Category: Statistics

J Cosmet Dermatol. 2022 Feb 14. doi: 10.1111/jocd.14848. Online ahead of print.

ABSTRACT

OBJECTIVE: Vitiligo is a common dermatological disease of unknown cause and progressing with depigmentation and affects approximately 1% of the world population. In the study, we aimed to compare plateletcrit (PCT), mean platelet volume (MPV), platelet (PLT), and thyroid-stimulating hormone (TSH) values in vitiligo patients.

MATERIAL AND METHODS: We retrospectively evaluated the medical data of 100 patients who were admitted to the dermatology outpatient clinic between January 2020 and December 2021 with a diagnosis of vitiligo. The control group was retrospectively constituted from medical records of 190 healthy individuals. PCT, MPV, PLT, and TSH levels of both groups were compared statistically.

RESULTS: A total of 190 participants (100 vitiligo patients and 90 healthy volunteers) were included in the study. The mean age of the patient group was 38.62±1.62, while the mean age of the control group was 41.52±1.54. There were no differences between the two groups in terms of age and gender. It was found that the mean MPV value in the patient group was lower than the control group (p=0.00). PLT and PCT values were significantly higher in the patient group than the control group (p=0.00, p=0.01, respectively). There was no statistically significant difference between the two groups in terms of TSH (p>0.05). A negative correlation between MPV and PLT values in the patient group (r=-0.218, p=0.029), and a negative correlation between MPV and TSH (r=-0.218, p=0.029). -0.230, p=0.021).

CONCLUSION: In the study, a comparison of the PCT, MPV, and PLT levels showed a difference between both groups, but no differences in TSH levels. To clarify these results, comprehensive studies with more samples are needed.

PMID:35156762 | DOI:10.1111/jocd.14848

J Magn Reson Imaging. 2022 Feb 14. doi: 10.1002/jmri.28106. Online ahead of print.

ABSTRACT

BACKGROUND: Magnetization transfer saturation (MTsat) imaging was developed to reduce T1 dependence and improve specificity to myelin, compared to the widely used MT ratio (MTR) approach, while maintaining a feasible scan time. As MTsat imaging is an emerging technique, the reproducibility of MTsat compared to MTR must be evaluated.

PURPOSE: To assess the test-retest reproducibility of MTR and MTsat in the mouse brain at 9.4 T and calculate sample sizes potentially required to detect effect sizes ranging from 6% to 14%.

STUDY TYPE: Prospective.

SUBJECTS: Twelve healthy C57Bl/6 mice.

FIELD STRENGTH/SEQUENCE: 9.4 T; magnetization transfer imaging using FLASH-3D Gradient Echo; T2-weighted TurboRARE spin echo.

ASSESSMENT: All mice were scanned at two timepoints (5 days apart). MTR and MTsat maps were analyzed using mean region-of-interest (ROIs: corpus callosum [CC], internal capsule [IC], hippocampus [HC], cortex [CX], and thalamus [TH]), and whole brain voxel-wise analysis.

STATISTICAL TESTS: Bland-Altman plots were used to assess biases between test-retest measurements. Test-retest reproducibility was evaluated via between and within-subject coefficients of variation (bsCV and wsCV, respectively). Sample sizes required were calculated (significance level: 95%; power: 80%), given effect sizes ranging from 6% to 14%, using both between and within-subject approaches. Results were considered statistically significant at P ≤ 0.05.

RESULTS: Bland-Altman plots showed negligible biases between test-retest sessions (MTR: 0.0009; MTsat: 0). ROI-based and voxel-wise CVs revealed high reproducibility for both MTR (ROI-bsCV/wsCV: CC-4.5/2.8%; IC-6.1/5.2%; HC-5.7/4.6%; CX-5.1/2.3%; TH-7.4/4.9%) and MTsat (ROI-bsCV/wsCV: CC-6.3/4.8%; IC-7.3/5.1%; HC-9.5/6.4%; CX-6.7/6.5%; TH-7.2/5.3%). With a sample size of 6, changes on the order of 15% could be detected in MTR and MTsat, both between and within subjects, while smaller changes (6%-8%) required sample sizes of 10-15 for MTR, and 15-20 for MTsat.

