bluuebunny/crossref_metadata_2025 huggingface dataset:
Harvesting COVID Convalescent Plasma Using Latest-Generation Apheresis Systems
Authors: Das Sudipta Sekhar , Biswas Rathindra Nath , Sen Subrata
Published: August 2023

Background and Objectives:

Transfusion of COVID convalescent plasma (CCP) has been found to be a useful and logistically feasible therapeutic strategy in COVID-19. Appropriate guidelines describing donor eligibility criteria, CCP collection and storage, and clinical transfusion of CCP have been described. In this study, we discussed the collection of CCP by plasmapheresis, quality of product obtained, and donor adverse reactions associated with CCP collection.

Methods:

This observational study included 209 screened eligible donors and 186 procedures of plasmapheresis for the collection of CCP. Donor selection and CCP collection were done as per the guidelines described by regulatory bodies. Statistical analysis was done using the SPSS statistical package.

Results:

The median age of the eligible donors was 42 years, with a male preponderance. The mean anti-severe acute respiratory syndrome coronavirus 2 immunoglobulin G value (S/Co) was 11.8 in eligible donors. The total mean whole blood volume processed to collect the targeted plasma volume, mean utilization of anticoagulant, and mean time needed to complete the procedure were significantly more in the Spectra Optia cell separator (P < 0.05). Quality of the plasma separated by Trima Accel and Spectra Optia was found to be comparable. A total of 9 (5.1%) donors experienced adverse events during or after plasmapheresis.

Conclusion:

Plasmapheresis using new-generation automated cell separators has the potential to generate CCP of optimized quality and potency. More emphasis is needed on the quality control of CCP with regard to the establishment of defined quality markers and their allowable limits. Appropriate donor vigilance, donor selection, and equipment management during the procedure may significantly prevent adverse events related to plasmapheresis.
Blood Cell Exchange in Sickle Cell Disease
Authors: Chowdhry Mohit , Agrawal Soma , Sharma Ankita , Thakur Uday Kumar
Published: August 2023

Background and Objectives:

Red cell exchange (RCE) is a type of therapeutic apheresis procedure aimed at removing the deformed red blood cells of a patient and replacing them with those obtained from healthy donors. It is a commonly used but yet underutilized procedure for the treatment of hemoglobinopathies such as sickle cell disease (SCD) (acute or chronic), and other diseases and conditions such as ABO-incompatible hematopoietic stem cell transplantation, severe erythrocytosis, hereditary hemochromatosis, severe infection with intra-erythrocytic parasites such as malaria, babesiosis or cases of a drug overdose, poisoning and to perform envenomation. The objective of the study is to study and understand the efficacy of RCE in the management of patients in various clinical scenarios.

Methods:

This is a retrospective study carried out at a tertiary care hospital in North India over a period of 4 years (2016–2020). All the RCE were performed on Spectra Optia apheresis (System 1 P0 4552 (Terumo BCT, Lakewood, CO, USA) which comes with a built-in software (Version 11) for performing RCE.

Results:

A total of 8 exchanges were performed in five patients. Three of these patients had undergone the procedure twice. Two out of the five patients were found to be antibody screen positive. Corresponding antigen-negative units of packed red cells were issued for these patients. The targeted and final fraction of red cell remaining values which were kept at ≤30% was achieved in all cases.

Conclusion:

RCE is a safe and effective therapeutic treatment modality for patients of SCD. It is a simple and relatively safe treatment modality that provides immediate relief in acute complications and also prevents the risk of long-term complications such as iron overload and iron-induced organ damage.
RH Phenotype, ABO and Kell Antigens, Alleles and Haplotypes Frequencies in North Indian Blood Donor Population
Authors: Mangwana Sadhana , Simon Nikhil , Sangwan Lalitesh
Published: August 2023

Background and Objectives:

ABO, RH and Kell blood group systems are clinically significant blood group systems among 36 blood group systems having total of 360 blood group antigens which cause most cases of alloimmunization following blood transfusions or pregnancy. India has regionally and ethnically very diverse population in different demographic areas. Due to different antigenic expression in different population, knowledge of antigen frequencies among their local and regional donor population is important to assess the risk of antibody formation, probability of antigen negative blood for patients having alloantibodies, inventory management and database for rare antigens thus enhancing patient safety.

Aim:

To know and compare phenotype prevalence, frequency distribution of ABO, RH and Kell antigens and Alleles in blood donors.

Methods:

A prospective study was conducted in a tertiary care hospital in North India over three years period. ABO, RH D grouping, RH and Kell phenotypes were performed on blood donors. Hardy Weinberg's equations were used to calculate ABO, RH and Kell allele frequencies and were analyzed.

Results:

During the study period, 24745 healthy individuals donated blood at Tertiary Care hospital; with 97.26% male and 2.74% female population. Prevalence of ABO antigens were B =37.74%, O = 31.38%, A = 21.77% and AB = 9.09% with allele frequency for O = 0.560, B = 0.266, A = 0.169 and AB = 0.091. The commonest RH phenotype observed was DCCee followed by DCcee, DCcEe, DccEe while commonest RH negative phenotype were ccee and Ccee. Homozygous phenotypes were absent in our population. Amongst five RH antigens phenotyped serologically, highest prevalence was of e antigen followed by D, C, c and E being the lowest. Prevalence of Kell phenotype was 2.57% (K) while that of k as 97.43% with allele frequencies of K and k as 0.0252 and 0.986 respectively.

