Effect of 830 nm Diode Laser Irradiation of Root Canal on Bond Strength of Metal and Fiber Post.

OBJECTIVE AND BACKGROUND: The correct selections of the cementing agent, the endodontic post material and placement protocol are critical to provide an increased longevity of the teeth that went through endodontic treatment. The irradiation with diode laser before post cementation, can promote an antimicrobial effect. However, there is a lack of information about the effect of 830 nm diode laser on the post bond strength. This study analyzed the effect of dentin root canal irradiation with high-intensity diode laser, at 830 nm, operating in continuous or pulsed mode, on the retention of metal or fiber posts, cemented with self-etching resinous composite (Panavia F) and zinc phosphate cement (ZnPO4). MATERIALS AND METHODS: Human roots were irradiated with diode laser (continuous and pulsed mode). The fiber posts were luted with Panavia F and the metal posts with Panavia F or ZnPO4 cement. Specimens were sectioned into three sections (cervical, middle, and apical). The bond strength was measured by a push-out mechanical analysis. For the statistical analysis, a three-way ANOVA test was applied following a Tukey's pairwise comparison with a significance level of p = 0.05. RESULTS: The irradiated groups presented higher bond strength compared with nonirradiated group (p < 0.05), and the cervical and middle thirds presented higher on bond strength than the apical. The association of metal post and Panavia F presented higher bond strength when irradiated on continuous mode (p < 0.05). Fiber post and Panavia F presented higher bond strength associated to pulsed mode. The mode seems not to make a significant difference. CONCLUSIONS: These results corroborate the importance of the post bond to dentin and root canal debris removal to increase the tooth longevity. It was shown that the dentin to post bond strength were enhanced by the diode laser irradiation either on continuous or pulsed modes.

Evaluation of low-level laser therapy in the treatment of masticatory muscles spasticity in children with cerebral palsy.

Spasticity is a motor disorder frequently present in individuals with cerebral palsy (CP). This study aimed to evaluate the effect of low-level laser therapy (LLLT) on the spasticity of the masseter and anterior temporal muscle fibers in children with CP over three weeks of intermittent laser exposures. The bite force (BF) of the masticatory muscles and the amplitude of mouth opening were evaluated before and after laser irradiation in 30 children with CP. Both sides of the masseter and temporalis muscles were irradiated with low-intensity diode laser pulses of 808-nm wavelength six times over three consecutive weeks. During the subsequent three weeks of postlaser exposures, although no laser treatment was applied, the evaluation parameters were measured and recorded. A significant improvement in the amplitude of mouth opening and a decrease in the BF were observed in the weeks following LLLT (P<0.05 ). However, by the sixth week post-LLLT, the BF and the amplitude of mouth opening reverted to values equivalent to those obtained before the first application of LLLT. Our investigation revealed low-level energy exposures from a 808-nm diode laser to be an effective short-term therapeutic tool. This method increased the amplitude of mouth opening and decreased the muscle tonus of children with spastic CP over a time course of three weeks of intermittent laser applications.

Evaluation of the effectiveness of packed red blood cell irradiation by a linear accelerator.

Irradiation of blood components with ionizing radiation generated by a specific device is recommended to prevent transfusion-associated graft-versus-host disease. However, a linear accelerator can also be used in the absence of such a device, which is the case of the blood bank facility studied herein. In order to evaluate the quality of the irradiated packed red blood cells, this study aimed to determine whether the procedure currently employed in the facility is effective in inhibiting the proliferation of T lymphocytes without damaging blood components. The proliferation of T lymphocytes, plasma potassium levels, and the degree of hemolysis were evaluated and compared to blood bags that received no irradiation. Packed red blood cell bags were irradiated at a dose of 25Gy in a linear accelerator. For this purpose, a container was designed to hold the bags and to ensure even distribution of irradiation as evaluated by computed tomography and dose-volume histogram. Irradiation was observed to inhibit the proliferation of lymphocytes. The percentage of hemolysis in irradiated bags was slightly higher than in non-irradiated bags (p-value >0.05), but it was always less than 0.4% of the red cell mass. Although potassium increased in both groups, it was more pronounced in irradiated red blood cells, especially after seven days of storage, with a linear increase over storage time. The findings showed that, at an appropriate dosage and under validated conditions, the irradiation of packed red blood cells in a linear accelerator is effective, inhibiting lymphocyte proliferation but without compromising the viability of the red cells.

