Allergic Reactions Research Articles

Strategies to manage the adverse effects of immunotherapy with dinutuximab beta in neuroblastoma: an Italian experience and literature review.

Patients with high-risk neuroblastoma (HR NB) frequently present with metastases in the bone marrow and bone. Approximately 15% of these patients are refractory to induction therapy, and 50% relapse. Dinutuximab beta is an anti-GD2 monoclonal antibody approved in Europe for maintenance therapy of pediatric patients with HR NB. Immunotherapy with anti-GD2 antibodies improves the survival of children with HR NB and relapsed or refractory disease. It is associated with adverse events, such as pain, fever, allergic reactions, capillary leak syndrome, and diarrhea. This manuscript aims to propose a practical guide in support and prevention treatment of adverse events. MEDLINE was searched using the terms "GD2," "ch14.18/CHO," "anti-GD2 antibody," "dinutuximab beta," and "neuroblastoma." The experts reappraised available evidence discussing different clinical Italian experiences. Neuropathic pain is the main toxicity associated with dinutuximab beta and can be prevented with analgesics, including intravenous opioids and gabapentin by mouth. The intensity of the supportive treatment decreases from course to course. In the experience of the authors, adverse events associated with dinutuximab beta may be prevented and managed in experienced centers. The supportive therapy may be reduced after the first cycle to improve the quality of life.

Knowledge of mothers on diaper dermatitis management and associated factors in Ethiopia

Diaper dermatitis is an inflammatory reactions of the skin under a diaper due to prolonged skin contact with irritants (urine and faeces), seborrhoea, allergic reaction, fungal (candida), and bacterial infections. It is more common in children aged 1–24 months, with the majority of instances occurring in newborns younger than one year. Over half of newborns suffer from the case at least once throughout their diaper-wearing phase. In low- and middle-income countries like Ethiopia, there is a lack of published data regarding the degree of parental knowledge of diaper dermatitis, its management, and the risk factors associated with the disease. Moreover, the topic receives little to no attention. Therefore, this study aims to assess the mothers’ knowledge of diaper dermatitis and the risk factors linked with the disease. Data was collected from 396 mothers who came for immunization services from August 01 to September 01, 2024, consecutively. The data was cleaned, checked for completeness manually, and entered into SPSS version 26 for analysis. A binary multivariable logistic regression was used to analyze the association between the independent and the outcome variables. Variables with a p-value < 0.05 were considered statistically significant, and an adjusted odds ratio with a 95% confidence interval was reported. The study findings revealed that 84.6% of mothers had self-reported good knowledge of DD and its management, and their main source of information is family members and relatives (35.4%). Nearly two-thirds (65.4%) of children experienced DD, and only 23.6% sought healthcare. Over one-third (37.1%) of mothers used Vaseline to treat DD at home, followed by baby powder (35.1%). The majority (83.6%) of mothers uses disposable diapers only, and 84.8% change 0–2 times per day. The output of logistic regression shows that being a 7–12 month-old child (aOR = 4.03; 95% Cl (1.41–11.50)), being a male child (aOR = 2.16; 95% Cl (1.14–4.06)), and being firstborn (aOR = 5.95; 95% Cl (1.39, 25.53)) variables had a significant association with knowledge of mothers. The study found that although the majority of mothers have self-reported good knowledge, a significant number of them have no awareness of the diapering practice, how to treat DD, when to seek medical attention, and how to take care of their skin after a bowel movement. Therefore, we suggest a structured teaching program to increase mothers’ understanding of DD, including its prevention and management.