Discussion:

Genetic variability in different population result in varied expression of red cell antigens in different races. Knowledge of varied frequency and phenotypic expression of major clinically relevant antigens and RH haplotypes in these blood groups systems would help in more rational approach for blood transfusion, decreasing alloimmunization thus enhancing blood safety.
Gray Zone Sample Testing in Enhancing Blood Safety
Authors: Kandukuri Maheshkumar , Vujhini Sudhir Kumar , Bonagiri Shanthi , Bogi Murali Krishna
Published: August 2023

Background:

Gray zone samples with optical density (OD) lying between cutoff OD and 10% below the cutoff OD (cutoff OD × 0.9) were identified during routine Transfusion Transmissible Infections (TTI) screening. Enzyme-linked immunosorbent assay (ELISA) used for this purpose can sometimes fail to detect blood donors who are recently infected or possessing the low viremia. Estimation of a gray zone in ELISA testing and repeat testing of gray zone samples can further help in reducing the risks of TTI in countries where nucleic acid amplification testing for TTIs is not feasible.

Methods:

Repeat ELISA testing was done on gray zone samples in duplicate, the samples showing both OD values below gray zone were marked nonreactive, and samples showing one or both OD values in the gray zone were marked indeterminate. The samples on repeat testing showing one or both OD above cutoff values were labeled reactive.

Results:

Out of the 196 gray zone samples, 33 samples turned out to be reactive (as shown in the table), 39 samples were nonreactive, and 124 samples were again in the gray zone and were labeled as indeterminate.

Conclusion:

Estimation of gray zone samples with repeat testing can further enhance the safety of blood transfusion in resource-poor developing nations where more sophisticated and sensitive methods such as nucleic acid amplification test (NAT) is not available in all the blood banks.
Prevalence of Unexpected Red Cell Antibodies in Healthy Donor Population in a Tertiary Care Center in South Kerala
Authors: Gayathri AM , Gupta Debasish
Published: August 2023

Background and Objectives:

Apart from naturally occurring red cell antibodies Anti-A and Anti-B in human plasma, there are two types of unexpected red cell antibodies: Alloantibodies and auto-antibodies. The presence of these antibodies, alone or in combination, makes difficulties with compatibility testing, thereby delaying in the issue of a compatible blood unit or may reduce posttransfusion red blood cells life span. Antibody screening is mandatory as laid down by the Drug and Cosmetic Act 1940 and Directorate General of Health Services guidelines. This goal of this paper was to study the prevalence of Unexpected Red Cell Antibodies in Healthy Donor Population in a Tertiary Care Centre in South Kerala.

Methods:

The sample size chosen for this study was 7000 randomly chosen healthy nonremunerated voluntary donors who attended in house and blood donation camps over a period between November 26, 2017, and February 15, 2019.

Results:

The prevalence of unexpected red cell antibodies was found to be 1 in 1000. Male blood donations were more than female and blood donors among 18–30 years of age were greater in number. There were no cases of direct antiglobulin test positivity encountered. Male: Female ratio is 2.5:1 and males had naturally occurring alloantibodies, whereas females had a previous history of pregnancy. Anti-M and Anti-Lewis antibodies were the most common alloantibodies followed by Anti-Rh (D and C) antibodies and Anti-IH in the current study. Benign cold agglutinins (BCA) were found predominately in the younger male population with a significant seasonal variation noted in the prevalence of these antibodies.

Conclusion:

All antibodies identified had the ability to cause immune hemolytic transfusion reactions in the recipients. BCA-positive cases were seen more during the winter season and rainy seasons when compared to hot climatic conditions.
Evaluation of Donor Demographic, Clinical, and Serological Characteristics in COVID Convalescent Plasma Donation by Plasmapheresis
Authors: Das Sudipta Sekhar , Biswas Rathindra Nath , uz Zaman Rafique , Sen Subrata
Published: August 2023

Background and Objectives:

Passive transfusion of convalescent plasma (CCP) in coronavirus disease 2019 (COVID-19) has proven to be a winning and logistically feasible therapeutic strategy. The efficacy of plasma depends on appropriate donor screening and selection. Ours being a tertiary care hospital with dedicated COVID facility, we obtained prescriptions of CCP from clinicians for the treatment of COVID-19. Here, we discuss the clinical and serological characters of the voluntary donors who altruistically visited the blood center for plasma donation.

Methods:

The study included 683 voluntary donors who visited the blood center for mandatory eligibility screening to donate plasma. Donor eligibility criteria were applied following established guidelines. Donor details were obtained from blood center records and software. Detailed investigations on blood samples were performed as mandated and discussed.

Results:

Among 683 donors initially registered 166 (24.3%) were deferred due to various causes The median age of eligible donors was 44 years with a male preponderance. The mean anti- severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) IgG (S/Co) was calculated to be 12.9. An upward trend in anti-SARS-CoV-2 IgG level was observed with increase in fever temperature, disease severity, and symptom-free days (P < 0.05).

