RESUMO O plasma rico em plaquetas (PRP) tem sido proposto como um agente para acelerar o processo de cicatrização e estimular a capacidade regenerativa dos tecidos, devido à sua abundância de fatores de crescimento. Uma grande variedade de kits e de protocolos está disponível para obtenção de PRP, utilizando-se diferentes sistemas de separação de células. No entanto, a falta de padronização pode levar a resultados inconsistentes. O objetivo deste estudo foi caracterizar a composição celular, os parâmetros plaquetários pelo citômetro de fluxo ADVIA 120 e a concentração de TGF-β1 do PRP obtido em sistema fechado, por centrifugação simples. Seis cavalos clinicamente saudáveis foram usados neste estudo. O protocolo no sistema fechado resultou em concentrações de plaquetas aproximadamente 1,6 vez maior e concentrações de leucócitos aproximadamente 2,0 vezes menores em comparação com os valores do sangue total. O sistema avaliado foi eficiente na concentração de plaquetas e na recuperação de um pequeno número de leucócitos, utilizando um protocolo de centrifugação única em baixa velocidade.

ABSTRACT Platelet-rich plasma (PRP) has been proposed as an agent to accelerate the healing process and stimulate the regenerative capacity of tissues due to its abundance of growth factors. A large variety of kits and protocols are available to obtain PRP by different cell-separation systems. However, the lack of standardization may lead to inconsistent results. The aim of this study was to characterize cellular composition, platelet parameters using the ADVIA 120 flow cytometer, and TGF-β1 concentration from the PRP product obtained through a closed system, using simple centrifugation. Six clinically healthy horses were used in this study. The protocol in the closed system resulted in approximately 1.6-fold higher platelet and approximately 2.0-fold lower white blood cell concentrations in comparison with whole blood values. The evaluated system was efficient in concentrating platelets and in retrieving a small number of leukocytes, using a protocol of single centrifugation at low speed.

Background: The severity of community acquired pneumonia (CAP) can be evaluated by the PSI and CURB-65 scales. However, it is unknown whether their predictive capacity varies according to the etiology of the disease. Aim: To compare the performance of these scales in adults with viral, bacterial, mixed, and no agent detected CAP. Material and Methods: We studied 725 patients hospitalized for CAP aged 18 to 95 years (47% females) Urinary S. pneumoniae and Legionella antigens were detected by immuno-chromatography (Binax®). Respiratory viruses and bacteria were detected by PCR in nasopharyngeal smears. The proportions of deaths, admission to the intensive care unit (ICU), and oxygen therapy were compared between mild and non-severe patients defined by PSI (I/II and I-III) and CURB-65 (1 and 1-2), according to the causative agent. Results: Ten percent of patients died. A causative agent was detected in 65%. The proportion of mild and non-severe patients according to PSI and CURB-65, and of deceased patients, admitted to the ICU and with oxygen therapy was similar in the four categories per agent. There were no deaths among non-severe patients with bacterial CAP. However, 6% of patients with CAP caused by virus or without causative agents, died. No deaths occurred among mild patients with bacterial CAP. In viral CAP, no deaths occurred among patients classified as mild only by PSI. The yields of PSI were greater than those of CURB-65 in non-severe patients who died and were admitted to the ICU with bacterial and viral CAP (5 and 14%; 7 and 12% respectively, p = 0.04). Conclusions: The prognostic performance of PSI in CAP varies according to the causative agent in adults. It is higher in non-severe bacterial cases, and superior to CURB-65.

Abstract The behavior of anaerobic digestion in batch and UASB reactors using a microaerobic process and natural zeolites was studied. Laboratory assays were carried out across 4 sets of variables: different COD/SO42- ratios, different airflow levels, with and without natural zeolites and room and mesophilic controlled temperatures. The microaerobic process demonstrated hydrogen sulfide removal levels exceeding 90% in most cases, while maintaining the flammable condition of the generated biogas. The level of COD removal exceeded 75% in UASB reactors despite their operation under very low hydraulic retention times (2.8-4.8 hours). The effectiveness of natural zeolites in accelerating UASB reactor startup was demonstrated. Results showing the positive influence of zeolites on the granulation process in UASB reactors were also achieved.

