Analysis Of Laboratory Data Research Articles

Особенности использования лимфоцитарного теста для прогнозирования степени тяжести острого лучевого поражения

One of the methods of biological dosimetry is the use of information on the concentration of lymphocytes in the peripheral blood of victims in the first days after irradiation. The aim of the study was to validate the lymphocyte test method for predicting the severity of acute radiation injury, taking into account the dose rate factor. Materials and research methods. The method of investigation was a correlational analysis of clinical, dosimetric and laboratory data of the victims of the accident at the Chernobyl nuclear power plant in 1986 (n=65) and in radiation accidents with gamma-neutron irradiation (n=19). The data were taken from the database of acute radiation injuries in humans of A.I. Burnazyan Federal Medical Biophysical Center of the Federal Medical and Biological Agency of Russia. Results of the study and their analysis. The results of correlation analysis indicated that average lymphocyte concentration in the range of 0.4-0.8×109/l on day 3-6 post-irradiation with dose rates greater than 2 Gy/h resulted in an average dose estimate which was 40.0% higher than that for dose rates of less than 2 Gy/h. Absolute error of dose estimation is (±1.0-1.5) Gy. For lymphocyte concentrations higher than 0.8×109/l the prognosis is uncertain: the range of dose assessment variability is 1-4 Gy. At a lymphocyte concentration of less than 0.4×109/l the average dose estimate is more than 4.0 Gy, corresponding to a severe or extremely severe degree of acute radiation disease. The predicted degree of severity of radiation injuries in the presence of the neutron component of radiation is lower in comparison with the predictions based on the data on the victims of the Chernobyl accident. It is concluded that the identified dependencies can be used for medical triage of the victims at advanced stages of medical evacuation. For the purpose of correct routing of medical evacuation to specialized centers, it is advisable to allocate 4 treatment-evacuation groups.

Is it possible to determine antibiotic resistance of E. coli by analyzing laboratory data with machine learning?

Abstract Objectives Microbial antibiotic resistance remains a serious public health problem worldwide. Conventional culture-based techniques are time-taking procedures; therefore, there is need for new approaches for detecting bacterial resistance. The aim of this study was to assess antibiotic resistance of Escherichia coli by analyzing biochemical parameters with machine learning systems without using antibiogram. Material and methods In this article, machine learning systems such as K-Nearest Neighbors, Artificial Neural Networks (ANN), Support Vector Machine and Decision Tree Learning were used to investigate whether E. coli is sensitive or resistant to antibiotics. The study was conducted based on the clinical records of 103 patients who were previously diagnosed with E. coli infection, including CBC and complete UA results, and CRP values. Results The accuracy rates of antibiotic resistance/susceptibility detected by ANN were as follows: Amikacin (96.0%), Ampicillin (77%), Ceftazidime (62%), Cefixime (63%), Cefotaxime (68%), Colistin (95%), Ciprofloxacin (76%), Cefepime (70%), Ertapenem (96%), Nitrofurantoin (90%), Phosphomycin (98%), Gentamicin (84%), Levofloxacin (98%), Piperacillin-Tazobactam (92%), and Trimethoprim-Sulfadiazine (79%). Conclusions The study determined the antibiotic resistance of E. coli with less time and cost compared to conventional culture-based methods machine learning based model contributes positively to artificial intelligence (AI) supported decision-making processes in laboratory medicine.

Cluster analysis of the acute diarrhea causes in young children admitted to the infectious diseases unit

Aim. To use the cluster analysis of clinical and laboratory data, characteristic to children aged 6 to 24 months with acute diarrhea, in demonstrating the signs of infectious or functional intestinal disorders. Materials and methods. 56 children admitted to the children’s infectious unit with diarrhea and 31 healthy toddlers of the control group were observed. Anamnesis, laboratory blood and urine tests, microscopy and bacteriological cultures of feces on selective media and tests to identify adeno- and rotaviruses were performed. The presence of Clostridium difficile A/B toxins in the stool, hemoglobin, fecal calprotectin (FC) and the content of undigested fecal carbohydrates also were studied. Results. Children who in their majority have received antibiotics only in 58.9 % of cases were corresponding to the bacterial or viral nature of the disease or the infection was clinically highly probable. Another 41.1 % of patients has experienced non-infectious diarrhea. In 7.1 % of all cases the diarrhea was triggered by an increase of the carbohydrate content in the stool. Diarrhea had the same mechanism in 3.4 % of patients with Giardia lamblia. In 17.9 % of patients the frequent bowel movements were the manifestation of symptomatic (parenteral) diarrhea caused by extraintestinal diseases, and in another 7.1 % the intestinal hypermotility was not explained but resembled irritable bowel syndrome in adults. Additionally, cluster analysis identified 5.4 % of patients with non-infectious diarrhea who had only significantly increased FC corresponding to allergic or immune inflammation in the gut. Conclusions. The classification of patients for the causes of diarrhea became possible due to the microbiological tests and highly informative markers of intestinal health – fecal calprotectin and reducing substances (carbohydrates) in the stool.

