Έκφραση και κλινική σημασία των Claudin77, PDL-1, PTEN, C-KIT, C-MET, CMYC, ALK, CK5/6, CK17, P53, EGFR, KI67 και P63 στον τριπλά αρνητικό καρκίνο του μαστού

Mapping Intimacies ◽

10.12681/eadd/48147 ◽

2018 ◽

Author(s):

Χλόη Κωνσταντίνου

Keyword(s):

Logistic Regression ◽

Regression Model ◽

Logistic Regression Model ◽

Tissue Microarrays ◽

P Value ◽

Exact Test ◽

Fisher's Exact Test ◽

Backward Elimination ◽

Fisher’S Exact Test ◽

Elimination Of Variables

Ο τριπλά αρνητικός καρκίνος του μαστού (TNBC) αντιπροσωπεύει το 10-15% των καρκίνωντου μαστού και ορίζεται ανοσοΐστοχημικά από την έλλειψη έκφρασης των ER, PR και HER2.Χαρακτηρίζεται από υψηλότερη θνησιμότητα σε σχέση με τους άλλους υποτύπους λόγω τηςεπιθετικής κλινικής συμπεριφοράς του, της κακής πρόγνωσης του και της έλλειψης στοχευμένων θεραπειών. Σκοπός της παρούσας μελέτης ήταν η αξιολόγηση προγνωστικών δεικτών για τους TNBCs -p53, p63, C-KIT, Ki67, cMet, claudin 7, CK 5/6, CK17, AR, PTEN, EGFR, ALK, PDL-1 και cMYC - σε σχέση με τον υψηλότερο βαθμό κακοήθειας, θετικούς λεμφαδένες, την λεμφαγγειακήδιήθηση (LVI), τοπική υποτροπή, μεταστάσεις, την ελεύθερη νόσου επιβίωση (DFS) καθώς και την συνολική επιβίωση (OS). Υλικό-Μέθοδοι: Διενεργήθηκε απλή ανοσοϊστοχημεία έναντι των 14 αντιγόνων σε 84 ασθενείς με τριπλά αρνητικό διηθητικό καρκίνωμα του μαστού. Επιλέγηκαν κατάλληλοι κύβοι παραφίνης για την δημιουργία ιστικών μικροσυστοιχιών (Tissue MicroArrays-TMA). Η ανοσοϊστοχημική διερεύνηση εφαρμόσθηκε σε τομές πάχους 3 μm, από τους τρεις ΤΜΑ κύβους παραφίνης. Αποτελέσματα: Μονοπαραγοντική ανάλυση με το Fisher’s exact test εδειξε στατιστικάσημαντική σχέση μεταξύ του βαθμού κακοήθειας του όγκου και της CLAUDIN 7 (pvalue=0.004), των θετικών λεμφαδένων και της πρωτεΐνης p53 (p-value=0.015), της λεμφαγγειακής διήθησης και της CLAUDIN 7 (p-value=0.032), καθώς και μεταξύ των μοριακών δεικτών ckit και των ck5/6 (p-value=0.022), ckit και EGFR (p-value=0.055), AR και cΜet (p-value=0.041), CK5/6 και EGFR (p-value=0.004), CK17 και Ki67 (p-value=0.041), Ki67 και cΜet (p-value=0.002). Η σημασία αυτής της συσχέτισης μεταξύ των δεικτών δεν έχει διερευνηθεί. Πολυπαραγοντική ανάλυση με logistic regression model with stepwise backward elimination of variables with a p-value=0.05 για τον βαθμό κακοήθειας έδειξε: Υψηλότερη έκφραση της cl7 ( OR=65.8, 95%CI=4.35-995.19, p-value=0.003), χαμηλότερη έκφραση της ckit (OR=0.14, 95%CI=0.025-0.793, p-value=0.026) αλλά και της πρωτεΐνης p63 (OR=0.18 95%CI=0.035-0.978, p-value=0.047) σχετίζονταν με υψηλότερο βαθμό κακοήθειας του όγκου. Παρατηρήθηκε υψηλότερη έκφραση του AR (OR=13.44, 95%CI=1.28-141.56, pvalue=0.031) και χαμηλότερη έκφραση των CK5/6 OR=0.072, 95%CI=0.007-0.732, (pvalue=0.026) σε ασθενείς με θετική LVI. Σύμφωνα με το Α-rank B, μόνο το Κi67 απεδείχθη στατιστικά σημαντικό για την OS (pvalue=0.0186) και για την DFS (p-alue=0.0378).Συμπέρασμα: Υψηλή έκφραση της claudin-7 και χαμηλή έκφραση της c-kit και της πρωτεΐνης p63 σχετίζονταν με υψηλότερο βαθμό κακοήθειας του όγκου. Υψηλότερη έκφραση του AR, και χαμηλότερη έκφραση των CK5/6 φαίνεται να σχετίζονται με θετικό LVI. Αυτά τα ευρήματα εισηγούνται ότι αυτοί οι μοριακοί δείκτες μπορεί να χρησιμοποιηθούν ως προγνωστικοί δείκτεςγια τους TNBCς.

