Effect of double dose plateletpheresis on target yield and donor platelet recovery

Abstract Introduction The demand for apheresis platelets has increased in the recent past and the shrinking donor pool has shifted the trend to collection of double-dose or higher yield of platelets. Objective The present study aimed to determine the effect of double-dose plateletpheresis on the target yield and donor platelet recovery. Methods The study was conducted on 100 healthy plateletpheresis donors, 50 of whom were in the study group, which underwent double-dose plateletpheresis (DDP), and 50 of whom were in the control group for single-donor plateletpheresis. Pre- and post-procedure samples of donors were subjected to a complete blood count. The DDP product was sampled for platelet yield and then split into two parts. Platelet yield, collection efficiency, collection rate, recruitment factor and donor platelet loss were calculated. Results The mean platelet yield in the SDP was 4.09 ± 1.15 × 1011 and in the DDP, 5.93 ± 1.04 × 1011. There was a significant correlation between the pre-donation platelet count and platelet yield. The total of platelets processed for the SDP were 5.42 ± 1.08 × 1011 and for the DDP, 7.94 ± 0.77 × 1011. The collection efficiency was 71.93 ± 25.14% in the SDP and 72.94 ± 16.28% in the DDP, while the collection rates were 0.78 × 1011 and 0.94 × 1011 per minute, respectively. The average recruitment factor observed was 0.98 in the SDP, while it was 0.99 in the DDP. The mean platelet loss observed in the SDP was 35.55 ± 8.53% and in the DDP, 37.76 ± 8.65%. Conclusion The double-dose plateletpheresis supplements the platelet inventory in developing countries where the apheresis donor pool is limited. It is prudent to ensure stringent donor selection criteria for donors donating high-yield platelet products, thus enhancing donor safety and retention.

Visual outcome after manual small-incision cataract surgery by viscoexpression technique

Purpose: Globally, cataracts have remained the major cause of blindness. Cataract accounts for 62.6% of blindness affecting 9� million people. The only treatment for cataracts is surgical removal of cataracts. The surgical procedures include phacoemulsification and extracapsular cataract extraction (ECCE). In India, there is a huge backlog of cataract patients. Phacoemulsification is preferred nowadays for early visual rehabilitation, but in developing countries like ours, where facilities are not widely available, small-incision cataract surgery (SICS) is a cost-effective alternative as no machine is required. Also, it provides early visual rehabilitation as it is sutureless when compared to ECCE. So, manual SICS has emerged as a substitute for phacoemulsification and ECCE. The aim of the study was to evaluate the visual acuity and surgically induced astigmatism in patients more than 40 years of age, undergoing manual SICS with nucleus management by viscoexpression technique. Methods: This was a prospective study that included 50 patients over the age of 40 years undergoing manual SICS at a tertiary health-care center in North India by viscoexpression technique. Only those patients whose functional visual disability could be attributed to cataracts were included in the study. Preoperative and postoperative astigmatism were analyzed in the first, fourth, and sixth weeks. Results: Fifty patients who were undergoing manual SICS were analyzed. Preoperative best-corrected visual acuity (BCVA) and astigmatism were compared to postoperative BCVA and astigmatism. Of 50 patients, 48 (96%) patients were able to gain good vision after 6 weeks. Conclusion: This study showed early visual rehabilitation with less surgically induced astigmatism following manual SICS by viscoexpression technique.

Placenta Accreta - Diagnosis and Management

Placenta accreta is a potential grievous obstetric condition that calls for a multidisciplinary timely management. Placenta accreta refers to placenta that is firmly adherent to the myometrium.1 Three types of adherent placental attachments are, placenta accreta (the uterine decidua is absent and the chronic villi attaches to the myometrium directly), placenta increta (the chronic villi invades into the myometrium), and placenta percreta (the villi penetrate the myometrium up to the serosal layer).2The incidence of placenta accreta has increased ten-fold in the past 50 years.3 It can lead to excessive bleeding, haemorrhagic and neurogenic shock, sepsis, uterine inversion, or need for hysterectomy.4Previous obstetrics interventions like caesarean deliveries are the largest risk factor for the placenta accreta, or previous dilatation and curettage or previous manual removal of placenta. Increasing maternal age and parity, as well as other uterine surgeries also have increased risks. When placenta accrete is suspected, a multidisciplinary team with expertise should be there to take care of such cases. Although ultrasound and magnetic resonance image (MRI) may or may not indicate clearly an invasive placenta, the final diagnosis is made intra-operatively and is supported by histopathological examination.4Placenta accreta is associated with high morbidity and mortality of the mother and the foetus and has high demands on health resources. Antepartum haemorrhage may occur in such cases if there is associated placenta previa. MRI is the best modality for diagnosis when there is suspicion of placenta accreta clinically.

