Blood Safety Research Articles

The effects of lutein/ zeaxanthin (Lute-gen®) on eye health, eye strain, sleep quality, and attention in high electronic screen users: a randomized, double-blind, placebo-controlled study

BackgroundLutein and zeaxanthin are fat-soluble antioxidant nutrients that have evidence of beneficial effects on vision and eye health.PurposeExamine the effects of supplementation with lutein and zeaxanthin isomers (Lute-gen®) on eye health, eye strain, sleep quality, and attention in high electronic screen users.Study designTwo-arm, 6-month, parallel-group, randomized, double-blind, placebo-controlled trial.MethodsSeventy volunteers aged 18 to 65 who used electronic screens for more than 6 h daily were supplemented with 10 mg of lutein and 2 mg of zeaxanthin-isomers or a placebo. Outcome measures included several ophthalmic examinations comprising the Schirmer tear test, photo-stress recovery time, contrast sensitivity, tear film break-up time, and self-report measures of visual fatigue, computer vision, sleep quality and attention.ResultsCompared to the placebo, lutein and zeaxanthin supplementation was associated with greater improvements in the Schirmer tear test, photo-stress recovery time, and tear film break-up time. However, there were no between-group differences in the change in self-report measures or contrast sensitivity. Lutein and zeaxanthin supplementation was well-tolerated, with no reports of serious adverse reactions or clinically significant changes in safety blood measures, including liver function, renal function, blood lipids, and full blood examination.ConclusionThe results from this study provide support for the beneficial effects of 6 months of lutein and zeaxanthin supplementation on regular users of electronic screens. Compared to the placebo, there were improvements in several ophthalmic examinations for dry eyes and visual health. However, these findings were not corroborated by group differences in the administered self-report measures. Lutein and zeaxanthin were well tolerated, with no serious adverse effects or significant changes in vital signs or blood safety measures.

Promoting Inclusivity in Blood Donation: Public Health

The practice of blood donation supports community unity, as it brings all individuals on a common platform where they help each other and the health system in the mission to save human lives. Regardless of the wide scope and merits of blood donation in saving lives and improving health, it is a fact that many patients who are in need do not receive safe blood timely. As the existing pool of donors cannot meet the requirements of everyone, it is the need of the hour to appeal to and encourage a diverse group of blood donors to support the healthcare delivery system. Acknowledging the need to have a diverse pool of donors, we must promote inclusivity in blood donation and this will require a combination of multiple strategies. In conclusion, the availability of a diverse blood donor base makes it extremely useful for patients from different backgrounds by making the entire process compatible and safe. Many barriers have been identified that could limit the inclusivity in blood donation, and this will require a comprehensive approach to ensure that all communities are equally represented in the donor pool, ultimately leading to a more diverse and adequate blood supply.

Tailoring anaesthetic strategies for diabetes research: Acepromazine vs. medetomidine in Aachen minipigs.

Pre-established anaesthetic protocols in animal models might unexpectedly interfere with the main outcome of scientific projects and therefore they need to account for the specific research goals. We aimed to optimize the anaesthetic protocol and animal handling strategies in a diabetes-related-study exemplifying how the anaesthetic approach must be adjusted for individual research targets. Aachen minipigs were used as a model to test long-lasting skin glucose sensors for diabetic human patients. A total of 6 animals participated in two or three rounds of experiments. Each round lasted 2 months, with a maximum of 2 rounds per year. In each round, animals were anaesthetised 4 times: for glucose sensors insertion, twice for glucagon stress tests (GST), and a last time for removal of sensors. Acepromazine (ACE) was compared to medetomidine (MED) in association with butorphanol (BUT) and Ketamine (KET) and 4 parameters were analysed to define the optimum anaesthetic protocol including: sedation level, anaesthesia duration, effects on blood glucose and safety. ACE-BUT demonstrated a weaker sedative effect but reduced overall experimental time, minimized anaesthetic risk and minimally interfered with the glucose metabolism. The improvement obtained by animal conditioning and handling strategies applied in this study were not objectively estimated, although the aversion behavior was completely abolished. Based on the analysed parameters, the use of acepromazine is proposed to be superior when Aachen Minipigs are used specifically as a model for diabetes-related studies, albeit the recommendations for the anaesthesia of minipigs suggest otherwise.

