Yates Continuity Correction Research Articles

In vitro alteration on erythrocytes mechanical properties by propofol, remifentanil and vecuronium

Several studies report flow disturbance and microcirculation disorders upon anesthesia treatment. These alterations are often related to blood rheology changes. In this work, it was attempted to make a detailed description of the alterations in erythrocyte mechanical properties by the action of propofol, remifentanil, and vecuronium. For this, an in vitro study was performed on red blood cell samples from healthy donors incubated with solutions of propofol (4 μg/mL whole blood), remifentanil (10 ng/mL plasma), and vecuronium (0.15 μg/mL plasma). Erythrocyte viscoelastic parameters were determined by octuplicate using a Reómetro Eritrocitario. Also, a Wilcoxon signed rank-test with Yates correction for continuity was performed to analyze the overall alteration in the mechanical properties of erythrocytes. Statistical analysis showed that the three studied anesthetics changed the erythrocyte mechanical properties at different parts of the membrane. These results would imply an interaction of these anesthetics with the erythrocyte membrane. Finally, this could conduce to alterations in microcirculation.

Effect of statin therapy on SARS-CoV-2 infection-related mortality in hospitalized patients.

AimAssessing the effect of statin therapy at hospital admission for COVID-19 on in-hospital mortality.Methods and ResultsRetrospective observational study. Patients taking statins were 11 years older and had significantly more comorbidities than patients who were not taking statins. A genetic matching (GM) procedure was performed prior to analysis of the mortality risk. A Cox proportional hazards model was used for the cause-specific hazard (CSH) function, and a competing-risks Fine and Gray (FG) model was also used to study the direct effects of statins on risk.Data from reverse transcription-polymerase chain reaction-confirmed 2157 SARS-CoV-2-infected patients (1234 men, 923 women; age: 67 y/o (IQR 54-78)) admitted to the hospital were retrieved from the clinical records in anonymized manner. 353 deaths occurred. 581 patients were taking statins. Univariate test after GM showed a significantly lower mortality rate in patients on statin therapy than the matched non-statin group (19.8% vs. 25.4%, χ2 with Yates continuity correction: p = 0.027). The mortality rate was even lower in patients (n = 336) who maintained their statin treatments during hospitalization compared to the GM non-statin group (17.4%; p = 0.045). The Cox model applied to the CSH function (HR = 0.58(CI: 0.39-0.89); p = 0.01) and the competing risks FG model (HR = 0.60(CI: 0.39-0.92); p = 0.02) suggest that statins are associated with reduced COVID-19-related mortality.ConclusionsA lower SARS-CoV-2 infection-related mortality was observed in patients treated with statin therapy prior to hospitalization. Statin therapy should not be discontinued due to the global concern of the pandemic or in patients hospitalized for COVID-19.

Administrative Databases Used for Sports Medicine Research Demonstrate Significant Differences in Underlying Patient Demographics and Resulting Surgical Trends

To discern differences between the PearlDiver and MarketScan databases with regards to patient demographics, costs, reoperations, and complication rates for isolated meniscectomy. We queried the PearlDiver Humana Patient Records Database and the IBM MarketScan Commercial Claims and Encounters database for all patients who had record of meniscectomy denoted by Current Procedure Terminology 29880 or 29881 between January 1, 2007, and December 31, 2016. Those that had any other knee procedure at the same time as the meniscectomy were excluded, and the first instance of isolated meniscectomy was recorded. Patient demographics, Charlson Comorbidity Index, reoperations, 30- and 90-day complication rates, and costs were collected from both databases. Pearson's χ2 test with Yate's continuity correction and the Student t test were used to compare the 2 databases, and an alpha value of 0.05 was set as significant. We identified 441,147 patients with isolated meniscectomy from the MarketScan database (0.36% of total database), approximately 10 times the number of patients (n= 49,924; 0.20% of total database) identified from PearlDiver. The PearlDiver population was significantly older (median age: 65-69) than the MarketScan cohort, where all patients were younger than 65 (median age: 52; P < .001). Average Charlson Comorbidity Index was significantly lower for MarketScan (0.172, standard deviation [SD]: 0.546) compared with PearlDiver (1.43, SD: 2.05; P < .001), even when we restricted the PearlDiver cohort to patients younger than 65 years (1.02, SD: 1.74; P < .001). The PearlDiver <65 years subcohort also had increased 30- (relative risk 1.53 [1.40-1.67]) and 90-day (relative risk 1.56 [1.47-1.66]) postoperative complications compared with MarketScan. Overall, laterality coding was more prevalent in the PearlDiver database. For those undergoing isolated meniscectomy, the MarketScan database comprised an overall larger and younger cohort of patients with fewer comorbidities, even when examining only subjects younger than 65 years of age. Level III, retrospective comparative study.