Evaluation of the effectiveness of packed red blood cell irradiation by a linear accelerator

Irradiation of blood components with ionizing radiation generated by a specific device is recommended to prevent transfusion-associated graft-versus-host disease. However, a lin- ear accelerator can also be used in the absence of such a device, which is the case of the blood bank facility studied herein. In order to evaluate the quality of the irradiated packed red blood cells, this study aimed to determine whether the procedure currently employed in the facility is effective in inhibiting the proliferation of T lymphocytes without damaging blood components. The proliferation of T lymphocytes, plasma potassium levels, and the degree of hemolysis were evaluated and compared to blood bags that received no irradiation. Packed red blood cell bags were irradiated at a dose of 25 Gy in a linear accelerator. For this purpose, a container was designed to hold the bags and to ensure even distribution of irradiation as evaluated by computed tomography and dose-volume histogram. Irradiation was observed to inhibit the proliferation of lymphocytes. The percentage of hemolysis in irradiated bags was slightly higher than in non-irradiated bags (p-value >0.05), but it was always less than 0.4% of the red cell mass. Although potassium increased in both groups, it was more pronounced in irradiated red blood cells, especially after seven days of storage, with a linear increase over storage time. The findings showed that, at an appropriate dosage and under validated conditions, the irradiation of packed red blood cells in a linear accelerator is effective, inhibiting lymphocyte proliferation but without compromising the viability of the red cells.

HIV/Sida y los principios de non-discriminación y non-estigmatización / HIV/AIDS and the principle of non-discrimination and non-stigmatization / HIV/Aids e os princípios da não-discriminação e não-estigmatização

The text examines the article 11 of the Universal Declaration on Bioethics and Human Rights of UNESCO that deals with the principle of non-discrimination and non-stigmatization. Both concepts are related to the theme of human dignity, while discrimination is an inherent part of stigma: stigma does not exist if there is no discrimination. In this context, this paper aims to study the relationship between stigma, discrimination and HIV / AIDS. The study argues that to loosen the bonds that hold the subjects that are attached to them is necessary questioning the broader forces - social, cultural, political and economic - that structure stigma, stigmatization and discrimination as social processes directly linked to production and reproduction of structural inequalities...

El texto analiza el artículo 11 de la Declaración Universal sobre Bioética y Derechos Humanos de la Unesco que trata del principio de la no-discriminación y la no-estigmatización. Ambos conceptos están relacionados con el tema de la dignidad humana, al mismo tiempo en que la discriminación es parte inherente del estigma; no existe estigma si no hay discriminación. En este contexto, el trabajo pretende estudiar la relación entre estigma, discriminación y el HIV/Sida. El estudio defiende que para soltar las amarras que prenden los sujetos que están presos a ellas es necesario cuestionar las propias fuerzas más amplias – sociales, culturales, políticas y económicas – que estructuran el estigma, la estigmatización y la discriminación como procesos sociales directamente ligados a la producción y la reproducción de las desigualdades estructurales...

O texto analisa o artigo 11 da Declaração Universal sobre Bioética e Direitos Humanos da UNESCO que trata do princípio da não-discriminação e não-estigmatização. Ambos os conceitos estão relacionados com o tema da dignidade humana, ao mesmo tempo que a discriminação é parte inerente do estigma: não existe estigma se não houver discriminação. Neste contexto, o trabalho objetiva estudar a relação entre estigma, discriminação e o HIV/Aids. O estudo defende que para soltar as amarras que prendem os sujeitos que estão presos a elas é necessário questionar as próprias forças mais amplas - sociais, culturais, políticas e econômicas - que estruturam o estigma, a estigmatização e a discriminação como processos sociais diretamente ligados à produção e reprodução de desigualdades estruturais...

