|Elaboration of Novel NanoparticulateTiO2-P25@n-TiO2 Composite for Photocatalysis
||Guy Didier Fanou
Abstract: A new mechanically stable TiO2-P25@n-TiO2 nanocoating was prepared after grafting of size-selected
titanium-oxo-alkoxy particles on P25-TiO2 nanoparticles surface and their immobilization on a glass substrate followed by
a thermal treatment. The 5-nm oxo-TiO2 particles were prepared in a sol-gel reactor with rapid reagents micromixing. The
photocatalyst with 65% TiO2-P25 loading shows the highest activity towards ethylene degradation in a continuous-flow
fixed-bed reactor. This material has a higher activity compared to that prepared by a conventional sol-gel method with
strongly polydispersed titanium-oxo-alkoxy nanoparticles and clusters. The reaction conditions were explicitly analyzed
along the reactor as a function of the ethylene concentration in framework of a kinetic model, which shows interplay
between zero and first order processes.
|Effect of Stress Annealing on Domain Wall Dynamics in Nanocrystalline Hitperm-Type Microwires
Abstract: We have studied the effect of stress induced anisotropy on domain wall dynamics in as-cast and annealed
nanocrystalline Hitperm-type microwires. Annealing without stress leads to stress relaxation of the strong stresses
frozen-in post the production process. Stress annealing at 300oC under 222.7 and 270.9 MPa, respectively, has
triggered most complex domain wall dynamics.
Observed results are discussed considering that annealing under higher stresses leads to an enhancement of
longitudinal (axial) anisotropy due to positive magnetostriction of both bcc-(Fe, Co) grain as well as the residual
amorphous matrix, and subsequently due to the decreasing of axial anisotropy due to back stresses arising from the
glass-coating after removing the mechanical load.
Magnetic anisotropies (axial and radial ones) after stress annealing can be responsible for the considerable influence of
the annealing conditions on domain wall dynamics observed in Hitperm-type microwires. As a result of decreasing both
anisotropies by different ways, the domain wall velocity decreased.
|High Quality InSb Microcrystal Hall Sensor Doped with Te or Bi
Abstract: InSb microcrystal doped with Cr, Al or Sn, which were radiation-resistant and were applied as magnetic
microsensors in Satellites. The magnetic field sensitivity, ! , as a function of temperature was determined for both Bi and
Te doped InSb microcrystals. Tellurium doping of InSb microcrystals at 3 x10 17 cm-3 leads to increase of the magnetic
field sensitivity, ! , to ≈ 1.1 V/AT, but it decreases to ≈ 0.45 V/AT at 450K. On the other hand doping with Bi at 1 x 1017
cm-3 gives ! ≈ 1 V/AT. The charge carriers mobility of the investigated microcrystals varies from about 2.11m2/V.s to 3.4
m2/V.s, for Te doped samples and from 3.2 m2/V.s to 4.3 m2/V.s for Bi doped samples at room temperature. The
electrical resistivity variation with temperature was also studied.
|Zr-Content Dependence of Electrical Properties in Heat-Treated In2O3: Zr Thin Films Grown on a Sapphire Substrate by Sputtering
Abstract: Zirconium-doped indium oxide (In2O3:Zr) thin films of various Zr-contens were hetero-epitaxially grown on a
sapphire single-crystalline substrate by a magnetron sputtering method. The films were heat-treated in an N2 atmosphere
and the variations of their electrical properties as a function of the Zr-content were investigated. We observed the
resistivity decreasing without any deterioration in their crystallinity and optical transmission property after the heattreatment
when the impurity content was within 2 wt.%, and then, the degree of the resistivity-decrease saturated since
their mobility started to decrease due to the heavy impurity doping
|Bipolar Bozukluğu olan Hastalarda Uyku Kalitesi, Biyolojik Ritim Örüntüsü ve Yaşam Kalitesinin Tedavi Uyumuyla İlişkisi
Bu çalışmada bipolar bozukluğa sahip tedavi uyumu olan hastalarla olmayan hastaların uyku kalitesi,
biyolojik ritim örüntüsü ve yaşam kalitesinin karşılaştırılması amaçlandı. Gaziantep Üniversitesi Tıp
Fakültesi Şahinbey Araştırma ve Uygulama Hastanesi Psikiyatri Polikliniği tarafından DSM-IV-TR tanı
ölçütlerine göre bipolar bozukluk tanısı almış ötimik durumdaki onam veren, polikliniğe ardışık olarak
gelen 102 hastaya Hamilton Depresyon Derecelendirme Ölçeği (HDDÖ), Young Mani Derecelendirme
Ölçeği (YMDÖ), tedavi uyumu için Morisky Tedaviye Uyum Ölçeği (MTUÖ), uyku kalitesi için Pittsburg
Uyku Kalitesi Ölçeği (PUKÖ), biyolojik ritim örüntüsü için Biyolojik Ritim Değerlendirme Görüşmesi
(BRDG), yaşam kalitesi için Yaşam Kalitesi Ölçeği (YKÖ), Sosyodemografik ve Klinik Veri Formu
uygulandı. Tedavi uyumu olan ve olmayan hastaların, uyku kaliteleri, biyolojik ritim örüntüleri ve
yaşam kaliteleri arasında ilişki olup olmadığına bakıldı. Tedavi uyumu olan hastaların daha iyi uyku
kalitesine sahip olduğu, daha az uyku bozukluğu yaşadıkları, sosyal yaşamlarında daha işlevsel
oldukları, biyoritimlerinin daha düzenli olduğu saptandı.