Tumor mamario canino: factores de riesgo y su influencia epidemiológica en Manizales-Colombia

Objetivo. Describir la prevalencia del tumor mamario canino (TMC) en hembras en el municipio de Manizales-Colombia durante 2014-2017. Materiales y métodos. Se consolidó una base de datos de 15961 pacientes. Las variables analizadas fueron raza, edad, historia reproductiva, condición corporal, tipo de dieta, y caracterización clínica del tumor mediante el sistema de estadificación tumor-nódulo-metástasis (TNM). El análisis estadístico incluyó prueba de chi-cuadrado de Pearson con corrección de Yates, prueba exacta de Fisher (p&lt;0.05), riesgo relativo, oportunidad relativa (IC95%) y análisis de supervivencia de Kaplan-Meier. Resultados. La incidencia en perros de razas puras fue 79.14%, con un pico promedio a la edad de 9.3 años. La prueba chi-cuadrado de Pearson, el riesgo relativo y las oportunidades relativas mostraron un riesgo alto para razas puras (p=0.019,3.96/100,1.64, respectivamente). Hembras entre los 9 y 12 años mostraron una probabilidad del 74% de desarrollo de tumor mamario. No se encontró una relación significativa entre la masa corporal o estado reproductivo pero una elevada asociación con la dita casera (p&lt;0.001). Los pares inguinales mamarios fueron los más afectados (6.9%). La estimación de Kaplan-Meier mostró una alta supervivencia para pacientes intervenidas quirúrgicamente, con 2013 días después del diagnóstico con cirugía en comparación con 1484 días sin cirugía. Conclusiones. El estudio confirma la relevancia de los factores de riesgo: tipo de raza, edad, condición corporal y tipo de dieta en la presentación de tumor mamario. Además, se destaca la necesidad de mejorar e integrar los sistemas de información de diagnóstico veterinario, considerando su importancia en la salud pública.

Influence of wing bands and behavior of Anastrepha fraterculus (Diptera: Tephritidae) by the presence of Megafreya sutrix (Araneae: Salticidae).

The objective of this study was to evaluate the influence of wing bands and the behavior of Anastrepha fraterculus in the presence of Megafreya sutrix. The first experiment used specimens of M. sutrix (n = 40), 20 males and 20 females of A. fraterculus and Musca domestica. The second experiment used 20 individuals of M. sutrix (10 males and 10 females) and 120 of A. fraterculus (20 males and 20 females) for each treatment. Marks were made on the wings of the flies: a group with painted wing bands (n = 40) with their wings fully painted; another with highlighted wing bands (n = 40) and normal bands (n = 40). Recordings were made for 15 min or until the fly was preyed upon. The analyses were performed through observation of the recordings and Chi-square test with Yates correction for continuity. The values found for predation of A. fraterculus were significant when compared to M. domestica when evaluating the predation factor, showing that, A. fraterculus is less predated than M. domestica. It was found that the wing patterns did not influence the predatory behavior of M. sutrix.

Yaşlı Bireylerin Cerrahi Girişim Sonrası Evde Yaşadıkları Sorunların Belirlenmesi

Objective: The study was conducted as a descriptive study to determine the problems experienced by individuals aged 65 years and older at home after surgical interventions and to evaluate the relationship between socio-demographic characteristics and problematic status.Materials and Methods: The research was carried out between March and July 2016 in the surgical clinics of a university hospital in the city of Konya. The sample of the study consisted of 227 individuals aged 65 years and older who underwent surgical interventions in these surgical clinics. A questionnaire developed by the researcher was used for collecting the data. In the first meeting, the data were collected by the researcher face to face in patients’ rooms and in the second meeting, they were collected face to face in the polyclinics a week after the discharge and the data of the patients who were not seen were collected over the phone. In the analysis of the data, mean, standard deviation, median, frequency and ratio, Mann Whitney U test and Pearson Chi-square test Yates Continuity Correction, Fisher’s Exact test and Fisher Freeman Halton were used.Findings: It was determined that 74,4%of the elderly individuals had problems at home after discharge. When these types of problems experienced at home after surgery were examined, it was found that most of them were related to the surgery area 64.3% followed by self-care activity 52.9% . Statistically significant differences were found in relation to the gender who is responsible for the domiciliary care, previous periods while the patient stayed at the hospital , the surgery hospital where the patient stayed, the status of staying at the hospital after the surgery , length of and the total hospital stays in addition to the situation of living problems at home p

Clinical and radiographic evaluation of indirect pulp capping with three different materials: a 2-year follow-up study.

