bluuebunny/crossref_metadata_2025 huggingface dataset:
Technology foresight for the South African road transport sector by 2035
Authors: Rust Frederik C. , Sampson Leslie R. , Cachia Adriana A. , Verhaeghe Benoit M.J.A. , Fourie Helena S. , Smit Michelle A. , Hoffman Alwyn , Steyn Wynand J.v.d.M. , Venter Karien , Lefophane Samuel
Published: August 2024

Background: Foresight can be used to define futuristic orientated research and development (RD) that is required to position the road transport sector for a challenging future.Objectives: To develop a set of futuristic RD projects that could be added to a balanced SANRAL RD portfolio to position SANRAL and the transport sector for the future on a 15-year horizon.Method: Inputs into and ranking of the drivers, trends and technologies that will impact the transport sector were obtained from interviews with eminent thinkers, participants in workshops and a survey leading to five potential future scenarios. Qualitative and quantitative data analysis yielded several key solutions (KSs) and key interventions (KIs) to position the sector. This was complemented with the novel use of technology trees to analyse the linkages between new and existing knowledge and to identify gaps in knowledge and subsequently the identification of key RD opportunities.Results: Through backcasting from the desired future scenario as well as using 412 stakeholder inputs, 12 KSs and 61 KIs were defined and ranked. The top 30, most futuristic KIs were analysed using 18 hierarchical technology trees to define RD opportunities.Conclusion: The analysis emphasised the importance of new technologies such as data science, machine learning, smart transport and advanced materials to position the sector.Contribution: The use of a novel, structured technology foresight approach that utilises scenario development combined with hierarchical technology trees was demonstrated. To position the road transport sector for a challenging future, 12 new thematic KSs and 61 KIs were developed.
The Southern African Society for Virology
Authors: Preiser Wolfgang , Venter Marietjie , Page Nicola A. , Burt Felicity J.
Published: August 2024

No abstract available.
Neurological examination of healthy term infants at ages 6 and 10 weeks in Tshwane District
Authors: Nel Marna , Feucht Ute , Mulol Helen , Eksteen Carina A.
Published: August 2024

Background: Globally, there is a significant gap in detailed neurodevelopmental data for infants under 3 months, despite 6 weeks being identified a critical milestone for neuro-behavioural development. Normative values and optimal scores for healthy infants at 6 and 10 weeks postnatally are lacking in many settings. In South Africa, the statutory neurodevelopmental assessments at these ages exclude notable characteristics of central nervous system maturation and limit opportunities to collect data of early developmental progress.Objectives: Our study aimed to assess developmental characteristics of healthy term infants aged 6 and 10 weeks using the Hammersmith Neonatal Neurological Examination (HNNE).Method: A prospective longitudinal study was performed on 35 healthy term-born infants from low-risk pregnancies at 6 and 10 weeks’ postnatal age in the Tshwane district. The statuses of infants’ neurodevelopment in six domains were recorded using the HNNE. Optimality scores were derived from the raw scores of 34 items, using the 10th and 5th percentiles as cut-off points.Results: Evidences of neurodevelopmental advancements, particularly in posture, muscle tone and visual behaviour between 6 and 10 weeks were illustrated, and total examination optimality scores of 29.5 in 91% and 31.5 in 94% of infants were recorded at 6 and 10 weeks, respectively.Conclusion: This article provides data on the neurodevelopment characteristics of infants at and between 6- and 10-weeks post term ages.Clinical Implications: The findings support the viewpoint to identify important milestone characteristics during early screening.
The Association between Cardiorespiratory Fitness and Obesity Predictors in Healthy Young Adults: An Observational Study
Authors: Buttar Karampreet Kour , Kacker Sudhanshu , Saboo Neha
Published: August 2024

Introduction:

Obesity lowers cardio respitaory fitness (CRF) or maximal oxygen uptake (VO2 max) by exhausting the circulatory system and working muscles. There has not been enough research done on the Indian population to determine the relationship between cardiorespiratory fitness and obesity predictors including body mass index (BMI), body fat percentage, and body surface area (BSA) in a single plot. Therefore, this study aimed to examine the associations between cardiorespiratory fitness and body fat parameters in young adults.

Materials and Methods:

Four hundred and nineteen respondents from the RUHS-College of Medical Sciences, Jaipur, India, were screened. A Harpenden skinfold caliper was used to determine their body fat percentage, after which a gas analyzer was used to determine their VO2 max. BSA (m2) was calculated using the Dubois equation. The “Pearson correlation coefficient” and “Student’s t-test” were applied for the statistical analysis.

Results:

The relationship between VO2 max with BSA, body fat percentage, and BMI was inverse. The correlation (r = −0.46) between body fat percentage and VO2 max was greater than that of BMI or BSA (r = −0.09 and r = −0.21, respectively). Both genders with normal BMI had the greatest VO2 max (47.22 ± 6.94; 37.75 ± 4.88 ml/kg/min). The maximum VO2 max (46.726.81; 38.744.08 ml/kg/min) is found in both men and women who fall into the fitness group of body fat percentage.

