Necessity of Improvised Antenatal Testing for Rh Isoimmunization - Exploring From a Case Series.

The study was conducted to compare the incidence and severity of dehydration in newborns admitted during warmer and cooler months. 55 out of 941 (5.8%) neonates were admitted with dehydration during the study duration. Dehydration warranting medical support was common in both cooler and warmer months of the year. 26 (47.2%) neonates were admitted in the cooler months and 29 (52.7%) in the warmer months. The severity of dehydration was marginally higher in warmer months (P = 0.09).

Clinical Assessment of SDF Effect in Arresting Dental Caries in Deciduous Teeth.

Objectives: Current research was done to evaluate the effectiveness of 38% silver diamine fluoride (SDF) on carious lesions in deciduous teeth. Materials and Method: The study included kids who had at least one carious lesion in accordance to the International Caries Detection and Assessment System II. A 38% SDF (FAgamin, Tedequim Company, Córdoba, Argentina) solution was applied directly to the lesion on the deciduous teeth as per the manufacturer's instructions. A follow-up evaluation was performed after one, three, and six months. Clinical results were used to assess the efficacy of SDF. The obtained data were statistically evaluated. Result: When it came to halting dental caries in primary teeth, 38% SDF was 92% effective. Conclusion: In conclusion, 38% SDF can be used to effectively stop caries in primary teeth.

Knowledge, attitudes and practices of resident doctors and interns on safe blood transfusion practices: a survey-based study

ABSTRACT Introduction: The knowledge of clinicians regarding blood transfusion services may impact patient care and transfusion outcome. The wide variation in transfusion practices among clinicians leads to inappropriate blood product usage and jeopardizes patient safety. Hence, this survey study aimed to assess knowledge, attitude and practice among the residents and interns of safe blood transfusion. Methods: The online survey was based on self-administered questionnaires of three sections: 1. Demography; 2. Knowledge, and; 3. Attitude and Practice. One point was assigned for the correct response of each question in every section. The knowledge score was further categorized into three categories, depending on the points obtained. The participants were also divided into four groups, depending on their experience. The Kruskal-Wallis test was applied to determine the difference of knowledge and practice scores in three designated groups of residents and interns. A p-value of less than 0.05 was considered to be significant. Result: A total of 247 residents and interns participated in this study. Thirteen participants had an incomplete response. Out of 234 participants, Senior Residents (SR), Junior Residents (JR), and interns were 70, 96 and 68 participants, respectively. The knowledge scores of interns were significantly low, as compared to SRs and JRs. Practice scores of interns were also significantly low, compared to the JRs. However, most of the residents and interns (85%) were aware of the pre-transfusion testing. Conclusion: Therefore, the mandatory incorporation of the transfusion medicine subject in the undergraduate curriculum can help the young budding doctors to better implement the patient blood management.

Efficacy of therapeutic plasma exchange in severe COVID-19 disease: A meta-analysis.

BACKGROUND AND OBJECTIVES: Therapeutic plasma exchange (TPE) has been used in severe COVID-19 disease to eliminate the cytokine storm. This meta-analysis aims to assess the effectiveness of TPE in reducing mortality in severe COVID-19 disease compared to standard treatment. MATERIALS AND METHODS: A comprehensive literature search was performed in PubMed, the Cochrane database and the International Clinical Trial Registry Platform (ICTRP). The random-effect model was used to calculate the risk ratio and standardized mean difference (SMD) as pooled effect size for the difference in mortality and length of the intensive care unit (ICU) stay. The risk of bias and publication bias were assessed in R version 4.1.0. The certainty of the evidence was calculated using the GradePro tool. RESULTS: The database identified 382 participants from six studies, including one randomized control trial. Egger's test did not detect any publication bias (p = 0.178). The random model analysis for mortality evaluated a risk ratio of 0.38 (95% CI: 0.28-0.52) with a significant reduction in the TPE group. The certainty of the evidence was moderate, with a risk ratio of 0.34 (95% CI: 0.24-0.49). Length of ICU stays between TPE versus standard care showed an SMD of 0.08 (95% CI: -0.38, 0.55) and was not significant. CONCLUSION: The length of ICU stay in the TPE group was not different from standard care. However, this meta-analysis revealed a significant benefit of TPE in reducing mortality in severe COVID-19 disease compared to standard treatment.

