bluuebunny/crossref_metadata_2025 huggingface dataset:
Association between obesity and diabetes prevalence and COVID-19 mortality in Mexico: an ecological study
Authors: Noyola Daniel Ernesto , Hermosillo-Arredondo Natalia , Ramírez-Juárez Carolina , Werge-Sánchez Annia
Published: November 2021

Introduction: Mortality rates associated with COVID-19 vary widely between countries and, within countries, between regions. These differences might be explained by population susceptibility, environmental factors, transmission dynamics, containment strategies, and diagnostic approaches. We aimed to analyze if obesity and diabetes prevalence are associated with higher COVID-19 mortality rates in Mexico.

Methodology: We analyzed the mortality rate for each of the 2,457 municipalities in Mexico, one of the countries with highest COVID-19 mortality rate, during the first seven months of the pandemic to identify factors associated with higher mortality, including demographic, health-related characteristics (prevalence of obesity, diabetes, and hypertension in adults older than 20 years old), and altitude.

Results: During the first seven months of the COVID-19 pandemic there were 85,666 deaths reported in Mexico, with a cumulative mortality rate of 67 per 100,000 population. The mean mortality rate for the 2,457 municipalities in Mexico was 33.9 per 100,000 population. At a municipal level, the prevalence of diabetes and obesity, as well as high human development index, and location at < 500 or > 2000 above sea level were associated with higher mortality rate.

Conclusions: Elevated obesity and diabetes prevalence explain, in part, high COVID-19 mortality rates registered in certain municipalities in Mexico. These results suggest that a regionalized approach should be considered to successfully limit the impact of SARS-CoV-2.
The Provision of Carrot Catfish Dumplings Affects the Weight of Elementary School Students with Low Nutritional Status
Authors: Dadang Rosmana , Silmi Dzakiyyah Munawaroh , Widartika Widartika , Maryati Dewi , Rahmat Mamat , Surmita Surmita , Pusparini Pusparini , Agung Fred , Ashri Nurfurqon Fuadah , Hamzah Ali , Mulyo Gurid Pramintarto Eko
Published: November 2021

BACKGROUND: A good nutritional status will improve health for average growth and physical development, and intelligence. The prevalence of schoolchildren (5–12 years) with malnutrition status based on brachial fat area is 11.2%, and the number of elementary schoolchildren with malnutrition status in Cibereum village is 107 students. The government has a School Child Supplement Program to meet schoolchildren’s dietary needs. It is necessary to have additional food for schoolchildren to improve their nutritional status, especially for students with low nutritional quality.

AIM: The purpose of this study was to determine the effect of carrot catfish dumplings on the bodyweight of elementary school students with poor nutritional status as a form of supplementary food for schoolchildren.

METHODS: Researchers conducted this study in January 2020 at Elementary Schools at the Cibereum Health Center (SDN Cibeureum 5, Cibeureum 7, and Cibereum Mandiri 2) with a sample of 25 people. The research design used is quasi-experimental using one-group pretest-posttest and statistical tests using the Wilcoxon test.

RESULTS: The research test results showed that carrot catfish dumplings affected elementary school students’ body weight with low nutritional status.

CONCLUSION: Carrot catfish dumplings can increase students’ energy intake and protein intake so that there is an increase in the average body weight of the sample by 0.55 kg. Suggestions for further research to conduct a similar study using a control group as the comparison group.
Rare Cases of Multidrug-resistant Tuberculous Spondylitis in Saiful Anwar General Hospital: A Case Series
Authors: Asmiragani Syaifullah , Risantoso Tjuk , Yudistira Andhika , Satriawan Ery , Lesmana Albert , Pribadi Alva , Siahaan Lasa Dhakka
Published: November 2021

BACKGROUND: Ten percent of all tuberculosis patients may develop skeletal involvement, and the spine is the most common anatomical location. Tuberculous spondylitis is further complicated by the fast-acid bacilli resistance to the usual chemotherapy regimen (multidrug-resistant/MDR) and its complications. In this case series, we would like to present three MDR tuberculous spondylitis cases effectively treated with tailored chemotherapy regimens and surgical interventions.

CASE REPORT: A series of three patients with MDR tuberculous spondylitis is presented. All three patients presented with back pain, lump, and weakness of both lower extremities. These cases were resolved with a combination of surgical intervention and tailored chemotherapy regiment after MDR resistant detected. Two cases were resolved completely, and only one patient had residual paresthesia on his legs.

CONCLUSION: A combination of MDR antituberculous chemotherapy and surgical intervention leads to an excellent outcome, in which the patient can perform regular daily tasks without pain, even in complicated MDR tuberculous spondylitis cases.
Relationship between CD 163 Tumor-Associated Macrophages and Colorectal-Cancer Stem Cell Markers
Authors: Rey Imelda , Putra Agung , Lindarto Dharma , Yusuf Fauzi
Published: November 2021

