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Introdução: O concentrado de hemácias (CH) é amplamente empregado na prática clínica para tratar anemias, incluindo hemorragias agudas. Para otimizar estoques e recursos financeiros, são empregados protocolos de reserva cirúrgica personalizados. Esses protocolos são baseados em cálculos matemáticos, como o índice de utilização de concentrado de hemácias (IUCH), índice de pacientes transfundidos (IPT) e maximum surgical blood order schedule (MSBOS). O estudo correlacionou procedimentos cirúrgicos realizados com os valores pré-operatórios de hemoglobina (Hb), analisando solicitações de reserva cirúrgica para identificar padrões hematológicos que impactam desfechos transfusionais. Objetivos: Verificar quais cirurgias foram efetuadas e quantas bolsas de CH foram reservadas e utilizadas no ano de 2023. Analisar o perfil de Hb dos pacientes que seguiram para cirurgia e qual o impacto transfusional de acordo com o protocolo. Metodologia: : A pesquisa analisou retrospectivamente todas as solicitações de sangue recebidas pela Agência Transfusional (AT) para cirurgias eletivas adultas. As solicitações foram categorizadas por tipo de cirurgia e registradas em planilhas, onde foram verificados o número de cirurgias eletivas solicitadas, a hemoglobina total e média por procedimento. Também foi avaliada a hemoglobina média que indicava a necessidade de transfusão. Resultados: A análise da quantidade de solicitações de sangue recebidas pela AT, apresentou os seguintes dados: 276 cirurgias de histerectomias (HTA), 25 gastroduodenectomias, 20 laparotomias exploradoras (LE), 20 hepatectomias, 7 ooforectomias, 6 esplenectomias, 5 miomectomias, 3 mastectomias, 3 pleuroscopias, 2 nefrectomias, 2 colpoperineoplastias, 1 colectomia e 1 esvaziamento molar. Entre as cirurgias avaliadas, 4 evoluíram com transfusão de CH: pleuroscopia (2 - 66,6%), LE (2 - 10%), hepatectomias (2 - 10%) e HTAs (7 - 3,2%). A média de Hbs dos pacientes que receberam transfusão durante o procedimento cirúrgico foi de 13 g/dl nas hepatectomias, 9,7 g/dl nas HTAs, 9,5 g/dl na pleuroscopia e 8,6 g/dl nas LE. Nos pacientes que não receberam transfusão, a média de Hb foi de 11,7 g/dl, 11,7 g/dl 10,7 g/dl, e 10,2 g/dl para os mesmos procedimentos, respectivamente. Discussão: As cirurgias mais frequentes foram HTA, gastroduodenectomia, LE e hepatectomia. Apenas uma hepatectomia necessitou de transfusão, e o paciente tinha Hb mais alta que os que não precisaram de transfusão, possivelmente devido à natureza da patologia. A pleuroscopia teve mais transfusões em comparação com outras cirurgias, o que pode ser explicado pela pequena amostragem e possível viés de seleção conforme a patologia do paciente. Conclusão: O estudo analisou o uso de concentrados de hemácias em cirurgias, focando em protocolos personalizados para economizar recursos. Identificou que histerectomias foram as cirurgias mais comuns. Houve variações significativas na necessidade de transfusão conforme o tipo de procedimento. Os resultados destacam a importância de protocolos hematológicos para otimizar o uso de sangue durante cirurgias, visando melhores desfechos clínicos e econômicos.

Background The prospect of chronic HIV patients obtaining their ART medication in community settings has considerable interest for health authorities. In Portugal, the Health Ministry promoted a pilot study randomizing the dispensing of ART therapy to hospital pharmacies and to community pharmacies in order to assess the impact of a transfer of dispensing from the current hospital setting. This study “piggy backs” on that pilot and uses data from patients randomized to community pharmacies. Objectives To evaluate the impacts of transferring the ART therapy from hospital to community pharmacies. Methods Observational, prospective cohort study of the patients in the pilot study randomized to community pharmacies who were invited to participate and followed for 6 months. Data were collected through the pharmacies’ software (demographics, drugs dispensed, and pharmacists’ interventions) and patients´ self‐reported questionnaires (QoL, satisfaction, adherence, travel and waiting times). Descriptive statistics characterize the participants, drug exposure, and pharmacist’s interventions and the analysis compares QoL, adherence, satisfaction, travel modes, travel times and waiting times between the two dispensing settings. Results 29 pharmacies recruited 43 patients with a mean age of 54 (SD 9.85), 72% male and 48% were unemployed. The most frequently dispensed drugs were Abacavir/Lamivudine, Ritonavir, and Emtricitabine/Tenofovir, 49%, 33% and 30% of the times, respectively. Patients reported a significant increase in satisfaction levels regarding waiting time, privacy, business hours and overall satisfaction (p < 0.05). Mean travel time decreased 74% from 46 (SD 28) to 12 (SD 16) minutes. 79% of the patients walked to the community pharmacy compared with the 37% that walked to the hospital. Waiting time was 11 minutes lower (p < 0.05). There were no impacts on the QoL and on self‐reported adherence. The clinical stability of all patients was maintained. A total of 235 pharmacist interventions were reported as a consequence of the identification of health and drug‐related problems, the most common being potential drug interactions. Conclusions The findings suggest that changing the dispense setting of ART therapy from the hospital to the community pharmacy will not have negative impacts on health gains, measured by QoL, adherence and clinical stability and it will positively impact on patient’s satisfaction levels and access times. Published in: 34th International Conference on Pharmacoepidemiology and Therapeutic Risk Management. 22 to 26 of August. Prague, Czech Republic