Lymphadenitis is the most common clinical feature in nontuberculous mycobacterium infection in immunocompetent children. We present two case reports of M. lentiflavum lymphadenitis diagnosed in a tertiary hospital in the last 10 years. Routine tests were performed after persistent adenopathy, and a sample for culture was obtained, being positive for this microorganism. Both patients received oral antibiotics during several weeks. Case 1 needed complete excision after five months of treatment, whilst Case 2 was cured by medical therapy. M. lentiflavum is considered, among the newly described nontuberculous mycobacterial species, an emergent pathogen in our environment. It has its own microbiological and clinical characteristics, different from the rest of nontuberculous mycobacteria. Case reports are limited in the literature since the infection was described for the first time in 1997.

La linfadenitis es la manifestación clínica más frecuente de la infección por micobacterias no tuberculosas en niños inmunocompetentes. Se presentan dos casos de linfadenitis por M. lentiflavum diagnosticados en un hospital de tercer nivel en los últimos 10 años. Se realizaron pruebas complementarias de rutina ante adenopatía persistente y se obtuvo una muestra mediante drenaje para el cultivo, que resultó positivo para este germen. Ambos pacientes recibieron tratamiento antibiótico oral durante varias semanas. El caso 1 precisó exéresis completa al quinto mes de evolución, mientras que el caso 2 presentó resolución completa de la lesión a los 4 meses. M. lentiflavum es considerado, de entre las nuevas especies de micobacterias no tuberculosas recientemente descritas, un germen emergente en nuestro medio. Posee unas características microbiológicas y clínicas especiales, diferentes del resto de las micobacterias no tuberculosas. Son pocos los casos publicados hasta la fecha desde que se describió por primera vez la infección en 1997.

Avaliou-se o congelamento do plasma rico em plaquetas (PRP) de equinos, a -196ºC em nitrogênio líquido, utilizando-se como crioprotetor o DMSO em duas concentrações (3% e 6%), e, como ponto final, a avaliação da morfologia e da agregometria plaquetária. Foram utilizadas 12 amostras de PRP em duas repetições. Previamente ao congelamento, as amostras foram submetidas a um resfriamento lento (-0,07ºC/minuto) até a temperatura final de 4-5ºC. A criopreservação do PRP equino, incluindo um resfriamento lento a 4-5ºC, previamente ao congelamento a -197ºC em nitrogênio líquido, foi similar para as concentrações do crioprotetor DMSO a 3% ou 6%, quando avaliado o percentual de ativação e de agregação plaquetária.

Equine platelet-rich plasma (PRP) frozen at -196°C in liquid nitrogen using DMSO as a cryoprotectant in two different concentrations (3% and 6%) was evaluated, using platelet morphology and aggregometry as the final parameters. Twelve PRP samples were used in two repetitions. The samples were submitted to slow cooling prior to frozen (-0.07°C/minute) until they reached the temperature of 4-5°C. Platelet cryopreserved in 3% or 6% DMSO, presented similar efficacy when the percentage of activation and platelet aggregation was evaluated.

