A randomized study of very low-dose factor VIII prophylaxis in severe haemophilia - A success story from a resource limited country

INTRODUCTION

Current factor prophylaxis strategy practised in developed countries is not feasible in resource constraint developing countries like India.

AIM

The aim of this study was to investigate the efficacy and safety of very low-dose factor prophylaxis in India.

METHODS

Children of 1-10 years of age with severe haemophilia were randomized to Prophylaxis group and Episodic (On demand) group. Children in prophylaxis group received very low-dose factor VIII (FVIII) concentrate, i.e. 10 units kg(-1) body weights on 2 days a week. Episodic group received factor concentrate in standard recommended doses. The study period was 11.5 months.

RESULTS

In total 21 children were enrolled in this study, 11 assigned to prophylaxis and 10 to episodic group. Children on prophylaxis had 11 joint bleeds in comparison to 57 joint bleeds in episodic group. Mean number of haemarthrosis per patient per month were 0.08 (0.08 ± 0.13) in prophylaxis group compared to 0.48 (0.48 ± 0.34) in episodic group (P < 0.05). Total FVIII consumption was 87.51 and 56.32 units kg(-1) month(-1) in prophylaxis and episodic group respectively (P = ns). Overall median hospital emergency visits were 1 day in prophylaxis group and 9 days in episodic group (P ≤ 0.05). Median days of absenteeism from school were 25 days in episodic group and 3 days in prophylaxis group (P < 0.05). No significant complications were noted in prophylaxis group and compliance was 98%.

CONCLUSION

To conclude, low-dose FVIII prophylaxis is cost effective, efficacious and a safe method of preventing joint bleeds and consequent joint damages.

Graphene decorated with Fe nanoclusters for improving the hydrogen sorption kinetics of MgH2 – experimental and theoretical evidence

Graphene decorated with Fe clusters is proposed to be a possible alternative catalyst for the hydrogenation and dehydrogenation reactions of MgH₂.

Healthcare waste management research: A structured analysis and review (2005-2014)

The importance of healthcare waste management in preserving the environment and protecting the public cannot be denied. Past research has dealt with various issues in healthcare waste management and disposal, which spreads over various journals, pipeline research disciplines and research communities. Hence, this article analyses this scattered knowledge in a systematic manner, considering the period between January 2005 and July 2014. The purpose of this study is to: (i) identify the trends in healthcare waste management literature regarding journals published; (ii) main topics of research in healthcare waste management; (iii) methodologies used in healthcare waste management research; (iv) areas most frequently researched by researchers; and (v) determine the scope of future research in healthcare waste management. To this end, the authors conducted a systematic review of 176 articles on healthcare waste management taken from the following eight esteemed journals: International Journal of Environmental Health Research, International Journal of Healthcare Quality Assurance, Journal of Environmental Management, Journal of Hazardous Material, Journal of Material Cycles and Waste Management, Resources, Conservations and Recycling, Waste Management, and Waste Management & Research. The authors have applied both quantitative and qualitative approaches for analysis, and results will be useful in the following ways: (i) results will show importance of healthcare waste management in healthcare operations; (ii) findings will give a comparative view of the various publications; (c) study will shed light on future research areas.

Analyzing drivers and barriers of coordination in humanitarian supply chain management under fuzzy environment

Purpose

– The purpose of this paper is to explore the barriers to coordination in humanitarian supply chain management (HSCM), proposes solutions and prioritizes them to overcome the barriers particularly in the Indian context.

Design/methodology/approach

– This study adopts a comprehensive and rigorous procedure to explore the barriers and solutions to coordination in HSCM. The research design is divided into three phases; first, the barriers and solutions are collected through an extensive literature review; second, barriers and solutions were verified with experts involved in relief operations of the disaster that occurred in Uttarakhand (a Northern state in India) on June 14, 2013 and finally, based on the weight of barriers estimated by fuzzy analytic hierarchy process, solutions to overcome the barriers are prioritized using fuzzy technique for order performance by similarity to ideal solution that considers uncertainty and impreciseness rather than a crisp value.

