A high rate of post thrombotic complication in pediatric portal vein thrombosis

INTRODUCTION

Portal vein thrombosis (PVT) is a rare disease in children and may be complicated by portal hypertension (PH), hepatopulmonary syndrome (HPS) and portopulmonary hypertension (PPHTN) but their incidence and risk factors are unknown.

METHODS

An observational, retrospective cohort study of all consecutive children (≤18 years) with PVT treated at the Emma Children's Hospital Amsterdam University Medical Centers between January 1996 and January 2022 was conducted to identify the incidence and risk factors of these post thrombotic complications (PTC) in pediatric patients.

RESULTS

In total 43/ 703 thrombosis patients had PVT (boys 72.1 %; mean age 1.3 ± 0.5 years). Overall, 51 % of patients developed PH (n = 22), complicated by PPHTN in one of them. In 16 of 22 patients, PVT presented with portal hypertension. Clinically relevant bleeding due to portal hypertension occurred in 13 (59.1 %) patients with PH. The mean age at the first clinically relevant bleeding was 5.1 ± 5.9 years. Risk factors for the development of PH were lack of complete thrombus resolution (OR 24.3, 95 % CI 1.2-7.0; p = 0.008) and unprovoked VTE (OR, 35.4; 95 % CI 1.4-6.3; p = 0.012). Median time from PVT to PH was 137 days (range: 0 days to 5.04 years).

CONCLUSION

We demonstrated that half of the patients develop PH after PVT, with a lack of thrombus resolution and unprovoked VTE as independent risk factors. This high incidence underlines the importance of long-term standardized follow-up of patients after PVT and standard screening in patients at risk of PTC.

Thiol-disulfide homeostasis in irritable bowel syndrome

OBJECTIVE

The etiopathogenesis and pathophysiological mechanism of irritable bowel syndrome (IBS) is not fully known. In this study, evaluating dynamic thiol-disulfide homeostasis (TDH) in patients with IBS was aimed.

SUBJECTS AND METHODS

A total of 92 people, 46 IBS patients and 46 healthy sex and aged-matched volunteers, were included in the study. Thiol/disulfide parameters in serum were measured in all cases, and the two groups were compared.

RESULTS

Disulfide levels (21.9 ± 5.0 µmol/L vs. 19.4 ± 4.2 µmol/L, respectively; p < 0.001), disulfide/native thiol (5.7%  ± 1.2% vs. 4.9% ± 0.8%, p < 0.001, respectively) and disulfide/total thiol ratio (5.1% ± 0.9% vs. 4.5% ± 0.7%, respectively, p < 0.001) were found to be higher in IBS patients, and native thiol/total thiol ratio (89.8% ± 1.9%, 90.6% ± 1.9%, p < 0.001, respectively) was found to be lower in IBS patients.

CONCLUSIONS

In our study, it was shown that TDH is impaired in IBS, which is an important result supporting studies showing that oxidative stress plays a role in IBS. On the other hand, it is thought that this study will contribute to the literature in terms of being the first study evaluating TDH in adult IBS.

Scapholunate Ligament Partial Tears; Tear Localization, Extrinsic Ligament Injury Association and Conservative Treatment Responses Prior to Instability: Cross-Sectional Study

PURPOSE OF THE STUDY Scapholunate interosseous ligament (SLIOL) tears with accompanying extrinsic ligament rupture have been associated with scapholunate (SL) instability. SLIOL partial tears were examined in terms of tear localization, grade and accompanying extrinsic ligament injury. Conservative treatment responses were scrutinized according to injury types. MATERIAL AND METHODS Patients with SLIOL tear without dissociation were evaluated retrospectively. Magnetic resonance (MR) images were reexamined in terms of tear localization (volar, dorsal or combined volar and dorsal tears), grade of injury (partial or complete) and extrinsic ligament injury accompaniment (RSC, LRL, STT, DRC, DIC). Injury associations were examined with MR imaging. All patients treated conservatively were recalled at their first year for re-evaluation. Conservative treatment responses were analyzed according to pre- and post-treatment first year visual analog scale for pain (VAS), disabilities of the arm, shoulder and hand questionnaire (DASH) and Patient-Rated Wrist Evaluation (PRWE) scores. RESULTS In our cohort, 79% (n: 82/104) of patients had SLIOL tear and 44% (n: 36) of them had accompanying extrinsic ligament injury. The majority of SLIOL tears and all extrinsic ligament injuries were partial tears. In SLIOL injuries, volar SLIOL was most commonly damaged portion (45%, n: 37). DIC (n: 17) and LRL (n: 13) were most frequently torn ligaments, radiolunotriquetral (LRL) injury generally co-existed with volar tears and dorsal intercarpal ligament (DIC) with dorsal tears regardless of injury time. Extrinsic ligament injury accompaniment was associated with higher pre-treatment VAS, DASH and PRWE scores than isolated SLIOL tears. Injury grade, location and extrinsic ligament accompaniment had no significant effect on treatment responses. Test scores reversal was better in acute injuries. CONCLUSIONS On imaging SLIOL injuries, attention should be paid to the integrity of secondary stabilizers. In partial SLIOL injuries, pain reduction and functional recovery can be achieved with conservative treatment. Conservative approach can be the initial treatment option in partial injuries especially in acute cases regardless of tear localization and injury grade if secondary stabilizers are intact. Key words: scapholunate interosseous ligament, extrinsic wrist ligaments, carpal instability, MRI of wrist, wrist ligamentous injury, volar and dorsal scapholunate interosseous ligament.

A novel unconventional T cell population enriched in Crohn's disease

OBJECTIVE

One of the current hypotheses to explain the proinflammatory immune response in IBD is a dysregulated T cell reaction to yet unknown intestinal antigens. As such, it may be possible to identify disease-associated T cell clonotypes by analysing the peripheral and intestinal T-cell receptor (TCR) repertoire of patients with IBD and controls.

DESIGN

We performed bulk TCR repertoire profiling of both the TCR alpha and beta chains using high-throughput sequencing in peripheral blood samples of a total of 244 patients with IBD and healthy controls as well as from matched blood and intestinal tissue of 59 patients with IBD and disease controls. We further characterised specific T cell clonotypes via single-cell RNAseq.

RESULTS

We identified a group of clonotypes, characterised by semi-invariant TCR alpha chains, to be significantly enriched in the blood of patients with Crohn's disease (CD) and particularly expanded in the CD8⁺ T cell population. Single-cell RNAseq data showed an innate-like phenotype of these cells, with a comparable gene expression to unconventional T cells such as mucosal associated invariant T and natural killer T (NKT) cells, but with distinct TCRs.

