bluuebunny/crossref_metadata_2025 huggingface dataset:
A Sutra as a Notebook? Printing and Repurposing Scriptures in Medieval Japan
Authors: Dolce Lucia
Published: May 2023

This study considers how printed scriptures were repurposed in medieval Japan through manuscript interventions. My starting point is the so-called Chū Hokekyō (Annotated Lotus Sutra), a copy of the Lotus Sutra probably printed in the Nara area and owned by the monk Nichiren (1222–1282). On this sutric text Nichiren wrote “notes,” filling the negative space between the lines of the scripture, the upper and lower margins of the printed area, and the verso. Such interventions generate a palimpsestic object, overlapping two types of text, the printed and the manuscript, and creating complex dynamics of interaction and multiple use. Is there a relation between what is inserted and the point of the scripture at which it is inserted? What information is supplemented by the “notes,” and to whom is this directed? Nichiren’s Lotus Sutra also urges us to interrogate the status and function of Buddhist printing in medieval Japan. Were sutras printed to be used as learning tools (reading matter and reference material), or does Nichiren’s specimen document a practice of repurposing scriptures originally printed for other reasons? How many scriptures were printed and how many were annotated? What was the nature of such paratextual accretions? This article explores these questions by reconstructing the life of the Annotated Lotus Sutra as an object that was produced with specific techniques and continued its life after Nichiren’s death. In order to contextualize this object, the article retrieves the printing history of the scripture owned by Nichiren, the Lotus Sutra, and the diverse practices of repurposing that affected this genre of printed scriptures in the medieval period.本論文では、中世日本において、印刷された経典が手書きの注記を通じてどのように転用されたかを考察する。最初に取り上げるのは、いわゆる『注法華経』である。これは奈良時代に印刷されたとされる『法華経』の経典で、日蓮（1222-1282）が所有していた。日蓮はこの経典の行間、天地、紙背などの余白に「注記」を施している。その結果、この経典は印刷物と写本の2種類のテキストの多層構造を持つようになり、相互作用と多重利用の複雑なダイナミズムが生まれた。注記文と、それが挿入された場所との間に関係はあるのだろうか？「注記」はどんな情報を補足しており、それは誰に宛てられたものなのだろうか？日蓮の『法華経』は、中世日本の経典印刷の持つ位置づけと用途についても、私達に問いかけている。そもそも経典は、教材（読み物、メモ帳など）として使用するために印刷されたのだろうか、それとも日蓮の『注法華経』は、当初は別の理由で印刷された経典を転用するという当時の習慣の一つの例なのだろうか？経典は何部ほど印刷され、そのうちいくつに注記が施されたのだろうか？さらに主要な文に添えられた注記というものはどんな性質を持っていたのか？こうした疑問への答えを見つけるため、本論文では「注法華経」を、特定の手法を用いて制作され、日蓮の死後も存在し続けた一個の物体とみなし、その「生涯」の再構成を試みた。当時の状況に基づいて判断を下せるように、ここでは日蓮が所有していた経典である『法華経』の印刷の歴史、そして中世においてこの種の印刷経典に影響したさまざまな転用の慣習を取り上げている。
The Emotional Toll of Wartime Bell Deployment in Japan
Authors: Fowler Sherry
Published: May 2023

Buddhist temple bells (bonshō) are a precious feature of almost every Japanese temple. These bells often have a singular status within their environment, with a strong aural and visual presence prominently positioned in their own structure. While most past studies of Buddhist bells have concentrated on their inscriptions, craftsmanship, technologies, or sound, this article will focus on how approximately 45,000 of them disappeared during the late 1930s and mid-1940s. During the Asia-Pacific War, as metals grew scarce, temple bells became a material resource for munition production. Why were temples and shrines convinced to give up their bells that embodied the hopes and vows of past donors? What was the process of transformation from a religious instrument used to comfort the dead into an object that would destroy life? Four case studies, presented as object biographies of bells that date from the seventeenth to eighteenth centuries, will be examined to consider these questions, as well as how these bells managed to escape the fate of being melted down and the international, national, and local ramifications of reuniting these survivors with their original temples.梵鐘は、日本のほとんどの仏教寺院に欠かせないものである。寺院の中でもしばしば特別の重要性を持つ梵鐘は、独立した建物に設置され、強い視覚的、聴覚的な存在感を放つ。これまで梵鐘に関しては、銘文、製作技術や技能、音色などに焦点を当てて研究が行われてきたが、本論文では、1930年代後半から1940年代半ばの間に、約4万5000点が姿を消したという事実に注目する。太平洋戦争中、金属不足が深刻になると、梵鐘は武器弾薬の素材として供出を求められるようになった。過去の寄贈者の願いや誓いが込められた梵鐘の供出要請に、神社仏閣はなぜ応じたのだろうか。死者を供養するための法具から、生命を破壊する武器への転換のプロセスは、どのようなものだったのだろうか。17～18世紀に鋳造され、現在まで残った4つの梵鐘の来し方を振り返るケーススタディを通じて、この問題への答え、およびこれらの梵鐘がどうやって溶解される運命を免れたかを探る。さらにこれらの梵鐘がもともと安置されていた寺院に返還された時に、海外、全国、そして地域レベルでどのように影響があったかを考察する。
“Is It Hype or Reality?”
Authors: Niranga Mahikala , Sedera Darshana
Published: May 2023