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The yield of colorectal cancer among fast track patients with normocytic and microcytic anaemia

Annals of The Royal College of Surgeons of England ◽

10.1308/003588414x13814021680076 ◽

2014 ◽

Vol 96 (4) ◽

pp. 289-293 ◽

Cited By ~ 6

Author(s):

IG Panagiotopoulou ◽

D Fitzrol ◽

RA Parker ◽

J Kuzhively ◽

N Luscombe ◽

...

Keyword(s):

Colorectal Cancer ◽

Logistic Regression ◽

Odds Ratio ◽

Fast Track ◽

Microcytic Anaemia ◽

Exact Test ◽

Fisher's Exact Test ◽

Significant Difference ◽

Fisher’S Exact Test ◽

Normocytic Anaemia

Introduction We receive fast track referrals on the basis of iron deficiency anaemia (IDA) for patients with normocytic anaemia or for patients with no iron studies. This study examined the yield of colorectal cancer (CRC) among fast track patients to ascertain whether awaiting confirmation of IDA is necessary prior to performing bowel investigations. Methods A review was undertaken of 321 and 930 consecutive fast track referrals from Centre A and Centre B respectively. Contingency tables were analysed using Fisher’s exact test. Logistic regression analyses were performed to investigate significant predictors of CRC. Results Overall, 229 patients were included from Centre A and 689 from Centre B. The odds ratio for microcytic anaemia versus normocytic anaemia in the outcome of CRC was 1.3 (95% confidence interval [CI]: 0.5–3.9) for Centre A and 1.6 (95% CI: 0.8–3.3) for Centre B. In a logistic regression analysis (Centre B only), no significant difference in CRC rates was seen between microcytic and normocytic anaemia (adjusted odds ratio: 1.9, 95% CI: 0.9–3.9). There was no statistically significant difference in the yield of CRC between microcytic and normocytic anaemia (p=0.515, Fisher’s exact test) in patients with anaemia only and no colorectal symptoms. Finally, CRC cases were seen in both microcytic and normocytic groups with or without low ferritin. Conclusions There is no significant difference in the yield of CRC between fast track patients with microcytic and normocytic anaemia. This study provides insufficient evidence to support awaiting confirmation of IDA in fast track patients with normocytic anaemia prior to requesting bowel investigations.

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Correlation between Demographic Status and Nutritional Status against the Occurrence of Anemia toward Female Students in SMP Negeri 3 Kediri

STRADA JURNAL ILMIAH KESEHATAN ◽

10.30994/sjik.v9i1.274 ◽

2020 ◽

Vol 9 (1) ◽

pp. 111-118

Author(s):

Lumastari Ajeng Wijayanti ◽

Eny Sendra ◽

Ratih Novitasari ◽

Tanti Dwi Pujaningsih

Keyword(s):