Background: Haemodialysis systems are potentially thrombogenic, so anticoagulation is routinely used. Its prescription involves certain risks, despite which the recommendations regarding dosage are still based on very disparate criteria. Methods: We performed a randomised, crossed pilot study. Six patients underwent six sessions of post-dilution haemodiafiltration with a polysulfone HF80® dialyser and standard anticoagulation with nadroparin, and six sessions with heparincoated poliacrylonitrile AN69ST® membrane without the administration of systemic anticoagulation therapy. The coagulation level of the dialyser and extracorporeal circuit was evaluated every hour using a visual scale along with variation in clotting parameters such as anti-Xa factor. Our primary objective was to assess anti-Xa activity in the absence of differences in the rate of massive coagulation between the two groups. Results: No complete or grade 4 dialyser clotting occurred in any of the 36 sessions with either dialyser. Partial clotting of the dialyser occurred below 25% (grade 1-2) in 32 (88.9%) AN69ST® sessions and 35 (97.2%) sessions using the standard dialyser, and partial clotting surpassed 25% (grade 3-4) in 4 (11.1%) AN69ST® sessions and 1 (2.8%) dialysis session with heparin. Arterial chamber blood clotting did not surpass 25% (grade 3 and 4) in any of the studied sessions, and venous chamber coagulation occurred in only 1 (2.8%) session with the usual dialyser and in 3 (8.4%) sessions with the AN69ST®, with no significant differences between the two dialysers. The activated partial thromboplastin time at two hours showed differences between the two techniques in correlation with the administration of low molecular weight heparin (33.3±2.7s with polysulfone and 27.5±2.3s in AN69ST®; P<0.05), which remained significant at the end of the session (29.8±2.1s with polysulfone and 27.2±1.8s with AN69ST®; P<0.05). Anti-Xa factor activity reached a maximum at two hours after the administration of nadroparin, with differences between the two dialysers (0.46±0.13IU/ml in dialysis with polysulfone and 0.04±0.04IU/ml with AN69ST®; P<0.05), and levels decreased after 4 hours (0.17±0.12IU/ml in dialysis with polysulfone and 0.02±0.03IU/ml in AN69ST®; P<0.05). One patient on dialysis with AN69ST® had an adverse reaction in the form of generalised pruritus and was excluded from the study, by withdrawing consent for participation in the first session. Conclusion: We demonstrate the low thrombogenicity of the AN69ST® dialyser, allowing for postdilution haemodiafiltration sessions without systemic anticoagulation therapy and without increasing the frequency of severe coagulation events as compared to the HF80® dialyser with nadroparin, with a lower associated risk of bleeding by not modifying anti-Xa factor activity.

Introducción: Los sistemas de hemodiálisis tienen capacidad trombogénica, por lo que se utiliza de forma rutinaria la anticoagulación. Su prescripción no se encuentra exenta de riesgos, a pesar de lo cual las recomendaciones respecto a la dosis pautada siguen basándose en criterios muy diversos. Métodos: Se realizó un estudio experimental aleatorizado y cruzado. Seis pacientes realizaron seis sesiones de hemodiafiltración posdilución con el dializador de polisulfona HF80® y anticoagulación habitual con nadroparina, y seis sesiones con el dializador AN69ST® de poliacrilonitrilo con una cubierta de heparina sin el uso de anticoagulación sistémica. Evaluamos cada hora el grado de coagulación del dializador y del circuito extracorpóreo mediante una escala visual y las variaciones en los parámetros de coagulación, entre los que se incluyó el factor anti-Xa. Nuestro objetivo primario fue valorar las variaciones en la actividad del factor anti-Xa en ausencia de diferencias en la tasa de coagulación masiva entre los dos grupos. Resultados: No se coaguló el dializador de forma completa o grado 4 en ninguna de las 36 sesiones realizadas con cada dializador. Se produjo una coagulación parcial del dializador inferior del 25% (grado 1-2) en 32 (88,9%) sesiones con AN69ST® y 35 (97,2%) con el dializador habitual, y superior del 25% (grado 3-4) en 4 (11,1%) sesiones con AN69ST® y en 1 (2,8%) sesión con el dializador con heparina. La coagulación del atrapaburbujas arterial no fue superior al 25% (grados 3 y 4) en ninguna de las sesiones estudiadas, y la cámara venosa en sólo 1 (2,8%) sesión con el dializador habitual y 3 (8,4%) con AN69ST® sin diferencias entre los dos dializadores. El valor del tiempo de tromboplastina parcial activada presentó diferencias a las dos horas entre ambas técnicas, relacionadas con la administración de la heparina de bajo peso molecular (33,3 ± 2,7 s con polisulfona y 27,5 ± 2,3 s en AN69ST®, p < 0,05), que continuaron siendo significativas al finalizar la sesión (29,8 ± 2,1 s con polisulfona y 27,2 ± 1,8 s con AN69ST® , p < 0,05). La actividad del factor anti-Xa fue máxima dos horas después de la administración de nadroparina, con diferencias entre ambos dializadores (0,46 ± 0,13 UI/ml en diálisis con polisulfona y 0,04 ± 0,04 UI/ml con AN69ST®, p < 0,005), para ir descendiendo en la determinación de las 4 horas (0,17 ± 0,12 UI/ml en diálisis con polisulfona y 0,02 ± 0,03 UI/ml en AN69ST®, p < 0,05). Un paciente fue excluido del estudio al presentar una reacción adversa caracterizada por prurito generalizado con el dializador AN69ST®, motivo por el que retiró en la primera sesión el consentimiento. Conclusión: Demostramos la baja trombogenicidad del dializador AN69ST® de forma que permite realizar sesiones de hemodiafiltración posdilución sin necesidad de anticoagulación sistémica, y sin aumentar la frecuencia de eventos de coagulación grave en comparación con el dializador HF80® junto a nadroparina y con menor riesgo de sangrado al no modificar la actividad del factor anti-Xa.