BACKGROUND: Colorectal-cancer stem cells (CR-CSCs) represent a specific subpopulation of colorectal cancer (CRC) cells, which are characterized by the expression of CD133 and CD166. Tumor-associated macrophages (TAMs), found near CSCs may represent polarized macrophages, which are characterized by CD163 expression. In most tumors, TAMs may promote aggressive tumor development, leading to poor prognoses. AIM: The aim of this study was to determine whether any association exists between CD163 expression in TAMs and CD133 and CD166 expression in CR-CSCs. METHODS: This study used a cross-sectional design that was conducted at the General Hospital and affiliates in Medan, from September 2018 to July 2019. CRC tissues were collected from colonoscopy biopsies and surgical resections performed on CRC patients, who fulfilled all necessary inclusion and exclusion criteria and provided informed consent. Subjects were divided into high- and low-CD163-level groups. We analyzed the expression levels of CD163, CD133, and CD166 using immunohistochemical (IHC) assays. RESULTS: A total of 118 CRC patients were enrolled in this study, of whom 58.5% were male. No significant differences in hemoglobin, leukocyte, or platelet levels were observed between high- and low-level CD163 expression. We didn’t find any significant association of CD163 TAM with CRC histological grade and TNM stagings. Significant associations were found between the CD 163 expression level and the CD133 expression level (p < 0.001) and between the CD 163 expression level and the CD166 expression level (p< 0.001). Increased TAM levels of CD163 was associated with 2.770-fold and 2.616-fold increased risks of elevated CD133 and CD166 levels, respectively. CONCLUSION: An association was found between the expression levels of CD163 in TAMs and the expression levels of CD133 and CD166 in CR-CSCs.
Risk Factors of Type 1 Leprosy Reaction in Leprosy Patients attending Leprosy Division of Dermatology and Venereology Outpatient Clinic of Dr Soetomo General Hospital in 2017–2019: A Retrospective Study
Authors: Rosdiana Brigita , Astari Linda , Astindari Astindari , Rosita Sigit Prakoeswa Cita , Zulkarnain Iskandar , Damayanti Damayanti , Utomo Budi , Listiawan M. Yulianto
Published: November 2021

BACKGROUND: Type 1 leprosy reaction is a delayed hypersensitivity reaction caused by increased response of cellular-mediated immunity to Mycobacterium leprae. Manifestations include skin and nerve lesions, edema, and permanent disabilities. There are several risk factors that should be recognized to prevent disabilities.

AIM: The aim of this study was to analyze the relationship of risk factors to the occurrence of type 1 leprosy reaction in leprosy patients treated at the Outpatient Clinic of Dr. Soetomo General Hospital.

METHODS: This study was an analytical study with retrospective observational study design. Data were secondary from the medical records of leprosy patients at the Outpatient Clinic of Dr. Soetomo General Hospital from January 2017 to December 2019.

RESULTS: Out of 364 patients in the Outpatient Clinic, 190 (52.2%) had leprosy without a reaction and 65 (17.9%) had type 1 reaction. Analysis showed that age, leprosy type, and treatment regimen were significantly associated with the incidence of type 1 reaction (p = 0.023; 0.003 and 0.004, respectively), with the leprosy type as the most dominant risk factor. Age 15–34 years old; leprosy types BB, BL, and BT; and the MB MDTL therapeutic regimen are risk factors for the occurrence of type I leprosy reaction.

CONCLUSION: There is a statistically significant correlation between the risk factor and the occurrence of type 1 leprosy reaction in leprosy patient. The risk factor that has significant correlation is age 15–34 years; leprosy types BB, BL, and BT; and the MB MDTL therapeutic regimen. The most significant risk factor for the occurrence of type 1 leprosy reaction from our study is the type of leprosy (BB, BL, and BT).
Autopsy Findings on Decomposing Drowned Body: Identification of Specific Diagnostic Features of External, Internal, and Laboratory Examinations
Authors: Perwira Satria , Affrita Tia Maya , Tambunan Edwin , Yudianto Ahmad
Published: November 2021

BACKGROUND: Drowning is one type of asphyxia caused by the entry of fluid into the airway. Death due to drowning is one of the hardest things that are difficult to diagnose in the field of forensic medicine, primarily if the victim found to be in a decomposed state. The state of decomposed examination often does not show typical signs. The diagnosis of drowning can be reached after considering all the results of the forensic examination including external, internal, and laboratory examinations.

CASE PRESENTATION: A body has been found in the residential area on the east side of the beach, Tambaksarioso Village, Asemrowo District, on Tuesday, May 18, 2021, at 13.30 West Indonesian Time and reported to the police for investigation. The body was then identified at Dr. Soetomo General Hospital by a forensic expert. External, internal, and laboratory investigations were conducted. On external examination, the corpse was not intact, with signs of decay, saponification, and violation. In an internal examination, sand in the airways and other signs of drowning were identified. In the acid destruction test using the right femur, a positive diatom result was obtained.

CONCLUSION: A complete autopsy is vital to determine the cause and mechanism of death, reconstruct the events before death, and identify the victim. It is also essential to determine whether the deceased died by drowning was alive before entering the water. All injuries suffered by the victims should be described.
Two new species of snail-eating snakes of the genus Tropidodipsas (Serpentes, Dipsadidae) from southern Mexico, with notes on related species
Authors: Grünwald Christoph I. , Toribio-Jiménez Sarahi , Montaño-Ruvalcaba Carlos , Franz-Chávez Hector , Peñaloza-Montaño Miguel A. , Barrera-Nava Eduardo Y. , Jones Jason M. , Rodriguez Christopher M. , Hughes India M. , Strickland Jason L. , Reyes-Velasco Jacobo
Published: November 2021

We describe two new species of Tropidodipsas related to the T. fasciata species group as defined by Kofron (1987), and provide morphological and molecular data to support the novelty of both species. A partial molecular phylogeny of the Mexican species of snail-eating snakes (Serpentes, Dipsadidae) is presented, and we discuss evolutionary relationships as supported by our molecular results. We analyze specific relationships of the new species described herein with their closest relatives. We present a distribution map for all species of Tropidodipsas and include photographs of living individuals of each species. Finally, we discuss other taxonomic changes based on our molecular phylogeny as well as conservation priorities of the new species.
Manuel de soins palliatifs
Authors: Belloir Marie-Noëlle
Published: November 2021

