Effects of Prestorage Leukoreduction on the Rate of Febrile Nonhemolytic Transfusion Reactions to Red Blood Cells in a Tertiary Care Hospital

Background:

Febrile nonhemolytic transfusion reactions (FNHTRs) are relatively common complications associated with allogenic transfusion. White blood cells (WBCs or leukocytes) are considered to be an important cause of FNHTRs; the rate of WBC derived pro-inflammatory cytokines increase with storage due to active synthesis of cytokines by these cells. The removal of the WBCs before storage will prevent the accumulation of cytokines during storage that leads to a reduction in the number of FNHTRs.

Aim:

We have conducted a retrospective analysis comparing the rate of FNHTRs in prestorage leukoreduced (PrSLR) and non leukoreduced RBCs transfusion.

Subjects and Methods:

A retrospective review of all the transfusion reactions (TRs) reported to the department over a period of 2 years from July 2012 to June 2014 was done. Patients were stratified by the date of reaction and by component received and then divided into two groups: (1) Patients who received allogeneic PrSLR RBCs and (2) nonleukoreduced RBCs. For the PrSLR RBC units, leukoreduction was performed by using buffy coat method of component preparation by quadruple bags and integral bags containing Sepacell^® Pure RC filters (Fenwal™ France).

Results:

37,232 RBCs units were transfused and out of which 14149 (38% i.e. is 14149/37232) were prestorage leukoreduced (PrSLR) and 23083 (62%) were non leukoreduced. A total of 142 (0.38%) TRs were reported during that time period, of which 62 (0.17%) were classified as FNHTRs. In the nonleukoreduced group 124 TRs were reported, of which 55 were classified as FNHTRs to RBCs and the overall rate of FNHTR to RBCs was 0.24%. In pre storage leukoreduced group, 18 TRs were reported, of which 7 were classified as FNHTRs to RBCs and the overall rate of FNHTR to RBCs was 0.05% (P ≤ 0.001). This represents a significant reduction in the rate of FNHTR after institution of prestorage leukoreduction.

Conclusion:

The rate of FNHTRs to allogenic RBC units after the implementation of prestorage leukoreduction has decreased significantly. Cytokines and chemokines accumulating during storage of cellular blood products are responsible for residual FNHTRs.

Decentralization and Interventions in the Health Sector

The democratic decentralization process was launched in Kerala with the Peoples Planning Campaign in 1996 followed by the 73rd and 74th Amendments to the Constitution of India and the passing of the Kerala Panchayat Raj Nagara Palika Act. One of the major objectives of the decentralization process in Kerala was to strengthen the public health care network and improve the quality of public health service delivery. This article attempts to analyze the transition in the health care sector during the last two decades linking it to the interventions of Local Self Governments (LSGs). It was found that decentralization improved infrastructure facilities and equipment in primary and secondary health care institutions and widened health care delivery. It succeeded in providing safe drinking water and sanitation facilities to the local people. The accountability of the public health care system was also enhanced. However, it could not address the issues of nutritional imbalance, old age care, lifestyle diseases and the changing morbidity pattern in the state. This article calls for a comprehensive health policy to ensure functional autonomy for LSGs to address the emerging health care needs in Kerala.

Simple, fast and efficient synthesis of β-keto esters from the esters of heteroaryl compounds, its antimicrobial study and cytotoxicity towards various cancer cell lines

A series of β-keto esters were synthesized from heteroaryl esters and ethyl acetate using LiHMDS as base at -50 to -30 °C. The increase in yields of cross condensed product were observed and the percentage of self condensed product was reduced drastically by applying the suitable base (LiHMDS), solvent and the minimum amount of ethyl acetate. All these β-keto esters were characterized using (1)H NMR, (13)C NMR and mass spectral data. A plausible mechanism is also depicted to prove the formation of trans-esterified products. All the synthesized compounds were subjected to test for their cytotoxicity towards various cancer cell lines and also tested for their antimicrobial activity towards various bacterial and fungal strains and some of them were found to have promising activity.