Nutritional Status ◽

Sampling Technique ◽

Simple Random Sampling ◽

P Value ◽

Cross Sectional ◽

Exact Test ◽

Fisher's Exact Test ◽

Fisher’S Exact Test ◽

Kolmogorov Smirnov ◽

Smirnov Test

This research used cross sectional design. The population was 194 respondents and the sample was 54 respondents which are taken by using simple random sampling technique. Independent variable in this research was demographic status that was measured by questionnaire and nutritional status that was measured based on Body Mass Index (BMI). Meanwhile, dependent variable in this research was the occurrence of anemia that was measured by using spectrophotometry. Data analysis used Fisher's Exact test and Two-Sample Kolmogorov-Smirnov test (α = 0,05). Result of Fisher's Exact test was obtained that p value = 1,000 > 0,05, which meant that there was no significant correlation between demographic status and the occurrence of anemia. Meanwhile, result of Two-Sample Kolmogorov-Smirnov test was obtained that p value = 0,017 < 0,05, which meant that there was a significant correlation between nutritional status and the occurrence of anemia.

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Aktivitas fisik berhubungan dengan kejadian obesitas pada anak Sekolah Dasar

Jurnal Gizi dan Dietetik Indonesia (Indonesian Journal of Nutrition and Dietetics) ◽

10.21927/ijnd.2016.4(3).123-128 ◽

2017 ◽

Vol 4 (3) ◽

pp. 123

Author(s):

M Zamzani ◽

Hamam Hadi ◽

Dewi Astiti

Keyword(s):

Physical Activity ◽

Elementary School ◽

Nutritional Status ◽

Univariate Analysis ◽

Energy Output ◽

P Value ◽

Cross Sectional ◽

Exact Test ◽

Fisher's Exact Test ◽

Fisher’S Exact Test

ABSTRACTBackgrounds: The increasing prevalence of obesity is caused by imbalance between energy input to energy output. Physical activity in children both at school and at home plays an important role in determining the nutritional status of children, including the risk of obesity. Objectives: To determine the relationship between children physical activity with obesity in Ngebel Elementary School, Tamantirto Kasihan Bantul. Methods: This study was an observational study with cross sectional design. The study population is all children grades 3, 4, and 5 Ngebel Elementary School, Tamantirto Kasihan Bantul. These samples included 96 children who met the inclusion and exclusion criteria obtained with less total sampling technique. Weight children measured using digital bathroom scales to the nearest 0.1 kg and height was measured using the nearest 0.1 cm microtoice assisted by trained enumerators. Physical activity data were obtained using a physical activity questionnaire was adopted from previous studies. Nutritional status data is calculated using the WHO software Anthro 2005. Univariate analysis using frequency distribution and bivariate analysis using Fisher’s Exact Test. Data were analyzed using software statistic.Results: Results analisis showed physical activity had a significant relationship with the incidence of obesity in children, with p Value 0.015 (<0,05) with OR of 4.78 (95% CI: 1.36 to 16.82), in other words children who do moderate to severe activity ≤1 hour/day had 5 times higher chance to be obese than children with moderate to severe activity >1 hour/day.Conclusions: Physical activity has a significant association with obesity. KEYWORDS: physical activity, obesity, elementary school children ABSTRAKLatar belakang: Peningkatan prevalensi obesitas disebabkan oleh adanya ketidakseimbangan antara masukan energi dengan keluaran energi. Aktivitas fisik pada anak-anak baik di sekolah maupun di rumah berperan penting dalam penentuan status gizi anak, termasuk risiko terjadinya obesitas.Tujuan: Untuk mengetahui hubungan antara aktivitas fisik dengan kejadian obesitas pada anak Sekolah Dasar Negeri Ngebel, Tamantirto Kasihan Bantul.Metode: Penelitian ini merupakan penelitian observasional dengan rancangan cross sectional. Populasi penelitian adalah semua anak kelas 3, 4, dan 5 SDN Ngebel, Tamantirto Kasihan Bantul. Sampel penelitian berjumlah 96 anak yang memenuhi kriteria inklusi dan eksklusi diperoleh dengn teknik total sampling. Berat anak-anak diukur dengan menggunakan timbangan injak digital dengan ketelitian 0,1 kg, sedangkan tinggi badan diukur menggunakan microtoise dengan ketelitian 0,1 cm dibantu oleh enumerator terlatih. Data aktivitas fisik diperoleh menggunakan kuesioner aktivitas fisik yang diadopsi dari penelitian sebelumnya. Data status gizi dihitung dengan menggunakan software WHO Anthro 2005. Analisis univariat menggunakan distribusi frekuensi dan analisis bivariat menggunakan Fisher’s Exact Test. Data dianalisis dengan menggunakan program software statistic.Hasil: Hasil analisis menunjukkan aktivitas fisik memiliki hubungan yang signifikan dengan kejadian obesitas pada anak dengan nilai p value 0,009 (<0,05) dengan nilai OR 5,69 (95% CI: 1,42-22,65), dengan kata lain anak yang melakukan aktivitas sedang-berat ≤1 jam/hari berpeluang 5 kali lebih besar untuk mengalami obesitas daripada anak dengan aktivitas sedang-berat >1 jam/hari.Kesimpulan: Aktivitas fisik memiliki hubungan secara bermakna dengan obesitas.KATA KUNCI: aktivitas fisik, obesitas, anak SD