Objective: to assess persistence of sustained viral response at 5 years of follow-up in patients with chronic viral hepatitis C treated with pegylated interferon and ribavirin. Design: a descriptive study. Patients: from August 2001 to May 2004, all patients treated at our center with pegylated interferon and ribavirin who achieved a sustained viral response were consecutively enrolled (93 patients). Demographic, histological, biochemical, and virological data were collected during treatment and 5 years after achievement of the sustained viral response. Eighty-six percent of patients enrolled (n = 80) attended the control visit at 5 years. Results: mean age of enrolled patients was 41 years (standard deviation = 10 years), and 30.1% (n = 28) were women. Liver biopsy had been performed before treatment in 68.8% of patients (n = 64), showing no or mild fibrosis in 62.3% (F0 and F1) and significant fibrosis and cirrhosis in 37.7% (F ≥ 3). Genotype distribution was: 58.1% genotype 1 (n = 54); 8.6% genotype 2 (n = 8); 24.7% genotype 3 (n = 23); 7.5% genotype 4 (n = 7), and indeterminate in one patient. Only one patient experienced virological recurrence. All other patients had negative HCV RNA levels and, in the absence of other liver diseases, normal ALT levels. Conclusion: in patients treated with pegylated interferon and ribavirin with sustained viral response, long-term recurrence rate was very low.

Objetivo: evaluar la persistencia de respuesta viral sostenida a los 5 años de seguimiento en pacientes con hepatitis crónica por virus C tratados con interferón pegilado y ribavirina. Diseño: estudio descriptivo. Pacientes: desde agosto de 2001 hasta mayo de 2004, se incluyeron de forma consecutiva todos los pacientes de nuestro centro tratados con interferón pegilado y ribavirina que alcanzaron respuesta viral sostenida (93 pacientes). Se recogieron datos demográficos, histológicos, bioquímicos y virológicos durante el tratamiento y a los 5 años de haber obtenido la respuesta viral sostenida. Se presentaron a la visita de control a los 5 años un 86% de los pacientes incluidos (n = 80). Resultados: los pacientes incluidos presentaron una edad media de 41 años (desviación estándar = 10 años); mujeres 30,1% (n = 28). En el 68,8% de los pacientes (n=64) se había realizado biopsia hepática previa al tratamiento, que mostraba ausencia de fibrosis o fibrosis leve en un 62,3% (F0 y F1) y fibrosis significativa o cirrosis en un 37,7% (F≥3). La distribución por genotipos fue: 58,1% genotipo 1 (n = 54); 8,6% genotipo 2 (n = 8); 24,7% genotipo 3 (n = 23); 7,5% genotipo 4 (n = 7) e indeterminado en un caso. Sólo uno de los pacientes presentó recurrencia virológica. El resto de pacientes presentaron niveles de ARN-VHC negativo y, en ausencia de otra hepatopatía, niveles de ALT normales. Conclusión: en pacientes tratados con interferón pegilado y ribavirina con respuesta viral sostenida la tasa de recurrencia a largo plazo es muy baja.

Objectives: To analyze the prioritization process for chemotherapy drugs in the Drug-Therapeutic Committees (DTCs) in Catalan hospitals and assess their impact on patients´ access to these drugs. Methods: A case qualitative study of the DTCs of tertiary hospitals in Catalonia was performed, based on semi-structured interviews and a review of the scientific literature. Key professionals were interviewed with technical and institutional involvement in the DTCs assessment process, including pharmacists, oncologists, clinical pharmacologists and other physicians with different medical specialties. The conceptual framework "accountability for reasonableness", by Daniels and Sabin, which analyzes prioritization processes from a "fair and legitimate decision-making" perspective, was used. Results: The current regulatory framework for the introduction of drugs is characterized by a fragmented hospital system and lacks coordination strategies. These weaknesses fail to allow the prioritization and optimization of resources in the Catalan health service. Conclusion: We propose the implementation of a decision-making coordination strategy for all public sector hospitals. This strategy would allow an increasingly innovative environment to be exploited, in which inequalities in access to drugs at the hospital level should be avoided.