CONCLUSIONS

We identified and characterised a subpopulation of unconventional Crohn-associated invariant T (CAIT) cells. Multiple evidence suggests these cells to be part of the NKT type II population. The potential implications of this population for CD or a subset thereof remain to be elucidated, and the immunophenotype and antigen reactivity of CAIT cells need further investigations in future studies.

Interobserver reliability of the Nancy index for ulcerative colitis: An assessment of the practicability and ease of use in a single-centre real-world setting

BACKGROUND

Histological disease severity assessment in ulcerative colitis (UC) has become a mainstay in clinical endpoints definition ("histologic remission") in clinical trials of UC. Several scores are established in the microscopical assessment of disease activity, but the Nancy index (NI) stands out being a histological index with the least amount of scoring items among these scores. To which extent histologic assessment using NI is affected by interobserver reliability in a real word setting, is poorly understood. We therefore performed a single-center retrospective analysis of NI assessment in patients with UC.

METHODS

We retrospectively evaluated the NI in two independent cohorts (total: 1085 biopsies, 547 UC patients) of clinically diagnosed UC patients, who underwent colonoscopy between 2007 and 2020. Cohort #1 consisted of 637 biopsies from 312 patients, Cohort #2 consisted of 448 biopsies from 235 patients. Two blinded pathologists with different levels of expertise scored all biopsies of each cohort. A consensus conference was held for cases with discrepant scoring results. Finally, an overall consensus scoring was obtained from both cohorts.

RESULTS

The interobserver-agreement of the NI was substantial after the assessment of 1085 biopsy samples (κ = 0.796 [95%-CI: 0.771-0.820]). An improvement of the interobserver-agreement was found with growing numbers of samples evaluated by both observers (Cohort #1: κ = 0.772 [95%-CI: 0.739-0.805]; Cohort #2: κ = 0.829 [95%-CI: 0.793-0.864]). The interobserver discordance was the highest in NI grade 1 (observer 1: n=128; observer 2: n=236). Interobserver discordance was the lowest in NI grades 0 (observer 1: n=504; observer 2: n=479) and 3 (observer 1: n=71; observer 2: n=66).

CONCLUSION

The NI is an easy-to-use index with high interobserver reliability to assess the histological disease activity of UC patients in a real-world setting. While NI grades 0 and 3 had a high level of agreement between the observers, NI grade 1 had a poorer agreement-level. This highlights the clinical need to specify histological characteristics leading to NI grade 1.

AB1082 FREQUENCY AND SEVERITY OF COVID-19 IN PATIENTS WITH VARIOUS RHEUMATIC DISEASES TREATED REGULARLY WITH COLCHICINE OR HYDROXYCHLOROQUINE

Background

Several anti-inflammatory drugs which were targeted different mechanisms and investigated for both prevention and treatment for COVID-19.

Objectives

The current study aimed to investigate whether patients regularly using colchicine or hydroxychloroquine (HCQ) have an advantage of protection from COVID-19 or developing less severe disease.

Methods

Patients who were taking colchicine or HCQ regularly for a rheumatic disease including Familial Mediterranean Fever, Behçet’s syndrome, Systemic Lupus Erythematosus, Rheumatoid Arthritis and Sjogren’s syndrome as well as their healthy household contacts as the control group were included into the study. The clinical data regarding COVID-19 were collected using a standard form, and serum samples were analyzed for anti-SARS-COV-2 nucleocapsid IgG. Patients treated with any biologic or immunosuppressive treatments were not included into the study.

Results

A total of 635 regular colchicine users with their 643 household contacts and 317 regular HCQ users with their 333 household contacts were analyzed. Anti-SARS-Cov2 IgG was positive in 43 (6.8%) regular colchicine users and 35 (5.4%) household contacts (OR=1.3; 95% CI:0.8-2; p=0.3) (Table 1). COVID-19 related symptoms were described by 29 (67.4%) of the patients and 17 (48.6%) household contacts (OR=2.2; 95% CI:0.9-5.5; p=0.09), and hospital admission was observed in five (11.6%) and one (2.9%) of these subjects (OR=4.5; 95% CI:0.5-40.2; p=0.1), respectively (Figure 1). Seropositive subjects were observed in 22 (6.9%) regular HCQ users and 24 (7.2%) household contacts (OR=1.1; CI:0.6-1.9; p=0.8) (Table 1). COVID-19-related symptoms occurred in 16 (72.7%) of the 22 patients and 12 (50%) of 24 household contacts (OR=2.7; 95% CI:0.8-9.1; p=0.1). Three patients (13.6%) were admitted to hospital, while one household contact (4.2%) was hospitalized (OR=3.6; 95% CI:0.3- 37.8; p=0.2) (Figure 1). Disease-specific analyses disclosed that there was no significant difference in terms of COVID-19 frequency and severity between a particular disease subset and household contacts (Table 1). Univariate logistic regression analysis showed no effect of age and gender on the SARS-CoV-2 seroprevalence rate among regular colchicine or HCQ users and household contacts (p=0.2 and p=0.7, respectively for colchicine users versus contacts, p=0.7 and p=0.3, respectively for HCQ users versus contacts).

Figure 1.

Severity of COVID-19 in regular colchicine or HCQ users and these patients’ household contacts

Table 1.

Disease specific outcomes of the entire cohort

VariableFMF (n=373)FMF HHC* (n=386)PBehcet Patients (n=262)Behcet HHC (N=257)PSLE Patients (N=197)SLE HH (n=221)pRA Patients (n=79)RA HH (n=73)PSjögren patients (N=41)Sjögren HH (N=39)pAge, mean ± SD years36.4 ± 13.236.3 ± 16.10.942.9 ± 11.438.1 ± 15.20.00144.2 ± 12.639.4 ± 170.00253.9 ± 10.340.3 ± 16.60.00157.1 ± 11.246.2 ± 16.10.001Gender, n (%) Female249 (66.8)173 (44.8)0.001160 (61.1)118 (45.9)0.001184 (93.4)75 (33.9)0.00173 (61.1)20 (27.4)0.00141 (100)10 (25.1)0.001Positive antibody to SARS-COV-2, n (%)25 (6.7)23 (5.9)0.618 (6.9)12 (4.7)0.314 (7.1)19 (8.6)0.64 (5.1)2 (2.7)0.54 (9.8)3 (7.7)0.9Symptomatic COVID-19 in seropositive cases, n (%)18 (72)10 (43.4)0.0411 (61.1)7 (58.3)0.611 (78.6)9 (47.3)0.073 (75)0 (0)0.42 (50)3 (100)0.4Hospital admission in seropositive cases, n (%)1 (3.8)0 (0)-4 (22.2)1 (8.3)0.32 (14.3)0 (0)0.21 (25)0 (0)-1 (25)1 (33.3)0.3Mean colchicine dose, mg/day ± SD1.5 ± 0.4--1.4 ±0.4-----------Mean duration of colchicine usage, years ± SD11.3 ± 8.3--10.4 ± 7.7-----------Mean HCQ dose, mg/day ± SD------263.6 ± 95.1--255 ± 90.8--273.7 ± 132.5--Mean duration of HCQ usage, years ± SD------10.1 ± 6.6--7.3 ± 5.2--9 ± 6.3--

HCQ hydroxychloroquine, FMF familial mediterranean fever, HHC household contacts, RA rheumatoid arthritis, SLE systemic lupus erythematosus

Conclusion

Being on a regular treatment of colchicine or HCQ was not resulted in the prevention of COVID-19 or amelioration of its manifestations.

