Borderline Levels Research Articles

PECULIARITIES OF THE COURSE OF COVID-19 IN SCHOOL-AGE CHILDREN AS A FUNCTION OF HUMORAL IMMUNITY AGAINST PERTUSSIS

Coronavirus disease remains one of the most serious diseases in the world. The percentage of severe and fatal cases inchildren is lower than in adults. The search for biomarkers of disease severity continues. There is evidence of heterologousimmunity between the causative agent of coronavirus infection and some other infectious agents. Both Bordetella pertussis and SARS-CoV-2 cause damage to the respiratory system. It should be noted that the incubation period and transmission mechanism are similar for these two microorganisms. Pertussis vaccinations are given in childhood.The purpose of the study is to fi nd the charcteristics of the course of COVID-19 in school-aged children depending on thestate of humoral immunity against pertussis toxin, assessing their level of immunoglobulin G against pertussis.Material and methods. 92 pediatric patients aged 6 to 17 years were studied, including 30 children without signs of thedisease in the control group and 62 children with manifestations of laboratory- confi rmed COVID-19. The clinical features of the disease and laboratory indicators (C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cells, D-dimer) were evaluated, as well as the levels of free salivary cortisol and vitamin D. According to the severity of the disease, 3 groups were formed: the fi rst – 20 children with a mild course of COVID-19, the second – 33 patients with a moderate course of the disease, the third – 9 with a severe course of the disease.All children were tested for immunoglobulin G (Ig G) to pertussis toxin by enzyme- linked immunosorbent assay (VIROTECHB. pertussis PT Ig G ELISA, Rüsselsheim, Germany). The result was considered negative (no increase in the titer of specifi c class G antibodies to pertussis toxin), borderline, and positive (there is an increase in the titer of immunoglobulin G to pertussis toxin). Statistical analysis was performed using the program «Stat Plus» (Shapiro- Wilk test, mean  SD (standard deviation) with correct distribution of characteristics; median, upper and lower quartiles with incorrect distribution, Chi-square test, Man-Whitney test, Fisher’s test).The study was conducted in accordance with the rules of patient safety and ethical principles of scientifi c medical researchinvolving human subjects (2000). The permission to conduct this study was given by the Bioethics Commission (Protocol No. 61 of 13.11.2020). The parents (legal representatives) of the patients gave their written consent to the conduct of this study.This study is a fragment of research work «An Integrated Approach to Symptom Control, Long- Term Prognosis in the Context of Comorbid Pathology in the Clinic of Internal Diseases and Family Doctor Practice» (state registration No. 0118U000361).Results. The mean age of the patients was 11.573.82 years. The study groups did not diff er in sex (x2=4.97, p=0.174) andage (p=0.490) composition. The level of humoral immunity against pertussis toxin diff ered signifi cantly between the study groups. A positive and borderline result for the presence of specifi c immunoglobulin G to tetanus toxin was found in 75.86 % of children without signs of disease. At the same time, only 41.51 % of children with COVID-19 manifestations had a positive and borderline result (p=0.005). A positive and borderline result for the presence of specifi c immunoglobulin G to tetanus toxin was seen in 66.67 % of children with mild infection, 33.33 % of patients with moderate disease, and only 12.50 % of patients with severe disease (X2=16.91, P=<0.001).Children with a negative result for immunoglobulin G to pertussis toxin have signifi cantly higher WBC count (1.3-fold), ESR(2.4-fold), D-dimer (3.4-fold), and CRP (1.5-fold) compared to patients with positive and borderline levels of these antibodies.In children with a negative result, there was a 6.25-fold increase in salivary free cortisol (p<0.001) and a 2.0-fold decrease invitamin D levels (p<0.001).Conclusions. In children with COVID-19 manifestations, there was a signifi cantly higher percentage of negative test resultsfor the presence of IgG to pertussis toxin compared to the control group, indicating a lower level of humoral immunity to tetanus in this group of patients. In children with mild disease, there was a signifi cantly higher percentage of positive and borderline test results for the presence of IgG to pertussis toxin (indicating a higher level of humoral immunity against this pathogen) compared to the groups of children with moderate and severe disease. The absence of specifi c immunoglobulins G to pertussis toxin is associated with an increase in the level of pro-infl ammatory markers (leukocyte count, ESR, CRP) and D-dimer, which also indicates a more severe course of COVID-19. Patients who are negative for pertussis toxin antibodies have elevated cortisol levels as a marker of stress and decreased vitamin D levels. Both biologically active substances are involved in the immune response to infectious agents and may serve as additional non-specifi c markers of COVID-19 severity. Therefore, low humoral immunity to pertussis contributes to the increase in COVID-19 severity in childhood.