Ultrasound-promoted synthesis of novel bipodal and tripodalpiperidin-4-ones and silica chloride mediated conversion to its piperidin-4-ols: synthesis and structural confinements

The ultrasound-promoted synthesis of novel bipodal and tripodalpiperidin-4-ones was carried out by the reaction of 4-piperidone hydrochloride monohydrate with different alkylating and acylating agents. It was preferably reduced to respective piperidin-4-ols by ultrasonic irradiation using silica chloride, which maintains higher yields by acting as an effective supporting polymer. The sterically hindered phthaloyl derivative of piperidin-4-one was synthesized by ultrasonic irradiation which was difficult by conventional methods.

9-(4-Hy-droxy-phen-yl)-3,3,6,6-tetra-methyl-4,5,6,9-tetra-hydro-3H-xanthene-1,8(2H,7H)-dione

In the title compound, C(23)H(26)O(4), the two cyclo-hexene rings adopt envelope conformations whereas the pyran ring adopts a boat conformation. In the crystal, pairs of inter-molecular O-H⋯O hydrogen bonds link the mol-ecules into inversion dimers.

Enhanced optical and nonlinear optical responses in a polyelectrolyte templated Langmuir-Blodgett film

Optical and nonlinear optical properties like fluorescence and second harmonic generation (SHG) of molecular materials can be strongly influenced by the mode of assembly of the molecules. The Langmuir-Blodgett (LB) technique is an elegant route to the controlled assembly of molecules in ultrathin films, and complexation of ionic amphiphiles in the Langmuir film by polyions introduced in the aqueous subphase provides a simple and efficient access to further control, stabilization, and optimization. The monolayer LB film of the hemicyanine-based amphiphile, N-n-octadecyl-4-[2-(4-(N,N-ethyloctadecylamino)phenyl)ethenyl]pyridinium possessing a "tail-head-tail" structure, shows fluorescence as well as SHG response. The concomitant enhancement of both of these linear and nonlinear optical attributes is achieved through templating with the polyanion of carboxymethylcellulose. Brewster angle and atomic force microscopy reveal the influence of polyelectrolyte templating on the morphology of the Langmuir and LB films. Polarized absorption and fluorescence spectroscopy provide insight into the impact of complexation with the polyelectrolyte on the orientation and deaggregation of the hemicyanine headgroup leading to fluorescence and SHG enhancement in the LB film.

Synthesis, characterization and bioactive evaluation of copper(II) 5,10,15,20-tetrakis[alpha,alpha,alpha,alpha-2-(2,6-bis(4-methylpiperazine-1-yl-methyl)-4-iminomethyl phenol)phenyl] porphyrin: a picket-fence porphyrin

We are interested in constructing deeper small cavities by adding more bulky substituents at the ortho-phenyl positions of tetrakis(o-aminophenyl)porphyrin. The synthesis of picket-fence porphyrin is initiated by the preparation of the tetrakis(o-nitrophenyl)porphyrin followed by the nitro to amino reduction and subsequent condensation with Schiff base ligand to form imine linkages of porphyrin complexes. The synthesis and characterization of a new series of picket-fence porphyrins and their copper complexes are described. 5,10,15,20-Tetrakis[alpha,alpha,alpha,alpha-2-(2,6-bis(4-methyl piperazine-1-yl-methyl)-4-iminomethyl phenol)phenyl] porphyrin can be synthesized from 2,6-bis[4-methylpiperazin-1-yl-methyl]-4-formylphenol (L) and 5,10,15,20-tetra[alpha,alpha,alpha,alpha-o-nitropheny1]-porphyrin. 5,10,15,20-Tetra[alpha,alpha,alpha,alpha-o-aminopheny1]-porphyrin was obtained by the reduction of 5,10,15,20-tetra[alpha,alpha,alpha,alpha-o-nitropheny1]-porphyrin. The spectral, electrochemical, antibacterial, antifungal and cytotoxicity properties of all the picket-fence porphyrin complexes were characterized and studied.