MacNemar Test Research Articles

Using mobile health in primiparous women: effect on awareness, attitude and choice of delivery type, semi-experimental

BackgroundOne of the reasons for the increase in cesarean section is the lack of knowledge of mothers in choosing the type of delivery. The present study aimed to determine the effect of education through pregnancy application during pregnancy on awareness and attitude and choice of delivery type in primiparous women at Shahid Alavi Specialized Medical Center clinic in Mashhad.MethodsThis study was a semi-experimental type. Seventy primiparous pregnant women who had no restrictions for birth was selected. Sampling was randomized and purpose-based. The data collection tool was a questionnaire. The starting time of the training was considered from the end of the 27th week of pregnancy and continued with regular intervals until the end of the pregnancy. The questionnaires were completed once before the training and once after the training as a pre-test and post-test by the research units. SPSS software (version 26) and MacNemar test and descriptive statistics were used for data analysis.ResultsAccording to the results of the MacNemar test, a significant statistical difference was seen between women’s knowledge and attitude after the training compared to before (p-value < 0.01). Choosing the type of birth was preferred before and after the training. But following the performance of women showed that only 62.86% of them chose natural birth. In fact, before the training, 40% and after 72.86% of women had chosen birth.ConclusionPregnancy education and application during pregnancy is effective in reducing the choice of cesarean section, so this application with the topic of birth and cesarean section has improved the level of attitude and also the positive attitude of pregnant women towards birth. Creation of facilities and promotion of different methods of painless childbirth and training of maternity staff to perform birth is expected.

Perubahan Perilaku Masyarakat Terhadap Kepatuhan Menjalankan Protokol Kesehatan Setelah Dilakukan Penegakan Disiplin Oleh Satpol PP

This study aims to provide a description of changes in people's behavior towards compliance with health protocols after discipline is enforced by Satpol PP based on Tegal Regent Regulation No. 62 of 2020. In this study, the approach used was a combination of qualitative and quantitative. A qualitative approach is used to describe whether the enforcement of discipline carried out by Satpol PP related to compliance with health protocols results in changes in community behavior, while the quantitative approach used is hypothesis testing on signs used to analyze changes in community behavior compliance in carrying out health protocols after enforcement. disciplined by Satpol PP, while in order to ensure whether or not there is a change in the state of compliance with community behavior in carrying out health protocols, before and after treatment (before and after treatment research design) a hypothesis testing method on growth is used using the Mac Nemar change test. The enforcement of discipline carried out by the Satpol PP on compliance with community behavior in carrying out health protocols as an effort to overcome the spread of Covid 19 in Tegal Regency is able to make changes to people's behavior in carrying out health protocols for the better. This conclusion is obtained from statistical testing which states that from this study (1) the enforcement of discipline by Satpol PP can increase the level of compliance of community behavior in carrying out health protocols in Tegal Regency, (2) there is a change in the state of compliance with community behavior in carrying out health protocols in Kabupaten Tegal. Tegal after the enforcement of discipline by the Tegal Regency Satpol PP.

PENGARUH TERAPI BIRTHING BALL TERHADAP LAMA KALA 2 PADA IBU BERSALIN DI PMB CITRA DUSUN JAMBESARI DESA MUMBULSARI KABUPATEN JEMBER

Labor is the process of moving the fetus out. Prolonged labor can have serious consequences for the mother and fetus, one or both at the same time. Prolonged labor is one of the causes of maternal and fetal death. Long parturition on average causes maternal death in primigravida due to prolongation by 8% in the world and 9% in Indonesia. This study aims to analyze the effect of birthing ball therapy on the length of the second stage of childbirth in PMB Citra Dusun Jambesari, Mumbul Sari Village, Jember Regency. This study used an experimental research design with the static-group comparison design. This research was conducted at PMB Citra, Jambesari Hamlet, Mumbul Sari Village, Jember Regency on all 30 mothers. The sample size in this study was 100% of the population, the sampling technique used was purposive sampling. Data were collected by documentation and analyzed by Mc Nemar statistic with SPSS. The results showed that the duration of the second stage of labor in women who were not given birthing ball therapy experienced a length of labor as many as 10 people (66.7%) and those who were given birthing ball therapy tended to be in accordance with their delivery as many as 11 people (73.3%). Based on the Mac Nemar test, the significance value (Asymp. Sig) was 0.031 &lt; 0.05, meaning that ho was rejected and ha was accepted, so that there was an influence of birthing ball therapy on the duration of the second stage of labor in women giving birth in PMB Citra Hambesari, Mumbulsari Village, Jember Regency. The hypothesis in this study is accepted and statistically proven. It is recommended that mothers can then exclusively breastfeed and be active in posyandu activities.

