bluuebunny/crossref_metadata_2025 huggingface dataset:
Eustrongylides spp. parasite risk management in Atherina boyeri from Lake Trasimeno
Authors: Franceschini Raffaella , Valiani Andrea , Ranucci David , Roila Rossana , Palma Giuseppe , Agnetti Francesco , Di Giacinto Giacomo , Branciari Raffaella
Published: August 2023

Atherina boyeri is the primary source of fishing profit in Lake Trasimeno and a common host for Eustrongylides spp. larvae. The presence of Eustrongylides in fish is a public health concern, and effective risk management procedures are necessary to guarantee that infected products do not reach the market. Currently, in the European Union, there is no official sampling plan for fresh fish that defines sample size, inspection methods, and criteria for accepting or rejecting the product. An approach to Eustrongylides risk management is proposed in this study. A total of 270 batches of Atherina boyeri, each consisting of 29 specimens, were collected and examined visually in 3 years (2020-2023). The prevalence (P) of the parasite was 20% in 2020, and in the first months of 2021, it grew up to ⁓40%, then dropped to 12.50% in December 2021 and settled at 16% in February 2022. In January and February 2023, the P fell below 1%. The mean abundance was calculated and used to establish a threshold value to determine fish marketability. In 2020 and 2021, several batches were judged not marketable, and in some batches, a freezing treatment was implemented to assure the inactivation of the parasite. In the last months of 2022 and in January and February of 2023, the presence of parasites in captured fish was negligible, and this allowed the marketability of fish as fresh. The proposed sampling plan was effective in preventing the commercialization of potentially hazardous products.
A native mitral valve mass beyond imagination
Authors: Alamri Fisal , Eltayeb Abdalla , Hamad Alaa , Alamri Soaad , Alamri Sultan , Kaidali Wassima , Tashkandi Loay , Arbili Lana , Pergola Valeria , Al Sergani Hani
Published: August 2023

The authors report a case of a patient with a history of IgA nephropathy that, during the admission for pneumonia, was found to have an incidental finding of a huge mitral valve (MV) mass on transthoracic echocardiography. The differential diagnosis was challenging because the clinical scenario raised the suspicion of possible infective endocarditis and the imaging features were suggestive of a myxoma or vegetation. The patient underwent urgent excision of the mass with MV replacement due to the high risk of embolism. Intraoperative findings were consistent with clot or vegetation. Pathology result of thrombus was beyond our imagination and at the best of our knowledge one case only has been reported. Awareness about native MV thrombosis and its etiologic factors, workup, and management is key for better medical and surgical management planning because this condition is extremely rare and challenging in the clinical and imaging arena.
Knowledge, attitude, perception and education on contact lenses for refractive errors in Kenya
Authors: Timothy Chikasirimobi G. , Van Staden Diane W. , Chepkeitany Harun C. , Osuagwu Levi U. , Shaviya Nathan
Published: August 2023

Background: Globally, contact lenses are an important part of the management process for refractive errors. Contact lenses are accepted widely in developed countries, but they are currently less used in developing countries like Kenya.Aim: To assess the knowledge, attitudes and perceptions (KAP) (both pre- and post-education) to contact lens uptake specifically for correction of refractive errors by patients attending a Kenyan University Eye Clinic.Setting: Academic Vision Centre, Masinde Muliro University of Science and Technology, Kakamega, Kenya.Methods: A quasi-experimental cross-sectional study was performed by reviewing all records from February 2014 to March 2020; 360 records were purposively selected. Thereafter, a structured questionnaire with educative content on contact lenses was administered by phone and online to determine KAP. Responses were collected over a period of one month. Knowledge, attitudes and perceptions were categorised and scored, and descriptive statistics and paired t-tests were used for data analysis.Results: More women (58.3%) and mostly students (59.2%) participated, with ages from 16 to 38 years (mean age and standard deviation of 22.85 ± 4.32). Overall, there was poor knowledge of contact lenses for refractive errors (96.7%). Attitudes to contact lenses were unfavourable, both pre- and post-education (94.7% and 92.8%). Perceptions of contact lens uptake were negative pre-education (92.5%) but positive post-education (95.3%).Conclusion: Education changed perceptions of contact lens usage for refractive errors correction, but even with some focused education, negative attitudes and poor knowledge regarding contact lenses persisted in the sample. Practitioners should inform patients about contact lenses as a possibility for refractive error management, and institutions training eye care providers should consolidate their clinical teaching regarding contact lenses.Contribution: This study showed that the more people with refractive errors are knowledgeable about contact lenses, the more uptake of contact lenses will happen, optometrists and ophthalmologists should educate people more on contact lenses.
Diversity in microbiota between Indian and Emiratis ethnicities is associated with benign prostatic hyperplasia
Authors: Al Shareef Zainab , Khan Naveed Ahmed , Ershaid Mai Nidal Asad , Soliman Sameh , Elmoselhi Adel B.
Published: August 2023

Background:

Herein, we investigated the correlation between microbiota profile and benign prostatic hyperplasia (BPH) in patients from two different ethnicities, Indian and United Arab Emirates.

Materials and Methods:

Prostate samples were collected from patients in Al Baraha Hospital in Sharjah, United Arab Emirates. Next, metagenomic analysis of bacterial species was carried out by extracting DNA and 16S rRNA analysis.