Conclusion:

Donor screening and selection in CCP donation should be performed meticulously to obtain safe and potent plasma products. Based on our findings, we suggest that in addition to optimum anti-SARS-CoV-2 IgG levels, factors such as the severity of disease, fever temperature, and symptom-free days which determine antibody adequacy may be considered while selecting CCP donors.
Performance Evaluation of Blood Donor Screening Assays for Serological Detection of Hepatitis B Surface Antigen and Antibodies to Hepatitis C Virus
Authors: Bajpai Meenu , Kakkar Brinda , Gupta Ekta , Kumar Guresh
Published: August 2023

Background and Objectives:

Screening for transfusion transmissible infections in donated blood can be done by either rapid diagnostic tests (RDTs) or enzyme-linked immunosorbent assay (ELISA) or any other available sensitive immunoassay such as chemiluminescence immunoassay (CLIA). The aim of this assay was to evaluate performance of two commercially available RDTs and CLIA against ELISA for serological screening of hepatitis B surface antigen (HBsAg) and anti hepatitis C virus (HCV). In addition, we also tested the seropositive samples by RDTs, CLIA, and/or ELISA by molecular assays (transcription-mediated amplification, transcription-mediated amplification, and quantitative polymerase chain reaction).

Methods:

In this prospective study, 1000 consecutive blood donors were screened from September 2017 to March 2018. All blood samples collected during the study period were tested by RDTs, CLIA, and ELISA, and the results obtained were compared.

Results:

On considering ELISA as a reference standard, low analytical sensitivity was noted for both RDTs (64.29%) and CLIA (71.43%) for HBsAg detection. Similar results were also noted for both RDTs (25%) and CLIA (75%). The positive predictive value of CLIA was found to be lower (HBsAg 31.25%; anti-HCV 50%) as compared to RDTs (HBsAg 90%–100%; anti-HCV 100%). High false positivity was noted with CLIA, while RDTs missed seropositive samples. The viral load for HBsAg and anti-HCV seropositive samples ranged from 29.7 IU/ml to 3.4 × 104 IU/ml and 7.56 × 106 IU/ml, respectively.

Conclusions:

Performance of CLIA as screening assay was better compared to RDTs. CLIA seems to be a suitable screening assay for emergency situations and predonation apheresis donor screening. RDTs may be used as supplemental assay prior to donor notification.
Two Sample Policy
Authors: Setia Rasika D , Dogra Mitu , Yadav Ramesh
Published: August 2023

Background and Objectives:

Pretransfusion testing has undergone remarkable changes over the past few decades starting from manual methods to semi-automation to full automation, but sample collection from the right person is out of scope of blood center. Through this study, we tried to address this issue by introducing two-sample policy in our institute. The objective of this study is to emphasize the importance of using two different samples for type and screen and crossmatch.

Methods:

This is a retrospective study extending over a period of 3.5 years (January 2015–June 2018) in a tertiary care health center. Retrospective data collections were done for the period post implementation of two-sample policy in the institute. As per the two-sample policy, two samples of the same patient would be collected, one at the time of type and screen and other at the time of blood component arrangement request. In case of any discordance between the two samples, incident is generated.

Results:

Of total 110,949 requests, 85,326 blood/blood components were issued, 56879 of which were for packed red blood cells (PRBCs) and a total of 34,922 PRBC units were released in the study duration. A total of 22/(0.06%) errors were recorded as grouping discrepancy between type and screen sample and sample received for blood component arrangement request. Incidentally, all 22 cases were for the arrangement of PRBC. Out of 22 errors, 20 were near misses and were detected in immunohematology laboratory at the time of compatibility testing and 2/22 (9.09%) errors were actual no harm events.

Conclusion:

The problem of wrong blood in tube (WBIT) is still a challenge faced by many laboratory persons. The issue can be resolved by training dedicated staff for sample collection. Although this policy has many drawbacks, such as added costs of sample collection and double testing, inconvenience to the patient, delay in providing blood, and increased type O blood use, we would like to emphasize that it would be helpful in error reduction.
Blood Component Therapy in Coronavirus Disease-2019 Patients Hospitalized in a Tertiary Care Center in Eastern India
Authors: Das Sudipta Sekhar , Biswas Rathindra Nath
Published: August 2023

Background and Objectives:

Most patients with coronavirus disease-2019 (COVID-19) do not need blood transfusion, and only a subset of critically ill patients requires transfusion. Here, we describe the pattern of blood usage in COVID-19 patients in our hospital with regard to indications, clinical and laboratory evaluations, and blood and blood component transfusions.

Methods:

This is a retrospective study that included 34 hospitalized transfused patients admitted with clinical features and diagnosis of COVID-19. Demographic, clinical, laboratory, and blood transfusion details were obtained from patient files and blood bank software. Statistical analysis was done using the IBM SPSS statistical package.

Results:

Among the 419 hospitalized COVID-19 patients, 34 (8.1%) received blood transfusion. Levels of D-dimer, serum ferritin, and interleukin-6 as high as 8545 ng/mL, 8486 ng/mL, and 256 pg/mL, respectively, were observed in few patients. Comorbidity was demonstrated in 91.2% of transfused patients. A total of 6 (17.6%) patients succumbed to disease. Packed red blood cell was the main blood component transfused to COVID-19 patients followed by platelet (PLT) and plasma products. A rise in trend in blood utilization was demonstrated from March to June 2020 with a dip in July 2020. Compared to other months, more patients required PLT concentrates in June 2020.

Conclusion:

Blood utilization in COVID-19 patients is usually low and does not affect the blood inventory significantly. Most transfused patients have been critically ill, and the trend in blood utilization in COVID-19 patients may be difficult to ascertain.
Justification of Blood Requisition
Authors: Kesarwani Nitika , Bahadur Shalini , Mahajan Saurabh , Kumar Anand
Published: August 2023

Background:

The purpose of this study is to compile and review the blood utilization in various surgical departments in a tertiary care trauma center. To monitor and improve transfusion practices, analysis of effective usage of blood and its components is necessary.

