Does categorizing scale scores with cutoff points affect hypothesis-testing results?

BACKGROUND: The aim of this study is to evaluate the hypothesis test results after categorizing the scale scores with cut-off points and to assess whether similar results would be obtained in that best represent the categories. METHODS: This cross-sectional study was conducted between March 15 and 20, 2023 via the Lime Survey. The questionnaire included questions about the sociodemographic and life characteristics of the participants and the Beck Depression Inventory II (BDI-II). Four groups (minimal, mild, moderate, severe depression) were formed using the cutoff points. Data analysis was performed with all participants and referred to as the conventional analysis group. Then, six subanalysis groups were determined to best represent the groups formed according to the BDI-II. In each BDI-II category, six subanalysis groups were created, including those between Q1-Q3 (IQR group), including those within ± 1 std, including those between 5p-95p (90% of the sample), including those between 2.5p-97.5p (95% of the sample). In addition, 100 different samples were randomly selected containing 50% of each group. RESULTS: Of the 1950 participants, 84.7% (n = 1652) were female and 15.3% (n = 298) were male. In terms of depression, it was observed that the significance varied in the analysis groups for sex (p = 0.039), medication use (p = 0.009) and age (p = 0.010) variables. However, these variables were not significant in some of the subanalysis groups. On the other hand, a p < 0.001 value was obtained for income, physical activity, health perception, body shape perception, life satisfaction, and quality of life variables in terms of depression in the conventional analysis group, and it was seen that the significance continued in all subanalysis groups. CONCLUSIONS: Our findings showed that variables with p < 0.001 in the conventional analysis group maintained their significance in the other analysis groups. In addition, as the p value got closer to 0.05, we observed that the significance changed according to different cutoff points in the analysis groups. In addition, 50% randomly selected samples support these results. At the end of our study, we reached results that support the necessity of secondary tests in the evaluation of scales. Although further studies are needed, we anticipate that our study will shed light on other studies.

Is the clinical course of non-arteritic ischemic optic neuropathy associated with oxidative damage and the dynamics of the antioxidant response?

PURPOSE: Oxidative stress is known to be a decisive factor in the wide etiopathogenesis of optic neuropathy. This study aimed to comprehensively evaluate the interaction of optic neuropathy's clinical course with systemic oxidative damage and antioxidant response dynamics in a large series. METHODS: This case-controlled clinical study included 33 non-arteritic anterior ischemic optic neuropathy (NAION) patients and 32 healthy individuals. Extensive systemic oxidation profiles were statistically compared between the two groups, and correlations between the clinical and biochemical data in the study group were analyzed. RESULTS: Vitamin E and malondialdehyde (MDA) levels were significantly higher in the study group. Significant correlations were observed in the analyses between clinical findings and oxidative stress parameters. Correlations between vitamin E and intraocular pressure (IOP), between B12 and cup-to-disk ratio (c/d), between antioxidant glutathione and superoxide dismutase (SOD) enzyme systems, and between uric acid (UA) and age were found to be very significant. As significant correlations were found in either clinical and biochemical data or in oxidative stress parameters, correlations between vitamin E and cholesterol, MDA were found to be very significant. CONCLUSIONS: This study not only supplies significant information regarding oxidative damage and antioxidant response in NAION, but also points out the specific interactions of neuromodulators, like vitamin E, in intracellular signaling pathways and regulation mechanisms. A better reading of these connections may help improve diagnosis, follow-ups and treatment criteria and strategies.