Indeterminate HIV PCR results within South Africa's early infant diagnosis programme, 2010–2019

ObjectivesWe describe the extent of, and variables associated with, indeterminate HIV-PCR results and final HIV status within South Africa's early infant diagnosis (EID) programme between 2010 and 2019. MethodsRetrospective analysis of routine paediatric HIV-PCR laboratory data from South Africa's National Health Laboratory Service Data Warehouse between 2010 and 2019. Final HIV status was determined by linking patient results (including HIV-PCR, HIV viral load, HIV serology and CD4 counts) using a probabilistic matching algorithm. Multivariate logistic regression was performed to determine variables associated with final HIV status among patients with an indeterminate HIV-PCR result. ResultsAmong 4 429 742 specimens registered for HIV-PCR testing from 3 816 166 patients, 113 209 (2.97%) tested positive and 22 899 (0.6%) tested indeterminate. As a proportion of HIV-detected results, 15.7% (23 896/151 832) of total and 31.5% (4900/15 566), 18.8% (11 400/60 794) and 10.1% (7596/75 472) among patients aged <7 days, 7 days–3 months and ≥3 months, respectively, were reported as indeterminate. Overall, 39.7% of patients with an indeterminate result had a linked HIV test to determine HIV status, of which 53.6% were positive with a median time to repeat testing of 30 days (interquartile range 15–69). Among patients who tested indeterminate, variables associated with a significantly higher odds of having a positive HIV status included testing indeterminate at birth (adjusted odds ratio (AOR) 0.63 (0.48–0.83) and 0.52 (0.39–0.69) for testing indeterminate at 7 days–3 months and ≥3 months respectively compared with birth), within a hospital (AOR 2.45 (1.99–3.03)), and in districts with an intra-uterine transmission rate ≥1.1% (AOR 3.14 (1.84–5.35)) (p < 0.001). DiscussionIndeterminate HIV-PCR results represent a considerable burden of missed diagnostic opportunities, diagnostic dilemmas and delays in making a definite diagnosis among HIV-infected infants within South Africa's EID programme. Alternative EID verification practices are urgently needed.

Data-based prediction of microbial contamination in herbs and identification of optimal harvest parameters

Abstract The quality of freshly harvested herbs is affected by several crucial factors, such as weather, tillage, fertilization, drying, and the harvesting process, e.g. Our main goal is to learn models that are able to predict spore contaminations in different types of herbs on the basis of information about the harvesting process, transport conditions, drying, and storage conditions. This shall enable us to identify optimal processing parameters, which will allow more effective and cost efficient contamination prevention. Using machine learning, we have generated ensembles of models that predict the risk for spore contamination on the basis of harvest processing parameters. The training information about contamination in herbs is given as results of laboratory analysis data. We applied different modeling algorithms (random forests, gradient boosting trees, genetic programming, and neural networks). In this paper we report on modeling results for yeast and mold contaminations in peppermint and nettle; e.g., for yeast contamination in peppermint we obtained models with 78.13% accuracy. Additionally, we use descriptive statistics to identify those parameters that have a statistically significant influence on the contamination; for example, our analysis shows that there seems to be a relationship between mold in peppermint and information about harrowing and the growth height (p = 0.001).

Effects of l-carnitine supplementation in patients with childhood-onset epilepsy prescribed valproate

BackgroundThe benefits of carnitine supplementation in patients treated with valproate (VPA) are not clear. Therefore, we retrospectively explored the benefits of carnitine supplementation by analyzing laboratory data. MethodsWe measured the serum-free carnitine (FC), VPA, aspartate aminotransferase, alanine aminotransferase, amylase, and ammonia levels, and the platelet count, in 69 patients with childhood-onset epilepsy treated with VPA. Eight patients had received carnitine supplementation. The serum FC and acylcarnitine levels were measured using an enzyme cycling method. We compared laboratory values between patients with and without carnitine supplementation and analyzed the correlations between serum FC levels and laboratory values. ResultsThe serum FC levels were normal (median, 48.8 μmol/L; range: 41.9–68.3 μmol/L) in all eight patients with carnitine supplementation, but below normal in 32 of 61 patients without supplementation. The median serum amylase levels were lower in the patients with carnitine supplementation (median, 48 U/L; range: 27–149 U/L) than in those without (median, 7 U/L; range: 14–234 U/L). The platelet count and serum ammonia levels did not differ significantly between patients with and without supplementation. There was no significant correlation between the serum FC level and the platelet count, serum amylase level, or ammonia level. ConclusionsCarnitine supplementation helps maintain serum FC levels in patients treated with VPA. The lower serum amylase levels in patients with carnitine supplementation may reflect protective effects of carnitine against latent pancreatic injury.

