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1.  Efficacy and safety of autologous bone marrow derived hematopoietic stem cell transplantation in patients with type 2 DM: A 15 months follow-up study 
Background:
there are dearths of studies describing the effect of autologous bone marrow derived stem cell transplantation (ABMSCT) through targeted approach in Type 2 Diabetes Mellitus. This study reports the efficacy and safety of super-selective injection of ABMSCT in T2DM.
Materials and Methods:
Ten patients (8 men and 2 women) with T2DM, with duration of disease >5 years and with documented triple drug failure receiving insulin (0.7 U/Kg/day), metformin and pioglitazone underwent super-selective injection of stem cells into superior pancreaticoduodenal artery under fluoroscopic guidance. The primary outcome measure was decrease in insulin requirement by ≥50% (defined as responders), while secondary endpoints were improvement in glucagon stimulated C-peptide levels, changes in weight, HbA1c, lipid profile and quality of life (QOL) at the end of 15 months.
Results:
Six patients (60%) were ‘responders’ at 15 months of follow-up showing a reduction in mean insulin requirement by 74% as compared to baseline and one patient was off-insulin till the end of the study. Mean HbA1c reduction in ‘responders’ was 1.1% (8.1 ± 0.5% to 7.0 ± 0.6%, P = 0.03), accompanied with a significant improvement in glucagon stimulated C-peptide levels (P = 0.03), Homeostasis Model Assessment -β (P = 0.03) and QOL scores. However, ‘non-responders’ did not show any significant alterations in these parameters. No serious adverse events were noted.
Conclusion:
Our observations indicate that ABMSCT is effective in management of T2DM and its efficacy is maintained over a period of 15 months without any adverse events. However, more number of patients and longer duration of follow-up are required to substantiate these observations.
doi:10.4103/2230-8210.140257
PMCID: PMC4192991  PMID: 25364680
β-cells; C-peptide; stem cells
2.  Role of Interleukin-6 as an Early Marker of Fat Embolism Syndrome: A Clinical Study 
Background
A few animal studies have shown that IL-6 can serve as an early marker of fat embolism syndrome. The degree to which this is true in human trauma victims is unknown.
Questions/purposes
In this clinical study, we sought to determine (1) whether elevated serum IL-6 levels at 6, 12, and 24 hours in patients with skeletal trauma were associated with the development of fat embolism syndrome (FES) within 72 hours after injury, and (2) at what time after trauma peak IL-6 levels are observed.
Methods
Forty-eight patients between 16 and 40 years old who presented to our tertiary trauma center within 6 hours of injury with long bone and/or pelvic fractures were included in this study. Serum IL-6 levels were measured at 6, 12, and 24 hours after injury. The patients were observed clinically and monitored for 72 hours for development of FES symptoms. Gurd’s criteria were used to diagnose FES.
Results
Elevated serum IL-6 levels 12 hours after trauma correlated with an increased likelihood of having FES develop; no significant relationship was observed between IL-6 levels at 6 or 24 hours and the development of FES. Patients with FES had a mean IL-6 level of 131 pg/mL, whereas those without FES had a mean IL-6 level of 72 pg/mL. Peak IL-6 levels were observed at 12 hours.
Conclusions
An elevated serum IL-6 level may be useful as an early marker of FES in patients with isolated skeletal trauma.
Level of Evidence
Level II, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.
doi:10.1007/s11999-013-2869-y
PMCID: PMC3676609  PMID: 23423626
3.  Evaluation of heat shrinkable films for shelf life, and quality of individually wrapped Royal Delicious apples under ambient conditions 
Effect of heat shrinkable films on shelf life and quality of apples under ambient conditions was studied. Fully mature Royal Delicious apples (starch index 2.5 on 4.0 point scale) were either shrink-wrapped in 3 heat shrinkable films like Cryovac (9 μ), polyolefin (13 μ) and LDPE (25 μ) or were not wrapped at all (control) and then stored at ambient conditions (22–28°C and 52–68% RH). Observations on physiological loss in weight (PLW), decay loss, firmness, juice recovery, total soluble solids (TSS), acidity, ascorbic acid content and overall sensory quality were recorded immediately before packing, and after packing at weekly intervals. Best results were obtained with Cryovac (9 μ) films, which exhibited least PLW (2.3%) and decay loss (2.8%) and higher juice recovery (65.2%) and TSS (16.4%) over other films or control. Apples wrapped in Cryovac films also had higher overall sensory acceptability (8.3 out of 9) over other films or control. These studies indicated that apples could be very well packed in Cryovac heat shrinkable films for about 35 days with least PLW or decay loss, and without any adverse effect on fruit quality.