Advances in surgical techniques are extremely demanding regarding the accuracy and level of detail expected for display of the vascular anatomy of the liver. Precise knowledge of the arterial, portal and hepatic vein territories are mandatory whenever a liver intervention is planned. Sectional anatomy can now be routinely performed on multidetector computed tomography (MDCT) with volumetric data and isotropic voxel display, by means of sub-millimetric slice thickness acquisition. The relevant vascular information can thus be gathered, reviewed and post-processed with unprecedented clarity, obviating the need for digital subtraction angiography. The scope of the present paper is to review the normal vascular liver anatomy, its most relevant variants including additional sources of vascular inflow. Apart from providing the surgeon with a detailed vascular and parenchymal roadmap knowledge of imaging findings may avoid potential confusion with pathologic processes.

Atopia, imunodeficiência e auto- imunidade são manifestações de disfunção do sistema imunológico. A atopia e a auto-imunidade são classicamente referidas como reacções imunológicas distintas. Estudos recentes sugerem a existência de possíveis mecanismos patogénicos comuns. Descrevemos o caso de uma adolescente com antecedentes familiares de asma brônquica e de miastenia gravis materna (HLA-B8) e com antecedentes pessoais de infecções respiratórias altas de repetição dos dois aos quatro anos, iniciando as pneumonias desde os cinco anos (3-4 por ano, em 3 anos consecutivos), associados a dispneia e hipoxemia, necessitando com frequência de internamento hospitalar. Na investigação efectuada os marcadores de atopia revelaram-se inicialmente negativos, sendo excluídas outras hipóteses, como tuberculose, fibrose quística, défice de α-1 anti-tripsina, cardiopatia congénita, malformações broncopulmonares ou aspiração de corpo estranho. Mais tarde, a repetição das análises confirmou finalmente atopia com IgE, RAST e testes de sensibilidade cutânea positivos (ácaros e pólenes). Foram detectados imunocomplexos circulantes e défice de IgG2, 3 e 4. O estudo dos auto-anticorpos mais frequentes e das precipitinas foi negativo e o estudo dos antigénios de histocompatibilidade revelou a presença de HLA-B8 (idêntico ao materno). A cintigrafia de ventilação-perfusão e as provas de função respiratória foram normais. Fez terapêutica com anti-histamínicos, corticóides tópicos e broncodilatadores, verificando-se a diminuição progressiva do número de infecções respiratórias e boa evolução clínica. Aos 16 anos voltou a ser internada, desta vez com o diagnóstico de eritema nodoso e suspeita clínica de sindroma de Sweet, com boa evolução. A relação entre atopia e auto-imunidade é enfatizada pelos autores, não correspondendo a sua ocorrência concomitante a uma associação meramente estatística, mas a um desequilíbrio global do sistema imunológico, com envolvimento simultâneo de diferentes tipos de hipersensibilidade.Atopy, immunodeficiency and autoimmunity are manifestations of immune system dysfunction. Classically atopy and autoimmunity are referred as distinct immunological reactions. Recent studies suggest the existence of common pathogenic mechanisms. We report the case of a teenager with familial history of asthma and miasthenia gravis in her mother (HLAB8+) and personal history of recurrent upper respiratory infections from two to four years old, and pneumonia since five years old (3 or 4 episodes/ year, in three consecutive years), with associated dyspnoea and hypoxemia, requiring frequently hospital admission. Investigation was initially negative for atopy markers, and excluded other hypothesis as tuberculosis, cystic fibrosis, α-1 antitrypsin deficiency, congenital heart disease, bronchopulmonary malformations or foreign body aspiration. Latter, further exams finally confirmed atopy with a rised IgE, positive RAST and cutaneous sensitivity tests (for house dust mites and pollen) and revealed circulating immune complexes and IgG 2, 3 e 4 deficit. Most frequent autoantibodies and precipitins study were negative, and histocompatibility antigens study revealed HLA- B8 (as her mother). Ventilation-perfusion scintigraphy and respiratory function tests were normal. Antihistamines, topical corticoids and bronchodilators were done with an excellent clinical response. At 16 years- old she is admitted again with the diagnosis of erythema nodosum and the clinical suspicion of Sweet’s syndrome, having a good evolution. The relation between atopy and autoimmunity is enfatized by the authors. This simultaneous occurrence does not correspond merely to a statistical association, but may represent a global immune system impairment, with the involvement of different types of hypersensibility.