In this study, it is aimed to compare the biological rhythm patterns and quality of life of bipolar
disorder treatment compliance with the sleep quality of patients with non-patients. Hamilton
Depression Rating Scale (HDRS), Young Mania Rating Scale (YMRS), treatment compliance for Morisky
Medication Adherence Scale (MMAS), sleep quality for the Pittsburgh Sleep Quality Index (PSQI),
Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN) for biological rhythm
patterns, Quality of Life Scale (QLS) for quality of life, Socio-demographic and Clinical Data Form were
used for the sequentially outpatient of 102 patients, in the Psychiatry Clinic of the University of
Gaziantep Sahinbey Research and Practise Hospital, the patients with bipolar disorder according to
the DSM-IV-TR diagnose criterions. Whether there is a relationship between the biological rhythm
patterns, sleep quality and quality of life of patients who have adherence to treatment and who do not
was evaluated. It appears that the patients who have adherence to treatment have a better quality of
sleep, less sleep disorder, are more functional in social life and have more regular biorhythms.
|Defect-Structure-Related Ferroelectric Properties of K0.5Na0.5NbO3 Lead-Free Piezoelectric Ceramics
Abstract: Lead-free piezoelectric ceramics K0.5Na0.5NbO3 (KNN) doped with Cu, Fe, and Ni have been prepared by a
conventional ceramic process. The results reveal that Cu-doped KNN ceramic exhibits double-loop-like characteristics,
while Fe & Ni-doped KNN ceramics show normal single loops. EPR spectra verified the formation of irreversible defect
''' ! VO
•• )' (DC1) and (VO
•• ! CuNb
''' ! VO
•• )• (DC2) in Cu-doped ceramics, while defect complexes were
observed in Fe-doped ceramics and very small defect complex signal in Ni-doped ceramics. The experimental results
show that the ferroelectric properties of KNN ceramics are strongly related to these defect structures.
|Chemical Etching and TEM Crystalline Quality Assessment of Single Crystalline ZnSe Ingots Grown by I2 Vapor Phase Transport
||Raúl L. D´Elía
||Myriam H. Aguirre
Abstract: Crystalline defects were studied in single crystalline ZnSe grown by chemical transport using I2 as gaseous
carrier. Transmission electronic microscopy determined an excellent structural order in the micrometric and nanometric
range. Larger material areas were studied by chemical etching using different reagents to determine average
dislocations density and average adjacent subgrains misorientation. Comparable micrographic results of different
reagents are shown. Characterization values of ZnSe commercial substrate grown by High Pressure Bridgman (HPB)
have been compared to those that correspond to our grown material wafers. Characterization proved that the
semiconductor crystalline quality in our wafers is appropriate for optical devices.
|Analytical Modeling and Numerical Simulation of Hg1-xCdxTe Based N+n0p+ Photodetector for MWIR Free Space Optical Communication
||P . Chakrabarti
Abstract: This paper reports an analytical modeling and numerical simulation of N+-Hg0.59 Cd0.41Te /n0 Hg0.65 Cd0.35Te
/p+-Hg0.65 Cd0.35 N+n0p+ photodetector for operation in medium wavelength infrared region (MWIR) for free space optical
communication. The photodetector has been studied in respect of quantum efficiency, responsivity and detectivity by
analytical method using closed form equations. Also numerical simulation has been performed using device simulation
software ATLASTM for obtaining the energy band diagram, electric field profile, doping profile, quantum efficiency,
responsivity and detectivity. The photodetector exhibits a high value of quantum efficiency~93%, responsivity~2.86A/W
and detectivity~1.33×1011 mHz1/2W-1 at wavelength of operation 3.8 μm.
|Effect of Silver Plasmonic Layer on Cu2O/In2S3 Solar Cell
Abstract: Solar cell with the structure Cu/Cu2O/In2S3/Ag@NP/Ag was fabricated where the In2S3-window layer and the
plasmonic Ag nano particle thin film layer were deposited using injection chemical spray pyrolysis technique. Quantum
efficiency measurement of these solar cells showed improved performance in the blue region of the visible spectrum
compared to their counterparts. The films with Ag nano particles exhibited surface plasmon resonance peak at 432 nm
which could be assigned to plasmon resonance of Ag nano-particles. The open circuit voltage of the best solar cell is
0.65 V, with short circuit current density of 1.2 mA/cm2, fill factor 22% and efficiency 0.17 %. We conclude that the incoupling
of light by the metallic nanoparticle thin film layer into the underlying semiconductor layer resulted in
improvement in electrical performance of these solar cells containing the plasmonic Ag nano particles.
|Leaching Hazardous Substances out of Photovoltaic Modules
Abstract: Photovoltaic modules contain hazardous substances such as lead and cadmium. Under normal operation
conditions, these materials will not be released into the environment. This study identifies conditions resulting in release.
Our worst case study uses milled module pieces of 0.2 mm size. Depending on the pH value of water based solutions,
more or less amounts of hazardous substances are leached out. Solutions with low pH values (acidic solutions) yield
substantial leaching. Three different solutions simulate different environmental conditions: i) “low mineralized water”
conditions, via water containing sodium hydroxide, ii) “sea water” conditions, via water containing sodium hydroxide and
sodium chloride, and iii) “rainwater” conditions, via water containing acetic acid. In “rain water”-like solutions with low pH,
already after a few days, around 30 % of the cadmium is leached out from milled cadmium telluride module pieces,
increasing to 50 % after 56 days! In the same time, more than 15 % of lead is leached out from c-Si module pieces.
Tellurium elutes in the range of 30 to 40 % with a weak dependence on the pH value of the solution indicating an
instability of the compound cadmiumtelluride out of the cadmiumtelluride modules. Most of the extractions increase
during several weeks of measurement. Therefore, the usual one-day-elution test does not give enough information.