Knowledge, attitudes and practices of resident doctors and interns on safe blood transfusion practices: a survey-based study.

INTRODUCTION: The knowledge of clinicians regarding blood transfusion services may impact patient care and transfusion outcome. The wide variation in transfusion practices among clinicians leads to inappropriate blood product usage and jeopardizes patient safety. Hence, this survey study aimed to assess knowledge, attitude and practice among the residents and interns of safe blood transfusion. METHODS: The online survey was based on self-administered questionnaires of three sections: 1. Demography; 2. Knowledge, and; 3. Attitude and Practice. One point was assigned for the correct response of each question in every section. The knowledge score was further categorized into three categories, depending on the points obtained. The participants were also divided into four groups, depending on their experience. The Kruskal-Wallis test was applied to determine the difference of knowledge and practice scores in three designated groups of residents and interns. A p-value of less than 0.05 was considered to be significant. RESULT: A total of 247 residents and interns participated in this study. Thirteen participants had an incomplete response. Out of 234 participants, Senior Residents (SR), Junior Residents (JR), and interns were 70, 96 and 68 participants, respectively. The knowledge scores of interns were significantly low, as compared to SRs and JRs. Practice scores of interns were also significantly low, compared to the JRs. However, most of the residents and interns (85%) were aware of the pre-transfusion testing. CONCLUSION: Therefore, the mandatory incorporation of the transfusion medicine subject in the undergraduate curriculum can help the young budding doctors to better implement the patient blood management.

Minor Cross-Matching in the Diagnosis of Pneumococcal Hemolytic Uremic Syndrome in an 18-Month-Old Boy.

In developing nations, limitations in diagnostic facilities act as a barrier for differentiation of hemolytic uremic syndrome (HUS) based on the etiology. A sick-looking 18-month-old boy presented to our hospital in Bhubaneswar, India, with clinical signs and symptoms of left lobar pneumonia, abnormal hematological and renal parameters, no growth in blood culture, a negative direct antiglobulin test (DAT) result, and low complement levels. A rapid deterioration in his clinical condition necessitated intensive care support, blood transfusion, and renal replacement therapy (peritoneal dialysis and hemodialysis). Because his health care team suspected atypical HUS, therapeutic plasma exchange (TPE) was initiated as soon as possible. In the absence of a lectin panel, minor cross-matching confirmed T-antigen exposure. With a diagnosis of HUS induced by Streptococcus pneumoniae (sp-HUS), TPE was stopped immediately, and washed blood components were administered. Despite the aforementioned measures, the boy died of HUS on day 20 after presentation. This case emphasized the role of minor cross-matching in the detecting of polyagglutination in resolving the diagnostic dilemma of sp-HUS.

Hemolysis in reverse grouping: Evaluation and implication of high titer isoagglutinin of two blood donors.

