RhD negative women transfused RhD positive blood: Alloimmunization prophylaxis protocol and experiences

Introduction/Objective

Preventing allomiunization from D-mismatched transfusions, i.e., transfusion RhD positive (RhD+) red blood cells (RBC) to an RhD negative (RhD–) individual, is not well established. We describe our hospital protocol and experiences managing RhD– young women who received emergency release D-mismatched transfusions.

Methods/Case Report

The pathologists evaluate all patients who received D-mismatched blood transfusions. The inclusion criteria for alloimmunization prophylaxis protocol include: RhD– females; <50 years old; No current or historical Anti-D; and received ≥1 unit of RhD+ blood.

The prophylaxis protocol depends on the RBC volume (RBCV) transfused. Patients who receive RBCV <20% of their total blood volume (TBV) are eligible to receive high dose RhIg, calculated based on the volume transfused. Those who received RBCV ≥20% of TBV would be eligible for red cell exchange (RBCX) followed by RhIg.

Results (if a Case Study enter NA)

Since 2016, four eligible patients received RhIg prophylaxis protocol and none met the criteria for RBCX. All the patients started the prophylaxis protocol within 24 hours of transfusion and completed it within 72 hours. One patient developed post treatment hemolysis and significant drop in hemoglobin requiring blood transfusion. Passive anti-D post treatment was confirmed in three patients, and one had passive anti C. Three of the four patients had follow up antibody screens >6 months post treatment that were negative for RhD alloimmunization.

Conclusion

Our therapeutic plan, the first well established protocol, involves identifying eligible patients based on set criteria and protocols. Our experience demonstrates that this protocol is effective in reducing/preventing RhD alloimmunization.

Multimodal prediction of trait emotional intelligence-Through affective changes measured using non-contact based physiological measures

Inability to efficiently deal with emotionally laden situations, often leads to poor interpersonal interactions. This adversely affects the individual's psychological functioning. A higher trait emotional intelligence (EI) is not only associated with psychological wellbeing, educational attainment, and job-related success, but also with willingness to seek professional and non-professional help for personal-emotional problems, depression and suicidal ideation. Thus, it is important to identify low (EI) individuals who are more prone to mental health problems than their high EI counterparts, and give them the appropriate EI training, which will aid in preventing the onset of various mood related disorders. Since people may be unaware of their level of EI/emotional skills or may tend to fake responses in self-report questionnaires in high stake situations, a system that assesses EI using physiological measures can prove affective. We present a multimodal method for detecting the level of trait Emotional intelligence using non-contact based autonomic sensors. To our knowledge, this is the first work to predict emotional intelligence level from physiological/autonomic (cardiac and respiratory) response patterns to emotions. Trait EI of 50 users was measured using Schutte Self Report Emotional Intelligence Test (SSEIT) along with their cardiovascular and respiratory data, which was recorded using FMCW radar sensor both at baseline and while viewing affective movie clips. We first examine relationships between users' Trait EI scores and autonomic response and reactivity to the clips. Our analysis suggests a significant relationship between EI and autonomic response and reactivity. We finally attempt binary EI level detection using linear SVM. We also attempt to classify each sub factor of EI, namely-perception of emotion, managing own emotions, managing other's emotions, and utilization of emotions. The proposed method achieves an EI classification accuracy of 84%, while accuracies ranging from 58 to 76% is achieved for recognition of the sub factors. This is the first step towards identifying EI of an individual purely through physiological responses. Limitation and future directions are discussed.

Advances in pemphigus therapy

The pemphigus variants represent a group of potentially life-threatening autoimmune mucocutaneous blistering diseases. Though systemic corticosteroids have dramatically reduced the rate of disease mortality, current therapeutic options are limited by their toxicity profiles. Advancements in our understanding of the molecular mechanisms involved in the pathogenesis of pemphigus have translated into the development of novel therapies. However, few treatments have been subject to randomized controlled trials to firmly establish therapeutic efficacy. Herein, we focus on the new and emerging therapies in the management of pemphigus.

Rituximab: a B-cell depletion therapy for dermatologic disease

Rituximab (Rituxan, Genentech/ Biogen Idec) is a genetically engineered chimeric murine/human monoclonal antibody directed against CD20, a B lymphocyte-specific antigen. Initially approved for the treatment of relapsed or refractory low-grade or follicular non-Hodgkin's lymphoma (NHL), rituximab has been increasingly used to treat a variety of immune-mediated and autoimmune diseases. While anecdotal case reports recommend its "off-label" use in dermatology, randomized clinical trials are required to firmly establish the safety and efficacy of this emerging biologic therapy.