“Impact Of Metformin Therpy on Serum Cobalamin and Homocysteine Among the Type II Diabetes Mellitus Patients”

Objective: The aim of the study is to observe the long-term treatment of metformin and its associated effect on Vitamin B12 among Type II Diabetes mellitus south Indian patients. Methods: An observational study conducted over a period of 54 months on Type II Diabetes mellitus patients who are in chronic therapy with metformin. The study described the Vitamin B12 levels among the Type II DM patients, which could alert the patients who are in the low and borderline range of serum Vitamin B12, which may prevent the risk of peripheral neuropathic complications and anaemic conditions, etc. Findings: Totally, 387 patients were enrolled as per the inclusion and exclusion criteria, including 232 males (59.94%) and 155 females (40.05%). A total of 39 patients had been observed to have low levels of Vitamin B12, among them 23 females (Mean 184.17 ± S.D. 10.69) and 16 males (Mean 185.31± S.D 7.56), followed by 16 patients found to be above the normal range of Vitamin B12, among them 02 females (Mean 991 ± S.D. 15.55) and 14 males (Mean 1578.14 ± S.D. 406.93), followed by 76 patients had been found to be borderline of Vitamin B12, among them 43 females (Mean 220.76 ± S.D 6.50). Conclusion: High doses of chronic Metformin therapy may alter Vitamin B12 levels. Some of the patients had an abnormally high level of serum Vitamin B12, whose medical condition should be ruled out, and such Patients’ diet histories were also cross-examined, which was a mixed normal diet, and they had various medical conditions. However, the high chances of metformin-associated effects on Vitamin B12 with higher doses and long-term therapy of metformin, whose duration was 10 to 20 years, Moreover, age is also an important factor, and the study reveals that, among genders, female populations had a higher rate of low-level Vitamin B12 than male populations. Patients in the age group between 50 and 65 years had a higher rate of low-level Vitamin B12 than other age groups, total 20 patients, among them 12 females (Mean 183.08 ± S.D. 13.17) and 8 males (Mean 185.5 ± S.D. 4.3). Patients with other comorbid conditions also had low levels and borderline levels of Vitamin B12 and had been on long-term metformin therapy. Further, homocysteine investigations had been done on low and borderline vitamin B12 patients. Investigation of homocysteine had been done on low range (39) and border line (76) of vitamin B12 patients. Among Low vitamin B12, 13 patients have elevated level of Homocysteine (6 males & 7 females). Among border line of vitamin B12, 4 patients (2 males and 3 females) have elevated level of Homocysteine. Therefore, our study concluded that chronic therapy and higher doses of metformin may lead to a deficit in serum Vitamin B12, which requires regular checks on Vitamin B12 among Type 2 DM patients to avoid the risk of Peripheral neuropathy and other complications.

Examining the Bidirectional Associations Between Sleep Duration, Screen Time, and Internalizing Symptoms in the ABCD Study

PurposeThe likelihood of meeting sleep duration and screen time guidelines decreases as children develop toward adolescence. Simultaneously, the prevalence of internalizing symptoms increases. The purpose of this paper was to examine the bidirectional associations between sleep duration and screen time with internalizing symptoms in a one-year longitudinal study starting in late childhood. MethodsParticipants were 10,828 youth (47.8% female) enrolled in the Adolescent Brain Cognitive Development Study. At baseline (mean age 9.9 years) and one-year follow-up (mean age 10.9 years), youth self-reported screen time for weekdays and weekend days. Responses were separately dichotomized as >2 versus ≤2 hours/day (meeting behavioral guidelines). Caregiver-reported youth sleep duration was dichotomized as <9 versus 9–11 hours/night (meeting behavioral guidelines). Caregivers reported internalizing symptoms via the child behavior checklist. The withdrawn/depressed, anxious/depressed, and somatic symptom child behavior checklist subscale t-scores were separately dichotomized as ≥65 (borderline clinical levels of symptoms and above) versus <65. Analyses were gender-stratified. ResultsIn females, longer baseline sleep duration was protective against withdrawn/depressed symptoms (odds ratio [OR] 0.6, 95% confidence interval [CI] 0.4–0.8) and somatic complaints (OR 0.8, 95% CI 0.6–0.97) one year later. In females, greater baseline weekend screen time was associated with increased risk of withdrawn/depressed symptoms (OR 1.6, 95% CI 1.1–2.2) one year later. No other significant associations were observed. DiscussionLongitudinal associations between sleep duration, weekend screen time, and internalizing symptoms were unidirectional (behavior preceding internalizing symptoms), among females only, and specific to withdrawn/depressed and somatic symptoms. These prospective study findings warrant attention and inform future research in this cohort.

Exploring the use of Skylight, a spiritual self-care mobile app for mental health, sleep, and spiritual well-being among Gen Z and young Millennials: a cross-sectional survey .

