Demographics and appropriateness of cellular blood component irradiation practices: Ambispective analysis from a tertiary care center.

BACKGROUND: Transfusion-associated graft versus host disease (TA-GVHD) is often underreported. There may also be lapses in TA-GVHD prevention practices due to lack of revision of some of the existing clinical guidelines as well as limited audits on practices of blood component irradiation. This study was undertaken to highlight these shortcomings, and generate data for development of institutional guidelines. METHODS/MATERIALS: Study cohort was selected from patients requiring transfusion support during June 2019 to May 2020. Transfusion history of these patients were followed, both retrospectively and prospectively till July 2021. Transfusion requisitions were categorized as IR (with request for irradiation) or NIR (with no request for irradiation) and justified or unjustified according to published international guidelines. RESULTS: Total 6963 requisitions for cellular blood components were received from 255 patients included in the study cohort. Of these, 3690 (54.9 %) were IR requisitions, while remaining 3029 (45.1 %) requisitions were NIR. Overall, 4242 (63.1 %) requisition were justified for their irradiation status as per published guidelines and 1595 (23.8 %) were found to be Unjustified while justification could not be assessed for remaining 882 (13.1 %) of the requisitions. The highest proportion of Unjustified demands in NIR requisitions was observed in patients with Severe Aplastic anemia (59.4 %). CONCLUSION: Many units were unnecessarily irradiated (7.7 %) while irradiation was missed in 16 % of the requisitions included in analysis which may be attributed to lack of institutional guidelines. We recommend that every centre should adopt a published well-researched guideline including amendments based on review of practices at their center.

Burden of Silicosis among stone crushing workers in India.

BACKGROUND: In North India, the mining industry is disorganized and profit-driven. It predisposes its workers towards the development of silicosis. Haryana, a major North Indian state, has developed a compensation-rehabilitation policy for mining workers. AIMS: This study is the review of the policy's functioning and limitation from the first 4 years of implementation. METHODS: The labour department does surveillance of workers in the mining industry. All suspected cases of silicosis are evaluated by a multidisciplinary team. Based on the final diagnosis, the compensation is decided. RESULTS: Nearly 5000 workers were screened, and 729 appeared before the medical board. Of these 729, 465 were having silicosis, and their data are presented here (data of 7 patients were missing). All workers were males. The mean age was 44.54 ± 9.6 years, and the mean exposure (work experience) was 17.25 ± 6.7 years. Most of the workers were between the age of 40 and 50 years and had exposure for 10-20 years. Chest radiography examination showed that progressive massive fibrosis (large size type C opacities) was the most common type of presentation (23%). Smaller opacities (p, q, r and s, t, u) were combined for further analysis, given their similar prognostic significance. It was found that age and experience both had a linear and significant correlation with the severity of lung involvement. CONCLUSIONS: Nearly a quarter of subjects were suffering from the worst type of lung involvement at screening itself. The policy has laid a foundation for the welfare of workers, but there is still a long way to go.

A Comparative Study of Rapid SARS-Cov-2 Antigen Detection Assay against RT-PCR Assay for Diagnosis of COVID-19 in a Tertiary Hospital of Kathmandu.

Background The Coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus (SARS-CoV-2) has spread worldwide since its first recorded case in the city of Wuhan, China, in December 2019. SARS-CoV-2 infection causes asymptomatic to sever pneumonia. Severe cases may develop acute respiratory disease symdrome (ARDS), with an average mortality rate of 6.9%. Real Time Reverse Transcriptase Polymerase Chain Reaction (rRT-PCR) assay is the current reference standard laboratory method for the diagnosis of SARS-CoV-2 infection. However, it takes around 6-8 hours to get the result and is time consuming. Therefore, rapid and accurate tests for SARS-CoV-2 screening are essential to expedite disease prevention and control. Lateral flow immunoassay using monoclonal anti SARS-CoV-2 antibodies which target for SARS-CoV-2 antigen can be complimentary screening test if their accuracy were comparable to that of the real time reverse transcriptionpolymerase chain reaction (RT-PCR) assay. Objective To find the sensitivity and specificity of a rapid antigentest kit in comparison to reverse transcription-polymerase chain reaction (RT-PCR). Method A cross-sectional hospital based study was carried out at Shree Birendra Army Hospital, Kathmandu for a period of four months. Result Our finding shows sensitivity and specificity of rapid diagnostic tests (RDT) Ag kit as 60.6% and 96.4% respectively. Positive and negative predictive value was 83.7% and 89.0%. Likewise, positive and negative likelihood ratio was 17.0 and 0.4. The overall accuracy of the antigen kit was 88.1% in comparison to reverse transcriptionpolymerase chain reaction (RT-PCR) as the gold standard. Conclusion Our study concluded the use of rapid antigen kit is mainly useful for screening purposes.