Disclosure of Interests

None declared

POS1279 FAVOURABLE COURSE OF COVID-19 IN PATIENTS WITH FAMILIAL MEDITERRANEAN FEVER USING BIOLOGIC AGENTS

Background

Serious infections are more frequently seen in patients with inflammatory rheumatic diseases, being treated with immunosuppressive or biologic disease-modifying antirheumatic drugs (b-DMARDs). Potential harmful effects of immunosuppressive drugs as well as b-DMARDs were a major concern during the early phases of the Coronavirus disease 2019 (COVID-19) pandemic, and preliminary data documented the worse outcome of COVID-19 associated with B cell depleting treatments (1). On the other hand, limited information has been shared about the course of COVID-19 in patients with monogenic autoinflammatory disorders using IL-1 inhibitors.

Objectives

We herein aimed to evaluate the course of COVID-19 in adult patients with the most common form of inflammasomopathy, Familial Mediterranean Fever (FMF), who were on biologic agents.

Methods

In this cross-sectionally study, FMF patients were evaluated by screening their clinical and electronic records in our database in October 2021. The FMF patients with a record of PCR-confirmed COVID-19 were investigated in more detail in our hospital. Characteristics of FMF findings as well as clinical and laboratory findings associated with COVID-19 were recorded from the outpatient follow-up cards.

Results

We identified 184 FMF patients using biologic agents, and their baseline characteristics are summarized in Table 1. Among them, 36 had PCR-confirmed COVID-19; 32 of them were currently on b-DMARD along with colchicine (31 anti-IL-1, 1 anti-TNF), and 4 of them had a previous history of b-DMARD treatment. Data about the course of COVID-19 could be reached in 34 patients. Four (11%) patients had an asymptomatic course. Remaining patients with symptomatic COVID-19 had the following symptoms: cough (50%), headache (47.2%), fever (44.4%), loss of taste and smell (41.6%), myalgia (0.6%), dyspnoea (27.8%), diarrhea (25%) abdominal pain (5.6%). Thorax computed tomography was performed in 10 patients, and findings of pneumonia were documented in 6 (16.7%). The mean values of the laboratory parameters were as follows: C-reactive protein 99.48 ± 112.66 mg/L; ferritin 316 ± 208.3; D-Dimer 2445 ± 3917, Lactate Dehydrogenase 253 ± 61, troponin T 26 ± 20, procalcitonin 0.348 ± 0.53. Lymphopenia was detected in 5 (13.9%) patients; mean lymphocyte count was 1080 ± 363. Data about the treatment could be reached in 34 patients. Antiviral therapy was prescribed in 25 (69.4%) patients (favipiravir, n=22; and oseltamivir, n=3). Antibiotics were given to 6 (16.7%) patients, and 6 (16.7%) received hydroxychloroquine. Parenteral steroids were administered to 2 patients during the hospitalization. Six (16.7%) patients required hospitalization, and 2 (5.6%) required oxygen support, non-invasive mechanical ventilation, and one of them followed in the intensive care unit. Twenty-two patients were on anakinra treatment, and none of them required additional dose. Only 1 patient, a 61-year-old male patient with a history of lung lobectomy and renal transplantation, received tocilizumab due to macrophage activation syndrome, and he later died of sepsis. This patient was on anakinra until 2 years before, and it was discontinued due to an allergic reaction. Only 4 patients had a history of vaccination before COVID-19, and none of them developed pneumonia and required hospitalization. Six patients had FMF attacks after recovering from COVID-19. None of the patients developed thromboembolism and secondary bacterial infections.

Conclusion

This survey identified 36 biologic b-DMARD receiving FMF patients, who had COVID-19. All but 1 patient had complete recovery, and b-DMARD usage did not negatively affect the COVID-19 course. None of the patients currently on anti-IL-1 or anti-TNF had a worse outcome. Based on these observations, it can be suggested that refractory FMF patients can continue their b-DMARD treatments when they had COVID-19.

References

[1]Jérôme Avouac, Elodie Drumez, Eric Hachulla, Raphaèle Seror, Sophie Grorgian-Lavialle, et al. COVID-19 outcomes in patients with inflammatory rheumatic and musculoskeletal diseases trated with rituximab: a cohort study. Lancet Rheumatol 2021 Published Online March 25, 2021, https://doi.org/10.1016/S2665-9913(21)00059-X

Disclosure of Interests

None declared

POS0223 AMYLOID BURDEN AND ASSOCIATED FACTORS PREDICT HIGHER MORTALITY AND POOR OUTCOME IN FAMILIAL MEDITERRANEAN FEVER-ASSOCIATED AA AMYLOIDOSIS: DATA FROM A TERTIARY REFERRAL AMYLOIDOSIS CENTER WITH 137 PATIENTS

Background

AA amyloidosis (AA-a) is a rare condition while the most common cause is Familial Mediterranean Fever (FMF) in Turkey. There is limited evidence about the impact of AA-a burden on prognosis and outcome in AA-a.

Objectives

We herein aimed to evaluate the AA-a burden and its association with outcome in patients (pts) with FMF-associated AA-a (FMF-AA)

Methods

We retrospectively evaluated FMF-AA pts from our AA-a cohort. Diagnosis of AA-a was confirmed by histologically. Heart involvement (inv.) was defined by documenting increased (>12 mm) septal wall thickness (CSWT) and at least one of three appropriate echocardiography findings (decreased ejection fraction, increased granular echogenicity or valvulopathy, diastolic dysfunction). The pts were divided in three groups according to AA-a burden: pts had only renal inv. (Group 1, G1), renal and gastrointestinal (GIS) (Group 2, G2); renal and GIS and heart (Group 3, G3)

Results

Data of 137 pts with FMF-AA (55% male) were analyzed. We classified 79 pts in G1, 20 in G2, and 14 in G3. CSWT, troponin (trop) and pro-BNP levels were higher in G3 than G1 and G2 but trop levels were not statistically (sts) significant (sig.) between G3 and G2. Overall mortality was in 15.3 %. While mortality rate increased gradually with higher AA-a burden (10 % in G1, 15 % in G2 and 43 % in G3), the difference was sts sig. between G3 and G1.

