Blood Contact Research Articles

Validity of Three-Dimensional Tortuous Pore Structure and Fouling of Hemoconcentration Capillary Membrane Using the Tortuous Pore Diffusion Model and Scanning Probe Microscopy.

Hemoconcentration membranes used in cardiopulmonary bypass require a pore structure design with high pure water permeability, which does not allow excessive protein adsorption and useful protein loss. However, studies on hemoconcentration membranes have not been conducted yet. The purpose of this study was to analyze three-dimensional pore structures and protein fouling before and after blood contact with capillary membranes using the tortuous pore diffusion model and a scanning probe microscope system. We examined two commercially available capillary membranes of similar polymer composition that are successfully used in hemoconcentration clinically. Assuming the conditions of actual use in cardiopulmonary bypass, bovine blood was perfused inside the lumens of these membranes. Pure water permeability before and after bovine blood perfusion was measured using dead-end filtration. The scanning probe microscopy system was used for analysis. High-resolution three-dimensional pore structures on the inner surface of the membranes were observed before blood contact. On the other hand, many pore structures after blood contact could not be observed due to protein fouling. The pore diameters calculated by the tortuous pore diffusion model and scanning probe microscopy were mostly similar and could be validated reciprocally. Achievable pure water permeabilities showed no difference, despite protein fouling on the pore inlets (membrane surface). In addition, low values of albumin sieving coefficient are attributable to protein fouling that occurs on the membrane surface. Therefore, it is essential to design the membrane structure that provides the appropriate control of fouling. The characteristics of the hemoconcentration membranes examined in this study are suitable for clinical use.

Air, inflammation and biocompatibility of the extracorporeal circuits.

The inflammatory response in cardiac surgery using extracorporeal circulation (ECC) has been widely discussed in the literature with analysis on cytokines released in humans; demonstrating manifold trigger causes. To mitigate this response-mainly linked to the contact and recognition by the blood of a "non-self" surface-many efforts have been made to make the circuits of the extra-corporeal circulation "biomimetics"; trying to emulate the cardio-vascular system. In other words, biomedical companies have developed many biocompatible products in order to reduce the invasiveness of the ECC. One of the techniques used to reduce the contact of blood with "nonself" surfaces is the "coating" of the internal surfaces of the ECC. This can be done with phospholipidic, electrically neutral, and heparin derivates with anticoagulant activity. The coating can be divided into two categories: the "passive coating" with Phosphorylcholine by biomedical companies and the administration of albumin added to the "priming" during the filling of the circuit by the perfusionist. Alternatively, we have the "active" coating: treatment of the internal surfaces in contact with the blood with neutral proteins and heparin. The latter are different according to the production company, but the aim is always to maintain high levels of systemic and local anticoagulation, inactivating the "contact" coagulation between the blood and the surfaces. A recent study demonstrates that the use of an "active coating" is associated with better preservation of the endothelial glycocalyx compared with "passive coating" circuits.

Computational Modeling of Cardiac Ablation Incorporating Electrothermomechanical Interactions

AbstractThe application of radio frequency ablation (RFA) has been widely explored in treating various types of cardiac arrhythmias. Computational modeling provides a safe and viable alternative to ex vivo and in vivo experimental studies for quantifying the effects of different variables efficiently and reliably, apart from providing a priori estimates of the ablation volume attained during cardiac ablation procedures. In this contribution, we report a fully coupled electrothermomechanical model for a more accurate prediction of the treatment outcomes during the radio frequency cardiac ablation. A numerical model comprising of cardiac tissue and the cardiac chamber has been developed in which an electrode has been inserted perpendicular to the cardiac tissue to simulate actual clinical procedures. Temperature-dependent heat capacity, electrical and thermal conductivities, and blood perfusion rate have been considered to model more realistic scenarios. The effects of blood flow and contact force of the electrode tip on the treatment outcomes of a fully coupled model of RFA have been systematically investigated. The numerical study demonstrates that the predicted ablation volume of RFA is significantly dependent on the blood flow rate in the cardiac chamber and also on the tissue deformation induced due to electrode insertion depth of 1.5 mm or higher.

Market characteristics and zoonotic disease risk perception in Cameroon bushmeat markets.