Conclusion:

Increased BMI, body fat percentage, and BSA are associated with decreased levels of V̇O2 max. Compared to BMI and BSA, body fat percentage is a better indicator of obesity. Thus, encouraging people to reduce their body fat percentage and obesity would improve their cardiorespiratory fitness.
A case report on para-Bombay blood group
Authors: Krishnaveni A. G. , Vasanth S.
Published: August 2024

Rare blood group detection is important as the incidence of these blood groups is very low. These rare blood groups need a transfusion of blood from the same group of people; sometimes, it is not available in blood banks. It is important to detect them in the field of transfusion medicine so that the right transfusion at the right time and for the right patient is ensured. We had one patient who was identified as blood group O in a private laboratory and the patient came to our hospital for anemia during the second trimester of pregnancy whose forward grouping showed no agglutination in the anti-a and anti-b and also no agglutination in the anti-H so we thought it to be Bombay blood group. We performed the reverse grouping and we found agglutination with pooled A cells and pooled B cells but no agglutination in the pooled O cells. We found forward and reverse grouping were discordant so we concluded that the patient had Bombay variant blood group, the secretor status of the patient was done in saliva using hemagglutination inhibition test and we found that the patient had secretion of H substance in the saliva. Rh typing: it was found that the patient had positive in Rh typing. Family members were screened and they all were O positive. Forward and reverse grouping along with the secretor status detection helped to detect the case. This case report highlights the importance of blood grouping forward and reverse and also using Anti-H reagent for blood grouping and also the use of secretor status in the detection of proper blood grouping of the patient.
Von Willebrand factor levels in healthy blood donors and their association with blood group
Authors: Agrawal Nikita , Pahuja Sangeeta , Sharma Sunita
Published: August 2024

BACKGROUND:

von Willebrand disease is a common inherited bleeding disorder caused by the deficiency of von Willebrand factor (vWF).[1] The levels of vWF depend on several factors, including exercise, hormones, and ABO blood type.[2] This study was planned to evaluate plasma vWF levels and factor VIII (fVIII) levels in healthy blood donors and its association with the ABO blood group.

AIMS:

The aim of this study was to evaluate plasma vWF levels and fVIII levels in healthy donors and its association with the ABO blood group.

METHODS:

This study was done in 2016 healthy adult blood donors. Complete history and relevant examination were done along with ABO and Rh (D) blood group typing, complete blood count, prothrombin time, activated partial thromboplastin time, vWF antigen (Ag) level, fVIII coagulant assay, and other tests for hemostasis.

STATISTICAL ANALYSIS USED:

Data were expressed in proportions and mean, median, and standard deviation, respectively. An appropriate test of significance was applied. P < 0.05 was considered statistically significant.

RESULTS AND CONCLUSIONS:

vWF level of donors ranged from 24 to 186 IU/dL with a mean of 96.31 IU/dL. Low vWF Ag level (below 50 IU/dl) was found in 2.5% of donors while 0.1% (2/2016) had level <30 IU/dL. O Rh (D)-positive blood group donors had the lowest vWF level (87.85 IU/dL), while ARh (D)-negative donors had the highest vWF level (117.27 IU/dL). fVIII level of the donor population ranged from 22% to 174%, with a mean of 98.82%. About 2.48% of donors had fVIII levels below 50%. There was a statistically significant correlation between fVIII level and vWF level (P < 0.001).
A conservative approach in finding compatible blood for a patient with sickle cell disease having multiple alloantibodies
Authors: Joshi Sanmukh Ratilal , Vekariya Mayuri M. , Rajapara Manisha M.
Published: August 2024

BACKGROUND:

Sickle cell disease (SCD) patients may develop multiple alloantibodies that pose problem in finding compatible blood for transfusion and require crossmatching with large number of blood.

AIM:

The aim of the present study was to find compatible blood with reduced cost by adopting a conservative approach.

MATERIALS AND METHODS:

A step-by-step approach using tube technique, antibodies in original serum, and the saved test supernatant (TS) in search of compatible blood for transfusion purposes.

RESULTS:

32 years SCD patient grouped A with multiple antibodies required transfusion. A total of 641 red blood cell (RBC) units of groups A and O were crossmatched using serum and the TS by tube method. Of 138 units tested using the serum at 4°C, 124 units showed direct agglutination in the saline phase and the remaining 14 units were processed through low ionic strength solution (LISS)-IAT, of which 2 units were compatible even by the gel-IgG-card method. The TS, saved from the tests on serum, was used in an identical manner as that of the serum to screen additional 503 units by saline tube method at 4°C units showed direct agglutination of the RBCs of 428 units, hence were removed from inventory for this patient. The remaining 75 units were tested by the LISS-IAT-tube method at 37°C, of which 8 units were found compatible but only 2 units were clear compatible by the gel-IgG-card method. As such, 4 units compatible by the sensitive gel-IgG-card method were issued for transfusion purposes.

CONCLUSION:

The new approach on using the saved TS consumed less of the patient's blood specimen, and the use of the tube method in screening and eliminating a large chunk of incompatible blood units has proved economical if compared with the use of the only gel-IgG-cards device in the entire maneuvering.
Exploring therapeutic plasma exchange as a progressive treatment modality for neurological disorders: Insights from a tertiary care hospital in Northwestern India over 3 years
Authors: Yadav Anshika , Sharma Smriti , Gupta Gajendra Nath
Published: August 2024

BACKGROUND:

Neurological disorders with autoimmune or inflammatory etiology pose significant challenges in terms of treatment. Therapeutic plasma exchange (TPE) has emerged as a promising adjunctive therapy for managing these conditions by removing pathogenic autoantibodies, immune complexes, and proinflammatory mediators. However, the experience with TPE in neurological disorders in the northwestern part of India is limited.