DATA CONCLUSION: MTsat exhibited comparable reproducibility to MTR, while providing sensitivity to myelin with less T1 dependence than MTR. EVIDENCE LEVEL: 2 TECHNICAL EFFICACY: Stage 1.

PMID:35156740 | DOI:10.1002/jmri.28106

Ginekol Pol. 2022 Feb 14. doi: 10.5603/GP.a2021.0233. Online ahead of print.

ABSTRACT

OBJECTIVES: Proteinuria is one of the diagnostic criteria of preeclampsia (PE). Measurement of 24-hour urine protein is the gold standard method for detection of proteinuria in PE. The 24-hour urine sampling is time-consuming, and inconvenient. To evaluate the accuracy of protein/creatinine (P/C) ratio in detection of significant proteinuria ( > 1 g/24-hours urine) in PE.

MATERIAL AND METHODS: One hundred and ten (110) preeclamptic women were included in this study and admitted for blood pressure monitoring, 24-hour urine collection, fetal well-being assessment and spot urine sample for measuring of P/C ratio. After thorough history and clinical examination, routine antenatal investigations were done for the women included in the study according to the hospital protocol, and to excluded pre-existing chronic renal disease. Twenty-four-hour urine collection started on the morning following hospital admission. Spot urine samples were obtained shortly before the 24-hour urine collection for measuring of P/C ratio. Collected data statistically analyzed to evaluate the accuracy of P/C ratio in detection of significant proteinuria in PE.

RESULTS: The P/C ratio of 1.35 ± 2.54 had 94.4% sensitivity, 94.9% specificity, 97.1% positive predictive value (PPV), 90.2% negative predictive value (NPV), and 94.5% overall accuracy in detection of significant proteinuria ( > 1 g/24-hour urine) in PE.

CONCLUSIONS: The P/C ratio of 1.35 ± 2.54 had 94.4% sensitivity, 94.9% specificity, 97.1% PPV, 90.2% NPV, and 94.5% overall accuracy in detection of significant proteinuria ( > 1 g/24-hour urine) in PE. This study suggests the use of P/C ratio as an alternative to 24-hour urine protein to detect significant proteinuria in PE.

PMID:35156696 | DOI:10.5603/GP.a2021.0233

Neurol Neurochir Pol. 2022 Feb 14. doi: 10.5603/PJNNS.a2022.0016. Online ahead of print.

ABSTRACT

INTRODUCTION: The present study aims to explore the factors influencing spinal clinically isolated syndrome (CIS) conversion to multiple sclerosis (MS).

MATERIAL AND METHODS: Sixty-one patients diagnosed with spinal CIS from January 2010 to November 2020 were divided into a non-progressing (CIS) group with 27 patients, and a conversion to MS (MS) group with 34 patients, based on whether they had converted to MS. The clinical presentation at onset, the Expanded Disability Status Scale (EDSS) before and after steroid therapy, the results of magnetic resonance imaging (MRI), the oligoclonal bands in cerebrospinal fluid (CSF-OCB), and the evoked potentials (EPs) were retrospectively analysed.

RESULTS: Differences in gender and age were not statistically significant between the MS and CIS groups. The median time to relapse was 12 months for the MS group, with an upper quartile of 23.7 months, and 91.2% of patients relapsed within three years. In univariate analysis, patients with CIS beginning with sensory symptoms had a lower level of progression to MS (OR = 0.311). Patients with Kurtzke Functional Systems Scores (FSSs) of pyramidal functions ≥ 2 (OR = 3.582) and positive CSF-OCB (OR = 5.208) quickly progressed to MS. There was no significant difference between the two groups in terms of spinal cord lesions < 3 vertebral segments, gadolinium enhancing lesions, or abnormal EPs. The difference in the EDSS scores before and after steroid therapy was higher in the MS group than in the CIS group (p = 0.001). Differences of ≥ 1.5 in the EDSS scores before and after steroid therapy were risk factors for CIS conversion to MS (OR = 9.333).

CONCLUSIONS: Patients with spinal CIS with pure sensory abnormalities at onset were less likely to convert to MS (OR = 0.311), and the risk factors were, in order of risk, the difference in EDSS score before and after steroid therapy (≥ 1.5; OR = 9.333), positive CSF-OCB (OR = 5.208), and those with an FSS of the pyramidal functions score ≥ 2; OR = 3.582). The present study serves as a simple ‘first step’. Any potential predictors identified should be validated via future prospective studies.