The number of MEFV variants was lower in pts with higher AA-a burden, especially those with M694V homozygosity were 93% and 72% in G1, 83% and 67% in G2, and 75% and 50% in G3 rsp; but the differences were not sts sig. (p=0.2 and p=0.7 for G1-G2, p=0.06 and p=0.2 for G1-G3, p=0.6 and p=0.4 for G2-G3).

The number of organ inv. was correlated with CSWT (r=0.559’ ‘p<0.001), trop (r=0.646’), pro-BNP (r=0.572’), bsl creatinine (Cre) (r=0.511’), bsl proteinuria (prt) levels (r=0.321 p=0.008) and negatively correlated with bsl e-GFR (r=-0.437’) and biologic DMARD duration (r=-0.235 p=0.03)

ROC analyses revealed 56% sensitivity (SS) and 70 % specificity (SP) for bsl Cre (cut off value [COV] 0.95, AUC=0.726 p=0.03 95% CI 0.56-0.9), 83.3 % SS and 74 % SP for trop (COV 35.5 AUC=0.864 p=0.006 CI 0.73-0.99), 100 % SS and 85.5 % SP for pro-BNP (COV 7246 AUC=0.897 p=0.024 CI 0.79-1.0), 79% SS and 58 % SP for CSWT (COV 11.5 AUC=727 p=0.007 CI 0.61-0.84) to be able to predict higher mortality.

Conclusion

This study showed the association of AA-a burden with higher morbidity such as ESRD and higher mortality in pts with FMF-AA. Bsl Cre, prt, trop and pro-BNP levels were correlated with extent of AA-a burden and predicted higher mortality. Lower frequency of pts with two exon 10 variants or M694V homozygosity in pts with higher AA-a burden indicates that additional genetic and environmental factors may play a role in the development and progression of AA-a in FMF.

Table 1.

Clinical and laboratory features of pts with FMF-AA according to AA-a burden

VariablesG1 (n=79)G2 (n=20)G3 (n=14)p1 (OR)p2p3Age * Ɨ42.8±1343.2±1348.9±110.90.10.2Gender, male**36 (45.6)15 (75)7 (50)0.02 (5.5)0.80.1Diagnosis age of AA-a * Ɨ30.7±1334.1±1434.9±150.30.30.9Duration of AA-a * Ɨ13.8±910.8±614.3±80.150.80.2BaselineCRP (mg/L) Ɨ20±1324±1913±70.40.050.07Prt (g/dL) Ɨ Ɨ3.8 (5.8)12.4 (16)5 (4.2)0.030.30.2Cre (mg/dL) Ɨ0.8±0.41.5±11.8±1.3<0.001<0.0010.6e-GFR Ɨ#104±31104±3159±390.020.0040.5CRF at admission**28/74 (38)13/19 (68)9/12 (75)0.02 (5.7)0.03 (6)0.7ESRD at admission**7/62 (11)6/18 (33)4/11 (36)0.03 (5)0.03 (4.6)0.9CSWT Ɨ10.2±1.710.6±1.113.9±1.60.3<0.001<0.001Trop ĸ Ɨ Ɨ9 (13)28 (68)75 (85)0.40.0050.1pro-BNP ĸ Ɨ Ɨ288 (1040)766 (1967)4968 (33800)0.50.0030.026ESRD (overall)**35 (45)10 (50)13 (93)0.70.001 (11)0.01 (7)Duration of b-DMARD (months) Ɨ##66±2967.7±3741.8±300.90.020.08Mortality **8 (10)3 (15)6 (43)0.50.006 (10)0.1

#estimated glomerular filtration rate

p1: G2-G1

p2: G3-G1

p3: G2-G3

Ɨ mean±std dev. Ɨ Ɨmedian (IQR) *years ** n, % ĸ pg/mL

Figure 1.

Comparison of survival rate between G3 and G1

Log-Rank: p=0.007

Disclosure of Interests

None declared

POS1359 TRANSIENT ELASTOGRAPHY (FIBROSCAN) AS A NON-INVASIVE METHOD FOR DETECTING AMYLOID DEPOSITION IN TRANSPLANTED KIDNEYS IN PATIENTS WITH AA AMYLOIDOSIS

Background

Amyloidosis is characterized by accumulation of insoluble fibrils composed of different monomers in extracellular spaces of different organs, and demonstration of deposits by non-invasive methods is important especially for organs difficult to sample. Transient elastography (Fibroscan) is a diagnostic method of measuring liver stiffness (LS) being used in chronic liver diseases.

Objectives

We herein aimed to search potential of fibroscan detecting kidney stiffness (KS) associated with amyloid deposition in patients with AA who received kidney transplants.

Methods

Renal transplant recipients (RTR) because of AA amyloidosis-related kidney failure (amyloidosis group; AG) and RTR due to other underlying diseases (control group; CG) enrolled into this study. KS and LS were measured by the same physician blinded to diagnosis. The stiffness results were expressed in kilopascals (kPa). Local ethics committee approval and patient consents were obtained.

Results

Nineteen AG and 16 CG patients included into the study. Patient age (p=0.4), gender (p=1), body mass index (BMI) (p=0.4), donor type (p=0.2), donor age (p=0.3), frequency of rejection history (p=0.4) and graft loss (p=0.2) did not show significant difference between two groups. Frequency of diabetes mellitus (DM) (p=0.01), median creatinine (p=0.015) and proteinuria (p<0.001) were higher in AG group than CG. Although median KS was higher in CG group (19.8 [IQR:34] vs 15.8 [IQR:16]), the difference was not significant (p=0.5). Baseline clinical and laboratory features were similar in AG patients with recurrent-amyloidosis (n=6) and non-recurrent AG patients (n=13). Median KS score was higher in recurrent compared to non-recurrent AG patients (p< 0.001). However median LS did not differ between two groups (p=0.4). In multivariate analysis only KS was associated with renal recurrence of AA (p=0.031; OR=1.18, 95% CI 1.015-1.362). In ROC analysis, a cut-off value of 24.55 kPa provided 83.3% sensitivity and 92.3% specificity (LR=10.8, AUC=0.936, p=0.003). Median KS was higher in patients with a history of rejection both among the patients with AG and CG, but the difference was not significant. Additionally, LS scores were similar between two groups.