Results:

Our results revealed that the gut bacterial communities of the Indian and Emirati populations were different. Principal coordinates analyses revealed differences in the bacterial community structure. Around 265 bacterial operational taxonomic units (OTUs) were specific to the Indian population vs. 968 bacterial OTUs observed in the Emirati population, whereas 586 bacterial OTUs were common to both groups. When the relative abundance of taxa was analyzed, Proteobacteria, Actinobacteriota, and Firmicutes represented the highest abundance, albeit the relative abundance was different between the two groups. At the genus level, the distribution of the genus Ralstonia was most abundant in the Emirati population followed by Pseudomonas, whereas Acinetobacter was the most abundant in the Indian population followed by Stenotrophomonas. Likewise, differences were observed between other genera in both groups. MetaStats analysis revealed that 21 bacterial species were considerably different between the two groups.

Conclusion:

Collectively, the data revealed that both groups showed differences in the structure of bacterial community. Further studies are warranted to determine the precise role of specific bacterial species in BPH and the underlying molecular mechanisms. The findings arising from these studies will be important in the rational development of therapeutic interventions.
Minimally invasive surgeries for the treatment of temporomandibular disorders
Authors: Talaat Wael M. , Hamdoon Zaid , Ghoneim Mohamed M.
Published: August 2023

Background:

Patients refractory to conservative treatment of temporomandibular disorders (TMD) are candidates for more invasive treatments such as arthroscopy and arthrocentesis. The aim of the present study was to identify the predictors of long-term success and the persistence of treatment outcome for temporomandibular joint (TMJ) arthroscopic lysis and lavage and arthrocentesis for the treatment of TMD.

Methods:

An analysis of 64 minimally invasive surgeries used to treat disk displacement without reduction in group I (n = 36), and osteoarthritis in group II (n = 28) was conducted. Success was identified as a pain score ≤ 3, disability score ≤ 2, and maximal mouth opening greater than 35 mm.

Results:

The overall success rate was 85.9%. The difference in success rate between groups was not significant (P = 0.441). Preoperative predictors of success in group I were fewer tender muscles (P < 0.01), shorter duration of symptoms (P = 0.046), lower pain (P < 0.01), and lower disability (P = 0.0104), whereas in group II there were fewer tender muscles (P < 0.01), less limitation in opening (P < 0.01), and lower disability (P = 0.0131).

Conclusion:

Arthroscopy and arthrocentesis were equally efficient after 5 years. Fewer tender muscles and lower disability preoperatively were common predictors of success. Pain recorded at 1 year, and maximum opening and disability recorded at 3 months were maintained after 5 years.
Correlation among cognitive functions, mood disturbance, and health-related quality of life in type 2 diabetes mellitus
Authors: Mohammad Noor , Naaz Neha , Khan Nahid
Published: August 2023

Background:

The purpose of this study was to find the possible correlation among cognitive functions, mood disturbance, and health-related quality of life in people with type 2 diabetes mellitus (T2DM).

Methods:

This study was a preliminary cross-sectional survey study carried out on 40 participants diagnosed with T2DM for more than 2 years. The age group ranged between 35 and 55 years. Demographic data were recorded. Cognitive function was assessed using Mini-Mental State Examination, mood disturbance was assessed using the profile of mood states questionnaire and health-related quality of life was assessed using the Euroqol-5d-5l questionnaire.

Results:

There was a significant negative correlation between cognitive functions and mood disturbance (r = −0.45, P < 0.05), no correlation between cognitive functions and health-related quality of life (examiner scoring) (r = 0.29, P = 0.06), significant weak positive correlation between cognitive functions and health-related quality of life (participant self-score) (r = 0.37, P < 0.05). Significant strong negative correlation between mood disturbance and health-related quality of life (examiner scoring) (r = −0.66, P < 0.001), significant negative correlation between mood disturbance and health-related quality of life (participant self-score) (r = −0.62, P < 0.001).

Conclusion:

Cognitive functions and mood disturbances are important factors that may adversely affect health-related quality of life in people with T2DM. More attention should be given to cognitive function and mood disturbance in people with T2DM to minimize the negative impact of the illness on their health-related quality of life.
Retrieval of overextending separated endodontic instrument
Authors: Al Shehadat Saaid , El-Kishawi Mohamed , Nisha Lobo Renira , Jain Priyanka
Published: August 2023

Instrument separation during root canal treatment is one of the most unpleasant mishaps. Several techniques have been described to retrieve the separated instruments; however, they generally require specific tools that are not always available at dental clinics. This case report aims at presenting a simple alternative technique for the removal of root canal instruments separated during endodontic treatment. Endodontic retreatment was indicated for a maxillary lateral incisor of a 19-year-old patient. The radiographic examinations revealed the presence of a separated (fractured) instrument beyond the apical part of the canal. Retreatment was initiated by removing the obturated materials. After several unsuccessful attempts to retrieve the broken fragment, a hypodermic needle with chemically self-cure acrylic resin was used under an endodontic microscope to remove the separated fragment successfully. The retrieval technique used in this case was safe, simple, and low cost.
Regulatory frameworks for a safe and effective use of essential oils
Authors: Naja Farah , Hamadeh Rena , Alameddine Mohamad
Published: August 2023