Indirect pulp capping (IPC) is a treatment that preserves pulp vitality. Several materials have been used for this procedure. The aim of this study is to evaluate the radiographic and clinical outcomes of TheraCal LC (Bisco Inc., Schaumburg, IL, USA) and to compare it with mineral trioxide aggregate (MTA) (Pro Root MTA, Dentsply Tulsa, Johnson City, TN, USA) and calcium hydroxide [Ca(OH)2] (Dycal, Dentsply De Trey Konstanz, Germany) biomaterials in IPC treatment. A total of 295 teeth, including second primary molars and first permanent molars with IPC indications from healthy and cooperative children aged between 4-15 years, were included in this study. Teeth were divided into three groups according to the materials used for pulp capping. Indirect pulp treatment was applied using Dycal for 91 teeth, ProRoot MTA for 89 teeth and TheraCal LC for 115 teeth. Primary molars were restored with the compomer material, and permanent molars were restored with the resin composite material. Restorations were evaluated with the Modified United States Public Health Service (modified USPHS) criteria. Clinical and radiographic findings were evaluated for 24 months at follow-up. Statistical analysis was performed using the IBM SPSS Statistics 22 (IBM SPSS, Turkey) program, with descriptive statistical methods (means, standard deviations) and Chi-square, Fisher's exact test, and Yates's continuity correction (p<0.05 significance level) to evaluate the data. There were no statistically significant differences between the materials (p>0.05). The respective success rates of ProRoot MTA, Theracal LC, and Dycal were 94.4%, 87.8%, and 84.6%. There was no statistically significant difference between primary and permanent teeth according to the modified USPHS criteria (p>0.05). These results support the idea that the success of IPC is independent from the capping material. Recently produced calcium-silicate based materials can also be used for IPC. The most important factors are to apply the indirect pulp treatment carefully, avoiding bacterial contamination, and to seal the teeth with hermetic restoration. More clinical studies with longer follow-up periods are required for understanding the clinical efficiency of these materials.

Age, BMI, and Race as Independent Predictors for 30 Day Readmission After Total Laparoscopic Hysterectomy [8C

INTRODUCTION: Readmission after hysterectomy is being used as a proxy for quality of care. We aim to assess the roles of patient age, BMI, and race on 30 days readmission after total laparoscopic hysterectomy (TLH). METHODS: Medical records of 168 consecutive patients who underwent TLH at a major academic center between 2010 and 2012 were reviewed. Age, BMI, race, and status of 30-day readmission were collected. Non-readmitted and readmitted group were compared using Welch t-tests and Pearson's Chi-square tests with Yate's continuity correction. RESULTS: Among 168 patients reviewed, 15 (8.9%) patients had unplanned readmission within 30 days of TLH while 153 (91.1%) did not. There was a statistically significant difference in age between the two groups, and younger age was observed in the readmitted cohort (Readmitted: 32.6 years vs. Non-readmitted: 38.6 years, p=.00397). No significant difference BMI were identified between the 2 groups (Readmitted: 30.95 vs. Non-readmitted: 31.45, p=0.836). Among 133 Non-Hispanic White and 32 Black patients, readmission rates were higher among Black patients; however, the difference was not statistically significant (Black: 15.6% vs. White: 7.5%, p=0.276). CONCLUSION: Our study demonstrated the significance of patient's age in 30-days readmission after total laparoscopic hysterectomy. Moreover, BMI and race were not found to be predictors of readmission. Future studies are necessary evaluate risk factors for readmission to improve surgical outcomes and quality of care.