Additional Yield of Active Case Finding Through House Hold Survey in Selected District of Kabul, Afghanistan, 2018

Every year, 10.4 million people get sick with Tuberculosis (TB) and 40 percent of them do not receive treatment care - they are “missed” to identify by the health systems. Missing TB cases is major challenge in fighting the disease; pose a serious threat to global health security. As per World Health organization estimation, in 2018, Afghanistan missed 27 percent TB case notification. Thus we conducted an active case finding through house hold survey from June – November, 2018 in Kabul city, districts of Afghanistan.&#x0D; This descriptive cross sectional study included all the residence of 21 sub-districts in Kabul City Afghanistan. After obtaining written consent, data was collected using a structured questionnaire from all presumptive TB cases. Sputum was collected from eligible participants and tested for AFB, Gene-Xpart and Chest X-ray was done. Standard test algorithm and case categorization was done according to WHO recommendations. Descriptive analysis of demographic, clinical and laboratory data was done.&#x0D; A total of 22,596 participants were included and among them 6740 were eligible. Among them 1614(24.3%) individuals were screened positive to have presumptive TB and 105 (6.5%) had laboratory confirmed TB. Thus the case notification rate was 465 in 100,000 populations. Among the presumptive TB cases, mean age was 38.6 + 18.5 years; 74% were female; 72% were housewives/unemployed; 2.6% were smokers.&#x0D; The case notification rate and the point prevalence showed increase numbers than the actual reports by the Afghanistan National TB program, which signifies the program was missing significant numbers of TB cases. Hence active TB case finding might be an effective approach in terms of case notification in Afghanistan. We recommend extending active community TB surveillance of the country.

The Darwin Prospective Melioidosis Study: a 30-year prospective, observational investigation

The global distribution of melioidosis is under considerable scrutiny, with both unmasking of endemic disease in African and Pacific nations and evidence of more recent dispersal in the Americas. Because of the high incidence of disease in tropical northern Australia, The Darwin Prospective Melioidosis Study commenced in October, 1989. We present epidemiology, clinical features, outcomes, and bacterial genomics from this 30-year study, highlighting changes in the past decade. The present study was a prospective analysis of epidemiological, clinical, and laboratory data for all culture-confirmed melioidosis cases from the tropical Northern Territory of Australia from Oct 1, 1989, until Sept 30, 2019. Cases were identified on the basis of culture-confirmed melioidosis, a laboratory-notifiable disease in the Northern Territory of Australia. Patients who were culture-positive were included in the study. Multivariable analysis determined predictors of clinical presentations and outcome. Incidence, survival, and cluster analyses were facilitated by population and rainfall data and genotyping of Burkholderia pseudomallei, including multilocus sequence typing and whole-genome sequencing. There were 1148 individuals with culture-confirmed melioidosis, of whom 133 (12%) died. Median age was 50 years (IQR 38-60), 48 (4%) study participants were children younger than 15 years of age, 721 (63%) were male individuals, and 600 (52%) Indigenous Australians. All but 186 (16%) had clinical risk factors, 513 (45%) had diabetes, and 455 (40%) hazardous alcohol use. Only three (2%) of 133 fatalities had no identified risk. Pneumonia was the most common presentation occurring in 595 (52%) patients. Bacteraemia occurred in 633 (56%) of 1135 patients, septic shock in 240 (21%) patients, and 180 (16%) patients required mechanical ventilation. Cases correlated with rainfall, with 80% of infections occurring during the wet season (November to April). Median annual incidence was 20·5 cases per 100 000 people; the highest annual incidence in Indigenous Australians was 103·6 per 100 000 in 2011-12. Over the 30 years, annual incidences increased, as did the proportion of patients with diabetes, although mortality decreased to 17 (6%) of 278 patients over the past 5 years. Genotyping of B pseudomallei confirmed case clusters linked to environmental sources and defined evolving and new sequence types. Melioidosis is an opportunistic infection with a diverse spectrum of clinical presentations and severity. With early diagnosis, specific antimicrobial therapy, and state-of-the-art intensive care, mortality can be reduced to less than 10%. However, mortality remains much higher in the many endemic regions where health resources remain scarce. Genotyping of B pseudomallei informs evolving local and global epidemiology. The Australian National Health and Medical Research Council.