Antimicrobial Efficacy of Prepared Herbal Denture Cleansers and Their Impact on Physical Properties of Denture Base Material: An Invitro Study

Background: Microbial colonization on dentures, particularly by Candida albicans, Streptococcus mutans, and Porphyromonas gingivalis, leads to oral infections and systemic health risks. Chemical denture cleansers, commonly used for hygiene, are associated with adverse effects such as tissue irritation, allergic reactions, and the potential for antimicrobial resistance, prompting the need for more biocompatible alternatives. Objectives: This study aimed to evaluate the antimicrobial efficacy of herbal denture cleansers prepared from Ocimum sanctum, Aloe barbadensis miller, Coffea arabica, Elettaria cardamomum, and Salvadora persica against common denture-colonizing microorganisms. Additionally, the impact of these cleansers on the physical properties of denture materials was assessed. Materials and Methods: Herbal methanolic extracts were prepared. Each extract was diluted to specific concentrations and tested for antimicrobial activity using the agar well diffusion method against Candida albicans, Streptococcus mutans and Porphyromonas gingivalis for zone of inhibition. Denture specimens were immersed in the cleansers for six months, and physical properties including Colour change, Surface roughness, Surface hardness and Flexural strength were evaluated using standard techniques such as colorimetric system, profilometry, Vicker’s Hardness Tester, and a three-point bending test, respectively. p-value&lt;0.05 considered statistically significant. Results: Ocimum sanctum and Aloe barbadensis miller demonstrated significant antimicrobial activity, though less than standard drugs (Nystatin, Amoxicillin, Chlorhexidine). Ocimum sanctum showed the highest inhibition against Candida albicans (17.56 mm) and Streptococcus mutans (20.02 mm). Aloe barbadensis miller showed the highest inhibition against Porphyromonas gingivalis (22.98 mm). Minimal adverse effects on denture properties were observed, with no significant deterioration over six months. Conclusion: Herbal denture cleansers, particularly those derived from Ocimum sanctum and Aloe barbadensis miller, exhibit promising antimicrobial efficacy and are potential eco-friendly alternatives to conventional chemical cleansers, with minimal impact on denture properties.

Docetaxel Micelles: A New Formulation to Diminish Hypersensitivity Reactions

Background/Objectives: Docetaxel is a potent anti-cancer agent capable of treating various types of cancer. However, it often induces a range of adverse reactions when used with its standard solubilizer, Tween-80, necessitating allergy prophylaxis with dexamethasone prior to administration. To mitigate the risk of allergic reactions, with nanomicelles garnering significant interest due to their enhanced solubility and thermodynamic stability. Methods: In this research, a mPEG-PLA-Lys(Fmoc) micellar carrier with m = 45 and n = 10 was engineered to encapsulate docetaxel, and its self-assembly into micelles was investigated. Additionally, allergic reaction studies were conducted on animals. Results: The findings indicated that the formulation did not cause hemolysis, vascular, or muscle irritation in rabbits, nor did it elicit an allergic response in guinea pigs. Conclusions: These results suggest that nanomicelle-encapsulated docetaxel can diminish the allergic reactions associated with docetaxel injections, offering a novel approach to enhance the therapeutic utility of this outstanding anti-cancer drug.

Adverse events following immunization surveillance on two types of enterovirus 71 vaccines: A real-world comparative study in China

ABSTRACT To comprehensively assess the safety and difference of two types of EV71 vaccines: EV71-Vero, produced using Vero cells and EV71-H2, using human diploid cells. Our research included children of the recommended age who voluntarily received the EV71 vaccine in Hebei Province from 2019 to 2023. Detailed data on adverse events following immunization (AEFI) were collected, analyzed and compared for EV71-Vero and EV71-H2 vaccines. With 477 AEFI reported, the reported rate was 14.21 per 100,000 doses. Most cases occurred in infants under one year of age (45.91%). No significant differences in the AEFI reported rate were found between two types of EV71 vaccines across various demographic. However, a higher number of AEFI was reported in children under 1-year old following EV71-Vero compared to EV71-H2 with a reversal in 4–5 years- group (χ 2 = 13.90, p = .01). The prognosis of cured took higher proportion for EV71-Vero than for EV71-H2 while inversely with improved outcome. The EV71 vaccine is advisable recommend to the appropriate age children to prevent EV7l infection. Both the EV71-Vero and EV71-H2 vaccines have good safety profiles. The reported AEFI, primarily high fever and allergic reactions, showed no significant differences in reported rates or case characteristics between the two types.

Clinically relevant evaluation of the antimicrobial and anti-inflammatory properties of nanocrystalline and nanomolecular silver.

