Significant Differences In Median Research Articles

Preconceptional paternal obesity may increase the risk of congenital urogenital anomalies in offspring: A case-control study.

Congenital urogenital anomalies affect 4-60 per 10,000 births. Maternal obesity, along with other risk factors, is well documented as a contributing factor. However, the impact of paternal obesity on risk is unclear. Obesity is prevalent among men of reproductive age, highlighting the need for further research into the potential association between paternal obesity and offspring congenital urogenital anomalies. This study aims to determine the association between paternal obesity and the risk of congenital urogenital malformations in offspring. Case-control study conducted on 179 newborns (91 cases, 88 controls) selected from the Notre Dame des Secours-university hospital database. Cases were identified as newborns presenting at least one congenital urogenital abnormality, defined as developmental anomalies that can result in a variety of malformations affecting the kidneys, ureters, bladder, and urethra. Controls were identified as newborns without any congenital abnormalities. The exclusion criteria were maternal obesity, infections during pregnancy, chronic diseases, prematurity, growth retardation, assisted reproductive technologies for conception, substance abuse, down syndrome, and other malformations. Data were collected through phone interviews, medical records, and questionnaires. In this study, the exposure was the preconceptional paternal body mass index (BMI), which was calculated based on self-reported height and weight. According to guidelines from the US Centers for Disease Control and Prevention (CDC), individuals are considered to be in the healthy weight range if their BMI (kg/m2) is between 18.5 and<25. They are classified as overweight if their BMI is ≥ 25, obese class I if their BMI is between 30 and<35, obese class II if their BMI is between 35 and<40, and obese class III if their BMI is 40 or higher. Logistic regression analysis was employed to quantify the association between paternal obesity and urogenital conditions in offspring. Significant differences in median (minimum-maximum) paternal BMI values were noted between the cases and controls at the time of conception (cases: 27.7 (43-20.1), controls: 24.8 (40.7-19.6); p<0.0001). Logistic regression analysis confirmed that at the time of conception, compared to normal-weight fathers, overweight fathers displayed a heightened risk of offspring congenital malformations, with an odds ratio (OR) of 4.44 (95% CI=2.1-9.1). Similarly, fathers categorized as obese Class I at conception had approximately eight times higher odds (OR=8.62, 95% CI=2.91-25.52) of having offspring with urogenital conditions compared to normal-weight fathers. Additionally, fathers classified as obese Class II at conception exhibited 5.75 times higher odds (OR=5.75, 95% CI=0.96-34.44) of having offspring with urogenital conditions in comparison to normal-weight fathers. We found that the risk of urogenital malformations increased with paternal BMI during the preconceptional period. The findings suggest the importance of addressing paternal obesity in efforts to reduce the risk of urogenital congenital malformations in offspring.

The Prevalence and Risk Factors of Sexual Dysfunction in the Elderly in Southern China.

This study aims to evaluate the epidemiological features of sexual dysfunction in people aged more than 65 years in parts of China, and to investigate the independent significant risk factors. According to the population distribution of five communities in Xiamen and Chongqing, we have randomly enrolled 2403 people more than 65 years-of-age. We collected data information through a questionnaire survey. Then demonstrated the current condition of sexual dysfunction in the samples by statistical analysis, and multivariable logistic regression was used to disclose the risk factors of sexual dysfunction in the older adults. According to this study, about 10.48% of the elderly had sexual dysfunctions of different degrees and duration. The proportion of men was about twice that of women (14.5% of males and 7.3% of females). During the course of the disease, 3.19% (43/1344) of women and 3.31% (35/1059) of men had more than 15 years duration of sexual dysfunction. In severity, 5.7% (77/1344) of women and 7.0% (74/1059) of men had very severe sexual dysfunction. There were statistically significant differences in BMI, smoking, drinking history, hypertension, depression incidence or median (p<0.05). Alcohol consumption history [OR = 1.711, 95% CI: 1.124-2.604, p = 0.012] and depression [OR = 2.107, 95% CI: 1.109-4.356, p =0.044] were independent risk factors for sexual dysfunction. The prevalence of sexual dysfunction was low among elderly in the southern part of China. But the course of the disease is long and the degree of the disease is very severe. Elderly with a history of drinking and depression are more prone to sexual dysfunction.