Behavioral practices are one of the key factors facilitating zoonotic disease transmission, especially in individuals who have frequent contact with wild animals, yet practices of those who work and live in high-risk animal-human interfaces, such as wild animal 'bushmeat' markets in the Congo Basin are not well documented in the social, health and medical sciences. This region, where hunting, butchering, and consumption of wild animal meat is frequent, represents a hotspot for disease emergence, and has experienced zoonotic disease spillover events, traced back to close human-animal contact with bats and non-human primates. Using a One Health approach, we conducted wildlife surveillance, human behavioral research, and concurrent human and animal biological sampling to identify and characterize factors associated with zoonotic disease emergence and transmission. Research was conducted through the USAID Emerging Pandemic Threats program between 2010 and 2019 including qualitative studies of bushmeat markets, with selected study sites prioritized based on proximity to bushmeat markets. Sites included two hospitals where we conducted surveillance of individuals with syndromes of acute febrile illness, community sites where we enrolled actors of the animal value chain (ie. hunters, middlemen, transporters), and bushmeat markets, where we enrolled bushmeat vendors, butchers, market managers, cleaners, and shoppers. Mixed methods research was undertaken at these sites and included investigation of bushmeat market dynamics through observational research, focus group discussions, quantitative questionnaires, and interviews. Participants were asked about their risk perception of zoonotic disease transmission and specific activities related to bushmeat trade, local market conditions, and regulations on bushmeat trade in Cameroon. Risks associated with blood contact and animal infection were not well understood by most market actors. As bushmeat markets are an important disease interface, as seen with CoVID19, risk mitigation measures in markets and bushmeat alternative strategies are discussed.

Pathophysiology of atherosclerosis: Association of risk factors and treatment strategies using plant-based bioactive compounds.

Under physiological conditions, endothelial cells act as protective barrier which prevents direct contact of blood with circulating factors via production of tissue plasminogen activator. Risk factors of metabolic disorders are responsible to induce endothelial dysfunction and may consequently lead to prognosis of atherosclerosis. This article summarizes the process of atherosclerosis which involves number of sequences including formation and interaction of AGE-RAGE, activation of polyol pathway, protein kinase C, and hexosamine-mediated pathway. All these mechanisms can lead to the development of oxidative stress which may further aggravate condition. Different pharmacological interventions are being used to treat atherosclerosis, however, these might be associated with mild to severe side effects. Therefore, plant-based bioactive compounds having potential to combat and prevent atherosclerosis in diabetic patients are attaining recent focus. By understanding process of development and mechanisms involved in atherosclerotic plaque formation, these bioactive compounds can be better option for future therapeutic interventions for atherosclerosis treatment. PRACTICAL APPLICATIONS: Atherosclerosis is one of major underlying disorders of cardiovascular diseases which occur through multiple mechanisms and is associated with metabolic disorders. Conventional therapeutic interventions are not only used to treat atherosclerosis, but are also commonly associated with mild to severe side effects. Therefore, nowadays, bioactive compounds having potential to combat and prevent atherosclerosis in diabetic patients are preferred. By understanding mechanisms involved in atherosclerotic plaque formation, bioactive compounds can be better understood for treatment of atherosclerosis. In this manuscript, we have focused on treatment strategies of atherosclerosis using bioactive compounds notably alkaloids and flavonoids having diverse pharmacological and therapeutic potentials with special focus on the mechanism of action of these bioactive compounds suitable for treatment of atherosclerosis. This manuscript will provide the scientific insights of bioactive compounds to researchers who are working in the area of drug discovery and development to control pathogenesis and development of atherosclerosis and its associated cardiometabolic disorders.

Comparison between biparietal bipolar and uniparietal bipolar radio frequency ablation techniques in a simultaneous procedural setting