Burns and chronic wounds present significant challenges in wound management due to risks of infection, excessive inflammation, and prolonged healing. Silver-based treatments have long been central to burn care, but limitations have prompted the exploration of nanocrystalline silver as an alternative, with its nanoscale properties offering distinct benefits. This paper reviews the structure, properties, mechanisms of action, and clinical applications of nanocrystalline silver in burn and general wound management, with particular emphasis on how wound healing processes inform the application of these dressings. Nanocrystalline silver's high surface area-to-volume ratio and crystal structure enhance its antimicrobial and anti-inflammatory efficacy. Nanocrystalline silver's mechanisms of action are disrupting cellular functions, inducing DNA damage, and inhibiting biofilms. Clinical studies demonstrate accelerated healing and reduced inflammation compared to traditional treatments. Whilst nanocrystalline silver dressings are costly, their effectiveness in lowering drug-resistant infections and minimising complications supports a financial case for their use, potentially reducing overall wound care expenses. Considerations of cytotoxicity, allergic reactions, and accessibility underscore the importance of individualised treatment selection based on wound and patient factors. In conclusion, nanocrystalline silver holds substantial promise in burn wound management, and further research is warranted to optimise its therapeutic potential and economic benefits in clinical practice.

Innovative separation of melittin from bee venom using micro-free-flow electrophoresis: An experimental and theoretical study.

Bee venom consists of more than 50% melittin (MLT), which has anti-cancer, anti-inflammatory, and antimicrobial properties. Bee venom also contains toxic components such as phospholipase A2 (PLA2) and hyaluronidase (HYA), which cause allergic reactions, so the toxic components must be removed to use MLT. In previous studies, analytical methods were used to separate MLT. This study used micro-free flow electrophoresis (μFFE) for MLT separation. This separation was simulated using computational fluid dynamics (CFD) and molecular dynamics simulation (MD). The glass chip was fabricated using the wet etched method, and MLT separation was investigated experimentally. The CFD results demonstrated that MLT was separated from PLA2 and HYA in less than 3min, and MLT and toxic components took different paths in the channel. The operating conditions, such as the sample flow rate, buffer flow rate, electric field strength, and channel dimensions, were optimized during the simulation. The MD results showed that MLT's conformation does not change the separation process. MD simulation with an atomistic resolution could give us more accurate results of molecular interactions. Also, MLT separation was performed on a glass chip, adding to the precision of the process. The channel outputs were analyzed using high-performance liquid chromatography (HPLC). MLT separation using μFFE was performed for the first time. The results indicated that melittin was purified 90% in this separation, and PLA2 was rejected by 90%. The results indicated that, for the first time, the separation of MLT from bee venom using μFFE could be achieved with a high recovery rate, thereby demonstrating its potential for biological applications. This separation in less than 3min has higher yield and purity than analytical methods such as HPLC.

Alpha-Gal Syndrome: A Growing Health Care Concern.

Alpha-gal syndrome is a serious, potentially life-threatening allergic reaction to mammalian products that has been linked to the lone star tick. Early recognition and management of alpha-gal syndrome is key for desirable patient outcomes and informed nursing care can make all the difference. The purpose of this article is to provide background information regarding alpha-gal syndrome, review common sources of potential reaction triggers including food and medications, and discuss strategies to detect and avoid allergic reactions from occurring.

Low-dose aspirin to reduce recurrence rate in colorectal cancer patients with PI3K pathway alterations: 3-year results from a randomized placebo-controlled trial.