Health Equity in Patients Receiving Durvalumab for Unresectable Stage III Non-Small Cell Lung Cancer in the US Veterans Health Administration.

Real-world evidence is limited regarding the relationship between race and use of durvalumab, an immunotherapy approved for use in adults with unresectable stage III non-small cell lung cancer (NSCLC) post-chemoradiotherapy (CRT). This study aimed to evaluate if durvalumab treatment patterns differed by race in patients with unresectable stage III NSCLC in a Veterans Health Administration (VHA) population. This was a retrospective analysis of White and Black adults with unresectable stage III NSCLC treated with durvalumab presenting to any VHA facility in the US from January 1, 2017, to June 30, 2020. Data captured included baseline characteristics and durvalumab treatment patterns, including treatment initiation delay (TID), interruption (TI), and discontinuation (TD); defined as CRT completion to durvalumab initiation greater than 42 days, greater than 28 days between durvalumab infusions, and more than 28 days from the last durvalumab dose with no new durvalumab restarts, respectively. The number of doses, duration of therapy, and adverse events were also collected. A total of 924 patients were included in this study (White = 726; Black = 198). Race was not a significant factor in a multivariate logistic regression model for TID (OR, 1.39; 95% CI, 0.81-2.37), TI (OR, 1.58; 95% CI, 0.90-2.76), or TD (OR, 0.84; 95% CI, 0.50-1.38). There were also no significant differences in median (interquartile range [IQR]) number of doses (White: 15 [7-24], Black: 18 [7-25]; P = .25) or median (IQR) duration of therapy (White: 8.7 months [2.9-11.8], Black: 9.8 months [3.6-12.0]; P = .08), although Black patients were less likely to experience an immune-related adverse event (28% vs. 36%, P = .03) and less likely to experience pneumonitis (7% vs. 14%, P < .01). Race was not found to be linked with TID, TI, or TD in this real-world study of patients with unresectable stage III NSCLC treated with durvalumab at the VHA.

Characteristics of Patients Requiring Surgical Removal of Subdermal Contraceptive Implants: A Case-Control Study.

PurposeEtonogestrel subdermal implants are a commonly used contraceptive device placed in the medial upper arm. Plastic and orthopedic surgeons may be consulted for difficult implant removals. We performed a case–control study comparing patients undergoing surgical and uncomplicated in-office removal at our institution.Patients and MethodsWe identified patients who underwent operative removal of implantable contraceptive devices by plastic or orthopedic surgeons at our institution from January 2014 to October 2019. Patients who underwent uncomplicated office removal during the same time were compared. Demographic and surgical variables were collected, and descriptive statistics were calculated. Univariate and multivariate logistic regression was performed with surgical versus outpatient removal as the outcome of interest.ResultsA total of 669 patients undergoing etonogestrel subdermal implant removals were identified during the five-year study period, of which thirteen patients required surgical removal (1.9%) and 326 were selected as uncomplicated removal comparisons. There were no significant differences in median (IQR) body mass index (BMI) (31.1 [28.2, 35.2] versus 29.3 [24.0, 35.1], p = 0.19), median (IQR) weight gain since device placement (5 [−0.6, 14.7] kilograms versus 1.6 [−1.2, 5.8] kilograms, p = 0.15), or length of time since device insertion (2.3 [0.8, 2.8] years versus 1.0 [0.4, 2.2] years, p = 0.17). Of those who needed surgical removal, the most common indication for implant removal was device expiration (n = 5, 38.5%). Devices placed by OBGYN attendings were less likely to require surgical removal (p = 0.02). Family medicine attendings were more likely to refer patients for surgical removal (p = 0.02). No significant findings were detected on univariate or multivariate regression. Among surgical removals, radiography was the most frequently used imaging modality. Implants were most frequently subdermal (n = 11, 84.6%) though intramuscular placement was also identified (n = 2, 15.4%). Only one patient had residual paresthesia along the length of the incision. No other complications were identified.ConclusionWe did not identify risk factors associated with the difficult removal of etonogestrel subdermal implants. Practitioners should consult upper extremity surgeons if they encounter difficult removals.