Intrathecal Chloroprocaine Plus Fentanyl and Levobupivacaine Plus Fentanyl in Infraumbilical Surgeries in Adults

Background: The changing trend from an inpatient to outpatient has urged us to use short-acting local anesthetic with adjuvantssuch as opioids to intensify sensory block without affecting sympathetic blockade in spinal anesthesia. This study was designedto compare the safety and efficacy of 25 µg fentanyl as an adjuvant to either 10 mg levobupivacaine or 40 mg chloroprocaineintrathecally.Materials and Methods: In this prospective, randomized, clinical trial, 60 patients of 18–60 years were randomly divided into twogroups of 30 each, to receive either 4 ml of 1% chloroprocaine (40 mg) plus 25 µg fentanyl (Group C) or 2 ml of 0.5% isobariclevobupivacaine (10 mg) plus 25 µg fentanyl (Group L) intrathecally. Patients were monitored for 24 h for sensory and motor blockcharacteristics as a primary outcome and post-operative analgesia, hemodynamics, and side effects as a secondary outcome.Results: Onset of sensory block and time to maximum sensory block were rapid in Group C (2.53 ± 1.20 min and 4.40 ± 1.45 min)as compared to Group L (4.43 ± 1.12 min and 8.10 ± 0.83 min) (P < 0.001). The maximum sensory block was T4 in Group C and T6in Group L. Maximum Bromage score was 2 in both groups but achieved earlier in Group C as compared to Group L (P < 0.001).Duration of sensory and motor block was significantly prolonged in Group L (264.47 ± 29.97 min and 173.80 ± 31.47 min)as compared to Group C (101.50 ± 10.30 min and 75.93 ± 10.41 min). The total duration of analgesia was also prolonged inGroup L (259.83 ± 29.60 min) as compared to Group C (96.50 ± 9.84 min). Patients remained hemodynamically stable and nosignificant side effects and complications were noted.Conclusion: Chloroprocaine provides adequate duration and depth of surgical anesthesia for short procedures with theadvantages of faster block resolution.

Comparison of determinants of morbidities of late preterms and terms

Background: To compare the determinants of neonatal morbidity in late preterms and terms.Methods: A total of 100 live late preterm (34-0/7 to 36-6/7 weeks) and 100 term infants (37-0/7 to 41-6/7 weeks) admitted in sri guru ram das institute of medical sciences and research were randomly selected to participate in this case control study. The study group include 100 neonates within gestation age of 34 0/7 to 36 6/7 weeks. Equal number of terms between 37 0/7 to 41-6/7 gestation age was taken for comparison. The maternal history including both antenatal and natal history as well as new-born profile was taken.Results: Maternal risk factors have been found to be the major determinants of morbidity in late preterms with PROM (p<0.0001), sepsis and hypertension being significant contributors. Respiratory distress, neonatal jaundice, sepsis has been found to be major morbidity factors in late preterms. The average duration of admission was higher in late preterms than terms.Conclusions: Late preterm infants have higher risks for acute metabolic complications, mortality and long-term disabilities as compared to term infants. Morbidities like respiratory distress, neonatal jaundice, sepsis, hypoglycaemia and hypothermia are more in late preterms due to their immaturity. The risks associated with late preterm birth suggest the need for refinement of obstetric paradigms to extend pregnancy duration if benefits outweigh risk to fetus and mother. There is need to make obstetricians and families aware of complications pertaining to late preterm birth and improving surveillance of high-risk pregnancies.