Statistical model for prediction of ABO hemolytic disease of the fetus and newborn in India.

ABO incompatibility is the most common cause of immune hemolytic disease of the fetus and newborn (HDFN). The American Academy of Pediatrics lists blood group incompatibility as one of the major risk factors for severe hyperbilirubinemia in newborns. We have estimated the risk of ABO HDFN to determine the need for its routine screening. Blood group data from all blood donors who donated in the last 10 years were collected and analyzed. The population prevalence of ABO blood group genes using the phenotype data of blood donors was estimated. This information was further used to calculate an incidence of ABO HDFN requiring intervention in the population. ABO blood group typing was analyzed in 425,743 blood donors. The ABO phenotypes of A, B, O, and AB were 22.48, 36.73, 31.59, and 9.2 percent, respectively. The gene frequencies were 0.1733, 0.2647, and 0.5620 for A, B, and O, respectively. It was estimated that 13.84 percent of group O women would give birth to a non-group O baby and that approximately 2.77 percent of deliveries would likely have ABO HDFN in the study population. In India, the estimated risk of ABO HDFN is 2.9 percent, with a daily 2196 babies at risk of ABO HDFN requiring intervention. This analysis estimates the overall burden of ABO HDFN in the population, which could aid in the decision-making of policymakers, physicians, and community health practitioners to improve neonatal care.ABO incompatibility is the most common cause of immune hemolytic disease of the fetus and newborn (HDFN). The American Academy of Pediatrics lists blood group incompatibility as one of the major risk factors for severe hyperbilirubinemia in newborns. We have estimated the risk of ABO HDFN to determine the need for its routine screening. Blood group data from all blood donors who donated in the last 10 years were collected and analyzed. The population prevalence of ABO blood group genes using the phenotype data of blood donors was estimated. This information was further used to calculate an incidence of ABO HDFN requiring intervention in the population. ABO blood group typing was analyzed in 425,743 blood donors. The ABO phenotypes of A, B, O, and AB were 22.48, 36.73, 31.59, and 9.2 percent, respectively. The gene frequencies were 0.1733, 0.2647, and 0.5620 for A, B, and O, respectively. It was estimated that 13.84 percent of group O women would give birth to a non­group O baby and that approximately 2.77 percent of deliveries would likely have ABO HDFN in the study population. In India, the estimated risk of ABO HDFN is 2.9 percent, with a daily 2196 babies at risk of ABO HDFN requiring intervention. This analysis estimates the overall burden of ABO HDFN in the population, which could aid in the decision-making of policymakers, physicians, and community health practitioners to improve neonatal care.

Effect of Breastfeeding on Relieving Pain during Immunization in Infant.

Background Advantages due to immunization are numerous and cannot be avoided but at the same time pain inflicted on babies needs to be addressed when possible. Pain associated with immunization injections has often been overlooked when remedies are available. Objective To find out the effect of breastfeeding on relieving pain during immunization injection in infants. Method An experimental study was conducted at Immunization clinic of B.P. Koirala Institute of Health Sciences (BPKIHS). Total 124 subjects were divided randomly into two groups. Experimental subjects were allowed to breastfeed for 5-10 minutes before immunization while control group was immunized without breastfeeding. Interview Questionnaire was used to obtain demographic variables and measurements were obtained. Measures of pain was recorded using duration of cry and Modified Behavior Pain Scale, by Taddio et al. Data was analyzed by using SPSS 20.0 where variables were assessed with frequency tables, Pearson's Chi-Square test, independent t test and Mann Whitney U test. Result The mean pain score in experimental group was 7.10 and in control group 7.56 which was statistically significant (p=0.001). The median duration of cry was significantly shorter in experimental group i.e. 25 seconds (IQR: 20-30) than control group 42.5 seconds (IQR: 30-61.5) (p < 0.001). Conclusion Breastfeeding before immunization is effective in reducing pain in infants.

