bluuebunny/crossref_metadata_2025 huggingface dataset:
Insights on the conformation and appropriate drug-target sites on retinal IMPDH1 using the 604-aa isoform lacking the C-terminal extension
Authors: Elyasi-Ebli Parisa , Yazdanparast Razieh , Gharaghani Sajjad , Barzegari Ebrahim
Published: November 2023

Background and purpose:

Retinitis pigmentosa (RP) accounts for 2 percent of global cases of blindness. The RP10 form of the disease results from mutations in isoform 1 of inosine 5'-monophosphate dehydrogenase (IMPDH1), the rate-limiting enzyme in the de novo purine nucleotide synthesis pathway. Retinal photoreceptors contain specific isoforms of IMPDH1 characterized by terminal extensions. Considering previously reported significantly varied kinetics among retinal isoforms, the current research aimed to investigate possible structural explanations and suitable functional sites for the pharmaceutical targeting of IMPDH1 in RP.

Experimental approach:

A recombinant 604-aa IMPDH1 isoform lacking the carboxyl-terminal peptide was produced and underwent proteolytic digestion with α-chymotrypsin. Dimer models of wild type and engineered 604-aa isoform were subjected to molecular dynamics simulation.

Findings/Results:

The IMPDH1 retinal isoform lacking C-terminal peptide was shown to tend to have more rapid proteolysis (~16% digestion in the first two minutes). Our computational data predicted the potential of the amino-terminal peptide to induce spontaneous inhibition of IMPDH1 by forming a novel helix in a GTP binding site. On the other hand, the C-terminal peptide might block the probable inhibitory role of the N-terminal extension.

Conclusion and implications:

According to the findings, augmenting IMPDH1 activity by suppressing its filamentation is suggested as a suitable strategy to compensate for its disrupted activity in RP. This needs specific small molecule inhibitors to target the filament assembly interface of the enzyme.
Curcumin supplementation prevents cisplatin-induced nephrotoxicity: a randomized, double-blinded, and placebo-controlled trial
Authors: Mehrab Hasan , Sharifi Mehran , Akhavan Ali , Aarabi Mohammad-Hosein , Mansourian Marjan , Mosavi Elaheh , Moghaddas Azadeh
Published: November 2023

Background and purpose:

Cisplatin-induced nephrotoxicity (CIN) remains the most prevailing unfavorable influence and may affect its clinical usage. This study sought to explore the possible impacts of curcumin on preventing CIN in human subjects.

Clinical design:

The investigation was a placebo-controlled, double-blinded, randomized clinical trial conducted on 82 patients receiving nano-curcumin (80 mg twice daily for five days) or an identical placebo with standard nephroprotective modalities against CIN. Data was gathered on patients' demographics, blood, urinary nitrogen, creatinine (Cr) levels, urinary electrolytes, and urine neutrophil gelatinase-associated lipocalin (NGAL) levels in treatment and placebo groups, 24 h and five days after initiating the administration of cisplatin.

Findings/Results:

Both investigation groups were alike considering the demographic characteristics and clinical baseline data. Curcumin administration led to a significant improvement in blood-urine nitrogen (BUN). BUN, Cr, glomerular filtration rate (GFR), and the ratio of NGAL-to-Cr considerably altered during the follow-up periods. However, the further alterations in other indices, including urinary sodium, potassium, magnesium, NGAL values, and potassium-to-Cr ratio were not statistically noteworthy. The significant differences in the NGAL-to-Cr ratio between the two groups may indicate the potential protective impact of curcumin supplementation against tubular toxicity. Curcumin management was safe and well-accepted; only insignificant gastrointestinal side effects were reported.

Conclusion and implications:

Curcumin supplementation may have the potential to alleviate CIN and urinary electrolyte wasting in cancer patients. Future research investigating the effects of a longer duration of follow-up, a larger participant pool, and a higher dosage of curcumin are recommended.
Combination of metformin and gallic acid induces autophagy and apoptosis in human breast cancer cells
Authors: Haghshenas Marziyeh , Firouzabadi Negar , Akbarizadeh Amin Reza , Rashedinia Marzieh
Published: November 2023

Background and purpose:

Breast cancer is the most common type of cancer and one of the major causes of death among women. Many reports propose gallic acid as a candidate for cancer treatment due to its biological and medicinal effects as well as its antioxidant properties. This study aimed to assess the effects of metformin and gallic acid on human breast cancer (MCF-7) and normal (MCF-10) cell lines.

Experimental approach:

MCF7 and MCF-10 cells were treated with various concentrations of metformin, gallic acid, and their combination. Cell proliferation, reactive oxygen species (ROS), as well as cell cycle arrest were measured. Autophagy induction was assessed using western blot analysis.

Findings/Results:

Metformin and gallic acid did not cause toxicity in normal cells. They had a stronger combined impact on ROS induction. Metformin and Gallic acid resulted in cell cycle arrest in the sub-G1 phase with G1 and S phase arrest, respectively. Increased levels of LC3 and Beclin-1 markers along with decreased P62 markers were observed in cancerous cells, which is consistent with the anticancer properties of metformin and gallic acid.

