Red-cell alloimmunization profile in multi transfused patients: Findings and insights of a blood transfusion service.

OBJECTIVES: Blood transfusion is a key intervention for decreasing morbidity and mortality in many cases and, besides its importance, potentially fatal consequences of incompatible transfusion are a great risk to patients. This study evaluated the incidence and specificity of erythrocyte alloantibodies in multi-transfused patients enrolled at an important Regional Blood Center. MATERIALS/METHODS: This was a single-center retrospective cohort study that eveluated patients enrolled at a Regional Blood Center in a period of four years. A total of 29,128 patient samples were screened, out of which 79 (0.27%) were multiple-transfused patients with alloantibodies identified. RESULTS: The most common alloantibody found was anti-E (22.55%) followed by anti-D (14.71%), anti-C (5.88%), anti-c (5.88%), anti-e (1.96%) and anti-Cw (0.98%). We also identified combinations of alloantibodies (25.32%), 5.88% of which showed an IgG autoantibody isolated or combined with alloantibodies. The most frequent reason for the need of blood transfusion included cases of surgery, emergency and urgency (36.71%). CONCLUSIONS: A low rate of development of alloantibodies in multi-transfused patients was found, which could be a consequence of the implementation of red blood cell phenotyping for patients who may receive frequent transfusions, as in the case of some hematological neoplasms and hemoglobinopathies. However, the most common alloantibodies identified were against the Rh and/or Kell systems, with high clinical significance since both can cause delayed hemolytic transfusion reactions. Thus, the implementation of reliable antibody screening tests and the transfusion of phenotyped units for selected patients in all transfusion services represent important measures to increase transfusion safety.

Biomechanical analysis in mandibular advancement and occlusal plane rotation with finite element analysis.

We used finite element analysis to assess stress on the cortical bone and plate fixation system, as well as mandibular resistance after sagittal split ramus osteotomy with different mandibular advancements and rotations of the occlusal plane. Three-dimensional mandibular models were obtained, and 6mm and 12mm advancements were planned associated with linear, clockwise, and counter-clockwise rotation of the angle of the occlusal plane. Each model was then fixed with one or two 2.0mm system plates and secured with four monocortical screws. A total of 12 models were built and subjected to a vertical load in the lower central incisor ranging from 50N to 500N in 50N increments. Results showed that the 12mm advancement was associated with higher stress on the bone and plate surface. Additionally, the models fixed with two plates exhibited lower plate stress than those fixed with a single plate. Counter-clockwise rotation of the angle of the mandibular plane in the 6mm advancement caused more plate stress, which did not occur in the 12mm advancement. This analysis has shown that change in the occlusal plane in large mandibular advancements does not act as an additional stress factor. These findings can help to better understand the tensions on bone and plate surfaces in patients who need large mandibular advancements that are associated with a change in the occlusal plane, and will aid better surgical planning.

Detection of White Root Rot in Avocado Trees by Remote Sensing.

White root rot, caused by the soilborne fungus Rosellinia necatrix, is an important constraint to production for a wide range of woody crop plants such as avocado trees. The current methods of detection of white root rot are based on microbial and molecular techniques, and their application at orchard scale is limited. In this study, physiological parameters provided by imaging techniques were analyzed by machine learning methods. Normalized difference vegetation index (NDVI) and normalized canopy temperature (canopy temperature - air temperature) were tested as predictors of disease by several algorithms. Among them, logistic regression analysis (LRA) trained on NDVI data showed the highest sensitivity and lowest rate of false negatives. This algorithm based on NDVI could be a quick and feasible method to detect trees potentially affected by white root rot in avocado orchards.

Structure of arboreal and herbaceous strata in a neotropical seasonally flooded monodominant savanna of Tabebuia aurea.

Large areas in the Pantanal wetland are covered by monodominant formations, e.g. typical landscapes with local names such as "paratudal", dominated by T. aurea. Studies on structure of these formations generally include only woody strata, consequently the species richness registered is usually low due to the absence of the 'ground layer' of herbaceous and others low species. We recorded 13 species, 12 genera and 11 families for the arboreal stratum. Considering arboreal flora without the dominant (T. aurea) individuals showed great establishment in relation to the flood level between 35 - 45 cm while the individuals of the dominant species of 30 - 45 cm. The diameter distribution revealed that the population of T. aurea did not show the reverse J curve, the usual pattern for species in constant regeneration, also evidenced in inconstant Licourt quotient, indicating an episodic recruitment that could lead to future changes in structure. In the herbaceous strata we recorded 78 species, included in 62 genera and 27 families. Using plots method we sampled 46 species, 40 genera and 22 families, while in line interception we found 65 species distributed in 57 genera and 26 families. The floristic similarity of Sørensen between both methods was 59.4%, with 33 species in common, and the method of line interception was more efficient in detecting richness, with 35% more species found in the same time. According to the methods of plots and line interception applied on the woody stratum, our results gave similar detailed information on the structure of this type of savanna, and in spite of being monodominant it shows high species richness when the herbaceous stratum is taken into account. Plots and line interception methods showed similar results for the woody stratum and high species richness of the herbaceous stratum.