The researchers commenced this study expecting to discover ample evidence of global digitalization – especially attributed to the COVID-19 global pandemic. Yet, the investigation using multiple highly credible indicators of digitalization for a period of 3 years (2018 to 2020), covering pre, during, and post-pandemic, the researchers could only identify partial evidence of a high rate of digitalization, and many of the countries slowed down their respective rates of digitalization. This study showed that only 61 of sampled countries demonstrated a high rate of digitalization, while the 96 remaining countries slowed down their digitalization rates. Considering the purported ‘hype of digitalization' spreading across the globe, notwithstanding the boundaries of geography and resources, the researchers appeal to academia and practice to witness the authentic indicators of digitalization in this global study.
Barriers in Replacement of Conventional Vehicles by Electric Vehicles in India
Authors: Bhattacharyya Disha , Pradhan Sudeep , Shabbiruddin
Published: May 2023

Electric vehicles are an emerging and evolving technology that brings in remarkable environmental gains over conventional vehicles, contributing significantly towards a decrease in fossil fuel dependence. However, infiltrating into the existing automobile market requires huge investment in charging facilities and intricate planning to make it more approachable to the consumers. Identifying the crucial challenges and finding a solution has been a major hurdle to the manufacturers. While various non-government agencies and government policies are urging both consumers and manufacturers to adopt electric mobility, many industries remain unguided. The paper aims to identify, study, and rank 12 of these influential challenges faced by the manufacturers based on their impact on enhancing the manufacturing and sales of electric vehicles in India using the triangular fuzzy number (TFN) method. Results obtained reveal that inadequate charging infrastructure is one of the biggest hurdles.
Small Data Fusion Algorithm for Personalized Library Recommendations
Authors: Liu Yi , Xu TianWei , Xiao MengJin
Published: May 2023

In order to better grasp the needs of library users and provide them with more accurate knowledge services, combining the characteristics of university libraries, this article applies library small data to personalized recommendation and proposes a small data fusion algorithm model for library personalized recommendation. This model combines the characteristics of small data and realizes multi-dimensional small data fusion by using fully connected neural network to capture the potential collaborative filtering information between users and projects, better grasp the needs of readers and users, and provide valuable assistance for subsequent personalized recommendation research. The effectiveness of the proposed method in personalized recommendation of library resources is verified by comparing several groups of experiments on public and self-built data sets.
Influence of Erbium and Thermal Treatments on the Microstructure and Hardness of Al-Mg-Si Alloy
Authors: Mikami Mizuki , Banjongprasert Chaiyasit
Published: May 2023

The influence of Erbium (Er) addition and thermal treatments on the microstructure and hardness of Al-0.5 wt.%Mg-1.0 wt.%Si alloy has been studied. Chemical composition of the alloys was measured by optical emission spectrometry (OES) and x-ray fluorescence (XRF). Microstructural evolution of as-cast, solution-treated, and aged samples were characterized by scanning electron microscope (SEM). The phase identification and elemental distribution were obtained from energy dispersive spectroscopy (EDS). From the microstructure, it was confirmed that solutionization at 570 ͦ C for 15 hours dissolved the Mg2Si and Er-rich intermetallics. However, some Fe-rich intermetallics remained after the solution heat treatment. Er addition had a role on the modification of β-AlFeSi and improved the hardness. Er-modified Al-Mg-Si alloy gave a significant improvement in mechanical properties. Therefore, Er is one of the candidate elements that could provide an opportunity for a high-strength Al-Mg-Si alloy.
Structures of Wooden Beams of Increased Load-Bearing Capacity
Authors: Egorov V. , Abu-Khasan M. , Mamyrova A. , Sidorova P.
Published: May 2023

The article suggests the use of glued reinforced wooden beams with increased load-bearing capacity. The beam is provided with reinforcing elements in the grooves, namely, in the lower zone – prestressed flexible bundles made of composite, and in the upper zone – steel rods. The analysis of structural behaviour of the beam and the location of the reinforcing elements, the calculation of the bearing capacity of beams and evaluation of the effectiveness decision on material and Flexural rigidity. Composite rods can be prestressed to increase the efficiency of the reinforcement and increase the beam stiffness and load-bearing capacity. Installation of reinforcing elements along the line of action of the main tensile stresses in a wooden beam creates tension in them, which allows the use of flexible bundles and leads to a decrease in the complexity of their installation in the lower grooves, and, therefore, reduces the complexity of manufacturing a wooden beam as a whole.
Property Improvement of Polybutylene Succinate (PBS), Polyhydroxybutyrate (PHB), and Polylactic Acid (PLA) Films with PCL (Polycaprolactone) for Flexible Packaging Application
Authors: Ramos Maximiano , Govindan Srinivasan , Al-Jumaily Ahmed M.
Published: May 2023

Nowadays, developing highly biodegradable polymer films for flexible packaging applications is one of many researchers' demanding and challenging tasks. Conventional plastics/polymers are still being extensively used, creating environmental pollution. Because most of the commercially available plastic products are marketed as biodegradable are not truly biodegradable and have several limitations for making flexible packaging films. The main objective of this work is to manufacture biodegradable polymer blends, with the best performance characteristics, for flexible packaging applications. The paper focused on improving the properties, i.e., tensile, barrier, and biodegradation properties, of commercially available polymers such as Polybutylene succinate (PBS), Polyhydroxybutyrate (PHB), and Polylactic acid (PLA) by blending with Polycaprolactone (PCL) for flexible packaging application. Polymer films of various compositions such as PBS-PCL, PHB-PCL, and PLA-PCL blends were fabricated by injection molding and hot pressing. The characterization analysis included analyzing polymer blends' tensile and water vapor barrier properties, as per ASTM D882-18 method and ASTM E96-16 method, respectively, following that biodegradation analysis in compost (ASTM D5338-15 method) and seawater medium (ASTM D6991-17 method) of the polymer blends, and analysis of PCL blends' effect. The research showed that compared to the pure polymer blends such as PBS, PHB, and PLA blends, polymer blends with 20% of PCL has increased tensile elongation by 26.3%, 68%, and 171%, respectively, and the water vapor barrier properties were increased by 28.3%, 26.8%, and 30.3%. the biodegradation rate in compost medium was increased by 21.9%, 6.4% and 21.2%, and the biodegradation rate in seawater medium was increased by 31%, 7.5%, and 16.6%, respectively, even though a slight decrease in tensile strength. In conclusion, the polymer blends with 20wt% of PCL provide overall improved of polymer properties.
Electrochemical Analysis of Magnesium Orotate Tautomers
Authors: Kanunnikova Olga M. , Reshetnikov S.M. , Chuchkova N.N. , Smetanina M.V.
Published: May 2023

