The effect of low altitude on blood count parameters

BACKGROUND AND OBJECTIVESHigh altitude has an effect on blood count parameters, but low altitude (especially below sea level) has not been studied.DESIGN AND SETTINGA cross-sectional study of aymptomatic subjects aged between 18 to 35 years of age who had reported to the blood bank at the King Abdullah University Hospital (KAUH)/Irbid and Ministry of Health, Jordan, during the period between January 2010 to June 2011 for blood donation.METHODSHematological values were compared in healthy adult blood donors living in areas 200 to 300 meters below sea level and areas 500 to 1500 meters above sea level. The study population consisted of 800 females and 666 males aged between 18 to 35 years.RESULTSThe mean values for hemoglobin level, mean corpuscular volume and leukocyte counts were significantly higher in people living above sea level than in people living below sea level (P<.0001), whereas platelet count and red cell distribution width were significantly higher in people living below sea level than in people living above sea level (P<.0001).CONCLUSIONWe found a significant difference in hematological parameters in healthy adults living above and below sea level. The hematological values presented here are from a large, representative population sample and the first report of people living below sea level

Genetic Detection of IMP-1 Gene and its Relationship with Biofilm Formation in Klebsiella pneumonia

المقدمة: Klebsiella pneumoniae,تعتبر بكتريا طبيعية موجودة على الجلد وفي الامعاء .لكن تسبب تلف الرئة و خطر هذه&nbsp; البكتريا هو التعرض لها اثتاء التواجد في المستشفى. المواد وطرق العمل: تم تشخيص البكتريا بواسطة الطرق المظهرية و البايو كيميائية وتم التاكيد على التشخيص بنظام الفايتك .مقاومة البكتريا للمضادات الحياتية تم باستخدام طريقة كيربي-باير.وبالطريقة الجينية تم الكشف عن وجود جينات الميتالوبيتالاكتاميز باستخدام تفاعل البلمرة و بعدها تحديد تكوين البايوفيلم بالعزلات بطريقة الاطباق الدقيقة . النتائج والمناقشة: تضمنت الدراسة الحالية جمع 50 عينة من عينات سريرية مختلفة (40٪ من الدم ، 30٪ من البول ، 20٪ من البلغم، 10٪ من الجروح). 10 Klebsiella pneumoniae واظهرت جميع العزلات قيد الدراسة مقاومة عالية تجاه السيفيتريكسون ، الأمبيسلين ، الأموكسيسيلين ، التيكارسيلين ، التيكارسيلين + حامض كلافولانيك ،و السيفتازيديم باختبار الانتشار بالاقراص. تميزت جميع العزلات باحتوائها على أعلى مقاومة بنسبة 100٪ ضد المضادات الحيوية قيد الدراسة. حددت هذه الدراسة قيمة التركيزالمثبط الأدنى لثمانية شرائط باستخدام اختبارE للعزلات. وكذلك كانت العزلات ذات إنتاج بيوفيلم قوي لثلاثة عزلات ، بينما كانت ثلاثة عزلات متوسطة تكوين الأغشية الحيوية والعزلات الأخرى كانت ضعيفة الانتاج, عندما كانت قيمة (P≤0.05) تعتبروجود فروق معنوية. والكشف عن النمط الجيني لجينات Metalo-beta ᵦlactamase ، ( (IMP-1,( &nbsp;بواسطة تقني PCR تفاعل البلمرة المتسلسل في Klebsiella pneumoniae ، تم الكشف عن ثلاث عزلات فقط ؛ 30٪ من العزلات (اثنتان من البول وواحدة من الدم) تحتوي على الجين. (IMP-1) كما وجدت الدراسة علاقة بين جين. وتكوين الأغشية الحيوية في العزلات التي كانت تحتوي &nbsp;الجين عندما كانت .(P≤ 0.05) الاستنتاجات: تم عزل البكتريا من مصادر مختلفة. كانت جميع العزلات مقاومة للمضادات الحياتية قيد الدراسة . العزلات كانت حاملة لجينات المقاومة IMP-1, ,كما وجدت الدراسة لن هناك علاقة بين وجود جين1 .IMP- &nbsp;وتكوين البايوفيلم في&nbsp; هذه البكتريا .Background: Klebsiella pneumoniae were considered as normal flora of skin, and intestine. It can cause damage to human lungs; the danger of this bacterium is related to exposure to the hospital surroundings. materials and methods: the detection of Klebsiella pneumoniae on morphological and biochemical tests and then assured with VITEK 2 system. Resistance to antibiotics was determined by Kirby-Baeur method. And genotyping of IMP-1 in isolates was done by PCR technique, then biofilm formation was identified by Micro titer plate method. Results: The present study included a collecting of 50 specimens from different clinical specimens, (blood 40%, urine 30%, sputum 20%, wound infection 10%); 10 isolates were identified as Klebsiella pneumoniae . All isolates, under study, developed high resistance toward Cefitrixon, Ampicillin, Amoxicillin, Ticarcillin, Ticarcillin+Clavulanic acid, and Ceftazidim estimated by disc diffusion method. All isolates characterized by harboring the highest resistant in a percentage reached 100% against antibiotics, under study. This study determined the Minimal Inhibitory Concentration were detected by eight E-test strips for isolates. As well as the isolates were strong biofilm production for three isolates, while three were moderate of biofilm formation and other isolates were weak former; at the value of (P≤0.05) was considered as a significant. Genotype detection of Metalo-beta lactamase (IMP-1) by PCR technique in Klebsiella pneumoniae . Upon using PCR technique exposed only three isolates;30% of isolates (two from urine, one from blood) samples harbored IMP-1 gene. The study was also found relationship between IMP-1 and biofilm formation in isolates which were harboring these genes, when (P ≤ 0.05). Conclusions: K. pneumoniae were isolated from different sources. All isolates were resistant to most antibiotics used in this study. The isolates have Metallo-beta lactamse. PCR was showed K. pneumoniae have IMP-1 gene,.This study also found there was relationship between biofilm formation and IMP-1 gene in K. pneumoniae (P≤0.05). &nbsp

