Fischer Exact Research Articles

Seizure following acute hemolysis caused by Glucose-6-phosphate dehydrogenase Deficiency

Background: Storage of platelet concentrates (PCs) at room temperature (20-24°C) limits its storage time to 5 Background: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common inherited enzyme deficiency of the human red blood cells . Most of G6PD deficient individuals are asymptomatic, but acute hemolytic anemia may be presented with nausea, vomiting, abdominal pain, headache, jaundice, pallor, discoloration of the urine, chills, and fever. Seizure is reported as a rare symptom, as well. The present study aimed to investigate seizure following acute hemolysis caused by Glucose-6-phosphate dehydrogenase deficiency. Material and Methods: This analytic cross-sectional study was conducted on all consecutive patients aged 1-12 years with G6PD deficiency hospitalized for hemolysis in 17 Shahrivar children hospital, Rasht, Iran, in 2016. Demographic characteristics and other variables such as place of inhabitants, type of drinking water, history of seizure in the patients and family, cause of hemolysis, hemoglobin level and hemoglobinuria on admission, and infection history prior to hemolysis were recorded. Data were analyzed by Mann-Whitney U test and Fischer Exact Test. P-value < 0.05 indicated statistical significance and data were assessed by SPSS (version 20). Results: The youngest patient was one year old and the oldest was 11 years old. Most of them were males (68.9%). Out of 244 patients, 8 ones (3.3%) experienced seizure. There was a significant correlation between seizure occurrence and family history of seizure (p=0.03) as well as fava bean consumption (p=0.019) as the causes of hemolysis; but not with infection as the cause of hemolysis, hemoglobin or hemoglobinuria level on admission, types of drinking water, place of living, and gender. Methemoglobinemia was considered as the main cause of the seizure. Conclusion: Although the rate of seizure was not so high (3.3%), it seems that seizure can be a critical and potentially life-threatening complication in these patients. Environmental factors may also play a role in the pathogenesis of the seizure in these patients.

S1640 POLYMORPHISMS IN CYTOKINES, CHEMOKINES AND THEIR RECEPTORS GENES CONTRIBUTED TO CYTOMEGALOVIRUS REACTIVATION AFTER ALLOGENEIC STEM CELL TRANSPLANTATION

Background: Cytomegalovirus (CMV) is the most common viral infection after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Without prophylaxis, 80% of CMV-seropositive patients experience CMV infection after allo-HSCT. Cytokines and chemokines are the first line of defence against viral infections and recent studies have shown that gene polymorphisms result in inter-individual differences in cytokine production. Aims: To determine the genotype of Cytokines and chemokines in the donor (D) and recipient (R) and their association with the CMV reactivation of patients receiving an allo-HSCT. Methods: Eighty-five patients who received allo-HSCT from an HLA-identical sibling donor from 2000 to 2015 were included. CMV DNAemia was evaluated until approximately day 100 after allo-HSCT. CMV reactivation was defined as the detection of CMV DNAemia ≥100 copies/ml in plasma. All of patients were classified according to epidemiological risk factors of clinical interest. Fifty genes were selected for their potential role in the pathogenesis of CMV: C-C Motif Chemokine Ligand (CCL) and Receptor (CCR), C-X-C Motif Chemokine Ligand (CXCL) and Receptor (CXCR), Forkhead Box P3 (FOXP3), CD48 Molecule (CD48), Interferon (IFN), Interleukin (IL), Killer Cell Immunoglobulin Like Receptor (KIR), Transforming Growth Factor Beta (TGFB), tumor necrosis factor alpha (TNF) and Lymphotoxin Alpha (LTA). Genomic DNA was purified from 170 PB (D and R) using Maxwell® RSC Blood DNA Kit (Promega, USA). Libraries were performed using an enrichment-capture gene panels according to the manufacturer's protocol. Paired-end 2x101 bp was performed using the Illumina HiSeq platform (Illumina, USA). Variants located in coding region, splicing sites and intronic polymorphisms were analyzed. Synonymous variants were excluded. During the variant calling process, the values of Depth, variant allele frequency (VAF) and the minor allele frequency (MAF) in European population are obtained and used to variants filtration (Depth ≥ 30, VAF ≥ 0.4 and MAF≥ 10%). Differences among groups were evaluated by Chi-Squared and Fischer Exact Test. Results: CMV reactivation was observed in 51/85 (60%) patients. Initial episodes of CMV DNAemia occurred at a median of 48 days (2–151) after transplant. Clinical variables are not associated with CMV reactivation: age, gender, stem cells, hematological disease, conditioning regimen, serology status and prior autologous transplant. Twenty-four patients (47.1%) had only one episode of CMV reactivation, 12 (23.5%) had two episodes and 15 (29.3%) had more than two episodes after allo-HSCT. Using filters discussing previously, 221 polymorphisms were detected in D and R. Although 209 variants studied had no apparent impact on the features of CMV reactivation, but we found that 12 variants in 7 different genes were associated significantly with the development or protection of CMV reactivation (Table 1). Our data showed that determined polymorphism in TNF-α, IL12A, TGBF2, IL1RN and CD48 play an important role to protection against CMV. On other hand, KIR3DL1 and CXCL12 represent examples of how receptor polymorphism can influence CMV development.Summary/Conclusion: The data presented suggest that screening of patients and donor pre-transplantation could help to predict the individual risk of the development of CMV infection. These results might also enable the identification of patients at high risk of CMV reactivation, enabling pre-emptive therapy or attempts to cure the infection by administrating antiviral therapy or CMV-specific T lymphocytes.