Résumé Le patient doit être pris en charge là où il se trouve et le soignant est en capacité de l'accompagner. Est-ce que l'offre répond aux besoins ? La démarche palliative, met l'accent sur plusieurs points : prendre soin, redonner du sens aux actes de soins, travailler sur ses propres représentations de la mort, de l'accompagnement, travailler en interdisciplinarité, mais la question est surtout d'« Oser être là ». La question de l'USP est celle de l'équité : ceux qui en bénéficient seraient des privilégiés ? La question des LISP est d'intégrer au projet de service une mission d'accompagnement et de la faire vivre. La question de l'EMSP est celle de la non-substitution (pour ne pas faire à la place – pertinence de l'enseignement).
Manuel de soins palliatifs
Authors: Boitte Pierre , Cobbaut Jean-Philippe
Published: November 2021

Résumé La quête sociale d'une bonne mort se traduit aujourd'hui soit par l'accompagnement des mourants par la médecine, soit par l'exigence d'un droit de mourir refusant la gestion médicale de la fin de vie. L'hypothèse que nous voudrions défendre dans ce texte, au départ de la situation française, est que les débats et l'adoption de réglementations en matière de fin de vie n'apportent pas à eux seuls de réponses suffisantes au vu des questions complexes qui émergent aujourd'hui en fin de vie. Cette complexité nécessite, selon nous, l'explicitation d'une articulation réfléchie entre les dispositifs institutionnels et les contextes d'action en fin de vie en vue de permettre un meilleur apprentissage social de ce qu'est mourir aujourd'hui. Favoriser les conditions d'un tel apprentissage constitue un enjeu éthique crucial pour la recherche en sciences humaines et sociales.
Les enjeux de la communication sur la tuberculose en Côte d’Ivoire
Authors: Seytre Bernard , Amalaman Djedou Martin , Diaby Moustapha , Sansan Kambou Édouard , Coulibaly Madiarra , Yoro Blé
Published: November 2021

Introduction : La tuberculose se présente comme un phénomène social total qui implique les dimensions économiques et socioculturelles des personnes infectées et des acteurs institutionnels de lutte contre le fléau. En Côte d’Ivoire, où seulement 59 % des cas estimés ont été notifiés et traités en 2018, le sous-diagnostic constitue l’un des principaux obstacles à la lutte contre la tuberculose. Objectif : L’objectif de cette étude socioanthropologique était de fournir des bases à des recommandations de communication susceptibles d’accroître la demande de dépistage de la tuberculose en Côte d’Ivoire. Elle a donc porté sur les représentations de la tuberculose susceptibles d’être influencées par les campagnes de communication. Méthode : Elle a mobilisé, d’une part, une approche qualitative à travers des entretiens semi-directifs auprès de 54 personnes et 28  focus groups de 8 personnes chacun et, d’autre part, une approche quantitative auprès de 400 personnes soumises à un questionnaire. L’étude s’est déroulée à Abidjan, Bouaké, Korhogo et San-Pédro, en Côte d’Ivoire. Résultats : Les résultats ont montré, entre autres, que la population a une très bonne connaissance de l’existence et de la gravité de la tuberculose, une bonne connaissance de ses symptômes, qu’elle fait peu confiance à la médecine traditionnelle en cas de tuberculose et qu’elle sait que la maladie peut être traitée par les médicaments de la médecine moderne. En revanche, la moitié de la population seulement sait que le traitement est gratuit, ce qui peut tenir des malades éloignés des structures sanitaires. Les enquêtés associent très majoritairement la tuberculose à l’infection à VIH et au sida. La peur suscitée par cette association est susceptible d’être un frein important à l’entrée dans une démarche thérapeutique en cas de suspicion de tuberculose. Conclusion : Il nous paraît donc nécessaire de renforcer la communication sur la gratuité du traitement contre la tuberculose et de dissocier tuberculose et VIH dans les outils de communication et de sensibilisation à la tuberculose comme au VIH.
Clinical, biochemical and imaging characteristics of adrenal histoplasmosis in immunocompetent patients in a non-endemic area
Authors: Jahan Sharmin , Mahmood Tahseen , Fariduddin Md , Faisal Ibrahim , Morshed Md Shahed , Yadav Anil , Shah Anil Kumar , Abdullah Chomon , Chowdhury Emran-Ur-Rashid , Begum Ferdousi , Hasanat M A
Published: November 2021

Objective:

To document the clinical, biochemical and imaging phenotypes of immunocompetent patients with adrenal histoplasmosis.

Methods:

The clinical, biochemical and radiologic data of 18 immunocompetent patients [age: 45.00 (39.25, 56.25) years, median (IQR), m/f (16/2)] with adrenal histoplasmosis presenting in the Department of Endocrinology, BSMMU between 2014 and 2020 were retrospectively analyzed.

Results:

All patients were seronegative for HIV infection, and 27.8% (5/18) had well controlled diabetes mellitus. The median duration of the symptoms was 6.00 (IQR: 4.00, 11.25) months. All had significant weight loss, anorexia and weakness. Fever was present in 61.1% (11/18) patients and night sweat was present in 27.8% (5/18) cases. Hypotension and hyperpigmentation were present in 55.6% (10/18) and 66.7% (12/18) cases, respectively. Three of 18 patients presented with adrenal crisis. Hyponatremia occurred in 55.6% (10/18) cases, but none had hyperkalemia. Thirteen of 18 patients had adrenal insufficiency whereas 83.3% (15/18) had high adrenocorticotropic hormone. CT scan revealed bilateral adrenal enlargement in all cases with oval shape and regular margin. All were hypodense having radiodensity 21-90 hounsfield unit, and 11.1% (2/18) were heterogeneous in contrast enhancement. None had noticeable calcification whereas 1.1% (2/18) cases had central necrosis with peripheral rim enhancement. Hepatomegaly was present in 6 cases, splenomegaly in 3 cases and 5 patients had abdominal lymphadenopathy. Histoplasmosis were confirmed by positive fine needle aspiration cytology of adrenal tissue.