PurposeTo make an in vitro evaluation of the lesion size and depth produced in two different sets of radio frequency energy bipolar delivery: simultaneous biparietal bipolar (SBB) and simultaneous uniparietal bipolar (SUB).MethodsTwo separate prototypes have been built for our purpose: one to be used in SBB mode and the other to be used SUB mode. Forty left atrium samples were taken from the hearts of freshly slaughtered pigs. They were ablated into a simulator ABLABOX, where blood flow, temperature, and contact force were controlled. After being sliced into a cryotome, the samples were digitalized by a flatbed scanner, and the images were analyzed by a computer morphometric software.ResultsTransmural lesions were achieved in 18/20 samples (90%) in SBB, while SUB showed transmurality in 9/20 samples (45%). Overall maximum diameter (DMAX) resulted larger in SUB than in SBB (2.43 ± 0.30 mm, 1.62 ± 0.14 mm, respectively; p < 0.05): Moreover, maximum epicardial and endocardial diameters (DEPI and DENDO, respectively) were wider in SUB group than SBB group (2.28 ± 0.30 mm, 2.26 ± 0.40 and 1.60 ± 0.14 mm, 1.59 ± 0.15 mm, respectively; p < 0.05). We observed the same tendency in lesion depth: The total area and volume (ATOT and VTOT) were broader in SUB group than in SBB one (581.01 ± 65.38 mm/mm2, 58.10 ± 6.53 mm/mm3 and 521.97 ± 73.05 mm/mm2, 52.19 ± 7.30 mm/mm3. respectively; p < 0.05).ConclusionsIn contrast with the smaller lesion sizes, the biparietal bipolar group showed a higher transmurality rate. These findings may suggest a better drive of the energy flow when compared with SUB lesions.

Enhanced Long-term Antithrombogenicity Instigated by Covalently-Attached Surface Modifier on Biomedical Polymers

During a variety of medical procedures such as renal dialysis, bypass surgery, and lung transplantation patient blood is exposed to the surface of a number of polymeric materials such as polycarbonate (PC), poly (vinyl chloride) (PVC) and polysulfone (PS) for a period up to several days. Such exposure may result in undesirable protein-material interactions that can potentially trigger deleterious biological processes including thrombosis, which may be responsible for other complications such as cognitive disability. In order to address this issue, we have further examined the behavior of an ultrathin antifouling and antithrombogenic coating based on monoethylene glycol silane surface chemistry. Samples of polymeric substrates were exposed to blood flow at a shear rate of ~20 s-1 for time periods of 3 and 6 hours, as well as 3 days. No additional anticoagulant chemistry was applied in the experiments. For all time periods, platelet adhesion, aggregation, and thrombus formation on the coated surfaces was inhibited compared to bare substrates (coated PC performing the best, followed by PVC-, and then PS-coated), strongly supporting the results of previous research conducted over far shorter blood contact times.

Infectious diseases related to the provision of medical care. Actual problems for health careers and patients

The article analyzes the data on blood contact infections in the world. The risks of diseases associated with the provision of medical care are shown. The analysis of the organizational and legal regulation of this issue in the Russian Federation.

Assessment of needlestick injuries and hepatitis B and C infection among surgeons

BackgroundSpecialist surgeons are at high risk of exposure to hepatitis viruses through occupational exposure to blood or body fluids. Protective measures against occupational exposure to the hepatitis B virus (HBV) and hepatitis C virus (HCV) must be taken in order to prevent infection in surgeons. We aimed to determine the needlestick injuries, and markers HBV and HCV in Iranian surgeons.MethodsThis study was cross-sectional research, performed in Baqyatallah, Shohada, Rasoul Akram, Sina, Taleghani, and Emam Hossein hospitals (all university hospitals) of Tehran, Iran. Overall 318 eligible surgeons were included. Anonymous questionnaires were used containing data about demographic characteristics, self-reported blood and needlestick contacts, occasional exposures, risk behaviors and vaccination. Also, the blood samples were taken and tested for hepatitis B surface antigen (HBsAg), antibody against Hepatitis B surface antigen (antiHBs) and HCV antibody (HCVAb). Fisher exact test and Kruskal Wallis test were used to analyze the data.ResultsThe mean age of the surgeons was 47.76 ± 8.95 years and 177 of them (55.66%) were male. The average number of needle–sticks was 28.28 ± 16.58 during the surgeons’ working life. Among them, 5 cases (1.59%) were positive for HBsAg and 2 cases (0.66%) were positive for HCVAb. ConclusionIn spite of the high needlestick rate in Iranian surgeons, prevalence of hepatitis B and C is not very high among them. A high degree of vigilance and a careful surgical technique is the only means available to prevent the transmission of the viruses.

