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.

Analysis of time-to-positivity data in tuberculosis treatment studies: Identifying a new limit of quantification.

The BACTEC Mycobacteria Growth Indicator Tube (MGIT) machine is the standard globally for detecting viable mycobacteria in patients' sputum. Samples are observed for no longer than 42 days, at which point the sample is declared "negative" for tuberculosis (TB). This time to detection of bacterial growth, referred to as time-to-positivity (TTP), is increasingly of interest not solely as a diagnostic tool, but as a continuous biomarker wherein change in TTP over time can be used for comparing the bactericidal activity of different TB treatments. However, as a continuous measure, there are oddities in the distribution of TTP values observed, particularly at higher values. We explored whether there is evidence to suggest setting an upper limit of quantification (ULOQM) lower than the diagnostic limit of detection (LOD) using data from several TB-PACTS randomized clinical trials and PanACEA MAMS-TB. Across all trials, less than 7.1% of all weekly samples returned TTP measurements between 25 and 42 days. Further, the relative absolute prediction error (%) was highest in this range. When modeling with ULOQMs of 25 and 30 days, the precision in estimation improved for 23 of 25 regimen-level slopes as compared to models using the diagnostic LOD while also improving the discrimination between regimens based on Bayesian posteriors. While TTP measurements between 25 days and the diagnostic LOD may be important for diagnostic purposes, TTP values in this range may not contribute meaningfully to its use as a quantitative measure, particularly when assessing treatment response, and may lead to under-powered clinical trials.

Predictive Modeling of Drug-Related Adverse Events with Real-World Data: A Case Study of Linezolid Hematologic Outcomes.

Electronic health records (EHRs) provide meaningful knowledge of drug-related adverse events (AEs) that are not captured in standard drug development and postmarketing surveillance. Using variables obtained from EHR data in the University of California San Francisco de-identified Clinical Data Warehouse, we aimed to evaluate the potential of machine learning to predict two hematological AEs, thrombocytopenia and anemia, in a cohort of patients treated with linezolid for 3 or more days. Features for model input were extracted at linezolid initiation (index), and outcomes were characterized from index to 14 days post-treatment. Random forest classification (RFC) was used for AE prediction, and reduced feature models were evaluated using cumulative importance (cImp) for feature selection. Grade 3+ thrombocytopenia and anemia occurred in 31% of 2,171 and 56% of 2,170 evaluable patients, respectively. Of the total 53 features, as few as 7 contributed at least 50% cImp, resulting in prediction accuracies of 70% or higher and area under the receiver operating characteristic curves of 0.886 for grade 3+ thrombocytopenia and 0.759 for grade 3+ anemia. Sensitivity analyses in strictly defined patient subgroups revealed similarly high predictive performance in full and reduced feature models. A logistic regression model with the same 50% cImp features showed similar predictive performance as RFC and good concordance with RFC probability predictions after isotonic calibration, adding interpretability. Collectively, this work demonstrates potential for machine learning prediction of AE risk in real-world patients using few variables regularly available in EHRs, which may aid in clinical decision making and/or monitoring.

An Observational Study on the Use of a Patient Navigator to Help Improve Outcomes in Patients on Chronic Opioids.

