Rh and Kell phenotyping in voluntary blood donors: A study from a tertiary care blood center of western India.

INTRODUCTION: In human beings, there are 45 blood group systems and 360 antigens currently recognized by ISBT (July 2023). The Rh blood group system has 56 antigens, out of them 5 antigens D, C, c, E, and e are clinically significant antigens. The Kell blood group system has 25 highly immunogenic antigens. Cases have been reported where IgG-type of antibodies against Rh and Kell antigens are found which are responsible for transfusion reactions and hemolytic disease of newborn. AIMS AND OBJECTIVES: To study the prevalence of Rh-Kell phenotype in voluntary blood donors, To provide Rh and Kell antigen-matched blood products to patients to prevent alloimmunization, To make a donor directory of Rh and Kell phenotyped donors for further use. MATEIALS AND METHODS: The antigen typing for Rh antigens (D, C, c, E, and e) and Kell (K) was performed on the collected ethylenediaminetetraacetic acid samples from 1014 voluntary donors. The test was performed by Erythrocyte Magnetic Technique using a microplate (DuoLys) in a fully automated immunohematology system (Diagast Qwalys Evo 3 instrument). RESULTS: From 1014 phenotyped donors, the most common antigen frequency was of "e" (98.6%) followed by "D"(96.2%),"C"(89.4%), "c"(54.8%), and "E"(18.6%). The frequency of the "K" antigen was (1.38%). The most common Rh phenotype from the study population was R1R1(CDe/CDe) (45%) and the rarest was r'r' (Ce/Ce) (0.1%). CONCLUSION: Knowledge of the phenotype frequency in the local population is helpful in making a donor directory, In situations where clinically significant alloantibodies are found in patient's serum, antigen-negative blood unit can be arranged using a donor directory.

Feasibility study of treatment of mixed astigmatism with small-incision lenticule extraction (SMILE) by using research software.

PURPOSE: To report the preliminary experience and initial clinical results following SMILE for the treatment of mixed astigmatism. METHODS: Thirteen eyes of nine patients with a mean age of 27 ± 4.36 years were included in the series. In 8/13 eyes, myopic SMILE license and in 4/13 eyes, hyperopic SMILE license (available as part of an open/research software) was used for the treatment. The mean follow-up was 9.5 ± 8.7 (0.5-24) months, and the median follow-up was 6 months. SETTING: Nethradhama Superspeciality Eye Hospital, Bangalore, India. DESIGN: Exploratory study. RESULTS: The mean preoperative sphere, cylinder, and spherical equivalent (SE) were 1.44 ± 1.63, -2.70 ± 2.30, and -0.24 ± 1.14 D, which changed to -0.03 ± 0.30, -0.28 ± 0.48, and -0.18 ± 0.49 D, respectively, 6 months postoperatively. Furthermore, 85% (11/13) eyes were within ± 0.50 D, 92% (12/13) eyes were within ± 1.00 D, while all eyes were within ± 1.50 D of SE correction. All eyes were within ± 1.00 D of cylinder correction. In addition, 92% (12/13) eyes had UDVA better than 20/32, with 54% (7/13) eyes having UDVA 20/20 or better. Safety and efficacy indices were 1.08 and 0.92, respectively. No eyes lost more than 1 line of CDVA. The mean corneal higher order aberrations (HOA) increased from 0.111 ± 0.048 to 0.209 ± 0.056 (P < 0.001). The mean objective scatter index (OSI) did not show a significant change (pre = 0.71 ± 0.69, 6 months = 0.89 ± 0.20; P = 0.35). CONCLUSION: Early experience showed that SMILE was feasible for the management of eyes with mixed astigmatism, without any intraoperative complications, unique to the procedure.

Quality control methods for fruit extracts of Kigelia africana using high performance thin layer chromatography.

Kigelia africana is a tree native to Africa but also found in eastern and southern parts of India with reported anti-bacterial, anti-inflammatory, and immunomodulatory activities. Verbascoside, caffeic acid and ferulic acid are important markers for the quality control of the plant. Two different HPTLC methods were developed and validated; method - 1 for estimation of verbascoside and caffeic acid while method - 2 for estimation of caffeic acid and ferulic acid. Developed methods were applied to the methanolic fruit extract to determine the quantities of markers. Both methods were found to be linear, specific, precise, accurate, sensitive and robust. Results indicated that both methods can be used for quantitative determination of verbascoside, caffeic acid and ferulic acid in fruit extract. The developed methods may be utilised as a part of the quality control and standardisation for the raw material and extracts of Kigelia africana and can also aid to chromatographic fingerprinting of the plant.

