about the donor, identifying risk factors in the donor’s behaviour, the medical history collected using a questionnaire and physical examination of the donor in order to find clinical signs of the infection. Donor selection is important because donors with high-risk behaviours compromise the safety of blood used for transfusion. Donors can be deferred during selection, which is particularly useful in the early period of infection when laboratory tests are not efficient 2,3 In developed countries, the prevalence of T. pallidum infection has dropped both in the general population and in blooddonors. However, the scenario is different in developing countries where the prevalence is raising because of the poor quality of laboratory screening due to the lack of equipment, trained personnel, reagents and standard procedures. In India, most blooddonors are first-time donors. The prevalence of syphilisamongblooddonors in India was recently reported to be 0.7%. 4 The global incidence of syphilisamongblooddonors is variable. In a study by Adjei et al. 5 , the incidence of syphilis was 7.5% among Ghanian donors whereas an incidence of 12.7% was noted among Tanzanian donors by Matee et al. 6 and Bhatti et al. 7 found an incidence of 0.75% among Pakistani donors. There are published data indicating that the prevalence of this disease is higher in replacement donors than in voluntary blooddonors. 4 The donor history questionnaire includes questions particularly related to past infection with syphilis. It is also focused particularly on sexual behaviour (past history of sexually transmitted diseases) and sometimes on specific signs observed during the clinical examination. Donors who are reactive for syphilis sometimes persistently continue to donate blood even after post-donation counselling. Certain lacunae remain in donor selection. These could be attributed to difficulty in understanding the questions due to a low level of education and ignorance about infections transmissible
Transfusion of blood and its components is lifesaving, however the patients are at a significant risk of contracting transfusion- transmitted infections (TTIs). The aim of the present study was to find out prevalence of TTIs in voluntary and replacement donors in a tertiarycarehospital. This study was done in the Blood Transfusion Department, PGIMS Rohtak Haryana, a tertiarycare centre in North India from January 2016- June 2018. Blood was collected from apparently healthy individuals following donor selection criteria after detailed history and examination. A total of 104090 donors were screened over the study period. TTIs testing were done with 3rd generation ELISA for HBV and HCV and HIV1 and 2 testing was done with 4th generation ELISA. Testing for malaria parasite was done by card test based on malarial (pLDH) antigen based principle. VDRL testing was done for syphillis. The total number of donors, who were found positive for TTIs, was 1806 (1.7%). The prevalence of HIV, HBV, HCV, syphilis infections amongdonors was 0.17%, 0.93%, 0.59% and 0.04% respectively. Prevalence of hepatitis infection (0.93%) formed the majority of the total TTI’s. No blooddonors were found positive for malaria parasite. The present study shows lower prevalence of TTIs as compared to other studies because of higher proportion of voluntary blood donation and stringent donor screening. Avoiding unnecessary blood transfusion and use of highly sensitive tests including nucleic acid testing can help to further reduce the risk of TTIs in this scenario .
Various studies reported that prevalence of HBV amongblooddonors was higher than HIV, HCV, syphilis and malaria [4-6]. In this study prevalence of HBV was more in comparisons to other TTIs over the years and in each year as well. Overall prevalence of HBV (2.18%) was lower in comparison to study carried out by Pahuja et al. But Fernandes H et al, Chandra T et al and Leena MS et al had reported lower prevalence rate of HBV compared to present study[4,11,13]. Studies from other countries like Tanzania, Saudi Arabia and Ethiopia had reported much higher prevalence of HBV[15-17]. In US and China the HBV prevalence among the blooddonors was quite lower compared to present study [18,21]. In present study HBV prevalence was higher in voluntary donors which was similar to study carried out by Kakar et al but many had reported higher prevalence of HBV in replacement donors[4-6, 9, 11]. HIV prevalence was 0.11% which was slightly higher compared to study carried out by Fernandes et al and Agarwal N et al. HIV prevalence was lower in present study in comparison to most of the studies carried out in India [5,6,11,10,13,14].