Etiology of anemia of blood donor candidates deferred by hematologic screening.

OBJECTIVE: Iron deficiency is the most common cause of anemia and one of the main factors in the clinical deferral of blood donors. This fact prompted the current study that aimed to determine the prevalence and etiology of anemia in blood donor candidates and to evaluate the hematological screening technique used for the exclusion of these donors. METHODS: This was a prospective study that compared two groups (Anemic and Non-anemic). Initially screening for anemia was performed by manually measuring hemoglobin (Bioclin(®) Kit); the results were subsequently compared with an automated screening method (Coulter T-890). The etiology was investigated by hemoglobin electrophoresis in alkaline and acid pH, Hb A2 dosage and measurement of the ferritin concentration by immunoagglutination. Differences and associations of interest were analyzed using the Yates and McNemar's Chi-square tests and the Fisher, Mann-Whitney, Wilcoxon and Kruskal-Wallis tests. RESULTS: The deferral rate due to anemia was 4.2%; iron deficiency was identified in 37.5% and beta thalassemia in 9.3% of the excluded candidates. There was a significant discrepancy between the two techniques used to measure hemoglobin with 38.1% of initially deferred donors presenting normal hemoglobin levels by the automated method. CONCLUSION: The results show a high rate of blood donors being deferred for anemia and confirm that iron deficiency is the most prevalent cause. The discrepancies found by comparing screening methods suggest that hemoglobin and hematocrit levels should be confirmed before deferring a donor due to anemia; this may increase supplies in blood banks.

Alloimmunization screening after transfusion of red blood cells in a prospective study.

BACKGROUND: Several irregular red blood cell alloantibodies, produced by alloimmunization of antigens in transfusions or pregnancies, have clinical importance because they cause hemolysis in the fetus and newborn and in transfused patients. OBJECTIVE: a prospective analysis of patients treated by the surgical and clinical emergency services of Hospital de Clínicas of the Universidade Federal do Triângulo Mineiro (HC/UFTM), Brazil was performed to correlate alloimmunization to clinical and epidemiological data. METHODS: Blood samples of 143 patients with initial negative antibody screening were collected at intervals for up to 15 months after the transfusion of packed red blood cells. Samples were submitted to irregular antibody testing and, when positive, to the identification and serial titration of alloantibodies. The Fisher Exact test and Odds Ratio were employed to compare proportions. RESULTS: Fifteen (10.49%) patients produced antibodies within six months of transfusion. However, for 60% of these individuals, the titers decreased and disappeared by 15 months after transfusion. Anti-K antibodies and alloantibodies against antigens of the Rh system were the most common; the highest titer was 1:32 (anti-K). There was an evident correlation with the number of transfusions. CONCLUSIONS: Given the high incidence of clinically important red blood cell alloantibodies in patients transfused in surgical and clinical emergency services, we suggest that phenotyping and pre-transfusion compatibilization for C, c, E, e (Rh system) and K (Kell system) antigens should be extended to all patients with programmed surgeries or acute clinical events that do not need emergency transfusions.

Etiology of anemia of blood donor candidates deferred by hematologic screening

OBJECTIVE: Iron deficiency is the most common cause of anemia and one of the main factors in the clinical deferral of blood donors. This fact prompted the current study that aimed to determine the prevalence and etiology of anemia in blood donor candidates and to evaluate the hematological screening technique used for the exclusion of these donors. METHODS: This was a prospective study that compared two groups (Anemic and Non-anemic). Initially screening for anemia was performed by manually measuring hemoglobin (Bioclin® Kit); the results were subsequently compared with an automated screening method (Coulter T-890). The etiology was investigated by hemoglobin electrophoresis in alkaline and acid pH, Hb A2 dosage and measurement of the ferritin concentration by immunoagglutination. Differences and associations of interest were analyzed using the Yates and McNemar's Chi-square tests and the Fisher, Mann-Whitney, Wilcoxon and Kruskal-Wallis tests. RESULTS: The deferral rate due to anemia was 4.2%; iron deficiency was identified in 37.5% and beta thalassemia in 9.3% of the excluded candidates. There was a significant discrepancy between the two techniques used to measure hemoglobin with 38.1% of initially deferred donors presenting normal hemoglobin levels by the automated method. CONCLUSION: The results show a high rate of blood donors being deferred for anemia and confirm that iron deficiency is the most prevalent cause. The discrepancies found by comparing screening methods suggest that hemoglobin and hematocrit levels should be confirmed before deferring a donor due to anemia; this may increase supplies in blood banks.

