Evaluation of Causes and Rate of Wastage of Blood and its Components – An Important Quality Indicator in Blood Banks.

Background: The evaluation of wastage of blood products represents an important element in the appropriate use of blood components, a critical control point in the system of blood administration. Discarding or wastage of blood can be attributed to several reasons namely time expiry, wasted import, non-usage of ordered blood, broken bags and seal with leakage, hemolytic reasons, clotted blood, returned after 30 min, and miscellaneous others.Wasting of blood and blood components are an inefficient use of resources and may be avoided. The present study was undertaken with aim of primarily to determine the frequency of blood products wasting and secondarily to determine the factors that affect blood products wastage at our institute. Methods: The present study is a retrospective cross sectional descriptive study conducted in a tertiary teaching hospital located in South Delhi catering to low socioeconomic population. Blood component wastage was defined as components that did not meet the required standards of hospitals or fractionation centres during collection, processing and storage. The main reasons included expiry date, inappropriate volume, haemolysis of red blood cells (RBCs), contamination of plasma or platelets with RBCs, blood bag leakage, reactive infectious disease tests and inappropriate temperature during storage or transportation. The required data from clinical units and blood bank were collected and analyzed for a period of 7 years. Results: A total of 13728 blood units were received during the specified period. Overall wasted factor was of 18.5% with maximum wastage of platelet concentrate units (53.7%). Analyzing the causes of blood and blood product wastage in the hospital for this study showed that blood and blood product wastage were associated with many causes of which the common causes, included the expiration of the usability period (69.2%), sero-reactivity for infectious diseases (13.7%) and Quality Control units (9.2%). Conclusion: Blood is an irreplaceable precious resource which needs to be properly utilized with minimal wastage. Although present study was limited due to its retrospective nature but it still outlines the importance to emphasize that measures should be taken into account for formulating guidelines, effective policies, and training efforts for personnel.

Knowledge about stroke among adults in Sharjah, United Arab Emirates

Background: In UAE, stroke is the second leading cause of disability after RTA, where annually 8,000 to 10,000 patients get a stroke. Our aim is to identify the knowledge levels of stroke among Sharjah’s adult citizens.Methods: Using self-administered questionnaires, in a cross-sectional design, a non-probability convenience sampling method was used to enrol subjects. Eligible subjects were above 18 years of age, comprehended Arabic or English, and are currently residing in Sharjah. The questionnaire was 17 questions structured in 5 sections which included: demographics, general knowledge, knowledge of signs and symptoms, risk factors, and appropriate response towards stroke. SPSS V.22 was used to analyse the data. Percentages, means, and ANOVA were used. A P-value less than 0.05 was considered to be statistically significant.Results: The study included 426 subjects, mean age was 35.1 years, 65.2% were females. 51.8% of the subjects claimed they know what stroke is, out of whom 24.3% provided incorrect descriptions. The mean knowledge level of signs and symptoms was 55.4%, and of risk factors was 40.6%. Visual disturbance was the least identified of the five signs and symptoms (38.0%). Female gender, African American race, and age above 60, were the least identified of the 8 risk factors (4.7%, 3.5%, 19.8% respectively). Better knowledge was associated with increased age and higher education. Conclusion: The majority of the sample showed an average to low level of knowledge. Such results indicate the importance of implementing more awareness programs that target younger age groups in the community.

Correlating lipid profile with age, gender, and body mass index of patients with type 2 diabetes mellitus: A single-center prospective study

