bluuebunny/crossref_metadata_2025 huggingface dataset:
Stability, Evolution and Diffusion of Intrinsic Point Defects in 4H-SiC
Authors: Bathen Marianne Etzelmüller , Karsthof Robert , Grossner Ulrike , Vines Lasse
Published: May 2022

Silicon carbide (SiC) is a wide band-gap semiconductor of great technological importance, showing promise for application areas ranging from quantum computing and communication to power devices. Vital in both the contexts of power devices and quantum technology is the understanding of intrinsic defects that are introduced during various device processing steps, both immediately after their formation and over the course of defect evolution with temperature. Here we monitor the formation and evolution of intrinsic point defects in n-type 4H-SiC after proton irradiation at room temperature and subsequent annealing in the temperature range 300-1000 °C, and discuss the nature and origin of the EH4 and EH5 deep level defects observed by deep level transient spectroscopy around 400-500 K. In particular, the controversy on the nature of the EH5 trap in particular is addressed, where we propose the presence of two overlapping defect peaks: one metastable level that appears after low energy electron irradiation below the silicon displacement limit, and one more stable level that gradually decreases in concentration until an annealing temperature of 1000°C. We argue that the former is likely related to carbon interstitials, while the latter was recently tentatively attributed to the carbon antisite-vacancy pair.
A Deeper Look into the Effects of Extended Defects in SiC Epitaxial Layers on Device Performance and Reliability
Authors: Das Hrishikesh , Sunkari Swapna , Justice Joshua , Hamann Danielle
Published: May 2022

The detection and classification of SiC Epitaxial extended defects was refined to separate out defective areas that influence device characteristics. Die level defect localization along with defect area calculations were performed on millions of die across product groups. A clear impact of non-killer defects was observed, especially with increasing density and defective area in the die. Specifically, all types of stacking faults caused higher leakage, lower blocking voltage, and increases in ON resistance and threshold leakage. Furthermore, MOSFET devices were affected to a much larger extent than diode devices. Testing die with higher numbers of defects provides insight on device reliability. Analyzing devices with specific counts of BPDs let us quantify the amount of bipolar degradation caused drift by product/voltage classes.
Polish Scratch Simulation vs. Polish Tool Type
Authors: Moeggenborg Kevin , Ju Meong Keun
Published: May 2022

Wafer scratching from handling and processing can impact the performance of devices grown on a substrate. Knowledge of process conditions and modeling of scratches on wafers can be used to elucidate the root cause of scratches so that they can be eliminated.
MiR-130a-5p contributed to the progression of endothelial cell injury by regulating FAS
Authors: Wang Wei , Tang Wenbo , Shan Erbo , Zhang Lei , Chen Shiyuan , Yu Chaowen , Gao Yong
Published: May 2022

MicroRNAs (miRNAs) play critical roles in the development of vascular diseases. However, the effects of miR-130a-5p and its functional targets on atherosclerosis (AS) are still largely unknown. In this regard, our aim is to explore the potentially important role of miR-130a-5p and its target gene during the progression of endothelial cell injury. We first found oxidized low-density lipoprotein (ox-LDL) induced FAS and cell apoptosis in HUVECs. Subsequently, miR-130a-5p expression was verified to be downregulated after ox-LDL treatment and negatively correlated with FAS, and FAS was identified as substantially upregulated in the ox-LDL-treated HUVEC cells. After that, the knockdown of FAS and overexpression of miR-130a-5p together were observed to aggregate ox-LDL-induced reduction of cell viability and apoptosis, cell cycle progression, cell proliferation, cell migration and invasion. In conclusion, we detected that miR-130a-5p contributed to the progression of endothelial cell injury by regulating of FAS, which may provide a new and promising therapeutic target for AS.
Pulse oximeter as a home assessment tool
Authors: Lee Siew-Keah , Ma Jin Wei , Chan Khai Ying , Cheong Yi Song , Hong Wan Ting , Ong Regine Chew Yi , Tay Wei Cheng , Chua Ang-Lim
Published: May 2022

Objective:

To determine the degree of knowledge in the usage of pulse oximeter as a home assessment tool among the community in Malaysia.

Methods:

A cross-sectional survey was conducted in November 2021. The questionnaire assessed the knowledge in using pulse oximeters, user experience and opinions in using pulse oximeter as a home assessment tool during the pandemic.

Results:

A total of 504 respondents were included in the study, and the mean score in knowledge related to application of pulse oximetry was 73.00%, while the mean score in knowledge related to factors affecting pulse oximetry readings was only 38.51%. A total of 90.5% of the respondents recognised normal pulse rate and 88.5% knew the blood oxygen saturation levels of a healthy adult, while 69.4% recognised the definition of silent hypoxia. In addition, the majority of the respondents agreed that factors such as poor blood circulation (71.2%), excessive movements (69.8%), and hand position (60.7%) affected oximetry readings. However, 61.7%, 81.7%, 77.2% and 76.8% of the respondents could not identify nail polish, skin colour, skin thickness and tattoos as factors that may affect oximetry readings respectively.

Conclusions:

The respondents showed a satisfactory level of knowledge related to application of pulse oximetry, but a poor level of knowledge related to factors affecting pulse oximetry readings among the community in Malaysia. Continuous efforts in educating the community on the correct use of pulse oximeters are crucial for appropriate home assessment and avoiding unnecessary stress.
Public knowledge, practices and perceptions on typhus fevers in Southern Sri Lanka
Authors: Liyanage Ashani , Chandrasena Nilmini , Gunathilaka Nayana , Sanjeewa Ruwan , Premaratna Ranjan
Published: May 2022

Objective:

To assess public knowledge, practices and perceptions on typhus fevers in Sri Lanka.