Initial treatment with a single capsule containing half-dose quadruple therapy vs standard-dose dual therapy in hypertensive patients (QUADUAL): a randomized, blinded, crossover trial

BackgroundGuidelines recognized dual combination in initial antihypertensive therapy. Studies found that low-dose quadruple combination were superior to monotherapy. However, whether low-dose quadruple therapy is better than dual combination is unknown.MethodsA randomized blinded crossover trial was conducted to compare the efficacy and safety of low-dose quadruple antihypertensives (irbesartan 75 mg + metoprolol 23.75 mg + amlodipine 2.5 mg + indapamide 1.25 mg) with standard-dose dual antihypertensives (irbesartan 150 mg + amlodipine 5 mg), both in a single pill, in the initial treatment of patients with mild to moderate hypertension. Patients were randomly assigned in a 1:1 ratio to two crossover sequences. Each sequence received four-weeks of either half-dose quadruple antihypertensives or standard-dose dual antihypertensives, followed by a two-week washout and crossover for four-weeks. Participants and researchers were blinded. The main outcomes were the reduction of blood pressure and safety outcomes. Analyses were per intention to treat.ResultsA total of 90 eligible participants were randomized between July 13, 2022, and April 20, 2023. The mean age was 43.88 years (SD 10.31), and 25.6% were women. The mean baseline 24-h blood pressure was 145.59/93.84 mm Hg. Compared to the standard-dose dual treatment, the half-dose quadruple treatment resulted in a further reduction in mean 24-h blood pressure by 4.72/4.17 mm Hg (P < 0.001 for both systolic and diastolic blood pressure), mean daytime blood pressure by 5.52/4.73 mm Hg (P < 0.001 for both), mean nighttime blood pressure by 2.37/2.25 mm Hg (P = 0.034 and 0.014, respectively), and mean office blood pressure by 2.91/1.73 mm Hg (P < 0.001 and 0.014, respectively). Apart from significant increases of fasting blood glucose (P = 0.029) and blood uric acid (P < 0.001) in the half-dose quadruple group, no other adverse events or changes in laboratory values differed significantly between the two treatments.ConclusionsInitiating treatment with half-dose quadruple combination therapy was more effective in lowering blood pressure than standard-dose dual therapy. The safety of half-dose quadruple therapy was comparable.Trial registrationClinicalTrials.gov Identifier: NCT05377203.

Factors involved in the recruitment and retention of voluntary blood donors in South Kivu (Democratic Republic of Congo), results from a qualitative study

Background and objectiveVoluntary blood donations remain a major concern in the Democratic Republic of Congo, increasing morbidity and mortality due to shortages of safe blood. Local studies show low rates of recruitment and retention of voluntary donations, as well as a high attrition rate of former donors. The psychosocial factors involved in deciding to become and remain a voluntary blood donor in sub-Saharan Africa remain poorly understood. Our study therefore aimed to explore the motivational factors and perceptions involved in voluntary blood donation in South Kivu.Materials and methodsWe conducted 20 individual interviews, and three focus group discussions were conducted with a total of 26 volunteer donors. As a way of triangulation, two additional focus-groups were held with 19 non-donors. The individual interviews were analysed thematically, using a starting list of 3 predefined units of analysis, namely: initiation, maintenance, and cessation of voluntary blood donation. The data was analysed inductively within these predefined units of analysis to generate possible factors of motivation that were then presented and further discussed during the focus-groups discussions with donors and non-donors.ResultsFear presented as a factor influencing the decisions to donate blood either positively or negatively, from recruitment to maintenance to cessation of donation. Other motivational factors were found to be linked to the perceived meaning of voluntary donation, such as the meaning given to the blood voluntary donation and material or non-material expectations. Our results suggest that expectations for material rewards are still high in the context of poverty.ConclusionIn conclusion, many motivational factors may act as incentives or barriers to voluntary blood donation, including high expectations towards the transfusion system. Local particularities need to be considered when promoting voluntary blood donation. The fear of being abused by the system needs to be addressed, by enhancing accessibility to transfusions.