Comparison of safety and efficacy of Ormeloxifene and Norethisterone acetate in the treatment of heavy menstrual bleeding

Background: Menorrhagia (menstrual blood loss more than 80% per cycle) affects 10-33% of women at some stage of their lives. Medical management is the first line of therapy for menorrhagia (heavy menstrual bleeding: HMB). Progestins have been found to be very effective in the management of heavy menstrual bleeding especially during acute episodes, norethisterone acetate being widely used for the same. Ormeloxifene is a new drug with promising results in managing HMB. The study was undertaken to compare the efficacy, safety and acceptability of Ormeloxifene /Norethisterone acetate in the medical management of heavy menstrual bleeding.Methods: This was a retrospective study conducted from January 2016 till December 2018 in which 98 women of reproductive age group presented with abnormal uterine bleeding without any organic, systematic and iatrogenic causes. The patients were divided into 2 groups. Those wanting contraception along with control of HMB were assigned to Group O and given Ormeloxifene and others were given norethisterone (Group N). The primary outcomes measured were menstrual blood loss assessed subjectively by patients and ultrasonography for endometrial thickness. The secondary outcomes measured were acceptability and side effects of Ormeloxifene and norethisterone.Results: There is a significant reduction in menstrual blood loss as evidenced by the history of patients recorded on follow up and there was a significant reduction in the endometrial thickness as evidenced on follow up scan at the end of 3-4 months. no major side effects were observed with both the drugs.Conclusions: Ormeloxifene in comparison to norethisterone acetate with its effectiveness, significant results, convenient dosages schedule and no major side effects is an effective and safe alternative medical management of HMB.

Comparison of empirical use of low dose aspirin and enoxaprin in the treatment of unexplained recurrent pregnancy loss

Background: Recurrent pregnancy losses have commonly been defined as three or more consecutive spontaneous pregnancy losses. About 1-2% of women suffer from recurrent miscarriages. The cause is multifactorial such as uterine anomalies, endocrine disorders, immunological causes, infections, chromosomal anomalies and maternal autoimmune diseases. In 50-60% of cases recurrent pregnancy losses, the cause remains unclear. Objective of this study was to compare the maternal and fetal outcome in patients with unexplained recurrent pregnancy loss treated with LMWH (Enoxaparin) vs Aspirin during pregnancy.Methods: Women with 3 or more pregnancy losses, aged between 18-40 years, booked for antenatal care and delivery in our hospital between January 2012 and December 2016 were followed till 6 months after delivery.Results: A total number of 146 women were assessed for eligibility. We had 62 women in Group A (aspirin group) and 84 women in Group E (enoxaparin group). Enoxaparin was given to all those ladies who had taken aspirin in previous pregnancies with no live outcome. Good neonatal outcome was observed with Enoxaparin.Conclusions: Live birth rates did not show significant difference between the two study groups. But empirical use of enoxaparin in patients with no live birth who have taken low dose aspirin in previous pregnancy had shown improved results, so enoxaparin should be used empirically as a first line agent in such cases.

Success of uterine artery embolization in the management of postabortal arteriovenous malformations

Background: Uterine artery arteriovenous malformations are an abnormal and non-functional connection between the uterine arteries and veins. It may be congenital or acquired. AVM can cause heavy menstrual bleeding and may have an impact on infertility. Uterine artery embolization is an alternate method to hysterectomy preserving the menstrual and reproductive function. Objectives of this study was to diagnose Arterio-venous malformations after abortions in patients with heavy menstrual bleeding and treating these patients with UAE.Methods: The retrospective study of patients with postabortal arteriovenous malformations managed at Dayanand Medical College and Hospital, during January 2012 to December 2018 was done. Inclusion criteria for this study post abortal heavy menstrual bleeding patients in reproductive age group diagnosed to be having AV malformations on CT angiography. Exclusion criteria for this study were H/O AUB prior to abortion, patients with fibroids, PID, endometriosis, adenomyosis, genital tract malignancies. Patients who do not have AV malformations on CT angiography.Results: This is a retrospective seven years study between January 2012 to December 2018 during which we received 23 patients who developed arterio-venous fistula following an abortion. The patients had heavy menstrual bleeding. All the patients had taken some hormonal treatment before reporting to us. All these patients underwent CT angiography. After that they all were subjected to UAE. All these patients were followed up to 6 months where they showed improvement in the symptoms.Conclusions: Acquired AVM is rare disorder following an abortion or a caesarean section. Heavy menstrual bleeding is a common symptom often requiring hysterectomy but with the advent of uterine artery embolization by blocking the uterine artery we can conserve the uterus where a lady can have normal menstrual and reproductive functions.