Effect of Kollidon VA®64 particle size and morphology as directly compressible excipient on tablet compression properties.

The study evaluates use of Kollidon VA®64 and a combination of Kollidon VA®64 with Kollidon VA®64 Fine as excipient in direct compression process of tablets. The combination of the two grades of material is evaluated for capping, lamination and excessive friability. Inter particulate void space is higher for such excipient due to the hollow structure of the Kollidon VA®64 particles. During tablet compression air remains trapped in the blend exhibiting poor compression with compromised physical properties of the tablets. Composition of Kollidon VA®64 and Kollidon VA®64 Fine is evaluated by design of experiment (DoE). A scanning electron microscopy (SEM) of two grades of Kollidon VA®64 exhibits morphological differences between coarse and fine grade. The tablet compression process is evaluated with a mix consisting of entirely Kollidon VA®64 and two mixes containing Kollidon VA®64 and Kollidon VA®64 Fine in ratio of 77:23 and 65:35. A statistical modeling on the results from the DoE trials resulted in the optimum composition for direct tablet compression as combination of Kollidon VA®64 and Kollidon VA®64 Fine in ratio of 77:23. This combination compressed with the predicted parameters based on the statistical modeling and applying main compression force between 5 and 15 kN, pre-compression force between 2 and 3 kN, feeder speed fixed at 25 rpm and compression range of 45-49 rpm produced tablets with hardness ranging between 19 and 21 kp, with no friability, capping, or lamination issue.

Uttar Pradesh Association of Physicians of India Position Statement: Betel Quid (Paan) and Diabetes.

Betel quid (paan) chewing is common in India, especially in Uttar Pradesh. Betel quid has multifaceted relationship with health, including metabolic and psychosocial health. The current recommendations have been released keeping in view the public health and clinical importance of this addictive behavior. The objective of this document is to offer clinical guidance for screening, diagnosis and management of co-occurring betel quid chewing among persons with Diabetes Mellitus (DM). The document aims to provide education and guidance to clinicians engaged in care and management of persons with DM, and improve access to treatment for co-occurring betel quid chewing among persons with DM. The current recommendation grades are based on published evidence, and categorized as strong, intermediate, weak and no evidence. The strength of these recommendations is based on the level of evidence.

Uttar Pradesh Association of Physicians of India Position Statement: Tobacco Use and Metabolic Syndrome.

Tobacco use is one of the main preventable causes of mortality and morbidity worldwide. The global disease burden due to tobacco use is huge with projected mortality of eight million lives per year by 2030. Metabolic syndrome (MS) is defined as a constellation of cardiovascular and endocrine risk factors such as insulin resistance, obesity, raised blood pressure, and abnormal lipid profile. The relationship between tobacco use and MS has been well established. Also, the causal association between tobacco use and development of individual components of MS is well established. The Uttar Pradesh Association of Physicians of India (UP API) has drafted this position statement on managing tobacco use among persons with or at risk of developing Metabolic Syndrome (MS). This position statement presents evidence-based recommendations as described below. Scope and purpose The objective of this position statement is to offer clinical recommendations for screening, diagnosis and management of tobacco use among persons with or at risk of developing Metabolic Syndrome (MS). The purpose of this document is to aid in identification and treatment of maladaptive patterns of tobacco use i.e. tobacco use disorder (tobacco dependence, harmful use, abuse) in person with or at risk of developing MS. Intended Audience The position statement is targeted at the clinicians engaged in care and management of person with or at risk of developing Metabolic Syndrome (MS). This might also be of relevance to the policy makers considering the public health burden of both MS and tobacco use disorders.

Population distribution and genetic relatedness in Indian Fusarium udum isolates based on ribosomal internal transcribe spacer and elongation factor.