Correlation between anxiety and chronic motion sensitivity.

Chronic motion sensitivity (CMS) is a combination of autonomic symptoms provoked by exposure to motion. The correlation between anxiety and CMS is not yet well understood. 1) To compare median anxiety levels between young adults with and without CMS. 2) To examine the effect of anxiety on postural stability with immersion virtual reality. 3) To compare anxiety levels between sexes. Participants included 60 adults (20-40 years), with and without CMS. After determining their current and general anxiety levels, postural stability was measured. There were significant differences in median (minimum, maximum) state- and trait-anxiety scores between participants with and without CMS, but no significant differences in median state- and trait-anxiety scores between males and females with CMS. There was a significant inverse relationship between state- and trait-anxiety scores and postural stability (ρ= -0.28, p = 0.03, and ρ= -0.32, p = 0.01, respectively). The stepwise regression analysis showed the Motion Sickness Susceptibility Questionnaire-Short Form score to be the only variable contributing significantly to postural stability (R2 = 26.2%; t = -4.5, p < 0.001). Young adults with CMS are more anxious, although anxiety does not contribute to postural stability in this group. Anxiety levels do not appear to differ between young adult males and females with CMS.

Controlled DCD Liver Transplantation Is Not Associated With Increased Hyperfibrinolysis and Blood Loss After Graft Reperfusion.

The specific effect of donation after circulatory death (DCD) liver grafts on fibrinolysis, blood loss, and transfusion requirements after graft reperfusion is not well known. The aim of this study was to determine whether transplantation of controlled DCD livers is associated with an elevated risk of hyperfibrinolysis, increased blood loss, and higher transfusion requirements upon graft reperfusion, compared with livers donated after brain death (DBD). A retrospective single-center analysis of all adult recipients of primary liver transplantation between 2000 and 2019 was performed (total cohort n = 628). Propensity score matching was used to balance baseline characteristics for DCD and DBD liver recipients (propensity score matching cohort n = 218). Intraoperative and postoperative hemostatic variables between DCD and DBD liver recipients were subsequently compared. Additionally, in vitro plasma analyses were performed to compare the intraoperative fibrinolytic state upon reperfusion. No significant differences in median (interquartile range) postreperfusion blood loss (1.2 L [0.5-2.2] versus 1.3 L [0.6-2.2]; P = 0.62), red blood cell transfusion (2 units [0-4] versus 1.1 units [0-3]; P = 0.21), or fresh frozen plasma transfusion requirements (0 unit [0-2.2] versus 0 unit [0-0.9]; P = 0.11) were seen in DCD compared with DBD recipients, respectively. Furthermore, plasma fibrinolytic potential was similar in both groups. Transplantation of controlled DCD liver grafts does not result in higher intraoperative blood loss or more transfusion requirements, compared with DBD liver transplantation. In accordance with this, no evidence for increased hyperfibrinolysis upon reperfusion in DCD compared with DBD liver grafts was found.

Evaluation of Plasma Circulating Cell Free DNA Concentration and Integrity in Patients with Prostate Cancer in Jamaica: A Preliminary Study.