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TLR4 T399I Polymorphism and Endometriosis in a Cohort of Italian Women

Diagnostics ◽

10.3390/diagnostics10050255 ◽

2020 ◽

Vol 10 (5) ◽

pp. 255 ◽

Cited By ~ 2

Author(s):

Enrica Marchionni ◽

Maria Grazia Porpora ◽

Francesca Megiorni ◽

Ilaria Piacenti ◽

Agnese Giovannetti ◽

...

Keyword(s):

Molecular Mechanisms ◽

Categorical Variables ◽

P Value ◽

Genotype Distribution ◽

Exact Test ◽

Fisher's Exact Test ◽

Genotype Frequencies ◽

Significant Difference ◽

Fisher’S Exact Test ◽

Italian Women

Background: Endometriosis is a widespread multifactorial disease in which environmental, genetic, and epigenetic factors contribute to the phenotype. Single Nucleotide Polymorphisms (SNPs) in genes implicated in pivotal molecular mechanisms have been investigated as susceptible risk factors in distinct populations. Among these, Toll-like receptor 4 (TLR4) represents a good candidate due to its role in the immune/inflammatory response and endometriosis pathogenesis. Methods: The TRL4 gene T399I SNP (C/T transition, rs4986791) was investigated in 236 Italian endometriosis patients and 150 controls by using the PCR-RFLP method. One-tailed Fisher’s exact test was used to compare differences between categorical variables. T399I genotype distribution was evaluated for Hardy–Weinberg equilibrium in both groups using the Chi-squared test for given probabilities. Results: Fisher’s exact test comparing C and T allele frequencies showed a difference in the frequency of T alleles between patients and controls (OR = 1.96, 95% confidence interval 0.91–4.23; p-value = 0.0552). Genotype frequencies did not show any significant difference between patients and controls. The homozygous TT genotype was observed in 2% of endometriosis women and not in controls. Conclusions: Our results show that the TLR4 rs4986791 T variant may be considered a genetic risk factor for endometriosis in Italian women. More extensive studies in other populations are needed to confirm this result.

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Response to Neoadjuvant Chemotherapy in the Breast Predicts Axillary Nodal Status

The American Surgeon ◽

10.1177/000313481207800624 ◽

2012 ◽

Vol 78 (6) ◽

pp. 693-697

Author(s):

Alfred John Colfry ◽

Xu Zhang ◽

George M. Fuhrman

Keyword(s):