Clinical outcomes after direct and indirect surgical venous thrombectomy for inferior vena cava thrombosis

ObjectiveInferior vena cava thrombosis is rare, but patients are at high risk for development of a post-thrombotic syndrome (PTS) in the long term. Surgical approaches include indirect transfemoral venous thrombectomy (iTFVT) and direct open venous thrombectomy (dOVT). This study reports patient outcomes after iTFVT and dOVT for inferior vena cava thrombosis covering a 25-year follow-up period. MethodsThe study period was from January 1, 1982, to December 31, 2013. Data were retrieved from archived medical records, and patients were invited for a detailed phlebologic follow-up examination (DPFE). Health-related quality of life was assessed with the 36-Item Short Form Health Survey questionnaire. Patient survival, patency rates, and freedom from PTS were calculated using Kaplan-Meier estimation with log-rank testing. The χ2 test with Yates continuity correction and logistic regression analysis were applied to identify associations between risk factors or coagulation disorders, mortality, and PTS. ResultsComplete medical records were available for 152 patients. Patients' 5-year survival was 91% ± 3%, and 5-year primary and secondary patency rates were 80% ± 3% and 94% ± 2%. Freedom from PTS after 25 years was 84% ± 6%. No differences for patient survival, patency rates, or freedom from PTS were identified between iTFVT, dOVT, and a combination of both procedures. Antithrombin III deficiency was the most common coagulation disorder, and patients' physical function and social function were impaired compared with those found in German normative data (P < .05). No risk factor or coagulation disorder was associated with survival or PTS. ConclusionsOpen surgical venous thrombectomy is safe and delivers satisfying short- and long-term outcomes compared with endovascular approaches. It remains valuable for patients who are not eligible for other interventional therapies.

The prevalence and distribution of the dental anomalies in the Turkish population

Introduction: The incidence of developmental dental anomalies can provide valuable information. The aim of this study is to investigate the prevalence and distribution of dental anomalies in the Turkish population. Material and Methods: Totally 2203 patients who came to university hospital were examined clinically and radiographically for 10 dental anomalies: rotation, diastema, hypodontia, hyperdontia, microdontia, macrodontia, dilaceration, talon cusp, gemination and ectopia. Descriptive characteristics of these dental anomalies, including gender and regions of the jaw, were recorded. The data were analyzed with Chi-square test and Yates continuity correction. Results: In 1517 patients (68.9%), tooth anomaly was detected. Rotation was found in 58.4% of patients, significantly lower in the molar region than in the anterior and premolar regions (P < 0.01). Diastema was found in 22.7% of the samples, at higher rates in the anterior region than in the premolar and molar regions (P < 0.01). Dilaceration was observed 3.8% of the patients, at significantly higher rates in the molar region (P < 0.01). Ectopia was found in 2.9% of individuals, less common in the molar region than in the anterior and premolar regions (P < 0.01). Hypodontia was seen in 3.4% of patients, significantly lower in the anterior teeth than in the premolar and molar teeth (P < 0.01). Patients having talon cusp were 2.7%, microdontia was 1%, and only 0.5% showed the presence of hyperdontia. The distribution of hyperdontia and microdontia did not significantly differ between regions (P > 0.05). Gemination was seen in only one anterior tooth and macrodontia in only one premolar tooth. Discussion and Conclusion: Rotation is the most common dental anomaly in Turkish population, followed by diastema. Knowledge of the prevalence of anomalies may help clinicians to the detection of these anomalies at early stages.

The association gene’s TNFα G(308) with quantity of TNFα and degree of liver’s fibrosis in patients with chronic hepatitis C

The data on the polymorphism of cytokine genes associated with individual reactivity on the effects of hepatitis C virus, predict the rate of progression of liver fibrosis. The purpose of this work is study the association of the polymorphic marker G308A of the TNFα gene with its quantitative content and degree of liver fibrosis in patients with chronic hepatitis C. A total of 100 patients with CSF were examined. The polymorphism of G308A gene’s TNFα was studied by amplification of the corresponding genome zones by PCR. The assessment of the degree of fibrosis was performed using the non-invasive Fibrotest method. The study of the quantity of TNFα cytokine in serum of patients was performed by ELISA. The distribution of genotypes on the investigated polymorphic loci was verified using Pearson's χ2 criterion. The frequencies of alleles and genotypes in the groups were compared using Pearson's χ2 criterion with Yates correction for continuity with the number of degrees of freedom 1. In order to detect the correlation dependencies between the individual parameters, the Spearman correlation coefficient was applied. It was found that a smaller degree of fibrosis was observed in carriers of the GG TNFα genotype, and a greater degree of fibrosis in the carriers of the genotype AA TNFα (moderate feedback between the degree of fibrosis and the genotypes of TNFα). The higher content of TNFα is noted in the carriers of the AA genotype TNFα, the lower content of TNFα - in the carriers of the GG TNFα genotype (moderate feedback between the TNFα genotypes and the TNFα content). It has been established that a higher TNFα content is observed in patients with F1-F0 fibrosis, a lower TNFα content in patients with F2-F3 fibrosis (a strong correlation between the degree of fibrosis and the amount of TNFα cytokine). It is assumed that the production of the cytokine is determined at the genetic level, and the severity of changes in the cytokine profile in chronic hepatitis C affects the course of the pathological process. An increase in the TNFα content in chronic hepatitis C may be a marker for significant morphological changes in the hepatic tissue and high activity of the inflammatory process.

