Forecasting demand for blood products: Towards inventory management of a perishable product.

Forecasting consumption of blood products can reduce their order frequency by 60% and inventory level by 40%. This also prevents shortage by balancing demand and supply. The study aimed to establish a "Simple Average with Mean Annual Increment" (SAMAI) method of time series forecasting and to compare its results with those of ARIMA, ratio to trend, and simple average to forecast demand of blood products. Monthly demand data of blood component from January 2017 to December 2022 (data set I) was used for creating a forecasting model. To avoid the effect of COVID19 pandemic instead of actual data of year 2020 and 2021, average monthly values of previous three years were used (data set II). The data from January to July 2023 were used as testing data set. To assess the fitness of model MAPE (Mean Absolute Percentage Error) was used. By SAMAI method MAPE were 18.82%, 13.392%, 14.516% and 27.637% respectively for of blood donation, blood issue, RDP issue and FFP issue for data set I. By Simple Average method MAPE were 20.05%, 12.09%, 29.06% and 34.85%, respectably. By Ratio-to-Trend method MAPE were 21.08%, 21.65%, 25.62% and 39.95% respectively. By SARIMA method MAPE were 12.99%, 19.59%, 37.15% and 31.94% respectively. The average MAPE was lower in data set II by all tested method and overall MAPE was lower by SAMAI method. The SAMAI method is simple and easy to perform. It can be used in the forecasting of blood components demand in medical institution without knowledge of advanced statistics.

Prevalence of TTI among Indian blood donors.

Transfusion Transmissible Infections (TTIs) such as human immune-deficiency virus (HIV-I/II), hepatitis B virus (HBV), Hepatitis C virus (HCV), Malaria parasite (MP) and syphilis can spread through contaminated blood or blood products. The present study was designed to analyze the prevalence of TTIs and their association with blood group, among the blood donors of Delhi. Blood group was determined by hem-agglutination using Gel card. HIV, HBV, and HCV test was performed by ELISA, syphilis by RPR and MP rapid card method. A total Transfusion Transmissible Infections (TTIs) such as human immune-deficiency virus (HIV-I/II), hepatitis B virus (HBV), Hepatitis C virus (HCV), Malaria parasite (MP) and syphilis can spread through contaminated blood or blood products. The present study was designed to analyze the prevalence of TTIs and their association with blood group, among the blood donors of Delhi. Blood group was determined by hem-agglutination using Gel card. HIV, HBV, and HCV test was performed by ELISA, syphilis by RPR and MP rapid card method. A total of 345(2.038%) blood donors were positive for TTIs. Prevalence of HBV, HCV, HIV-I/II, syphilis and MP were 188(1.111%), 73(0.431%), 34(0.201%), 49(0.29%) and 1(0.006%) respectively. Our result shows a trend of decrease in prevalence of TTIs; 2.267%, 2.111% and 1.614% between the year 2020, 2021 and 2022 respectively. Significant association of syphilis infection (P=0.036) and HCV infection (P=0.012) with ABO blood group antigen was observed. Blood group O donors were 1.81 times more infected with syphilis compared to donor having A and B antigen. Donors having blood group antigen B were 1.80 times more infected with HCV compared to donor not having B antigen. HBV and HIV prevalence found to be not associated with ABO and Rh blood group antigens. A low prevalence of TTIs positivity was observed among blood donors. Public awareness, proper counseling, medical examination and testing can help to minimize TTIs. Our study results shows ABO blood group has an association with HCV and VDRL infection.

Link between human ABO blood groups with diseases influencing blood donors and recipients frequency at RBTC, Delhi, India.