The oxide-ruthenium electrode is used for the analysis of oxygen-containing biologically active organic substances. This electrode can be recommended for the analysis of formic acid in dilute solutions (no more than 2 ml in 100 ml of solution). Due to the presence of two display potentials, the reliability of the determination of formic acid in solution is quite high. For the determination of nitrogen-containing compounds (urea), oxide-ruthenium electrodes are unsuitable.
The obvious differences in the polarization curves of magnesium orotate tautomers indicate that the structural differences of tautomers persist in aqueous solutions. An electrochemical method using a ruthenium oxide electrode can be recommended for the analysis of the isomeric state of organic compounds containing OH and COOH groups. The electrochemical method has clearly shown that the difference in the structural state of magnesium orotate tautomers persists in solutions.
Morphology and Properties of Poly(Lactic Acid) and Polybutylene Succinate and Ethylene-Co-Methyl Acrylate-Co-Glycidyl Methacrylate Ternary Blends
Authors: Wacharawichanant Sirirat , Netphong Patcharin , Pipatbannakit Thakoon , Phankokkruad Manop
Published: May 2023

This work studied the morphological, mechanical, and thermal properties of poly(lactic acid) (PLA)/polybutylene succinate (PBS)/ethylene-co-methyl acrylate-co-glycidyl methacrylate (EMA-GMA) ternary blends. The polymer blends were prepared in an internal mixer and then molded into films by compression molding. The results showed that the PLA/PBS blends had immiscible morphology in which the PBS phase was dispersed in PLA matrix as spherical shape. The PBS droplet size increased with increasing PBS content. The fractured surface of PLA/PBS/EMA-GMA blends displayed more small crack of plastic deformations than that of PLA/PBS blends and the fracture behavior of PLA/PBA blends was changed to more ductile fracture when added with EMA-GMA. The addition of EMA-GMA in polymer blends improved the compatibility of two phases. The results of the mechanical properties showed that PBS and EMA-GMA addition improved the strain at break of PLA/PBS and PLA/PBS/EMA-GMA blends, respectively. The incorporation of EMA-GMA had no effect on the melting temperature and degradation temperature of PLA blends. The PLA/PBS/EMA-GMA blends had lower percent crystallinity than that of PLA/PBS blends and most of percent crystallinity decreased with increasing EMA-GMA loading due to its more amorphous structure than PLA and PBS.
Mutations to the BTN2A1 Linker Region Impact Its Homodimerization and Its Cytoplasmic Interaction with Phospho-Antigen–Bound BTN3A1
Authors: Nguyen Khiem , Jin Yiming , Howell Matthew , Hsiao Chia-Hung Christine , Wiemer Andrew J , Vinogradova Olga
Published: May 2023

Intracellular binding of small-molecule phospho-Ags to the HMBPP receptor complex in infected cells leads to extracellular detection by T cells expressing the Vγ9Vδ2 TCR, a noncanonical method of Ag detection. The butyrophilin proteins BTN2A1 and BTN3A1 are part of the complex; however, their precise roles are unclear. We suspected that BTN2A1 and BTN3A1 form a tetrameric (dimer of dimers) structure, and we wanted to probe the importance of the BTN2A1 homodimer. We analyzed mutations to human BTN2A1, using internal domain or full-length BTN2A1 constructs, expressed in Escherichia coli or human K562 cells, that might disrupt its structure and/or function. Although BTN2A1 is a disulfide-linked homodimer, mutation of cysteine residues C247 and C265 did not affect the ability to stimulate T cell IFN-γ production by ELISA. Two mutations of the juxtamembrane region (at EKE282) failed to impact BTN2A1 function. In contrast, single point mutations (L318G and L325G) near the BTN2A1 B30.2 domain blocked phospho-Ag response. Size exclusion chromatography and nuclear magnetic resonance (NMR) experiments showed that the isolated BTN2A1 B30.2 domain is a homodimer, even in the absence of its extracellular and transmembrane region. [31P]-NMR experiments confirmed that HMBPP binds to BTN3A1 but not BTN2A1, and binding abrogates signals from both phosphorus atoms. Furthermore, the BTN2A1 L325G mutation but not the L318G mutation prevents both homodimerization of BTN2A1 internal domain constructs in size exclusion chromatography (and NMR) experiments and their binding to HMBPP-bound BTN3A1 in isothermal titration calorimetry experiments. Together, these findings support the importance of homodimerization within the BTN2A1 internal domain for phospho-Ag detection.
Impact of viral co-infection on clinical outcomes and mortality of COVID-19 patients: a study from Saudi Arabia
Authors: Abu Elhassan Usama E. , Alqahtany Saad M.A. , Al Saglan Naif S. , Hawan Ali , Alshahrani Khadejah M. , Al-Malih Hana S. , Alshehri Mohammed A. , Alqahtani Faisal S. , Alshomrani Fatimah , Almtheeb Roaa S. , Feteih Ibrahim H.E. , Abdelwahab Magda S.R. , Mahmoud Ibrahim M.A.
Published: May 2023

