Safety and Efficacy of Hypoxia-Inducible Factor-Prolyl Hydroxylase Inhibitors vs. Erythropoietin-Stimulating Agents in Treating Anemia in Renal Patients (With or Without Dialysis): A Meta-Analysis and Systematic Review.

Hypoxia-inducible factor-prolyl hydroxylase domain inhibitors (HIF-PHIs) are a novel group of drugs used to treat renal anemia, but their benefits vary among different trials. Our meta-analysis aims to assess the safety and efficacy of HIF-PHI versus erythropoiesis-stimulating agents (ESA) in managing anemia among patients with chronic kidney disease (CKD), regardless of their dialysis status. PubMed, Embase, and Google Scholar were queried to discover eligible randomized controlled trials (RCTs). To quantify the specific effects of HIF-PHI, we estimated pooled mean differences (MDs) and relative risks (RR) with 95% CIs. Our meta-analysis involved 22,151 CKD patients, with 11,234 receiving HIF-PHI and 10,917 receiving ESA from 19 different RCTs. The HIF-PHI used included roxadustat, daprodustat, and vadadustat. HIF-PHI yielded a slight but significant increase in change in mean hemoglobin (Hb) levels (MD: 0.06, 95% CI (0.00, 0.11); p = 0.03), with the maximum significant increase shown in roxadustat followed by daprodustat as compared to ESA. There was a significant decrease in efficacy outcomes such as change in mean iron (MD: -1.54, 95% CI (-3.01, -0.06); p = 0.04), change in mean hepcidin (MD: -21.04, 95% CI (-28.92, -13.17); p < 0.00001), change in mean ferritin (MD: -16.45, 95% CI (-27.17,-5.73); p = 0.03) with roxadustat showing maximum efficacy followed by daprodustat. As for safety, HIF-PHI showed significantly increased incidence in safety outcomes such as diarrhea (MD: 1.3, 95% CI (1.11, 1.51); p = 0.001), adverse events leading to withdrawal (MD: 2.03, 95% CI (1.5, 2.74), p = 0.00001) among 25 various analyzed outcomes. This meta-analysis indicates that HIF-PHIs present a potentially safer and more effective alternative to ESAs, with increased Hb levels and decreased iron usage in CKD patients without significantly increasing adverse events. Therefore, in these patients, we propose HIF-PHI alongside renal anemia treatment.

Red Cell Distribution Width and Ratio of Red Cell Distribution Width-to-Total Serum Calcium as Predictors of Outcome of Acute Pancreatitis.

Background: Current severity assessment scores of acute pancreatitis (AP) include multiple variables, the results of which are available only after 48 h of admission. Red cell distribution width (RDW) and total serum calcium (TSC) are simple routine parameters related to inflammatory status and results of which are readily available. Aim: The aim of this study was to evaluate RDW and RDW: TSC within 24 h of hospital admission as predictors of outcome (severity and mortality) and intervention (medical/percutaneous drainage/surgical) required by patients of AP. Materials and Methods: All the patients diagnosed with AP at a tertiary care hospital were enrolled for the study. Values of RDW and TSC along with data regarding the treatment given were collected. Diagnosis and severity were defined according to the revised Atlanta classification 2012. Results and Interpretation: Cutoff value for RDW (area under the receiver operating characteristic curve [AUROC]: 0.997; P = 0.000) to predict the severity of AP was 16.25% (sensitivity - 100% and specificity - 97.1%,) (sensitivity - 100% and specificity - 97.1%, positive predictive value - 92.31%, negative predictive value - 100%, and Youden Index - 0.971), while that of RDW:TSC (AUROC: 1; P = 0.000) was 2.42 (sensitivity - 100%; specificity - 100%, positive predictive value - 100%, negative predictive value - 100%, and Youden Index - 1.00). Similarly, the cutoff value for RDW (AUROC: 0.947; P = 0.000) to predict mortality in AP was 17.20% (sensitivity - 100%; specificity - 87.4%, positive predictive value - 38.89%, negative predictive value - 100%, and Youden Index - 0.874) and that of RDW-to-TSC ratio (AUROC: 0.975; P = 0.000) was 2.9 (sensitivity - 100%; specificity - 96.6%, positive predictive value - 70%, negative predictive value - 100%, and Youden Index - 0.966). Conclusion: Our study found that RDW and RDW: TSC were quick, convenient, economic, sensitive, and dependable prognostic predictors of severity and mortality in patients with AP.

Appendicitis Inflammatory Response Score in Acute Appendicitis: A Study at a Tertiary Care Center in North India.

Introduction: Appendicitis is a common cause of acute abdominal pain. The diagnosis is eminently clinical and the cause is surgically correctable. However, a decision of surgery based on the clinical presentation only has a 15%-30% chance of the removal of a normal appendix. Thus, the diagnosis involves a corroboration of clinical, laboratory, and radiological findings. Appendicitis scoring systems can be considered to expedite the diagnostic and decision-making process. Aim: The present study was conducted to study the efficacy of Appendicitis Inflammatory Response (AIR) score in the diagnosis of acute appendicitis and its correlation with the histopathological findings. Materials and Methods: A cross-sectional study was conducted at a tertiary care center in North India comprising patients who presented to the surgery department with a provisional diagnosis of acute appendicitis and required appendectomy. Results: Appendicitis was histopathologically proven in 54 patients. Patients with an AIR score ≥5 were 2.18 times more likely to have appendicitis. The probability of having appendicitis with AIR score ≥5 was 92.16% (positive predictive value). The diagnostic accuracy of AIR score was 82.81%. Conclusion: AIR score has a high sensitivity and positive predictive value in the diagnosis of acute appendicitis. It is a quick and convenient system for clinical evaluation of patients in primary care or peripheral hospitals where advanced facilities such as USG scan or CT scan are not available all the time. The application of this scoring system definitely improves diagnostic accuracy and reduces negative appendectomy rate.