Gen Z and young Millennials (ages 18-35) are unique in that they either have no memory of or were born shortly after the internet "explosion." They are constantly online, face significant challenges with their mental health (depressive symptoms, anxiety, stress) and sleep, and are frequent users of digital wellness apps. Gen Z and young Millennials also uniquely identify with and practice spirituality, which has been linked to better mental health and sleep in adult populations. Research has not examined digital approaches to spiritual self-care and its relationship to mental health and sleep in Gen Z and young Millennials. The purpose of this study was to describe a sample of adult Gen Z and young Millennials who use a spiritual self-care app (i.e., Skylight), describe how users engage with and perceive the app, and assess the relationship between frequency of using the app with mental health, sleep, and spiritual well-being. Participants were 475 adult Gen Z (ages 18-28) and young Millennial (ages 29-35) Skylight app users who responded to an anonymous survey online. The survey asked about demographics, spiritual self-care and practice, and user engagement and perceptions of the app. Outcome measures included four validated surveys for mental health (i.e., depression, anxiety, stress) and sleep disturbance, and one validated survey on spiritual well-being. Mean scores were calculated for all measures, and linear regressions were conducted to examine the relationship between frequency of app use and mental health, sleep, and spiritual well-being outcomes. Participants were predominantly White (68.2%), female (53.7%), and approximately half Gen Z (54.5%) and half young Millennials (45.3%). Most users engaged in spiritual self-care (84%) and said it was important/very important to them (92%). Users downloaded the app for spiritual well-being (30%) and overall health (26.3%). Users had normal, average depressive symptoms (6.9/21) borderline abnormal anxiety levels (7.7/21), slightly elevated stress (6.7/16) and non-clinically significant sleep disturbance (5.3/28). Frequency of app use was significantly associated with lower anxiety (moderate use, β= -2.01, P=.02; high use, β= -2.58, P<.001). There were no significant relationships between frequency of app use and mental health, sleep, and spiritual well-being outcomes except for the personal domain of spiritual well-being. This is the first study to describe a sample of adult Gen Z and young Millennials who use a spiritual self-care app and examine how frequency of app use is related to their mental health, sleep, and spiritual well-being. Spiritual self-care apps like Skylight may be useful in addressing anxiety among Gen Z and young Millennials and be a resource to spiritually connect to their personal spiritual well-being. Future research is needed to determine how a spiritual self-care app may benefit mental health, sleep, and spiritual well-being in adult Gen Z and young Millennials.

Rare Case of Chronic Limb-Threatening Ischemia in a 32-Year-Old Patient with Nephrotic Syndrome: A Case Report

AbstractChronic limb-threatening ischemia represents the end stage of peripheral artery disease (PAD), primarily affecting individuals over 60 years old. While quite rare, nephrotic syndrome (NS) is recognized for increasing the susceptibility to arterial thromboembolism (ATE). A 32-year-old male complained of resting pain in his left leg and pain after walking 50 meters with his right leg. He had a 9-year history of NS confirmed through biopsy and was on a daily regimen of 2 × 360 mg mycophenolic acid and 1 × 8 mg methylprednisolone. He had no history of hypertension, diabetes, or smoking. Atrophy and ulcers were observed on his left leg. Laboratory tests revealed elevated D-dimer and borderline high cholesterol levels. The right ankle-brachial index was 0.5, and for the left, it was 0.33. Computed tomography angiography identified occlusion in the left external iliac artery and right superficial femoral artery (SFA). The patient underwent percutaneous transluminal angioplasty with a plain balloon on both legs and an additional drug-eluting stent on the left SFA. He was discharged on rivaroxaban, clopidogrel, aspirin, simvastatin, mycophenolic acid, and methylprednisolone, with no complaints. The mechanism behind NS-caused ATE remains unclear, although it is associated with the loss of anticoagulants in urine, increased procoagulant activity, altered fibrinolytic systems, thrombocytosis, and enhanced platelet activation. Prolonged corticosteroid therapy in NS management also amplifies the risk of thromboembolism by promoting a hypercoagulable state. We suspected NS and the prolonged use of corticosteroids as risk factors for ATE, manifested as PAD in our patient. While optimal NS therapy may reduce the risk of PAD, prolonged corticosteroid use should be closely monitored.