Effect of dental education on knowledge and clinical behavior of turkish dentists' regarding oral-systemic health of geriatric patientsOral-systemic health of geriatric patients (Running title) / Efeito da educação odontológica no conhecimento e comportamento clínico de dentistas turcos em relação à saúde oral e sistêmica de pacientes geriátricos

Objective: The aim is to evaluate the perspectives of dentists' clinical approaches in terms of their knowledge and education regarding oral-systemic health relation of geriatric patients with a digital survey. Materials and Methods: The demographics, oral-systemic health-related lectures in participants' dentistry education, the level of awareness of the oral-systemic health relationship, and behaviors related to clinical applications were investigated on a digital platform with 49 multiple-choice questions. The results were analyzed with the SPSS 24.0 program. Results: Of a total of 410 dentists (206 women and 204 men), 23% have doctoral and/or specialty titles. While 93.1% of dentists had taken systemic health-related lectures, 21.3% of them rated these courses as "adequate" and 49.3% as weak. 72% of the participants received medical history only at the initial appointment, while 17.9% of them received it at each appointment. Dentists more often associate diabetes and cardiovascular diseases with periodontitis, compared to the development of dental caries. Dentists who think that they should work with physicians in the treatments of geriatric patients with systemic diseases refer more patients to physicians per year (p < 0.001). Conclusions: Dentists have found the lectures on the relationship between oral-systemic health of geriatric patients in dentistry education inadequate. Besides, there is a lack of information on the effects of systemic diseases on caries development, intra-oral findings, and knowledge on treatment approaches. Dentists believe that defining a curriculum that emphasizes interdisciplinary work and organizing scientific activities in partnership with medical associations will play an important role in establishing awareness of oral-systemic health. (AU)

Objetivo: O objetivo é avaliar as perspectivas das abordagens clínicas dos dentistas em relação ao seu conhecimento e educação sobre a relação da saúde oral e sistêmica de pacientes geriátricos através de um questionário digital. Material e Métodos: Os dados demográficos, as aulas relacionadas à saúde oral-sistêmica na educação odontológica dos participantes, o nível de conhecimento da relação saúde oral e sistêmica e os comportamentos relacionados às aplicações clínicas foram investigados em uma plataforma digital com 49 questões de múltipla escolha. Os resultados foram analisados com o programa SPSS 24.0. Resultados: De um total de 410 dentistas (206 mulheres e 204 homens), 23% possuem título de doutor e / ou especialidade. Enquanto 93,1% dos dentistas tiveram aulas sobre saúde sistêmica, 21,3% avaliaram esses cursos como "adequados" e 49,3% como fracos. 72% dos participantes recebem histórico médico apenas na consulta inicial, enquanto 17,9% deles recebem em cada consulta. Os dentistas associam mais frequentemente diabetes e doenças cardiovasculares à periodontite, em comparação ao desenvolvimento de cárie dentária. Os dentistas que acham que devem trabalhar em conjunto com médicos no tratamento de pacientes geriátricos com doenças sistêmicas encaminham mais pacientes ao médico por ano (p <0,001). Conclusões: Os cirurgiões-dentistas consideram inadequadas as palestras sobre a relação entre saúde oral e sistêmica de pacientes geriátricos no ensino de odontologia. Além disso, faltam informações sobre os efeitos das doenças sistêmicas no desenvolvimento de cárie, achados intraorais e conhecimento sobre as abordagens de tratamento. Os dentistas acreditam que a definição de um currículo que enfatize o trabalho interdisciplinar e a organização das atividades científicas em parceria com as associações médicas terá um papel importante no estabelecimento da consciência sobre a saúde oral e sistêmica (AU)

Evaluation of the most optimal multiparametric magnetic resonance imaging sequence for determining pathological length of capsular contact.