Clinical case of eosinophilic granulomatous polyangiitis debuted by myocardial infarction

The article presents clinical observations demonstrating the difficulties of diagnostic search in establishing the diagnosis of systemic vasculitis associated with antineutrophil cytoplasmic antibodies, which include a rare disease eosinophilic granulomatosis with polyangiitis (ChurgStrauss syndrome). Carefully collected anamnesis, participation of specialists of different profiles, retrospective analysis of laboratory and instrumental data allowed to verify the diagnosis, to prescribe adequate therapy. The aim of the publication is to discuss the need for early diagnosis of eosinophilic granulomatosis with polyangiitis, which can improve the effectiveness of therapy and improve the overall prognosis for this disease, taking into account modern approaches based on the main provisions of international recommendations that were prepared in 2015 with the participation of leading experts from Europe, USA and Canada and were called to become the basis for choosing a personalized patient therapy strategy. In some cases, the diagnosis of eosinophilic granulomatous polyangiitis is complicated by the diversity of the clinical picture, the non-simultaneous appearance of the main symptoms and the violation of the stages of the process. In the differential diagnosis of systemic vasculitis, assessment of initial clinical manifestations, testing for the presence of antibodies to the cytoplasm of neutrophils, multispiral computed tomography of the chest organs and diagnostic biopsy of the affected tissues are crucial. In the histological conclusion, a picture of focal ulcerative-necrotic lesions of the nasal mucosa with signs of vasculitis and a pronounced eosinophilic cell component of inflammation was noted. The distinctive features of this case include the onset of the disease with the development of myocardial infarction and early damage to the hearing organ in the form of cochlear neuritis, complicated by sensorineural hypoacusis. The combination of high doses of glucocorticosteroids and cyclophosphamide is still the gold standard for the treatment of severe cases, but the use of biological agents such as rituximab or mepolizumab seems to be a promising therapeutic alternative (4 figs, bibliography: 3 refs).

Features of Diseases of the Anterior Part of the Eye in Patients after COVID-19

There are quite systematic data of the ophthalmic manifestations in SARS-CoV-2, on the presence of conjunctivitis in patients with COVID-19, as well as on the detection of viruses in the lacrimal fluid and eye tissues. And, although ophthalmic manifestations are considered rather rare for COVID-19 and are not included in the list of important for diagnosis, there is not enough reliable data on the inflammatory processes of the eye’s anterior part and their connection with COVID-19, as well as those arising against the background of the treatment.Purpose. To study the development of inflammatory diseases of the anterior part of the eye in patients who have undergone the new coronavirus infection COVID-19.resu. In the Department of Infectious and Allergic Eye Diseases of the Helmholts National Medical Research Center of Eye Diseases, 88 patients with confirmed transferred new coronavirus infection COVID-19 of varying severity were observed. The main method of laboratory diagnostics is the detection of SARS-CoV-2 RNA in swabs from the nasopharynx, the patient’s sputum. Serodiagnostics of COVID-19 includes the determination of IgG-, IgM-antibodies to SARS-CoV-2 in the blood in an enzyme-linked immunosorbent assay.Results. Acute conjunctivitis associated with COVID-19 is quite rare and is an early sign of the disease. In the complex nonspecific topical therapy of viral conjunctivitis in COVID-19, along with etiopathogenetic systemic treatment, local eye medications with immunomodulatory and antiviral activity should be used. Conjunctivitis during a pandemic may be the only sign of COVID-19. The development of allergic conjunctivitis in COVID-19 is possibly associated not only with the effect of a viral agent, but also depends on the toxic effect of drugs used in the complex treatment of this disease. The increase in the number of patients with episcleritis after the postponed coronavirus infection needs further detailed study, with the analysis of laboratory data from this group of patients and the accumulation of clinical material.Conclusion. Ophthalmic manifestations in COVID-19 are very different, affecting various structures of the eye, occur at different periods — both during the course of the disease and after clinical recovery, and, of course, need further consideration, study and structuring.

