Immunogenic Modulations Induced by Prospective Anti-Malarial Herbal Extracts in Murine Model

Keeping in view the ever increasing problem of drug resistance and affordability of the antimalarial drugs by the poor mass, herbal medicines can become an important and alternative sustainable strategy for malaria treatment. Aqueous extracts of three Himalayan herbs― _Equisetum ravense_, _Artemisia vulgaris_ and _Centella asiatica_, with reported antimalarial property were screened for clinical efficacy against a local strain of _Plasmodium vivax_ antigen in murine model. _E. arvense_ extract was consistent in boosting phagocytic activity, nitric oxide generation, acid phosphatase and alkaline phosphatase activities in the peritoneal macrophages. The effectiveness of the rest herbals was discrete. A need for further detailed investigation to evaluate the clinical efficacy of these herbals seems essential

Logarithmic Corrections to Black Hole Entropy and AdS/CFT Correspondence

We calculate the correction to the Bekenstein-Hawking entropy formula for five dimensional AdS-Schwarzschild black holes due to thermodynamic fluctuations. The result is then compared with the boundary gauge theory entropy corrections via AdS/CFT correspondence. We then further generalise our analysis for the rotating black hole in five dimensional AdS space.Comment: 7 pp. Accepted for publication in JHE

Optimization of blood safety through essential characterization of naturally occurring lewis antibody

Background: Lewis (Le) antibodies are usually naturally occurring; however, they may be clinically significant, may be immunoglobulin G (IgG) type, and may cause hemolytic transfusion reactions. The present study depicts the clinical significance and detailed characterization of Le antibodies in blood donors and patient populations and their implication in safe blood transfusion. Materials and Methods: The prospective study included seven individuals who were detected with Le antibodies. Further investigations were performed for detailed characterization of these antibodies with regard to antibody type, thermal amplitude, titer, and enzyme study and secretor status of the individuals. Results: Of the 69,354 donors and patients subjected to antibody screening, anti-Lea was detected in 7 individuals with none having anti-Leb. All showed the Le (a−b−) phenotype with 4 individuals presenting with IgG anti-Lea optimally reacting at 37°C, with a highest titer of 32. Where all seven individuals were ABH secretors, however none revealed any Le substances. For patients requiring transfusion, compatible Lea antigen-negative red cell units were issued without any adverse events. Conclusions: As naturally occurring Le antibodies may be clinically significant and cause hemolytic transfusion reaction, therefore identification and detailed characterization of antibody in blood donor or recipient is very crucial to blood safety

Autoimmune hemolytic anemia: From lab to bedside

Autoimmune hemolytic anemia (AIHA) is not an uncommon clinical disorder and requires advanced, efficient immunohematological and transfusion support. Many AIHA patients have underlying disorder and therefore, it is incumbent upon the clinician to investigate these patients in detail, as the underlying condition can be of a serious nature such as lymphoproliferative disorder or connective tissue disorder. Despite advances in transfusion medicine, simple immunohematological test such as direct antiglobulin test (DAT) still remains the diagnostic hallmark of AIHA. The sensitive gel technology has enabled the immunohematologist not only to diagnose serologically such patients, but also to characterize red cell bound autoantibodies with regard to their class, subclass and titer in a rapid and simplified way. Detailed characterization of autoantibodies is important, as there is a relationship between in vivo hemolysis and strength of DAT; red cell bound multiple immunoglobulins, immunoglobulin G subclass and titer. Transfusing AIHA patient is a challenge to the immunohematologist as it is encountered with difficulties in ABO grouping and cross matching requiring specialized serological tests such as alloadsorption or autoadsorption. At times, it may be almost impossible to find a fully matched unit to transfuse these patients. However, transfusion should not be withheld in a critically ill patient even in the absence of compatible blood. The "best match" or "least incompatible units" can be transfused to such patients under close supervision without any serious side-effects. All blood banks should have the facilities to perform the necessary investigations required to issue "best match" packed red blood cells in AIHA. Specialized techniques such as elution and adsorption, which at times are helpful in enhancing blood safety in AIHA should be established in all transfusion services