Appropriate Blood Usage and Adherence to Guidelines in Orthopaedic Patients Managed at Moi Teaching and Referral Hospital, Eldoret, Kenya

Blood transfusion is required in the management of life threatening orthopaedic trauma hemorrhage. However, this practice is faced with erratic supply, increasing demand for safe blood and inappropriate transfusions which may expose patients to transfusion associated risks. Appropriate use of blood and related products as well as adherence to transfusion guidelines has been shown to ameliorate these challenges. This study set out to determine the appropriate blood and blood components usage and adherence to guidelines in orthopaedic patients managed at Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya. Descriptive cross-sectional study design was and involved 132 transfused orthopedic trauma patients, recruited by consecutive sampling, between March 2019 and January 2020. Data was collected using interviewer administered structured questionnaire. Continuous data were summarized as median (inter-quartile range) and categorical data as frequency tables and proportions. Fisher’s Exact Test was used to assess associations between categorical variables and non-parametric Kruskal-Wallis Test was used for continuous independent variables. A p value &lt; 0.05 was considered statistically significant. The results: Males were 101 (76.5%), median age was 36 (IQR 28, 47) years, majority of the patients, 95 (72%) were referrals, 64 (48.5%) were unskilled workers and 64 (48.5%) had primary school level of education. Most of the patients, 105 (79.5%) were injured in road traffic accidents. Most patients, 105 (79.5%) and 115 (87.1%) had normal pulse rate and systolic blood pressure respectively while 77 (58.3%) had increased respiratory rate. The median pre-transfusion haemoglobin was 8.90 (IQR 7.98, 10.35) g/dl and the commonest blood group was O positive. Patients with isolated femur fractures were 62 (47.0%). Patients who underwent primary open reduction and internal fixation were 61(46.2%). Majority of the patients, 127 (96.2%) received packed red blood cells. The proportion adherent to transfusion guidelines was 16.7% [95% CI: (10.75, 24.14)]. The factors associated with adherence were pre-transfusion haemoglobin and haematocrit levels, Fisher’s Exact and Kruskal-Wallis p value being &lt; 0.001. Mild transfusion reactions were noted in 15 (11.4%) patients. Conclusions made were that most patients were males, transfused with packed red blood cells and majority of injuries sustained were due to road traffic accidents. The level of adherence to the institutional transfusion guidelines was low at 16.7%. Factors associated with transfusion guidelines adherence were pre-transfusion haemoglobin and haematocrit levels. The recommendation was that Moi Teaching and Referral Hospital Transfusion Committee should increase transfusion guidelines awareness among clinicians in orthopaedic trauma.

P1116 Imaging of CCR9 in the small bowel of patients with Crohn’s disease: effects of the CCR9-depleting monoclonal antibody AZD7798

Abstract Background Management of patients with small bowel Crohn’s disease (SBCD) remains challenging due to limited efficacy from current therapeutic options. AZD7798 is a first-in-class monoclonal antibody for CD that depletes CCR9+ lymphocytes, with potential for targeted treatment of SBCD given the critical role that CCR9 plays in lymphocyte homing to the small bowel. Monitoring CCR9+ cell depletion and repletion in the blood is straightforward, but difficult in the small bowel due to accessibility for biopsy. Here we use positron emission tomography (PET) with a novel CCR9-specific PET tracer, [11C]vercirnon, to assess the ability of AZD7798 to deplete CCR9+ cells in the intestines of healthy volunteers and patients with SBCD. Methods We performed an open-label phase 1b study to evaluate the effects of single and repeat intravenous doses of AZD7798 on intestinal [11C]vercirnon uptake in healthy volunteers and patients with SBCD (NCT06053424). Additional endpoints were safety and pharmacodynamics in blood (CCR9 cell depletion). PET imaging using [11C]vercirnon was performed prior to AZD7798 dosing and at 2 follow-up timepoints, approximately 2 and 6 weeks post dosing. Results A total of 6 healthy (aged 25-64 years, 4 female) and 6 SBCD participants (aged 24-59 years, 4 female) completed the study. There were no major adverse tolerability or safety findings following single or repeat doses of AZD7798. Mild cytokine release syndrome (CTCAE Grade 1) was observed after first doses, but not after second doses in the repeat dose cohort. There were no serious adverse events or treatment discontinuations due to adverse events. In 4 out of 6 SBCD participants, PET imaging showed a quantitative reduction in [11C]vercirnon uptake of up to 21.6% (median 11.5%) in the intestines at 6 weeks following single (n = 3 out of 4) and repeat (n = 1 out of 2) IV doses of AZD7798 (Figure 1). Rapid, profound and sustained CCR9+ cell depletion was observed in blood in all healthy and SBCD participants (Figure 2). Conclusion The use of a CCR9-specific PET tracer has enabled repeatable, non-invasive quantification of CCR9 expression in the gut. Preliminary evidence of intestinal CCR9+ cell depletion in patients with SBCD following single and repeat doses of AZD7798 was provided. The study demonstrates the value of molecular imaging for understanding treatment effect in the target tissue in vivo. An ongoing PET imaging study will assess the effects of AZD7798 on CCR9+ cell depletion/repletion in the gut following multiple doses, alongside Phase 2 studies evaluating the clinical efficacy of AZD7798 in moderate-to-severe Crohn’s disease.