PMID:35156691 | DOI:10.5603/PJNNS.a2022.0016

Gulf J Oncolog. 2022 Jan;1(38):38-46.

ABSTRACT

INTRODUCTION: Breast cancer (BC) is the leading malignancy globally with consequent morbidity, mortality and burden on health care resources when diagnosed at an advance stage. Early-stage diagnosis is crucial to the better outcome. Screening is pivotal to early detection at an early stage. It is understood to reduce mortality, improve outcome, and is cost effective.

OBJECTIVE: The objective of the study was to see the impact of screening program on Breast cancer stage in Oman. In this study we looked into the trends in stagespecific breast cancer incidence during two pre-specified time periods 2006-2010 and 2015-2017, before and after the introduction of a national screening programme in Oman.

PATIENTS AND METHODS: It is a retrospective analysis, where breast cancer patient’s data was retrieved from Oman national cancer Registry ministry of health Sultanate of Oman, for two pre-specified time periods 2006-2010 before the introduction of cancer screening programs and 2015-2017. The cases included were those who had confirmed histopathology diagnosis and where a composite stage, based on TNM stage, was available to be analysed and compared in these two pre-specified time periods to find out the difference between these two time periods. The statistical analysis was carried out and p values were determined. Ethical approval obtained from Royal Hospital medical ethics and scientific research committee.

RESULTS: There was a 41% reduction in stage IV breast cancer from 23.01% to 13.58 %, and 86.15% increase in stage 0-1 from 6.86 % to 16.98%. (p Value<001). The stage 0 cases increased from 0% to 4.26 %. With regard to tumour size, T0-1 tumours increased from 14.16% to 26.03%, while T4 tumours decreased from 16.59% to 7.69%. There was increase in node negative breast cancer cases in Oman. The N0 increased from 28.43% to 37.64%. The diagnosis as Non-metastatic M0 disease increased from 39.77% to 60.23%, while diagnosis as metastatic M1 disease decreased from 55.32% to 44.68%.

DISCUSSION AND CONCLUSIONS: The introduction of national screening programme in Oman resulted in a continued increase in localized cancers and a decline in advanced disease. Screening programmes should be evaluated continuously and systematically to ensure their targeted objectives. The causal link between stage distribution and mortality needs to be investigated further in the context of screening. Health planners, policymakers, and other stakeholders; including clinicians, educators, community members, and advocates, should be aware of the health system requirements, as well as overall costs of these approaches to breast cancer early detection, to make effective investments, plans, and policies. Key Words: Breast Cancer; Screening; Oman; Royal hospital; early detection; early stage; OCA.

PMID:35156643

Gulf J Oncolog. 2022 Jan;1(38):47-52.

ABSTRACT

BACKGROUND: Laryngeal toxicity (LT) following concurrent chemo-radiotherapy (CCRT) for non-laryngeal head & neck cancers(NLHNC) has been inadequately studied. Electroglottography (EGG), a non-invasive technique for objective quantification of LT, measures the change in electrical impedance generated by glottic closure.

AIM: Objective and subjective assessment of acute LT post-CCRT in NLHNC.

MATERIALS AND METHODS: A prospective study on 30 NLHNC patients, treated with CCRT; 66-70Gy/33- 35fractions with weekly Cisplatin. Flexible laryngoscopic examination and EGG were performed at baseline, 6weeks, and 3months post-CCRT; Grades of LT and contact quotients(CQ) were documented. Patientreported outcomes of voice-related quality of life(QoL) performed at the same intervals, using a 30-item Voice Symptom Scale (VoiSS) questionnaire.

STATISTICAL ANALYSIS: Results of continuous measurements were studied by mean +/- standard deviation. Analysis of variance (ANOVA) was used for comparison of pretreatment and post-treatment results in more than two groups. Significance was assessed at 5% level ofsignificance. Post- hoc analysis has been done using Tukey-Krammer method for multiple comparisons. Correlation analysis was performed using Pearson correlation test.