BACKGROUND: In the United States, the prevalence of opioid use disorders has increased in recent years along with an attendant rise in the incidence of chronic pain disorders and prescription opioid use. Patient navigation services have been used to improve health outcomes in cancer and other chronic disease states, but it is unclear whether the implementation of patient navigation services can facilitate improved outcomes among patients receiving chronic opioid therapy. OBJECTIVES: The objective of this study was to compare the outcomes of patients receiving chronic opioid therapy plus patient navigation services and those receiving chronic opioid therapy as a part of usual care. STUDY DESIGN: This was a prospective, observational study. Consecutive patients receiving chronic opioid therapy were enrolled, with alternating assignments to patient navigation (n = 30) or usual care (n = 30). Participants in the patient navigation group received support from a non-physician, non-advanced practice provider staff member who initiated frequent contact via telephone, telemedicine, or in-clinic visits to discuss the patient's health goals. The minimum follow-up period was 90 days. Outcomes qualitatively compared across groups included final pain score, final morphine milligram equivalent (MME) per day, and discharge rates. Risk factors for discharge within the navigation group were assessed. Patient feedback was also solicited. SETTING: This study was conducted at a single independent pain clinic in the United States. RESULTS: Demographic features were similar between the navigator group and the control group. The control group had a higher average initial pain score (7.0/10) than the intervention group (5.9/10) and were receiving a higher initial dose of opioids (23.1 vs 19.0 MME/d). After an average follow-up of 108.7 days, patients in the navigator group had a 16% decrease in final opioid dose compared with a 23% increase in the control group. Furthermore, patients in the control group were discharged from the practice at a higher rate (23.3% vs 6.6%), suggesting increased opioid misuse in the control group compared with the navigator group. In the navigator group, higher levels of anxiety and depression were the primary predictors of discharge. LIMITATIONS: This was a single-center study with a small sample size. The generalizability of these results to other clinic settings is unknown. CONCLUSIONS: Patient navigation decreased opioid use and practice discharge compared with usual care in an independent pain clinic, suggesting a role for patient navigation in reducing opioid misuse and potentially reducing adverse events.

Generalized anetoderma: An unusual manifestation of secondary syphilis treated with injection penicillin.

Anetoderma also called macular atrophy is a rare, benign disorder characterized microscopically by the pan-dermal loss of elastic fibers in the dermis and presenting clinically as circumscribed, skin-colored or gray-white atrophic macules and/or patches on the trunk and/or extremities. Lesions are described as having a "sac-like" appearance, since they bulge or herniate upon palpation. It is a rare benign condition of diverse etiology; whose characteristic is the diminution or absence of the dermal elastic fibers. Anetoderma is divided into primary (idiopathic) and secondary anetoderma, with the former occurring in areas of previously normal skin and the latter developing in areas of prior skin pathology. Both may occur in association with underlying systemic conditions and warrant evaluation for associated disorders. There are no effective treatment options for anetoderma at present. We report here an unusual case of generalized anetoderma occurring in association with secondary syphilis treated with injection benzathine penicillin.

Impact of ocular hypotensive lipids on clinically significant diabetic macular edema.

PURPOSE: To study the impact of ocular hypotensive lipids (OHL) on the incidence, progression, and response to treatment of clinically significant diabetic macular edema (CSDME). METHODS: A total of 379 patients (232 female, 147 male) with a history of diabetes mellitus (DM) and primary open-angle glaucoma (POAG) were identified and included in the study. Patients were stratified into groups based on CSDME development and OHL exposure. Main outcome measures included time to development of CSDME, total duration of OHL exposure, and duration of DM and POAG. RESULTS: Seven patients (1.8%) developed CSDME after OHL exposure (group 1A), 15 (4.0%) developed CSDME prior to OHL exposure (group 1B), and 197 (52.0%) were treated with OHL but never developed CSDME (group 2). Of patients not exposed to OHL, 22 (5.8%) developed CSDME (group 3) and 138 (36.4%) did not (group 4). Mean duration of DM was longer (p<0.0001) in patients who developed CSDME (20.2 years) compared to patients who did not (12.4 years). There was no difference (p=0.67) in the amount of OHL exposure between patients who developed CSDME (4.1 years) and patients who did not (4.6 years). Once developed, there was no difference in the interval until CSDME resolution between OHL treated (17.8 mo) and untreated (12.7 mo) patients (p=0.36). CONCLUSIONS: The CSDME development correlated most strongly with the duration of diabetes, irrespective of OHL use. Ocular hypotensive lipids treatment of POAG seems not to affect the incidence, progression, or response to treatment of CSDME in diabetes.