Mission Hospital Durgapur

The emergence of e-commerce platforms has fundamentally reshaped consumer behaviour in the healthcare and pharmaceutical sectors. This paper extensively reviews existing literature to analyse this transformative shift. Several factors influencing consumers toward online healthcare and pharmaceutical product purchases are identified, focusing on convenience, accessibility and privacy. The study presents a well-structured model with nine hypotheses addressing variables as per UTAUT2 model such as 'performance', 'effort expectation', 'social influence', 'conducive circumstances', 'habit', 'hedonic motivation', 'pricing value' and 'personal innovativeness' in information technology that contributes to behavioural intent. It matches up with modern models such as 'TAM, TPB, UTAUT and UTAUT2'. A meticulously crafted questionnaire methodologically approached a diverse demographic, collecting 356 samples covering urban, semi-urban and rural populations. The reliability analysis exhibited a satisfactory level of internal consistency (α = 0.684), laying a credible foundation for subsequent analyses. Independent variable analysis elucidated multifaceted aspects driving consumer choices, underlining the influence of app usage, fulfilment, effort, cost savings and social validation.

Epilepsy is a common health problem and affects any group patients. Valproate is indicated in all seizure disorders. It has wide range of pharmacokinetic properties with a narrow therapeutic range. Long term use can cause many side effects including gynecomastia. So we describe a case of valproate induced gynecomastia in patient on chronic valproate therapy.

Peripherally inserted central catheters (PICC) are commonly used in the neonatal intensive care unit. They help in administering fluids, nutrition, and antibiotics. They have a lower risk for injury, infection, and thrombosis compared to central venous catheters. PICC fracture in a neonate has been rarely documented. We present a pre term neonate who had a PICC fracture remnant in the right atrium which was diagnosed following a contrast x ray and echocardiography. The PICC was removed percutaneously by our intervention pediatric cardiologist. All central venous access lines should be carefully monitored in the neonatal intensive care unit for risk of complications.

Sir, The causes of anemia in patients with chronic kidney disease (CKD) are multifactorial. Blood transfusion still remains an important alternative for treating anemia in CKD patients undergoing hemodialysis (HD). According to the first study from India, there is a 1.3% risk of alloimmunization in CKD patients.[1] After that several studies showed the minimum risk of red blood cell (RBC) alloimmunization in CKD patients.[2,3] There is no data available in the eastern Indian population, therefore, this study was planned to determine the prevalence and specificity of RBC alloimmunization in CKD patients undergoing HD. This was a prospective study which was done over a 1-year period. A total of 68 CKD patients were recruited who were undergoing HD at least once in a 2-week interval and had received at least one unit of red cells which were only matched for ABO/RhD. The mean age of the cohort was 52.4 ± 8.7 years (range: 44.5–83 years) with a male-to-female ratio of 1.37. Patients with an initial negative antibody screening on the day of enrolment were recruited and prospectively followed up by doing antibody screening and direct antiglobulin test (DAT) before each HD for 1 year irrespective of their transfusion requirements. Antibody screening and identification were performed using 3-cell and 11-cell panels with LISS/Coombs cards. Out of the 68 patients, only 2 (2.94%) were identified to develop erythrocytes alloantibody. One patient had developed anti-E and anti-M was identified in the second case. Henceforth, both received corresponding antigen-negative red cell transfusions. In both cases, DAT was negative. A total of 520 units of red cells were transfused in these patients, and the median number of transfusions was 6.5 (interquartile range: 3–9). Patients undergoing HD showed the lowest alloimmunization risk (calculated risk, 0.38 [95% confidence interval, 0.20–0.49]). There was no link observed between the rate of alloimmunization and the number of red cell units transfused to these patients. The innate and adaptive immune responses are altered in patients suffering from renal failure and there are quantitative and qualitative deficiencies of the T-and B-lymphocytes.[4] Furthermore, specific HD-related factors (e.g., interactions with bio-incompatible solutions, contamination of dialysis solutions, etc.) may aggravate this reversible immune paralysis. In conclusion, this data show significantly lower incidences of transfusion-induced RBC alloimmunization among CKD patients undergoing HD; therefore, these patients are not at a higher risk of alloimmunization compared to the general population, and extended phenotype matching for routine transfusion is not warranted in this group. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Factor XIII deficiency is an autosomal recessive disorder with an incidence of 1 in 1-5 million. On activation factor XIII stabilizes clot formation by cross-linking fibrin strands. Deficiency is characterized by severe bleeding due to impairment in clot formation. We describe a case of a child presenting with drowsiness following a trivial fall and trauma to the head. An emergency CT scan of the brain was suggestive of acute on chronic (recurrent) hemorrhage. Intraoperatively he was noted to have an intraparenchymal multiloculated cystic cavity with a thinned out cortex in the right frontal region. The child underwent right frontal craniotomy and decompression of an intracerebral hemorrhage. He was subsequently diagnosed to have factor XIII deficiency. He is presently on monthly cryoprecipitate prophylaxis with which he has not experienced a recurrence of a similar episode.

Abstract High on-treatment platelet reactivity (HPR) with P2Y12 receptor antagonists in patients treated with dual antiplatelet therapy (DAPT) is strongly associated with adverse ischemic events after percutaneous coronary intervention (PCI). This prospective study was conducted to assess individual platelet response and HPR to antiplatelet medications in post-PCI cases by thromboelastography platelet mapping (TEG-PM). Total 82 patients who were on aspirin and on either clopidogrel, prasugrel, or ticagrelor were evaluated. The percentage of platelet inhibition to arachidonic acid (AA) and adenosine disdiphosphate (ADP) was calculated by [100-{(MA ADP/AA–MA Fibrin) / (MA Thrombin–MA Fibrin) × 100}], taking 50% response as cut-off for HPR. HPR to clopidogrel and prasugrel was 14.29 and 12.5%, respectively. No HPR was detected to aspirin and ticagrelor. The mean percentage of platelet inhibition was significantly higher in patients with ticagrelor 82.99, 95% confidence interval (CI) of [77.3, 88.7] as compared with clopidogrel 72.21, 95% CI of [65.3, 79.1] and prasugrel 64.2, 95% CI of [52.5, 75.9] (p-value of 0.041 and 0.003, respectively). Aspirin along with ticagrelor is associated with a higher mean percentage of platelet inhibition, and lower HPR as compared with the usage of aspirin combined with clopidogrel or prasugrel. Additionally, it might also be concluded that TEG-PM could be used effectively to measure the individual platelet functions which would make oral antiplatelet therapy more personalized for cardiac patients.

Congenitally corrected transposition of the great arteries (CCTGAs) is a condition, which includes atrioventricular and ventriculoarterial discordant connections along with ventricular septal defect (VSD), pulmonary stenosis (PS), or pulmonary atresia (PA). Without treatment, progressive systemic ventricular failure begins, which is followed by sudden cardiac death by the fourth or fifth decade. We report a case of a 4-year-old with CCTGA, VSD, and PS operated by Senning procedure and pulmonary root translocation (PRT) with uneventful postoperative recovery. PRT overcomes problems with the right ventricle to the pulmonary artery conduit and maintains pulmonary valve function and growth capacity. Our initial experience with PRT in CCTGA indicates that it is a feasible surgical alternative for such patients.