Table 3 shows the distribution of the study population according to their knowledge score with respect to their socio-demographicprofile. It was found that donors from urban areas, higher educational and socio-economic status as well as those who had previous history of blood donation had higher knowledge scores. This was statistically significant (p<0.05). Regarding the source of knowledge regarding blood donation, it can be said that mass media like television and radio had an insignificant role in creating awareness as only 5%
Comparatively, the overall deferral based on anemia (n = 36/1886; 1.9%) in this study is low when compared to other previous studies in Nigeria; 25.3% in a study in Nnewi southeastern Nigeria by Aneke and colleagues  and 6.2% in a study in Uyo southern Nigeria by Ekwere et al . However, the finding is similar to 1.4, 2.86 and 2.24% being studies in India , Tanzania  and India , respectively. Several factors ranging from methodology and demographic factors can explain these variations. While the present study used PCV/ hematocrit cutoff of 0.4 L/L (40%) using microhemato- crit method, the study by Aneke and colleagues  used hematocrit and hemoglobin cutoff of 38% and 12.5 g/dL, respectively without specifying the method used. Ekwere and colleagues  used hemoglobin cutoff of 12.5 g/dL without specifying the method used while the study by Rehman et al  used hemoglobin cutoff of 12.5 g/dL using haemometer Sahli plano paralal method. On the other hand, the study by Valerian and colleagues  and Shrivastava et al  did not specify the cutoff and method of assessment used (just low hemoglobin). Demographic variables such as gender and age have been shown to be independently associated with hemoglobin deferral in a study that made use of 715,000 blooddonors. The study showed female gender posses- sing 11-times greater chance of being deferred than their male counterpart whereas increasing age in males (effect not noted in females) was linked with 1.5-times greater chance of deferral per decade [60, 61]. Smoking status has also been documented to elevate Hb and conse- quently lower deferral due to Hb owing to the compen- satory mechanism to the resulting chronic hypoxia created by carboxyhemoglobin . Hemoglobin incre- ment of 0.26 g/dL has been observed in donors who
Africa faces the highest transfusion needs in the world, but also the highest prevalence of blood-borne pathogens and the weakest transfusion programs . Most blood banks in Africa are small, hospital-based and relying on an important proportion of replacement donors, in contrast with western transfusion units orga- nized with large pools of voluntary donors . In addi- tion, recommended reference screening tests like enzyme immunoassays (EIA) or nucleic acid testing (NAT) are technically, logistically and financially still far beyond reach of many resource-constrained blood banks . In such settings with limited capacity and low throughput, WHO accepts the use of rapid and simple serological assays for TTI screening, provided that they are quality-assured, locally validated and quality-con- trolled. Rapid test-based screening protocols tend to be used increasingly in African blood banks . It seems indeed effective at least for HIV and HCV screening , although safety of such a strategy has been recently challenged in an international quality control survey . For some experts, rapid testing has also the advan- tage of immediate counseling of infected candidates and referral to appropriate care, although this is not the pri- mary objective of transfusion medicine .
Study design and samples: The present study is a descriptive case-control study. A total of 120 male who were matched for age, employment status, marital status, and education were recorded in the study. According to status of donations within the previous year, the male blooddonors were divided into three groups: group Ι (regular donation those who have donated blood at 3 to 4 times in a year for at least two consecutive years), group II ( irst time donors consisted of men who were registered as new blooddonors without any prior donations. and group III (non-donors) with 40, 40 and 40 people in each group, respectively. The study was conducted in the main public hospital: European Gaza Hospital in Khanyounis. The study was carried out during the period of October 2018 to February 2019.