Background: Diabetes mellitus is a group of metabolic disorder characterized by chronic hyperglycemia with disturbances in carbohydrate, fat, and protein metabolism due to defects in insulin secretion, insulin action, or both. Diabetic dyslipidemia is characterized by increases low-density lipoprotein cholesterol (LDL-C), decreased high-density lipoprotein cholesterol (HDL-C) level, and elevated triglyceride (TG) levels. Objectives: The objectives of this study were to correlate the lipid profile with age, gender, and body mass index (BMI) of type 2 diabetes mellitus (T2DM) patients. Materials and Methods: A total of 76 T2DM patients were studied at Diabetes, Obesity, and Thyroid Center, Gwalior, Madhya Pradesh, between May 2016 and May 2017. After detailed demographic details including age, sex, weight, height, and BMI, total cholesterol (TC), TG, LDL-C, very LDL-C (VLDL-C), and HDL-C were estimated for all the patients. Results: The mean age of diabetes patients was 54.80 ± 11.07 years. The mean duration of diabetes was 5.38 ± 4.90 years. Lipid profile of T2DM patients was similar across the different age and BMI groups (P > 0.05). Except HDL-C (P < 0.001) which was significantly low among males other lipid parameters such as TC, TG, LDL-C, and VLDL-C were comparable between genders (P > 0.05). TC, TG, LDL‑C, and VLDL-C were showed positive correlation with fasting plasma glucose and postprandial glucose, whereas HDL-C showed negative correlation (P > 0.05). Conclusion: There was no significant difference in TC, TG, HDL-C, LDL-C, and VLDL-C level between different age and BMI groups. We found a significantly lower HDL-C level among the male population.

Paediatric blunt torso trauma: injury mechanisms, patterns and outcomes among children requiring hospitalisation at the sultan Qaboos university hospital, Oman

Objectives: Trauma is the greatest cause of morbidity and mortality in paediatric/adolescent populations worldwide. This study aimed to describe trauma mechanisms, patterns and outcomes among children with blunt torso trauma admitted to the Sultan Qaboos University Hospital [SQUH] in Muscat, Oman

Methods: This retrospective single-centre study involved all children

Results: A total of 70 children were admitted with blunt torso trauma during the study period, including 39 [55.7%] male patients. The mean age was 5.19 +/- 2.66 years. Of the cohort, 35 children [50.0%] received their injuries after having been hit by cars as pedestrians, while 19 [27.1%] were injured by falls, 12 [17.1%] during car accidents as passengers and four [5.7%] by falling heavy objects. According to computed tomography scans, thoracic injuries were most common [65.7%], followed by abdominal injuries [42.9%]. The most commonly involved solid organs were the liver [15.7%] and spleen [11.4%]. The majority of the patients were managed conservatively [92.9%] with a good outcome [74.3%]. The mortality rate was 7.1%. Most deaths were due to multisystem involvement

Conclusion: Among children with blunt torso trauma admitted to SQUH, the main mechanism of injury was motor vehicle accidents. As a result, parental education and enforcement of infant car seat/child seat belt laws are recommended. Conservative management was the most successful approach

[Safety and complications of Double-Lumen Tunnelled Cuffed Central Venous Dialysis Catheters; clinical and radiological perspective from a tertiary centre in Oman]

Objectives: This study aimed to assess the technical success, safety and immediate and delayed complications of double-lumen tunnelled cuffed central venous catheters [TVCs] at the Sultan Qaboos University Hospital [SQUH], Muscat, Oman

Methods: This retrospective study took place between January 2012 and October 2013. The clinical records and radiological data of all patients who underwent ultrasound- and fluoroscopy-guided TVC placement at SQUH during the study period were reviewed. Demographic data and information regarding catheter placement, technical success and peri- and post-procedure complications [such as catheter-related infections or thrombosis] were collected

Results: A total of 204 TVCs were placed in 161 patients. Of these, 68 were female [42.2%] and 93 were male [57.8%]. The mean age of the patients was 54.4 +/- 17.3 years. The most common reason for catheter placement was the initiation of dialysis [63.4%]. A total of 203 procedures were technically successful [99.5%]. The right internal jugular vein was the most common site of catheter placement [74.9%]. Mild haemorrhage which resolved spontaneously occurred in 11 cases [5.4%]. No other complications were observed. Subsequent follow-up data was available for 132 catheters [65.0%]; of these, thrombosis-related catheter malfunction was observed in 22 cases [16.7%] and catheter-related infection in 29 cases [22.0%]. Conclusion: Radiological-guided placement of tunnelled haemodialysis catheters can be performed safely with excellent technical success. The success rate of catheter insertion at SQUH was favourable in comparison with other studies reported in the literature

Role of oxidative stress & antioxidant defence in ulcerative colitis patients from north India.

