Reference values of lead in blood and related factors among blood donors in the Western Amazon, Brazil.

The aim of this study was to (1) determine the reference value of blood lead levels (BLL) in a sample of blood donors of Rio Branco, the capital city of Acre, in the Western Brazilian Amazon, and (2) explore factors influencing lead (Pb) exposure levels. Between 2010 and 2011, blood samples were collected from universal blood donors attending the Central Hemotherapic Unit in Rio Branco with a total number of 1196. Information on characteristics of 1183 donors was obtained through questionnaires. Blood Pb concentrations were determined by inductively coupled plasma-mass spectrometry with detection limit of 0.003 µg/L. Association between BLL and participant characteristics was examined by linear regression analysis. Reference values of BLL were calculated as the upper limit of the 95% confidence interval of the 95th percentile. Reference values of BLL were 109.5 µg/L for men, 70.7 µg/L for women, 88.9 µg/L for younger individuals (18-29 yr), 115.3 µg/L for older ones (≥30 yr), 94.2 µg/L for nonsmokers, and 164.5 µg/L for smokers. Levels of BLL were significantly higher in males, subjects older than 29 yr, non-whites, smokers, regular consumers of manioc flour, and donors practicing any activity related to paints, ceramics, pottery, fishing, or firearms. Subjects with higher education, higher income, vitamin intake use, and drinkers of bottled water displayed lower BLL. In general, BLL in men and women from Rio Branco were higher than those described in other adult populations. Prevention of exposure of this population to local sources of Pb needs to be addressed.

Real-world evidence of the burden of sickle cell disease: a 5-year longitudinal study at a Brazilian reference center.

INTRODUCTION: Sickle cell disease (SCD) is an inherited and multisystem blood disorder characterized by hemolytic anemia, vaso-occlusive crises (VOCs), progressive multiorgan damage and increased mortality. In Brazil, it is one of the most common monogenic diseases afflicting 60,000 to 100,000 individuals, however, there are sparse epidemiological data, as well as information on the utilization of public healthcare resources. METHOD: This was a 5-year (2016 - 2020) retrospective study conducted at one Brazilian reference center on SCD - Santa Casa de Sao Paulo, in Sao Paulo, Brazil. RESULTS: Among a total of 100 eligible adult patients, the median age was 31.0 years old, 84% of the patients were aged between 18 and 45 years old; 59% were women and 91% presented the genotype HbSS. The number of hematologist and non-hematologist visits at the outpatient unit were 2,198 and 1,436, respectively. The number of hospital ER visits was 758, of which 51% required 864 days of hospitalization. The main cause for seeking hospital medical care was the VOCs. The numbers and ratios of VOCs were: 1 to 10 VOCs, 64%; 11 to 20, 15%, and; 21 or more, 1%. There was a statistically significant difference between the number of VOCs and hospitalizations, as well as infection. CONCLUSION: Results indicate the burden of SCD on Brazilian patients' daily lives, the impact of VOCs on public healthcare resources, the importance of having a national surveillance program to improve resource utilization and clinical outcomes of patients with SCD and the urgent need for the revitalizing of the current national comprehensive SCD care programs.

Real-world evidence of the burden of sickle cell disease: a 5-year longitudinal study at a Brazilian reference center

ABSTRACT Introduction: Sickle cell disease (SCD) is an inherited and multisystem blood disorder characterized by hemolytic anemia, vaso-occlusive crises (VOCs), progressive multiorgan damage and increased mortality. In Brazil, it is one of the most common monogenic diseases afflicting 60,000 to 100,000 individuals, however, there are sparse epidemiological data, as well as information on the utilization of public healthcare resources. Method: This was a 5-year (2016 - 2020) retrospective study conducted at one Brazilian reference center on SCD - Santa Casa de Sao Paulo, in Sao Paulo, Brazil. Results: Among a total of 100 eligible adult patients, the median age was 31.0 years old, 84% of the patients were aged between 18 and 45 years old; 59% were women and 91% presented the genotype HbSS. The number of hematologist and non-hematologist visits at the outpatient unit were 2,198 and 1,436, respectively. The number of hospital ER visits was 758, of which 51% required 864 days of hospitalization. The main cause for seeking hospital medical care was the VOCs. The numbers and ratios of VOCs were: 1 to 10 VOCs, 64%; 11 to 20, 15%, and; 21 or more, 1%. There was a statistically significant difference between the number of VOCs and hospitalizations, as well as infection. Conclusion: Results indicate the burden of SCD on Brazilian patients' daily lives, the impact of VOCs on public healthcare resources, the importance of having a national surveillance program to improve resource utilization and clinical outcomes of patients with SCD and the urgent need for the revitalizing of the current national comprehensive SCD care programs.