Methods:

A retrospective cross-sectional study was done in the department of pathology in our center for a period of 6 months. Data from blood requisition forms, transfusion forms, and issue register were compiled and reviewed. The number of units requested cross-matched and transfused for every patient was collected. Statistical Analysis: The data were entered in SPSS version 20 and analyzed through the calculation of blood transfusion parameters: (i) cross-match to transfusion ratio (C/T), (ii) transfusion probability (T%), and (iii) transfusion index (TI).

Results:

2724 units of blood was cross-matched and 2108 units of blood was transfused. The overall C/T ratio calculated was 1.29, TI was 0.77, and T% was 88.2%. All these figures are under the desirable range.

Conclusion:

The study concluded that though the trauma center in our hospital meets the parameters required for blood transfusion, yet the departments requiring blood should critically analyze the blood requisitions to minimize the blood bank load and cost.
Challenges faced by frontline health managers during the implementation of COVID-19 related policies in India: A qualitative analysis
Authors: Kundapur Rashmi , Aggarwal Sumit , Gaitonde Rakhal , Rashmi Anusha , George Leyanna Susan , Pandey Arvind , Bavaskar Yogita
Published: August 2023

Background & objectives:

The COVID-19 pandemic exposed the strengths and weaknesses of the healthcare systems across the world. Many directives, guidelines and policies for pandemic control were laid down centrally for its implementation; however, its translation at the periphery needs to be analyzed for future planning and implementation of public health activities. Hence, the objectives of this study were to identify the challenges faced by frontline health managers in selected States in India during the pandemic with regard to implementation of the COVID-19-related policies at the district level and also to assess the challenges faced by the them in adapting the centrally laid down COVID-19 guidelines as per the local needs of the district.

Methods:

A qualitative study using the grounded theory approach was conducted among frontline district-level managers from eight different States belonging to the north, south, east and west zones of India. The districts across the country were selected based on their vulnerability index, and in-depth interviews were conducted among the frontline managers to assess the challenges faced by them in carrying out COVID-19 related activities. Recorded data were transcribed verbatim, manually coded and thematically analyzed.

Results:

Challenges faced in implementing quarantine rules were numerous, and it was also compounded by stigma attached with the disease. The need for adapting the guidelines as per local considerations, inclusion of components of financial management at local level, management of tribal and vulnerable populations and migrants in COVID context were strongly suggested. The need to increase human resource in general and specifically data managers and operators was quoted as definite requirement.

Interpretation & conclusions:

The COVID-19 guidelines provided by the Centre were found to be useful at district levels. However, there was a need to make some operational and administrative modifications in order to implement these guidelines locally and to ensure their acceptability.
Skin as a Window to Diagnose Inborn Errors of Metabolism
Authors: Somasundaram Arun , Chiramel Minu Jose , Sathishkumar Dharshini , Korula Sophy
Published: August 2023

Skin serves as a window to diagnose many systemic diseases, including inborn errors of metabolism (IEM). IEM occur due to disturbance in the metabolism of carbohydrates, proteins, fats, and other micronutrients. Amino acid disorders, organic acidurias, transport defects, urea cycle diseases, storage disorders, and micronutrient defects are some of them which are included under this spectrum. As timely intervention can improve the outcome in some of these conditions, it is prudent to be aware of their clinical presentation. Dermatologist can play a crucial role in the diagnosis of these conditions as many of them can have skin, hair, and mucosal findings that serve as markers for unrecognized IEM. The aim of this review is to give a succinct outline of the cutaneous features seen in commonly encountered IEMs.
Waardenburg Syndrome with Rare Ocular Features
Authors: Puri Neerja , Goyal Sheenu , Brar Balvinder Kaur
Published: August 2023

Introduction:

Waardenburg syndrome (WS) is an uncommon autosomally inherited disease with four subtypes.

Case Report:

We report a case of a 5-year-old girl with molluscum contagiosum with features of Waardenburg syndrome with dystopia canthorum, synophrys, broad nasal root, and sensorineural hearing loss.

Discussion:

The association between Waardenburg syndrome and ocular albinism is rare and hence reported.
Is there a Role for Combined Therapy with Oral Corticosteroids and Propranolol in Patients with Infantile Hemangioma? A Retrospective Cohort Study
Authors: García-Valencia Claudia , Sáez-de-Ocariz Marimar , Orozco-Covarrubias Luz
Published: August 2023

Introduction:

Infantile hemangioma (IH) is the most common benign tumor in infancy. Oral corticosteroids (OCs) still have an important role in the treatment of complex IH. In the present study, we provide our experience of oral propranolol + OCs treatment for IH.

Materials and Methods:

This was a retrospective cohort study of 26 IHs treated with propranolol, either alone or in combination with OCs, at the National Institute of Pediatrics, Mexico. Information on clinical and demographic data was collected. Data were summarized as mean (standard deviation) or median (minimum, maximum) or frequencies and proportions as needed. Comparative analysis between the group only treated with propranolol and the group treated with propranolol plus OCs was performed with Fisher’s exact test or Mann–Whitney U-tests.

Results:

All of our patients had a positive response to treatment. The comparison between both groups showed that the maximum and mean propranolol doses were significantly lower in the group of patients receiving combined treatment.