Breast Cancer ◽

Neoadjuvant Chemotherapy ◽

Lymph Nodes ◽

Early Stage ◽

Nodal Status ◽

P Value ◽

Exact Test ◽

Fisher's Exact Test ◽

Fisher’S Exact Test ◽

Response To Neoadjuvant Chemotherapy

We hypothesize that the diminishing role of axillary node dissection (ALND) in early stage breast cancer could be further reduced in patients with advanced disease depending on the response to neoadjuvant chemotherapy (NC). We reviewed records of patients managed with NC and recorded demographics, tumor characteristics, pre/postoperative axillary nodal status, and NC response. We define a response to NC as follows: T2 tumors at least a 50 per cent reduction in the product of the length and width of the tumor and in T3–4 tumors a reduction in tumor size to less than 2 cm. We defined a negative axillary nodal status as either a negative sentinel node biopsy before or after NC or a negative ALND. We defined a positive axillary nodal status as clinical persistence of nodal disease despite NC or involved nodes determined by ALND. Fisher's exact test was used to evaluate the association between response to NC and nodal status. Over the past 4 years, 35 patients have completed NC and surgical treatment including lymph node assessment. Sixteen cancers demonstrated a response to NC and two (12.5%) had positive lymph nodes. Nineteen cancers failed to respond to NC and 13 (68.4%) had involved lymph nodes. Fisher's exact test shows a strong association between NC response and nodal status (two-tailed P value 0.0016). Patients with advanced locoregional breast cancer that respond to NC are unlikely to benefit from ALND. If this study's findings are confirmed in larger trials, ALND could be limited to patients with advanced locoregional breast cancer unresponsive to NC.

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Endoscopic third ventriculostomy in the treatment of childhood hydrocephalus in Uganda: report of a scoring system that predicts success

Journal of Neurosurgery Pediatrics ◽

10.3171/2009.9.peds09196 ◽

2010 ◽

Vol 5 (2) ◽

pp. 143-148 ◽

Cited By ~ 94

Author(s):

Benjamin C. Warf ◽

John Mugamba ◽

Abhaya V. Kulkarni

Keyword(s):

Logistic Regression ◽

Regression Model ◽

Logistic Regression Model ◽

Endoscopic Third Ventriculostomy ◽

Successful Outcome ◽

Third Ventriculostomy ◽

P Value ◽

Training Set ◽

Childhood Hydrocephalus ◽

Validation Set

Object In Uganda, childhood hydrocephalus is common and difficult to treat. In some children, endoscopic third ventriculostomy (ETV) can be successful and avoid dependence on a shunt. This can be especially beneficial in Uganda, because of the high risk of infection and long-term failure associated with shunting. Therefore, the authors developed and validated a model to predict the chances of ETV success, taking into account the unique characteristics of a large sub-Saharan African population. Methods All children presenting with hydrocephalus at CURE Children's Hospital of Uganda (CCHU) between 2001 and 2007 were offered ETV as first-line treatment and were prospectively followed up. A multivariable logistic regression model was built using ETV success at 6 months as the outcome. The model was derived on 70% of the sample (training set) and validated on the remaining 30% (validation set). Results Endoscopic third ventriculostomy was attempted in 1406 patients. Of these, 427 were lost to follow-up prior to 6 months. In the remaining 979 patients, the ETV was aborted in 281 due to poor anatomy/visibility and in 310 the ETV failed during the first 6 months. Therefore, a total of 388 of 979 (39.6% and [55.6% of completed ETVs]) procedures were successful at 6 months. The mean age at ETV was 12.6 months, and 57.8% of cases were postinfectious in origin. The authors' logistic regression model contained the following significant variables: patient age at ETV, cause of hydrocephalus, and whether choroid plexus cauterization was performed. In the training set (676 patients) and validation set (303 patients), the model was able to accurately predict the probability of successful ETV (Hosmer-Lemeshow p value > 0.60 and C statistic > 0.70). The authors developed the simplified CCHU ETV Success Score that can be used in the field to predict the probability of ETV success. Conclusions The authors' model will allow clinicians to accurately identify children with a good chance of successful outcome with ETV, taking into account the unique characteristics and circumstances of the Ugandan population.