Hemolysis is a positive agglutination reaction and is primarily associated with high anti-A or anti-B antibody titers. This high titer may result in no agglutination due to the "prozone" phenomenon. Platelet concentrate of high titer has an adverse effect on the recipient of the non-identical ABO blood group. Similarly, the blood products with higher titers of isoagglutinin have recently increased the incidence of intravenous immunoglobulins-related hemolysis. In this Asian subcontinent, the impact of O blood donors with high antibody titers or ABO incompatible platelets is hardly addressed. Blood was collected from two healthy donors and subjected to blood grouping as done routinely. Hemolysis was observed in the reverse grouping with the "B-"cell. Blood grouping was repeated with the conventional tube technique (CTT) where there was no agglutination with the "B"-cell. Suspecting the "prozone" phenomenon, serial dilution of anti-B was done by CTT, and the titer was found to be 1:256 and 1:128 in both cases. Then, the reverse grouping was repeated with a diluted serum (1:8), and the blood group was confirmed to be A RhD-positive and O RhD-positive, respectively. The absence of agglutination in a reverse grouping is not only an indicator of weak antibody but also a presentation of the "prozone" phenomenon. This could be differentiated by doing the titer of isoagglutinin. Hemolysis due to high agglutinin levels should be documented and evaluated, and blood components should be properly labeled to ensure that the product is transfused to the same blood group patients.

Detection of ABO Discrepancy in a Case of Coronary Artery Disease by Conventional Tube Technique: A Miss by Column Agglutination Technology.

ABO and Rh blood grouping of donors and recipients is the first and foremost step in pretransfusion compatibility testing. Conventional tube technique (CTT) is used to test for blood grouping and Rh D typing. But the procedure is cumbersome, and there may be subjective variation during the interpretation of the test results. The other disadvantage is that it is not adaptable to automation. Many newer techniques, such as the column agglutination technique (CAT) used for pretransfusion testing, are amenable to automation. It is being preferred to shift from CTT to semiautomated or fully automated CAT platforms or other newer technologies in many blood centers. The CAT has the added advantage of increased sensitivity and stable end-point results. The results in automated platforms using CAT are equally efficient and reliable as CTT. However, sometimes it is noted that CAT misses subgroups detection. Here, we report a case with a subgroup of A that was failed to be detected by the CAT using dextran acrylamide gel, signifying the use of CTT in evaluating blood group discrepancy.

Analysis of Blood Group Discrepancy in Healthy Blood Donors at a Tertiary Care Referral Hospital from Eastern India: A Retrospective Study.

Objective ABO typing constitutes cell grouping and serum grouping. The discrepancy may arise in ABO typing due to a mismatch in cell grouping and serum grouping. It may be due to technical errors, missing or weak ABO antibodies (type I), weak ABO subgroups (type II), Rouleaux formation (type III), or other miscellaneous reasons (type IV). This study was carried out to determine the prevalence and cause of ABO blood group discrepancy in donor samples at our center. Methods A retrospective study of ABO blood group typing of blood donors was conducted at our center. The blood group typing was routinely performed using gel cards and a microcentrifuge system (Tulip Diagnostics(P) Ltd, Goa, India). If any discrepancy in ABO typing was noted, the test was repeated using the conventional tube technique. After sorting clerical/technical error, the causes of discrepancy were analyzed and resolved using anti-A 1 , anti-H, anti-AB, and other immunohematological tests like antibody screening and identification, saliva inhibition test, adsorption-elution studies. Results A total of 12,715 (98.6% males and 1.4% females) donor samples were tested. The number of ABO discrepancies detected were 15 (0.12%). The discrepancies were characterized as type I (6 cases; 40%), type II (1 case; 6.7%), type III (0 cases; 0%), and type IV (8 cases; 53.3%). Three cases, each of anti-M and anti-Le b , were detected in the study population. A single case of A 3 , a subgroup of A blood group, was found during the study. Conclusion The prevalence of ABO group discrepancy was 0.12% at our center. Discrepancy arising during ABO typing of blood donor must be resolved before reporting ABO blood group to minimize the recipient's chances of transfusion reaction. The serum grouping is equally crucial as cell grouping for reporting the ABO group of an individual.

Impact of COVID-19 on blood donor deferral patterns during the COVID-19 pandemic: A retrospective analysis.

