Prospective Case-control Study Research Articles

Kynurenine Pathway Dysregulation and Pain Perception in Acute Pancreatitis: Has the Connection Unraveled?

AimTryptophan (TRP), an essential amino acid, undergoes catabolism through various pathways. Notably, the kynurenine pathway (KP), constituting one of these pathways, exhibits a unidirectional impact on immune response and energy metabolism. Nonetheless, its influence on pain sensation is characterized by biphasic dynamics. This study aims to scrutinize the influence of the KP pathway on pain sensation, particularly within the context of pancreatic inflammation. MethodsOur prospective case-control study involved individuals diagnosed with acute pancreatitis and a control group matched for gender and age. The patient cohort was subsequently subdivided into severe and non-severe subgroups. To assess metabolites within KP, two blood samples were collected from the patient cohort, one at the time of diagnosis and another during the recovery phase. Furthermore, for pain quantification, daily pain scores utilizing the Visual Analog Scale (VAS) were extracted from the patients’ medical records. ResultsThe study incorporated 30 patients along with an equivalent number of controls. A noticeable distinction was evident between the patient and control groups, characterized by an increase in kynurenine levels and a decrease in the tryptophan/kynurenine ratio. Throughout the process of disease recovery, a uniform decrease was observed in all KP metabolites, excluding 3-Hydroxykynurenine. Elevated levels of Kynurenic acid (KYNA) were correlated with increased pain scores. Critically, no apparent distinctions in KP metabolites were discerned concerning pain severity in patients with comorbidities characterized by neural involvement. ConclusionBased on our results, the kynurenine pathway (KP) is activated in instances of acute pancreatitis. Elevated levels of KYNA were found to be associated with heightened pain scores. The operative stages within the KP responsible for pain modulation are impaired in cases characterized by neuropathy-induced pain sensation.

Can Combination Therapy with Endothelin Receptor Antagonist and PDE5 Inhibitors Prevent Echocardiographic Findings Suspicious for Pulmonary Arterial Hypertension? Description of a Real-Life Case Series.

To retrospectively evaluate the incidence rate (IR) of elevated echocardiographic estimated systolic pulmonary artery pressure (sPAP), suspected for pulmonary hypertension (PH), in systemic sclerosis (SSc) patients after the introduction of a combination therapy with bosentan and sildenafil for treatment or prevention of digital ulcers. Patients attending the Scleroderma Unit of the Universital Hospital of Careggi from July 2010 to July 2023 were enrolled. Patients older than 18 years old with a history of digital ulcers, treated with bosentan and sildenafil in combination for at least 12 months, were included. Patients with a diagnosis of PH preceding the introduction of the therapy were excluded. Demographical data, disease duration, laboratoristic, and instrumental data (pulmonary function tests, echocardiographic estimation of sPAP, and ultrasonographic value of renal resistive index) were collected. The IR of echocardiographic signs suspected of pulmonary hypertension and their 95% confidence interval were calculated in events/1000 patients-years. Thirty-five patients were enrolled; the mean disease duration was 12.82 years (SD 5.92). The mean duration of the combination treatment was 81.03 (SD 43.1.3) months, and the total at-risk time was 2674 months. Two patients (5.7%) presented echocardiographic signs of PH (sPAP 50 mmHg and 40 mmHg); the IR was calculated to be 9/1000 patients-years (95% CI 7.95-10.12). In one of the two patients, right heart catheterism (RHC) excluded PAH, while the other patient refused to undergo RHC, and PAH could not be confirmed/excluded. The stability of PFTs and echocardiographic sPAP was observed during the observation time. The results of this retrospective study suggest that combination therapy with endothelin receptor antagonists and phosphodiesterase-5 (PDE5) inhibitors could help in preventing PAH in SSc; prospective case-control studies on a larger population are needed to improve knowledge in this field.

Anti-α-1,4-D-polygalacturonic acid antibodies as a new biomarker for juvenile idiopathic arthritis.

Diagnosing juvenile idiopathic arthritis (JIA) is challenging. Our study aimed to investigate the clinical significance of anti-α-1,4-D-polygalacturonic acid (PGA) antibodies in JIA, focusing on their role in diagnosis and assessing disease activity. In this prospective case-control study, we examined variations in serum levels of PGA-IgA and PGA-IgG among children with different types of JIA and healthy controls. Serum PGA-IgA and PGA-IgG levels were assessed concurrently in children with active and inactive JIA. This study included 126 patients diagnosed with JIA, 13 neonates, and 76 healthy children. Serum PGA-IgA and PGA-IgG levels were assessed, which revealed significant differences in PGA-IgA levels between various JIA subtypes and controls. An analysis of PGA-IgA levels in various JIA states revealed a statistically significant difference. Receiver operating characteristic (ROC) analysis demonstrated the robust predictive capability of PGA-IgA, with an AUC of 0.879 (p < 0.001), along with a specificity of 0.842 and sensitivity of 0.848. Increased levels of anti-PGA antibodies, particularly PGA-IgA, were significantly associated with JIA. PGA-IgA may serve as a sensitive biomarker for disease activity in JIA and could potentially aid in the diagnosis of JIA. Key Points • This study found a significant correlation between blood levels of PGA-IgA and juvenile idiopathic arthritis (JIA), which may provide valuable diagnostic insights. • PGA-IgA shows potential as a sensitive biomarker for the assessment of disease activity in JIA patients, helping to determine disease activity.