Findings

– This study explored 23 barriers to coordination in HSCM and grouped into five categories i.e., strategic barriers, individual barriers, organizational barriers, technological barriers and cultural barriers, and finally 15 solutions were proposed and prioritized to overcome the barriers so decision makers can focus on overcoming these barriers and realize the benefits of coordination in HSCM.

Practical implications

– This study provides a more efficient, effective, robust and systematic way to overcome barriers to coordination and improve the competencies of humanitarian supply chain (HSC).

Originality/value

– This is the first kind of study that prioritizes the solutions to enhance coordination in HSC based on the weight of the barriers.

An empirical investigation of the enablers in humanitarian supply chain management in India

Purpose

– The purpose of this paper is to empirically analyze the perception of stakeholders, i.e. disaster victims, volunteers and managers, who were involved in relief activities, toward the enablers in humanitarian supply chain management (HSCM) with special emphasis on heart wrenching and deadliest disaster, that occurred in the Uttarakhand (a northern state in India) on June 14, 2013.

Design/methodology/approach

– A detailed case study of the recently disaster, that occurred in the Uttarakhand has been carried out to investigate the enablers associated with the HSCM and the data were collected from published literature and newspaper articles, semi-structured interviews with academic experts and practitioners, hypothesis were formulated and tested using analysis of variance.

Findings

– The findings of the study indicate that, there is no significant difference in the perception of disaster victims, volunteers and managers toward the enablers in HSCM in India. There is a strong need for more effective and efficient monitoring of over-exploitation of the mountainous regions, Geographic Information Systems mapping of the state and a separate disaster communication network.

Research limitations/implications

– The scope of study is limited to flash floods that occurred in the Uttarakhand. Extending the research on other types of disaster could be considered as the scope for further research.

Practical implications

– The paper investigates some of the enablers of HSCM and discusses some of the emerging issues and lessons learned from the disaster that occurred in the Uttarakhand, in managing future disasters in India and the other world.

Originality/value

– This paper presents the first attempt in India with its combination of field-based qualitative research and survey analysis to investigate the enablers of HSCM in India.

Rutin potentially attenuates fluoride-induced oxidative stress-mediated cardiotoxicity, blood toxicity and dyslipidemia in rats

This study was undertaken to evaluate cardio protective effect of rutin against sodium fluoride (NaF)-induced oxidative stress-mediated cardiotoxicity and blood toxicity. Cardiac injury was induced by daily administration of NaF 600 ppm in distilled water for four weeks. The animals exposed to NaF exhibited a significant increase in levels of cardiac serum markers, lipid peroxidative markers, serum total cholesterol, LDL, triglycerides and decrease in HDL levels. Decrease in hematological parameters, namely hemoglobin, red blood cells, mean corpuscular volume, mean corpuscular hemoglobin (MCH), MCH count and increase in white blood cells and erythrocyte sedimentation levels were also observed. Marked histopathological lesions and increased DNA fragmentation in cardiac tissues were observed. Activity of antioxidants-catalase, superoxide dismutase and reduced glutathione contents were decreased (p < 0.01), whereas lipid peroxidation product (malondialdehyde) was increased. A significant decrease in body and heart weight was also observed. Treatment with rutin effectively ameliorated the alterations in the studied parameters of rat through its antioxidant nature. There was also significant improvement in hematological parameters. Thus, results of this study clearly demonstrated that treatment with rutin against NaF intoxication has a significant role in protecting F-induced cardiotoxicity, blood toxicity and dyslipidemia in rats.