Management of single submucosal fibroid in unmarried females with uterine artery embolization

Background: Uterine fibroids (leiomyomas) are the most common benign neoplasm of the female pelvis. The location of fibroids, whether submucosal, subserosal, pedunculated subserosal, intramural, or endocavitary, is important because signs and symptoms may be determined by location. Uterine artery embolization (UAE) for many patients is an effective alternative treatment to surgical therapy for fibroid tumors. It is a minimally invasive procedure, which allows for rapid recovery and return to normal activities. Objective of this study was to know the efficacy of minimally invasive technique UAE for reducing symptoms in sub-mucous uterine leiomyoma in unmarried females.Methods: This retrospective analysis was performed on 9 unmarried females with symptomatic single submucosal fibroid diagnosed on MRI with size range of 3.5 cms to 6.5 cms. They presented at Dayanand Medical College and Hospital, Ludhiana, Punjab in a period of 3 years from January 2016-December 2019. Inclusion criteria were unmarried females, single submucosal fibroid diagnosed on USG/MRI. Exclusion criteria was active infection, more than one fibroid in uterus, prior GnRH analogues treatment during the previous 3 months.Results: All patients presented with heavy menstrual bleeding (HMB) and dysmenorrhea, lower abdomen pain was encountered in 3 patients and 2 patients had inter-menstrual bleeding. Recurrent, UTI was there in 1 patient and 1 patient had vaginal discharge. All fibroids belonged to stage 1 FIGO classification. UAE was done and patients were followed for 6 months. Symptomatic success was seen in 100% patients and 77.77% patients expelled the fibroid per vaginally.Conclusions: UAE is alternative method of treatment for submucosal fibroids in unmarried females who do not want to undergo surgery. Proper case selection can give us good results and symptomatic relief.

Spot protein/creatinine ratio as a marker for fetomaternal outcome in hypertensive disorder of pregnancy

Background: Gestational hypertension is defined as systolic BP level of > 140 mmHg or a diastolic BP of > 90 mmHg that occur after 20 weeks of gestation. Pre-eclampsia is the hypertensive disorder of pregnancy, associated with adverse fetomaternal complications. It is assosciated with proteinuria. 24 hours urine collection is cumbersome, time consuming and potentially misleading if collected inaccurately. The spot P/C ratio has been considered equivalent to 24-hour urinary protein for predicting proteinuria. Aim of study was to compare spot P/C ratio to 24 hours urinary protein in patients of pre-eclampsia and to determine the fetomaternal outcome in the patients admitted in Dayanand Medical College and Hospital, Ludhiana.Methods: A prospective simple random study. It included 100 hypertensive pregnant women being evaluated for pre-elampsia, regardless of the alerting signs or symptoms. The main measures were the urinalysis of patients which included urinary spot P/C and 24 hours urinary protein excretion and the fetomaternal outcome in these patients. The data was statistically analyzed.Results: A good positive correlation existed between the P/C ratio and 24 hours protein excretion, with a correlation coefficient (r) of 0.912. The sensitivity and specificity of 24 hours urinary protein versus spot P/C ratio ranged between 86.29%-99.51% and 8.35%-99.95% respectively. The positive and negative likelihood ratio of 24 hours urinary protein versus spot P/C ratio was 48 (ranged between 6.89-334) and 0.04 (ranged between 0.01-0.16) respectively. The positive and negative predictive value of 24 hours urinary protein versus spot P/C ratio was 97.96% and 96.08% respectively. Our data showed that urine spot P/C ratio above 3.9/mg strongly predicts significant proteinuria of more than 4 gram/day.Conclusions: Spot urinary P/C ratio with suspected preeclampsia can be used as a rapid alternative test to 24 hours urinary protein.

