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Introduction: high levels of impulsivity and psychological inflexibility characterize nicotine dependent subjects and some psychopathology symptoms are also related to the tobacco consumption but it is unknown if there is a relationship between these. Objective: to evaluate the correlation of impulsivity with psychological inflexibility, and symptoms of psychopathology in nicotine dependent subjects. Method: an observational study was carried out, the universe of which was 24 patients who attended the smoking clinic of the State Center for Mental Health of Puebla for the first time (January-March 2020). The instruments were applied: the Fagerström test to measure nicotine dependence, the Barratt impulsivity scale, the Acceptance and Action questionnaire to measure the inflexibility score and the symptom list, to identify psychopathology symptoms. Correlations were made with the Spearman test. Results: in nicotine dependence subjects (moderate and severe) no correlation was found between impulsivity and psychological inflexibility. There was a moderate correlation of impulsivity with anxiety (rs = .467, p () .05), somatization (rs = .451, p () .05) and hostility (rs = .426, p () .05). None of the psychopathology symptoms correlated with psychological inflexibility. The comparison between high and low impulsivity and psychological inflexibility showed that the high impulsivity and low inflexibility groups had high scores for psychopathology symptoms. Only the anxiety scale marked significant differences according to the level of impulsivity. Discussion and conclusions: in the subjects of the sample the correlations between impulsivity and symptoms of anxiety somatization and hostility suggest identifying these characteristics early to improve abstinence rates in them.

Cellular blood components should be irradiated as a preventive measure against transfusion-associated graft-versus-host disease in severely immunocompromised patients.

Blood component therapy is considered the gold standard for the treatment of the massively bleeding patient, but it can be challenging to perform outside the hospital environment. The successful experience from the military shows that whole blood can efficiently provide treatment for massively bleeding patients. Whole blood transfusion has been in use in Norway to some extent in paediatric cardiac surgery, but no major interest has been paid from the blood centres to implement the use of whole blood as an alternative or a supplement to traditional blood component therapy. On the other hand, the increasing number of reports showing a potential benefit of whole blood and the availability of the last generation whole blood leukocyte filters, allowing the platelets to remain in the blood product, has led to the first experiences with prehospital use of whole blood in Norway. Our institution is completing the planning of a program for the use of prehospital whole blood transfusion in the civilian setting, following the same trend at two other hospitals in Norway.

Objectives To reduce the risk of RhD alloimmunization during the last trimester of pregnancy, a targeted routine antenatal anti-D prophylaxis (RAADP) programme was implemented in Norway in 2016. Here, we present and discuss our experience with the nationwide implementation of the programme, and report sample uptake and preliminary data of de novo anti-D in pregnancy. Background The targeted RAADP was advised by the academic community and evaluated by the health authorities. A National Working Group has conducted the implementation in the transfusion services and contributed to organise the administration of the antenatal anti-D prophylaxis. Fetal RhD type is determined by non-invasive prenatal testing at gestational week 24, and anti-D prophylaxis is administrated at gestational week 28 only to women with RhD positive fetuses. Methods We describe the implementation process of targeted RAADP in Norway. The sample uptake is calculated by comparing the number of fetal RHD screens with the expected number of samples. Results The sample uptake shows regional variations: 88%-100% after 3 years. Promising decrease in de novo anti-D detected during pregnancy is observed. Conclusions Nationwide targeted RAADP is implemented and included in the Norwegian maternity care programme. Compliance to sample uptake should further improve in some regions. A remaining issue to fulfil is the documentation of the accuracy of the fetal RHD-typing at all sites. Post-natal prophylaxis will then be guided by the fetal RHD result. Dedicated registries will ensure data to evaluate the expected reduction in pregnancy-related RhD immunisations, which is the final success criterion of the programme.

Blood products are a limited resource. A number of studies have shown that the use of thromboelastography (TEG) may reduce the need for blood transfusions. The analysis can be used in acute situations in patients with massive haemorrhage as a guide to transfusion therapy. Use of TEG may play an important role in targeting transfusion therapy.