Feelings of powerlessness in patients with venous leg ulcers.

OBJECTIVE: To assess feelings of powerlessness in patients with venous leg ulcers. METHOD: An exploratory, descriptive, analytic, cross-sectional study was conducted at the Plastic Surgery Outpatient Clinic of the São Paulo Hospital (HSP) and at the Outpatient Wound-Care Clinic of the Sorocaba Hospital Complex (CHS), Brazil, from May 2010 to April 2012. Sixty patients with venous leg ulcers (VLUs), of both sexes, aged greater than or equal to 18 years, from the two outpatient wound-care clinics were selected to participate in the study. All participants responded to the Powerlessness Assessment Tool (PAT) for adult patients. Statistical analysis was performed using the Chi-square test, Mann-Whitney U test and Kruskal-Wallis test at a significance level of 5% (p<0.05). RESULTS: Forty-four (73%) patients were women and 38 (63%) were aged 61-70 years. Eight (13%) patients were alcoholics and 46 (77%) were smokers. Thirty-two (53%) patients had a VLU for more than 10 years; the ulcer area ranged from 11-20 cm2 in 19 (32%) patients and was >30 cm2 in 18 (30%) patients. Mean total PAT score was 47.83 ± 7.99 and ranged from 51-60 for 31 (52%) patients and from 41-50 for 19 (32%) patients. CONCLUSION: Most patients with venous leg ulcers reported high PAT scores, revealing the presence of strong feelings of powerlessness. DECLARATION OF INTEREST: The authors have no conflicts of interest to declare.

Analysis of the antioxidant response of Nicotiana benthamiana to infection with two strains of Pepper mild mottle virus.

The present study was carried out to investigate the role of reactive oxygen species (ROS) metabolism in symptom development and pathogenesis in Nicotiana benthamiana plants upon infection with two strains of Pepper mild mottle virus, the Italian (PMMoV-I) and the Spanish (PMMoV-S) strains. In this host, it has been shown that PMMoV-I is less virulent and plants show the capability to recover 21 d after inoculation. Analyses of oxidative stress biomarkers, ROS-scavenging enzyme activities, and antioxidant compounds were conducted in plants at different post-infection times. Only PMMoV-I stimulated a defence response through: (i) up-regulation of different superoxide dismutase isozymes; (ii) maintenance of adequate levels of three peroxiredoxins (2-Cys Prx, Prx IIC, and Prx IIF); and (iii) adjustments in the glutathione pool to maintain the total glutathione content. Moreover, there was an increase in the level of oxidized glutathione and ascorbate in the recovery phase of PMMoV-I-infected plants. The antioxidant response and the extent of oxidative stress in N. benthamiana plants correlates to: (i) the severity of the symptoms elicited by either strain of PMMoV; and (ii) the high capacity of PMMoV-I-infected plants for symptom recovery and delayed senescence, compared with PMMoV-S-infected plants.

Fungos veiculados por sementes comerciais de braquiária / Fungi associated to commercial seed of braquiaria grass