transmission from mother to child. HIV is present in body fluids in the form of free virus particles and also within infected immune cells. HIV infects vital cells in the human immune system such as helper T cells (specifically CD4+ T cells), macrophages, and dendritic cells . It leads to lowering the level of CD4 + T cells through a number of mechanisms including apoptosis of uninfected bystander cells . The HIV/AIDS epidemic is one of the largest public health crises of the 21 st century, which has evolved from a mysterious illness to a global pandemic in less than 20 years. In 2007, a total of 33.2 million people were living with HIV with global prevalence of 2.5 million. In India, the estimated number of HIV-infected people was 2.4 million in 2007. Although globally, as well as in India, the predominant mode of HIV transmission is through heterosexual contact, the risk of contracting HIV infection from transfusion of a unit of infected blood is estimated to be over 95% . In 1992, Government of India demonstrated its commitment to combat the disease with the launch of the first National AIDS Control Programme (NACP-I) as a comprehensive programme for prevention and control of HIV/AIDS in India . Responding to the immense challenge of the HIV/AIDS threat in India, National AIDS Control Organization (NACO) has a response to increase access to services and effectively communicate for behavior change. With continuous efforts, today we stand at the beginning of NACP IV . In 2010, NACO approved the Teach AIDS curriculum for use in India, an innovation which represented the first time that HIV/AIDS education could be provided in a curriculum which did not need to be coupled with sex education .
The choice of antifungal agent is different in yeasts,filamentous moulds and dermatophytes. The drug of choice of OM in diabetic patients is same as that of the patients without diabetes. But elderly diabetic patients require a longer duration to treat and there may be associated complications like cellulitis, diabetic foot ulcers and gangrene, which will increase the admission rates in hospital and surgical interventions  . Onychomycosis may also serve as a reservoir of infection. Reports of drug-resistant Candida species in onychomycosis have not appeared, although antifungal resistance to fluconazole has been documented in oral candidiasis in immunocompromised patients  . By doing in-vitro antifungal susceptibility an
blood and blood components stored below 20°C is very low. However, it was observed that many cases were associated with the appearance of a sore on the blood donor few days after the donation. Thus, syphilis can be transmitted from donors who are clinically and biologically negative. It is clear that medical selection and mainly information and questioning are essential to identify those who have been exposed to the infection two months prior to the donation of their blood (1) . Syphilis is
CONCLUSION: The present study provided much needed information on the prevalence of bacterial pathogens in blood stream infections and their antibiotic sensitivity patterns. The study identified both gram positive and gram negative bacteria were responsible for blood stream infections and most of them were multi drug resistant. The main forces driving the increase in antimicrobial resistant bacteria are poor infection control practices and inappropriate use of antibiotics. Specific antibiotic utilization strategies like antibiotic restriction, combination therapy and antibiotic recycling may help to decrease or prevent the emergence of resistance and antibiotic usage according to the standard antimicrobial susceptibility testing may reduce the incidence of blood stream infections.
Osogbo, South-West Nigeria by Fiekumo IB, et al. , where commercial donors accounted for 80.9%, replacement 18.3% and voluntary donors were only 0.8%. The amount of voluntarily donated blood has continued to fall over the years in Nigeria, commercial blood donation is the order of the day. Voluntary blood donation has been adjudged the safest source of donor blood procurement however they are limited and cannot sustain the blood requirement of medical practice in most facilities in Nigeria . Most centres have resorted to replacement and paid donors in some instances to meet the increased demand for blood and blood products [11,12]. Contrary to WHO directives that blood donation should be completely voluntary, the center recorded five hundred and ninety-nine (22.2%) as voluntary donation during the period. This proportion is grossly insufficient to meet the blood demands of the hospital. In our setting, replacement and remunerated donations still play important roles in addressing blood insufficiency and should not be discarded in spite of the associated risk. Other measures to increase blood sufficiency such as blood component therapy and rational blood use should be implemented in addition to increase campaign for voluntary donations. The
To identify key items in QNWL scale hindering higher scores (Table 3) the 6-point scale was collapsed to two categories: agree and disagree. In the worklife-homelife dimension, approximately 70% of respondents reported their need to have on-site child care services for sick children during work hours and 72.5% agreed that it is important to have on-site/near childcare services. About 56.4% of the respondents felt that the policy for their vacation was inappropriate. Over one-third of the respondents stated that they had no energy left after work (33.3%) and were not able to balance work with their family needs (35.2%). In the work design dimension, about one-third (34.3%) of the respondents indicated that there are not enough registered nurses in their Hospital. Majority of them felt that their work load was too heavy (72%) and they had many interruptions during daily work routine (73.2%). Nearly two-thirds (64.6%) of the respondents stated that they had many non-nursing tasks. In the Work context dimension, majority of the respondents expressed the importance of having a private break area (71.8%) for some time away from patients. In the work world dimension, more than half (53.2%) reported that their salary is not adequate. Nearly 58% stated that they will be able to find a similar job in another organization easily.
