0
selected
-
1.
Comparison of efficacy of packed red blood cell transfusion based on its hemoglobin content versus the standard transfusion practice in thalassemia major patients (HEMOCON study)
Raja A, Jain A, Marwaha N, Trehan A
Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis. 2020;:102736
-
-
-
Full text
-
Editor's Choice
Abstract
The hemoglobin (Hb) content of packed red blood cell (PRBC) units is heterogenous. The efficacy of a transfusion episode can be assessed if the Hb content of the PRBC is known and the patient's post-transfusion Hb increment is also determined. This prospective study compared the efficacy of PRBC transfusion based on its Hb content versus the standard transfusion practice. A total of 160 thalassemia major patients were enrolled and randomly divided into two equal groups: Group I (n = 80) - they received ABO/RhD identical PRBCs after determining its Hb content (≥50 g); and Group II (n = 80) - they received randomly selected ABO/RhD identical PRBCs. Hb estimation and a direct antiglobulin test were performed on the post-transfusion sample (1 h). The mean Hb content of the PRBC units was significantly higher (p = 0.000) in group I (67.86 +/- 8.07 g; range: 50.80-92.13 g) than group II (60.92 +/- 8.29 g; range: 40.86-86.76 g). The mean Hb increment was also significantly higher in group I patients (p = 0.04). In both the groups, there was a significant negative correlation between Hb increment and weight, age, body surface area and blood volume (p < 0.05). There was a significant positive correlation between Hb increment and Hb dose adjusted for body surface area as well as blood volume (p < 0.05). PRBC transfusion was more efficacious in patients who were transfused with PRBCs having a Hb content ≥50 g as compared to those who received randomly selected PRBCs.
PICO Summary
Population
Thalassemia major patients (n=160).
Intervention
ABO/RhD identical packed red blood cell (PRBCs) after determining its Hb content (>/=50 g) group I, (n = 80).
Comparison
Randomly selected ABO/RhD identical PRBCs group II ,(n = 80).
Outcome
The mean Hb content of the PRBC units was significantly higher in group I (67.86 +/- 8.07 g; range: 50.80-92.13 g) than group II (60.92 +/- 8.29 g; range: 40.86-86.76 g). The mean Hb increment was also significantly higher in group I patients. In both the groups, there was a significant negative correlation between Hb increment and weight, age, body surface area and blood volume. There was a significant positive correlation between Hb increment and Hb dose adjusted for body surface area as well as blood volume. PRBC transfusion was more efficacious in patients who were transfused with PRBCs having a Hb content >/=50 g as compared to those who received randomly selected PRBCs.
-
2.
Combining Platelet-Rich Plasma Instillation With Core Decompression Improves Functional Outcome and Delays Progression in Early-Stage Avascular Necrosis of Femoral Head: a 4.5- to 6-Year Prospective Randomized Comparative Study
Aggarwal AK, Poornalingam K, Jain A, Prakash M
J Arthroplasty. 2020
Abstract
BACKGROUND Avascular necrosis of femoral head is a debilitating disease frequently progressing to femoral head collapse and joint destruction. The efficacy of core decompression (CD) remains controversial. METHODS About 40 consecutive age-matched and gender-matched patients (53 hips) were randomized into 2 groups by computer-generated algorithm table in a prospective randomized double-blinded comparative study. Group A (platelet-rich plasma [PRP] with CD) included 19 patients (25 hips), and group B (CD only) included 21 patients (28 hips). Postoperative Harris Hip Score and magnetic resonance imaging to quantify the necrotic area by using modified Kerboul angle were done and evaluated. Mean follow-up was 64.3 months (range, 54-72) and 63.7 months (range, 56-72) in groups A and B, respectively. RESULTS There was statistically significant difference between PRP and control groups in pain score (P = .00), functional score (P = .02), and Harris Hip Score (P = .00) at final follow-up. There was no progression in stage 1 disease. Stage 2 disease showed 24% progression in group A and 43% progression in group B. The difference was statistically significant (P = .025). Survivorship from femoral head collapse, any procedure, and total hip arthroplasty was 84%/68% (P = .00), 76%/57% (P = .02), and 92%/78% (P = .01) in 2 groups, which was statistically significant. CONCLUSION PRP use after CD provides significant pain relief, better midterm functional outcome, retards the progression, and enhances the survivorship free from reoperation for hip arthroplasty and femoral head collapse in early stages of avascular necrosis of hip than CD alone.
-
3.
