An Observational Study of Paediatric Preoperative Transfusion Practice in a Resource-Limited Setting.

BACKGROUND: Paediatric anaemia is highly prevalent in low-middle-income countries and can negatively impact postoperative outcomes. Currently, there are no guidelines for the management of paediatric preoperative anaemia. To ensure optimal care in resource-limited settings: balancing the risks of anaemia and using resources such as blood transfusion, we first need to understand current practices. To address this, a joint UK-Bangladesh team conducted an observational study at a paediatric surgical centre in Bangladesh. METHODS: A total of 464 patients ≤16 years who underwent elective and emergency surgery were categorised into major (351/464), moderate (92/464) and minor (21/464) surgery groups according to anticipated blood loss. Preoperative anaemia testing and transfusion was assessed retrospectively through patient notes. RESULTS: Median age was 4 years and 73% were male. 32.5% (151/464) patients had preoperative blood testing for anaemia. 17.5% (81/464) children were transfused preoperatively. Of those children transfused, 40.7% (33/81) underwent transfusion solely based on visible signs of anaemia on clinical examination. Seventy-five percentage (36/48) of children who underwent transfusion after blood testing had haemoglobin ≥80 g/L. Major surgery category had the highest proportion of children who were transfused and tested for anaemia. CONCLUSION: A liberal transfusion approach is evident here. Discussion with local clinicians revealed that this was due to limitations in obtaining timely blood results and reduction in laboratory costs incurred by families when clinical suspicion of anaemia was high. Further research is needed to analyse the potential of using bedside haemoglobin testers in conjunction with patient blood management strategies to limit blood transfusions and its associated risks.

Identification of potential inhibitory analogs of metastasis tumor antigens (MTAs) using bioactive compounds: revealing therapeutic option to prevent malignancy.

The deeper understanding of metastasis phenomenon and detection of drug targets could be a potential approach to minimize cancer mortality. In this study, attempts were taken to unmask novel therapeutics to prevent metastasis and cancer progression. Initially, we explored the physiochemical, structural and functional insights of three metastasis tumor antigens (MTAs) and evaluated some plant-based bioactive compounds as potent MTA inhibitors. From 50 plant metabolites screened, isoflavone, gingerol, citronellal and asiatic acid showed maximum binding affinity with all three MTA proteins. The ADME analysis detected no undesirable toxicity that could reduce the drug likeness properties of top plant metabolites. Moreover, molecular dynamics studies revealed that the complexes were stable and showed minimum fluctuation at molecular level. We further performed ligand-based virtual screening to identify similar drug molecules using a large collection of 376,342 compounds from DrugBank. The results suggested that several structural analogs (e.g., tramadol, nabumetone, DGLA and hydrocortisone) may act as agonist to block the MTA proteins and inhibit cancer progression at early stage. The study could be useful to develop effective medications against cancer metastasis in future. Due to encouraging results, we highly recommend further in vitro and in vivo trials for the experimental validation of the findings.

Immunoinformatics approach for designing a universal multiepitope vaccine against Chandipura Virus.

Chandipura vesiculovirus (CHPV) is a fast-emerging virus that causes acute encephalitis with a high death rate. Because of its extensive prevalence in African and Asian countries, this infection has become a global hazard, and there is an urgent need to create an effective and non-allergenic vaccine or appropriate treatment to combat it. A vaccine candidate is offered utilizing a computational technique in this study. To build a potential vaccine candidate, viral protein sequences were acquired from the National Center for Biotechnology Information database and evaluated with several bioinformatics techniques to identify B-cell and T-cell epitopes. V1 was shown to be superior in terms of various physicochemical qualities, as well as highly immunogenic and non-allergic. Molecular docking revealed that the CHPV vaccine construct had a greater binding affinity with human Toll-like receptors (TLR-3 and TLR-8) and that it was stable in molecular dynamics simulations. MEC-CHPV was in silico cloned in the pET28a (+) expression vector using codon optimization. The current research identifies potential antigenic epitopes that could be used as vaccine candidates to eradicate the CHPV. This in-silico development of a CHPV vaccine with multiple epitopes could open the path for future rapid laboratory tests.