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Introduction: The stiff person syndrome (SPS) is a rare and disabling neurological disorder characterized by muscle stiffness, painful spasms and rigidity involving the proximal and axial limb muscles, with an estimated incidence of 1 case per million per year. The first line of treatment for symptomatic management includes gamma-aminobutyric acid (GABA)ergic agonists, benzodiazepines and baclofen. The therapeutic plasma exchange (TPE), alone or as an adjuvant to other forms of immunomodulation, has been used as a therapeutic option, particularly in refractory cases., Methods: An observational study was performed to review SPS patient symptoms, comorbidities, electromyography (EMG) studies and treatment, identifying autoantibodies, therapeutic plasma exchange (TPE) procedural details and clinical response., Main Results: Five patients (4 male and one female) were treated with TPE during the study period as adjuvant therapy. The average age was 47 years (range 34 - 61 years), and anti-glutamic acid decarboxylase 65-kilodalton isoform (anti-GAD65) antibodies were positive in 80 % (4/5) of the patient population. All patients received immunosuppressive drugs along with TPE. Four patients received TPE during the first admission and one received it during the third hospital admission. All patients showed good improvement immediately after TPE, but it was not a sustainable effect., Conclusion: TPE may be helpful as adjuvant therapy for SPS patients to provide relief from clinical symptoms., Competing Interests: Conflicts of interest None., (Copyright © 2024 Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular. Published by Elsevier España, S.L.U. All rights reserved.)

Rose petals exhibit a phenomenal wetting property of being sticky and superhydrophobic simultaneously. A recent study has shown that for short timescales, associated with drop impact phenomenon, lotus leaf and rose petal replicas exhibit similar wettability, thereby highlighting the difference between long and short time wettability. Also, short time wetting on rose petals of different colors remains completely unaddressed, as almost all existing study on wetting of rose petals have been performed with the classical red rose ( Rosa chinensis ). In this paper, we compare the drop impact studies on replicas of a yellow rose petal, with those on extensively studied red rose petal replicas and the lotus leaf over a wide range of Weber number ( We ), by varying the height of fall ( h ) from 10 to 375 mm. Our results reveal that over the replica of a yellow rose petal, the initial impact outcome varies from complete rebound to micro pinning and eventually complete pinning depending on the kinetic energy of the impacting drop, in contrast to that on red rose petal replica on which the droplet always pinned. Based on experimental finding, we present a comprehensive regime phase map of the post impact behavior of the drop on different surfaces as a function of impact height. We also present a simple scaling analysis to understand the combined effect of pattern height and periodicity on the critical h corresponding to wetting regime transition. Additionally, variation of maximum spreading diameter and spreading time with the h for the different surfaces is also discussed. The results highlight that the initial impact dynamics of a water drop over a topographically patterned substrate is a strong function of the topographical parameters and can be very different from the equilibrium wetting state.

Background: The IL-33/ST2 immune axis plays crucial roles in infection and immunity. A dysregulated IL-33/ST2 axis can induce autoimmune reaction and inflammatory responses. Guillain-Barré syndrome (GBS) is an acute peripheral neuropathy, mostly caused by post-infection autoimmunity. The role of IL-33/ST2 axis is not known in GBS. This study aimed to explore the role of IL-33/ST2 axis in GBS., Methods: Three single nucleotide polymorphisms (SNPs) of Il33 gene (rs16924159, rs7044343, rs1342336) and three SNPs of Il1rl1 gene (rs10192157, rs1041973, rs10206753) coding for suppressor of tumorigenicity 2 (ST2) were genotyped in 179 GBS patients and 186 healthy controls by TaqMan Allelic Discrimination Assay. Plasma levels of IL-33 and sST2 were measured in a subset of GBS patients (n = 80) and healthy controls (n = 80) by ELISA., Results: The frequencies of CC genotype of rs10192157 (p = 0.043) and TT genotype of rs10206753 (p = 0.036) SNPs of Il1rl1 gene differed significantly between GBS patients and healthy controls. Gene-gene interaction between Il33 and Il1rl1 genes also conferred significant risk for GBS. In addition, the plasma sST2 levels were significantly elevated in GBS patients compared to healthy subjects (24,934.31 ± 1.81 pg/ml vs. 12,518.97 ± 1.51 pg/ml, p < 0.001). Plasma sST2 levels showed a significant correlation with the disability scores at the peak of neurological deficit in GBS patients., Conclusions: The IL-33/ST2 axis is suggested to influence the immunopathogenesis of GBS. Genetic variants of Il1rl1 gene might serve as a risk determinant of GBS and plasma sST2 levels might emerge as a biomarker of severity of GBS, if replicated further by other studies., (© 2022 European Academy of Neurology.)

