inmunología. Se analizaron los resultados de la pesquisa inicial de infecciones de transmisión sanguínea por las pruebas establecidas en la red de bancos de sangre del país, el número de pacientes transfundidos según tipo de hemocomponente y los reportes de reacciones adversas clasificadas, según lo establecido en los procederes de medicina transfusional. Se calcularon y compraron los valores absolutos y las frecuencias relativas de cada variable.Resultados: se procesaron 4 456 donantes de sangre, de ellos, solamente 83 mujeres (1,86 %). Se rechazaron 216 por positividad a la pesquisa inicial. Se transfundieron 13 884 pacientes con 25 592 unidades de los diferentes hemocomponentes. Se informaron 50 reacciones adversas asociadas a la transfusión (40 inmediatas y 10 tardías), todas de etiología inmune. Se consideró la posibilidad de omisiones en la notificación de las reacciones adversas a la transfusión del tipo no inmune, y de las reacciones adversas durante el proceso de la donación.Conclusiones: debe reforzarse el sistema de reporte de las reacciones adversas a la donación y la transfusión, sobre todo de las tardías no inmunes, particularmente en las de etiología infecciosa(AU)

Introduction: hemovigilance requires an organized control over adverse effects and reactions manifested in blood donors and recipients as well as epidemiologically follow up during the whole transfusional chain.Aim: to determine the accuracy of the report of adverse reactions in donation and transfusion processes in order to establish an hemovigilance system.Methods: a descriptive study was performed with data obtained from donation and transfusion registries from 2009 to 2011 of the Department of Transfusion Medicine of the Institute of Hematology and Immunology. Results of the initial research of blood transmitted infections were analized according to the tests recognized in the Cuban blood bank network, as well as the number of patients receiving transfusion of different hemoderivates and reports of classified adverse reactions, according to transfusion medicine procedures. Absolute values and relative frequencies of each variable were calculated and frequencies compared.Results: 4 456 blood donors were processed, only 83 (1,83 percent) were female and 216 were rejected due to positive serological studies; 13 884 patients were transfused using a total of 25 592 units of the different blood components. Only 50 adverse reactions to transfusion were reported (40 immediate and 10 delayed), all of an immune origin. Possible omissions in notification of non-immune adverse reactions to transfusion or during the donation process were considered.Conclusions: donation and transfusion adverse reactions reporting system must be reinforced emphasizing in delayed non-immune reactions such as those of an infectious origin(AU)

Parameters of the center of pressure displacement on the saddle during hippotherapy on different surfaces

Background: Hippotherapy uses horseback riding movements for therapeutic purposes. In addition to the horse's movement, the choice of equipment and types of floor are also useful in the intervention. The quantification of dynamic parameters that define the interaction of the surface of contact between horse and rider provides insight into how the type of floor surface variations act upon the subject's postural control. Objective: To test whether different types of surfaces promote changes in the amplitude (ACOP) and velocity (VCOP) of the center of pressure (COP) displacement during the rider's contact with the saddle on the horse's back. Method: Twenty two healthy adult male subjects with experience in riding were evaluated. The penetration resistances of asphalt, sand and grass surfaces were measured. The COP data were collected on the three surfaces using a pressure measurement mat. Results: ACOP values were higher in sand, followed by grass and asphalt, with significant differences between sand and asphalt (anteroposterior, p=0.042; mediolateral, p=0.019). The ACOP and VCOP values were higher in the anteroposterior than in the mediolateral direction on all surfaces (ACOP, p=0.001; VCOP, p=0.006). The VCOP did not differ between the surfaces. Conclusion: Postural control, measured by the COP displacement, undergoes variations in its amplitude as a result of the type of floor surface. Therefore, these results reinforce the importance of the choice of floor surface when defining the strategy to be used during hippotherapy intervention. .

The main sceneries of Chagas disease transmission. The vectors, blood and oral transmissions - A comprehensive review

This review deals with transmission of Trypanosoma cruzi by the most important domestic vectors, blood transfusion and oral intake. Among the vectors, Triatoma infestans, Panstrongylus megistus, Rhodnius prolixus, Triatoma dimidiata, Triatoma brasiliensis, Triatoma pseudomaculata, Triatoma sordida, Triatoma maculata, Panstrongylus geniculatus, Rhodnius ecuadoriensis and Rhodnius pallescens can be highlighted. Transmission of Chagas infection, which has been brought under control in some countries in South and Central America, remains a great challenge, particularly considering that many endemic countries do not have control over blood donors. Even more concerning is the case of non-endemic countries that receive thousands of migrants from endemic areas that carry Chagas disease, such as the United States of America, in North America, Spain, in Europe, Japan, in Asia, and Australia, in Oceania. In the Brazilian Amazon Region, since Shaw et al. (1969) described the first acute cases of the disease caused by oral transmission, hundreds of acute cases of the disease due to oral transmission have been described in that region, which is today considered to be endemic for oral transmission. Several other outbreaks of acute Chagas disease by oral transmission have been described in different states of Brazil and in other South American countries.