Background: In COVID-19 patients undetected co-infections may have severe clinical implications associated with prolonged hospitalization, ICU admission and mortality. Therefore, we aimed to investigate the impact of viral co-infections on the outcomes of hospitalized patients with COVID-19 in a large tertiary Saudi Arabian Hospital.Methods: A total of 178 adult patients with confirmed SARS-CoV-2 who were hospitalized at the Armed Forces Hospital Southern Region (AFHSR), Saudi Arabia, from March 1st to June 30th 2022, were enrolled. Real-time PCR for the detection of viral co‑infections was carried out. Cases (SARS-CoV-2 with viral coinfections) and control (SARS-CoV-2 mono-infection) groups were compared.Results: 12/178 (7%) of enrolled COVID-19 patients had viral coinfections. 82/178 (46%) of patients were males. 58% of patients had comorbidities. During the study period, 4/12 (33%) and 21/166 (13%) cases and control patients died, p=0.047, respectively. Duration of hospitalization was the only significant independent factor associated with SARS-CoV-2 coinfections, OR 1.140, 95% CI 1.020–1.274, p=0.021.Conclusions: The findings of this study from a large tertiary Saudi Arabian Center revealed a prevalence of 7% for SARS-CoV-2 viral coinfections. SARS-CoV-2 coinfected patients had a significantly prolonged duration of hospitalization and higher mortality than those with SARS-CoV-2 alone. Future studies are needed.
A Survey of Chinese Regular Blood Donors who were Enrolled into an Iron Replenishment Program – a Hint for Dietary Factors
Authors: LEE Idy Yik Mun , CHU Chelly Chui Yee , WONG Nga Sze , LEUNG Lai Yi , LEE Cheuk Kwong
Published: May 2023

Background and Objectives:

Concern on donors' health and safety is growing in importance in many countries. One of the key issues is related to low body iron store in regular blood donors that some countries have advocated iron supplementation in addition to education. A survey was performed to look at the dietary factors in blood donors under an iron replenishment program in Hong Kong. The objectives of this survey were to evaluate the possible causes for iron deficiency and evaluate the effectiveness of education and iron supplementation program.

Methods:

A pre- and post- health education survey was conducted to evaluate the effectiveness of an iron replenishment program addressing iron deficiency among regular blood donors. Eligible donors were invited to attend a health education held by a registered nurse after predonation hemoglobin test. A questionnaire was used to ask donors on their dietary habit, knowledge on iron deficiency, and iron supplement.

Results:

Of 428 participants, male donors preferred eating out for breakfast (P = 0.003) and lunch (P = 0.0005) than females. Those donors who preferred eating out were also likely to have higher frequency of taking tea or coffee (P = 0.0005). When compared the donors' knowledge and confident level in taking iron replacement, significance was identified between genders and pre- and posthealth education. An affirmative donor satisfaction toward the nursing support and the iron replenishment program was also observed.

Conclusion:

The study result provided an insight into the possible dietary factors. The positive outcome of the health education warrants further planning of educational strategies to address the gender difference but also to achieve a better effect from iron replenishment.
Dramatic Response to Therapeutic Plasma Exchange in Acute Transverse Myelitis following Dengue Fever
Authors: Kaur Pandeep , Kumar Rakesh , Singh Mohitpreet , Singh Prabhjeet
Published: May 2023

Dengue is a mosquito-borne viral disease which has reached fearsome proportions in the past few years. Acute transverse myelitis (ATM) is a rare complication of dengue characterized by onset of bilateral lower limb weakness, paresthesia, and urinary retention and magnetic resonance imaging of the whole spine shows diffuse areas of abnormal hyperintensity on T2-weighted images involving the cord in the cervical and the dorsal region extending up to the level of conus. Treatment is usually steroids, intravenous immunoglobulin, and therapeutic plasma exchange (TPE). We report a case of ATM in a young male patient who was successfully treated by TPE.
Immunohematological Discrepancy – Due to Nuisance Antibody!
Authors: Mehra Ruhi , Bhave Abhay , Pujare Savita , Chavan Nitin
Published: May 2023

Timely provision of blood plays an important role in the management algorithm of patients. Interference by minor blood group (BG) antibodies has become a common entity among multi-transfused patients; other nonsignificant antibodies are too encountered rarely. We report one such interfering nonspecific antibody in a 55-year-old female patient posted for splenectomy at our institute. BG discrepancy (type one) with a pan-positive (4+) antibody screening panel was found in her testing results. Crossmatches were compatible at antihuman globulin phase and at room temperature, and autocontrol was negative. Detailed meticulous immunohematological workup helped us in concluding that the offending antibody was not directed against the ingredients of column matrix of gel cards or the enhancement media (low ionic strength solution); rather it was directed against the chemical constituents in the suspension medium of commercial cell panel. Bearing the presence of nonspecific “nuisance” antibodies in mind becomes extremely important so that they can be detected and managed quickly.
Assessment of Quality Management Practices across Asian Countries
Authors: Mangwana Sadhana , Bhatnagar Nidhi , Aravinth L. , Choudhury Nabajyoti
Published: May 2023

Background and Objectives:

Globally, there is a wide variation in Quality management practices and availability of Quality Standards. Because of a paucity of data on QM practices in BTS in various Asian countries, this study was undertaken to understand the quality assurance (QA) programme within the blood bank settings.

Methods:

The study was conducted by the Quality Working Group of Asian Association of Transfusion Medicine (AATM), by an online questionnaire having 25 questions which were circulated amongst various blood centres of member Countries of Asian Association of Transfusion Medicine (AATM).