Conclusion and implications:

The effects of metformin and gallic acid on cancerous cells indicate the positive impact of their combination in treating human breast cancer.
Moderate exercise mitigates cardiac dysfunction and injury induced by cyclosporine A through activation of the PGI2 / PPAR-γ signaling pathway
Authors: Nourmohammadi Khatereh , Bayrami Abolfazl , Naderi Roya , Shirpoor Alireza , Soraya Hamid
Published: November 2023

Background and purpose:

The present study investigated the role of the prostaglandin I2/peroxisome proliferator activator receptor (PGI2/PPAR) signaling pathway in cardiac cell proliferation, apoptosis, and systemic hemodynamic variables under cyclosporine A (CsA) exposure alone or combined with moderate exercises.

Experimental approach:

Twenty-four male Wistar rats were classified into three groups, namely, control, CsA, and CsA + exercise.

Findings/Results:

After 42 days of treatment, the findings showed a significant enhancement in the expression of the β-MHC gene, enhancement in protein expression of Bax and caspase-3, and a significant decline in the protein expression of Bcl-2 expression, as well as increased proliferation intensity in the heart tissue of the CsA group compared to the control group. Systolic pressure, pulse pressure, mean arterial pressure (MAP), QT and QRS duration, and T wave amplitude, as well as QTc amount in the CsA group, showed a significant increase compared to the control group. PPAR-γ and PGI2 showed no significant changes compared to the control group. Moderate exercise along with CsA significantly enhanced the protein expression of PPAR-γ and PGI2 and declined protein expression of Bax, and caspase-3 compared to those in the CsA group. In the CsA + exercise group, systolic pressure, MAP, and Twave showed a significant decrease compared to the CsA group. Moderate exercises along CsA improved heart cell proliferation intensity and significantly reduced β- MHC gene expression compared to the CsA group.

Conclusions and implications:

The results showed moderate exercise alleviated CsA-induced heart tissue apoptosis and proliferation with the corresponding activation of the PGI2/PPAR-γ pathway.
Hyponatremia in Acute ST-elevation Myocardial Infarction – A Retrospective Observational Study
Authors: Aravind CL , Ravikiran R , Kumar Amith , Ranjith Kumar GK
Published: November 2023

Introduction:

Hyponatremia is a common electrolyte disorder in hospitalized patients and has been linked to increased morbidity and mortality in various clinical settings. Patients with ST-elevation myocardial infarction (STEMI) are at risk of developing hyponatremia due to complex interplay of pathophysiological mechanisms. This study aimed to investigate the prevalence, risk factors, and prognostic value of hyponatremia in patients with STEMI.

Materials and Methods:

This was a retrospective study of 192 patients with STEMI who were admitted to a tertiary care hospital between July 2021 and December 2021. Patients were divided into two groups based on their serum sodium levels during hospitalization: Hyponatremia group (serum sodium <135 mEq/L) and normonatremia group (serum sodium ≥135 mEq/L). The prevalence of hyponatremia, demographic variables, ejection fraction, Killip classification, type of STEMI, and in-hospital mortality were compared between the two groups.

Results:

20.8% of patients with STEMI had hyponatremia during their hospital stay. Patients with heart failure, lower ejection fraction, and higher Killip classification at admission were more likely to have hyponatremia ([odds ratio (OR): 2.71, 95% confidence interval (CI): 1.23–5.97, P = 0.014], [P = 0.023] and P = 0.002). Patients with lateral STEMI were more likely to have hyponatremia compared to those with other types of STEMI (OR: 2.68, 95% CI: 1.06–6.81, P = 0.037). Patients with hyponatremia had higher in-hospital mortality rate (8 [22.9%], [OR: 4.27, 95% CI: 1.54–11.85, P = 0.005]) and longer hospital stays (P = 0.019) compared to normonatremia group.

Conclusion:

Hyponatremic patients with STEMI are associated with increased morbidity and mortality. Patients with heart failure, lower ejection fraction, and higher Killip classification at admission should be closely monitored for dyselectrolytemia.
A Study of Diabetes in Young Individuals with Special Reference to Type 2 Diabetes Mellitus
Authors: Babu M. Suresh , Yavasani Neil Krishna Reddy
Published: November 2023

Background:

Type 2 diabetes mellitus (T2DM) in young individuals is a serious concern for the society. Literature suggests that the incidence of T2DM is not only increasing, but also there is a shift of age of onset of T2DM toward younger age groups in India and worldwide. However, data about the frequency of T2DM among young subjects below 25 years of age are sparse in the Indian subcontinent. Hence, the current study was undertaken to find out the frequency and clinical profile of young individuals with T2DM in the departments of internal medicine and pediatrics in a tertiary care hospital.

Aims and Objectives:

The aim of the study was to study the frequency and clinical profile of T2DM among young individuals with diabetes mellitus.

Materials and Methods:

The study was a cross-sectional observational study conducted in the Departments of General Medicine and Pediatrics at JSS Hospital, Mysuru, Karnataka, India, over a 2-year period. The subjects with age of onset of diabetes mellitus below 25 years were included in the study. They were categorized according to the C-peptide values as type 1 diabetes mellitus (T1DM) and T2DM. Maturity-onset diabetes of the young (MODY) was diagnosed with the age of onset of diabetes below 25 years with a strong family history of diabetes for three generations and no insulin requirement for metabolic control for 5 years after diagnosis. The statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS version 25).