Meaningful leaching experiments should last for at least ten days.
|Transverse Dynamics for Super-Rapid Acceleration in Circular High-Energy Particle Accelerators
Abstract: A new particle acceleration concept had been presented to realize a short acceleration time of μs to produce
high-energy muons in circular accelerators. The acceleration method is also expected to accelerate heavy-mass
particles with large momentum spread: protons, deuterons, and various heavy ions. It is most important to develop a
beam injection method into a main accelerator and to investigate the vertical motion of particles, especially for heavy ion
acceleration. The outlines of beam injection method and beam focusing method to solve the vertical divergence problem,
which causes the beam loss, are shown in this paper. In addition, a new compact magnet system, which produces
magnetic field like a quadrupole field for beam focusing especially in wide aperture accelerators, is also described here.
|Numerical Simulation of HgCdTe Based Simultaneous MWIR/LWIR Photodetector for Free Space Optical Communication
Abstract: In this paper we report a theoretically simulated multilayer Hg1-xCdxTe based heterojunction photodetector for
dual band operation at temperature 78K. The detector is designed to operate at two strategic atmospheric windows in
the MIR (3.8 m) and in the LWIR (10.6 m) region. The device has been modeled using closed form analytical formula
and is also simulated using the device simulation software ATLAS from SILVACO® international. The device has been
theoretically characterized in respect of energy band diagram, electric field profile, current voltage characteristics,
spectral response and quantum efficiency. The detector is expected to find application in free space optical
communication at 3.8 m and at 10.6 m.
|Gradation of Nanoparticle Size by Stokes' Law: A New Approach for Synthesis of CdS Nanoparticles
||Beer Pal Singh
Abstract: The synthesis technique and its allied process parameters have a specific effect on the nucleation, growthdominated
microstructure and properties of nanostructure materials. The properties of semiconductor nanoparticles
strongly depend on its size, shape, composition, crystallinity and structure. Recently, semiconductor nanoparticles have
been extensively investigated and gained much interest due to their unique properties and applications in diverse areas
of science and technology. A new controlled technique for synthesis of CdS nanopartlicles by means of kinetic approach
using well-known Stokes' law for free body falling in quiescent and viscous fluid has been employed. Nanoparticles of
cadmium sulfide (CdS) have been synthesized by simple controlled chemical method using IR radiation heating without
using any capping agent and stirring. The desired concentration of aqueous solutions of cadmium chloride (CdCl2.2H2O)
and thioacetamide (CH3CSNH2) were reacted in a controlled manner by IR radiation heating at the reaction area (top
layer of reactants solution) of solution results the formation of CdS nanoparticles following Stokes' law. The assynthesized
nanoparticles were characterized by XRD, optical spectroscopy and SEM with EDX analysis.
|Properties of the Coherence Length and Van Hove Singularity in High-Tc Superconductors
c superconductors are characterized by a short coherence length
0 . From the quasi-2D structure of
these compounds, we calculate the density of states
n( ) , the Fermi velocity
F and the gap energy
(0) . From these
parameters, we deduce a formula of the coherence length
0 . We study the effect of the phonon-interaction
Vp , the
effective mass of carriers m
and the Coulomb repulsion
C on the coherence length
0 . We show that when the
p is in the range 0.06 – 0.30 and the effective mass m
is between 2m0 and 6m0 (m0 is the free
electron mass), the values obtained of the coherence length and the gap energy are in a good agreement with
|Conceptual Design of Rapid Circular Particle Accelerator Using High-Gradient Resonant Cavities with Fixed Frequency
cavities is introduced for muon acceleration up to 300 MeV and proton acceleration up to 400 MeV. The accelerator
concept is expected to realize Mpps-class rapid cycling high-energy particle acceleration in circular particle accelerators.
Conceptual designs of the circular accelerator are discussed with an emphasis on short lifetime particles. The
fundamental concept of particle acceleration and the related practical issues, which should be discussed when designing
the accelerators, are described as well.
|Nanoparticulate ZrO2/SO4 2- Catalyst for Biofuel Production
||Mounir Ben Amar
Abstract: This study reports on the preparation of zirconia coatings based on monodispersed zirconium-oxo-alkoxy
(ZOA) nanoparticles for conversion of free fatty acid (FFA) into biofuel. Monodispersed ZOA nanoparticles of 3.6 nm size
were prepared by sol-gel method in a rapid micro-mixing reactor with turbulent fluids flow at 20°C. The ZOA
nanopowders obtained after precipitation and nanocoatings deposited on glass beads, after subsequent sulfatation,
drying and calcinations, show high catalytic activity towards esterification process. The biofuel yield in esterification of
palmitic acid in methanol reached 67% (after t=3.5 hours) on nanopowders while it increases to 98% on nonocoatings.
|Management of Allogeneic Stem Cell Transplant Recipients with Hepatic Veno-Occlusive Disease
Abstract: Hepatic veno-occlusive disease (VOD) or sinusoidal obstruction syndrome (SOS) is one the major limiting
factor for the successful outcome of patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT), with
a reported mortality rate of up to 50%. VOD/SOS is thought to result from an endothelial damage and occurs with a
highly variable incidence ranging from 8% to 14%. Management of patients with VOD/SOS is based on both prevention
and treatment, which rely on non-pharmacological approaches, for instance the control of additional risk factors, and
Herein we provide a review of the current understanding for the management of patients with VOD/SOS after allogeneic
|Approach to Aplastic Anemia- An Overview and Practical Approach
||Attili Vs Suresh
Abstract: Despite the fact that cytopenia has been a common hematological entity seen in clinical practice for decades,
the understanding of its etiopathogenesis has been changing, which in turn impacts on the management strategies. The
current review focuses on the understanding of the current concepts and a brief overview of the management of aplastic
anemia. As the spectrum of stem cell biology, etiology, and treatment from transplantation to graft-versus-host disease
cannot be covered in few paragraphs, the most concise form is presented here.
|The Impact of Patient and Parents’ Education by Nurses on Serum Ferritin Levels in Children with Beta-Thalassemia Major
Abstract: Background: Through education and information, nurses can help patients learn more about their health
status and can contribute to improvement in patient drug adherence, clinical and laboratory outcomes. The aim of this
study was to assess the impact of patient and their family education by nurses on serum ferritin levels.
Methods: The study included 85 children with transfusion-dependent beta-thalassemia aged between 2.4 to 17 (mean
7.6 ± 3.3) years, 44 (52%) of whom were male. All patients received deferasirox doses ranged from 12 to 40 mg/kg/day.