LBA125 Background: Colorectal cancer (CRC) affects 1.9 million individuals globally each year. Among patients with stage II-III CRC, 20-40% develop metastatic disease. Aspirin lowers the incidence of adenomas and CRC in high-risk patients. In addition, observational studies suggest that post-diagnosis aspirin treatment improves disease-free survival (DFS) in unselected populations. Furthermore, retrospective findings indicate that somatic PIK3CA mutations predict treatment response, but requires validation in randomized trials. Methods: The ALASCCA trial was a randomized, double-blind, multicenter, placebo-controlled trial with two parallel arms, across 33 hospitals in Sweden, Denmark, Finland, and Norway. Patients with stage I-III rectal cancer or stage II-III colon cancer exhibiting somatic alterations in the PI3K signaling pathway were included. Patients were randomized to receive either 160 mg of aspirin daily or placebo, initiated within three months post-surgery and continued for three years. To detect a hazard ratio (HR) of 0.36 for the primary outcome of time to recurrence (TTR) assessed at 3 years, with 80% power and a two-sided alpha of 0.05, 150 patients with PIK3CA mutations in exon 9 and/or 20 (“Group A”) were required per arm. An additional 300 patients with other somatic PI3K pathway driver alterations (PIK3CA outside exon 9/20, PIK3R1, or PTEN; "Group B") were required for secondary analyses. A stratified Cox proportional hazards model was fitted for the primary efficacy analysis. Results: A total of 3508 patients were screened for somatic alterations in the PI3K pathway. Of the 2980 patients with conclusive genomic analyses, 1103 patients (37%) had an alteration in the PI3K pathway: 515 patients (17.3%) in Group A and 588 patients (19.7%) in Group B. In total, 626 patients were randomized. After three years of follow-up, the HRs for TTR comparing aspirin to placebo were 0.49 (95% CI; 0.24-0.98; p=0.044) in Group A and 0.42 (95% CI; 0.21-0.83; p=0.013) in Group B. For DFS, the HRs were 0.61 (95% CI; 0.34-1.08; p=0.091) in Group A, and 0.51 (95% CI; 0.29-0.88; p=0.017) in Group B. Three patients experienced aspirin-related severe adverse events (one GI-bleeding, one hematoma, one allergic reaction). Conclusions: Primary endpoint was met. Adjuvant treatment with 160 mg aspirin daily for three years reduced recurrence rate in CRC patients with somatic alterations in the PI3K signaling pathway. These findings could lead to immediate changes in clinical praxis for about a third of CRC patients. Clinical trial information: NCT02647099 .

Leveraging Quality Improvement Tools to Improve Administration of First-line Surgical Antibiotic Prophylaxis in Patients Labeled as Penicillin Allergic.

A reported penicillin allergy reduces the likelihood that the patient will receive first-line surgical antibiotic prophylaxis (SAP), which can increase the risk of developing a surgical site infection (SSI). This project aimed to increase the use of first-line SAP agents in orthopedic and pediatric surgery patients with a reported penicillin allergy. The Institute for Healthcare Improvement quality improvement methodology was followed. Key drivers included patient and family awareness of true penicillin allergies, standardization for ordering antibiotics, staff buy-in, electronic medical record utilization, and staff comfort with ordering first-line SAP. Initial plan-do-study-act cycles focused on provider education. Subsequent plan-do-study-act cycles focused on the antibiotic delivery process, antibiotic selection, screening tool development for severe delayed hypersensitivity reactions, education, and data transparency. The outcome measure was the percentage of orthopedic and pediatric surgery patients with a reported penicillin allergy that received first-line SAP per month. Since the start of the project in December 2022, there were 2 statistically significant changes in the outcome measure's mean, shifting the mean from 25% to 84% in orthopedic and pediatric surgery patients with a reported penicillin allergy who received first-line SAP. There were no adverse medication reactions and no statistically significant change in SSIs. The mean has been at 84% for 9 months showing a sustainable process and culture change regarding first-line SAP usage for orthopedic and pediatric surgery patients. This was achieved through targeting the antibiotic delivery processes without relying on hard stops within the medical record.

Identification and characterization of the Cul t 1 as major allergen from biting midge Culicoides tainanus.