Folate Deficiency: Is it Related to the Development of Depression

Objectives: To determine the frequency of serum folate deficiency among patients with depression and to compare mean serum folate levels with the severity level of depression.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Armed Forces Institute of Mental Health, Rawalpindi Pakistan, from Sep 2021 to Feb 2022.&#x0D; Methodology: We consecutively recruited 155 study subjects. Basic demographic data were recorded. The severity of depression was assessed using the Hamilton Depression Rating Scale–Urdu version (HAM-D U). Blood samples were collected to determine serum folate before commencing any treatment for depression; serum Folate levels were assessed at the Armed Forces Institute of Pathology.&#x0D; Results: The mean HAM-D score was 17.14±4.29, with minimum and maximum scores of 8 and 22. 97(62.6%) cases had mild– moderate depression, and 58(37.4%) patients had severe depression. The mean serum folate levels were 3.10±1.40 ng/ml. There were 57(36.8%) cases that had normal folate levels, 45(29%) cases that had borderline folate levels, and 53(34.2%) cases that had folate deficiency. The frequency of borderline folate deficiency was statistically higher in cases with severe depression, (p-value&lt;0.001).&#x0D; Conclusion: Results of this study highlight that the frequency of borderline–folate deficiency was statistically higher in cases with moderate and severe depression.

Dietary and Serum Antioxidants Associated with Prostate-Specific Antigen for Middle-Aged and Older Men.

High prostate-specific antigen (PSA) levels can indicate potential prostate problems and are a warning sign of prostate cancer. The impact of antioxidants on the PSA of generally healthy men is understudied. This study aims to evaluate 14 dietary and endogenous antioxidants associated with PSA levels for United States (US) men. We assessed 7398 men using the 2003-2010 US population-based National Health and Nutrition Examination Survey (NHANES). The PSA levels were categorized into three groups: Normal, borderline, and elevated levels. We performed analyses for middle-aged and older groups aged 40-64.9 and ≥65, respectively. The weighted multinomial regressions were performed to evaluate antioxidants associated with the PSA status. For results, 0.3% and 3.4% of middle-aged and older men, respectively, had elevated PSA (>10 ng/mL). Men with a higher serum albumin level had a lower risk of an elevated PSA, adjusting for age. The magnitude of albumin's impact on PSA is larger in middle-aged men than in older men (OR of elevated PSA = 0.82 and 0.90, respectively, interaction p = 0.002). Other antioxidants are not associated with PSA. Our findings support men with low serum albumin tend to have an elevated PSA level, so related interventions can be considered to decrease PSA for maintaining prostate health.

Psychological impact of COVID-19 vaccination in patients with cancer: The VACCINATE study.

e24207 Background: Measures adopted to contain COVID-19 may impact cancer pts' psychological well-being and clinical status. We assessed the psychological status and attitude towards COVID-19 vaccination in adult cancer pts who accepted vaccination at the University and Hospital Trust of Verona and Camposampiero Hospital in the Veneto region. Methods: A self-reported questionnaire was administered to pts undergoing the first and second dose of COVID-19 vaccination in the context of the vaccination campaign promoted by the Veneto Oncology Network (Rete Oncologica Veneta - ROV) between March and May 2021. Overall, 27 items were investigated: i) demographics/clinical characteristics; ii) psychological status (Hospital Anxiety and Depression Scale - HADS - and Distress Thermometer - DT); iii) awareness about infection risks, interference with anticancer treatments, and vaccine side effects. Results: Overall, only 2.5% of the invited active oncological population refused COVID-19 vaccination. Data collected in both Verona and Camposampiero (1089 and 286 respondents, respectively) demonstrated borderline and clinical levels of anxiety in 14% and 10% of pts, borderline and clinical levels of depression in 14% and 8% of pts; and moderate and severe distress levels in 33% and 9% of pts, respectively. No significant differences between the two sites and between the first and second dose were observed, with the exception of significantly lower levels of distress at the time of the second dose administration at the Camposampiero site. In the Verona cohort, clinical anxiety was significantly more frequent in breast cancer and rare tumor pts (17.5% and 21.4%, respectively; p= 0.005); no significant associations were found for depression and distress. Overall, there was high confidence that vaccination would reduce the risk of contracting COVID-19 (70%), which would make pts feel less worried about contracting the infection (60%); among pts with borderline and clinical depression levels, there was less confidence that vaccination would "make [them] feel less worried to contract COVID-19" ["Not at all" or "Only a little" in 16.2% and 20% of pts with borderline and clinical depression levels, respectively, as opposed to 6.6% among pts with normal depression levels (p = 0.005)]. Fear that vaccine-related side effects would interfere with anticancer treatment and/or global health status was low (10% and 9% for items 3 and 4, respectively) and significantly associated with baseline psychological status at multivariate analysis. Similar results were obtained in the Camposampiero cohort. Conclusions: During the COVID-19 vaccination campaign, adult cancer pts demonstrated high levels of confidence towards vaccination; baseline psychological status was the only significant predictor of reduced confidence.

Prevalence of hypercholesterolaemia in outpatient children aged 9-11 years.

