No abstract

The objective of this paper is to examine the relationship between fetal asymmetry measured sonographically and the incidence and severity of shoulder dystocia in diabetic patients. Ultrasound data were collected retrospectively from examinations of women with gestational and pregastational diabetes who delivered at University of California, Irvine Medical Center from 1993-1995. Sonographic fetal asymmetry was quantified by calculating the difference between the abdominal diameter and the biparietal diameter in centimeters (AD-BPD). The residual AD-BPD was a patient's actual AD-BPD at the time of the ultrasound minus the mean AD-BPD obtained in our population at the patient's gestational age. The correlations between fetal asymmetry and the incidence and severity of shoulder dystocia were assessed using an analysis of variance as well as a logistic regression analysis. Mild shoulder dystocia was defined as a delivery requiring McRobert's maneuver and/or suprapubic pressure, while severe shoulder dystocia was assessed when delivery of the posterior arm with Wood's corkscrew maneuver was required. One hundred twenty-three women met the inclusion criteria for the study. Dividing the cohort into three groups based on AD-BPD residual values resulted in the following AD-BPD residual ranges and incidences of shoulder dystocia: Group I, -1.80 to -0.32 cm (9.8%), Group II, -0.31 to 0.32 cm (19.5%), and Group III .33 to 2.0 cm (34.1%), (p <0.03). The residual AD-BPD difference correlated with the incidence of shoulder dystocia after controlling for maternal age, weight, parity, birth weight, and the gestational age at ultrasound (P <0.03). Similar results were found with regards to dystocia severity as the mean residual AD-BPD difference between those with no dystocia, mild dystocia, and severe shoulder dystocia was -0.09, 0.23, and 0.46 cm, respectively, (p <0.006). The residual AD-BPD correlated with the severity of shoulder dystocia after controlling for the above-mentioned confounding variables (p <0.05) in a regression analysis. There is a direct correlation in diabetic patients between the level of fetal truncal asymmetry measured sonographically and the incidence and severity of shoulder dystocia.

Data on the effect of HLA-A and HLA-B matching between unrelated donors and recipients focus mainly on graft survival. After linking the follow-up data of the European Dialysis and Transplant Association and those of the Eurotransplant Foundation, the effect of HLA-A and HLA-B matching on recipient survival could be studied. Recipients of well-matched kidneys--i.e., without mismatches for the HLA-A and B antigens--had 51 per cent graft survival at five years, whereas recipients of grafts mismatched for four antigens had 32 per cent graft survival at five years. The overall P value between the five different mismatch classes was 0.0005. Patient survival at five years was 72 per cent in recipients of a kidney without HLA-A and B mismatches and 54 per cent in recipients of a completely mismatched donor kidney (overall, P = 0.001). These results suggest that matching for the HLA antigens has a beneficial long-term effect not only on renal-allograft survival but also on patient survival.

BackgroundMitochondrial disease (MD) is a heterogeneous group of disorders characterized by impaired energy production caused by abnormal oxidative phosphorylation. Diagnosis of MD is challenging given the variability in how the disease can affect an individual’s neurologic, cardiovascular, ophthalmologic, or gastroenterological systems. This study describes the health care utilization and cost in patients diagnosed with MD.MethodsThis study was a retrospective claims analysis based on data from the Truven Health Analytics MarketScan Database and Milliman’s Consolidated Health Cost Guidelines Sources Database. For the purpose of this study the diagnosis of MD was defined by ICD-9-CM (prior to October 2015), and ICD-10-CM (October 2015 or later), and included patients identified between January 1, 2008 to December 31, 2015. ICD-9-CM code of 277.87 (disorders of mitochondrial metabolism) and the ICD-10-CM codes of E88.40, E88.41, E88.42 and E88.49 (mitochondrial metabolism disorders) were used as inclusive criteria. Patients were included if they had at least six months of exposure after the first MD-related claim occurrence, and either one MD claim in the inpatient setting OR two MD claims in an outpatient setting. Claims of MD patients are compared to those of a general insured total member population, as well as to those from multiple sclerosis (MS) and amyotrophic lateral sclerosis (ALS) patients.ResultsDuring the study period, 3825 patients between the ages of 0 and 15 (pediatric) and 4358 patients 16 years of age and greater (adult) were identified. Total allowed per member per month (PMPM) cost for pediatric patients was $4829 and $3100 for adults, compared with an average of $202 and $486, respectively, for the total member population. The greatest drivers of costs based on allowed claims came from inpatient, surgery, and prescription medications. In the adult population, MD imposes a PMPM cost burden that was comparable to that observed for multiple sclerosis ($3518) and ALS ($3460) patients.ConclusionsThis retrospective claim study highlights the significant differences in the cost of medical care for MD patients compared to those of a general population. Mitochondrial disorders are associated with multisystem disease manifestations and a greater care and cost burden similar to other devastating neuromuscular diseases.