Conclusions:

Adrenal histoplasmosis should be considered in the list of differentials of bilateral adrenomegaly in immunocompetent individuals even living in non-endemic areas.
Detection of dengue virus serotype 3 in Cajamarca, Peru
Authors: Aguilar-Luis Miguel Angel , Carrillo-Ng Hugo , Kym Sungmin , Silva-Caso Wilmer , Verne Eduardo , del Valle Luis J. , Bazán-Mayra Jorge , Zavaleta-Gavidia Victor , Cornejo-Pacherres Daniel , Tarazona-Castro Yordi , Aquino-Ortega Ronald , Cornejo-Tapia Angela , del Valle-Mendoza Juana
Published: November 2021

Objective:

To describe and molecularly characterize an outbreak of dengue virus (DENV) infection in Cajamarca, an Andean region in Peru.

Methods:

A total of 359 serum samples from patients with acute febrile illness were assessed for the presence of DENV via RT-PCR, ELISA NS1, IgM and IgG in Cajamarca, Peru from January 2017 to June 2017. The evaluation of the different diagnostic tests and their applicability was performed.

Results:

Dengue virus was detected in 24.7% of samples by RT-PCR. Meanwhile, serological analysis detected 30.3% positive cases via ELISA NS1 antigen, 16.7% via ELISA IgG and 9.7% via ELISA IgM. Most of the cases corresponded to DENV-3 (77.5%). The use of RT-PCR performed better in primary infections (P<0.01), while detection of ELISA IgM performed better in secondary infections (P<0.01). The combination of NS1 and IgM performed better than the other assays in detecting primary (92.5%) and secondary infections (96.6%). The most frequent symptoms associated with fever were headaches, myalgias, and arthralgias across all groups.

Conclusions:

We report an important outbreak of dengue infection caused by DENV-3 in Cajamarca, Peru. Our findings encourage the use of NS1 antigen and IgM co-detection. These findings demonstrate an increasing expansion of DENV-3 in Peru and highlight the importance of molecular diagnosis and serotype characterization among the clinically defined dengue cases to strengthen the Peruvian epidemiological surveillance.
Prevalence of non-tuberculosis mycobacteria among samples deposited from the National Tuberculous Reference Laboratory of Iran (2011-2018)
Authors: Ayoubi Saman , Farnia Parissa , Farnia Poopak , Aghajani Jafar , Ghanavi Jalaledin , Velayati Ali Akbar
Published: November 2021

Objective:

To investigate the prevalence of non-tuberculosis mycobacteria (NTM) among the samples deposited from the National Tuberculosis Reference Laboratory of Iran between 2011 and 2018.

Methods:

The study evaluated the prevalence of NTM among specimens from patients with pulmonary tuberculosis symptoms (n=15 771) deposited at the National Tuberculosis Reference Laboratory of Iran from 2011 to 2018. Detection of Mycobacterium (M.) tuberculosis was based on presence of a 190-bp amplicon from IS6110 insertion sequence using Tb1 and Tb2 primers, and amplicon-negative specimens were tested for NTM and M. tuberculosis (refractory to IS6110 amplification) using restriction fragment length polymorphism PCR of hsp65 amplicon fragment.

Results:

A total of 7 307 (46.33%) M. tuberculosis and 658 (4.17%) NTM specimens were found, the latter mainly comprising M. abscessus (10.18%), M. avium (2.28%), M. chelonae (8.97%), M. intracellulare (10.49%), M. kansasii (4.71%), and M. simiae (56.08%).

Conclusions:

As treatment for NTM differs from that for M. tuberculosis, accurate detection of Mycobacterium sp. is of public health significance.
Use of Inferior Venacaval Collapsibility Index in Spinal Anesthesia during Orthopedic Surgeries
Authors: Devi K. Poolan , Doddamane K. Poonam , Manjunath H. G , Murdeshwar Greeshma N.
Published: November 2021

Background:

Volume deficit is one of the predictors of hypotension. Inferior venacaval collapsibility index (IVCCI) can detect volume deficit and aids volume resuscitation in patients of intensive care unit.

Aims:

The primary aim was to compare the incidence of postspinal anesthesia hypotension (PSAH) in IVCCI measured and nonmeasured groups. The secondary aim was to determine IVCCI association with PSAH within IVCCI measured group in spite of fluid bolus.

Settings and Designs:

This was a prospective, randomized, controlled, single-blinded study.

Methodology:

One hundred patients posted for orthopedic surgery under spinal anesthesia (SA) were randomly divided as IVCCI measured (CI) and non-IVCCI measured (NCI) groups before SA. If IVCCI was more than 40% fluid bolus was given. Intraoperative hemodynamics was monitored. PSAH managed with fluids and vasopressors which were noted. Data collected were analyzed with unpaired t-test, Z-test, logistic regression test, and Pearson's correlation.

Results:

PSAH incidence was 18% in group (CI) whereas 38% in group (NCI), and the difference was statistically significant. Vasopressors given were higher in group NCI. Perioperative fluids were more in group CI, but the intraoperative fluids were more in group NCI. There was no statistically significant association between PSAH after fluid preloading and IVCCI within the IVCCI measured group.

