Scripta Medica

Blood Group Antigens Visualisation on Leukocytes

Pavlo Grigorovich Kravchun — 2024-10-23

Background/Aim: The leukocytes have been reported to contain blood group specific antigens, that are clinically relevant, however visualisation of A and B group antigens on leukocytes is a big issue. In cases of ABO discrepancies weak blood group antigens on nuclear cells have been demonstrated by using expensive techniques. Thus, the development of the method of the detection of weak blood group antigens on leukocytes available for any laboratory technician is hardly essential. The study aimed to reveal and analyse A and B blood group specific adsorbing antigens on leukocytes and erythrocytes and to develop a method for visualisation of weak blood group antigens on leukocytes.

Methods: Polyclonal and monoclonal anti-A and anti-B antibodies, received from international laboratories according to the program of Workshop IV, held in Paris, 2000, were used for the study. Mixed agglutination reaction was performed as the method for visualisation of weak blood group antigens on leukocytes as nuclear cells.

Results: Polyclonal sera from O blood group persons without weak blood group antigens in contrast to monoclonal antibodies demonstrated the ability to reveal weak blood group specific antigens on leukocytes by the method of mixed agglutination reaction. However, the test erythrocytes from the persons with increased levels of platelets and erythrocyte sedimentation rate did not allow to visualise weak antigen expression on the studied leukocytes in contrast to the persons with normal levels of platelets and erythrocyte sedimentation rate, that successfully formed mixed agglutinates with weak blood group antigens on leukocytes in mixed agglutination reaction. The leukocytes suspended in 0.9 % saline (as a diluent) incubated with the mixture of the serum with 0.9 % saline (1:2) led to the formation of specific agglutinates with test erythrocytes. The experiments with different temperature regimes and time of incubation demonstrated the usefulness of the studied method in specific leukocytes antigen visualisation during prolonged incubation at 4 °C. The persons with weak group A and B antigens, revealed on the leukocytes by the studied method, demonstrated decreased level of erythrocytes, platelets, titre of corresponding warm agglutinating antibodies (less than 1:8) and increased erythrocyte sedimentation rate.

Conclusion: The mixed agglutination reaction with prolonged incubation at 4 °C and the use of the selected polyclonal sera and test erythrocytes from the donors with normal values of platelets and erythrocyte sedimentation rate may be used for weak blood group antigens detection on leukocytes. The donors of the sera and test erythrocytes used in mixed agglutination reaction should be investigated on common blood analysis, agglutinating titre of corresponding warm group specific antibodies and presence of weak blood group antigens.

A Validity and Reliability of the Atraumatic Care Education Model Questionnaire Based on Family-Centred Care in Minimising the Stress of Hospitalisation in Children

Dera Alfiyanti — 2024-10-23

Background/Aim: Hospitalisation is a traumatic occurrence in which children must be admitted for acute or chronic diseases. The purpose of this study was to test the validity and reliability of the atraumatic care education model test, instrument based on family-centred care of mother behaviour in minimising children’s hospitalisation stress.

Methods: Questionnaires were developed based on each parameter of each variable. After the questionnaires were developed, the researcher conducted a pilot study with 50 respondents to assess their validity and reliability. The validity test used the Product Moment test, while the reliability test used Croncbach's alpha value.

Results: All questionnaire statement items on the nurse factor, the mother factor, the service factor, the learning process, the atraumatic care education factor and on mother behaviour variables were declared valid (r count = 0.280-0.854), (r count = 0.292-0.767), (r count = 0.517-0.779), (r count = 0.737-0.918), (r count = 0.303-0.781; r table = 0.275) and (r count = 0.315-0.815; r table = 0.275), respectively. All questionnaires to measure nurse factors, maternal factors, service factors, learning process factors, atraumatic care education, maternal behaviour variables and distress questionnaires were reliable. The internal consistency (alpha coefficient) of the total scale ranged between 0.713-0.925.

Conclusion: All questionnaires developed to assess the atraumatic care education model based on family-centred care on mother behaviour in minimising children’s hospitalisation stress were valid and reliable and thus have certain application value.