Political Education in Indonesia: Community Assessment and Preferences for Political Education Conducted by Political Parties

One of the functions carried out by political parties is the function of public political education. Political education is the process of imparting knowledge to the public about state politics and finally implementing it in general election activities. The success or failure of political education carried out by political parties to the public can be seen by the level of community participation in general elections. This study aims to describe people's assessments and preferences for political education conducted by political parties in Indonesia. Descriptive quantitative approaches were used in this research. While testing the hypothesis the Mac Nemar hypothesis on signs and testing changes was used. Based on testing the hypothesis on signs, it was found that more respondents who answered that political education carried out by political parties for the community failed or were not successful were more than respondents who answered that political education carried out by political parties for the community was successful. As an implication, political education carried out by political parties is declared a failure or the function carried out by political parties in conducting political education has not been carried out properly. Based on the Mac Nemar change test hypothesis, it was found that the calculated chi-squared value was 0.167 and this value was smaller than the khai squared value in table 3.841. So that the null hypothesis is declared accepted and has the implication that there is no change in respondents' preferences after joining a political party.

Synbiotic Structured Education (Probiotics and Prebiotics) in order to increase the community's resistance to the spread of Covid-19

This study aims to provide an overview of community service carried out in the form of Synbiotic Structured Education (Probiotics and Prebiotics). The data analysis method uses a statistical test of hypothesis testing on changes in the Mac Nemar change test to ascertain whether or not there is a change in the behavior of the object of research. In this method, the change in state or response shown by the object is analyzed with the help of a table called a 2 x 2 frequency table. The table is used as a tool because this method is applied to 2 groups of paired samples. The conclusion of community service that has been carried out in the form of structured education of synbiotics (probiotics and prebiotics) in order to increase the community's resistance to the spread of COVID-19 is able to make changes in behavior by the community in general and families in particular in applying the use of synbiotics to increase the body's resistance to enteric cases. acute and respiratory infections.

412.1: Lip Actinic Cheilitis and Its Relationship to Clinical Characteristics and Immunosuppression in Kidney Transplant Recipients

Introduction: Due to drug immunosuppression after kidney transplantation (KT), as well as factors such as chronic uremia and chronic sun exposure, Kidney Transplant Recipients (KTR) have a 46-fold increased incidence of Lip Cancer (LC). Because of the high prevalence of LC in KTR, there are concerns about its prevention, which can be accomplished by diagnosing Actinic Cheilitis (AQ) on lips, a potentially malignant oral lesion that can progress to LC. Aim: The purpose of this investigation was to see if there was a link between the clinical manifestations of AQ and the clinical profile of KTRs. Methods: Convenience sampling in a cross-sectional observational clinical study. An expert researcher completed the diagnosis and clinical staging of AQ in KTRs using Pointevin et al 2017 criteria and a clinical evaluation and photographic record of six different angulations of the lower lip were used to calibrate the researcher (Kappa intra-avaliador >0.8). Demographic data, time since KT, immunosuppressants, exposure to AQ risk factors such as alcoholism, smoking, chronic sun exposure, and exposure to volatile chemical agents, and history of positive serology for oncogenic viruses after KT were all obtained retrospectively from electronic medical records. For the association of variables, Chi-square and Macnemar tests were performed, with a significance value of (0.05). Results: The sample size was 48 (100%) KTR, with 29 people diagnosed with AQ (60.41 percent). Light-siknned KTR was linked with the most severe AQ staging in 9 subjects (18.75 percent; p=0.035). History of exposure to volatile chemical agents (16.33 percent; p=0.007), drunkenness (15.25 percent; p=0.008), and smoking (20.66 percent; p=0.05) were also risk factors for AQ. A history of prolonged sun exposure was linked to a higher severity of QA 22(45.83 percent; p<0.001). The prevalence of AQ was linked to the usage of tacrolimus 43 (89,58 percent; p<0.001) and azathioprine 11 (22,91 percent; p0.001). However, the use of Mycophenolate Mofetil was linked to the most severe cases of AQ in 7 patients (14.58 percent; p=0.05). Individuals who got sirolimus, on the other hand, showed less AQ expression, with 7 patients (14.58 percent; P=0.016) manifesting with lesser degrees. After TxR, positive Epstein-Barr Virus serology was linked to the existence of AQ 17 (35,41 percent; p=0.028). Conclusion: The presence and severity of AQ in KTR were linked to fair skin, chronic sun exposure, Epstein-Barr Virus infections, and the use of Mycophenolate Mofetil. Sirolimus appears to have a protective effect against the development of AQ. It is possible to select groups of patients at higher risk for AQ and, as a result, for LC using this clinical profile associated with the manifestation of AQ, allowing for prevention and early diagnosis. This study was approved by the Ethics and Research in Human Beings Committee under protocol CAAE12798019.3.0000.5417.