Stem Cell Transplantation in Pediatric Patients with Myelodysplastic Syndrome at a Single Institution

In MDS, the bone marrow produces abnormal, immature blood cells called blast cells. Imprecise, in half of pediatric MDS, blast count is normal. A retrospective observational study was conducted to review the outcome of our HCT in pediatric patients with MDS. Record of 35 MDS patients after BMT, 1993-2016, were reviewed. Median age at transplant was 4 yrs (0.8-14.8) and median time to transplant from diagnosis 8.1 (2.3-102.5) months. TRM was 17.1% (6); [low risk (LR) = 5 (19.2%) and high risk (HR) = 1 (11.1%)] MDS group succumbed within first 100 days. The rest were fully engrafted; [low risk = 21 (72.4%) and high risk = 8 (27.6%)]. Primary and secondary graft failure was observed in one patient each (2.9%). VOD was seen in 2 patients (5.7%) and 5 (14.3%) had hemorrhagic cystitis. With a median follow-up of 112.4 months and 12 events of mortality, 3-years OS was 68.1% ± 8.0%. No significant risk factor including age, time to transplant, disease risk group, gender, conditioning regimen, source of stem cells, or a GvHD through uni- or multi-variable analyses were found to be associated with OS. Bu/Cy/±ATG conditioning regimen showed a trend of superiority for OS and EFS in our small series. The relapse incidence in our cohort was 11.5% in LR MDS

Flexural impact resistance of steel beams with rectangular web openings

This paper focuses on the flexural impact behaviour of steel I-beams with rectangular web openings. Published studies on impact resistance and design requirements of perforated steel beams are limited. To shed light such a topic, detailed non-linear three-dimensional finite element models (FEMs) were developed using ABAQUS. Rigorous validation process was employed to verify the FEMs built against published experimental tests in terms of force and displacement time histories. Reasonably good agreement was obtained between the numerical results and the corresponding experimental ones. Then, the validated FEMs were exploited to investigate the flexural impact resistance of perforated steel beams with rectangular openings. The factors examined in the current study were the area, depth, number and reinforcement of web openings under different impact velocities ranged between 2.214 to 7 m/s to provide comprehensive understanding on the flexural impact response of steel beams perforated with rectangular openings. It was observed that increasing the number of narrow web openings negligibly effected the flexural impact resistance of steel beams. Moreover, using wide openings significantly reduced the dynamic flexural resistance of such beams. Besides, slight effect on the flexural impact resistance and mid-span deflections were obtained if the depth of openings increased. Moreover, a considerable improvement was observed by providing perforated beams by horizontal steel reinforcement particularly for those with wide openings. The perforated steel beams showed similar mode of failure by generating four plastic hinges around the edges of an opening, which is the failure mode produced for perforated beams under quasi-static loading

THE SYSTEMS OF ENTERPRISE RESOURCE PLANNING (ERP) IN READY-MADE CLOTHING FIRM (THE SAMPLE OF E-MOR TM)