METHODOLOGY:

This retrospective study analyzed the medical records of patients who underwent TPE for neurological disorders over a 3-year period at a tertiary care hospital. Patient demographics, clinical diagnoses, TPE protocols, and adverse events were collected and analyzed. Descriptive statistics were used to summarize the data.

RESULTS:

A total of 26 patients (14 males, 11 females) underwent 111 TPE procedures during the study period. The most common clinical diagnoses were generalized dystonia, Guillain–Barré syndrome, myasthenia gravis, and chronic inflammatory demyelinating polyneuropathy. TPE protocols involved exchanging one plasma volume every alternate day, with replacement solutions including fresh-frozen plasma (FFP), albumin, or a combination of FFP and albumin. The majority of patients showed positive clinical improvement measures, indicating the efficacy of TPE in halting disease progression and ameliorating symptoms. Adverse events were reported in seven procedures but were successfully managed.

CONCLUSION:

This study demonstrates the effectiveness and safety of TPE in the management of autoimmune or inflammatory neurological disorders in the northwestern part of India. TPE showed positive clinical improvement measures and a favorable safety profile. These findings contribute to the growing recognition of TPE as an emerging therapeutic modality in the field of neurology. Further research and prospective studies are needed to optimize TPE’s use, including patient selection, treatment protocols, and long-term outcomes in this population.
Aliquoting of red blood cells for transfusion in pediatrics
Authors: Arora Satyam , Dua Seema
Published: August 2024

BACKGROUND AND OBJECTIVES:

Small-volume transfusions of red blood cell (RBC) aliquots are a very common practice across the world; however, there is a lack of data on various strategies of aliquot preparation and their utilization.

MATERIALS AND METHODS:

A descriptive retrospective study, from January 1, 2022, to December 31, 2022, was conducted at the blood center of a government-owned children’s teaching hospital in India. The study aimed to analyze the practices of preparation, utilization, and practice of various number of RBC aliquots prepared.

RESULTS:

A total of 222 RBC units were divided into 591 aliquots with a mean volume of 98.4 ± 32.3 ml (median 100 ml; 2.66 aliquots per RBC unit). Out of these 222 RBC units, 81 were split into two aliquots (Group 1); 141 RBC units were split into three (Group 2) and 6 units were prepared into four aliquots (Group 3). A total of 577 patients (359 male; 218 female) were transfused (2.3% of aliquots discarded due to expiry). 85.2% (492 of 577) of children who were transfused these aliquots were <2 years of age. The majority of RBC aliquots (>80%) were prescribed by the department of pediatric medicine (35%). Groups 2 and 3 were aliquoted from significantly fresh RBC units (mother unit) compared to aliquots prepared in Group 1.

CONCLUSION:

Our data show a high utilization rate (97.3%) of RBC aliquots at our institute. Uniform practices in aliquoting practices will help us harmonize the data as well as establish best practices in neonatal and pediatric transfusion practices.
Factors associated with adequacy of stem cell harvest in patients undergoing hematopoietic stem cell transplantation in a tertiary care hospital in Southern India
Authors: Nadeem Naadia Fatima , Kannan Narasimhapriyan , Basavarajegowda Abhishekh , Kayal Smita , Manivannan Prabhu
Published: August 2024

BACKGROUND:

Hematopoietic stem cell transplantation (HSCT) is a treatment modality for many hematologic diseases. Peripheral blood (PB) stem cells are its recommended source and enumerated using flow cytometry preapheresis which could predict the final yield. There are numerous factors affecting this process, and the aim was to explore and analyze the effect of various factors which were known to affect and predict the adequacy of stem cells.

MATERIALS AND METHODS:

This was a retrospective study, in which a total of 78 patients who had undergone HSCT were included, and flow cytometric CD34+ stem cell enumeration was done on the PB preapheresis and postapheresis in the final harvest using single-platform International Society for Hematotherapy and Graft Engineering protocol.

RESULTS:

Among all factors analyzed, we found that the preapheresis PB CD34+ cell count had the best and significant correlation with the final adequacy of stem cell dose in overall analysis, allogeneic, and autologous subgroups separately. Among the other factors studied, preapheresis total leukocyte count, platelet count, weight, and body mass index (BMI) had a significant correlation with the adequacy of stem cell dose in the final harvest in overall analysis, whereas only BMI was significant in allogeneic subgroup analysis. The autologous subgroup did not show any significant correlating factors other than the preapheresis PB CD34 count.

CONCLUSION:

The preapheresis PB CD34+ cell count came out as the most reliable factor, and the institutional cutoff of 10.35 CD34+ cells/μL was established with the sensitivity and specificity of 86.2% and 55%, respectively, in predicting the adequacy of stem cells in the final harvest.
Comparison of platelet indices in dengue fever patients based on platelet transfusion
Authors: Asha J. , Baiju Nithya M. , Innah Susheela J. , Rafi Aboobacker , John Bins M.
Published: August 2024

CONTEXT:

Dengue fever is the most prevalent mosquito-borne viral disease in humans. Platelet indices (PIs) are given by the cell counters but are often not reported which is possibly due to under-recognition of the utility of these parameters.