The purpose of this study was to evaluate the importance of universal screening for dyslipidemia in children aged 9-11 years. An observational, descriptive, cross-sectional study was conducted from July 2021 to June 2022. A total of 532 children (279 girls and 253 boys) aged 9-11 years were enroled, and non-fasting blood samples were obtained to measure total cholesterol (TC) levels in the blood. The mean serum TC was 136.4±28.1mg/dl. Thirty-two children (6%) of the screened participants had abnormal TC levels; those were tested subsequently by fasting serum TC, and 19 children were confirmed as dyslipidemic (3.5%). The prevalence of borderline blood cholesterol levels (TC between 170 and 199mg/dl) was 2.6% CI 95% (2.2-3.2), and the prevalence of hypercholesterolaemia (TC ≥200mg/dl) was 0.9% CI 95% (0.5-1.4). A positive correlation was found between body mass index and blood cholesterol level. (r = 0.55, P =0.002). Universal non-fasting TC screening in children aged 9-11 years old is effective in detecting hypercholesterolaemia. Since the authors found that the positive family history as the sole basis for selective examination in children is insufficient.

Population Status of Vitamin B12 Values in the General Population and in Individuals with Type 2 Diabetes, in Southwestern Colombia.

Vitamin B12 (B12) is necessary for the proper functioning of the central and peripheral nervous systems. Although there is no exact definition for B12 levels, a value of 200 pg/mL is compatible with deficiency, 200-299 pg/mL is considered borderline, and 300 pg/mL is considered normal. In population studies, the prevalence of B12 deficiency ranges between 2.9% and 35%. Furthermore, many medications, such as metformin [for type 2 diabetes mellitus (T2DM)], can cause B12 deficiency. The objectives of this study were to determine the population status of B12 in southwestern Colombia (and the status of B12 in subjects with T2DM). In the total population (participants with and without T2DM), the prevalence of B12 deficiency was 17.8%; that of borderline was 19.3%; and that of normal levels was 62.9%. The prevalence of deficiency increased with age and was significantly higher in those aged ≥60 years (p = 0.000). In T2DM subjects, the prevalence of deficiency was significantly higher concerning those without T2DM (p = 0.002) and was significantly higher in those who received >1 gm/day of metformin (p = 0.001). Thus, the prevalence of deficiency and borderline levels of B12 in our population was high, particularly in those >60 years of age. B12 deficiency was significantly higher in individuals with T2DM than in individuals without T2DM, especially among those receiving high doses of metformin.

Utility of Class-Switched B-Cells in Diagnosing Common Variable Immunodeficiency

Measuring the relative quantity of peripheral blood class-switched CD27 +IgD- B-cells (CSBs) has previously been proposed as useful in the subclassification of CVID diagnoses. Perhaps incautiously, this practice has been adopted widely among clinical immunologists and has even been included as supportive diagnostic criteria for CVID. Existing research has also shown lower numbers of CSBs in CVID than in IgG deficiency; however, the diagnostic utility of CSBs was not evaluated and additional cohorts have not been studied. This study aimed to determine if low peripheral blood CSB numbers accurately differentiate CVID from other forms of humoral immunodeficiency.We performed a retrospective chart review of all patients at Children's Hospital of Colorado with 8-marker comprehensive B-cell panel results from the time of the panel's implementation in 2020. Inclusion criteria included: age ≥5 years and absolute CD19 B-cell measurement within 60 days of B-cell panel results. Subjects were assigned a diagnosis of CVID based on ICON criteria and by expert opinion when the workup was incomplete, such as in cases with borderline serum immunoglobulin levels or where polysaccharide antibody responses were not available. Patients that did not meet CVID criteria but were considered to have a humoral immunodeficiency based on immunoglobulin levels were separately categorized. Of the patients included (n = 64), 3 met all ICON criteria, 10 had a diagnosis by expert opinion, and 24 had a non-CVID immunological defect. Multinomial logistic regression accounting for age and sex demonstrated no significant association between absolute or percent CSB levels and whether the patient had a known or suspected CVID diagnosis; however, binary logistic regression indicated the odds of having any humoral immunodeficiency, including CVID, increased with decreasing CSB percentage (p = 0.026). Additionally, a linear regression between percent CSBs and in vivo serum IgG levels found a statistically significant relationship (p = 0.046), which has not been demonstrated previously. This observation is consistent with peripheral blood CD27+IgD- CSBs reflecting a person's general ability to class-switch to IgG production. Ultimately these findings suggest that CSBs may have utility as a general indicator of humoral immune disruption but are not an adequately specific metric in forming a CVID diagnosis.

Study of the Role of Cerebrospinal Fluid C-reactive Protein and Adenosine Deaminase to differentiate Various Types of Meningitis.