Serum Catestatin Level in Preeclampsia

Basima Sh Alghazali — 2024-10-23

Background/Aim: Preeclampsia, a significant cause of maternal morbidity and mortality, is linked to increased cardiovascular risks. Catestatin regulates cardiovascular function which indicates its usefulness in understanding pathophysiology of preeclampsia and its severity. Aim of this study was to evaluate association of catestatin in preeclamptic women and control non preeclamptic women and assess its association with presence and severity of preeclampsia.

Methods: A case-control study at Al-Zahraa Teaching Hospital, Iraq, performed from January to December 2023 involved 90 pregnant women: 30 with severe preeclampsia, 30 with mild preeclampsia and 30 healthy controls. Inclusion criteria were preeclamptic pregnant women at 27-40 weeks of gestation and age ranging from 20-40 years and similar non-eclamptic controls. Exclusions were smokers, chronic drug users and those with chronic illnesses. Data collection included general and clinical information, BMI, vital signs, examinations and laboratory tests including serum catestatin.

Results: Catestatin levels varied significantly among severe preeclampsia, mild preeclampsia and control groups. Average catestatin level in severe preeclampsia group was markedly lower at 29.01, compared to 43.67 in mild preeclampsia and 59.96 in controls. The diagnostic performance of catestatin for severe preeclampsia was notable, with a cutoff point of ≤ 37.165, sensitivity of 80 % and specificity of 83.3 %, highlighting its potential as a critical biomarker in preeclampsia evaluation.

Conclusion: Catestatin level was significantly lower in sever preeclampsia compared to mild and control group, which may indicate its association with preeclampsia. Lower catestatin in sever preeclampsia suggest its inverse relation with preeclampsia severity.

Frequency of Neuropathy Symptoms in Diabetic Patients

Tharani Gnanamoorthy — 2024-10-23

Background/Aim: One of the most common consequences of diabetes mellitus is diabetic neuropathy, which is triggered on by nerve damage. The characteristic of neuropathies is a progressive loss of nerve fibre function resulting in numbness, tingling, aching, burning and throbbing sensations. In addition, it adds to the risk of falls, joint deformities, muscular atrophy and foot ulcers. The study aimed to analyse the incidence of motor and sensory dysfunctions in patients with diabetes mellitus in Chennai, India.

Methods: This was an observational study of analytic type. Clinically diagnosed diabetic patients between the age of 45 to 60 years were considered for this study. Patients who consented to participate in this study, with a history of diabetes mellitus spanning more than ten years were chosen. Patients found to have other causes of neuropathy, diabetic ulceration, lactating (or) pregnant women and non-cooperative patients were excluded from this study. All the subjects enrolled in the study at the aforementioned centres were given the Michigan neuropathy screening instrument (MNSI). Total score of MNSI was calculated and interpreted for the prevalence.

Results: A total of 246 subjects have participated in this study out of which 54 % were male and 46 % were female, 127 (51 %) had diabetic peripheral neuropathy, 41 (17 %) had partial diabetic neuropathy and 78 (32 %) had no symptoms of diabetic neuropathy.

Conclusion: Through the questionnaire and physical examination, the current study demonstrated a high prevalence of motor and sensory impairments as well as diabetic neuropathy symptoms in the diabetic population.

The Relationship Between Preoperative Inflammatory Indexes and Adherent Perinephric Fat in Laparoscopic Partial Nephrectomy

Gökhan Çil — 2024-10-23

Background/Aim: Partial nephrectomy (PN) is favoured for cT1a renal tumours. However, factors like adherent perinephric fat (APF), linked to prolonged operation time due to chronic inflammation are often overlooked. The objective of this study was to assess the relationship between the composite inflammatory index and APF in patients with renal cell carcinoma (RCC) prior to laparoscopic partial nephrectomy (LPN).

Methods: The retrospective analysis included 189 LPN patients from April 2015 to June 2021, categorised by APF presence. Demographic, laboratory and radiological data assessed composite inflammatory index and Mayo adhesion probability (MAP) scores. Chi-Square and Mann-Whitney U-test analysed categorical and continuous variables. Area under curve (AUC) measured parameter discrimination. Logistic regression identified APF predictive factors.