Virtual Reality Simulation in a Health Assessment Laboratory Course: A Mixed-methods Explanatory Study Examining Student Satisfaction and Self-confidence.

BACKGROUND: The purpose of this mixed-methods study was to examine the relationship between virtual reality simulation (VRS) and student satisfaction and self-confidence in a health assessment laboratory course. METHODS: Second-year students (n = 37) completed a postoperative respiratory distress scenario using Elsevier's Simulation Learning System with Virtual Reality. All participants completed the Satisfaction and Self-Confidence in Learning Scale; a subset participated in 1:1 semistructured interviews. RESULTS: Satisfaction and self-confidence scores were strongly correlated. VRS experiences of fidelity, communication confidence and competence, learning with peers, integrated learning and critical thinking, and a safe space to learn were related to students' satisfaction and self-confidence. CONCLUSIONS: VRS experiences are correlated with high student satisfaction and self-confidence.

Membrane-based therapeutic plasma exchange: Proposed techniques for preventing filter failure.

BACKGROUND AND OBJECTIVES: Therapeutic plasma exchange (TPE) is commonly performed using membrane-based TPE (mTPE) and is prone to filter failure. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We report on 46 patients, with a total of 321 mTPE treatments using the NxStage machine. This was a retrospective study with an aim to evaluate the effect of heparin, pre-filter saline dilution and the impact of total plasma volume exchanged (< 3 L vs. ≥3 L) on the rate of filter failure. Primary outcome was the overall rate of filter failure. Secondary outcomes included factors that may have indirectly influenced the rate of filter failure, including hematocrit, platelet count, replacement fluid (Fresh Frozen Plasma vs. albumin), and access type. RESULTS: We found that treatments that received both pre-filter heparin and saline had a statistically significant decrease in filter failure rate as compared to those that received neither (28.6% vs. 5.3%, P = .001), and compared to the treatments that received pre-filter heparin alone (14.2% vs. 5.3%, P = .015). In treatments that received both pre-filter heparin and saline predilution, we noted a significantly higher filter failure rate when the plasma volume exchanged was ≥3 L as compared to those that had <3 L exchanged (12.2% vs. 0.9%, P = .001). CONCLUSIONS: Rate of filter failure in mTPE can be reduced by implementing several therapeutic interventions including pre-filter heparin and pre-filter saline solution. These interventions were not associated with any clinically significant adverse events. Despite the above-mentioned interventions, large plasma volume exchanges of ≥3 L can negatively impact filter life.

Altered color of plasma component - Unnecessary wastage of a precious resource.

BACKGROUND AND OBJECTIVES: The present study was conducted to evaluate the etiology of altered color of plasma component of blood in transfusion practice. MATERIALS AND METHODS: The study was conducted at the blood center of a tertiary care teaching hospital in western India for a period of 6 months. After component separation, all the plasma units with altered color were segregated and samples were taken for further evaluation. Altered colored plasma units were divided into three - green discoloration, yellow discoloration, and lipemic plasma. Donors were called, their detailed history was taken, and necessary investigations were done accordingly. RESULTS: Forty plasma units out of 20,658 (0.19%) donations showed discoloration. Out of which, 3 plasma units showed green discoloration, 9 plasma units showed yellow discoloration, and the remaining 28 plasma units were lipemic. Among three donors whose plasma showed green discoloration, one female donor had a history of oral contraceptive pill usage and had higher values of copper and ceruloplasmin. All donors with yellow plasma had a higher value of unconjugated bilirubin. All the donors with lipemic plasma gave a history of intake of fatty meal prior to donating blood and showed higher values of triglyceride, cholesterol, and very-low-density lipoprotein. CONCLUSION: Plasma component with altered color restricts its issue to the patient and also for use in fractionation. In our study, many of the altered color plasma units were safe to transfuse, but the decision regarding transfusion was debatable on consultation with the treating doctor. Further studies with a large sample size are recommended for the use of these plasma components.