Distribution of ABO and Rhesus Blood Groups among Blood Donor Attending Transfusion Medicine Department of Chattagram Maa-O-Shishu Hospital Medical College

Introduction: The ABO blood group system was the first human blood group system to be discovered by Karl Landsteiner in 1900. Next to ABO, Rhesus system the second most significant blood group system. Blood group is applied to the genetically determined antigen which can be detected on the red cell surface of an individual by specific antibody. The aim of this study to examine the distribution patterns of ABO and Rh-D blood group among the blood donor attending at Transfusion Medicine Department in CMOSH. It is helpful to increase social awareness among the population and maintain safe blood transfusion to patient. Materials and methods: It was a cross sectional study conducted in the Department of Transfusion Medicine,Chattagram Maa O Shishu Hospital Medical College, from January to December 2022. After proper ethical consideration a total of 7,289 blood donors were included in this study. ABO and Rh blood groupings were carried out in our blood bank by standard tile techniques. Results: Among 7,289 blood donors male blood donors were 6,936(95.15%), female blood donors were 353(4.84%).2,775 (38.07%) blood donor were identified as having blood group B while 2,185 (29.97%) were blood group O, 1702( 23.35%) and 627(8.6%)were blood group A and AB respectively. Rh-D positive were 6,960(95.48%) and Rh-D negative were 329(4.51%). Conclusion: The knowledge of ABO and Rhesus D blood group is important in blood transfusion service.Study of blood grouping not only generates a simple database but also create a great social awareness about self-blood grouping and safe blood transfusion among the population of a country. Chatt Maa Shi Hosp Med Coll J; Vol.23 (1); January 2024; Page 52-55

New Pathogens in Blood Donors and Patients in Albania

Introduction: The emergence of novel pathogens poses a significant and immediate threat to global blood safety, particularly in regions experiencing epidemiological shifts. This study urgently examines the prevalence and impact of newly identified pathogens among blood donors and recipients in Albania, focusing on assessing their implications for public health and transfusion medicine. Results revealed a prevalence of new pathogens among donors and patients, highlighting the potential risk of transmission through blood transfusion. Travel history, socioeconomic status, and urban-rural disparities significantly influenced pathogen prevalence. This study underscores the urgent need for enhanced screening protocols and public health interventions to mitigate the risks associated with emerging pathogens. Our findings contribute to a growing body of evidence emphasizing the crucial role of continuous surveillance and adaptive strategies in transfusion medicine to ensure blood safety and protect vulnerable populations in Albania and beyond. Conclusion: The study highlights the presence of emerging pathogens in blood donors and patients in Albania, underscoring their potential to significantly impact blood safety and public health. The findings emphasize the necessity for improved screening protocols, continuous epidemiological surveillance, and targeted public health interventions to address the risks associated with these pathogens. Adopting adaptive strategies in transfusion medicine is critical to safeguarding the health of donors and recipients in the region.

Prevalence and risk factors evaluation for transfusion-transmissible infections among blood donors from Shiyan, China.