In FMF-associated AA, median KS was higher in patients with one MEFV variant compared to those with two variants and tended to be higher in other MEFV variants compared to M694V homozygotes (p=0.027 and p=0.08, respectively). There was no correlation between the patient age, disease duration, duration of renal transplantation, donor age, BMI, LS, creatinine, CRP, proteinuria, and KS both in patients with AG and CG.

Table 1.

Comparison of clinical and laboratory features between patients had amyloidosis recurrence and not

VariablesTotalRecurrence -Recurrence +p valueAge (years)*48 (22)47 (17)50 (27)1Gender, maleƗ13 (68.4)9 (69.2)4 (66.7)1Duration of amyloidosis (months)*206 (89)220 (99)163 (203)0.08Diagnosis age of amyloidosis (years)*28 (17)27.5 (17)28 (20)1Duration of renal transplantation (months)*145 (137)144 (110)123 (50)0.7Kidney stiffness (kPa)*15.8 (15.8)10.9 (7.7)29.3 (18.9)<0.001Liver stiffness (kPa)*5.45 (2.8)5.4 (2.7)5.9 (8.9)0.4RejectionƗ(n, %)3 (15.8)2 (15.4)1 (16.7)1Creatinine (mg/dL)*1.4 (0.6)1.4 (0.7)1.7 (0.5)0.24CRP (mg/L)*2.7 (4.4)1.3 (4.1)3.5 (13.9)0.3ProteinuriaƗ3 (15.8)1 (7.7)2 (33.3)0.2Proteinuria (g/day)*0.4 (1.2)0.4

*median; IQR Ɨ n, %

Conclusion

Median KS scores were similar between AG and CG groups; however it was higher in AG patients with recurrent kidney amyloidosis than those without recurrent disease, which may support using the fibroscan method as a useful screening method for establishing AA recurrence. Additionally, higher KS scores in patients with one MEFV variant compared to those with two variants need further studies to be able to identify other yet unidentified amyloidogenic factors.

Disclosure of Interests

None declared

OP0313 PRELIMINARY CRITERIA FOR MACROPHAGE ACTIVATION SYNDROME ASSOCIATED WITH CORONAVIRUS DISEASE-19

Background:

COVID-19 runs a severe disease associated with acute respiratory distress syndrome in a subset of patients, and a hyperinflammatory response developing in the second week contributes to the worse outcome. Inflammatory features are mostly compatible with macrophage activation syndrome (MAS) observed in other viral infections despite resulting in milder changes. Early detection and treatment of MAS may be associated with a better outcome. However, available criteria for MAS associated with other causes have not been helpful.

Objectives:

To identify distinct features of MAS associated with COVID-19 using a large database enabling to assess of dynamic changes.

Methods:

PCR-confirmed hospitalized COVID-19 patients followed between March and September 2020 constituted the discovery set. Patients considered to have findings of MAS by experienced physicians and given anakinra or tocilizumab were classified as the MAS group and the remaining patients as the non-MAS group. The MAS group was then re-grouped as the cases with exact-MAS and borderline-MAS cases by the study group. Clinical and laboratory data including the Ct values of the PCR test were obtained from the database, and dynamic changes were evaluated especially for the first 14 days of the hospitalization. The second set of 162 patients followed between September-December 2020 were used as the replication group to test the preliminary criteria. In the second set, hospitalization rules were changed, and all patients required oxygen support and received dexamethasone 6mg/day or equivalent glucocorticoids. Daily changes were calculated for the laboratory items in MAS, borderline, and non-MAS groups to see the days differentiating the groups, and ROC curves and lower and upper limits (10-90%) of the selected parameters were calculated to determine the cutoff values.

Results:

A total of 769 PCR-confirmed hospitalized patients were analysed, and 77 of them were classified as MAS and 83 as borderline MAS patients. There was no statistically significant difference in the baseline viral loads of MAS patients compared to the non-MAS group according to the Ct values. Daily dynamic changes in the MAS group differed from the non-MAS group especially around the 6th day of hospitalization, and more than a twofold increase in ferritin and a 1.5-fold increase in D-dimer levels compared to the baseline values help to define the MAS group. Twelve items selected for the criteria are given in Table 1 below. The total score of 45 provided 79.6% sensitivity for the MAS (including borderline cases) and 81.3% specificity around days 5 and 6 in the discovery set, and a score of 60 increased the specificity to 94.9% despite a decrease in sensitivity to 40.8%. The same set provided a similar sensitivity (80.3%) in the replication, but a lower specificity (47.4-66% on days 6 to 9) due to a group of control patients with findings of MAS possibly masked by glucocorticoids.

Table 1.

Preliminary Criteria for Macrophage Activation Syndrome Associated with Coronavirus Disease-19

1.Fever (>37.0 °C)2.Ferritin concentration > 550 ng/mL3.More than 2 times increase of ferritin concentration within 7 days of disease onset4.Neutrophil count > 6000 cell/mm35.Lymphopenia < 1000 cell/mm36.Neutrophil/lymphocyte ratio > 67.D-dimer concentration > 1000 ng/ml8.More than 50% increase of D-dimer concentration within 7 days of disease onset9.CRP concetration > 50 mg/L10.LDH concentration > 300 U/L11.ALT or AST concentration > 50 U/L12.Procalcitonin concentration < 1.2

1 point for each positive item assessed on Days 5-7

Score calculation: Total points / 12 x 100

Possible MAS ≥45 and Definite MAS ≥60

Conclusion:

This study defined a set of preliminary criteria using the most relevant items of MAS according to the dynamic changes in the parameters in a group of COVID-19 patients. A score of 45 would be helpful to define a possible MAS group with reasonable sensitivity and specificity to start necessary treatments as early as possible.

Disclosure of Interests:

None declared.

POS1339 MORE FREQUENT AND EARLIER HIP INVOLVEMENT IN SPONDYLOARTHRITIS ASSOCIATED WITH FAMILIAL MEDITERRANEAN FEVER

Background:

Familial Mediterranean fever (FMF) is a hereditary autoinflammatory disorder caused by the MEFV gene variants. Although association between FMF and spondyloarthritis (SpA) has previously been reported, clinical and laboratory features of patients with FMF and SpA have not been defined in detail.

Objectives:

We aimed to evaluate clinical and laboratory characteristics, disease outcome and biologic responses of patients with FMF+SpA compared to patients with only SpA who were followed-up in our tertiary referral center.