Background & objectives: Oxidative stress contributes to severity of ulcerative colitis (UC) but the status of erythrocyte antioxidant defence remains unknown. The present study was aimed to study the role of oxidative stress and antioxidant levels in erythrocytes of UC patients from north India. Methods: A total of 81 adult UC patients and 85 age and sex matched apparently healthy controls were included in this study. Levels of lipid peroxidation (LPO), reduced glutathione (GSH), catalase and superoxide dismutase (SOD) were measured in erythrocytes. Results: Mean age of UC patients was 43.5 yr (range 18-64 yr) while in the control group this was 45.3 yr (range 20-64 yr). LPO, catalase and SOD levels in UC patients were significantly increased (P<0.05) compared to healthy controls, while GSH levels in UC patients were significantly decreased (P<0.05) compared to healthy controls Ulcerative colitis activity score (UCAI) was 157.4±27.6 in UC patients. Interpretation & conclusions: Increased levels of LPO, SOD, catalase and a decreased level of GSH represent that oxidative stress plays a significant role in pathophysiology of UC. Further, the levels of LPO, GSH, catalase and SOD remained same during different UCAI.

Prevalence of Rheumatic Fever and Rheumatic Heart Disease Among School Children.

Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are significant public health concerns in the developing countries like India. A total number of 10330 school children were examined clinically for evidence of acute rheumatic fever and rheumatic heart disease . Those suffering with the disease were subjected to electrocardiographic, rontgenographic and echocardiographic examination. Prevalence of acute rheumatic fever and rheumatic heart disease was found to be 0.87 per 1000.

Reproducibility and validity of a quantitative food frequency questionnaire in an urban and rural area of northern India.

Background. Food frequency questionnaires (FFQs) have been used in epidemiological studies across the world to capture the usual food intake of individuals. As food habits vary in different population groups, FFQs should be validated before use. Hence, we determined the reproducibility and validity of FFQs designed for urban and rural populations of northern India. Methods. Separate FFQs, designed for urban and rural populations using standard methods, were administered to a sample of 200 subjects (100 urban and 100 rural) in the age group of 35–70 years in the beginning (baseline FFQ) of the study and after an interval of 1 year (1-year FFQ) to assess their reproducibility. Six 24-hour dietary-recalls, taken at an interval of 2 months over a period of 1 year, were used as a reference method to test the validity. Crude and energyadjusted nutrient intakes estimated from FFQs and 24-hour dietary-recalls were compared using Pearson correlation coefficients. Bland and Altman plots were also used to test the agreement between the two methods. Results. Nutrient intakes were found to be similar at the baseline and 1-year FFQs in urban and rural areas. The unadjusted Pearson correlation between 24-hour dietaryrecalls and 1-year FFQ ranged from 0.22 for vitamin C to 0.63 for iron in the urban area. It ranged from 0.06 for vitamin C to 0.74 for energy in the rural area. The correlations lowered after adjusting for energy and there was a minimal increase after de-attenuation. Conclusion. The FFQs were reproducible and valid for assessing nutrient intakes except for some micronutrients.

Sjogren Larsson Syndrome.

Sjogren Larsson Syndrome( SLS) is a rare neuroectodermal disorder characterized by congenital icthyosis, mental retardation and spastic diplegia along with pathognomic opthalmological findings. We report two siblings with Sjogren Larsson Syndrome from an Indian family but, without eye involvement.

Pro-inflammatory and anti-inflammatory cytokine response in diarrhoea-predominant Irritable bowel syndrome patients.