A prospective, randomized, comparative clinical study to compare the safety and efficacy of different hydrophobic aspheric monofocal intraocular lenses.

Purpose: To report the 1-year clinical outcomes related to safety, efficacy, predictability, contrast sensitivity, patient satisfaction, complications, and overall results with Optiflex Genesis and Eyecryl Plus (ASHFY 600) monofocal aspheric intraocular lenses (IOLs) and compare the same with Tecnis-1 monofocal IOL. Methods: This prospective, single-center, single-surgeon, randomized, three-arm study included 159 eyes of 140 eligible patients who underwent cataract extraction with IOL implantation with any of the three study lenses. Clinical outcomes related to safety, efficacy, predictability, contrast sensitivity, patient satisfaction, complications, and overall results were compared at a mean follow-up of 1 year (12 ± 1.20 months). Results: Preoperatively, age and baseline ocular parameters of all the three groups were matched. At 12 months post-op, no significant differences were noted among the groups in terms of mean postoperative uncorrected and corrected distance visual acuity (UDVA and CDVA, respectively) sphere, cylinder, and spherical equivalent (SE; P > 0.05 for all parameters). Eighty-nine percent eyes in the Optiflex Genesis group as against 96% eyes in the Tecnis-1 and Eyecryl Plus (ASHFY 600) groups were within ± 0.5 D, and 100% of eyes in all the three groups were within ± 1.00 D of SE accuracy. Postoperative internal higher-order aberrations (HOAs) and coma, and mesopic contrast sensitivity at all spatial frequencies were comparable across all the three groups. Two eyes in the Tecnis-1 group, two eyes in the Optiflex group, and one eye in the Eyecryl Plus (ASHFY 600) group underwent YAG capsulotomy at the last follow-up. No eye in any of the groups showed glistenings or required IOL exchange due to any reason. Conclusion: At 1-year post-op, all the three aspheric lenses showed comparable results in visual and refractive parameters, post-op aberrations, contrast sensitivity, and posterior capsule opacification (PCO) behavior. Further follow-up is needed to evaluate the long-term behavior for refractive stability and PCO rates of these lenses. Trial registry: CTRI/2019/08/020754 (www.ctri.nic.in).

Maternal allo anti-M antibody-induced hemolytic disease of newborn.

Hemolytic disease of the fetus and newborn is a syndrome associated with immune destruction of the fetal and newborn red cells by maternal red cell alloantibodies. The detection of anti-M in antenatal screening can be responsible for neonatal red cell aplasia. A 32-h-old full-term neonate admitted with inconsolable cry and mild fever. Laboratory tests revealed progressive anemia and hyperbilirubinemia on day 3. The peripheral blood smear showed evidence of hemolysis and reticulocyte count was reduced. Intensive phototherapy and antibiotics were started after ruling out other causes of hyperbilirubinemia. Blood group typing and advanced red cell serology workup were done. Antibody screening and identification was suggestive of the presence of anti-M antibody in both mother and baby. Intravenous immunoglobulin and red blood cell transfusions were given. Anti-M is capable of causing hemolytic disease of the fetus and newborn and prolonged anemia. Newborns with anemia should be evaluated for all the possible causes to establish a diagnosis.

Bacteroides meningitis in a healthy child: A case report and review of the literature.

A 7-year-old male presented with meningitis. CSF gram stain showed gram negative rods, but the organism failed to grow on culture. 16 s rRNA sequencing identified the organism as Bacteroides fragilis. The patient fully recovered with antibiotic therapy targeting that organism.

Early Laser for Burn Scars (ELABS): protocol for a multi-centre randomised, controlled trial of both the effectiveness and cost-effectiveness of the treatment of hypertrophic burn scars with Pulsed Dye Laser and standard care compared to standard care alone [version 1; peer review: 2 approved].