Methods:

Database of FMF Clinic was screened for FMF patients with coexistent SpA and 113 patients were identified fulfilling Tel Hashomer and ASAS criteria for FMF and SpA, respectively. A group of patients with SpA without FMF matched for age, gender and disease duration were selected as the control group.

Results:

Thirteen patients were excluded because of missing data, and 100 patients (F/M: 52/48) were included into the analysis. Mean follow-up time was 93.6 ± 77 (range[r]: 3-324) months and mean patient age was 43.3 ± 12 (r: 20-87) years. Mean age of onset for FMF was 12.5 ± 8 (r: 1-36) and for SpA was 25 ± 11 (r: 7-72) years. SpA findings was classified as axial in 35.4%, axial and peripheral in 47.9% and only peripheral in 16.7% in FMF+SpA group. Half (49%) of the patients had hip involvement (70% bilaterally), and 21.5% of them needed total hip joint replacement (TJR), which were significantly more frequent compared to control group. Two exon 10 MEFV variants were found in 69.4%, and most (69.8%) had homozygous M694V. Hip involvement was more frequent in patients with two exon 10 variants (p=0.036; OR=4.4) compared to those with one variant; and TJR was more frequent in those with homozygous M694V compared to other exon 10 variants (p=0.001; OR=10). Radiographic sacroiliitis was less frequent in patients with homozygous M694V (p=0.019; OR=5.48). HLA-B27 positivity was not associated with hip or axial involvement in patients with FMF+SpA.

Biologics were used in 60 patients (anti-TNF in 43, secukinumab in 1, and tocilizumab in 2). Anti-IL-1 drugs were used in 23 patients for refractory FMF. In 9 patients, anti-TNF and anti-IL-1 drugs were tried for refractory joint involvement: 5 switched to anti-TNFs from anti-IL-1, 4 patients switched to anti-IL-1 from anti-TNFs. Biologic DMARD requirement was more frequent in patients with two exon 10 variants (p=0.006; OR=7.4), especially in those with homozygous M694V (p=0.006; OR=7.6). Although anti-IL-1 usage did not differ among MEFV variants, anti-TNF was used more frequently in patients with homozygous M694V (p=0.007; OR=7.2). FMF+SpA patients had higher serum CRP and developed amyloidosis more frequently than those patients with SpA.

Table 1.

Comparison of clinical and laboratory findings between the patients with FMF+SpA and SpA control

FMF + SpA (n=100)SpA (n=217)P valueAge (years)*43.3 ± 1243.4 ± 110.6Sex (n, %) Male48104 (47.9)0.99 Female52113 (52.1)Duration of SpA (monnths)*181.6 ± 108180.2 ± 1120.8Age onset of SpA (years)*25.1±1128.4±80.008Peripheral arthritis (n, %)35/80 (43.8)79/212 (37.3)0.3HLA-B27 positivity (n, %)6/21 (28.6)105/139 (75.5)<0.001 (OR=18.9)CRP (mg/dL)*26.7 ± 25**18.96±290.001ESR (mm/hour)*39.7 ± 2739.4 ± 280.8Hip involvement (n, %)47/96 (49)23/118 (19.5)<0.001 (OR=20.9)TJR (n, %)20/93 (21.5)8/205 (3.9)<0.001 (OR=23.3)Fulfilling mNY criteria (n, %)52/81 (64.2)164/199 (82.4)0.001 (OR=10.8)Biologic DMARD (n, %)6068/214 (31.8)<0.001 (OR=22.5)Anti-TNF (n, %)4668/214 (31.8)0.015 (OR=5.96)Amyloidosis (n, %)165/205 (2.4)<0.001 (OR=19.3)

* mean±standard deviation, **during the attack-free period

Conclusion:

In this group of FMF+SpA patients, hip involvement and need for TJR were more frequent and associated with penetrant MEFV variants rather than HLA-B27 positivity. These patients had higher inflammatory response and risk of developing amyloidosis, and they needed biologics more frequently compared to SpA group. More severe disease course in FMF+SpA patients requires further attention and analysis in larger cohorts.

Disclosure of Interests:

None declared

Austrian Pinot blanc wines: Typicity, wine styles and the influence of different oenological decisions on the volatile profile of wines

Pinot blanc is found in all wine regions of Austria. However, it plays an economically subordinate role compared to the most important white grape variety, Grüner Veltliner. The concept of wine typicity and terroir is that the geographical origin and oenological practices, along with the grape variety, make an important contribution to the final expression of the finished wine. The purpose of this study was to discuss different styles of Austrian Pinot blanc wines and to discuss the various wine production decisions in terms of wine stylistics and aromatic profile. 131 commercial Austrian wine samples of the Pinot blanc variety of the 2015 to 2017 vintages were collected and the manufacturer's practices were determined by means of a questionnaire related to the wine styles. Using various GC-SIM-MS methods, more than 100 essential volatile substances were quantified. A trained panel, an expert panel and consumers evaluated the wines based on typicity and quality. 15 typical wines were then assessed on a sensory basis by means of predetermined aroma and wine styles. The four Austrian Pinot blanc wine styles previously discussed and presented by the same authors (citrus (1st style), green apple and green pear (2nd style), ripe yellow apple, quince, cooked pear, bread and honey notes (3rd style), as well as intensive oak notes (4th style)) were able to be partially reproduced by the trained panel. The following three wine styles could be better understood by the consumers: fresh fruity (style A), complex aroma with or without moderate wood (style B) and lots of wood aroma (style C). These styles (A–C) were able to withstand a sensory examination and a discriminant analysis by substance. An oenological guideline could help the producers to achieve the respective style. Austria's wine-growing area is probably too small and the importance of the Pinot blanc variety for the individual areas still too low to support the terroir concept for this grape variety.

Retrograde intrarenal surgery for stone disease under spinal anaesthesia, a minimally invasive technique. A retrospective analysis of 1,467 cases

INTRODUCTION AND OBJECTIVES

The aim of the present study was to compare RIRS procedures applied under general anaesthesia (GA) and spinal anaesthesia (SA) regarding success and complication rates.

MATERIALS AND METHODS

A retrospective evaluation was conducted with the data obtained from patients treated with RIRS under SA and GA at 2centres from October 2014 until January 2018. The SA and GA groups were evaluated according to the parameters of stone-free and complication rates, postoperative pain control and length of in-hospital stay. The stone-free rates from the RIRS procedures applied with SA were evaluated by the surgeons who participated in the study.