Diagnostic workup of multiple myeloma in resource-constrained setting

Background Monoclonal protein detection and characterization is integral component of myeloma workup and is at times used as the first step toward diagnosis. Costs of these tests are major concern in developing countries. Recent studies have emphasized on the prognostic importance of risk stratification with cytogenetic in patients with myeloma. Aims We intend to analyze additional information obtained by two costly tests, namely, serum free light chain assay (sFLC) and fluorescent in situ hybridization (FISH), for high-risk cytogenetic abnormalities during baseline workup of patients with myeloma and their necessity. Patients and methods We retrospectively analyzed laboratory data of 130 patients with myeloma enrolled at our institute between years 2016 and 2019. Subset analyses of 71 patients who underwent all three tests, namely, serum protein electrophoresis (SPEP), immunofixation electrophoresis (IFE), and sFLC for monoclonal protein detection, were done. Patterns of cytogenetic abnormalities were noted in 70 patients undergoing FISH testing for high-risk cytogenetic abnormalities and serum lactate dehydrogenase (LDH) level. International staging system (ISS) and revised international staging system (RISS) categories were compared among this group of patients. Statistical analysis used A proportion test was used. Results SPEP detected and quantified M protein in 55 (77.4%) patients. IFE detected M protein in 68 (95.7%) patients and typing was done. sFLC ratio was abnormal in 66 (92.6%) patients. IFE and sFLC were more sensitive in detecting monoclonal protein as compared with SPEP (P=0.001 and 0.009, respectively) at diagnosis. In 70 patients with FISH and LDH results available, seven (10%) patients had high-risk karyotype on FISH, and LDH was raised in five (7.1%). Based on these results, three (4.2%) patients who were ISS stage I were upgraded to RISS stage II and 21 (30%) ISS III patients were downgraded to RISS II category, thereby helping in 34.2% patients for accurate prognostication. Conclusion In resource-constrained setting, using sFLC sequentially after SPEP is noninformative, but UPEP/IFE shows M band, which can be a viable approach at diagnosis. For better prognostication, FISH for high-risk karyotypic abnormalities is required.

A Data Analysis of D-Dimer &amp; Interleukin-6 (IL-6) Test for Covid Patient

Various biomarkers, especially inflammatory markers like C-reactive protein (CRP), ferritin, fibrinogen, D-dimer and Interleukin 6 (IL-6) are associated with Covid-19 progression. Thrombosis prophylaxis with low molecular weight heparin has shown beneficial results in preventing coagulopathy a reducing risk of mortality due to thrombotic events. The COVID-19 patients highlighting the role of D-dimer, and Interleukin-6 (IL-6). During plasma coagulation soluble fibrin is generated by the influence of thrombin on fibrinogen. The soluble fibrin is crosslinked to the vessel walls by factor XIIIa. When splitting this cross linked fibrin, characteristic products called D-dimers are released. Increased D-dimer concentrations are found in thrombotic diseases and microthrombotic events (e.g. in case of disseminated intravascular coagulation, DIC). D-dimer determination is mainly used to exclude deep vein thrombosis of the leg and pulmonary embolism. D-Dimer levels rise during pregnancy and high levels are associated with complications. D-dimer is a fibrin degradation product that is often used to measure and assess clot formation. Amid the COVID-19 pandemic, elevated D-dimer levels have been associated with disease severity and mortality trends. Interleukin-6 (IL-6) is a pro-inflammatory cytokine secreted by T cells and macrophages to stimulate immune response to trauma, especially burns or other tissue damage leading to inflammation. IL-6 is also secreted by macrophages in response to specific microbial molecules, referred to as Pathogen Associated Molecular Patterns (PAMPs), which trigger the innate immune response and initiate inflammatory cytokine production. IL-6 is one of the most important mediators of fever and of the acute phase response. IL-6 is also called a “myokine”, a cytokine produced from muscle that increases in response to muscle contraction. Additionally, osteoblasts secrete IL-6 to stimulate osteoclast formation. The detection and control of pro-inflammatory response is crucial in the early stages of viral infection. COVID-19 is an emerging viral disease of global concern and optimal treatment has yet to be determined. Unknown response of treatment of COVID-19 is important during patient monitoring. IL-6 is one of the key cytokines after activated macrophages. Here we will present a laboratory data analysis of COVID-19 patients in different age group highlighting the role of positivity D-dimer and interleukin-6 (IL-6).

Диференційна діагностика тромбоцитопенії під час вагітності: клінічні і діагностичні алгоритми

