Historical Group Research Articles

Do we need group and save for trans-urethral resection of bladder tumour and trans-urethral resection of the prostate procedures?

Background: Trans-urethral resection of the prostate (TURP) and trans-urethral resection of bladder tumour (TURBT) are urological procedures essential for treating benign prostatic hyperplasia (BPH) and non-muscle invasive bladder cancer, respectively, these procedures may result in post-operative bleeding. In our hospital, pre-operative blood group and save is a routine to enhance patient safety. This study aims to evaluate transfusion rates and the potential cost benefits of limiting routine blood group and save. Methods: We conducted a retrospective audit of patients undergoing TURP and TURBT between October 2018 and October 2020. Data was collected using theatre system records and blood bank information regarding transfusions. Results: Out of 233 patients (average age 74), 141 underwent TURBT, 89 underwent TURP, and 3 underwent both simultaneously. Historical group and save were found in 214 (91.84%) patients, and 162 (69.5%) had same-day group and save. Only 2 patients (0.85%) necessitated transfusions. Conclusions: The necessity for blood transfusion after TURP and TURBT is low, indicating that routine pre-operative group and save may not be essential for all patients. Tailoring this practice to high-risk individuals may reduce costs and relieve workloads. Enhanced surgical techniques and tools are likely contributors to these improved outcomes.

Acknowledgment of collective victimization: Findings from four contexts of historical victimization

AbstractAcknowledgment of collective victimization is often understood as a crucial precursor to promoting victimized groups’ well‐being and breaking the cycle of violence. Yet, research on acknowledgment has focused on a few forms of acknowledgment from the perpetrator group, thus limiting our understanding on what acknowledgment entails and who should engage in it. Furthermore, what is considered to be appropriate acknowledgment may be shaped by the historical and sociopolitical context. To address these issues, we conducted a qualitative online survey that explored how four historical victim groups (Armenian Americans, Black Americans, Jewish Americans, and the Palestinian diaspora, total N = 273) perceive how acknowledgment of their group's collective trauma should look like. Qualitative content analysis revealed four broad theoretical categories of what acknowledgment entails: symbolic gestures, knowledge and education, structural redress, and learning lessons and preventing violence. We also found four categories concerning who should acknowledge the ingroup's trauma: everyone, adversaries, the ingroup, and third parties. Responses varied across groups, suggesting the importance of the sociopolitical context in acknowledgment. The findings extend theoretical and empirical work on acknowledgment and have important program and policy implications.

Liebe Seniorinnen und Senioren! vs. Dragi seniori! Wortschatzveränderungen im Bereich der Altersgruppenbezeichnungen im Deutschen und Rumänischen

The fact that certain social groups in a language community, people over 55 are elevated to the subject of discourse allows conclusions to be drawn both about the cultural attention paid to these groups and about the defining group. The formation of new names for certain groups can also be understood as an indication of changes in the group of those responsible for the foreign designations, which lie between an unmarked "we" and the conceptually marked "other". In the semiotic changes of language use, the collective formation of social categories, including their contradictions, becomes palpable in specific terms – making the conceptual historical analysis group designations a practicable linguistic tool of cultural analysis.

Measuring the Vaccine Success Index: A Framework for Long-Term Economic Evaluation and Monitoring in the Case of Rotavirus Vaccination.

New vaccination programs measure economic success through cost-effectiveness analysis (CEA) based on an outcome evaluated over a certain time frame. The reimbursement price of the newly approved vaccine is then often reliant on a simulated ideal effect projection because of limited long-term data availability. This optimal cost-effectiveness result is later rarely adjusted to the observed effect measurements, barring instances of market competition-induced price erosion through the tender process. However, comprehensive and systematic monitoring of the vaccine effect (VE) for the evaluation of the real long-term economic success of vaccination is critical. It informs expectations about vaccine performance with success timelines for the investment. Here, an example is provided by a 15-year assessment of the rotavirus vaccination program in Belgium (RotaBIS study spanning 2005 to 2019 across 11 hospitals). The vaccination program started in late 2006 and yielded sub-optimal outcomes. Long-term VE surveillance data provided insights into the infection dynamics, disease progression, and vaccine performance. The presented analysis introduces novel conceptual frameworks and methodologies about the long-term economic success of vaccination programs. The CEA evaluates the initial target vaccination population, considering vaccine effectiveness compared with a historical unvaccinated group. Cost-impact analysis (CIA) covers a longer period and considers the whole vaccinated and unvaccinated population in which the vaccine has direct and indirect effects. The economic success index ratio of CIA over CEA outcomes evaluates long-term vaccination performance. Good performance is close to the optimal result, with an index value ≤1, combined with a low CEA. This measurement is a valuable aid for new vaccine introductions. It supports the establishment of robust monitoring protocols over time.

