Health-Related Quality of Life after Dengue Fever, Morelos, Mexico, 2016-2017.

We adapted the EQ-5D-3L questionnaire and visual analog scale to assess health-related quality of life (HRQOL) and persistent symptoms in 79 patients with laboratory-confirmed dengue in Morelos, Mexico. The lowest HRQOLs were 0.53 and 38.1 (febrile phase). Patients recovered baseline HRQOL in ≈2 months.

Persulfate Reaction in a Hair-Bleaching Formula: Unveiling the Unconventional Reactivity of 1,13-Diamino-4,7,10-Trioxatridecane.

The stability and unconventional reactivity of 1,13-diamino-4,7,10-trioxatridecane in the presence of NH3, H2O2, and (NH4)2S2O8 are described. The ether-diamine is an ingredient marketed to hair salons and consumers for so-called "plex" services to compensate for hair damage during bleaching. The main reaction product identified is an unexpected azanyl ester derivative. This is considered relevant for the safety evaluation when used in cosmetic products. The mechanism of reaction was explored through DFT calculations. This study represents the first attempt to assess the stability of a plex active in an oxidative environment.

The Important Role for Intravenous Iron in Perioperative Patient Blood Management in Major Abdominal Surgery: A Randomized Controlled Trial.

OBJECTIVE: To determine if preoperative intravenous (IV) iron improves outcomes in abdominal surgery patients. SUMMARY BACKGROUND DATA: Preoperative iron deficiency anemia (IDA) occurs frequently; however if left untreated, increases the risk of blood transfusion allogeneic blood transfusion (ABT). Limited evidence supports IDA treatment with preoperative IV iron. This randomized controlled trial aimed to determine whether perioperative IV iron reduced the need for ABT. METHODS: Between August 2011 and November 2014, 72 patients with IDA were assigned to receive either IV iron or usual care. The primary endpoint was incidence of ABT. Secondary endpoints were various hemoglobin (Hb) levels, change in Hb between time points, length of stay, iron status, morbidity, mortality, and quality of life 4 weeks postsurgery. RESULTS: A 60% reduction in ABT was observed in the IV iron group compared with the usual care group (31.25% vs 12.5%). Hb values, although similar at randomization, improved by 0.8 g/dL with IV iron compared with 0.1 g/dL with usual care (P = 0.01) by the day of admission. The IV iron group had higher Hb 4 weeks after discharge compared with the usual care group (1.9 vs 0.9 g/dL, P = 0.01), and a shorter length of stay (7.0 vs 9.7 d, P = 0.026). There was no difference in discharge Hb levels, morbidity, mortality, or quality of life. CONCLUSIONS: Administration of perioperative IV iron reduces the need for blood transfusion, and is associated with a shorter hospital stay, enhanced restoration of iron stores, and a higher mean Hb concentration 4 weeks after surgery.

Dynamic changes in clot formation determined using thromboelastometry after reinfusion of unwashed anticoagulated cell-salvaged whole blood in total hip arthroplasty.

BACKGROUND: Cell salvage is a key part of patient blood management. Different techniques are available for salvaging blood. A new intra-operative autotransfusion filter system became available for reinfusion of unwashed whole blood. Concern exists regarding whether this technique induces coagulation disturbances, offsetting the benefits of the reinfusion of autologous blood. This study was designed to investigate the content of intra-operatively salvaged filtered blood and its impact after reinfusion on clot formation in patients undergoing primary hip arthroplasty. MATERIALS AND METHODS: Twenty-five patients scheduled for primary total hip arthroplasty were enrolled in the study. Cell salvage was performed using a new intra-operative autotransfusion filter system. Before surgery and within 1 hour of reinfusion of 300 mL or more of salvaged whole blood, blood samples were taken to assess clot formation by thromboelastometry and standard laboratory-based coagulation profiling. Cytokine content of the salvaged blood was assessed by enzyme-linked immunosorbent assays. RESULTS: Following reinfusion of 460 mL (median) of salvaged blood, thromboelastometry showed normal clot formation and did not indicate a coagulopathy. Clotting time, clot formation time, maximum firmness and maximum lysis all remained within the normal range. Standard laboratory coagulation tests were also normal in all patients before surgery and after reinfusion. Although monocyte chemoattractant protein-1 levels were higher than normal, all other measured cytokines were either undetectable or within the normal range. No adverse events were seen following cell salvage. DISCUSSION: Reinfusion of unwashed salvaged whole blood did not alter clot formation in our patients. The results add to the knowledge about this approach and contribute to the growing body of evidence regarding the lack of adverse events when reinfusing unwashed shed blood in major orthopaedic procedures.

Heating capabilities of the Hotline and Autoline at low flow rates.

BACKGROUND: At low flow rates, fluid warmers using coaxial warming tubes are superior in preventing heat loss. This laboratory investigation was performed in order to compare the heating capabilities of two coaxial fluid warmers. METHODS: The Hotline and the Autoline were investigated by using normal saline at various flow rates (10-99 ml x h(-1)). Final infusion temperatures were measured six times in a row at the end of the tubing by using a rapid-response thermometer. Final temperatures were compared with those of infusions, which passed through disposable i.v. tubing covered and warmed using an 'off label' convective air warming system (WarmTouch). Measurements were performed at two different room temperatures (20 and 24 degrees C). Each group was analyzed with respect to differences between various flow rates as well as differences between the groups at comparable flow rates by using a three-way anova with multiple comparisons according to Tukey's procedure. Significance was defined at P < 0.05. RESULTS: Both devices heat infusions at low flow rates efficiently above 34 degrees C, with the Hotline being more effective than the Autoline (P < 0.0001). Except for the lowest flow rate (10 ml x h(-1)), the Hotline delivered infusion temperatures between 38 and 39 degrees C, while the Autoline warmed the infusions upto 36 degrees C. While heating capability of the Hotline was improved with elevated room temperatures at low flow rates (10-60 and 80 ml x h(-1)), the Autoline demonstrated lower infusion temperatures throughout elevated room temperature at flow rates between 20 and 90 ml x h(-1). Both devices heated infusions more efficiently compared with 'off label used' convective air warmer (each with P < 0.0001). CONCLUSIONS: Both the Hotline and the Autoline heated infusions sufficiently at low flow rates. However, the heating capability of the Hotline was superior and can further be increased at low flow rates by increasing the room temperature.