Association Between Positive Occipital Sharp Transients of Sleep and Lambda Waves

Positive occipital sharp transients of sleep (POSTS) and lambda waves have similar morphology and location. We studied a possible association between these 2 normal EEG patterns. We reviewed a series of consecutive unselected ambulatory EEGs during a 3-month period (October 16, 2017 to January 19, 2018) and identified records with POSTS and records with lambda waves. Statistical analysis was performed using a chi-square test. A total of 140 ambulatory EEGs were reviewed. Duration of EEGs ranged from 24 to 168 hours (mean 76 hours). The population was 34% males, with ages ranging from 3 to 93 years (mean 48 years). Of the 140 records, 30 were abnormal, including 20 with epileptiform abnormalities. A chi-square test for independence (with Yates continuity correction) indicated a significant association between POSTS and lambda waves, χ2(1, n = 140) = 69.208, p < .001, φ = 0.72. In addition, 100% of records with lambda waves had POSTS, and 72% of records with POSTS had lambda waves. There is a high association between lambda waves and POSTS. This suggests a strong similarity between the 2 waveforms, and possibly a common occipital generator.

Improvement of appointment compliance in an underserved lupus clinic

BackgroundTo identify major obstacles to appointment compliance and quantify a measurable effect of a simple phone call intervention on the clinic show rate.MethodsWe retrospectively looked at the show rates from November 1st, 2013 to June 30th, 2014 at our Lupus clinic, which is located in Bronx, NY. The scheduled patient chart was crosschecked if the patient made it to the appointment by verifying the provider note. A patient survey was implemented over a period of 8 weeks from July 1st, 2014 to August 12th, 2014. A reminder phone call intervention 2–3 days prior to the visit was planned. The intervention was implemented from September 1st, 2014 to April 30th, 2015. Data was analyzed after the end of the intervention period.ResultsIn the pre-intervention period, our clinic show-rate was 207/352 (58.8%) The pilot survey had a total of 43 responses. The most common reason for a missed appointment was ‘forgot about the appointment’ (45.5%). Reminder phone calls were the preferred intervention (76.74%), which patients’ thought might help to keep scheduled appointments. In the intervention period, 283 of the scheduled 378 appointments were completed (74.8) in the lupus clinic. The difference in the show rate before and after the intervention by Pearson’s Chi-squared test with Yates continuity correction was statistically significant with a p-value of 0.0062.ConclusionA simple telephone call reminder significantly improves clinic show rates in an underserved Lupus clinic, which can help improve health parameters in the Lupus population.

Abstract 393: Is High Grade Atrioventricular Block Reversible in Hypothyroidism

Background: Hypothyroidism is considered a reversible cause of atrioventricular block (AVB) but rigorous studies to support this are limited. An important consideration in clinical practice is whether pacemaker placement should be deferred in patients with hypothyroidism who present with high degree AV block while awaiting reversal of block. This period of waiting places patients at risk of morbidity and mortality, while extending length of stay and cost of care. Objective: To evaluated if high degree AVB in hypothyroidism is in fact reversible, and therefore justify delaying pacemaker(PM) placement. Method: Retrospective review of all adult admission with high degree (Mobitz type II or type III) AVB admitted to a Regional hospital over a 10 year period. Out of 271 cases identified, 41 had hypothyroidism (either prior history or newly diagnosed), and were matched by age and sex with 41 patients with AVB but without hypothyroidism. Each group of 41 patients had 25 females (61%) and 16 men (39%). Placement of PM is assumed to indicate lack of reversibility of AVB. Statistic analysis for matched pairs was by McNemar’s test with Yates continuity correction. Results: In the hypothyroidism group, 31 of 41 patients(76%) received PM, while 34 of 41 patients (83%) in the group without hypothyroidism received PM. The calculated test statistic was 12.02, and when referred to the Chi-squared distribution table with 1 degree of freedom, gives a probability of &lt; 0.01, which is highly significant. 14 of the 41 patients(34%) with hypothyroidism had thyroid dysfunction based on thyroid hormone levels, with 10(24%) having sub-clinical hypothyroidism, and 4 (10%) having overt disease. The mean duration in days from time of admission to time of PM placement in the hypothyroidism group was 4.35, while that in the group without hypothyroidism was 2.26. Conclusion: The finding rejects the null hypothesis that there is no difference in need for PM (and thus reversibility of AVB) in both groups, suggesting AVB may in fact be reversible in hypothyroidism. Larger and more rigorous studies are therefore warranted to definitively determine if AVB in hypothyroidism is reversible, and adopt delaying PM placement while awaiting reversal, as standard of care.

