An audit on usage of fresh frozen plasma in a tertiary care hospital in north western part of India

Background: Every blood Component carries inherent risk of adverse transfusion reactions and transmission of transfusion transmitted disease (TTD). The adverse transfusion reactions are unpredictable and makes transfusion services puzzled, FFP being the most common one, it is therefore necessary that appropriate and rational use of FFP is done to make transfusion safer in terms of patient safety. The objective of the study was to assess the utilisation of FFP in a tertiary care Hospital.Methods: We conducted a retrospective study on 256 patient who received FFP transfusion at our tertiary care hospital over a period of 6 months .The usage was classified as appropriate or inappropriate based on the guidelines for FFP usage by British committee for standards in haematology, 2004 and college of American pathologist, 1994.Results: There were 256 patients in the study period who received 1370 units of FFP transfusions. The male: Female ratio was 162 M & 94 F. Most of the patients belonged to Gastroenterology Department (41.75%) followed by CTVS (15.32%). 29.48% of FFP transfusions were reclassified as inappropriate either due to Lack of indication or inappropriate doses.Conclusions: The study emphasize on the need to incurate rational use of blood components which is FFP in present case for evolving safe transfusion practices in the country. This study highlights no adherence to guidelines among clinicians which is mainly due to lack of knowledge of appropriate usage

Incidence of low bone mineral density in patients with advanced prostate cancer before hormonal manipulation

Background: Prostate cancer is the second most commonly diagnosed cancer in men with an estimated 1.3 million cases diagnosed in 2018 according to the most recent International Agency for Research on Cancer (IARC) report.A large proportion of men still present with advanced disease and in this situation androgen deprivation therapy (ADT) is the mainstay of treatment.Prostate cancer is largely androgen-dependent and responds to endocrine therapy. ADT is an effective treatment modality which decreases the rate of disease progression, alleviates symptoms, and prolongs patients’ survival. ADT can be achieved through surgery (i.e., bilateral orchidectomy) or medical therapy (gonadotropin releasing hormone agonists, antagonists and antiandrogens).Methods: With the approval from institutional ethic committee, a case control study was planned at the urology outpatient department (OPD) at SMS Hospital from April 2019 to March 2020. Based on inclusion and exclusion criteria, 44 patients with newly diagnosed advanced prostate cancer and requiring hormone manipulation were enrolled in study. Age matched control (age±2 years) was selected from patients attending urology clinics with conditions other than prostate cancer. Ratio of cases and control was kept 1:1. Written consent was taken from all participants.Results: Total 88 patients were enrolled in study, 44 in each group. The age of patients ranged from 57 to 86 years among the case group and 55–85 among the control group. Mean age of cases was 65.24±6.8 and control was 64.98±7.6 years (p=0.25). Body mass index which is calculated with standard formula (weight in kg/height in meter square) was significantly high among controls (24.20±2.46) in comparison to cases (23.42±2.84). Statistically significant difference was observed among case and control groups for PSA (p=0.0001) and serum calcium (p=0.005) however difference for alkaline phosphatase (ALP), parathyroid hormone (PTH) and vitamin D was found insignificant (p>0.05).Conclusions: Low bone mineral density in patients with advanced prostate cancer before hormonal manipulation is nearly 50%. PSA and serum calcium level were significant different among case and control however this difference was not found for ALP, PTH and vitamin D. Consideration should be given to performing BMD studies in these men before initiating treatment, to avoid or minimize potential bone-related complications in these patients

The changing trend of alloimmunization in antenatal females: experience from a tertiary care centre in north-western India