Transfusion-transmissible infections (TTIs) are severe threats to blood safety and public health. A retrospective study of blood donor records from 2015 to 2019 in Shiyan, China, was conducted. TTI prevalence was analyzed using ELISA, RT-PCR, and demographic data. Chi-square test and logistic regression were used to analyze incidence trends and associations for HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), and Treponema pallidum (T. pallidum). Of 230,225 donors, 2,453 (1.07 %) were TTI-positive. HIV, HBV, HCV, syphilis rates were 0.08 %, 0.40 %, 0.19 %, 0.40 %. Significant decreases in HBV, HCV, T. pallidum from 2015 to 2019; HIV decreased from 2018 to 2019. The prevalence is higher among women aged 35-60, farmers with T. pallidum and young female students with HIV infection. Despite the relatively low prevalence of TTIs at present, awareness of TTIs and ongoing blood screening are still needed to ensure blood safety.

Blood donation and post donation care: A clinical update

Donating blood is an essential component of healthcare systems, and it is imperative to administer adequate post-donation care to donors in order to safeguard their health and maintain the blood supply's safety. This brief offers a succinct outline of crucial suggestions for persons who have made a blood donation. After receiving a donation, the initial treatment usually involves taking rest, staying hydrated, and having a light meal to replenish blood volume and glucose levels. Adequate fluid intake is crucial for preventing dehydration and promoting the restoration of blood volume. In order to maintain the health and safety of blood donors and guarantee the excellence of donated blood, recommendations frequently advise following dietary limitations, which may include refraining from alcohol and restricting caffeine use. It is highly recommended to cease smoking, as it enhances general well-being and increases the amount of oxygen in the bloodstream. Donors should vigilantly observe the donation location for any unusual symptoms and promptly seek medical aid if needed. Long-term care prioritizes maintaining good physical well-being by promoting a balanced diet, regular physical activity, and adequate rest. Regular blood donors, particularly women, may require iron supplements to avoid iron deficiency anaemia. Donors must strictly adhere to the recommended time intervals between donations in order to maintain blood safety and prevent donor exhaustion. Adhering to post-donation obligations is essential for the well-being of donors, guaranteeing the security of the donated blood, and promoting ongoing blood donation. The objective of present review is to optimise the donor recovery process, mitigate any adverse consequences, and ensure the continuous availability of a safe blood supply for patients in need.

Advancement of the Dragon Heart 7-Series for Pediatric Patients With Heart Failure.

Safe and effective pediatric blood pumps continue to lag far behind those developed for adults. To address this growing unmet clinical need, we are developing a hybrid, continuous-flow, magnetically levitated, pediatric total artificial heart (TAH). Our hybrid TAH design, the Dragon Heart (DH), integrates both an axial flow and centrifugal flow blood pump within a single, compact housing. The axial pump is embedded in the central hub region of the centrifugal pump, and both pumps rotate around a common central axis, while maintaining separate fluid domains. In this work, we concentrated our design and development effort on the centrifugal blood pump by performing computational modeling. An iterative process was employed to improve the DH design. The pressure generation, scalar stress levels, and fluid forces exerted on the magnetically levitated impellers were computationally estimated. A shaft driven centrifugal prototype was also manufactured and tested using a hydraulic flow loop circulating a water-glycerol blood analog. Pressure and flow performance of the pump prototype was measured for a given rotational speed for comparison to computational predictions. Our design achieved the target pump pressures of 60-140 mm Hg for flow rates of 1-5 L/min, and strong agreement in pressure rise was demonstrated between the experimental data and simulation results (less than 10% deviation on average). Fluid stress levels were, however, found to exceed thresholds in the outflow region of the pump, and fluid residence times were less than 600 ms. The findings of this work demonstrate that the more compact, next-gen DH's centrifugal pump design is able to achieve pressure-capacity requirements. Next steps will require a focused strategy to reduce hemolytic potential and to integrate magnetic suspension components for full rotor levitation.

Correlation of cyclosporine A blood concentration with kidney injury for pediatric patients after hematopoietic stem cell transplantation: a retrospective cohort study.