Conclusion:

Prespinal anesthesia evaluation of IVCCI to optimize fluid therapy can reduce the incidence of PSAH in orthopedic surgeries and the vasopressor requirement, and hence, the association of IVCCI of more than 40% with PSAH.
An Observational Study of Hemostatic Profile during Different Stages of Liver Transplant Surgery Using Laboratory-Based Tests and Thromboelastography
Authors: Bansal Shweta , Garg Ankur , Khatuja Amit , Ray Ramdip , Bora Giriraj
Published: November 2021

Background:

Liver produces most of the blood coagulation factors, so it is not surprising to see a deranged coagulation profile in patients receiving liver transplants. Besides standard laboratory methods to evaluate coagulation profile, point-of-care assays are being used regularly since their results are rapidly available. However, sparse information is available on the comparability of point-of-care coagulation assays with laboratory coagulation assays in this special setting. In this study, our aim is to observe the changing hemostatic profile during different stages of liver transplant surgery using laboratory-based tests and thromboelastography (TEG).

Methods:

Fifty patients undergoing living donor liver transplantation surgery were selected. Coagulation tests (prothrombin time [PT], activated partial thromboplastin time [APTT], platelet count, and fibrinogen) and TEG were performed at various intervals during liver transplant surgeries – before induction of anesthesia, 2 h into dissection phase, 30 min into anhepatic phase, 30 min after reperfusion of homograft, postoperative – at closure of surgery, 12 h postoperative, and 24 h postoperative. Statistical analysis and Pearson correlation were performed between laboratory-based coagulation tests and TEG, and their pattern through various stages of the surgery analyzed.

Results:

Platelet count and fibrinogen have a significant positive correlation with TEG in almost all phases of liver transplant. PT and APTT have a positive correlation with TEG until uptake of new liver and predominantly negative correlation after that. However, this correlation is significant only before induction of anesthesia and anhepatic phase.

Conclusions:

TEG can be used to estimate platelet count and fibrinogen concentrations in all phases but PT and APTT only before induction and anhepatic phase of liver transplant surgery. The decision regarding transfusion of blood products should be based on a combination of the clinical assessment of surgeon and anesthesia personnel combined with results from laboratory and TEG.
Quadratus Lumborum Block for Patients Undergoing Percutaneous Nephrolithotomy
Authors: Raman Rajesh , Prabha Rati
Published: November 2021

Background:

Recent studies have supported the use of quadratus lumborum block (QLB) for postoperative analgesia for patients undergoing renal surgery.

Aims:

The aim was to study the efficacy of posterior QLB for postoperative analgesia in patients undergoing percutaneous nephrolithotomy (PCNL).

Settings and Design:

This trial was a hospital-based, randomized, double-blind, controlled, prospective study.

Materials and Methods:

Forty patients aged from 18 to 60 years, belonging to the American Society of Anesthesiologists physical status I–III and scheduled for unilateral PCNL under spinal anesthesia were administered ultrasound-guided posterior QLB with 30 ml of either 0.2% ropivacaine (Group Q) or normal saline (Group C) after the subarachnoid block. Duration of analgesia was the primary outcome variable.

Statistical Analysis Used:

Data were compiled in Microsoft Excel, and analyses were performed in SPSS (version 24.0.0.0; IBM, Armonk, New York, USA). Unpaired t-test, Mann–Whitney U test, and Fisher's exact test were used for the comparison of continuous, ordinal, and categorical data, respectively.

Results:

Duration of analgesia was significantly longer in Group Q (1167.10 ± 89.74 vs. 290.25 ± 47.38 min), as compared to Group C. Except at the end of the surgery, visual analog scale at rest and on movement was significantly lower till 20th h in Group Q. Patient satisfaction was better, and analgesic consumption was lower in Group Q. Side effects were similar in both groups.

Conclusions:

QLB provides good quality, and prolonged duration of postoperative analgesia compared to placebo for PCNL, but more large-scale studies are needed to recommend it for routine use.
Ease and Safety of Securing Airway by Railroading ProSeal Laryngeal Mask Airway over Bougie versus Traditional Digital Insertion Technique
Authors: Tosh Pulak , Rajan Sunil , Narayani Naina , Kumar Lakshmi
Published: November 2021

Background:

ProSeal insertion is usually more time-consuming with lower first-attempt success.

Aim of the Study:

We aimed to compare the incidence of successful placement of ProSeal laryngeal mask airway (PLMA) in the first attempt by railroading it over soft gum-elastic bougie introduced into esophagus versus traditional digital insertion technique. Time taken and ease of securing airway, associated hemodynamic responses, and trauma were also assessed.

Settings and Design:

This was a prospective randomized study conducted in a tertiary care institute.

Subjects and Methods:

Forty patients were recruited into two groups. Following induction in Group P, PLMA was introduced using digital technique, whereas in Group B, a soft gum-elastic bougie was introduced into esophagus and then PLMA was railroaded over the bougie. Correct placement was confirmed with end-tidal carbon dioxide waveform.

Statistical Tests Used:

Fisher's exact test and independent samples t-test were used for statistical analysis.

Results:

Successful first-attempt insertion was significantly higher in Group B compared to Group P (100% vs. 70%). Percentage of easy insertion was also significantly higher in Group B (95% vs. 65%). Time taken to insert ProSeal was significantly shorter in Group B (30.8 ± 7.8 vs. 59.5 ± 44.6 s). No patient in Group B had blood-stained secretion versus 70% in Group P. Mean arterial pressures at and after ProSeal insertion were significantly higher in Group P. However, heart rate remained comparable in both the groups.

Conclusion:

Bougie-guided ProSeal insertions had significantly higher first-attempt insertion success rates and were significantly faster and less traumatic with blunted blood pressure response compared to traditional digital insertion technique.
Regulated upon activation, normal T cells expressed and secreted (CCL5) in platelet concentrate
Authors: Shukla Rinku V. , Mody H. , Gupte Snehalata C. , Ghosh Kanjaksha
Published: November 2021

BACKGROUND AND OBJECTIVES:

Platelet concentrates (PCs) can be prepared in several different ways, and they can be stored over few days before the use. Regulated on activation, normal T cells expressed and secreted (RANTES) levels in these concentrates may vary depending on the type of preparation and duration of storage of this component. We measured RANTES levels in platelet supernatants in different preparations and with different storage duration.