With the objective to study the geographical distribution pattern and pathotype classification, isolates from 12 major pigeonpea growing states of India were examined at morphological and molecular levels. Two DNA based internal transcribe spacer (ITS) region derived primers FDP 3 (ITS1/ITS2), FDP 25 (mRNA, LOC100383610) and two elongation factors FDP 4 (F98-BKR5) and FDP 29 (M9968PY) were employed to genetically differentiate the isolates. As a result, each marker system gave an average of 3 alleles/marker. The higher efficiency of ITS over EF-1α marker was revealed using detailed comparative analysis that included various parameters like gene diversity index, effective marker ratio, and marker index. Neighbour Joining tree analysis grouped the isolates into three major clusters and showed narrow existence of genetic divergence. Combination of genotyping data with pathological measurements indicates dominance of variant 1 in the Central zone, South zone and North East Plain Zone, while North East Plain Zone and North West Plain Zone were largely dominated by variants 2 and 1, with strong possibility of evolving other variants. The present study would help in identifying specific isolate and patterns of its distribution in various pigeonpea growing regions thereby enhancing the scope for precise resistance breeding for crop improvement.

Demonstration of IgG subclass (IgG1 and IgG3) in patients with positive direct antiglobulin tests.

Serologic characterization of autoantibodies helps in the management and monitoring of the course of autoimmune hemolytic anemia (AIHA). The purpose of this study was to evaluate gel centrifugation test (GCT) cards for immunoglobulin G (IgG) titer and determination of IgG subclasses IgG1 and IgG3 and their influence on hemolysis. Eighty direct antiglobulin test (DAT)-positive patients were examined with the help of GCT cards for IgG titer and IgG subclasses. The results were correlated with the presence and absence of hemolysis. A statistically significant (p < 0.005) association of hemolysis with increasing anti-IgG titer was observed. When IgG titer was 30 or less, 28 (50.91%) patients had no hemolysis, whereas 15 (93.75%) patients had features of hemolysis when titer was at least 300. Statistically significant (p < 0.005) association of subclass of IgG (IgG1, IgG3) coating the red blood cells with intravascular hemolysis was also seen. Twenty-nine (80.56%) patients had evidence of hemolysis when IgG1 or IgGl-IgG3 both were present. Gel technology is helpful to demonstrate red blood cell-bound autoantibodies and their characterization with regard to class, subclass, and titer. This information is useful to identify patients with AIHA who are at risk of severe hemolysis with adverse prognosis.

Review on Synthesis of 2-(2-Hydroxyaryl) Benzothiazoles (HBT) for Excited-State Intra-molecular Proton Transfer (ESIPT)-Based Detection of Ions and Biomolecules.

In this review, we present a systematic and comprehensive summary of the recent developments in the synthetic strategies of 2-(2-hydroxyarylsubstituted)-benzothiazole (HBT) framework along with incorporation of various substituents on phenolic and benzothiazole rings which affect the emission process. The literature, spanning the years 2015-2024, on excited-state intramolecular proton transfer (ESIPT)-based studies of HBT derivatives comprising the effects of solvent polarity, substituents, and extended conjugation on fluorophores has been searched. ESIPT, intramolecular charge transfer, and aggregation-induced emissions enable these fluorescent probes to specifically interact with analytes, thereby altering their luminescence characteristics to achieve analyte detection. These fluorescent probes exhibit large Stokes shifts, high quantum yields, and excellent color transitions. Finally, the applications of HBTs as ESIPT-based fluorescent probes for the detection of cations, anions, and biomolecules have been summarized. We anticipate that this review will provide a comprehensive overview of the current state of research in this field and encourage researchers to develop novel ESIPT-based fluorophores with new applications.

Evaluation of health care workers' knowledge and functioning of blood centres in north India: a questionnaire based survey.

For quality, safety and efficacy of blood components, adequate infrastructure and trained manpower are essential requirements. Objective of this study is to analyse existing systems of transfusion services in north India, various testing methodologies practiced and to assess the level of knowledge of health care professionals working at these centres. Participants included laboratory technicians and nurses whose knowledge and various practices at blood centres were assessed using a questionnaire. Knowledge of those having more experience, working at urban blood centres and received an additional training was significantly higher. Only a few blood centres are performing all mandatory tests on donors' samples.

Impact of sequential herbicides application on crop productivity, weed and nutrient dynamics in soybean under conservation agriculture in Vertisols of Central India.