The safe and effective use of essential oils (EOs) will only be fully realized when coupled with supportive regulatory frameworks ensuring the safety, quality, and efficacy of these oils. The aim of this short communication was to present a critical appraisal of existing regulations governing the use and production of EOs, within the health and therapeutics, food industry, and cosmetics sectors. Although few regulations target the use of EOs in cosmetics, more structured regulatory frameworks exist within the health and therapeutics, and food industry domains. To that end, the main international entities involved in the regulation of EOs within these sectors are the World Health Organization and the Food and Agricultural Organization. As for the production of EOs, the International Organization for Standardization has set standard specifications for the derivation, characterization, packaging, labeling, and storage of EOs. Although existing regulations address important dimensions related to the production and use of EOs, a comprehensive and harmonized outlook on their regulations would be necessary to ensure their safe integration in the various industries. Such regulations ought to be informed by the important advances in the chemical and biological research unraveling the versatile and complex characteristics of these oils.
Assessment of Dental Fluorosis and Dental Caries Among 8–16-year-old Schoolchildren in Kanpur Rural Region, Uttar Pradesh
Authors: Sachdev Rohan , Garg Kriti , Shwetam Samiksha , Srivastava Aaryan Raj
Published: August 2023

Context:

Dental caries remains a major public health problem, affecting 60-90% of school children. The assessment of dental caries and fluorosis in endemic fluoride areas will facilitate in assessing the relation between fluoride concentrations in water with dental caries, dental fluorosis simultaneously.

Aims:

The aim of the following study is to assess the dental caries and dental fluorosis prevalence among 8–16-year-old school children in Kanpur rural region, Uttar Pradesh.

Settings and Design:

This was a cross-sectional study.

Materials and Methods:

School children, residing in the village since childhood, in the age group of 8–16 years were selected from government schools. School children were categorized in five age groups and were examined for oral examination of available 8–16-year-old children fulfilling the inclusion and exclusion criteria was carried out to assess dental caries and fluorosis.

Statistical Analysis Used:

The influence of demographic characteristics on caries and fluorosis was tested using Chi square test, independent sample t-test and one-way ANOVA wherever applicable. Spearman rank correlation was applied to analyze the relationship between decayed teeth and dental fluorosis.

Results:

The caries prevalence was found to be 84.7%. Out of 1565 school children, 53.4% were males and 46.5% were females. The prevalence of dental fluorosis was found to be 87.5%. The fluorosis prevalence increased with increasing fluoride concentration with no difference in gender and age distribution.

Conclusions:

Children and teenagers are the most typically damaged by dental caries and fluorosis, it is necessary for the management of the prevalence of caries and fluorosis.
Percutaneous Retrieval of an Embolized Chemoport Catheter from Right Side of Heart Using Novel Technique
Authors: Singhal Anuj , Kumar Sudhir , Joshi Sudhir
Published: August 2023

Chemoport, a central venous infusion system, is commonly used in cancer patients for administration of chemotherapy. Dislodgment with subsequent migration of chemoport catheter into the heart is a rare but potentially catastrophic complication. The treatment of choice is immediate retrieval of dislodged part of catheter by either surgery or percutaneous approach. Percutaneous removal is safer and less invasive, making it the standard treatment modality. We herein report the case of a 22-year-old male who was referred to us for the management of a dislodged chemoport catheter used for chemotherapy for Hodgkin’s disease. In this article, we discuss the treatment approach in this particular case as well as review the existing literature.
New Gepants Against Acute Migraine
Authors: Gupta Dhyuti , Dhaneria Suryaprakash , Singh Alok
Published: August 2023

Objectives:

Recently two calcitonin gene-related peptide receptor antagonists (ubrogepant and rimegepant) were approved for the acute attack of migraine. This systematic review and network meta-analysis was performed, so as to evaluate and comprehend the effectiveness of both ubrogepant and rimegepant in alleviating the acute attack of migraine.

Materials and Methods:

An in-depth search was performed through Cochrane library, Pub Med, and clincialtrials.gov, for the period 2015–2019, using the key words: ubrogepant; rimegepant; and acute migraine. The randomized double-blind phase III clinical trials that explored the efficacy of these drugs were considered for inclusion in this review. The outcomes for this review were considered as the proportion of patients who had to resort to rescue medication within 24 h of taking either of the gepant, and the proportion of patients who had achieved sustained pain freedom and relief. In addition, an indirect meta-analysis was also conducted to establish the comparative effectiveness of these drugs. In addition, risk of bias and heterogeneity among the trials were also assessed to ascertain the strength of the trials.

Results:

A total of five placebo-controlled RCTs were included in this review. Altogether, both drugs demonstrated well in the parameters assessed. Rimegepant was better than ubrogepant, as a lesser proportion of patients used rescue medication by 3.4%, and a significantly higher number of patients achieved sustained pain freedom by 2.1% at 2–24 h. In sustained pain relief at 2–24 h, rimegepant was slightly better than ubrogepant by 0.5%. Hence, rimegepant 75 mg emerged to be better in all outcomes.