Photo-functionalized TiO2 nanotubes decorated with multifunctional Ag nanoparticles for enhanced vascular biocompatibility

Titanium dioxide (TiO2) has a long history of application in blood contact materials, but it often suffers from insufficient anticoagulant properties. Recently, we have revealed the photocatalytic effect of TiO2 also induces anticoagulant properties. However, for long-term vascular implant devices such as vascular stents, besides anticoagulation, also anti-inflammatory, anti-hyperplastic properties, and the ability to support endothelial repair, are desired. To meet these requirements, here, we immobilized silver nanoparticles (AgNPs) on the surface of TiO2 nanotubes (TiO2-NTs) to obtain a composite material with enhanced photo-induced anticoagulant property and improvement of the other requested properties. The photo-functionalized TiO2-NTs showed protein-fouling resistance, causing the anticoagulant property and the ability to suppress cell adhesion. The immobilized AgNPs increased the photocatalytic activity of TiO2-NTs to enhances its photo-induced anticoagulant property. The AgNP density was optimized to endow the TiO2-NTs with anti-inflammatory property, a strong inhibitory effect on smooth muscle cells (SMCs), and low toxicity to endothelial cells (ECs). The in vivo test indicated that the photofunctionalized composite material achieved outstanding biocompatibility in vasculature via the synergy of photo-functionalized TiO2-NTs and the multifunctional AgNPs, and therefore has enormous potential in the field of cardiovascular implant devices. Our research could be a useful reference for further designing of multifunctional TiO2 materials with high vascular biocompatibility.

The impact of roller pump-assisted cardiotomy suction unit on hemolysis.

Hemolysis in cardiac surgery is often related to the contact of blood with air or artificial surfaces. Variations of negative pressure in the suction cannulas may represent an additional factor. Limited data exist on the contribution of a roller pump-assisted (RPA) cardiotomy suction unit to hemolysis. Elevation of free hemoglobin (fHb) following air suction (AS) or suction tip occlusion (STO) events of a pump-assisted cardiotomy suction unit was investigated in a mock circuit filled with blood from slaughtered domestic pigs. AS-associated hemolysis was measured over 240minutes with 2minutes of AS occurring every 10minutes. STO-associated hemolysis was analyzed over 80-minute periods: configuration 1 (c1) comprised a cycle of 20minutes (min) occlusion and 60minutes RPA flow (20/60minutes); c2 comprised 20 cycles of 1/3minutes; c3 comprised 40 cycles of 0.5/1.5minutes; and c4 comprised 80 cycles of 0.25/0.75minutes. The AS setup did not lead to significant hemolysis after 2 (P = .97), 3 (P = .40) or 4 (P = .11) hours. The STO setup showed the greatest hemolysis (ΔfHb of 30mg/dL) in c1 after 20minutes. ΔfHb was different in c1 from all other configurations at 20minutes (P < .0001) and 80minutes (P < .05). Ex vivo generation of large negative pressures by STO events is the main cause of cardiotomy suction-associated hemolysis. The clinical relevance of this mechanism needs further investigations.

Adequate Knowledge and Low Vaccination Rates of Hepatitis B Virus Infection Among Students, Medical, and Paramedical Persons in a Tertiary Care Teaching Hospital.

Introduction Hepatitis B virus (HBV) is probably the only vaccine-preventable virus transmitted from one person to the other by blood transfusion, sex, and contact with blood and blood products. HBV is highly transmissible, where the infection has been noted to transmit among the household contacts. HBV is also transmitted from the mother to the child through the transplacental barrier. Clinical infection with HBV may be chronic and could remain for a lifetime. Most exposures with HBV are automatically resolved, but a few infected people may become carriers and may transmit infections. Although HBV can be treated, complete elimination of the virus and the morbidity and mortality associated with chronic infection should be considered as a cause of serious concern. Because healthcare workers are predisposed to HBV infection, adequate knowledge about the virus and the vaccine to prevent the infection is necessary. This study is carried out to assess the knowledge of HBV infection and the status of vaccination among medical, paramedical students, laboratory technicians, and doctors.MethodsThe study included 256 participants attending a tertiary care teaching hospital in Telangana, South India. The participants belonged to three groups, the MBBS students (first, second-, and third-year students), the doctors (the postgraduates, medical teachers, and the clinicians), and the paramedical personnel. All the participants in the study were included after oral consent, and the study was approved by the Institutional Ethics Committee. A questionnaire containing 13 points was used for the study. Seven questions were asked to know the respondent’s knowledge of HBV infection, and the other six were used to know the participant's knowledge and status of HBV vaccination. The study participants filled in the responses with their current understanding of the HBV infection and the vaccine. All the responses were analyzed using Microsoft Office Excel and drawing means and percentages.ResultsAmong the 94 medical students, 79 (84%) knew about HBV infection. There was a significant improvement in the knowledge of HBV infection among MBBS students, with first-year MBBS (68%) to the final-year MBBS (100%). The knowledge of HBV among the doctors (postgraduates, medical teachers, and clinicians) was 100%. Among the paramedical participants that included the laboratory technicians and the nursing students, all (100%) knew about HBV infection. Very few MBBS students (12%), 28% of paramedical persons, and 45% of doctors were tested for HBV infection. The knowledge of HBV vaccination was best among the doctors (100%) followed by the paramedical personnel (89%) and the MBBS students (72%). The teaching faculty including the postgraduate students (83%) were vaccinated followed by the paramedical persons (66%), and only 24% of MBBS students were vaccinated.ConclusionsThe study participants had a reasonably good knowledge of HBV infection, and low vaccination rates were observed among various participants. There is an urgent need to understand the significance of HBV infection, especially among healthcare workers. Being easily transmissible and because of the availability of an effective vaccine, healthcare workers should be adequately vaccinated to prevent the spread of infection.