Evaluation of contrast alternation efficacy in diagnosis of vertical root fracture in conventional digital radiography

Background and objective: Most digital imaging systems today offer a variety of image processing techniques. Due to the importance of the accuracy of this imaging and its widespread use in this study we investigate the effect of contrast change in the diagnosis of vertical root fracture in conventional digital radiography. Materials and methods: in this in vitro study 24 human single-rooted teeth induced vertical root fracture with underwent vrf. Digital images were prepared before and after induction vrf. Images with three low, medium and high contrasts were examined by two radiologists.Data were tested using kappa and MacNemar tests in SPSS software. Overall accuracy was calculated using Roc curve analyzes. Results: The highest sensitivity specificity and overall accuracy are related to images with moderate contrast (95.83%, 100% and 98% in the first observer and 100%, 100% and 100% in the second observer, respectively). In case of low and high contrast to detect vertical root fracture, there is no statistically significant difference with reality (p&lt;0/001). Conclusion: Medium contrast can be used as a processing filter in the detection of vertical root fractures.

Comparing surgeons’ skin tolerance and acceptability to alcohol-based surgical hand preparation vs traditional surgical scrub: A matched quasi-experimental study

BackgroundWe aimed to compare the tolerance and acceptability of alcohol-based surgical hand preparation versus handscrubbing with antimicrobial soap and water by surgeons. MethodsMatched quasi-experimental trial in an academic quaternary care hospital in Ribeirão Preto, Brazil, from April 1 to October, 31, 2017. Participants were cardiac and orthopedics surgeons from the study facility. In the first study phase, they performed handscrubbing with either 2% chlorhexidine (CHG) or 10% iodopovidone (PVP-I) and, in the second phase, they performed handrubbing with alcohol-based handrub (ABHR). Surgeons' skin tolerance and acceptability were evaluated using WHO-validated tools. Data were analyzed using the MacNemar's test within STATA. ResultsA total of 33 surgeons participated to the “per protocol” population; the majority were male (94%); mean age of 35 years (SD, 8.5). On product tolerance, there was a minimal variation in redness, scaliness, fissures, and visual evaluation of the skin when handrubbing with ABHR was compared to handscrubbing with either PVP-I or CHX. Regarding acceptability, participants rated better handrubbing with ABHR than handscrubbing with PVP-I when assessing product smell (66.6% vs 0%, p=0.002), color (73.3% vs 0%, p=0.001), product texture (60% vs 0%, p=0.004), skin dryness (60% vs 0%, p=0.004), ease of application (66.6% vs 0%, p=0.002) and overall satisfaction (66.6% vs 6.7% p=0.011). Participants rated similarly handrubbing with ABHR and handscrubbing with CHX, except for product texture, where handrubbing rated better (71,4% vs. 0%, p=0.002). Handrubbing with ABHR was preferred by 73.3%. ConclusionAlthough handrubbing and handscrubbing were equally well tolerated by surgeons, alcohol-based surgical hand preparation fell into the personal preference for most of them. Trial registration. Brazilian Clinical Trials Registry (ReBEC), RBR-8ym9yj.