Results:

Of the 250 patients included in the study, 208 (83.2%) subjects were T1DM, 38 (15.2%) T2DM, and 4 (1.6%) with MODY. The mean age of onset of T1DM was 13.7 ± 6.201 years and T2DM was 23.28 ± 3.68 years. Body mass index (BMI) and waist circumference of young T2DM patients were more compared to T1DM, which were statistically significant P < 0.0001, and family history showed strong positivity in patients with young T2DM compared to T1DM. Low-density lipoprotein cholesterol (LDL-C), triglycerides (TGs), and total cholesterol (TC) were more in young T2DM patients compared to T1DM which were statistically significant with P = 0.003 (LDL), P = 0.0015 (TG), and P = 0.03 (TC), respectively.

Conclusions:

T2DM, previously considered a middle-aged or elderly condition, is now commonly occurring in young adults and children, probably due to a growing epidemic of childhood obesity and lifestyle. Obesity and dyslipidemia were more in T2DM compared to T1DM among young diabetics.
Ruptured hydrosalpinx masquerading an ectopic pregnancy in a woman of reproductive age group
Authors: Kalluri Sri Sowmiya , Priyanka Yoga P , Vijayan Sharmila , Sankaralingappa Arundati
Published: November 2023

Acute abdomen in women of child-bearing age remains a diagnostic dilemma. Etiology of acute abdominal pain may be due to obstetric, gynecological, gastrointestinal, or genitourinary causes. Early diagnosis and decision on conservative management versus emergency laparotomy/laparoscopy should be made in cases with acute abdomen as a lifesaving approach. We report a rare case of acute abdomen with hemoperitoneum due to rupture of hydrosalpinx.
Perioperative myocardial infarction: An anesthesiologist’s nightmare!
Authors: Sebastian Geethu , Kesavan Rajesh , Thomas Dimple E , Kumar Lakshmi
Published: November 2023

An acute ST elevation myocardial infarction (STEMI) in the perioperative period can be challenging. Effective cardiopulmonary resuscitation with multidisciplinary support systems including percutaneous coronary intervention within the recommended times enhances recovery and outcomes. We present a case of a young patient who developed STEMI despite being a low risk for intraoperative major adverse cardiac events.
Cholecystoduodenal fistula: An incidental finding of gall stone disease in a young male
Authors: Sharma Aditya , Meena Ram N , Khanna Rahul
Published: November 2023

Chronic calculous cholecystitis, if left untreated for a long time, can lead to a bilioenteric fistula, which is an aberrant connection between the bile duct system and the gastrointestinal tract. These fistulas have a variety of clinical manifestations and may risk the patient’s life. Hence, the authors report a rare case of a patient presenting with a cholecystoduodenal fistula.
Evaluation of Efficacy of Low-Intensity Pulsed Ultrasound on Comorbidities Following Mandibular Impacted Third Molar Surgery: A Prospective Study
Authors: Rao Keerthana , Kumar KR Ashok , Kumar R. Mahesh , Marimallappa T. R. , Pal Supriyo , Dutta Subham
Published: November 2023

Introduction:

Despite several in vitro and in vivo applications of low-intensity pulsed ultrasound (LIPUS), it remains an under-studied feature of the oral and maxillofacial region. The goal of this in vivo study was to objectively investigate the efficacy of low-intensity pulsed ultrasound on wound healing and related morbidities following surgical removal of an impacted third molar.

Materials and Methods:

The following in vivo prospective, comparative, randomised controlled clinical study was carried out amongst 56 patients who reported to the Department of Oral and Maxillofacial Surgery fulfilling the inclusion criteria. Group A received sham ultrasound, whereas Group B received LIPUS therapy. Based on the group allocated LIPUS 1 MHz, pulsed 20% and dose 1.0 watts/square centimetre (W/cm2)/sham, ultrasound therapy was given on 1st, 2nd and 3rd post-operative days. The assessment of post-operative pain, oedema, trismus and wound healing on preoperative, first, third and seventh postoperative days.

Results:

The quantitative variables of the study were assessed using independent sample t-test, and qualitative variables were assessed using the Chi-square test. The P < 0.05 on third and seventh post-op days for pain, trismus and wound healing in the LIPUS group compared to control group making it statistically significant. There was no statistically significant difference in the reduction of oedema amongst the two groups.

Discussion:

Post-LIPUS application in the patients, postoperative pain was significantly reduced, trismus was noticeably improved and wound healing was satisfactory and can be employed as a complementary technique.
A Review of Arrhythmias in Endocrinology
Authors: Ram Nanik , Salik Muhammad
Published: November 2023

Endocrine disorders can lead to cardiac arrhythmias, which can have serious implications for an individual’s health, including sudden cardiac death. The pathophysiology of arrhythmias in endocrine disorders is a multifaceted process that includes alterations in hormone levels, disruptions in electrolyte levels, and changes to the heart’s structure. Tachycardia and bradycardia are common rhythm abnormalities caused by defects in the cardiac conduction system or autonomic nervous system, metabolic disorders, and medication use. Therefore, it is crucial to identify and manage underlying endocrinopathies in patients with rhythm or conduction abnormalities. The aim of this analysis is to offer a thorough summary of the current understanding on the pathophysiology and mechanisms of cardiac arrhythmias in relation to endocrine disorders. The review will concentrate on prevalent arrhythmias that frequently occur in endocrine disorders and will also offer clinical suggestions for their treatment. The objective is to enhance awareness and enhance clinical practices when treating patients with endocrine disorders who may be at risk of developing cardiac arrhythmias.
Challenges of Glycemic Control in Patients with Prader–Willi Syndrome Associated with Congenital Leptin Deficiency
Authors: Imran Javed , Hasan Sohali , Sheuly Azimunnessa , Rahman Shahin Ibn , Hossain Kazi Nazmul , Rouf Rushda Sharmin Binte , Afsana Faria , Pathan Md. Faruque , Amin Md. Feroz
Published: November 2023