Dielectric properties and in vitro hemocompatibility of Nd:YAG laser-irradiated polyethylene terephthalate.

Surface properties and morphology of the biomaterial play an essential role in the polymer-material interaction. In this work, laser surface modification of polyethylene terephthalate as a polymer with distinguished mechanical properties was carried out using (neodymium-doped yttrium aluminum garnet) Nd:YAG laser (1.064µm) with different output power (0.3, 3, and 6W). The structural, surface, and dielectric properties of PET before and after laser irradiation have been studied using attenuation total reflection-Fourier transform infrared (ATR-FTIR), dielectric spectroscopy (DS), scanning electron microscope (SEM), and contact angle measurements. Moreover, the anticoagulant properties of the laser-irradiated PET was determined through measuring the prothrombin time (PT), partial thromboplastin time (PTT), and international normalized ratio (INR). In vitro platelet adhesion test was used to assess the platelets adhered to the surface of the samples; in addition to hematological study. It was found that contact angle (θ) measurements of laser-irradiated PET samples decreased compared to the unirradiated PET. The irradiated samples at 0.3W have the lowest contact angle which is a clear indication that surface treatment with Nd:YAG laser brought about improving the wettability of the polymer. From the dielectric measurements, both values of permittivity and dielectric loss decrease by increasing the laser power. The electrical conductivity decreases with increasing laser power, but still in the same order 10-14S/cm. The decrease in electrical conductivity σ may be due to the cross-linking of the polymeric matrix which led to a decrease in the total polarity and consequently decrease in electrical conductivity. The magnitude of σ obtained is highly recommended to be used for insulator purposes in addition to the main purpose that is blood contact.

Methodology for measuring the gap size using a fiber-optic displacement sensor exemplified by a centrifugal blood pump

In order to avoid blood clotting, in the second generation of rotary blood pumps the impeller is suspended without mechanical bearing, using balance of magnetic and hydrodynamic forces. Reaching single tens of microns gap between pump housing and impeller is crucial for level of blood traumatization by the pump. In this paper we would like to present the method of physical measurement of this gap on a running pump with the use of commercial fiber-optic proximity sensor on the example of Polish rotary blood pump ReligaHeart ROT. We also discussed technical requirements of the construction of laboratory stand. Full Text: PDF ReferencesS. Westaby, "Rotary blood pumps as definitive treatment for severe heart failure", Future Cardiol. 9, 2 (2013). CrossRef R. Delgado, M. Bergheim, "HeartMate® II left ventricular assist device: a new device for advanced heart failure", Epert Rev. Med. Devices, 2, 5 (2005). CrossRef M. Ozban, T. Yagdi, C. Engin et al, Transplant proc., 44, 6 (2012). CrossRef A.T. Lanfear, M. Hamandi, J. Fan et al., "Trends in HeartMate 3: What we know so far", J. Card. Surg., 35, 1 (2020). CrossRef Ch. Zengsheng, S. Anqiang, W. Hongyu, "Non-physiological shear stress-induced blood damage in ventricular assist device", Medicine in Novel Technology and Devices, 3 (2019). CrossRef A. M. Robertson, A. Sequeira, R. G. Owens, Rheological models of blood In: L. Formaggia, A. Quarteroni, A Veneziani (eds) Cardiovascular Mathematics (Milano, Springer-Verlag 2009) CrossRef M. Gawlikowski et al., "Necessity of telemonitoring in patients treated by means of cardiac assist systems on the example of Polish rotary blood pump ReligaHeart ROT", Advances in Intelligent Systems and Computing, 925 (2019). CrossRef R. Kustosz, et al., "The tin coating utilisation as blood contact surface modification in implantable rotary left ventricle assist device religaheart ROT", Arch. Matall. Mater., 60, 3 (2015). CrossRef S. S. Patil, A. D. Shaligram, "Analytical study of performance variations of fiber optic micro-displacement sensor configurations using mathematical modeling and an experimental test jig", IJSER, 4, 11 (2013). DirectLink Philtec Application Note, 6, 25 (2017) CrossRef