La musculatura del sistema masticatorio y la articulación temporomandibular (ATM) están protegidos por reflejos nerviosos básicos y sistema neuromuscular a través de la coordinación de fuerzas musculares, todo lo que produce sobrecarga muscular repetitiva como los hábitos parafuncionales (HPF) pueden ocasionar trastornos temporomandibulares (TTM)1. Los HPF se caracterizan por movimientos anormales a la función mandibular normal sin objetivo funcional, al estar alterados constituyen una fuente productora de fuerzas traumáticas caracterizadas por dirección anormal, intensidad excesiva y repetición frecuente y duradera (Rolando Castillo Hernández, 2001)4. El objetivo del estudio fue identificar la asociación entre la presencia de hábitos parafuncionales de la cavidad bucal y los TTM en adolescentes de la ciudad de Puebla. Estudio observacional descriptivo. Se incluyeron 258 adolescentes, 132 (51.2%) mujeres y 126 (48.8%) hombres, con una edad promedio de 12.5±.73 y quienes fueron diagnosticados con los CDI/TTM y los HPF fueron auto-reportados por los pacientes. Se encontró una prevalencia de los TTM del 39.9% y una prevalencia de HPF del 86%. Los HPF más frecuentemente reportados fueron la succión labial y la onicofagia. Se encontró una asociación significativa (x2=7.31, p=0.007) entre los hábitos parafuncionales y los TTM en adolescentes. Palabras clave: Trastornos temporomandibulares, hábitos parafuncionales, adolescentes, articulación temporomandibular. Abstract The muscles of the masticatory system and temporomandibular joint (TMJ) are protected by basic nerve reflex and neuromuscular system through the coordination of muscle forces, all that repetitive muscle overload occurs as habit parafunctional (HPF) can cause temporomandibular disorder TMD)1. The characteristics of HPF are abnormal jaw movements without a functional objective. Being the jaw movements altered, they constitute a source of traumatic forces with an abnormal direction, excessive intensity and long-lasting and frequent duration. (Rolando Hernandez Castillo 2001)4. Objective: was to identify the association between the presences of parafunctional habits of the oral cavity and TMD in adolescents in the Puebla city in Mexico. Material and methods: Is a observational study, we included 258 adolescents 132 (51%) females and 126 (48.8%) were men, mean age 12.5±.73 and who were diagnosed with CDI/TTM and HPF were self- reported by patients. Results: The prevalence of TMD was 39.9% and a prevalence of 86% HPF. The most frequently reported HPF were lip sucking and nail biting. We found a significant association (x2= 7.31, p = 0,007) between HPF and TMD in adolescents. Key words: Parafunctional habits of oral cavity, temporomandibular disorders, temporomandibular joint. (Odontol Pediatr 2011;10(2): 90-94).

Despite recent advances in the understanding and treatment of coagulopathy, the management of the bleeding patient remains as a major challenge. Traditionally, the main task of the blood bank has been to guarantee the supply of high quality blood and blood components/products to the hospital. Decisions regarding the use of blood components have always been the clinicians' responsibility, with little active involvement of the transfusion service. In the last years, many hospitals have implemented the use of "acute transfusion packages" for massively bleeding patients and point-of-care (POC) instruments such as TEG and RoTEM for monitoring coagulation status in this patient group. This, in addition to the implementation of patient blood management programs in the hospitals, has led to an increasing involvement of transfusion medicine specialists in transfusion decision making, especially regarding strategies for monitoring and treatment of the massively bleeding patient. This new trend may contribute to a more optimal management and monitoring of the bleeding patient, as POC testing may be used as an early predictor for blood usage. The blood bank should optimise the use of POC testing to provide accurate information in a cost-effective way.

Blood products are a limited resource. A number of studies have shown that the use of thromboelastography (TEG) may reduce the need for blood transfusions. The analysis can be used in acute situations in patients with massive haemorrhage as a guide to transfusion therapy. Use of TEG may play an important role in targeting transfusion therapy.

Norway has recently established a working group to implement a national patient blood management (PBM) program. Although benchmarking regarding blood usage is challenging in Norway due to legal barriers, a survey was sent to different hospitals to identify possible areas to be prioritized in the first phase of the PBM program. Among them, optimizing the patient's hemoglobin level before elective surgery and implementing electronic check-lists for the indication of transfusion when ordering blood products are two measures that may have a considerable impact on blood usage. The results of the survey also showed that patients may receive a red blood cell transfusion at hemoglobin levels that are higher than those internationally recommended. Since there are no national guidelines for the use of blood products, agreement regarding hemoglobin thresholds is essential to reduce variation in transfusion practice. To achieve these goals, the transfusion specialist plays a key role in promoting the principles behind the PBM concept at the local hospital.

