Search

Background: Human hemoglobin is a tetrameric metalloporphyrin. The heme part contains iron radicle and porphyrin. The globin part consists of two pairs of amino-acid chains. The absorption spectrum of hemoglobin spans from 250 nm to as high as 2,500 nm, with high coefficients reported in blue and green color zone. The visible absorption spectrum of deoxyhemoglobin has one, while the visible absorption spectrum of oxyhemoglobin shows two peaks., Objective: (1) To study absorption spectrometry of hemoglobin in 420 to 600 nm range; (2) to conduct preclinical experiments to validate a new device and technology based on green color absorption by hemoglobin; (3) to use this new technology and device for phase 1 study in healthy human volunteers for confirmation., Design Material and Methods: (1) Checking absorption spectrometry of hemoglobin in venous blood. We measured absorption spectrometry of 25 mother-baby pairs as an observational study. Readings were plotted from 400 nm to 560 nm. These included peaks, flat lines and deeps. Graph tracings of all samples - cord blood and maternal blood - showed similar patterns. (2) Preclinical experiments were set up (a) to correlate the reflection of green light by hemoglobin and concentration of hemoglobin, (b) to correlate concentration of O 2 and reflection of green light related to oxyhemoglobin, (c) to correlate concentration of melanin in upper and the hemoglobin in lower layer of tissue phantom and to check the sensitivity of new device with green light for measuring Hb in presence of high levels of melanin, and lastly (d) to check if the new device can measure changes in oxy-hemoglobin and deoxy-hemoglobin, again in presence of high levels of melanin with normal as well as with low levels of hemoglobin. The experiments using bilayer tissue phantom were conducted with horse blood in lower cup as dermal tissue phantom and synthetic melanin in upper layer as epidermal tissue phantom. (3) Phase 1 observational studies following a protocol approved by the institutional review board (IRB) were done in two cohorts. Readings were taken using our device and a commercially available pulse oximeter. In the comparison arm we had Point of Care (POC) Hb test (HemoCu or iSTAT blood test). We had 127 data points of POC Hb test and 170 data points for our device and pulse oximeters. This device uses two wavelengths from the visible spectrum of light and uses reflected light. Light of specific wavelengths is shone on the skin of the individual, and the reflected light is collected as 'optical signal'. This optical signal - after conversion to electrical signal - is processed and finally analysed with a digital display on the screen. Melanin is accounted using Von Luschan's chromatic scale (VLS) and a specially designed algorithm., Results: In this set of various preclinical experiments using different concentrations of hemoglobin and melanin, we indeed demonstrated good sensitivity of our device. It could pick up signals from hemoglobin despite high levels of melanin. Our device is a non-invasive device to measure hemoglobin like a pulse oximeter. Results of our device and pulse oximeter were compared with those by POC Hb test like HemoCu and iSTAT. Our device showed better trending linearity and concordance than a pulse oximeter. Since the absorption spectrum of hemoglobin is the same is new-borns and adults, we could develop one device for all age groups and for people of all colors. Furthermore, the light is shone on the wrist of the individual and is then measured. So, in future this device has the potential of being incorporated in a wearable or smart watch technology., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2023 Gokhale et al.)

Background: Human hemoglobin (Hb) is a tetrameric metalloporphyrin. Heme part contains iron radicle and porphyrin. The globin part has pairs of amino-acid chains. Healthy adults have "Hemoglobin-A" made of two alpha and two beta chains (α2 β2) while a newborn baby has "Hemoglobin-A (α2 β2)" and "Hemoglobin-F (α2 γ2)". There are few reports about absorption spectrometry of Hb in cord blood. We have here compared absorption spectrum of Hb in cord blood and maternal blood samples (adult blood samples) together., Objective: This was done in two parts. Part 1 was about studying absorption spectrum of Hb in cord blood and maternal blood. Part 2 was about developing a comprehensive noninvasive technology and using the same for measurement of Hb in mother (adult) and new-born baby., Design: Observational study., Material and Methods: Part 1 . After IRB approval, 25 pregnant mothers enrolled for the study. Cord blood/neonatal blood samples were collected from placental end in ethylene diamine tetra-acetic acid (EDTA) tube after the delivery of fetus and placenta (venous blood). Maternal blood was collected by peripheral venepuncture before delivery/labor. Part 2 . Using noninvasive technology for measurement of Hb in mother (adult) and new-born baby. After the necessary approval five pairs of mother and new-born were enrolled in the study to measure Hb by noninvasive method using our novel device. The novel device (SH-1) uses electromagnetic radiations of specific wavelengths between 520 and 580 nm. Light was projected on forehead for a few seconds, operating the light sources one by one. Of the projected light, some was reflected by the recipient's skin. This optical signal was collected by photosensors and converted to electrical signals. After amplification, this was then transmitted to processor unit. Later, Hbs values are displayed. The results were then tallied with standard laboratory methods in clinical laboratory., Results: Part 1 . As expected in our study; all blood samples showed Soret band of same peak and wavelength. We expected different spikes corresponding to four globin chains namely alpha, beta, gamma, and delta. But interestingly, both neonatal and maternal blood samples had identical peaks. Part 2 . The results appear promising. The Hb as measured by noninvasive method matches well with standard laboratory test., Significance: The energy level of Hb is low in deoxygenated state compared to oxyhemoglobin. In a state of high energy level, alpha and beta and gamma globin chains show obvious different peaks. Since cord blood and maternal sample was obviously venous or in deoxygenated state with low energy level, single peak of absorption was observed for all three globin chains. Since maternal and cord blood showed similar absorption spectra, it was possible to develop a common method for estimation of biomarkers - Hb in adults and new-borns alike.