Patients and their families were requested for education intervention provided by nurses. Seventeen patients (group 1)
(11 male, 6 female) refused to receive education or not compliant with the study protocol. Sixty-eight (33 male, 35
female) patients (group 2) and their parents educated by nurses, including drug instructions, telephone interviews and
home visits for 12 months.
Results: Mean deferasirox dose at the 24th and 36th months of the study were 31.6 ± 7 and 32 ± 8 mg/kg/day in group 1,
and were 32.7 ± 8 and 33.6 ± mg/kg/day in group 2, respectively. Mean serum ferritin levels at the 24th and 36th months
of the study were reduced from 4424 ± 2305 ng/mL to 3425 ± 1661 ng/mL (the mean difference was 662 ng/mL) (P
=0.044) in group 1, and were reduced from 3177 ± 1645 to 2748 ± 1343 ng/mL (the mean difference was 274 ng/mL) (P
= 0.033) in group 2, respectively
Conclusion: Our study’s results suggested that patient and parents’ education by nurses have no significant impact in
reducing ferritin levels in children with beta-thalassemia major. Deferasirox dose was the only significant predictor that
contributed to reduction in ferritin levels.
|Is there any Relationship between Rh(D) Blood Group and Von Willebrand Factor Antigen Concentration?
||I. S. Akpan
||E. M. Essien
Abstract: Background: Several reports have documented the influence of ABO blood group on plasma von Willebrand
Factor Antigen (vWF:Ag) levels. However, a thorough search through the literature has not revealed any study on the
relationship between Rh blood group and plasma von Willebrand Factor antigen levels.
Objective: The aim of this study was to determine the relationship between plasma vWF:Ag levels and Rh(D) blood
group among apparently healthy Nigerian subjects.
Methods: This was a cohort study of 100 Blood Donors attending the Blood Bank Unit at University of Uyo Teaching
Hospital, Uyo, Nigeria. Plasma vWF:Ag levels were determined by ELISA method while the ABO and Rh(D) blood group
phenotypes were determined using the standard tube method. The data were analyzed with SPSS version 16.0. Chi
square was used for test of significance.
Results: The study population consisted of 63 (63%) males and 37 (37%) females with a mean age of 31.7 ± 6.39 years.
The frequency of Rh(D) positive and Rh(D) negative blood groups were 95% and 5%, respectively. The mean plasma
vWF:Ag concentration of the subjects was 1.38 ± 1.02 IU/ml. Group B Rh(D) positive subjects had the highest mean
vWF:Ag level (2.27 ± 1.57 IU/ml), followed by group O Rh (D) negative (2.00 ± 1.04 IU/ml), group AB Rh(D) positive
(1.69 ± 1.06 IU/ml), group B Rh(D) negative (1.53 ± 0.57 IU/ml), group O Rh(D) positive (1.24 ± 1.00 IU/ml) and group A
Rh(D) positive (1.08 ± 0.40 IU/ml) having the lowest level.
Conclusion: There was no statistically significant association between the plasma vWF:Ag levels and Rh(D) blood
groups of study subjects (P = 0.1546). However, further research with larger sample size is required to determine the
relationship between plasma vWF:Ag levels and Rh blood group in general before reaching definite conclusion about the
lack of influence of Rh blood group on the plasma level of vWF:Ag
|Influence of Blood Transfusion on the Clinical Course and Immediate Outcome of Trauma Patients: Retrospective Study in a Tertiary Trauma Care Centre in Northern India
Abstract: Background: Red blood cell transfusion is a prominent faction of the standard protocol for management of
trauma patients. Clinical research over the past two decades has linked RBC transfusion with increased odds of
morbidity and mortality. We conducted a study to assess influence of transfusion on survival and the clinical course of
trauma patients in a level I trauma care center.
Methodology: Retrospective review of the blood bank registry was conducted (Jan-June 2012). 100 acutely injured
trauma patients who received blood transfusion were selected and categorized based on the number of units transfused;
group I (1-5 units) n= 40; group II (6-9 units) n=40 & group III (>10 units) n= 20. Study control were trauma patients who
did not receive transfusion group IV (n= 40). The clinical course of the patients was followed via computerized patient
record system maintained by our institution. Analysis was done to compare outcome (in hospital mortality, organ failure,
infections, length of stay) between the study and control groups, also between groups based on units transfused.
Results: Severity of injury was significantly higher in patients who received transfusion than those who did not (p<
0.001). Transfusion was associated with high rate of infection (62%), organ failures (43%) and mortality (39%). Number
of units transfused also correlated with injury severity (p< 0.001). Incidence of renal failure (20%), liver failure (35%) was
high in group II. Also 50% developed sepsis in group II compared to 13.6 % in group I, and 31.8 % in group III. (p<
0.001). Highest mortality rate was observed in group II (67.5%), followed by 60% in group III and lowest in group IV 2.5%
Conclusion: We observed a surrogate relationship between severity of injury and transfusion requirements. Transfusionrelated
adversities may be more reflective of the confounding effect of severity of injury than RBC transfusion. Therefore
evaluating the risks and benefits of blood transfusion in trauma management is recommended.
|A Look under the Hood of the Engineered Human Natural Killer Cells
Abstract: Notwithstanding multimodal approaches including chemotherapeutic agents and radiation have been used for
decades as major strategies to successfully treat cancer patients; however, the emergence of drug or radiation
resistance led to a significant incidence of tumor relapse and hence limits their effectiveness. Therefore, the need for
novel and effective strategies which are clinically vital; not only for improved efficacy to eliminate resistant tumor cells but
also to permit less-toxic doses and potentially overcome resistance, was and still a hopeful goal. Natural killer (NK) cells
comprise 5–10% of peripheral blood lymphocytes (PBLs). Owing to the fact that NK cells have an importance role in antitumour
immunity as demonstrated by several elegant studies, therefore, this NK-cell activity has been exploited as the
basis of cancer immunotherapy strategies. Nevertheless, tumor cells can effectively escape NK cell-mediated apoptosis
through a cocktail of different mechanisms. Thus, to enhance NK cell effector function against tumors, different
approaches have been recently developed to achieve an ex vivo NK-cell enhancement. One adoptive transfer approach
uses expanded allogeneic NK cells, which are MHC class I-resistant. A second approach uses stable allogeneic NK cell
lines, which is more practical for large-scale production and safety. A third approach is the genetic modification of NK
cells or NK cell lines to highly express cytokines, Fc receptors and/or chimeric tumor-antigen receptors. Therapeutic NK
cells can be derived from different sources, including peripheral or cord blood cells, stem cells or induced pluripotent
stem cells (iPSCs). Here, we summarize the recent developments in genetic engineering of NK-cell-based
biopharmaceuticals, and covering the usefulness, effectiveness, and safety for their clinical applications.
