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This thesis works with measuring possibilities of blood oxygen saturation, analysis methods used and their calibration. It also deals with design of the block diagram of pulse oximeter for measuring blood oxygen saturation.

Der Diabetes mellitus zählt zu den Hauptursachen einer terminalen Niereninsuffizienz. Aufgrund der veränderten Erythropoiese ist die Verwendung des HbA1c für die Beurteilung der Stoffwechseleinstellung bei Diabetikern mit einer chronischen Nierenerkrankung im Stadium 5 nach KDOQI immer noch in Frage gestellt. Die vorliegende Arbeit untersuchte die HbA1c-Variabilität in Abhängigkeit der ESA-Dosis und des ESA-Präparates bei Hämodialysepatienten. Zum Einsatz kamen entweder das klassische Epoetin-Analogon Erythropoietin α oder ein Wirkstoff der neueren Generation Methoxy-Polyethylenglycol-Epoetin beta. Es wurden 102 Hämodialysepatienten, darunter 41 Diabetiker und 61 Nicht-Diabetiker, über einen Zeitraum von neun Monaten beobachtet. Von den Untersuchungsteilnehmern erhielten 48 Patienten Epoetin α und 54 Patienten Methoxy-Polyethylenglycol-Epoetin beta. Unsere Daten konnten zeigen, dass es zu einer Beeinflussung des HbA1c durch die Therapie mit ESA-Präparaten kommt. Das als alternativer Stoffwechselparameter fungierende Fructosamin unterlag keiner derartigen Beeinflussung, korrelierte jedoch nur ungenügend mit den höheren Blutzuckerwerten, sodass seine Anwendbarkeit bei Diabetikern ebenfalls erheblich einschränkt ist. In der Gegenüberstellung der beiden ESA-Präparate erzielten beide Wirkstoffe vergleichbare Ergebnisse bezüglich des Erreichens der Hämoglobin-Zielwerte. Methoxy-Polyethylenglycol-Epoetin beta zeigte im Gegensatz zu Epoetin α eine seltener notwendige Dosisanpassung und längere Applikationsintervalle. Aus der vorliegenden Arbeit geht hervor, dass bei Hämodialysepatienten das HbA1c kritisch und mit Bedacht auf mögliche Einflussfaktoren interpretiert werden sollte. Es ist dennoch derzeit der konstanteste Parameter in der Stoffwechselverlaufskontrolle bei Diabetes mellitus.

Objetivo: Determinar la relación entre el nivel de hemoglobina glicosilada y el riesgo de desarrollar diabetes mellitus tipo 2 en el plazo de diez años, en pacientes no diabéticos de un Hospital de Lima Norte. Metodología: El presente estudio fue descriptivo, observacional, transversal y prospectivo, se realizó en el consultorio externo de un Hospital de Lima Norte, participaron 101 personas no diabéticas entre 18 y 65 años de uno u otro sexo, y se relacionó los niveles de hemoglobina glicosilada con el riesgo de desarrollar diabetes mellitus tipo 2 en el plazo de diez años mediante el test de FINDRISK. Resultados: Se estudiaron 101 pacientes no diabèticos, el 66.7% fueron del sexo femenino, el grupo etario más frecuente fue los menores de 35 años, (44.1%). El 99% de los encuetados presentaron valores normales de hemoglobina glicosilada. Los resultados del test de FINDRISK mostraron que el 29.7% de los evaluados tuvieron riesgo bajo de desarrollar diabetes tipo 2 en el plazo de 10 años, y el 21.8% tuvieron riesgo de moderado y alto. Cuando se asoció hemoglobina glicosilada con el riesgo de desarrollar diabetes s mellitus tipo 2 no se encontró asociación p=0.218. Conclusión: No se halló relación estadísticamente significativa cuando se relacionó la hemoglobina glicosilada con los riesgos de desarrollar diabetes mellitus tipo 2, en la población estudiada. / Objective: To determine the relationship between the glycosylated hemoglobin level and the risk of developing type 2 diabetes mellitus within ten years in non-diabetic patients in a Hospital in North Lima. Methodology: This study was descriptive, observational, transversal, and prospective, and was carried out in the outpatient clinic of a Hospital in Lima Norte, 101 non-diabetic persons between 18 and 65 years of age from one sex or another, And glycosylated hemoglobin levels were associated with the risk of developing type 2 diabetes mellitus within ten years using the FINDRISK test. Results: 101 non-diabetic patients were studied, 66.7% were female, the age group was the most frequent ones under 35 years of age (44.1%). 99% of respondents had normal glycosylated hemoglobin values. Results of the FINDRISK test showed that 29.7% of those evaluated had a low risk of developing type 2 diabetes within 10 years, and 21.8% had moderate and high risk. When glycosylated hemoglobin was associated with the risk of developing type 2 diabetes Mellitus, no association was found p=0.218. Conclusion: No statistically significant relationship was found when glycosylated hemoglobin was associated with the risks of developing type 2 diabetes mellitus in the study population. / Trabajo de investigación