Platelet count in the steady state phase and clinical severity of sickle cell disease in a reference centre for sickle cell disease in Mali

Risk factors associated with complications occurring in sickle cell disease are not fully elucidated. The purpose of this study was to evaluate the existence of an association between the clinical severity of sickle cell disease and platelet count in the steady state phase in patients with sickle cell disease followed up at the Center for Research and Control of Sickle Cell Disease in Bamako, Mali. We conducted a retrospective review of 40 medical records of patients aged 5 to 42 years with sickle cell disease at the Center for Research and Control of Sickle Cell Disease in Bamako, Mali. Clinical severity of sickle cell disease was assessed according to the criteria of VOC and/or hospitalizations < 2 or ≥ 2 per year. Data entry was carried out using the Excel 2013 version. The statistical tests used were the Chi2, Student and Mac Nemar tests. Of the 40 patients, 82.5% had haemolytic phenotype and 17.5% hyperviscous phenotype; complications of sickle cell disease were more frequent in the haemolytic phenotype group (p < 0.05). There was a significant association between mean platelet count ≥ 450 G/L in the steady state phase and the annual number of CVOs ≥ 2 (p = 0.002). This study shows that mean platelet count ≥ 450 G/L in sickle cell patients in the steady state phase could be a risk factor for the frequent occurrence of CVO. It underlines the importance of conducting prospective studies focusing on both hyperplateletosis and platelet activation markers in larger sample sizes, as well as therapeutic trials involving platelet activation inhibitors, such as Crizanlizumab, a humanised anti-P-selectin monoclonal antibodies.

How to conduct inferential statistics online: A brief hands-on guide for biomedical researchers

Introduction: Research data are first organized and visualized with the help of descriptive statistics. The next step is the inferential statistics. Result of the inferential statistics helps to conclude the finding. Many researchers and medical students may not have access to dedicated software for biostatistics. Aim: This study aimed to provide a guide on the conduct of common inferential statistics that can be done online. Methods: Common inferential statistical tests for both numerical data and categorical data were described in this study. All the tests were conducted online and the process is described step by step with example data. Results: The following tests were described-one-sample t-test, one-sample median test, unpaired t-test, Mann–Whitney U-test, paired t-test, Wilcoxon signed-rank test, one-way analysis of variance (ANOVA), Kruskal–Wallis test, repeated-measure ANOVA, Friedman Test, Pearson correlation test, Spearman correlation test, Binomial test, Chi-square test, Fisher's exact test, and MacNemar test. All these tests could be conducted online from a computer connected to the internet. Conclusion: We could conduct common inferential statistical tests online without any installed software. Anyone without prior data analysis knowledge may conduct the tests with example data on any internet browser. We presume that these would help the medical undergraduate and postgraduate students.

Improving the knowledge of high school students about zoonotic diseases from pets in Medellín-Colombia.

Background and Aim:The “One Health” concept is a global strategy that recognizes that public health is related to animal health and the environment; however, the role of domestic animals and their involvement in the transmission of zoonoses is often underestimated. The aim of the study was to evaluate and improve the knowledge about zoonotic diseases of domestic animals in high school students from Medellín, Colombia.Materials and Methods:A quasi-experimental intra-subject study was carried out. This study was conducted with 11th-grade students from four schools in Medellín, Colombia. A structured multiple-choice questionnaire was used from March 2021 to May 2021. The research had two phases, first, “naive” knowledge and learning. Then, descriptive, association, and comparative analysis were carried out using absolute and relative frequencies, Pearson’s Chi-square test, and MacNemar’s test with a value of p<0.05 considered statistically significant.Results:A research poll from 315 students of four private schools found that feeding their pets with raw food and leftovers cooked for human consumption were common practices; the results also show a lack of knowledge of their pets’ immunization deworming status. It was understood that when the students were able to identify at least two symptoms of zoonoses, one route of its’ transmission and two preventive measures, we found that only 12.49% of the polled students had proper knowledge of the disease in domestic animals. After conducting an educational strategy, the findings show a general increase in knowledge, leading us to accept that the academic approach was adequate to statistically increase the recognition of symptoms, routes of transmission and preventive measures (p=0.00).Conclusion:The use of the theoretical lecture is effective to improve the understanding of the concept of transmission of diseases from animals to humans; in addition, the results show an increase of knowledge in high school students of the related symptoms, transmission routes, and preventive measures of zoonoses diseases in the region.