This paper outlines the protocol for a study that is being carried out at multiple centres across the UK in the next three years. It is a Research for Patient Benefit (RfPB) study funded by the National Institute for Healthcare Research (NIHR). The aim is to assess the effectiveness of treating hypertrophic burns scars with pulsed dye laser (PDL) at an early stage of scar formation. The objective is to improve Quality of Life for the patient by improving both the appearance and quality of burn scarring, as well as reducing its psychological impact. This is a parallel-arm randomised, controlled trial to compare PDL and standard care against standard care alone. The difference is measured between baseline and six-month follow-up. Recruits are within three months of healing from a burn injury; with wounds showing a defined potential for hypertrophic scarring. A total of 120 patients are recruited in a multi-centre study; with randomisation in a 1:1 allocation to each arm. The treatment arm receives 3 PDL treatments at six-week intervals in addition to standard care, whereas the control arm receives standard care alone. The primary outcome is the patient-rated part of the Patient and Observer Scar Scale (POSAS). Psychological and psycho-social impact is evaluated using the CARe burn scale (UWE, Bristol) and Quality Adjusted Life Years (QALY) is determined using the Short-Form Health Survey (SF-12). The study evaluates both the cost-effectiveness through an economic analysis and the patient-reported experience of the treatment by phone interviews.

NCLEX-RN readiness: HESI Exit Exam validity and nursing program policies.

BACKGROUND: The HESI® Exit Exam (E2) has been used to assess student readiness for the NCLEX-RN® examination for over two decades. PURPOSE: In this study, we examined the relationship between students' average E2 scores and their first time NCLEX-RN pass or fail outcomes to understand the validity of the E2 as a predictor of NCLEX-RN readiness. In addition, we examined the relationship between policies governing E2 use in programs and success on the NCLEX-RN. METHODS: Over 40 programs across the United States participated in the study, providing NCLEX-RN outcome information for 3686 students that took the E2 in 2018-2019 and information about policies. RESULTS: Students who achieved an average E2 score of 850 and above had a NCLEX-RN first-time pass rate (FTPR) of 96.33%. The NCLEX-RN FTPR was 97.29% for students whose average E2 score was 900 and above. Policies such as test preparation requirements and remediation for the E2 were associated with statistically significantly higher student NCLEX-RN FTPR. CONCLUSION: This study builds upon past evidence about the validity of the E2 and extends research in new directions by demonstrating the role of specific E2 policies in supporting students' success on the NCLEX-RN.

Impact of prefilter dilution on IgG removal in membrane-based therapeutic plasma exchange.

INTRODUCTION: Previous studies have demonstrated that a "one plasma volume exchange" would result in an estimated 63% decline in pretreatment IgG levels. We evaluated the use of prefilter dilution with normal saline as a method to prevent filter failure without decreasing the efficiency of IgG removal. METHODS: Twenty-one treatment sessions were analyzed and all received prefilter dilution with normal saline. Primary outcome was to determine whether prefilter dilution resulted in decreased treatment efficiency in removing the targeted IgG. Secondary outcome was filter failure in conjunction with the combined use of prefilter heparin and saline infusions. RESULTS: All 21 treatments (100%) received prefilter dilution with saline solution and 19/21 (90.47%) also received prefilter heparin (bolus and/or hourly infusion). We demonstrated a 60%-70% decline in pretreatment IgG levels. CONCLUSION: Prefilter dilution during membrane-based therapeutic plasma exchange based treatment did not result in a demonstrable decrease in efficiency of IgG removal while maintaining filter patency.

Membrane-based therapeutic plasma exchange: Hemodynamics and operational characteristics leading to procedure failure.