Characteristics of Diaper Dermatitis in Patients Aged 0-24 Months After Congenital Heart Disease and the Effects of a Diaper Dermatitis Care Bundle: A Comparison of 2 Groups.

The purpose of this study was to examine characteristics of diaper dermatitis (DD) in critically ill patients aged 0 to 24months following surgery for congenital heart disease (CHD), the effects of a diaper dermatitis care bundle (DDCB), and factors associated with the development of DD in this population. Nonrandomized comparison cohort study with a historical comparison group. Convenience sampling was used to identify children aged 0 to 24months undergoing CHD and cared for in a pediatric intensive care unit in central Taiwan (Taichung). The sample comprised 54 participants; 24 were in the historical comparison group and 30 received the DDCB. The rate of DD from the historical comparison group was compared to that in an intervention group managed with a bundle of interventions used to prevent and manage DD, which includes the routine use of a topical skin protectant. The participants in the historical comparison group received usual care to prevent and manage DD including routine cleansing with a moistened, disposable cloth every 3hours and following defecation or urination. The DDCB comprised diaper changes at least every 3hours and as needed after soiling, along with the routine application of a dimethicone and sodium hyaluronate-based skin protectant before diaper changes. Both groups were evaluated for use of an antifungal cream when candidiasis was present. Participants managed with the DDCB have a significantly lower rate of DD than the historical comparison group who received routine care (41.65% vs 6.67%, P =.002). Univariate logistic regression showed an odds ratio of 0.10 (95% confidence interval of 0.019-0.520, P =.006), suggesting that the DDCB acted as a protective factor against the development of DD. Multivariate analysis of the historical comparison group indicated that non-cyanotic heart disease was associated with a lower likelihood of postoperative DD compared to those with cyanotic heart disease (odds ratio=0.01, 95% confidence interval of 0.000-0.946, P =.047). Managing critically ill patients with a DDCB recovering from cardiac surgery significantly decreased the incidence of DD. We recommend routine use of this type of care bundle for preventing DD in this vulnerable population in all children with CHD, with particular attention being paid to this with cyanotic CHD.

Early Iterations of Bisexual Activism in Toronto, Ontario: A Historical Examination of Bykes and the Ontario Bisexual Network

This article seeks to illuminate the activities of historical bisexual community groups in Toronto in the late twentieth century, a peak era of bisexual activism in Ontario. The city’s first bisexual women’s group, Bykes, was founded in 1983, and the first mixed gender group, the Ontario Bisexual Network, was established later in 1989. While the former was influenced by radical lesbian separatist politics in 1970s and 1980s Toronto, the latter demonstrated the need to amplify bisexual concerns across the gender spectrum, in addition to serving a growing membership within the burgeoning bisexual community in the city. In order to contextualize the significance of these bisexual community groups, the following research questions are addressed: what were the objectives of Toronto’s early bisexual community groups and how did activists accomplish them? How did bisexual people in these groups situate themselves in Toronto’s gay and lesbian landscape? What were the main tenets of bisexual community building in the city? Through analyses of oral history interviews and archival materials, we can observe that bisexual activists involved in Toronto’s first community groups participated in creating meeting spaces for each other and engaging in public advocacy that revolved primarily around visibility, education, and community care.

Post-transplant cyclophosphamide with post-engraftment anti-thymocyte globulin reduce moderate to severe chronic graft-versus-host disease in peripheral stem cell transplantation from HLA-matched unrelated and haploidentical donors.