To Study the Characteristic of Occlusion of Primary Dentition in Pre School Children-An Epidemiological Study

Background: Childhood is the mirror that reflects our future and habits that form part of our childhood are inculcated in our adulthood. Similarly the primary dentition lays down foundation stone for our permanent dentition and determines all the basic characteristics of permanent dentition. The objective of the study is to assess the occlusal characteristics of primary dentition in the age group of 3-5 years in school of Sriganganagar. All the basic parameters, terminal molar relationship, primary canine relationship, the degree of overbite and overjet (in millimeters) were considered in this study. Methods: The study was based on examination of the primary dentition of 600 preschool children aged 3-5 years old from Sriganganagar, India. The sample was selected from nursery school and the age of each child were obtained from school records. Healthy preschool children irrespective of socioeconomic status whose age was between 3-5 years were included in the study. Results: A total of 600 children who met the selection criteria were examined. In this sample size, 136 were of 3 year of age, 152 children were 4 year of age and 321 children were of 5 year of age respectively. Age wise distribution of primary molar relationship for Right side was 83.8% for flush terminal plan, 12.5 % was mesial step, 3.7 % distal step and on left side it was 84.6% for flush terminal plan, 11.8% was mesial step, 3.7% distal step and it was found to be significant however the age wise distribution of canine relationship, overbite and overjet was found to be insignificant. Conclusion: There is an increase in mesial step molar relationship with age, which is statistically highly significant. Distal step molar relationship was less prevalent and was not significant with age. However, the Class I canine relationship was the most prevalent type of deciduous canine relationship than the Class II canine relationship, though the changes in canine relationship with age were not statistically significant. In addition, the changes in overjet and overbite with age were not statistically significant. Also No case of anterior open bite (negative overlap) was observed. Probably larger scale of sample size may be required to assess the incidence of cases of negative overlap.

To Study Quality of Life in Hand Eczema Patients Using Skindex Score.

Background: Hand Dermatitis affects a significant portion of the population. The disease is severely distressing and has chronic course with negative impact on quality of life. Aim: To evaluate the clinical profile and quality of life in hand eczema patients. Materials and Methods: A total of hundred patients, clinically diagnosed as a case of Hand Eczema of different age and sex groups participated in this study. The patient’s quality of life was assessed by a self administered questionnaire using skindex-16. Results: It was seen that increased severity of the eczema might have become more tolerated with increasing age. Males had significantly more severe hand Eczema. The total skindex QoL mean score was 31.4. Of the three domains included in our study the symptoms domain was the most affected (mean percentage score 2.27), followed by emotional (mean 1.93) and functioning (mean 1.74). Responders reported being bothered most by itching, hurting due to skin condition, and hard to do work. After adjustment for potential confounders, poorer QoL was significantly associated with female gender (mean 31.45), unmarried group (mean 32.33), rural origin (mean 32.07), long duration between 1-5 years (51%). Individuals who elected to change jobs because of their skin condition reported worse QoL. Conclusion: We suggest that quality of life modification and emotional support should be included as a part of treatment for hand eczema. Educational programs are recommended for patients who are more vulnerable to having poorer QoL to prevent further impairment, as well as further studies of QoL in Indian patients for specific diseases using disease-specific instruments.

An analysis of the pattern of blood requisition and utilization in a tertiary care center.

Background: Blood utilization audit helps to formulate guidelines for improving transfusion practice in a health care centre. With increasing demand for blood components being unable to meet the supply particularly in developing countries, there is a need to implement strategies for rational use of blood and its components. The present study aims to evaluate the transfusion practices in a hospital based blood centre. Material and Methods: A retrospective audit was conducted on 1000 blood requisitions and 300 requisitions for fresh frozen plasma and platelets. The requisitions were reviewed for pre transfusion hematological values, utilization trends and appropriateness. Results: Out of 1000 requisitions, 67.8% were for packed red cells and 32.2% were for whole blood. Pre transfusion hemoglobin values were available for 11.1%. The urgency for transfusion and indication was mentioned on 18.1% of requisition forms. The maximum cross match to transfusion ratio was for Department of Obstetrics and Gynaecology. The blood utilization was 41.3%. Out of 300 requisitions for fresh frozen plasma/platelets, 67.33% were for fresh frozen plasma and 32.6% were for platelets. Only 25.66% of requisitions had prothrombin index/platelet count mentioned. Over ordering was seen in 37.33% of requisitions. Conclusion: Retrospective audits help to identify key areas that need interventions to change local guidelines for transfusion. There is need for regular audit to improve transfusion practices in a health care set up. A type and screen policy for routine surgeries and obstetric patients should be implemented to save valuable time and resources in developing countries.