Methods:

A descriptive study was done in four selected typhus- prone areas in Southern Sri Lanka. A mixed-method was employed using face-to-face interviews and questionnaire-based surveys among confirmed cases of typhus and at-risk populations, respectively. Frequencies, percentages, and means were used to characterize socio-demography and evaluate disease awareness.

Results:

The lay terms for typhus fevers reported in the studied region were “peacock fever”, “tick fever” and “bird fever”. A total of 499 subjects participated [mean±SD, (45±16) years] in the questionnaire-based survey, and 13.6% (n=68) reported past experience of typhus fever, 1.2% (n=6) identified the disease as “typhus” while 58.7% (n=293) and 11.8% (n=59) knew it as ‘peacock fever’ and ‘tick fever’, respectively. The etiological agent was unknown to 95.2% (n=475), but 53.5% ((n=267) were aware that it was vector-borne. Fever (57.3%, n=286), eschar (35.7%, n=178), headache (22.0%, n=267) and myalgia (19.2%, n=96) were identified as key symptoms. Past disease experience was significantly associated with higher awareness of the main disease symptoms (fever: χ2=15.713, P<0.001; headache: χ2=19.447, P<0.001; lymphadenopathy: Fisher’s exact test, P=0.023; eschar: χ2=12.049, P<0.001). None knew of any disease prevention methods. Participants with a past history of typhus fever had sought treatment at state hospitals (55.9%, 38/68) and private sector hospitals (5.9%, 4/68).

Conclusions:

Public awareness on preventive practices for typhus fevers was rare among the participants though vector-borne aspect was known to many. Clinical disease awareness was deficient among those without past experience of typhus fever. Community sensitization on vector avoidance strategies is highly recommended.
A Clinical Comparison between Single-Space Technique and Double-Space Technique for Combined Spinal and Epidural Anesthesia
Authors: Basheer Pyarejan , Brijesh G. C. , Kumar Raman , Kumar Shailesh , Kumar Priyesh , Prakash Jay
Published: May 2022

Background:

Combined spinal and epidural anesthesia (CSEA) is commonly performed by double space technique (DST) and single space segment technique (SST) or needle-through-needle technique (NNT).

Aims and Objectives:

We designed a double-blind randomized controlled study to compare the effect of the double-space technique with that of the single-space technique on time required by the procedure, the number of attempts, and a level of sensory, side effects and cost-effectiveness.

Materials and Methods:

Patients undergoing elective lower abdominal and lower limb surgeries under regional anesthesia were randomized to receive CSEA with either the double-space technique (double group, n = 30) or the single-space technique (single group, n = 30). In the single group, the procedure was performed at the L3-4 interspace using the needle-through-needle technique. In the double group, an epidural catheter was inserted at the L1–2 interspace, and dural puncture was performed at the L3–4 interspace.

Results:

The single space (needle-through-needle) technique for CSE takes less time, less number of spinal punctures. There was no difference between the two groups in terms of side effects. Sensory level at T10 on 5 min in group I was 90% and group II was 100% whereas at T8 it was 10% in group I; sensory level at T10, T8 and T6 on 10 min. in group I were 53.3%, 43.3% and 3.3% respectively whereas in group II were 80%, 16.7% and 3.3% respectively; sensory level at T10, T8, T6 and T4 on 15 min. in group I were 6.7%, 43.3%, 50% and 0% respectively whereas in group II were 23.3%, 50%, 23.3% and 3.3% respectively; and sensory level at T4, T6 and T8 on 20 min. in group I were 0%, 73.3% and 26.7% respectively whereas in group II were 16.7%, 33.3% and 50% respectively.

Conclusions:

Single-space (needle-through-needle) CSEA takes less time, less number of spinal punctures and results in improved patient satisfaction. There were no differences in intraoperative variables between the DST and SST for CSEA.
Assessment of dengue virus inactivation in random donor platelets using amotosalen and ultraviolet A illumination
Authors: Kumar Ankit , Tiwari Aseem Kumar , Kumar Satendra , Biswas Ashutosh , Singh Gurpreet , Chatterjee Kabita , Chakroborty Sourit , Sunil Sujatha
Published: May 2022

OBJECTIVES:

The study objective was evaluation of amotosalen and ultraviolet A (UVA) illumination-based inactivation of dengue virus (DENV) in blood platelets.

MATERIALS AND METHODS:

Whole blood was collected from healthy donors and platelet concentrates were prepared at a tertiary care hospital in Gurugram, India. Platelet units collected from five blood group matched individuals were pooled and spiked with DENV. The spiked platelet units were subjected to amotosalen treatment followed by UVA illumination, to evaluate the efficiency of this method for viral inactivation. The treated platelet units were evaluated for the presence of infectious DENV. Amotosalen levels were quantified in the treated samples using high-performance liquid chromatography.

RESULTS:

The presence of replicating DENV was not observed in spiked platelet units treated with amotosalen and UVA illumination, whereas untreated units contained actively replicating DENV. Amotosalen levels were found to be in the permissible range after photochemical inactivation.