Covid-19 pandemic had affected transfusion services including recruitment of donors and blood donation camps activities. The blood donors may have concerns, confusion, and misleading rumours about blood donation during pandemic. People's priorities for blood donation may shift because of a dearth of necessities. It is important to identify factors which prevent or motivate blood donors during pandemic. This study was designed to understand blood donors' knowledge, attitudes, and perceptions during the Covid-19 pandemic. A descriptive cross-sectional study to assess donor's knowledge, attitude, and perception regarding blood donation using self-administered 20 questions. The study duration was 4 months. A total 503 whole blood donors participated. The fear of infection and reduced blood donor motivation were observed to be the major deterrents of blood donation activity. Environment of blood donation area and travel to blood donation site were perceived two major sources of Covid-19 infection by participants. The top 3 motivational factor for blood donation were direct patient request to donate (30%), followed by family/ friends need and social media campaigns (26% each). Most donors (70.6%) were aware of importance of Covid-19 appropriate behaviour during current pandemic. The 67% donors felt that adequate Covid-19 preventive measures had been followed by the staff involved in blood collection. Based on the survey results, the inferences are that donors may harbour fear of infection and concerns for their safety, deterring blood donation. The direct appeal from a patient's relative to donate blood or a requirement in their family/friends and social media appeals emerge important factors to motivate donors. Travel facility arrangement may aide blood donation. Most of the donors are more than satisfied with the blood donation experience and are motivated to inform the transfusion services of any appearance of Covid-19 symptoms post donation. The donors were satisfied with the steps to reduce Covid-19 infection., Supplementary Information: The online version contains supplementary material available at 10.1007/s12288-021-01504-y., Competing Interests: Conflict of interestThe authors declare that they have no conflicts of interest relevant to the manuscript submitted to journal., (© Indian Society of Hematology and Blood Transfusion 2021.)

The brain is the most complex organ in the human body, and it is also the most complex organ in the whole biological system, making it the most complex organ on the planet. According to the findings of current studies, modern study that properly characterises the EEG data signal provides a clear classification accuracy of human activities which is distinct from previous research. Various brain wave patterns related to common activities such as sleeping, reading, and watching a movie may be found in the Electroencephalography (EEG) data that has been collected. As a consequence of these activities, we accumulate numerous sorts of emotion signals in our brains, including the Delta, Theta, and Alpha bands. These bands will provide different types of emotion signals in our brain as a result of these activities. As a consequence of the nonstationary nature of EEG recordings, time-frequency-domain techniques, on the other hand, are more likely to provide good findings. The ability to identify different neural rhythm scales using time-frequency representation has also been shown to be a legitimate EEG marker; this ability has also been demonstrated to be a powerful tool for investigating small-scale neural brain oscillations. This paper presents the first time that a frequency analysis of EEG dynamics has been undertaken. An augmenting decomposition consisting of the "Versatile Inspiring Wavelet Transform" and the "Adaptive Wavelet Transform" is used in conjunction with the EEG rhythms that were gathered to provide adequate temporal and spectral resolutions. Children's wearable sensors are being used to collect data from a number of sources, including the Internet. The signal is conveyed over the Internet of Things (IoT). Specifically, the suggested approach is assessed on two EEG datasets, one of which was obtained in a noisy (i.e., nonshielded) environment and the other was recorded in a shielded environment. The results illustrate the resilience of the proposed training strategy. Therefore, our method contributes to the identification of specific brain activity in children who are taking part in the research as a result of their participation. On the basis of several parameters such as filtering response, accuracy, precision, recall, and F-measure, the MATLAB simulation software was used to evaluate the performance of the proposed system., Competing Interests: The authors declare that they have no conflicts of interest to report regarding the present study., (Copyright © 2022 Kapil Kumar Nagwanshi et al.)