Background: Haemolytic disease of the foetus and new-born (HDFN) is a major concern during the antenatal period, especially in countries with low human development index (HDI). The guidelines for antenatal screening and management significantly vary from one geographical region to another. Since the introduction of RhIG immunoprophylaxis, the incidence of HDFN caused by alloimmunization to D antigen has markedly reduced, while that caused by other minor blood group antigens has not been addressed significantly and needs to be given due consideration.Methods: The study was carried out to evaluate the incidence of alloimmunization and analyse various factors associated with HDFN in north-western India. A total of 1700 antenatal cases were evaluated over a period of 20 months, antibody screening and identification was performed on their samples and results were analysed.Results: Out of the 1700 cases, 21 were detected to have the presence of an alloantibody with a prevalence of 1.24%. Out of these, 11 were Rh (D) negative while the remaining 10 were Rh (D) positive. The rate for alloimmunization was higher in females who had a history of blood transfusion (1.24%), bad obstetric history (1.24%), and multigravida status (1.24%).Conclusions: Screening all pregnant females for alloimmunization to RBC antigens, irrespective of their Rh status will help in minimizing the incidence of the HDFN. The practice of providing partial phenotype matched blood to the females of the childbearing age group should be encouraged to reduce the overall incidence of alloimmunization and HDFN

31st Annual Meeting and Associated Programs of the Society for Immunotherapy of Cancer (SITC 2016) : part two

Background The immunological escape of tumors represents one of the main ob- stacles to the treatment of malignancies. The blockade of PD-1 or CTLA-4 receptors represented a milestone in the history of immunotherapy. However, immune checkpoint inhibitors seem to be effective in specific cohorts of patients. It has been proposed that their efficacy relies on the presence of an immunological response. Thus, we hypothesized that disruption of the PD-L1/PD-1 axis would synergize with our oncolytic vaccine platform PeptiCRAd. Methods We used murine B16OVA in vivo tumor models and flow cytometry analysis to investigate the immunological background. Results First, we found that high-burden B16OVA tumors were refractory to combination immunotherapy. However, with a more aggressive schedule, tumors with a lower burden were more susceptible to the combination of PeptiCRAd and PD-L1 blockade. The therapy signifi- cantly increased the median survival of mice (Fig. 7). Interestingly, the reduced growth of contralaterally injected B16F10 cells sug- gested the presence of a long lasting immunological memory also against non-targeted antigens. Concerning the functional state of tumor infiltrating lymphocytes (TILs), we found that all the immune therapies would enhance the percentage of activated (PD-1pos TIM- 3neg) T lymphocytes and reduce the amount of exhausted (PD-1pos TIM-3pos) cells compared to placebo. As expected, we found that PeptiCRAd monotherapy could increase the number of antigen spe- cific CD8+ T cells compared to other treatments. However, only the combination with PD-L1 blockade could significantly increase the ra- tio between activated and exhausted pentamer positive cells (p= 0.0058), suggesting that by disrupting the PD-1/PD-L1 axis we could decrease the amount of dysfunctional antigen specific T cells. We ob- served that the anatomical location deeply influenced the state of CD4+ and CD8+ T lymphocytes. In fact, TIM-3 expression was in- creased by 2 fold on TILs compared to splenic and lymphoid T cells. In the CD8+ compartment, the expression of PD-1 on the surface seemed to be restricted to the tumor micro-environment, while CD4 + T cells had a high expression of PD-1 also in lymphoid organs. Interestingly, we found that the levels of PD-1 were significantly higher on CD8+ T cells than on CD4+ T cells into the tumor micro- environment (p < 0.0001). Conclusions In conclusion, we demonstrated that the efficacy of immune check- point inhibitors might be strongly enhanced by their combination with cancer vaccines. PeptiCRAd was able to increase the number of antigen-specific T cells and PD-L1 blockade prevented their exhaus- tion, resulting in long-lasting immunological memory and increased median survival

Analog and RF Performance Analysis of 22nm Modified Source/Drain Dual Gate FDSOI MOSFET

In this paper, 22nm FDSOI MOSFET having Modified Source/Drain with Dual Gate has been analyzed. This device, not only provides higher ON current but it has also a lower leakage current in order of pA. With the help of Dual Gate (DG) electrical characteristics and Short Channel Effects improved. Analysis parameters like Drain Induced Barrier Lowering (DIBL), Subthreshold Swing, Threshold roll-off, Carrier Concentration, Gate to drain Capacitance, Gate to Source Capacitance, cut-off frequency, Conduction and Valence Band Banding are analyzed using high-k spacers

Protection from exposure to second hand SLT use in public places - spitting a public health concern or a public nuisance?