Alloimmunization screening after transfusion of red blood cells in a prospective study

BACKGROUND: Several irregular red blood cell alloantibodies, produced by alloimmunization of antigens in transfusions or pregnancies, have clinical importance because they cause hemolysis in the fetus and newborn and in transfused patients. OBJECTIVE: a prospective analysis of patients treated by the surgical and clinical emergency services of Hospital de Clínicas of the Universidade Federal do Triângulo Mineiro (HC/UFTM), Brazil was performed to correlate alloimmunization to clinical and epidemiological data. METHODS: Blood samples of 143 patients with initial negative antibody screening were collected at intervals for up to 15 months after the transfusion of packed red blood cells. Samples were submitted to irregular antibody testing and, when positive, to the identification and serial titration of alloantibodies. The Fisher Exact test and Odds Ratio were employed to compare proportions. RESULTS: Fifteen (10.49%) patients produced antibodies within six months of transfusion. However, for 60% of these individuals, the titers decreased and disappeared by 15 months after transfusion. Anti-K antibodies and alloantibodies against antigens of the Rh system were the most common; the highest titer was 1:32 (anti-K). There was an evident correlation with the number of transfusions. CONCLUSIONS: Given the high incidence of clinically important red blood cell alloantibodies in patients transfused in surgical and clinical emergency services, we suggest that phenotyping and pre-transfusion compatibilization for C, c, E, e (Rh system) and K (Kell system) antigens should be extended to all patients with programmed surgeries or acute clinical events that do not need emergency transfusions.

Identification of platelet refractoriness in oncohematologic patients.

OBJECTIVES: To identify the occurrence and the causes of platelet refractoriness in oncohematologic patients. INTRODUCTION: Platelet refractoriness (unsatisfactory post-transfusion platelet increment) is a severe problem that impairs the treatment of oncohematologic patients and is not routinely investigated in most Brazilian services. METHODS: Forty-four episodes of platelet concentrate transfusion were evaluated in 16 patients according to the following parameters: corrected count increment, clinical conditions and detection of anti-platelet antibodies by the platelet immunofluorescence test (PIFT) and panel reactive antibodies against human leukocyte antigen class I (PRA-HLA). RESULTS: Of the 16 patients evaluated (median age: 53 years), nine (56%) were women, seven of them with a history of pregnancy. An unsatisfactory increment was observed in 43% of the transfusion events, being more frequent in transfusions of random platelet concentrates (54%). Platelet refractoriness was confirmed in three patients (19%), who presented immunologic and non-immunologic causes. Alloantibodies were identified in eight patients (50%) by the PIFT and in three (19%) by the PRA-HLA. Among alloimmunized patients, nine (64%) had a history of transfusion, and three as a result of pregnancy (43%). Of the former, two were refractory (29%). No significant differences were observed, probably as a result of the small sample size. CONCLUSION: The high rate of unsatisfactory platelet increment, refractoriness and alloimmunization observed support the need to set up protocols for the investigation of this complication in all chronically transfused patients, a fundamental requirement for the guarantee of adequate management.

