Molecular genotyping of clinically important blood group antigens in patients with thalassaemia

Background & objectives: In multitransfused thalassaemic patients, haemagglutination fails to phenotype the patient's blood group antigens due to the presence of donor-derived erythrocytes. DNA-based methods can overcome the limitations of haemagglutination and can be used to determine the correct antigen profile of these patients. This will facilitate the procurement of antigen-matched blood for transfusion to multitransfused patients. Thus, the aim of this study was to compare the serological phenotyping of common and clinically important antigens of Rh, Duffy, Kell, Kidd and MNS blood group systems with molecular genotyping amongst multitransfused thalassaemic patients. Methods: Blood samples from 200 patients with thalassaemia and 100 'O' group regular blood donors were tested using standard serological techniques and polymerase chain reaction-based methods for common antigens/alleles (C, c, D, E, e, Fya, Fyb, Jka, Jkb, K, k, M, N, S, s). Results: Genotyping and phenotyping results were discordant in 77 per cent of thalassaemic patients for five pairs of antithetical antigens of Rh, Duffy, Kell and Kidd blood group systems. In the MNS blood group system, 59.1 per cent of patients showed discrepancy. The rate of alloimmunization among thalassaemics was 7.5 per cent. Interpretation & conclusions: Molecular genotyping enabled the determination of the actual antigen profile in multitransfused thalassaemia patients. This would help reduce the problem of alloimmunization in such patients and would also aid in the better management of transfusion therapy.

Magnetic resonance imaging in pre‑operative staging of endometrial cancer.

INTRODUCTION: Endometrial cancer (EC) is one of the most common gynecological cancers and the fourth most common cancer in the female. Although clinical evaluation with diagnostic imaging has not yet proved to be accurate enough in the evaluation of tumor extent to replace surgical staging, it may enable optimization of the surgical procedure and a better tailored therapeutic strategy. This study will review the characteristic magnetic resonance imaging (MRI) findings in endometrial carcinomas in the pre‑operative staging of endometrial carcinomas and compare it with the newly revised Federation of Gynecology and Obstetrics (FIGO) staging scheme of 2009 based on post‑operative surgical histopathology. MATERIALS AND METHODS: It is a retrospective analysis of 36 patients diagnosed and treated for endometrial carcinoma in our institute from January 2009 to December 2012. RESULTS: Majority of the patients (61%) were between the age group of 41‑60 years. Most of the patients (72%) were postmenopausal at the time of presentation. Most common histopathology of endometrial carcinoma was endometroid adenocarcinoma (27 patients, 75%). FIGO staging of 12 patients (85.7%) showed concordance with MRI Staging for Stage Ia, with up‑gradation of two patients to Stage Ib. CONCLUSION: The information provided by MRI can define prognosis, help planning the surgical approach and identify those patients requiring neoadjuvant chemotherapy or radiation therapy.

A Comparative Evaluation of Levobupivacaine Hydrochloride and Levobupivacaine Hydrochloride with Dexmedetomidine in Epidural Anesthesia and Postoperative Pain Relief undergoing Infraumbilical Surgeries.

Epidural anesthesia is a versatile technique which is widely used for surgeries for providing intra- and postoperative analgesia. Several adjuvants have been used to prolong the action of the local anesthetic agent used. Aims and objectives: We performed prospective randomized, double blinded controlled study on 90 patients to compare the effects of adding of dexmedetomidine to levobupivacaine in prolonging the analgesia produced by epidural levobupivacaine alone in patients undergoing infraumbilical surgeries and also compared the duration of motor block and sedation scores. Materials and methods: Ninety American Society of Anesthesiologists (ASA) I and II patients (18-60 years), under going infraumbilical surgery, were prospectively randomized to one of two groups to receive epidural anesthesia with 17 ml of 0.5% levobupivacaine + 3 ml of normal saline (group L) or epidural anesthesia with 17 ml of 0.5% levobupivacaine with 75 mg (0.75 ml) of dexmedetomidine +2.25 ml of normal saline (group LD). Various parameters hemodynamic changes, onset time of sensory and motor blockade, highest level of sensory blockade, duration of sensory and motor block, postoperative pain using visual analog scale (VAS) score, and any side-effects were recorded and data were statistical analyzed using student’s t-test by statistics calculator SPSS software. Results: The two study groups were similar for mean age, weight and duration of surgery. Mean duration of analgesia was significantly longer in group LD (438.33 ± 38.72 min) than in group L(271.2±23.77 min); p<0.05. Onset time of sensory and motor blockade was significantly less in group LD as compared to group L; p< 0.05. Duration of sensory and motor block was significantly higher in group LD when compared tog roup L(p < 0.05). More sedation was observed in group LD. Conclusion: Dexmedetomidine in a dose of 75 µg added as an adjuvant to 0.5% levobupivacaine for epidural anesthesia, during infraumbilical surgeries, prolongs the duration of analgesia of levobupivacaine and increases postoperative sedation, without any other adverse effects.

Bone mineral content in normal and malnourished children.

Bone mineral content (BMC) was determined at the distal radius in 70 children aged 2-14 years; Group I comprising 34 normal healthy children and Group II 36 malnourished children by the method of single photon absorptiometry. The mean value of BMC in Group I was 0.3 +/- 0.04 g/cm in 2-5 year, 0.52 +/- 0.08 g/cm in 6-10 year and 0.77 +/- 0.88 g/cm in 11-14 year age groups. No significant difference in the BMC was seen between boys and girls. An increase of BMC corresponded to growth spurts in 2-5 year and 11-14 year age groups. There was a significant reduction of BMC in Group II and in grade III malnutrition in 2-5 year and 11-14 year age groups as compared to Group I children. The study provides normal BMC data for Indian children and suggests that this can help to detect undemineralization of bones in malnourished children during the growth periods.