CONCLUSIONS:

Amotosalen/UVA pathogen inactivation treatment showed efficient inactivation of DENV in platelet components. Therefore, it seems to be a promising method for mitigating the risk of dengue transmission through transfusion of potentially contaminated platelet components in dengue-endemic countries such as India.
A case report on non-D HDFN
Authors: Singh Bharat , Chaudhary Rajendra , Elhence Preeti , Bharati Jyoti Kala , Srivastava Anubha
Published: May 2022

The widespread use of anti-D immunoglobulin has resulted in a relative increase in the importance of non-D alloimmunization as a cause of hemolytic disease of the fetus and newborn (HDFN). Non-D alloantibodies that are capable of causing severe HDFN include anti-K, anti-E, and anti-c. Anti-c is clinically the most important Rh system antibody after anti-D. Here, we report three cases of neonates presenting with anemia and hyperbilirubinemia with strongly positive direct antiglobulin test who required phototherapy and neonatal exchange transfusion due to non-D antibody in RhD positive antenatal women. Anti-c was common in all the three cases while two cases have one additional non-D antibody. Due to faulty practices, antenatal antibody screening was not done for any case considering the mother's RhD positive status. Hence, antenatal antibody screening should be performed routinely, in all RhD positive pregnant women to reduce the delay in diagnosis and the management of HDFN occurring due to non-D antibodies.
Maternal allo anti-M antibody-induced hemolytic disease of newborn
Authors: Mathew Ashly Monson , Shah Sangita , Bhatnagar Nidhi , Shah Mamta , Patel Tarak , Thakkar Truptee
Published: May 2022

Hemolytic disease of the fetus and newborn is a syndrome associated with immune destruction of the fetal and newborn red cells by maternal red cell alloantibodies. The detection of anti-M in antenatal screening can be responsible for neonatal red cell aplasia. A 32-h-old full-term neonate admitted with inconsolable cry and mild fever. Laboratory tests revealed progressive anemia and hyperbilirubinemia on day 3. The peripheral blood smear showed evidence of hemolysis and reticulocyte count was reduced. Intensive phototherapy and antibiotics were started after ruling out other causes of hyperbilirubinemia. Blood group typing and advanced red cell serology workup were done. Antibody screening and identification was suggestive of the presence of anti-M antibody in both mother and baby. Intravenous immunoglobulin and red blood cell transfusions were given. Anti-M is capable of causing hemolytic disease of the fetus and newborn and prolonged anemia. Newborns with anemia should be evaluated for all the possible causes to establish a diagnosis.
Seroprevalence of anti-severe acute respiratory syndrome coronavirus 2 antibody among healthy blood donors in a hospital-based blood center in Eastern India during the COVID-19 pandemic
Authors: Das Sudipta Sekhar , Bera Subhas Chandra , Biswas Rathindra Nath
Published: May 2022

BACKGROUND:

Few international studies have reported the prevalence of anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies in healthy, asymptomatic blood donors. These findings have definitely raised queries regarding blood safety and transfusion-transmitted coronavirus disease (COVID)-19. We conducted this first anti-SARS-CoV-2 seroprevalence survey among the healthy blood donors in Eastern India.

MATERIALS AND METHODS:

The study included 611 healthy blood donors who donated whole blood (WB) in our blood center. For detailed analysis, social and demographic details of all donors like gender, age, weight, occupation, and place of residence were included. Donor eligibility criteria for WB donation were followed as per existing national guidelines. Residual serum samples leftover after screening the mandatory infectious markers were tested for the presence of anti-SARS-CoV-2 IgG directed against domain S1 and S2 of the SARS-CoV-2 spike protein using automated enhanced chemiluminescence technology following the manufacturer's instructions.

RESULTS:

The mean overall seroprevalence of anti-SARS-CoV-2 antibody in blood donors was observed to be 4.4% (95% confidence interval 3.8–4.9) with a monthly increasing trend. Seroprevalence adjusted for sensitivity and specificity of the assay was 4.1%. The mean S/Co values of reactive donor samples were observed to be 2.99 and 3.42 in June and July 2020, respectively (P = 0.013). No significant variation in seroprevalence rate was observed among donor variables like donor age, gender, profession, and educational qualification. A higher significant prevalence of antibody was observed among voluntary donors and donors residing in suburban areas (P < 0.05). Among the ABO blood groups, no statistical significance of seroprevalences was observed among the various ABO blood groups.

CONCLUSION:

We conclude that despite many limitations in the current study, we found 4.4% seroprevalence of anti-SARS-CoV-2 antibody in the asymptomatic, healthy, epidemiologically, and medically screened blood donors. These data are definitely the tip of an iceberg and signify much higher seroprevalence in the normal population and indicate that protective measures like masking and social distancing should remain implemented for a long term.
A retrospective study to assess the impact of ABO incompatibility on outcomes of allogeneic peripheral blood stem cell transplants at a tertiary care hospital in Western Maharashtra
Authors: Nalukettil Balu B , Biswas Amit Kumar , Asthana Bhushan , Kushwaha Neerja , Baranwal Ajay Kumar , Sharma Sanjeevan
Published: May 2022

BACKGROUND:

Hematopoietic stem cell transplantation (HSCT) has emerged as a curative measure for life-threatening hematological disorders. It can be autologous or allogeneic depending on the disease characteristics. Providing transfusion support to the transplant patients can be challenging, especially in AB-mismatched allogeneic HSCT. In this study, we investigated the impact of ABO incompatibility in patients undergoing allogeneic HSCT.

MATERIALS AND METHODS:

A retrospective review was conducted in 76 patients with hematological diseases who underwent allogeneic HSCT. Transfusion requirements, engraftment profile, incidence of graft versus host disease (GvHD), and mortality for a period of 1 year were analyzed.