Background: Cell free circulating DNA (cfcDNA) is a promising diagnostic tool for prostate cancer (PCa). This study aimed to measure the cfcDNA concentration and integrity in PCa patients using quantitative polymerase chain reaction (qPCR) analysis. This study also assessed the correlation between these molecular biomarkers with total prostate-specific antigen (PSA), Gleason score, prostate volume, and age. Methods: Eleven PCa patients and 9 persons with benign prostatic hyperplasia (BPH) were recruited. Blood samples were collected before prostate biopsy and plasma quantified by qPCR amplification of the ALU 115 DNA sequence, with the ratio of ALU 247 to ALU 115 reflecting cfcDNA integrity. Results: There were no significant differences in median, interquartile range (IQR) cfcDNA concentration or cfcDNA integrity between the patients with PCa (47.9 (214.93) ng/mL; 0.61 (0.49)) and persons with BPH (41.5 (55.13) ng/mL, p = 0.382; 0.67 (0.45), p = 0.342). A weakly positive correlation exists between cfcDNA concentration and total PSA (r = 0.200, p = 0.555) but not with age or Gleason score in PCa patients. Conclusion: cfcDNA concentration was relatively nonsignificantly higher in PCa patients in comparison to persons with BPH, whereas cfcDNA integrity was similar in both groups. Though limited in sample size, this study shows that cfcDNA concentration may be a potentially valuable noninvasive biomarker for the diagnosis of PCa.

Age-stratified pediatric reference values of lymphocytes in the Moroccan population.

The aim of this study was to establish the age-stratified normal reference values of blood lymphocyte subsets for the pediatric Moroccan population. We measured the concentration of lymphocyte subpopulations by flow cytometry from 83 Moroccan healthy subjects stratified into 5 age groups of 0-1, 1-2, 2-6, 6-12 and > 12-18 (adult). The absolute and relative amounts of the main lymphocyte subsets of T-cells, B cells and Natural Killer (NK) cells were measured and compared to previously described reference values from Cameroonian, Turkish, American and Dutch populations. Additionally, we also observed an age-related decline in the absolute population sizes of lymphocyte subsets within our study group. Relative proportions of CD3+CD4+ helper T lymphocytes decreased with increasing age and by 12 years-adult age, both proportions of CD3+CD4+ helper T lymphocytes and CD3+CD8+ cytotoxic T lymphocytes, as well as CD3-CD19+ B lymphocytes were also decreased. Finally, we compared the median values and range of our Moroccan study group with that of published results from Cameroon, Turkey, USA and Netherlands and observed significant differences in median and mean values of absolute number and relative proportions of lymphocyte subsets especially at 0-1 years and 1-2 years age groups. Above age 12 years, the Moroccan values were lower. For NK cells, the Moroccan values are also lower. The results of this study have a significant impact in improving the threshold values of the references intervals routinely used in the diagnosis of paediatric diseases such as PIDs or mother-to-child transmitted HIV within the Moroccan population.

Perception of the acquisition of competences for university professors in a context of problem-based learning methodology

This research studies the impact of a training course for University professors based on active methodologies, such as Problem-Based Learning (PBL), on their perception of the acquisition of some relevant specific and generic competences. To that end, we prepare a survey about competences and compare the perception for the teaching staff before and after carrying out the PBL activity, by analysing if there are statistically significant differences in mean (ANOVA-F test), median (Kruskal-Wallis test) and variance (Levene test). Our results may confirm that the perception would improve in competences related to the appropriate use of ICTs and problem-solving skills, among others, showing statistically significant differences. Finally, university professors would positively evaluate the practical use of the training course (4.5 out of 5), remarking the need to apply active methodologies such as PBL in the training of teachers.

Perception of the acquisition of competences for university professors in a context of problem-based learning methodology

This research studies the impact of a training course for University professors based on active methodologies, such as Problem-Based Learning (PBL), on their perception of the acquisition of some relevant specific and generic competences. To that end, we prepare a survey about competences and compare the perception for the teaching staff before and after carrying out the PBL activity, by analysing if there are statistically significant differences in mean (ANOVA-F test), median (Kruskal-Wallis test) and variance (Levene test). Our results may confirm that the perception would improve in competences related to the appropriate use of ICTs and problem-solving skills, among others, showing statistically significant differences. Finally, university professors would positively evaluate the practical use of the training course (4.5 out of 5), remarking the need to apply active methodologies such as PBL in the training of teachers.