Prader–Willi syndrome (PWS) is a rare multisystem genetic disorder and one of the syndromic causes of childhood obesity. It is characterized by learning difficulties and behavioral challenges with subsequent multiple endocrine and multisystem involvement. Congenital leptin deficiency is also a very rare disorder that causes early-onset obesity with hormonal and metabolic disturbances. In this report, we describe the case of an 11- year- old girl who presented to us with uncontrolled blood sugar, significant weight gain, behavioral disturbances and was diagnosed with PWS with congenital leptin deficiency, type 2 diabetes mellitus, hypothyroidism, hypertension and obstructive sleep apnea. The main purpose of this case report is to describe the barriers of glycemic control and lifestyle modification challenges and implement the optimal management plan in such a rare association.
Correlation between Hepatitis B Viral Load and Hepatitis B Surface Antigen Levels in Asymptomatic Seropositive Blood Donors
Authors: Pandey Prashant , Setya Divya , Ranjan Shweta , Kumari Supriya , Kumar Dharmender
Published: November 2023

Background and Objectives:

Correlation has been shown between hepatitis B surface antigen (HBsAg) and hepatitis B virus (HBV) levels in different patient categories. However, this has not been studied for donors. The aim of this study was to study the relationship between HBV DNA levels and E ratio obtained for HBsAg testing by chemiluminescence immunoassay (CLIA) performed on donor samples.

Methods:

A prospective, observational study was conducted in the department of transfusion medicine at a large tertiary health-care setup in North India from 2017 to 2021. Serological testing for HBV included HBsAg testing by CLIA. All reactive samples were tested in duplicate by electro CLIA (eCLIA). All samples found to be reactive in all three tests were then tested by a rapid diagnostic test and quantitative polymerase chain reaction.

Results:

During the study duration, 251 donors were found to be reactive for HBsAg by CLIA and eCLIA in screening. Of these 251, HBV DNA could not be detected in 85 (33.86%) samples, whereas in rest 166 (66.14%) samples, HBV DNA was detected. Mean E ratio for CLIA for all 251 samples was 5177.45, whereas mean viral copies detected were 19645858.66. The correlation for all 251 samples was found to be weak negative. The correlation for sero-reactive samples with the presence of HBV DNA was also found to be weak negative.

Conclusion:

In conclusion, we found significant but weak correlation between HBsAg results obtained by CLIA and HBV DNA levels for blood donors. The measurement of HBV DNA level is necessary for all apparently healthy donors coming for blood donation and testing reactive for HBsAg in screening assays.
Improving Turnaround Time for the Issue of Blood Components in Case of Emergency
Authors: Gnanaraj John , Kulkarni Rajendra , Sahoo Dibyajyoti , Basavarajegowda Abhishekh
Published: November 2023

Background and Objectives:

During a surgical or medical emergency, the timely issue of crossmatched blood is crucial for efficient and satisfactory patient revival. Turnaround time (TAT) is the duration taken from the time blood requests, and samples are received in the blood center until the blood is crossmatched and available for blood transfusion. The study aimed to audit the TAT in our center, analyze and study the factors delaying TAT, and formulate plans to improve it by implementing corrective measures. These actions would directly or indirectly impact the outcomes of the delivery of patient care in emergency services.

Methods:

A record-based prospective study was performed in a tertiary care teaching hospital with trauma and all emergency services in Southwestern India. TAT was calculated for all emergency blood requests received over 16 months in a systematic sampling method. Cases with prolonged TATs, where the product issue TAT exceeded the internal policy and quality indicator standards (15 min for emergency packed red blood cells issue), were further evaluated for causes of delay and analyzed at frequent intervals.

Results:

The mean TAT at the start of the study was 17.1 min (standard deviation [SD] 1.05 min), gradually reducing to 14.9 min (SD 0.62 min) by the end of the study, and it was statistically significant with P = 0.01.

Conclusion:

It is essential to deduce the causes for delayed TAT and work on those variables amenable to modifications based on priority to improve the TAT regarding pretransfusion testing and the issue of blood products, which is crucial in emergency services.
Pilot Study of Centralized Management System in Shanghai: A Promising Solution to Platelet Collection and Supply Imbalance in Small Blood Banks
Authors: Ma Rongna , Liu Yuning , Liu Hong , Xu Zhong , Wu Xiaofei , Jia Yao , Huang Yuwen , Mo Qin , Wang Xun
Published: November 2023

Background and Objectives:

While there exists a significant wastage of platelets on one side (volatile demands and short lifetime), there is also a shortage for use on the other (lack of donors and emergency transfusions). A new centralized management system was established to tackle this dilemma.

Methods:

To assess the function of this system, data were collected from the Fengxian Blood Bank (FBB) Collection and Supply Information System during 2016 and 2018, then analyzed by IBM SPSS Statistics version 20.