Bioactivities of the leaf essential oil of Curcuma longa (var. ch-66) on three species of stored-product beetles (Coleoptera)

Essential oil extracted from the leaves of turmeric, Curcuma longa L., was investigated for contact and fumigant toxicity and its effect on progeny production in three stored-product beetles, Rhyzopertha dominica F. (lesser grain borer), Sitophilus oryzae L. (rice weevil), and Tribolium castaneum Herbst (red flour beetle). Oviposition-deterrent and ovicidal actions of C. longa leaf oil were also evaluated against T. castaneum. The oil was insecticidal in both contact and fumigant toxicity assays. The adults of R. dominica were highly susceptible to contact action of C. longa leaf oil, with LD50 value of 36.71 microg/mg weight of insect, whereas in the fumigant assay, adults of S. oryzae were highly susceptible with LC50 value of 11.36 mg/liter air. Further, in T. castaneum, the C. longa oil reduced oviposition and egg hatching by 72 and 80%, respectively at the concentration of 5.2 mg/cm2. At the concentration of 40.5 mg/g food, the oil totally suppressed progeny production of all the three test insects. Nutritional indices indicate >81% antifeedant action of the oil against R. dominica, S. oryzae and T castaneum at the highest concentration tested.

Toxicity, feeding deterrence, and effect of activity of 1,8-cineole from Artemisia annua on progeny production of Tribolium castanaeum (Coleoptera: Tenebrionidae)

1,8-Cineole isolated from Artemisia annua was tested against Tribolium castaneum (Herbst) for contact toxicity, fumigant toxicity, and antifeedant activity. The adults of T. castaneum were more susceptible than larvae to both contact and fumigant toxicity of 1,8-cineole, and LD50 and LC50 values of 108.4 microg/mg body weight of adult insect and 1.52 mg/liter air were found, respectively. Furthermore, 14-d-old T. castaneum larvae were more tolerant than 16- and 18-d-old larvae and adults to the contact toxicity of 1,8-cineole, but the 16- and 18-d-old larvae have similar susceptibility. In contrast, all the larvae (14-18 d old) of T. castaneum were much more tolerant than the adults to the fumigant action, but larvae of different ages had similar susceptibility. The compound 1,8-ciineole applied to filter paper at a concentration of 3.22-16.10 mg/cm2 significantly (P < 0.05) reduced the hatching of T. castaneum eggs and the subsequent survival rate of the larvae. Adult emergence was also reduced by 1,8-cineole. Feeding deterrence of 81.9% was achieved in T. castateum adults by using a concentration of 121.9 mg/g food, whereas larvae showed 68.8% at the same concentration.

Sesamin a potent antifeedant principle from Piper mullesua

Sesamin, a major lignan of Piper mullesua of Manipur origin, exhibited significant antifeedant activity and moderate growth inhibition towards 4th instar larvae of Spilarctia obliqua. No larval toxicity of sesamin could be established in topical bioassay experiments. Its effective dose for 50% feeding deterrence (ED(50)) and growth inhibition (GI(50)) were found to be 3856 and 6212 ppm, respectively.

Repellency and toxicity of oil from Artemisia annua to certain stored-product beetles

The essential oil of Artemisia annua L. was tested for its toxic repellent and development inhibitory activities against 2 economically important stored product insects: Tribolium castaneum (Herbst) and Callosobruchus maculatus (L.). Adult beetles of T. castaneum were repelled significantly by oil of A. annua at 1% concentration (vol:vol) and above in filter paper arena test. Dose-response relationship of A. annua oil revealed a significant negative correlation between larval survival; pupal survival and adult emergence of T. castaneum (i.e., increase in dose caused decrease in survival and adult emergence). Effective concentration (EC50) to reduce F1 progeny by 50% was calculated to be 2.6 and 4.1 microl/ml solvent against both the insect species, C. maculatus and T. castaneum, respectively. The relationship between bioactivity of oil from A. annua and responses of T. castaneum and C. maculatus is discussed. We found that oil from A. annua was largely responsible for both repellent (behavioral) and toxic (physiological) actions on 2 species of insect tested.

Characterization of an ursane triterpenoid from centella asiatica with growth inhibitory activity against spilarctia obliqua

A new triterpenoid glycoside 3-O-[a-L-arabinopyranosyl] 2 a, 3 ß , 6 ß , 23-a tetrahydroxyurs-12-ene-28-oic acid ( 1 ) accompanied by 6ß-hydroxyasiatic acid and asiatic acid were isolated from Centella asiatica . The structure of 1 was established by physicochemical data. Compound 1 exhibited dose-dependent growth inhibitory activity against larvae of Spilarctia obliqua but was not as active as azadirachtin.