Genome-wide association study on meningioma risk in Japan: a multicenter prospective study.

Although meningiomas are the most common primary intracranial tumors, their genetic etiologies have not been fully elucidated. To date, only two genome-wide association studies (GWASs) have focused on European ancestries, despite ethnic differences in the incidence of meningiomas. The aim of this study was to conduct the first GWAS of Japanese patients with meningiomas to identify the SNPs associated with meningioma susceptibility. In this multicenter prospective case-control study, we studied 401 Japanese patients with meningioma admitted in five institutions in Japan, and 50,876 control participants of Japanese ancestry enrolled in Biobank Japan. The quality control process yielded 536,319 variants and imputation resulted in 8,224,735 variants on the autosomes and 224,820 variants on the X chromosomes. This GWAS eventually revealed no genetic variants with genome-wide significance (P < 5 × 10 - 8) and observed no significant association in the previously reported risk variants rs11012732 and rs2686876 due to low minor allele frequency in the Japanese population. This is the first GWAS of meningiomas in East Asian populations and is expected to contribute to the development of GWAS research for meningiomas.

Association between coronary artery stenosis and myocardial injury in patients with acute pulmonary embolism: A case-control study.

The potential impact of pre-existing coronary artery stenosis (CAS) on acute pulmonary embolism (PE) episodes remains underexplored. This study aimed to investigate the association between pre-existing CAS and the elevation of high-sensitivity cardiac troponin I (hs-cTnI) levels in patients with PE. In this multicenter, prospective case-control study, 88 cases and 163 controls matched for age, sex, and study center were enrolled. Cases were patients with PE with elevated hs-cTnI. Controls were patients with PE with normal hs-cTnI. Coronary artery assessment utilized coronary computed tomographic angiography or invasive coronary angiography. CAS was defined as ≥50% stenosis of the lumen diameter in any coronary vessel >2.0mm in diameter. Conditional logistic regression was used to evaluate the association between CAS and hs-cTnI elevation. The percentage of CAS was higher in the case group compared to the control group (44.3% [39/88] vs. 30.1% [49/163]; P=0.024). In multivariable conditional logistic regression model 1, CAS (adjusted odds ratio [OR], 2.680; 95% confidence interval [CI], 1.243-5.779), heart rate >75 beats/min (OR, 2.306; 95% CI, 1.056-5.036) and N-terminal pro-B type natriuretic peptide (NT-proBNP) >420 pg/mL (OR, 12.169; 95% CI, 4.792-30.900) were independently associated with elevated hs-cTnI. In model 2, right CAS (OR, 3.615; 95% CI, 1.467-8.909) and NT-proBNP >420 pg/mL (OR, 13.890; 95% CI, 5.288-36.484) were independently associated with elevated hs-cTnI. CAS was independently associated with myocardial injury in patients with PE. Vigilance towards CAS is warranted in patients with PE with elevated cardiac troponin levels.

Detection of PROM with Vaginal Fluid Creatinine Levels: A Prospective Case–Control Study

Detection of PROM with Vaginal Fluid Creatinine Levels: A Prospective Case–Control Study

Risk of acute coronary syndrome and relationship with the use of khat and tobacco products in the Jazan region, Saudi Arabia: A prospective case-control study.

Previous studies have identified several risk factors for acute coronary syndrome (ACS). This study was intended to examine the potential risk of ACS associated with khat and tobacco use. A case-control study of 344 people (172 cases and 172 controls) was conducted at Prince Mohammed Bin Nasser Hospital in Jazan, Saudi Arabia, from April to September 2019. The cases and controls were matched for age (±5 years) and gender. Data were analyzed using descriptive, inferential, and modeling analyses. We utilized the adjusted odds ratio (AOR) to express the results. The prevalence of ever khat chewing among all study participants was 29.1%, significantly higher for the cases with ACS than for the control group (43.6% vs 14.5%, p<0.001). Cigarette smokers accounted for 33.4% of the study participants, and 22.1% were ACS cases, which is a significantly higher percentage than the control group. The prevalence of smokeless tobacco was 20.3% among ACS cases and 14.5% among controls, with no statistically significant differences (p>0.05). In the final model, tobacco use was more likely to be reported among cases with myocardial infarction (MI) (AOR=4.58; 95% CI: 1.01-4.73, p<0.05) as was khat chewing (AOR=3.4; 95% CI: 1.55-7.46, p<0.05), after controlling for other traditional risk factors. Khat chewing was reported more by those who reported ACS. ACS cases were more likely to be frequent khat users with chewing sessions of five or more days per week. Regular tobacco use was also reported in those who reported ACS, and this increases with the amount of tobacco used. Implementing early intervention strategies can help mitigate the impact of khat chewing and smoking on the development of ACS.