Results: APF was present in 90 patients (47.6 %). The APF-positive group had significantly higher C-reactive protein (CRP) levels and longer operation times (p = 0.016 and p = 0.001, respectively). Elevated MAP scores and systemic inflammatory index (SII) values were also observed in the APF-positive group (p = 0.002 and p = 0.001, respectively). Receiver operating characteristic (ROC) analysis determined SII's cut-off at 600 (sensitivity: 60.0 %, specificity: 60.6 %, AUC: 0.640, p = 0.001), MAP score at 2.5 (sensitivity: 67.8 %, specificity: 64.5 %, AUC: 0.640, p < 0.001) and operation time at 122.5 min (sensitivity: 74.4 %, specificity: 67.7 %, AUC: 0.807, p < 0.001).

Conclusion: Presented results indicate that SII is linked to APF in patients undergoing LPN and may serve as an independent predictor of APF positivity.

Effectiveness of Community-Based Educational Package on Stress Levels Among Postmenopausal Women

Rajinder Kaur — 2024-10-23

Background/Aim: Postmenopausal women often face increased stress due to various physiological and psychological changes. This study aimed to analyse how effectively a community-based educational package (CBEP) reduces stress among postmenopausal women.

Methods: A total of 200 postmenopausal women were assigned to either a control group (n = 100) or an experimental group (n = 100). The control group received routine care, while the experimental group engaged in a CBEP aimed at stress management. Stress levels were assessed before and after the intervention using a validated assessment tool and independent t-tests were used to compare the stress levels between the two groups and to evaluate changes in stress.

Results: The pre-test stress levels showed no significant difference between the control and experimental groups (t = 1.184, p = 0.238), indicating similar stress levels at the start. However, post-test results demonstrated a significant reduction in stress for the experimental group (mean: 13.810 ± 2.339) compared to the control group (mean = 20.160 ± 3.281) (t = 15.762, p = 0.0001). Additionally, the gain in stress levels was significantly lower in the experimental group (0.150 ± 1.149) compared to the control group (6.000 ± 3.247) (t = 16.982, p = 0.0001).

Conclusion: The results indicate that the community-based educational package effectively reduced stress levels among postmenopausal women, proving its efficacy as a non-pharmacological intervention. These findings advocate for the adoption of educational programs for managing stress in postmenopausal women and emphasise the need for further research to enhance these interventions for long-term efficacy.

Effect of Spiritual Emotional Freedom Technique (SEFT) on Pain During the COVID-19 Pandemic

Dwi Mulianda — 2024-10-23

Background/Aim: Effective pain management has become more difficult during the COVID-19 pandemic. The spiritual emotional freedom technique (SEFT) can be one of the efforts to overcome acute and chronic pain because SEFT is an intervention that can overcome physical problems by combining spiritual and psychological energy through sincerity of prayer and surrender. Aim of this study was to analyse the effect of SEFT on pain during the COVID-19 pandemic and the difference in the effect of SEFT on pre- and post-intervention pain.

Methods: The research method was a quasi-experiment with a pre-post-test group design. The study was conducted by assessing the pain scale before and after using the numeric rating scale (NRS). The sample size in the study was 98 respondents. Inclusion criteria were: patients experiencing acute or chronic pain, composed consciousness, being able to communicate well enough and being consistent with the stages of intervention. Exclusion criteria were, unconsciousness, patients diagnosed with COVID-19, shortness of breath, cognitive impairment and hearing loss.

Results: Pain measured by NRS in respondents for the pretest was 2.40 (1.679) and the post-test was 1.39 (0.490) with the interpretation of mild pain. Pretest and post-test on respondents showed significant pain reduction (Wilcoxon test, p = 0.0001; Mann Whitney test, p = 0.013).

Conclusion: Respondents experienced less pain after SEFT than before the intervention. The impact of the pain scale on respondents was different before and after SEFT.

Prevalence of Gastrointestinal Symptoms in COVID-19 Patients; Result From Tertiary Care Hospital in Pakistan

Rashk e Hinna — 2024-10-23

Background/Aim: The most commonly reported COVID-19 symptoms are high-grade fever, cough and body aches with atypical symptoms ie vomiting, diarrhoea and abdominal discomfort. The primary purpose of this research was to ascertain the frequency of gastrointestinal problems experienced by patients due to COVID-19. Goal was to determine whether or not there was a correlation between the severity of COVID-19 disease and the presence of gastrointestinal symptoms in studied individuals.