Maternal Serum Endocan Concentration in Pregnancies Complicated by Intrauterine Growth Restriction.

Endocan plays a role in the development of vascular tissue in health and disease and is an indicator of endothelial cells activation and angiogenesis. Therefore, this study aimed to investigate the relationship between maternal endocan serum level and intrauterine growth restriction (IUGR) as well as ultrasound Doppler flow measurements indicating placental insufficiency. This study included a group of women with IUGR (n = 37) and a group of healthy pregnant women (controls, n = 37). The endocan serum concentrations were assessed using commercially available enzyme-linked immunosorbent assay kit. Every woman underwent an ultrasound examination with Doppler flow measurements of the uterine arteries, umbilical vessels, and fetal middle cerebral artery. We used the cerebroplacental ratio (CPR) to determine placental insufficiency. We found significant differences in median (interquartile) endocan serum level (pg/mL) between study and control groups (464 [374-532] vs 339 [189-496], respectively; P < .001). The endocan serum level correlated neither with umbilical cord blood gases nor with Apgar score. Ultrasound Doppler findings revealed significant differences in middle cerebral artery pulsatility index (PI), umbilical artery PI, CPR, as well as mean uterine arteries PI between IUGR group and controls. In the study group, we found significant correlations between the serum endocan and CPR ( R = 0.56, P < .001) as well as between serum endocan and mean uterine arteries PI ( R = 0.46, P = .006). Endocan is likely involved in the pathogenesis of IUGR in pregnant women and possibly is a useful marker of endothelial dysfunction in these cases.

Evaluation of Plasma Cell‐Free Circulating DNA Integrity in Patients with Prostate Cancer in Jamaica

Cell free circulating DNA (cfcDNA) is a promising diagnostic tool for prostate cancer (PCa). The study aimed to measure the cfcDNA concentration and cfcDNA integrity in prostate cancer patients using quantitative polymerase chain reaction (qPCR) analysis on plasma samples. The study also assessed correlation between cfcDNA concentration and integrity with baseline PSA, Gleason score, total prostate volume, age and the number of presenting comorbidities. Eleven patients with PCa and 9 patients with Benign Prostatic Hyperplasia (BPH) were enrolled. Plasma samples were collected before prostate biopsy and quantified by qPCR amplification of ALU115 DNA sequence, and the quantitative ratio of ALU 247 to ALU 115 reflected the integrity of cfcDNA. There were no significant differences in median (IQR) plasma cfcDNA concentration or its integrity between the patients with PCa [47.9 (214.93) ng/mL, 0.61 (0.49)] and patients with BPH [41.5 (55.13) ng/mL, 0.67 (0.45); p = 0.382, p = 0.342]. There was no correlation between cfcDNA and cfcDNA integrity with baseline PSA, Gleason score, total prostate volume, age and the number of presenting comorbidities.ConclusionThe small sample size of the current study did not allow for the differentiation of PCa from BPH using cfcDNA concentration and integrity. There was also no correlation with cfcDNA concentration and integrity with the selected clinical and pathological variables.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

