bluuebunny/crossref_metadata_2025_split huggingface dataset:
Maximum surgical blood order schedule: A key component of perioperative blood management in neurosurgery
Authors: Kumatagi Shivanand Hemant , Rajendran Vinu , Nair Amita Radhakrishnan , Gupta Debasish 
Published: August 2024

Abstract:

CONTEXT:
Institute specific protocols are needed to reduce unnecessary cross matches. Type and screen policies for surgical procedures which does not require blood and maximum surgical blood order schedule (MSBOS) for procedures which require blood units are the two protocols in use currently.

AIM:
To compare the effect of maximum surgical blood order schedule in neurosurgery between pre- and post-implementation.

SETTINGS AND DESIGN:
It is a study of 5 years’ duration (4 years retrospective and 1 year prospective) conducted at the departments of transfusion medicine, neurosurgery and neuroanesthesia.

SUBJECTS AND METHODS:
The patients above 18 years for whom blood requisition were sent were included, whereas those who underwent emergency procedures, massive transfusion, or had underlying bleeding disorders were excluded. The MSBOS was developed based on 4 years’ retrospective data and the new protocol was followed for 1 year. The transfusion indices were compared between preimplementation and postimplementation.

RESULTS:
A total of 2462 patients were included in the retrospective period, whereas it was 746 in the prospective group. Overall, reduction of crossmatch to transfused ratio from 3.6 to 2.4 and increase of blood utilization from 27.40% to 41.55% was observed. The patients for whom type and screen were performed increased from 18% in the retrospective period to 75% in the prospective period. Eighteen out of 30 common procedures were managed with T and S and seven of them did not require even a single unit of red blood cells intraoperatively.

CONCLUSIONS:
Our study highlights the importance of including both diagnosis and procedure to formulate MSBOS and the use of modified formulas “transfusion index for type and screen and transfusion probability for type and screen” for revision of MSBOS.
Refractory pruritus in cholestatic drug-induced liver injury secondary to androgenic anabolic steroids: Plasmapheresis to the rescue
Authors: Shastri Arpit , Paranthamaiah Ganesh Chandragiri , Gandhi Anuj , Gangadharappa Ramesha Chinakarihalli , Shastri Malvika , Mitra Suvradeep , Lamba Divjot Singh , Sharma Ratti Ram , De Arka 
Published: August 2024

Abstract:
Anabolic androgenic steroids (AASs) have long been misused by professional athletes. Easy online and over-the-counter availability of AASs makes it an alluring option even among amateurs for their desired cosmetic and performance-enhancing effects. AASs have been associated with distinct forms of liver injury including transient transaminitis, peliosis hepatis, and hepatic tumors. An acute cholestatic syndrome with bland histology is another characteristic form of liver injury rarely reported with AASs. Plasmapheresis may provide a long-lasting relief of symptoms when conventional pharmacotherapeutic measures fail. Herein, we report a challenging case of a young male with refractory pruritus secondary to AASs, managed effectively with plasmapheresis.
Unraveling the complexity: Case reports of drug-induced hemolytic anemia due to ceftriaxone
Authors: Yadav Anshika , Agarwal Pankaj 
Published: August 2024

Abstract
Drug-induced hemolytic anemia (DIHA) is a rare but significant condition characterized by the premature destruction of red blood cells (RBCs) triggered by certain medications. Ceftriaxone, a commonly used antibiotic, has been linked to DIHA, presenting diagnostic challenges due to its diverse clinical manifestations. This study examines three cases of DIHA caused by ceftriaxone therapy at our center. The patients presented with symptoms such as fatigue, jaundice, and dark urine following ceftriaxone therapy. Laboratory tests indicated hemolytic anemia with decreased hemoglobin, elevated lactate dehydrogenase, and positive direct antiglobulin tests. Immunohematological workups confirmed ceftriaxone-induced antibodies targeting RBCs and guided management strategies, including discontinuation of ceftriaxone, supportive therapy, and corticosteroids. Timely diagnosis and collaboration between clinicians and laboratory specialists are crucial for optimal patient outcomes.
A false reactive hepatitis B surface antigen result due to dislodged gel from Vacutainer
Authors: Sawant Rajesh B. , Tanvi Yardi U. , Shaikh Raees A 
Published: August 2024