Exploring Genetic Link of Residual Ridge Resorption in Completely Edentulous Individuals: A Prospective Case-Control Clinical Study.

Residual ridge resorption presents obstacles in prosthodontic treatment, affecting denture stability and the success of dental implants. Genetic elements, specifically the single nucleotide polymorphism (SNP) 1772C>T variant within the hypoxia-inducible factor 1 subunit alpha (HIF-1α) gene, are hypothesized to contribute to residual ridge resorption progression. Nevertheless, its impact remains insufficiently investigated, especially within the context of South Indian populations. We sought to investigate the connection between SNP 1772C>T and residual ridge resorption (RRR) among fully edentulous individuals, considering demographic factors, genotyping methodologies, and statistical evaluations. In a prospective case-control study, we recruited 100 completely edentulous participants from South India. Participants were categorized based on alveolar ridge height. Saliva samples were non-invasively collected for DNA extraction, and polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis was employed to determine genotype distribution using the HphI restriction enzyme. The statistical evaluations comprised the utilization of chi-square and Fisher's exact tests. We observed no significant variations in genotype distributions between the case and control cohorts (CT: p=0.24; CC: p=0.65; TT: p=0.30). The heterozygous genotype CT was prevalent in both groups. Although we did not observe significant associations between SNP 1772C>T and RRR, our findings imply a genetic predisposition to residual ridge resorption that warrants further exploration. Variations in genetic susceptibility across ethnicities and the influence of other genetic variants on residual ridge resorption require additional investigation. This study lays the groundwork for personalized prosthodontic care by highlighting the potential of genetic analysis in routine dental practice to improve treatment strategies.

Bioconcentration of polycyclic aromatic hydrocarbons in the adipose tissue of women with pelvic endometriosis and idiopathic infertility: A case-control study

PurposePolycyclic aromatic hydrocarbons (PAHs), present in air and food, generated during energy production and waste incineration, are known for health toxicity. PAHs may activate the aryl hydrocarbon receptor, which could in turn modify estrogen-dependent inflammatory pathways in endometriosis. The possible role of PAHs in the pathogenesis of endometriosis remains unclear. The study aimed to evaluate the potential link between exposure to PAHs and the occurrence of peritoneal and ovarian endometriosis. MethodsA prospective case-control tertiary-center study included 46 women aged 22–45 undergoing laparoscopy due to pelvic endometriosis (n ​= ​32; arm 1) and idiopathic infertility (n ​= ​14; arm 2). A sample of the greater omentum was collected intraoperatively for detection of 16 standard PAHs by gas chromatography-isotope dilution mass spectrometry method. PAHs concentrations were compared in both study arms. The associations between PAHs concentrations and selected variables were investigated. ResultsThere were no significant differences between both arms in terms of reference PAHs concentrations, nor correlations between PAHs concentrations and the stage of endometriosis. However, notable differences were observed in specific PAHs concentrations related to certain conditions. The concentrations of acenaphthene (p ​= ​0.016) and fluorene (p ​= ​0.013) were significantly lower in women with peritoneal adhesions, while the concentrations of benz[a]anthracene, benzo[k]fluoranthene and indeno[1,2,3-cd]pyrene [ng/g] were higher in cigarette smokers. ConclusionsThe study showed no differences in exposure to PAHs between women with and without pelvic endometriosis. Determining the toxicity of PAHs in endometriosis requires further research.

Relationship of insulin resistance with microvascular and macrovascular complications, death rate and other factors in patients with type 2 diabetes: A case-control study

Abstract: There is a lack of studies analyzing Severe Insulin Resistance (SIR) forms, especially from clinical aspects. The main objective of this research was to assess the relationship between micro- and macrovascular complications and the death rate of patients with SIR. Methods: It was a partially prospective case-control study of 120 participants with T2DM. Patients with doses of insulin &gt;1 IU/kg/day were considered to have SIR (case group), with an insulin requirement of &lt;1 IU/kg/day - control group. Statistical analyses were performed. Results: Regarding microvascular complications, an association was found between insulin doses and the rate of Diabetic Nephropathy (DN) in the case group compared with the control group (138 vs. 170 IU/day), p = 0.002. Men with T2DM and SIR were more likely to present with myocardial infarction than women (39.3% vs. 13.3%); p = 0.036. Subjects of the case group with lower eGDR (2.44 vs. 1.35) (or higher insulin resistance) were more likely to suffer a stroke, p = 0.003. Case group males were more likely than females to undergo coronary artery bypass graft surgery (21.4% vs. 3.3%); p = 0.048. Higher mortality was observed in the case group of patients with lower eGDR (1.01 vs. 1.85); p = 0.031. Conclusion: As for microvascular outcomes, the rate of DP and DR was similar in both control and case groups. Only the rate of DN in the case group was associated with higher insulin doses. Macrovascular complications such as stroke, myocardial infarction, and bypass surgery were related to the male gender and SIR, as well as higher mortality according to eGDR.

