Outcome of chest re-exploration for haemostasis in intensive care unit post-cardiac surgery: A retrospective analysis.

INTRODUCTION: Chest re-exploration is potentially life-saving in the treatment of early post-operative complications of open-heart surgery such as for surgical haemostasis, hemodynamic instability, and cardiac arrest. The procedure is often performed in the intensive care unit (ICU) rather than in the operating theatre (OT). The incidence of chest reexploration may range from 2 to 12%. To analyse the complications of patients who underwent chest reexploration in the ICU for haemostasis after heart surgery vs in those who were operated in an OT. Secondary outcome measured is all-cause mortality in the patients involved. MATERIALS AND METHODS: This is a retrospective analysis of patients' medical records who underwent chest reexploration in the ICU for haemostasis over a 2-year period (2019 to 2020). The cases which needed re-exploration for haemostasis were divided into two groups: cases conducted in those ICU and those conducted in the OT. Complications post-chest re-exploration were measured and categorized into renal failure needing dialysis, pulmonary complication, gastrointestinal complication, heart failure, pericardial effusion, fever, and surgical site infection. RESULTS: 4406 cases of open-heart surgeries were analysed. 351 of the patients underwent chest re-exploration, and majority of the cases were re-explored for haemostasis (88.9%). 64.2% of the chest re-exploration were conducted in the ICU. 21.9% patients who underwent post-chest reexploration in the ICU died, while 13.1% of the patients died post- chest re-exploration in the OT. From the total number of cases of chest re-exploration, 75.9% of patients who had chest re-exploration in the ICU developed complication, whereas patients who developed complication post-chest re-exploration in the OT were 35.1% (p-value < 0.001). CONCLUSION: Chest re-exploration in the ICU for post-cardiacsurgery patients showed a higher percentage of complications, which contributes to mortality.

Red Cell Alloantibodies in Thalassaemia Patients Who Received Ten or More Units of Transfusion.

Thalassaemia patients are the highest consumers of blood. Recurrent exposure to allogenic red cell antigen puts this population at increased risk of alloimmunization. This causes delayed hemolytic transfusion reactions. So transfusion requirement increases. But no data regarding alloimmunization was available in Bangladesh. Aim of this study was to estimate the prevalence of alloimmunization and to find out the potential factors associated with its development. This analytical cross sectional study was done by enrolling 97 patients, received at least 10 units transfusions, through convenient sampling. Indirect and direct antiglobulin tests were done to detect immunization by spin tube technique keeping an autocontrol and carried out in the Department of Haematology & Department of Transfusion Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from March 2016 to March 2017. Polyclonal anti-AHG reagent was used. A total 21 patients developed alloimmunization (21.6%) and 4 patients (4.1%) developed autoimmunization. Age, gender, splenectomy and number of transfusion are shown significant risk factors for alloimmunization. Data from this study demonstrate that the RBC alloimmunization is significantly high in our country. So, pretransfusion antibody screening needs to be initiated in order to ensure safe transfusion and RBC phenotyping should be started before starting first transfusion to prevent alloimmunization.

Evaluation of Bcr-Abl Gene Rearrangement among Bangladeshi Chronic Myeloid Leukaemia Patients.

Chronic Myeloid Leukaemia (CML) is a clonal myeloproloferative disorder. Presence of molecular translocation t (9; 22) in CML patients can be confirmed by Reverse Transcriptase Polymerase Chain Reaction (RT-PCR). Among haematological malignancies CML is the commonest leukaemia of adults in Asia. Despite this, there are very few studies published from Bangladesh, documenting the frequency of bcr-abl fusion transcripts. So, we would like to perform this observational study to evaluate bcr-abl fusion transcripts and demographic status among RT-PCR positive chronic phase CML patients at BIRDEM & other two centers of Dhaka city, Bangladesh where patients admitted from different districts of Bangladesh in the period of January 2010 to June 2012. Twenty patients from three centers willing to perform RT-PCR test and showed positive PCR result, were enrolled under written consent before starting treatment with targeted molecular therapy. The age range of the sample was 18 to 52 years, with mean age of 34.80 and male - female ratio of 4:1. This study showed among chronic phase CML patients bcr-abl transcript rearrangement frequency was b3a2 (e14a 2) 45% while b2a2 (e13a2) was 55% by RT-PCR testing method. Cytogenetic and molecular analysis has become mandatory in order to make a correct diagnosis and monitoring response to newer molecular targeted treatment modalities. So our health sector should be enriched with laboratories with modern technology to diagnose haemato-oncological diseases as per WHO guideline.

Transgenic oil palm: production and projection.

Oil palm is an important economic crop for Malaysia. Genetic engineering could be applied to produce transgenic oil palms with high value-added fatty acids and novel products to ensure the sustainability of the palm oil industry. Establishment of a reliable transformation and regeneration system is essential for genetic engineering. Biolistic was initially chosen as the method for oil palm transformation as it has been the most successful method for monocotyledons to date. Optimization of physical and biological parameters, including testing of promoters and selective agents, was carried out as a prerequisite for stable transformation. This has resulted in the successful transfer of reporter genes into oil palm and the regeneration of transgenic oil palm, thus making it possible to improve the oil palm through genetic engineering. Besides application of the Biolistics method, studies on transformation mediated by Agrobacterium and utilization of the green fluorescent protein gene as a selectable marker gene have been initiated. Upon the development of a reliable transformation system, a number of useful targets are being projected for oil palm improvement. Among these targets are high-oleate and high-stearate oils, and the production of industrial feedstock such as biodegradable plastics. The efforts in oil palm genetic engineering are thus not targeted as commodity palm oil. Due to the long life cycle of the palm and the time taken to regenerate plants in tissue culture, it is envisaged that commercial planting of transgenic palms will not occur any earlier than the year 2020.