Blood groups had associations with many diseases that affect blood transfusion services by increasing or decreasing the blood demand of particular blood group. The present study was designed to compare the frequency of ABO and Rh blood groups among blood donors and blood component recipients. The ABO and Rh(D) blood groups of donors and recipients were determined using Gel card method. The frequency of blood donors and blood component recipients from January 1, 2020, to December 31, 2023, at regional blood transfusion centre of Delhi, were compared using χ² test. The ABO blood group frequencies of blood donors (n=23025) were: A(23.1%), B(37.53%), AB(10.09%), and O(29.29%). The blood issue (n=20255) was significantly (p=0.0000) higher in A(24.96%), B(39.92%), and lower in AB(9.76%) and O(25.37%). The RDP issue (n=7239) was significantly (p=0.0000) higher in A(24.71%), B(39.34%), and AB(11.53%) and lower in O(24.41%). The FFP issue (n=4164) was significantly (p=0.00024) higher in AB (12.3%) and lower in A (22.05%), B(37.32%), and O(28.14%). The difference between the blood donor frequencies of Rh(D)+Ve(95.19%) and Rh(D)-Ve(4.81%) and the blood issued by Rh(D)+Ve(95.06%) and Rh(D)-Ve(4.94%) was statistically not significant(P=0.52).Blood issues were higher in blood group A and B than in O, platelet issues were higher in A, B and AB than in O, and FFP issues were higher in the AB. Non-O blood groups may have a higher frequency of blood transfusions, while O blood groups may have a protective influence against diseases due to their innate immune response.

Phenotype, allele and genotype frequency distribution of ABO and Rh(D) blood group among blood donors attending regional blood transfusion centre in Delhi, India.

The ABO and Rh blood group phenotypes, alleles, and genotype frequencies have many biological and medical implications. The frequency differs broadly according to races, geographical borders and ethnicity, even within the same region. This study was designed to determine the frequency of ABO and Rh blood groups among blood donors attending the regional blood transfusion centre in Delhi. The gel card method was used to determine the ABO and Rh(D) blood groups of donors who donated blood between January 1, 2020, and June 30, 2022. The assumption of Hardy-Weinberg equilibrium was used to determine allele and genotype frequencies of blood donors. A total of 16,925 blood units were donated during the study period. Donors phenotype frequencies of ABO were as follows: 'A' (23.88%), 'B' (37.38%), 'AB' (9.97%) and 'O '(29.27%). Rh(D)+Ve (D) were (94.9%) and Rh(D)-Ve (d) were (5.01%), which follow an order of B > O > A > AB and Rh-D > d for Rh. Donors ABO and Rh (D) allele frequencies were IA-0.183, IB-0.277, IO-0.541 and ID-0.776, Id-0.224 respectively. Allele frequencies follow an order of IO > IB > IA and Rh- ID > Id. Donors ABO genotype frequencies were AA-0.0333, AO-0.198, BB-0.0768, BO-0.30, AB-0.101, OO-0.293 and Rh(D) genotype frequencies were DD-0.602, Dd-0.347, dd-0.0501. Genotype frequencies follow an order of BO > OO > AO > AB > BB > AA and DD > Dd > dd. Among our donors, which were mostly from northern India, the ABO and Rh(D) blood groups have the highest proportion of ABO-B and Rh(D)+Ve and the lowest proportion of ABO-AB and Rh(D)-Ve, with a stable order of B > O > A > AB and D > d for phenotype, IO > IB > IA and ID > Id for allele and BO > OO > AO > AB > BB > AA and DD > Dd > dd for genotype.

Alloantibody among Thalassemia patients receiving multiple blood transfusions at a tertiary care hospital in India.