AIMS:

This study aimed to compare PIs in patients with dengue fever to assess their role in the outcome such as hospital stay and platelet transfusion requirements.

SETTINGS AND DESIGN:

Prospective observational study in a tertiary care center, Thrissur, Kerala.

SUBJECTS AND METHODS:

A group of 250 dengue patients was studied over a period of 18 months. The platelet parameters (platelet count, mean platelet volume [MPV], platelet distribution width [PDW], platelet large cell ratio [PLCR], plateletcrit [PCT] and immature platelet fraction [IPF]) were measured with Sysmex XN-1000 and followed up every 24 h. The clinical features, duration of hospital stay and platelet transfusion requirements details were collected.

STATISTICAL ANALYSIS USED:

Independent t-test, Chi-square test, Karl Pearson correlation coefficient.

RESULTS:

A total of sample size was 250. The study showed normal PDW and MPV, low platelet count and PCT, and high PLCR and IPF in dengue patients. There were significant differences in PIs (lower platelet count and PCT, higher MPV, PDW, PLCR, and IPF) in comparison between dengue patients based on platelet transfusion.

CONCLUSIONS:

PIs may act as a predictive tool in the diagnosis and predicting outcomes in dengue fever. Low platelet count and PCT, high PDW, MPV, PLCR, and IPF in transfused dengue patients were found to be statistically significant. Clinicians need to be sensitized about the utility and limitations of these indices and rationalize the need for red cell and platelet transfusions in dengue.
Transfusion medicine hackathon: Nurturing the innovative ideas to revolutionize voluntary blood donation
Authors: Shastry Shamee , Gupta Gajendra Nath , Mangwana Sadhana , Choudhury Nabajyoti , Shanbhag Arun , Sachdev Suchet
Published: August 2024

BACKGROUND AND OBJECTIVE:

Blood transfusion is an essential component of health care. However, several issues can hamper the promotion and sustainability of voluntary blood donation programs. This article is about a hackathon in the field of transfusion medicine that was designed to stimulate original ideas to promote voluntary blood donation.

MATERIALS AND METHODS:

The transfusion medicine hackathon was conducted as a joint project of an educational institute, the Asian Association of Transfusion Medicine, and the Innovation Center. It was conducted in eight main phases, which included planning and preparation, choosing the problem statement, participant recruitment and registration, launch, and mentoring as the first steps. Participants presented their ideas in the ideation phase, and the top five teams were selected for the prototyping phase. Selection was based on innovation/originality (10 points), feasibility (10 points), and social impact (5 points). In the prototype phase, two teams were selected as winners and were awarded by the organizers.

RESULTS:

A total of 36 multidisciplinary teams representing various parts of India pitched innovative ideas. The majority have proposed new strategies for the retention of blood donors to maintain the donor pool and teams came up with novel ideas aimed at enhancing the overall blood donation experience. One of the winning teams completed the project and launched the product.

CONCLUSION:

Health-care hackathons promote interdisciplinary education and innovation. This is a first-of-its-kind effort from the field of transfusion medicine to explore a hackathon platform to promote voluntary blood donation.
Transfusion reactions in neonates and pediatrics
Authors: Basavarajegowda Abhishekh , Plakkal Nishad
Published: August 2024

Neonates and children are physically as well as physiologically different from adults. They are immunologically vulnerable, and the effects of transfusion can be longstanding, including with respect to their development. The transfusion reactions in children differ from those in adults in the type of reactions, incidence, and severity. The incidence is more than that in adults for the common type of reactions noted in children. Transfusion reactions are most commonly associated with platelets, followed by plasma and red blood cell transfusions in children. Febrile, allergic, and hypotensive reactions or volume overload are the common types in children. Standardizing pediatric adverse transfusion reaction definitions and criteria are necessary to improve studies and reports. Several modifications are needed to be adapted for transfusing blood products in neonates and children to evade the reactions as much as possible and make transfusion safer in this vulnerable population. This article provides a brief articulation of the transfusion reactions in neonatal and pediatric populations describing how they are different from adults.
Dealing with blood group discrepancies in donor populations in a resource-poor blood center, practical approach: A single blood center study from Eastern India
Authors: Mukherjee Sourav , Bhattacharya Prasun , Mukherjee Krishnendu , Biswas Durba
Published: August 2024

BACKGROUND:

ABO and RhD grouping are the most important pretransfusion tests. Discrepancies in blood grouping are one of the major causes of transfusion reactions. Although ABO and RhD blood group discrepancies are not a very frequent phenomenon, an overall prevalence in the healthy populations was not known in the south-eastern part of West Bengal, India.

AIMS:

To analyze the overall prevalence of ABO-Rh (D) blood group discrepancies in healthy blood donor populations, serological methods to resolve them and to supply blood in emergency circumstances to such persons.

MATERIALS AND METHODS:

In this study, a total of 8000 voluntary blood donors were chosen by the simple random sampling from South-Eastern part of West Bengal and blood grouping was done by the conventional tube technique method. Discrepancies were found among 24 blood donors with overall incidence of 0.3%. Resolution of group discrepancies done by extended incubation, weak D testing, subgroup detection with specific antisera, adsorption elution technique, secretor status by inhibition technique, etc., Direct immunoglobulin test (DAT) was done on all the samples by the polyspecific gel card method.