Abstract:
Preanalytical variables play a key role in the correctness of laboratory test results. We report a false reactive result for hepatitis B surface antigen (HBsAg) on serological testing with a relatively low OD. The pilot sample was collected in yellow top BD Vacutainer® (SST™ II Advance 5 mL tube) with separator gel and was marked for serological testing. It was centrifuged at 7000 rpm for 30 min. Serological testing was performed by chemiluminescence on Abbott Architect Plus i1000SR with Abbott kits for HBsAg, anti-HIV, and anti-HCV. This particular sample tested reactive for HBsAg with S/CO of 1.91, S/CO for HBsAgQ2NC (Negative kit control) being 0.19 and that of HBsAgQ2PC (Positive kit control) being 3.65. Repeat testing from the same Vacutainer was also reactive for HBsAg with S/CO of 2.10. Nucleic acid testing was performed and was found to be nonreactive. We repeated serological testing with a sample from fresh frozen plasma of the same donor unit. It was nonreactive. Cross contamination was ruled out by repeat testing of two serial samples before and after this unit number. The serum showed an unusual appearance on visual inspection after centrifugation. By exclusion, we concluded that the gel probably got partially dislodged into the serum, giving a relatively low reading and false reactive result for HBsAg. This highlights the possibility of inert gel not always being inert, the importance of repeat testing from a different sample in case of low reading, the importance of visual inspection, a need for manufacturers and laboratory personnel to consider such preanalytical variables which, though not much mentioned in literature, can affect test results. These results have a multi-fold impact on the donor or patient’s mindset, treatment outcome and/or fate of blood donation. These are definitely preventable if more such guidelines are made available for handy reference in handling such results.
Prevalence and specificity of clinically significant red blood cell alloantibodies among hospitalized patients attending a tertiary care center in the southern part of India: A retrospective observational study
Authors: Kumar I. Suresh , Hariharan A. , Thangavel Gokhula Prasath , Kumar I. Praveen , Sukumaran Suma 
Published: August 2024

Abstract:

BACKGROUND:
Alloimmunization due to red blood cell (RBC) transfusions may occur due to discrepancy between donor and recipient’s antigenic exposure on RBCs. A thorough literature search shows limited data pertaining to the rate of alloimmunization and specificity of alloantibodies in the general patient population. The main aim of our study is to find the prevalence of alloimmunization rate and specificity of RBC alloantibodies among the patients who were admitted under different clinical departments in a tertiary care hospital.

MATERIALS AND METHODS:
Our study was a retrospective observational study in which the patient data regarding their blood grouping status, alloimmunization status, and other relevant details were collected from the case records that were recorded between 2021 and 2022. Antibody screening of these patients was carried out using Bio-Rad ID DiaCell I, II, III Asia (Mia+), 3-cell panel with the lot number (45330.13.x). The specificity of these alloantibodies was identified using the 11-cell antibody identification panel Bio-Rad (ID-DiaPanel 11 × 4) which belongs to lot number (06171.47.x–06271.47.x).

RESULTS:
The overall prevalence of RBC alloimmunization in our study was found to be 1.3% (n = 137). The most prevalent alloantibody in our study was considered to be anti-D (30.65%), followed by anti-c (18.24%) and anti-Jkb (16.05%). Females had a more significant association with the development of alloantibodies than males with P = 0.001. Patients with a history of transfusion also had a significant association with alloantibody formation (P = 0.008).

CONCLUSION:
Since alloimmunization may result in drastic unforeseen responses in patients during transfusions, prior alloantibody screening may provide an additional safety layer in providing safe transfusions to patients. Hence, this study advocates the provision of antigen-matched RBC units for ABO, Rh, and Kell antigens.
A case report of plasma exchange in imidacloprid poisoning: A promising therapeutic approach for acute toxicity
Authors: Yadav Anshika , Gupta Gajendra Nath , Agarwal Pankaj , Sheemhar Akhil 
Published: August 2024