Left ventricular global strain early alteration in symptomatic forms of SARS-co2 infection

IntroductionSeveral diseases are known to induce left ventricular global strain (SLG) alteration in the speckle tracking echography. However, to our knowledge, SARS-COV2 infection inducing such an alteration has reported only in a few series.ObjectifTo describe a case series of patients developing SLG alteration after SARS-COV2 infection.MethodIt was a prospective study (February2020 - March 2020), performed in the cardiology and pneumology departments of Mahdia Hospital-Tunisia. We included in this study, young patients without any medical history, developing SLG alteration after SARS-COV2 infection. For each patient, we assessed the SLG at the acute phase of SARS-Cov 2 infection (SLG initial: SLGi) and at one month after infection recovery (SLG control: SLGc). The comparison between SLGi and SLGc was based on delta SLG (=SLGc-SLGi) and Mc Nemar test. Continuous data were expressed as mean + -SD [min-max] and dichutomous variables were expressed as number (percentage).ResultsA total of 34 patients were included in the study. The sex ratio M/F was 0.45. The mean age was 34.9± 8.0 years [19-47]. The mean Body Mass Index (BMI) was 25.7 [19–29]. The severity grade of SARS-cov2 infection was 11%;3%;83%;3% for severe, moderate, mild and asymptomatic, respectively. The SLGi varied from −11% to −18.1% with a mean value at −16.24%. During the second visit, the SLGc was normal in 15 Patients (44.1%). The mean absolute delta SLG was 2.5 ± 1.8. Mac Nemar test showed a significant improvement of SLG one month after SRS-COV 2 recovery (P < 10̄3: SLGi versus SLGc).ConclusionWe reported here an original case series of SLG alteration induced by SARS-COV2 infection. However, this affection seems to be spontaneously reversible with the total extinction of symptoms several weeks after SARS-COV2 infection recovery.

PEMAHAMAN DAN HARMONISASI KONSEP-KONSEP STANDAR PELAYANAN MINIMAL DESA TERHADAP APARATUR DESA ADINUSO KECAMATAN REBAN KABUPATEN BATANG

This study aims to provide a description of the understanding and harmonization of the concepts of village minimum service standards according to the Republic of Indonesia's Minister of Home Affairs Regulation Number 2 of 2017 to the apparatus of the Adinuso Village, Reban District, Batang Regency. This research is based on community service in Adinuso Village, Reban District, Batang Regency from January to February 2020. In this study, the approach used is a combination of qualitative and quantitative. A qualitative approach is used to describe how the process provides understanding and harmonization of the concepts of village minimum service standards according to the Republic of Indonesia's Minister of Home Affairs Regulation Number 2 of 2017 to the Adinuso Village apparatus, Reban District, Batang Regency, while the quantitative approach used is hypothesis testing of the signs used to analyze service standards village before and after community service is carried out. Meanwhile, in order to ascertain whether or not there is a change in the state of public service standards, before and after treatment (before and after treatment research design) a hypothesis testing method is used for changes using the Mac Nemar change test. The conclusions of this study are (1) that the community service carried out can improve the service standards of the Village Government community, (2) that there has been a change in the standard state of community service in the Adinuso Village Government, Reban District, Batang Regency after community service.

Specialised wound care clinics in Spain: distribution and characteristics.