Trali, una amenaza enmascarada: definición, aspectos epidemiológicos y clínicos / Trali, a masked threat: definition, epidemiological and clinical aspects

El daño pulmonar agudo relacionado con la transfusión o TRALI, como más comúnmente se le conoce, por definición no se diferencia de otros tipos de distrés respiratorios, salvo por su origen demostrable y su estrecha relación temporal con la transfusión. Constituye una de las reacciones adversas más peligrosas del uso de productos sanguíneos y sus peculiares características le permiten enmascararse entre los muchos factores que pueden desencadenar un daño pulmonar agudo, especialmente en algunos pacientes que resultan más susceptibles a su desarrollo. El propósito de esta revisión es hacer un recordatorio de su existencia, sobre todo a aquellos médicos que manejan cotidianamente pacientes demandantes de componentes sanguíneos y cuya condición clínica favorece su aparición. Sus principales variables epidemiológicas (ej: incidencia y mortalidad) varían, a veces de manera notable, entre los distintos informes. La heterogeneidad de criterios aun después de la consecución de consensos internacionales para su diagnóstico, dificulta aprovechar al máximo los datos obtenidos de los distintos estudios realizados sobre su comportamiento y ha promovido la aparición de no pocos resultados contradictorios. Su diagnóstico clínico representa un reto al presentarse en medio de contextos clínicos que hacen plantear otras causas para la aparición del distrés respiratorio. Por ello, muchas veces pasa inadvertido o es mal identificado(AU)

Transfusion-related acute lung injury better known as TRALI, has not differences with other kinds of acute respiratory distress, except for its close relation with transfusion. It is considered among the greatest hazards on blood products use. With its peculiar characteristics it mimics within the many factors that may trigger an acute respiratory distress, especially among those patients at high risk for suffering lung damage after transfusion. The main purpose of this review is to make a recall of the existence of TRALI for those physicians who deal with high transfusion-demanding patients or those with conditions which could represent a risk for its development. TRALI´s main epidemiological variables (such as incidence and mortality) show important variations among different investigations. The criteria heterogeneity, even after the consecution of international diagnostic consensus, has made it difficult to take advantage of the data arose from multiple studies about its behavior, promoting the report of not a few contradictory results on worldwide publications. Diagnosing TRALI represents a real challenge for the clinician since it often appears within the context of various possible causes for an acute respiratory distress. This is why TRALI is frequently overlooked or misdiagnosed(AU)

La interrupción precoz del tratamiento triple con telaprevir de la hepatitis crónica C por efecto adverso grave no presupone necesariamente el fracaso del tratamiento / Early interruption of triple therapy with telaprevir in chronic hepatitis C due to severe adverse effects does not necessarily lead to treatment failure

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CD40 e transfusão de sangue: uma revisão integrativa

A transfusão de concentrados de plaquetas é basicamente indicada em casos de sangramento com trombocitopenia com o objetivo principal de evitar a hemorragia. Entretanto podem ocorrer complicações e reações adversas pós transfusionais, apesar da adoção de medidas preventivas. Entre os fatores pró-inflamatórios derivados de plaquetas, o CD40 tem sido considerado o mediador que mais contribui para tais reações, sendo uma proteína transmembrana e membro da família do fator de necrose tumoral. Nesse contexto optou-se pela revisão integrativa da literatura como método de pesquisa, a fim de reunir e sintetizar os resultados sobre este tópico, buscando as semelhanças e diferenças entre os artigos levantados. O levantamento bibliográfico foi realizado através da base de dados do National Center for Biotechnology Information – NCBI, PubMed, dos quais foram selecionados sete dos 21 artigos encontrados. A partir da leitura dos artigos pôde-se constatar fortes correlações entre a concentração de CD40L e hemocomponentes, principalmente concentrado de plaquetas, bem como seu possível envolvimento em reações transfusionais. A remoção destes mediadores através de técnicas de leucorredução ou adsorção de Ligante de CD40 por beads de celulose podem ser uma alternativa de prevenção para tais reações.

Transfusion of platelet concentrates is basically indicated in cases of bleeding with thrombocytopenia with the main objective to prevent bleeding. However complications and adverse reactions after transfusion can occur, despite the adoption of preventive measures. Among the pro-inflammatory factors derived from platelets, CD40 has been considered the mediator that contributes to such reactions, a transmembrane protein and family member of the tumor necrosis factor. In this context we opted for the integrative literature review as a research method in order to gather and synthesize the results on this topic, looking for similarities and differences between the raised articles. The literature review was conducted by the National Center database for Biotechnology Information – NCBI, PubMed, which were selected eight of the 21 items found. From reading the articles could be observed strong correlations between the concentration of CD40L and blood components, mainly platelet concentrate, and their possible involvement in transfusion reactions. The removal of these mediators by leukoreduction techniques or CD40 Ligand adsorptive cellulose beads may be an alternative for preventing such reactions.