Evaluation of diastolic dysfunction in multi-transfused thalassemia patients

Background: An important complication of thalassemia is iron deposition in the cardiac tissue resulting in degeneration, fibrosis and dysfunction. Cardiac disease is the primary cause of death. Aims and objectives were to detect early cardiac involvement in patients with transfusion dependent thalassemia by conventional doppler echocardiography and tissue doppler imaging while they are still asymptomatic.Methods: 150 patients in the age group of 2-18 years who were receiving regular and frequent blood transfusions were enrolled in this study. Institutional ethical clearance was taken. After informed consent, 2D echocardiography was performed on all the patients. Previous blood reports reviewed. Various parameters like mitral flow pattern, LVEF and Tricuspid regurgitant jets were taken into account to diagnose cardiac dysfunction. Results analysed by standard statistical tests.Results: Out of 150 patients, 58% were males and 42% were female patients. The 13 (8.6%) patients were diagnosed as having diastolic dysfunction. Out of 150, majority (86.6%) were below the age of 15 years, 81.33% children were diagnosed as having thalassemia before the age of 2 years, 97% patients were on regular iron chelation therapy, 32% patients had pre-transfusion Hb <7 gm/dl, 78.66% patients had S. ferritin levels >2500 ng/ml and more number of males (7.33%) have undergone splenectomy than females.Conclusions: Diastolic dysfunction on Doppler echocardiography is an early sign of myocardial dysfunction in patients with beta thalassemia.

Study of tuberculosis and other infections among children (age 2 to 18 years) with multitransfused thalassemia major

Background: In India, beta thalassemia is prevalent across the country, with an average frequency of carriers being 3-4%. Infection is the major cause of morbidity and mortality in thalassemia, so regular screening is required for this disease.Methods: Ethical clearance taken from institutional ethical committee. 150 thalassemia patients were enrolled in study after informed written consent. The medical histories were obtained from the patients and their files. Clinical examination was done including anthropometry, general examination, and systemic examination. MT and chest X-ray (CXR) were done for screening of tuberculosis infection. Blood samples were taken for S. ferritin, S. creatinine, serum glutamic pyruvic transaminase (SGPT), human immunodeficiency virus (HIV), and hepatitis B surface antigen (HBsAg) tests. Transfusion and other detail were taken like iron chelator, folic acid (FA) and calcium supplements.Results: In this study, out of 150 patients, 4 patients were RVD positive and 34 patients were HCV positive. No Patients found HBsAg positive. No patient had Montoux test reactive and chest X-ray positive finding.Conclusions: : Increase frequency of transfusion-related infection (hepatitis C, B, and HIV) in multi-transfused thalassemia. No correlation was found between tuberculosis infection and thalassemia patients in this screening study.

Pattern of adverse events following immunization in an Indian teaching hospital.

Background: Vaccination is an essential component of the public health programs and among most cost effective medical intervention. Vaccines like other pharmaceutical product are not entirely risk free; while most known side effects are mild and non-serious. But some vaccines have been associated with very rare but serious side effect. So, there is a need of a surveillance program to monitor and record such events. Aims & Objective: To detect adverse events following immunizations (AEFI) in children and find vaccine responsible for them. Material and Methods: A one year, prospective, vaccine safety study was undertaken in 2011 covering a pediatric population who were administered vaccines. A two-phase telephone survey of all patients was conducted, comprising of an initial call at 1 week and a follow-up call at 30 days after the vaccine administration date. All AEFI were recorded in Vaccine Adverse Event Reporting System (VAERS) form. Results: Of a total sample of 4320 children, ranging in age from 0 to 14 years, 10110 vaccine doses were given. Each child received 2.34 vaccines on an average. Out of 4320 children, 899 children (20.8%) suffered 1003 AEFI. The most frequent types of adverse reactions to vaccines were fever (34.33 per 1000 doses), excessive crying (30.95 per 1000 doses) and injection site swelling (18.57 per 1000 doses). AEFI rate per 1000 doses was 99.2%. Conclusion: Most of the adverse events reported were mild and non-serious. Establishment of national AEFI database can be a worthy long term goal in Indian context.