Results:

Since implementing the centralized management system, a total of 1340 units of apheresis platelets were distributed by FBB. However, the number of units collected was 2737, twice as much as what had been distributed. With the aid of the system, the excess of 1644 units of apheresis platelets were transferred to the Shanghai Blood Center (SBC) inventory at their disposal. On the other hand, 247 units (included in 1340 distributed units) were compensated by SBC during the platelet shortage. In addition, the hospital demand meeting rate shows a significant increase from 82.61% to 99.78%, especially for type AB which increases from 62% to 100%.

Conclusions:

In conclusion, the centralized management system vastly improved the efficiency of platelet collection and distribution by the regional supply and demand. Such success would be a superb example of blood banks facing similar problems.
Experience of Granulocyte Collections and Transfusions in Resource-constrained Settings
Authors: Mangwana Sadhana , Dixit Gaurav , Celluzzi Christina M. , Cui Wanxing , Bapat Asawari
Published: November 2023

Background:

Neutrophil granulocytes are essential components of innate immune response. An absolute number of neutrophils are a fundamental indicator of host defense. With increasing severity of neutropenia, either due to the disease or as a result of chemotherapy for hematologic malignancies, there is an exponential increase in the risk of severe infection. In such conditions, granulocyte transfusion is considered a potential therapeutic option due to its phagocytic properties. The study was undertaken to analyze data of granulocyte collections and transfusions in resource-constrained Settings.

Methods:

In this observational prospective study, granulocytes were harvested by combined administration of granulocyte colony-stimulating factors and dexamethasone mobilization and transfused to severely neutropenic patients. Data on granulocyte collections and transfusion, various determinants of donor, and procedural characteristics and patient outcomes, with respect to 30-day mortality, were analyzed.

Results:

After granulocyte transfusion, patients' posttransfusion white blood cell and neutrophils increased significantly. Higher platelet counts in the harvested products resulted into significant increment of patients' platelet count and markedly reduced demands of platelet transfusions, reducing chances of alloimmunization. Eighty-five percent of patients could be saved, showed improvements in their clinical conditions, and were discharged from hospital in stable condition.

Conclusion:

Granulocyte transfusions are an important therapeutic modality in neutropenic patients with resistant infections, until spontaneous recovery of neutrophil count occurs in patients. Cost Reduction of some of the resources should be considered for LMIC as lower price will encourage more facilities willing to offer similar procedures to aid patients. Training workforce for new and novel processes is need of hour and will add value by equipping LMIC facilities in serving the patients. Granulocyte transfusions are life-saving tool and found to be safe and well tolerated by recipients. They can play a vital role in improving outcomes and saving patients in resource-constraint countries, where there is increasing emergence of multidrug-resistant bacterial infections.
Hypercoagulability in Pediatric Autologous Hematopoietic Progenitor Cell Collection – Is it the Time to Reconsider Screening? – A Case Report
Authors: Sriraman P. , Noushad Shahida , Basavarajegowda Abhishekh , Sahoo Dibyajyoti , Kulkarni Rajendra G. , Karnesh Sunil Jai
Published: November 2023

Peripheral blood hematopoietic progenitor cell harvest by apheresis in pediatric patients, a double-edged sword, has advantages and disadvantages over conventional bone marrow transplantation. The effect of granulocyte colony-stimulating factor (G-CSF) mobilization on hemostasis in literature is very scarce. A 3-year-old female child with metastatic neuroblastoma planned for autologous transplant. Following G-CSF mobilization (75 mg; 4 days), the procedure was performed with all default parameters in Spectra Optia with an acid citrate dextrose (ACD) flow rate 1:12, assuming 3-total blood volume (TBV) to be processed with 150 ml of expected collection with target yield of 6 × 106 CD34 cells/kg. Despite normal coagulation laboratory parameters, it was abandoned for reasons such as low-flow alarms and thrombi in the kit tubings. In the subsequent procedures, the ACD to whole blood ratio was decreased to 1:16, and used bolus of heparin was followed by continuous heparin infusion throughout the procedure. Despite using heparin anticoagulation, a long thrombus was aspirated at needleless port. The procedure was completed with continuous low-flow alarms. A cumulative dose of 5.67 × 106 CD34 cells/kg was achieved over four procedures, but the cause of hypercoagulability was unknown. All the coagulation parameters were within normal limits before and after the procedure. The exact cause for hypercoagulability remains elusive. There are no studies or case reports in the pediatric population on hypercoagulability following apheresis procedure after G-CSF mobilization, but evidence is available for adults, with lack of explanation. It can also be due to low draw flow from the patient side or embolization of thrombi developed in the anticoagulant unprimed site in the kit tubings. More extensive studies are required to explain the mechanism of hypercoagulability during apheresis procedures in the pediatric population.
Prospective Audit of Blood Transfusion Practices among Nurses and Role of Education and Intervention at a Tertiary Care Hospital
Authors: Prinja Nippun , Kaur Sarabjeet , Matthews Jyothi , Nagrath Priyanka , Pal Lokesh , Sharma Girja , Bajaj Archana
Published: November 2023

Background and Objectives:

Periodical internal audits evaluate the process flow of transfusion which arrests the spectrum of adverse events. The objective of the study was to provide evidence that blood is being ordered, handled, and administered according to transfusion guidelines and to highlight the deviations with the secondary objective of improving knowledge and practices in nursing officers.

Methods:

Nursing officers were audited on 50 patients each in P1 and P2 phase. Training of 243 nursing staff was done after P1 phase. Training comprised education and interventions over 45 days – 18 didactic lectures and 36 bedside classes. Nurses were audited both before and after the completion of the training.