Midges are widely distributed globally. They can transmit numerous serious diseases as well as trigger an allergic reaction in the host. Their saliva contains a variety of proteins that act as sensitizers to stimulate the host's immune response, leading to IgE-mediated allergic symptoms. In the present study, we constructed a mouse sensitization model with the thorax extract of the Culicoides tainanus, and evaluated the sensitization model by behavior and specific antibody expression. SDS-PAGE/western blot was used to detect the binding proteins by IgE antibody in the thorax extract of the C. tainanus. The objective band was cut for mass spectrometry to preliminarily clarify the potential allergen. The pET21a-Cul t 1 recombinant expression vector was constructed and the target protein was purified by Ni affinity chromatography. The sensitizing effect of the sensitizer was verified in vitro and in vivo. Immunoblot analysis revealed that a 66 kDa protein (Cul t 1) from the chest extracts of C. tainanus could bind to serum IgE of sensitized mice. Cul t 1 was further identified by fragmentation, mass spectrometry and bioinformatics as maltase, an enzyme involved in sugar digestion. In vivo validation of the Cul t 1-mouse sensitization model showed that the scratching behavior of the Cul t 1 sensitized group was significantly higher than that of the control group according to behavioral evaluation. The results of HE staining of the skin of the injected area showed that Cul t 1 sensitized group was found to have a large number of inflammatory cell infiltration and increased fibrosis in the dermis. The ELISA detection of IgE showed that the Cul t 1 sensitized group was significantly elevated from the beginning of the 28th day onwards, and the expression level of IgE had a tendency to slow down with the prolongation of the sensitization time. The ELISA assay showed that the expression level of IgG1 increased significantly in the Cul t 1 group on day 42, while the results of the specific antibody IgG2a showed that there was no significant difference in both the Cul t 1 sensitized group and the control group. The results suggest that the immune response induced by Cul t 1 sensitized mice may be shifted toward a Th2 type immune response. In this study, we identified the sensitizer of the C. tainanus, named Cul t 1. We successfully constructed the recombinant expression vector pET21a-Cul t 1, purified the Cul t 1 sensitizer by affinity chromatography, and verified the sensitizing effect of Cul t 1 in mice. The results laid a practicable foundation for the subsequent immune therapy of midge bites and bite control.

Safety evaluation of the food enzyme acylglycerol lipase from the genetically modified Penicillium sp. strain AE‐LGS

Abstract The food enzyme acylglycerol lipase (glycerol‐ester acylhydrolase, EC 3.1.1.23) is produced with the genetically modified Penicillium sp. strain AE‐LGS by Amano Enzyme Inc. The Panel could not conclude on the taxonomic identification of the production strain due to a lack of appropriate data. The genetic modifications do not give rise to safety concerns. The food enzyme was free from viable cells of the production organism and its DNA. The food enzyme is intended to be used in two food manufacturing processes. The compositional data provided were insufficient to characterise the food enzyme batches for commercialisation and the batch used for toxicological testing. As a result, the suitability of the batch used in the toxicological tests could not be established. The toxicological studies were thus not considered and the dietary exposure not calculated. A search for the homology of the amino acid sequence of the acylglycerol lipase to known allergens was made and no match was found. The Panel considered that a risk of allergic reactions upon dietary exposure to the food enzyme cannot be excluded, but the likelihood is low. Taken together, due to insufficient data regarding the production strain and the food enzyme composition, the Panel could not complete the safety assessment of the food enzyme.

Isobavachin attenuates FcεRI-mediated inflammatory allergic responses by regulating SHP-1-dependent Fyn/Lyn/Syk/Lck signaling

Isobavachin, isolated from Psoralea corylifolia L. exhibits therapeutic potential for osteoporosis or skin disease. Here, we evaluated the pharmacological effects of isobavachin on IgE-dependent inflammatory allergic reactions, as well as the underlying mechanisms, in bone marrow-derived mast cells and a mouse model of passive cutaneous anaphylaxis (PCA). Isobavachin reduced IgE/Ag-stimulated degranulation, eicosanoid (leukotriene C4 and prostaglandin D2) generation, and release of pro-inflammatory cytokines (tumor necrosis factor-α (TNF-α) and interleukin (IL)-6). Mechanistic studies revealed that isobavachin suppressed activation of Fyn, Lyn, spleen tyrosine kinase (Syk), and lymphocyte-specific-protein-kinase (Lck), receptor-proximal tyrosine kinases that initiate and play a central role in FcɛRI-mediated mast cell activation, as well as their common downstream signaling molecules including linker for activation of T cells, phospholipase Cγ1, AKT, mitogen-activated protein kinases (MAPKs), and intracellular Ca2+. Additionally, isobavachin increased phosphorylation of Src homology region 2 domain-containing phosphatase-1 (SHP-1), thereby strengthening its interaction with Syk and Lck as well as Fyn and Lyn, resulting in de-phosphorylation of these proximal tyrosine kinases. Genetic knockdown of SHP-1 reversed the inhibitory effects of isobavachin on mast cell activation, as well as the related signaling pathways, indicating that the inhibitory effects of isobavachin are mediated by negative regulation of SHP-1-dependent Fyn, Lyn, Syk and Lck. The anti-inflammatory properties of isobavachin were also examined in macrophages. Isobavachin suppressed production of lipopolysaccharide-stimulated production of pro-inflammatory cytokines and nitric oxide. Furthermore, oral administration of isobavachin attenuated mast cell-mediated PCA reactions in mice. These results suggest that isobavachin is a potential treatment for mast cell-mediated allergic inflammatory diseases.