Conclusions:

Our findings support that the use of propranolol plus corticosteroids in IH allows the use of lower doses of both drugs for longer periods with less risk of adverse effects and fewer or no relapses.
A Clinical Study of Dermatoses in Neonatal Intensive Care Unit in a Tertiary Health-Care Center
Authors: Reddy Suga , Kavya K. B. , Guruprasad G.
Published: August 2023

Introduction:

Neonatal period is defined as the first 4 weeks of extrauterine life. The skin and appendages of the newborn present different features compared to adults. The imperative knowledge of normal phenomena and their differentiation from the more significant cutaneous disorders of the newborn is critical for dermatologists for timely intervention, which could facilitate a better therapeutic outcome.

Materials and Methods:

We conducted a hospital-based, observational, cross-sectional study of a total of 128 neonates with cutaneous manifestation from May 2021 to November 2021. Results were analyzed statistically.

Results:

Of all neonates examined, i.e., 128, 77 (60.15%) were male and 51 (39.85%) were female, with a male: female ratio of 1.5:1. 87 (67.96%) neonates were term, 35 (27.34%) were preterm, and 6 (4.68%) were postterm. 33 (25.78%) neonates had more than one cutaneous lesion. Of all the cutaneous lesions, physiological skin lesions were most common, which accounted for 70% of skin lesions, followed by iatrogenic 8%, transient noninfective conditions 5%, eczema 5%, developmental defects 4%, birthmarks 4%, and others 4%.

Conclusion:

Neonatal skin lesions are often physiological. Both dermatologists and pediatricians have to be aware of the course of the disease. Nursing mothers have to be explained the natural course of the skin lesions to reduce unnecessary anxiety; whereas to reduce iatrogenic infections, nursing staff has to be explained to handle newborn’s skin with care as they are sensitive.
A cross-sectional study exploring the positive aspects of caregiving in opioid dependence and its relation with quality of life, social support, and caregivers’ burden
Authors: Saha Priyanka , Saha Sayan , Kaloiya Gauri Shanker , Sarkar Siddharth
Published: August 2023

Background and Aims:

Despite a large body of research linking caregiver burden and social support in substance dependence, positive aspects of caregiving in these disorders have received very minimal attention. This exploratory observational study aimed to assess the positive aspects of caregiving for opioid dependence and evaluate the association of these positive aspects with caregiver quality of life, burden, and social support.

Methods:

This cross-sectional study included 199 caregivers of patients with opioid dependence recruited through purposive sampling. Participants were assessed using the Scale for Positive Aspects of Caregiving Experience (SPACE), World Health Organization Quality of Life–BREF version, Family Burden Interview Schedule (FBIS), and Social Support Questionnaire.

Results:

Of the 199 caregivers recruited, a majority of the caregivers were middle-aged women. About two-thirds of the patients were currently using opioids (n = 135, 67.8%), while the remaining were abstinent. Among the SPACE domain scores, the mean was highest for motivation for the caregiving role (2.07), which was followed by self-esteem and social aspect of caring (2.04), caregiving personal gains (1.76), and caregiver satisfaction (1.65). Caregivers of patients currently abstinent experienced greater positive aspects of caregiving (SPACE mean item score 2.57 versus 1.62, P < 0.001), and lesser burden (FBIS mean score 13.4 versus 29.3, P < 0.001).

Conclusion:

Positive aspects of caregiving can be potentially utilized for better caregiver engagement in treatment and improved caregiver outcomes.
Crestal sinus augmentation in a head back position: Retrospective case series
Authors: Zhang Yuhang , Zhang Chunyuan
Published: August 2023

Objectives:

To evaluate the clinical efficacy of Crestal Sinus Augmentation (CSA) in a head back position (CSA-HBP) for maxillary sinus mucosa elevation.

Materials and Methods:

We enrolled 209 patients, 246 maxillary sinuses, 348 sites in this study. Complications, maxillary sinus mucosal perforation rate and cumulative survival rate (CSR) data were collected to evaluate the clinical efficacy of CSA-HBP. Maxillary sinus mucosal elevation height (EH) and new bone height (NH) were measured by cone-beam computerized tomography and standard periapical radiographs. The implantation sites of residual bone height (RBH) ≤5 mm and RBH >5 mm were marked as Groups A (n = 81) and B (n = 267), respectively. The implantation sites of the second and third molar sites were marked as Group C (n = 134), and the remaining sites were marked as Group D (n = 214).

Results:

The RBH before implant placement was 6.63 ± 2.10 mm (95% confidence interval [CI] 6.41– 6.85 mm). The mucosal EH was 4.04 ± 1.86 mm (95% CI 3.85 – 4.24 mm). The NH was 2.36 ± 1.20 mm (95% CI 3.85–4.24 mm). No other complications were found except three cases of postoperative swelling and one case of nasal blood secretions. The overall mucosal perforation rate was 1.44% (5/348, 95% CI 0.2%–2.7%) and the rate of RBH ≤ 5 mm (Group A) was 1.49% (2/134, 95% CI 0%–3.50%). The 8-year CSR was 99.71% (347/348, 95% CI 99.2%–100.0%). Mucosal EH and NH were higher in RBH ≤5 mm (Group A) than in RBH >5 mm (Group B) (P = 0.001 and P = 0.001, Mann–Whitney U-test). There were no significant differences in mucosal EH and perforation rate between second and third molar sites (Group C) and other sites (Group D) (P = 0.77, Mann–Whitney U-test, and P = 0.16, Yates’ Chi-square independence test).