Clinical Significance of Abnormal Results of Second Trimester Hormones in the Absence of Aneuploidy

Background: Abnormal levels of hormones during the second trimester of pregnancy may predict genetic disorders and complications of pregnancy. Objectives: This study was performed to evaluate the clinical significance of abnormal results in second-trimester markers in the absence of aneuploidy. Methods: This case-control study was conducted between May 2014 and December 2015 in the maternal-fetal unit, Trakya University Faculty of Medicine in Turkey. Overall, 108 Turkish pregnant females were included in this study. This research recruited patients (n = 46) with normal karyotype, who underwent invasive prenatal tests because of abnormal levels of second-trimester hormones, along with a cohort of controls (n = 31) with hormonal results within normal ranges. For each patient, the researchers recorded the mode of delivery, gestational age at delivery, birth weight, complications, and adverse outcome of the pregnancy. Data were analyzed using Fisher’s exact tests and Yates continuity correction tests for qualitative variables, and t- test and Mann-Whitney U test for quantitative variables. Results: Maternal age (mean ± SD) of the entire group was 31.77 ± 5.68 years (study group: 31.23 ± 4.39; controls: 32.13 ± 6.43, P > 0.05). Preterm delivery and preeclampsia were significantly higher in the study group (P = 0.02). In the study group, Alpha Fetoprotein (AFP) levels were significantly higher in patients with preeclampsia yet not in the controls. The AFP values under 0.77 multiple of the median in patients with elevated test results in the absence of aneuploidy appeared to be associated with the development of preeclampsia later in pregnancy. Conclusions: Although the significance of higher AFP values have been discussed in the literature in terms of the development of adverse outcomes, the present study suggests that lower values must also be taken into account during patient follow-up.

Renal manifestations of tuberous sclerosis complex: patients\u2019 and parents\u2019 knowledge and routines for renal follow-up \u2013 a questionnaire study

BackgroundRenal angiomyolipomas (AMLs) are a major clinical feature in patients with tuberous sclerosis complex (TSC). Spontaneous bleeding can be life threatening, and appropriate information and proper surveillance and management are important to limit morbidity and mortality. Because TSC is a rare disease, patients are at risk of suboptimal medical management. Our aim was to investigate patients’ and parents’ knowledge about renal angiomyolipomas (AMLs) in Tuberous Sclerosis Complex (TSC) and to identify current routines for renal follow-up.MethodsA questionnaire survey was initiated by the French Reference Centre on TSC. It was distributed in France through university hospitals and the patients’ association (2009-2011), and to patients registered by the Norwegian National Centre for Rare Epilepsy-Related Disorders (2013-2014). Contingency tables with Chi-Square test for independence (with Yates Continuity Correction) and Pearson-Chi-Square value were used for correlation statistics.ResultsWe included 357 patients (France, n=257; Norway n=100). Most participants knew that TSC is associated with AMLs. However, 42 % did not know about the risk of AMLrelated bleeding, and 37 % had been informed about the risk of bleeding only after the age of 15 years. Furthermore, 14 % did not know whether they themselves or their child had AMLs. Patients had less knowledge than parents. Medical consultations and patient associations were the main sources of information. Among 30 % of patients, renal imaging was not received at all, or not conducted every 1-3 years, as recommended by current guidelines. Regular imaging was more frequent in patients with AMLs < 15 years, than in patients with AMLs ≥ 15 years. Ultrasound was the most frequently used imaging modality.ConclusionsKnowledge of renal AML in TSC patients and their parents was lower than expected, and follow-up by renal imaging was suboptimal for a substantial proportion of patients. Patients and parents should be informed about the risk and symptoms of renal bleeding, at the latest when the patient is 15 years. Monitoring the growth of AMLs should be standardized to comply with guidelines. Transition between adolescence and adulthood is a high-risk period and ensuring appropriate follow-up at this time is particularly important.