Improving Cefazolin Administration for Surgical Prophylaxis in Reported Penicillin Allergy: A Retrospective Study of a Health System Intervention

Cefazolin is the most common first-line antibiotic to prevent surgical-site infections. Patients with penicillin allergy labels often receive alternative antibiotics, which is associated with increased rates of surgical-site infections, multi-drug-resistant infections, and cost. We sought to determine whether a hospital-wide guideline recommending first-line surgical prophylaxis in patients with penicillin allergy labels can increase the use of cefazolin without compromising safety. We conducted a retrospective cohort study of adult surgical patients with penicillin allergy labels. The main intervention was updated hospital-wide surgical guidelines recommending first-line prophylaxis in most patients with penicillin allergy labels. We compared the preintervention and postintervention groups. The primary outcome was cefazolin use. Secondary perioperative outcomes included alternative antibiotic use and severe allergic episodes (anaphylaxis). The total sample comprised 7187 patients with penicillin allergy labels who underwent 8945 surgical encounters (median age [interquartile range], 61 [46-71] years); 4891 [68%] female). Cefazolin was used in 2256 (73%) patients in the preintervention group and 3390 (83%) patients in the postintervention group (P< .001), with an adjusted odds ratio of 1.87 (95% CI, 1.67-2.10). There was a decrease in the use of clindamycin from 14% to 8% (P< .001) and gentamicin from 16% to 8% (P< .001). There were no episodes of severe allergic reactions among patients who received guideline-directed therapy. A hospital-wide guideline can improve use of cefazolin in surgical patients with penicillin allergy labels without increasing the risk for severe allergic reactions. National and international guidance should be considered to enhance administration of cefazolin in surgical patients with penicillin allergy labels.

Phase II study of neoadjuvant FLOT and chemoradiation for trimodality therapy of esophageal/GEJ adenocarcinoma.

466 Background: Recent data support use of perioperative FLOT (5-FU/leucovorin/oxaliplatin/docetaxel) chemotherapy over pre-operative chemoradiation (CRT) for patients with resectable esophageal/GEJ adenocarcinoma with limited studies evaluating combined FLOT/CRT. This prospective phase II study (NCT04028167) evaluated a neoadjuvant approach of FLOT followed by CRT for resectable esophageal/GEJ adenocarcinoma (EAC). Methods: Operable patients with cT1-2 N1-2 or cT3-4N any4 Nany non-metastatic EAC were eligible. Neoadjuvant treatment consisted of FLOT x 3 cycles followed by restaging PET and chemoradiation (41.4 Gy / 23 fractions to the primary site and regional lymphatics with weekly carboplatin/paclitaxel). Adjuvant nivolumab for non-pathologic complete response (pCR) was permitted. The primary endpoint was pCR rate among patients receiving the study regimen and undergoing resection, with secondary endpoints including disease free survival (DFS), overall survival (OS), toxicity, and correlative studies. DFS/OS was measured using the Kaplan Meier (KM) method. Interim results are presented after a planned safety analysis. Results: Since 4/2020, 23 patients with median age of 62 (range 40-73) have enrolled. cT3-4 and cN+ disease was present in 20/23 (87%) and 16/23 (70%) of patients, respectively. FLOT was completed by 21/23 patients (reasons for discontinuation included allergic reaction and G5 sepsis/endocarditis). All 21 patients initiating chemoradiation completed planned treatment and 17/21 underwent resection (2 refused surgery after achieving cCR, 1 died of cardiac arrest, 1 patient is awaiting surgery). A pCR was observed in 5/17 resected patients (29%), with pCR or near pCR observed in 9/17 (53%). The complete response rate (pCR + cCR for patients refusing surgery) was 7/19 (37%). Adjuvant nivolumab was administered in 9 patients. The median follow-up among all patients was 20 months with 2-year DFS and OS estimates of 61% and 73%. The regimen was tolerated with G3+ hematologic, G3+ gastrointestinal, and G3+ other toxicity observed in 39%, 13%, and 22% of patients, respectively. Conclusions: In a locoregionally advanced population, neoadjuvant sequential FLOT followed by CRT was well tolerated with encouraging DFS/OS and a high rate of complete response compared to prior studies. This hybrid platform may enhance both locoregional and distant control and is of interest for expanded evaluation. Clinical trial information: NCT04028167 .