Este trabalho objetivou avaliar a qualidade sanitária de 50 lotes comerciais de sementes de braquiária, produzidos em diferentes regiões nas safras de 2004-2005 e 2005-2006. Sementes de Brachiaria brizantha cvs. Marandu e Xaraés, B. decumbens cv. Basilisk, B. humidicola cv. Humidicola e B. ruziziensis cv. Ruziziensis, destinadas ao comércio interno, foram submetidas ao teste de sanidade pelo método de papel de filtro. Adicionalmente, avaliou-se a sanidade de sementes de 'Marandu' (2 lotes) e 'Basilisk' (1 lote) destinadas à exportação. As sementes foram distribuídas sobre papel de filtro acondicionado em gerbox e incubadas a 20º C, com fotoperíodo de 12h, durante sete dias. Os fungos secundários ou de armazenamento (FSA) mais frequentemente detectados nos lotes de braquiária foram Aspergillus sp. e Rhizopus sp. Quanto aos fungos potencialmente patogênicos (FP), constatou-se elevada frequência dos gêneros Bipolaris. Curvularia. Fusarium e Phoma. Em geral, foi elevada a incidência de Bipolaris sp., Fusarium sp. e Phoma sp. nas sementes. A ocorrência de Phoma sp. foi crítica, pois 42% dos lotes registraram índices superiores a 70%. Bipolaris sp., Fusarium sp. e Phoma sp. também foram associados às sementes de braquiária tipo exportação, em alguns casos, com incidência considerável. Os resultados revelaram que as sementes comerciais de braquiária apresentam baixa qualidade sanitária e que, em todas as regiões produtoras, existe pelo menos um fator afetando a sanidade dessas sementes.

This work aimed to evaluate the sanitary quality of 50 commercial lots of seeds of braquiaria grass, produced in different regions in the crop of 2004­2005 and 2005­2006. The lots consisted of seeds of the cultivars Brachiaria brizantha cvs. Marandu and Xaraes, B. decumbens cv. Basilisk, B. humidicola cv. Humidicola and B. ruziziensis cv. Ruziziensis. Additionally, seeds of 'Marandu' (2 lots) and 'Basilisk' (1 lot) for exportation were analyzed. The blotter test was used, at 20º C under alternating light and darkness in a 12h photoperiod, for 7 days. Aspergillus sp. and Rhizopus sp. were the secondary or storage fungi with greatest frequency in lots of seeds. High frequency of potential pathogenic fungi, specifically of the Bipolaris. Curvularia. Fusarium and Phoma genera, was observed. In general, there was a high incidence of Bipolaris sp., Fusarium sp. and Phoma sp. in braquiaria grass seeds. The occurrence of Phoma sp. was severe, because 42% of the lots showed incidence superior to 70%. Bipolaris sp., Fusarium sp. and Phoma sp. were associated to braquiaria grass seeds for exportation, in some cases, with significant incidence. The results evidenced the low sanitary quality of commercial seeds of braquiaria grass, and demonstrated that in all producer regions there is at least one factor affecting the sanitary quality of these seeds.

Once-daily, low-cost, highly effective Helicobacter pylori treatment to family members of gastric cancer patients.

BACKGROUND: Helicobacter pylori eradication in family members of gastric cancer patients is now widely accepted, although problems related to costs and compliance persist. AIM: To compare the efficacy, tolerability and long-term re-infection rates of two once-daily regimens for the eradication of H. pylori in family members of gastric cancer patients. METHODS: 106 first-degree family members of gastric cancer patients were recruited and submitted to the 13C-urea breath test (UBT) to detect H. pylori. If positive, they were randomly allocated to receive a combination of lanzoprazole 30 mg, clarithromycin OD (extended-release formulation) 500 mg and furazolidone 400 mg, once daily, in the morning, for 7 days (Group A) or the same regimen with only 200 mg furazolidone (Group B). Eradication was confirmed by urea breath test performed 6 weeks after treatment. 13C-urea breath test was repeated at 944 (784-1258) days after treatment in successfully treated participants to look for re-infection. RESULTS: Twenty-five participants were H. pylori negative and two H. pylori-positive individuals refused to sign the informed consent and were excluded. Therefore, 79 participants were studied. Forty participants were allocated to Group A and 39 to Group B. All participants completed treatment. Adverse effects, mostly mild, were observed in 18% of Group A and 18% of Group B (N.S.). The intention-to-treat eradication rate was 87.5% in Group A and 61.5% in Group B (P = 0.006). The mean annual re-infection rate was 3%. CONCLUSIONS: The combination of lanzoprazole 30 mg, one tablet of clarithromycin OD (extended release formulation) 500 mg and furazolidone 400 mg, once daily for 7 days, constitutes an inexpensive, safe and effective alternative for anti-H. pylori therapy in family members of gastric cancer patients.

El Concepto Halliwick como base de la hidroterapia infantil / The Halliwick concept as a base for the children´s hydrotherapy

El Concepto Halliwick contribuye significativamente en los programas de tratamiento hidroterápico, utilizando el agua en toda su amplitud como medio para la rehabilitación. Se emplea en gran parte del mundo con niños que presentan diferentes patologías, entre las que destaca la parálisis cerebral. Esta metodología, basada en anatomía, psicología y principios de hidrodinámica, combina el entrenamiento motórico con el placer que produce el juego. Las sesiones se realizan generalmente en grupo y tienen lugar una o dos veces por semana, requiriendo la presencia y colaboración de los padres (AU)

The Wada test with propofol in a patient with epilepsy.

