A Pilot Seroprevalence Study Suggests Silent Zika virus Transmission in Bhopal Region of Central India.

BACKGROUND: Several sporadic cases and outbreaks of Zika virus disease have been reported from different states of India. OBJECTIVES: This paper explored the possibility of any ongoing transmission of Zika virus (ZIKV) in the Bhopal region of Central India, where the last outbreak of this disease was reported in 2018. MATERIALS AND METHODS: We screened a group of 75 febrile patients who had already tested negative for the locally endemic causes of fever like dengue, chikungunya, enteric fever, malaria, and scrub typhus and two groups of asymptomatic healthy individuals represented by blood donors (n = 75) and antenatal mothers (n = 75). We tested blood samples of febrile patients for ZIKV RNA using real-time polymerase chain reaction (PCR), and for the healthy individuals, we determined anti-zika immunoglobulin G (IgG) antibodies using enzyme-linked immunosorbent assay. RESULTS: ZIKV RNA was not detected in any of the 75 samples tested by real-time PCR assay. Among the voluntary blood donors and antenatal mothers, a total of 10 (15.38%) and 5 (6.66%) individuals were found to be seropositive for anti-ZIKV IgG antibodies, respectively. The seropositive group was found to have higher age 33.06 (±10.83) years as compared to seronegative individuals 26.60 (±5.12) years (P = 0.037). CONCLUSION: This study, which is the first survey of seroprevalence of anti-Zika antibodies from India, reports an overall seropositivity rate of 10% for anti-Zika antibodies among the healthy population, suggesting an ongoing, low level, silent transmission of ZIKV in the local community.

Time Trend and Prevalence Analysis of Transfusion Transmitted Infections among Blood Donors: A Retrospective Study from 2001 to 2016.

Context: Transfusion-transmitted infections (TTIs) remain a major threat to the patients receiving blood. The incidence of the transmission of various infectious agents has reduced ever since the introduction of various molecular techniques for detection. Aims: The study tried to figure out accurate estimates of risk and trend of TTI over a period of sixteen years, essential for monitoring the safety of blood supply and evaluating the efficacy of the currently employed screening procedures. Methods and Material: A total of 57942 blood donors' records were analyzed for the period from January 2001 to December 2016. Chi-square test (χ2) was used to evaluate the relationship between serological positivity and particular donor characteristics. A P value of less than 0.05 was considered statistically significant. Results: Of the 57942 donations, overall prevalence of TTI was 2.7%. Of these, the reactivity rate of hepatitis B (HBV), hepatitis C, HIV, syphilis, and malaria was 1.8%, 0.42%, 0.2%, 0.31%, and 0.017%, respectively with significant P value (P < 0.05, CI: 95%). Overall prevalence was higher in replacement donors as compared to voluntary blood donors. Trend of TTI prevalence decreased from 2001 to 2016. Conclusions: This epidemiological research on TTI is important for the region, as estimated disease burden based on comprehensive epidemiological research provides the foundation for public policy to ensure an easily accessible and adequate supply of safe and quality blood and blood components to the needy patients.

Strengthening quality management system: An assessment of awareness and knowledge in trainees in blood bank.

OBJECTIVES: The objective of this study was to assess the changes in knowledge concerning quality management system (QMS) among the participants before and after attending a QMS training. METHODS: After obtaining the ethical approval, a retrospective study was designed to evaluate the effectiveness of QMS. Fifty participants from district blood banks of three different states participated in the study organized at two different periods. After obtaining informed consent, the participants were subjected to set of questionnaire containing 45 questions (35 multiple choice and 10 subjective questions) as pretest on quality standards and were again subjected to posttest questionnaire containing the same set of questions after 5 days of workshop. Twenty minutes were granted to solve the questions. Each question was given one mark. There was no negative marking. An assessment of knowledge gained during training was evaluated by comparing the scores of pre- and post-assessment. RESULTS: Of the total 50 delegates, 29 were trained in the month of July (Training I) and 21 were trained in the month of November (Training II). There were 96% (n = 48) males and 4% (n = 2) females. In both the training sessions, that is, Training I and II, the mean scores of objective questions in pretest were 13.629 ± 6.58 and 9.34 ± 5.74, and after the training, the posttest scores increased significantly to 17.77 ± 7.05 and 14.34 ± 7.09, respectively. Paired Student's t-test was applied which showed statistically significant increment in knowledge (P = 0.001). CONCLUSIONS: There was a significant positive change in the knowledge of the participants after attending QMS workshop.