(1) To study cerebrospinal fluid (CSF) adenosine deaminase (ADA) and CSF C-reactive protein (CRP) levels in the differentiation of viral, pyogenic, and tuberculous meningitis (TBM). (2) To estimate the borderline levels of CRP in CSF in viral, pyogenic, and TBM. A prospective and cross-sectional study was conducted at the Department of Medicine, SRN Hospital, Prayagraj, Uttar Pradesh, India, between August 2016 and September 2018. In this study, a total of 100 patients with meningitis were included applying specific inclusion and exclusion criteria after proper ethical approval. Out of 100 patients, 61 were TBM, 31 were pyogenic meningitis, and eight were viral meningitis (VM). CSF CRP level was significantly increased in pyogenic meningitis (1.05 ± 0.36 mg/dL) compared to nonpyogenic meningitis [TBM (0.42 ± 0.13 mg/dL) and VM (0.37 ± 0.09 mg/dL)]. At the cut-off level of CRP in CSF &gt; 0.6 mg/dL, its diagnostic sensitivity in pyogenic meningitis was 93.55% and specificity 94.20%. While CSF ADA levels were higher in the TBM group (13.32 ± 3.21 U/L) compared to the other two groups [pyogenic meningitis (6.15 ± 1.27 U/L) and VM (4.86 ± 0.88 U/L)]. At a cut-off, CSF ADA level of &gt;10 U/L, its diagnostic sensitivity for TBM was 91.67% and specificity 90%. Cerebrospinal fluid (CSF) CRP levels were found to be raised in pyogenic meningitis, and CSF ADA was found to be elevated in TBM. While both ADA level and CRP level in CSF are found low in VM.

Prevalence of Vitamin B12 Deficiency in Type 2 Diabetes Mellitus Patients on Metformin Therapy.

Background Long-term metformin treatment in individuals with type 2 diabetes mellitus causes vitamin B12 insufficiency, which is typically neglected, undetected, and under-treated. A severe deficit may cause life-threatening neurological problems. This study assessed the prevalence of vitamin B12 deficiencies among T2DM patients and its factors at a tertiary hospital in the Tamil Nadu district of Salem. Materials and Methods This is an analytical cross-sectional study conducted in a tertiary care hospital in the Salem district, Tamil Nadu, India. Patients with type 2 diabetes mellitus who were prescribed metformin at the outpatient department of general medicine took part in the trial. Our research instrument was a structured questionnaire. We used a questionnaire containing information on sociodemographic characteristics, metformin use among diabetic mellitus patients, diabetes mellitus history, lifestyle behaviors, anthropometric measurement, examination findings, and biochemical markers. Prior to administering the interview schedule, each participant's parents provided written informed consent. A thorough medical history, physical exam, and anthropometric examination were performed. Data were entered in Microsoft Excel (Microsoft Corporation, Redmond, WA) and analyzed using SPSS version 23 (IBM Corp., Armonk, NY). Results Among the study participants, we diagnosed nearly 43% of diabetes cases in participants between the ages of 40-50 years, while we diagnosed 39%aged under 40 years. Nearly 51% had diabetes for 5-10 years, while only 14% had diabetes for over 10 years. In addition, 25% of the study sample had a positive family history of type 2 diabetes. Nearly 48% and 13% of the study group had been on metformin for 5-10 years and >10 years, respectively. The majority, 45%, were found to take 1000 mg of metformin per day, whereas just 15% take 2 g per day. In our study, the prevalence of vitamin B12 insufficiency was 27%, and nearly 18% had borderline levels. The duration of diabetes mellitus, the duration of metformin intake, and the dose of metformin were statistically significant (p-value = 0.05) among the variables associated with diabetes mellitus and vitamin B12 deficiency. Conclusion The results of the study show that a deficiency in vitamin B12 increases the likelihood that diabetic neuropathy would worsen. Therefore, individuals with diabetes who take larger dosages of metformin (more than 1000mg)for an extended period must have their vitamin B12 levels monitored often. Preventative or therapeutic vitamin B12 supplementation can mitigate this issue.

Protein Profiling in Presymptomatic Individuals Separates Myeloperoxidase-Antineutrophil Cytoplasmic Antibody and Proteinase 3-Antineutrophil Cytoplasmic Antibody Vasculitides.