Sporadic bilateral synchronous multicentric papillary renal cell carcinoma masquerading as bilateral multifocal pyelonephritis

Pyelonephritis is defined as an inflammation of the kidney and renal pelvis. The diagnosis is usually clinical. Acute multifocal bacterial nephritis is a rare form of pyelonephritis that is more severe and sepsis is more common. We report a patient who presented with fever and right-sided abdominal pain associated with right flank tenderness, suggesting right acute pyelonephritis. Bilateral multifocal pyelonephritis was diagnosed on ultrasonography, radionuclide renal scintigraphy and computed tomography. However, owing to non-resolution of symptoms, a biopsy was performed, which showed bilateral papillary renal cell carcinoma (PRCC). PRCC is known to exhibit multicentricity. To our knowledge, a case of bilateral multicentric PRCC masquerading as bilateral multifocal pyelonephritis has not been reported in the English literature. This case highlights the need to be vigilant while treating patients with focal lesions of the kidney as an inflammatory condition lest a malignancy should be missed.

Late onset epidermal nevus with hypertrichosis and facial hemihypertrophy

Epidermal nevus syndromes are rare conditions, characterized by different types of keratinocytic or organoid epidermal nevi in association with ocular, neurological, and skeletal manifestations. We present a case of late onset epidermal nevus with hypertrichosis and hemihypertrophy of face. Genetic analysis did not reveal presence of FGFR3 or PIK3CA mutations. The patient has features that cannot be categorized into the present well-known syndromes.

Sustaining a "culture of silence" in the neonatal intensive care unit during nonemergency situations: a grounded theory on ensuring adherence to behavioral modification to reduce noise levels

The aim of this study was to generate a substantive theory explaining how the staff in a resource-limited neonatal intensive care unit (NICU) of a developing nation manage to ensure adherence to behavioral modification components of a noise reduction protocol (NsRP) during nonemergency situations. The study was conducted after implementation of an NsRP in a level III NICU of south India. The normal routine of the NICU is highly dynamic because of various categories of staff conducting clinical rounds followed by care-giving activities. This is unpredictably interspersed with very noisy emergency management of neonates who suddenly fall sick. In-depth interviews were conducted with 36 staff members of the NICU (20 staff nurses, six nursing aides, and 10 physicians). Group discussions were conducted with 20 staff nurses and six nursing aides. Data analysis was done in line with the reformulated grounded theory approach, which was based on inductive examination of textual information. The results of the analysis showed that the main concern was to ensure adherence to behavioral modification components of the NsRP. This was addressed by using strategies to “sustain a culture of silence in NICU during nonemergency situations” (core category). The main strategies employed were building awareness momentum, causing awareness percolation, developing a sense of ownership, expansion of caring practices, evolution of adherence, and displaying performance indicators. The “culture of silence” reconditions the existing staff and conditions new staff members joining the NICU. During emergency situations, a “noisy culture” prevailed because of pragmatic neglect of behavioral modification when life support overrode all other concerns. In addition to this, the process of operant conditioning should be formally conducted once every 18 months. The results of this study may be adapted to create similar strategies and establish context specific NsRPs in NICUs with resource constraints.

The Effect of Fiber Length on Tensile Properties of Polyester Resin Composites Reinforced by the Fibers of <i>Sansevieria trifasciata</i>

This paper presents the study of the tensile properties of Sansevieria trifasciata – fiber (here after called STF) reinforced polyester composites. The composite sample was fabricated with five different fiber lengths of STF (2, 4, 6, 8 and 10 mm). The fabrication was made by hand lay-up technique. Mechanical properties were determined using tensile testing. An interact between fiber and matrix was observed from the SEM (scanning electron microscope) micrographs. The study reveals that the tensile strength increased with fiber length without effecting the elongation at break of the composite.

The Effect of Fiber Length on Tensile Properties of Polyester Resin Composites Reinforced by the Fibers of Sansevieria trifasciata

This paper presents the study of the tensile properties of Sansevieria trifasciata – fiber (here after called STF) reinforced polyester composites. The composite sample was fabricated with five different fiber lengths of STF (2, 4, 6, 8 and 10 mm). The fabrication was made by hand lay-up technique. Mechanical properties were determined using tensile testing. An interact between fiber and matrix was observed from the SEM (scanning electron microscope) micrographs. The study reveals that the tensile strength increased with fiber length without effecting the elongation at break of the composite.