Reference values of cadmium, arsenic and manganese in blood and factors associated with exposure levels among adult population of Rio Branco, Acre, Brazil.

This study aimed to investigate the distribution and factors influencing blood levels of Cadmium (Cd), Arsenic (As), and Manganese (Mn), and to determine their reference values in a sample of blood donors residing in Rio Branco, capital city of Acre State, Brazil. Blood samples were collected from all blood donors attending the Central Hemotherapic Unit in Rio Branco between 2010 and 2011. Among these, 1183 donors (98.9%) answered to a questionnaire on sociodemographic and lifestyle factors. Blood metal concentrations were determined by atomic spectrometry. Association between Cd, As and Mn levels and donors' characteristics was examined by linear regression analysis. Reference values were estimated as the upper limit of the 95% confidence interval of the 95th percentile of metal levels. References values were 0.87 µg L(-1) for Cd, 9.87 µg L(-1) for As, and 29.32 µg L(-1) for Mn. Reference values of Cd and As in smokers were 2.66 and 10.86 µg L(-1), respectively. Factors contributing to increase Cd levels were smoking, ethnicity (non-white), and lower education, whereas drinking tea and non-bottled water were associated with lower Cd. Lower levels of As were associated with higher household income, living near industrial facilities, working in a glass factory, a compost plant or in metal mining activities. Risk factors for Mn exposure were not identified. In general, blood Cd concentrations were in the range of exposure levels reported for other people from the general population, whereas levels of As and Mn were higher than in other non-occupationally exposed populations elsewhere.

Clinical and laboratory characteristics of patients with dengue hemorrhagic fever manifestations and their transfusion profile.

BACKGROUND: Dengue is an infectious disease with a recurring incidence, especially in developing countries. Despite recent economic growth, success in disease control has not been achieved, and dengue has evolved from cyclic epidemic outbreaks to a lack of seasonality. The lack of scientific basis for the proper management of cases with hemorrhagic manifestations, especially regarding transfusion procedures, might contribute to the high death rate in potentially avoidable cases. OBJECTIVE: The aim of the study was to identify the clinical and laboratory manifestations in hemorrhagic dengue fever treated at the emergency services in Rio Branco, AC, Brazil, as well as to describe transfusion characteristics of patients and identify possible prognostic factors. METHODS: A retrospective descriptive study was performed to analyze the distribution of relative frequencies of clinical and laboratory variables. The study was carried out in Rio Branco with confirmed dengue fever cases. Secondary data were obtained by Acre Epidemiological Surveillance teams of cases with bleeding or platelet counts under 100.0 × 10(9)/L. The patients' clinical, laboratory and transfusion data were obtained from hospital records. RESULTS: A total of 90,553 dengue cases were reported of which 7,447 had serologic confirmation; 267 cases had hemorrhagic manifestations and 193 patients were located. Nearly half of the patients had anemia and the mean of the lowest platelet count of these patients was 26.4 × 10(9)/L. Platelet concentrate was transfused in 22.3% of cases with a mean of 7.5 IU/patient, fresh frozen plasma in 21.2% with a mean of 5.2 IU/patient and just 2.6% of patients received concentrated red blood cells with a mean of 3.2 IU/patient. Bleeding led to transfusions. Signs of plasma leakage and cardiopulmonary dysfunction were correlated to unfavorable outcomes. CONCLUSION: The pattern of clinical and laboratory criteria observed in this investigation does not differ from the literature. Transfusions were used as part of the treatment of dengue hemorrhagic fever manifestations. Some of the clinical manifestations may be related to unfavorable outcomes.

Serum cadmium levels in a sample of blood donors in the Western Amazon, Brazil, 2010-2011.