Burden of respiratory illnesses in pediatric intensive care unit and predictors of mortality: Experience from a low resource country.

Acute respiratory infections (ARI), a major cause of childhood mortality and morbidity, place substantial burden on health services worldwide. Due to scarce data regarding respiratory illnesses requiring Pediatric intensive care unit (PICU) admissions (especially in low income/developing countries), we studied the burden of respiratory illnesses in the PICU and the risk factors contributing to mortality. This prospective observational study was conducted over 18 months. Children (aged 1 month to 12 years) admitted to the PICU for acute respiratory/cardiorespiratory illnesses were enrolled. Demographic and clinical details of the study population were recorded and tabulated. Risk factors contributing to mortality (severity of illness [PRISM III score], diagnosis/etiology, need for mechanical ventilation, immunocompromised status, malnutrition, and length of stay [LOS]) were analyzed (using the χ2 test or Fischer Exact test). Two hundred and ninety-three children were enrolled (median age: 5 months; range, 1-132 months; male/female: 181/112). Mean LOS in PICU was 5.25 ± 5.48 days and mean length of hospital stay of 14.82 ± 13.35 days. Mechanical ventilation was required in 62.8% cases. Pneumonia contributed to 66.89% of respiratory admissions and 91% of mortality. Ninety patients (30.7%) died; mortality being higher in cardiorespiratory cases (52.7%). PRISM III score and shock (respiratory cases) and age below 1 year (cardiorespiratory group) were significantly associated with higher mortality ( P < 0.05). Respiratory illnesses are a significant contributor to PICU admissions and are associated with significant mortality risk in presence of high PRISM III score and shock (respiratory group); and age below 1 year (cardiorespiratory group).

Clinico-pathological correlations of odontogenic tumors: Some critical observations based on a 20 year institutional study and a comprehensive review of literature.

Odontogenic tumors (OTs) represent a rare subset of pathologies of the oral and maxillofacial region. The classification of OTs has undergone several changes over the years due to a lack of uniform international identification criteria. The histomorphological similarity and the many variations in behavioral patterns elaborated by these lesions warrant research. Using the update from the fourth edition of the World Health Organisation Classification of Head and Neck Tumors (2017), this dental institution carried out an epidemiological study on OTs in the state of Goa (India) and compared the data obtained with similar studies on OTs done within India. The clinical and pathological data of OTs from August 1996 to December 2016 was retrieved from the oral and maxillofacial pathology department archives, belonging to the lone dental college and hospital in the state of Goa, India. Demographic data such as frequency, age, gender, and site along with pathological subtype was analysed. Descriptive analysis (i.e. frequency of age, gender, and location), Chi-Square Test and Fischer Exact test. The relative frequency of OTs was 2.61% of all oral biopsied specimens. The most common OT encountered was ameloblastoma (57.9%). The posterior aspect of the mandible was the most favored site (77.2%). The frequency of OTs decreased after the fourth decade. An overall marginal male predilection (55%) was seen. This study contributes to the establishment of a comprehensive loco-regional epidemiological database on OTs in India, aiding research on their aetio-pathogenesis and diagnosis.