Preparation and characterization of polyethylene terephthalate-chamomile oil blends with enhanced hydrophilicity and anticoagulant properties.

New blend films based on polyethylene terephthalate (PET) with different concentrations (50, 100 and 200 µL) of chamomile oil (CAO) were prepared. The effect of oil on the dielectric properties, structural and surface properties of PET was studied. The wettability of the blend films was evaluated by contact angle measurements. In vitro platelet adhesion on the surface and coagulation assessment were conducted to evaluate the behavior of the new blends for blood contact applications. Results of the study indicate that the wettability of PET-CAO blends up to 100 µL has been enhanced relative to the pure PET as indicated by the decrease in contact angle measurements. The attenuation total reflection-Fourier transform infrared spectra of the blends confirmed the presence of chamomile oil in the polymer matrix and suggested the presence of interaction between them. The permittivity ε' values decreased by increasing oil content upto 100 µL. On the other hand, the values of dielectric loss ε″ were found to increase by increasing oil content to 100 µL after which it decreased. The delay in partial thromboplastin time (PTT) of the blood would validate the anti-coagulant property of PET-CAO blends. The results demonstrated that the PET-CAO blends with concentration of 100 µL could be considered as a promising candidate material in blood contact application.

Evaluation of the Biocompatibility of Water-Soluble Pristine С60 Fullerenes in Rabbit

C60 fullerenes have proved their therapeutic effects and efficacy by the results of countless experiments. For further usage of these nanoparticles, the systematic toxicological investigations are required. Blood compatibility should be studied for C60 fullerenes due to the potential blood contact. Currently, available data is not systematic and has not provided insights into possible side effects of C60 fullerenes on blood components. In this study, water-soluble pristine C60 fullerenes were tested in vitro to assess their biocompatibility in rabbit. The blood compatibility has been evaluated looking at the impact of C60 fullerenes on erythrocyte integrity, platelet aggregation, and some blood factors involved in coagulation. Our results revealed that C60 fullerenes cannot elicit hemolysis at studied concentrations and did not show any effect on coagulation process. C60 fullerenes in concentration-dependent manner increased ADP-dependent platelet aggregation and changed the key kinetic parameters of these processes. C60 fullerenes inhibited thrombin amidolytic activity but did not affect the activities of other studied coagulation factors. The prothrombotic property of C60 fullerenes could be the potential risk factor that leads to enhancement of vascular thrombosis. The ability of fullerene to inhibit thrombin activity is important for the pharmacological use of these carbon nanoparticles as anticoagulant agents.

Epidemiology of hepatitis B and C virus infections among patients who booked for surgical procedures at Felegehiwot referral hospital, Northwest Ethiopia.