Supervised, individualised exercise reduces fatigue and improves strength and quality of life more than unsupervised home exercise in people with chronic Guillain-Barré syndrome: a randomised trial.

QUESTION: In people in the chronic phase of Guillain-Barré syndrome (GBS), how much more does a supervised, individualised exercise program improve functional independence with activities of daily living than a home-based exercise program? How do the two exercise programs compare regarding their effects on muscle strength, fatigue, pain and quality of life? DESIGN: Randomised controlled trial with concealed allocation, intention-to-treat analysis and blinding of outcome assessors. PARTICIPANTS: Sixteen adults with stable residual disability ≥ 6 months after the onset of GBS. INTERVENTION: Participants in the experimental group were allocated to 60-minute sessions of physiotherapist-supervised strengthening, endurance and breathing exercises, gait training and pain management, two to three sessions/week for 12 weeks. The control group was prescribed a home program of 30-minute sessions of maintenance exercises and education in self-management, two to three sessions/week for 12 weeks. OUTCOME MEASURES: Functional independence in activities of daily living on the 100-point Barthel Index (primary outcome), muscle strength on the 60-point Medical Research Council scale, fatigue on the 0-to-63 Fatigue Severity Scale, a visual analogue scale of pain severity, and quality of life, measured at baseline and months 6 and 12. RESULTS: At month 6, the median between-group difference was 5 (95% CI 0 to 20) for functional independence, 8 (95% CI 4 to 18) for strength, -13 (95% CI -28 to -1) for fatigue, and 12 (95% CI 3 to 13) for the environment domain of quality of life. Estimated effects at month 12 had a similar magnitude, but most of the CIs had greater uncertainty. CONCLUSION: Supervised, individualised exercise reduced fatigue and improved strength and quality of life more than unsupervised home exercise in people with chronic Guillain-Barré syndrome. REGISTRATION: CTRI/2016/08/007150.

Practice of antimicrobial stewardship in a government hospital of India and its impact on extended point prevalence of antibiotic usage.

BACKGROUND: Antimicrobial resistance (AMR) is a global concern requiring immediate attention. Among many proven measures of decreasing AMR, practice of antimicrobial stewardship is the lowest hanging which can be adapted with negligible financial implications. METHODS: This is a case record based extended cross-sectional type of observational operation research study conducted at an institute of national importance established by Government of India. Point prevalence of antibiotic usage among the patients admitted in the hospital, on four different days in four different quarters of a year was done to study the impact of antimicrobial stewardship program (AMSP). RESULTS: A cumulative 711 patients were exposed on antibiotics among 1396 study participants. There was a significant decrease in antibiotic consumption across the 1st and 4th quarter. The average antibiotic usage was 50.9% (61.75, 60%, 48.4%, and 39% respectively in the 1st to 4th quarter). Among the total number of patients, intravenous antibiotic usage was 47.9% (60.71%, 58.4%, 44.9%, and 34.2% respectively in 1st to 4th quarter). Among the newly admitted patients, the consumption of antibiotic usage decreased from 45.9% to 25.7%. Among the intravenous antibiotics, the top 10 consumed antibiotics were 3rd generation cephalosporin (39.8%), aminoglycoside (14.8%), amoxicillin/amoxy-clav (12.5%), piperacillin-tazobactum (8.5%), carbapenams (6.6%), cefuroxime (6.4%), quinolones (4.3%), vancomycin/linezolid (4.1%), colistin (0.8%), and others (0.8%). CONCLUSION: Government run hospitals can run low budget antimicrobial stewardship program with sustainable impact on antibiotic consumption. For a successful AMSP, it requires change in attitude, commitment, and administrative support rather than a huge financial support.

Mutational analysis of thalassemia in transfusion-dependent beta-thalassemia patients from central India.