Malnutrition and cardiovascular risk in haemodialysis patients with chronic kidney disease

ABSTRACT Objective To verify the association between nutritional status and traditional and non-traditional cardiovascular risk factors in haemodialysis patients. Methods A cross-sectional study with 132 patients over 18 years of age on haemodialysis to evaluate nutritional status through Subjective Global Assessment. Information on traditional and non-traditional cardiovascular disease risk factors were obtained using a structured questionnaire; the Framingham score was also used to assess cardiovascular risk. Data analysis was performed using the Chi-square Test or Fischer Exact Test and a Log-binomial Regression Model. Results Malnutrition affected 31.1% of patients. Among them, a higher percentage of smokers (p=0.016), former smokers (p=0.034) and diabetes Mellitus patients (p=0.001) were detected. Malnutrition was found to be 4.53 times more prevalent in diabetic individuals (95%CI: 1.99-10.27) and 2.26 times more prevalent among former smokers (95%CI: 1.04-4.95). Malnourished individuals exhibited a 4.03 times prevalence of moderate to severe cardiovascular risk. Conclusion A high prevalence of malnutrition and of other risk factors for cardiovascular disease were observed. Such factors included diabetes Mellitus, smoking and former smoker conditions and were associated with malnutrition. Inaddition, it was found that malnourished individuals were more likely to develop cardiovascular disease within 10 years.

Comparative evaluation of the antimicrobial efficacy of three endodontic sealers against Enterococcus faecalis with and without incorporation of Chitosan nanoparticles

Aims and Objectives: The aim of the present study was to evaluate and to compare the antibacterial activity of AH Plus, Tubliseal and MTA Fillapex against E.faecalis with and without incorporation of Chitosan nanoparticles. Methodology: The antibacterial effect against Enterococcus faecalis was evaluated by i) direct contact test (DCT) and ii) agar diffusion test (ADT). The nanoparticles were incorporated into the sealers at concentration of 2 % weight/ weight. Bacterial growth rates were analysed using ANOVA followed by Fischer Exact Test Results: The antibacterial tests demonstrated significant E.faecalis growth inhibition in the DCT with the sealer samples incorporated with chitosan nanoparticles. Direct contact test showed total growth inhibition of up to 8 logs in count in AH Plus, up to 7 logs in count in Tubliseal, and up to 6 logs in count in MTA Fillapex which were incorporated with chitosan nanoparticles. Significant differences were found between the unmodified sealers and the modified sealers. No antibacterial effect was observed in the ADT, indicating Chitosan nanoparticles were not diffusing into the agar. Conclusion: The endodontic sealers incorporating Chitosan nanoparticles exhibited significant and stable antimicrobial properties.

PRÁTICAS MATERNAS E USO DE TERAPIAS ALTERNATIVAS NO CUIDADO DA CRIANÇA

RESUMO: Objetivo: analisar o cuidado da criança e uso de terapias alternativas pelas mães nos primeiros 42 dias pós-parto. Método: pesquisa quantitativa descritiva transversal realizada em maternidade pública de baixo risco e visita domiciliar aos 42 dias pós-parto, entre julho de 2013 e janeiro de 2014, em Londrina-PR. Utilizou-se o Teste de Exato de Fischer e Qui-Quadrado com intervalo de confiança de 95%. Resultado: entre as 357 puérperas, 50,7% com idade ≤24 anos, 69,2% multíparas, 75,4% escolaridade ≥8anos e 49% renda ≥2 salários mínimos. A terapia complementar foi indicada predominantemente por avós, utilizada no banho da criança (97=27,2%), coto umbilical (143=39,9%), conjuntivite (108=81%) e icterícia (56=34,6%). A classe social foi significativa (p=0,005) com a faixa etária, escolaridade, renda e uso de chás. Conclusão: as práticas maternas se mantiveram entre as gerações, algumas indiscriminadamente, sendo necessário que a equipe de saúde previna agravos e promova saúde considerando os aspectos culturais familiares.

Addressing transition to motherhood, guideline adherence by midwives in prenatal booking visits: Findings from video recordings