RESULTS:

ABO incompatibility between donor and the patient did not significantly affect the neutrophil and platelet (PLT) engraftment time (P= 0.389, 0.349, respectively), packed red blood cells transfusion requirement, and duration of initial hospital stay. However, patients of ABO-incompatible HSCT received more PLT transfusions posttransplant which was statistically significant. 29.1% of ABO compatible and 16.7% incompatible HSCT patients developed GVHD. Mortality rates in the two groups were 16.7% and 8.3%, respectively. However, differences in both the parameters were not statistically significant.

CONCLUSION:

Our study showed that ABO incompatibility does not significantly affect the outcome and should not be a limiting factor for selection of donor. Donor availability and human leukocyte antigen (HLA) matching remain the critical selection criteria.
Comparative study between chronic automated red blood cell exchange and manual exchange transfusion in patients with sickle cell disease
Authors: Al Mozain Nour , Elobied Yasmin , Al-Omran Amal , Aljaloud Alhanouf , Omair Alanoud Bin , Tuwaim Reema Bin , Alkhalifah Sara , Altawil Esraa S. , Abraham Sheena , Salcedo Lejardine Rose , Parena Aljoyce , Shah Farrukh , Ayyoubi M. Tayyeb , Hermelin Daniela , Al Gahtani Farjah , Alfeky Mervat Abdalhameed , El Gohary Ghada
Published: May 2022

BACKGROUND:

Red cell transfusion remains the gold standard in managing sickle cell disease (SCD) with severe complications. Offering red blood cell exchange (RBCX) either manual exchange transfusion (MET) or automated RBCX (aRBCX) can reduce the complications of chronic transfusion and maintain target Hb thresholds. This study audits the hospital experience of overseeing adult SCD patients treated with RBCX, both automated and manual, and compares the safety and efficacy.

MATERIALS AND METHODS:

This retrospective observational study was conducted as an audit for chronic RBCX for adult patients with SCD in 2015–2019 at King Saud University Medical City, Riyadh, Saudi Arabia.

RESULTS:

A total of 344 RBCX for 20 adult SCD patients who were enrolled in regular RBCX, (11/20) patients had regular aRBCX with a total of (157) sessions, and (9/20) patients had MET with a total of (187) sessions. The median level of HbS% post-aRBCX was significantly lower than MET (24.5.9% vs. 47.3%, P < 0.010). Patients on aRBCX had fewer sessions (5 vs. 7.5, P < 0.067) with better disease control. Although the median yearly pRBC units per patient for aRBCX was more than the double needed for MET (28.64 vs. 13.39, P < 0.010), the median ferritin level was 42 μg/L in aRBCX versus 983.7 μg/L in MET, P < 0.012.

CONCLUSION:

Compared to MET, aRBCX was more effective in reducing HbS, with fewer hospital visits and better disease control. Although more pRBCs were transfused, the ferritin level was better controlled in the aRBCX group without increasing alloimmunization risk.
Successful management of Methemoglobinemia and G6PD deficiency in a patient posted for surgical excision of branchial cyst
Authors: Arun V J , Deorukhkar Anuradha , Rafi Aboobacker Mohamed , Charles Deepak , Devendra Rati , Innah Susheela J , Kedar Prabhakar
Published: May 2022

A 27-year-old female patient who came for branchial cyst excision was found to have cyanosis and a saturation gap during preanesthetic check-up and hence she was referred to haematology for further workup. She had a Hb of 9 gm% with all other baseline tests as normal. Blood samples were sent for methaemoglobin estimation and related work up to the National Institute of Immunohematology (NIIH) Mumbai. She was diagnosed as a case of Methemoglobinemia with a methaemoglobin level of 68.7% with NADH cytochrome B5 reductase activity of 10.82 IU/g Hb. The drug of choice for treatment is Methylene blue and hence G6PD deficiency had to be ruled out prior to initiating therapy. She was found to have a concurrent existence of G6PD deficiency. The blood sample was further sent to NIIH for genetic confirmation. We avoided methylene blue and other precipitating factors that could trigger a haemolysis. She was further consulted by the Patient blood management team to optimize her erythropoiesis and avoid unnecessary transfusions. Anaesthetic consultation and planning were done to avoid drugs that could induce haemolysis. She was started on Vitamin C, Niacin, hematinic and advised to follow up after a month. She was symptomatically better. Cyanosis had reduced, and Hb improved to 12 gm%. She was taken up for surgery with all precautions. The surgery and the post-operative period were uneventful. She was discharged on postoperative day 4 with an advice to continue Vitamin C & Niacin and to follow-up in Haematology OPD after a month.
Reappraisal of screening strategy in hepatitis B surface antigen-negative blood donors
Authors: Alam Md. Sohrab , Samdani Tushar , Hassan Md. Sawkat
Published: May 2022

BACKGROUND:

In spite of screening for hepatitis B surface antigen (HBsAg), transfusion-associated hepatitis B virus (TAHBV) infection remains a serious public health problem due to transmission of HBV in window period and occult HBV infection. To avoid TAHBV infection, some health-care facilities have started Hepatitis B core antibody test along with HBsAg, but this leads to a lot of potential donor rejection who are not HBV infected. Our aim is to find a new protocol of donor screening to prevent TAHBV without compromising blood availability.

MATERIALS AND METHODS:

A total of 88 HBsAg-negative anti-HBc total positive blood donors were included in this study. All samples were also tested for anti-HBs by enzyme immunoassay and for the presence of HBV-DNA viral load by real-time polymerase chain reaction.

