Knowledge, attitudes and practices of resident doctors and interns on safe blood transfusion practices: a survey-based study

ABSTRACT Introduction: The knowledge of clinicians regarding blood transfusion services may impact patient care and transfusion outcome. The wide variation in transfusion practices among clinicians leads to inappropriate blood product usage and jeopardizes patient safety. Hence, this survey study aimed to assess knowledge, attitude and practice among the residents and interns of safe blood transfusion. Methods: The online survey was based on self-administered questionnaires of three sections: 1. Demography; 2. Knowledge, and; 3. Attitude and Practice. One point was assigned for the correct response of each question in every section. The knowledge score was further categorized into three categories, depending on the points obtained. The participants were also divided into four groups, depending on their experience. The Kruskal-Wallis test was applied to determine the difference of knowledge and practice scores in three designated groups of residents and interns. A p-value of less than 0.05 was considered to be significant. Result: A total of 247 residents and interns participated in this study. Thirteen participants had an incomplete response. Out of 234 participants, Senior Residents (SR), Junior Residents (JR), and interns were 70, 96 and 68 participants, respectively. The knowledge scores of interns were significantly low, as compared to SRs and JRs. Practice scores of interns were also significantly low, compared to the JRs. However, most of the residents and interns (85%) were aware of the pre-transfusion testing. Conclusion: Therefore, the mandatory incorporation of the transfusion medicine subject in the undergraduate curriculum can help the young budding doctors to better implement the patient blood management.

Assessment of Cardiac Function in Children by Strain Imaging and its Correlation with Conventional Echocardiographic Parameter

Background: The objectives of this study were to find out of normal reference value for age?dependent longitudinal strain values in children and find its correlation with conventional echocardiographic parameters. Methods: In total, 100 healthy normal children aged between 2 and 15 years were enrolled and divided into three age groups, namely, 2–5 years, 5–10 years, and 10–15 years. Using the GE Vivid 7 ultrasound platform with 4 or 7 MHz probes, both LV and RV global longitudinal strains and conventional echocardiographic parameters were acquired. Results: In normal healthy children, left ventricular GLS values were –20.10 to –19.68 (mean: –19.89), –21.93 to –21.02 (mean: –21.48), and –20.87 to –20.41 (mean: –20.64)) in children aged 2–5 years, 5–10 years, and 10–15 years and right ventricular GLS values were –16.80 to –16.44 (mean: –16.62), –27.85 to –27.27 (mean: –27.56), –28.44 to –27.93 (mean: –28.19) in the above three groups, respectively. No significant increase was noted in the left ventricular strain value from basal to the apical segment from age group 2 years to 15 years and no gender differences were seen. None of the conventional echocardiographic parameters commonly used to assess the left or right ventricular systolic function had a significant correlation with LVGLS and RVGLS. Conclusions: The mean LVGLS values were –19.89, –21.48, and –20.64 and RVGLS were –16.62, –27.56, and –28.19 in healthy normal children aged 2–5 years, 5–10 years, and 10–15 years, respectively, and conventional echocardiographic parameters did not have any significant correlation with these values.

Assessment of Cytomorphometric Features of Oral Squames from Buccal Mucosa of Tobacco Users using Oral Brush Biopsy: An Exfoliative Cytological Study.

Background: Tobacco comprises of one of the most common addiction in the society. All the forms of the tobacco are harmful, causing alterations in the cellular parameters of the oral mucosal cells. A number of techniques and methods are available along with chair side examination for supplementing the diagnosis of tobacco induced premalignant lesions. Exfoliative cytology is one such technique, which is non-invasive and can be used for mass screening. Therefore, we evaluated the cytological and cytomorphometric changes in the oral squames using brush biopsy from buccal mucosa of tobacco users. Methods: A total of 300 patients with age group of 25 to 60 years were included in the study. Detailed history of the patients were taken to known the method (smoking, smokeless or both) and frequency of tobacco intake. Scrapings from the buccal mucosal scrape were obtained, smeared on slides and were subsequently stained with Hematoxylin and Eosin staining. Observation and analyses of the smears was done under microscope followed by analysis in the computer using software Dewinter Biowizard version 3.0. various cellular parameters were assessed and compared in between different groups. Patients were divided into two major groups- Habituers and Nonhabituers. The habituers were again divided into: Tobacco smokers, Tobacco chewers and patients having combined habit. Independent-Samples T Test and One-Way ANOVA were used to assess the level of significance. Results: Significant results were obtained while comparing nuclear parameter, cellular area, cellular perimeter, cell contour and nucleo-cytoplasmic ratio in between lesional group and tobacco smoking group. While comparing between tobacco smoking group and Non habituers group, significant results were obtained in all the parameters except for cell contour and N/C ratio. Significant results were obtained while comparing between lesions and combined habit groups. While comparing between habituers and non- habituers group, except for cell contour significant results were obtained in all other cellular parameters. Conclusion: Early changes detection in clinically normal oral mucosa of tobacco users is possible by using non-invasive, painless procedures like oral brush biopsy and cytomorphometry. Further studies recommended.

Serial assessment of biochemical parameters of red cell preparations to evaluate safety for neonatal transfusions.

Background & Objectives: Neonatologists often prefer fresh blood (<7 days) for neonatal transfusions. The main concerns for stored RBCs are ex vivo storage lesions that undermine red cell functions and may affect metabolic status of neonatal recipients. This study was designed to evaluate serial in vitro changes of biochemical parameters in different RBC preparations during storage to consider for neonatal transfusions even after storage beyond one week. Methods: Twenty five units each of whole blood (CPDA-1 RBC, SAGM RBC) were selected for serial biochemical parameter assessment after each fulfilled the quality criteria (volume and haematocrit). These units were tested serially for supernatant potassium, pH, lactate, haemoglobin, glucose and red cell 2,3 diphosphoglycerate (2,3 DPG) up to 21 days of storage. Results: Within each group of RBC, rise in mean concentration of potassium, lactate and plasma haemoglobin from day 1 to 21 of storage was significant in CPDA-1 RBC having the highest levels at day 21. From day 3 to 21, SAGM RBC had higher mean pH value than CPDA-1 RBC though this difference was not statistically significant. SAGM RBC had highest mean glucose concentration during storage than other two types of red cell preparations (P<0.005). Within each group, fall in mean 2,3 DPG concentration from day 1 to 7 was significant (P<0.05). A positive correlation existed between mean plasma potassium and haemoglobin in all three types of red cells (r=0.726, 0.419, 0.605 for CPDA-1 RBC, SAGM RBC and whole blood respectively, P<0.005). Interpretation & Conclusions: All the three red cell preparations tested revealed biochemical changes within acceptable limits of safety till 21 days of storage. CPDA-1 RBCs had the highest degree of these changes.

Sequencing Batch Reactor (SBR) treatment for simultaneous organic carbon and nitrogen removal--a laboratory study.

The performance of a laboratory-scale Sequencing Batch Reactor (SBR) has been studied in aerobic-anoxic sequence for simultaneous organic carbon and nitrogen removal. The reactor was operated under three different variations of aerobic-anoxic sequence, viz. 4+4, 5+3 and 3+5 hours with input solutions of soluble COD (SCOD) level 1000 +/- 100 mg/L and initial ammonia nitrogen of 40 and 90 mg/L. It has been observed that 85 to 92% of SCOD removal would be possible at the end of 8.0 hour of overall reaction period, irrespective of the length of the aerobic react period. In the case of 4+4 hour operating cycle, reasonable degree of nitrification (88-100%) and denitrification (73-75%), along with 91-94% of organic carbon removal have been achieved, which has been considered to be the optimum performance of the reactor.