However, the outcomes of our secondary analyses create new uncertainty regarding the usage of a restrictive threshold for transfusion after cardiac medical procedures. It is complicated to interpret the total results of secondary analyses when many statistical testing are performed,37 but the higher frequency of death in the restrictive-threshold group, which persisted in sensitivity analyses , is a cause for concern. It is not clear in what way anemia that was attributable to the restrictive threshold may have got resulted in an elevated number of deaths. The difference in hemoglobin level between the groups was modest , and an assessment of causes of death or of serious adverse occasions that preceded death didn’t suggest a cause-and-effect romantic relationship, although establishing a cause-and-effect relationship might have been an unrealistic expectation provided the small amount of deaths that occurred and provided a medical setting where death typically occurs after a sequence of adverse events.Our email address details are in keeping with those of the two-step model for the advancement of leprosy, in which successful infection of M. Leprae is normally first set up in genetically predisposed individuals, and the subsequent medical manifestation of disease is influenced by various other host factors and environmental factors.19 Genomewide association studies that directly test for a genetic association with the multibacillary or the paucibacillary form may uncover additional host genetic factors involved in the second stage of disease development. Variants of HLA genes, HLA-DRB1 specifically, have been associated with leprosy20; both protecting and risk alleles have been described. HLA-DR molecules present M. Leprae peptide antigens to CD4+ T cells, that allows the T cells to become activated.