|Preanalytical Factors Affecting the Mean Platelet Volume: a Review
||Katalin S Zsóri
||Judit M Mahalek
Abstract: Mean platelet volume (MPV) as an indicator of platelet activation is a subject of many studies. Since the
introduction of automated hematology analyzers, many authors described mean platelet volume as a marker for different
pathologic conditions. It is also known that numerous preanalytical conditions could affect MPV results. Specimens are
usually tested several hours after blood collection. There are some specific hematology analyzers which are in use by
the majority of hematology laboratories. This review demonstrates some important aspects related to MPV measurement
in routine laboratory.
|Retrospective Evaluation of Anemia in Relation to Body Mass Index [BMI] in Women Presenting to Tertiary Care Hospital from Telangana
Abstract: Objective: This is a retrospective analysis to investigate the prevalence, nature [Like megaloblastic vs Iron
deficiency vs blood loss vs hemolytic etc.] and determinants of anemia among women in a tertiary care hospital during
the period 2011-2014. We examined differences in anemia related to, urban/rural location, nutrition status as reflected by
body mass index (BMI) and serum albumin levels and hemogram values
Methods: The Hb values of all women presenting to the OPD was captured along with the details of the Haemogram,
Iron profile, as well as other clinical examination findings. Wherever the complete work up was performed, the details
were also captured. The standard definitions were used for entering the data and MEDCALC version 7.0 was used for
the statistical analysis.
Results: A total of 463 women aged 15–59 were analyzed. (Elderly were not included as the etiologic of the anemia will
be different in them as well as multiple co-morbidities confounding the analysis) Prevalence of anemia was high among
all women, however as compared to national statistics; this is slightly less in the current study. In all 28.4% of women
had mild, 12.6% had moderate, and 5.2% had severe anemia. Both high and low BMI were associated with anemia,
though very low BMI had mixed picture, Low BMI had Iron deficiency and high BMI had Megaloblstic variants of anemia.
Conclusion: Anemia still is an important health burden in women of both urban and rural origin, even-though the
prevalence compared to a decade ago appears to be slightly less. New differential and tailored program strategies are
needed for improving the hemoglobin for those with very low BMI [Iron supplements alone may not be enough and they
need both Iron and B12 with folic acid]. Similarly in urban women, its essential to sensitize regarding the balanced diet,
[especially if the BMI is high] with focus on the B12 and folate supplements [besides other dietary modifications].
|Usefullness of Baseline Neutrophil to Lymphocyte Ratio (NLR) in Hematological Malignancies
Abstract: Systemic inflammatory response was reported to be a poor prognostic factor in several malignancies. An
inexpensive and readily available laboratory tool, neutrophil to lymphocyte ratio (NLR), can be easily obtained from
differential blood counts. Current evidence suggests that a baseline NLR may predict the long-term survival results of
patients with lymphoproliferative diseases (especially diffuse large B-cell lymphoma). The relationship between systemic
inflammation and cancer, and the usefulness of NLR in hematological malignancies will be disscussed in this
|Probability Predicting Tool for Identifying Incidence and Severity of Pancytopenia as a Result of Megaloblastic Anemia
||Attili Vs Suresh
Abstract: Background: One of the most common etiology in the diagnosis of pancytopenia in physician practice is
megaloblastic anemia. However there is significant confusion associated with marrow megaloblastic features, which
need not always because of pancytopenia. They may be just co-incidental findings. Its often difficult to establish that the
peripheral pancytopenia is related to marrow megaloblastic features, as Vitamin B12 and folate are often normal in these
cases [because of prior treatment]
Aim: This study was conducted to develop a probability predicting system for possible incidence and severity of
pancytopenia as a result of megaloblastic anemia.
Materials and Methods: This is a retrospective analysis conducted at a tertiary care center with approximately 2,000 new
cases of megaloblastic anemia. We Hypothesized age, duration of symptoms, Mean Corpuscular Volume [MCV],
nutritional status, B12 and folate levels, underlying illness and response to therapy as possible factors associated with
pancytopenia of megaloblastic anemia. Receiver operating characteristic (ROC) curves were drawn to predict the cutoff
values for risk factors, and a final scoring system was developed with sensitivity and specificity data.
Results: A total of 458 patients with pancytopenia and marrow findings of megaloblastic anemia were analyzed. Based
on ROC analysis, following cutoff values were selected: age > 40 years or <20, Folate <30% lower limit, B12 any value
close to lower limit of reference laboratory value, Mean Corpuscular Volume>110 fl, duration of symptoms more than 18
weeks, Serum Albumin <2.5 gm/dl [taken as marker for nutrition]. The remaining factors were indicated as present or
absent. A score of 1 was assigned for the above factors if they were present. For patients, the final score of 2 or less
there is 22% probability of having pancytopenia while patients having score of 6 or more have 89% probability. Similarly
when the Mean Corpuscular Volume recovered/reduced by 8 fl at week 3, patients have positive predictable recovery
pattern. Those who does not have such recovery by week 3, the etiology of pancytopenia is unlikely to be megaloblastic
anemia. And they need further evaluation
Conclusion: The current tool is fairly accurate in predicting development of pancytopenia in patients with low B12 and
folate/megaloblastic anemia. This will further help clinicians to look for other reasons of pancytopenia in case, where
MCV does not recover beyond week 3 of therapy, so that valuable time of patient is not lost in resource constraints
nations like India.
|The Effect of Iron Deficiency Anemia Treatment on Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio
Abstract: Background: Both neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are costeffective
and readily available biomarkers. An increment in either NLR or PLR is an indicative of a prolonged chronic
inflammatory condition and increased host inflammatory response. Iron deficiency anemia (IDA) is frequently associated
in chronic disorders.