The Frequency of Blood Transfusion Reactions: A Retrospective Study from a Tertiary Care Hospital

Blood Transfusion Reactions (BTRs) are complications that may occur during or after transfusion, in which allergic reactions and Febrile Non-Hemolytic Transfusion Reactions (FNHTRs) being the most common. Objective: To assess the frequency and types of transfusion reactions among patients at Shahida Islam Medical College Hospital and a blood transfusion service supplier. Methods: This study analyzed transfusion reactions reported between January, 2022, and September, 2024. A total 1936 transfused has done during this time frame. Data were collected using non-probability convenience sampling, covering patient demographics, blood products used, and Incident rate of transfusion reactions. IBM SPSS version 28.0 was utilized for statistical analysis, with categorical variables presented as frequencies and percentages. Results: Out of 1936 transfusions a total 12 (0.6%) reported transfusion reactions in which allergic reactions accounted for the majority (50.0%), followed by FNHTRs (33.33%) and none or very limited reactions of other reactions seen both on whole blood and PCV. The overall incidence of transfusion reactions was 0.53%. Conclusions: This study highlighted that allergic reactions are the most prevalent Blood Transfusion Reactions, emphasizing the need for premedication protocols for high-risk patients. Future research should focus on identifying predictive markers for allergic reactions, refining transfusion protocols.

The Critical Role of Penicillin in Syphilis Treatment and Emerging Resistance Challenges

Syphilis, a global healthcare burden, is a sexually transmitted infection caused by the spirochete Treponema pallidum, a spiral-shaped, Gram-negative obligate human pathogen. Despite its easy identification and treatability, the disease affects over 50 million people worldwide, with 8 million new cases in the 15–49 age group annually, as per the WHO 2024 report. If left untreated, syphilis progresses through its primary, secondary, latent, and tertiary stages, causing severe complications like neurosyphilis, congenital syphilis, and organ damage. The first-line treatment, penicillin, faces challenges, including logistical issues, shortages, allergic reactions, and patient non-compliance. Secondary treatment options are sparse, and there are reported cases of T. pallidum strains resistant to those antibiotics. The absence of an effective vaccine for syphilis has led to efforts to control its spread through sexual education, condom usage, and post-exposure prophylaxis with doxycycline, which raises concerns about antimicrobial resistance (AMR). The continued reliance on penicillin and the increasing rates of doxycycline post-exposure prophylaxis (DoxyPEP) use have both contributed to concerns about AMR development. Recent works pointing to emerging antibiotic resistance and treatment failures highlight the urgent need for new antibiotics to manage syphilis effectively and reduce dependency on penicillin. This review has focused on the shortcomings and limitations of penicillin treatment, recently identified antimicrobial-resistant strains of T. pallidum, and case studies where its application failed to treat the disease adequately.