Standardisation of the requirements for the production of autologous and allogeneic serum eye drops (SEDs) is needed [1]. In addition to already agreed technical and safety specifications, additional tests should be considered for the production of allogeneic SEDs to avoid potentially the cytokine imbalance, which may contribute to a poorer clinical response. The use of SEDs was first described by Fox et al. in 1984 [2] and the first in vivo study showing the efficacy of allogeneic SEDs was performed by C-C Chiang et al. [3]. In this study, patients who did not respond to conventional autologous SEDs were treated with allogeneic SEDs produced from the patient’s relative’s serum. One of the contraindications for autologous serum eye drops (SEDs) is their use in patients with autoimmune diseases, due to the presence of inflammatory mediators and/or traces of medications. The authors concluded that the treatment with allogeneic SEDs was a safe alternative option for therapy. Serum contains a variety of substances such as vitamin A, fibronectin and epidermal growth factors that promote epithelial cell migration and have anti-apoptotic effects [4], thought to be responsible of the healing effects of the SEDs [5]. Patients with autoimmune diseases may have an imbalance between pro-and anti-inflammatory cytokines that may affect the outcome of the treatment. This was shown by Hwang et al. [6] in a recent study, where the authors compared the effect of autologous SEDs in patients with primary and secondary Sjogren syndrome (SS). They found that autologous SEDs were effective in patients with primary SS, but not in secondary SS. They concluded that the content of proand anti-inflammatory cytokines was different in these patients groups, with an increased level of proinflammatory cytokines in patients with secondary SS compared to primary SS. The importance of the cytokine composition in the SEDs was recently shown by Stenwall PA et al. [7]. In their study, the authors measured the content of several cytokines in the serum from healthy allogeneic blood donors. They found that the cytokine composition of the serummay differ, also * Corresponding author. E-mail address: jseghatchian@btopenworld.com (J. Seghatchian).

BACKGROUND: Inactivation of pathogens and white blood cells in platelet (PLT) components with amotosalen and UVA light (INTERCEPT, Cerus Europe BV) has entered clinical practice in European blood centers. A prospective cohort study was implemented to characterize the safety profile of this new PLT component in a broad patient population. STUDY DESIGN AND METHODS: Apheresis or buffy-coat PLT components were leukoreduced, suspended in approximately 35 percent plasma and 65 percent PLT additive solution, and treated with the INTERCEPT process. Blood centers were requested to complete a safety data form after each transfusion. RESULTS: Data for 5106 INTERCEPT components administered to 651 patients were monitored. A total of 5051 (98.9%) transfusions and 609 (93.5%) patients had no reported reactions. Fifty-five (1.1%) transfusions were associated with adverse events, and 42 (0.8%) were possibly, probably, or related to the PLT transfusion. Adverse events occurred in 42 (6.4%) patients, but in only 32 (4.9%) patients was a causal relationship to PLT transfusion established. One reaction was serious, and no deaths were related to PLT transfusion. Among the transfusions reactions, the most frequent clinical events in descending frequency were chills, fever, dermatologic reactions, dyspnea, nausea or vomiting, and hypotension. No episodes of transfusion-related acute lung injury were reported. CONCLUSIONS: In this cohort study, 99.2 percent of transfusions were without reactions attributed to PLTs. INTERCEPT PLTs exhibited a safety profile similar to that previously reported for conventional PLT components.

The use of autologous serum eye drops has been shown to be effective for the treatment of many ocular diseases. For patients were repeated blood sampling is not possible, allogeneic serum eye drops have been shown to be an effective and safe alternative. In our institution, we have managed to produce allogeneic serum eye drops from regular blood donors using a standardised procedure. The effectiveness and safety of this product will be evaluated in a clinical trial.

Introduction: Fetomaternal haemorrhage (FMH) refers to the passage of fetal erythrocytes to the maternal circulation.