Results:

One hundred and forty-five nurses had knowledge and practice score in between 11 and 15 in P1 which improved to 243 (100%) in P2. Transfusion order for one patient was not written in P1, whereas 100% compliance was seen in P2. Noncompliance in taking consent for transfusion improved from 5 to 1 in P2. Blood request error and sample labeling error reduced from 8% to 0% and 4% to 0%, respectively, in P2. Sample labeling was inappropriate in 2 patients in P1 which improved to nil in P2. Checking of vital signs check and intravenous cannula patency improved from 96% to 98%. Crosscheck of packed red blood cell nursing officers before transfusion reduced from 8% to 0% and from 30% to 2% among medical officer (P< 0.05). Delay in the initiation of transfusion, reduced from 7 to 2 patients.

Conclusion:

Timely audit of transfusion practices reduces mistakes and errors hence improved patient care.
Hypotensive Transfusion Reaction due to Leukoreduced Platelets
Authors: Natarajan Ramasubramaniam , Arumugam Rajasekar
Published: November 2023

Hypotensive transfusion reaction is a distinct category of adverse sequelae of transfusion characterized by an early and abrupt onset of hypotension, typically resolving promptly upon discontinuation of the transfusion. The primary mechanism behind this reaction seems to be the accumulation of bradykinin in the transfused blood product during processing. The authors wish to highlight a case of isolated hypotensive reaction following administration of leukoreduced platelets in an Indian male patient, which required vasopressors. Awareness of the risk factors and clinical presentation for this type of reaction are vital for proper patient care and the prevention of future incidents.
Assessment of Patient's Knowledge about Blood Transfusion and Impact of Structured Information on this Knowledge: Single-Center Report from India
Authors: Gupta Shubham , Tiwari Aseem Kumar , Agnihotri Naveen , Agnihotri Ajju , Aggarwal Geet
Published: November 2023

Background and Objectives:

Blood transfusions are frequently prescribed for acute and chronic conditions. When transfused judiciously, blood can save life and improve the health of the patient(s). However, transfusion of blood and blood components is never risk-free. Despite this, transfusion consent may not be obtained satisfactorily. We assessed the knowledge of patients about their blood transfusion and consenting process and the impact of structured information on their knowledge.

Methods:

A cross-sectional qualitative study design was employed. The study included all consenting adult patients who were intended recipients of red blood cell transfusion. Patient information sheet (PIS) along with pre- and postquestionnaire was administered to study patients.

Results:

Our study examined patients “knowledge and their attitude” about blood transfusion and recalling of their decision on consenting to transfusion. For the reason of being transfused, 58.5% were not aware, while 73% were unaware about the benefits of blood transfusion. Similarly, 85.5% were unaware about the risk of blood transfusion. There was a lack of knowledge about the “alternative option” of blood transfusion. Our findings also suggest that a standardized informed consent process was not being carried out.

Conclusion:

There is a need for strengthening IEC in the blood transfusion process. The present study has highlighted the role of printed/written information (PIS) in the native language and in imparting knowledge in the context of blood transfusion.
Adverse Blood Transfusion Reaction Reporting at a Tertiary Care Hospital, Bhutan
Authors: Yangdon Tshering , Getshen Mahrukh , Dorji Sangay , Tashi Lobzang
Published: November 2023

Background and Objectives:

Even though Blood Transfusion Service is considered as life-saving intervention, it is associated with the occurrence of uneventful reactions from the transfusion of blood and blood units. Bhutan Blood Bank is fragmented with different levels of services provided which leads to varied levels of adverse blood transfusion reaction reported. Study on the hemovigilance system at tertiary care hospital is conducted so as to study the frequency and types of reactions over a period of three years from 1st January 2019 to 31st December 2021.

Methods:

All ATRs occurring within a period of 3 years were studied according to the Blood Bank standard operating procedure. Adverse transfusion events related to blood and blood units were analyzed and classified on the basis of their clinical features and laboratory tests. Descriptive statistics were used to represent the adverse transfusion reactions.

Results:

During this period, a total of 19,961 blood and blood components were issued and 120 adverse transfusion events were reported. Most reaction reported were febrile non-hemolytic transfusion reaction, FNHTR (59.2%) followed by allergic reaction (22.5%) occurring predominantly in females (93%). Packed red cells were the common component causing adverse events (83 %) with most observable in Group A (42.5%) blood units.

Conclusion:

Febrile and allergic reactions are the most common type of reaction reported. Although such reaction type is least harmful but fatal reaction can occur and preventive measures must be taken to avoid such reactions. This preliminary study indicates the importance of having continuous monitoring and quality assessment scheme in addressing the issues of adverse transfusion reaction. Furthermore, establishing a hospital transfusion committee is vital for delivery of safe and efficient blood transfusion services.
Informed Consent: A Tool for Patient Education; Not Merely a Regulatory Requirement
Authors: Chandrashekar Shivaram
Published: November 2023