BACKGROUND: Thalassemia and hemoglobin (Hb) disorders are the most common genetic disorders among humans. These disorders entail huge morbidity, economic, and psychological burden on the families of the affected. Genetic counseling and prenatal diagnosis are the steps, which helps to reduce this burden. At present, there is paucity of data on the mutational spectrum of thalassemia from the central Indian region. METHODS: Blood samples were collected from 62 transfusion-dependent patients, demographic and relevant data were collected and screened for the two rare mutations - 88 (C-T) and CAP + 1 (A-G) using amplification refractory mutation system-polymerase chain reaction (PCR) and GAP PCR technique. PCR was performed for rare Hb disorders such as Hb Lepore and δ ß chain disorder by GAP PCR in addition to five common Indian beta-thalassemia mutations IVS1-5 (G-C), IVS1-1 (G-T), Cd41/42 (-TCTT), Cd8/9 (+G), 619 bp deletion. RESULTS: Overall 93.5% of the mutations could be identified. Among the abnormal Hb, sickle cell and HbE were found at 4% and 3% of all the loci studied. We also reported two loci with Hb δ ß and one locus with Hb Lepore in the present samples. IVS I-5 (G-C) was the common mutation (46%) followed by IVS I-1 (G-T) (12%) and 619 bp (9%). CONCLUSION: The identification of the genotypes helps to define the severity of the phenotype, plan therapy and form the basis of the comprehensive diagnostic database that would be useful not only for genetic counseling but prenatal diagnosis as well, contributing to the current focus of the National Policy to prevent and control hemoglobinopathies.

Assessment of change in knowledge about research methods among delegates attending research methodology workshop.

AIM: In an era of evidence based medicine research is an essential part of medical profession whether clinical or academic. A research methodology workshop intends to help participants, those who are newer to research field or those who are already doing empirical research. The present study was conducted to assess the changes in knowledge of the participants of a research methodology workshop through a structured questionnaire. METHODS: With administrative and ethical approval, a four day research methodology workshop was planned. The participants were subjected to a structured questionnaire (pre-test) containing 20 multiple choice questions (Q1-Q 20) related to the topics to be covered in research methodology workshop before the commencement of the workshop and then subjected to similar posttest questionnaire after the completion of workshop. The mean values of pre and post-test scores were calculated and the results were analyzed and compared. RESULTS: Out of the total 153 delegates, 45(29 %) were males and 108 were (71 %) females. 92 (60%) participants consented to fill the pre-test questionnaire and 68 (44%) filled the post-test questionnaire. The mean Pre-test and post-test scores at 95% Confidence Interval were 07.62 (SD ±3.220) and 09.66 (SD ±2.477) respectively. The differences were found to be significant using Paired Sample T test (P <0.003). CONCLUSION: There was increase in knowledge of the delegates after attending research methodology workshops. Participatory research methodology workshops are good methods of imparting knowledge, also the long term effects needs to be evaluated.

Plasma Exchange as a Therapeutic Modality in a Rare Case of Cryptogenic New Onset Refractory Status Epilepticus (NORSE).

Refractory Status Epilepticus (RSE) not responding to any therapy and not associated with any aetiology has been termed as New Onset Refractory Status Epilepticus (NORSE). Guidelines for optimal management of cryptogenic NORSE are not clearly defined so far in the literature. Other than common medication, use of high-dose steroids, IV immune globulins and plasma exchanges in NORSE of unknown aetiology have been scarcely described. Immunomodulatory therapy like plasmapheresis is based on the fact that a pathological substance exists in the plasma that contributes to the disease process and its symptoms, which gets removed. We report a case of young female patient diagnosed as NORSE who responded to treatment with plasma exchange after becoming refractory to antiepileptic therapy and treatment with anaesthetic agents for recurrent seizers.

Guillain-Barre syndrome: Demographics, clinical profile & seasonal variation in a tertiary care centre of central India.

BACKGROUND & OBJECTIVES: Guillain-Barre syndrome (GBS) is an autoimmune disease and a recognized cause of generalized progressive paralysis worldwide. The present study was aimed to document the clinical findings, demographics and seasonal variations amongst the patients with GBS during the hospital stay. METHODS: A retrospective analysis of 66 referred cases diagnosed as GBS was conducted. Medical records and the data related to age, sex, antecedent illness, duration of symptoms before admission, muscle power graded by the Medical Research Council scale, functional scores, details of Intensive Care Unit complications and need for ventilation were obtained. The patients were divided into four seasonal groups: S1 (spring, February to April), S2 (summer, May to July), S3 (rainy, August to October) and S4 (winter, November to January) and parameters were studied. RESULTS: The mean age of the patients was 40.69 yr. Forty one (62.1%) patients had a history of preceding illness. Forty nine (74.2%) patients showed quadriparesis as most common complaint. Thirty three (50%) patients were of acute inflammatory demyelinating polyneuropathy (AIDP) variant. The highest number of GBS cases (60%) was found in S1 and S2. The maximum duration of hospital stay was observed in S3 group (mean 23 days). INTERPRETATION & CONCLUSIONS: GBS seems to affect all age groups with male preponderance. Most common antecedent event and presenting feature were flu-like illness and quadriparesis, respectively. AIDP was the most common variant. Most cases occurred from February to July (S1 and S2 group) (maximum in July) with preceding influenza and diarrhoea and maximum duration of hospital stay was observed in S3 group. Prospective studies with follow up of GBS patients need to be done to confirm findings.