Hepatitis B virus(HBV) and hepatitis C virus(HCV) are the main causes of cirrhosis, liver cancer, and death. This study aimed to determine the seroprevalence and associated factors of HBV surface antigen(HBsAg) and anti-HCV among patients screened for surgery at Felegehiwot referral hospital, Northwest Ethiopia. A hospital-based cross-sectional study was conducted among 433 patients in 2018. Data on socio-demographic and risk factors were collected by an exit interview using a pretested structured questionnaire. A venous blood sample of 5ml was collected from each participant, and serum was tested for HBsAg and anti-HCV using one-step rapid test kits and enzyme-linked immunosorbent assay. Multivariable logistic regression analysis was computed to identify factors associated with HBV and HCV infections. The odds ratio with 95%CI was used to describe the strength of association and statistical significance. A total of 422 patients gave data and included in the analysis. The mean age of patients was 36±5 years. About two-thirds, 269(64%) and 274(65%) patients were males, and from rural areas, respectively. The seroprevalence of HBsAg was 34(8%) followed by 18(4.3%) anti-HCV and 4(0.9%) co-infections. Being single(AOR = 1.96, 95%CI = 1.12-3.10), rural residence (AOR = 2.68, 95%CI = 1.28-5.61), ever heard about HBV (AOR = 2.41, 95%CI = 1.18-5.20), having multiple sexual partners(AOR = 2.85, 95%CI = 1.30-5.58), HIV positive(AOR = 3.14, 95%CI = 1.31-7.61), history of tooth extraction(AOR = 3.0, 95%CI = 1.40-6.56), hospitalization history(AOR = 2.95, 95%CI = 1.26-5.81), sharing of sharp instruments (AOR = 3.86, 95%CI = 1.82-8.79), and had blood contact(AOR = 2.64, 95%CI = 1.14-5.42) were statistically significant factors to HBV infection. Similarly, sharing of sharp instruments(AOR = 4.65, 95%CI = 1.32-15.1), tooth extraction practice(AOR = 2.81, 95%CI = 1.12-6.56), surgical history (AOR = 3.68, 95%CI = 1.64-9.82), hospitalization history(AOR = 4.51, 95%CI = 1.62-8.35) and had blood contact(AOR = 3.2, 95%CI = 1.56-8.51) were significant factors to HCV infection. The seroprevalence of HBsAg and ant-HCV was high compared to WHO and previous study findings. Giving special attention to awareness creation, rural settings, improving personal behaviors, infection prevention activities of health facilities, quality of healthcare procedures is crucial to prevent viral hepatitis infection.

Evaluation of the Injury Experiences of Healthcare Worker and the Measures taken, in a Training and Research Hospital

Aim: Healthcare workers frequently carry out invasive procedures as part of their jobs. Regarding this situation, they are at risk for stab injuries and also for infectious diseases such as primarily hepatitis infections and Immune Deficiency Syndrome (HIV) depending on the contact of blood and body fluids to mucous membranes. Applying the infection control measures effectively is very important to reduce the risk of transmission. In this study, it was aimed to evaluate the occupational injuries in our hospital and to ensure the relevant measures by determining whether the necessary precautions were taken. Mehtod: Healthcare workers injuries which were occurred at Recep Tayyip Erdoğan University Education and Research Hospital between 2016 and 2018 were investigated retrospectively. After the records of the infection control committee were examined retrospectively in the first two years, the rate of injury was found to be high, once a month, by the Infectious Diseases Specialist, Medical Microbiology Specialist and Infection Control Committee. Face-to-face training seminars were given to reduce the changes in the data in the last three months of 2018, when the training was given. Results: A total of 220 healthcare workers were included in our study in 3 years. The average age of the workers was 26.4 ± 4.1 years, and the female / male ratio was found as 143/77. In all three years, injuries were seen most commonly in nurses, second in intern students. After the trainings, the greatest reduction in the injury rates was observed in injectör needle sting injuries. Among the hospital staff, the greatest decrease in the injuries was observed in the cleaning staff Conclusion: Healthcare workers should be followed up that whether or not take protective measures such as primarly active and passive immune prophylaxis and carry out infection control measures correctly and effectively, against the occupationally transmitted diseases. Feedback should be received for this purpose and in case of deficiencies, it should be ensured to raise awareness by regular and continuous trainings. Keywords: Education, awareness, healtcare injury DOI: 10.7176/JHMN/75-01

P0542EVALUATION OF BLOOD CELL ADHESION AND SOLUTE REMOVAL PERFORMANCE BY AN EX VIVO EXPERIMENT OF A POLYSULFONE HEMOFILTER USING AN NV POLYMER MEMBRANE FOR CONTINUOUS RENAL REPLACEMENT THERAPY