The potential nephrotoxicity of cyclosporine A (CsA) has been a problem for treating graft-versus-host disease (GVHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT). However, the relationship between CsA blood concentration and acute kidney injury (AKI) in pediatric patients after allo-HSCT remains unclear. We performed a retrospective study including pediatric patients who received allo-HSCT in West China Second Hospital of Sichuan University from 2000 to 2022 and collected their clinical data. Included patients' CsA blood concentration were divided into three cohorts according to the guideline. Multivariate logistic regression was used to estimate the relationship between AKI and CsA blood concentration and other factors. And the maximum cut-off value for the safe blood concentration range of CsA was obtained by the receiver operating characteristic (ROC) curve. Seventy-nine patients (average age 6.75 ± 4.25) were included. The incidence of kidney injury for three CsA blood concentration cohorts (< 200ng/ml, 200-300ng/ml, > 300ng/ml) were 21.30%, 23.50%, and 66.70%, respectively. A multivariate logistic regression identified CsA blood concentration (> 300ng/ml) and infection were risk factors for AKI (OR <200ng/ml: 0.115, 95% CI: 0.029-0.458; OR 200-300ng/ml: 0.184, 95% CI: 0.036-0.929; OR infection: 5.006, 95% CI: 1.491-16.810). Meanwhile, the maximum cut-off value for the safe blood concentration range of CsA is 276.85ng/ml with an AUC value of 0.684 (P = 0.010). In conclusion, clinical treatment for the pediatric patients after allo-HSCT may be considered to control the blood concentration of CsA in 200-276.85ng/ml and closely monitoring patients who have infections.

Dissolving microneedle synergistic rocaglamide-loaded liposome to regulate abnormal neutrophils for anti-psoriasis.

Psoriasis seriously affects the physical and mental health of patients. Rocaglamide (RocA), derived from Aglaia odorata, exhibits potent pharmacological activities. Although its efficacy in psoriasis is unclear, RocA could be a promising therapeutic drug. In this work, RocA showed a good therapeutic effect in psoriasis mice induced by imiquimod, and subsequent TMT-based proteomics analysis verified that the effect of RocA was related to IL-1 family cytokines. Furthermore, a RocA-loaded liposome (RocA@Lipo) was developed and encapsulated in the tip-layer of microneedles (MNs) to construct a MN-based nano drug delivery system (RocA@Lipo-MNs). In vitro HaCaT cell assays demonstrated that RocA@Lipo enhanced the cytotoxicity and cell uptake of RocA. In vivo, RocA@Lipo-MNs outperformed other RocA formulations in inhibiting psoriasis epidermal thickening and spleen enlargement. Immunohistochemical, ELISA, western blot, and PCR experiments further proved that RocA@Lipo-MNs could inhibit neutrophil infiltration in the skin, revealing that the anti-psoriasis mechanism of RocA was deemed to inhibit the binding of IL-1α and IL-1R1 to regulate the activation of MAPK and NF-κB pathways. Thus, the production of inflammatory factors and neutrophil chemokines was reduced, which was associated with apoptosis inhibition. Importantly, RocA@Lipo-MNs significantly improved the transdermal properties of RocA and exhibited good skin and blood safety. This work provides new ideas for the clinical application of RocA and the treatment options for psoriasis.

Performance Validation and Blood Donation Analysis in Nagqu, Tibet, One of the Highest Cities in the World.

Due to the unique geographical and climatic conditions in Nagqu (Tibet), the blood station laboratory was only fully established and accredited by 2020. This study validated the performance of the laboratory's blood screening system and analyzed recent trends in blood donation and screening effectiveness. Various serum samples were used to assess the performance of hepatitis B, hepatitis C, HIV, and syphilis tests, both serological and nucleic acid tests. Donation data were also collected and analyzed. Serological testing demonstrated excellent sensitivity, specificity, and reproducibility (all 100%), with detection limits for HBsAg, HCV Ab, HIV-1 Ab, HIV-1 p24, and TP Ab of 0.2 IU/mL, 0.013 NCU/mL, 0.25 NCU/mL, 1.25 U/mL, and 1.5 mIU/mL, respectively. Nucleic acid testing systems also achieved 100% reproducibility with precision below 5%. PROBIT analysis revealed the 95% detection limits for HBV DNA, HCV RNA, and HIV-1 RNA as 8.29, 97.14, and 40.52 IU/mL, respectively. The study also found a high rate of unqualified donations for local markers such as ALT, HBsAg, syphilis, and HBV DNA. The validation confirmed the screening system's high sensitivity, specificity, and reproducibility, highlighting the importance of effective predonation checks to ensure a safe blood supply in high-altitude areas.