RESULTS:

A total of 88 HBsAg negative and anti-HBc, total positive blood donors were tested for anti-HBs and HBV-DNA (Qn.). Among them, 76 donors (86.4%) (males 73 and females 3) were found to be positive for anti-HBs, while rest 12 (13.6%) showed no detectable antibody against HBsAg. HBV-DNA was found to be positive in 4 (7.7%) donor samples among 52 (60%) who have anti-HBs level <100 mIU/ml, while 36 (40%) donor samples were found to have >100 mIU/ml anti-HBs antibody with no detectable HBV-DNA.

CONCLUSION:

HBV-DNA should be implemented as a screening test of the blood donors to prevent TAHBV infection without potential donor rejection.
Therapeutic plasma exchange in HELLP syndrome
Authors: Chowdhry Mohit , Agrawal Soma , Gajulapalli Shiva Prasad , Thakur Uday Kumar
Published: May 2022

BACKGROUND:

HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome occurs in about 0.5%–0.9% of all pregnancies, but its prevalence is higher in patients with severe preeclampsia, accounting for a substantial maternal and perinatal morbidity and mortality. According to the latest American Society for Apheresis guidelines, Therapeutic plasma exchange (TPE) performed for postpartum cases and antepartum HELLP syndrome cases fall in Categories III and IV, respectively.

MATERIALS AND METHODS:

Retrospective analysis was done at our tertiary care center from January 2014 to June 2019 for patients diagnosed with HELLP syndrome. Clinical data for age, gestational age at the time of diagnosis, type of delivery, outcome of pregnancy, history of preeclampsia /eclampsia, hemoglobin levels, AST, ALT, LDH, platelet counts, prothrombin time, activated partial thromboplastin time, international normalised ratio, complete blood count, was obtained from patients' electronic medical records. The TPE was initiated within 24 hrs of diagnosis. All TPE was done on Spectra Optia apheresis system (Terumo BCT, Inc, USA). Statistical testing was conducted with the statistical package for the social science system version SPSS 20.0 and R-3.2.0. Continuous variables were expressed as mean±SD and were compared between Pre and Post TPE records of patients by using the paired T test.

RESULTS:

Nine patients fulfilled the criteria of HELLP syndrome. Seven (77.8%) were diagnosed in the postpartum period and 2 (22.2%) during the second trimester. Out of the total nine patients, two patients (22.2%) recovered completely and were discharged on day 15 ± 7 days, whereas 4 (44.4%) patients were discharged on day 21 ± 7 days with the advice of hemodialysis. Two (22.2%) patients had an intrauterine death and were discharged 3–4 days after the demise. In all these patients (except one), the TPE was initiated within 24 h of the diagnosis. A significant increase in platelet count and decrease in the lactate dehydrogenase levels (P < 0.05) was observed post TPE.

CONCLUSION:

Our data showed that TPE improved the treatment outcome in patients with HELLP syndrome despite being a Category III and IV indication among postpartum and antenatal females, respectively. However, a timely diagnosis and management are of paramount importance for a favorable outcome. TPE needs to be performed within 24 h of the diagnosis postdelivery when the patient is not responsive to the usual therapies, especially in class I HELLP syndrome.
Identification of rare anti-f alloantibody in a tertiary care center in India
Authors: Bhardwaj Gunjan , Tewari Ashish , Tiwari Deepak , Vishwakarma Sanjay
Published: May 2022

A 68-year-old male known follow-up patient of nonalcoholic steatohepatitis and carcinoma stomach was admitted to hospital for further management. The patient was planned for radical gastrectomy and required two units of packed red blood cell (PRBC), due to low hemoglobin of 6.6 g/dl. The patient blood grouping and antibody screening (ABS) were done. Patient ABS was positive. On antibody identification, using eleven-cell identification panel, resolve Panel A (Ortho Clinical Diagnostics, Johnson and Johnson, USA), “anti-f” alloantibody was identified in the patient sample. Select cells, from another resolve panel were used to rule out remaining antibodies. Anti-f antibody is produced due to the exposure of “f antigen.” Anti-f antibody can cause hemolytic disease of fetus and new-born and possible hemolytic transfusion reactions. At our center, we successfully transfused two units of anti-human globulin compatible and “c-negative” units, to the patient without any adverse reactions. Thus, the patient having anti-f antibody can be managed by transfusing “c-negative” or “e-negative” PRBC units or units lacking both the “c” and “e” antigens.
Para-Bombay blood group: Report of a rare blood group
Authors: Joibi Kimberly Fe , Noor Noor Haslina Mohd. , Hassan Mohd Nazri , Iberahim Salfarina , Rahman Wan Suriana Wan Abdul , Yusoff Shafini Mohd , Ramli Marini , Bahar Rosnah , Akbar Nurul Asyikin Nizam , Zulkafli Zefarina
Published: May 2022

Para-Bombay blood group is a rare blood group typically characterized by the absence of H antigens on red blood cell and the presence of ABH substances on secretion. It can be easily missed and often mistaken as blood group O without extended testing. Detection is important as it significantly affect transfusion management. We report two cases of Para-Bombay A blood group in a teaching hospital in a North-Eastern state of Malaysia.
A cross-sectional study on thrombopoietin levels in immune thrombocytopenia and its correlation with platelet count, megakaryocytes, and treatment response
Authors: Oberoi Gurleen , Jain Mili , Natu Shankar Madhav , Kushwaha Rashmi , Tripathi Anil Kumar , Kumar Ashutosh
Published: May 2022

INTRODUCTION:

Thrombopoietin (TPO) being the major regulator of megakaryopoiesis is expected to show a compensatory increase in immune thrombocytopenia (ITP), however, it is not so observed. This study was undertaken to measure TPO levels in ITP and assesses its association with platelet count, megakaryocytes, and response to steroid therapy.