Blood donor selection and deferral pattern as an important tool for blood safety in a tertiary care hospital.

CONTEXT: Blood donor selection criteria based on science and regulatory rules influence donor as well recipient safety and demographics. AIM: To evaluate and analyze the blood donor deferral pattern and its causes among blood donors in a tertiary care hospital blood bank and to review its influence on blood safety. SETTINGS AND DESIGN: Hospital based blood bank, retrospective analysis. SUBJECTS AND METHODS: The data available as donor deferral record over a period of 13 years from 2001 to 2013 was analyzed. RESULTS: The blood donor deferral rate was 11.5%, the deferral rate in various categories was 4.8%, 4.7%, 1.6%, and 0.3% in Category 1, Category 2, Category 3, and Category 4, respectively. The majority of deferrals were temporary deferrals (62.8%) of young donors. The maximum number of donors deferred (28.2%) due to a history of jaundice (permanent) followed by 19.4% due to low hemoglobin (temporary). History of malaria, intake of medicines, infections, underweight, last blood donation within 3 months (temporary deferral), and history of heart and lung diseases, diabetes, and with suspicious identity (permanent deferral) were other major causes identified. CONCLUSION: The pattern of donor deferral identified is an important tool for blood safety and also provides key areas to focus on a region or policy formulation nationally for donor selection as well ensure donor safety. The value of determining donor deferral pattern by the categories described is in calling back donors deferred due to temporary reasons and can help retain pool of motivated blood donors.

Detection of rare blood group, Bombay (Oh) phenotype patients and management by acute normovolemic hemodilution.

BACKGROUND: Due to lack of correct blood grouping practices, the rare Bombay Oh phenotype may be missed, subjecting patients to the risk of severe hemolytic transfusion reaction. In the absence of blood donor registry, transfusion management of patients needing immediate surgery is a challenge. This study presents detection of rare Bombay Oh phenotype patients and their management by acute peri-operative acute normovolemic hemodilution (ANH) in a hospital from central India. MATERIALS AND METHODS: Blood grouping of patients and blood donors with a standard tube method was carried out and samples identified as rare Bombay phenotype were confirmed by saliva inhibition test. Surgical management of cases needing transfusion was done by ANH, as per the British Committee for Standards in Hematology guidelines. RESULTS: The incidence of Bombay phenotype was 0.002% or 1 in 51,924 in the study. Amongst three cases (patients) identified as Bombay phenotype, one was Bombay Oh, Rh negative. Two cases were missed in the first instance and one case actually did not require transfusion. In the absence of a blood donor registry for Bombay phenotype, the cases needing transfusion were successfully managed with ANH in the operation theatre. CONCLUSION: A simple test like blood grouping should be done with serious intention with incorporation of both forward and reverse grouping, so that no patient receives wrong blood leading to fatal hemolysis due to transfusion. ANH is a cost-effective transfusion option for suitable patients. Appropriate clinical decision making, use of strategies to decrease peri-operative blood losses and cost-effective country based planning could be more widely applied to improve clinical transfusion practice.

Early diagnosis and management of postpartum hemolytic uremic syndrome with plasma exchange.

The likelihood of survival in cases of postpartum hemolytic uraemic syndrome (HUS) is as high as 80-90% with early diagnosis and aggressive treatment using plasma exchange (PE). The patients, referred to our center, diagnosed as postpartum HUS presented with thrombocytopenia, microangiopathic hemolytic anaemia with or without fever and severe renal failure, were managed aggressively with PE in conjunction with hemodialysis. All patients showed clinical improvement, along with laboratory indicators like normal renal function tests, increased platelet counts and decreased lactic dehydrogenase levels. Awareness amongst treating physicians, early diagnosis and treatment with PE could be the key factors in reducing maternal mortality due to postpartum HUS in developing countries.

The platelet storage lesion.

The continuous increase in the demand for platelet transfusion has necessitated the need to establish standards for determining the quality of platelets during storage. Bacterial contamination of platelet products and deleterious changes in structure and function referred to as the platelet storage lesion (PSL), have restricted the platelet shelf life to 5 days. The PSL and platelet health variables have been well studied and documented. The precise correlation between in vitro assays and in vivo platelet recovery and survival is yet to be established. This review presents an overview of the current understanding of PSL and the novel approaches being developed to negate the storage lesion.