Dental pulp stem cells immobilized in alginate microspheres for applications in bone tissue engineering

AIM

To immobilize dental pulp stem cells (DPSC) in alginate microspheres and to determine cell viability, proliferation, stem cell characteristics and osteogenic potential of the immobilized DPSCs.

METHODOLOGY

Human DPSCs isolated from the dental pulp were immobilized in 1% w/v alginate microspheres. Viability and proliferation of immobilized DPSCs were determined by trypan blue and MTT assay, respectively. Stem cell characteristics of DPSCs post immobilization were verified by labelling the cells with CD73 and CD90. Osteogenic potential of immobilized DPSCs was assessed by the presence of osteocalcin. Alizarin red staining and O-cresolphthalein complexone method confirmed and quantified calcium deposition. A final reverse transcriptase PCR evaluated the expression of osteogenic markers - ALP, Runx-2 and OCN.

RESULTS

More than 80% of immobilized DPSCs were viable throughout the 3-week study. Proliferation appeared controlled and consistent unlike DPSCs in the control group. Presence of CD73 and CD90 markers confirmed the stem cell nature of immobilized DPSCs. The presence of osteocalcin, an osteoblastic marker, was confirmed in the microspheres on day 21. Mineralization assays showed high calcium deposition indicating elevated osteogenic potential of immobilized DPSCs. Osteogenic genes- ALP, Runx-2 and OCN were also upregulated in immobilized DPSCs. Surprisingly, immobilized DPSCs in the control group cultured in conventional stem cell media showed upregulation of osteogenic genes and expressed osteocalcin.

CONCLUSION

Dental pulp stem cells immobilized in alginate hydrogels exhibit enhanced osteogenic potential while maintaining high cell viability both of which are fundamental for bone tissue regeneration.

Metabolism of the environmental toxicant benzo(a)pyrene by subcellular fractions of human ovary

Knowledge of the ability of the female reproductive system to metabolize environmental chemicals is critical not only from the standpoint of toxicity but also from infertility risk assessment. Benzo(a)pyrene (BaP) is a toxicant that is released into the environment from automobile exhausts, cigarette smoke, burning of refuse, industrial emissions, and hazardous waste sites. In exposed animals, BaP becomes activated to reactive metabolites that interfere with target organ function and as a consequence cause toxicity. Studies on animal models conducted in our laboratories and those of others have shown that BaP possess endocrine disrupting properties. Thus, this chemical has the potential to cause infertility and cancers in the female genital tract. An understanding of BaP metabolism in the female reproductive system will be of importance in the diagnosis and management of female fertility as well as cancers in the reproductive tissues. Therefore, the objective of our study was to examine the metabolism of BaP by human ovarian subcellular fractions. Human ovary samples (eight individuals) were obtained from postoperative tissue removed from subjects with uterine tumors. Subcellular fractions (nuclear, cytosolic, mitochondrial, and microsomal) were prepared by differential centrifugation. BaP (1 μM and 3 μM) was individually incubated with individual subcellular fractions for 15 min and the products were analyzed by high-performance liquid chromatography. Among the different fractions tested, microsomal BaP metabolism was higher than the rest of the fractions. The BaP metabolites identified were as follows: BaP-9,10-diol, BaP-4,5-diol, BaP-7,8-diol, 9(OH) BaP, 3(OH) BaP, BaP-1,6-dione, BaP-3,6-dione, and BaP-6,12-dione. Of interest was the presence of DNA-reactive metabolites such as BaP-3,6-dione, BaP-6,12-dione, and BaP 7,8-diol, which have been implicated in the causation of infertility and cancer. Our results indicate that women who are exposed to BaP via cigarette smoke, occupational settings, and diet are more likely at a larger risk of this toxicant-induced infertility and cancer than others.