Objectives: To determine the variability in therapeutic apheresis (TA) and non-blood donor related apheresis practices, and the extent of expertise and knowledge of blood centre staff., Background: Apheresis activity that was earlier limited to therapeutic plasma exchange (TPE) and donor apheresis at few centres in India has seen remarkable surge involving many centres practising TA and non-blood donor related apheresis. The decentralised transfusion medicine practice in country has resulted in wide variability of knowledge and practice of TA. An online survey was conducted to achieve study objectives., Study Design and Methods: A 22 questionnaire survey was sent to the 215 blood centres through e-mail link focussing on three aspects; basic information of the participating centres, details of TA procedures and education and training levels of the staff., Results: Majority (71.9%) of centres were teaching institutions among analysed 57 centres. TPE (85.9%) and therapeutic cytapheresis (71.9%) were the most common TA procedures. The clinical haematology (68.4%) followed by neurology (64.9%) were the specialities utilising TA. The 64.9% centres used continuous flow cell separator and central venous access (52%) was preferred vascular access. A combination of normal saline, fresh frozen plasma and 5% albumin replacement fluid was first choice. Doctors involved in TA were trained in apheresis during their MD/DNB degree, but no structured training program existed for other category of staff., Conclusion: There was a wide variability in TA practice in India and a dedicated training program for all categories of staff was emphasised by majority of participants., (© 2021 British Blood Transfusion Society.)

The apheresis platelets are the preferred blood components for the thrombocytopenic hemato-oncology patients. The one of the important factors for post transfusion increment is the dose of the platelet product infused. The minimum platelet product yield is defined but the amount of maximum possible platelets collection from a single donor is not universally defined. There is lots of apprehension in our country for apheresis procedures harvesting more than a standard unit. This retrospective observational study was conducted to determine safety of high yield plateletapheresis collection among Indian donors This retrospective observational study was conducted for a period of 15 months including all consecutive plateletapheresis procedures. The informed consent had been obtained from all donors including high yield plateletapheresis (Yield ≥ 5 × 10 11 ). The apheresis product was subjected to platelet count. The donor adverse reactions were recorded along with procedural details. Post procedure complete blood count was done for the donors who consented for post procedure blood sample draw A total 569 procedures were performed during this period including 174 high yield procedure. The 526 procedures were analyzed for adverse donor reactions. The 43 were excluded for adverse donor reaction analysis due to yield less than 3 × 10 11 ( n  = 43). The adverse reactions rate between high yield procedures (18/174, 10.34%) and normal yield (20/352, 5.68%) were not statistically different ( p  = 0.052). The phlebotomy related complication (3.23%) followed by citrate toxicity (2.28%) were the two most common adverse reaction observed. The adverse reactions associated with high yield plateletapheresis procedures are comparable to normal yield procedures in term of overall adverse reactions observed and post procedural platelet counts. This can be beneficial to patients by providing products of greater yield., Competing Interests: Conflict of interestThe authors declare that they have no conflicts of interest relevant to the manuscript submitted to journal., (© Indian Society of Hematology and Blood Transfusion 2020.)

Competing Interests: Compliance with Ethical StandardsNone for all authors.Obtained from parents of index case.