Background and aim: Irritable bowel syndrome (IBS) is referred to as a functional bowel disorder which is diagnosed by a number of characteristic symptoms (Rome II criteria) in the absence of detectable structural abnormalities. Low-grade inflammation of the intestine may be one of the reasons for development of diarrhoea-predominant IBS (IBS-D). We undertook this study to estimate the serum levels of pro-inflammatory (IL-6, TNF-a) and anti-inflammatory (IL-10) cytokines in IBS-D patients. Methods: A total of 108 diarrhoea patients were screened. Out of these only 63 adult IBS-D patients were enrolled. Age and sex matched 62 apparently healthy controls with no GI symptoms were also recruited. Out of 63 IBS-D patients, 37 were males while there were 32 males among the controls. The patients with IBS-D were diagnosed according to the Rome II criteria. Levels of serum IL-6, TNF-a and IL-10 were measured in all subjects using ELISA. Results: Mean (+SD) age of IBS-D patients (42.6+19.5 years) was comparable (p=0.64) to that of controls (43.5+18.7 years). The mean (+SD) levels of IL-6 in IBS-D patients (32.2+12.01pg/ ml) was significantly higher (p<0.001) than in controls (7.48+2.55pg/ml). The levels of TNF-a in IBS-D patients (16.3+5.2 pg/ml) were also significantly higher (p<0.05) than in controls (7.94+2.19 pg/ml). There was no significant difference in the serum levels of IL-10 (p=0.23) between IBS-D patients (5.75+2.1 pg/ml) and controls (5.84+1.9 pg/ml). Conclusion: Our results indicate that mild inflammation is involved in IBS-D patients as proinflammatory cytokines were increased although no difference in anti-inflammatory cytokine was observed.

Epidemiological Study of Morbidity Pattern of Critically Ill Children Admitted in Child Intensive Therapy Unit.

Background : In India 34.3% of the total population is constituted by the most vulnerable segment of our society i.e. infants and children. Malnutrition, respiratory and diarrhoeal diseases are three main scourges of the children but the great devils hovering upon them are lack of proper treatment and management. The present study was conducted to find out the morbidity pattern of our vulnerable children. Aims and Objectives : 1. To find out the prevalence of critically ill children admitted in the hospital. 2. To find out the morbidity pattern of critically ill children admitted in the child intensive therapy unit, in a hospital. Research Question : What is the epidemiological pattern of morbidity in critically ill children of age 1 month to 12 years? Study Design : Cross-sectional Study. Study Participants : All critically ill children coming to the emergency unit of the hospital during study period. Statistical Analysis : Simple percent and proportions, Chi square test.

Family history of diabetes and parental consanguinity: important risk for impaired fasting glucose in South East Asians / Historia familiar de diabetes y consanguinidad de los padres: riesgo importante para la glucosa en ayunas alterada en Asiáticos Sudorientales

OBJECTIVE: Offsprings of Type 2 diabetics have increased risk of metabolic disturbances. The aim of the study is to assess the potential effect of family history of Type 2 diabetes (FHD) and parental consanguinity on fasting plasma glucose (FPG) levels. SUBJECTS AND METHODS: Non-diabetic offsprings of one or both parents with Type 2 diabetes and healthy controls of comparable age, without a FHD were the subjects of this study. Family history of Type 2 diabetes was defined by the presence of Type 2 diabetes in one or both parents of the subject. Consanguinity was defined as history of marriage with a first cousin. Fasting plasma glucose levels were determined in cases and controls. RESULTS: Impaired fasting glucose (IFG) was identified in 42% ofsubjects with FHD and in 14% without FHD. We found a strong independent association of FHD with impaired fasting glucose in both males and females by logistic regression analysis after adjusting the data for age, gender and body mass index (BMI). Parental consanguinity modifies the effect of FHD on IFG. CONCLUSION: We concluded that family history of diabetes and parental history of consanguinity determine the risk for impaired fasting glucose in this study population.