Evaluation of the Role of Neutrophil to Lymphocyte Ratio, Platelet to Lymphocyte Ratio and Mean Platelet Volume as Predictors of the Outcome in Patients with Hemotoxic Snake Bite: A Prospective Study on Patients in Poison Control Centers Ain Shams University Hospitals and Assiut University Hospitals

Abstract Background Snakebite envenomation is considered a major health problem especially in developing centuries. Snakebite envenomation cause major morbidities, disabilities and mortalities. Novel biomarkers as; neutrophils to lymphocytes Ratio (NLR) and plateletto lymphocytes Ratio (PLR)are hematological inflammatory indices that can be a guide for diagnosis, prognosis of the snakebite envenomation. Methodology This was a prospective case control study, which was carried out on 60 hemotoxic snake bite envenomed patients that admitted at Poisoning Control Center AinShams University Hospitals (PCCAUH) and Assiut University Hospitals (AUH) in the period from 1st of July 2019 to 31st of October 2021. In addition, 60 healthy volunteers were used as control subjects. The study aimed to evaluate the role of NLR, PLR and Mean Platelet Volume (MPV) at admission as predictors of the outcome in patients with hemotoxic snakebite envenomation. The patients were divided into mild, moderate and severe groups according to severity of snake envenomation. Result Sixty hemotoxic snake bite envenomed patients (28 patients admitted at PCC-ASUH and 32 admitted at AUH), were divided into (38.4%) mild, (31.6%) moderate and (30%) severe groups according to the severity of snake envenomation. Maximum incidence was found in male (95%) from rural areas (80%) and were farmers (43.3%) from total cases. It was observed that bite was more frequent at lower limbs (70%), outdoors (81.6%), at night (51%) and during autumn season (43.3%). It was found that there was significant positive correlation between NLR at admission and duration of hospitalization, PLR, creatine phosphokinase (CPK) level and whitebloodcells (WBCs) count. While, significant negative correlation was found between NLR and prothrombin concentration (PC), red blood cells(RBCs) and plateletcounts. Also, significant positive correlation was found between PLR at admission and duration of hospitalization, NLR, CPK level and platelets count. Inaddition, significant positive correlation was found between MPV and PT. About 47 (78.33%) patients had complete recovery and about 13 (21.67%) patients recovered with complications including; local complications in (21.67%), systemic complications in (13.33%) and chronic complications In (5%). There were no recorded deaths in the study. It was found that hemotoxic snake bit eenvenomed patients Admitted at PCC-ASUH were significantly more severe,required more antivenom vials and more intensive care unit(ICU) admission than those admitted at AUH. Conclusion NLR and PLR values at admission were significantly high in hemotoxic snake bite envenomed patients and can be used as predictors for diagnosis and prognosis of hemotoxic snake envenomation.In addition, NLR and PLR had significant association with severity of envenomation, duration of hospitalization.

Comparative Clinical Trial of Dermapen Microneedling and Platelet-Rich Plasma versus Dermapen Microneedling Alone in the Treatment of Stretch Marks in Egyptian Adults

Abstract Background Striae distensae are common skin lesions affecting up to 90% of pregnant women, and many adolescents and men. They pose a psychological burden to many people and no known treatment is completely effective for them. The current treatment options are limited by significant side effects, operator skill, cost, prolonged treatment period, or a combination thereof. Platelet-rich plasma (PRP), along with microneedling (MN), are promising dermatologic procedures with a wide range of applications, excellent safety profiles, yet only partially understood mechanisms of action. Aim of the Work to evaluate the effectiveness and side effects of MN with PRP versus MN alone in the treatment of striae distensae. This work included 40 patients who were divided into left-side lesions (MN alone) versus right-side lesions (PRP + MN). PRP was prepared using single-spin technique, and applied topically just before MN on right-side lesions. An automated MN pen device was used on both sides. Patients and Methods This was a prospective case control study with a split-body design which included 40 adult patients with striae distensae. The patients were recruited from the outpatient dermatology clinic in Ain Shams University hospitals, Cairo. Miravex Antera TM 3D Camera system measured the efficacy by indentation and roughness indices, and patients’ subjective improvement and reported side effects were recorded and analysed. Results A significant improvement was illustrated in both MN and MN + PRP sides in both the indentation and roughness indices measured by the Antera 3D camera system, and most patients reported subjective improvement in color (62.5%), smoothness (97.5%), size (82.5% vs 85%), and general appearance (92.5% vs 90%). Side effects including pain and erythema affected virtually all cases, while pruritis, edema, bleeding, and tram-tracking were less common and short-lasting. Post-inflammatory hyperpigmentation affected about 20% of patients and lasted more than one month in about half of those affected. No significant difference was found between MN and MN + PRP in efficacy or side effects. Conclusion Microneedling offers an effective, cheap, and relatively safe treatment option for striae distensae. Miravex Antera TM 3D Camera system is a powerful objective method of documenting lesions and following up the treatment process. Platelet-rich plasma did not offer additional benefit over microneedling alone.