A cross-sectional study was conducted to determine the distribution of serum cadmium (Cd) levels in blood donors in Rio Branco, Acre State, Brazil. Blood samples were obtained from 922 volunteer blood donors from 18 to 65 years of age at the Hemoacre blood center in 2010-2011. Mean serum Cd was 0.37µg/L (95%CI: 0.33-0.41). Increased serum Cd was associated with lower schooling; individuals with less than five years of schooling showed a mean Cd of 0.61µg/L (95%CI: 0.34-0.89), compared to 0.34µg/L (95%CI: 0.28-0.40) among those with more than nine years of schooling. Mean serum Cd was three times higher among smokers. Smoking showed a positive association with Cd level, with an OR of 12.36 (95%CI: 7.70-19.84). Meanwhile, serum Cd was lower among individuals that regularly drank tea, as compared to non-tea drinkers. Serum Cd levels were mostly below the reference value (88.3% of participants). Mean serum Cd in the current study indicates that in general the population studied here is not exposed to worrisome Cd levels.

Clinical and laboratory characteristics of patients with dengue hemorrhagic fever manifestations and their transfusion profile

Background: Dengue is an infectious disease with a recurring incidence, especially in developing countries. Despite recent economic growth, success in disease control has not been achieved, and dengue has evolved from cyclic epidemic outbreaks to a lack of seasonality. The lack of scientific basis for the proper management of cases with hemorrhagic manifestations, especially regarding transfusion procedures, might contribute to the high death rate in potentially avoidable cases. Objective: The aim of the study was to identify the clinical and laboratory manifestations in hemorrhagic dengue fever treated at the emergency services in Rio Branco, AC, Brazil, as well as to describe transfusion characteristics of patients and identify possible prognostic factors. Methods: A retrospective descriptive study was performed to analyze the distribution of relative frequencies of clinical and laboratory variables. The study was carried out in Rio Branco with confirmed dengue fever cases. Secondary data were obtained by Acre Epidemiological Surveillance teams of cases with bleeding or platelet counts under 100.0 × 109/L. The patients' clinical, laboratory and transfusion data were obtained from hospital records. Results: A total of 90,553 dengue cases were reported of which 7,447 had serologic confirmation; 267 cases had hemorrhagic manifestations and 193 patients were located. Nearly half of the patients had anemia and the mean of the lowest platelet count of these patients was 26.4 × 109/L. Platelet concentrate was transfused in 22.3% of cases with a mean of 7.5 IU/patient, fresh frozen plasma in 21.2% with a mean of 5.2 IU/patient and just 2.6% of patients received concentrated red blood cells with a mean of 3.2 IU/patient. Bleeding led to transfusions. Signs of plasma leakage and cardiopulmonary dysfunction were correlated to unfavorable outcomes...

Serum cadmium levels in a sample of blood donors in the Western Amazon, Brazil, 2010-2011 / Niveles séricos de cadmio en una muestra de donantes de sangre en la Amazonia occidental, Brasil, 2010-2011

Objetivou-se, por meio de estudo transversal, determinar a distribuição dos níveis séricos de cádmio (Cd) em doadores de sangue em Rio Branco, Acre, Brasil. O sangue foi obtido de 922 doadores voluntários entre 18 e 65 anos no Hemoacre, entre 2010-2011. A média da concentração de Cd foi de 0,37µg/L (IC95%: 0,33-0,41). Houve tendência de aumento com a diminuição do nível de escolaridade; indivíduos com menos de cinco anos de estudo apresentaram média de 0,61µg/L (IC95%: 0,34-0,89), enquanto aqueles com mais de nove anos de estudo obtiveram média de 0,34µg/L (IC95%: 0,28-0,40). A média da concentração de Cd apresentou-se três vezes maior entre os fumantes. O tabagismo demonstrou associação positiva com OR 12,36 (IC95%: 7,70-19,84). Já a concentração de Cd entre os indivíduos com hábitos de tomar chás apresenta-se menor quando comparada àqueles que não utilizam. Os níveis séricos de Cd foram, em sua maioria, abaixo do valor de referência (88,3% dos participantes). As médias encontradas no presente estudo indicam que, no geral, a população estudada não está exposta a níveis preocupantes de exposição ao Cd.