OBJETIVO: Los hijos con diabetes de Tipo 2 tienen un riesgo mayor de trastornos metabólicos. El objetivo de este estudio es evaluar el efecto potencial de la historia familiar en la diabetes Tipo 2 (HFD) y la consanguinidad de los padres en los niveles de glucosa plasmática en ayunas (GPA). SUJETOS Y MÉTODOS: Los hijos no diabéticos de uno o ambos padres con diabetes de Tipo 2 y controles sanos de edad comparable, sin HFD, constituyeron los sujetos de este estudio. La historia familiar de diabetes de Tipo 2 se definió por la presencia de la diabetes de Tipo 2 en uno o ambos padres del sujeto. La consanguinidad se definió como la historia del matrimonio con un primer primo o prima. Los niveles de glucosa plasmática fueron determinados en los casos y los controles. RESULTADOS: La glucosa en ayunas alterada (GAA) fue identificada en el 42% de los sujetos con HFD y en 14% sin HFD. Se halló una fuerte asociación independiente fuerte de HFD con la glucosa en ayunas alterada tanto en varones como en hembras, mediante el análisis de regresión logística después de ajustar los datos de edad, género e índice de masa corporal (IMC). La consanguinidad de los padres modifica el efecto de HFD sobre la GAA. CONCLUSIÓN: Se llegó a la conclusión de que la historia familiar de diabetes y la historia de consanguinidad de padre y madre determina el riesgo de glucosa en ayunas alternada en la población bajo estudio.

Identification of lysine positive non-fermenting gram negative bacilli (Stenotrophomonas maltophilia and Burkholderia cepacia complex).

BACKGROUND: The Burkholderia cepacia complex (BCC) and Stenotrophomonas maltophilia are closely related groups of non-fermenting gram-negative bacilli (NFGNBs) having a similar spectrum of infections ranging from superficial to deep-seated and disseminated infections. Identification of these lysine decarboxylase-positive NFGNBs lags behind in most Indian laboratories. A simplified identification scheme was devised for these two pathogens that allowed us to isolate them with an increasing frequency at our tertiary care institute. MATERIALS AND METHODS: A simple five-tube conventional biochemical identification of these bacteria has been standardized. In the beginning, some of the isolates were confirmed from the International B. cepacia Working group, Belgium. Molecular identification and typing using recA polymerase chain reaction-restriction fragment length polymorphism was also standardized for BCC. For short-term preservation of BCC, an innovative method of preserving the bacteria in Robertson's cooked medium tubes kept in a domestic refrigerator was developed. RESULTS: Thirty-nine isolates of BCC isolates were obtained from various specimens (30 from blood cultures) and 22 S. maltophilia (13 blood cultures and 9 respiratory isolates) were isolated during the year 2007 alone. CONCLUSIONS: BCC and S. maltophilia can be identified with relative ease using a small battery of biochemical reactions. Use of simplified methods will allow greater recognition of their pathogenic potential and correct antimicrobials should be advised in other clinical laboratories and hospitals.

Ectopic Cushing's syndrome: experience from a tertiary care centre.

BACKGROUND & OBJECTIVE: Ectopic secretion of adrenocorticotropic hormone (ACTH) is rare, contributing to 10 per cent cases of endogenous Cushing's syndrome. We describe our experience of about two decades of patients with ectopic Cushing's syndrome (ECS) seen at a tertiary care centre from north India. METHODS: Records of patients with ECS from 1985 to 2006 were retrospectively reviewed that included the presenting manifestations, clinical symptoms and signs, biochemical investigations including plasma cortisol, ACTH and high dose dexamethasone suppression test (HDDST), imaging modalities to localize the non pituitary source of ACTH production, management and follow up of these patients. RESULTS: The study group included 12 patients (7 men) with mean (+/-SD) age at presentation 27.6 +/- 9.5 yr (range 13 to 48 yr) and the mean lag period between onset of symptoms and the diagnosis was 18.3 +/- 12.9 months with a range of 3 to 48 months. The weight loss (41.7%) followed by hyperpigmentation (25%) and infections (16.7%) were the common presenting manifestations. Cuticular atrophy (100%), hypertension (100%), bruise (92%) and proximal myopathy (83%) were the commonest signs. Plasma cortisol at 0800 h was 1267.3 +/- 483.3 nmol/l and at 2200 h was 1214.9 +/- 442.6 nmol/l indicating loss of circadian rhythm. The mean plasma ACTH was 221.1 +/- 55.9 (range 21.7 to 950 pg/ml). All but 2 patients had non-suppressibility of 0800 h plasma cortisol with HDDST. Five patients had thymic carcinoid, 3 had bronchial and one each had islet, hepatic and gut carcinoid and one had medullary thyroid carcinoma as a cause of ectopic ACTH secretion. The mean duration of follow up of these patients was 42.6 months and only two could sustain cure while remaining had either residual or recurrence. INTERPRETATION & CONCLUSION: Ectopic Cushing's syndrome is a rare disease with varied manifestations and associated with increased morbidity and mortality. It presents with clinical features quite similar to classical Cushing's. Surgery with removal of primary tumour was found to be treatment of choice.