RESULTS:

Most of the discrepancies were due to weak or missing serum reactivity, (11 samples, incidence 0.13%), extra serum or red cell activity found in 6 samples (incidence 0.07%), subgroups causing weak red cell activity found in 4 samples (incidence 0.05%), and weak D antigen found in three samples (incidence 0.03%). One sample was DAT positive with no grouping anomaly.

CONCLUSION:

Here, in this study, blood group discrepancies were resolved using simple serological techniques. This study may help to resolute group discrepancies in day to day transfusion practices where modern facilities are not available.
Unraveling complexity: A case report on ABO hemolytic disease of the fetus newborn in a preterm neonate and delayed hemolytic transfusion reaction in the beta thalassemic mother due to alloanti kidd a antibody
Authors: Nayana V. K. , Prakash Satya , Mukherjee Somnath , Sahu Ansuman , Varghese K. Stephy , Mishra Debasish
Published: August 2024

ABO hemolytic disease of the fetus and newborn (HDFN) generally occurs due to transplacental passage of maternal IgG ABO antibodies causing fetal and newborn red cell hemolysis. Preterm, premature neonates born to O blood group mothers with a high titer of anti-A and/or anti-B antibodies are more prone to developing ABO HDFN. This is a case of ABO HDFN in a preterm, premature, and low birth weight B-positive baby of an O-positive, HbE-beta thalassemic mother. The mother had a very high titer of anti-B antibodies, leading to ABO HDFN. The mother was also allo-immunized with anti-Jk (a) antibodies from past packed red blood cell (PRBC) transfusions she received for thalassemia. This anti-Jk (a) antibody was not detected in the antenatal period, probably due to the low titer of the antibody. The mother had an anamnestic response to the PRBCs provided in the antenatal period, and thus, the anti-Jk (a) became identifiable during the pretransfusion workup for the baby. Even if the baby was Jk (a) antigen positive, the baby developed HDFN mostly due to ABO incompatibility. The baby was managed with a double-volume exchange transfusion with reconstituted whole blood and phototherapy. During the postnatal period, the mother developed a delayed hemolytic transfusion reaction (DHTR) due to the anti-Jk (a) antibodies, as she had received Jk (a) antigen-positive PRBC transfusions in the antenatal period. Later, the mother responded well to the Jk (a) antigen-negative PRBC transfusions and conservative management for the DHTR.
Time-deferred consequences: A deep dive into delayed adverse reactions among whole blood donors
Authors: Jain Romesh , Gupta Anubhav , Bava Davood , Patil Vilasini , Sinha Pratul , Garg Sachin , Mishra Snehashish , Jain Shubhangi
Published: August 2024

BACKGROUND:

The Blood Donor Health is an important component in blood transfusion services. The retention of blood donors is important, if not less than the recruitment of new blood donors. Despite the recognized importance of donor health, several challenges impede the retention of donors. These include the donor experience in the form of adverse reactions ranging from mild to severe which can be immediate or delayed. Such experiences can deter blood donors from returning to donor pool. Our study focuses on the incidence, types, and impacts of delayed adverse reactions (DARs) among whole blood donors in an Indian context, aiming to enhance donor retention through improved safety and experience.

MATERIALS AND METHODS:

A prospective observational study was conducted at a premier tertiary care and research institute in Central India. The study included 1615 whole blood donors over 6-month period and used telephonic interviews on day 7 for postdonation follow-up. Statistical analysis was performed using Epi Info software, focusing on donor demographics, incidence, and types of DARs, and their association with various factors.

RESULTS:

The study found a 6.31% incidence of DARs, the most common being generalized weakness, followed by bruising and painful arms. A higher body mass index (BMI) significantly associated with an increased incidence of DARs. Notably, 75.5% of donors who experienced DARs expressed reluctance toward future blood donations, compared to 2.8% of those without DARs, highlighting the impact of DARs on donor retention.

CONCLUSION:

This study underscores the importance of monitoring and managing DARs to enhance donor safety and experience, thereby improving retention rates. It suggests the need for systematic follow-up protocols, focused strategies for high-risk groups, enhanced support for female donors, standardization in definitions, and robust donor education programs. The findings contribute to the knowledge base on DARs in blood donation, ensuring a reliable blood supply crucial for healthcare.
Increased Occurrence of Functional Movement Disorders during the COVID-19 Pandemic
Authors: Divya K. P. , Cherian Ajith , Paramasivan Naveen K. , Krishna S. , Amod R. , Sundaram Soumya
Published: August 2024

BACKGROUND:

An increase in functional movement disorders (FMDs) was perceived during the pandemic and an objective assessment of the same was performed.

OBJECTIVE:

To assess the frequency of FMDs during the coronavirus disease 2019 (COVID-19) pandemic compared to the pre-pandemic period and to identify the factors causing its increased incidence.

METHODS:

This cross-sectional comparison study conducted during the COVID-19 pandemic included patients attending the neurology outpatient department at a tertiary care center over a 6-month period. Those with FMDs documented by video evidence were compared against a baseline in the pre-pandemic period. Demographics, clinical features, duration of FMDs, presence of psychiatric comorbidity, as well as anxiety [by the Hospital Anxiety and Depression Scale (HADS-A)], depressive symptoms (HADS-D), and sleep quality by the Pittsburgh sleep quality index (PSQI) were recorded.