RESULTS: 26/30 patients completed CCRT; 14 were available at 6weeks; 10 at 3months post-CCRT for analysis. At 6 weeks, 3/14(21.5%) patients had Grade II LT; 11/14(78.57%) had grade III. At 3months, 2/10(20%) had Grade I, 6/10(60%) had grade II but 2/10(20%) had worsened to grade IV. Mean CQ at baseline was 50.77 +/- 5.55; which decreased at 6 weeks to 48.56 +/- 4.66 and further at 3months to 45.56 +/- 4.66 (>0.05) suggestive of glottic hypo-adduction. VoiSS responses showed a significant impact on QoL in all three domains at six weeks and three months post-CCRT, compared to baseline (P < 0.0001).

CONCLUSION: Electroglottography is a potential tool to quantify acute LT post CCRT. Patient-reported outcomes may not correlate to the objective measures of laryngeal toxicity and require separate recording and reporting. A larger sample size would be required to draw further significant correlations. Key Words: Electroglottography; laryngeal toxicity; head neck cancer; voice; chemo-radiotherapy.

PMID:35156644

Gulf J Oncolog. 2022 Jan;1(38):31-37.

ABSTRACT

INTRODUCTION: The study aim is to determine the association of post-menopausal status with abnormal Pap smear cytology and cervical dysplasia detected by colposcopically-directed biopsy. We also study the association of biopsy-confirmed dysplasia with Pap smear results.

PATIENTS AND METHODS: This retrospective study included 480 women with abnormal Pap smear results who were referred for colposcopy. Covariates considered included demographic (age, race/ethnicity, smoking status), sexual activity (age first sexual intercourse, number lifetime partners, duration current partner), and disease (HIV, high-risk HPV, immunosuppression).

RESULTS: Post-menopausal status was not significantly associated with abnormal Pap smear cytology or cervical dysplasia. We found a statistically significant association of high-grade dysplasia with high-grade Pap smear results: ASC-H (B=3.43, SE=0.84, p< 0.001); HSIL (B=3.50, SE=0.84, p< 0.001) and AGC (B=3.47, SE=1.02, p< 0.01).

DISCUSSION AND CONCLUSION: Although clinicians may want to consider not requiring colposcopically-directed biopsy for certain post-menopausal patients, we recommend continuing with current cervical cancer guidelines of screening for all women regardless of menopausal status.

PMID:35156642

Eur J Rheumatol. 2022 Feb 14. doi: 10.5152/eurjrheum.2021.20166. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study is to examine the changes in physical activity level, fatigue, depression, and sleep quality in patients with Behçet’s disease during the COVID-19 pandemic.

METHODS: The study was designed as an online questionnaire applied to individuals who are being followed up with the diagnosis of Behçet’s disease in the rheumatology department. Data were collected using multiple scales including International Physical Activity Questionnaire (IPAQ), Fatigue Severity Scale (FSS), Beck Depression Inventory (BDI), Pittsburg Sleep Quality Index (PSQI), and Visual Analogue Scale (VAS) to evaluate physical activity level, fatigue, depression, sleep quality, and pain, respectively.

RESULTS: Sixteen patients diagnosed with Behçet’s disease were included in the study. No statistically significant difference was observed between the IPAQ, FSS, BDI, PSQI, and VAS assessment scores before COVID-19 and during COVID-19 period (P > .05 for all).

CONCLUSION: Thinking of the negative effects of aggressive clinical symptoms, Behçet’s disease patients should be supported in physical activity and psychosocial status.

PMID:35156635 | DOI:10.5152/eurjrheum.2021.20166

Eur J Rheumatol. 2022 Feb 14. doi: 10.5152/eurjrheum.2022.21135. Online ahead of print.

ABSTRACT

OBJECTIVE: Patients with undefined systemic autoinflammatory diseases (uSAIDs) are challenging to manage, as there are no guidelines or recommendations for targeted therapy. We aimed to evaluate the efficacy of empiric treatment with colchicine in our single-center uSAID population in the United States, as well as the patient characteristics associated with the most robust colchicine response.