The Pre-Enrollment Medical Student Data Predictios of Pre-Clinic Failure

Objective: To identify potential pre-enrollment predictors of undergraduate medical students failure in pre-clinic class.Material and Method: A retrospective descriptive analytic study, medical students who had admitted in 2008-2012 to the Prince of Songkla University. The pre-enrollment data base was used to identify students background, high school Grade Point Average (GPA), Ordinary National Education Test (O-NET) score, and family background. The entry pathway and academic performance in the pre-clinic class were also collected and entered into analytic studies by using p-value&lt;0.050 for each significant variable.Results: Nine hundred and fifty six medical students were enrolled, 418 (43.7%) was male, 274 (28.7%) had entered via the Collaborative Project to Increase Production of Rural Doctor (CPIRD) entry pathway, and 419 (43.8) had graduated from a high school in Songkhla province. Thirty nine (4.1%) students had failed in pre-clinic course. Comparing in achievement with the failure group revealed significant differences in GPA median (interquartile range) [3.8 (3.7, 3.9) vs 3.7 (3.5, 3.8)] and O-NET score [60 (51.4, 69.0) vs 53 (43.8, 60.0)], and proportion of CPIRD entry pathway (27.4% vs 59.0%) (p-value&lt;0.001). However univariate conditional logistic regression analysis regression showed that the 10 (1%) with absent parent [odds ratio (OR)=42, 95% confidence interval (95% CI)=11.3 to 156 p-value&lt;0.001), GPA less than 3.5 (OR=5.14, 95% CI=2.47 to 10.69, p-value&lt;0.001), and O-NET score less than 50 compare with at least 60 (OR=4.34, 95% CI=1.81 to 10.40, p-value=0.001) were associated with pre-clinic failure.Conclusion: The GPA and O-NET scores, CPIRD entry pathway and absent parent were identified as significant pre-enrollment predictors of pre-clinic failure.

Structured Education Programme on Patient Controlled Analgesia (PCA) for Orthopaedic Patients

Patient-controlled analgesia (PCA) via an infusion pump enables patient to administer their own analgesia. The aim of this study was to evaluate the effect of an educational programme in managing post-operative pain and satisfaction on PCA following orthopedic surgery. A pre-test and post-test interventional study design with implementation of patient education programme on PCA was provided to 54 respondents. The control group received conventional PCA briefing from the Acute Pain Service protocol. Pain intensity was measured at 2 hrs, 6 hrs and 24 hrs following surgery and pre-test and post-test of the Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R) was administered. There was difference in respondents’ level of pain score among the study respondents’ medians for control group at 2 hrs, 6 hrs and 24 hrs following surgery and they were 7.00 (IQR=3.00), 5.00 (IQR=2.00) and 3.00 (IQR=2.00); intervention group at 2 hrs, 6 hrs and 24 hrs following surgery were 6.00 (IQR=2.00), 3.00 (IQR=1.00) and 1.00 (IQR=1.00) respectively. There were significant differences in median of pain score between intervention and control group at 2 (U=142.0, p<0.05), 6 (U=150.50, p<0.05) and 24 (U=120.00, p<0.05) hrs following surgery. There were statistically significant differences (p<0.05) in the median of patient’s pain severity at all pain levels i.e. least pain, worst pain, and severe pain between intervention and control group (least pain, U=219.50, p<0.05; worst pain, U=117.0, p<0.05; severe pain, U=49.0, p<0.05). In conclusion, patients who received pre-operative structured education programme showed improvement in managing post-operative pain and satisfaction on PCA after orthopedic surgery.

Zinc and copper levels are not correlated with angiographically-defined coronary artery disease in sudanese patients.

We investigated zinc and copper levels in angiographically defined obstructive coronary artery disease (CAD) in patients undergoing elective coronary angiography in El-Shaab Hospital, Sudan. We performed a cross-sectional study. One hundred forty-two patients were enrolled. Sociodemographic and medical characteristics were collected using a questionnaire. Glucose, lipid, zinc, and copper levels were measured. Out of 142 patients, 102 (71.8%) had CAD and 40 (28.2%) had patent coronary arteries. There were no significant differences in median (interquartile range) zinc [118.5 (97.2–151.0) vs. 130.0 (106.0–174.0) μg/ml, P = 0.120] and copper [150.6 (125.0–183.0) vs. 158 (132.0–180.0) μg/mL, P = 0.478] levels between patients with CAD and those with patent coronary arteries. In linear regression analysis, there were no associations between CAD and zinc and copper levels. The current study failed to show any significant association between CAD and zinc and copper levels.