Clinical and serological characterization of autoimmune hemolytic anemia in a tertiary care hospital in North India

Clinical and serological characterization of autoimmune hemolytic anemia (AIHA) helps in the diagnosis, management, and monitoring course of disease. In the present study, we serologically characterized the red-cell-bound autoantibodies in diagnosed AIHA patients with regards to antibody class, subclass, direct antiglobulin test (DAT) strength, and their correlation with in vivo hemolysis. A total of 157 samples were evaluated for DAT. Clinically and serologically, 43 of them were diagnosed as AIHA. Detailed serological characterization of autoantibodies was performed in these 43 patients using the gel technology. Hematological and biochemical parameters were obtained from the Hospital Information System. Polyspecific (immunoglobulin G (IgG)+C3) DAT-positive samples were tested for monospecific DAT (IgG, IgM, IgA, C3c, and C3d) and IgG subclass (IgG1 and IgG3). Thermal amplitude of autoantibodies was determined on eluates. Median age of the patients was 31 years (range, 12-70 years) with male to female ratio of 1:3.3. In 55.8% of patients, AIHA was secondary to an underlying disorder. Patients with strong reactive DAT had increased likelihood of hemolysis (p=0.000). IgG was the solitary autoantibody coating the red cells in 72.1% of patients. Red cells coated with multiple immunoglobulins/complements and IgG subclass IgG1 and/or IgG3 were more susceptible to undergo hemolysis. Gel technology helps the immunohematologist to diagnose and serologically characterize AIHA patient with regard to red-cell-bound autoantibodies' class, subclass, and titer as these correlate with in vivo hemolysis

Machine and man individualities in apheresis adverse events

Background: Adverse events due to plateletpheresis are not unheard of, citrate-related reactions being the most common. Most of these events are mild and self-limiting. The current study describes adverse events in plateletpheresis using modern apheresis systems. Materials and Methods: The prospective study included 1455 plateletpheresis procedures from July 2013 to April 2016. Procedures were performed on Amicus, Trima Accel and Cobe spectra cell separators. The endpoint of each procedure was a yield of 3 × 1011 platelets (PLTs) per unit. Donor adverse reaction if any was managed, reported, and documented. Results: The median age of donors was 31 years with male-to-female ratio of 13:1. The median body surface area and body mass index were 1.64 m2 and 22.4 kg/m2, respectively. The mean PLT count of donors was 199.8 × 103/uL with a mean hemoglobin value of 13.6 g/dl. ACD infusion was significantly more in the Cobe (P < 0.01). Donation time was least with the Trima compared to Amicus (P < 0.01) and Cobe (P < 0.001). Total whole blood volume processed was higher in Cobe (P < 0.01). Paresthesia due to citrate toxicity was the most common adverse reaction (65.3%), and vascular injury was observed in only five donors. Adverse reaction was significantly more with the Cobe (P < 0.01). The overall incidence of adverse reaction was 3.4%. Conclusion: Serious adverse events were not observed. The modern-generation apheresis machines are more donor-friendly and cause less adverse reactions compared to the older versions. Good donor screening, optimized donor physiognomic and hematological values, and skilled operator are the key factors to reaction reduction by apheresis

FORMULATION, IN-VITRO RELEASE KINETICS AND STABILITY INTERPRETATION OF SUSTAINED RELEASE TABLETS OF METFORMIN HYDROCHLORIDE