Çağın rekabet şartları, işletmeleri, yeni sistem ve stratejiler aramaya yönlendirmiş, bilgi teknolojisindeki gelişmelerin desteğiyle de ERP sistemi doğmuştur. ERP, işletmenin stratejik amacı ve hedefleri doğrultusunda, müşteri taleplerini en uygun şekilde karşılayabilmek için, farklı coğrafi bölgelerde bulunan, tedarik, üretim ve dağıtım kaynaklarının, en etkin ve en verimli şekilde planlanması, koordinasyonu ve kontrol edilmesi fonksiyonlarını bulunduran bir sistem olarak önem kazanmıştır. Araştırmada, ERP sistemlerinden biri olan E-MOR'un Hazır Giyim İşletmelerin için yeri ve öneminin belirlenmesi, işletmelerin kurulum öncesi, kurulum aşaması ve kurulum sonrasında karşılaştıkları zorlukların saptanması, sistemin uygulanmasındaki başarı ve başarısızlık faktörlerinin saptanması, sistemin avantaj ve dezavantajlarının belirlenmesi, sistemin işletmelerin performanslarına ne gibi katkılar sağladığının tespiti için çalışılmıştır. Araştırmanın evreni, Türkiye'de Kurumsal Kaynak Planlama (ERP) yazılımını kullanan Hazır Giyim İşletmeleridir. Örneklem grubu ise, E-mor kullanıcısı olan Hazır Giyim İşletmelerinin tamamını oluşturmaktadır. Bu araştırmada veri toplama aracı olarak anket yöntemi kullanılmıştır. Anket 22 sorudan oluşmuştur. Güvenilirliği tespit edilen anket formu, işletmelere uygulanmış ankette ki her bir sorunun işletme içindeki ilgili birim yetkilileri tarafından cevaplanması sağlanmıştır. Anketlerden elde edilen verilere SPSS programı ile çeşitli istatistik uygulamaları yapılarak sonuçlara ulaşılmaya çalışılmıştır. Araştırma sonuçlarına göre, E- Mor TM sistemini kullanan işletmelerde mamul stok seviyesinin % 100 azaldığı tespit edilmiştir. Maliyetinin yüksek olması, sorun olduğun da gidermenin zor oluşu, kullanıcılarda hata yapma korkusu, iş üzerinde kontrolün azalması gibi sorunlar E-Mor TM yazılımının dezavantajlarıdır. E-Mor TM'nin kullanıcı işletmelere faydaları araştırılmış, bilgi akış süresini hızlandırdığı, kullanılan bilginin kalitesini geliştirdiği, kurumların karşılıklı etkileşimini artırdığı, sipariş yönetimini geliştirdiği, üretim planlamasını kolaylaştırdığı ve üretimi hızlandırdığı saptanmıştır. ERP yazılımları genellikle büyük ölçekli işletmeler tarafından kullanılmaktadır. Ülkemizde faaliyet gösteren işletmelerin çoğunluğu ise orta ve küçük ölçekli işletmelerdir. Orta ve küçük ölçekli işletmelerin verimliliğin ön plana çıktığı, artan bir rekabet ortamında çalıştıkları göz önüne alındığında, bu yazılım programının küçük ve orta ölçekli işletmelerde de uygulanması teşvik edilmelidir.The needs appearing as a matter of the age have directed the firms to look for new systems and strategies, so ERP system has appeared with the support of the developments in information technology. To meet the customers' demands most suitably in accordance with the strategic aims and goals of the firm, ERP has gained importance as a system that has the functions of effective control, coordination and planning of supply, production and delivery sources in different geographic regions. This study has been made for the determination of the importance of E-MOR, an ERP system, for ready-made clothing firms, finding the difficulties encountered pre-establishment, establishment and post-establishment stages, determination of factors for applying the system, and observing the contributions of system to the firm performance. The universe of the study constitutes the Apparel Companies using the Corporate Resource Planning (ERP) software in Turkey. And the sample group is comprised of all Apparel Companies using e-MOR. This study utilized the questionnaire method as its data gathering tool. The questionnaire is made up of two sections and 22 questions aimed at determining the demographical features of companies and questions about the e-MOR system. A reliability analysis was carried out for the questionnaire form, which was then applied to the companies, asking for responses of each question in the questionnaire from authorized unit officials in the company. Descriptive statistical applications were carried out on data obtained from the questionnaires using the SPSS software with the purpose of achieving the results. According to the results of the study, it is observed that product stock level decreased by %100 in the firms using E-Mor TM. The problems such as high cost, difficulties for troubleshooting, the risk of making mistake for the users, the decrease on business are the disadvantages of E-Mor TM software. The benefits of E-Mor TM for firms have been investigated and it is observed that the software accelerates the information flow rate, develops the quality of data, increases the interaction of the firms, develops the management of order, eases the production planning and accelerates the production. ERP software is usually used by the large scale firms. Most of the firms in our country are medium and small scale firms. When the competition environment and the productivity of medium and small scale firms are considered, this software should be encouraged for using in medium and small scale firms

Implications of Intrachromosomal Amplification of Chromosome 21 on Outcome in Pediatric Acute Lymphoblastic Leukemia: Does It Affect Our Patients Too?