Purpose — to create an algorithm for early diagnosis and differential diagnosis of conditions accompanied by thrombocytopenia (TP) during pregnancy, as well as an algorithm for the treatment of immune thrombocytopenia during pregnancy based on analysis of clinical, laboratory data and obstetric and perinatal results of such pregnant women. Materials and methods. We analyzed 155 histories of pregnancy and childbirth of women with TP, who underwent inpatient treatment and/or gave childbirth in the obstetric clinic of the State Institution «Institute of Pediatrics, Obstetrics and Gynecology named after Academician O.M. Lukyanova NAMS of Ukraine» from January 2008 to August 2018. According to the inclusion criteria, 111 histories were selected for further analysis. Pregnant women are divided according to the etiological principle of TP into three groups: with gestational thrombocytopenia, immune thrombocytopenia, secondary thrombocytopenia. The first group included 32 women (28.8%), the second — 65 (55.6%), the third — 14 (12.6%). During the selected period of time there were 99 births, 100 babies were born, 1 twin birth. Results and conclusions. The number of platelets progressively decreases during pregnancy with a minimum in childbirth. The algorithm of examination, the decision on the initiation or intensification of treatment, the choice of monitoring tactics for TP during pregnancy, the calculation of obstetric and perinatal risks, preparation for childbirth and the choice of method depend on the cause of TP and differ significantly. Developed «Algorithm for diagnosis and differential diagnosis in the detection of thrombocytopenia during pregnancy» and «Algorithm for the treatment of immune thrombocytopenia during pregnancy» are aimed at the prevention of obstetric and perinatal complications in pregnant women with thrombocytopenia. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local Ethics Committee of an participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: thrombocytopenia, pregnancy, diagnostic algorithm, treatment algorithm.

Measurement of Liver Iron Concentration in a Population of Non-Transfusion Dependent Thalassemia Patients Using a Trained Artificial Neural Network to Analyse Magnetic Resonance Images

Background: Measurements of liver iron concentration (LIC) by magnetic resonance imaging (MRI) have become established and validated in several research intensive centers. However, challenges remain with translating these measurement methodologies for routine clinical use. Current methods involve many steps presenting multiple opportunities for human error and can lead to systematic severe measurement error. Artificial neural networks (ANNs) can be trained to replace human input into image processing and may have a role in providing a simple, robust, and low cost solution for LIC measurement.Aims: The aim of the study wasto determine the limits of agreement between measurements of LIC by a reference standard spin-density-projection-assisted (SDPA) R2-MRI method (FerriScan) and a method using trained ANNs to analyse image data. MR image datasets (400) previously acquired from Siemens scanners were pre-processed and then, together with their corresponding SDPA R2-MRI LIC values, were filtered through publically available ANNs. The ANNs had been pre-trained on large image sets (ImageNet). Relevant features were extracted and then used to train a machine learning (gradient boosting) algorithm to predict LIC values from previously unseen MR image datasets.Methods: Thalassemia patients (N=100) referred by the National Institute of Haematology and Blood Transfusion, Hanoi, Vietnam for routine LIC measurement by MRI were prospectively recruited with informed consent. Patients were randomised to be scanned in either a Philips Ingenia or a Siemens Avanto 1.5T scanner. Image data were acquired using the FerriScan protocol. Images were then processed (1) using a quality controlled core laboratory data analysis service using the SDPA R2-MRI method and (2) by a non-radiologically-trained technician using the trained artificial neural network to generate LIC values. The technician was required to trace the outline of the torso and then click a mouse button. The technician using the ANN was blinded from the SDPA R2-MRI results and the analysts generating the SDPA R2-MRI results were blinded from the ANN results. Reported data were analysed using the statistical methods of Bland and Altman.Results: A plot of the ANN-predicted LIC values against the SDPA R2-MRI LIC values (Figure) shows the data scattered about the line of equivalence indicating that the ANN method is generating results that correlate with the validated SDPA R2-MRI reference standard. The geometric mean ratio of ANN LIC to SDPA R2-MRI LIC was 0.93 (95% CI 0.91 -0.96) indicating a small but statistically significant systematic underestimation of LIC by the ANN. The geometric mean ratios of the two LIC measurements were significantly different for the two scanners (0.98 for Philips and 0.90 for Siemens, p = 0.006) indicating that the bias of the ANN method against the reference standard is not universal but is dependent on scanner. Bland Altman analysis indicates that 95% of pairs of measurements are predicted to have ratios between 1.23 and 0.69 indicating a modest random variability between the ANN method and the reference standard that is better than that between biopsy and the reference standard. The performance of the ANN method in predicting SDPA R2-MRI LIC values above the clinically relevant thresholds of 7 and 15 mg Fe/g dw is characterized in Table 1 showing positive predictive values (PPVs) and negative predictive values (NPVs) together with their 95% CIs.Conclusion: The data indicate that the ANN method of measurement of LIC has potential to be used as a fast and robust method of analysing MR image data to generate LIC values. Further testing is required on a wider range of scanner types and with more patients with lower LICs. The performance of the ANN will also likely be improved through training on a larger number of datasets. [Display omitted] DisclosuresSt Pierre:Resonance Health Ltd: Consultancy, Equity Ownership, Speakers Bureau. Cooper:Resonance Health Ltd: Consultancy. Boulos:Resonance Health Ltd: Employment. House:Resonance Health Ltd: Employment. Pang:Resonance Health Ltd: Employment. Bangma:Resonance Health Ltd: Employment. Taher:Novartis Pharmaceuticals: Honoraria, Research Funding; Celgene: Research Funding.