MATERIALS AND METHODS:

Fifteen PCs were prepared by platelet-rich plasma (PRP) and buffy coat (BC) method each. Forty-two single donor platelets (SDPs) were prepared using cell separators Cobe Spectra, Trima Accel, and Amicus. Filtered PCs were prepared using labside and bedside filters. The supernatants were collected after 1, 18, 65, and 112 h of preparation. SDP samples were taken on the 0 day, 3rd day, and 5th day. In filtered PC, pre- and post-filtration samples were taken, and aliquots were frozen at − 56°C for the measurement of RANTES.

RESULTS:

RANTES at 1 h was 1210 ± 560 pg/ml in PRP-PC, 1384 ± 463 pg/ml in BC-PC. At 112 h, 1617 ± 451 pg/ml and 1949 ± 134 pg/ml, respectively. In SDP, 0-day level was 1850 ± 278 pg/ml and >2000 pg/ml on 5th day. In prestorage, filtered PC RANTES was 1035 ± 496 pg/ml, and in the poststorage sample, it was 310 ± 508 pg/ml. With bedside filters, presample showed 1243 ± 832 pg/ml and postsample showed 556 ± 748 pg/ml.

CONCLUSION:

The concentration of RANTES increased continuously from 1 h to 5 days of storage in all PCs. After 65 h, BC-PC showed higher levels of RANTES compared to PRP-PC. Filtered PRP-PCs appear to be the best in terms of low RANTES to prevent allergic reactions and cultures negative.
Frequency of hepatitis B virus-DNA among hepatitis B surface-Ag negative, anti-hepatitis B core antibody-positive blood donors in Yazd, Iran
Authors: Vaziri Mahtab , Shahshahani Hayedeh Javadzadeh
Published: November 2021

BACKGROUND:

The diagnosis of hepatitis B infection in most blood transfusion centers is based on hepatitis B surface (HBs) antigen detection by an enzyme immunoassay method. This study aimed to determine the frequency of hepatitis B core (HBc) antibody, HBs antibody, and hepatitis B virus (HBV) DNA among HBs antigen-negative healthy blood donors of Yazd province, Iran.

MATERIALS AND METHODS:

This cross-sectional study was conducted on 1500 healthy blood donor samples negative for HBs antigen, hepatitis C virus antibody, human immunodeficiency virus antigen/antibody, and rapid plasma regain tests. All samples were screened for HBc antibody test. HBs antibody and real-time polymerase chain reaction were performed for HBc antibody-positive samples.

RESULTS:

HBc antibody was positive in 74 (4.9%) samples and 11 (14.9%) of 74 positive samples for HBc antibody were negative for HBs antibody. Sixty-three (85.1%) positive samples for HBc antibody had HBs antibody titer over 10 IU/L, and 43 (58.1%) had HBs antibody titer over 100 IU/L. There was no hepatitis B DNA-positive sample in the present study.

CONCLUSIONS:

The study results suggest that there is a very low risk for transmission of HBV through blood donors of Yazd, Iran.
Molecular and serological markers of human parvovirus B19 infection in blood donors
Authors: Farahmand Mohammad , Tavakoli Ahmad , Ghorbani Saied , Monavari Seyed Hamidreza , Kiani Seyed Jalal , Minaeian Sara
Published: November 2021

BACKGROUND:

Human parvovirus B19 (B19V) is one of the blood-borne viruses. The virus can be transmitted to susceptible individuals by blood or blood products. The virus is not associated with significant disease in general population, while people with underlying problems such as immunodeficiency can cause anemia and arthritis. The current systematic review and meta-analysis aimed to estimate the overall prevalence of B19V DNA, anti-B19V IgG, and anti-B19V IgM antibodies in blood donors worldwide.

METHODS:

A systematic search was carried out in online databases for relevant studies from inception until March 30, 2019. Study selection was performed based on predesigned eligibility criteria. The proportion of B19V DNA, anti-B19V IgG, and anti-B19V IgM antibodies were pooled using the inverse variance method. All statistical analyses were performed using the R version 3.5.3, package “meta.”

RESULTS:

According to the random-effects model, the pool prevalence of B19V DNA, anti-B19V IgM, and anti-B19V IgG among blood donors was calculated to be 0.4% (95% confidence interval [CI] =0.3%–0.6%), 2.2% (95% CI = 1.3%–3.7%), and 50.1% (95% CI = 43.1%–57.1%), respectively.

CONCLUSION:

For the transmission of B19V through blood, the presence of the virus genome is required, and the present study showed that the prevalence of the virus genome in blood donors is <1%. Therefore, there is no need to screen donated blood for B19V infection.
An insight into the utilization of allogenic blood transfusion and factors affecting blood transfusion in total knee replacement surgery in a tertiary care hospital in Eastern India
Authors: Das Sudipta Sekhar , Kamilya Ranjan , Biswas Rathindra Nath , Ghosh Susanta
Published: November 2021

BACKGROUND:

Significant blood loss and requirement of allogenic blood transfusion during or after total knee replacement (TKR) have been reported. Incidence of blood transfusion in TKR is highly variable and depends on several factors. We investigated the blood utilization in patients undergoing TKR in our hospital and depicted the important risk factors that determine the need of allogenic blood transfusion in primary unilateral TKR.

MATERIALS AND METHODS:

The study included 1241 consecutive patients undergoing primary unilateral total knee arthroplasty. All the surgeries were performed by a single surgical team of orthopedists following standard procedure. Patient and disease details were obtained from patient file and hospital information system. Compatibility test was performed in blood bank before blood reservation following mandatory guidelines. Details of test, blood issue, and blood transfusion were documented in the blood bank.

