An Unusual Case of DRESS Syndrome Presenting with Marked Leucocytosis.

Drug reaction with eosinophilia and systemic symptom (DRESS) syndrome is a rare severe drug-induced idiosyncratic hypersensitivity characterized by maculopapular and/or erythrodermic eruption, fever, peripheral lymphadenopathy, eosinophilia or atypical lymphocytosis, and visceral organ involvement. The estimated incidence of this syndrome ranges from 1/1000 to 1/10,000 drug exposures. In this report, we describe a case of DRESS syndrome in a young female with a unique presentation. The DRESS syndrome can be difficult to diagnose as its clinical findings can mimic those of other systemic diseases. This case emphasizes the importance of incorporation of the patient’s clinical and medication history in the interpretation of hematological investigations.

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.

Expanding healthcare coverage: An experience from Rashtriya Swasthya Bima Yojna

Background & objective: Given that Ayushman Bharat Yojna was launched in 2018 in India, analysis of Rashtriya Swasthya Bima Yojna (RSBY) become relevant. The objective of this study was to examine the scheme design and the incentive structure under RSBY. Methods: The study was conducted in the districts of Patiala and Yamunanagar in the States of Punjab and Haryana, respectively (2011-2013). The mixed method study involved review of key documents; 20 in-depth interviews of key stakeholders; 399 exit interviews of RSBY and non-RSBY beneficiaries in Patiala and 353 in Yamunanagar from 12 selected RSBY empanelled hospitals; and analysis of secondary databases from State nodal agencies and district medical officers. Results: Insurance companies had considerable implementation responsibilities which led to conflict of interest in enrolment and empanelment. Enrolment was 15 per cent in Patiala and 42 per cent in Yamunanagar. Empanelment of health facilities was 17 (15%) in Patiala and 37 (30%) in Yamunanagar. Private-empanelled facilities were geographically clustered in the urban parts of the sub-districts. Monitoring was weak and led to breach of contracts. RSBY beneficiaries incurred out-of-pocket (OOP) expenditures (?5748); however, it was lower than that for non-RSBY (?10667). The scheme had in-built incentives for Centre, State, insurance companies and health providers (both public and private). There were no incentives for health staff for additional RSBY activities. Interpretation & conclusions: RSBY has in-built incentives for all stakeholders. Some of the gaps identified in the scheme design pertained to poor enrolment practices, distribution of roles and responsibilities, fixed package rates, weak monitoring and supervision, and incurring OOP expenditure.