Identification of platelet refractoriness in oncohematologic patients

OBJECTIVES: To identify the occurrence and the causes of platelet refractoriness in oncohematologic patients. INTRODUCTION: Platelet refractoriness (unsatisfactory post-transfusion platelet increment) is a severe problem that impairs the treatment of oncohematologic patients and is not routinely investigated in most Brazilian services. METHODS: Forty-four episodes of platelet concentrate transfusion were evaluated in 16 patients according to the following parameters: corrected count increment, clinical conditions and detection of anti-platelet antibodies by the platelet immunofluorescence test (PIFT) and panel reactive antibodies against human leukocyte antigen class I (PRA-HLA). RESULTS: Of the 16 patients evaluated (median age: 53 years), nine (56 percent) were women, seven of them with a history of pregnancy. An unsatisfactory increment was observed in 43 percent of the transfusion events, being more frequent in transfusions of random platelet concentrates (54 percent). Platelet refractoriness was confirmed in three patients (19 percent), who presented immunologic and non-immunologic causes. Alloantibodies were identified in eight patients (50 percent) by the PIFT and in three (19 percent) by the PRA-HLA. Among alloimmunized patients, nine (64 percent) had a history of transfusion, and three as a result of pregnancy (43 percent). Of the former, two were refractory (29 percent). No significant differences were observed, probably as a result of the small sample size. CONCLUSION: The high rate of unsatisfactory platelet increment, refractoriness and alloimmunization observed support the need to set up protocols for the investigation of this complication in all chronically transfused patients, a fundamental requirement for the guarantee of adequate management.

Prevalência de inaptidão sorológica pelo vírus HCV em doadores de sangue no hemocentro regional de Uberaba (MG), Fundação Hemominas / Prevalence of serological ineligibility due to HCV virus infection among candidates for blood donation at hemocentro regional de Uberaba (Brazil)

Introdução: Hepatite C é causada por flavivírus e sua prevenção é feita especialmente pela triagemsorológica nos bancos de sangue. Objetivos: Calcular a prevalência de doações inaptas pelo vírus da Hepatite C (HCV), analisar o perfil epidemiológico dos inaptos e a tendência de inaptidão por HCV e verificar a concordância entre os testes ELISA e RIBA (Recombinant Immunoblot Assay). Métodos: estudo retrospectivo da sorologia das doações realizadas no Hemocentro Regional de Uberaba (HRU) entre 1995 e 2008, análise do perfil segundo valores proporcionais (para 10.000 doações), estudo de tendência através do coeficiente de correlação linear, com 5por cento de significância e análise da concordância entre ELISA e RIBA com cálculo do coeficiente kappa. Resultados: Foram realizadas, no período, 218.871 doações, sendo 814 (0,4por cento) inaptas por sorologia para o HCV pelo ELISA, com proporções superiores e estatisticamente significativas de inaptos do gênero masculino, idade igual ou superior a 30 anos, procedentes de Uberaba e casados. Houve correlação linear forte inversamente proporcional dos índices de inaptidão para HCV com os anos de estudo (r igual 0,870631). A concordância entre ELISA e RIBA foi de 46,8por cento (kappa igual 0,637). Conclusão: Por meio da análise desses resultados, demonstrou-se uma tendência decrescente de inaptidão para HCV entre doadores, indicando queda do risco de contaminação via transfusão de sangue.

The influence of erbium:yttrium-aluminum-garnet laser ablation with variable pulse width on morphology and microleakage of composite restorations.

The objective of this study was to evaluate the influence of various pulse widths with different energy parameters of erbium:yttrium-aluminum-garnet (Er:YAG) laser (2.94 mum) on the morphology and microleakage of cavities restored with composite resin. Identically sized class V cavities were prepared on the buccal surfaces of 54 bovine teeth by high-speed drill (n = 6, control, group 1) and prepared by Er:YAG laser (Fidelis 320A, Fotona, Slovenia) with irradiation parameters of 350 mJ/ 4 Hz or 400 mJ/2 Hz and pulse width: group 2, very short pulse (VSP); group 3, short pulse (SP); group 4, long pulse (LP); group 5, very long pulse (VLP). All cavities were filled with composite resin (Z-250-3 M), stored at 37 degrees C in distilled water, polished after 24 h, and thermally stressed (700 cycles/5-55 degrees C). The teeth were impermeabilized, immersed in 50% silver nitrate solution for 8 h, sectioned longitudinally, and exposed to Photoflood light for 10 min to reveal the stain. The leakage was evaluated under stereomicroscope by three different examiners, in a double-blind fashion, and scored (0-3). The results were analyzed by Kruskal-Wallis test (P > 0.05) and showed that there was no significant differences between the groups tested. Under scanning electron microscopy (SEM) the morphology of the cavities prepared by laser showed irregular enamel margins and dentin internal walls, and a more conservative pattern than that of conventional cavities. The different power settings and pulse widths of Er:YAG laser in cavity preparation had no influence on microleakage of composite resin restorations.