METHODS: Children with uSAID 18 years old at initial evaluation during 2000-2019 were included if they received 3 months of colchicine therapy. Data on demographics, clinical features, laboratory/ genetic studies, and treatment responses were collected. Most statistics were based on chi-square analyses for categorical data. Complete response to colchicine was defined as resolution of episodes or the presence of minor residual symptoms that did not require any further therapy. A partial response was defined as a decrease in the frequency, severity, or length of episodes but still necessitating additional therapy. Patients were considered nonresponders if they did not experience any improvement with colchicine at target therapeutic dosing.

RESULTS: We identified 133 children diagnosed with uSAID who met our inclusion criteria. The median time to starting empiric colchicine was 5 months from the diagnosis of autoinflammatory disease. 92.5% (n ¼ 123) of patients had a beneficial response to colchicine, including 46.6% (n ¼ 62) partial responders and 45.9% (n ¼ 61) complete responders. The presence of a nonurticarial rash was associated with an incomplete colchicine response (29.2% (n ¼ 21) vs 13.1% (n ¼ 8), P ¼ .025). The presence of a heterozygous MEFV mutation in patients who did not fit Familial Mediterranean Fever diagnostic criteria (n ¼ 25) appeared to be associated with a greater likelihood of complete colchicine response, although this was not statistically significant (62.5% (n ¼ 14) vs 42.6% (n ¼ 11), P ¼ .08). In MEFV mutation-negative patients, a nonurticarial rash was even more strongly associated with incomplete colchicine response, with an OR of 27.53 (CI [1.59-477], P ¼ .023). The presence of oral ulcers also corresponded to incomplete colchicine response, although this did not reach clinical significance (38.9% (n ¼ 28) vs 24.6% (n ¼ 15), P ¼ .08). There was no significant association between episode duration or frequency and colchicine response.

CONCLUSION: Colchicine leads to clinical benefits in most children with uSAID. We, thus, recommend an early trial of colchicine in newly diagnosed patients with uSAID.

PMID:35156637 | DOI:10.5152/eurjrheum.2022.21135

Epidemiol Psychiatr Sci. 2022 Feb 14;31:e15. doi: 10.1017/S2045796022000014.

ABSTRACT

AIMS: To evaluate the quality of mental health care delivered to patients with schizophrenia and related disorders taken-in-care by mental health services in four Italian regions (Lombardy, Emilia-Romagna, Lazio, Sicily).

METHODS: Thirty-one clinical indicators concerning accessibility, appropriateness, continuity and safety were defined and estimated using healthcare utilisation (HCU) databases, containing data on mental health treatments, hospital admissions, outpatient interventions, lab tests and drug prescriptions.

RESULTS: A total of 70 586 prevalent patients with schizophrenia and related disorders treated in 2015 were identified, of whom 1752 were newly taken-in-care by the facilities of regional mental health services. For most patients community care was accessible and moderately intensive. However, care pathways were not implemented based on a structured assessment and only half of the patients received psychosocial treatments. One patient out of ten had access to psychological interventions and psychoeducation. Activities specifically addressed to families involved a third of prevalent patients and less than half of new patients. One patient out of six was admitted to a community residential facility, and one out of ten to a General Hospital Psychiatric Ward (GHPW); higher values were identified in new cases. In general hospitals, few patients had a length of stay (LoS) of more than 30 days, while one-fifth of the admissions were followed by readmission within 30 days of discharge. For two-thirds of patients, continuity of community care was met, and six times out of ten a discharge from a GHPW was followed by an outpatient contact within 2 weeks. For cases newly taken-in-care, the continuity of community care was uncommon, while the readiness of outpatient contacts after discharge was slightly more frequent. Most of the patients received antipsychotic medication, but their adherence to long-term treatment was low. Antipsychotic polytherapy was frequent and the control of metabolic side effects was poor. The variability between regions was high and consistent in all the quality domains.

CONCLUSIONS: The Italian mental health system could be improved by increasing the accessibility to psychosocial interventions, improving the quality of care for newly taken-in-care patients, focusing on somatic health and mortality, and reducing regional variability. Clinical indicators demonstrate the strengths and weaknesses of the mental health system in these regions, and, as HCU databases, they could be useful tools in the routine assessment of mental healthcare quality at regional and national levels.

PMID:35156603 | DOI:10.1017/S2045796022000014