Hemolytic disease of the fetus and newborn caused by anti-D and anti-S alloantibodies: a case report

<p>Abstract</p> <p>Introduction</p> <p>Hemolytic disease of the fetus and newborn is most commonly caused by anti-D alloantibody. It is usually seen in Rhesus D (RhD)-negative mothers that have been previously sensitized. We report here a case of hemolytic disease of the fetus and newborn in a newborn baby caused by anti-D and anti-S alloantibodies, born to a mother who was RhD negative, but with no previous serological evidence of RhD alloimmunization.</p> <p>Case presentation</p> <p>A one-day-old Chinese baby boy was born to a mother who was group A RhD negative. The baby was jaundiced with hyperbilirubinemia, but with no evidence of infection. His blood group was group A RhD positive, his direct Coombs' test result was positive and red cell elution studies demonstrated the presence of anti-D and anti-S alloantibodies. Investigations performed on the maternal blood during the 22 weeks of gestation showed the presence of anti-S antibodies only. Repeat investigations performed post-natally showed the presence of similar antibodies as in the newborn and an anti-D titer of 1:32 (0.25 IU/mL), which was significant. A diagnosis of hemolytic disease of the fetus and newborn secondary to anti-D and anti-S was made. The baby was treated with phototherapy and close monitoring. He was discharged well after five days of phototherapy.</p> <p>Conclusions</p> <p>This case illustrates the possibility of an anamnestic response of allo-anti-D from previous sensitization in a RhD-negative mother, or the development of anti-D in mid-trimester. Thus, it highlights the importance of thorough antenatal ABO, RhD blood grouping and antibody screening, and if necessary, antibody identification and regular monitoring of antibody screening and antibody levels for prevention or early detection of hemolytic disease of the fetus and newborn, especially in cases of mothers with clinically significant red cell alloantibody.</p

COMPARATIVE STUDY OF PROFESSIONALISM OF FUTURE MEDICAL PROFESSIONALS AMONG THREE PRIVATE MEDICAL COLLEGES OF BANGLADESH

Objectives: Medical professionalism forms the bridge between doctors and society. Conserving and maintaining professionalism is obligatory for physician curriculum. The objective of this study was to scrutinize and compare the professionalism of future medical professionals among different medical institutes. Methodology: It was a cross-sectional study conducted on 332 year-III and year-IV MBBS students of session 2012-2013 from three private medical colleges in Bangladesh. Data was collected using a mixed validated instrument containing items under fundamental elements of professionalism, measured by 5-points Likert scale giving a maximum score of 220. Results: Among 332 respondents, 44% were male, 56% female; Year-III respondents constituted 51% and Year-IV constituted 49%. Mean professionalism scores for male and female were 176.21 and 175.33, while for Year-III and Year-IV were 174.96 and 176.50 respectively. No significant differences observed between gender and year of study. However, significant differences were noticed between year-IV male students among three medical colleges. Majority (83%) students were imprecise of professionalism. Conclusions: Lack of focus is a worry for professionalism. Educators should focus on fundamental elements of professionalism. KEYWORDS: Professionalism, Medical-student, Core-values, Comparisons, Bangladesh

Haematopoietic stem cell transplantation in thalassaemia major: A narrative review

Thalassaemia constitutes an especially prevalent human monogenic illness caused by a lack of synthesis of the α- or β-globin chains. The clinical impact of β-thalassaemia is worse since it consists of the same pair gene configuration, thalassaemia major, causing significant health discouragement and loss of life due to life threateningly insufficient haemoglobin (Hb) levels. Only a few nations have successfully reduced the prevalence of β-thalassaemia major, even though comprehensive screening, group counselling, pre-natal detection and public education can all be used. Since over ½ century ago, the fundamental elements of treatment for thalassaemia major have been iron chelation and hypertransfusion. The globin chain that makes up the adult Hb molecule is missing or synthesised at a reduced rate in β-thalassemia. The aberrant buildup of the α-globin chain and faulty formation of red blood cells (RBCs) leading to RBC haemolysis are the outcomes of this genetic abnormality. Since allogeneic haematopoietic stem cell transplantation (Allo-HSCT) has been a well-established gene replacement therapy for individuals with thalassaemia major for several years, it has had very successful outcomes for patients with access to it. Over the past 20 years, the consequences for more susceptible patients have also steadily improved, leading to 80%–90% longer-term life expectancy amongst this group of patients. However, providing Allo-HSCT as a treatment for these patients globally presents numerous difficulties. Replacing genes in autologous HSCs employing viral vectors has been possible in recent years

HEPATO-PROTECTIVE ROLE OF THE AQUEOUS AND N-HEXANE EXTRACTS OF NIGELLA SATIVA LINN. IN EXPERIMENTAL LIVER DAMAGE IN RATS

Objective: Liver disease is associated with the formation of oxygen derived free radicals. Reactive oxygen species (ROS) as well as nitrogen species are responsible for nuclear DNA fragmentation and cell death. Active principle of thymoquinone (TQ) of Nigella sativa acts as a scavenger of superoxide anion. Current study was conducted to evaluate the hepatoprotective effect of Nigella sativa on rats. Methods: The study was carried out at prime postgraduate medical University of Bangladesh. Liver damage and oxidative stress were evaluated by measuring serum alanine amino transferase (ALT), hepatic malondialdehyde (MDA) and hepatic Glutathione (GSH) levels. Aqueous extract of Nigella sativa and n-hexane extract of Nigella sativa were administered orally into two groups' of rats through intra-gastric tube for 28 days. Both the groups received paracetamol intraperitoneally on day 28th and were sacrificed on day 30th. Subsequently, the following parameters were studied: Serum ALT, hepatic MDA, and hepatic GSH. Results: Hepatic damage was evaluated by significant increases in serum ALT (p&lt;0.001) and hepatic MDA (p&lt;0.001) concentration with depleted hepatic GSH (p&lt;0.001) in paracetamol treated group. Pre-treated with aqueous extract of Nigella sativa significantly reduced serum ALT (p&lt;0.001) and hepatic MDA (p&lt;0.001) levels and also significantly associated with the increase in hepatic GSH (p&lt;0.01). Pretreatment with n-hexane extracts of Nigella sativa decreased serum ALT (p&lt;0.001), hepatic MDA (p&lt;0.001) and increased hepatic GSH (p&lt;0.001). Conclusion: Hepatoprotective properties of Nigella sativa in liver damage of experimental rats by reducing oxidative stress is evident. Protection afforded by the n-hexane extract of Nigella Sativa in pre-treated group has also been validated. KEY WORDS: Hepatoprotective, Liver-damage, Nigella sativa Linn