Iron deficiency is common in frequent blood donors. At Ryhov blood center, hemoglobin and ferritin levels are measured in all newly registered blood donors. After June 2017, additional control for S-ferritin levels was added after the 4th and 5th blood donation, in women and men, respectively. The study aimed to evaluate S-ferritin levels in newly registered blood donors in 2018 and compare the number of rejected donors between men and women. Moreover, to compare S-ferritin levels between new registration and follow-up and compare the number of screening controls in 2016 with 2020. The study included all newly registered and rejected blood donors in 2018. Additionally, blood donors who were newly registered during 2018–2019 and underwent the follow-up S-ferritin control between 2018–2021 were included. The number of newly registered in 2018 was 544 blood donors, 17% were rejected due to low S-ferritin levels where all were women. Results showed that S-ferritin levels decreased at follow-up and the difference was greater in men than women. However, women had lower S-ferritin levels at new registration compared to men. The study could not show that follow-up S-ferritin control has an effect in reducing the number of screenings controls.

No presenta resumen. / Revisión por pares

Background: Previously, we had shown that elevation of cerebral perfusion pressure, using pressors, improved short-term outcomes after traumatic brain injury and hemorrhagic shock in swine. The current study evaluates outcomes after resuscitation with diaspirin cross-linked hemoglobin (DCLHb)-a hemoglobin-based oxygen carrier with pressor activity-in the same swine model of traumatic brain injury and hemorrhagic shock. Methods: Anesthetized and ventilated swine received traumatic brain injury via cortical fluid percussion (6-8 atm) followed by 45% blood volume hemorrhage. One hour later, animals were randomized to either a control group (SAL) resuscitated with normal saline equal to three times shed blood volume or to one of two experimental groups resuscitated with DCLHb. The two experimental groups consisted of a low-dose group, resuscitated with 250 mL of DCLHb (Hb1), and a high-dose group, resuscitated with 500 mL of DCLHb (Hb2). Animals were observed for 210 minutes postresuscitation. Outcomes evaluated were cerebral oxygenation by measuring partial pressure and saturation of oxygen in cerebrovenous blood; cerebral function by evaluating the preservation and magnitude of cerebrovascular carbon dioxide reactivity; and brain structural damage by semiquantitatively assessing beta amyloid precursor protein positive axons. Results: Postresuscitation, cerebral perfusion pressure was higher in the DCLHb groups (p < 0.05, Hb1 and Hb2 vs. SAL), and intracranial pressure was lower in the Hb2 group (p < 0.05 vs. SAL). Cerebrovenous oxygen level was similar in all groups (p > 0.05). At baseline, 5% carbon dioxide evoked a 16 ± 1% increase in cerebrovenous oxygen saturation, indicating vasodilatation. At 210 minutes, this response was nearly absent in SAL (4 ± 4%) (p < 0.05 vs. baseline) and Hb1 (1 ± 5%), but was partially preserved in Hb2 (9 ± 5%). There was no intergroup difference in beta amyloid precursor protein positive axons. Five of 20 SAL and 0 of 13 DCLHb animals developed brain death (flat electroencephalogram) (p = 0.05, SAL vs. DCLhb). Postresuscitation, DCLHb animals maintained higher mean pulmonary arterial pressure (28 ± 1 mm Hg, SAL; 42 ± mm Hg, Hb1; 45 ± 1 mm Hg, Hb2) (p < 0.05, Hb1 and Hb2 vs. SAL) and lower cardiac output (3.9 ± 1.6 L/min, SAL; 2.6 ± 0.1 L/min, Hb1; 2.7 ± 0.1 L/min, Hb2) (p < 0.05, Hb1 and Hb2 vs. SAL). Three Hb2 animals died as a result of cardiac failure, and one SAL animal died as a result of irreversible shock. Conclusion: In this swine model of traumatic brain injury and hemorrhagic shock, resuscitation with DCLHb maintained a higher cerebral perfusion pressure. Low-dose DCLHb (minimal increase in oxygen carriage) failed to significantly improve short-term outcome. With high-dose DCLHb (significant improvement in oxygen carriage), intracranial pressure was lower and cerebrovascular carbon dioxide reactivity was partially preserved; however, this was at the cost of poorer cardiac performance secondary to high afterload.