MATERIALS AND METHODS:

A total of 41 cases of ITP and twenty controls with normal platelet count were enrolled in this prospective study. Complete blood count, bone marrow examination, and ELISA for serum TPO were measured. Response to steroid therapy was evaluated for thirty cases.

RESULTS:

The TPO levels were increased in 80.5% of patients in comparison to the controls. The degree of rise, however, was variable. On analyzing low, normal, and high TPO levels with reference to platelet and megakaryocyte count no statistically significant difference was observed. Raised TPO levels were seen with significant lowering of functional megakaryocytes. The mean TPO levels in nonresponders were higher than responders but highly variable and statistically nonsignificant.

CONCLUSION:

Quantitative alterations in TPO are in a way regulated by qualitative efficacy of megakaryocytes rather than platelet or megakaryocyte count. Nonresponders with markedly increased TPO levels (due to qualitative megakaryocyte injury) are less likely to respond to TPO receptor agonist.
Detection of a weaker subgroup of A in ABO blood group system
Authors: Chopra Gurika , Kataria Manpreet , Batra Arshpreet Kaur , kaur Gurkiran , Kumar Rajesh
Published: May 2022

Testing to detect ABO incompatibility between a donor and potential transfusion recipient is the foundation on which all other pretransfusion testing is based. Sometimes, weak agglutination reactions may be obtained with reagent antibodies due to weak expression of A and B antigens on red blood cell (RBC) surface which may cause a discrepancy in blood group typing. Here, we report a patient showing discrepancy between RBCs (forward) and serum (reverse) typing. After doing detailed analysis, the blood type as a variant of blood Group A revealed. Subgroups of A are very rare phenotype of blood. Weaker subgroups of A blood group reported so far are mainly A3, Aend, Ax, Am, Ay, and Ael. We are reporting a case of a 35-year-old patient whose RBCs showed a discrepancy between cell and serum grouping during initial testing. Serological investigation included absorption elution tests and saliva tests after performing initial blood grouping. The serological characteristics of the patient's red cells were similar to A3 subtype. The patient was a secretor and A and H substance was present in the saliva. Serum did not show any presence of anti-A1. The weak A phenotype identified had serological characteristics similar to A3.
Transfusion-transmitted infections, its risk factors and impact on quality of life
Authors: Biswas Bijit , Naskar Narendra Nath , Basu Keya , Dasgupta Aparajita , Basu Rivu , Paul Bobby
Published: May 2022

BACKGROUND:

Multi-transfused thalassemic children are at higher risk of acquiring transfusion-transmitted infections (TTIs). There are limited data available on TTIs among thalassemic children, especially on its impact on their quality of life (QoL).

AIM:

The aim of this study is to find out the proportion of multi-transfused β-thalassemia major (β-TM) children suffering from TTIs, its risk factors and impact on QoL.

METHODS:

This was a hospital-based, analytical observational study, cross-sectional in design, conducted among 328 β-TM children and their caregivers attending thalassemia day care unit of a medical college during May 2015–April 2016, with a structured schedule. Data were analyzed with appropriate statistical methods using the Statistical Package for the Social Sciences.

RESULTS:

Two-fifth (39.9%) of them were found to have TTIs with hepatitis C being the most common (34.5%), followed by hepatitis B (4.5%) and human immunodeficiency virus (1.8%). In the multivariable model, place of residence (adjusted odds ratio [AOR] – 2.23 [1.19–4.17]), per capita monthly family income (AOR – 1.84 [1.10–3.07]), and blood transfusion frequency (AOR – 1.19 [1.10–1.29]) were significant predictors of TTIs adjusted with their age, age at diagnosis, last pretransfusional hemoglobin level, size of spleen, and caregivers knowledge regarding the disease. The study participants with TTIs had a lower QoL compared to others as there were significant differences in between the total QoL scores ([49.9 ± 15.6 vs. 57.4 ± 15.5], P ≤ 0.001) and its various domains.

CONCLUSION:

There was high burden of TTIs among multi-transfused β-TM children and it has significant negative impact on their quality of lives.
Clinical outcomes of dual fixation of femoral shaft fracture nonunion
Authors: Elbarbary Ahmed N. , Badawy Emad B. , Badr Ismail T.
Published: May 2022

Background

The key to success in femoral shaft nonunion cases is the achievement of mechanical stability. We aimed to provide the clinical outcome of dual-fixation femoral shaft fracture nonunion using intramedullary nailing and plate augmentation in the same setting.

Patients and methods

This was a retrospective study of 12 patients with femoral shaft fracture aseptic nonunion operated at our university hospital between January 2017 and June 2021. All patients underwent revision surgery with synchronous nailing and plate augmentation. Demographics, comorbidities, history of previous trauma, fracture healing, and complications were recorded. We also reviewed radiological images.

Results

Twelve patients (nine males and three females) with a mean age of 31.1±9.8 years were included. Six patients had a previous fixation with an intramedullary nail, five with a plate, and one with an external fixator. Ten patients had atrophic nonunion, and two patients had hypertrophic nonunion. Patients achieved fracture healing after the surgical intervention, except two patients required another surgical intervention for delayed union as bone grafting (at 6 and 8 months, respectively). At the end of the study, they achieved fracture healing in all patients. The mean healing time was 6.1±2.4 months.