Informed consent is an ethical and legal requirement for medical treatment. Informed consent is the process by which a blood center educates a donor and patient regarding their safety, benefits, and adverse effects using the twin tools of blood donor consent and blood transfusion consent. In case of other patient procedures, the health-care provider educates a patient about the risks, benefits, and alternatives of a given procedure or intervention. Consent by the patient may be implied (where a patient passively cooperates in a process without a formal consent), verbal (where the health-care professional provides information to patient regarding the procedure and its relevance through effective communication), or written. It is important for medical practitioners to have written and signed informed consent from their patients before performing any invasive or irreversible procedures. Informed written consent is also needed to publish scientific data regarding patient and incorporating images of the patients while publishing case reports. Written consent may have fixed formats or may be personalized adapting to the needs of the patient and the practitioner. The purpose of obtaining consent must be to make the patient understand the procedure planned and give him/her an opportunity to make a decision about whether to undergo the procedure or intervention. Informed consent may be waived in emergency situations if there is no time to obtain consent or if the patient is unable to communicate and no surrogate decision-maker is available. The process of informed consent is shifting-focusing more on communication and less on obtaining signatures. No matter how well worded the consent form is, if the patient does not understand what is being communicated, the purpose of it lost, and it does not stand well in the court of law. The present review addresses some of the vital issues and nuances regarding informed consent when providing medical care. Literature search for the present article was conducted using databases such as PubMed, Medline, and relevant articles published in peer-reviewed journals.
Contributions of Voluntary Blood Donor Organizations to Voluntary Blood Donation
Authors: Henry Nittin , Nirmal C. , Pullangodan Anu , Raj K. Ajay , Arun V. J.
Published: November 2023

Background and Objectives:

An ideal model for the foundation of a safe blood supply is a committed group of healthy, altruistic voluntary blood donors (VBDs) recruited by a well-organized, dynamic VBD organization (VBDO). We address the data deficiency on VBDOs in strengthening the voluntary blood donation program. The aims of the study are to assess the part played by VBDO in strengthening VBDs, regular repeat blood donor (RRBD), and regular repeat VBD (RRVBD), classifying the VBDOs on their functional realm, and analyzing the variables affecting blood donations based on their association with VBDOs.

Methods:

This was a cross-sectional observational study from September 2019 to December 2019. All donors provided a questionnaire in “Google Forms” with a consent form through social media. Modified Kuppuswamy score 2019 was used to classify donors based on occupation, education, and socioeconomic classification (SEC). Pearson's Chi-square test was used for statistical analysis.

Results:

Eight hundred and thirty-four responses were obtained from 960 donors. 78.7% responses belonged to VBDs, 62.6% belonged to donors not associated with VBDOs and there was no statistically sifnificant difference between VBDs and replacement donors based on their association with VBDOs. 46.9% and 55.6% of VBDO donors are RRBD and vice versa, respectively, showing statistical significance. Majority of RRVBDs, i.e., 97 (52.2%), belong to VBDO showing statistical significance. Site of donation and gender showed statistical significance unlike age, education, occupation, and SEC. 61.25% of VBDO donors were associated with nongovernmental organizations.

Conclusions:

VBDOs contribute more toward the regularity of donation rather than donating blood voluntarily and retaining blood donors.
Comparison of four different techniques of i-gel insertion by anaesthesia trainees in children undergoing daycare surgery: A single-blind, randomised, comparative study
Authors: Priyadarshi Priya , Behera Bikram Kishore , Misra Satyajeet
Published: November 2023

Background and Aims:

Different techniques of i-gel insertion have been described with variable success rates. This study aimed to assess the incidence of malposition of i-gel in children with 90° rotation, 180° rotation, jaw thrust–assisted and standard insertion techniques.

Methods:

The study included 132 children undergoing elective surgery under general anaesthesia without neuromuscular blockade after approval from the Institutional Ethics Committee. The i-gel was inserted using one of the four randomised techniques (90° rotation, 180° rotation, jaw thrust–assisted insertion or standard insertion technique) by anaesthesia trainees. The primary objective of this study was to assess device malposition using three alternative techniques compared to the standard insertion technique by flexible video bronchoscopy.

Results:

The incidence of malposition was the least in the 180° rotation technique group (27%) versus 39% in the standard and 90° rotation technique groups and 70% in the jaw thrust technique group (P = 0.004). Oropharyngeal leak pressure (OLP) was highest in the 180° rotation technique group, that is, 27.1 (5.3) cm H2O in the 180° rotation technique group versus 23 (4.3), 25.8 (4.1) and 24.7 (5.6) cm H2O in the standard, 90° rotation and assisted jaw thrust groups, respectively (P = 0.006). The time to i-gel insertion was the least with the standard insertion technique, that is, 16.9 (3.3) s, compared to 18.4 (3.1) s in the 90° rotation group, 19.5 (3.2) s in the180° rotation group and 20.1 (3.4) s in the assisted jaw thrust technique group (P < 0.001).

Conclusion:

The 180° rotation technique for i-gel placement in children by anaesthesia trainees has the lowest incidence of malposition and the best OLP versus other techniques but lacks any clear advantage in clinical performance and ventilation.
Comparison of clinical performance of Baska mask and Ambu AuraGain in patients undergoing surgery: A single-blinded, randomised comparative trial
Authors: Raman Rajesh , Prabha Rati , Rampal Surbhi , Tiwari Tanmay , Gautam Shefali , Prakash Ravi
Published: November 2023

Background and Aims:

The Baska mask (BM) and the Ambu AuraGain (AAG) have shown promising results in recent trials but have not been compared. Therefore, we aimed to compare the clinical performance of the BM and the AAG for airway management of adult patients.

