Introduction: It has been shown recently that platelet indices like mean platelet volume (MPV), platelet size deviation width (PDW) and platelet-to-large-cell ratio (P-LCR) are helpful in the discrimination between hyperdestructive thrombocytopenia like idiopathic thrombocytopenic purpura (ITP) and hypoproductive thrombocytopenia (HT). The aim of the study is to assess the reliability of these indices in the differentiation of ITP from other thrombocytopenias. Methods: We recruited 134 thrombocytopenic patients (69 men, 65 women) who were divided into two groups according to the underlying disease: group I (n = 63) included ITP patients, whereas group II (n = 71) included patients with HT due to myelosuppression secondary to chemotherapy for hematological malignancies. Platelet indices were derived from a Sysmex automated cell counter. Sensitivity, specificity, positive prognostic value, negative prognostic value, efficiency and Youden index were calculated. Results: Concerning MPV and PDW indices, sensitivity, specificity, positive prognostic value, negative prognostic value, efficiency and Youden index were 100% for the diagnosis of ITP. On the contrary, the values for P-LCR were significantly lower. Conclusions: MPV and PDW can be safely relied on for a positive diagnosis of ITP. MPV and PDW were superior to P-LCR.
Accepting the positive results that public participation can bring in the implementation of the Water Framework Directive (WFD), this paper seeks to contribute to ongoing discussions on the rather problematic WFD implementation in southern Europe. Within this framework, we fi rst focus on the national level and the analysis of 'water governance' and 'public participation' within the context of WFD implementation in Greece, and secondly on the examination of the participatory methods introduced locally for the preparation of the Evrotas River Basin management plan. The fi rst section focuses on public participation as an indispensable ingredient of good water governance. The next focuses on the introduction of the WFD as an instance of governance that promotes participatory arrangements. We then present the centralized structure of the Greek state as an impediment to the introduction of public participation in water governance. The fourth section focuses on the Evrotas River Basin and describes the participatory arrangements for the preparation of the management plan. The paper concludes with the verifi cation of the need for participatory processes to respect the context within which they are pursued and with specifi c alterations to the way public participation has been planned and implemented in Greece.
The two most frequent microcytic anemias are beta-thalassemic trait (beta-TT) and iron deficiency anemia (IDA). Several discrimination indices have been proposed to distinguish between these two conditions. These indices are derived from several simple red blood cell indices, like red blood cell (RBC) count, mean cell volume, and RBC distribution width (RDW), as these are provided by electronic cell counters. The purpose of the study is to examine the diagnostic accuracy of six discrimination indices in the differentiation between IDA and beta-TT. The six discrimination indices that were examined were as follows: Mentzer Index (MI), Green & King Index (G&K), RDW Index (RDWI), England & Fraser Index (E&F), RDW, and RBC count. We calculated these indices on 373 patients (205 men, 168 women) with beta-TT and 120 patients (50 men, 70 women) with IDA, as well as their sensitivity, specificity, positive and negative prognostic value, efficiency, and Youden's index (YI). G&K shows the highest reliability, followed by E&F, RBC count, MI, and RDWI. On the contrary, RDW completely failed to differentiate between IDA and beta-TT. G&K proved to be the most reliable index as it had the highest sensitivity (75.06%), efficiency (80.12%), and YI (70.86%) for the detection of beta-TT. These six discrimination indices cannot be relied on for a safe differential diagnosis between beta-TT and IDA. They do have high specificity, but their sensitivity for the detection of beta-TT is not satisfactory. Consequently, they cannot be used neither as a screening tool for beta-TT because they could result in a significant number of false negative results.
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