Indian Society of Hematology and Blood Transfusion (ISHBT) Consensus Document on Hematological Practice During COVID-19 Pandemic

The SARS-CoV-2 (COVID-19) pandemic is a worldwide public health emergency with widespread impact on health care delivery. Unforeseen challenges have been noted during administration of usual haematology care in these unusual COVID-19 times. Medical services have been overstretched and frontline health workers have borne the brunt of COVID-19 pandemic. Movement restrictions during lockdown prevented large sections of population from accessing health care, blood banks from holding blood drives, and disrupted delivery of diagnostic hematology services. The disruption in hematology care due to COVID-19 pandemic in India has been disproportionately higher compared to other subspecialities as hematology practice in India remains restricted to major cities. In this review we chronicle the challenges encountered in caring for hematology patients during the COVID-19 pandemic in India and put forth recommendations for minimizing their impact on provision of hematology care with special emphasis on hematology practice in lower and middle income countries (LMICs).     

Isolated tubercular liver abscess in children treated with percutaneous isoniazid infusion

Isolated Tubercular liver abscess is mainly reported in adult patients. We report two cases of isolated tubercular liver abscess in paediatric patients. Diagnosis was made by clinical and ultrasound guided aspiration of pus showing acid fast bacilli in one case. In second case, biopsy of the abscess wall was confirmatory. In both cases percutaneous drainage of pus and transcatheter infusion of Isoniazid was given. After two weeks of infusion no acid fast bacilli was detected and cavity size decreased. Direct infusion of anti-tubercular drugs is more efficient than systemic therapy alone. This is first of its kind in treating isolated tubercular abscess in paediatric patients. So, percutaneous infusion of anti-tubercular agents can be considered in the treatment of tubercular liver abscess.     

Echocardiographic predictors of atrial fibrillation after mitral valve replacement

Objectives

Detection of the echocardiographic predictors of post-operative atrial fibrillation in patients with rheumatic mitral valve disease undergoing mitral valve replacement.

Changes in brain size with treatment in patients with hyper- or hypothyroidism

BACKGROUND AND PURPOSE: Although neuropsychological symptoms and signs are common in thyroid disease, their organic substrate is unknown. We performed brain MR imaging in patients with hyperthyroidism or hypothyroidism before and after treatment and correlated the results with hormonal markers. METHODS. Eight patients with hyperthyroid disease and three with hypothyroid disease underwent imaging within 1-2 days of a thyroid hormone testing. Images were registered, and brain and ventricular sizes were measured by using a semiautomated contour and thresholding technique. Changes in brain and ventricular volume were correlated with serum levels of total thyroxine (T(4)), unbound triiodothyronine (free T(3)), and thyroid-stimulating hormone (TSH) before and after treatment. RESULTS. With treatment, brain size decreased by 6,329-31,183 mm(3) in the hyperthyroid group and increased by 2,599-48,825 mm(3) in the hypothyroid group. Conversely, with treatment, ventricular size increased by 325-6,279 mm(3) in the hyperthyroid group and decreased by 760-2,376 mm(3) in the hypothyroid group. There was a highly significant correlation between reduction in brain size and reduction in T(4), as well as between the increase in ventricular size and reduction in T(4). There was a significant correlation between reduction in ventricular size and reduction in free T(3). There were highly significant correlations between reduced levels of TSH and increase in brain size, as well as between increased levels of TSH and increase in ventricular size. CONCLUSION. In thyroid disease, the size of the brain and ventricles significantly change after treatment, and these changes are correlated with T(4), free T(3), and TSH levels. The mechanism of these changes is uncertain, but it may involve osmolyte regulation, the sodium and water balance, and alterations in cerebral hemodynamics.     

Magnetic resonance imaging of the liver with ultrashort TE (UTE) pulse sequences

PURPOSE: To assess the feasibility of imaging the liver in volunteers and patients with ultrashort echo time (UTE) pulse sequences. MATERIALS AND METHODS: Seven normal controls as well as 12 patients with biopsy-proven generalized liver disease and three patients with focal disease were examined using pulse sequences with initial TEs of 0.08 msec followed by three later echoes, with or without frequency-based fat suppression. T(2)* values were calculated from regions of interest in the liver. RESULTS: Good image quality was obtained in each subject. There was a highly significant difference in the mean T(2)* values between the normal controls and patients with generalized liver disease (P = 0.001). T(2)* was significantly decreased in hemochromatosis (P = 0.002) and increased in cirrhosis (P = 0.04), compared with controls. T(2)* also correlated with functional status assessed by Child's grade (P = 0.001). A hepatocellular carcinoma showed reduced short T(2) components in the region of thermal ablation and evidence of a subcapsular hematoma which were not apparent with conventional imaging. CONCLUSIONS: Imaging of the liver with UTE sequences showed good image quality and tolerance of abdominal motion. T(2)* was specifically correlated with the presence of hemochromatosis, cirrhosis, and functional grade. Imaging of short T(2) relaxation components may provide useful information in disease.     