Regular blood transfusion is a lifesaving treatment for thalassemia patients; however, it exposes them to multiple alloantigens. The present study was designed to assess the frequency of alloantibodies in thalassemia patients receiving multiple blood transfusions. Blood samples were tested by Gel card method for ABO, Rh, Direct Antiglobulin Test (DAT), Indirect Antiglobulin Test (IAT), Auto Control (AC) and presence of alloantibody. Alloantibody screening and identification were performed using commercial 3-cell and 11-cell identification panels. Of a total of 66 thalassemia patients, 37 were male and 29 were female, with a mean age of 15.63±5.93 years and a range of 4.0 to 29.0 years. The ABO profiles of thalassemia patients were B-33, A-19, O-11, and AB-3, with 63 Rh-D positives and 3 Rh-D negatives. An average of 533.39±284.95 units were transfused an average of 304±119.65 times. Positive cases for DAT were 29(43.93%), AC was 26(39.39%) and IAT was 4(6.06%). Nine (13.636%) patients had developed alloantibodies, in which anti-K was seen in 5(27.77%), anti-Kpa in 4(22.22%), anti-C in 3(16.66%), anti-Cw in 3(16.66%), anti-D in 1(5.55%), anti-Lea in 1(5.55%), anti-Lua in 1 (5.55%). Alloantibodies were single in 4(44.44%) and multiple in 5(55.55%) patients. The rate of alloimmunization and positivity of DAT, AC, ICT, and splenectomy were significantly associated with higher age, the number of units transfused, and also the number of times of transfusion. Every new thalassemia patient needs extended blood group typing prior to the start of a blood transfusion and antigen-matched blood. For patients with alloantibodies, corresponding antigen-negative blood must be selected for cross-matching.

Prevalence of viral load suppression and acquired drug resistance among people living with HIV in Nepal: a nationally representative surveillance study.

OBJECTIVES: This is the first nationally representative study to estimate the prevalence of viral load (VL) suppression and acquired HIV drug resistance (ADR) among people living with HIV (PLHIV) in Nepal. METHODS: A cross-sectional study recruited 1418 PLHIV from 20 ART centres in Nepal, using a two-stage cluster design. Participants were eligible if they were HIV-positive individuals on ART for 9-15 months or at least 48 months. Plasma specimens were collected and tested for the quantification of HIV-1 RNA. Specimens with a VL ≥1000 copies/mL were further processed for sequencing of PR and RT genes of HIV-1. The sequences were then analysed to detect mutations causing HIV drug resistance. RESULTS: The prevalence of ADR was 3.7% (95% confidence interval [CI]: 1.8-7.6) and 3.0% (95% CI: 1.8-5.2) among PLHIV who received ART for 9-15 months and 48 months or more, respectively. The prevalence of VL suppression was 95.3% (95% CI: 91.7-97.4) among those on ART for 9-15 months, and 96.5% (95% CI: 94.7-97.7) among those on ART for at least 48 months. The prevalence of any detectable acquired resistance to antiretroviral drugs was 80.7% (95% CI: 58.6-92.5) among those on ART for 9-15 months with VL ≥1000 copies/mL and 81.6% (95% CI: 55.4-94.0) among those on ART for at least 48 months with VL ≥1000 copies/mL. CONCLUSION: This study suggests that improved accessibility to VL monitoring and timely assessment of drug resistance in routine HIV programs are crucial in Nepal to ensure access to HIV treatment for all in need.

Effect of COVID-19 pandemic on blood transfusion service: an experience from a regional blood transfusion center.

The unforeseen and uncertain life-threatening situation of the COVID-19 pandemic dramatically affected all areas of the human daily work schedule. This study was designed to assess the impact of the COVID-19 pandemic on blood transfusion services and discuss the adopted confrontation measures for uninterrupted blood supply during the pandemic situation. The data on blood donation, blood component preparation, and issue from January 2019 to December 2022 were collected from the inventory registers of the RBTC, Delhi, India. Compared to the non-pandemic year 2019, during the year 2020, all variables decreased gradually. The observed maximum decrease in variables such as blood collection (-79.16%) in the month of October, blood issue (-71.61%) in the month of August, random donor platelets (RDP) preparation (-98.09%) in the month of October, RDP issue (-86.08%) in the month of September, fresh frozen plasma (FFP) preparation (-100%) in the month of October, and FFP issue (-96.08%) in the month of July with an annual decrease of -45.52%, -42.87%, -33.00%, -59.79%, -40.98%, and -54.48%, respectively, as compared to year 2019. Compared to year 2020, in year 2021, the annual increase in blood collection, blood issue, FFP preparation, FFP issue, RDP preparation, and RDP issue was +50.20%, +21.68%, +65.31%, +78.52%, +116.23%, and +213.30%, respectively. Our study results show that the COVID-19 pandemic has significantly affected blood transfusion services at our blood bank. The adopted coping strategies to maintain the safe and uninterrupted blood transfusion chain at our blood bank gave us lessons for future preparedness if faced with a similar situation.