doi:10.1007/s13197-011-0332-1
PMCID: PMC3602566  PMID: 24425958
Heat shrinkable film; Physical changes; Chemical changes; Sensory quality; Shelf life
6.  Leukoreduced blood components: Advantages and strategies for its implementation in developing countries 
Removal of leucocytes from various blood products has been shown to minimize Febrile nonhemolytic transfusion reactions, HLA alloimmunization, platelet refractoriness in multitransfused patients and prevention of transmission of leukotropic viruses such as EBV and CMV. Rapidly growing size of hemato-oncological patients in our country requiring multiple transfusion of blood and components during the course of their management pose a great challenge to transfusion services to provide them red cell and platelet antigen matched products in alloimmunized subjects. Thus removal of leucocytes below a certain threshold, ≤ 5 × 106 in a blood component certainly helps in prevention of alloimmunization and associated risks in these patients. Currently the best Leucoreduction can be achieved with the help of 3rd and 4th generation leukofilters, both in laboratory and patient bed side, and state of the art apheresis devices. The present article briefly reviews the current literature for pros and cons of leucofilteration and its scope of implementation in the cost constrained settings.
doi:10.4103/0973-6247.59384
PMCID: PMC2847337  PMID: 20376259
Blood component; developing countries; leukoreduced component
7.  Transfusion-related adverse events at the tertiary care center in North India: An institutional hemovigilance effort 
Aim:
This study was designed to analyze the incidence and spectrum of adverse effects of blood transfusion so as to initiate measures to minimize risks and improve overall transfusion safety in the institute.
Materials and Methods:
During the period from July 2002 to July 2003 all the adverse events related to transfusion of blood and blood components in various clinical specialties were recorded. They were analyzed and classified on the basis of their clinical features and laboratory tests. Attempt was also made to study the predisposing risk factors.
Results:
During the study period 56,503 blood and blood components were issued to 29,720 patients. A total of 105 adverse reactions due to transfusion were observed during the study period. A majority of the adverse reactions was observed in hemato-oncology patients 43% (n = 45) and in presensitized patient groups 63% (n = 66). FNHTR 41% (n = 43) and allergic reactions 34% (n = 36) were the most common of all types of adverse transfusion reactions, followed by AcHTR 8.56% (n = 9). Majority of these AcHTR were due to unmonitored storage of blood in the refrigerator of wards resulting in hemolysis due to thermal injury. Less frequently observed reactions were anaphylactoid reactions (n = 4), bacterial sepsis (n = 4), hypervolemia (n = 2), hypocalcemia (n = 2), TRALI (n = 1), DHTR (n = 1), and TAGvHD (n = 1).
Conclusion:
Analysis of transfusion-related adverse outcomes is essential for improving safety. Factors such as improvement of blood storage conditions outside the blood bank, improvement in cross-matching techniques, careful donor screening, adherence to good manufacturing practices while component preparation, bedside monitoring of transfusion, and documentation of adverse events will help in reducing transfusion-related morbidity and mortality.
doi:10.4103/0973-6247.83245
PMCID: PMC3159249  PMID: 21897598
Hemovigilance; transfusion reaction; adverse events of transfusion; haemolytic transfusion reaction; risk associated with transfusion
9.  Di-n-butyltin(IV) Complexes Derived from Heterocyclic β-diketones and N-Phthaloyl Amino Acids: Preparation, Biological Evaluation, Structural Elucidation Based upon Spectral [IR, NMR (1H, 13C, 19F and 119Sn)] Studies 
Stable, six coordinated Bu2SnLA type complexes have been prepared [where LH = RCOC:C(OH)N(C6 H5)N:CCH3; R = -4-F-C6H4-(L1H), R = -4-Cl-C6H4-(L2H), R= -4-Br-C6H4-(L3H), R=-CF3(L4H) and AH = C(O)C6 H4 C(O)NCHR'COOH; R'= -H(A1H), -CH3(A2H), -CH(CH3)2(A3H)] by the interaction of 1:1:1 molar ratios of di-n-butyltin(IV) dichloride with corresponding organic moieties in refluxing benzene using two moles of Et3N as a base. In these complexes LH and AH behave as bidentate and coordination is taking place through oxygen, this is inferred from IR and 13C NMR studies. These complexes possess tin atoms in skew trapezoidal bipyramidal geometry with the C-Sn-C angles ranging from 149.88° to 156.84°. Some of these complexes with their corresponding organic moieties (LH, AH) were tested for their antimicrobial activities.