BACKGROUND AND OBJECTIVES: Blood donor deferral is an essential tool for blood safety. The ongoing COVID-19 pandemic has adversely affected blood transfusion services all over the world. But its impact on donor deferral rate and the pattern is unclear in light of the new donor deferral policy due to the COVID-19 pandemic. MATERIALS AND METHODS: This retrospective study was divided into pre-COVID and COVID (15 March 2019-14 March 2021). All the deferred donors were divided into six different categories: (1) medical causes, (2) surgical causes, (3) drugs and vaccination, (4) risk of transfusion-transmitted diseases, (5) miscellaneous causes and (6) flu-like symptoms. In addition, COVID-related deferrals were also incorporated. All these above categories along with the donor demography were analysed by SPSS software version 25. RESULTS: The donor deferral rate was 17.03% and 12.74% during the pre-COVID and COVID periods, respectively. During the pre-COVID period, Category 3 deferrals and during COVID period, Category 6 deferrals were significantly higher. A reversal in pattern with increased blood pressure (40.2% vs. 24.04%) over-riding low haemoglobin (34.77% vs. 55.5%) was noted in the Category 1 deferral during the COVID period. Category 1 deferral was more in middle-aged adults as compared to young and old adults (p < 0.05). Among middle-aged adults, deferral due to flu-like symptoms was also significantly more during the COVID period (p < 0.05). CONCLUSION: COVID-19 significantly affected the donor pool and changed the pattern of donor deferral. Understanding donor deferral patterns may help in identifying targeted donor populations and planning donor recruitment strategies in future pandemic crises.

P2X7 receptor in multifaceted cellular signalling and its relevance as a potential therapeutic target in different diseases.

P2X7 receptor, a purinergic receptor family member, is abundantly expressed on many cells, including immune, muscle, bone, neuron, and glia. It acts as an ATP-activated cation channel that permits the influx of Ca2+, Na+ and efflux of K+ ions. The P2X7 receptor plays crucial roles in many physiological processes including cytokine and chemokine secretion, NLRP3 inflammasome activation, cellular growth and differentiation, locomotion, wound healing, transcription factors activation, cell death and T-lymphocyte survival. Past studies have demonstrated the up-regulation and direct association of this receptor in many pathophysiological conditions such as cancer, diabetics, arthritis, tuberculosis (TB) and inflammatory diseases. Hence, targeting this receptor is considered a worthwhile approach to lessen the afflictions associated with the disorders mentioned above by understanding the receptor architecture and downstream signalling processes. Here, in the present review, we have dissected the structural and functional aspects of the P2X7 receptor, emphasizing its role in various diseased conditions. This information will provide in-depth knowledge about the receptor and help to develop apt curative methodologies for the betterment of humanity in the coming years.

Tn Red cell polyagglutination in a healthy blood donor: A case report.

INTRODUCTION: Polyagglutination is a rare entity in immunohematology and unusually presents in a healthy blood donor. The general presentation was described in the literature in association with bacterial infections, which result in the exposure of crypt antigens. Nowadays, polyagglutination is rarely detected due to the use of monoclonal antisera. Our case report describes the presence of Tn polyagglutination in a healthy adult blood donor with no prior history of any infection in the recent past. METHODS: Immunohematology work-up for incompatible cross-match was done in the serology lab using commercially procured antisera and column agglutination gel card (Tulip Diagnostics India Pvt. Ltd, Goa, India). The three cell-screening panel was procured commercially (ID Dia cell I, II, III; Bio-Rad, Switzerland), and in-house lectin was prepared as per the standard method. RESULT: We have come across a case of incompatible cross-match with negative antibody screen, auto-control, and Negative direct coombs test. Cross-match with multiple adult serum and cord serum gives us a clue towards polyagglutination. Further, Polyagglutination was confirmed serologically using anti-A1 lectin and later concludes of Tn type by lectin prepared in-house from Salvia Sclarea. CONCLUSION: Resolution of incompatible cross-match in a case of polyagglutination needs a skilled workforce and rare reagents. Identification of reason for incompatibility helps in an early issue of blood units.