that PaGIA, ICT, and ELISA had sensitivity of 100%, 98.8% and 100%, respectively and the specificity of PaGIA, ICT, and ELISA was found to be 78.7%, 97.8%, and 93.5% . The RPR titre was more than 8 in 35.6% (n=47) RPR reactive donor whereas the titre was less than 4 in 66 reactive donors. It was also observed that TPHA and ELISA reactivity was certain in samples which had RPR titer of 1:16 or more and 1: 8 or greater respectively. In contrast, in 40 % cases ELISA/TPHA were negative with RPR titers of 1 in 2 and 75% in cases with RPR titres of 1:1. Agreement and kappa coefficient of the syphilis screening tests performed in blooddonors (Table 5). An overall agreement of 91.6 % was found in all four treponemal tests. When any of the two treponemal tests were compared, the agreement ranged from 93.1 to 98.5 %.
The limitations of our study are as follows. All study participants were selected from a single tertiary-carehospital. Secondly, the sample size is also limited. Hence, the study population may not be representative of the general population as a whole and must be carefully used for extrapolation. It is suggested that future larger, multi- institutional and longitudinal studies would be helpful to adequately address these limitations and provide better understanding of various factors related to teenage pregnancy.
Health consultation and screening of high-risk groups before blood donation need to be further improved. Blood donor recruitment should emphasize on excluding the high-risk donors and recruiting more low-risk blooddonors. The seroprevalence of syphilis in blooddonors from 2005 to 2017 in Chengdu showed an overall up- ward trend. However, Chinese MOH permanently defers donors with TP-positive, thus, the rate of TP-positive in primary blooddonors was higher than in repeat blooddonors. In addition, this study also shows that sharing cosmetic surgical instrument has been proven to trans- mit blood-borne diseases. Therefore, the syphilis in blood circulation should not be ignored. The research provides a valuable reference for popularizing syphilis- related knowledge and is conducive to reducing the risk behaviors of blooddonors.
Many developmental changes were introduced in the management of neonatal jaundice. Hour–Specific monogram for predicting neonatal hyperbilirubinemia was imported by Bhutani et al which was also supported by American Academy of Paediatrics. Hence the present study was carried to evaluate the occurrence, various aetiologies and treatment profile for neonatal jaundice in a tertiarycarehospital 8 .
Organophosphates and aluminium phosphide constituted the majority of cases in rural areas (63%), while zinc phosphide, aluminium phosphide, sedatives and delirients accounted For majority of the urban cases (80%) but in our study organophosphate was most common agent with 58.66 %.there were 62 males (59.6%) and 42 females (40.4%) in M. Shoaib Zaheer et al. (ShoaibZaheer, 2009). Study but in our study only 27.81% (92) male. BibhutiBhusana Panda et al. (BibhutiBhusana Panda, 2015). Study conducted at a tertiarycare teaching hospital at Bhubaneswar, Odisha, India Most of the poisoning cases are aged between 20 to 30 years similar to our study. Muhammad Imran Sulimanet al..conducted a study at department of Medicine, Bahawal Victoria Hospital, Bahawalpur Pakistan Mean age was 22.1 years in the 111 suicidal cases (77.62%) and 78 (70.27%) of them were less than 24 years.
The seropositivity of all TTIs is lower in our study as compared with studies from other parts of the country and worldwide. Also, seropositivity is lower among voluntary donors than replacement donors. The knowledge of current infectious disease pattern and trends in donor population can help in planning of future blood transfusion related health challenges. Encouraging female population as well as voluntary blooddonors for blood donation will increase the number of donors and safe donor pool. With the advent of nucleic acid amplification techniques, western countries have decreased the risk of TTI to a major extent. However, the cost effectiveness is poor. NAT has added benefits but its high financial cost is of concern.