Organizing groundwater regimes and response thresholds by soils: A framework for understanding runoff generation in a headwater catchment

AbstractA network of shallow groundwater wells in a headwater catchment at the Hubbard Brook Experimental Forest in New Hampshire, U.S. was used to investigate the hydrologic behavior of five distinct soil morphological units. The soil morphological units were hypothesized to be indicative of distinct water table regimes. Water table fluctuations in the wells were characterized by their median and interquartile range of depth, proportion of time water table was present in the solum, and storage‐discharge behavior of subsurface flow. Statistically significant differences in median, interquartile range, and presence of water table were detected among soil units. Threshold responses were identified in storage‐discharge relationships of subsurface flow, with thresholds varying among soil units. These results suggest that soil horizonation is indicative of distinct groundwater flow regimes. The spatial distribution of water table across the catchment showed variably connected/disconnected active areas of runoff generation in the solum. The spatial distribution of water table and therefore areas contributing to stormflow is complex and changes depending on catchment storage.

Ultrasonographic findings in hereditary neuropathy with liability to pressure palsies

Objectives:The aims of this study were to evaluate the sonographic findings of patients with hereditary neuropathy with liability to pressure palsies (HNPP) and to examine the correlation between sonographic and electrophysiological findings.Methods:Nine patients whose electrophysiological findings indicated HNPP and whose diagnosis was confirmed by genetic analysis were enrolled in the study. The median, ulnar, peroneal, and tibial nerves were evaluated by ultrasonography.Results:We ultrasonographically evaluated 18 median, ulnar, peroneal, and tibial nerves. Nerve enlargement was identified in the median, ulnar, and peroneal nerves at the typical sites of compression. None of the patients had nerve enlargement at a site of noncompression. None of the tibial nerves had increased cross-sectional area (CSA) values. There were no significant differences in median, ulnar, and peroneal nerve distal motor latencies (DMLs) between the patients with an increased CSA and those with a normal CSA. In most cases, there was no correlation between electrophysiological abnormalities and clinical or sonographic findings.Discussion:Although multiple nerve enlargements at typical entrapment sites on sonographic evaluation can suggest HNPP, ultrasonography cannot be used as a diagnostic tool for HNPP. Ultrasonography may contribute to the differential diagnosis of HNPP and other demyelinating polyneuropathies or compression neuropathies; however, further studies are required.

Replacement of anesthesia machines improves intraoperative ventilation parameters associated with the development of acute respiratory distress syndrome

BackgroundThe impact of anesthetic equipment on clinical practice parameters associated with development of acute respiratory distress syndrome (ARDS) has not been extensively studied. We hypothesized a change in anesthesia machines would be associated with parameters associated with lower rates of ARDS.MethodsWe performed a retrospective cohort study on a subset of data used to evaluate intraoperative ventilation. Patients included adults receiving a non-cardiac, non-thoracic, non-transplant, non-trauma, general anesthetic between 2/1/05, and 3/31/09 at the University of Michigan. Existing anesthesia machines (Narkomed IIb, Drager) were exchanged for new equipment (Aisys, General Electric). The initial subset compared the characteristics of patients anesthetized between 12/1/06 and 1/31/07 (pre) with those between 4/1/07 and 5/30/07 (post). An extended subset examined cases two years pre and post exchange. Using the standard predicted body weight (PBW), we calculated and compared the tidal volume (total Vt and mL/kg PBW) as well as positive end-expiratory pressure (PEEP), peak inspiratory pressure (PIP), Delta P (PIP-PEEP), and FiO2.ResultsA total of 1,414 patients were included in the 2-month pre group and 1,635 patients included in the post group. Comparison of ventilation characteristics found statistically significant differences in median (pre v post): PIP (26 ± 6 v 21 ± 6 cmH2O,p < .001), Delta P (24 ± 6 v 19 ± 6 cmH2O, p < .001), Vt (588 ± 139 v 562 ± 121 ml, p < 0.001; 9.3 ± 2.2 v 9.0 ± 1.9 ml/kg predicted body weight, p < .001), FiO2 (0.57 ± 0.17 v 0.52 ± 0.18, p < .001). Groups did not differ in age, ASA category, PBW, or BMI. The two year subgroup had similar parameters. Risk adjustment resulted in minimal differences in the analysis. New anesthesia machines were associated with a non-statistically significant reduction in postoperative ARDS.ConclusionsIn this study, a change in ventilator management was associated with an anesthesia machine exchange. The smaller Vt and lower PIP noted in the post group may imply a lower risk of volutrauma and barotrauma, which may be significant in at-risk populations. However, there was not a statistically significant reduction in the incidence of post-operative ARDS.