Patterns of infections among blood donors in a tertiary care centre: A retrospective study.

Background. Transfusion-transmitted infections continue to be a threat to safe transfusion practices. We analysed the prevalence and patterns of co-infections among voluntary and replacement donors. Methods. Blood donations collected over a 5-year period were studied for the type of donation (voluntary or replacement), number of seroreactive cases and the number, type and distribution of co-infections. Results. Of the 42 439 units of blood collected over a 5- year period, 19 118 (45%) were from voluntary and 23 321 (55%) from replacement donors. There were 1603 seroreactive cases (3.8%). These included 250 with HIV (0.6%), 734 with hepatitis B surface antigen (HBsAg; 1.7%), 337 with hepatitis C virus (HCV; 0.8%) and 282 (0.7%) with VDRL (Venereal Diseases Research Laboratory) reactivity. Twenty-three (0.05%) of these had >2 seroreactive infections; 20 of these were in replacement donors and only 3 in voluntary donors and the difference was statistically significant (p<0.005). Among HIV seropositive donors, there were 4 seroreactive for syphilis and 5 for HBsAg. Among HIV seronegative donors, 5 were seroreactive for HBsAg and VDRL, 4 for HCV and VDRL, and 2 for HBsAg and HCV. One person was seroreactive for HIV, HBsAg and VDRL. The multiple infection rate showed a decreasing trend over the years. Conclusion. Multiple infections pose a small but definite risk to the recipients of blood products. Voluntary donations are safer as compared with replacement ones and need to be encouraged.

Gastrointestinal stromal tumors: Cytomorphologic spectrum in fine needle aspiration smears.

Objective: To study the variation in the cytologic features of gastrointestinal stromal tumors (GISTs) at different sites targeted by different modalities. Study design: Cytologic smears of 9 cases of gastrointestinal stromal tumors were reviewed with their histopathologic follow-up. Immuno-cytochemistry was performed where possible. Results: The study includes eight males and one female patient with an age range of 42 to 71 years. There were four classical cases of gastrointestinal stromal tumors that showed tight cellular bundles and fascicles of slender spindle cells with scant cytoplasm. The cytological features of three recurrent and one malignant case included moderately to markedly pleomorphic, plump spindle to ovoid cells with variable chromatin pattern and variable pale blue to vacuolated cytoplasm, present in loose clusters and singly. There was one case with classical gastrointestinal stromal tumor cytology but myxoid stroma. All other cases were confirmed with either CD117 immunostain and/or histopathology. Benign mucosal fragments from stomach or duodenal mucosa were observed in smears obtained by endoscopic ultrasound - fine needle aspiration (EUS FNA). Conclusion: The variability in cytologic features in GIST implies that a diagnosis of gastrointestinal stromal tumor should be rendered on cytology only in conjunction with immune-cytochemistry result of CD117.

Bombay phenotype in two North Indian brothers: a case report.

Bombay phenotype is unique in the aspect that the red cells are not agglutinated by antisera A, B and H. However the serum of such individuals contains anti A, B and strongly reactive anti H which agglutinates red cells of 'O' group individuals through a wide thermal range. The blood specimen of a 35 year old male donor who donated blood for the first time was subjected to detailed cell and serum grouping. There was a discrepancy between the results. The possibility of Bombay phenotype was considered and the sample was tested with anti H lectin. Further confirmation of blood group and secretor status was done from a reference laboratory. Family studies showed the same blood group in the elder sibling of the propositus. The present case highlights the significance of correlating cell and serum grouping results. Moreover, this blood group is very rare in North India. Family studies revealed the propositus to possess the B gene which was suppressed in the donor but expressed in the offsprings. The use of anti H in discrepant blood grouping results is recommended.