Abdominoplasty Combined with the Anterior Component Separation Technique for Reconstruction of Midline Large Ventral Hernias: Functional and Aesthetic Outcome Clinical Study

Abstract Background Large midline ventral hernias, diastasis of recti and the associated laxity and abdominal shape deformity, represent aesthetic and functional problems for the patients. So, the surgical treatment of both pathologies at the same time is highly recommended if the patient’s general condition permits. This can be achieved by a comprehensive technique incorporating abdominoplasty performed by a transverse lower abdominal incision into any of the hernia repair techniques. Objective The aim of this study is to evaluate the functional and aesthetic outcome of the combined abdominoplasty and anterior component separation technique in the management of midline ventral abdominal hernias. Patients and Methods This study is a prospective case control study that evaluates both functional and aesthetic outcome of performing abdominoplasty on patients with large midline ventral hernias. This study was conducted between December 2020 to March 2022 at the Plastic Surgery Department, Demerdash University Hospital, Cairo, Egypt. Study consisted of fifteen patients with different presentations of abdominal wall laxity and ventral hernias. Patients were evaluated regarding their age, BMI, degree of rectus diastasis, Pre-operative radiological findings, post Operative complication and hernia reoccurrence, patients’ satisfaction, and the pre-operative and post-operative umbilical measurements were compared. Results and Conclusion The current study showed that Abdomioplasty can be combined with complex hernia repair by anterior component separation technique within the same setting in high-risk patients safely with an excellent functional outcome and acceptable satisfactory aesthetic results. Although, this can be associated with an increased risk of postoperative surgical site complications such as; skin necrosis and wound infection. Patient characteristics associated with the development of complications following anterior component separation combined with abdominoplasty include obesity, previous abdominal procedures and previous pregnancies.

Post Covid-19 Vaccination Immune Response in Hemodialysis Patient Compared to Normal Population

Abstract Background The COVID-19 pandemic has profound adverse effects on the population on dialysis. Patients requiring dialysis are at an increased risk of SARS-CoV-2 infection and mortality, and many have experienced psychological distress as well as delayed or suboptimal care. COVID-19 survivors have prolonged viral shedding, but generally develop a robust and long-lasting humoral immune response that correlates with initial disease severity. However, protection against reinfection is incomplete. Aim of the Work This study aimed to studying the immune response to COVID-19 Viruse vaccination in hemodialysis patients compared to the normal population Patients and Methods This study is a prospective case control study which include 40 prevalent HD patients received COVID-19 vaccination in haemodialysis units, Ain Shams University Hospitals. In comparison to 20 healthy control individuals who also received COVID-19 vaccination. Results Our study showed that there was no statistically significant difference between the studied groups as regard demographic data. Where the age ranges from 24-60 years old. There was 11 female and 29 males in our participant. Regarding occupation, there were 11 participants not working and 29 were working. In our study, there was a significant negative correlation between, SARS COVID IgG Au/ml &amp; age per year, duration of hemodialysis per year, and parathyroid hormone. Whereas, there is a significant positive correlation between SARS COVID IgG Au/ml and kt/v % of renal hemodialysis dialysis patients. Otherwise, there is no significant relation between, SARS COVID IgG. In our study, there is a lower significant value of SARS COVID igG in renal dialysis patients compared to the control group regarding the history of COVID19 infection before vaccination and occurrence of post- vaccine adverse effects. Conclusion Hemodialysis patients demonstrate a hyporesponsiveness to vaccination against COVID-19. Although most patients on maintenance hemodialysis developed a substantial humoral response following the COVID vaccine, it was significantly lower than controls.

P-448 Placental histopathology in frozen embryo transfer HRT induced IVF pregnancies and non-IVF pregnancies and its correlation with maternal and fetal outcomes: a prospective case-control study