RESULTS:

Twenty-two out of 382 patients [64% women; age, 24.7 years (4–68)] examined during the pandemic (6 months) had FMDs compared to 31/1462 [67% women; age, 26.9 years (5–63)] examined in the pre-pandemic period, showing a 2.71-time increase. Among FMDs, functional myoclonus was the most common (36.4%), followed by functional gait disorder (27.2%), functional tremor (18.2%), functional dystonia (9.1%), and mixed phenotype (9.1%). Furthermore, 90.9% had an abnormal score (>11) on HADS-A or HADS-D and 86.3% had a score of >5 on PSQI, indicating poor sleep quality. There was a strong correlation between higher anxiety scores (P < 0.001) and poor sleep quality (P < 0.005) with an increase in frequency of FMD during the pandemic.

CONCLUSION:

The frequency of FMDs was 2.71 times higher during the pandemic, suggesting the vulnerability of predisposed patients (as evidenced by their elevated HADS scores) during stressors. Coexistent anxiety and depression increase the risk of FMDs, of which functional myoclonus was the most common phenotype, followed by gait disorders and functional tremor. Recognizing this entity will help avoid unnecessary work-up, which can be economically draining in such trying times.
Recombinant vaccines: Current updates and future prospects
Authors: Kumar Vivek , Verma Anuj , Singh Riddhi , Garg Priyanshi , Sharma Santosh Kumar , Singh Himanshu Narayan , Mishra Santosh Kumar , Kumar Sanjay
Published: August 2024

Recombinant technology-based vaccines have emerged as a highly effective way to prevent a wide range of illnesses. The technology improved vaccine manufacturing, rendering it more efficient and economical. These vaccines have multiple advantages compared to conventional vaccines. The pandemic has heightened awareness of the advantages of these vaccine technologies; trust and acceptance of these vaccines are steadily growing globally. This work offers an overview of the prospects and advantages associated with recombinant vaccines. Additionally, it discusses some of the challenges likely to arise in the future. Their ability to target diverse pathogen classes underscores their contributions to preventing previously untreatable diseases (especially vector-borne and emerging diseases) and hurdles faced throughout the vaccine development process, especially in enhancing the effectiveness of these vaccines. Moreover, their compatibility with emerging vaccination platforms of the future like virus-like particles and CRISPR/Cas9 for the production of next-generation vaccines may offer many prospects. This review also reviewed the hurdles faced throughout the vaccine development process, especially in enhancing the effectiveness of these vaccines against vector-borne diseases, emerging diseases, and untreatable diseases with high mortality rates like AIDS as well as cancer.
Validity of using serum D-dimer titer in prefatory to computed Tomography pulmonary angiography scans in the early identification of pulmonary embolism amid emergency room patients: a single-center retrospective observational study
Authors: Seyam Sameh H. , Razein Hassan , Abdelhamid Ali Mohammed , Elkousy Islam , Singh Shailender , Gebaly Ihab , Ashok Rajini
Published: August 2024

Background and aim

Pulmonary embolism emerges when a thrombus forms in the veins or right heart and travels to the pulmonary arteries. The study aims to ascertain the robustness of D-dimer testing for PE compared with CTPA and identify the threshold values to support its use.

Patients and methods

The positivity threshold for D-dimer was above 250 ng/ml. CTPA was performed after performing blood sampling. Patients were managed in the ICU with anticoagulants by parenteral use. The most commonly used items were heparin, either unfractionated (UFH) or low-molecular-weight heparin (LMWH).

Results

Twenty-four patients of the total number of cases were positive for CTPA, while four patients were negative for PE by CTPA. Embolism was detected in the anterior, posterior, medial, and lateral basal segmental branches of the right lung, the lateral, posterior, and anterior basal segmental branches of the left lung, and the posterior segmental branch of the left lung. The D-dimer test and CTPA both provided similarly accurate PE diagnoses with no significant differences between them. There were 28 patients in total, three of those patients had D-dimer levels below the cutoff value of 250 ng/ml, whereas the remaining 25 had D-dimer levels over the diagnostic threshold. Those with a positive CTPA diagnosis of PE had greater levels of D dimers than those with a negative CTPA diagnosis of PE.

Conclusion

D-dimer levels can help in guiding the option of CTPA and the initiation of treatment for patients with suspected PE.
Assessment of prevalence of surgical site infections among diabetes patients in Nigeria hospitals
Authors: Olorunfemi Olaolorunpo , Akpor Oluwaseyi A. , Kolapo Kehinde S. , Sodimu Jeminat O. , Osunde Ngozi R.
Published: August 2024

Background and Aim

Surgical site infections (SSIs) among diabetes patients are found to be the leading type of infection among hospitalized patients globally. Careful handling of surgical equipment reduces the chances of SSIs, and those who incorporate best practices can reduce the morbidity and mortality associated with SSIs. To assess the factors responsible for the high prevalence of SSIs among diabetes patients in Nigeria.

Methods

The data for this study were from published studies. Electronic databases of Medline, Scopus, PubMed, CINAHL, and Google Scholar were searched using the keywords: SSI, medical litigation, and literature were retrieved and screened for eligibility. The data limit considered in the literature search was from 2018 to 2022 to capture only the variables identified in this study objective.