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a chronic relapsing condition with unknown etiology. To gain insight into the molecular processes underlying the disease, we examined biomarkers in blood samples collected prior to symptom onset. The National Patient Register and Cause of Death register were searched for AAV-related International Classification of Diseases, Ninth Revision and Tenth Revision codes and linked to the registers from 5 biobanks. Eighty-five AAV patients with samples predating symptom onset of AAV were identified. For each case of AAV, 2 matched controls were included. Proteinase 3 (PR3)-ANCA and myeloperoxidase (MPO)-ANCA expression levels were analyzed using enzyme-linked immunosorbent assays. Using an Olink Inflammation panel, 73 of 92 proteins were included after quality control. Data were replicated in a second cohort of 48 presymptomatic individuals and 96 controls. Of the 20 proteins with the lowest P values in the original cohort, 7 were replicated in the second cohort and 5 proteins were found to be significant between the groups in a meta-analysis. Eleven different pathways were identified in network enrichment analyses and were found to be significant in both cohorts. Stratification of samples obtained ≤5 years before symptom onset showed significant levels of CCL23, vascular endothelial growth factor A, and hepatocyte growth factor, which were also increased at borderline significant levels in the replication cohort (interleukin-6 was found to be significantly increased in the replication cohort). In presymptomatic AAV patients, 6 proteins were associated with MPO-ANCA positivity, and 7 proteins were associated with PR3-ANCA positivity. To our knowledge, this is the first study to identify protein markers preceding symptom onset in AAV patients. These findings set the stage for further research into the underlying cellular and molecular mechanisms in the pathogenesis of AAV and the diversification of patients into PR3-ANCA+ and MPO-ANCA+ subphenotypes.

Correlation of lipid profile with diastolic dysfunction in normotensive young patients under 40 years of age

Background: Diastolic dysfunction in young adults is associated with increased morbidity and mortality. The identification of risk markers associated with diastolic dysfunction could allow for targeted primary prevention efforts. Aims and Objectives: The aim of the study was to study whether dyslipidemia is associated with diastolic dysfunction independent of systemic hypertension in young patients under 40 years of age. Materials and Methods: This was a cross-sectional analytical study done from April 2021 to March 2022 in SSMC and SGMH Rewa (M.P.), 214 normotensive cases under 40 years of age were taken as cases by simple random sampling. Sample size calculated by standard formula with confidence level of 95% and margin of error was &lt;5%. Lipid profiles (S. Triglyceride [TG], S. Cholesterol, and S. low-density lipoprotein [LDL]) of all the patients were checked. 2D echocardiogram of patients was done to check for diastolic dysfunction. All data were compiled and compared with the previous studies. Results: We found that the prevalence of diastolic abnormalities in adults under 40 years of age was 21.9%. It was found that there was significant correlation between dyslipidemia and presence of diastolic dysfunction in patients. Patients with higher than normal levels of S. TG, S. Cholesterols, and S. LDL were found to have more prevalence of diastolic dysfunction then patients with normal levels of S. TG, S. Cholesterols, and S. LDL. Higher grades of diastolic dysfunction were found in patients with dyslipidemia as compared to patients without dyslipidemia. High levels of TG and LDL and even Borderline high levels of LDL can be good predictors of diastolic dysfunction. Conclusion: Dyslipidemia is associated with diastolic dysfunction in young patients even without systemic hypertension.

Effect of diet on cardiovascular health-related circulating parameters in men and women athletes participating in a marathon race: A cross-sectional study.

The main objective of this study is to understand how diet affects performance and cardiovascular health in a group of women participating in a demanding aerobic race such as marathon, compared to men. Fifteen women participating in the Barcelona Marathon-2016 were recruited to participate in the study. A group of men (n=15) that performed the same marathon race was selected. Anthropometric parameters and diet records were collected before the race. Circulating parameters were analyzed 24 h-pre-race, immediately after the race and 48 h-post-race. These included certain minerals, lipid profile, muscle damage, inflammatory and cardiovascular health markers. Diets were very similar in the men and women, with inadequate amounts of carbohydrates and proteins for endurance events. Creatine kinase (CK; a muscle damage marker) and C-reactive protein (CRP; a marker of inflammation) remained elevated 48 h post-race in all participants, but was significant in women (641 vs. 143 U/L for CK and 5.8 vs. 0.7mg/dL for CRP). Cardiac markers (high sensitivity troponin T (Hs-TnT), suppression of tumorigenicity and N-terminal pro B-type natriuretic peptide) increased post-race and returned to pre-race values after 48 h in men and women. In particular, Hs-TnT (marker of myocyte stress) increased from 2.2 to 62.5ng/L post-race in women and from 3.1 to 52.9ng/L in men. Finally, circulating lipid parameters were at borderline unhealthy levels in both sexes. Structural and functional cardiac advantages that women display compared to men in aerobic efforts are not manifested when diet is not adequately designed.

Educational challenges for 22q11.2 deletion syndrome in Japan: Findings from a mixed methods survey.