BACKGROUND AND OBJECTIVES: Therapeutic plasma exchange (TPE) is a blood purification treatment capable of removing large molecular weight substances from plasma. It is commonly used for the removal of circulating pathogenic immunoglobulins presumed to be the cause of many autoimmune diseases. TPE can be performed with a membrane-based system (mTPE) or a centrifugal-based system (cTPE). When plasma separation is performed with a membrane, filter clotting can lead to longer treatment time, higher cost and can negatively impact patient satisfaction. In this study, we examine the operational characteristics that might influence filter life. DESIGN, SETTING, PARTICIPANTS, & MEASURES: We report on 24 patients, with a total of 135 mTPE treatments in a single tertiary care academic center using the NxStage machine. The study focuses on treatment specific parameters that may lead to procedure failure. The main parameters of interest were transmembrane pressure (TMP) and the filtration fraction as displayed on the machine (FFd) compared to the calculated filtration fraction (FFc). Primary outcome was to measure whether TMP, FFc, and FFd influenced filter survival. Secondary outcomes included factors that might have indirectly resulted in filter failure, including hematocrit (Hct), platelet count, heparin use, and intra-treatment calcium administration. RESULTS: In this study, we demonstrated that machine displayed filtration fractions (FFd) were lower than FFc and this difference was significantly larger in TPE sessions that experienced a clotting event (7.58 vs 6.22, P = .031). TPE sessions that clotted had a higher mean TMP (57.48 mmHg vs 44.43 mmHg, P = .001) and clotting events tended to have a lower mean blood flow rate (175.83 mL/min vs 189.55 mL/min, P = .002). In TPE sessions that received prefilter calcium administration, a higher mean dose of calcium gluconate was found in the sessions that experienced clotting (3.27 g vs 2.70 g, P = .013). Patients who experienced at least one clotting event were noted to be heavier than those patients without any clotting events (91.52 kg vs 72.15 kg, P = .040). Prefilter heparin administration was not associated with a lower incidence of filter clotting. We did not find a statistically significant difference in clotting events based upon type of intravenous access, pretreatment hematocrit, or pretreatment platelet counts. CONCLUSION: Among patients undergoing mTPE, machine FFd on the NxStage system are consistently lower than FFc. Treatments where there was a greater difference between displayed and FFc had a greater likelihood of filter clotting. Treatments with higher TMP were associated with failed treatments. Prefilter calcium administration during treatment was associated with increased filter clotting. Lower blood flow rates and higher patient weight were also associated with increased filter clotting. Prefilter heparin administration did not reduce the incidence of filter clotting.

Clinical outcomes and rotational stability following implantation of Eyecryl toric intraocular lens - Results of a 12-months prospective study.

Purpose: To evaluate the clinical performance and rotational stability after implantation of Eyecryl Toric monofocal IOL following cataract surgery. Methods: Patients undergoing phacoemulsification for age-related cataract and satisfying the eligibility criteria were implanted with Eyecryl Toric IOL. All implantations were done under balanced salt solution. A marker-less system Callisto Eye (Carl Zeiss Meditec, Germany) was used to guide the intra-operative alignment of the toric IOL. Results: A total of 50 eyes from 39 patients with mean age of 68.2 ± 8.7 years were included in the study. At 12 months, 82% (41) eyes had cumulative UDVA of 20/20 or better. Post-op SE refraction accuracy was within ± 0.50 D for 94% (n = 47) eyes and refractive cylinder accuracy was within ≤0.50 D in 98% (n = 49) eyes. Average post-op rotation at 1 year was 4.06 ± 2.15 degrees. Eighty-four percent of eyes were within 5 degrees and 16% were within 6-10 degrees of intended axis. Two eyes required IOL re-positioning due to significant rotation of the toric IOL (>10 degrees), identified within the 1st week after surgery. Conclusion: Eyecryl toric IOL demonstrated the ability to achieve a significant reduction in astigmatism, improved UDVA outcomes, high levels of spectacle independence, low rates of intra-operative injector related complications and good rotational stability at 12 months post-op.

Outcomes of bioptics with small-incision lenticule extraction as a sequential treatment after implantable collamer lens for management of extreme myopia.

PURPOSE: To study the safety and efficacy of bioptics using implantable collamer lens (ICL) followed by small-incision lenticule extraction (SMILE) for management of extreme myopia. SETTING: Nethradhama Superspeciality Eye Hospital, Bangalore, India. DESIGN: Retrospective case series. METHODS: Data were analyzed for patients who underwent bioptics using ICL in the first stage and SMILE in the second stage for correction of the residual refractive error. The mean interval between stage 1 and stage 2 correction was 24.2 ± 13.33 days. The mean follow-up after the SMILE procedure was 12.26 ± 1.39 (range 11 to 14) months. RESULTS: Fifteen eyes from 9 patients with mean age 26 ± 4.69 years were included. Preoperatively, the mean SE was -22.89 ± 3.04 diopter (D) (-16.50 to -28.00 D), which decreased to -3.40 ± 1.89 D after ICL and further reduced to -0.48 ± 0.24 D after final correction with SMILE, at the end of the mean follow-up. The mean cylinder reduced from -2.88 ± 1.69 D to -1.93 ± 1.07D post-ICL and to -0.38 ± 0.24 D post-SMILE surgery. The mean corrected distance visual acuity (CDVA) significantly improved from 0.38 ± 0.22 to 0.068 ± 0.09 logMAR after SMILE correction (P = .00). The mean uncorrected distance visual acuity (UDVA) at the end of follow-up was 0.15 ± 0.09 logMAR, with all eyes achieving UDVA of 0.3 logMAR or greater. All eyes had gain in CDVA, with 53% eyes gaining 2 or more lines. No wound-, intraocular pressure-, or ICL-related complications were observed during and after the SMILE surgery. No patient required spectacles, contact lenses, or enhancement for further improvement of vision. CONCLUSIONS: Bioptics with SMILE after ICL implantation might be a valid option for extremely myopic patients, resulting in significant improvements in visual acuity and high patient satisfaction.