Results:

60 blood centres participated. 43 were Hospital based Blood Centres and 17 were from Stand-alone Blood Centres. The majority of the responders were from a tertiary care hospital (92%). More than 83% of blood centres, either accredited or planning to move forward, were conducting internal audits, more than 86% were having Quality policy and QMS.

Conclusion:

It is evident from this study that blood centres, by and large, maintain good practices as they are under the purview of regulatory bodies of the respective countries and hence follow Good Manufacturing Practices (GMP). As the Asian countries come under the LMIC category; hence the financial cost could be a major hindrance in achieving quality standards, but few extra miles to achieve quality standards or accreditation will ultimately lead to better patient care.
A Prospective Study on the Prevalence of Red Cell Alloimmunization via Fetomaternal Hemorrhage and its Association with Bad Obstetric History
Authors: Vijayakumar Divya , Shaiji P. S. , Meena D. , John Soonam
Published: May 2023

Background and Objectives:

The presence of irregular red cell antibodies in the serum of pregnant women is named maternal alloimmunization. Sensitizing events such as traumatic delivery and miscarriage can cause fetomaternal hemorrhage, increasing the risk of alloimmunization. Our objective was to estimate the prevalence of red cell alloantibodies among multigravidae and to study its association with those cases with bad obstetric history (BOH).

Methods:

This was a 1-year cross-sectional study done on 900 multigravidae in the Department of Transfusion Medicine, Medical College, Thiruvananthapuram. We excluded patients with a history of blood transfusion.

Results:

Out of 900 subjects, 49 (5.4%) were alloimmunized. The RhD-positive cases were predominant (77.4%), while 203 (22.6%) were RhD negative. Among the D-positive women, the prevalence of alloimmunization was 1.3%. The most frequent alloantibody identified was anti-D, followed by anti-G (18.4%). The alloantibodies identified among RhD-positive were anti-E, anti-c, anti-C, anti-Fya, anti-M, anti-Jka, and anti-Leb. We identified a total of 58 clinically significant alloantibodies. Thus, Rh blood group alloantibodies constitute 93.1% and the remaining 6.9% by other blood groups. Out of 159 cases with BOH, 17 were alloimmunized, and there was a statistically significant association between them (P = 0.001).

Conclusion:

Alloantibodies potentially causing hemolytic disease of the fetus and newborn were found in D-negative (19.7%) and D-positive (1.3%) mothers. The clinicians should change the current practice of screening only D-negative pregnant women, and antibody screening should be offered to all females or at least those with BOH. We may thus ensure early detection and periodic monitoring of all alloimmunized women.
R2 R2 Phenotype Blood Requirements for Liver Transplantation Surgery in a Child with Multiple Rh Antibodies
Authors: Sachan Deepti , Gundrajukuppam Deepthi Krishna , Shanmugam Naresh , Rajalingam Rajesh , Rela Mohamed
Published: May 2023

Red cell alloimmunization often poses challenge for transfusion support during surgery. As transfusion needs are unpredictable in liver transplant recipients, it requires well-equipped immunohematology laboratory for timely antibody identification and good coordination with other blood centers, for the arrangement of compatible units in case of rare phenotypes. We present a case of child with multiple Rh antibodies (Anti-C & anti-e) requiring rare R2R2 phenotype blood units for liver transplantation. With no antigen negative units available in inventory, various blood centers in India were approached individually and through social media. Eleven R2R2 units were transferred by air from three blood centers from North India (New Delhi) to South India (Chennai) with the help of Courier services maintaining cold chain over 24 h with data logger facilities. The patient underwent LT with 2 units (R2R2 phenotype) transfused intraoperatively and 3 units in postoperative period. The patient was discharged on postoperative day 18 with Hb 8.0 gm/dL. The case highlights the need for national/zonal database of rare phenotype blood donors to timely fulfil the blood requirement of patients in need.
A Rare Case of Hb Q India- An Uncommon Hemoglobin Variant
Authors: Ahuja Tejal Vishandas , Bhatnagar Nidhi , Soni Shital , Shah Mamta C , Shah Sangita D
Published: May 2023

Hemoglobinopathies are the most common hereditary disorders in India and pose a major health problem. Both beta-thalassemia and structural hemoglobin (Hb) variants are relatively common in North-Western India. Here, we report a case of a 26-year-old female (caste-Lohana) who came to us for premarital screening hemoglobinopathy. A complete blood count was done on automated cell counter. Hb analysis was carried out using high-performance liquid chromatography (HPLC) Bio-Rad VARIANT II Hb Testing System. HPLC analysis showed a peak in the unknown window with retention time (RT): 4.72 min and area: 18.9% and S-window with RT: 4.33 min and area: 0.5%, which was suggestive of Hb Q India. Further workup was done on other family members also. And found that the mother and sister of the patient also had similar findings (Hb Q India) and the father of the patient was positive for beta-thalassemia trait. Hb Q India is a rare hemoglobinopathy, which presents in mostly heterozygous form. The inheritance of Hb Q India is autosomal dominant.
Transitory Absence of ABO Antibodies during Severe Acute Respiratory Syndrome Coronavirus 2 Infection
Authors: Das Soumya , Karaskar Manisha , Dabhekar Sandeep B. , Khot Rajashree , Prathipati Kiran Kumar , Bidkar Vijay G. , Shrikrishna BH , Kumbhalkar Sunita
Published: May 2023