P11.05: Subjective ultrasound assessment and the ADNEX model to differentiate between benign and malignant ovarian tumours

To compare subjective ultrasound assessment and the ADNEX model to differentiate benign and malignant ovarian tumours. This was a retrospective study including women with ovarian tumours who underwent surgery for these lesions. All patients underwent both transabdominal and transvaginal examination to assess tumour morphology and extent of the disease. Two expert sonographers performed all the scans. The ultrasound examiner assessed tumour morphology according to the IOTA protocol. Finally, the sonographer predicted the tumour as benign or malignant. This assessment was based on subjective evaluation based on knowledge from previously published IOTA studies and was given without knowledge of the results of the ADNEX model. Accuracy of the ADNEX was calculated for the cut-offs of 3% (ADNEX-3%) and 10% (ADNEX-10%) total risk of malignancy. The McNemar's test with the Yates continuity correction was used to compare the accuracy of subjective evaluation with ADNEX-3% and ADNEX-10%, respectively to compare subjective ultrasound assessment and the ADNEX model to differentiate benign and malignant ovarian tumours. A total of 207 women were included in the study with a median (range) age of 52 (15-81) years. Subjective ultrasound evaluation had a significantly higher accuracy (91.8%) in discriminating benign and malignant ovarian tumours in comparison with ADNEX-3% (77.3%; p<0.001) and ADNEX-10% (81.6%; p<0.001). Sensitivity and sensibility of subjective ultrasound evaluation, ADNEX-3% and ADNEX-10% were respectively: 92.2% and 92.4%, 94.0% and 68.9%, 99.1% and 50.0%. This study shows that subjective ultrasound assessment performed by an expert sonographer is more accurate than ADNEX model using two different cut-off points in differentiating benign and malignant ovarian tumours. Future prospective studies with larger population of patients should confirm these preliminary findings.

Dural Puncture Epidural Technique Improves Labor Analgesia Quality With Fewer Side Effects Compared With Epidural and Combined Spinal Epidural Techniques: A Randomized Clinical Trial

The dural puncture epidural (DPE) technique is a modification of the combined spinal epidural (CSE) technique, where a dural perforation is created from a spinal needle but intrathecal medication administration is withheld. The DPE technique has been shown to improve caudal spread of analgesia compared with epidural (EPL) technique without the side effects observed with the CSE technique. We hypothesized that the onset of labor analgesia would follow this order: CSE > DPE > EPL techniques. A total of 120 parturients in early labor were randomly assigned to EPL, DPE, or CSE groups. Initial dosing for EPL and DPE consisted of epidural 20 mL of 0.125% bupivacaine plus fentanyl 2 μg/mL over 5 minutes, and for CSE, intrathecal 0.25% bupivacaine 1.7 mg and fentanyl 17 μg. Upon block completion, a blinded coinvestigator assessed the outcomes. Two blinded obstetricians retrospectively interpreted uterine contractions and fetal heart rate tracings 1 hour before and after the neuraxial technique. The primary outcome was time to numeric pain rating scale (NPRS) ≤ 1 analyzed by using Kaplan-Meier curves and Cox proportional hazard model. Secondary outcomes included block quality, maternal adverse effects, uterine contraction patterns, and fetal outcomes analyzed by using the χ test with Yates continuity correction. There was no significant difference in the time to NPRS ≤ 1 between DPE and EPL (hazard ratio 1.4; 95% confidence interval [CI] 0.83-2.4, P = .21). DPE achieved NPRS ≤ 1 significantly slower than CSE (hazard ratio 0.36; 95% CI 0.22-0.59, P = .0001). The median times (interquartile range) to NPRS ≤ 1 were 2 (0.5-6) minutes for CSE, 11 (4-120) minutes for DPE, and 18 (10-120) minutes for EPL. Compared with EPL, DPE had significantly greater incidence of bilateral S2 blockade at 10 minutes (risk ratio [RR] 2.13; 95% CI 1.39-3.28; P < .001), 20 minutes (RR 1.60; 95% CI 1.26-2.03; P < .001), and 30 minutes (RR 1.18; 95% CI 1.01-1.30; P < .034), a lower incidence of asymmetric block after 30 minutes (RR 0.19; 95% CI 0.07-0.51; P < .001) and physician top-up intervention (RR 0.45; 95% CI 0.23-0.86; P = .011). Compared with CSE, DPE had a significantly lower incidence of pruritus (RR 0.15; 95% CI 0.06-0.38; P < .001), hypotension (RR 0.38; 95% CI 0.15-0.98; P = .032), combined uterine tachysystole and hypertonus (RR 0.22; 95% CI 0.08-0.60; P < .001), and physician top-up intervention (RR 0.45; 95% CI 0.23-0.86; p = .011). Analgesia onset was most rapid with CSE with no difference between DPE and EPL techniques. The DPE technique has improved block quality over the EPL technique with fewer maternal and fetal side effects than the CSE technique for parturients requesting early labor analgesia.