Dengue and Scrub Typhus Co-infection at a Tertiary Care Centre in Nepal: A Case Series in Pediatric Patients

This case series highlights four pediatric patients with coinfection of dengue fever and scrub typhus, presenting at Patan Hospital. Dengue fever is caused by flavivirus transmitted by Aedes mosquitoes, and scrub typhus is caused by Orientia tsutsugamushi transmitted by Leptotrombidium mites, which share overlapping symptoms such as fever, headache, and abdominal pain, complicating the diagnosis. The cases were from different geographical regions of Nepal with varied presentation: from febrile illness to severe manifestations like meningoencephalitis and raised intracranial pressure. Two patients presented with hepatosplenomegaly, one with severe rash, and another with pneumonia-like symptoms. Laboratory findings confirmed coinfection, and management included IV antibiotics, antipyretics, and supportive management. Complications such as thrombocytopenia, transaminitis, and allergic reactions required interventions. This case series highlights the importance of early suspicion and treatment of coinfection to reduce prolonged hospitalization and prevent end-organ dysfunction, and mortality, especially in endemic regions.

Effect of intraoperative noise isolation on postoperative nausea and vomiting in patients undergoing gynecological laparoscopic surgery: protocol for a randomized controlled trial.

Postoperative nausea and vomiting (PONV) are common complications following general anesthesia, particularly in gynecological laparoscopic surgeries. This study aims to evaluate the effect of intraoperative noise isolation on PONV incidence. This single-center, prospective, randomized controlled trial will enroll 192 adult patients undergoing laparoscopic gynecological surgery. Patients will be randomly assigned in a 1:1 ratio and stratified by age into either the control group (Group C), without noise-cancelling headphones, or a noise reduction group (Group NR), using noise-cancelling headphones from anesthesia induction until the end of surgery. All patients will receive intraoperative dexamethasone and ondansetron prophylaxis. The primary outcome is the incidence of PONV within 48h post-surgery. Secondary outcomes include PONV severity at 24 and 48h, antiemetic use, pain scores, need for rescue analgesia, Quality of Recovery-15 (QoR-15) scores, Richards-Campbell Sleep Questionnaire (RCSQ) scores, hemodynamic interventions, extubation time, length of stay in PACU and hospital, adverse events (hypertension, hypotension, bradycardia, tachycardia, desaturation after extubation, postoperative shivering, emergence agitation, allergic reactions, severe arrhythmias arrhythmia, cardiac arrest, hypothermia), patient satisfaction, and postoperative complications based on the Postoperative Morbidity Survey (POMS). Analyses will be conducted using modified intention-to-treat (mITT) and per-protocol (PP) populations. We hypothesize that intraoperative use of noise-cancelling headphones will reduce PONV incidence in patients undergoing gynecological laparoscopic surgery. The findings could enhance postoperative care protocols for thoracoscopic gynecological procedures. Chinese Clinical Trial Registry (ChiCTR2400087460).

A rare rosuvastatin-induced urticaria in a high-risk cardiovascular patient: A case report

Statins are widely used lipid-lowering agents essential for the prevention and management of cardiovascular diseases. Despite their proven efficacy and safety, rare adverse drug reactions (ADRs), such as allergic skin reactions, can occur. This case report describes a 54-year-old male with ischemic heart disease, hypertension, and type 2 diabetes mellitus, who developed pruritic, red-pigmented skin lesions characteristic of urticaria within 10 days of starting rosuvastatin 40 mg daily. The symptoms resolved after discontinuation of the drug and administration of symptomatic treatment with cetirizine and calamine lotion. The likelihood of rosuvastatin causing the urticaria was assessed using the Naranjo Adverse Drug Reaction Probability Scale, which indicated a probable relationship. Although statins are generally well-tolerated, rare hypersensitivity reactions may occur due to immune-mediated mechanisms or mast cell activation. Early recognition and withdrawal of the offending agent are crucial for swift symptom resolution and prevention of further complications. In patients requiring continued lipid-lowering therapy, alternative agents such as pravastatin may be considered. This case highlights the importance of post-marketing surveillance in identifying rare ADRs, ensuring pharmacovigilance, and improving patient care. Increased awareness among clinicians is essential for timely detection and management of uncommon drug-related reactions to enhance treatment outcomes.