Methods: The study was conducted at the Gastroenterology Department, PEMH Rawalpindi, Pakistan from January 2022 to January 2023. Confirmed inpatient cases of COVID-19 disease were recruited, referred to Pak Emirates Military Hospital Rawalpindi, Pakistan. Real-time polymerase chain reaction (RT-PCR) verified the presence of COVID-19 in the patients of this research study.

Results: There were 345 patients (335 men and 10 women), with 116 patients exhibiting gastrointestinal symptoms and only 27 patients presented with severe disease. Diarrhoea and anorexia were the most frequently reported digestive symptoms with a frequency of 44 (12.8 %) and 34 (9.9 %), respectively. Clinical outcomes and disease severity were not significantly different between patients with and without digestive issues.

Conclusion: The course of a COVID-19 infection seems to include gastrointestinal symptoms, which include, but are not limited to vomiting, diarrhoea, anorexia, etc. Numerous gastrointestinal symptoms are linked to COVID-19 infection even in the absence of respiratory symptoms. As a result, COVID-19 infection should be taken into account for individuals who primarily present with gastrointestinal symptoms. The establishment of personalised COVID-19 therapies will be aided by an understanding of the varying susceptibility of the individual gastrointestinal system to SARS-CoV-2.

The Role and Importance of Risk Factors in the Development of Laryngeal Cancer During the COVID-19 Pandemic

Mirjana Gnjatić — 2024-10-23

Background/Aim: Laryngeal cancer is one of the most common malignancies in the head and neck region, with the highest incidence among 50 years old patients. The leading risk factors are alcohol consumption and tobacco use as the most correlated behaviours. This study aimed to assess the extent of laryngeal cancer and leading risk factors for the onset of the disease during the COVID-19 pandemic.

Methods: This retrospective study included 102 patients who were treated both diagnostically and therapeutically for laryngeal cancer during a 1-year period. All patients had a previous history of being treated for COVID-19.

Results: The sample included male (88.3 %) and female (11.7 %) respondents. The age group 60-69 years was predominant (40.0 %). The youngest patient was 41 and the oldest 82. Total laryngectomy was performed in 15.7 % of patients, while partial laryngectomy was performed in 57.85 % patients. Advanced stages of the cancer (T3, T4) prevented 17.65 % patients from receiving surgery. Tobacco use was the most leading risk factor (99 %).

Conclusion: Advanced stages (T3, T4) of laryngeal cancer and radical surgical techniques with a potentially high rate of disability showed a higher incidence during the COVID-19 pandemic. The COVID-19 pandemic impacted timely diagnosis and delays between diagnosis and surgical treatment of the cancer. Old age, male gender and tobacco use proved to be the most common risk factors of laryngeal cancer.

Insights on Effective Complementary Strategies in the Management of Urinary Tract Infections

Shweta Gandhi — 2024-10-23

Urinary tract infections (UTIs) are common health issues that occur frequently in both women and men. These infections occur in the urinary tract, leading to discomfort and potential complications. Prompt medical attention is essential to diagnose and treat UTIs effectively. Aim of this research was to provide an overview of effective complementary strategies in the management of UTIs. This review paper focuses on the current and future treatment strategies for UTI infections. Various natural remedies have been investigated as potential complementary therapies to enhance health outcomes for UTI patients. The efficacy of frequently employed natural products, including cranberry juice/extracts, ascorbic acid, hyaluronic acid, probiotics and multi-component formulations designed for the treatment and prevention of UTIs, has been explored. The probiotics serve to break down food and increase our immunity. Usually, multiple doses of antibiotics are used to treat these infections, but there are many side effects and bacterial resistance rates are increasing. Complementary UTI management strategies, including effective dietary regimens and new formulations, are attaining approvals. Drinking liquids daily significantly suppresses UTI infections. Incorporating daily consumption of cranberry juice may still be regarded as a viable complementary strategy to aid in the management of UTI infections.