RESULTS:

Of 1241 enrolled patients, 1069 (86.2%) were female. The median age of patients was 66 years with mean preoperative hemoglobin of 9.9 g/dL. Allogenic blood transfused was needed in 223 (17.9%) patients. Diabetes mellitus, hypertension, thyroid disorders, and chronic heart diseases were the major comorbid conditions. Risk factors such as gender, American Society of Anesthesiologists score, preoperative hemoglobin, and intraoperative and postoperative blood losses were significantly associated with blood transfusion.

CONCLUSION:

The risk factors determining blood transfusion in TKR vary between studies, however, all centers should establish standard operating procedures describing the surgical procedure and transfusion support in TKR. In addition, each center may develop specific blood management strategy to rationalize blood transfusion in TKR and overall successful care in TKR.
Patient blood management in a neurosurgical patient with anti-e antibody
Authors: Chand Sreethu , Mani Anila , Amita R. , Gupta Debasish
Published: November 2021

The successful application of patient blood management approach in a 48-year-old neurosurgery patient planned for meningioma excision and requiring transfusion is described. The patient had multiple past immunizing events and developed antibody against a high-frequency antigen “e” of the Rh blood group system. With the joint effort from transfusion medicine specialist, anesthesiologist, and surgeon, the patient was successfully managed using the preoperative autologous blood donation program.
Effect of prolonged storage at 2°C–6°C for 120 h on the coagulation factors of thawed cryoprecipitate
Authors: Marik Arghyadeep , Philip Joseph , Mallhi Rajiv Singh , Kushwaha Neerja , Kumar Sudeep , Biswas Amit Kumar , Yadav Arvind Kumar
Published: November 2021

BACKGROUND:

Cryoprecipitate helps in replenishing important coagulation factors like fibrinogen, Factor VIII and von Willebrand factor without running the risk of volume overload. It is very useful in the treatment of trauma patients with active bleeding and works best when administered early. Extending the shelf life of thawed cryoprecipitate beyond 4 hours enables us to manage inventory better, reduces the burden of demand vs supply as well as minimizes wastage. It can also help in logistically supporting the transfusion services in making cryoprecipitate readily available in mass casualty scenarios (war, natural calamity) in remote locations by reducing the time required for thawing cryoprecipitate and the need for costly storage equipment. AIM: The aim of this study was to compare the levels of Factor VIII, Fibrinogen and von Willebrand factor on thawed cryoprecipitate after prolonged storage for 5 days at a temperature of 2-6°C.

METHODOLOGY:

The above mentioned coagulation factors were analyzed in cryoprecipitate at the time of product thaw and again after 120 hours of 2 to 6°C storage using fully automated coagulation analyser (STA Compact Max). All parameters were expressed as Mean ± Standard deviation and were analyzed using paired t-test with level of significance, P < 0.05.

RESULTS:

There was a significant decrease in the level of Factor VIII, whereas the levels of fibrinogen and von Willebrand Factor remained stable during the storage period. All the cryoprecipitate units retained factor activities above therapeutic range even after 5 days of storage at 2-6°C.

CONCLUSION:

Although the levels of clotting factors are reduced during storage, they are still maintained above the therapeutic range. In scenarios where maintaining frozen cryoprecipitate inventory is a logistical challenge and emergency massive demands of cryoprecipitate are foreseen, the use of pre-thawed cryoprecipitate can be considered as a viable option.
Analysis of red blood cell irradiation practices from South India
Authors: Murugesan Mohandoss , Augustine Merline , Nayanar Sangeetha Keloth
Published: November 2021

INTRODUCTION:

Age of red blood cell (RBC) units at the time of irradiation is important and prolonged storage of preirradiated units is detrimental. The objectives were to determine RBC age at irradiation, days from expiry (DFE), and percentage of late transfusions of irradiated RBC. To estimate the concordance on expiry of irradiated RBC units with present American Association of Blood Banks (AABB)/Directorate General of Health Services (DGHS), New Delhi over British Committee for Standards in Hematology (BCSH) and Council of Europe (CE) guidelines.

METHODS:

All the RBC units irradiated for a 1 year period were included. Retrieved data included date of collection, irradiation, revised expiry, and issue of blood. Late transfusions are units transfused in the last 2 week of RBC's shelf-life and wastage due to expiry was determined. Chi-square and Kruskal–Wallis test were used for comparisons between the guidelines.

RESULTS:

Out of 1303 RBC units irradiated, the median age for irradiation was 2 (0–36) days and 99.3% units irradiated within day +14. Median DFE for these units transfused was 26 (0–28) days. 2.8% units expired as per local standards. Late transfusions happened in 121 (9.3%) units transfused. AABB/DGHS practice was not concordant with CE standards for 86 (6.6%) units and with BCSH 94 (7.2%) units. Overall discordance between the present practices was CE and BCSH was seen in 130 (10%) events.