Results

This study found that SSI among diabetes patients results from medical negligence or malpractice, which is a recurrent challenge in the field of medical practice in Nigeria. This occurs as a result of failure to carry out due diligence and professional responsibility in the acts or omissions of medical practitioners while discharging their duties in the treatment and care of their patients.

Conclusion

Nurses and other medical personnel must be aware that their practice could be a major trap for their litigation because most patients are becoming more aware of their rights, and the public will not forgive them when perceived harm to patients is as a result of medical negligence, or malpractice. There is a need to instill best practices that will reduce the morbidity and mortality associated with SSIs as a result of a breach of professional obligations.
Management of spinal trauma in resource-limited circumstances during the COVID-19 pandemic
Authors: Maziad Ali M.
Published: August 2024

Background data

In December of 2019, Covid-19 virus was discovered in the district of Wuhan, China. Within a few weeks, it affected almost every country in all six continents and was declared a pandemic by the World Health Organization (WHO). As of the date of writing this paper, there have been more than 85 million confirmed cases and more than 1.7 million deaths worldwide. Given the very high contagiousness of the virus, strict precautions to avoid its spread among the population and particularly in health care facilities have been implemented around the world. Such measures proved to be helpful in providing some control over the spread. Still they were not fail proof in many situations whether in developed or developing countries, thus leading to further spread of the contagion and increased mortality.

Purpose

On February 14, 2020, the first Covid-19 case was reported in Egypt. In this article, we review the steps taken to limit the spread of Covid-19 at a busy tertiary hospital in Cairo, Egypt, and present a case series of patients with spinal trauma presenting during the peak phase of the pandemic in spring of 2020 and the rationale of their management including the first Covid-19 case in Egypt with acute spinal trauma and complete paraplegia operated upon in isolation.

Study design

This was a case series.

Patients and methods

The study was performed for short-term follow-up.

Results

Satisfactory results were obtained in this patient series with good clinical and radiological outcomes.

Conclusion

Precautionary measures are mandatory during the Covid-19 pandemic. TLICS classification is a simple algorithm that can help guide proper management.
Surgical management of proximal tibial epiphyseal fracture in children
Authors: Badawy Ahmed , Akar Ahmed , Adam Mostafa
Published: August 2024

Background

Fractures of the proximal tibial physis require a significant amount of force, and therefore, these injuries account for less than 1% of all physeal separations. The proximal tibial physis has intrinsic varus–valgus and side-to-side translational stability because of the collateral ligaments and the lateral fibular buttress.

Purpose

The aim was to evaluate operative treatment of children who have proximal tibial epiphyseal fracture (indications, techniques, advantage, disadvantages, complications, and results).

Patients and methods

From December 2015 to February 2018, a prospective case series study was performed at Al Mataria Teaching Hospital and Al-Hussein University Hospital. A total of 20 patients with proximal epiphyseal fractures were admitted and treated.

Results

The mean operative time was 54±22.45 min (range: 25–90 min), with average intraoperative blood loss of 25 ml (range: 20–30 ml). The method of fixation changes according to the type of fixation. K-wire accounts for ∼75%, whereas cannulated screw 4.5 accounts for ∼25% in the physeal group. In the tubercle group, cannulated screw 4.5 accounts for ∼50%, cannulated 4.5+ tension band accounts for ∼25%, and K-wire accounts for ∼25%.

Conclusion

Fractures of the proximal tibial epiphysis are rare, and the potential complications in this young population are limb threatening. Constant monitoring of neurovascular status is essential to identify acute and delayed compromise. A low tolerance should be taken in to account to use supplementary fixation, such as K-wires, in view of the difficulty in maintaining the reduction and the potential for poor outcomes should this be lost.
Minimally invasive antegrade intramedullary fixation for unstable subcapital fracture of the fifth metacarpal by single elastic nail
Authors: Ewais Waleed M. , Romaih Mohammed A.-E.
Published: August 2024

Background

Fractures of the neck of the fifth metacarpal are common and mainly occur in young men. The injury often occurs through aggression, such as a fist fight or punching a hard object. The aim of this study was to assess clinical and radiological outcomes of fifth metacarpal neck fractures using minimally invasive antegrade single intramedullary fixation prepending elastic nails in the selected patients and to explore the ideal puncture point to avoid iatrogenic ulnar nerve injury.

Patients and methods

A single elastic nail with suitable diameter was used in 24 cases of fifth metacarpal neck fractures with dorsal angulation over 45°. An initial entry point was perforated at the ulnar-dorsal base of the metacarpal. The nail was inserted in an antegrade approach. The nail was usually removed at about 8 weeks postoperatively.

Results

This study reported the results of 24 patients who were affected by closed fractures of the neck of the fifth metacarpal bone (boxer’s fracture) and were treated with percutaneous single elastic intramedullary nailing to verify the effectiveness of this surgical treatment. The average follow-up period was 20.75 months. The parameters evaluated included angulation, rotational alignment, postoperative metacarpophalangeal range of motion, and time to union. At the final follow-up, no patient reported residual pain, and all fractures proceeded to bony union.