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Determinants of acute respiratory infection among under-five children in rural Ethiopia

BMC Infectious Diseases ◽

10.1186/s12879-021-06864-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Amanuel Mengistu Merera

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Regression Model ◽

Respiratory Infection ◽

Acute Respiratory Infection ◽

Logistic Regression Model ◽

P Value ◽

Under Five ◽

Under Five Children ◽

Rural Ethiopia

Abstract Introduction In low- and middle-income nations, acute respiratory infection (ARI) is the primary cause of morbidity and mortality. According to some studies, Ethiopia has a higher prevalence of childhood acute respiratory infection, ranging from 16 to 33.5%. The goal of this study was to determine the risk factors for acute respiratory infection in children under the age of five in rural Ethiopia. Methods A cross-sectional study involving 7911 children under the age of five from rural Ethiopia was carried out from January 18 to June 27, 2016. A two stage cluster sampling technique was used recruit study subjects and SPSS version 20 was used to extract and analyze data. A binary logistic regression model was used to identify factors associated with a childhood acute respiratory infection. The multivariable logistic regression analysis includes variables with a p-value less than 0.2 during the bivariate logistic regression analysis. Adjusted odds ratios were used as measures of effect with a 95% confidence interval (CI) and variables with a p-value less than 0.05 were considered as significantly associated with an acute respiratory infection. Results The total ARI prevalence rate among 7911 under-five children from rural Ethiopia was 7.8%, according to the findings of the study. The highest prevalence of ARI was found in Oromia (12.8%), followed by Tigray (12.7%), with the lowest frequency found in Benishangul Gumuz (2.4%). A multivariable logistic regression model revealed that child from Poor household (AOR = 2.170, 95% CI: 1.631–2.887), mother’s no education (AOR = 2.050,95% CI: 1.017–4.133), mother’s Primary education (AOR = 2.387, 95% CI:1.176–4.845), child had not received vitamin A (AOR = 1.926, 95% CI:1.578–2.351), child had no diarrhea (AOR = 0.257, 95% CI: 0.210–0.314), mothers not working (AOR = 0.773, 95% CI:0.630–0.948), not stunted (AOR = 0.663, 95% CI: 0.552–0.796), and not improved water source (AOR = 1.715, 95% CI: 1.395–2.109). Similarly, among under-five children, the age of the child, the month of data collection, anemia status, and the province were all substantially linked to ARI. Conclusions Childhood ARI morbidity is a serious health challenge in rural Ethiopia, according to this study, with demographic, socioeconomic, nutritional, health, and environmental factors all having a role. As a result, regional governments, healthcare staff, and concerned groups should place a priority on reducing ARI, and attempts to solve the issue should take these variables into account.

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HUBUNGAN PENGETAHUAN DAN POLA ASUH ORANG TUA DENGAN KEMAMPUAN TOILET TRAINING PADA ANAK USIA TODDLER DI PAUD ASYIYAH 2 PROVINSI SULAWESI TENGAH

GEMA KESEHATAN ◽

10.47539/gk.v10i2.42 ◽

2019 ◽

Vol 10 (2) ◽

Author(s):

Nurhayati Nurhayati

Keyword(s):

Toilet Training ◽

P Value ◽

Cross Sectional ◽

Exact Test ◽

Fisher's Exact Test ◽

Fisher’S Exact Test

Toilet training sangat penting dalam membentuk karakter anak dan membentuk rasa saling percaya dalam hubungan anak dan orang tua. Keberhasilan toilet training dipengaruhi oleh pengetahuan dan pola asuh orang tua dalam mendorong anak mencapai tujuan yang diinginkan. Penelitian ini bertujuan untuk menganalisis hubungan pengetahuan dan pola asuh orang tua dengan kemampuan toilet training pada anak usia toddler di PAUD Asyiyah 2 Provinsi Sulawesi Tengah. Jenis penelitian ini adalah analitik dengan desain cross sectional. Populasi penelitian ini yaitu semua orang tua yang memiliki anak usia toddler di PAUD Aisyah 2 Provinsi Sulawesi Tengah sebanyak 32 orang. Sampel dalam penelitian ini adalah orang tua yang memiliki anak usia toddler di PAUD Aisyah 2 Provinsi Sulawesi Tengah sebanyak 32 orang dengan teknik pengambilan sampel total sampling. Data dianalisis menggunakan Fisher’s Exact test. Hasil uji Fisher’s Exact didapatkan nilai p=0,000 dan nilai p=0,001 (p Value < 0,05), ini berarti secara statistik ada hubungan pengetahuan dan pola asuh orang tua dengan kemampuan toilet training pada anak usia toddler. Berdasarkan hasil penelitian tersebut disarankan bagi orang tua (ibu) yang menerapkan pola asuh kurang baik agar dapat merubah atau menerapkan pola asuh yang tepat kepada anaknya agar mampu melaksanakan toilet training dengan baik. Kata kunci : Pengetahuan, pola asuh, toilet training.