Modulation of CYP4502E1 and oxidative stress by testosterone in liver and kidney of benzene treated rats.

Bilateral castration increased lipid peroxidation and consequently reduced glutathione in both liver and kidney. Testosterone administration reduced lipid peroxidation in the liver of castrated and benzene treated rats, however, reduced glutathione status could not be restored. Benzene depleted CYP4502E1 in castrated rats, however, the enzyme was restored in liver and kidney both after testosterone treatment. The results suggest that testosterone affects the metabolism and disposition of benzene by influencing CYP4502E1. Other hormonal and cellular/molecular factors may also alter the actions of testosterone. Testosterone dependent mechanism of toxicity of benzene in the liver and kidney has been discussed.

Orocecal transit time in patients with celiac disease from North India: a case control study.

AIM: The mechanisms responsible for bowel disturbances in celiac disease are still unknown. Small bowel motor abnormalities may be involved in this pathological condition; however, there is no study addressing small bowel transit in patients of celiac disease from Northern India. METHOD: The mouth-to-cecum transit time was studied in 80 celiac patients and 80 age and sex matched apparently healthy controls. RESULTS: Orocecal transit time in celiac patients was significantly delayed being 180+/-10.6 minutes (Mean+/-SE) as compared to 105+/-12.4 minutes in apparently healthy controls. CONCLUSION: This prolonged orocecal transit time could be due to impaired small bowel function (deranged motility) in patients with celiac disease.

Molecular markers of heavy metal toxicity--a new paradigm for health risk assessment.

Last decade has witnessed increased interest in studies dealing with molecular markers of health and disease expression of genes. Specific toxicant "signatures" have been detected using genome base technologies such as microarrays. Further toxins have been classified on the basis of these signatures. Knowledge on these signatures has helped in the identification of novel drug candidates. This review discusses the gene expression studies recently made on arsenic, cadmium, mercury, chromium, lead, copper, nickel, manganese, and other essential elements. Toxicogenomics standards and their organizations have also been briefly described. Although this information can not be considered as complete, recent reports from different laboratories on bacteria, fish, laboratory animals and humans have been summarized. It is expected that toxicogenomics data presented in this review will be helpful in planning and excretion of human health risk assessment programs.

Study of small intestinal bacterial overgrowth in North Indian patients with irritable bowel syndrome: a case control study.

BACKGROUND: Approximately 20% of the general population has irritable bowel syndrome. Despite this high prevalence, the cause of irritable bowel syndrome is unknown. There is no data available concerning the prevalence of small intestinal bacterial overgrowth in North Indian patients with irritable bowel syndrome. AIM: This study evaluated the prevalence of small intestinal bacterial overgrowth in patients with irritable bowel syndrome compared with healthy controls. METHODS: This study included 225 consecutive patients of irritable bowel syndrome between the ages 20 and 65 years attending the gastroenterology clinics. Diagnosis of irritable bowel syndrome was made according to the Rome II criteria. Small intestinal bacterial overgrowth was estimated by using the non-invasive glucose hydrogen breath test. RESULTS: Of 225 patients of irritable bowel syndrome, 160 (71.1%) were male and 65 (28.9%) were female. Of 100 controls, 65 (65%) were male and 35 (35%) female. The prevalence of small intestinal bacterial overgrowth was 25 of 225 (11.1%) patients with irritable bowel syndrome and 1 of 100 (1%) in apparently healthy controls. This difference was statistically significant. The prevalence of small intestinal bacterial overgrowth in male and female patients was not significantly different. CONCLUSION: This study indicates that the prevalence of small intestinal bacterial overgrowth in irritable bowel syndrome patients from North India is approximately 11.1%, which is lower than the reported prevalence.