Background Until 1990, spitting was an offence in United Kingdom carrying a £5 fine. Spitting was also banned in other developed countries especially in Europe early in the 20 th Century as a preventive measure against tuberculosis and later to maintain cleanliness. Several health experts consider spitting a public health concern and smokeless tobacco in all its forms induces spitting, thereby causing risk for communicable diseases like tuberculosis. Methods A comprehensive review of existing literature on prohibition of spitting in public places was undertaken. Legislative and policy publications were reviewed for the reasons of such prohibition and punishments thereon. Results Spitting has been considered a public inconvenience and a nuisance. Spitting of chewing and other smokeless tobacco stains and defaces public vehicles, buildings and other public property and is a public nuisance. In a scientific study done in India the most frequent cited reason for quitting tobacco use was spitting and ash dropping which was embarrassing in-front of others. Several states in India have banned spitting by law. Nepal has banned use of any kind of tobacco products in public places. Bhutan prohibits smearing lime and spitting doma in public area. Hangzhou- a province in China has banned spitting in public places. Countries like Singapore, Myanmar and Australia also have imposed ban on spiting in public and impose hefty fine for violation of the provisions. Conclusions Several countries and cities have promulgated norms against spitting in public places, including spitting after SLT use. There is a need to undertake further research to study impact of spitting ban on SLT use

Customized implant full-mouth rehabilitation: A biomechanical depiction

The rationale for implant full-mouth rehabilitation is believed to present the better quality of life to the older population. This type of modalities preserves the soft and hard tissue of oral cavity. It is also helpful to check the temporomandibular joint disease. Literature exposes that implant full-mouth fixed rehabilitation is one of the taxing procedures in the field of prosthodontics. The current clinical report discusses a customized biomechanical approach for the fabrication of implant complete-mouth rehabilitation. A systematic approach in managing this patient can lead to a predictable and favorable prognosis. This article also presents the stages of prosthodontic rehabilitation from diagnosis to final treatment planning as a customized radiographical Gutta Percha template, precise implant surgery of 12 implants (ADIN, Dental Implant System, Israel) over the both the arches and provisional restorations with group function occlusion. Lastly, full-mouth restorations were fabricated as cement-retained (open hole) metal-ceramic restoration. Advocated patient is absolutely happy with customized implant full-mouth rehabilitation

Comparative Analysis of Powdery Mildew Disease Resistance and Susceptibility in <i>Brassica</i> Coenospecies

Erysiphe cruciferarum, a causative agent of powdery mildew disease, has emerged as a serious threat in Brassica juncea and its closely related species. To date, no resistant cultivars have been identified in Brassica species against powdery mildew. Here, we used histopathological, biochemical, and molecular approaches to elucidate the powdery mildew disease progression and host responses in three Brassica cenospecies, namely B. juncea, Camelina sativa, and Sinapis alba. Based on the results of disease progression, S. alba was found to be extremely resistant to powdery mildew infection, whereas B. juncea and C. sativa were highly vulnerable. In addition, the disease spread rate to uninfected parts was comparatively higher in B. juncea and C. sativa. Histopathological results revealed more pathogen-induced cell death in B. juncea and C. sativa compared to S. alba. We also examined the role of antioxidant enzymes such as superoxide dismutase (SOD), peroxidase (POD), and catalase (CAT) in B. juncea, C. sativa, and S. alba after powdery mildew infection. Based on our findings, the enzyme activity of SOD, POD, and CAT was relatively higher in S. alba then that of B. juncea and C. sativa after powdery mildew infection. Furthermore, we evaluated the expression levels of salicylic acid (SA) signature genes, including pathogenesis-related protein viz., PR1, PR2, and PR5 in B. juncea, C. sativa, and S. alba after E. cruciferarum infection. Based on our findings, the expression levels of SA marker genes PR1, PR2, and PR5 increased in all three species after infection. However, the fold change was relatively higher in S. alba than in B. juncea and C. sativa. In future, further studies are required to identify the potential candidates in S. alba that are involved in powdery mildew disease resistance

Overexpression NPR1 in Brassica juncea confers Broad spectrum resistance to fungal pathogens.