Conclusions:

CSA-HBP is a minimally invasive and reliable technique.
Comparative clinical evaluation of a local drug delivery of cranberry and garcinia fruit gel with tetracycline fibers for amelioration of periodontitis: A split mouth study
Authors: Panda Vandana , Patidar Pragya , Gaikwad Rajesh , Borade Shrutika , Fernandes Lynette
Published: August 2023

Background:

The present study formulates and evaluates a polyberry gel comprising extracts of cranberry (Vaccinium
macrocarpon) and brindle berry (Garcinia
cambogia) in patients suffering from chronic periodontitis.

Materials and Methods:

The polyberry gel was evaluated for various physicochemical parameters, in vitro permeability and stability, and the active phytoconstituents were quantified by High-performance thin layer chromatography (HPTLC). Total phenolic content, total antioxidants, and ascorbic acid were estimated in the two extracts by in vitro assays. Patients suffering from chronic periodontitis with probing pocket depth (PPD) up to 5 mm were divided into 3 groups of 21 patients each and treated with scaling and root planing (SRP) or SRP followed by subgingival placement of polyberry gel or tetracycline fibers (standard). Plaque Index (PI), Gingival Index (GI), PPD, Clinical Attachment Level (CAL), and the salivary aspartate aminotransferase (AST) and C-reactive protein (CRP) levels were recorded at baseline and after 1 month.

Results:

A significant (P < 0.01) reduction in the periodontic disease parameters was observed in the standard and gel-treated groups between their baseline and 1-month time-interval readings. The polyberry gel treatment significantly (P < 0.05 for AST and P < 0.01 for the rest) attenuated the periodontitis-elevated PI, GI PPD, CAL, AST and CRP levels when compared with SRP at the end of the study and was comparable with tetracycline.

Conclusion:

The amelioration of periodontitis and gingival inflammation may be attributed to the potent antioxidant activity of the polyphenolic phytoconstituents of the gel. The polyberry gel may thus be used as a safe adjunct to SRP/tetracycline in chronic periodontitis.
Clinical and radiographic assessment of periodontal status among patients with post-COVID mucormycosis: A cross-sectional study
Authors: Arunachalam Muthukumaraswamy , Natarajan Rajakumari , Krishnamurthi Malathi , Gopalakrishnan Ramesh Kumar
Published: August 2023

Background:

An escalation in cases of rhinomaxillary mucormycosis among post-COVID patients is being reported. However, there is limited information about periodontal features in mucormycosis cases. This study explored the periodontal signs and symptoms among post-COVID mucormycosis individuals.

Materials and Methods:

This cross-sectional study was carried out with a total of 25 post-COVID mucormycosis patients attending tertiary care public teaching hospital. Clinical and radiographic assessments were done.

Results:

An elevation in mean probing pocket depth (PPD) up to 6.21 ± 2.7 mm was noted. Nearly 16%–40% of patients had Miller’s Grade III mobility in the affected site. Forty-four per cent had localized single or multiple abscess, 40% had palatal swelling, 32% had necrosis of soft tissue and bone exposure, and 52% had maxillary dentoalveolar segmental mobility in the affected site. Radiographic examination revealed varying stages of interdental bone loss.

Conclusion:

The present study observed an increase in mobility and mean PPD which did not commiserate with interdental bone loss in the affected maxillary region.
Effect of Nursing Care Regarding Postoperative Complications among Diabetic Patients after Hip Replacement Surgery
Authors: Tariq Mohammed , Natheer Munther , Allo Rami Ramadhan
Published: August 2023

Background:

The total hip arthroplasty surgery is an effectiveness intervention to improve patients function with osteoarthritis. This surgery is usually done for patients who aged more than 60 years and are associated with uncontrolled pain or hopeless damage hip joints. The effect of diabetes disease at post-surgical time, influencing on wounds healing process and promoting sores formation which lead to a complex of nursing care performance for patients has a big challenge, to deal with patients and their family feeling to help them to promote independence.

Objective:

This study aimed to evaluate the nursing management for diabetic patients undergoing surgical total hip replacement.

Materials and Methods:

A case–control study design applied on diabetic patients with a hip operation after fractured hip at orthopedic wards at Al-Rabea and Ninevah private hospitals in Mosul city. The study was conducted from September 10, 2022 until December 10, 2022. Postoperative nursing care provided to the control group was the daily common nursing care management in our hospitals, whereas that provided to the study group depended on a special standard nursing care management protocol.

Results:

Evaluation of postoperative disorders and complications showed a positive direction in decreasing their occurrence after depending on a special standard nursing care management protocol.

Conclusions:

The study concludes that all the postoperative complication may be relieved after total hip replacement as any surgical intervention if the orthopedic nursing staff applied the standard tool for nursing care management.
Biofilm Formation and Virulence Factors among Multidrug Resistant Pseudomonas aeruginosa Isolated from Patients in Babylon Province
Authors: Almuttairi Ahmed Abdulkareem H. , Abdulla Anwar A.
Published: August 2023

Background:

Pseudomonas aeruginosa is often multidrug resistant that is associated with hospital-acquired infections.

Objectives:

The objective of this study was to identify the patterns of antibiotic resistance, biofilm formation, the occurrence of multiple drug resistant (MDR), and virulence genes (Alg, OprL, and OprI) in P. aeruginosa isolated from patients.