ObjectiveTo assess if and how primary care midwives adhere to the guideline by addressing transition to motherhood at the first prenatal booking visit and to what extent there was a difference in addressing transition to motherhood between nulliparous and multiparous women. DesignCross-sectional observational study of video-recorded prenatal booking visits. Setting and participants126 video recordings of prenatal booking visits with 18 primary care midwives in the Netherlands taking place between August 2010 and April 2011. MeasurementsFive observers assessed dichotomously if midwives addressed seven topics of transition to motherhood according to the Dutch guideline prenatal midwifery care from the Royal Dutch Organization of Midwives and used six communication techniques. Frequencies and percentages of addressing each topic and communication technique were calculated. Differences between nulliparous and multiparous women were examined with Chi-Square tests or Fischer Exact tests, were appropriate. The agreement between the five observers was quantified using Fleiss' Kappa. FindingsDuring all visits at least one of the seven topics of transition to motherhood was addressed. The topics mother-to-infant bonding and support were addressed respectively in 2% and 16% of the visits. In almost all visits the topics desirability of the pregnancy, experience with the ultrasound examination or abdominal palpation or hearing the foetal heartbeat and practical preparation were addressed. Open questions for addressing transition to motherhood were used in 6% of the prenatal booking visits. Dutch midwives addressed transition to motherhood mostly by giving information (100%) and by using closed-ended questions (94%) and following woman's initiative (90%). Nulliparous women brought up transition to motherhood on their own initiative more often than multiparous women (97% versus 84%). For the topics ‘desirability of the pregnancy ‘and’ practical preparations’ and for conversation techniques ‘giving information’ and ‘closed-ended questions’, 100% agreement was achieved. However, the topic ‘Support’ had poor agreement (kappa = 0.19). Key conclusions and implications for practiceAlthough during every visit the transition of motherhood was addressed, the topics mother-to-infant bonding and support should get more attention. Midwives should improve adherence to the guideline by addressing transition to motherhood and by using more open questions. Furthermore, they should focus on taking the initiative to address the transition to motherhood in multiparous women themselves.

EP15.19: Assessing myometrial infiltration by measuring the tumour‐free distance and depth of invasion through 2D transvaginal ultrasound among patients with endometrial cancer

To determine the diagnostic accuracy of 2D transvaginal ultrasound (TVS) in assessing myometrial infiltration by measuring tumour-free distance (TFD) and depth of invasion (DOI) among patients with endometrial cancer admitted for elective surgery in Philippine General Hospital. This prospective validation study involved 49 patients with endometrial cancer admitted from October 1, 2016 to February 28 2017. All patients had 2D transvaginal ultrasound at least within 1 week prior to surgery. The tumour-free distance and depth of invasion were measured and compared with histopath results. The diagnostic accuracy was computed and test of association was done using 2x2 Fischer Exact test at 0.05α while AUC-ROC was plotted. The association between transvaginal ultrasound and histopath result in assessing myometrial infiltration was statistically significant (p=0.004). The TVS measurement for myometrial infiltration demonstrated 94.4% sensitivity and 43.8% specificity in detecting >50% infiltration wherein a likelihood would likely to occur by 1.68 times higher than those with <50% based on the final histopathology. Moreover, the accuracy values of TVS reflected in the AUC index were as follows, a TFD cut off value of ≤0.82cm had higher sensitivity (46.88%) and specificity (100%) in predicting >50% myometrial infiltration while a DOI ratio of 0.50 is the cut off value which initiated a sensitivity (16.7%) and specificity (75%) in predicting >50% infiltration. Finally, TFD (AUC =0.749) yielded a higher accuracy as compared with DOI (AUC=0.388) in predicting myometrial infiltration. Myometrial infiltration assessment by measuring the tumour-free distance through 2D transvaginal ultrasound among endometrial cancer patients demonstrated clinically acceptable accuracy with higher sensitivity in detecting >50% myometrial infiltration. TFD (cut off value of ≤0.82cm) has a higher accuracy compared with DOI in predicting >50% myometrial infiltration. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Effectiveness and Significance of Fine Needle Aspiration Cytology in the Diagnosis of Thyroid Swelling: A Single Institute Experience in a Series of 710 Patients

Context: Thyroid swelling is a relatively common problem encountered in clinical practice throughout the world. Early detection of thyroid neoplasm is the fundamental basis of thyroid screening. A quest for ease, simple and accurate diagnostic tool that would differentiate between benign and malignant lesion has facilitated fine needle aspiration cytology (FNAC) as the first line tool in the initial thyroid evaluation. Aims: The study was aimed at classifying thyroid lesions according to the Bethesda System for Reporting Thyroid Cytopathology and to compare the diagnostic efficacy of fine needle aspiration cytology by correlating with gold standard histopathology. Settings and Design: This prospective cross-sectional study was conducted over a period of two years in a tertiary hospital, Kerala. Methods and Material: A total of 710 patients were included in the study. FNAC was performed and Staining was performed with Haematoxylin &amp; Eosin (H&amp;E), Papanicolaou and May-Grünwald Giemsa Stains. Diagnosis was made based on TBSRTC. Excision biopsies were fixed in 10% formalin. Statistical Analysis used: IBM Statistical Package for the Social Sciences Software version 21 was used to perform Pearson Chi-square test and Fischer Exact. Results: In this study 592 (83.4%) cases of non-neoplastic lesions, 111 (15.6%) cases of neoplastic lesions and seven cases were found unsatisfactory for diagnosis. FNAC showed high sensitivity and specificity in diagnosing neoplastic thyroid lesions and it showed high level of significance in diagnosing papillary thyroid carcinoma. Conclusions: FNAC is an excellent diagnostic tool in the management of thyroid lesions since it provides rapid diagnosis with high accuracy rate.