Not AvailableBrassica juncea (Indian mustard) is a commercially important oil seed crop, which is highly affected by many biotic stresses. Among them, Alternaria leaf blight and powdery mildew are the most devastating diseases leading to huge yield losses in B. juncea around the world. In this regard, genetic engineering is a promising tool that may possibly allow us to enhance the B. juncea disease resistance against these pathogens. NPR1 (non-expressor of pathogen-related gene 1) is a bonafide receptor of salicylic acid (SA) which modulates multiple immune responses in plants especially activation of induced and systemic acquired resistance (SAR). Here, we report the isolation and characterization of new NPR1 homolog (BjNPR1) from B. juncea. The phylogenetic tree constructed based on the deduced sequence of BjNPR1 with homologs from other species revealed that BjNPR1 grouped together with other known NPR1 proteins of Cruciferae family, and was nearest to B. napus. Furthermore, expression analysis showed that BjNPR1 was upregulated after SA treatment and fungal infection but not by jasmonic acid or abscisic acid. To understand the defensive role of this gene, we generated B. juncea transgenic lines overexpressing BjNPR1, and further confirmed by PCR and Southern blotting. The transgenic lines showed no phenotypic abnormalities, and constitutive expression of BjNPR1 activates defense signaling pathways by priming the expression of antifungal PR genes. Moreover, BjNPR1 transgenic lines showed enhanced resistance to Alternaria brassicae and Erysiphe cruciferarum as there was delay in symptoms and reduced disease severity than non-transgenic plants. In addition, the rate of disease spreading to uninfected or distal parts was also delayed in transgenic plants thus suggesting the activation of SAR. Altogether, the present study suggests that BjNPR1 is involved in broad spectrum of disease resistance against fungal pathogens.Not Availabl

Heparin free dialysis in critically sick children using sustained low efficiency dialysis (SLEDD-f): A new hybrid therapy for dialysis in developing world.

In critically sick adults, sustained low efficiency dialysis [SLED] appears to be better tolerated hemodynamically and outcomes seem to be comparable to CRRT. However, there is paucity of data in critically sick children. In children, two recent studies from Taiwan (n = 11) and India (n = 68) showed benefits of SLED in critically sick children.The objective of the study was to look at the feasibility and tolerability of sustained low efficiency daily dialysis-filtration [SLEDD-f] in critically sick pediatric patients.Design: Retrospective study Inclusion criteria: All pediatric patients who had undergone heparin free SLEDD-f from January 2012 to October 2017. Measurements: Data collected included demographic details, vital signs, PRISM III at admission, ventilator parameters (where applicable), number of inotropes, blood gas and electrolytes before, during, and on conclusion of SLED therapy. Technical information was gathered regarding SLEDD-f prescription and complications.Between 2012-2017, a total of 242 sessions of SLEDD-f were performed on 70 patients, out of which 40 children survived. The median age of patients in years was 12 (range 0.8-17 years), and the median weight was 39 kg (range 8.5-66 kg). The mean PRISM score at admission was 8.77±7.22. SLEDD-f sessions were well tolerated, with marked improvement in fluid status and acidosis. Premature terminations had to be done in 23 (9.5%) of the sessions. There were 21 sessions (8.6%) terminated due to hypotension and 2 sessions (0.8%) terminated due to circuit clotting. Post- SLEDD-f hypocalcemia occurred in 15 sessions (6.2%), post- SLEDD-f hypophosphatemia occurred in 1 session (0.4%), and post- SLEDD-f hypokalemia occurred in 17 sessions (7.0%).This study is the largest compiled data on pediatric SLEDD-f use in critically ill patients. Our study confirms the feasibility of heparin free SLEDD-f in a larger pediatric population, and even in children weighing <20 kg on inotropic support