Three experiments were conducted to study the effect of zinc deficiency on hemoglobin, red cell counts, red cell fragility, storage of erythropoietic minerals in livers and circulating levels of zinc, iron and copper in the rat. In the experiment 1, twenty weanling rats were divided into four groups. Two groups were fed zinc-deficient diet ( < 0.5 ppm); and two groups, zinc-supplemented diet (50 ppm). The rats in the first and third groups were bled three times a week (bled), however the rats in remaining groups were bled once a week (non-bled). All rats received ad libitum food. Mean food intake per day was considerably less for zinc-deficient rats than that for zinc-supplemented rats. Approximately 2 to 3 times as much food was required for each gram of body weight gained by the zinc-deficient group as by the controls. In the experiment 2, fifty-two male weanling rats were divided into six groups; three groups were bled and three non-bled. The 2nd and 5th groups of (zinc-supplemented) rats were pair-fed with the same amount of food as the 1st and 4th zinc-deficient groups ate. The 3rd and 6th groups (control) were fed ad libitum. Hemoglobin levels were lower (P < 0. 05) in bled groups than in the non-bled groups irrespective of zinc treatment in experiment 1 and 2. Within the bled and non-bled groups the zinc-deficient rats consistently exhibited decreased hemoglobin values as compared to zinc-supplemented rats. All zinc-deficient rats had a significantly lower (P < 0. 05) liver zinc content than did the zinc-supplemented ones. There was no difference in iron as well as in copper content of the livers among the groups of experiment 1. However, in experiment 2, copper content per liver was significantly less (P < 0.05) in zinc-deficient rats than in t he zinc-supplemented rats. Serum zinc values were lower in zinc deficient than in control rats. No differences in the concentration of copper in the serum were observed. Red~blood-cell membrane fragility in experiment 2 indicated that there were no differences in percent hemolysis among bled groups. However, percent hemolysis was significantly lower (P < 0.05) in zinc-deficient non-bled groups which clearly indicated that treatment did affect hemolysis. Among other possibilities this might be attributed to more rapid turn-over of red-blood-cells in zinc-deficient rats. In the experiment 3, twenty-four male weanling rats were divided into three groups; one group of zinc-supplemented rats was pair-fed to the zinc-deficient group; and remaining control group, fed ad libitum. All the rats were bled once a week. After 28 days of feeding the rats were injected with 2-c14-glycine (5μc/100 g body weight). It was observed that incorporation of glycine into hemoglobin in the zinc deficient rats was significantly (P < 0.05) more than in the zinc-supplemented rats. With the limited data it is difficult to draw a definite conclusion. Perhaps, it may be true that the red-blood-cells of zinc-deficient rats might have a short life span resulting in the new red cell formation.

A crossover design study was conducted to determine if reducing pain, by using alternative sites off the finger tip, would increase testing frequency and improve clinical outcome as measured by glycosylated hemoglobin. Subjects with type I and type 2 diabetes tested with the FreeStyle alternative-site meter (group I) or tested with their original meter (group 2). After 3 months the subjects used the alternate meter. Testing frequency and blood glucose concentrations were recorded for the month before the study began and monthly thereafter. Glycosylated hemoglobin was tested initially, at the crossover point, and at study conclusion. Insulin users increased testing frequency from 2.4 to 3.0 tests per day. Testing frequency for non-insulin users remained the same at 1.5 tests per day. Testing frequency was essentially the same with the FreeStyle and the original meters. The average hemoglobin A1c was 7.4% (standard deviation 1.5%) initially, 7.3% (standard deviation 1.5%) at the crossover point, and 6.9% (standard deviation 1.1%) after 6 months. There was no significant difference in hemoglobin A1c measurements between meter types after 6 months. Thirteen months later a final hemoglobin A1c, testing frequency, and a questionnaire regarding meter preference and pain rating were obtained. Seventy-four percent of participants preferred the alternative-site meter, which was rated as significantly (p < .05) less painful. Testing frequency significantly improved (p = .001) while free strips were being provided. Testing frequency 13 months later was not significantly different from the baseline (p = .101). Hemoglobin A 1 c was significantly lower 6 months after the study began (p = .000) and 13 months later (p = .008) at baseline.