Effect of Soft-start Curing Mode on Postoperative Hypersensitivity of Class I Posterior Composites Restorations

Objectives: To evaluate the occurrence of postoperative hypersensitivity (POH) in Class I posterior composite restorations comparing the soft-start with the constant light curing modes. Materials and Methods: Seventy patients with each having contra lateral class I occlusal caries lesions in premolars and molars teeth were participated. 140 class I cavity preparations were restored with Adper™ Single Bond 2 adhesive and Filtek™ Z250 XT resin composite (3M-ESPE). For each patient, one restoration was cured with soft-start mode and the contralateral restoration was cured with constant curing modes using Light Emitting Diode (LED) curing light. POH to various stimuli was evaluated at week 1, 4, and 13 post-treatment using Visual Analog Scale (VAS). Data were collected and analyzed by Chi-Square and Fischer Exact tests.&#x0D; Results: No statistical significant differences were observed between the two curing modes (soft-start or constant) in occurrence of postoperative hypersensitivity (P&gt;0.05). Out of 140 restorations that were placed, only two (1.4 %) restorations reported POH to cold stimuli at week 1 post-treatment, being in mild; VAS=3 for soft-start and moderate; VAS=5 for constant light curing mode. No POH was reported at week 4 and 13 for soft-start or constant curing modes.&#x0D; Conclusion: Soft-start curing mode did not show any difference in occurrence of POH in class I posterior composite restorations when compared with constant curing mode.

A Comparative Study of Endoscopic Versus Navigation Guided Microscopic Transsphenoidal Pituitary Surgery at Tertiary Care Centre in India

Abstract Introduction: The transsphenoidal route for pituitary surgery is considered the standard treatment for pituitary adenomas. The disadvantage of the smaller exposure of this route is partially compensated for by the introduction of the microscope with its coaxial illumination, stereoscopic view, adequate magnification, and microsurgical instruments. However, there are only few reports about the outcome of endonasal endoscopic transphenoidal technique. Aims &amp; Objectives: Current study has been conducted to compare the efficacy, advantages and dis advantages of endoscopic versus navigation guided microscopic transsphenoidal Pituitary surgery. Material and methods: A controlled study was done in the department of neurosurgery, at tertiary care hospital in India, from the period of August 2012 to December 2017 prospectively. In Group A- 30 patients in whom endoscopic transnasal trans Sphenoidal pituitary surgery and in Group B - 30 patients, intraoperative neuronavigation was used. Observations and Results: Both the groups were similar in demographic variables. The most common age group of pituitary tumor patients was 30-40 years. Fourteen (46.6 %) patients in group A and fifteen (50 %) of the patients in group B had tumor volume less than 5 ml. In group A, thirteen (43%) patients had intrasellar tumors with no suprasellar extension, while in group B, fifteen (50%) patients had intrasellar tumors with no extension. Operative time was noted from incision to closure and average time taken in both the groups was compared. Twenty five (83%) cases of group A took between 2-3 hours and only four cases (13%) took more than 3 hours. While in group B, twenty (66%) cases took between 4-5 hours. This shows a significant difference by fisher extact test (p&lt;0.001) in the operative time required in both the groups. Eighteen (60%) patients in group B had a residual volume between 1-1.5 ml while only two patients in group A had so. This difference is also significant Fischer Exact test (p&lt;0.001). Four (13.3%) patients in group A had diabites insipidus while only half of this, i.e. two (6.6%) had so in group B. however this difference in postoperative complication rate is not statistically significant between two groups. Conclusion: The results of our study correlate with many previous studies to compare endoscopic and microscopic transsphenoidal surgery. These two approaches are equally efficacious in oncological outcomes and the complication rates are comparable.