Post-transplantation cyclophosphamide (PTCy) has unique advantages for graft-versus-host disease (GVHD) prophylaxis after allogeneic hematopoietic stem cell transplantation (allo-HSCT). In this single-center retrospective landmark analysis, we evaluated chronic GVHD (cGVHD) and clinical outcomes in patients receiving PTCy, tacrolimus, and post-engraftment low-dose anti-thymocyte globulin (PTCy-ATG) as GVHD prophylaxis after HLA-matched unrelated or haploidentical donor transplantation. Two historical patient groups receiving calcineurin inhibitor-based GVHD prophylaxis were used as control groups. A total of 71 patients with myeloid malignancies undergoing allo-HSCT with myeloablative conditioning regimens were included in the analysis. The 3-year cumulative incidences of cGVHD and moderate to severe cGVHD (M/S cGVHD) were 39.2% (95%CI 27.4%-51.0%) and 11.5% (95%CI 4.1%-18.9%), respectively, in the PTCy-ATG group, and only one instance of bronchiolitis obliterans (BO) was observed. The disease-free survival (DFS), overall survival (OS), and GVHD-free and relapse-free survival rates were 94.0% (95%CI 88.3%-99.7%), 93.0% (95%CI 87.1%-98.9%) and 83.8% (95%CI 75.0%-92.6%) respectively. Of note, the PTCy-ATG group presented with a significantly lower incidence of M/S cGVHD and BO, which translated into superior OS in multivariate analysis. In this retrospective analysis, we observed that PTCy-ATG-based GVHD prophylaxis was associated with a lower incidence of M/S cGVHD and better transplantation outcomes beyond day 100, which invites prospective evaluation.

Directly Isolated Allogeneic Virus–Specific T Cells in Progressive Multifocal Leukoencephalopathy

Progressive multifocal leukoencephalopathy (PML) is a life-threatening viral infection with no approved antiviral treatment. To determine whether restoring the compromised immune system of patients with PML with directly isolated allogeneic virus-specific (DIAVIS) T cells is a promising therapeutic strategy, especially if other curative options are absent. A retrospective case series of patients with PML who were treated with DIAVIS T cells was conducted between March 2020 and February 2022. T cells were isolated from healthy donors within 24 hours and targeted against the BK polyomavirus. Patients with PML were treated monocentrically. Eligibility for treatment with DIAVIS T cells was assessed for patients with confirmed PML, and exclusion criteria included stable PML disease and previous treatment with natalizumab. Fresh DIAVIS T cells were administered with a maximum dose of 2 × 104 CD3+ cells/kg body weight. Remaining T cells were cryopreserved in divided doses and administered in additional treatments approximately 2 and 6 weeks later. Primary outcome measures were clinical response and survival of patients, compared with the outcomes of a historical reference group of PML cases receiving best supportive treatment (BST) and with recently published real-world data of patients with PML who were treated with immune checkpoint inhibition. The study cohort consisted of 28 patients (median [IQR] age, 60 [51-72] years; 20 male [71.4%]). Twenty-two patients (79%) treated with DIAVIS T cells showed response, resulting in significant clinical stabilization or improvement and a reduction in viral load. Six individuals (21%) were classified as nonresponders, deteriorated rapidly, and died, as did 2 other patients during a 12-month follow-up. Older age was the only predictor of a poor treatment response. Survival analysis revealed better 12-month survival rates (hazard ratio, 0.42; 95% CI, 0.24-0.73; P =.02) from diagnosis for patients treated with DIAVIS T cells (18 of 26 [69%]; 12-mo survival rate, 69%) compared with historical controls with BST (57 of 113 [50%]; 12-mo survival rate, including censored data, 45%). This case series of DIAVIS T-cell therapy in PML provides first class IV evidence suggesting efficacy to reduce mortality and improve functional outcome. Further prospective studies are required to confirm these results.

Centering Belonging for NIRSA: Leaders in Collegiate Recreation

Volunteer leaders and staff in NIRSA: Leaders in Collegiate Recreation (NIRSA) aimed to establish shared norms for belonging, guided by recommendations from the Association's climate study conducted by 122 Consulting Group. The climate study precipitated the formation of an implementation team for justice, diversity, equity, and inclusion (JDEI). This case study explored stakeholders’ perspectives about shared norms (diversity, equity, inclusion, justice, and respect) for belonging, using multiple data points (historical context, JDEI trends, association reports, and focus groups) to ignite action. Analysis of these perspectives at in-person and virtual NIRSA educational sessions identified three themes: positive reception, action/accountability, and integration/ongoing engagement. The study provides valuable insights for association leaders to shape belonging initiatives by using shared expectations, thus effectively guiding actions based on the findings of a climate study. This study is essential for associations, and its findings can also empower members to drive similar initiatives on their respective campuses.

Reduction of hemodialysis catheter-related blood stream infections in intensive care units after systematic use of taurolidine-citrate-heparin locking solution.