Conclusions:

Both gepants proved to be efficacious in alleviating the acute attack of migraine. Rimegepant displayed superiority over the ubrgepant.
Metabolic Acidosis and Cardiovascular Function in Chronic Kidney Disease
Authors: Uduagbamen Peter Kehinde
Published: August 2023

Metabolic acidosis (MA) is a very common finding in chronic kidney disease (CKD) and in cardiovascular disease due to the close relationship between the two organ systems. It depresses the myocardium; induces CKD; depresses urine acidification, bone mineral disease (CKD-BMD); and its presence reduces the quality of life, as well as increases cardiovascular events and mortality. The diagnostic strategies, patient assessment, treatment, prognostication, and possible patient referral entail good clinical acumen to prevent or limit complications, some of which can be fatal. Chronic metabolic acidosis in CKD is often associated with structural cardiac changes such as increased left ventricular mass and significant intradialysis blood pressure variations.

The use of sevelamer, and the inhibitors of aldosterone in these patients could worsen MA; however, bicarbonate in the lower, upper normal, and elevated levels and its replacement could all be associated with various structural and functional cardiovascular changes.
Rhinogenic Contact Point Headache in Pediatric Age
Authors: Swain Santosh K. , Sahu Ansuman
Published: August 2023

Background:

Headache is a common clinical entity seen among pediatric patients in routine clinical practice. The pressure of two opposing mucosa in the nasal cavity even in the absence of inflammation can be a cause of headache, which is called a rhinogenic contact point headache. Anatomical variations of the nose such as rhinogenic contact point headache may result in headache due to the contact of the nasal mucosa which often missed during the evaluation of the pediatric patients.

Objective:

The aim of this study is to assess the rhinogenic contact point headache in the pediatric age group.

Materials and Methods:

This is a prospective study and 112 children with rhinogenic contact point headache enrolled in this study. This study conducted at a tertiary care teaching hospital during September 2018–October 2021. The anatomical variations of the nose were evaluated with help of diagnostic nasal endoscopy and computed tomography (CT) scan. These anatomical variations in rhinogenic contact point headache were treated surgically.

Results:

Out of 112 children with rhinogenic contact point headache, 31 (27.67%) had deviated nasal septum, 28 (25%) had septal spur, 20 (17.85%) middle turbinate concha bullosa, 11 (9.82%) enlarged ethmoidal bullosa, 11 (9.82%) had hypertrophied inferior turbinate, 7 (6.25%) had hypertrophied super turbinate, and 4 (3.57%) had nasal septal bullosa. Treatment of each child with rhinogenic contact point was personalized for every patient.

Conclusion:

Headache is a common clinical symptom and is nearly universal in the life of a child. The contact between opposing mucosa in the nasal cavity in the absence of inflammation can result in headache and/or facial pain in the pediatric age group. Endoscopic excision of the contact points of nasal cavity is effective for the treatment of rhinogenic contact point headaches.
Ensuring Problem-Based Learning for Medical Students and Looking Forward to Developing Competencies
Authors: Taywade Manish , Gopi Kumbha , Pal Debkumar , Sahoo Bimal Kumar
Published: August 2023

Problem-based learning (PBL) is one of the most efficient teaching methods leading to critical thinking and problem-solving abilities or competencies. Medical education has multiple opportunities to use PBL in its curriculum. The educator and students have a bidirectional understanding, which encourages the activation of prior knowledge skills, facilitates the comprehension of new information, and improves learners’ critical thinking. Students have the scope of exploring the topic of interest in a real-life scenario. PBL is an innovative instructional method in which problem forms learning basics, and it allows the students to solve complex issues efficiently. Training of medical students involves both classroom teaching and practical applications. PBL is gaining popularity due to significant suggestions such as students’ learning and encouraging motivation to learn with an interdisciplinary integration of knowledge. PBL is more effective than lecture-based learning in the academic performance of medical students in producing better quality medical students.
“Booster Vaccine” to Mitigate the Threat of “Emerging COVID-19 Variants”
Authors: Pandian Mahalakshmi , Veepanattu Pranav , Moni Merlin , Sathyapalan Dipu Thareparambil
Published: August 2023

Vaccination is the time-tested strategy in controlling the infectious diseases. The global scientific community has agreed upon the role of mass vaccination, as a strategy in abating the ongoing COVID pandemic. By immunizing the at-risk population vaccination aims not only to break the chain of spread of disease but also reduces the severity of the disease, hospitalization, and mortality. In the wake of waning immunity and emerging variants, spreading the world over its time to review the evidence of a third dose as a booster.

When deciding on the booster dose, availability of the vaccine, type of vaccine, circulating SARS-CoV-2 variants, and emerging variants have to be taken into consideration. Booster dose as the name suggests boosts the waning immunity of the population and when implemented as a public health measure has the potential to increase the antibody level of the population beyond a threshold, thereby mitigating the spread of COVID infection. Cross-protection is likely to the newly emerging SARS-CoV-2 variants by virtue of the enhanced immune response. However, to develop robust recommendations, investigations on the effectiveness and cost-effectiveness of booster doses vaccines are needed in the context of rapidly spreading variant, the omicron.
Impact of COVID-19 Pandemic and Subsequent Lockdown on Blood Transfusion Service in a Tertiary Healthcare Institute of South India – A Learning Experience
Authors: Tripathi Parmatma Prasad , Kumawat Vijay , Patidar Gopal Kumar
Published: August 2023

Background and Objectives:

Coronavirus disease-19 (COVID-19) pandemic has affected people all over the world and poses challenges to health-care services. Lockdown was first response strategy implemented by governments including India to prevent spread of coronavirus 2. The lockdown and anxiety among public had severely affected transfusion services. This paper analyses the impact of COVID-19 pandemic and lockdown on blood transfusion services.