Presence of Immunoglobulin Heavy Chain Gene (IGH) Translocations in Chronic Lymphocytic Leukemia Is Related to Poor Prognosis.

Background: Genetic analysis has an important role in the diagnosis, classification, and management of patients with CLL. Although translocations involving the IGH locus are well characterized in B-cell malignancies such as follicular cell lymphoma, their frequency in CLL are less well defined and little is known about their prognostic significance. We studied a series of CLL patients using a FISH probe set which included an IGH probe and reviewed clinical data and disease course of CLL patients with IGH translocations.Methods: FISH was performed on blood using a DNA probe set designed to detect common chromosome anomalies associated with CLL and translocations involving IGH. Patients with an IGH abnormality were further studied using FISH probes sets for IGH and cyclin D1, BCL-2, BCL-3, BCL-6, BCL-11a, c-MYC, MALT-1, c-MAF, FGFR-3 or PAX-5. Between 5/15/03 and 5/15/07, samples from 4,976 patients with a presumed lymphoproliferative disorder were analyzed by FISH. Of these, 316 patients (6.3%) had translocations involving the IGH locus. Sixty-three (21%) of the 316 patients with IGH translocations had been seen at Mayo Clinic Rochester and had clinical and laboratory data for detailed review and analysis of associations to the FISH results.Results: We identified 39 patients with CLL and IGH translocations. Identified partner genes were: BCL-2 (n=22), BCL-3 (n=7), CMYC (n=2), MALT-1 (n=1). The partner gene was not identified despite using above mentioned panel of partner gene probes in 7 patients. Median age at time of diagnosis of patients with IGH translocations was 62 (45-82), 29 patients were males. The median time to initial treatment (TTT) of all 39 patients with IGH translocations was 3.1 years. The median TTT for patients with IGH/BCL-2 was 3.6 years; 70% of patients required treatment by 5 years. The median TTT for IGH/BCL-3 patients was significantly shorter, 1.5 years, p=0.017, with all patients requiring therapy 3 years from diagnosis (see Figure 1).Conclusion: The presence of IGH translocations in CLL appears to be associated with rapid disease progression and the need for an early initiation of therapy. The IGH partner gene seems to be important; IGH/BCL-3 fusion is associated with a worse prognosis than IGH/BCL-2. Further studies on the biological significance of IGH translocations in CLL are warranted and continue at our institution. [Display omitted]

VIRAL HEPATITIS E IN PLEVEN REGION – CLINICAL, LABORATORY AND EPIDEMIOLOGICAL CHARACTERISTICS

Viral hepatitis E (VHE) is endemic in most countries nowadays. Our purpose was to analyze the characteristics of VHE in the Pleven region. Material and Methods: We performed a retrospective analysis of clinical, laboratory, and epidemiological data of 33 consecutive serologically confirmed cases of VHE treated in Clinic of Infectious Diseases at University Hospital – Pleven (2016-2019) (18 male – 56%, mean age 59±15 years). Statistical methods – t-test and χ2 test (for parametric and non-parametric distributions, respectively; P&lt;0.05 was considered to be significant). Results: Totally 283 cases of hepatitis were treated in the Clinic (2016-2019) (cases of VHE- 12%). Fifty-five percent of VHE cases were older than sixty years (79% – urban residents); 39% acquired the disease during March-April. Only in two cases had contacts with pigs. The commonest symptoms were hepatomegaly (100%), fatigue (94%), darkness of urine (92%), jaundice (79%), anorexia (76%), splenomegaly (67%), nausea and vomiting (58%). The jaundice was protracted (median six days). Laboratory investigations- mild leukocytosis (21%), thrombocytopenia (18%), increased serum bilirubin with a prevalence of direct fraction (82%; mean ± sd 94±91 µmol/L; 95% CI 63÷125), increased aminotransferases in 100% (ASAT mean ± sd 812±629 IU/L; 95% CI 598÷1027; ALAT mean ± sd 1327± 790 IU/L; 95% CI 1058÷1597), mild to moderately increased alkaline phosphatase and GGT (90% and 100%, respectively). All of the patients were successfully treated with glucose infusions, hepatoprotective drugs and vitamins (mean 10 days). Conclusions: The clinicians should consider VHE in the diagnostic process. The disease affects mainly older ages, and jaundice is protracted.