Evaluation of metformin treatment in patient with polycystic ovary syndrome in Kirkuk city

Background and objectives: Polycystic ovary syndrome (PCOS) is one of the most&nbsp;&nbsp; common endocrine disorders in women of fertile age, affecting 5-10% of the female population. The aim of the present study is to evaluate the endocrine and metabolic effects of metformin in patients with polycystic ovary syndrome in Kirkuk city. Methods: Eighty female with polycystic ovary syndrome (PCOS), were classified in to two groups, the first group ,who received Clomifene citrate and Metformin hydrochloride included 45 patients and the second group , who received Clomifene citrate only (control group) included 35 patients. All study patients, were diagnosed as polycystic ovary syndrome and they were on treatment at least two months before blood sample collection. Laboratory assessment that obtained included serum, free testosterone, leptin and insulin glucose and lipid profile. Results: No significant differences in median of, serum insulin, insulin resistance or serum leptin between study groups were observed. The median free serum testosterone was significantly lower (23 pg/ml) in those treated with metformin compared to those on ordinary treatment (50 pg/ml). Fasting serum glucose, HDL – cholesterol and total cholesterol were significantly higher in group without metformin (116.2 , 41.3 , 161.8&nbsp;&nbsp; mg/dL respectively) compaired to group with metformin (101.5, 34.3 , 138.8&nbsp;&nbsp; mg/dL&nbsp;&nbsp; respectively). The remaining biomarkers (serum&nbsp;&nbsp; LDL-cholesterol, serum VLDL-cholesterol and triglyceride) showed no statistically significant differences between two groups. We conclude that metformin treatment has beneficial effects on serum, free testosterone cholesterol and glucose in obese women with PCOS.

Comparison of analgesic efficacy of subcostal transversus abdominis plane blocks with epidural analgesia following upper abdominal surgery

Subcostal transversus abdominis plane (TAP) catheters have been reported to be an effective method of providing analgesia after upper abdominal surgery. We compared their analgesic efficacy with that of epidural analgesia after major upper abdominal surgery in a randomised controlled trial. Adult patients undergoing elective open hepatobiliary or renal surgery were randomly allocated to receive subcostal TAP catheters (n=29) or epidural analgesia (n=33), in addition to a standard postoperative analgesic regimen comprising of regular paracetamol and tramadol as required. The TAP group patients received bilateral subcostal TAP catheters and 1 mg.kg(-1) bupivacaine 0.375% bilaterally every 8 h. The epidural group patients received an infusion of bupivacaine 0.125% with fentanyl 2 μg.ml(-1) . The primary outcome measure was visual analogue pain scores during coughing at 8, 24, 48 and 72 h after surgery. We found no significant differences in median (IQR [range]) visual analogue scores during coughing at 8 h between the TAP group (4.0 (2.3-6.0 [0-7.5])) and epidural group (4.0 (2.5-5.3) [0-8.5])) and at 72 h (2.0 (0.8-4.0 [0-5]) and 2.5 (1.0-5.0 [0-6]), respectively). Tramadol consumption was significantly greater in the TAP group (p=0.002). Subcostal TAP catheter boluses may be an effective alternative to epidural infusions for providing postoperative analgesia after upper abdominal surgery.