Abstract:
Imidacloprid, a neonicotinoid insecticide, is commonly used in agricultural and urban settings for pest control. However, its toxic effects on both target and nontarget organisms, including humans, have raised concerns. Imidacloprid poisoning can result in a wide range of symptoms, including neurological, gastrointestinal, and cardiovascular manifestations, and may even be fatal in severe cases. In recent years, plasma exchange has emerged as a potential therapeutic approach in cases of imidacloprid poisoning, with promising outcomes reported in a few published case reports. This article reviews the role of plasma exchange in imidacloprid poisoning, highlighting its mechanism of action, clinical indications, technical aspects, and potential benefits. The article also discusses the current evidence supporting the use of plasma exchange in imidacloprid poisoning, including relevant case reports and studies. While plasma exchange appears to be a promising adjunctive therapy in managing imidacloprid poisoning, further research and clinical experience are needed to establish its effectiveness and safety. This article emphasizes the importance of early recognition and management of imidacloprid poisoning, including considering plasma exchange as a potential treatment modality in severe cases.
Uptake and Determinants of Tetanus Vaccination among Female Clinical Medical Students in North-Western Nigeria
Authors: Abubakar Muhammad Shakur 
Published: August 2024

Background and Aim:
Neonatal and maternal tetanus have remained endemic in tropical countries of Asia and Africa, with high fatality. Vaccination of women of childbearing age is the main strategy for their prevention/elimination. However, the uptake of these vaccines among these women has remained dismally low in these parts of the world. This study looked at the uptake and determinants of tetanus vaccination among the female clinical medical students of Bayero University, Kano, purposely looking at the interplay between knowledge and other factors on vaccine uptake.

Materials and Methods:
This was a cross-sectional study of female medical students aged 15–45 years, selected using probability proportionate to size and simple random sampling. The required information was collected using a validated semi-structured questionnaire. The data were analyzed using the Statistical Product and Service Solutions (SPSS) for Windows version 23. Prevalences of tetanus vaccination were calculated. The presence of a statistically significant difference in prevalence and other characteristics of the study groups were determined using appropriate tests. P
<0.05 was considered statistically significant.

Results:
The participants were 140 with the mean age and mean knowledge scores of 23.96 (±2.74) years and 6.61 (±2.47), respectively. Most of them (59.3%) had good knowledge score (>7). The prevalence of tetanus toxoid (TT)1 and TT2 was 20.7% and 17.1%, respectively. Being married, ever pregnant, and higher level of study were significantly associated with being vaccinated (χ2/P =59.093/P <0.001, P = 65.011/P <0.001, and P = 9.860/P =0.020, respectively).

Conclusions:
Despite the good knowledge of the vaccination, the uptake of TT vaccination among clinical female students was poor. Factors significantly associated with higher vaccine uptake were marital status, age of the participants, and their class of study.
Consumer’s Knowledge, Attitude, and Practices toward Self-medication: Questionnaire Development and Validation
Authors: Ansari Nahid , Dadhich Abhishek 
Published: August 2024

Background and Aim:
Self-medication practices (SMPs) are a common phenomenon prevalent with both prescription and nonprescription medicines. Still, the availability of a valid and reliable instrument to assess the knowledge, attitude, and practices toward self-medication (SM) remains limited. The current pilot study aimed to develop and validate a tool that effectively evaluates these aspects among consumers in Delhi, India.

Materials and Methods:
The research involved 100 consumer participants from Delhi, India. Reliability and validity testing was conducted to assess reproducibility, internal consistency, and content validity. The questionnaire underwent validation by a panel of five experts to evaluate face and content validity.

Results:
Test–retest reliability was assessed using Karl Pearson’s correlation co-efficient yielding values of 0.841 (P = 0.002), 0.827 (P = 0.003), and 0.792 (P = 0.006) for the three domains of knowledge, attitude, and frequency of performing SM, respectively. Cronbach’s alpha statistics were used to determine internal consistency, yielding values of 0.775 and 0.839 for knowledge and attitude domains, respectively. The association between the demographic characteristics of respondents and knowledge, attitude, and frequency of SM was assessed using an independent sample t-test and one-way ANOVA, demonstrating satisfactory known group validity.