With the better understanding that serum and platelet lysates contain high concentrations of growth factors [1] and presumably large numbers of blood cell-derived microvesicles [2,3] and other biological response modifiers, attention in some transfusion services is focused towards developing and validating standardized production, storage, and distribution methods of blood derived serum, for an effective and convenient therapy of patients with dry eyes and related syndromes [4,5]. In the recent theme articles on serum eye drop (SED) published in TRASCI [6–10], various groups have already highlighted critical safety/quality standards of SED including the procurement of safe donors and continual improvement of processes. This is in line with the regulatory requirements for blood products [11] and the fact that whole blood and blood components have recently been included in the WHO model list of essential medicines [12] and should be prepared following the principles of good manufacturing practices. Some new information will soon be available [13] on sustained patient outcomes in Australia following SED therapy. Clearly, consistently producing high quality SED products and demonstrating safe storage and application in patients are the bases for improving sustained effective clinical outcomes. While progress is already being made at local and national levels to enhance standardization and harmonization in preparing SEDs, questions remain, as for any therapeutic biological products, whether room for further improvement should be considered. Addressing the following questions may contribute to developing the next generations of SED products and build the best clinical practices

Background Intensive care unit (ICU) patients usually have abnormal biochemical and hematological laboratory test results as a consequence of organ dysfunction and underlying disease. Thromboelastography (TEG®) is a point-of-care laboratory analysis that gives an overview of several aspects of the coagulation process. In order to be able to perform a clinical interpretation of abnormal TEG® results the expected values from non-bleeding ICU patients should be known. The aim of this study is to report the normal variability observed in non-bleeding, non-transfused ICU patients. Methods Adult ICU patients without bleeding in the last 24 hours, who had not received blood products within the last 24 hours, with no hematological diseases and no anticoagulation therapeutic treatment were included. Standard clinical chemistry tests, coagulation tests and TEG® were obtained. All results were reported in relation to standard reference values. TEG® values were compared with routine coagulation measurement using Spearman correlations. Results We observed that the normal variability observed in non-bleeding, non-transfused ICU patients in this study included abnormally high TEG® values for maximum amplitude (MA) (73%). None of the patients showed MA results corresponding to hypocoagulability. Other coagulation tests were also changed with elevated D-Dimer, fibrinogen and APTT values, and a low ATIII value. Conclusion In unselected ICU patients without bleeding or known factors that influence coagulation, a TEG® value of MA is often elevated suggesting hypercoagulability. This finding should be considered when interpreting TEG® observations obtained in ICU patients.

Background: Bleeding complications in cardiac surgery may lead to increased morbidity and mortality. Traditional blood coagulation tests are not always suitable to detect rapid changes in the patient's coagulation status. Point-of-care instruments such as the TEG (thromboelastograph) and RoTEM (thromboelastometer) have been shown to be useful as a guide for the clinician in the choice of blood products and they may lead to a reduction in the need for blood transfusion, contributing to better patient blood management. Methods: The purpose of this study was to evaluate the ability of the TEG, RoTEM and Sonoclot instruments to detect changes in hemostasis in elective cardiac surgery with cardiopulmonary bypass and to investigate possible correlations between variables from these three instruments and routine hematological coagulation tests. Blood samples from thirty-five adult patients were drawn before and after surgery and analyzed in TEG, RoTEM, Sonoclot and routine coagulation tests. Data were compared using repeated measures analysis of variance and Pearson's test for linear correlation. Results: We found significant changes for all TEG variables after surgery, for three of the RoTEM variables, and for one variable from the Sonoclot. There were significant correlations postoperatively between plasma fibrinogen levels and variables from the three instruments. Conclusions: TEG and RoTEM may be used to detect changes in hemostasis following cardiac surgery with CPB. Sonoclot seems to be less suitable to detect such changes. Variables from the three instruments correlated with plasma fibrinogen and could be used to monitor treatment with fibrinogen concentrate. © 2014 Espinosa et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

In Norway, 55 hospitals collect blood and there are 62 hospital associated laboratories that issue blood. All of the blood banks in Norway have performed universal leukodepletion of cellular blood components since 2001. Approximately 200,000 whole blood donations are performed per year and approximately 250,000 blood components are transfused. Blood components are considered as pharmaceutical products and blood banks are audited by the Norwegian Medicines Agency. The Council of Europe defines the term Hemovigilance as ‘‘the detection, gathering and analysis of information regarding untoward and unexpected effects of blood transfusion’’. Although a system for reporting transfusion reactions has been in use in Norway during the last years, it is well known that transfusion reactions are not systematically reported. Most European countries have implemented, or are just about to implement a hemovigilance system, mainly as ‘‘hybrids’’ of the two main hemovigilance models, the