Dialysis catheter-associated bacteremia in Intensive Care Units (ICUs) increases morbidity and mortality, prolongs hospital admission and increases admission costs. Taurolidine-Citrate-Heparin Locking Solution (TCHLS) is a catheter-locking solution with a broad antimicrobial activity against gram-positive and gram-negative bacteria and fungi. The aim of this study was to analyze the effect of systematic sealing of hemodialysis catheters in the ICUs of the Hospital Clínic de Barcelona on the incidence of hemodialysis catheter-related blood stream infections (CRBSI). CRBSI episodes of patients who underwent intermittent hemodialysis (IHD) during ICU admission were reviewed. TCHLS was established as a routine dialysis catheter sealing solution in the hospital ICUs in 2015. As a control group an historic pre-TCHLS group from 2010 to 2014 was used. The post-TCHLS period comprised from 2015 to 2018. A total of 243 and 266 patients required IHD in the pre- and post TCHLS periods, respectively. The number of CRBSI in the pre-TCHLS period was 18 (7.43%) as compared to 9 (3.38%) in the post-TCHLS period (p = 0.043). All infections were from percutaneous catheters except for three catheters that were tunneled. There was no association between the location of the catheter and the incidence of CRBSI. The most frequent isolated microorganisms were Gram positive bacteria (48.38%), with a global predominance of Staphylococcus epidermidis (32.25%). There were no significant differences in the median days from the start of hemodialysis to the onset of bacteremia (23.5 days in pre-TCHLS group vs 21 days in the post-TCHLS). There were also no significant differences between the days of ICU stay in the CRBSI in both groups or in mortality, being the overall mortality of 65.9%. In our population, the systematic application of TCHLS in the sealing of dialysis catheters in critically ill patients reduces the incidence of CRBSI in ICUs.

Increased cardiovascular morbidity and reduced life expectancy in a large Italian cohort of patients with resistance to thyroid hormone β (RTHβ).

Decreased survival and higher cardiovascular morbidity have been recently reported in a UK cohort of 61 RTHβ patients, but there is no evidence from other countries. Retrospective cohort study from an historical group of 284 Italian RTHβ patients, diagnosed between 1984 and 2023. We collected data on diagnosis of 284 cases and longitudinal data of 249 RTHβ who carried heterozygous pathogenic variants in the THRB gene. We studied how thyroid function and recognized risk factors for cardiovascular disease, such as hypertension and diabetes, affected overall mortality and major cardiovascular events. The cumulative prevalence of sinus/supraventricular tachycardia and atrial fibrillation was 40% and 18%, respectively. FT4 values 57% higher than the upper limit of normal were associated with premature cardiovascular manifestations. Major cardiovascular events (MACEs) occurred in RTHβ patients at a median age (IQR) of 59.4 years (50.4-66.4) and early mortality resulted in a mean of 11 years of life lost. While at univariable analysis hypertension, dyslipidemia, high fasting glucose/diabetes were also associated with MACEs, at multivariable analysis only age at diagnosis, increased fT4 levels, and male gender remained significantly associated with MACEs and age at diagnosis and higher fT4 levels with mortality. Previous thyroidectomy or radioiodine therapy had no statistically significant effect in the prevention of major cardiovascular events or all-cause mortality. These data should raise the general awareness on the cardiovascular risk and prompt a proactive cardiovascular monitoring in RTHβ, especially in men and those with fT4 levels above 30 pmol/L.

Implementation of standardized feeding pathways for infants with gastroschisis to improve patient outcomes: A quality improvement project in a level IV surgical NICU.

Gastroschisis is a leading cause of pediatric intestinal failure. Feeding guidelines may lead to improved patient outcomes including decreased time to reach full feeds, a reduction in the duration of parenteral nutrition, and reduced length of stay. However, there is limited evidence on what the ideal feeding guidelines are for this complex gastrointestinal diagnosis. In this quality improvement project, after completing a literature review, we created three pathways based on the complexity of the gastroschisis. We reviewed historical data without a defined feeding pathway/guideline to our newly created pathways in the intervention group. The study included 35 patients with varying degrees of gastroschisis complexity, consisting of 9 current patients (October 2021-December 2022) who were provided with defined feeding pathways and 26 historical patients before the protocol was implemented (January 2015-August 2021). There were no significant differences in the number of days required for full feeds between the two groups. However, the mean duration of parenteral nutrition was 18.9 days (95% CI, -31.8 to -7.0) shorter in the intervention group. Although not statistically significant, the patients in the intervention group had a mean length of stay that was 13.1 days (95% CI, -50.0 to 25.4) shorter than the historical group. The creation of standardized feeding guidelines for the gastroschisis population resulted ina statistically nonsignificant decrease in time to reach full enteral feeds, a statistically significant reduced duration of parenteral nutrition, and astatistically nonsignifiant decreased length of stay.