Since the advent of the pandemic, ABO blood group has a role in the immunopathogenesis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Disagreement between forward and reverse typing leads to ABO discrepancy which arise either due to intrinsic problems or from the technical errors in performing the test. Here, we document the two cases of transient absence anti-A and anti-B antibodies among two COVID patients proved by serological techniques, with the photographic representation of their immunohematological workups. SARS-CoV-2 viral envelop proteins mimicking as A and B antigen expressed on red blood cells (ABOs) and anti-A and anti-B antibodies acting as viral neutralizing antibodies, possible explanation for appearance of such phenomenon among patients. The ABO blood grouping of such discrepancy patients should be cautiously reported and advised to repeat once after full recovery. Transfusion center should be prepared appropriately in case of blood component support needed among such patients.
Assessment of blood collection, demand and supply during COVID-19 pandemic in a tertiary care hospital in Northern India
Authors: Solanki Archana , Kumar Sunil , Singh Ashutosh , Chauhan Abhishek , Chandra Tulika
Published: May 2023

Background:

During the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) disease (COVID-19) outbreak, blood donations were significantly decreased; hence, blood transfusion services (BTSs) faced difficulties in delivering the blood supply to the patients in need.

Methods:

This study aimed to assess the blood collection, supply and demand during pandemic so that it helps to find the appropriate measures to tackle similar global emergencies in the near future. All the patients whose requisition forms for blood requirements came to us from various hospitals were included in the study.

Results:

Blood collection has been reduced to 46.6%, demand for blood has declined to 54.5% and the blood supply has also been reduced to 67.0% during the COVID-19 pandemic. The demand for blood in females was relatively higher than in male patients. Maximum demands of packed blood cells were recorded for O-positive blood group patients in 30–39 years of age with severe anaemia, followed by cancer and trauma. The demand for blood was more as compared to blood collection and supply. This gap between demand and supply showed a negative impact of the COVID-19 pandemic on BTSs.

Conclusions:

The COVID-19 pandemic had a negative impact on donor attendance and participation. Thus, adversely affects the BTSs in sustaining the equilibrium between blood demand and blood supply.
Knowledge and attitude of females on female genital cosmetic surgery at a tertiary healthcare institute of India
Authors: Gowardhan Atul K. , Bagade Priya Manohar
Published: May 2023

Background:

Female genital cosmetic surgery (FGCS) is relatively a new contemporary introduction to the field of plastic and cosmetic surgery. The present study aims at ascertaining the knowledge, outlook and attitude for Female Genital Cosmetic Surgeries in the female patients attending the outpatient department in one of the private health care institute of India.

Methods:

A cross-sectional study was conducted in a tertiary health care centre over a period of six months involving 526 patients. Knowledge and attitude of these patients towards FGCS was assessed using a questionnaire. Perineoplasty, labioplasty, hymenoplasty, labia majora augmentation and G-spot amplification were the procedures included in the study.

Results:

Knowledge about FGCS was evident in 26.2%. Social Media (56.5%) was the most common source of information in these participants. Apositive attitude towards FGCS was seen in 82.9% of patients after counselling. Age, education, employment, marital status, parity etc., were the different parameters which influenced the acquirement of knowledge in the study population.

Conclusions:

Majority of the patients had poor knowledge about FGCS procedures, but most of the patients had positive attitude towards these procedures after proper guidance and reassurance.
Autoimmune thyroid disease: Case reports of two siblings
Authors: Onwukwe Chikezie Hart , Nwalozie Justin Chibueze , Kalu Okorie Kalu , Chikezie Nkiru Ifeoma
Published: May 2023

Autoimmune thyroid disease (AITD) is typified by Graves’ disease (GD) and Hashimoto’s thyroiditis (HT) at both ends of the disease spectrum with subclinical thyroid dysfunctions in between. Genetic associations have been described in the pathogenesis of AITD. We describe a case each of GD and HT occurring in two siblings.
Neuromuscular blockade characteristics of cisatracurium in patients receiving chemotherapy: A preliminary study in breast cancer patients
Authors: Gupta Sonali , Dubey Mamta
Published: May 2023

Background and Aims:

Cancer chemotherapeutic agents cause alteration in the response to neuromuscular blocking drugs, which can have serious perioperative implications. Magnesium, commonly found to be deficient in these patients, plays an indispensable role in neuromuscular transmission. This study aimed to understand the effect of neoadjuvant chemotherapy on the neuromuscular blocking properties of cisatracurium.

Material and Methods:

One hundred female patients scheduled for breast cancer surgery were divided into two groups (n = 50 each). Group B received neoadjuvant chemotherapy with taxane, adriamycin, and cyclophosphamide, and Group A did not receive neoadjuvant chemotherapy. Neuromuscular block following cisatracurium 0.15 mg/kg was measured using peripheral nerve stimulator at the ulnar nerve. Onset time, duration of intense block, clinical duration of action, time to TOF4 after the last dose of cisatracurium, along with preoperative serum magnesium concentration were measured. Correlation and multiple regression were run to analyze the relationship between history of neoadjuvant chemotherapy, preoperative magnesium, and the abovementioned time points. Mediation analysis was done to ascertain if magnesium was mediating the observed effects.

Results:

Onset time was prolonged by nearly 18% in Group B compared to Group A (P = 0.001). The duration of intense block was 35.27 ± 8.9 min in Group B and 42.07 ± 10.99 min in Group A (P < 0.001). The clinical duration of action of cisatracurium was significantly shorter in Group B (46.06 ± 8.68 min) compared to Group A (55.87 ± 11.04 min, P < 0.001). The time to TOF4 was 32.86 ± 5.66 min in Group B and 36.57 ± 8.49 min in Group A (P < 0.05). Preoperative serum magnesium levels were significantly lower in Group B (P < 0.001).