The usual drug used in the Wada test is amobarbital, but it is not available in Brazil. Propofol was already used by Bazin et al. in 1998, and in their report the test resulted good in the absence of any adverse effect. We report the use of propofol as the anesthetic for the Wada test. The test was carried out in a 26 years old woman with temporal medial lobe epilepsy refractory to medical treatment. Language functions and memory were tested after injection in both hemispheres by three procedures (Seattle, Montreal and Interview procedures). Propofol showed to be good to carry on the Wada test.

Application of isotope-selective non-dispersive infrared spectrometry for the evaluation of the 13C-urea breath test: comparison with three concordant methods.

The aim of this work was to compare the performance of isotope-selective non-dispersive infrared spectrometry (IRIS) for the 13C-urea breath test with the combination of the 14C-urea breath test (14C-UBT), urease test and histologic examination for the diagnosis of H. pylori (HP) infection. Fifty-three duodenal ulcer patients were studied. All patients were submitted to gastroscopy to detect HP by the urease test, histologic examination and 14C-UBT. To be included in the study the results of the 3 tests had to be concordant. Within one month after admission to the study the patients were submitted to IRIS with breath samples collected before and 30 min after the ingestion of 75 mg 13C-urea dissolved in 200 ml of orange juice. The samples were mailed and analyzed 11.5 (4-21) days after collection. Data were analyzed statistically by the chi-square and Mann-Whitney test and by the Spearman correlation coefficient. Twenty-six patients were HP positive and 27 negative. There was 100% agreement between the IRIS results and the HP status determined by the other three methods. Using a cutoff value of delta-over-baseline (DOB) above 4.0 the IRIS showed a mean value of 19.38 (minimum = 4.2, maximum = 41.3, SD = 10.9) for HP-positive patients and a mean value of 0.88 (minimum = 0.10, maximum = 2.5, SD = 0.71) for negative patients. Using a cutoff value corresponding to 0.800% CO2/weight (kg), the 14C-UBT showed a mean value of 2.78 (minimum = 0.89, maximum = 5.22, SD = 1.18) in HP-positive patients. HP-negative patients showed a mean value of 0.37 (minimum = 0.13, maximum = 0.77, SD = 0.17). IRIS is a low-cost, easy to manage, highly sensitive and specific test for H. pylori detection. Storing and mailing the samples did not interfere with the performance of the test.

Application of isotope-selective non-dispersive infrared spectrometry for the evaluation of the 13C-urea breath test: comparison with three concordant methods

The aim of this work was to compare the performance of isotope-selective non-dispersive infrared spectrometry (IRIS) for the 13C-urea breath test with the combination of the 14C-urea breath test (14C-UBT), urease test and histologic examination for the diagnosis of H. pylori (HP) infection. Fifty-three duodenal ulcer patients were studied. All patients were submitted to gastroscopy to detect HP by the urease test, histologic examination and 14C-UBT. To be included in the study the results of the 3 tests had to be concordant. Within one month after admission to the study the patients were submitted to IRIS with breath samples collected before and 30 min after the ingestion of 75 mg 13C-urea dissolved in 200 ml of orange juice. The samples were mailed and analyzed 11.5 (4-21) days after collection. Data were analyzed statistically by the chi-square and Mann-Whitney test and by the Spearman correlation coefficient. Twenty-six patients were HP positive and 27 negative. There was 100 per cent agreement between the IRIS results and the HP status determined by the other three methods. Using a cutoff value of delta-over-baseline (DOB) above 4.0 the IRIS showed a mean value of 19.38 (minimum = 4.2, maximum = 41.3, SD = 10.9) for HP-positive patients and a mean value of 0.88 (minimum = 0.10, maximum = 2.5, SD = 0.71) for negative patients. Using a cutoff value corresponding to 0.800 per cent CO2/weight (kg), the 14C-UBT showed a mean value of 2.78 (minimum = 0.89, maximum = 5.22, SD = 1.18) in HP-positive patients. HP-negative patients showed a mean value of 0.37 (minimum = 0.13, maximum = 0.77, SD = 0.17). IRIS is a low-cost, easy to manage, highly sensitive and specific test for H. pylori detection. Storing and mailing the samples did not interfere with the performance of the test.