Abstract Study question Is Placental histopathology altered in Frozen Embryo transfer, HRT induced IVF pregnancies when compared to non-IVF pregnancies; if yes,any implications on maternal and fetal outcome? Summary answer Pathological placental lesions and adverse maternal outcomes were found to be significantly higher in IVF pregnancies compared to non-IVF pregnancies. What is known already Studies on placental histopathology in IVF pregnancies suggest that there may be differences compared to naturally conceived pregnancies. Some research indicates an increased risk of certain placental abnormalities such as changes in vascularization and structure (Uroka Belak, et al., 2023). Additionally, alterations in gene expressions and epigenetic modifications in placenta have been observed in IVF pregnancies. However, it is essential to note that findings can vary, and more research is needed to fully understand the implications and potential long-term effects. Study design, size, duration Prospective, single centre, comparative clinical study, including 100 pregnancies between November, 2022 and November, 2023; 50 FET HRT induced IVF pregnancies, 50 non-IVF pregnancies. Participants/materials, setting, methods Patients aged 32-45 years, &amp;gt;34 weeks gestation, with no associated maternal and obstetrical complications were recruited after proper screening and informed consent. Among 100 pregnancies, we compared placental HPE using the Amsterdam Placental Workshop Group Consensus and feto-maternal outcomes between FET HRT induced IVF pregnancies and non-IVF pregnancies. We used Chi-square test to compare groups(p &amp;lt; 0.05). Main results and the role of chance Out of 100 participants, 50 were frozen embryo transfer, HRT induced IVF pregnancies and 50 were non-IVF pregnancies. Out of 50 IVF pregnancies; 27(54%) had pathological placental lesions, of which 17(63%) were noted to have adverse maternal outcomes and 6(22.2%) had adverse fetal outcomes. Out of 50 non-IVF pregnancies, 4(8%) had pathological placental lesions; of which 1(25%) were noted to have adverse maternal outcomes and 1(25%) had adverse fetal outcomes. On comparing these 2 groups, our result was found to be statistically significant(p &amp;lt; 0.05). Limitations, reasons for caution This study has some limitations owing to it being a single centered comparative trial, possibility of observer bias in histopathological examination and that the study is restricted to HRT induced IVF pregnancies. Wider implications of the findings This study reveals valuable insights into potential differences in placental and fetal development. Understanding these variances could influence clinical practices, patient counseling, and contribute to advancements in assisted reproductive technologies. Additionally, insights into long-term health outcomes for both mothers and babies may emerge, guiding future research and healthcare strategies. Trial registration number Not applicable

Role of Lipocalin-2 Levels in Non-Alcoholic Fatty Pancreatic Disease and its Association with Non-Alcoholic Fatty Liver Disease

Abstract Background Lipocalin-2 (LCN2) is a 25-kDa secretory protein with great importance as a sensitive and specific screening and diagnostic biomarker for hepatic inflammation, acute hepatic injury, hepatic cancer, and radiation-induced early phase hepatic damage and lipid abnormalities. However, little is known about LCN2's functions in the homeostasis and metabolism of hepatic lipids or in the development of steatosis as well as its actual role in the event of inflammation. Aim and Objectives To establish a correlation between the levels of lipocalin as a useful biomarker with increasing severity of steatosis in NAFLD and NAFPD patients. Subjects and Methods This was observational prospective case–control study, was conducted at Hepatology Unit of Ain Shams University Hospital on 50 patients diagnosed with NAFPD and 50 healthy age and sex-matched volunteers without NAFPD during a period of 6 months. All patients were subjected to; Full history taking and thorough clinical examination, Anthropometric measurements, Laboratory investigations, and abdominal ultrasonography. Result There was a significant Positive correlation between Lipocalin 2, BMI, LDL (mg/dL), Cholesterol (mg/dL), Insulin (μU/mL) and HOMA-IR in patient group(P-value ≤ 0.001), Conclusion; lipocalin-2 is a good blood biomarker for detection of hepatic and Pancreatic steatosis. The lipocalin levels increase with increasing severity of steatosis. In addition to this, lipocalin will be useful for early diagnosis of NAFLD, NAFPD and convenient to do with other blood tests. The early intervention may prevent high morbidity and mortality and to manage the disease properly.

O-126 Blastocyst spent culture medium metabolite levels and reproductive outcomes