To determine the number of specialised wound care units/clinics (SWCUs) in Spain, at present, and to describe their most important characteristics. This was an observational study with a descriptive-analytical, cross-sectional, multicentre approach, where the studied population consisted of SWCUs in Spain. A specific data-collection questionnaire was designed using a modified Delphi method, consisting of four rounds, with the collaboration of 10 wound experts. The final questionnaire included 49 items distributed across four dimensions/areas with a content validity index (CVI-Total for pertinence=0.96 and CVI-Total for relevance=0.94. A total of 42 SWCUs were included in the study. Most SWCUs were based in hospitals (n=15, 35.7%) or healthcare centres, covering a specific healthcare area (n=17, 40.5%). SWCU coordinators were primarily nurses (n=33, 78.6%). Staff members' professions in SWCUs included registered nurses (n=38 units, 92.7%), nursing assistants (n=8 units, 19.5%), podiatrists (n=8 units, 19.5%), vascular surgeons (n=7 units, 17%), osteopaths (n=2 units, 4.8%) and medical doctors from different specialties (n=3 units, 7.2%). For wound aetiology, the most prevalent wounds managed were diabetic foot ulcers (n=38 units, 90.5%), followed by venous leg ulcers (n=36 units, 85.7%) and arterial ischaemic ulcers (n=36 units, 85.7%). A statistically significant association was found between the number of staff members in a SWCU and the existence of resistance/opposition barriers when developing a SWCU (Chi-square test, p=0.049; Cramér's V=0.34; 34%), as well as between resistance/opposition barriers when developing a SWCU and a nurse as coordinator of a SWCU (MacNemar test, p=0.007, Cramér's V=0.35; 35%). The typical SWCU implemented in Spain is located in a hospital or integrated in a healthcare structure that offers coverage to a whole health area and providing services for people with hard-to-heal wounds (wound management and prevention) and health professionals (advice, consultancy and training/education). Despite the growing number of SWCUs in Spain, the future of this new organisational model is uncertain, as there can be barriers to creating them and some deficiencies, such as low staff numbers, which need to be addressed.

Validation of a videoconference‐based neuropsychological assessment: The e‐COG study

AbstractBackgroundThe videoconference‐based neuropsychological assessment, also called teleneuropsychology, is a promising tool for the diagnosis and follow‐up of individuals living in underserved areas, care facilities or other institutions, and even emigrants. This kind of consultation has proved particularly useful during the COVID‐19 pandemic, suggesting how it could be used more systematically. This study is the first to explore the reliability of neuropsychological teleassessment in France.MethodIn the e‐COG study, we included 150 older memory‐complainers, with an MMSE&gt;20, seeking medical advice at a memory clinic (Pitié‐Salpêtrière Hospital) or at the Aloïs Memory Network, both based in Paris, France. At baseline, all participants underwent a comprehensive face‐to‐face neuropsychological assessment. After 4 months, the participants were randomized, so that half of them performed another face‐to‐face assessment, and the other half a teleassessment. For the teleassessment, the examiner used a MacBook Pro system with internet connection, microphone and speaker. The patient was with an assistant with no training in neuropsychology, who intervened during certain tests requiring material handling or physical contact. Two cameras were installed, one to film the entire room, and the other to film what the participant wrote or drew. We compared (i) face‐to‐face versus teleassessment scores using t‐tests and Chi2 tests (or Fisher Exact test when relevant); (ii) scores at assessment 1 versus 2, according to the administration method, using Paired t‐tests and MacNemar tests (or Bowker test when relevant).ResultDemographic characteristics of the sample are shown in Table 1. The two assessments 4 months apart yielded overall stable scores, regardless of the method of administration (Face‐to‐Face or Video). Very few tests showed significant differences between the two assessments, but the effect size was very weak (all Cohen's d ≤ 0.35). The STAI‐Y‐A score, measuring the level of anxiety felt at the moment, was slightly but non‐significantly higher in the Face‐to‐Face (versus Video) condition (p=0.07), and therefore it seems that the remote assessment does not induce greater anxiety in the patient.ConclusionNeuropsychological teleassessment is a valid and promising tool that could be incorporated into the diagnostic and follow‐up processes of patients with suspected or full‐blown cognitive impairment.