Aims: We decided to investigate whether the efficient treatment of IDA should affect NLR and/or PLR values in an adult
population with IDA.
Methods: This was a retrospective (case-series) observational study conducted at an adult Hematology clinic in Turkey.
Patients were ≥ 18 years-old, with IDA defined according to the World Health Organisation criteria. The hematological
parameters, NLR, and PLR levels were noted before and after oral iron (Fe+2) repletion treatment.
Results: A total of 200 patients with IDA (median age 44 years, IQR 32-52 years, women 91%) were included. NLR
values did not differ significantly in terms of IDA treatment (2.07 vs. 2.01, p= .558). PLR levels were significantly
decreased after IDA treatment (170.63 vs. 140.32, p< .001). The NLR and PLR were positively correlated (p= .01). A
low-unremarkable inverse correlation between NLR, and serum iron levels (p= .024) and Tfsat (p= .038) was observed; a
similar negative correlation was also observed between PLR, and serum iron (p= .002) and Tfsat (p= .013) levels.
Conclusion: The treatment of IDA did not affect NLR, whereas it was associated with significant decrease in PLR. The
NLR and PLR were positively correlated. However, both the NLR and PLR were inversely correlated with serum iron and
|Review of Blood Transfusion Strategies among Trauma Patients
Abstract: Introduction: Trauma is the third most common cause of mortality worldwide and leading cause of death in the
age group 1 to 44 years. Among those trauma patients, major hemorrhage is responsible for 30 to 40% of mortality,
despite the fact that it could be preventable and reversible. The ideal resuscitation strategy for trauma patients remains a
topic of ongoing debate. Transfusion services stress trauma centers with demands for strict accountability for individual
blood component units and adherence to indications in a clinical field where research has been difficult and guidance
opinion-based. New data suggest that the most severely injured patients arrive at the trauma center already
coagulopathic and these patients benefit from prompt specific and corrective treatment. At present, no consensus has
been reached on ideal fluid for early resuscitation and on the threshold for blood product transfusions. This review article
provides a brief overview of recent advances in trauma induced hematological complications, role of pathologist in
managing them and subsequent complicating issues. Thereby, covering the widest possible body of literature.
Aims and objectives: In this review we address ongoing resuscitation strategies along with potential complications in
management of the trauma patients. This review also assesses the still ongoing, controversial debate of the best fit
treatment options. This research is clarifying trauma system requirements for new blood products and blood-product
usage patterns, but the inability to obtain informed consent from severely injured patients remains an obstacle to further
Methods: We considered systematic reviews identified through searches of Cochrane databases from inception to April
2015 and PubMed up to April 2015.
Results and Conclusions: Polytrauma patients with severe shock from haemorrhage and massive tissue injury present
major challenges for management and resuscitation. Many of the current recommendations for damage control
resuscitation remain controversial. A lack of large, randomized, control trials leaves most recommendations at the level
of consensus and expert opinion. Ongoing trials and improvements in monitoring and resuscitation technologies will
further influence how we manage these complex and challenging patients.
|A Medical Emergency: “Leukostasis”
Abstract: Hyperleukocytosis is commonly defined as a white blood cell (WBC) count exceeding 50-100 x 109 L-1 in
peripheral blood and can be seen in newly diagnosed leukemias. Increased WBC count can lead to increased blood
viscosity, leukocyte aggregation, and consequently stasis in blood vessels. Hyperleukocytic leukemia is associated with
a risk of organ failure and early death secondary to leukostasis. The main sites that tend to be injured are the central
nervous system (CNS) and lungs. The goal of the treatment of hyperleukocytosis and/or leukostasis is to remove
leukocytes or blasts from the peripheral circulation as soon as possible and to prevent or reduce acute symptoms of
leukostasis. The cytoreduction can generally be achieved by leukapheresis and/or some chemotherapeutic agents
before starting induction chemotherapy. Leukapheresis is an effective and safe procedure which can be used for
symptomatic relief, some special and rare conditions (serious respiratory failure, CNS involvement, priapism), or
prophylactically. The supportive care has to be a part of the treatment in order to prevent tumor lysis syndrome or
coagulopathy. The difference of hyperleukocytosis and leukostasis, pathophysiology and clinical presentation of
leukostasis, and treatment options of hyperleukocytosis and/or leukostasis in the light of the current literature will be
discussed in this review.
|Vitamin B12 and/or Folate Deficiency is a Cause of Macro Thrombocytopenia
Abstract: This retrospective study reveals that it is likely that vitamin B12 and / or folate deficiency is an important cause
for isolated thrombocytopenia with larger than normal sized platelets. Data collection and interpretation from the
laboratory has revealed this and as this can have further therapeutic utility, more studies on the subject are indicated.