Conclusion

s Good mechanical stability and hence union can be achieved with synchronous nailing and plate augmentation as a treatment option for femoral shaft fracture aseptic nonunion.
Comparative study between arthroscopic reduction and internal fixation versus open-reduction internal fixation for tibial-plateau fractures
Authors: Waly Ahmed H.T. , Gawish Hesham M.
Published: May 2022

Background

Tibial-plateau fractures are challenging for orthopedic surgeons. The gold-standard treatment for most tibial-plateau fractures is open-reduction internal fixation using either screws only or plates and screws. Recently, arthroscopy has invaded the field of trauma as a useful aid in the management of intra-articular fractures. The main advantages of arthroscopic reduction and internal fixation for tibial-plateau fractures are direct visualization of intra-articular fractures, accurate fracture reduction, and diagnosis and treatment of meniscal and ligamentous injuries. This study was done to compare the results of open-reduction internal fixation versus arthroscopic reduction and internal fixation for tibial-plateau fractures.

Patients and methods

A prospective comparative study was held in EL Hadra University Hospital between January 2017 and December 2019 over 56 patients. In all patients, the fracture was fixed using two to three cannulated screws. In the first group, the fixation was done using arthroscopy, while in the second group, the fixation was done using arthrotomy. All cases were assessed using Rasmussen clinical and radiological forms, Lysholm, and International Knee Documentation Committee (IKDC) scores. The minimum follow-up was 24 months since index surgery.

Results

There was no statistically significant difference between the two groups regarding the clinical and radiological Rasmussen scores. Moreover, the results of the Lysholm and IKDC were comparable. However, the arthroscopic group had longer operative time than the arthrotomy group.

Conclusion

Arthroscopic fixation technique was not inferior to open technique for management of Schatzker I–III fracture types with excellent comparable clinical and radiological outcomes while avoiding the drawbacks of the open approach.
High thoracic disc herniation
Authors: Maziad Ali M.
Published: May 2022

Aim

This article aims to describe a case of a 28-year-old male patient with progressively worsening of myelopathic symptoms owing to a large T4-5 thoracic disc herniation with severe cord compression.

Background

A 28-year-old male patient was referred to the clinic by a neurologist for worsening of bilateral lower extremity numbness, tingling, and progressive weakness over a period of few months with a clinical examination significant for severe myelopathy and imaging confirming a large thoracic disc herniation.

Procedure

T4-5 left hemilaminectomy and transfacet discectomy with unilateral right T4/T5 fixation and fusion were done.

Outcomes

The patient experienced delayed postoperative paraplegia that was reversible despite negative imaging studies, suggesting intraoperative incidental trauma to the cord or progressive postoperative cord edema.

Scientific message

Literature review of similar cases is presented as well as learning points from this challenging case. If the posterior approach is to be used, complete thorough decompression of the cord is advisable to minimize the risk of complications.
Bleeding Complications and Possible Resistance Patterns of Anti-Angiogenesis Treatments in Recurrent/Metastatic Head-and-neck Squamous Cell Carcinoma – Reflections from a Phase II Study of Pazopanib in Recurrent/Metastatic Head-and-neck Squamous Cell Carcinoma
Authors: Chen Jo-Pai , Hong Ruey-Long
Published: May 2022

Background:

Due to smoking, alcohol, and betel nut use, head-and-neck squamous cell carcinoma (HNSCC) is a serious public health problem in Taiwan.

Materials and Methods:

We performed a single-arm Phase II trial of pazopanib in patients with platinum-refractory recurrent or metastatic HNSCC in 2011.

Results:

We screened 43 patients in about 6 months. Thirty-three of the patients were excluded due to easy bleeding and vessel contact resulting from the advanced tumor status. The remaining ten patients were included in this study. An objective response was seen in one patient; six patients had clinical benefits, which was comparable with the outcomes of sorafenib or sunitinib in this patient group. Four patients experienced at least Grade 3 bleeding. The tumor response was usually seen in the central cavity; the rim of the cavity extended outside, reflecting peripheral invasion and future resistance.

Conclusion:

The early use of anti-angiogenesis treatments is necessary for better tumor control and to prevent bleeding and potential resistance. In future, vascular endothelial growth factor receptor and/or epidermal growth factor receptor tyrosine kinase inhibitors may be used in combination with immunotherapy to increase the clinical benefits and avoid the risk of hyperprogression.
Comparison of Survival Outcomes using Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Colon Versus Rectal Cancer with Peritoneal Carcinomatosis in an Asian Medical Center
Authors: Yu Hsin-Hsien , Hsieh Mao-Chih , Su Bor-Chyuan
Published: May 2022

Background:

The use of hyperthermic intraperitoneal chemotherapy (HIPEC) for colorectal cancer (CRC) with peritoneal carcinomatosis (PC) is still very controversial. The National Comprehensive Cancer Network guideline only recommends cytoreductive surgery (CRS) combined with HIPEC for colon cancer with PC for patients with limited metastases and can be removed with surgery. The short-term and long-term outcomes between colon versus rectal origin in this setting remain unclear. The present study compared our experience in the management of colon versus rectal cancer with PC through CRS-HIPEC and investigated whether the feasibility of extending the indication to the PC of rectal origin.

Materials and Methods:

The data of 78 and 10 patients with PC of colon and rectal origin, respectively, were collected from a prospectively maintained database of patients receiving CRS-HIPEC for peritoneal surface malignancy at any period during 2002–2018. CRS followed by HIPEC with mitomycin-C or 5-fluorouracil plus oxaliplatin was administered at 42° for 60 min. In addition, adjuvant chemotherapy was administered postoperatively. Data on sex, age, prior surgical score, preoperative or postoperative peritoneal cancer index (PCI), completeness of cytoreduction (CC) score, blood loss, operation time, transfusion unit, and hospital stay were recorded. Survival was compared between the colon and rectal groups.