Abstract Study question Is there any relationship between blastocyst spent culture medium metabolite levels and reproductive outcomes? Summary answer Metabolomic analysis of 173 metabolites revealed differences in pregnancy, implantation, and live birth rates, highlighting specific metabolites' associations with reproductive outcomes. What is known already Identifying embryos with higher implantation potential poses a significant challenge in assisted reproductive technology (ART). Currently, morphological criteria are utilized for this selection; however, this method does not consistently offer precise predictions of successful implantation. In recent years, there are several hypothesis to employ metabolomic approaches to assess developing embryos and discriminate preferable profiles associated with embryo viability. Metabolomics involves the non-targeted identification and quantification of low molecular weight end-products of metabolism, referred to as metabolites. However, there is limited knowledge regarding the impact of metabolomic profile on implantation rates. Study design, size, duration This prospective case control study enrolled 70 patients who underwent intracytoplasmic sperm injection (ICSI) and single blastocyst transfer. Spent culture mediums (SCM) were collected in fifth day of each embryo. Metabolite levels of SCMs were measured by Liquid Chromatography-Mass Spectrometry. Metabolite levels were compared according to pregnancy, implantation and live birth rates. Participants/materials, setting, methods Normo-responder patients aged between 21 and 39, experiencing primary infertility, whose embryos progressed to the blastocyst stage and underwent single blastocyst transfer. Human Metabolome Database and Compound Discoverer 3.3 was used for the identification of the metabolites. Statistical Package for the Social Sciences (SPSS) software were used for statistical analysis. p&amp;lt;.05 was considered statistically significant. Main results and the role of chance The baseline parameters between groups were not significantly different between pregnant and non-pregnant patient groups. A total of 173 metabolites were analysed. When the metabolomics compared according to pregnancy results(68.5%), 1-(4-Methoxyphenyl)-3-pentanone, morpholine propane sulfanoic acid, naproxen were found higher in pregnant group while 4-indolecarbaldehyde, eicosapentaenoic acid, hepes were significantly higher in non-pregnant group (p&amp;lt;.05). According to the implantation (65.7%) rates, 1-(4-Methoxyphenyl)-3-pentanone was significantly higher in the implantation group. According to the live birth rates (54.2%), 1-(4-Methoxyphenyl)-3-pentanone, 15,16-Dihydroxyoctadecanoic acid, ALA-PRO, HEPES, Naproxen, pyroglutamylglycine, lactamide (p&amp;lt;.05) was higher in the live birth group. 1,2,3,4-Tetrahydro-β-carboline-3-carboxylic acid, diethyl ether and L-Glutamine was higher in non-livebirth group. Limitations, reasons for caution These results can not be generalized to the entire population due to small sample size of our study. More work is needed on the subject. Wider implications of the findings We detected significant differences in some of the metabolites in patients with different reproductive outcomes. The metabolomic analysis of blastocyst spent culture medium can be used as an adjunt method for improving non invasive embryo evaluation in clinical practice after evidence based results. Trial registration number none

P-279 Significant increased isolation of escherichia coli in Iranian women with endometriosis: a case control – study

Abstract Study question Considering the role of bacterial infection in causing endometriosis, we decided to compare the cultures of endometriosis-affected women a in this study Summary answer Considering the possible role of E. coli in the progression and/or recurrence of endometriosis and also infertility What is known already (5). Due to the finding of endotoxin of E. coli species in the peritoneal cavity and menstrual fluid of endometriosis patients, infection with this bacterium has recently been proposed as an effective factor in the occurrence and growth of endometriosis lesions. Study design, size, duration This prospective case-control study was carried out in the Women’s Department of Shiraz University of Medical Sciences in collaboration with the Bacteriology and Virology Department between 60 participants. Participants/materials, setting, methods 30 women with endometriosis in stages 3 and 4 of the disease, and 30 women without endometriosis who were candidates for surgery due to benign uterine diseases, underwent endometrial biopsy with Novak Kort in sterile conditions before starting their operation, and the results of their endometrial culture were analyzed and compared in terms of the presence of Enterobacter spp., Klebsiella spp., and E. coli species. Main results and the role of chance Based on the comparison between the two groups, only E. coli species had a significant association with the presence of endometriosis (P = 0.001). There was no significant relationship between the location of endometriosis in the pelvic cavity and culture results. Parity among the E. coli negative group was significantly higher compared to the E. coli positive group (P &amp;lt; 0.001). Limitations, reasons for caution Lack of sample trail for repeat testing and antibiotic susceptibility testing, low taxonomical resolution, and costly laboratory setup and maintenance are other limitations of this technology Wider implications of the findings we suggest that in women who have endometriosis and recurrent IVF failure and also in cases of endometriosis recurrence after surgical treatment, treatment of couples with appropriate antibiotics and repeated culture along with subsequent antibiotic susceptibility testing until their culture becomes negative could be beneficial. Trial registration number IR.SUMS.MED.REC.1400.097

Diagnostic Value of Plasma Methylated Septin 9 in Detection of Hepatocellular Carcinoma in Egyptian Patient with Post Hepatitis C Liver Cirrhosis in Comparison to Serum Level of Alphafeto Protein

