Impact of COVID-19 outbreak on the blood donation and utilization and strategies adopted to combat it in a tertiary care center of Jammu province

Background: The COVID-19 pandemic has major implications for blood transfusion. There are uncertain patterns of demand, and transfusion institutions need to plan for reductions in donations and loss of crucial staff because of sickness and public health restrictions. A range of strategies need to be planned to maintain ongoing equitable access to blood for transfusion during the pandemic, in addition to providing new therapies such as convalescent plasma. The main role of transfusion institutions during this period, is the monitoring of supply and demand so that sufficient blood stocks are maintained to support ongoing critical needs. The main aim of our study was to study the impact of COVID-19 outbreak on blood transfusion services (BTS) and to identify the challenges faced by our blood center and mitigation strategies adopted to combat it.Methods: Total number of donations and total number of blood and its components issued were noted from the donor and issue registers respectively, both during the pre-COVID and COVID-19 pandemic and the results were compared thereafter. Various strategies were adopted during the COVID pandemic in order to maintain balance between demand and supply of blood and its products.Results: There has been sudden decrease in the number of blood donations in the month of April 2020 (35%) in the COVID pandemic as compared to pre-COVID time with percentage difference of 65%. This was followed by gradual decrease in the no. of donations in COVID pandemic when compared with donations in the pre-COVID time. The percentage difference in blood donation gradually improved over a period of time from 65% in April 2020 to 7% in April 2021. Similarly, no. of blood units issued also decreased from 1147 in April 2019 to 553 units in April 2020.Conclusions: The BTS need to provide an uninterrupted blood supply, and this stays true even in the face of a pandemic. The plan of action has to be started early so that the supply can be maintained and monitored effectively. Health-care workers being one of the main pillars in the fight against COVID-19 have to be supported and protected.

The Evolution of Asymmetries in the Tropical Cyclone Boundary Layer Wind Field during Landfall

The evolution of the tropical cyclone boundary layer (TCBL) wind field before landfall is examined in this study. As noted in previous studies, a typical TCBL wind structure over the ocean features a supergradient boundary layer jet to the left of motion and Earth-relative maximum winds to the right. However, the detailed response of the wind field to frictional convergence at the coastline is less well known. Here, idealized numerical simulations reveal an increase in the offshore radial and vertical velocities beginning once the TC is roughly 200 km offshore. This increase in the radial velocity is attributed to the sudden decrease in frictional stress once the highly agradient flow crosses the offshore coastline. Enhanced advection of angular momentum by the secondary circulation forces a strengthening of the supergradient jet near the top of the TCBL. Sensitivity experiments reveal that the coastal roughness discontinuity dominates the friction asymmetry due to motion. Additionally, increasing the inland roughness through increasing the aerodynamic roughness length enhances the observed asymmetries. Lastly, a brief analysis of in-situ surface wind data collected during the landfall of three Gulf of Mexico hurricanes is provided and compared to the idealized simulations. Despite the limited in-situ data, the observations generally support the simulations. The results here imply that assumptions about the TCBL wind field based on observations from over horizontally-homogeneous surface types - which have been well-documented by previous studies - are inappropriate for use near strong frictional heterogeneity.

Perioperative Anesthetic Management in Preterm 12 Days Infants with Giant Meningoencephalocele at Mid Occipital and Secondary Trigonocephaly

Introduction: A meningoencephalocele is herniation of neural element along with meninges through a congenital defect in cranium. The incidence of encephalocele is approximately 1/5000 live births; occipital encephalocele is more common in females than males. It is called as giant meningoencephalocele when the head is smaller than the meningoencephalocele. These giant meningoencephaloceles harbor a large amount of cerebrospinal fluid (CSF) and brain tissue, so there occur various surgical challenges and anesthetic challenges in positioning and intubation. Case: A 12 days neonate was consulted to the neurosurgery department with complaints of large swelling over the back of head and difficulty in feeding. She was diagnosed with ventriculomegaly and meningoencephalocele since 32-33 pregnancy. The swelling was small at the time of birth, but it gradually increased in size. The child was born by section caesarean because of fetal distress and meningoenchepalocele. The neonate current weight was 3.195 grams with Post Conceptional Age (PCA) 35-36 weeks. On examination, the patient large spherical swelling was present over occipital region and there was no head control. The patient was active, conscious with no impression of focal neurological deficit. Systemic examination was unremarkable. The head circumference was 30 cm and circumference of occipital swelling was 40 cm. Potential problems in this patient include preoperative preparation and optimization of general condition, difficulty in positioning the patient, difficult airway (intubation), periodic apnea and potential hemodynamic disturbances and a sudden decrease in intracranial pressure during cele resection. Conclusion: Perioperative management in this case started from preoperative to postoperative evaluation. Preoperative preparation in anticipation of airway difficulties and communication with the operator is very important. Appropriate anesthetic techniques should aim to maintain stable hemodynamics and oxygenation and prevent a sudden increase or decrease in intracranial pressure.