Abstract Background and Aims Since hemofilters used for continuous renal replacement therapy (CRRT) come in prolonged contact with blood during treatment, clotting and cell adhesion induced by contact of blood with the membrane often occur, increasing the risk to the patient and burden on the staff. Suppressed platelet adhesion and better biocompatibility have been reported with the use of a dialysis membrane whose surface has been modified with an NV polymer in patients on maintenance hemodialysis. Therefore, it may be advantageous to use the NV membrane as a hemofilter for CRRT. In the present study, we evaluated the solute removal performance change and blood cell adhesion on the NV membrane after it comes in contact with blood, to clarify the characteristics of the NV membrane for long-time use. Methods A new polysulfone membrane containing the NV polymer (SNV) and a conventional polysulfone membrane (SHG) were used for the ex vivo blood filtration experiment. To compare the solute removal performance change and blood cell adhesion after blood comes in contact with the membranes, porcine blood collected from a single animal was divided into two portions, and a 24-hour of continuous hemofiltration (CHF) experiment was performed. The circulation conditions were as follows; blood flow rate, 100 mL/min; filtrate flow rate, 20 mL/min; heparin dose adjusted as appropriate to maintain the activated clotting time from 300 to 400 sec during the experiment. We evaluated the time-courses of the transmembrane pressure (TMP) and pressure drop at the hemofilter and the change in the sieving coefficients of dextran of different molecular weights (molecular weight cutoff curve) before and after the experiment, and blood cell adhesion. The amount of blood cell adhesion was evaluated based on the hemoglobin content and lactate dehydrogenase (LDH) activity in the eluate from the residual blood clots on the hemofilter 24 hours after the CHF experiment. Results The changes in the TMP and the pressure drop were significantly lower with the use of SNV as compared to SHG (n = 9, p &amp;lt; 0.01). From the molecular weight cutoff curves before and after the experiment, the molecular weights when the sieving coefficient was 0.1 to 0.4, which reflect the pore size of the pores through which relatively small molecules can pass, decreased to a lower extent after blood contact with SNV as compared to SHG (n = 3, SC = 0.1-0.3, p &amp;lt; 0.05; SC = 0.4, p &amp;lt; 0.01).The hemoglobin content and LDH activity in the blood clots adhering to the membrane after the experiment were significantly lower in SNV as compared to SHG (n = 9; Hb, p &amp;lt; 0.01; LDH, p &amp;lt; 0.05), indicating that blood cell adhesion on SNV was less pronounced than that on SHG. Conclusion SNV suppressed the increase in the TMP and also the pressure drop, allowed a high rate of solute removal performance to be maintained, and suppresses blood cell adhesion to a greater extent as compared to the conventional polysulfone membrane.

Ex vivo evaluation of the blood compatibility of mixed matrix haemodialysis membranes

The patients with end stage kidney disease need haemodialysis therapies, using an artificial kidney. Nevertheless, the current therapies cannot remove a broad range of uremic toxins compared to the natural kidney. Adsorption therapies, using sorbent-based columns, can improve the clearance of uremic toxins, but the sorbent particles often require polymeric coatings to improve their haemocompatibility leading to mass transfer limitations and to lowering of their performance.Earlier, we have developed a dual layer Mixed Matrix fiber Membrane (MMM) based on polyethersulfone/polyvinylpyrrolidone (PES/PVP) polymer blends. There, the sorbent activated carbon particles are embedded in the outer membrane layer for achieving higher removal whereas the inner blood contacting selective membrane layer should achieve optimal blood compatibility. In this work, we evaluate in detail the haemocompatibility of the MMM following the norm ISO 10993–4. We study two generations of MMM having different dimensions and transport characteristics; one with low flux and no albumin leakage and another with high flux but some albumin leakage. The results are compared to those of home-made PES/PVP single layer hollow fiber and to various control fibers already applied in the clinic. Our results show that the low flux MMM successfully avoids contact of blood with the activated carbon and has good haemocompatibility, comparable to membranes currently used in the clinic. Statement of SignificanceHaemodialysis is a life-sustaining extracorporeal treatment for renal disease, however a broad range of uremic toxins cannot still be removed. In our previous works we showed that a double layer Mixed Matrix Membrane (MMM) composed of polyethersulfone/polyvinylpyrrolidone and activated carbon can achieve higher removal of uremic toxics compared to commercial haemodialysers. In this work we evaluate the haemocompatibility profile of the MMM in order to facilitate its clinical implementation. The lumen particle-free layer of the MMM successfully avoids the contact of blood with the poorly blood-compatible activated carbon. Moreover, thanks to the high amount of polyvinylpyrrolidone and to the smoothness of the lumen layer, the MMM has very good haemocompatibility, comparable to membranes currently used in the clinic.