Transfusão de plaquetas: do empirismo ao embasamento científico / Platelet transfusion: from empiricism to scientific evidence

Despite major advances in Brazilian blood transfusion therapy with a growing number of scientific publications, an increased number of repeat donors and a decline in serological ineligibility, a lack of conformity in the application of pre-transfusion tests that may compromise transfusion safety is still observed at transfusion agencies in the fringes of the blood transfusion therapy system. Additionally, although high rates of platelet transfusion refractoriness and significant rates of alloimmunization have been demonstrated in the international literature, few Brazilian centers have been concerned with the study of platelet alloimmunization and even fewer centers have evaluated the efficacy of platelet concentrate transfusion. As more than one million Brazilians, including many repeat blood donors, are listed in the National Bone Marrow Donor Registry (Redome), why not grant transfusion therapy services access to the HLA typing of these blood and marrow donors after obtaining their consent? And why not make use of the Redome data to evaluate the HLA compatibility of donors for alloimmunized patients who are candidates for bone marrow transfusion and who have already been typed? These measures, together with the identification of ABO and HPA antigens, will permit a complete assessment of platelet immunology, will guarantee the transfusion safety of this blood component, and will put Brazil at the same level as the so-called developed countries in terms of transfusion medicine.

Qualidade de vida de pacientes hemofílicos acompanhados em ambulatório de hematologia / Quality of life of patients with hemophilia treated in a hematology clinic

O objetivo deste trabalho foi caracterizar a qualidade de vida de pacientes hemofílicos em acompanhamento ambulatorial em serviço especializado. Foi feita abordagem quantitativa da qualidade de vida (QV) de pacientes hemofílicos acompanhados em ambulatório de hematologia de um hemocentro regional. A coleta de dados foi realizada por meio de entrevistas utilizando-se o Whoqol-bref e questionário adicional com variáveis sociodemográficas e clínico-epidemiológicas. Para análise dos dados utilizaram-se o Epi-info 6.04d e o SPSS, cujos resultados foram expressos através de distribuição simples, medidas de tendência central e dispersão, proporções e correlação de Pearson entre facetas e domínios. Foram entrevistados 23 pacientes, com média de idade de 21 anos; todos moravam com familiares, 47,8 por cento eram residentes na cidade sede do hemocentro. Do total, 78,3 por cento eram solteiros, 69,6 por cento estudavam, sendo que 45,5 por cento possuíam o 1º grau incompleto e 82,6 por cento não trabalhavam. A maioria (91,3 por cento) possuía hemofilia A. Quanto à avaliação da QV, 47,8 por cento responderam ser boa e 55 por cento possuíam um bom nível de satisfação com a saúde. O domínio psicológico apresentou o maior escore médio e o menor foi o do domínio meio ambiente. Com esse estudo conseguiu-se salientar a magnitude de alguns problemas dos hemofílicos.

The objective of this work was to characterize the quality of life of hemophilic patients being followed up in a specialized service. A cross-sectional study of hemophilic patients in a Regional Blood Bank of Brazil was carried out to evaluate their quality of life. The data were obtained by interviews employing the WHO QOL-brief questionnaire, which was analyzed using SPSS and Epi-info 6.04d computer programs. Twenty-three male patients with a mean age of 21 years old were interviewed. All reported that they live with their families, 47.8 percent were residents in Uberaba, 78.3 percent were single, 69.6 percent were students with 45.5 percent having a low level of education and 82.6 percent did not work. Of the 23 cases, 91.3 percent had hemophilia A. In respect to quality of life, 47.8 percent responded that their quality of life was good and 55 percent had a good level of satisfaction with their health. The psychological dominion presented the highest average score and the environment presented the lowest. This study highlights the magnitude of some problems of hemophilic patients.