Vitrectomy With Peeling the Internal Limiting Membrane for the Treatment of Macular Hole Following Ruptured Retinal Arterial Macroaneurysm: A Case Report

Background: This study aimed to report a case of vitrectomy with peeling the internal limiting membrane for the treatment of macular hole (MH) following ruptured retinal arterial macroaneurysm (RAMA).Case Presentation: A 65-year-old woman noticed a sudden decrease in vision in the left eye. She had no other ocular problems apart from a mild cataract in both eyes before. Her best-corrected visual acuity (BCVA) was 20/33 in the right eye, and 6/100 in the left eye. Fluorescein angiography (FFA) showed a retinal arterial macroaneurysm with telangiectatic retinal vascular changes in the inferior temporal macular region. Optical coherence tomography (OCT) examination demonstrated the presence of subretinal hemorrhage extending into the foveal area and incomplete posterior vitreous detachment. Because of the presence of submacular hemorrhage, some medicine was administrated and the patient was followed up. Then, 5 months later, the hemorrhage was absorbed. OCT examination exhibited a full-thickness MH with a macular epiretinal membrane. The size of the MH was 722 μm in diameter. She was then given a standard three-port pars plana vitrectomy (PPV), along with peeling of the internal limiting membrane (ILM) and filling the vitreous cavity with air. Anatomic closure of the MH was achieved after 4 weeks of the surgery by the examination of OCT. The BCVA was improved to 15/100.Conclusions: This case expanded our knowledge of the association of MH secondary to ruptured RAMA. We reported a case with successful surgical closure of the MH and improvement of BCVA.

The interplay between unexpected events and behavior in the development of explicit knowledge in implicit sequence learning

Some studies in implicit learning investigate the mechanisms by which implicitly acquired knowledge (e.g., learning a sequence of responses) becomes consciously aware. It has been suggested that unexpected changes in the own behavior can trigger search processes, of which the outcome then becomes aware. A consistent empirical finding is that participants who develop explicit knowledge show a sudden decrease in reaction times, when responding to sequential events. This so called RT-drop might indicate the point of time when explicit knowledge occurs. We investigated whether an RT-drop is a precursor for the development of explicit knowledge or the consequence of explicit knowledge. To answer this question, we manipulated in a serial reaction time task the timing of long and short stimulus-onset asynchronies (SOA). For some participants, the different SOAs were presented in blocks of either long or short SOAs, while for others, the SOAs changed randomly. We expected the participants who were given a blocked presentation to express an RT-drop because of the predictable timing. In contrast, randomly changing SOAs should hamper the expression of an RT-drop. We found that more participants in the blocked-SOA condition than in the random-SOA condition showed an RT-drop. Furthermore, the amount of explicit knowledge did not differ between the two conditions. The findings suggest that the RT-drop does not seem to be a presupposition to develop explicit knowledge. Rather, it seems that the RT-drop indicates a behavioral strategy shift as a consequence of explicit knowledge.

Two Different Descriptions of a Thermocline in the Persian Gulf

The Persian Gulf (PG) is a shallow sea connected to the rest of the world by the Strait of Hormuz. Temperature changes in the water column, which indicate the thermocline, are typically explained by the depth of the mixed layer and the thermocline. The thermocline is caused by a sudden decrease in temperature in the water column's subsurface layer, resulting in stratification in the PG from winter to summer. The parameters are approximated numerically through the Princeton Ocean Modeling (POM) method and compared to those determined by some CTD profiles collected in the PG. The most obvious method for approximating thermocline depth is to find the maximum negative slope \(\frac{\partial T}{\partial z}\) in a temperature profile. The method produces applied results with sufficient depth resolution and smooth temperature changes with depth. This method is a component of the Princeton Ocean Modeling (POM) framework for numerically modeling temperature variation in the water basins used in this study. The depth of the mixed layer is approximated by the surface equality temperature (Sea Surface Temperature), regardless of the thermocline approximation. The variable isotherm behavior accurately approximates the thermocline depth. Thermocline formation occurs in the PG during the summer, and this article will conclude using two methods, observational and numerical modeling.

A Pilot Study on the Degree of Tooth Staining Caused by Pollen Water and Chlorhexidine: In Vitro Study

Background: Chlorhexidine oral rinse has been used as an adjuvant in the treatment of periodontal disease. However, there are drawbacks of using chlorhexidine i.e. tooth staining and other side effects, including allergy reaction. In light of the proven therapeutic properties of pollen water as well as its relatively cheap cost in the market, pollen water has a potential to be an effective alternative to chlorhexidine oral rinse. The aim of this study is to compare the degree of tooth staining influenced by water-based pollen mouthwash to the standard Chlorhexidine mouthwash using spectrophotometer. Materials and Methods: 24 specimens from extracted intact human teeth were soaked into the three different solutions, Chlorhexidine, Pollen water (date palm pollen water suspension), and normal water. Color measurements were carried out by a spectrophotometer devise and recorded at 5 different time intervals. Color change (∆E), Chroma (C*) and Hue (H*) were analyzed and compared among the three solutions. Results: Overall mean ∆E was similar in all groups, significant difference between all time points was found only in pollen water. The change in C* was higher in pollen water as compared to other solutions. There was a subtle increase in H* in the Chlorhexidine samples after week 3. The H* values in pollen water were stable, but a sudden decrease was observed in week 6. The difference in H* among the three solutions was significant after 3 weeks. Conclusion: Within the limitation of our study, it can be concluded that Pollen water stained teeth to a lesser extent than did chlorhexidine. It might be beneficial to use Pollen water as mouthwash however, further investigation is needed regarding the efficacy of plaque control.