The purpose of a haemovigilance system is to identify complications related to transfusion or blood donation, analyze them and learn in order to avoid complications in the future. The Norwegian Haemovigilance System (Troll) started as a voluntary, professionally led reporting system in 2004. In 2007 haemovigilance became an authority task, according to the EU blood directive, and reporting of serious adverse reactions and serious adverse events became mandatory. The Norwegian Directorate of Health became responsible for the system and asked The Norwegian Knowledge Centre for the Health Services to run it. Results from the first eight years of reporting are presented. A total of 2607 transfusion complications or incorrect blood component transfused (IBCT) have been reported (127 per 100,000 transfusions). Most transfusion reactions are mild. The most frequently reported are febrile non-hemolytic and mild allergic reactions. Serious adverse reactions such as anaphylaxis, TRALI and hemolytic transfusion reactions occur, but are rare. One incident of bacterial transmission and four incidents of viral transmission have been reported, among them one case of HCV transmission. No incidents of transmission of HIV or hepatitis B have been reported. IBCT was reported 168 times. Our data are comparable with data from other countries. Recommendations from the haemovigilance system are included in local and national guidelines. Increased knowledge of haemovigilance among physicians and nurses can lead to improved transfusion safety. It is safe to receive blood in Norway, but serious adverse reactions do occur. Our reporting system seems to be well accepted. We have not yet been able to document any change of practice that has lead to a reduction in the number of complications.

H. W. Reesink, S. Panzer, C. A. Gonzalez, N. Lena, P. Muntaabski, S. Gimbatti, E. Wood, M. Lambermont, V. Deneys, D. Sondag, T. Alport, D. Towns, D. Devine, P. Turek, M.-K. Auvinen, T. Koski, C. K. Lin, C. K. Lee, W. C. Tsoi, E. Lawlor, G. Grazzini, V. Piccinini, L. Catalano, S. Pupella, H. Kato, S. Takamoto, H. Okazaki, I. Hamaguchi, J. C. Wiersum-Osselton, A. J. W. van Tilborgh, P. Y. Zijlker-Jansen, K. M. Mangundap, M. R. Schipperus, D. Dinesh, P. Flanagan, O. Flesland, C. T. Steinsvag, A. Espinosa, M. Letowska, A. Rosiek, J. Antoniewicz-Papis, E. Lachert, M. B. C. Koh, R. Alcantara, M. Corral Alonso & E. Muniz-Diaz

to describe the dental characteristics of patients with temporomandibular disorders (TMD).a survey in 130 out patients from a Clinic of Maxilofacial Surgery Service, who fulfilled the selection criteria. The social and demographic data were reported in other paper. It was used a questionnaire to identify factors of risk for TMD according to the Research Diagnostic Criteries/Temporomandibular Disorders proposed by Dworkin. It was registered the Angle to molar bilaterally and canine, the presence of canine guides and incisal margin, the dental lost organs and previous surgical removal of third molars. Unvaried and bivariate statistical analysis was made.the clinical manifestations in patients with TMD which they appear in the upheavals temporomandibular were: pain to articulate, muscular pain, noises you will articulate with statistically significant differences (p0.05) in the variables class to molar and canine of Angle, absence of canine guides and incisal margin, previous retirement of third molars, parafunctions, mandibulars deviations at rest, number of dental absences.the physiomechanical conditions in the oral cavity of the patients of upheavals temporomandibular are considered a risk factor condition.

To compare family functionality of patients with and without temporomandibular disorders (TMD).A comparative cross-sectional study was conducted with 130 patients attending to a maxillofacial surgery service.patient with or without TMD, age between 18 and 60 years, able to read and write and accepted to participate in the study. We registered sociodemographic variables, and we applied a questionnaire to identify risk factors for TMD, and finally intensity of pain was measure by a visual analogous scale. All patients were clinically evaluated to ascertain TMD according to the research diagnostic criteria for TMD proposed by Dworkin in 1992. The Family Adaptability and Cohesion Scale III (FACES-III) was used to evaluate family functionality.The mean of age was 34 +/- 10 years, ratio women : men, was 2 : 1; 67.7% were married or had a partner; the mean of education was 14 +/- 3.5 years; 56 % of women had TMD; 67.6 % had familiar dysfunction.Families of patients with TMD were dysfunctional more frequently and this suggests a relation.