Feasibility of implementing public-private mix approach for tuberculosis case management in Pokhara Metropolitan City of western Nepal: a qualitative study.

Background: The Public-Private Mix (PPM) approach is a strategic initiative that involves engaging all private and public health care providers in the fight against tuberculosis using international health care standards. For tuberculosis control in Nepal, the PPM approach could be a milestone. This study aimed to explore the barriers to a public-private mix approach in the management of tuberculosis cases in Nepal. Methods: We conducted key informant interviews with 20 participants, 14 of whom were from private clinics, polyclinics, and hospitals where the PPM approach was used, two from government hospitals, and four from policymakers. All data were audio-recorded, transcribed, and translated into English. The transcripts of the interviews were manually organized, and themes were generated and categorized into 1. TB case detection, 2. patient-related barriers, and 3. health-system-related barriers. Results: A total of 20 respondents participated in the study. Barriers to PPM were identified into following three themes: (1) Obstacles related to TB case detection, (2) Obstacles related to patients, and (3) Obstacles related to health-care system. PPM implementation was challenged by following sub-themes that included staff turnover, low private sector participation in workshops, a lack of trainings, poor recording and reporting, insufficient joint monitoring and supervision, poor financial benefit, lack of coordination and collaboration, and non-supportive TB-related policies and strategies. Conclusion: Government stakeholders can significantly benefit by applying a proactive role working with the private in monitoring and supervision. The joint efforts with private sector can then enable all stakeholders to follow the government policy, practice and protocols in case finding, holding and other preventive approaches. Future research are essential in exploring how PPM could be optimized.

Isolated abducens nerve palsy - A rare clinical presentation in dengue haemorrhagic fever.

Dengue fever is the most prevalent flavivirus infection in tropical and subtropical areas of the world. It is transmitted by the haematophagous mosquito Aedes aegypti, and it manifests clinically as classical dengue fever, dengue haemorrhagic fever and dengue shock syndrome. Rarely, dengue can be associated with neurophthalmic manifestations. We present the case of a 21-year-old woman, suffering from dengue with an isolated abducens nerve palsy.

Microalbuminuria and Its Risk Factors in Type 2 Diabetic Patients.

BACKGROUND: Diabetic nephropathy is one of the dreaded complications of diabetes leading to chronic kidney disease and end stage renal failure globally. Microalbuminuria is the most sensitive marker of early recognition of the diabetic nephropathy. This study was carried out to find out the prevalence and potential risk factors of microalbuminuria which is the marker of diabetic nephropathy among diabetes patients in Nepal. METHODS: A cross-sectional study was conducted on a random sample of 227 in T2DM patients in private diabetic clinics and Bir hospital in Kathmandu. Data were collected using standard questionnaire format to collect demography, anthropometry, and laboratory assessment of, HbA1c, post prandial, fasting glucose and micro albumin in urine. Micro albuminuria was measured using early morning urine specimen. Micro albuminuria was considered positive when urinary albumin to creatinine ratio was found to be 30-300 mg/g creatinine in preferably an early morning or a spot urine sample. The entire lab test will be done by applying the internationally accepted standards of tools and techniques.Those that were reported >30mg/mL of micro albumin were considered as positive. RESULTS:   Out of total 217 diabetic patients, 56.2% (122/217) were male and 43.8% (95/217) were female. Among all age groups, maximum patients enrolled were between the age group 41 to 80 (95%).Of the total, 20% (44/217)) patientswereMA positive. A statistical significant association was seen between MA and BMI (p=0.029), duration of DM (p=<0.001, hypertension (p=<0.001, smoking (p=<0.001) and physical activity (p=<0.001). CONCLUSIONS: Diabetic patients in Nepal have prevalence of 20.3% microalbuminurea. Hypertension, obesity, sedentary lifestyles, duration more than 5 years of illness are found the most important risk factors for the development of microalbuminurea in diabetes.     Keywords:  Mellitus; microalbuminuria; type 2 diabetes.