Serum cadmium levels in a sample of blood donors in the Western Amazon, Brazil, 2010-2011 / Niveis sericos de cadmio em uma amostra de doadores de sangue na Amazonia Ocidental, Brasil, 2010-2011 / Niveles sericos de cadmio en una muestra de donantes de sangre en la Amazonia occidental, Brasil, 2010-2011

A cross-sectional study was conducted to determine the distribution of serum cadmium (Cd) levels in blood donors in Rio Branco, Acre State, Brazil. Blood samples were obtained from 922 volunteer blood donors from 18 to 65 years of age at the Hemoacre blood center in 2010-2011. Mean serum Cd was 0.37µg/L (95%CI: 0.33-0.41). Increased serum Cd was associated with lower schooling; individuals with less than five years of schooling showed a mean Cd of 0.61µg/L (95%CI: 0.34-0.89), compared to 0.34µg/L (95%CI: 0.28-0.40) among those with more than nine years of schooling. Mean serum Cd was three times higher among smokers. Smoking showed a positive association with Cd level, with an OR of 12.36 (95%CI: 7.70-19.84). Meanwhile, serum Cd was lower among individuals that regularly drank tea, as compared to non-tea drinkers. Serum Cd levels were mostly below the reference value (88.3% of participants). Mean serum Cd in the current study indicates that in general the population studied here is not exposed to worrisome Cd levels.

Objetivou-se, por meio de estudo transversal, determinar a distribuição dos níveis séricos de cádmio (Cd) em doadores de sangue em Rio Branco, Acre, Brasil. O sangue foi obtido de 922 doadores voluntários entre 18 e 65 anos no Hemoacre, entre 2010-2011. A média da concentração de Cd foi de 0,37µg/L (IC95%: 0,33-0,41). Houve tendência de aumento com a diminuição do nível de escolaridade; indivíduos com menos de cinco anos de estudo apresentaram média de 0,61µg/L (IC95%: 0,34-0,89), enquanto aqueles com mais de nove anos de estudo obtiveram média de 0,34µg/L (IC95%: 0,28-0,40). A média da concentração de Cd apresentou-se três vezes maior entre os fumantes. O tabagismo demonstrou associação positiva com OR 12,36 (IC95%: 7,70-19,84). Já a concentração de Cd entre os indivíduos com hábitos de tomar chás apresenta- se menor quando comparada àqueles que não utilizam. Os níveis séricos de Cd foram, em sua maioria, abaixo do valor de referência (88,3% dos participantes). As médias encontradas no presente estudo indicam que, no geral, a população estudada não está exposta a níveis preocupantes de exposição ao Cd.

El objetivo de utilizar un estudio transversal para determinar la distribución de los niveles séricos de Cd en los donantes de Río Branco no expuestos al metal. Se obtuvo sangre de 922 voluntarios de entre 18 y 65 años en Hemoacre entre 2010-2011. La concentración media de Cd fue 0,37µg/L (IC95%: 0,33-0,41). Hubo una tendencia de aumento según el nivel educativo: las personas con menos de cinco años de estudio tenían una media de 0,61µg/l (IC95%: 0,34-0,89), mientras que quienes contaban con más de nueve años de escolaridad poseían un promedio 0,34µg/L (IC95%: 0,28-0,40). La concentración promedio de Cd se presentó tres veces mayor entre los fumadores. El consumo de cigarrillos mostró una asociación positiva con OR 12,36 (IC95%: 7,70-19,84). Ya la concentración de Cd en las personas con hábitos de tomar té era más pequeña en comparación con aquellos que no lo toman. Los niveles séricos de Cd fueron en su mayoría por debajo del valor de referencia (88,3% de los participantes). Los medios encontrados en este estudio indican que, en general, la población no está expuesta a niveles preocupantes de Cd.