Hypothyroidism may also be another cause for the findings.
|Expression of the Recombinant Soluble Glycoprotein IIb: Lessons Learned and Future Directions
Abstract: The platelet glycoprotein IIb (GPIIb) is an integral membrane protein, which forms with GPIIIa a calciumdependent
heterodimer. This heterodimer forms in the endoplasmic reticulum (RE) and in the absence of heterodimer
formation, both GPIIb and GPIIIa are retained and degraded in the ER. Efforts have been previously made to produce
recombinantly the soluble GPIIb, which can be used in the solid phase assays for the antibody identification. However,
all previous attempts to produce such a construct have not yield any product. This mini-review describes the previous
attempts and the future challenges.
|Effect of Environmental Tobacco Smoke on Plasma Iron, Zinc and Copper Concentrations in Infants
Abstracts: The deleterious effects of cigarette smoking on trace elements concentrations are well known. Recent
studies show that exposure of nonsmokers to environmental tobacco smoke (ETS) results in many biochemical
processes and diseases. The aim of this study was to investigate the plasma concentrations of iron (Fe), zinc (Zn) and
cooper (Cu) in 29 infants (14 boys and 15 girls, age range: 2-6 months, mean age: 3.6 months) who had been exposed
to ETS (range 8-30 cigarettes/day mean 12.4 ± 4.7) for at least two months at home, while the control group included 30
infants (13 male, 17 female, age range: 2-6 months, mean age: 3.3 months) who had never been exposed to ETS. All
infants had been breast fed. The plasma iron concentrations were determined by commercial kit, cotinine levels were
determined by luminometric method. Cu and Zn concentrations were analyzed by atomic absorption spectrometry. The
plasma Fe and Zn concentrations in the study group were significantly lower than in the controls (P < 0.05). However,
plasma Cu levels were not different between the two groups (P > 0.05). In conclusion, the plasma Fe and Zn
concentration decline in the ETS exposed infants.
|Prognosis of Elevated Serum Ferritin in Allogeneic-HCT
Abstract: Introduction: Serum ferritin was demonstrated to be a useful tool to predict the risk in patients who undergo
hematopoietic stem cell transplantation (HCT). Still it is not clear if its predictive value solely represents iron overload
(IO) and published results are sometimes contradictory. So the objective of present study was to determine relationship
between elevated pre-HCT serum ferritin levels, morbidity and mortality after allogeneic hematopoietic stem cell
transplantation (allo-HCT) on one side, and its correlations with various risk indexes which were developed recently to
predict outcomes after allo-HCT on the other side.
Patients and Methods: In this retrospective study we have reviewed medical records of one hundred six consecutive
patients (52 males and 54 females), with a median age of 32 years (range, 5 to 60), who underwent allo-HCT with
unmanipulated grafts between Jan 2013 and Dec2014. We retrieved pre-allo-HCT serum ferritin levels and also
calculated risk indexes before HCT. The incidence of complications and outcomes after allo-HCT was assessed. The
median follow-up period was 12 (range, 4-27) months after allo-HCT.
Results: We have determined a cuttoff ferritin level of 500 ng/mL for early complications and 737 for outcomes. We
found increased incidence of number of febrile neutropenic episodes (P =0.02), number of bacterial infection episodes (P
=0.009), pneumonias (P =0.039), slower period of neutrophil engraftment (P=0.032), demand for multiple red blood cell
(RBC) transfusions (P =0.002) within 100 days post transplantation. A significant association was found between pretransplant
ferritin concentrations and different risk indexes; European Group for Blood and Marrow Transplantation
(EBMT) risk score (P=0.001), Hematopoietic cell transplantation comorbidity index (HCT-CI) (P=0.003), Pre-transplant
Assessment of Mortality (PAM) score (P=0.007) and disease risk (DR) (P =0.037).
Conclusion: On the one hand we did confirmed that even moderate serum ferritin elevation is associated with increased
incidence of infections, slower period to engraftment and increasing demand of RBC units transfusions, but strong
correlation with pre-transplant indexes that take into account disease risk raises the question if IO is the only factor that
adversely affect the outcome of HCT in patients with increased ferritin. This should be studied in prospective trials
|Ferrous Sulfate Versus Ferrous Fumarate Plus Zinc Sulfate and Vitamin C for Treatment of Iron Deficiency Anemia in Children
Abstract: During childhood, different oral iron preparations are widely used in iron deficiency anemia (IDA) and
prophylaxis. The purpose of this study was to compare the efficacy of different oral iron preparations in children with IDA.
Eighty-nine children (age range, 1 to 17 years) with IDA were randomized to receive therapy orally in two divided doses
of either 5 mg Fe2+/kg/day ferrous sulfate (FS group, n = 45) or ferrous fumarate plus zinc and vitamin C (FZ group, n =
44). Hematological profile and iron status were evaluated at the beginning and on days 15 and 45 of treatment. Mean
Hb, mean corpuscular hemoglobin (MCH), mean corpuscular volume (MCV), red cell distribution weight (RDW), and iron
and ferritin levels were significantly higher in both groups on days 15 and 45 of treatment. Mean changes in Hb were 2.5
± 1.2 g/dL and 2.1 ± 0.7 g/dL on day 15 (P = 0.295), and 3.9 ± 1.8 g/dL and 3.5 ± 1.2 g/dL on day 45 (P = 0.331) in the
FS and FZ groups, respectively. Our study suggests that ferrous sulfate and ferrous fumarate plus zinc and vitamin C
were well tolerated and were highly effective in correcting IDA in children. Ferrous fumarate plus zinc and vitamin C did
not influence hematologic recovery compared with ferrous sulfate in this group.
|Infections in Hematopoietic Stem Cell Transplantation Recipients in the Pre-Engraftment Period
||Attili V.S. Suresh
Abstract: Introduction: The recipients of the hematopoietic stem cell transplantation (HSCT) are at increased risk of a
variety of infections due to their immunocompromised state. The severity of the immunocompromise differs depending
upon host, underlying disease, comorbidities, type of transplantation, conditioning regimen, and immunosuppressive
drugs. Pre-engraftment period is attended by neutropenia, mucosal barrier disruption, broad spectrum antibiotic usage
and invasive procedures like central lines.
