Determination of difference between groups in multivariate analysis of variance: An application [Çok degişkenli varyans analizinde gruplar arasindaki farkin tespiti: Bir uygulama]

Objective: Although there is a healthy trend toward employment of multivariate analysis of variance (MANOVA) in the analysis of data from experiments which involve multiple dependent variables, there remains a need to demonstrate the wide variety of data analytic techniques available for post hoc analysis of statistically significant multivariate results. As a post-hoc test, using Stepdown Analysis after MANOVA was explained with application in this study, Material and Methods: In this study, the data set were used that contain 19 healthy (control group) pregnant, 21 pre-eclamptic pregnant and 11 eclamptic pregnant, who submitted to Obstetric and Gynecologist Department of Research Hospital of Y. Y. University Medical School between 2004-2005 years. Urinary protein, systolic blood pressure, lactate dehydrogenase, alanine amino transferase, aspartat transaminase, malonyl dialdehyde and platelets measurements were measured from pregnants. Results: It showed that urinary protein, systolic blood pressure and LDH were affected on groups' differences according to results of Stepdown analysis. Conclusion: Stepdown analysis, a test for the incremental discriminatory power of a dependent variable after the effects of other dependent variables has been taken into account. This analysis is similar to stepwise regression or discriminant analysis in that it relies on a specific order of entry to determine how much an additional dependent variable adds to the explanation of the differences between the groups in the MANOVA analysis. Because of this properties, Stepdown analysis is a suitable post-hoc tes for MANOVA. Copyright © 2007 by Türkiye Klinikleri

Sleep disorders in Behçet's disease, and their relationship with fatigue and quality of life

Behçet's disease, a systemic vasculitis, can cause varying degrees of activity limitation, fatigue and quality of life impairment. To date, there have been no studies regarding sleep disturbance and its relationship with fatigue and life quality in Behçet's disease. We aimed to evaluate sleep disorders and polysomnographic parameters, and to determine their relationship with fatigue and quality of life in Behçet's disease. Fifty-one patients with Behçet's disease without any neurological involvement were interviewed regarding sleep disorders. Twenty-one subjects with no sleep complaints were included as the control group. Sleep-related complaints were evaluated in a face-to-face interview. Sleep quality, excessive daytime sleepiness, fatigue, depression, anxiety, disease activity/severity, and quality of life questionnaires and an overnight polysomnography were performed. Prevalences of restless legs syndrome (35.3%) and obstructive sleep apnea syndrome with/without other sleep disorders (32.5%) were higher than in the control group and the general population. Fatigue was higher in patients with restless legs syndrome and obstructive sleep apnea syndrome, and in those with lower minimum oxygen saturation; hence, only patients with restless legs syndrome had quality of life impairment. Sleep efficiency index and sleep continuity index were lower, and wake after sleep onset, respiratory disturbance index and apnea-hypopnea index were higher than in controls (P<0.01). Neither sleep disorders nor polysomnographic parameters were related to disease activity and severity. In conclusion, it is important to question sleep disorder followed by a polysomnography, if necessary, in order to improve quality of life and fatigue in Behçet's disease. © 2011 European Sleep Research Society

Clinical impact of high-dose intravenous methylprednisolone for ten days in relapses of multiple sclerosis: "Treatment of relapses in multiple sclerosis"

Background: Glucocorticoid treatment is recommended as the first-line treatment of MS relapses, however there is still no clear evidence supporting an optimum therapeutic regime. The high dose (HD) consisted of at least 500 mg/day, but the total dose of intravenous MP administered and the regimen varied among studies. The aim of this study was to assess the improvement following a standard regime of IVMP (1 g/day MP given for 10 days, without tapering) for MS relapses. A second objective was to search baseline predictors of outcome. Method: Consecutive treatments with IVMP for ten days (1 g/day, single dose in 150cc. saline, over 40 min) administered at our Neurology clinic for an episode of acute neurological deterioration in 44 patients (55 relapses) diagnosed with RR MS were recruited retrospectively. Results: Attack severity was mild in three, moderate in 28 and severe in 24 relapses. Significant improvement (? 1.0 EDSS point) occurred in 81 % of attacks at one month. The rate of improvement at ten days was 83.6%, and 85.5% at six months. There was no difference in means of latency to treatment between the patients that responded well to therapy and responded poor, at the first month. However response to therapy was higher at the sixth month in patients with latency to treatment shorter than fifteen days (68.4%, 94.4%). Conclusions: In conclusion the results of our retrospectively designed clinical study support that HD MP, 1 g/day for ten days administered IV can accelerate the recovery from MS relapses. This regimen with proper early timing for starting therapy might determine the optimum benefit. © Universitätsverlag Ulm GmbH 2009

Survival in rhino-orbito-cerebral mucormycosis: An international, multicenter ID-IRI study

Background: Mucormycosis is an emerging aggressive mold infection. This study aimed to assess the outcome of hospitalized adults with rhino-orbito-cerebral mucormycosis (ROCM). The secondary objective was to identify prognostic factors in this setting.Methods: This study was an international, retrospective, multicenter study. Patients' data were collected from 29 referral centers in 6 countries. All qualified as "proven cases" according to the EORTC/MSGERC criteria.Results: We included 74 consecutive adult patients hospitalized with ROCM. Rhino-orbito-cerebral type infection was the most common presentation (n = 43; 58.1%) followed by rhino-orbital type (n = 31; 41.9%). Twenty (27%) had acquired nosocomial bacterial infections. A total of 59 (79.7%) patients (16 in combination) received appropriate antifungal treatment with high-doses of liposomal amphotericin B. Fifty-six patients (75.7%) underwent curative surgery. Thirty-five (47.3%) required intensive care unit admission (27; 36.5% under mechanical ventilation). Hospital survival was 56.8%, being reduced to 7.4% in patients with invasive mechanical ventilation. A multivariate binary backward logistic regression model identified confusion at admission (OR 11.48), overlapping hospital-acquired infection (OR 10.27), use of antifungal treatment before diagnosis (OR 10.20), no surgical debridement (OR 5.92), and the absence of prior sinusitis (OR 6.32) were independently associated with increased risk for death.Conclusion: Today, ROCM still has high mortality rate. Improving source control, rational therpy, and preventing nosocomial infections may improve survival in this severe infection