Growth and Challenges in Hospital Palliative Cancer Care Services: An Analysis of Nationwide Surveys Over a Decade in Japan

ContextThe development of palliative care services is a public health priority. The Japanese Cancer Control Act has been promoting palliative care services nationwide for over 10 years. ObjectivesTo evaluate long-term changes in the structure and processes of hospital palliative cancer care services nationwide. MethodsThis was an observational study using three representative questionnaire surveys between 2008 and 2018. The questionnaire consisted of domains on the structure and process regarding hospital palliative cancer care services. The changes over time were assessed using the MacNemar test. The differences between groups, namely community hospitals and designated cancer hospitals, were determined using χ2 tests. ResultsWe analyzed changes over time from 281 designated cancer hospitals and compared the services between 1395 community hospitals and 380 designated cancer hospitals. The development of the structure and processes for designated cancer hospital's palliative cancer care services was greater for 10 years including the number of Palliative Care Consultation Teams (PCTs) with more than 50 patient referrals annually (from 2010 to 2018: 76.2% to 85.4%, P < 0.001). The palliative cancer care services of community hospitals were poorly prepared compared with designated cancer hospitals in 2018, such as the “direct medical care by any member of the Palliative Care Consultation Team at least 3 times a week (41.7% vs. 81.3%; P < 0.001). ConclusionHospital palliative cancer care services in designated cancer hospitals have developed significantly from 2008 to 2018. Building a system to promote palliative care services in community hospitals is a challenge for the next decade.

MON-LB51 Stimulation for Bilateral Inferior Petrosal Sinus Sampling May Be Unnecessary for Diagnosis of ACTH Dependent Cushing Syndrome

Introduction: Bilateral inferior petrosal sinus sampling (BIPSS) is the gold standard test to differentiate Cushing’s disease (CD) and ectopic ACTH syndrome (EAS). Stimulation test for diagnosis may be unnecessary in some cases and the diagnostic yield of the stimulation test may be similar to the basal measurement. Methods: 34 adult patients referred for diagnosis of ACTH dependent Cushing syndrome. Basal simples for prolactin and ACTH were taken from bilateral inferior petrosal sinus and from peripheral vein. Stimulation test with desmopressin (32 subject) or CRH (2 subjects) was performed. Samples were taken at 0, 3, 5 and 10 minutes. To compare the percentage of diagnosis with each measurement the MacNemar test was done. Results: Right basal ACTH was 465 pg./ml (ICR 62-1250), ACTH at 3 minutes was 647 (ICR 227-2610), ACTH at 5 minutes was 1250 (ICR 245-1965), ACTH at 10 minutes was 230 (71-550). Left basal ACTH was 230 (71-550), at 3 minutes was 453 (ICR 116-1250), at 5 minutes was 431 (91-1250), at 10 minutes was 534 (140-1250). Median basal ACTH ratio was 13.8 (ICR 5.1-26), at 3 minutes was 34.5 (ICR 13-82), at 5 minutes was 30.6 (11.4-49.8), at 10 minutes was 18.5 (8.2-48.2). The higher ratio was at 3 minutes. Basal ACTH ratio was <2 in only 4 cases. 2 out of 4 cases had ratio >3 after stimulation test. CD was diagnosed with basal ratio in 88.6% of cases, and at 3, 5 and 10 minutes in 94.3% of cases. There was no difference in percentage of CD diagnosis at 3, 5 or 10 minutes (p=1.0). Discussion: Basal ACTH ratio was able to differentiate CD from ECS in most cases (88.6%). At least one additional sample with CRH or desmopressin stimuli identify 94.3% of CD cases with the higher increases at 3 minutes. Additional stimuli do not improve overall diagnosis, therefore, a basal ratio and additional stimulation test at 3 minutes is enough for CD diagnosis. This may decrease the cost of BIPSS and total duration of the procedure.

COMPARISON BETWEEN BUFFY COAT SMEAR AND DAT FOR THE DIAGNOSIS OF VL IN SUDAN

Visceral Leishmaniasis is considered by WHO as one of the leading diseases in the world and is present in 88 countries worldwide.It affects poor communities in peripheral areas. It infects the internal organs of the body. It is fatal if not treated.It is caused by the parasite L.donovani in the old world and L.infantum in the new world. Correct diagnosis is necessary if the disease is to be treated.Many diagnostic techniques are known but none is agreed upon worldwide.This study aims to compare two techniques for the diagnosis of VL in Sudan.37 patients was included in this study.Buffy coat smears were prepared from peripheral blood of these patients and were searched for the presence of the parasite.Serum from these blood samples was used to preform DAT technique.The sensitivity of buffy coat smear was 37.8% and that of DAT was 100%.When MacNemar test was conducted, it was found that DAT is better than buffy coat smear for the diagnosis of VL.We concluded that DAT is a better diagnostic technique and could be adapted for diagnosis of VL in Sudan.