doi:10.1155/BCA.2005.201
PMCID: PMC2267094  PMID: 18365100
Di-n-butyltin(IV) dichloride; heterocyclic β-diketones; N-phthaloyl amino acids; antimicrobial testing; spectral studies; micro organisms
10.  Platelet audit: Assessment and utilization of this precious resource from a tertiary care hospital 
Background:
To assess the appropriate utilization of platelet transfusions [random donor platelets (RDP) and single donor platelets (SDP)]; a six-month retrospective audit was carried out in a tertiary care hospital.
Materials and Methods:
A six-month retrospective platelet audit was carried out from May to October 2005 to estimate its preparation, appropriate utilization and wastage rate. Patient's demographics, transfusion triggers and episodes and ABO and Rh (D) group specific or non-group specific transfusions were also assessed.
Results:
About 5525 units of platelets [PRP-PC, 3,813 (69%); BC-PC, 983 (17.8%); PRP, 648 (11.7%) and SDP 81 (1.5%)] were prepared and transfused to 853 patients (RDP to 814 patients and SDP to 39 patients) in 2,093 transfusion episodes. Adult and pediatric hemato-oncology were the main user specialties utilizing 39.1 and 87.6% of the RDPs and SDPs prepared. Of the patients receiving RDPs, 95% were transfused ABO and Rh (D) group specific platelets whereas 100% SDPs transfusions were of group specific platelets. 88% of prophylactic platelet transfusions were appropriate as per the recommended BCSH guidelines. However, 12% of the prophylactic platelets were transfused inappropriately in cardiopulmonary bypass (CPB) surgeries with normal platelet counts and no evidence of bleeding related to platelets. Out of 5,444 RDPs prepared 1,585 (29.11%) units were not utilized.
Conclusions:
Regular audit of blood and blood components is a must so that necessary remedial measures can be taken to maximize appropriate and judicious utilization of each component.
doi:10.4103/0973-6247.28066
PMCID: PMC3168134  PMID: 21938226
Appropriate utilization; platelet transfusion; transfusion audit
11.  Extradural application of bismuth iodoform paraffin paste causing relapsing bismuth encephalopathy: a case report with CT and MRI studies. 
Bismuth iodoform paraffin paste (BIPP) is used in dressings in ear, nose, and throat, dental, and neurosurgical practice. Neurotoxicity due to absorption of bismuth from the BIPP pack is rare. It is preventable and reversible but likely to be fatal if unrecognised. A case of relapsing but reversible toxic encephalopathy due to a large extradural BIPP pack is reported in a 57 year old Caucasian woman, operated on for a huge basal cell carcinoma of the vertex invading the skull and extradural space. Clinical, neuroradiological (CT and MRI), and biochemical studies are presented and discussed in the light of the available literature.
Images
PMCID: PMC1073090  PMID: 8057127
13.  Cerebellopontine angle epidermoid cysts: a report on 30 cases. 
Thirty cases of cerebellopontine angle epidermoid cysts treated over a period of 20 years are reviewed with regard to their clinical features, the pathophysiology of their symptoms and their management. The predominating symptoms were related to the 7th and 8th cranial nerves and headaches. The signs and symptoms were present for an average period of 4 months. It was not always possible to determine if the signs and symptoms were due to local involvement by the epidermoid, increased intracranial pressure, or both. Diagnostic procedures evolved from angiography and ventriculography to non-invasive computed tomography and MRI. The posterior cranial fossa approach was used in 27 cases. Total excision of the epidermoid was the aim and was carried out in five (18%) patients but concern regarding the preservation of nearby important neurovascular structures forced partial removal in 22 patients. To minimise reformation, the residual epidermoid was carefully coagulated with the aid of the operating microscope and bipolar cautery without damaging surrounding neurovascular structures.
Images
PMCID: PMC1031839  PMID: 2795068

Results 1-13 (13)