A Very Rare Presentation of Type 1 Monteggia Equivalent Fracture with Ipsilateral Fracture of Distal Forearm-approach with Outcome: Case Report.

INTRODUCTION: We report a case of Type 1 Monteggia equivalent injury with intact radio-capitellar congruity, associated with epiphyseal fracture of distal radius and distal ulna shaft in an 11-year-old boy. There are only a few cases of Monteggia or Monteggia equivalent injury with ipsilateral forearm fractures in children, and injury pattern being reported by us is not only rare but also the only case reported thus far to the best of our knowledge, Sood et al. described Type 1 equivalent with epiphyseal injuries of both radius and ulna Osada et al. also described injury pattern same as Sood et al. with epiphyseal separation in both distal radius and ulna. Our case was slightly different than above two in that distally, there was ulna shaft fracture with Salter Harris Type 2 epiphyseal separation in the radius. CASE REPORT: An 11-year-old, right-hand dominant boy presented in casualty with a history of fall one day back with pain, swelling and deformity in the left forearm with bleeding from left forearm and loss of movement of fingers and thumb of the left hand. On examination, there was a wound of size one centimeter on mid-forearm over the ulnar aspect. Extension of fingers and thumb at metacarpophalangeal joints was lost with intact sensations suggestive of posterior interosseus nerve involvement. No vascular was deficit was present. X-rays were performed which suggested type two epiphyseal separation proximal radius with fracture shaft ulna with lateral angulation in elbow and proximal forearm. Radiocapitellar joint congruity was maintained in the views performed. X-rays of wrist suggested fracture both bones distal forearm epiphysis in distal radius and distal shaft in ulna. The patient was operated with toileting, debridement, and open reduction of proximal ulnar fracture with K-wire. Proximal radius epiphyseal separation was approached by Kocher approach and fixed with two K-wires, while for distal radius epiphyseal separation open reduction and internal fixation was performed. Follow-up of the patient showed posterior interosseus nerve recovery and subsequent union of all fractures with good functional outcome. CONCLUSION: This type of lesion is rare in children probably because the annular ligament is relatively lax and the radial head dislocates more easily anteriorly, rather than occurrence of fracture as seen in our case, and associated fracture of distal forearm is a very rare injury.

Non-lethal? Penetrating chest injury due to beanbag bullet.

We report a case of serious lung injury from beanbag bullet. A 46-year-old gentleman, shot with beanbag bullets was brought to the emergency department. Upon arrival he was in obvious respiratory distress and complained of severe pain in the right chest. A 3.0×3.5 cm entry wound on the right parasternal area was identified. Chest x-ray revealed a right haemopneumothorax, parenchymal changes at the right lung base and a radiopaque foreign body. A right-sided intercostal chest tube was inserted, draining air and 750 ml of blood. After stabilisation patient underwent a right thoracotomy. A beanbag bullet was found in the oblique fissure of the right lung, with extensive haematoma of the middle lobe. The bullet and skin fragments overlying the lung and along the bullet track were extracted. The pleural cavity was washed with normal saline and haemostasis was confirmed. The patient had an uneventful postoperative recovery.

Acute primary angle closure in a patient with high myopia: a case report.

Primary angle closure in a high myopic patient is rare. Here is presented a report of one such patient who presented with acute primary angle closure in one eye. Conservative management followed by laser iridotomy was effective in the treatment of this patient.