Conclusion

The authors recommend that this percutaneous single elastic intramedullary nailing was a minimally invasive and reliable fixation technique for fifth metacarpal neck fractures with good functional results and low morbidity.
Acute Exacerbation of Heart Failure Associated with Atrioventricular Node Ablation and Right Ventricular Pacing Therapy
Authors: Zhai Zhengqin , Guan Wenzhuo , Zhou Yifeng , Li Jing
Published: August 2024

We present the case of a 69-year-old man with chronic congestive heart failure and persistent atrial fibrillation with drug-refractory tachycardia. He received atrioventricular node ablation and right ventricular pacing therapy with a baseline heart rate programmed to be 50 beats/min. He experienced acute deterioration of heart failure just 3 h after a procedure with increased brain natriuretic peptide level, reduced left ventricular ejection fraction and diffuse left ventricular wall hypokinesis, and spetal wall no-movement. We programmed the baseline pacing rate to a higher level of 70 beats/min and optimized the therapy for heart failure, and then his symptoms were relieved accompanied by improvement in cardiac function. There may be a relationship between atrioventricular node ablation combined with right ventricular pacing and temporary deterioration of heart failure.
Evaluation of Synbiotics in the Prevention of Ventilator-Associated Pneumonia: A Randomized, Triple-Blind, Placebo-Controlled Clinical Trial
Authors: Kasiri Faranak , Soltani Rasool , Khorvash Farzin , Ataei Behrooz , Nasirian Maryam , Hakamifard Atousa
Published: August 2024

Background:

Ventilator-associated pneumonia (VAP) is one of the most common nosocomial infections. The role of probiotics in preventing VAP is still questionable. This study aimed at evaluating the effect of synbiotic FamiLact 2plus on the prevention of VAP in patients admitted to the intensive care unit (ICU).

Methods:

A total of 80 mechanically ventilated patients were included and divided into two groups of 40. Group 1 received FamiLact 2plus, and group 2 received placebo. The outcome variables were compared, including the incidence of VAP, the time interval between the onset of ventilation and VAP, the duration of mechanical ventilation, and the length of stay in the ICU.

Results:

VAP is documented in four patients (10%) in group 1 and 11 patients (27.5%) in group 2 (P = 0.045). The length of stay in the ICU in group 1 was significantly shorter than in group 2, and the time interval between the start of intubation and the onset of VAP in group 1 was longer than in the placebo group. During the intervention, 15 patients in group 1 (37.5%) and 26 patients in group 2 (65%) developed diarrhea, which was a significant difference (P = 0.02).

Conclusions:

Synbiotic is associated with a reduction in the incidence of VAP as well as a reduction in ICU stay and delayed VAP.
Intra-operative Predictors of Neurological Outcomes After Cardiac Surgery
Authors: Barnawi Amjad I. , Albouri Danah Y. , Alsaeed Aljowhara H. , Fallatah Bassam A. , Mahmoud Ahmed E. , El-Goneimy Yasser A.
Published: August 2024

Background:

Despite the advancement in surgical techniques, neurological complications encountered post-cardiac surgery remain significant. Stroke, seizure, and deep coma are major postoperative neurological complications reported in numerous patients. This study aims to identify perioperative predictors for neurological complications and focus on the relationship between these predictors and major neurological complications, particularly stroke, seizure, and deep coma.

Materials and Methods:

This retrospective cohort study was conducted among patients who underwent cardiac surgery between January 2014 and December 2020 at King Fahd Hospital of University, Khobar, Saudi Arabia. Out of 432 patients who had surgery, only 331 patients met the inclusion criteria. A comparison was made between patients who developed postoperative neurological complications and those who did not. The collected data was analyzed using the Statistical Package of Social Sciences program version 29 (Armonk, NY: IBM Corp. USA).

Results:

There were 50 patients with postoperative neurological complications compared to 281 patients with no complications. The rate of perioperative haemodynamic instability was higher in the complication group (14/48, 29.2%) compared to the non-complication group (47/238, 19.7%). Stroke was the highest neurological complication encountered (14/50, 28%).

Conclusions:

Perioperative haemodynamic instability is more common in patients with postoperative neurological complications compared to patients with no complications. Additionally, stroke is the most common major neurological complication. Aortic surgeries, combined surgeries, and haemodynamic instability are the most common perioperative predictors of stroke.
The effect of negative pressure wound therapy on necrotizing fasciitis following total abdominal hysterectomy: a case report
Authors: Yazdi Zahra , Mirzaie Monireh , Savari Marzieh , Farshadpour Narges , Sedaqat Morteza
Published: August 2024

Negative pressure wound therapy or Vacuum therapy of a wound is a sort of therapy to aid wounds to heal by decreasing air pressure on the wound. A 69-year-old female was admitted due to large leiomyoma who underwent a total abdominal hysterectomy. During hospitalization, the incision site of the patient changed color and the patient had a mild fever with an initial diagnosis of necrotizing fasciitis. The patient had debridement four times and no remarkable improvement was achieved due to the extent and depth of the wound. Therefore, vacuum therapy was performed for the patient and after applying this procedure, the patient’s wound got smaller and healed with frequent follow–up and the administration of appropriate antibiotics. Wound care is one of the important steps after that total abdominal hysterectomy and vacuum therapy is useful and safe method for faster healing with satisfactory results for its wounds.