Abstract Background Egypt has the highest hepatitis C virus (HCV) prevalence worldwide. Cirrhosis secondary to HCV is associated with the highest annual risk for developing hepatocellular carcinoma. The burden of HCC has been increasing in Egypt with a doubling in the incidence rate in the past 10 years. HCC contributes to 14.8% of all cancer mortality in Egypt. Most HCCs (80%) arise in a cirrhotic liver, a situation where there has been longstanding hepatocyte damage and chronic inflammation leading to fibrosis. Aim of the Work This study aims to evaluate the diagnostic value of plasma mSEPT9 assay in detection of HCC in Egyptian patients with post hepatitis C liver cirrhosis in comparison to serum level of α-fetoprotein (AFP). Patients and Methods This is a prospective case-control study conducted at the Gastroenterology department in Ain Shams University Hospital. The study population consisted of 80 subjects, divided into three groups: 40 patients with hepatocellular carcinoma, 20 patients with liver cirrhosis, and 20 healthy subjects as controls with matched age and gender. Results The study found that hepatocellular carcinoma (HCC) was more frequent in male patients and that the age of HCC patients was statistically significantly higher than patients with cirrhosis and healthy controls. Patients with HCC and cirrhosis had a higher Child Pugh score than healthy controls. Portal hypertension and portal vein thrombosis were more frequent in HCC and cirrhosis patients than in the control group. Liver enzymes were higher in patients with HCC and cirrhosis compared to healthy controls, while hemoglobin and platelet levels were lower in patients with HCC. Hepatitis C antibody and PCR were positive in HCC and cirrhosis patient groups. AFP and Methylated Septin 9 levels were higher in patients with HCC and cirrhosis than in healthy controls, and AFP had better diagnostic accuracy than Methylated Septin 9. Both AFP and Methylated Septin 9 levels were positively correlated with age, Child Score, liver enzymes, and coagulation profile and negatively correlated with platelet count and hemoglobin level. AFP level was positively correlated with the number of focal lesions and liver size. Conclusion This study demonstrated that plasma Methylated Septin 9 can be a promising noninvasive and circulating epigenetic biomarker for HCC diagnosis at the individual level. However, our results showed that AFP was superior than Methylated Septin 9 in the detection of HCC, Methylated Septin 9 has higher Sensitivity. It was suggested that the combination of plasma mSEPT9 and AFP could enhance the sensitivity of Methylated Septin 9 or AFP alone in the diagnosis of HCC. Further comparative studies with larger sample size and longer follow-up are needed to confirm our results and to identify risk factors of adverse events.

P-275 Advanced hemostasis assessment in endometriosis: strengthening confidence in the safety of hormonal treatments

Abstract Study question Are women with endometriosis in a state of systemic imbalance between pro- and anti-coagulants? Summary answer Women with endometriosis do not seem to exhibit a coagulation imbalance, at least at a systemic level. What is known already A state of platelet hyperactivation potentially leading to a hypercoagulation status has been described in women with endometriosis. This phenomenon could induce an altered local environment, promoting platelet-mediated paracrine changes in endometrial tissue and also increasing cardiovascular risk, which could be worsened by the use of estrogen dependent hormonal treatments. However, despite a slight difference in some coagulation parameters has been observed between women affected and controls, their levels remain, generally, within the normal reference range. Study design, size, duration This prospective case-control study including 101 women seeking infertility consultation at the Infertility Unit of Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano between January and July 2023 aimed to assess hemostasis function beyond traditional coagulation parameters. Participants/materials, setting, methods Blood of women with endometriosis (n = 51) or tubal or male factor infertility (controls; n = 50) was obtained before any ART treatment, and a complete panel of coagulation tests were performed, including basic parameters (aPTT, PT, FVIII, FII, PC, AT, FIV-C, DD, vWF, ADMT) as well as more sophisticated ones, such as Thrombin Generation Assay and Thromboelastometry, providing data on endogenous thrombin potential (ETP), clot formation time (CFT) and maximal clot firmness (MCF). Main results and the role of chance There were no significant differences between cases and controls in terms of age (37 [34-39] vs 36 [33-39]; p = 0.53, respectively) and smoking habits (14% vs 28%; p = 0.14, respectively). Women affected had a lower BMI compared to controls (22.7 [20.9-24.9] vs 21.4 [19.6-23.8]; p = 0.03), as it is usually expected. Results from TGA were expressed as ETP ratio (with-/without- thrombomodulin), and high ones were indicative of thrombomodulin resistance, taken as indexes of procoagulant imbalance; however, it was not different between women with and without the disease (0.75 [0.65-0.82] vs 0.75 [0.66-0.82]; p = 0.82, respectively). Other markers of procoagulant imbalance evaluated by thromboelastometry were also similar between cases and controls, including CFT (66 sec [58-78] vs 65 sec [59-79]; p = 0.69, respectively) and MCF (65 mm [62-68] vs 66mm [63-68]; p = 0.95, respectively). Considering the vWF/ADAMTS13 ratio, recently proposed to be altered in endometriosis, no difference was seen between affected and no-affected women (0.95 [0.76-1.14] vs 0.91 [0.68-1.15]; p = 0.41, respectively). Finally, all the basic coagulation parameters were also similar between groups. Limitations, reasons for caution Our sample size does not allow us to perform sub-analyses regarding the type of endometriosis, although we cannot exclude differences according to the various manifestations of the disease. Also, not having a systemic haemostasis imbalance does not exclude the possibility of local coagulation imbalances. Wider implications of the findings An altered systemic haemostasis could be worsened by the use of hormonal treatments. Our result indicating that there is no coagulation imbalance at a systemic level reassures about the absence of further contraindications to hormonal drugs as a treatment for endometriosis. Trial registration number not applicable