An Integrated Supply Chain Model for Predicting Demand and Supply and Optimizing Blood Distribution

Background: The blood supply chain (BSC) is crucial for providing safe and sufficient blood, but it faces numerous challenges and needs to be robust and resilient. This study provides a comprehensive model for managing and optimizing the BSC in real-world scenarios, including emergency and routine circumstances and with consideration of health equity concepts. Method: Classic time-series models are applied to predict future supply chain circumstances, addressing uncertainty in blood demand and the need for timely supply. A structured framework and medical preferences are prioritized to optimize distribution, minimize blood shortages, minimize wastage due to expiry, and maximize blood freshness. Genetic algorithms (GA) and particle swarm optimization (PSO) are used to solve mathematical models quickly and efficiently, ensuring reliable operation. Result: The model’s outcomes can effectively meet the daily needs of the BSC and assist decision-makers managing blood inventory and distribution, improving robustness and resilience. Conclusions: Utilizing weights allows for the effective management of each objective function to convert the model into a single-objective mixed-integer linear programming (SO-MILP) based on unique conditions, enabling the system to self-adjust for optimal performance, boosting the sustainability of the blood supply chain, and promoting the principle of health equity under diverse real-world settings.

Combining Cleaning and Disinfection – An Alternative Approach for Preventing the Contamination of Blood Products

Aim: Disinfection products and protocols have been devised to provide safe blood and blood derivatives for transfusion; however, sepsis is still the leading cause of transfusion reaction fatalities. This raises the question whether disinfection on its own is sufficient for preventing such outcomes and whether cleaning of the arm prior to disinfection can further reduce the amount of skin commensals responsible for the contamination of blood products. Methodology: One of the blood donor’s arms was disinfected according to the standard protocol and swabs were taken before and after disinfection (Scenario 1). The other arm was cleaned with a hypoallergenic soap-free and alcohol-free wipe and then disinfected (Scenario 2). Swabs from this arm were taken before cleaning, after cleaning and after disinfection. Tryptone soya agar plates were inoculated and incubated at a temperature which facilitates bacterial and fungal growth. Results: A rate reduction was set and plates that failed this criterion were due to coagulase negative staphylococci. The commonest bacteria identified was Staphylococcus epidermidis. Less fungi were isolated on the after-disinfection plates that failed disinfection and these were Penicillium sp. and Cladosporium sp. Resultant colony counts from both Scenarios were statistically analysed and resulted in a significant reduction of bacterial colony counts post disinfection; however, the after disinfection plates of Scenario 2 had a lower average of colony counts than Scenario 1. Cleaning the skin prior disinfection resulted in a significant reduction of bacterial colony count and leading to a higher average of bacterial reduction in Scenario 2 than Scenario 1. Although Scenario 2 had a reduction rate of 98.3% which was more than that of Scenario 1 which had a reduction rate of 97.5%, there was no statistically significant difference (P=0.293) between the outcomes. Conclusion: Cleaning the skin prior to disinfection reduces the bacterial load on the skin which makes the disinfection process more effective and reduces the probability of contamination of blood products.

Quantifying the impact of a novel virus on the economic value of pathogen reduction technology for platelets.

Pathogen reduction technology (PRT) is an intervention designed to proactively reduce the amount of known and unknown pathogens in donated blood. As current screening for known pathogens is highly effective, some previous evaluations have found that the value of PRT largely hinges on a previously unknown pathogen, most likely a novel virus, emerging and entering the blood supply. In such situations, the risk of emergence can and should be modeled and presented transparently in the cost-effectiveness results for deliberation by decision-makers. We built a Markov cohort model assessing the economic value of introducing PRT for platelets in the United Kingdom. Input data were obtained from the existing PRT literature, national sources, or by conservative assumption. The primary objective of the study was to demonstrate methods for modeling and presenting the risk of emergence of a novel virus, using alternative time-to-emergence scenarios in the probabilistic sensitivity analysis. As expected, PRT will be more cost-effective the sooner the novel virus emerges after the introduction of PRT. In the base-case cost scenario, the deterministic ICER was £270 K/QALY gained if the virus emerged immediately and rose to £3.3 M/QALY gained if the virus emerged after 25 years. At current prices, PRT is unlikely to be cost-effective when judged against thresholds for medicines and treatments. Given significant additional willingness-to-pay for blood safety, PRT is only likely to be cost-effective if a novel virus that causes chronic infection with significant morbidity and mortality emerges very soon after the introduction of PRT.