OBJECTIVES: To assess the most optimal multi-parametric magnetic resonance imaging sequence (Mp-MRI) in determining pathological length of capsular contact (LCC) for the diagnosis of prostate cancer extraprostatic extension (EPE). METHODS: 105 patients with prostate cancer who underwent Mp-MRI of prostate prior to radical prostatectomy were enrolled in this retrospective study. LCC was determined from T2-weighted images (T2WI), Apparent Diffusion Coefficient (ADC) map, dynamic contrast-enhanced MRI (DCE-MRI) separately by two blinded radiologists. The LCCs in patients with and without EPE were compared with Mann Whitney-U test. The relationship between pathological LCC and the LCC that was measured from each Mp-MRI sequences were calculated by using Spearman test. The ability of all individual Mp-MRI sequences in determining pathological LCC was calculated by drawing receiver operator characteristic (ROC) curves. The diagnostic accuracy of LCC based on each MRI sequences for EPE diagnosis was also calculated with ROC curve analysis. RESULTS: The patients with EPE had longer median LCC than patients without EPE for each Mp-MRI sequences and for both readers. In addition, the LCC showed a broader overlapping between patients with and without EPE on ADC map (reader-1, p = 0.01; reader-2, p = 0.01) when compared with T2WI (reader-1, p = 0.002; reader-2, p = 0.001) and DCE-MRI (reader-1, p = 0.001; reader-2, p = 0.001). LCC based on DCE-MRI showed the strongest correlation with pathological LCC. The area under the curve (AUC) based on LCC was higher when using the DCE-MRI (reader-1: 0.874, p = 0.030; reader-2: 0.862, p = 0.02) than when using T2WI and ADC map in predicting pathological LCC for both readers. While the LCC based on ADC map showed poor diagnostic accuracy, LCC based on T2WI and DCE-MRI had fair diagnostic accuracy for EPE diagnosis. CONCLUSION: The contact between prostate tumor and capsule seems to be a useful and objective parameter for evaluating the EPE of prostate cancer with Mp-MRI. More specifically, LCC based on DCE-MRI has highest correlation with pathological LCC and has better ability to predict pathological LCC when compared with other Mp-MRI sequences. However, the performance of LCC based on T2WI and DCE-MRI was similar for EPE diagnosis. It seems measurement of LCC from DCE-MRI and measurement of LCC from T2WI does not show any difference in clinical EPE assessment.

The Assessment of Serum Endocan Levels in Children With Juvenile Idiopathic Arthritis.

OBJECTIVES: This study aims to evaluate the levels of serum endocan in children with juvenile idiopathic arthritis (JIA). PATIENTS AND METHODS: Sixty-seven children with JIA (30 males, 37 females; mean age 10.4±4.9 years; range 2 to 18 years) and a sex- and age- matched healthy control group of 39 children (16 males, 23 females; mean age 9.3±4.1 years; range 1 to 17 years) were recruited. Patients with JIA were divided into two groups as the clinically active JIA group (n=27) and inactive JIA group (n=40). RESULTS: The median serum endocan level in patients with JIA was significantly higher than in the control group (633.75 ng/L vs. 379.76 ng/L, p<0.01). Comparison between patients with active JIA and inactive JIA was not significant in terms of endocan levels (618.70 ng/L vs. 687.36 ng/L, p=0.34). There was a weak negative correlation between Childhood Health Assessment Questionnaire scores of patients with JIA and serum endocan levels. CONCLUSION: The high level of serum endocan highlighted the endothelial damage in patients with JIA.

Acceleration of Fracture Healing in Experimental Model: Platelet-Rich Fibrin or Hyaluronic Acid?

In this study, we compared the bone-healing effects of the local application of platelet-rich fibrin (PRF) and hyaluronic acid (HA) to bilateral tibial fractures in rats. Twenty-three adult male Sprague-Dawley rats were used. Twenty-two animals were randomly allocated to a control group (n = 6) and 2 study groups: PRF (n = 8) and HA (n = 8). The 23rd rat was used as a donor to obtain PRF. Each group was divided into 2 subgroups for histomorphometric and radiologic assessments at 2 and 6 weeks. Foreign body reaction, necrosis, inflammation, new bone formation, and fibrosis were investigated as bone healing parameters in terms of histopathologic analysis. The difference between the groups for these parameters was evaluated. The radiologic evaluation was performed by comparing the 3-dimensional reconstruction images of the fracture sites between the study and control groups. Histomorphometric evaluation showed that at 2 weeks postoperatively, the control group showed lesser bone formation (26.1 ±â€Š6.6%) when compared to the study (HA: 54.7 ±â€Š9.7%; PRF: 75.3 ±â€Š19.2%) groups and PRF group showed highest total ossification. At 6 weeks postoperatively the PRF group showed lesser total ossification (50.7 ±â€Š28.2%) when compared to control (76.3 ±â€Š21.7%) and HA group. The HA (88.8 ±â€Š13.3%) showed highest total ossification. In the control group, fibrosis was more prominent at week 6, whereas in the HA and PRF groups the amount of ossification increased. In contrast to histopathologic healing, radiologic bone healing did not differ significantly among the study and control groups 2 weeks after surgery, whereas at 6 weeks, the results of radiologic bone formation were in accordance with those of histopathologic bone healing.

