ABSTRACT
Global growth in the elderly population for both health care providers and families and also the community is an important challenge. Elders are the largest and fast factor for increasing hospital admissions in Society. Increasing costs of aging is the most concern to elders and their families. This study aimed to investigate the health teams approach about cost-effective alternatives for aging health services. This study is a qualitative research which was done through content analysis. 18 people consisting of five faculty members, 6doctors, 3 nurses and 4health public health expert were participated. Samples were selected based on purposive sampling. Data were collected through interviews. Four core themes derived from this study which included: 1- Emphasis on training for aging care [including training doctors, nurses, health professionals, public health experts, elder sand their family caregivers]. 2- Emphasis on proper implementation of primary health care for the elderly. 3- Emphasis on home care for elderly.4-attntion to mental health of elderly. It seems effectiveness of tree alternatives; emphasis to training, home care and mental health for elderly are obvious and evident, so implementing and applying these suggestions would be helpful. But the second alternative; emphasis on proper implementation of primary health care for the elderly must be performed based on a comprehensive needs assessment in elders population. Finally it is stressed that calculating and comparing actual costs of each alternative in elders caring must be measured through quantitative researches
ABSTRACT
Reverse transcriptase-polymerase chain reaction [RT-PCR] assay is a useful tool for the detection of fusion transcript resulting from specific chromosomal translocation of the leukemia cells. A specific chromosomal abnormality, the Philadelphia chromosome [Ph], is present in 90% to 95% of CML patients. The aberration results from a reciprocal translocation between chromosome 9 and 22, creating a BCR-ABL fusion gene. There are two major forms of the BCR/ABL fusion gene, involving ABL exon 2, but including different exons of BCR gene. The transcripts b2a2 or b3a2 code for a p210 protein. Another fusion gene leads to the expression of an e1a2 transcript, which codes for a p190 pro-tein. Another, less common fusion genes are b3a3 or b2a3 [p203] and e19a2 [p230]. The incidence of one or other rearrangement in chronic myeloid leukemia [CML] patients varies in different reported series. In general, fusion transcripts are determined individually, a process which is labor intensive in or-der to detect all major fusion transcripts. This study was designed to determine the frequency of different fusion genes in 75 iranian patients with CML. peripheral blood samples were analyzed by multiplex reverse transcriptase poly-merase chain reaction [RT-PCR] from adult patients to detect all types of BCR-ABL transcripts of the t [9:22] and found that all cases were positive for some type of BCR/ABL rearrangement. Most of our patients showed b3a2 fusion gene [62%], while the remaining showed one of the transcripts of b2a2, b3a3, b2a3, e1a2 or coexpression of b3a2 and b2a2. The rate of coexpression of the b3a2 and b2a2 was 5%. In contrast to the other reports, we did not see any coexpression of p210/p190. This may reflect either the sensitivity of the detection techniques used or the possibility of genetic differences be-tween the populations studied. Coexpression may be due to alternative splicing or to phenotypic varia-tion, with clinical course different from classical CML
Subject(s)
Humans , Male , Female , Fusion Proteins, bcr-abl/analysis , Reverse Transcriptase Polymerase Chain ReactionABSTRACT
Blood transfusion may lead to the manifestation of anti-HLA and platelet-specific antibodies that may in turn bring about different problems like platelet refractoriness. It appears that the study of antibodies against HLA-Class I and platelet-specific antigens are useful for the selection and success of the appropriate treatment protocol. The aim of this study was to detect anti-HLA and anti-platelet-specific antibodies by flowcytometry in patients with hematologic disorders [including Acute Leukemia, Aplastic Anemia] and patients with ITP. In this descriptive study, anti-HLA and platelet-specific antibodies were detected by flowcytometric technique, using 62 sera drawn from patients with different hematological disorders who showed a poor response to platelet transfusion and 20 from patients with ITP. The results of anti-HLA antibodies were then compared by Panel Reactive Antibodies [PRA]. Our results showed 44 [53.7%] out of 82 patients had anti-HLA Class-I antibodies in their sera. The frequency of each antibody isotype was found to be as follows: IgM [51.2%], IgG [32.9%] and IgA [1.2%]. 36 [43.9%] out of 82 patients had platelet specific antibodies and the frequency of each antibody isotype was found to be as follows: IgM [40.2%], IgG [30.5%] and IgA [12.2%]. 27 [31.7%] out of 82 patients had both antibodies. No difference was found between the two groups in platelet specific antibodies. Despite significant correlation between flowcytometry and PRA methods, PRA can only detect antibodies which react with complement. With increase in the number of platelet transfusion, immunization to HLA antigens occures; moreover, immunization against platelet specific antigens may also occure during autoimmunity. The presence of these antibodies may be one of the reasons of poor response to platelet transfusion and platelet refractoriness in patients under study. Conducting similar studies with higher number of samples, platelet cross-match, and the use of HLA- matched platelets for these patients are recommended