Background: Glucometers are the excellent tools for self-monitoring of blood glucose (SMBG). They are important especially in the circumstances where continuous monitoring is mandatory and at decision making levels. Tight glycemic control protocols are important for preventing the ill effects of fluctuating glucose levels. This increases the use of glucometers in various healthcare settings. As technology advances, glucometers are getting better in terms of quality of results. But still some lacunae are there., Methods: Present study was conducted in the tertiary care referral hospital. One hundred twenty five patients were recruited from pediatric wards. Bland-Altman plot, Parke error grid and Surveillance error grid analysis were used for comparing results of glucose meter with that of standard laboratory method., Results: It is found that there is significant difference between the results by two methods. Though minimal but glucose meter results deviate from the results of standard lab method. This will affect the overall patient care especially in emergency conditions., Conclusions: This study is the first of its kind as no similar studies have been reported in the pediatric population. For effective use of glucose meter it should give as accurate as possible estimate of actual glucose levels. Results should not only be accurate but also precise without which critical errors may be possible. We recommend that for any glucose meter there should be regular maintenance as well as calibration is to be done. So that agreement with reference laboratory method is maintained and effective medical decisions are made.

Background: To evaluate the effects of intraalveolar placement of gel containing 0.2% chlorhexidine and 10gm of metronidazole on the incidence of alveolar osteitis., Material and Methods: A total of 300 impacted third molars were extracted in 150 patients enrolled in this trial. In each subject a socket was randomly selected and packed to the crest of alveolar ridge with the gel. The contralateral socket was packed with placebo dressing. The occurrence of dry socket was assessed during 3rd and 5th postoperative days .The data was analysed using a meta analytical program., Study Design: Double blind, prospective, placebo controlled trial., Results: The combination of metronidazole + chlorhexidine gel significantly reduced dry socket incidence from 22.6% to 6.6% ( P ≤ 0.001) [McNemar and chi-square tests]., Conclusions: The decrease in incidence of adverse reactions and complications related to local application of metronidazole and chlorhexidine gel explains its clinical use, specifically in mandibular molar extractions where the chances of dry sockets are high. Key words: Chlorhexidine, dry socket, intra-alveolar, metronidazole, placebo., Competing Interests: Conflict of interest statement:The authors have declared that no conflict of interest exist.

Temporomandibular Joint (TMJ) ankylosis is a situation in which the mandibular condyle is fused to the glenoid fossa by bone or fibrous tissue. The management of TMJ ankylosis has a complicated chore and it is challenging for the maxillofacial surgeon because of technical hitches and high rate of re-ankylosis. Interpositional gap arthroplasty is one of the modalities for its management. A range of inter-positional materials have been used to avert recurrence after gap arthroplasty in TMJ ankylosis. The aim of this series was to evaluate the effectiveness of the temporomyofacial flap in the treatment of TMJ ankylosis as an interpositional gap arthroplasty. A total of 10 cases with unilateral TMJ ankylosis were treated by interpositional gap arthroplasty by pedicled temporalis myofacial flap and evaluated with a follow-up of 6 months to 5 years (Mean 3.3 years) for the functional stability of TMJ. All the patients were successfully treated. There were no signs of recurrence in any patients up to last follow up visit. The result showed that temporalis myofascial flap is a preferable choice for inter-positional gap arthroplasty which proves its versatility as an inter-positional material.