Evaluation of efficacy of Bombax ceiba extract and its major constituent, mangiferin in streptozotocin (STZ)-induced diabetic rats.

OBJECTIVES: Based on the ethno-medicinal use of Bombax ceiba leaf, in the treatment of diabetes, the present study is aimed at evaluation of antidiabetic potential of leaf extract and its major constituent mangiferin. METHODS: Efficacy of hydroalcoholic extract of Bombax ceiba leaf (BCL, 200 and 400 mg/kg body wt.) and mangiferin (MF, 20 mg/kg body wt) was studied in streptozotocin (STZ)-induced diabetic rats and associated complications visually, retinopathy, cardiopathy and nephropathy. After 20 days, serum glucose, lipid profiles, glycol-hemoglobin % (HbA1c%), liver enzymes activity and glycogen content, and histopathology of the pancreas were corroborated. The study was coxswained for development of validated RP-HPLC method for the estimation of MF in BCL. RESULTS: The results demonstrated significant reductions in the levels of glucose (p<0.001), glycated hemoglobin (HbA1c%, p<0.001), cholesterol, triglycerides and low-density lipoproteins, and concurrent elevation of high density lipoproteins level in the groups administered BCL and MF relative to the controls. It significantly reversed most of the altered metabolic and oxidative stress parameters and histopathological changes. Mangiferin content in BCL was found to be 0.04%w/w. CONCLUSIONS: The anti-diabetic effects of BCL may be attributed to its ability to enhance insulin release, antioxidant and hypolipidemic potential.

Examining the Technological Pedagogical Content Characteristics of Games for Medical Education.

Virtual learning environments (VLEs) such as games can greatly enhance medical education curriculum. In this monograph, we argue for the importance of identifying existing VLEs and analyzing their characteristics in order for medical educators to establish alignment with their curricular goals. We introduce the co-opted technological pedagogical content knowledge framework as an analytical lens for examining the context-attuned design features of games [1]. We apply the lens to study three games designed to advance medical education; namely, CD4 Hunter, Septris, and Microbe Invader. We conclude with implications for enhancing medical education curricula through the incorporation of digital games.

In silico Screening of Natural Compounds as Potential Inhibitors of SARS-CoV-2 Main Protease and Spike RBD: Targets for COVID-19.

Historically, plants have been sought after as bio-factories for the production of diverse chemical compounds that offer a multitude of possibilities to cure diseases. To combat the current pandemic coronavirus disease 2019 (COVID-19), plant-based natural compounds are explored for their potential to inhibit the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), the cause of COVID-19. The present study is aimed at the investigation of antiviral action of several groups of phytoconstituents against SARS-CoV-2 using a molecular docking approach to inhibit Main Protease (Mpro) (PDB code: 6LU7) and spike (S) glycoprotein receptor binding domain (RBD) to ACE2 (PDB code: 6M0J) of SARS-CoV-2. For binding affinity evaluation, the docking scores were calculated using the Extra Precision (XP) protocol of the Glide docking module of Maestro. CovDock was also used to investigate covalent docking. The OPLS3e force field was used in simulations. The docking score was calculated by preferring the conformation of the ligand that has the lowest binding free energy (best pose). The results are indicative of better potential of solanine, acetoside, and rutin, as Mpro and spike glycoprotein RBD dual inhibitors. Acetoside and curcumin were found to inhibit Mpro covalently. Curcumin also possessed all the physicochemical and pharmacokinetic parameters in the range. Thus, phytochemicals like solanine, acetoside, rutin, and curcumin hold potential to be developed as treatment options against COVID-19.