A prática transfusional e a formação dos profissionais de saúde / Transfusion practice and the instruction of healthcare professionals

A terapêutica transfusional é uma das mais importantes intervenções da medicina. Sendo a transfusão de sangue um procedimento complexo, não isento de riscos e frequente no Centro de Terapia Intensiva - CTI, torna-se essencial uma atuação profissional competente. O objetivo deste estudo é descrever a formação dos profissionais médicos e de enfermagem que atuam em CTI, relacionada à prática transfusional. A pesquisa foi realizada em um hospital universitário localizado no Triângulo Mineiro. Foi aplicado um instrumento estruturado e confeccionado para conhecer a participação dos profissionais na prática transfusional e qual a sua abordagem no processo de formação. Referem participar do processo transfusional 64 por cento dos profissionais de saúde, os quais se sentem informados sobre o assunto. No entanto, 54 por cento não participaram de atualização, 73 por cento não participaram de programas de capacitação e 89 por cento receberam informação sobre alguns aspectos da transfusão através de aulas teóricas. Considerando os resultados, torna-se necessário rever o processo de formação destes profissionais, bem como dos programas de capacitação sobre medicina transfusional oferecidos pelas instituições.

Transfusion therapy is one of the most important interventions in medicine. However, blood transfusion is a complex proceeding, which is not devoid of risk but as it is common in the Intensive Care Unit (ICU), professional experience is essential. The objective of this study is to describe the level of instruction of medical and nursing professionals who work with transfusions in the Intensive Care Unit. This study was carried out in a University Hospital located in the Triângulo Mineiro region. A structured instrument was developed and applied to discover the professionals' participation in the transfusion practice and their approach to the process of instruction. About 64 percent of healthcare professionals participate in the transfusion process, all of whom felt they were informed about this subject. However, 54 percent did not participate in recycling training courses, 73 percent did not participate in training programs and 89 percent received information on some theoretical aspects of transfusion in classes. In light of the results, it is important to review the education of these professionals, as well as training programs on transfusion medicine offered by institutions.

Influência da coleta, da produção e da estocagem na qualidade dos concentrados de plaquetas / Influence of collection, preparation and storage on the quality of platelet concentrates

Como o controle de qualidade dos concentrados de plaquetas (CP), feito na data de seu vencimento, não possibilita distinguir o momento e o procedimento que determina a eventual redução de sua qualidade, decidimos investigar, separadamente, a influênciada coleta, da produção e da estocagem sobre a qualidade deste hemocomponente. Foram avaliados, em 33 CP randômicos, diariamente, durante cinco dias, os seguintes parâmetros: a agregação, o número de plaquetas e leucócitos, a pO2 e pCO2, o pH, sódio e potássio, a presença de swirling, grumos, hemácias e lipemia e cultura para bactérias. Observamos maior queda da agregação plaquetária com pares de agonistas durante a produção dos CP (de 99,4% para 59,8%, p<0,01), seguida de queda gradativa durante a estocagem, atingindo 40,4% no quinto dia. Durante o período deestocagem observamos também: 1. queda gradativa da concentração de plaquetas (p<0,05), porém com valores sempre maiores que 5x1010/70 mL; 2. diminuição da concentração de leucócitos (p<0,05); 3. aumento da pO2 e queda da pCO2 (p<0,05); 4. aumento do pH (p<0,05 a partir do quarto dia) e da concentração de sódio e de potássio (em geral p<0,05); 5. swirling em todos os CP, grumos plaquetários em apenas um e ausência de hemácias e de lipemia em todos; e 6. negatividade das culturas para bactérias. Os resultados demonstram que as alterações foram mais evidentes no processo de produção e sugerem que o controle de qualidade dos CP deve contemplar da coleta ao final do período de estocagem.