Objective: The objective of the present study was to formulate, study the in-vitro release kinetics and stability of sustained release tablets of metformin hydrochloride.Methods: Sustained release formulations that would maintain the plasma level for 8 – 12 h might be sufficient for daily dosing of metformin. The granules of metformin hydrochloride were prepared by wet granulation method using polymers such as ethyl cellulose (EC) and hydroxyl propyl methyl cellulose E15 (HPMC E15).Results: The granules were evaluated by determining the angle of repose (26.010±0.110 to 31.950±0.100), bulk density, tapped density, Hausner ratio and Carr's index. It shows satisfactory results. The tablets were subjected to measurement of thickness (4.78 ± 0.07 to 5.20±0.13 mm), weight variation (within limit), drug content (98.08±0.20 to 99.22±0.22%), hardness (9.27±0.16 to10.30±0.97 kg/cm2), friability (0.2to 0.3%w/w), and in-vitro release studies.Conclusion: It was found that as the concentration of HPMC increased the drug release rate declined due to formation of viscous layer. The release can be fine tuned by adding a hydrophobic polymer like EC in the hydrophilic matrix of HPMC. The release mechanisms were analyzed and were found that the release data was best fitted with Higuchi equation although there is no significant difference between the correlation coefficients of Zero-order and Higuchi model. The result also shows different parameters of stability studies and compare with initial results of different batches.Â

Immunohematological and clinical characterizations of mixed autoimmune hemolytic anemia

Background and Aim: Patients with warm autoimmune hemolytic anemia (AIHA) may carry immunoglobulin (Ig) M antibodies that react at room temperature and are nonpathological, but few may have cold agglutinins that react at or above 30°C and are referred to as “mixed” AIHA (MAIHA). Here, we present our experience on characterizing MAIHA both clinically and serologically. Materials and Methods: Out of 134 AIHA patients, 13 diagnosed as MAIHA were subjected to detailed immunohematological characterization. Most patients were severely anemic and required urgent transfusions. Resolution of blood group discrepancy, elution, Donath-Landsteiner test, and adsorption study were performed following established protocol. “Best match” blood units were selected and transfused to patients. Results: Eight of the 13 patients had severe hemolysis. The median age of patient was 37 years with a female preponderance and secondary MAIHA was observed in 8 (61.5%) patients. Blood group discrepancy was encountered in 4 (30.8%) patients. Multiple red cell bound autoantibodies and high titer serum-free IgM autoantibodies were detected in all samples. Twenty-nine units of “best match” packed red blood cells were transfused to 12 patients without any adverse reaction. Improvement in hematological and biochemical values was observed in all follow-up patients. Conclusion: Patients with MAIHA often present with severe hemolysis necessitating blood transfusions. While red cells are coated with multiple autoantibodies, both warm reactive IgG and cold reactive IgM autoantibodies are present in the serum. These serological complexities not only render a crossmatch incompatibility but often lead to blood group discrepancy. “Best match” blood transfusion is always lifesaving

Monitoring errors in a blood bank immunohematology laboratory: Implementing strategies for safe blood transfusion

Background: Errors occurring at patient bedside during specimen collection are the most common causes of adverse outcomes. We planned this prospective study to estimate the incidence and nature of transfusion errors, identify the source, site of occurrence, and assess the underlying problems in the system with the aim to prevent the potentially fatal human error. Materials and Methods: The study was performed over a period of 5 years at a hospital based blood transfusion service where all errors and discrepancies both in the recipient and donor samples were reported into an 'incident and error reporting register' and then analyzed. Results: While a total of 72,381 patient samples were received for pretransfusion testing, 43,762 samples were from blood donors for ABO and Rh grouping. A total of 79782 blood components were issued to patients during the study. Out of 229 errors in the blood transfusion chain, 164 (0.22% of total requisitions and 0.21% of total component issued) were reported in patient pretransfusion samples, and 65 errors (0.15%) were reported in donor samples. Majority of the errors were clerical in nature and related to human errors. Of the 164 errors in pretransfusion testing samples, 107 (65.2) were observed in night shift. The overall error frequency per 1000 requisitions was 2.26. Conclusion: Near miss event reporting can prevent potential transfusion associated mortality and morbidity caused by simple human ignorance. A good error reporting not only helps in accurate collection and analysis of data but also makes recommendations that improve transfusion safety