RESULTS

A total of 1361 patients were included in the study. A stone-free rate of 84.4% was obtained in the global results: 85.3% in the SA group and 83.5% in the GA group (P=.364). No statistically significant difference was determined regarding surgeons who practiced RIRS under SA with respect to success/complication rates and operating time (P=.676). Operating time was determined as 44.2±14.2 mins in the SA group and 49.7±19.1 mins in the GA group (P=.014).

CONCLUSIONS

The RIRS method can be applied safely, either under spinal anaesthesia, or under general anaesthesia. The success of RIRS under spinal anaesthesia has been shown as an independent factor regarding surgeon. It can be considered a good alternative to general anaesthesia.

Non-HACEK Gram-negative bacillus endocarditis

PATIENTS AND METHODS

Retrospective analysis of clinical data using 26 diagnosed non-HACEK Gram-negative infective endocarditis cases from nine hospitals in Turkey.

RESULTS

Mean age of patients was 53 (28-84) years, with a 23% case fatality. Nineteen (73%) of the 26 patients had at least one predisposing factor. The presence of a central venous catheter was the most common predisposing factor (7/26 patients). Pseudomonasaeruginosa (7/26 patients) and Escherichiacoli (7/26 patients) were the most common pathogens. The median duration of the antibiotic therapy was 42 days (range 3-84 days). Surgical procedures were performed in 10 patients. The case fatality was similar in patients who did or did not undergo surgery (20% vs. 25%).

Changes in the inflammatory markers with advancing stages of diabetic nephropathy and the role of pentraxin-3

BACKGROUND

Immunological and inflammatory mechanisms have been shown to have role in both the development and progression of diabetic nephropathy (DNP). There is need for more specific markers for inflammation as the ones commonly used are influenced by many factors. Pentraxin-3 (PTX-3) seems to be a potential candidate. We aimed in our study to evaluate the changes of PTX-3 levels in different stages of DNP and its relationship with other inflammatory markers.

METHODS

This is a cross sectional study in which patients with DNP at different stages were involved. Patient were divided into three groups according to estimated glomerular filtration rate (eGFR), microalbuminuria and proteinuria levels: Group-1: eGFR >60 mL/min and microalbuminuria, Group-2: eGFR >60 mL/min and macroalbuminuria, Group-3: eGFR <60 mL/min and macroalbuminuria. Besides the routine biochemical parameters, levels of PTX-3, high sensitivity C-reactive protein (hsCRP), interleukin (IL)-1 and tumor necrosis factor (TNF)-α was measured. Groups were compared with each other regarding the study parameters and correlation of PTX-3 with other markers was evaluated.

RESULTS

The mean PTX-3 level in Group-2 (0.94 ± 0.26 ng/mL) and -3 (1.35 ± 1.55 ng/mL) were higher than in Group-1 (0.81 ± 0.25 ng/mL) (p = 0.009 and p = 0.012). There was a significant correlation of PTX-3 with proteinuria (r = 0.266, p = 0.016), microalbuminuria (r = 0.304, p = 0.014) and hypoalbuminemia (r = 0.197, p = 0.043). PTX-3 was not correlated with other markers of inflammation (IL-1, TNF-α and hsCRP) and diabetic metabolic parameters (hbA1c, C-peptide, insulin and HOMA-IR). PTX-3, IL-1 and TNF-α levels increased with the advancing stage of DNP while hsCRP level did not change.

CONCLUSION

PTX-3 that increases similar to other markers of inflammation (IL-1, TNF-α) is a better inflammatory marker than hsCRP. Furthermore, there is a relationship between PTX-3 and proteinuria independent from eGFR.

Treatment of horizontal root fractured central incisors and 30 months follow up: 2 case reports

BACKGROUND

Horizontal root fractures are rare in comparison to other types of injuries and according to the literature account for between 0.2%?7% of all traumatic tooth injuries.

CASE REPORTS

Case 1: A 12-year-old girl was referred to our clinic with a complaint of tenderness and mobility as a result of an orofacial injury in her permanent upper left central incisor. A horizontal fracture was diagnosed on the middle third of the root during radiographic examination. Case 2: A 12-year-old boy was referred to our clinic with an injury to his upper left central incisor. During radiographic examination a horizontal fracture was diagnosed on the middle third of the root. Semi-rigid splints were applied to the teeth for 4 weeks without further treatment in both of the cases and they were followed-up for 30 months. At the end of the 30th month, the teeth were vital and they had no clinical signs nor symptoms. Also the radiographic examination showed healing with hard tissue in the fracture line for both of the cases.

CONCLUSION

Using semi- rigid splints without any further treatment resulted with hard tissue healing in both of the cases and was successful for the treatment of horizontal root fractures.

Pentraxin 3 and C-reactive protein as inflammatory markers after a kidney transplant

OBJECTIVES

There are numerous changes in inflammatory status that occur after a kidney transplant. Pentraxin 3 is a marker of inflammation, but little information is available about pentraxin 3 levels after a kidney transplant. We evaluated the relation between pentraxin 3 and other inflammatory markers including high sensitivity C-reactive protein, interleukin 6, and tumor necrosis factor alpha in kidney transplant recipients.

MATERIALS AND METHODS

Adult patients (40 patients; aged, 18-80 y; mean age, 38 ± 10 y) who had a kidney transplant from living-related donors were studied. Patients who had comorbidities associated with chronic inflammation were excluded. Blood samples were obtained before starting immunosuppressive treatment and 2 months after kidney transplant for measurement of pentraxin 3, high sensitivity C-reactive protein, interleukin 6, and tumor necrosis factor α levels.

RESULTS

After transplant, mean levels of high sensitivity C-reactive protein and interleukin 6 decreased but levels of pentraxin 3 and tumor necrosis factor alpha did not change. There were significant correlations between interleukin 6 and high sensitivity C-reactive protein before transplant (r = 0.71; P ≤ .0001) and after transplant (r = 0.45; P ≤ .003). There was no correlation between tumor necrosis factor alpha and high sensitivity C-reactive protein before transplant, but there was a significant correlation between tumor necrosis factor alpha and high sensitivity C-reactive protein after transplant (r = 0.36; P ≤ .03). There was no correlation between interleukin 6 and pentraxin 3, tumor necrosis factor alpha and pentraxin 3, or high sensitivity C-reactive protein and pentraxin 3 before or after transplant.

CONCLUSIONS

After a kidney transplant, pentraxin 3 may not be useful in determining inflammatory status, and high sensitivity C-reactive protein may be better than pentraxin 3 as a marker of inflammation.