CONCLUSION:

Median RBC irradiation age and DFE was two and 26 days respectively at our center. Only 90% concordance was observed between AABB/DGHS and CE/BCSH guidelines with 9.3% units transfused as late transfusions. Restricting late transfusions of irradiated RBC can act as surrogate to improve the quality of units transfused through an inexpensive strategy.
Surgical management of endometriosis in a severe Hemophilia A female patient and the role of transfusion medicine specialist
Authors: Pinki Sanooja , Mohan Ganesh , Venugopal Divya , Innah Susheela J.
Published: November 2021

Hemophilia A is an X-linked recessive bleeding disorder occurs due to deficiency of factor VIII (FVIII). The disease manifests exclusively in males though it rarely occurs in females due to complex pathophysiological mechanisms. We present a rare case of female hemophilia due to skewed X-inactivation which adversely affected the quality of patient life. She presented with recurrent abdominal pain and was diagnosed with severe endometriosis and underwent total abdominal hysterectomy with left salpingo-oophorectomy and appendicectomy. She was infused recombinant factor VIII both prophylactically and postoperatively as per the World Federation of Hemophilia guidelines. Recombinant Factor VIII was supplemented every 12th hourly and Factor VIII activity levels were monitored daily. She was discharged uneventfully on the postoperative day 21 after screened negative for acquired inhibitors.
Irradiating stored blood and storing irradiated blood
Authors: Balasubramanyam Pramanya , Basavarajegowda Abhishekh , Hanumanthappa Nandeesha , Negi Vir Singh , Harichandrakumar K. T.
Published: November 2021

INTRODUCTION:

Gamma Irradiation of blood products accentuates biochemical changes in the blood stored at 4°C. This study tried to compare the changes in potassium, sodium, glucose, lactate, and lactate dehydrogenase (LDH) levels in packed red blood cell (PRBC) units irradiated at various time points and then stored versus those stored for a particular period then irradiated.

METHODOLOGY:

One hundred and eighty units of RBCs were randomly assigned equally to be irradiated or not. Eighteen units each were irradiated by gamma irradiator using cobalt 60 (BI 2000) on day 1, 7, 14, 21, and 28 of their storage, respectively, in the irradiation group. All the units were assessed for their plasma levels of potassium, sodium, glucose, LDH, and lactate by clinical chemistry auto analyzer Beckman coulter AU680 weekly. The values were documented and analyzed by SPSS.

RESULTS:

Baseline values on day 1 for studied biochemical parameters were comparable between irradiated and nonirradiated groups. Mean values of potassium, lactate and LDH were higher in irradiated than nonirradiated PRBC bags. In contrast, Sodium and Glucose mean values were lower than baseline values. Maximum cumulative mean values were noted in day-21 irradiated bags when the parameters were measured on day-28 for potassium and lactate levels. This was followed by day 14 irradiated bags, followed by day 7 irradiated bags.

CONCLUSION:

The study indicates that irradiation of red cells later in their storage period had comparatively more detrimental changes in relation to potassium and lactate than irradiation in earlier days. Consideration of irradiation to be performed as close to the issue as possible to reduce a lesser number of days of storage postirradiation is to be explored.
Buffy coat pooled platelet concentrate
Authors: Kumar Rakesh , Dhawan Hari Krishan , Sharma Ratti Ram , Kaur Jyotdeep
Published: November 2021

BACKGROUND:

Buffy coat pooled platelet concentrate (BCPP) is a new blood component mainly used in Europe, which has good attributes of both random donor platelets and apheresis platelets in terms of high platelet count, leukoreduced and available in emergency. We planned this study to compare quality parameters and biochemical activation markers among buffy coat pooled platelets and apheresis platelet concentrate (AP-PC) to establish the quality and safety of this new blood component during storage.

MATERIALS AND METHODS:

Three different preparations of BCPP were prepared: Nonleukoreduced (BCPP Part A), leukoreduced (BCPP Part B), and leukoreduced with platelet additive solution (PAS) (BCPP Part C) using a pool of 15 ABO-matched, nonreactive buffy-coats in each experiment to avoid any donor-related variations. Ten such experiments were done. Each BCPP was equivalent to 5 buffy coat units. Ten apheresis platelets were taken as control. Serial samplings were done on day 0, 3, and 5 of collection and were assessed for: volume, platelet count, white blood cell count, swirling, pH, sterility, glucose, lactate, soluble p-selectin, Interleukin (IL)-6, IL-1 β, and tumor necrosis factor alpha (TNF-α).

RESULTS:

BCPP Part C (leukoreduced with PAS) maintained the best quality parameters in terms of maintenance of pH, least lactate accumulation, least sP-selectin levels, and least accumulation of inflammatory mediators (IL-6, IL-1 β, and TNF-α) than the other groups >BCPP part B >AP-PC and >BCPP Part A. On day 5 of storage pH for BCPP Part A, Part B, Part C, and AP-PC was: 6.33, 6.42, 6.64, and 6.29, respectively, and soluble p-selectin (ng/ml) was 201 ± 22, 186 ± 11, 149 ± 18, 200 ± 23, respectively. BCPP Part B and AP-PC had comparable quality parameters and activation markers.

CONCLUSIONS:

Buffy coat pooled platelet has comparable and even better-quality control parameters (especially leukofiltered with PAS) than conventional platelet preparation and is a good alternative for meeting platelet transfusion requirements of critical patients during emergency hours in resource-constraint setting.
Blood group discrepancy in mixed-type autoimmune hemolytic anemia in a pediatric patient
Authors: Wasnik Minal , Lahare Saurabh , Jagzape Tushar , Chandrakar Ramesh Kumar
Published: November 2021

Autoimmune hemolytic anemia (AIHA) is characterized by the presence of antibodies directed against self-antigens on red blood cells (RBCs) leading to progressive RBC destruction along with reduced red cell survival. Mixed-type AIHA is characterized by the presence of both warm and cold-autoantibodies. These autoantibodies may cause blood-group discrepancy or cross-match incompatibility leading to delay in arranging suitable blood unit for transfusion. The detection of autoantibodies by monospecific-direct antiglobulin test showing positive reaction on immunoglobulin G and C3d and presence of cold-agglutinins leads to the diagnosis. We report a rare case of mixed AIHA in a 15 years female showing severe anemia, blood group discrepancy, and cross-match incompatibility. She received transfusion of least incompatible packed RBCs without any untoward effect.