Multi-centre cross sectional observational study of hand preference for perineal hygiene: An essential question in upper limb surgery

Hand preference for perineal hygiene is not a commonly recorded data unlike hand dominance. Ability to reach the perineum is essential for a good functional outcome. There is no evidence in orthopaedic literature regarding its variability. The aim of this study was to examine hand preference for perineal hygiene in a cohort of hospital staff and enumerate possible factors that may associate with this preference. One hundred hospital staff in two NHS hospitals were asked questions regarding dominance of hand and hand preference for personal hygiene, ethnicity and gender. They were also asked which hand they thought others used for perineal hygiene. Data was analysed using Fischer exact and Chi2 tests. The most common ethnicity was British (64%). Male/female ratio was 56/44; 88 participants were right hand dominant; 71.8% of British ethnicity used the right hand and 81.25% of South Asians used the left hand for perineal hygiene. There was a significant correlation between hand preference and ethnicity (P<0.001) but not with gender (P=0.402) or hand dominance (P=0.063). There is a significant variation in hand preference for personal hygiene between different groups. The common assumption is that the hand used by others is the same as that used by the participant. Documentation of this hand preference is important while planning procedures like wrist or elbow arthrodesis and for the analysis of the functional outcome of other upper limb procedures. Level of evidenceII.

Utility of Echocardiogram and Electrocardiogram in the Prediction of TTR Amyloid Diagnosed by Tc-Pyrophosphate SPECT Imaging

Introduction Cardiac transthyretin amyloidosis (ATTR) results from myocardial deposition of insoluble TTR fibril proteins. In contrast to AL cardiac amyloidosis, there are no blood or urine tests to aid in the diagnosis. In clinical practice, ATTR is most commonly suspected when there is unexplained heart failure with preserved ejection fraction (HFpEF), left ventricular hypertrophy (LVH) on transthoracic echocardiogram (TTE), along with low voltage criteria on electrocardiogram (ECG). Definitive diagnosis historically required invasive endomyocardial biopsy, however technetium pyrophosphate (Tc-PYP) scans have recently emerged as a highly useful non-invasive test in the diagnosis of ATTR. We sought to examine the predictive value of multiple ECG and TTE parameters in the diagnosis of Tc-PYP positive ATTR. Methods We performed a retrospective chart review of 34 consecutive patients during January 2017-April 2018 at Scripps Clinic who underwent Tc-PYP scanning for clinically suspected ATTR. Patients were then separated into Tc-PYP positive and negative groups, and ECG and TTE obtained closest to the scan were reviewed. Statistical significance was determined by Mann-Whitney U and Fischer Exact test. Results Twenty patients had Tc-PYP positive scans versus 11 patients with Tc-PYP negative scans. Three patients with “equivocal” reads were excluded from the analysis. Overall no ECG parameters were significantly predictive of Tc-PYP+ scans. Rates of “low voltage” ECGs were similar between both groups (3/11 vs. 1/8, p-NS), and while there was a trend towards lower occurrence of sinus rhythm (5/20 vs. 5/11, p-NS) and increased ventricular-paced rhythms in patients with Tc-PYP+ scans (9/20 vs. 3/11, p-NS), these were not statistically significant. Comparing TTE variables, we found that Tc-PYP+ patients had significantly higher LV mass index values (171 vs. 123, p = 0.026) compared to Tc-PYP- patients. Additional TTE parameters (listed in Table) did not demonstrate any statistical significance. Conclusion In this single center study, we demonstrated that routinely used ECG and TTE parameters in clinical practice such as low voltage ECG and Tissue Doppler velocities lack sensitivity in the prediction of TTR Amyloid by Tc-PYP scans. Of various echocardiographic parameters, only LV mass index was statistically significant in predicting Tc-PYP positive scans. With promising new therapies on the horizon, and the emergence of Tc-PYP SPECT imaging as a highly specific noninvasive imaging modality for the diagnosis of ATTR, clinicians should have a high index of suspicion and should not stop with a TTE or ECG as both modalities lack sensitivity.

Obstetric anesthesia/analgesia does not affect disease course in multiple sclerosis: 10-year retrospective cohort study.

ObjectivesMultiple sclerosis (MS) often occurs in young women and the effect of obstetric anesthesia/analgesia on the disease is poorly understood. No previous study has investigated the course of the disease in women in labor in the Czech Republic. The aim of this study was to evaluate the occurrence or absence of relapses in the 6‐month postpartum period in MS parturients with and without obstetric anesthesia/analgesia.Materials and MethodsWe retrospectively studied all deliveries (n = 58,455) at the University Hospital Brno from 2004 to 2013 and identified those of the women with an ICD‐10 code G35 (MS) recorded anytime in their medical history (n = 428). We included only deliveries of women with confirmed diagnosis at the time of labor (n = 70). Statistical analysis was performed using the Fischer Exact Test.ResultsThere were 70 deliveries of 65 women, including 45 vaginal deliveries and 25 Cesarean deliveries (16 under general anesthesia, 8 with epidural anesthesia and 1 with spinal anesthesia). Epidural obstetric analgesia was performed in 11 deliveries. There was no statistically significant difference in relapses between the vaginal delivery group (n = 15; 33%) and Cesarean section group (n = 10; 40%), p = 0.611.ConclusionNeither delivery mode (vaginal vs Caesarean) nor type of obstetric anesthesia/analgesia was found to have any impact on the course of MS at 6 months postpartum in women with this condition.

