Prevalence of Weak D (Du) in Blood Donors in a Referral Teaching Hospital

Background: Rh D is the most important Blood Group antigen after ABO Blood group antigen for transfusion purpose. All negative blood units by routine methods must be tested to detect weak D using IAT method. When the test for D and Du is positive, the label should read Rh(D) Positive . When the test for D and Du is negative, the label should read Rh(D) Negative. Objective: To know the prevalence of weak D in the donor population. No study has been done in this part of the country earlier. It will help in the knowledge of weak D, which is very important for better patient care and prevent allo-immunzation in blood recipients. Materials and Methods: Blood samples were tested by ID Gel technique or by tube method with two anti D reagents - anti-D IgM monoclonal and blend of anti-D IgM&IgG. All negative samples were further tested for weak D in IAT phase by LISS/Coombs' gel card. Results: A total of 13043 samples were tested from January 2011 to December 2013. 12196 were Rh positive and 847 were Rh D negative. Weak D was positive in 8 samples. Conclusion: The study shows the prevalence of weak D as 0.07% in blood donors who were primarily from in and around Jalandhar in Punjab. These donors may have posed problem to the recipients of blood and blood product and their detection prevented them from alloimunisation.

Gallbladder disease in type-2 Diabetes mellitus patients.

Background: Diabetes mellitus is a modern epidemic which leads to various complications over a period of time. Autonomic neuropathy is one such complication which may lead on to gallbladder dysmotility and gallbladder stones. Objectives: To determine the incidence of gallbladder disorders in patients of type 2 diabetes mellitus and to find out the incidence of autonomic dysfunction in type 2 diabetes mellitus and correlate it with presence of gall bladder disorders. Material and Methods: The present study was conducted in 50 cases of type 2 diabetes mellitus and 25 healthy age and sex matched normal individuals were taken as controls. The cases as well as the controls underwent ultrasonographic examination for gall bladder volume, wall thickness, intraluminal mass and contraction in response to fatty meal. Data thus collected was compared and analysed statistically by using students ‘t’ test and chi- square test. Results: Mean postprandial gallbladder volume was 20.56±8.87 cm3 in diabetics with ANP with gallstones, 26.16±1.24 cm3 in diabetics with ANP with dysmotility 13.0±6.26 cm3 in diabetics with gallstones without ANP, 12.14±4.88 cm3 in normal diabetics and 13.60±5.95 cm3 in controls. The percentage contraction post fatty meal was calculated from these values and found to be 24.73±14.64% in diabetics with ANP with dysmotility, 26.38±17 .04% in diabetics with ANP with dysmotility, 43.48±8.45% in diabetics with gallstones without ANP, 56.84±9.02% in normal diabetics and 57 .64±9.92% in controls. Conclusion: Incidence of gallbladder disease is much higher in type 2 diabetics (40%) as compared to normal healthy adults (4%). It was concluded that diabetics with ANP had significantly impaired gallbladder emptying. Poor control of diabetes, hypercholesterolemia and diabetic autonomic neuropathy are important risk factors for the development of gallbladder disease.

Impact of a comprehensive telephone-based disease management programme on quality-of-life in patients with heart failure.

BACKGROUND: Disease management programmes for patients with heart failure have improving the quality-of-life (QOL) of patients with heart failure. METHODS: Patients attending the heart failure clinic were randomized into 2 groups of 25 patients each. The control group was managed in the heart failure clinic and the intervention group underwent the following additional interventions: (i) interactive sessions with the patient and spouse informing them about the disease, drugs, and self-management of fluid intake and diuretic dose; (ii) a telephonic helpline was established and regular telephone calls made to reinforce the information and modify drug dosages. The QOL was assessed using the Kansas City Cardiomyopathy questionnaire. Functional capacity was assessed by the 6-minute walk test. Continuous variables were compared with the Student t-test (paired or unpaired). RESULTS: There was significant improvement in the QOL and functional capacity of patients in the intervention group compared with controls over a 6-month period. The mean (SD) QOL scores in the intervention group improved from 60.0 (23.6) to 76.3 (17.3) but did not change significantly in the control group (62.2 [22.6] to 63.4 [21.9]). There was a similar improvement in the functional capacity measured by the 6-minute walk test in the intervention group (from 202.2 [81.5] to 238.1 [100.9] metres, p < 0.05) but not in the control group (193.8 [81.5] to 179.7 [112.0] metres). In the intervention group, the use of beta-blockers and angiotensin-converting enzyme inhibitors was similar but in the intervention group patients were placed on higher doses. There was no significant difference in the number of emergency room visits or admissions in either group. For every 20 patients in the intervention group, 14 patients improved by 1 functional class while in the control group this was observed in only 3 patients for every 20 treated. CONCLUSION: This study demonstrates that in the setting of a developing country, improvement in QOL by intensive management of heart failure patients through a heart failure programme with telephonic reinforcement and a helpline is greater than that usually achieved with drug therapy in a routine heart failure clinic.

Lepromatous leprosy with bilateral facial nerve palsy and hyperthyroidism.

Bilateral lagophthalmos secondary to facial nerve is extremely uncommon. Further, the aetiology in most of these cases is of central origin unlike the peripheral involvement in leprosy. A patient of lepromatous leprosy (LL) may be euthyroid or hypothyroid on account of leprous involvement of the thyroid gland. A case of LL with bilateral lagophthalmos and hyperthyroidism is reported.

Preventive action of zinc against lead toxicity.

The study was aimed to assess the protective efficacy of zinc against hemo and hematotoxicity induced by lead. Two groups of 8 rats each, were administered lead acetate 20 mg/kg bw (ip) for 3 days. One group in addition was injected 5 mg/kg bw (ip) zinc acetate for next three days. A third group of 8 rats was given three injections of normal saline and served as control. All the animals were sacrificed on eighth day and assessed for hematological changes, heme synthesizing pathway enzymes, hepatic drug metabolizing status and sulfhydryl levels in blood and liver. Lead administration resulted in decreased hemoglobin, increased reticulocytosis, depression of delta aminolevulinic acid dehydratase (ALAD) and uroporphyrinogen I synthetase (UPS) activity in blood and liver. In vitro metabolism of drugs aminopyrine, aniline and p-nitroanisole by liver homogenate and in vivo metabolism of pentabarbitone was also reduced in lead exposed rate. Zinc treated rats showed improved hematological profile and activated ALAD and UPS activity, recovery of N-demethylation of aminopyrine and O-demethylation of p-nitroanisole and partial restoration of free thiol levels in blood and liver thereby indicating that zinc could confer protection against lead toxicity.