Background: This study was designed to determine the prevalence and assess the risk factors responsible for platelet transfusion refractoriness in hemato-oncological patients., Materials and Methods: The study included 30 patients. Twelve were clinically diagnosed as aplastic anemia and the 18 were of acute myeloid leukemia. A prospective 3 months follow-up was planned to monitor the response of platelet transfusion therapy, based on their posttransfusion corrected count increment at 1(st) and 24(th) h. Based on the observations, patients were categorized into refractory and nonrefractory groups. Common nonimmunological causes such as fever, sepsis, bleeding, disseminated intravascular coagulation, chemotherapy, splenomegaly, ABO mismatch, and antithymocyte globulin therapy were monitored. Among the immunological causes, presence of antihuman leukocyte antigen (HLA) class I antibodies and platelet glycoprotein antibodies in patient's serum were monitored., Results: During the study period, 17 (56.66%) patients did not show desired platelet count increment. Transfusion requirements of refractory group for both red cell and platelet product were significantly higher (P < 0.05) in comparison to nonrefractory group. Among immunological causes, anti HLA class I antibodies (P < 0.013), antihuman platelet antigen-5b antibodies (P < 0.033) were significantly associated with refractoriness. Among nonimmunological causes, bleeding (P < 0.019, odd ratio 8.7), fever (P < 0.08, odd ratio 5.2), and infection (P < 0.07, odd ratio 5.4) were found to associated with refractoriness., Conclusion: Platelet refractoriness should be suspected in multitransfused patients not showing expected increment in platelet counts and thoroughly investigated to frame further guidelines in order to ensure proper management of these kind of patients.

Background: The development of anti-red blood cell antibodies (both allo-and autoantibodies) remains a major problem in thalassemia major patients. We studied the frequency of red blood cell (RBC) alloimmunization and autoimmunization among thalassemia patients who received regular transfusions at our center and analyzed the factors, which may be responsible for development of these antibodies., Materials and Methods: The study was carried out on 319 multiply transfused patients with β-thalassemia major registered with thalassemia clinic at our institute. Clinical and transfusion records of all the patients were examined for age of patients, age at initiation of transfusion therapy, total number of blood units transfused, transfusion interval, status of splenectomy or other interventions. Alloantibody screening and identification was done using three cell and 11 cell panel (Diapanel, Bio-rad, Switzerland) respectively. To detect autoantibodies, autocontrol was carried out using polyspecific coombs (IgG + C3d) gel cards., Results: Eighteen patients out of total 319 patients (5.64%) developed alloantibodies and 90 (28.2%) developed autoantibodies. Nine out of 18 patients with alloantibodies also had autoantibodies. Age at first transfusion was significantly higher in alloimmunized than non-immunized patients (P = 0.042). Out of 23 alloantibodies, 52.17% belonged to Rh blood group system (Anti-E = 17%, Anti D = 13%, Anti-C = 13%, Anti-C(w) = 9%), 35% belonged to Kell blood group system, 9% of Kidd and 4% of Xg blood group system., Conclusion: Alloimmunization was detected in 5.64% of multitransfused thalassemia patients. Rh and Kell blood group system antibodies accounted for more than 80% of alloantibodies. This study re-emphasizes the need for RBC antigen typing before first transfusion and issue of antigen matched blood (at least for Rh and Kell antigen). Early institution of transfusion therapy after diagnosis is another means of decreasing alloimmunization.

A 32 year old Indian female was referred to our hospital at 32 weeks of gestation because of difficulty in blood group determination and further antenatal care. The results of cell and serum grouping of her blood sample were suggestive of Bombay (O(h)) Rh (D) negative phenotype. An indirect antiglobulin test (IAT) using a pool of red cells from two Bombay Rh (D) positive blood donors gave negative result using the tube as well as the gel technique (LISS-Coombs Card, BioRad, Switzerland), thus ruling out anti-D antibody in her serum. The anti-H titer was 16 (tube technique) and with dithiothreitol (DTT) treated patient's serum the antibody screening was negative suggestive of IgM type of anti-H antibodies. Within the patient's family, only one member (younger sister) was of O(h) phenotype and also was Rh (D) negative. The baby was born vaginally at 38+6 weeks of gestation and was non-hydropic with a packed cell volume (PCV) of 55%. The baby's blood group was AB Rh (D) negative and the cord blood direct antiglobulin test (DAT) was negative. Thus, a careful serological testing of O(h) phenotype antenatal women especially with Rh (D) negative phenotype is of utmost importance in determining the isoimmunization status., (Copyright © 2012 Elsevier Ltd. All rights reserved.)