Aim: We sought to evaluate the type and frequency of the infections in the pre-engraftment period in our transplant
Methods and Results: We reviewed 17 HSCT cases done in our center over 24 months from August, 2011 upto August,
2013 which included 11 autologous and 6 allogeneic HSCT cases. We found a total of 20 febrile neutropenic episodes
with 12 bacterial and 6 fungal infections. Eighteen of the 73 cultures were positive (24.65%). Nine out of 17 patients
(52.94%) had at least one culture positive. Eight out of 11 bacteria were ESBL producing (extended spectrum beta
lactamase) and one organism was only sensitive to colistin. Only 2 of the 12 bacteria were gram positive (16.67%). Only
one stool test was positive for Clostridium deficile. We had only one culture documented fungal infection (Aspergillus
sinusitis) and 5 presumed Aspergillus infections.
Conclusion: The incidence of febrile neutropenia is similar to other centers in India and Western world, though the
organisms are different. Gram negative bacteria continue to be the major threat to hematopoietic cell transplant
recipients especially in the early post-transplant period in India.
|Indications and Spectrum of Haematological Disorders from Bone Marrow Aspiration Examination: A Three Year Review Study
||Timothy Amos Ekwere
||Mabel Benson Ino-Ekanem
Abstract: Background: Haematological disorders have diverse modes of presentation that often requires bone marrow
examination for both diagnosis and management. This simple and relatively safe procedure is important particularly in
resource poor centres since access to adjuvant diagnostic techniques are often lacking or absent. This study was
conducted to determine the indications and the spectrum of Haematological diseases diagnosed using this procedure.
Methodology: This was a retrospective study conducted in the Department of Haematology University of Uyo Teaching
Hospital from January 2011 to December 2013. Bone marrow aspiration cytology records of 62 suspected cases of
haematological diseases were reviewed and analyzed using STATA software version 10.
Results: Majority of the patients who had bone marrow aspiration were adults aged 19 years and above. The male to
female ratio was 1.2:1. Most (93.5%) of the marrow aspirate examined had definitive pathologic features while 4 (6.5%)
were normal marrow elements. The main indications for BMA examination in order of decreasing frequency include;
anaemia (37.1%), diagnosis of Leukaemia (30.7%) and pancytopaenia (5.1%). Acute leukaemia was the most common
haematological disease diagnosed using this procedure. Acute myeloid leukaemia was twice as common as acute
lymphoblastic leukaemia. Also, mixed nutritional deficiencies occurred more commonly than single nutrient deficiency.
Conclusion: The indications for BMA examination in this study are similar to those reported in other studies. This
procedure remains a veritable tool in the diagnosis and management of a wide range of haematological diseases
especially in a resource poor centre like ours.
|Diffuse Alveolar Hemorrhage: A Fatal Complication of Rituximab
||Sheikh A. Saleem
Abstract: Pulmonary toxicity is a rare but severe adverse effect of Rituximab, associated with significant morbidity and
mortality. Despite increased reporting, few case reports associated with alveolar hemorrhage due to Rituximab have
been published. The authors present the case of a 61 year old Caucasian male with a diagnosis of small lymphocytic
lymphoma who recently completed chemotherapy with Rituximab and Bendamustine. The patient presented to the
emergency room with a one week history of nonproductive cough associated with shortness of breath and low grade
fevers. Differential diagnosis at the time of presentation included health care associated pneumonia, Rituximab-induced
pulmonary toxicity, and Pneumocystis jiroveci infection given his history of lymphoma and treatment with Rituximab. The
patient was initiated on intravenous (IV) broad-spectrum antibiotics, oral atovaquone, and IV methylprednisolone. A CT
scan showed bilateral diffuse pulmonary opacities and a video-assisted thorascopic surgery guided lung biopsy revealed
early diffuse alveolar hemorrhage with no evidence for infection. However, the remaining work-up consisting of blood
cultures, blood tests, and bronchopulmonary lavage did not produce any suggestive findings. Despite initiating the above
aggressive therapies, the patient continued to rapidly deteriorate. An autopsy revealed diffuse alveolar hemorrhage of
the lungs, thought to be secondary to Rituximab toxicity. The authors recommend emphasizing the importance of early
identification of worsening pulmonary symptoms in patients receiving Rituximab, with diagnostic consideration given to
|Cancer Associated Retinopathy in Non-Hodgkin’s Lymphoma
||Mohammad Muhsin Chisti
Abstract: Cancer-associated retinopathy (CAR) is an uncommon paraneoplastic retinopathy usually associated with
small cell lung carcinoma. To our knowledge, there is no previous report in the English literature of CAR syndrome
occurring in lymphoma patients. We describe a rare case of CAR syndrome in a 62-year-old male with non-Hodgkin’s
lymphoma (NHL) treated with four doses of intravenous immunoglobulin.
|Iron Overload in Patients Receiving Allogeneic Hematopoietic Stem Cell Transplantation
Abstract: Iron overload has been associated to a variety of post-transplant complications, including infections,
sinusoidal obstructive syndrome and it is conceivable that increased hepatic iron may mimic the clinical picture of GVHD
or even may contribute to the worsening of hepatic GVHD.
Objectives and Methods: aim of present review was to summarize the current knowledge about diagnosis and treatment
strategies of iron overload following HSCT.
Results: serum ferritin may be considered as surrogate marker of iron overload and is widely used as an indicator of
body iron status; however other noninvasive diagnostic methods, namely SQUID and MRI, may provide more precise
information on iron burden in specific organs, such as liver and heart. Since there are not physiological tools to remove
efficiently the excess of iron, it is of particular importance to consider iron depleting therapy. Phlebotomy should be
considered as the first line treatment of iron overload, while iron chelators, such as deferasirox, may represent an
alternative option for patients with an inadequate hematological recovery.
Discussion: additional prospective studies are mandatory to investigate the relationship between iron overload and the
outcome of patients receiving an allogeneic stem cell transplantation.
|Lymphomatoid Granulomatosis: A Diagnostic Challenge
Abstract: Lymphomatoid granulomatosis is a rare Epstein barr virus associated lymphoma. It most commonly involves
lungs, skin, central nervous system and kidneys. When lungs are involved, it often mimics common pulmonary
conditions like pneumonia, making diagnosis extremely challenging. We present one such interesting case of
Lymphomatoid granulomatosis in an immunocompetent young man.