Intrachromosomal amplification (iAMP) of chromosome 21 entity is associated with a dismal outcome in B cell Acute Lymphoblastic Leukemia (B-ALL). This cytogenetic abnormality is caused by a novel mechanism; breakage-fusion-bridge cycles followed by chromothripsis along with major gross rearrangements in chromosome 21.Charts of B-ALL diagnosed at King Faisal Specialist Hospital and Research Center between 2005 and 2015 were reviewed.iAMP is a rare entity occurring at around 2.4% of all pediatrics B-ALL. No statistically significant difference was found among patients with iAMP21, patients with extra copies of 21 and other patients with B-ALL. The reported adverse prognostic effect of iAMP21 could be due to other coexistent adverse factors, including older age at the time of diagnosis. The most common associated abnormality in our population in addition to the hyperdiploidy was ETV6/RUNX1

A Case of Multicentric Carcinoid in a Patient with Psoriatic Spondyloarthropathy

We describe the first case of a patient presenting with multicentric carcinoid occurring in the lung and subsequently in the rectum, with chronic psoriatic arthritis. Although reports have been published regarding carcinoid syndrome occurring alongside rheumatoid arthritis, no reports have been made on such a case. Initial presentation of carcinoid syndrome in this patient was insidious and atypical with few symptoms, including shortness of breath and long standing abdominal bloating. Several years later a sudden change in bowel habit prompted a colonoscopy with biopsy that revealed a carcinoid rectal polyp. The case we report describes a rare presentation of carcinoid syndrome in chronic psoriatic arthropathy

Predictors of severe hemolysis in patients with glucose-6-phosphate dehydrogenase deficiency following exposure to oxidant stresses

BACKGROUND AND OBJECTIVES: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a genetic enzymatic disorder that affects millions of people worldwide, and is a major health problem in Jordan. We studied factors that may predict severe hemolysis in children with G6PD deficiency. METHODS: We reviewed the records of patients with low G6PD activity admitted to a teaching hospital between 1996 to 2007. We collected demographic data, details of sign and symptoms, history and type of fava bean ingestion, blood and Rh group, history of neonatal jaundice, history and type of drug use, abdominal pair at admission and the results of tests for hemoglobin, white blood cells (WBC), and hepatic function. We classified patients into mild and severe groups based on hemoglobin levels at admission. RESULTS: Of 428 children with G6PD deficiency, 79 (18%) were severe cases and 349 (82%) patients with milt disease. There were no statistically significant differences in most factors between the two groups. Factors tha achieved statistical significance for severe hemolysis included younger age (P<.05), male gender (P<.05), highe alkaline phosphatase (ALP) (P<.05), presence of fever at admission (P<.01), presence of vomiting during the attack (P=.006), and a negative family history for G6PD deficiency (P=.005). CONCLUSIONS: Severe hemolysis can be predicted during hemolytic episodes in children with low G6PD by young age, male gender, a negative family history of G6PD deficiency, the presence of fever and vomiting and a high ALP

Discrepancies between DNA index by flow cytometry and cytogenetic studies in childhood B-lymphoblastic leukemia

Background: DNA index by flow cytometry (DNAI-FCM) is a rapid technique used in classification of acute B-lymphoblastic leukemia (B-ALL). The objective of this study is to estimate the reliability of FCM in the early classification of childhood B-ALL and to analyze the causes of discrepancies between the DNAI-FCM and the cytogenetic studies (CG) (Karyotype and Fluorescent in situ Hybridization [FISH]). Materials and Methods: DNAI-FCM and CG (Karyotype and FISH) were analyzed in 69 consecutive children, newly diagnosed with B-ALL in King Faisal Specialist Hospital and Research Centre between January 2013 and June 2014. Results: A statistically significant correlation existed between DNAI-FCM and CG (P = 0.001). DNAI-FCM was proportional to CG in 82.6% (57/69) of the cases. There was a discrepancy between the DNAI-FCM and the CG in 17.4% (12/69) of the cases. Conclusion: DNAI-FCM shows 82.6% concordance with CG in childhood B-ALL with a predictive value of 81%. Discrepancies occur due to either the small size of the chromosome or due to insufficient genetic material representing the abnormality