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HUBUNGAN KADAR GULA DARAH SEWAKTU DENGAN GEJALA NEUROPATI PERIFER PENDERITA DIABETES MELITUS TIPE 2

Jurnal Penelitian Keperawatan ◽

10.32660/jurnal.v5i1.345 ◽

2019 ◽

Vol 5 (1) ◽

Author(s):

Supriyadi Supriyadi ◽

Susmini Susmini

Keyword(s):

Random Sampling ◽

Simple Random Sampling ◽

P Value ◽

Cross Sectional ◽

Exact Test ◽

Fisher's Exact Test ◽

Fisher’S Exact Test ◽

Diabetes Melitus

Gangguan metabolik mampu menyebabkan beberapa penyakit salah satunya ialah diabetes melitus. Gejala umum yang sering muncul pada kasus diabetes melitus yaitu hiperglikemia. Hiperglikemia yang berkepanjangan dapat mengakibatkan berbagai macam komplikasi diantaranya komplikasi mikrovaskuler dan makrovaskuler. Tujuan penelitian ini untuk mengetahui hubungan kadar gula darah sewaktu dengan gejala neuropati perifer penderita diabetes melitus tipe 2. Desain penelitian ini menggunakan cross sectional. Jumlah sampel 32 penderita diabetes melitus yang dipilih melalui teknik simple random sampling, penelitian ini dilakukan di Desa Kedung Dowo Kecamatan Nganjuk. Berdasarkan uji statistik Fisher’s Exact Test didapatkan p value 0.002 (p value < 0.05) yang berarti terdapat hubungan antara kadar gula darah sewaktu dengan gejala neuropati perifer penderita diabetes melitus tipe 2.

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Διερεύνηση του ρόλου των κατασταλτικών αυτοαντισωμάτων έναντι του υποδοχέα της θυρεοτρόπου ορμόνης ως αίτιου αποβολών στις εγκύους με θυρεοειδική αυτοανοσία

10.12681/eadd/42287 ◽

2013 ◽

Author(s):

Κωνσταντίνος Τουλής

Keyword(s):