Graded exposure therapy for adults with persistent symptoms after mTBI: A historical comparison study

ABSTRACT Fear avoidance behaviour is associated with slow recovery from mild traumatic brain injury (mTBI). This study is a preliminary evaluation of graded exposure therapy (GET), which directly targets fear avoidance behaviour, for reducing post-concussion symptoms (PCS) and disability following mTBI. In a historical comparison design, we compared two groups from independent randomized trials. The GET + UC group (N = 34) received GET (delivered over 16 videoconference sessions) in addition to usual care (UC). The historical comparison group (N = 71) received UC only. PCS severity (Rivermead Post Concussion Symptoms Questionnaire; RPQ) and disability (World Health Organization Disability Assessment Schedule; WHODAS 2.0 12-item) were measured at clinic intake (M = 2.7, SD = 1.1 months after injury) and again at M = 4.9 (SD = 1.1) months after injury. Between-group differences were estimated using linear mixed effects regression, with a sensitivity analysis controlling for injury-to-assessment intervals. The estimated average change on the RPQ was −14.3 in the GET + UC group and −5.3 in the UC group. The estimated average change on the WHODAS was −5.3 in the GET + UC group and −3.2 in the UC group. Between-group differences post-treatment were −5.3 on the RPQ and −1.5 on the WHODAS. Treatment effects were larger in sensitivity analyses. Findings suggest that a randomized controlled trial is warranted.

Frequency of exposure incidents in hospital workers before and during the COVID-19 pandemic based on the hospital status and the use of personal protective equipment: a descriptive study with a historical comparison group

BackgroundAn occupational exposure, i.e. exposure incident (EI), is contact with potentially contaminated material that may contain bloodborne pathogens and that occurs during occupational activities inside or outside a health care facility, either during direct work with a patient or during contact with a patient’s body fluids and tissues. This study aimed to compare the frequency of EIs in a university hospital before and during the Coronavirus Disease 2019 (COVID-19) pandemic.MethodsThis was a descriptive study with a historical comparison group conducted at the Dubrava University Hospital (DUH) in Zagreb, Croatia. We compared the frequency of EIs among healthcare and non-healthcare workers before (from March 11, 2018, to March 10, 2020) and during (from March 11, 2020, to March 11, 2022) the COVID-19 pandemic, expressed as the number of EIs per number of hospitalized patients and the total number of hospital activities. We analyzed data based on the status of the hospital (a COVID-19 hospital or not) and the use of personal protective equipment (PPE) as recommended by the World Health Organization.ResultsDuring the total analyzed period, 241 EIs were reported in DUH. Before the pandemic, 128 EIs were reported, compared to 113 during the pandemic. Before the pandemic, 91% of EIs were recorded in healthcare workers, while during the pandemic, 96% of EIs were recorded in healthcare workers. Slightly more EIs were recorded during the period of mixed work form and de-escalation of PPE. The rate of EIs relative to the total number of hospital patients was significantly higher during the pandemic (3.9/1000) than in the pre-pandemic period (2.5/1000). The rate of EIs relative to the total number of hospital activities was significantly higher during the pandemic (0.4/1000) than in the pre-pandemic period (0.2/1000).ConclusionThe rate of EIs relative to the total number of hospitalized patients and the total number of hospital activities in DUH was significantly higher during the pandemic, and the rate of total EIs increased among healthcare workers during the COVID-19 pandemic. The results of this study show that it is necessary to constantly and effectively work on the prevention of EI.

“Why Do People Accept Ideologies that Contradict their Conscious Interests?”

For a short time in the mid-1930s, Prague turned into the hub of discussions about the role of psychology in history. Far from being a mere methodological debate, the question why masses act against their conscious interests was seen as a central point of this endeavor. The issue intrigued not only the left-leaning Czechoslovak historians who formed the Historická skupina (the Historical Group) and were influenced by similar attempts in Germany, namely by the Institut für Sozialforschung in Frankfurt am Main, but also psychoanalysts in exile, like Otto Fenichel, who conducted inquiries in a similar vein, all the more as the menace of German fascism grew stronger. The paper sketches the contacts between different groups and presents the main results of their deliberations.