COMPARISON OF EFFICACY AND SAFETY OF RANOLAZINE AND IVABRADINE IN CHRONIC ISCHEMIC HEART DISEASE PATIENTS

Background: Ischemic heart disease (IHD) frequently produces persistent angina that may significantly impair quality of life despite standard treatment. There is need for effective adjunctive therapies to manage refractory angina. Ranolazine and Ivabradine are two potential options that have shown efficacy in alleviating angina symptoms and improving quality of life in IHD patients. Methods: Ethical clearance was obtained from hospital ethical committee before initiation of study. Those patients fulfilling study inclusion criteria were enrolled. Written informed consent was obtained from all the patients. This randomized clinical trial enrolled patients from the Department of Cardiology, PIMS Hospital, Islamabad. The information regarding demographic and baseline patient characteristics were recorded. Patients were randomly assigned into two groups by lottery method. Treatment group (group A) was Ranolazine 500 mg tablets twice daily for 8 weeks plus standard treatment while the Placebo group (group B) was Ivabradine 5 mg tablets twice daily for 8 weeks plus standard treatment. The primary outcome of study was improvement in angina as assessed by SAQ. Other outcomes like hemodynamic stability (heart rate and Blood pressure) and associated side effects were also recorded at 2, 4, 6, and 8 weeks after the start of treatment in both the study groups. The collected data was analyzed by using SPSS 23 version. Results: The mean age of patients in Group A was 64.59±5.47 years and in Group B were 65.41±5.95 years. In Group A 36(78.3%) patients were male and 10(21.7%) patients were female and in Group B 38(82.6%) patients were male and 8(17.4%) patients were female. The baseline score of SAQ in Group A and Group B was as (41.93±4.23 vs 43.24±4.44) and at 8 week as (90.98±3.12 vs 81.48±2.52). Ranolazine had better clinical outcome than Ivabradine for the treatment of persistent angina in patients with chronic stable ischemic heart disease in terms of SAQ score, systolic &amp; diastolic blood pressure and safety profile. Conclusion: This study concluded that Ranolazine in comparison to Ivabradine has better clinical outcomes in terms of efficacy &amp; safety in patients with chronic IHD who had persistent symptoms.

Medication Changes After Renal Denervation: Current Evidence and Patient Perspectives.

Renal denervation (RDN) is recognized as an adjunct therapy for hypertension management with a favorable and consistent blood pressure-lowering efficacy and safety profile. Alteration in medication burden is another noteworthy outcome of RDN for clinicians and patients. In this review, we summarized current clinical trials and patient perspectives, focusing on the use of antihypertensive medication (AHM) after RDN. The results of randomized controlled trials demonstrated that patients undergoing RDN exhibited lower blood pressure levels with a similar AHM burden or similar blood pressure levels with fewer AHMs than the sham control group. In studies with follow-ups of ≤6 months, AHM use increased or remained generally consistent in patients undergoing RDN, which may be attributed to the prespecified study process. In studies with follow-ups of >6 months, the blood pressure-lowering efficacy of RDN was consistent with a decreasing or similar AHM burden compared with baseline conditions, except for the 36-month results in the SPYRAL HTN-ON MED (Safety and Efficacy of Renal Denervation in Patients Taking Antihypertensive Medications) trial. Huge gaps exist between current evidence on medication changes after RDN and patient expectations, which may be addressed through adequate communication in a shared decision-making process and further improvement of the RDN procedure. Moreover, novel evaluation methodologies for assessing medication burden changes, incorporating adherence to AHMs and modifications in drug classes, may be required to evaluate the impact of RDN on medication usage in the future.