Methods:

A retrospective analysis of the transfusion services for 5 months was carried out. The data regarding blood collections, blood donation camps, blood issued, and therapeutic plasma exchange (TPE) performed were collected and analyzed during 3 phases of the study period, i.e., phase 1 (pre-lockdown, 84 days), phase 2 (complete lockdown, 40 days), and phase 3 (partial lockdown, 28 days), and compared.

Results:

A significant drop (P = 0.010) was observed in blood donation from phase 1 to phase 2 but slight nonsignificant improvement was found from phase 2 to phase 3. The issue of blood was significantly reduced from phase 1 to phase 2 (P < 0.0001) and improved from phase 2 to phase 3 (P < 0.0049). There was a significant reduction (P < 0.00001 and 0.002) in patients referred for TPE during two phases of LD.

Conclusion:

There is significant decrease in blood supply and utilization due to pandemic and lockdown. An emergency blood management plan is required which can include donor education focusing to alleviate donor hesitation, relaxation to donor selection criteria, blood drive planning with inventory management and ensuring staff and product safety.
Crossmatch Incompatibility, Indwelling Experience from a Single Center, Bangladesh
Authors: Miah Sonia Shormin , Doha Mostofa Ahmed , Islam Ashadul , Quader Md Abdul
Published: August 2023

Background and Objectives:

Crossmatch incompatibility among the blood donor and recipient is common. The cause for which may vary in patients despite rational transfusion practices. Provision of appropriate blood components can also be complicated by transfusion, pregnancy, exposure to drug, or various diseases. Therefore, the reasons for assessing the crossmatching incompatibility are important in transfusion safety. The present study was conducted to determine the prevalence of crossmatch incompatibility in this region and the reasons behind it.

Methods:

In this retrospective observational study, 32,403 crossmatch data were reviewed from crossmatch register between July 2018 and June 2019. Crossmatch was performed with both saline and antihuman globulin method. Incompatible crossmatch was evaluated further.

Results:

About 0.15% (n = 50) of patients showed crossmatch incompatibility: of this, 66% were female and 34% male. About 80% of crossmatch incompatibility was associated with multiple transfusions; of these, direct antiglobulin test (DAT) was positive in 78% (n = 39) and indirect antiglobulin test (IAT)/antibody screen was positive in 68% (n = 34) of patients. Both DAT and IAT were positive in 46% (n = 23). Further antibody identification was done.

Conclusion:

This study highlights the need for introducing antibody screening before compatibility testing, especially in multitransfused individuals.
Is Convalescent Plasma Therapy Effective for COVID-19? Our Initial Experience at Tertiary Care Center
Authors: Hurkat Neha Jayant , Ramulu Venkat , Gurram Srinivas
Published: August 2023

Background and Objectives:

Previous studies suggest that convalescent plasma (CP) may be effective in improving survival rates in COVID-19 patients. But still there is uncertainty regarding effectiveness of CP in improving mortality or clinical improvement in COVID-19 patient as randomized studies were short of statistical significance. We aim to report our initial experience with CP transfusions for COVID 19 patients at a tertiary care set up with regard to its efficacy and safety in patients at various stages of disease.

Methods:

This is an observational study which includes 324 patients who have received convalescent plasma from 1st July to 31st August 2020 in a tertiary care set up. The outcome of the study was measured by recovery of the patient and discharge from hospital in stable condition. Recovery was defined as no fever for 3 consecutive days, respiratory rate and oxygen saturation returning to normal at room air and patient being hemodynamically stable.

Results:

The overall recovery was attained in 249/324 patients (76.9%) and 75/324 patients (23.1%) died in hospital. In moderate disease patients the recovery rate was found to be 96.1%. In Severe disease patients, 38.8% recovered and in critically ill patients, 23.4% recovered. 80.6% patients recovered who received plasma within 5 days of hospitalization where as only 67.4% patients recovered who received plasma after 5 days of hospitalisation indicating earlier administration of CP in disease course has better outcomes. SARS-CoV 2 IgG ab levels of CP units correlated with outcome. The recovery was significantly higher in patients who received CP with higher IgG values (>12) as compared to patients who received CP with lower IgG values (<12). No adverse effects of CP transfusion were reported.