Conclusion:

Patients who had received neoadjuvant chemotherapy had a delayed onset, shorter duration of action, and faster recovery for cisatracurium. Although preoperative magnesium levels were lower in Group B, it was found to be an independent predictor rather than a mediator of these effects.
Does the objective measurement of muscle strength improve the detection of postoperative residual muscle weakness?
Authors: Padmaja Durga , Singam Geetha , Tappa Rabbani , Maremanda Krishnarao , Kabra Nitesh , Barada Anupama
Published: May 2023

Background and Aims:

The postoperative residual neuromuscular block (PRNB) has a significant impact on patient safety and well-being, but continues to remain underestimated. Objective evaluation of handgrip strength using a force dynamometer can be useful to identify postoperative muscle weakness.

Material and Methods:

Thirty-two American Society of Anesthesiologists (ASA) class I and II patients who received general anesthesia were included. Patients were extubated after the train-of-four (TOR) ratio (TOFR) was >0.90 and the clinical criteria for motor power recovery were judged as adequate. The measurements of handgrip strength and peak expiratory flow rate (PEFR) were obtained at baseline, 15 min after extubation, and 1, 2, and 4 h postoperatively. The incidence of significant decline from baseline (>25%) was determined. The correlation between handgrip strength and PEFR was assessed using Spearman correlation. The time to return to baseline for muscle grip strength and PEFR was performed using Kaplan–Meier survival analysis. A P value of 0.05 was considered significant for all tests.

Results:

The incidence of the significant decline in handgrip strength from baseline was 100% at 15 and 60 min, 76% at 2 h, and 9.4% at 4 h. There was a strong correlation between muscle grip strength and PEFR (0.89, P < 0.001). None of the patients exhibited the potential complications of PRNB. (PRMB in abstract. It should be uniform) The mean time to return to the baseline value of muscle grip strength was 3.8 h (95% confidence interval [CI] 3.6–3.9), and the mean time to return to baseline for PEFR was 3.2 h (95% CI 2.9–3.4 h).

Conclusion:

Objective assessment of muscle grip strength using a force dynamometer has the potential to be a new objective metric to monitor postoperative muscle weakness.
Coping strategies and emotional responses adopted by health care workers during COVID-19 pandemic-braving the storm
Authors: Sharma Shruti , Sharma Sarit , Gunchan Paul , Parshotam Gautam Lal , Bansal Namita , Singh Gurwinder , Kaur Arshdeep
Published: May 2023

Background and Aims:

Health care workers (HCWs) are caught in the middle of the COVID-19 pandemic storm and are exposed to a large degree of physical and emotional stress. This study was planned to describe the stressors, stress levels, emotional responses, and coping strategies adopted by HCWs amidst this pandemic.

Material and Methods:

This cross-sectional, web-based survey was conducted after ethics approval, using a structured performa incorporating standardized stress (PSS-10 C), emotional responses (PANAS-10), and coping strategy (Brief COPE) scales. The snowball sampling technique was used to conduct the study and collect data. Data were analyzed using SPSS 26 version (SPSS Inc., Chicago, IL, USA) statistical software. A P value of <0.05 was considered significant.

Results:

Out of 402 participants (65% doctors and 35% nurses), 87% perceived moderate stress levels, and nearly half of the participants were interns, residents, and medical officers. Infection to self or family members (77.1%), survival of sick patients (75.6%), aggression by patients and relatives (70.3%), and long duty hours (67%) were some of the major stressors as reported by HCWs. The most common positive emotion felt was being alert (19.17 ± 5.57) and negative emotion perceived was being upset (15.6 ± 6.06). Many participants adopted emotion and problem-focused coping strategies such as planning and strategization (68%) and positive reframing (67.6%), whereas dysfunctional coping strategies such as venting and denial were adopted less commonly.

Conclusion:

Moderate stress levels perceived by HCWs are a cause for concern. Emotional responses of HCWs to stress vary; however, appropriate coping strategies including emotional and problem-focused coping strategies are the need of the hour to tackle pandemic-related stress.
Emergency use of sugammadex after failure of standard reversal drugs and postoperative pulmonary complications: A retrospective cohort study
Authors: Bruceta Melanio , Singh Preet M. , Bonavia Anthony , Carr Zyad J. , Karamchandani Kunal
Published: May 2023

Background and Aims:

The use of sugammadex instead of neostigmine for the reversal of neuromuscular blockade may decrease postoperative pulmonary complications. It is unclear if this finding is applicable to situations where sugammadex is administered after the administration of neostigmine. The objective of this study was to compare the incidence of a composite outcome measure of major postoperative pulmonary complications in patients who received sugammadex as a rescue agent after neostigmine versus those who received sugammadex alone for reversal of neuromuscular blockade.

Material and Methods:

This retrospective cohort study analyzed the medical records of adult patients who underwent elective inpatient noncardiac surgery under general anesthesia and received sugammadex for reversal of neuromuscular blockade, at a tertiary care academic hospital between August 2016 and November 2018.

Results:

A total of 1,672 patients were included, of whom 1,452 underwent reversal with sugammadex alone and 220 received sugammadex following reversal with neostigmine/glycopyrrolate. The composite primary outcome was diagnosed in 60 (3.6%) patients. Comparing these two groups, and after adjusting for confounding factors, patients who received sugammadex after reversal with neostigmine had more postoperative pulmonary complications than those reversed with sugammadex alone (6.8% vs. 3.1%, odds ratio, 2.29; 95% confidence interval [CI], 1.25 to 4.18; P = 0.006).