[Effectiveness of platelet rich plasma in pain management of osteoarthritis knee: Double blind, randomized comparative study]
Ghai B, Gupta V, Jain A, Goel N, Chouhan D, Batra YK
Revista brasileira de anestesiologia. 2019
Abstract
BACKGROUND Intra-articular injections of platelet-rich plasma to treat symptoms of knee osteoarthritis have been successfully used in young patients. However in most of these studies the control and test knees were present in different patients thus incorporating a large amount of bias in the results. Therefore, the present study was designed in which patients with bilateral osteoarthritis knee were included and platelet-rich plasma was administered in one knee and normal saline in another knee of same patient. METHODS 20 patients aged 30-65years with bilateral osteoarthritis knees (ASA class I and II) of either gender were included in the study. Patients were randomized to receive platelet-rich plasma and normal saline in one of the two knees. The primary outcome was VAS and WOMAC score at 6months after procedure. The secondary outcome included changes in joint stiffness, physical function, any adverse effects noted during the course of study. RESULTS The baseline VAS score in platelet-rich plasma knee was 8.4 +/- 0.88 which improved significantly to 4.85 +/- 2.48 (p < 0.001) at 6months as compared to normal saline knee (p = 0.017). The WOMAC pain score also improved from baseline (14.5 +/- 1.3) to over 6month 7.00 +/- 4.24 (p < 0.001) in platelet-rich plasma knee while in the normal saline knee, no significant change occurred from baseline to six months (10.2 +/- 1.2 to 10.05 +/- 1.23). There was also significant decrease in stiffness and improvement of physical activity in the platelet-rich plasma knee as compared to normal saline knee. CONCLUSION The present study showed significant decrease in pain and stiffness and improvement of physical functions of knee joint with intra-articular platelet-rich plasma injection as compared to normal saline.
-
4.
Comparative evaluation of platelet rich fibrin and dehydrated amniotic membrane for the treatment of gingival recession - a clinical study
Jain A, Jaiswal GR, Kumathalli K, Kumar R, Singh A, Sarwan A
Journal of Clinical and Diagnostic Research : Jcdr. 2017;11((8)):ZC24-ZC28.
Abstract
INTRODUCTION The main objective of any therapeutic intervention aimed at root coverage is to restore the tissue margin to the cemento-enamel junction and to regenerate the lost periodontium. AIM: To compare the effectiveness of Platelet Rich Fibrin (PRF) and Amniotic Membrane (AM) in the treatment of gingival recession by Coronally Advanced Flap (CAF) Technique. MATERIALS AND METHODS Thirty systemically healthy patients who met inclusion-exclusion criteria were selected. After Phase-I therapy, patients were randomly allocated to one of the groups; PRF (Group-A) and Amnion Group (Group-B). Clinical parameters like Plaque Index (PI), Recession Depth (RD) and Width of Keratinized Gingiva (WKG) were measured on the baseline day, three months and six months postoperatively. Mann-Whitney test and Wilcoxon signed ranks test were applied for intergroup and intragroup comparisons respectively. RESULTS Intergroup comparison between platelet rich fibrin and amniotic membrane showed statistically insignificant difference in the recession depth and width of keratinized gingiva at three and six months postoperatively. CONCLUSION Both the membranes were equally effective in terms of recession coverage and increase in width of keratinized gingiva.
-
5.
Does the use of platelet-rich plasma at the time of surgery improve clinical outcomes in arthroscopic rotator cuff repair when compared with control cohorts? A systematic review of meta-analyses
Saltzman BM, Jain A, Campbell KA, Mascarenhas R, Romeo AA, Verma NN, Cole BJ
Arthroscopy. 2016;32((5)):906-18.
Abstract
PURPOSE The aims of the study were as follows: (1) to perform a systematic review of meta-analyses evaluating platelet-rich plasma (PRP) use at the time of arthroscopic rotator cuff repair surgery and to determine its effect on retear rates and clinical outcomes; (2) to provide a framework for the analysis and interpretation of the best currently available evidence; and (3) to identify gaps within the literature where suggestions for continued investigational efforts would be valid. METHODS Literature searches were performed to identify meta-analyses examining arthroscopic rotator cuff repairs augmented with PRP versus control (no PRP). Clinical data were extracted and meta-analysis quality was assessed using the Quality of Reporting of Meta-analyses and Oxman-Guyatt scales. RESULTS Seven meta-analyses met inclusion and exclusion criteria. All were considered as being of similar quality with Quality of Reporting of Meta-analyses scores >15 and Oxman scores of 7. A total of 3,193 overlapping patients treated were included with mean follow-up from 12 to 31 months. When compared with control patients, use of PRP at the time of rotator cuff repair did not result in significantly lower overall retear rates or improved clinical outcome scores. The following postoperative functional scores comparing PRP versus control were reported: Constant (no significant difference demonstrated with PRP use in 5 of 6 reporting meta-analyses), University of California - Los Angeles (no difference, 6 of 6), American Shoulder and Elbow Society (no difference, 4 of 4), and Simple Shoulder Test (no difference, 3 of 5). Subgroup analysis performed by 3 meta-analyses showed evidence of improved outcomes with solid PRP matrix versus liquid, small- and/or medium-sized versus large and/or massive tears, PRP application at the tendon-bone interface versus over tendon, and in the setting of double-row versus single-row rotator cuff. CONCLUSIONS The current highest level of evidence suggests that PRP use at the time of arthroscopic rotator cuff repair does not universally improve retear rates or affect clinical outcome scores. However, the effects of PRP use on retear rates trend toward beneficial outcomes if evaluated in the context of the following specific variables: use of a solid PRP matrix; application of PRP at the tendon-bone interface; in double-row repairs; and with small- and/or medium-sized rotator cuff tears. LEVEL OF EVIDENCE Level III, systematic review of Level II and III studies.Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
-
6.