Conclusions:
The developed questionnaire proved valid and reliable for determining consumer’s knowledge, attitudes, and practices toward SM. The final tool could be valuable for future research and interventions to improve consumers’ understanding of SMP.
Re-establishing Facial Aesthetics - Patient-specific Orbital Implant for Post-traumatic Deformity
Authors: Shetty Sujeeth Kumar , Kale Revati , Kathuria Abhinav , Prakash Sonakshi , Makam Prajwal 
Published: August 2024

Abstract

Rationale:
Complex fractures of the maxillofacial region can require staged interventions to achieve optimal outcomes. A significant example of this are complex fractures of the orbital floor, which may be difficult to restore during primary treatment. The secondary correction is often required which can be using stock- or customised implants.

Patient Concerns:
A previously operated case of panfacial trauma presented with an aesthetic concern regarding the asymmetrical appearance of his eyes.

Diagnosis:
On clinical and radiological evaluation, the patient was diagnosed with enophthalmos of the left eye secondary to orbital floor fracture.

Treatment:
A patient-specific implant (PSI) was fabricated and placed for orbital floor reconstruction.

Outcomes:
Postoperatively, aesthetic and functional outcomes were satisfactory.

Take-away Lessons:
This case report highlights the use of PSIs in orbital floor reconstruction, made possible due to the advent of virtual surgical planning and three-dimensional printing in the field of oral and maxillofacial surgery.
Observational Study with a New Portable Cryosurgery Device, HYDROZID®, in Superficial Epidermal Lesions: An Indian Experience
Authors: Bangaru H , Mishra Shivani , Sachan Sonam S. , Ramrakhiani Sonam 
Published: August 2024

Abstract

Background:
Cryosurgery remains an important treatment modality in dermatology practice. HYDROZID®, a new portable cryosurgery medical device using norflurane as a cryogen, was recently introduced in the Indian market. This paper reports the findings of the phase IV study conducted in India.

Aims:
This is a prospective phase IV study to evaluate its safety and efficacy in the treatment of superficial epidermal and dermal lesions.

Methods:
The study was conducted across 4 centres in India. The cryosurgery cycles were decided based on the skin lesion considered for the treatment. Safety and efficacy parameters were assessed at day 1, day 7, day 14, day 30 (±2) (end of treatment), and day 60 (±2) after the initial cryosurgery treatment. The local skin reactions scale, pain VAS scale, and Vancouver scale for assessment of pigmentation and scarring were used for the assessment of cutaneous reactions. Assessment of efficacy was done by evaluating the total disappearance of skin lesions at the end of the study visit.

Results:
Ninety-seven patients completed the study. The reported post-procedural pain was mild to moderate and subsided over the period of 24 hours. There was no pain observed in 84.76% of patients at the end of 24 hours. Complete disappearance of the lesion was seen in 47.4% of patients at the end of the study, while the reduction in the diameter of skin lesions by more than 50% was observed in 79.38% of patients.

Conclusion:
The data from this study support good clinical tolerability and safety of the Hydrozid® portable cryo device.
The Effect of Diabetes Mellitus on Outcomes of Patients Admitted with COVID-19
Authors: Mittal Naveen , Dhooria Harmeet Pal S. , Arora Saurabh , Kumar Vipin , Bansal Ekta , Singh Parminder , Kalra Sanjay , Goyal Saloni , Mittal Namit , Naved Khizar , Mohan Bishav 
Published: August 2024

Background and Objectives:
Diabetes mellitus is associated with poor clinical outcomes in patients with coronavirus disease 2019 (COVID-19). This study aimed to explore the clinical characteristics of patients with type 2 diabetes with COVID-19, and to determine the impact of type 2 diabetes on clinical outcome of patients with COVID-19.

Material and Methods:
This single-center, retrospective, observational study enrolled patients admitted from March 2020 to June 2021 with COVID-19. The clinical and biochemical characteristics of patients with known type 2 diabetes, newly diagnosed diabetes, type 2 diabetes with comorbidities and those who succumbed to illness were analyzed.

Results:
Of 4,559 patients with COVID-19, 2,090 (45.8%) had type 2 diabetes. Patients with COVID-19 with diabetes were older, more likely to receive mechanical ventilation, had higher odds of mortality from COVID-19 as compared with patients without diabetes. In addition, patients with diabetes had significantly higher levels of serum creatinine, C-reactive protein, ferritin, lactate dehydrogenase, and D-dimer. Compared with previously diagnosed patients with diabetes, newly diagnosed patients had higher mortality (33% vs. 27%, P = 0.049). Among patients with COVID-19 and diabetes, nonsurvivors had significantly higher levels of inflammatory markers and had severe impairment of cardiac, renal, and coagulation parameters as opposed to survivors.