Conclusion:

This study showed CP therapy was well tolerated and could potentially improve the clinical outcomes. Thus it is reasonable to consider CP therapy as an effective, safe and feasible therapeutic option for COVID-19 in the early course of disease.
Diagnosis and Management of Hemolytic Uremic Syndrome in Children
Authors: Datta Suvro Sankha , De Dibyendu , Naik Archana
Published: August 2023

Hemolytic uremic syndrome (HUS) is one of the important causes of severe acute kidney injury in children. Among many etiologies which are responsible for this syndrome, herein we are reporting two interesting cases of HUS caused by anticomplement factor H autoantibodies and Streptococcus pneumoniae infection where the transfusion medicine department played a crucial role in early diagnosis and prompt management.
HLA Class II Positivity by Lysate Crossmatch in Renal Transplant Scenario-Dangerous if Ignored!!!
Authors: Sawant Rajesh B , Mehta Pooja , Naker Deepali
Published: August 2023

The detection of antibodies before transplantation is an important step in assessment of patient immunological risk and exclusion of incompatible donors. Many centers have now implemented donor-specific antibody (DSA) along with complement-dependent cytotoxicity crossmatch (CDC XM) for renal transplant cases. A 34-year-old male with end-stage kidney disease was referred for an ABO-compatible transplant from his mother. The CDC XM done 30 days before transplant was negative. DSA XM was negative for Class I (median fluorescence intensity [MFI] 189) and positive for Class II (MFI 1671). Since CDC and DSA Class I were negative, the nephrologists went ahead with the transplantation. On day 6 posttransplant, serum creatinine showed a rising trend (up to 2.13 mg/dl), and therefore, renal biopsy was done which showed mild acute tubular necrosis with positive C4d staining. DSA XM performed on day 15 posttransplant showed negative Class I (MFI 148) and positive Class II (MFI 9987) confirming antibody-mediated rejection (AMR). The patient was started on steroids, and intravenous immunoglobulin and serial plasma exchanges were performed. Then, DSA Class II levels came down to 1602. DSA levels have been monitored periodically and Class II MFI values have been ranging from 2000 to 4000. The patient is maintained on routine immunosuppression, and a graft is intact with serum creatinine level between 1.7 and 1.8 mg/dl 8 months posttransplant. DSA-isolated Class II positivity in renal transplant recipients correlates strongly with AMR and should be considered clinically significant.
Role of Lipoprotein Apheresis in the Management of Familial Hypercholesterolemia
Authors: Iyengar Shamanna Seshadri , Kantharaj Ambuja , Shivaram Chandrashekar , Hemantha Kumara DS , Murgod Roopa , Shreedhara G
Published: August 2023

Familial Hypercholesterolemia (FH) is an autosomal dominant disorder due to a congenital absence of low-density lipoprotein receptor (LDL-R) that transports cholesterol-carrying lipoprotein particles into cells. Absence of these receptors results in increased levels Non-HDL lipoproteins (like LDL, VLDL, Triglycerides, Lipoprotein a) which predisposes to premature atherosclerosis and cardiac complications. Treatment modalities for this condition include use of high intensity statins and diet control. However some of these patients with familial hypercholesterolemia do not respond to diet and drug therapy. Here Lipoprotein apheresis is believed to be a feasible and effective option. Lipoprotein apheresis is a relatively new technique in India used to treat familial hypercholesterolemia. Lipoprotein apheresis using cascade filter is effective in reducing non-HDL lipoprotein levels by 60-75% in a single procedure. However, the disadvantage of the procedure it is expensive and needs to be repeated every 2 weeks for lifetime. This case is being reported for rarity of this condition (1 case per million) and more so the rarity of the use of Lipoprotein apheresis procedure in our country.
Alloimmunization to Minor Red Cell Antigen Leading to Massive Hemolysis in Newly Diagnosed Thalassemia Intermedia
Authors: Arora Satyam , Shankar Ravi , Dua Seema , Radhakrishnan Nita
Published: August 2023

Alloimmunization to red cell antigens is a taxing complication of thalassemia major and intermedia patients who receive routine blood transfusions. The data on alloimmunization in beta-thalassemia are sparse from developing countries. The risk of alloimmunization is higher in thalassemia patients who received their first transfusion after the age of 3 years. We describe the presentation and outcome of a 4.5-year-old girl who presented with massive hemolysis following the first transfusion received following the diagnosis of beta-thalassemia intermedia. Despite best efforts with all available therapeutic modalities, hemolysis could not be controlled and she succumbed to the illness. The case is being presented as such severe hemolysis caused by alloimmunization to a blood group antigen is rare and posed a challenge for both diagnosis and treatment.
The Evaluation of M-TRAP Technology in Detection of ABO Groups and Its Subgroups and Its Efficacy as a Point-of-Care Test for Blood Grouping
Authors: Patel Tarak R. , Shah Sangita D. , Bhatnagar Nidhi , Shah Mamta C. , Tripathi Sujata , Soni Shital , Mathew Ashly Monson , Ahuja Tejal
Published: August 2023

Background and Objectives:

Accurate ABO blood grouping including detection of subgroups is a core component in transfusion medicine to prevent adverse transfusion reactions. This article highlights the importance of using M-TRAP technology in a pad-based platform as a point-of-care test for offsite blood donation camps, pre release of blood bags from blood center and at patient's bedside for rapid evaluation of blood groups as compared to conventional methods.

Methods:

ABD-PAD works on principal of membrane trapping technology used for the evaluation of blood group and their subgroup as a point of care test.

Result:

Total 1,03,987 blood group test were performed, of which 71,885 of patients' and 32,102 of donors' by EMT (Model – QWALYS 3, Manufacturer – Diagast, France). Among them, 4516 blood group discrepancies were detected. Out of 4516 blood group discrepancies, 17 (00.38%) group discrepancies were due to ABO subgroups. Among them, 13 (76.47%) were subgroup A and 4 (23.53%) were subgroup B. These subgroups were detected by M-TRAP technology.