Adoption of conservation agriculture (CA) is very slow due to weed infestations. The application of herbicides is the only viable option to deal with problem of weed management to adhere with basic principles of CA. A field experiment was carried out for three years to evaluate the expediency of different herbicides and their sequential applications under CA. In this study, seven treatments comprised of either alone or sequential application of pre-emergence (PE) and post-emergence (PoE) herbicides, hand weeding and weedy check were tested in soybean. Result indicated that sequential application of glyphosate at 1 kg ai ha-1 + pendimethalin at 1 kg ai ha-1as PE followed by PoE application of imazethapyr at 100 g ai ha-1 at 30 days after sowing (DAS) proved to be the best economical option in terms of plant growth parameters, crop biomass, seed yield, weed index and carbon and nutrient recycling. Pearson's correlation coefficients matrix revealed that grain yield was significantly (P<0.0001) related to weed density at harvest (r = -0.84), (WDH) (r = -0.63), weed dry biomass (WDB) (r = -0.52), weed nitrogen (N), phosphorus (P) and potassium (K) uptake (r = -0.56, r = -0.59 and r = -0.66), respectively and weed index (WI) (r = -0.96). The bivariate linear regression study of grain yield on weed control efficiency (WCI) biomass, N, P and K uptake by grain showed a clear significant (P<0.0001) dependence with R2 value of 0.53, 0.99, 0.95 and 0.98, respectively. The fitted stepwise multiple regression model also revealed that N and P uptake in grain, weed density at 20 DAS and K uptake in weed were actual predictor for grain yield. We concluded that, effective and economical weed control under CA in soybean can be achieved through sequential application of glyphosate along with pendimethalin at 1 kg ai ha-1 each PE followed by PoE use of imazethapyr at 100 g ai ha-1 at 30 DAS.

Dynamics of soil organic carbon of jhum agriculture land-use system in the heterogeneous hill of Arunachal Pradesh, India.

Land-use conversion affects soil organic carbon (SOC) dynamics. Therefore, an in-depth study of change in SOC, SOC pool, fractions of SOC and enzymatic activities of soil microbial biomass carbon (SMBC) and dehydrogenase (DHA) with the conversion of forest land to jhum, fallow jhum and settle cultivation use has been undertaken on the hills of Arunachal Pradesh of India. Geo-referenced soil samples from eight different locations, each from different land uses were collected at three depth. One part of the soil sample had been used for the analysis of SOC and its carbon fraction. The second portion was kept in a deep freezer for determining SMBC and DHA. The third part was used for the analysis of bulk density. The result revealed that the highest loss of SOC pool was recorded in jhum land (41.8 to 13.4%), and the labile carbon was also found to decrease in jhum land. The highest SMBC was observed on the surface soil of the natural forest; the highest DHA was found in the natural forest; and the lowest DHA was recorded in jhum land. This study found that the converting natural forest to jhum reduces SOC storage, enzymatic activities and C fractions significantly whereas fallow jhum shows sign of recovery because all of these parameters improved when compared to the jhum land-use system. This study also confirms that the fallow period helps restore the initial situation.

Synthesis, prototropic tautomerism studies of indenocarbothioamides and their conversion to biologically active indenothiazole derivatives.

Indenocarbothioamides 2, obtained from reaction of indane-1,3-dione with aryl isothiocyanates, on condensation with 3-chloropentane-2,4-dione and chloroacetyl chloride furnished 1,3-indanedione coupled thiazole and thiazolidin-5-one derivatives, respectively. The structure of the obtained products was assigned on the basis of spectral data (IR, NMR and Mass). Prototropic tautomerism studies of carbothioamides 2 were carried out in solution (1H NMR, 13C NMR and UV-vis), gas phase (Mass) and solid state (IR and X-ray). X-ray diffraction studies of carbothioamide 2a have revealed the existence of enolic form in the solid state. DFT studies of various possible tautomeric forms in gas phase as well as in solution state corroborated by the experimental results. Antibacterial studies of indenothiazole and indenothiazolidin-5-one derivatives have been reported.

The utility of pre-test clinical scoring for clinical diagnosis of heparin-induced thrombocytopenia in cardiac surgery patients of a tertiary care centre in north India.