Serum cadmium levels in a sample of blood donors in the Western Amazon, Brazil, 2010-2011 / /Niveis sericos de cadmio em uma amostra de doadores de sangue na Amazonia Ocidental, Brasil, 2010-2011 / /Niveles sericos de cadmio en una muestra de donantes de sangre en la Amazonia occidental, Brasil, 2010-2011

A cross-sectional study was conducted to determine the distribution of serum cadmium (Cd) levels in blood donors in Rio Branco, Acre State, Brazil. Blood samples were obtained from 922 volunteer blood donors from 18 to 65 years of age at the Hemoacre blood center in 2010-2011. Mean serum Cd was 0.37µg/L (95%CI: 0.33-0.41). Increased serum Cd was associated with lower schooling; individuals with less than five years of schooling showed a mean Cd of 0.61µg/L (95%CI: 0.34-0.89), compared to 0.34µg/L (95%CI: 0.28-0.40) among those with more than nine years of schooling. Mean serum Cd was three times higher among smokers. Smoking showed a positive association with Cd level, with an OR of 12.36 (95%CI: 7.70-19.84). Meanwhile, serum Cd was lower among individuals that regularly drank tea, as compared to non-tea drinkers. Serum Cd levels were mostly below the reference value (88.3% of participants). Mean serum Cd in the current study indicates that in general the population studied here is not exposed to worrisome Cd levels.(AU)

Objetivou-se, por meio de estudo transversal, determinar a distribuição dos níveis séricos de cádmio (Cd) em doadores de sangue em Rio Branco, Acre, Brasil. O sangue foi obtido de 922 doadores voluntários entre 18 e 65 anos no Hemoacre, entre 2010-2011. A média da concentração de Cd foi de 0,37µg/L (IC95%: 0,33-0,41). Houve tendência de aumento com a diminuição do nível de escolaridade; indivíduos com menos de cinco anos de estudo apresentaram média de 0,61µg/L (IC95%: 0,34-0,89), enquanto aqueles com mais de nove anos de estudo obtiveram média de 0,34µg/L (IC95%: 0,28-0,40). A média da concentração de Cd apresentou-se três vezes maior entre os fumantes. O tabagismo demonstrou associação positiva com OR 12,36 (IC95%: 7,70-19,84). Já a concentração de Cd entre os indivíduos com hábitos de tomar chás apresenta- se menor quando comparada àqueles que não utilizam. Os níveis séricos de Cd foram, em sua maioria, abaixo do valor de referência (88,3% dos participantes). As médias encontradas no presente estudo indicam que, no geral, a população estudada não está exposta a níveis preocupantes de exposição ao Cd.(AU)

El objetivo de utilizar un estudio transversal para determinar la distribución de los niveles séricos de Cd en los donantes de Río Branco no expuestos al metal. Se obtuvo sangre de 922 voluntarios de entre 18 y 65 años en Hemoacre entre 2010-2011. La concentración media de Cd fue 0,37µg/L (IC95%: 0,33-0,41). Hubo una tendencia de aumento según el nivel educativo: las personas con menos de cinco años de estudio tenían una media de 0,61µg/l (IC95%: 0,34-0,89), mientras que quienes contaban con más de nueve años de escolaridad poseían un promedio 0,34µg/L (IC95%: 0,28-0,40). La concentración promedio de Cd se presentó tres veces mayor entre los fumadores. El consumo de cigarrillos mostró una asociación positiva con OR 12,36 (IC95%: 7,70-19,84). Ya la concentración de Cd en las personas con hábitos de tomar té era más pequeña en comparación con aquellos que no lo toman. Los niveles séricos de Cd fueron en su mayoría por debajo del valor de referencia (88,3% de los participantes). Los medios encontrados en este estudio indican que, en general, la población no está expuesta a niveles preocupantes de Cd.(AU)

Risco residual de transmissão por transfusão das hepatites Be C na coorte de doadores de sangue do estado do Acre / Residual risk of transfusion transmission of hepatitis B and C in the blood donor cohort of the state of Acre