Psychiatric comorbidities in children with specific learning disability

Objective: Spesific learning disability (SLD) is a significant reason of academic failures during school age. Learning difficulties are frequent issues in childhood and adolescence that can potentially impair the personal, social and familial functionality of the child or the adolescent leading to psychiatric disorders. The aim of this research is to reveal the concomitant diagnoses of SLD cases. Methods: Our research was cross-sectional. Case group, clinical comparison group and healthy comparison group were composed of 66, 30 and 55 children, respectively. Sociodemographic Data Form, Schedule for Affective Disorders and Schizophrenia for School Aged Children- Present and Lifetime Version (SADS-PL), the Bender Visual Motor Gestalt Test and SLD diagnosis battery were used. The data were evaluated by using Pearson’s chi square test, Fisher-Freeman-Halton test, Fisher’s exact test and Yates’ continuity correction test. Results: The mean ages of 14 girls (21.2%) and 52 boys (78.2%) that attended to our study were 9.18 and 8.91 respectively. It was found that 72.7% had a concomitant diagnosis and 27.3% had no other psychiatric diagnosis. The most frequent concomitant diagnoses of SLD were attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder, separation anxiety disorder, social anxiety disorder, enuresis, and depression, respectively. Discussion: Our results were consistent with the literature reporting that dual comorbidity rate in children with SLD was high. It is known that the difficulty in school affects many areas such as peer relations, family relations, self-confidence and mental state. For this reason, the screening of psychiatric comorbidities and their interventions are the most important steps.

Evaluation of cord blood irisin levels in term newborns with small gestational age and appropriate gestational age.

BackgroundMost recently, a novel myokine, named irisin, was identified in human that expressed by skeletal muscle after exercise. Irisin increases energy expenditure by turning white adipose tissue into brown adipose tissue. Thus improves carbohydrate homeostasis in humans. Irisin is considered as a potential biomarker for obesity and metabolic syndrome. In recent years, numerous studies have been conducted about irisin with adults, although number of studies with newborns is limited.ObjectiveTo evaluate cord blood irisin level with small gestational age (SGA) and appropriate gestational age (AGA) in term newborns.MethodsA cross-sectional study of 34 AGA and 34 SGA term newborns who were born in (1–30) December 2015 in Fatih University Hospital. Estimated fetal weight were calculated using the Hadlock formula by gynecologists to pregnant women in second trimester. All the babies were classified at birth as SGA or AGA. SGA was defined according to the Lubchenco scale for gender and gestational age. We collected umbilical cord blood at the time of delivery. Cord blood irisin levels were measured using commercial enzyme-linked immunosorbent assays in our hospital laboratory.ResultsCord blood irisin levels were significantly lower in SGA group [median 30 (25 ± 8) ng/ml] than in AGA group [median 40 (39 ± 13) ng/ml, p < 0.001]. No statistically significant differences were observed among the groups in terms of the demographic features (gender, mode of delivery, gestational weeks, 1–5 min Apgar score) (p > 0.05). Mothers with gestational diabetes, hypertension, asthma, chronic disease, use of drug or a history of smoking exposure were excluded from the study. When the study data were evaluated, Yates Continuity Correction and Fisher’s exact tests were used in descriptive statistical methods and for comparison of qualitative data.ConclusionOur results support the idea that irisin have a physiologic role in neonates. Low level of irisin is associated with the impaired carbohydrate metabolism in term infants with SGA. However, further studies with larger series are warranted to confirm this.