Individual donor-nucleic acid testing for human immunodeficiency virus-1, hepatitis C virus and hepatitis B virus and its role in blood safety.

BACKGROUND: Transfusion-transmitted infections (TTIs) are one of the biggest threats to blood transfusion safety. Nucleic acid testing (NAT) in blood donor screening has been implemented in many countries to reduce the risk of TTIs. NAT shortens this window period, thereby offering blood centers a much higher sensitivity for detecting viral infections. AIMS: The objective was to assess the role of individual donor-NAT (ID-NAT) for human immunodeficiency virus-1 (HIV-1), hepatitis C virus (HCV) and hepatitis B virus (HBV) and its role in blood safety. MATERIALS AND METHODS: A total of 32978 donations were tested for all three viruses using enzyme-linked immuno-sorbent assay (Vironostika(®) HIV Ag-Ab, Hepanostika(®) HCV ultra and hepatitis B surface antigen ultra by Biomerieux) and ID-NAT using Procleix Ultrio plus(®) Assay (Novartis Diagnostic, USA). All initial NAT reactive samples and serology nonreactive were retested in triplicate and NAT discriminatory assay for HIV-1, HCV and HBV were performed. RESULTS: Of the 32978 samples, 43 (0.13%) were found to be ID-NAT reactive but seronegative. Out of 43, one for HIV-1, 13 for HCV and 27 for HBV were reactive by discriminatory assays. There were two samples that were reactive for both HCV-HBV and counted as HCV-HBV co-infection NAT yield. The prevalence of these viruses in our sample, tested by ID-NAT is 0.06%, 0.71%, and 0.63% for HIV-1, HCV and HBV respectively. The combined NAT yield among blood donors was 1 in 753. CONCLUSION: ID-NAT testing for HIV-1, HCV and HBV can tremendously improve the efficacy of screening for protecting blood recipient from TTIs. It enables detection of these viruses that were undetected by serological test and thus helped in providing safe blood to the patients.

Acute transfusion reactions encountered in patients at a tertiary care centre in Punjab.

BACKGROUND: Blood transfusion is a life-saving procedure, which can occasionally be unsafe and result in a spectrum of adverse events. We aimed to determine the characteristics and type of acute transfusion reactions occurring in patients at a tertiary care centre. METHODS: A retrospective study was conducted at the Department of Immunohaematology and Blood Transfusion, Dayanand Medical College and Hospital, Ludhiana, Punjab. All acute transfusion reactions reported to the department from 1 Jan 2012 to 31 March 2013 were evaluated. All the adverse reactions were recorded, analysed and classified on the basis of their clinical features and laboratory tests. RESULTS: During the study period, 45 092 blood components were issued from the department and 190 transfusion reactions (0.42%) were reported. The most frequent were febrile non-haemolytic transfusion reactions (54.2%) followed by allergic reactions (36.3%), haemolytic reactions (1%) and non-specific reactions (8.5%). CONCLUSION: Each transfusion has to be monitored carefully with prompt recognition and treatment of acute transfusion reactions to decrease transfusion-related morbidity and mortality. Data from a well-functioning haemovigilance system can be used as a quality indicator for monitoring blood transfusion safety and contribute to evidence-based transfusion medicine.

Acute Transfusion Reactions (ATRs) in Intensive Care Unit (ICU): A Retrospective Study.

BACKGROUND: Blood transfusion is a frequent and integral part of critical care. Although life saving, it can occasionally be unsafe and result in a spectrum of adverse events. Acute transfusion reactions (ATRs) are probably under diagnosed in critically ill patients due to confusion of the symptoms with the underlying disease. AIM: To analyze the incidence and spectrum of ATRs occuring in critically ill patients. MATERIALS AND METHODS: This was a retrospective review conducted from 1(st) April 2011 till 31(st) March 2013. The ATRs related to the administration of blood components in the patients admitted in various Intensive Care Units (ICUs) were recorded, analyzed and classified on the basis of their clinical features and laboratory tests. RESULTS: During the study period 98651 blood components were issued. Out of these 21971 were issued to various ICUs. A total of 225 transfusion reactions were reported from the various critical care departments during this period. The most frequent were Febrile Non Hemolytic Transfusion Reactions (FNHTR) 136 (60.4%), allergic reactions 70 (31.2%), hemolytic reactions 1(0.4%) and non specific reactions 18 (8%). The incidence of ATRs in our study was found to be 1.09% in adult ICUs and 0.36% in pediatric ICUs. CONCLUSIONS: Blood transfusion is a vital therapeutic procedure with a potential risk to already critical patients. So a strict vigilance has to be kept and each transfusion has to be monitored carefully with prompt recognition and treatment of ATRs. A rational use of these products considering their deleterious effects can decrease transfusion related morbidity and mortality in the critically ill patients.

Oro-facial granulomatosis--a case report.

Oro-facial granulomatosis includes a group of disorders which present as a chronic, non-ceasating granulomatous lesion involving the perioral tissues of face and oral mucosa. This condition was first referred by Mart in 1859, Hubschmann in 1894 and Luscher in 1949; later, Wiesenfeld in 1985 introduced the term "Oro-facial Granulomatosis" (OFG) which is characterized by persistent or recurrent soft tissue enlargement and oral ulceration. Hence, it is important to establish the diagnosis accurately because this condition sometimes is a manifestation of Crohn's disease or Sarcoidosis. A case of Orofacial granulomatosis in a 15-year-old male is reported.