Results:

The average patient was 56.4 years old, and 44 were men and 44 were women. The mean preoperative and postoperative PCI scores were 15.6 and 6.6, respectively. A complete CC score of 0-1 was achieved in 507 (56.9%) patients. The median overall survival durations were 34.0 ± 7.8 and 20.8 ± 13.2 months in the colon and rectal groups, respectively (P = 0.367). The 1-, 2-, 3-, 4-, and 5-year survival rates in the colon and rectal groups were 79% and 68%, 63% and 68%, 50% and 51%, 44% and 10%, and 44% and 0%, respectively. In multivariate analysis, the location of the primary tumor did not affect survival (P = 0.597; 95% confidence interval [CI] = 0.237–2.291); however, the postoperative PCI strongly predicted long-term survival (P = 0.001; 95% CI = 3.715–255.547).

Conclusion:

The management of CRC with PC remains challenging. CRS-HIPEC can provide similar survival benefits when applied to PC of rectal origin than when applied to PC of colon origin. The usage of mitomycin-C for HIPEC yields to a comparable survival benefit and a safe therapeutic option. However, the indication should be only extended to highly selective patients considering the possibility of adequate cytoreduction and performed in experienced centers.
Experts' Opinions Progress and Trends in the Surgical Management of Breast Cancer in Taiwan
Authors: Liu Chia-Hua , Hung Chih-Chiang , Liao Guo-Shiou , Chang Chuan-Hsun , Wu Cheng-Chung
Published: May 2022

Objective:

Radical mastectomy was first described by Halsted almost 130 years ago, and has been applied as a treatment strategy in Taiwan since the middle of the 20th century. However, due to the development of nonsurgical treatment modalities, the management of breast cancer has undergone tremendous change. This study examined Taiwanese publications between 1965 and 2020 to identify trends in the surgical management of breast cancer.

Data Sources:

We searched for papers published by authors from the Taiwan Breast Cancer Society and 18 tertiary referral medical centers in Taiwan.

Study Selection:

After excluding papers completely unrelated to surgery, there were 50 English language articles and 5 Chinese language articles available for historical review.

Results:

This nationwide survey of breast cancer over the past 40 years revealed the following trends in surgical management. (1) As detection rates of early-stage breast cancer increased, the amount of removed breast tissue decreased, with a corresponding reduction in percentage of total mastectomy. (2) Axillary sentinel node biopsy should be routinely performed in early breast cancer rather than axillary lymph node dissection without lymph node metastasis. (3) Since the development of gonadotropin antagonist, bilateral oophorectomy is no longer needed in the early stage in premenopausal population. Further pregnancy is allowed if the cancer is well controlled. (4) Breast reconstruction may be recommended, depending on the patients' preference, after total mastectomy for malignancy.

Conclusion:

Although this review of the literature may not be complete, the trends revealed in our analysis indicate that surgical management of breast cancer has become more patient-friendly, humanistic, and feasible in Taiwan. Currently, breast cancer may not have a poor outcome if the tumor can be detected at an earlier stage.
Does harvesting cancellous bone destabilize cervical spine in cervical interbody fusion? A prospective clinicoradiological analysis
Authors: Parthiban J. K. B. C. , Ali Sheena
Published: May 2022

Background:

To analyse the effect of graft harvesting from adjacent vertebral bodies in Anterior Cervical Discectomy and Fusion.

Objective:

The objective of this study is to analyze the effect of harvesting bone graft from adjacent vertebral bodies on cervical spine stability, vertebral segment height, and cervical lordosis in single-level anterior cervical discectomy and fusion (ACDF).

Material and Methods:

Thirty patients suffering from cervical radiculopathy and myelopathy were operated on using adjacent corticocancellous bone graft (ACBG) technique. In this technique, autologous cancellous bone is harvested from adjacent vertebral bodies and packed in the intervertebral body cage and the cavities in vertebral bodies are filled with tricalcium phosphate granules. Radiological studies with X-rays of the cervical spine were taken in lateral views preoperatively, immediate postoperatively, and during follow-up periods at intervals of 3-month duration, namely 3, 6, 9, 12 months, and at the end of 2 years postoperatively. Studies undertaken were – degree of fusion using modified Bridewell's formula, disc space settlement using Indigenous method, and vertebral segment height and lordotic angle using Cobb's angle.

Results:

Satisfactory bony fusion was seen achieved in all patients at the end of 1 year. Although the settlement of disc space was appreciated, vertebral segment height remained increased at the end of 1 year. Cervical lordosis increased over a period of time during fusion process. The average preoperative Cobb's angle of 15.61° ± 1.81° improved to 20° ± 1.37°degrees at the end of 2 years postoperatively.

Conclusion:

Harvesting bone from adjacent cervical vertebrae does not weaken spinal segment and the fear and skepticism that prevailed over the years are false. ACBG technique is a potential alternative to other existing techniques in ACDF.
Sub-axial cervical dislocation
Authors: Shukla Amit , Singh Suyash
Published: May 2022

A cervical dislocation injury is unstable and defined by the ligamentous complex disruption with separation of the adjacent spine vertebrae. Dislocation is used when the articular facets of the apophyseal joints are no longer in contact with each other and both inferior articular facets of the upper vertebra are locked in front of the superior articular facets of the lower vertebra. Hence, dislocation can be unilateral or bilateral accordingly. It is usually the result of combined flexion and distraction moments most commonly caused by a road traffic accident. In this review article, we have made an attempt to simplify and brief the topic and collectively presented all available recommendations for practical usage.