ABSTRACT
Introduction: India has a huge disease burden of thalassemia major with an estimated 40 million carriers and over a million thalassemia major patients. Very few patients are optimally treated, and the standard of care “hematopoietic stem cell transplant” (HSCT) is out of reach for most patients and their families. The cost of HSCT is significant, and a substantial proportion of it goes to human leukocyte antigen (HLA) testing of family members (HLA screening) in hope of getting a matched related donor (MRD) for HSCT. The aim of this study was to establish that a new proposed testing algorithm of HLA typing would be more cost-effective as compared to the conventional HLA screening within MRD families for possible HSCT. Material and Methods: Buccal swab samples of 177 thalassemia patients and their prospective family donors (232) were collected. Using a new HLA testing algorithm, samples were tested for HLA typing in a sequential manner (first HLA-B, then HLA-A, and finally HLA-DR) using the sequence-specific oligonucleotide probe method on the Luminex platform. Results: The new sequential HLA-A, HLA-B, and HLA-DRB1 testing algorithm showed a 49.1% reduction in cost compared to the conventional HLA testing algorithm. Furthermore, 40 patients (22.59%) were found to have HLA-MRD within the family among other samples that were tested. Conclusion: The new HLA testing algorithm proposed in the present study for identifying MRD for HSCT resulted in a substantial reduction in the cost of HSCT workup.
ABSTRACT
Introduction– The alcohol withdrawal seizure(WS) occurs during the early phase of withdrawal and is characterized by reduction in the seizure threshold and it emerges within 48 hours of cessation of prolonged drinking (Brathen G et al,1999;Victor M et al,1967.)The appearance of a withdrawal seizure represents a strong risk factor for progression into a severe withdrawal state with following development of DT in up to 30% of cases(Victor M et al,1967). Aim– The purpose of the current study is to identify the most parsimonious collection of risk factors present at the time of hospital admission that were predictive for the development of WS. METHODOLOGY– 102 subjects admitted at deaddiction centre, SMS hospital were selected using a screening performa which was followed by a comprehensive assessment of alcohol use followed by relevant laboratory investigations with blood pressure and pulse rate recording. Severity of alcohol withdrawal syndrome (AWS) was determined in analogy to the revised Clinical Institute Withdrawal Assessment for Alcohol (CIWA–Ar) scale. Patients were put on standard treatment based upon institute guidelines and withdrawal was assessed for 1 week. Patients were monitored for withdrawal seizure and diagnosis was made as per criteria of ICD 10. RESULTS– Age of onset of drinking, duration of alcohol abuse and daily ethanol intake were found to be significantly correlated to the development of WS. Systolic BP, Diastolic BP, Heart rate had significant correlation to the occurrence of WS which can be attributed to the autonomic hyperactivity during the withdrawal state. CIWA–Ar score also came out to be a significant risk factor to the development of WS.Previous history of seizures, delirium tremens, previous alcohol withdrawal syndrome and previous detoxification episodes were also a significant risk factor for the occurrence of WS . CONCLUSION– The various variables that were found to be significantly correlated to the occurrence of WS are mentioned as follows: age, duration of abuse, daily alcohol intake, CIWA–Ar score>15, systolic & diastolic BP, previous history of WS and DT, previous history of alcohol withdrawal syndrome and previous detoxification episodes.