Conclusion:
Patients with COVID-19 with diabetes were more likely to have severe disease and had higher mortality. Presence of chronic kidney disease and coronary artery disease in patients with diabetes with COVID-19 was associated with adverse outcome. Patients with newly diagnosed diabetes had higher odds of severe disease at presentation and had higher mortality.
Twice or Thrice Weekly versus Daily Thyroxine in Hypothyroid Fasting Ramadan
Authors: Elsherbiny Tamer Mohamed 
Published: August 2024

Abstract

Context:
Hypothyroid patients require to take levothyroxine (L-T4) on an empty stomach, 60 min before next meal which is difficult to achieve while fasting Ramadan, on a daily basis. This pilot study aimed to assess the effect of twice or thrice weekly versus standard daily L-T4 dosing during Ramadan on adherence, post-Ramadan TSH, and thyroid status.

Methods and Materials:
The study included 2 groups; group 1 included 11 patients assigned to take L-T4 twice or thrice a week, and group 2 included 113 patients assigned to take L-T4 daily. Patients chose between three L-T4 regimens: regimen 1 – 60 min before Iftar; regimen 2 – 60 min before Suhor, on empty stomach for 3–4 h; regimen 3 – before the next fast, on empty stomach for 3–4 h. Thyroid status was assessed before and within 6 weeks after Ramadan. Only euthyroid patients were included.

Results:
No significant differences between the two groups regarding adherence, post-Ramadan TSH, or post-Ramadan thyroid status. 90.9% in group 1 and 88.5% in group 2 were adherent [p = 1.000]. Post-Ramadan TSH in group 1 was 1.9 ± 1.5 mIU/L, in group 2 was 2 ± 1.6 mIU/L [p = 0.809]. 81.8% in group 1 and 82.3% in group 2 were euthyroid post-Ramadan [p = 0.209].

Conclusions:
In this pilot study, taking L-T4 twice or thrice weekly during Ramadan achieved similar adherence and metabolic control to standard daily L-T4, making it an easier option for hypothyroid patients wishing to fast Ramadan.
Pharmacokinetic Similarity between Biosimilar Insulin Aspart Premix SAR341402 Mix 70/30 and Originator Insulin Aspart Mix 70/30 (NovoMix 30) in Indian Adults with Type 2 Diabetes
Authors: Mohan Viswanathan , Schmider Wolfgang , Singh Kiran P. , Rotthaeuser Baerbel , Mukherjee Bhaswati , Aravind S. R. 
Published: August 2024

Background:
We compared the pharmacokinetic exposure, efficacy, safety and immunogenicity of biosimilar insulin aspart premix SAR341402 Mix 70/30 (SARAsp-Mix) with its originator NovoMix® 30 insulin aspart mix (NN-Mix) in adults with type 2 diabetes.

Methods:
This was a randomized, open-label, parallel-group, substudy of the phase 3 GEMELLI M trial performed in three Indian centres. Totally 13 Indian participants previously treated with premix insulin received a single subcutaneous 0.3 U/kg dose of each treatment and underwent pharmacokinetic sampling for 16 h after dosing. Participants were then treated for 26 weeks as per the main GEMELLI M trial with efficacy, safety and immunogenicity compared between groups.

Results:
The extent of exposure (area under the plasma concentration-time curve and maximum insulin aspart concentration) to SAR341402 insulin aspart in SARAsp-Mix and to insulin aspart in NN-Mix was similar following single doses of the allocated treatment. After 26 weeks, the mean ± SD [median] change in HbA1c from baseline was similar in both treatment groups (SARAsp-Mix −0.38% ± 1.54 [−1.00%]; NN-Mix −0.18% ± 1.97 [−0.80%]). Other efficacy endpoints, insulin dosages, anti-insulin aspart antibody response, hypoglycemia and adverse events were similar between groups.

Conclusions:
Our results support the findings from previous studies, that SARAsp-Mix has a similar pharmacokinetic profile to NN-Mix and provides effective glycemic control with similar safety and immunogenicity profile in Indian adults with type 2 diabetes.