As quality control of platelet concentrates obtained at the expirationdate does not distinguish between the different stages that may cause reductions in quality, such as collection and storage, we decided to separately investigate the influence of collection, processing and storage on the quality of these blood components. This study evaluated 33 random platelet concentrates daily for five days for the following parameters: aggregation, number of platelets and leukocytes, PO2and PCO2, pH, sodium and potassium, the presence of swirling, platelet clots, red blood cells and lipemia, and bacteria culture. We observed a greater decrease in platelet aggregation with pairs of agonists during the production of platelet concentrates (from 99.4%to 59.8%, p<0.05), followed by a gradual drop during storage reaching 40.4% on day five. During storage the following were also observed: 1. a gradual drop of platelet concentration (p<0.05) although the values always remained higher than 5x1010/70 mL; 2.a decrease in leukocyte concentration (p<0.05); 3. increases in pO2 and decreases in pCO2 (p<0.05); 4. increase in the pH (p<0.05 from day 4) and in concentrations of sodium and potassium (in general p<0.05); 5. swirling in all platelet concentrations, platelet clots in only one and absence of red blood cells and lipemia in all; and 6. negative cultures for bacteria. The results showed more apparent changes in the production process and suggest that the quality control of platelet concentrations should encompass allstages, from collection to the end of the storage period.

Adult T-cell leukemia/lymphoma: report of two cases.

Adult T-cell leukemia/lymphoma is a lymphoproliferative disorder of mature T lymphocytes associated with infection with human T-cell lymphotrophic virus type I (HTLV-I). Adult T-cell leukemia/lymphoma is characterized by clinical and laboratory polymorphism that allows it to be classified into four distinct subgroups: smoldering, chronic, acute and lymphomatous types. We present here two cases of adult T-cell leukemia/lymphoma, respectively in the acute and lymphomatous forms of the disease. Case 1 was a 35-year-old woman who presented abdominal distension accompanied by hepatosplenomegaly, adenomegaly, skin lesions, positivity for anti-HTLV-I antibodies and leukocytosis with the presence of flower cells. Case 2 was a 38-year-old man who was admitted with generalized lymphadenomegaly, positivity for anti-HTLV-I antibodies, hypercalcemia and osteolytic lesions. In this paper, we correlate the clinical-laboratory findings of these two cases with data in the literature.

Adult T-cell leukemia/lymphoma: report of two cases / Leucemia/linfoma de células T do adulto: relato de dois casos

Adult T-cell leukemia/lymphoma is a lymphoproliferative disorder of mature T lymphocytes associated with infection with human T-cell lymphotrophic virus type I (HTLV-I). Adult T-cell leukemia/lymphoma is characterized by clinical and laboratory polymorphism that allows it to be classified into four distinct subgroups: smoldering, chronic, acute and lymphomatous types. We present here two cases of adult T-cell leukemia/lymphoma, respectively in the acute and lymphomatous forms of the disease. Case 1 was a 35-year-old woman who presented abdominal distension accompanied by hepatosplenomegaly, adenomegaly, skin lesions, positivity for anti-HTLV-I antibodies and leukocytosis with the presence of flower cells. Case 2 was a 38-year-old man who was admitted with generalized lymphadenomegaly, positivity for anti-HTLV-I antibodies, hypercalcemia and osteolytic lesions. In this paper, we correlate the clinical-laboratory findings of these two cases with data in the literature.

A leucemia/linfoma de células T do adulto é um distúrbio linfoproliferativo de linfócitos T maduros associado à infecção pelo vírus linfotrópico de células T humanas tipo I (HTLV-I). A leucemia/linfoma de células T do adulto tem polimorfismo clínico e laboratorial, que a classifica em quatro subgrupos distintos entre si: smoldering, crônica, aguda e linfomatosa. Apresentamos neste artigo, dois casos de leucemia/linfoma de células T do adulto, respectivamente, nas formas aguda e linfomatosa da doença. O caso 1: uma paciente de 35 anos apresentava distensão abdominal com hepato-esplenomegalia, adenomegalia, lesões cutâneas, anticorpos anti-HTLV-I positivo e leucocitose com presença de flower cell. O caso 2: homem de 38 anos, internado com linfadenomegalia generalizada, anticorpos anti-HTLV-I positivo, hipercalcemia e lesões osteolíticas. Neste artigo correlacionamos os achados clínicos e laboratoriais destes dois casos com dados da literatura.