Estado de salud oral antes, durante y después del tratamiento antineoplásico en un instituto de cáncer en Barranquilla, Colombia.

Chemotherapy and radiotherapy are aggressive treatments for cancer management. Both therapies make the stomatogatic system vulnerable to adverse effects on the oral mucosa and hard tissues. This may result in severe oral complications that can affect the quality of life of the oncologic patient. Consequently, oral diagnosis and interdisciplinary management by the stomatologist are critical for cancer treatment, regardless of its location. Objective. To determine the oral health status of cancer patients before, during and after antineoplastic treatment at a cancer institute in the city of Barranquilla, Colombia. Materials and Methods. A descriptive, longitudinal and prospective study of 131 cancer patients, was conducted. The study consisted of initial stomatological assessment of the antineoplastic therapy; classification according to the antineoplastic therapy given by the oncologist; a second stomatological assessment during treatment; and a final stomatological assessment or evaluation forty days after the end of therapy. Descriptive statistics, chi-square and MacNemar test were used to compare and identify variances at the different stages. Results. Female patients accounted for 69%, and breast cancer had 24% prevalence among the included subjects. At the initial stomatological assessment, high frequency lesions were identified, such as generalized biofilm-associated gingivitis in 69% of the cases, followed by oral candidiasis in 61%. The specific prevalence of lesions was 10.65%. In the second stomatological assessment, a greater frequency of periodontal abscesses was observed in 31%, and oral mucositis type II in 18%. The third clinical assessment showed significant changes in oral health status; an increase in the frequency of gingivitis was found in 9.9% (p&lt;0.001); unlike before and during, there was an increment in dental caries of 26.73% (p&lt;0.00000) at this last stage, root remains increased by 39.53% (p&lt;0.00000), and finally, xerostomia increased by 45%. Oral candidiasis was the only lesion that showed improvement. Conclusion. An increase in the number of lesions was observed during and after antineoplastic treatment. The oral cavity is susceptible to antineoplastic treatments; gingivitis, candidiasis, xerostomia, and mucositis were observed, among others conditions.

Impact of a community program for child malnutrition.

To evaluate the impact of a community program aimed at improving the children mal nutrition in a rural community of the State of Chiapas, Mexico, 2013. Des criptive study of the evaluation program from a secondary database of nutritional data registry of 113 children under five years of age in a rural area of Mexico. The intervention and the survey were carried out during 2013. Baseline and 4-month measurements were recorded. The World Health Organization (WHO) Anthro software was used to calculate nutritional status indicators. According to WHO guidelines, the following data were estimated: weight for age (W/A), height for age (H/A), weight for height (W/H), and Body mass index for age (BMI/A). Position and dispersion measures were calculated; Student's T-test, Kruskal-Wallis, and MacNemar test were used for paired data and linear regression. Between the beginning and the end, the median of the Z W/H went from -0.7 (p25 -1.24, p75 -0.01) to -0.62 (p25 -1.09, p75 -0.15). The prevalence of low weight decreased from 5.31% (CI 2.38-11.44) to 4.42% (CI 1.83-10.32) (Z BMI/A). The appropriate weight according to Z score W/H increased from 78.76% (CI 70.12-85.43) to 84.96% (76.98-90.51). In the subgroup with low initial weight, the mean of Z BMI/A and Z W/H increased 0.4 (p = 0.003). The change in the mean of Z W/H was 0.02 points in the subgroup that received the direct transfer program and of -0.3 in which it did not (p = 0.020). It is concluded that the community program during the four months of implementation contributed to improve some anthropometric indicators, although no apparent effects were found in indicators related to chronic malnutrition.