Centbucridine, a newer topical anaesthetic compared with lignocaine: a randomized double masked single drop instillation clinical trial.

A randomized double-masked single drop instillation clinical trial was conducted on 60 healthy volunteers divided into 3 equal groups to compare the efficacies of centbucridine and lignocaine. One eye of each volunteer was instilled with a single drop of either 0.5% centbucridine hydrochloride, 1% centbucridine hydrochloride or 4% lignocaine hydrochloride, with the other eye as an unanaesthetized control-side effects, if any, were also recorded. The onset of anaesthesia assessed both objectively and subjectively, was quickest with lignocaine 4% (P < 0.001) followed by centbucridine 0.5% and 1%. However, the period of peak activity as well as the total duration of surface anaesthesia, and also the depth of analgesia, were significantly highest with 1% centbucridine, followed by 0.5% centbucridine and 4% lignocaine respectively. Minor side effects like burning sensations were longest with 1% centbucridine--no significant adverse effects, local or systemic, were observed. Prolonged surface anaesthetic and analgesic actions of centbucridine 1% may be advantages for longer duration ophthalmic microsurgeries.     

The efficacy and tolerability of sildenafil in patients with moderate-to-severe pulmonary hypertension

BACKGROUND: Pulmonary arterial hypertension is a life-threatening disease for which continuous intravenous infusion of prostacyclin has proved effective. However, it carries the risk of serious complications arising from the complex delivery system. Prostacyclin analogs, endothelin antagonists, and the phosphodiesterase-5 inhibitor sildenafil are emerging promising therapies. This study was aimed at evaluating the utility of oral sildenafil in patients with pulmonary hypertension of varied etiology, poorly controlled on conventional treatment. METHODS AND RESULTS: Ten consecutive patients with pulmonary hypertension, either primary or related to previous left-to-right shunts, thromboembolism, or interstitial lung disease, poorly controlled on conventional therapy such as warfarin, calcium antagonists, digitalis, and diuretics, were included. A thorough clinical, laboratory, and comprehensive echo Doppler evaluation was performed before enrollment in the trial to establish the diagnosis and obtain baseline data. Subjects received sildenafil 25 mg 8 hourly, or a matching placebo for two weeks each, in a randomized, double-blind, crossover design. A run-in period of two weeks was permitted between the two therapies during which patients continued to receive the conventional therapy without any vasodilator. At the end of each therapy period, the patients were evaluated for symptoms, New York Heart Association class, distance covered during the 6 min walk test, rating of modified Borg dyspnea score, and systolic pulmonary artery pressure using echo Doppler. The differences in the above variables at the end of sildenafil and placebo therapies were compared. Nine patients completed the study protocol. Sildenafil, compared to placebo, was associated with improved exercise tolerance as determined by the 6 min walk test (266.67+/-131.45 m v. 170+/-105 m; p<0.005), decrease in modified Borg dyspnea score (3.56+/-1.01 v. 5.11+/-1.45; p<0.01), decrease in Doppler-estimated pulmonary artery systolic pressures (55.33+/-16.52 mmHg v. 75.33+/-19.75 mmHg; p<0.005), improvement in New York Heart Association class (2 patients), and improvement in symptoms. Sildenafil was well tolerated with no untoward effects; further, no significant changes in heart rate or blood pressure occurred during the study period. CONCLUSIONS: Sildenafil improves exercise capacity and symptoms, and decreases pulmonary artery pressures in patients with primary or secondary pulmonary hypertension of varied etiology.     

Multivariate Analysis of Selected Metals in Agricultural Soil Receiving UASB Treated Tannery Effluent at Jajmau,Kanpur (India)

Tannery effluent and soils samples were collected from 12 different sites of an agricultural area receiving treated tannery wastewater near Kanpur city (India). The samples were analyzed for heavy metals (Fe, Cr, Zn, Mn, Cu, Ni and Pb) content with a view to assess the impact of industrial wastewater on agricultural soils. The results revealed elevated levels of Fe and Cr in agricultural soils irrigated with treated tannery effluents. Cluster analysis of tannery effluent and soil datasets yielded two groups of the metals and demonstrated their relationship in each media. Principal component analysis performed on two datasets yielded two significant factors each for the effluents and soils, suggested tanneries as the probable sources of metals in the soils.