Conclusion:

The use of M-TRAP technology (ABD PAD) is a reliable method for manual blood grouping and is useful to detect blood group at patient's bedside, outside blood donation camp, and at the time of issue of blood from blood center.
A Retrospective Study of Single-Unit Transfusion in a Tertiary Care Center of Southern India
Authors: Das Soumya , Basavarajegowda Abhishekh
Published: August 2023

Background and Objectives:

Single-unit transfusions continue to be a widespread transfusion practice. Single-unit red blood cell (RBC) transfusions were treated with substantial denunciation in the past but recently have been reviewed as to whether it is acceptable or could be acceptable. This study was undertaken to observe the overall profile of the patients receiving the single-unit transfusion and analyze the possible rationale of such transfusion.

Methods:

This was a retrospective record-based study conducted in multispecialty tertiary level care teaching hospital over a period of 1 year from January to December 2017. Variables included were age, gender, diagnosis, indication for transfusion, pre- and post-hemoglobin, additional modality of treatment received including other blood components and length of hospital stay. Qualitative variables were described as number and percentages, and quantitative variables as number, mean, and standard deviation.

Results:

During the study, 50,880 blood components were issued out of which, packed RBCs (PRBCs) accounted to 19760. Twenty-four percent (4742 units) of the total blood units were transfused as single unit of PRBC. 52.1% of these single-unit transfusions were carried out by the surgical specialties.

Conclusion:

Single-unit transfusions are more common in medical specialties probably due to the chronic nature of the diseases. However, even in surgical specialties, especially those striving toward reducing blood usage and the ones operating in more of an elective setting, single-unit transfusions were higher.
Maximum Surgical Blood Ordering Schedule for Cancer Surgeries
Authors: Kusumgar Rima
Published: August 2023

Background and Objectives:

Although blood ordering is a common practice in surgical field, the average requirement for a particular procedure is usually based on subjective anticipation of blood loss rather than on evidence-based estimates. In the absence of an explicit maximum blood demand policy, ordering for blood transfusion is frequently based on subjective anticipation of blood loss instead of evidence-based estimates of average requirement in a particular surgery. Maximum surgical blood order schedule (MSBOS) is a criterion developed from institutional usage statistics providing a figure for the number of units to be crossmatched for any given surgical procedure. Aims and objectives of this study were to prepare and implement MSBOS, to increase blood availability to other medical patients and surgical patients. Promote efficient use of blood inventory, workforce, and consumables. This also helps to reduce unnecessary pre transfusion testing and cross match studies.

Methodology:

A retrospective analysis of various surgeries was done and then, a maximum surgical blood order schedule (MSBOS) was prepared and implemented and various parameters were analyzed in the largest tertiary cancer care hospital of Gujarat over a 2-year period. The goal was to study the blood ordering strategies in the hospital for surgical patients and evolve an MSBOS. The total units demanded and the corresponding units issued were studied for surgical patients. Thereafter, transfusion probability, transfusion index (TI), and ratio of units crossmatched to actual units transfused (C/T ratio) were calculated. Transfusion guidelines for all surgeries requiring transfusions were proposed and implemented.

Results:

Crossmatch to transfusion ratio improved from 9.54 to 3.68. Transfusion probability was down to 30.04 from 13.24 and TI increased to 0.31 from 0.179. P value by using Z test for all three parameters was <0.05.

Conclusions:

Z-test calculation showed significant statistical improvement in the above three measures. The study also identified the common cases where “Type and Screen” (T and S) procedure could be introduced in cases where the transfusion probability was low. The implementation of this proposal will avoid over ordering of blood which is beneficial to the institute.
Reappraisal of Quality Indicators in the Blood Center of a Tertiary Care Teaching Hospital - Are We Ready for Accreditation?
Authors: Mukherjee Gargi , Pramanik Parijat , Das Dipmala , Roy Asitava Deb
Published: August 2023

Background and Objectives:

Ensuring quality in transfusion services has become an essential part of the hospital quality management system to provide safe blood supply to the patients. To assess the overall quality performance of our blood center, this study was conducted to evaluate the five mandatory quality indicators (QI) put forward by the National Accreditation Board for Hospitals and Healthcare Providers (NABH) and make recommendations, if any, for improvement of the same.

Methods:

The five mandatory QIs (defined by NABH) were observed and monitored monthly for a period of 1 year from April 2019 to March 2020, information was gathered in a structured manner, root causes for any deviation were analyzed, and specific corrective and preventive actions were taken.

Results:

The overall performance was found to be satisfactory with the mean transfusion-transmitted infection % being 1.82%, mean transfusion reaction rate 0.30%, and mean wastage rate 13.5%. The turnaround time was maintained at 28.5 min for emergency cases and 141.38 min for routine. There was no case of component quality control failure during the study period.

Conclusion:

The study observed that by strictly following the quality parameters put forward by NABH, processes can be controlled in a manner that errors are avoided or kept at minimum. This, in turn, shall help in attaining higher levels of performance. The study concluded by putting forward few important recommendations.
High Yield of Minipool NAT in India using a Sensitive Multiplex Assay for Blood Donor Screening
Authors: Uppal Anju , Priya Parul , Sethi Jatinder P.
Published: August 2023

Background and Objectives:

Nucleic acid amplification testing (nucleic acid testing [NAT]) for blood donor screening is increasingly being adopted in India to reduce the risk of transfusion-transmitted diseases. The high sensitivity of NAT enables testing of a large volume of donations in minipool format; reducing the costs of testing compared to individual donation testing. This study was aimed at evaluating the yield of minipool NAT testing for hepatitis B, hepatitis C, and human immunodeficiency virus (HIV) in blood donors from Uttar Pradesh.