Platelet rich fibrin combined with decalcified freeze-dried bone allograft for the treatment of human intrabony periodontal defects: a randomized split mouth clinical trail
Agarwal A, Gupta ND, Jain A
Acta Odontologica Scandinavica. 2016;74((1)):36-43.
Abstract
OBJECTIVE Polypeptide growth factors of platelet rich fibrin (PRF) have the potential to regenerate periodontal tissues. Osteoinductive property of demineralized freeze-dried bone allograft (DFDBA) has been successfully utilized in periodontal regeneration. The aim of the present randomized, split mouth, clinical trial was to determine the additive effects of PRF with a DFDBA in the treatment of human intrabony periodontal defects. MATERIALS AND METHODS Sixty interproximal infrabony defects in 30 healthy, non-smoker patients diagnosed with chronic periodontitis were randomly assigned to PRF/DFDBA group or the DFDBA/saline. Clinical [pocket depth (PD), clinical attachment level (CAL) and gingival recession (REC)] and radiographic (bone fill, defect resolution and alveolar crest resorption) measurements were made at baseline and at a 12-month evaluation. RESULTS Compared with baseline, 12-month results indicated that both treatment modalities resulted in significant changes in all clinical and radiographic parameters. However, the PRP/DFDBA group exhibited statistically significantly greater changes compared with the DFDBA/saline group in PD (4.15 +/- 0.84 vs 3.60 +/- 0.51 mm), CAL (3.73 +/- 0.74 vs 2.61 +/- 0.68 mm), REC (0.47 +/- 0.56 vs 1.00 +/- 0.61 mm), bone fill (3.50 +/- 0.67 vs 2.49 +/- 0.64 mm) and defect resolution (3.73 +/- 0.63 vs 2.75 +/- 0.57 mm). CONCLUSION Observations indicate that a combination of PRF and DFDBA is more effective than DFDBA with saline for the treatment of infrabony periodontal defects.
-
7.
Treatment with platelet-rich plasma is more effective than placebo for knee osteoarthritis: a prospective, double-blind, randomized trial
Patel S, Dhillon MS, Aggarwal S, Marwaha N, Jain A
American Journal of Sports Medicine. 2013;41((2):):356-64.
Abstract
BACKGROUND Specific growth factors have been proposed as therapeutic proteins for cartilage repair. HYPOTHESIS Platelet-rich plasma (PRP) provides symptomatic relief in early osteoarthritis (OA) of the knee. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS A total of 78 patients (156 knees) with bilateral OA were divided randomly into 3 groups. Group A (52 knees) received a single injection of PRP, group B (50 knees) received 2 injections of PRP 3 weeks apart, and group C (46 knees) received a single injection of normal saline. White blood cell (WBC)-filtered PRP with a platelet count 3 times that of baseline (PRP type 4B) was administered in all. All the groups were homogeneous and comparable in baseline characteristics. Clinical outcome was evaluated using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire before treatment and at 6 weeks, 3 months, and 6 months after treatment. They were also evaluated for pain by a visual analog scale, and overall satisfaction with the procedure and complications were noted. RESULTS Statistically significant improvement in all WOMAC parameters was noted in groups A and B within 2 to 3 weeks and lasting until the final follow-up at 6 months, with slight worsening at the 6-month follow-up. The mean WOMAC scores (pain, stiffness, physical function, and total score) for group A at baseline were 10.18, 3.12, 36.56, and 49.86, respectively, and at final follow-up were 5.00, 2.10, 20.08, and 27.18, respectively, showing significant improvement. Similar improvement was noted in group B (mean WOMAC scores at baseline: 10.62, 3.50, 39.10, and 53.20, respectively; mean WOMAC scores at final follow-up: 6.18, 1.88, 22.40, and 30.48, respectively). In group C, the mean WOMAC scores deteriorated from baseline (9.04, 2.70, 33.80, and 45.54, respectively) to final follow-up (10.87, 2.76, 39.46, and 53.09, respectively). The 3 groups were compared with each other, and no improvement was noted in group C as compared with groups A and B (P < .001). There was no difference between groups A and B, and there was no influence of age, sex, weight, or body mass index on the outcome. Knees with Ahlback grade 1 fared better than those with grade 2. Mild complications such as nausea and dizziness, which were of short duration, were observed in 6 patients (22.2%) in group A and 11 patients (44%) in group B. CONCLUSION A single dose of WBC-filtered PRP in concentrations of 10 times the normal amount is as effective as 2 injections to alleviate symptoms in early knee OA. The results, however, deteriorate after 6 months. Both groups treated with PRP had better results than did the group injected with saline only.
-
8.
Autologous platelet derived growth factors as a treatment modality in early osteoarthritis knee a prospective randomized control trial abstract
Jain A, Patel S, Aggarwal S, Marwaha N, Dhillon MS
Vox Sanguinis. 2012;103((S1):):61.. Abstract No. 6A-S48-02.