BACKGROUND: Heparin-induced thrombocytopenia (HIT) should be diagnosed clinically as well as by laboratory assays for timely recognition, prevention and management of complications. OBJECTIVE: To evaluate the clinical utility of pre-test clinical scoring system in combination with two immunoassays for the diagnosis of HIT in cardiac surgery patients. MATERIALS AND METHODS: A total of 100 consecutive patients undergoing cardiac surgery were studied. Pre-test clinical scoring was carried out in patients with thrombocytopenia and further tested by two immunoassays, i.e., Heparin platelet factor 4 (H-PF4) enzyme-linked immunosorbent assay (ELISA) and particle gel immunoassay (PaGIA). RESULTS: Of the 100 patients studied, 42 patients developed thrombocytopenia post-operatively. On pre-test clinical scoring, low T-score was observed in 6 patients, intermediate in 28 and high score in 8 patients, whereas 19 patients (45.2%) were positive by H-PF4 ELISA and 10 (23.8%) by PaGIA for H-PF4 antibody. The difference in the incidence of clinically significant HIT antibodies in the three categories was statistically significant. A good correlation was also observed with ELISA optical density, T-scoring and PaGIA. CONCLUSIONS: Pre-test clinical scoring correlates well with the development of H-PF4 antibodies which are incriminated in the causation of thrombotic complications in patients with HIT. We also propose a protocol for diagnosing patients with clinical suspicion of HIT using pre-test clinical scoring and immunoassay.

New method for synthesis of Pt nanoparticles embedded in a carbon matrix.

Platinum (Pt) nanoparticles embedded in a carbon matrix were synthesized for the first time in benzene by an electric plasma discharge generated in the cavitation field of benzene due to an ultrasonic horn. Transmission electron microscopy (TEM) and X-ray diffraction (XRD) were used to study the particle size, structure and morphology of the synthesized nanoparticles. The Pt nanoparticles have FCC bulk Pt crystal structure. On the average Pt nanoparticle diameter ranged from 8 nm to 40 nm when synthesized at 4.1 kV and from 5 nm to 25 nm when synthesized at 3.4 kV. X-ray photoelectron Spectroscopy (XPS) and Energy dispersive X-ray Spectroscopy (EDX) were used to study the chemical composition of the synthesized nanoparticles. A cost effective new method for carbon supported Pt nanoparticles will be of potential interest in fuel cell and catalysis applications.

Root cause analysis of transfusion error: identifying causes to implement changes.

BACKGROUND: As part of ongoing efforts to improve transfusion safety, an error reporting system was implemented in our hospital-based transfusion medicine unit at a tertiary care medical institute. This system is based on Medical Event Reporting System-Transfusion Medicine (MERS-TM) and collects data on all near miss, no harm, and misadventures related to the transfusion process. Root cause analyses of one such innocuous appearing error demonstrate how weaknesses in the system can be identified to make necessary changes to achieve transfusion safety. STUDY DESIGN AND METHODS: The reported error was investigated, classified, coded, and analyzed using MERS-TM prototype, modified and adopted for our institute. RESULTS: The consequent error was a "mistransfusion" but a "no-harm event" as the transfused unit was of the same blood group as the patient. It was a high event severity level error (level 1). Multiple errors preceded the final error at various functional locations in the transfusion process. Human, organizational, and patient-related factors were identified as root causes and corrective actions were initiated to prevent future occurrences. CONCLUSION: This case illustrates the usefulness of having an error reporting system in hospitals to highlight human and system failures associated with transfusion that may otherwise go unnoticed. Areas can be identified where resources need to be targeted to improve patient safety.

Antiviral activity of some plants used in Nepalese traditional medicine.

Methanolic extracts of 41 plant species belonging to 27 families used in the traditional medicine in Nepal have been investigated for in vitro antiviral activity against Herpes simplex virus type 1 (HSV-1) and influenza virus A by dye uptake assay in the systems HSV-1/Vero cells and influenza virus A/MDCK cells. The extracts of Astilbe rivularis, Bergenia ciliata, Cassiope fastigiata and Thymus linearis showed potent anti-herpes viral activity. The extracts of Allium oreoprasum, Androsace strigilosa, Asparagus filicinus, Astilbe rivularis, Bergenia ciliata and Verbascum thapsus exhibited strong anti-influenza viral activity. Only the extracts of A. rivularis and B. ciliata demonstrated remarkable activity against both viruses.