Congenital myasthenic syndrome: a case report

Congenital myasthenic syndromes (CMS) are diseases of the neuromuscular junction. They usually belong to the disease groups that begin in the infantile or childhood period and carry genetic characteristics. The following is important in establishing the diagnosis of this disease: clinical findings, electromyography, genetic tests, determination of serum acetylcholine receptor antibodies. Acetylcholine esterase inhibitor drugs are used in treatment of CMS. A seven-month old male patient was brought to our department with the complaints of difficult breathing, falling of the eyelids and swallowing difficulty. With clinical and laboratory findings, he was diagnosed with congenital myasthenia and treatment was started. CMS should be suspected in patients with no pathological findings on the physical examination, and normal chest X-rays.

Cancer-related false knowledge in relatives of cancer patients and the general public

PURPOSE

Although there are many myths about cancer in Turkey, there is no study evaluating Turkish public's knowledge about cancer. The goals of our research were to: 1) measure the extent of knowledge of cancer among the Turkish public; 2) determine the differences in extent of cancer-related knowledge between participants who have relatives with cancer and those who do not; and 3) determine the sources of knowledge possessed.

METHODS

Data were obtained from a total of 415 participants (244 female, 171 male), all of them sitting at the Marmara University Faculty of Medicine Hospital (MUFMH) outpatient clinic waiting area for non-cancer-related reasons. Each participant completed a 3-part questionnaire. Appropriate statistical tests were used for comparison.

RESULTS

The mean age was 41 years. Of 415 participants, 65.3% stated that they had one or more cancer patient in their immediate family; 70.1% of the participants had a high-school education or greater. The questionnaire showed that, depending on the question, anywhere from 1.7% to 88.5% of the general public possesses some false information; furthermore, the difference in accuracy between relatives of cancer patients and non-relatives was marginal. Only 3 specific questions, related to the following ideas, rendered answers that were statistically significantly different between these 2 groups: breast cancer is only seen in females (p <0.005), cell phones cause cancer (p <0.001), and cancer is always very painful (p <0.001).

CONCLUSION

The proportion of false knowledge about cancer was unacceptably high in our cohort. Broader efforts should be made to inform the Turkish public about cancer.

The effect of formocresol on bond strength of adhesive materials to primary dentine

The aim of this study was to evaluate the effect of formalin cresol on bonding of two compomers (Prime & Bond and Dyract, Futurabond and Glasiosite to primary dentine. Eighteen non-carious primary mandibular molar teeth were used. The two materials were placed onto the tooth surfaces before being sheared with a knife-edged blade with a crosshead speed of 1 mm min(-1). Two randomly selected teeth from each group were evaluated by scanning electron microscopy (SEM). The statistical analysis (paired t-test and Student's t-test) revealed that shear bond strength was significantly higher in the formocresol-applied group than in the group that was not applied formocresol (P < 0.05), but there was no significant difference between the restorative materials. SEM analyses also supported the results obtained. In conclusion, if compomers are used after endodontic processes which require the application of formocresol in primary teeth, dentinal bonding would not be decreased, but on the contrary, increase.

Color Doppler sonography in cold thyroid nodules for malignancy prediction

The aim of the present study was to assess the usefulness of thyroid nuclear medicine studies, fine needle aspiration biopsy (FNAB) and color doppler sonography in the evaluation of thyroid nodules. Our study group consists of 81 patients with a solitary hypoactive thyroid nodule or with multinodular goiter having dominant nodule. Perinodular and intranodular blood flow, diameter of inferior thyroid artery and its flow velocity were the parameters measured by color doppler sonography. Also estimation of arterio-venous (A-V) shunt formation was another important parameter indicating the angioneogenesis. Results were not significant to distinguish the malignant and benign thyroid nodules (p > 0.05); 66% (n: 14) of 21 patients who had A-V shunt, had the final diagnosis of thyroid carcinoma. These data revealed sensitivity, specificity, negative and positive predictive values of color doppler sonography in carcinoma diagnosis among the patients with solitary hypoactive nodules or multinodular goiters having dominant nodule, as corresponding: 66%, 100%, 83% and 100%. In conclusion, arterio-venous shunt detected with color doppler sonography was the only parameter having high predictive value for malignancy. Recent studies on this topic imply that color doppler sonography will take place in algorithm of thyroid nodule evaluation.

The relationship between occlusal factors and bruxism in permanent and mixed dentition in Turkish children

The aim of this study was to investigate the relationship between occlusal factors (overjet, overbite, Angle's Classification of molars and cuspids, the relationship of the primary molars, openbite, lateral openbite, scissorbite and crossbite) and bruxism in permanent and mixed dentition in Turkish children. For this reason 182 children with mixed dentition and 212 children with permanent dentition were included in this study. Occlusal conditions were examined clinically and bruxism was assessed by using interview and questionnaires. Z Test was used to compare the results. It was found that in both dentitions some occlusal factors related with bruxism (overjet > 6 mm, overbite > 5 mm, negative overjet, openbite in permanent dentition; overjet > 6 mm, overbite > 5 mm, scissorbite, anterior-posterior multiple teeth crossbite, Angle Class I occlusion in mixed dentition.

Investigation of the relationship between oral parafunctions and temporomandibular joint dysfunction in Turkish children with mixed and permanent dentition

The purpose of this study was to investigate the relationship between temporomandibular joint (TMJ) dysfunction, bruxism and oral parafunctions in the permanent and mixed dentition of Turkish children. Examinations were performed on 59 children (26 girls and 33 boys) without TMJ dysfunction and 123 children (54 boys and 69 girls) with TMJ dysfunction in the mixed dentition. In the permanent dentition 89 children without TMJ dysfunction (45 girls and 44 boys) and 123 children with TMJ dysfunction (69 girls and 54 boys) were inducted into this study. The children with oral parafunctions (bruxism, nail biting and thumb/finger sucking) were determined through questionnaires. The Z-test was used for the analyses of the correlation between variables and differences between the groups. Generally a significant correlation was found between finger/thumb sucking and nail biting and TMJ dysfunction in the mixed dentition and bruxism was observed significantly to be associated with TMJ dysfunction in the permanent dentition (P < 0.05). The evaluation of the results showed that in the mixed dentition groups nail biting was significantly higher in the girls with TMJ dysfunction and finger or thumb sucking was significantly higher in the boys with TMJ dysfunction compared with those without TMJ dysfunction (P < 0.01). In the permanent dentition; bruxism and thumb/finger sucking were significantly higher in girls with TMJ dysfunction higher than those without TMJ dysfunction (P < 0.05). However, thumb/finger sucking was significantly higher in boys without TMJ dysfunction than with TMJ dysfunction (P < 0.05). The results of this study showed that the association of parafunctions and TMJ dysfunction is present in the mixed (thumb/finger sucking and nail biting) and the permanent dentitions (bruxism).