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ObjectiveDifferent indices and formulas of CBC parameters have been suggested as indicators of early stage screenings to detect couples with β-thalassemia minor (BTMi). In this study, we evaluated the accuracy of five previous published formulas and compared them to our new formula (│80-MCV│×│27-MCH│) in screening of β-thalassemia.MethodsAll couples in the premarital β-thalassemia screening program of Roodbar, Iran, for whom molecular analysis had been done, were selected during two years. The red blood cell parameters were applied to each formula, and a ROC curve was plotted for each one to check its discriminative effectiveness in β-thalassemia detection.ResultNone of the studied indices and formulas demonstrated 100% precision. However, we found that the Shine–Lal formula and our formula had the highest sensitivity in identifying BTMi individuals. The highest specificity belonged to our formula and Sirdah formula.ConclusionPrevious studies reported different sensitivities and specificities for the formulas. This can be attributed to different kinds of HBB gene mutations in various populations. Undoubtedly, physicians in different areas should evaluate the accuracy of published formulas for their own populations in the discrimination of BTMi from other causes of microcytic hypochromic anemia.

This study was undertaken to determine the dose-response relation between epileptiform activity burden and outcomes in acutely ill patients. Methods: A single center retrospective analysis was made of 1,967 neurologic, medical, and surgical patients who underwent >16 hours of continuous electroencephalography (EEG) between 2011 and 2017. We developed an artificial intelligence algorithm to annotate 11.02 terabytes of EEG and quantify epileptiform activity burden within 72 hours of recording. We evaluated burden (1) in the first 24 hours of recording, (2) in the 12-hours epoch with highest burden (peak burden), and (3) cumulatively through the first 72 hours of monitoring. Machine learning was applied to estimate the effect of epileptiform burden on outcome. Outcome measure was discharge modified Rankin Scale, dichotomized as good (0-4) versus poor (5-6). Results: Peak epileptiform burden was independently associated with poor outcomes (p < 0.0001). Other independent associations included age, Acute Physiology and Chronic Health Evaluation II score, seizure on presentation, and diagnosis of hypoxic-ischemic encephalopathy. Model calibration error was calculated across 3 strata based on the time interval between last EEG measurement (up to 72 hours of monitoring) and discharge: (1) <5 days between last measurement and discharge, 0.0941 (95% confidence interval [CI] = 0.0706-0.1191); 5 to 10 days between last measurement and discharge, 0.0946 (95% CI = 0.0631-0.1290); >10 days between last measurement and discharge, 0.0998 (95% CI = 0.0698-0.1335). After adjusting for covariates, increase in peak epileptiform activity burden from 0 to 100% increased the probability of poor outcome by 35%. Interpretation: Automated measurement of peak epileptiform activity burden affords a convenient, consistent, and quantifiable target for future multicenter randomized trials investigating whether suppressing epileptiform activity improves outcomes.

There is a significant positive relationship between the size and perceived strength of an individual's social network and internalized stigma and some recovery attitudes. Clinical programs that address any of these factors could potentially improve outcomes for this population.

Background-Burst suppression in mechanically ventilated intensive care unit (ICU) patients is associated with increased mortality. However, the relative contributions of propofol use and critical illness itself to burst suppression; of burst suppression, propofol, and critical illness to mortality; and whether preventing burst suppression might reduce mortality, have not been quantified.Terms of use and reuse: academic research for non-commercial purposes, see here for full terms. https://www.springer.com/aamterms-v1

Introduction: Breast cancer cells and tumor stroma produce different cytokines and soluble factors. Cytokines, while playing crucial roles in immune responses to tumors, also favour tumor growth and progression. IL-7 and G-CSF are two cytokines that may exert influences on the pathophysiology of breast cancer. Materials and Methods: Sera were collected from 136 females with breast cancer before receiving chemotherapy or radiotherapy. The control group comprised of 60 healthy age-matched females without any acute or chronic diseases with no family history of breast cancer. Serum levels of IL-7 and G-CSF were measured by commercial enzyme linked immunosorbent assay. Results: While there was no significant difference in the level of G-CSF between patients (92.81±594.54 pg/ml) and controls (0.00 pg/ml), G-CSF level in sera of patients with advanced stages of breast cancer was elevated compared to early stages (p=0.0001). Moreover, the highest level of G-CSF was seen in patients with N3 phase tumors (p=0.0001). IL-7 was slightly but not significantly higher in the control group (0.04±0.11 pg/ml) in comparison with patients (0.02±0.10 pg/ml). Interestingly, a significant increase in the level of IL-7 in patients with skin involvement was observed (p=0.001). Conclusion: Our results showed an elevation of G-CSF in sera of patients with advanced stages of tumor, while IL-7 elevation correlated with skin involvement of breast cancer. IL-7 can be produced by keratinocytes in skin tissue and may be involved in the pathologic establishment of metastatic tumor cells in skin.

Background: To evaluate the relationship between presenting Glasgow Coma Scale (GCS) or laboratory data of patients with TBI and Extended Glasgow Outcome Scale (GOSE) and final outcome (deceased, survived) at one year.Methods: 74 patients (59 males and 15 females; mean age ±SD of 40±19years) who presented with TBI were entered into the study, and their GCS and laboratory data were recorded. After one year, GOSE level and final outcome were evaluated with 11 yes/no questions obtained from the patients or their first-degree relatives.Results: The patients with lower GCS on admission or day six, significantly had lower GOSE. Moreover, the lower the GCS in the first week of admission, the poorer the final outcome. Among laboratory data, the base deficit (BD) level of -6 or worse on admission was an indicator of mortality at one year. Hypernatremia was the only laboratory factor which predicted poor GOSE after a year. Furthermore, patients with serum hypernatremia, hyperkalemia, or high PTT levels on the first week of admission had poor final outcome.Conclusions: Presenting GCS and metabolic derangements are reliable indicators of long-term outcome and GOSE at one year.

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