Methods:

Samples from routine blood donors collected between August 16, 2016, and December 31, 2020, that were seronegative for hepatitis B virus (HBV), hepatitis C virus (HCV) and HIV, syphilis, and malaria were further screened by NAT in pools of six donations (MP6) using the cobas TaqScreen MPX Test, version 2.0 (MPX2) on the cobas s 201 System. Members of reactive pools were tested to identify the reactive donation(s). Viral load testing was performed on randomly selected NAT-reactive samples.

Results:

Of 172,443 seronegative donors, 463 were NAT reactive: 369 HBV, 89 HCV, 2 HIV, and 3 co-infected with HBV and HCV. The overall NAT yield was 0.27%, with individual virus yield rates of 1/464 for HBV, 1/1874 for HCV, and 1/86,222 for HIV. Viral load testing of 19 HBV NAT-yield donations showed low concentrations in 16 samples and undetectable viral load in three; the two HCV NAT-yield donations tested had high viral loads.

Conclusion:

Screening of blood donations by minipool NAT using the highly sensitive MPX2 assay identified a high yield of serology negative, NAT-positive donations, including HBV reactive donations with low viral concentrations.
Efficacy of Therapeutic Leukapheresis in Acute Lymphoblastic Leukemia Presenting with Leukostasis
Authors: Mohapatra Tapti , Das Prabodha Kumar
Published: August 2023

Therapeutic leukapheresis is performed in patients having hyperleukocytosis, leading to leukostasis. The aim of this study was to evaluate the efficacy of therapeutic leukapheresis in reducing white cell count in leukemic patients with symptoms of leukostasis. Two cases of acute lymphoblastic leukemia, admitted to the hematology intensive care unit between January and May 2015, were taken up for therapeutic leukapheresis, using COBE Spectra Cell Separator. The first patient was a 24-year-old male, admitted with fever, weakness, headache, blurred vision, and a total leukocyte count (TLC) of 564,000/μL. The second patient was a 36-year-old male admitted with fever, headache, dyspnea, and a TLC of 530,000/μL. The first patient had a 31.38% and 30.19% reduction in TLC after first and second procedures, respectively. The second patient had a reduction in TLC of 31.7% and 31.41% after first and second procedures, respectively. This significant decrease in white cell count achieved reversal of symptoms of leukostasis. Patients with hyperleukocytosis may present as a medical emergency, requiring prompt recognition and initiation of therapy to prevent respiratory failure or intracranial hemorrhage. Leukapheresis removes circulating blasts quickly to alleviate symptoms.
Chimeric Antigen Receptor T-Cell Therapy
Authors: Rajadhyaksha Sunil B. , Navkudkar Anisha A. , Desai Priti D.
Published: August 2023

Various cytotoxic approaches for cancer therapy have been developed over the years. However, due to their limited efficacy, there is a continual search for therapeutic approaches with better outcomes, such as immunotherapy that develops and augments the patient's immune system. Chimeric Antigen Receptor (CAR) T-cell immunotherapy involves genetic modification of patient's own T-cells to express CAR exclusive for a tumor antigen. It involves bioengineering, ex vivo cell expansion, and re-infusion back to the patient. The application of CAR-T therapy is seen as a potential mainstay treatment for hematologic cancers, while it is still being explored for solid-organ malignancies. In this review, the rationale for the development of genetically modified T-cells, its generations, the process of preparing CAR T cells, challenges and potential strategies, limitations, and various clinical applications are described. Information for review was obtained from available material in Google and PubMed.
A Case Report of Apheresis Granulocyte Concentrates and the Whole Blood-Derived Pooled Buffy Coat Transfusions in a Neutropenic Hematopoietic Stem Cell Transplant Recipient
Authors: Gupta Abhaykumar Malind , Ojha Shashank , Sumathi S H , Poojary Minal
Published: August 2023

Granulocytes may be procured either as apheresis granulocyte concentrate (AGC) or as a pooled buffy coat granulocytes (PBCG) derived from whole blood donations. The chronic myelomonocytic leukemia patient with active pneumocystis pneumonia infection, received two transfusions of AGC and PBCG each, for prolonged severe neutropenia. AGCs had a higher mean white blood cells count per bag (1.63 × 1010 vs. 1.53 × 1010), neutrophil count per bag (1.05 × 1010 vs. 0.76 × 1010), and mean neutrophils percentage (62.45% vs. 49.25%), whereas PBCGs had a higher mean red blood cells volume per bag (196.1 vs. 62.5 ml) and platelet counts (5.03 × 1011 vs. 3.6 × 1011). The rise in patients' absolute neutrophil count was comparable with both AGC and PBCG transfusions. Granulocyte transfusions helped in the management of an acute neutropenic crisis. Whole blood-derived PBCGs may be a viable alternative in to AGCs. PBCGs have a lot of logistic issues and each blood center should have its standard operating procedure.