A terapêutica transfusional é reconhecida como prática médica com risco de efeitos adversos, como as infecções transmissíveis por transfusão (ITT). Com a identificação do vírus da imunodeficiência humana, a ITT ganhou relevância, com consequente preocupação para estimar o risco residual de ITT. O estado do Acre (Região Norte do Brasil), apresenta alta prevalência de hepatite viral B (HBV) e hepatite viral C (HCV), com possível risco aumentado para a ITT. O objetivo desta tese é caracterizar o perfil epidemiológico, dos doadores de repetição, e resultado sorológico de HBV e HCV, estimar seu respectivo risco residual, pela modelagem matemática, utilizando valores de incidência de soroconversão e janela sorológica, em um estudo de coorte retrospectivo das doações de sangue realizadas entre janeiro de 2001 e dezembro de 2015. O método de enzimaimunoensaio (ELISA) foi utilizado em 75% das doações e em 25% foi utilizada quimioluminescência (CMIA). Foram cadastrados 80.602 doadores, dos quais 90,61% eram caucasianos brasileiros, 66,85% do sexo masculino, 55,13% solteiros e 65% tinham segundo grau completo ou mais. Foram realizadas 131.563 doações, sendo que 108.284 (82,3%), por doadores de repetição e 17,7% por doadores de primeira vez. A positividade para os doadores de repetição foi: para o antígeno de superfície do HBV (HBsAg) de 0,06% (CMIA) a 0,27% (ELISA), para o antígeno core do HBV (Anti-HBc) de 0,25% (CMIA) a 2,52% (ELISA), e para o HCV de 0,12% (CMIA) a 1,07% (ELISA). A positividade para doadores de primeira vez foi consideravelmente maior. Para o HBV, a taxa de incidência foi de 33,38/100.000 pessoas-ano, e o risco residual estimado pelo HBsAg foi de 53,9 (variando de 33,8 a 79,6) para cada 1.000.000 de doações de sangue, e para HBV total foi de 512,4 (321,3-755,5) para cada 1.000.000 de doações. Para o HCV, a taxa de incidência foi de 117,97/100.000 pessoas-ano e o risco residual de 213,3 (122,8-303,8) para cada 1.000.000 de doações. O risco residual estimado no presente estudo, foi maior, quando comparado a países desenvolvidos, sendo que a vacinação, aliado à triagem clínica dos doadores, podem ter evitado que o risco pudesse ser maior. Reconhecê-la como problema de saúde pública irá contribuir para que autoridades sanitárias e de saúde mantenham o controle da evolução com consequente prevenção de impactos negativos à população.

Risco residual de transmissão por transfusão das hepatites Be C na coorte de doadores de sangue do estado do Acre / Residual risk of transfusion transmission of hepatitis B and C in the blood donor cohort of the state of Acre

A terapêutica transfusional é reconhecida como prática médica com risco de efeitos adversos, como as infecções transmissíveis por transfusão (ITT). Com a identificação do vírus da imunodeficiência humana, a ITT ganhou relevância, com consequente preocupação para estimar o risco residual de ITT. O estado do Acre (Região Norte do Brasil), apresenta alta prevalência de hepatite viral B (HBV) e hepatite viral C (HCV), com possível risco aumentado para a ITT. O objetivo desta tese é caracterizar o perfil epidemiológico, dos doadores de repetição, e resultado sorológico de HBV e HCV, estimar seu respectivo risco residual, pela modelagem matemática, utilizando valores de incidência de soro conversão e janela sorológica, em um estudo de coorte retrospectivo das doações de sangue realizadas entre janeiro de 2001 e dezembro de 2015. (...) O risco residual estimado no presente estudo,foi maior, quando comparado a países desenvolvidos, sendo que a vacinação, aliado à triagem clínica dos doadores, podem ter evitado que o risco pudesse ser maior. Reconhecê-la como problema de saúde pública irá contribuir para que autoridades sanitárias e de saúde mantenham o controle da evolução com consequente prevenção de impactos negativos à população. (AU)

Transfusion therapy is recognized as medical practice with risk of adverse effects,such as transfusion-transmissible infections (TTI). With the emergence of the human immunodeficiency virus, TTI has gained relevance, with a consequent concern to estimate the residual risk of transfusion transmission. The State of Acre (Northern Region of Brazil), has high prevalence of viral hepatitis B (HBV) and viral hepatitis C (HCV), with possible increased risk for TTI. The purpose of this thesis is to characterize the epidemiological profileof frequent blood donors and serological results of HBV and HCV, estimate the residual risk,through a mathematical modeling, using seroconversion and serological window incidencevalues, in a retrospective cohort study of blood donations performed between January 2001 and December 2015. (...) The residual risk estimated in the present studywas higher when compared to developed countries, considering that it is a state with high historical HBV and HCV indexes, and vaccination, combined with clinical screening ofdonors, may have avoided that the risk could be greater. Recognizing it as a public health problem will contribute to health and health authorities maintaining control of the evolution with consequent prevention of negative impacts to the population. (AU)