Objetivos: Analizar el proceso de priorización de fármacos oncológicos en las comisiones farmacoterapéuticas (CFT) de los hospitales de Cataluña y examinar el grado en que influyen en el acceso de los pacientes a estos fármacos. Métodos: Estudio cualitativo de casos de las CFT de hospitales de tercer nivel de Cataluña basado en entrevistas semiestructuradas y en una revisión de la literatura científica. Los sujetos de estudio son profesionales que pueden aportar una visión técnica del funcionamiento de las CFT, entre ellos farmacéuticos, oncólogos médicos, farmacólogos clínicos y profesionales de otras especialidades médicas, y otra visión de carácter institucional sobre el marco de gestión hospitalario y autonómico. Para el análisis del proceso de establecimiento de prioridades se ha utilizado el marco conceptual conocido como «justificación de la acción responsable», de Daniels y Sabin, que propone una perspectiva analítica de la toma de decisiones justas y legítimas. Resultados: El estudio permite identificar las debilidades del actual marco regulador en la introducción de fármacos, fragmentado por hospital y carente de estrategias de coordinación que permitan priorizar y optimizar recursos en el conjunto del sistema sanitario catalán. Conclusión: Se propone desarrollar una estrategia de coordinación de las decisiones para todo el sector público hospitalario con el fin de afrontar un entorno cada vez más innovador en el cual se eviten las desigualdades de acceso.

Objectives: To analyze the prioritization process for chemotherapy drugs in the Drug-Therapeutic Committees (DTCs) in Catalan hospitals and assess their impact on patients´ access to these drugs. Methods: A case qualitative study of the DTCs of tertiary hospitals in Catalonia was performed, based on semi-structured interviews and a review of the scientific literature. Key professionals were interviewed with technical and institutional involvement in the DTCs assessment process, including pharmacists, oncologists, clinical pharmacologists and other physicians with different medical specialties. The conceptual framework "accountability for reasonableness", by Daniels and Sabin, which analyzes prioritization processes from a "fair and legitimate decision-making" perspective, was used. Results: The current regulatory framework for the introduction of drugs is characterized by a fragmented hospital system and lacks coordination strategies. These weaknesses fail to allow the prioritization and optimization of resources in the Catalan health service. Conclusion: We propose the implementation of a decision-making coordination strategy for all public sector hospitals. This strategy would allow an increasingly innovative environment to be exploited, in which inequalities in access to drugs at the hospital level should be avoided.

Objetivos: Analizar el proceso de priorización de fármacos oncológicos en las comisiones farmacoterapéuticas (CFT) de los hospitales de Cataluña y examinar el grado en que influyen en el acceso de los pacientes a estos fármacos. Métodos: Estudio cualitativo de casos de las CFT de hospitales de tercer nivel de Cataluña basado en entrevistas semiestructuradas y en una revisión de la literatura científica. Los sujetos de estudio son profesionales que pueden aportar una visión técnica del funcionamiento de las CFT, entre ellos farmacéuticos, oncólogos médicos, farmacólogos clínicos y profesionales de otras especialidades médicas, y otra visión de carácter institucional sobre el marco de gestión hospitalario y autonómico. Para el análisis del proceso de establecimiento de prioridades se ha utilizado el marco conceptual conocido como «justificación de la acción responsable», de Daniels y Sabin, que propone una perspectiva analítica de la toma de decisiones justas y legítimas. Resultados: El estudio permite identificar las debilidades del actual marco regulador en la introducción de fármacos, fragmentado por hospital y carente de estrategias de coordinación que permitan priorizar y optimizar recursos en el conjunto del sistema sanitario catalán. Conclusión: Se propone desarrollar una estrategia de coordinación de las decisiones para todo el sector público hospitalario con el fin de afrontar un entorno cada vez más innovador en el cual se eviten las desigualdades de acceso.