Background: Vitamin D deficiency is recognized as a global public health problem. Despite ample sunshine, vitamin D deficiency is very common in the Middle East (15°-36°N) and African (35°S-37°N) countries; and in South Asian countries., Aim: To find a simple, affordable and practical plan to treat vitamin-d deficiency., Type of Study: This was a prospective interventional study., Outcome Variable: The primary outcome was typed as vitamin-D level more than 50 nanograms/ml as 'yes' and poor response or 'no' when it was less than 50 ng/ml., Participants: 80 Women participated in study. Laboratory tests: Vitamin D [25-OHD]-estimations were performed with LCMSMS-liquid chromatography tandem mass spectrometry. Corrective vitamin-D doses: All participants received TWO doses of Vitamin-D injections one ml at a time [600K IU/ml or 600,000 IU/ml]. All participants received their first dose; after collecting blood samples for Vitamin-D estimations. Second dose was given about a month after the first one [range 30-37 days]. These doses were given to correct the deficiency., Results: Even with this high dose treatment 60% woman had unsatisfactory Vitamin-D levels.

Clinical trials are interventional studies on human beings, designed to test the hypothesis for diagnostic techniques, treatments, and disease preventions. Any novel medical technology should be evaluated for its efficacy and safety by clinical trials. The costs associated with developing drugs have increased dramatically over the past decade, and fewer drugs are obtaining regulatory approval. Because of this, the pharmaceutical industry is continually exploring new ways of improving drug developments, and one area of focus is adaptive clinical trial designs. Adaptive designs, which allow for some types of prospectively planned mid-study changes, can improve the efficiency of a trial and maximize the chance of success without undermining validity and integrity of the trial. However it is felt that in adaptive trials; perhaps by using accrued data the actual patient population after the adaptations could deviate from the originally target patient population and so to overcome this drawback; special methods like Bayesian Statistics, predicted probability are used to deduce data-analysis. Here, in this study, mathematical model of a new adaptive design (shuffling adaptive trial) is suggested which uses real-time data, and because there is no gap between expected and observed data, statistical modifications are not needed. Results are obviously clinically relevant.

Prehospital use of blood products may improve survival. However, transfusion support with frozen blood components is logistically burdensome and constrains the configuration of prehospital medical support. Alternatives to frozen plasma, including lyophilised plasma, offer the potential for advanced resuscitation in the prehospital environment. We describe the successful use of lyophilised plasma by a UK patrol in the prehospital environment during operations in Afghanistan in 2012 and reflect on recent military experience and the need for further developments., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Transfusion-associated graft versus host disease [TAGVHD] results from the engraftment of transfused immuno-competent cells in blood transfusion recipients, whose immune system is unable to reject them. All blood products containing viable, immuno-competent T cells have been implicated in TAGVHD. Presence of a "one-way HLA match between donor and recipient" is associated with a significantly increased risk of TAGVHD. Though sharing of haplotype is the most probable explanation, it is far from adequate. Since TAGVHD is not seen in patients with AIDS, and an acute GVHD-like syndrome has been noted in some identical twins and autologous (self) transplants, some other processes, possibly of an "autoimmune" nature are responsible for TAGVHD. Most of the cases have been reported from Japan. This clustering in space and time is rather intriguing. We offer here alternative hypothesis. Foetal and then neonatal lymphocytes exhibit tolerance towards donor cytotoxic T lymphocytes; and consequently very few cases of TAGVHD have been reported in neonates than expected. This tolerance is a part of altered immunology of pregnancy. We feel that it is possible to use maternal blood for transfusion to her newborn baby by following certain protocol and procedure and TAGVHD is no barrier.

Objective: To determine transfusion compatibility of maternal RBCs for her neonate up to 4 weeks of age, irrespective of maternal-neonatal ABO mismatch., Methods: This was a prospective observational study involving eligible mothers with their neonates delivered in participating site from 1 July 2012 till 31 December 2012. Mother's blood was collected before child birth. Neonatal blood sample was collected from placental end, shortly after birth. Blood Groups of mother-baby pair were individually tested for ABO and Rh-D groups. Pairs with negative Rh-D antigen/s or with same ABO blood groups were excluded. Thus, 28 pairs with both maternal and neonatal samples positive for Rh-D antigen and with different maternal neonatal ABO blood groups were included in the study. Blood samples were collected at birth and at 4 weeks. Cross matching was done at birth and at 4 weeks for each pair with standard blood bank protocols., Results: All 28 pairs showed positive compatibility with standard blood bank cross-matching protocols at birth and at 4 weeks., Conclusions: Maternal blood irrespective of ABO compatibility might be a viable and potentially acceptable option for her new born baby in neonatal period. This may be especially important in developing world with limited blood bank resources.

During the process of evolution, segmented structures like heart and kidneys appeared earlier than vertebral column. Single piece notochord was transformed into segmented vertebral column. Ribs followed the segmented vertebral column but preceded the fore limbs in evolution. Segmentation is the underlying principle of the body plan even in annelids and arthropods. In these animals apart from vertebral column; segmentation is obvious in other structures like kidneys and heart. Somewhere on the temporal axis of evolution--vertebral column, heart and kidneys have evolved together; and have shared the genetic control of embryological morphogenesis. Mutations or micro-evolution in homeotic--Hox--genes led to macro evolution and a sudden change in morphology, when six-legged insects diverged from crustacean-like arthropod ancestors with multiple limbs. The control of embryonic morphology has been highly conserved in evolution between vertebrates and invertebrates and Hox genes occupy a central role in the scheme of molecular control of early morphogenesis. Mutations affecting regulatory genes, including those containing homeobox sequences, have been important. Malformations and association like VACTERL can be rationally explained considering the genetic and evolutional mechanisms controlling morphogenesis.