Materials and Methods:

A total of 131 isolates from various sites including (burn, wound, and urine) were collected from different hospitals in Babylon province for both genders and ages. These isolates were identified using traditional techniques as well as the Vitek 2 system. Pseudomonas aeruginosa isolates were subjected to disc diffusion antimicrobial susceptibility testing. Alg, oprL, and oprI-specific primers were used in the polymerase chain reaction technique for the molecular identification of virulence factors genes.

Results:

Pseudomonas aeruginosa isolates that were one hundred thirty-one (100%) had oprL gene. On the other hand, Alg and oprI each have 129 (98.47%).

Conclusion:

Alarming factors for public health include the high rate of MDR among P. aeruginosa isolates and its capacity to form biofilm.
Tumor Size Assessment with Three Breast Imaging Modalities
Authors: Sediguli Sreenidhi , Gowda Raghu Srinivasa , Ranganathan Rupa , Kumar B Senthil
Published: August 2023

Background and Objectives:

Diagnostic accuracy of breast MR is higher than the routinely used sonomammography and digital mammography. There are mixed reports regarding usefulness of breast MR imaging regarding the tumor size estimation. The objective of this study was to determine which modality can assess the exact tumor dimension in comparison with corresponding tumor dimension at pathologic examinations.

Materials and Methods:

In a prospective study, 68 patients who came for screening diagnostic mammogram and who had breast lesions of Breast Imaging Reporting and Data System (BIRADS) category 3 and more were evaluated. All patients underwent bilateral digital mammography and targeted high-frequency sonography of the primary lesion. Those patients who were thought to possibly have breast cancer and to be candidates for surgical management were offered bilateral contrast-enhanced breast MRI. Tumor size was evaluated by digital mammography, sonomammography, contrast-enhanced mammography, and compared with histopathology reports.

Results:

Size of the lesions as measured by DM or SM correlated well with the size determined through breast MR (r = 0.975, P < 0.01). There was a statistically significant difference between the measured sizes of lesions between breast MR and HPE (P = 0.76). Breast MR imaging, true size was overestimated in 28 breasts with range of 0–0.6 cm and underestimated in 25 breasts with range of 0–0.9 cm.

Conclusion:

Breast MR imaging depicts more accurate dimensions of the tumor and its extensions than digital and sonomammography.
Impact of Lipid-Lowering Drugs on Lipid Profile in Hyperlipidemia Patients
Authors: Shemran Khawla A. , Edin Sarah H. , Alta’ee Abdulsamie H.
Published: August 2023

Background:

Hyperlipidemia is an umbrella term for any of the genetic or acquired disorders that result in an elevated level of lipids circulating in the blood. These lipids can enter the walls of arteries and increase the risk of developing hardening of the arteries, which can lead to atherosclerosis, stroke, and heart attack.

Objectives:

The present study tries to investigate the impact of lipid-lowering drugs on lipid profile in patients with hyperlipidemia and to determine the best drug of choice in such patients.

Materials and Methods:

Sixty hyperlipidemia patients with the mean age of 45.52 ± 13.24 years admitted to a private clinic in Hilla city, Iraq, during a period extant from October 2022 to November 2022 were subjected to the present cross-sectional study. Patients were categorized according to the type of drug used and gender. Group 1 (G1) patients treated with rosuvastatin, group 2 (G2) patients treated with atorvastatin, group 3 (G3) patients treated with ezetimibe, and group 4 (G4) patients treated with combination of ezetimibe + simvastatin. Lipid profile was determined using enzymatic method.

Results:

The combination of ezetimibe + simvastatin has a better effect to lower the body mass index. Ezetimibe alone reduces total cholesterol (TC), whereas combination of ezetimibe + simvastatin was found to reduce TC, low-density lipoprotein cholesterol (LDL-C) and triacylglycerol (TG). Rosuvastatin raises the high-density lipoprotein cholesterol (HDL-C).

Conclusions:

The combination of ezetimibe and simvastatin gives a good result in reducing the level of TC in the body, and this leads to a better reduction of LDL-cholesterol than using atorvastatin alone.
Employing E-learning Tools and Resource Materials in the Successful Implementation of Competency-based Medical Education in India
Authors: Shrivastava Saurabh RamBihariLal , Shrivastava Prateek Saurabh
Published: August 2023

Competency-based medical education (CBME) has emerged as one of the modes of the curriculum which is built around a framework of competencies and plays an important role in the making of a healthcare professional who is competent enough to meet the health care needs of the society. The purpose of the current review was to explore the role of e-learning in enhancing learning in different domains of learning and identify the various e-learning resources. An extensive search of all materials related to the topic was carried out on the PubMed search engine and a total of 35 articles were selected based upon the suitability with the current review objectives and analyzed. The search was carried out for a period of one month and all articles published between 2003 to 2021 were included. As only one search engine was used, there were no duplications. Keywords used in the search include e-learning and medical education in the title alone only. E-learning has been acknowledged as one of the significant curricular reforms, which has the potential to bring about a paradigm shift in medical education in India. The basic rationale for the utility of e-learning in the medical curriculum originates from the fact that the syllabus is extremely vast and students have to study many subjects in a fully-packed schedule, and that cannot happen only within the classroom hours. E-learning can play an important role in the augmentation of cognitive, psychomotor, and attitudinal/communication skills through the optimal use of e-learning resources. To conclude, e-learning has emerged as an important approach to strengthen the process of implementation of competency-based medical education in Indian settings. The need of the hour is to acknowledge the merits of e-learning and plan strategies for the successful integration so that the overall process of CBME implementation can be strengthened and streamlined.
Comparison of ropivacaine (0.2%) and ropivacaine (0.125%) with 2 μg/ml fentanyl for epidural labor analgesia
Authors: Rapeti Kalyani Manasa , Mulam Santhisree , Sowbhagya Lakshmi B. , Sharma Ankur
Published: August 2023

Aim:

The aim of this study was to determine the minimum effective local anesthetic concentration required to provide good analgesia with less consumption of opioids.