The Historical Memory Paradigm as a Methodological Approach for Historical Commissions: The Case of Colombia's Historical Memory Group

Abstract: The last three decades have seen an increasing recognition of the potential of historical commissions as a tool to address the legacies of the past in contexts where social and political unrest and divisions are historically deeply rooted. Given their broad definition, historical commissions enjoy great flexibility in terms of how they carry out their investigations. This article analyzes the activities of the Historical Memory Group set up in Colombia in 2007, which adopted the historical memory paradigm, characterized by a combination of archival research and oral testimonies, as a core aspect of its investigative work, and argues that this paradigm provides a useful methodological approach to be included in the wide range of tools available to historical commissions.

Reduction of peritoneal dialysis associated infections using a novel exit-site care practice.

Peritoneal dialysis (PD) related infections are a significant obstacle leading to PD discontinuation. Since catheter related infections (CRI), defined as exit site infections and/or tunnel infection, can progress to peritonitis, vigorous efforts are implemented in CRI prevention. Following an increased CRI rate in our institution, partially related to environmental organisms found in water distribution systems, we hypothesized that exit site care that includes prevention of water exposure-related pathogens may reduce CRI. In this prospective single center study, we compared a contemporary cohort consisting of PD patients who implemented the modified exit-site care protocol, mainly including water avoidance during shower with stoma bag usage and local Mupirocin ointment against a historical control group before the protocol implementation. The historical cohort was allowed water exposure and used local gentamicin ointment. The primary outcome was the development of a CRI. Secondary outcomes were PD associated peritonitis and infection related outcomes. There were 55 patients in contemporary cohort and 58 in historical group. The CRI rate was significantly lower in study group (0.11/episodes per patient year [EPP]) compared to control group (0.71 EPP), p < 0.001. A multivariate Cox regression analysis demonstrated a protective effect of being in the contemporary cohort compared to historical group (HR for first CRI = 12.0 95%CI: 4.0-35.7, p < 0.001). Peritonitis rate was significantly lower in contemporary cohort (0.19/EPP) compared to the historical group (0.40/EPP), p = 0.011. Transfer to hemodialysis was significantly lower in contemporary cohort than historical group (7.3% vs 31.0% in contemporary and historical group respectively, HR = 0.2, 95%CI; 0.05-0.6, p = 0.001). An exit site care protocol that includes water avoidance and local Mupirocin use reduced substantially both CRI and peritonitis rate in patients treated with PD.

A rare case of ABO grouping discrepancy due to probable blood group switching which presented as lost antigens detectable only with indigenous reagents in less sensitive platforms compared to highly sensitive automated platforms using non indigenous reagents

Abstract: Blood group switching in the form of loss or diminished expression of RBC antigens has been reported in malignancies and infections. Blood group antigens are present on the red cell surface. ABO blood group system is the most clinically significant system. Some cases can present as grouping discrepancy. Here we present a rare case of ABO grouping discrepancy due to probable blood group switching which presented as lost antigens detectable only with indigenous reagents in less sensitive platforms compared to highly sensitive automated platforms using non indigenous reagents. 66 year old female whose historic blood group was A Rh D positive with history of uneventful transfusion of 2 units of A Rh D positive packed red cell one and half years back now presented with mycoplasma pneumonia and acute pulmonary edema. On routine complete blood count testing her hemoglobin was 3.6 gm%, request send to blood bank for pretransfusion testing. Testing performed via conventional tube technique and ABO blood group discrepancy was noted with forward grouping turned to be A Rh D positive (positive reaction with anti A1 lectin) and on reverse grouping 3+ reactions was observed in both A and B cell giving a picture of O blood group. Blood grouping was performed in different platforms including fully automated, semi automated and manual using commercially available antisera and human plasma as a source of anti A, anti B antibodies for forward grouping. The antisera used in automated platforms are non indigenous and that for manual are indigenous. Discrepancy was noted (Forward A and Reverse O) in CTT with commercially available antisera and human plasma as reagents for forward grouping .The same discrepancy was noted with CAT in neutral card with commercially available antisera for manual grouping. But when grouping performed with Column Agglutination Technology using matrix grouping gel card the discrepancy was resolved reporting the blood group as O. For further confirmation we repeated the blood grouping in another fully automated platform, SPRCA Technology (Immucore NEOIRIS) and in that also no discrepancy noted giving a picture of O group. This patient probably had undergone a blood group switching from A to O by losing some but not all A epitopes and started anti A antibody production. Some A epitopes which were not lost had been picked up by the commercially available antisera intended for manual grouping. These antisera are indigenous in origin. Also when human plasma was used as source of antibodies the A epitopes which were not lost were detected. But when grouping was done with non-indigenous antisera in both manual and automatic platform the A epitopes were not detected. This case points towards the relevance of incorporating indigenous antisera in automated platforms.