P Value ◽

Exact Test ◽

Whitney Test ◽

Fisher's Exact Test ◽

Mann Whitney Test ◽

Fisher’S Exact Test

Σκοπός Με βάση περιπτώσεις μοριακού μιμητισμού μεταξύ των γλυκοπρωτεϊνών και των υποδοχέων τους, διατυπώσαμε την υπόθεση ότι αυτοαντισώματα έναντι του υποδοχέα της θυρεοτροπίνης (TSH-Rab) κατασταλτικού τύπου (blocking) πιθανά να έχουν δραστικότητα αποκλειστή επί του υποδοχέα της ανθρώπινης χοριακής γοναδοτροπίνης (LH/hCG-R) στο ωχρό σωμάτιο, το τελικό βιολογικό αποτέλεσμα της οποίας θα ήταν η απώλεια κύησης κατά το πρώτο τρίμηνο. Ο σκοπός της μελέτης ήταν η κλινική διερεύνηση της παραπάνω υπόθεσης και συγκεκριμένα η διερεύνηση της παρουσίας και εκτίμηση των συγκεντρώσεων bTSH-Rab στις γυναίκες με θυρεοειδίτιδα Hashimoto και ιστορικό καθ’ έξιν αποβολών (ασθενείς) και η σύγκριση τους με γυναίκες με θυρεοειδίτιδα Hashimoto και φυσιολογικό αναπαραγωγικό ιστορικό (μάρτυρες). Ασθενείς και Μέθοδοι Συνολικά επιλέχθηκαν 86 γυναίκες (46 ασθενείς και 46 μάρτυρες με ηλικιακή εξομοίωση) από εξωτερικά ιατρεία και κλινικές του Νομού Θεσσαλονίκης στο πλαίσιο αναδρομικής μελέτης τύπου ασθενών-μαρτύρων. Για τη συμπερίληψη στην ομάδα των ασθενών, η γυναίκα έπρεπε να είχε ηλικία μικρότερη των 35 ετών στην τελευταία αποβολή και κάτω των 50 ετών κατά την επιλογή, χωρίς να εντοπίζονταν από το ιστορικό, την κλινική εξέταση και τον κατά περίπτωση παρακλινικό έλεγχο, δευτεροπαθείς αιτίες καθ’ έξιν αποβολών. Σε υπο-ομάδα των ασθενών (n=15) πραγματοποιήθηκε ορμονολογική εκτίμηση υποφυσιακής λειτουργίας, διακολπικό υπερηχογράφημα πυέλου, καρυότυπο, ανίχνευση μεταλλάξεων του παράγοντα V, μέτρηση επιπέδων ομοκυστεΐνης, αυτοαντισωμάτων έναντι της διπλής έλικας του DNA, αντιπηκτικού του λύκου, β2-γλυκοπρωτείνης και αντικαρδιολιπινικών αντισωμάτων. Η στατιστική ανάλυση πραγματοποιήθηκε με το λογισμικό Stata 10.0 Αποτελέσματα Δεν ανιχνεύθηκε σημαντική διαφορά στον επιπολασμό (Fisher’s exact test, p-value = 1.00) ή στους τίτλους TSH-Rab μεταξύ των ασθενών και των μαρτύρων (Mann-Whitney test, p = 0.59). Οι αναλύσεις ευαισθησίας με βάση τους ορισμούς των καθ’ έξιν αποβολών, των αυτόματων αποβολών, της θυρεοειδίτιδας Hashimoto και της θετικότητας των TSH-Rab δεν τροποποίησαν την κατεύθυνση των ευρημάτων. Η απουσία συσχέτισης μεταξύ TSH-Rab και αναπαραγωγικού ιστορικού επιβεβαιώθηκε σε μονομεταβλητό μοντέλο λογαριθμικής παλινδρόμησης [OR = 1.00, 95% CI = 0.19-5.25], είτε όταν χρησιμοποιήθηκε ο τίτλος των TSH-Rab (OR = 0.77, 95% CI = 0.29 - 2.08). Η παρουσία των TSH-Rab δεν προέβλεψε με στατιστικώς σημαντικό τρόπο τον αριθμό των αυτόματων αποβολών στις ασθενείς (Coef = -0.4, 95% CI = -1.15 - 0.34, p = 0.285) και απουσία συσχέτισης επιβεβαιώθηκε όταν χρησιμοποιήθηκε ο τίτλος τους (Coef = -.0.53, 95% CI = -1.08 - 0.10, p = 0.054). Τα παραπάνω ευρήματα παρέμειναν ανθεκτικά στην ιεραρχική στάθμιση με την ηλικία και το ΒΜΙ κατά την τελευταία κύηση ή αποβολή σε πολυμεταβλητά μοντέλα παλινδρόμησης. Συμπεράσματα Στην παρούσα μελέτη, δεν προέκυψαν ενδείξεις ότι τα TSH-Rab έχουν σημαντικό ρόλο στην παθογένεια των αυτόματων αποβολών και δεν μπορεί να υποστηριχθεί η κλινική και ερευνητική χρησιμότητα της ανίχνευσής τους στις γυναίκες με θυρεοειδίτιδα Hashimoto και ιστορικό καθ’ έξιν αποβολών.

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