Objective:

Among various labor analgesic techniques, epidural analgesia is the most effective form of analgesia. This study aimed to determine the minimum effective local anesthetic concentration required to provide good analgesia with less consumption of opioids. The objective of this study was to evaluate the efficacy of 0.125% and 0.2% ropivacaine, both with fentanyl 2 μg/ml for epidural labor analgesia.

Materials and Methods:

A total of 50 term parturients of American Society of Anesthesiologists physical status Grade I and II with vertex presentation in active labor were randomly assigned to two groups, Group R1 and Group R2, which received 10 ml of 0.125% ropivacaine with injection fentanyl 2 μg/ml and 10 ml of 0.2% ropivacaine with fentanyl 2 μg/ml, respectively, as an initial bolus dose and intermittent top-up doses epidurally. Characteristics of the block, onset and duration of analgesia, and total analgesic requirements were noted. Pain and overall satisfaction scores were assessed with the Visual Analog Scale score. The maternal and fetal outcomes were recorded.

Results:

Maternal demographic characteristics were comparable. Although both the concentrations are effective in providing optimal labor analgesia, decreasing the concentration of ropivacaine has resulted in an increased number of repetition of doses and thus an increased consumption of fentanyl. There were no significant differences between the two groups regarding motor block, hemodynamic, and neonatal outcomes.

Conclusion:

We conclude that 0.2% ropivacaine was found superior in terms of faster onset, prolonged duration, lesser breakthrough pain requiring lesser top-ups, and hence a lesser consumption of opioids. Hence, we conclude that the use of 0.2% ropivacaine is superior to 0.125% ropivacaine with fentanyl.
Overcoming the obstruction, anesthetic management of hypertrophic obstructive cardiomyopathy
Authors: Monteiro Joseph Nascimento , Bedekar Unmesh Pramod , Ponde Chandrashekhar , Sankhe Milind
Published: August 2023

Hypertrophic obstructive cardiomyopathy (HOCM) is a genetically mediated disease causing left ventricular outflow tract obstruction (LVOTO) predisposing the patient to systolic and diastolic dysfunction leading to arrhythmias and sudden cardiac deaths in the perioperative period. This case report describes the anesthetic management of a 76-year-old female posted for a semi-emergent three level lumbar canal decompression with severe HOCM with dynamic LVOTO with an initial resting gradient >70 mmHg, noninsulin-dependent diabetes mellitus, bronchial asthma, deep-vein thrombosis, and hypothyroidism as comorbidities. Preoperative evaluation of the risks, cardiac optimization, interdisciplinary shared decision making, preoperative invasive monitoring, preanesthetic placement of defibrillator pads, careful titration of anesthetic agents, with meticulous perioperative monitoring, and perioperative intensive care collaboration contributed to a successful outcome.
Preemptive analgosedation with ketamine-dexmedetomidine versus ketamine-propofol in upper limb surgeries under supraclavicular brachial plexus block
Authors: Makwana Mehul D. , Pathak Bhumika P. , Panchal Nirali Nimeshkumar , Chaudhari Madhavi Sanjay , Phatak Ajay Gajanan
Published: August 2023

Background and Aims:

Analgosedation before and during regional anesthesia provides analgesia, anxiolysis, and amnesia. This study has been conducted to compare ketamine-dexmedetomidine (KD) versus ketamine-propofol (KP) for sedation, pain on needle prick while giving block, hemodynamics, and their side effects under supraclavicular brachial plexus block.

Materials and Methods:

After obtaining ethics committee approval, CTRI registration and patient consent, 75 patients were recruited who satisfy inclusion and exclusion criteria. Patients were divided into two groups. Group KP received a loading dose of ketamine 0.5 mg/kg, propofol 1 mg/kg over 10 min, followed by a maintenance dose of ketamine 0.3 mg/kg/h and propofol 10 μg/kg/min. Group KD received loading dose of ketamine 0.5 mg/kg, dexmedetomidine 0.5 μg/kg over 10 min, followed by maintenance dose of ketamine 0.3 mg/kg/h and dexmedetomidine 0.3 μg/kg/h. Patients were monitored for sedation, pain on needle prick while performing block, side effects of study drugs, hemodynamic and respiratory parameters. An independent sample t-test was used to compare continuous outcomes, descriptive statistics were used to depict the baseline profile of the study participants, Chi-square test was used to compare the categorical outcomes. A value of P < 0.05 was considered statistically significant.

Results:

Pain on needle prick was experienced in 5.7% and 42.9% in Group KD and Group KP, respectively. In Group KD, 28.6% and Group KP 5.7% of patients experienced nausea.

Conclusion:

In this study, group KD has adequate sedation as compared to group KP with less pain on needle prick while performing supraclavicular block. Group KD has higher incidence of nausea than gruop KP.