Conclusion:

The use of sugammadex following reversal with neostigmine was associated with a higher incidence of postoperative pulmonary complications as compared to the use of sugammadex alone. The implications of using sugammadex after the failure of standard reversal drugs should be investigated in prospective studies.
Ultrasound guided erector spinae plane block versus thoracic epidural analgesia in traumatic flail chest, a prospective randomized trial
Authors: Mostafa Shaimaa F , Eid Gehan M
Published: May 2023

Background and Aims:

Pain contributes to flail chest morbidities. The aim of this study was to compare the analgesic effects of ultrasound-guided erector spinae plane block (ESPB) with thoracic epidural analgesia (TEA) in patients with traumatic flail chest.

Material and Methods:

Sixty patients aged 18 – 60 years, ASA I-II, with unilateral flail chest were allocated into TEA group with a loading dose of 6 ml bupivacaine 0.25% and 2 μg/ml fentanyl and ESPB group with a loading dose of 20 ml bupivacaine 0.25% and 2 μg/ml fentanyl. This was followed by continuous infusion of 6 ml/hour bupivacaine 0.125% and 2 μg/ml fentanyl in both groups for 4 days. Pain scores at rest and on coughing, rescue analgesic consumption, PaO2/FIO2 ratio, PaCO2, pulmonary functions and adverse events were recorded.

Results:

In both groups, Visual Analog Scale (VAS) scores at rest and on coughing were significantly decreased after block initiation as compared to pre-block value. At all-time points, VAS scores at rest and on coughing were insignificantly different between both groups. PaO2/FIO2 ratio, forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) were significantly increased and respiratory rate, PaCO2, were significantly decreased as compared to pre-block values of the same group without significant difference between both groups. The incidence of hypotension was significantly higher in TEA group than ESPB group.

Conclusions:

ESPB can achieve adequate analgesia in traumatic flail chest equivalent to that of TEA with significant improvement of arterial oxygenation and pulmonary functions and without serious adverse effects.
High daily caffeine intake is associated with lower propofol requirements for anesthetic induction
Authors: O’Connor Stuart AJ. , Maese Samuel J. , Vizcaychipi Marcela P.
Published: May 2023

Background and Aims:

There is significant interindividual variation in the dose of propofol required for anesthetic induction. Factors dictating this are poorly described, but understanding them would be useful for anesthetic drug dosing. It has been shown in rats and recently in humans that caffeine administration accelerates recovery from anesthesia, but no study has assessed the effect on anesthetic induction.

Material and Methods:

Forty American Society of Anesthesiologists (ASA)-I, 18–65-year-old patients, undergoing day case general anesthesia with propofol and fentanyl took part in this observational study. Total daily caffeine intake (mg) was estimated using the caffeine assessment tool and caffeine content values from the US Department of Agriculture National Nutrient Database. Pharmacokinetic–pharmacodynamic modeling was used to estimate the effect site concentration of propofol at loss of consciousness (Ce(p) LOC).

Results:

Median (interquartile range [IQR]) daily caffeine intake was 106 (51–193) mg. Ce(p) LOC was lower in those with caffeine intake greater than or equal to the median of 106 mg (median (IQR) = 0.64 μg/ml (0.51–0.72) vs. 0.70 μg/ml (0.57–1.10), P = 0.04). The effect was robust when controlling for weight-adjusted fentanyl dose, age, smoking status, and alcohol intake (F (1,34) = 4.66, P = 0.04).

Conclusion:

High daily caffeine intake is associated with lower propofol requirements for day case anesthetic induction. We propose that high daily caffeine intake may cause lower arousal levels prior to surgery due to a relative caffeine deficit caused by being nil by mouth. As such, assessment of daily caffeine intake preoperatively may aid anesthetic drug dosing.
Efficacy of fixed-dose phenylephrine bolus for treating post-spinal hypotension: Comparison between pre-eclamptics and normotensives
Authors: Salhotra Rashmi , Tyagi Asha , Rautela Rajesh Singh , Chauhan Jainendra , Dolma Lhamo , Sharma Ankit , Batra Prerna , Srivastava Himsweta
Published: May 2023

Background and Aims:

Pre-eclamptic parturients may have an exaggerated response to vasopressors. This study compares the efficacy of a 50 μg fixed bolus of phenylephrine for treatment of post-spinal hypotension in pre-eclamptic versus normotensive parturients.

Material and Methods:

After written informed consent and ethics committee approval, 30 normotensive and 30 pre-eclamptic parturients between 18 and 40 years with singleton term pregnancy about to undergo cesarean section (CS) under spinal anesthesia were included. Post-spinal hypotension was treated with a 50 μg fixed bolus of phenylephrine. The cumulative dose of phenylephrine, the number of boluses, and the median dose required to treat the first hypotensive episode, total number of hypotensive episodes, maternal side effects, neonatal appearance, pulse, grimace, activity, and respiration (APGAR) scores, and umbilical arterial cord blood pH were noted. Statistical analysis was done using Student’s t-test, Mann–Whitney U-test, Chi-square test/Fisher’s exact test as appropriate. A P <0.05 was considered significant.

Results:

The cumulative dose and number of boluses of phenylephrine required to treat post-spinal hypotension were comparable. The median dose required to treat the first episode of post-spinal hypotension was also similar (p = 0.792). The time to develop the first hypotensive episode was significantly earlier for group N (p = 0.002). The efficacy of a single fixed bolus of 50 μg phenylephrine was similar in both groups (p = 1.000). Neonatal median APGAR scores at 1 min after birth were significantly higher for group N (p = 0.016).

Conclusion:

A fixed-dose bolus of 50 μg phenylephrine is safe and effective in treating post-spinal hypotension in pre-eclampsia. The efficacy of phenylephrine is comparable in pre-eclamptic and normotensive parturients.