Increasing the Threshold to Perform Preperitoneal Pelvic Packing Decreases Morbidity Without Affecting Mortality.

To determine the effectiveness of an updated protocol that increased the transfusion threshold to perform preperitoneal pelvic packing in patients with pelvic ring injuries and hemodynamic instability (HDI). Retrospective review. Urban level 1 trauma center. Severely injured (injury severity score > 15) patients with pelvic ring injuries treated before and after increasing the threshold to perform preperitoneal pelvic packing from 2 to 4 units of red blood cells (RBCs). HDI was defined as a systolic blood pressure <90 mm Hg. Mortality from hemorrhage, anterior pelvic space infections, and venous thromboembolisms before and after increasing preperitoneal pelvic packing threshold. One hundred sixty-six patients were included: 93 treated under the historical protocol and 73 treated under the updated protocol. HDI was present in 46.2% (n = 43) of the historical protocol group and 49.3% (n = 36) of the updated protocol group (P = 0.69). The median age of patients with HDI was 35.0 years (interquartile range 26.0-52.0), 74.7% (n = 59) were men, and the median injury severity score was 41.0 (interquartile range 29.0-50.0). Patients with HDI in the updated protocol group had a lower heart rate on presentation (105.0 vs. 120.0; P = 0.004), required less units of RBCs over the first 24 hours (6.0 vs. 8.0, P = 0.03), and did not differ in age, injury severity score, systolic blood pressure on arrival, base deficit or lactate on arrival, resuscitative endovascular balloon occlusion of the aorta, resuscitative thoracotomy, angioembolization, or anterior pelvis open reduction internal fixation (P > 0.05). The number of PPPs performed decreased under the new protocol (8.3% vs. 65.1%, P < 0.0001), and there were fewer anterior pelvic infections (0.0% vs. 13.9%, P = 0.02), fewer VTEs (8.3% vs. 30.2%; P = 0.02), and no difference in deaths from acute hemorrhagic shock (5.6% vs. 7.0%, P = 1.00). Increasing the transfusion threshold from 2 to 4 units of red blood cells to perform pelvic packing in severely injured patients with pelvic ring injuries decreased anterior pelvic space infections and venous thromboembolisms without affecting deaths from acute hemorrhage. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Sensory-Motor-Oral Stimulation Combined with Early Sucking During the Mandibular Distraction Osteogenesis Process in Children with Robin Sequence.

To describe the findings of children with Robin Sequence (RS) who received sensory-motor-oral stimulation combined with early sucking during mandibular distraction osteogenesis (MDO), compared with children who did not receive the intervention. A quasi-experimental study. Setting: A tertiary public hospital. Patients: Children with RS referred to MDO. A historical group from the same population but managed according to the institution's standard protocol (no sucking) served as a control group. Interventions: Sensory-motor-oral stimulation, including sucking, starting 24 h after MDO (intervention group). Main Outcome Measure: Our hypothesis is that sensory-motor-oral stimulation, including sucking during the DOM process, do not negatively affect surgical outcomes. Twenty-nine children were included. Eight (72.7%) of the 11 patients in the intervention group and 13 (72.2%) of the 18 controls had MDO complications, with no significant difference between the groups (p = 1.000). The most common surgical outcome was antibiotic therapy for surgical site infection (76.2%). Six months after MDO, 22 (75.9%) children attained full oral feeding or associated with alternative feeding methods. The intervention group did not have higher complication rates, from a surgical point of view, than control group. The protocol adopted by some centers that contraindicates sucking during MDO should be revised to consider the benefits of such stimulation. Keywords: Pierre Robin Syndrome, deglutition, therapeutics, child development.