Retrospective study to evaluate local tumor control and survival data after transcatheter arterial chemoembolization with doxorubicin eluting beads in the treatment of hepatocellular carcinoma. Between April 2007 and November 2008, a total of 47 patients (mean age 61,7 years; range 42-84 years) with hepatocellular carcinoma were treated with transcatheter arterial chemoembolization. In total 73 chemoembolization procedures were performed in superselective manner with microcatheter (mean 1,57 procedures per patient). The local chemoembolization protocol consisted of doxorubicin eluting beads mainly 300-500 micra but also 500-700 micra and 700-900 micra, to a maximum dose per session of 150 mg doxorubicin. Tumor response was evaluated with CT imaging. Change in tumor size was calculated and response was evaluated according to the European Association for the Study of the Liver (EASL) criteria. Survival from first chemoembolization was calculated in the subgroup treated between April 2007 and January 2008 (24 patients). Follow-up imaging was performed until January 2009 or patient death. Evaluation of tumor response resulted in complete response in 13 patients (27,7%), partial response in 15 patients (31,9%), stable disease in 9 patients (19,1%) and progressive disease in 10 patients (21,3%). The one year survival rate after chemoembolization in the 24-patient subgroup was 54%. Chemoembolization with doxorubicin eluting beads is a minimally invasive, safe and effective therapy option for palliative treatment of hepatocellular carcinoma.

Aquatic organisms may absorb organic compounds mainly from water and by ingestion of contaminated food. The toxicity of such compounds may be intensified by the presence of certain inorganic compounds such as nitrite (NO2–). In order to evaluate the effect of phenanthrene (PHE), a polycyclic aromatic hydrocarbon, in the presence and absence of NO2–, juvenile sea bass, Dicentrarchus labrax L, were exposed to PHE i.p. and to NO2– in water, and several endpoints were measured at days 1, 3, and 6 of exposure. Sea bass exposed to PHE exhibited lower hepatic 7-ethoxyresorufin O-deethylase (EROD) activity as compared to the control group. The activity of the phase II enzyme, glutathione S-transferase (GST), was similar in all the groups of fish. The concentration of PHE metabolites, determined as fluorescent aromatic compounds, was nearly 14 times higher both in the presence and absence of NO2–, showing that even at low EROD activities this PAH is metabolized. The presence of micronuclei was observed to be significantly higher only in sea bass treated with PHE alone, suggesting that different PHE metabolites, without genotoxic properties, were formed in the presence of NO2–.

Allergic diseases are a major public health problem. It is essential to develop prevention strategies applied to it. A number of risk factors have been identified, but some are still under contradictory. Changing the dietary pattern of the at-risk infant may prevent food allergy. Evidence suggests that exclusive breast-feeding for the first 4-months seems to protect against atopic dermatitis in infants and early childhood wheezing. Breast-feeding should be encouraged for all infants because of all its well known benefits. Hydrolyzed formulas cannot substitute breast milk on the prevention of allergic diseases. Extensively hydrolysed formulas should be encouraged as a supplement to breast milk in high-risk infants whenever necessary. Partially hydrolysed formulas may be a reasonable substitute, but more studies are necessary. There is no evidence that avoiding allergenic foods during pregnancy will reduce the incidence of allergenic diseases in child. Avoidance food and aeroallergen seems effective in reducing early childhood wheeze, atopic dermatitis and asthma. Maternal avoidance of allergenic foods during lactation should only be undertaken under medical supervision by highly motivated mothers with a high risk of allergy in the offspring.

A posttraumatic visual deficit which worsened eleven weeks later, with sudden visual loss, is reported. The neuro-ophthalmologic examination was suggestive of central retina artery occlusion. The intra-arterial angiography revealed a traumatic pseudo-aneurysm of the ipsilateral high extracranial portion of the internal carotid artery. Based upon the clinical examination, the hypothesis of embolization has been considered the most probable mechanism, which is a rarely described etiopathogenesis. The clinical, pathogenic and diagnostic aspects of this situation are discussed. Finally, the authors describe the treatment, which consisted of the occlusion of the internal carotid artery with detachable latex balloons.

This study addresses the challenge of optimizing energy management in the electric vehicle industry, specifically focusing on motorsport. It particularly targets optimizing energy management during an endurance event at the Formula Student competition. The research involves detailed simulation of a complete endurance event, including developing precise track and vehicle models and their application in real-time energy management of our motorsport vehicle. The primary objective is to develop an energy reference profile that optimizes point scoring following the event's specific rules. The energy reference profile serves as a strategic guideline for energy consumption and its regeneration throughout the endurance event. What sets this study apart is its emphasis on the real-time feedback controller's implementation in the Formula Student prototype, FST12, specifically during the endurance event. This controller dynamically regulates the inverter's power output, ensuring the vehicle closely follows the pre-established energy reference profile. This real-time energy management approach enhances overall performance by optimizing energy utilization for maximum scoring potential. The developed distance estimation method presented an error of less than 0.7% compared to experimental measurements. The Formula Student prototype, FST12, underwent experimental validation on a real 20 km closed-loop track. Results showed that the optimized strategy can be implemented with less than 0.5% of error in energy consumption and 6.8% of error in the obtained competing points. [ABSTRACT FROM AUTHOR]