The 22q11.2 deletion syndrome (22q11DS) is characterised by a changing pattern of overlapping intellectual, physical, and mental disabilities along the course of one's life. However, the impact of overlapping disorders (multimorbidity) on educational challenges remains unclear. A survey was conducted with 88 caregivers of individuals with 22q11DS. A quantitative analysis of educational challenges and support needs divided into age groups (7-12, 13-15, 16-18, and 19 years and over) and a qualitative analysis of the free-text items in the questionnaire was conducted. Caregivers were more interested in comprehensive developmental support when their children were younger, and the emphasis shifted to concerns regarding environments that matched individual characteristics at older ages. Furthermore, when there are multiple disabilities or disorders, support is concentrated on the more obvious disabilities, and the lack of support for the less superficially obvious disabilities associated with multiple difficulties, including mental health problems, can be a challenge for people with 22q11DS and their families. This study suggests a need for increased focus on multimorbidity and associated disabilities in school education that are difficult to observe because of their mildness or borderline levels if present alone.

Bereavement outcomes of carers of patients with high grade glioma: Experiences of support before and after the death

Carers of people with High Grade Glioma (HGG) completed a survey assessing their anxiety, depression, and grief in addition to open-ended questions exploring their experiences of support pre- and post-death (N = 25). One-third reported borderline or clinical levels of anxiety, depression, and grief related distress. Given the poor prognosis and rapid deterioration of patients with HGG, the findings highlight the importance of sensitive communication about prognosis early in the disease trajectory, information tailored to disease stage, the initiation of a referral to psychological support services, and timely discussions about the preferred place of care and death.

Comparative Study of Lipid Profile between Hypertensive Patient and Normotensive Individuals in Northern Region of Bangladesh

Background: Hypertension and dyslipidemia are well-established and partially overlapping risk factors for cardiovascular disease. Hypertension affects nearly 26% of the adult population worldwide and is an important independent predictor of cardiovascular disease, cerebrovascular accidents and death. The prevalence of cardiovascular diseases and Hypertension is rapidly increasing in developing countries. Hypertension has been reported to be responsible for 57% of all stroke deaths and 24% of all cardiovascular deaths in East Asians. Objective: To compare the lipid profile of hypertensive patients with normotensive individuals and socio-demographic and dyslipidemia patterns in hypertensive and normotensive individuals. Methodology: A total of 167 hypertensive patients. This is a descriptive cross-sectional study. An equal number of normotensive individuals were selected at Hypertension &amp; Research Center, Rangpur and the Department of Medicine, Rangpur medical college hospital, Rangpur, from February 2013 to November 2013. Consecutive purposive sampling method and fasting lipid profile was done. Informed written consent was taken from the patient and the normotensive individual. Results: In this study, we studied a total of 334 patients; among them, 167 were hypertensive, and an equal number of normotensive individuals. The age range for hypertensive patients was 20-89 years, whereas for normotensive patients was 20-80. The mean age of the study population was 47.58 (SD±12.027) for the hypertensive group and 40.29 (SD±15.493) for the normotensive group. Males were dominant in both hypertensive (57.5% Vs 42.5%) and normotensive individuals (66.5% Vs 33.5%). The hypertensive population lived more in urban areas (55.6% vs 53.29%). Conclusion: Sub-categorized serum lipid profile as this study shows exceptionally high total cholesterol, high triglycerides and borderline LDL-cholesterol levels are positively associated with Hypertension. Higher lipids levels may be attributed to physical inactivity and stress. So timely lipid profile assessment is necessary in all hypertensive cases, especially in northern Bangladesh, to stop further aggravation and risks of coronary artery diseases.

S Estimation of HbA2 Alone Sufficient for Screening Beta Thalassaemia Carriers: A Case in Perspective

Beta thalassaemia is one of the most common inherited haemoglobinopathies, characterised by reduced or absent production of the beta globin chain. In India, the carrier frequency of thalassaemia is estimated to be 3-4%. The prevention of Beta thalassaemia is the best strategy, and this can be achieved through carrier screening and prenatal diagnosis. Carriers of beta thalassaemia can be easily identified using haematological parameters such as complete blood count and High Performance Liquid Chromatography (HPLC) for haemoglobin analysis. The characteristic findings observed in thalassaemia carriers include microcytosis, hypochromia, with a Mean Corpuscular Volume (MCV) of less than 80 fL and Mean Corpuscular Haemoglobin (MCH) of less than 28 pg. They also present with elevated levels of HBA2 (α2δ2) ≥3.5%. Carrier screening for beta thalassaemia primarily relies on the observation of elevated HbA2 levels. However, in rare cases, some carriers can have normal HbA2 levels, leading to false-negative screening results. In a case involving a married couple who underwent routine preconceptional screening by complete blood count and HPLC for thalassaemia screening, the male partner had elevated HbA2 levels (5.2%), while the female partner had normal HbA2 levels (1.6%). Molecular testing revealed that the male partner was heterozygous for the Intervening Sequence (IVS) 1-5 (G&gt;C) mutation, while the female partner was found to be heterozygous for the CD41-42 (-CTTT) mutation. It is important to consider molecular testing of the HBB gene in couples, even if one partner is a carrier and the other partner has normal or borderline HbA2 levels.