Reevaluation of the Critically Ill Patients With Nonconvulsive Status Epilepticus by Using Salzburg Consensus Criteria.

OBJECTIVE: We aimed to assess the usefulness of the Salzburg Consensus Criteria (SCC) for determining the prognosis of critically ill patients with nonconvulsive status epilepticus (NCSE). METHODS: We retrospectively reviewed consecutive patients with unconsciousness followed up in the intensive care unit (ICU). Three clinical neurophysiologists, one of them blinded to clinical and laboratory data, reevaluated all EEG data independently and determined NCSE according to SCC. The incidence of NCSE and ictal EEG patterns and their relationship to clinical, laboratory, neuroradiological, and prognostic findings were assessed. RESULTS: A total of 107 consecutive patients with mean age 68.2 ± 15.3 years (57 females) were enrolled in the study. Primary neuronal injury was detected in 59 patients (55.7%). Thirty-three patients (30.8%) were diagnosed as NCSE. While authors decided to treat 33 patients (30.8%), 32 patients (29.9%) had been treated in real-life evaluation. Clinical and EEG improvement were detected in 12 patients (11.3%) in real-life treatment group showing correlation with lack of intubation and ICU stay related to postsurgical event. Rate of mortality (45.8%) was high showing association with systemic-metabolic etiology, severity of coma and presence of "plus" modifiers in the EEG. CONCLUSION AND SIGNIFICANCE: Our findings suggest that SCC is highly compatible with clinical practice in the decision for treatment of patients with NCSE. The presence of "plus" modifiers in the EEG was found to be associated with mortality in these patients and was a significant marker for the high mortality rate.

Peri-ictal Prone Position Is Associated With Independent Risk Factors For Sudden Unexpected Death In Epilepsy: A Controlled Video-EEG Monitoring Unit Study.

INTRODUCTION: Sudden unexpected death in epilepsy (SUDEP) is a major cause of death in patients with chronic drug-resistant epilepsy, and peri-ictal prone position has been elucidated as a risk factor for SUDEP. We aimed to investigate consecutive patients in peri-ictal prone positions in our video EEG monitoring (VEM) unit and compare patients with and without peri-ictal prone position to emphasize its relationship with other independent risk factors for SUDEP. METHODS: We retrospectively screened all patients with peri-ictal prone position who underwent VEM for a 10-year period and these patients constituted the prone (+) group. All patients without peri-ictal prone position who underwent VEM in the past 2 years constituted the prone (-) control group. Sequences of peri-ictal positions and interventions were evaluated. Clinical and laboratory features and SUDEP-7 scores were compared between the groups. RESULTS: A total of 21 seizures were identified with peri-ictal prone position from 16 patients. SUDEP-7 scores were significantly higher in the prone (+) group. Longer duration of epilepsy, early age at seizure onset, mental retardation, and frequency of seizures of any type (>50 seizures per month for the past year) were found significantly different between the prone (+) and prone (-) groups. CONCLUSION: Peri-ictal prone position in the VEM unit may relate with other independent risk factors of SUDEP, especially with mental retardation. Nocturnal supervision becomes important to reduce SUDEP risk, especially in patients with mental retardation.