Indomethacin Does Not Reduce Heterotopic Ossification In Two-incision Distal Biceps Repairs

Objectives:Our objective was to evaluate whether indomethacin would reduce the incidence of heterotopic ossification (HO) after two-incision distal biceps repairs.Methods:After obtaining IRB approval, all two-incision distal biceps tendon repairs performed between 2008 and 2015 by 17 surgeons in a multi-center (14) integrated, health care system were retrospectively reviewed. Indomethacin use was confirmed by the use of our pharmacy database search of a prescription being filled 10 days prior and up to 6 weeks after to surgery. A minimum of 1 year of follow-up was required for all patients. Variables recorded were patient demographics, time from injury to surgery, re-operation rate, infection, re-rupture, nerve complications, and time to release from medical care. Inclusion criteria included age 18 and over, primary repairs using the two-incision technique with bone tunnel - suture fixation. A Fischer Exact test was performed to test for significance.Results:146 patients met our inclusion criteria. The average age was 48 years (range: 23-69). All (100%) were male. The non-dominant side was involved in 76 patients (52.1%). There was no difference in age, gender, time from injury to surgery in groups receiving indomethacin to those not receiving it (P>0.05). 109 (74.7%) patients underwent distal biceps repair without indomethacin and 6 (5.5%) patients developed HO. In 37 patients who received indomethacin prophylaxis, 5 (13.5%) patients developed HO. There was no statistically significant difference in HO formation between patients who received indomethacin prophylaxis and those who did not (P=0.14).Conclusion:Based on our findings and the risk of gastrointestinal complications, we do not recommend indomethacin prophylaxis for two-incision distal biceps repairs.

Knowledge and Use of Dietary Supplement Products by Deaf Athletes

The purpose of this study was to determine the knowledge and use of dietary supplement products (DSP) among the deaf athletes of the Turkish Deaf Sports Federation. A total 74 voluntary athletes from various sports, 11 female and 63 male athletes (Mage=23.62±5.38 years) participated in this study. The data was collected through the survey method and was analyzed by Fischer Exact test, frequencies and percentage distribution. As a result, it has been determined that 39.2% of deaf athletes have knowledge about DSP and athlete diets; their rate of DSP use increases as their educational level increases; the rate of DSP use in national athletes is higher and that taekwondo athletes do not use DSP while a rate of at least 30.8% DSP use is evident in other branches. In addition, the findings show that the deaf athletes do not have sufficient knowledge about their DSP use and they have problems in accessing reliable information about this issue.

De-escalation of Primary Target and Elective Neck Doses in HPV-Positive Oropharyngeal Cancers

Human papilloma virus-related oropharyngeal squamous cell carcinoma (OPSCC) is a highly curable malignancy that is increasing in incidence. Primary radiation therapy (RT) with or without chemotherapy currently achieves excellent long-term outcomes; however, it may be associated with significant acute and long-term side effects. We hypothesized that reductions in dose to the primary target (<69.3 Gy) and elective neck (<50 Gy) would result in similar control and may reduce acute toxicity. After IRB approval was obtained, a database of HPV or p16 positive non-metastatic OPSCC patients treated with definitive radiation therapy with or without chemotherapy was queried. Relevant features of patients in high-dose groups and low-dose groups were compared with Fischer Exact test. Locoregional control (LRC), regional control (RC), and overall survival (OS) were calculated from the end of RT and estimated via Kaplan-Meier method and comparisons made via log-rank test. A total of 387 patients were available for analysis with a median follow-up was 33 months. Standard doses of ≥69.3 Gy (median 70, range 69.3-75.2) were used in 298 patients, and <69.3 Gy (median 66 Gy, range 58-68 Gy) in 89 patients. Standard elective neck doses of ≥50 Gy (median 56 Gy, range 50-56 Gy) were used in 311 patients and <50 Gy (median 46, range 40-49.6) in 71 patients. Patients in the high-dose range to the primary target or elective neck were more likely to be higher AJCC 8th edition T stage, N stage, and overall stage (P < .05 for all comparisons). There was no difference in the 3-year LRC comparing <69.3 Gy and ≥69.3 Gy (95.2% and 91.8% respectively, P = .67), no difference in the 3-year RC comparing the <50 Gy and ≥50 Gy arms (94% vs 90% respectively P = .41). There was no difference in 3-year OS for both <69.3 Gy (95.3% and 87.3%, respectively, P = .13) and <50 Gy (95.6% and 87.9%, respectively, P = .20). When stratifying by AJCC 8th edition T, N, overall stages, or concurrent chemotherapy, there was no difference in LRC, RC, or OS at the different dose levels (P > .22 for all comparisons). The need for reactive gastrostomy tube (PEG) placements was significantly lower in patients receiving lower doses, 4.4% and 19.5% (P < .01). There were 14 (4.9%) grade ≥3 late effects in the ≥ 69.3 Gy arm compared to 1.1% in the <69.3 Gy; however, this was not statistically significant (P = .32). Mild de-escalation of doses to the primary tumor and elective neck does not appear to adversely affect LRC, RC, or OS in patients with AJCC 8th edition I-III HPV-related OPSCC, which remained true after stratification. Patients treated with lower doses had significantly reduced PEG tube rates compared to those in the high-dose group.