Methods:

In this randomised comparative study, patients aged 18–60 years and with an expected surgical duration of less than 2 h were enroled. Patients were randomly allocated to AAG (Group A, n = 37) and BM (Group B, n = 37) for airway management. After induction of anaesthesia, an allocated supraglottic airway device (SAD) was inserted. Oropharyngeal leak pressure (OLP), time taken to insert SAD, number of insertion attempts, leak fraction (LF), first-attempt success rate, overall success rate, ease of insertion, fiberoptic view of the glottis, and complications were compared. The data were analysed using Student’s t-test, Mann–Whitney U test, and Fisher’s exact tests.

Results:

Baseline and demographic characteristics were comparable. OLP (31.32 ± 2.59 versus 27.54 ± 1.32 cmH2O) was higher (P < 0.001), and LF (6.19% ± 1.20% versus 7.24% ± 1.72%) was lower (P = 0.003) in the BM group. First-attempt and overall success rate, time taken to insert, number of insertion attempts, ease of insertion, and fibreoptic view of glottis through the SADs were statistically similar between groups. However, the incidence of sore throat (P = 0.007) and cough (P = 0.028) was higher with AAG.

Conclusion:

Clinical performance of BM was better than AAG as the former had higher OLP, lower LF and complications.
Evaluation of age-based local anaesthetic dosing of bupivacaine for popliteal sciatic nerve block in children undergoing foot and ankle surgery: A prospective single arm interventional study
Authors: Parthasarathy Srinivasan , Venkatesh T. Kumar , Saravanan Balachandar
Published: November 2023

Background and Aims:

Recommendations on paediatric single-injection local anaesthetic (LA) dosing for peripheral nerve blocks (PNBs) are based on the children’s weight and limited by weight-based toxicity concerns. In this study, we assessed the extent of circumferential spread and block characteristics following the injection of an age-based volume (age in years = LA volume) of 0.25% bupivacaine following popliteal sciatic nerve block (PSNB).

Methods:

Thirty children aged between 2 and 12 years with the American Society of Anesthesiologists (ASA) physical status I and II and undergoing foot and ankle surgical procedures were given single-injection ultrasound-guided subparaneural PSNB using 0.25% bupivacaine at age-based LA volume after the administration of anaesthesia. The circumferential pattern of LA spread (primary objective) was assessed along the nerve (both cephalad and caudal) using ultrasound from the point of administration and the block characteristics in terms of duration of sensory block.

Results:

The mean [standard deviation (SD)] cephalic circumferential LA spread distance was 2.52 (0.68) [95% confidence interval (CI): 2.27–2.76] cm. The mean (SD) caudal circumferential LA spread distance was 2.27 (0.48) [95% CI: 2.09–2.44] cm. The mean (SD) duration of the sensory block was 9.03 (0.97) [95% CI: 8.67–9.38] h.

Conclusion:

The age-based LA volume of bupivacaine for ultrasound-guided PSNB resulted in a longitudinal circumferential spread of around 4.7 cm (adding both cephalic and caudal spread) and provided adequate analgesia for nine postoperative hours.
Comparison of oropharyngeal leak pressure of LMA Protector and LMA ProSeal in anaesthetised paralysed patients – A randomised controlled trial
Authors: Bhardwaj Mamta , Dhania Sunny , Kaur Kiranpreet , Lal Jatin , Priya  , Singhal Suresh K.
Published: November 2023

Background and Aims:

In the present study, we hypothesised that the laryngeal mask airway (LMA) Protector would provide higher oropharyngeal leak pressure (OLP) than LMA ProSeal. Thus, we planned this study to compare the clinical performance of LMA Protector and LMA ProSeal in terms of OLP as a primary objective and insertion characteristics as secondary objectives.

Methods:

Ninety patients of either gender, aged 18–70 years, were randomised into groups PS (LMA ProSeal) and P (LMA Protector). Following anaesthetic induction, the device was inserted as per group allocation. OLP of both devices was taken as a primary objective. Secondary objectives such as insertion time, ease of insertion, number of attempts required, fibre-optic view grading, amount of air (mL) required to get a cuff pressure (CP) of 60 cm H2O, and CP adjustment required and complications, if any, were also noted. Data were analysed using coGuide statistics software, Version 1 (BDSS Corp. Bangalore, Karnataka, India).

Results:

The median (interquartile range) OLP was significantly higher with LMA protector than with LMA ProSeal [33.00 (27.0, 36.0) versus [29.50 (26.0, 32.0) (P = 0.009)]. First-attempt success rate was 95.4% (42/44) in group PS and 93% (40/43) in group P. Insertion time, ease of insertion, and fibre-optic view grading were not different between the groups. Gastric tube placement failed in one patient in group PS and in three patients in group P (P = 0.606). The median amount of air (mL) required to get a CP of 60 cm H2O was 26.5 (20, 28) in group PS and 12 (8,13) in group P (95% confidence interval [CI] =10.808–14.575) (P < 0.001). At all time points, CP was significantly higher, and more CP adjustments were needed in group PS than in group P (P < 0.001). Incidence of blood staining and post-operative sore throat at 1 and 24 h were not different between the groups.

Conclusion:

LMA Protector provided a significantly higher OLP and less requirement of CP adjustments but comparable first-attempt success rate, mean insertion time, fibre-optic view, and gastric tube insertion as compared to LMA ProSeal.