Mural Endocarditis and Embolic Pneumonia Due to Trueperella pyogenes in an Adult Cow with Ventricular Septal Defect

Bacterial endocarditis represents one of the most frequently acquired cardiac diseases in adult cattle. Congenital heart diseases as a ventricular septal defect can facilitate bacterial endocarditis as a consequence of turbulent blood flow through the defect, causing damage to the endocardium. We describe a case of mural endocarditis associated with a ventricular septal defect in an eight-year-old female Holstein Friesian cow. The cow’s history revealed that she had presented dysorexia and a sudden decrease of milk production in the last 10 days prior to the examination. On clinical examination, jugular pulses, tachycardia with irregular heart rate and tachypnea with harsh bronchovesicular sounds were evident. Electrocardiographic examination allowed the diagnosis of an atrial fibrillation with high ventricular response rate. Transthoracic echocardiography revealed a large vegetation originating from the endocardium between the tricuspid and pulmonic valves in the right ventricle outflow. On post-mortem examination, a small muscular septal defect under the right coronary cusp of the aortic valve and a mural vegetative endocarditis were found. An abscess in the chondro-costal junction of the third right rib and metastatic pneumonia were also observed. This case report describes a rare consequence of a small ventricular septal defect that had not been previously diagnosed in an adult cow.

Urban Biodiversity in Pre- and Post-Social Isolation Times: A Case Study of the Public Squares on the City of Sorocaba, SP, Brazil

The environmental range has long been neglected. Species that play crucial roles for the good functioning of the planet have their activities jeopardized by human ignorance, but the emergence of a zoonotic disease (COVID-19) in December 2019 turned attention to an atypical fact: previously uncommon animals seen in urban environment began to frequent them looking for resources, this is due to the measures of confinement, distance and social isolation adopted in order to contain the spread of the virus. In this work, public squares located in the city of Sorocaba, inlands of São Paulo, were studied, regarding the richness of species, bioindicator groups (birds, butterflies and dragonflies) in three different periods: before the social isolation system coming into effect, during and after it, to analyze whether such measures had an influence on urban biodiversity. The Sorensen and Cluster (Jaccard estimator) analytics methods, Non-metric Multidimensional Scaling (nMDS) and One-Way ANOVA variance analysis showed that, with the reclusion of the citizens, there were no significant difference in species abundance in the sampled locations during the three periods, but the lockdown was marked by the illustrious presence of a rare species butterfly (Greta oto [Hewitson 1854]), unregistered in previous surveys carried out in the municipality. It could be concluded that, although the functioning of urban ecosystems is intrinsically linked to human presence, the sudden decrease in the circulation of people and vehicles has had positive consequences for the environment richness inserted in cities.

Vitreous hemorrhage: A rare ophthalmic adverse effect due to imatinib treatment

Introduction Imatinib is generally well tolerated by patients. The most common ophthalmic side effects are eyelid edema and periorbital edema. Other side effects which occur at rates of <1% include blepharitis, blurred vision, conjunctival hemorrhage, conjunctivitis, retinal hemorrhage, etc. An uncommon case is here reported of a 51-year-old male with chronic myeloid leukemia who developed vitreous hemorrhage due to imatinib after 9 months of treatment. Case report A 51-year-old male with leukocytosis detected in the blood test examination was referred to the Hematology Department. The bone marrow biopsy result was compatible with chronic myeloid leukemia. Imatinib treatment (400 mg/day) was started. In the ninth month of imatinib treatment, the patient complained of a sudden decrease in vision. Vitreous hemorrhage was detected in the left eye and the patient underwent surgery. Vitreous hemorrhage recurred 1 month after the operation. On the fourth day after the discontinuation of imatinib treatment, the patient's ophthalmic complaints improved significantly. The Naranjo algorithm was applied and a score of 9 was detected. The vitreous hemorrhage of the patient was attributed to imatinib, and so the treatment of the patient was switched to bosutinib. Discussion Imatinib is an oral signal inhibitor that targets tyrosine kinase for BCR/ABL, platelet-derived growth factor, stem cell factor, and c-kit (CD117). The conjunctiva and sclera have a large amount of c-kit positive mast cells which are inhibited by imatinib. The inhibition of c-kit positive mast cells by imatinib may be responsible for further exposure of the conjunctival mucosa to injuries.