Clinical Aspects of Acute Mesenteric Ischaemia

Zoran Matković — 2024-10-23

Acute mesenteric ischaemia (AMI) is a serious disease with mortality between 50 and 80 %. Oxidative stress plays a major role in the pathophysiology of AMI. AMI should be considered for any acute abdominal pain that requires analgesia with morphine and for which no other obvious aetiology is found. CT is the main diagnostic procedure to confirm the diagnosis of AMI. There is no specific diagnostic biomarker for AMI that can be used in routine practice. AMI is an urgent diagnostic and therapeutic situation. Treatment of AMI includes a protocol combining digestive rest, curative anticoagulant, antiplatelet, antibiotic therapy, arterial revascularisation to salvage viable bowel and resection of necrotic digestive segments. The strategy of revascularisation depends on the mechanism of arterial occlusion, the morphological appearance of the lesions and the indications for exploratory laparotomy. Endovascular and open surgical techniques can be combined and complemented. Open surgical revascularisation is indicated in case of failure or impossibility of endovascular revascularisation and in case of need for laparotomy. Early diagnosis and timely surgical intervention are the cornerstones of modern treatment to reduce the high mortality of AMI. The emergence of endovascular approaches and modern imaging techniques is developing and providing new treatment options. A multidisciplinary approach based on early diagnosis and treatment is necessary.

Publication Trend on Oral Mucositis Induced by Chemotherapy 1978-2023: Bibliometric Analysis

Abu Bakar — 2024-10-23

Oral mucositis (OM) is the oral mucosa inflammation caused by an adverse side-effect of cancer therapy and is expressed as atrophy, enlargement, erythema and ulceration. This bibliometric study aimed to review the publication of OM induced by chemotherapy. The search of bibliometric study using Scopus was performed (accessed on 16 July 2023). In total, 521 documents were retrieved from the Scopus database from 1978-2023. About 2680 authors global were encompassed in writing papers. Investigation of the retrieved papers indicated 424 original articles and 59 review articles. The repossessed papers exhibited top 10 cited articles. The study that obtained the highest number of citations was published in the Cancer in 1999 and received 301 citations (1999-2023). The quotation of this paper was nearly 3-fold higher quotation than those the other ten highest cited scientific papers. The top journal in publishing papers related to the OM stimulated by chemotherapy was the Supportive Care in Cancer, with a total number of papers 41, quadruple than others. This investigation showed that the studies on OM have been more noticeable in the last ten years.

Acute Promyelocytic Leukaemia With PML – RAR α Fusion Presenting as Pancytopenia and Atypical Morphology – A Case Report

Sai Sridevi Krishna — 2024-10-23

Acute myeloid leukaemia (AML) is characterised by uncontrolled proliferation of malignant marrow stem cells and is associated with infection, anaemia and bleeding. An improved understanding of pathophysiology has led to revamping the diagnostic, prognostic and therapeutic landscape of AML. AML is classified based on the defined genetic abnormalities and based on the differentiation. AML with predominance of abnormal promyelocytes shows characteristic t(15;17)(q24.1;q21.2) leading to promyelocytic leukaemia – retinoic acid receptor alpha (PML – RARA) fusion oncoprotein. A 75-year-old male with features of acute promyelocytic leukaemia – hypogranular variant with atypical morphology and PML-RARA fusion is presented. The bilobed buttock shaped nuclei is an atypical presentation and is important to diagnose this morphology.

A Unique Manifestation of Postural Orthostatic Tachycardia Syndrome (POTS) Resembling Symptoms of Irritable Bowel Syndrome

Mohamed Alshmandi — 2024-10-23

Postural orthostatic tachycardia syndrome (POTS) exhibits a broad spectrum of presentations, with severity varying from individual to individual. These diverse symptoms vary from person to person but usually presents with palpitations, dizziness, blurred vision, mental fatigue, collapse, shortness of breath and chest pain. It may also manifest with less usual presentations including abdominal symptoms that can often go misdiagnosed or undiagnosed for a long time. A case of a 29 years-old woman, who was hospitalised for evaluation of persistent abdominal discomfort accompanied by bloating and chronic episodes of watery diarrhoea is presented. Diagnosis of POTS was established. It's crucial to consider POTS in the differential diagnosis for patients displaying autonomic symptoms, including those related to the abdomen.

Insightful Exchange With ChatGPT on Hyperthyroidism

Sara Mohamed Ali — 2024-10-23

Embracing innovative solutions is crucial for navigating modern healthcare complexities. Platforms such as ChatGPT represent progress toward this aim. By leveraging AI, we empower patients, improve healthcare outcomes and enhance lives. Ongoing research and refinement are imperative for unlocking ChatGPT's full potential.