A study to assess the knowledge and practice of initiation of immunisation in mothers of low birth weight Neonatal Intensive Care Unit (NICU) graduates in a tertiary care centre

Background: Premature and low birth weight (LBW) infants are susceptible to infections including those which are preventable. The coverage of immunization in this subset of babies is poor. The present pilot study was an attempt to identify factors which lead to delay in initiation of immunization in this vulnerable group. The objective of this study was to assess knowledge and practice of initiation of immunization in mothers of low birth weight (&lt;2 Kg) NICU graduates and effect of specific counselling on the practice of immunization. Methods: A prospective pilot study was done between 1st April to 30th June 2016. In the first phase, mothers of LBW and preterm babies were assessed using 2 validated questionnaires on discharge and in High-Risk OPD. In the second phase, a different set of mothers were assessed similarly but counseled specifically by the principal investigator to initiate immunization irrespective of the weight and chronological age. Results were interpreted using the Fischer Exact test, Independent T-test and McNemar.Results: Among 30 babies in the study, 16 (53.33%) were immunized, of which 6 (37.5%) babies had a timely initiation. Birth weight and duration of NICU stay significantly affected the time of initiation of immunization. There was a significant lack of knowledge in mothers of non-immunized babies. When counseled by the primary investigator, 85.8% and 50% of mothers agreed that immunization can be initiated at birth and even if birth weight is less than 2 kg respectively.Conclusions: Immunization initiation was delayed in most of the preterm and low birth weight babies. Post counseling a favorable change was observed in mothers’ knowledge but not practice.

Therapeutic Mastoidectomy Does Not Increase Postoperative Complications in the Management of the Chronic Ear.

Tympanoplasty with or without concurrent therapeutic mastoidectomy is a controversial topic in the management of chronic ear disease. We sought to describe whether there is a significant difference in postoperative complications. Retrospective cohort study. American College of Surgeons National Surgical Quality Improvement Program public files. Current procedural terminology codes were used to identify patients with chronic ear disease undergoing tympanoplasty ± concurrent mastoidectomy in the 2011 to 14 American College of Surgeons National Surgical Quality Improvement Program files. Therapeutic. Variables were compared with χ, Fischer's exact, and Mann-Whitney U tests, as appropriate to analyze postoperative complications between tympanoplasty with or without concurrent mastoidectomy. To account for confounding factors, presence of a complication was analyzed in binary logistic regression. Analysis considered sex, hypertension, obesity, advanced age, diabetes, smoking status, American Society of Anesthesiologists Physical status, procedure. There were 4,087 patients identified meeting criteria (tympanoplasty = 2,798, tympanomastoidectomy = 1,289). There was no statistical difference in postoperative complications (tympanoplasty n = 49 [1. 8%], tympanomastoidectomy n = 33 [2. 6%]; p = 0. 087) or return to the operating room (tympanoplasty = 4 [0. 1%], tympanomastoidectomy = 6 [0. 5%]; p = 0. 082). Binary logistic regression demonstrated smoking as a predictor of a postoperative complication (OR: 1. 758, 95% CI: 1. 084-2. 851; p = 0. 022), while concurrent mastoidectomy did not significantly increase the risk of complication (OR: 1. 440, 95% CI: 0. 915-2. 268; p = 0. 115). There was a significant difference in mean operative time between tympanoplasty and tympanomastoidectomy: 85.7 versus 154.23 min, p < 0. 001. In the management of chronic ear disease, tympanoplasty with concurrent mastoidectomy increases time under anesthesia, but it is not associated with any increased postoperative complications compared with tympanoplasty alone.