Clinical and Hematological Characteristics of Patients with COVID-19 Co-infected with Bacteria

Background: The pandemic caused by the new coronavirus is overwhelming the world. Bacteria and fungi were detected in some cases, which suggested the associations between COVID-19 and bacterial and fungal infections. Objectives: To provide suggestions and treatment opinions by analyzing laboratory data of COVID-19 patients co-infected with bacteria. Methods: We analyzed 63 patients with COVID-19 admitted to the isolation ward of the First Affiliated Hospital of Wenzhou Medical University. COVID-19 was detected using PCR, and bacteria were identified using culture. Patients were divided into two groups, including those with and those without bacterial infections, and differences in hematologic indices between the groups were analyzed. Results: There were 63 patients with median age of 55.82 years. The average hospital stay was 22.56 days. Seven patients (11.11%) had coincident bacterial infections. Detection rates in sputum/alveolar lavage and blood were the highest, 60.52% and 21.05%, respectively. Klebsiella pneumoniae, Acinetobacter, and Stenotrophomonas maltophilia were the most common found in 31.58%, 18.42%, and 15.79%, respectively. Interleukin 6 (IL-6) levels were elevated in 84.13% of patients, while IL-10 levels were elevated in 69.84%, blood ammonia levels were elevated in 82.05%, lactate levels were elevated in 75.41%, and LDH levels were elevated in 69.84%. There were significant differences between the groups in terms of expression levels of IgG, C4, AST, LDH, IL-6, IL-10, percentage of neutrophils, percentage of lymphocytes, and platelets. Conclusions: For patients with COVID-19 suspected of having bacterial infections, empiric antibiotics should be given to cover K. pneumoniae, Acinetobacter, and S. maltophilia.

Особенности течения острого инсульта на фоне новой коронавирусной инфекции COVID-19

Despite the modern advances of medicine, the incidence and death rate of COVID-19 remains quite high. The data about complications associated with the infection caused by SARS-CoV-2 are constantly updated. There is more and more information about complications from the nervous system, where stroke plays a leading role. The desire to more accurately understand the mechanisms of stroke development in patients with the novel coronavirus infection and the search for ways to improve the results of treatment of this pathology incurred the analysis of 289 cases of the new coronavirus infection in the specialized hospital of the City Clinical Hospital No. 15 named after O.M. Filatov (Moscow) for the period March-June 2020. All patients underwent the analysis of clinical, laboratory, and instrumental data. The features of the course of stroke against the background of COVID-19 and changes in indicators of clinical, laboratory and instrumental research methods are considered. The most common forms of extracerebral pathology in stroke in patients with COVID-19 are shown. English version of the article on pp. 569-576 is available at URL: https://panor.ru/articles/features-of-the-acute-stroke-run-associated-with-the-new-coronavirus-infection-covid-19/70262.html

DNAqua‐Net conference unites participants from around the world with the quest to standardize and implement DNA‐based aquatic biomonitoring

AbstractThe EU COST Action DNAqua‐Net has since its start in 2016 gathered European researchers with the quest to standardize and implement DNA‐based aquatic biomonitoring. On March 9–11, 2021, their work culminated in their first conference. Here, an astounding 1500 participants from around the world gathered virtually to share their research on DNA‐based aquatic biomonitoring encompassing DNA reference databases, field and laboratory protocols, data analyses and storage, implementation strategy and legal issues, and biotic indices and metrics. The overwhelming interest in DNA‐based aquatic bioassessment and monitoring strongly underlines its relevance and timeliness.

Patients discharged with elevated baseline high-sensitive cardiac troponin T from the emergency department

Background Elevated levels of high-sensitive cardiac troponin T (hs-cTnT) are linked to poor prognosis among emergency department (ED) patients. Objective Examine the effect of our ED risk assessment among patients with suspected acute coronary syndrome (ACS) and elevated baseline hs-cTnT levels. Design Observational cohort study of 16776 ED patients with chest pain or dyspnoea and a hs-cTnT sample analyzed at the time of the ED visit. Of these 1480 patients were sent home with elevated hs-cTnT levels (>14 ng/L). Methods Analysis of clinical and laboratory data from the local hospital and data from the National Board of Health and Welfare. Results Admitted patients had 11% and discharged patients had 1.2% 90-day mortality indicating effective risk assessment of patients with suspected ACS. However, if the suspected ACS patient presented with hs-cTnT between 14 and 22 ng/L, the 90-day mortality was 4.1% among discharged and 6.7% among admitted patients. Among discharged patients, an hs-cTnT level above 14 ng/L was a higher independent risk factor for 90-day mortality (HR 3.3, 95% CI 2.9–3.7, p < 0.001) than if the patient was triaged as a high-risk patient (HR 1.6, 95% CI 1.1–1.8, p < 0.001). Conclusions Our ED risk assessment was less effective among patients presenting with elevated hs-cTnT levels.