History Of Hyperlipidemia Research Articles

Symptoms: Abdominal Pain, Diaphoresis, Fever, Nausea, and Constipation

Symptoms: Abdominal Pain, Diaphoresis, Fever, Nausea, and Constipation

CHIOS MASTIC IMPROVES NIGHT-TIME DIASTOLIC PRESSURE IN WELL-CONTROLLED PATIENTS WITH HYPERTENSION; PRELIMINARY RESULTS OF THE HYPER-MASTIC CLINICAL TRIAL

Objective: Chios mastic is a natural nutritional supplement consisting of several bioactive compounds and it possesses antioxidant and anti-inflammatory activities. Preliminary recent evidence suggests an anti-hypertensive effect of mastic. HYPER-MASTIC is a double-blind, randomized and controlled clinical trial, with the aim of investigating the additional effect of a three-month supplementation with Chios mastic on arterial hypertension of Greek patients with well-managed cardiovascular risk factors. Design and method: Patients with well controlled hypertension are being consecutively recruited and randomly allocated into three groups of supplements: 1500mg of mastic, 2800 mg of mastic and placebo in this ongoing study. For the current analyses, the two mastic groups were merged. Blood pressure measurements, using both office and 24h blood pressure measurement, and blood tests were performed at baseline and at 3 months. Flow-mediated dilatation (FMD) at the level of the brachial artery was measured in all patients as a measure of endothelial function. Patients reported no recent history of acute myocardial infarction or stroke and no history of heart failure. Herein, the preliminary results of the study are presented. Results: At the time of analysis, twenty one patients [48% females, age: 62 (14)] were consecutively recruited and randomized, with available data at 3 months. Thirteen volunteers were allocated to mastic and eight to placebo. No difference was found regarding age, sex distribution, BMI levels, personal or family history of hyperlipidemia and hypertension, diabetes mellitus type 2 and coronary artery disease between the two groups. Patients in the mastic group reduced their night-time diastolic blood pressure compared to placebo [-5 (10) vs -2.5 (16.3) mmHg | p = 0.025, respectively]. No other differences from placebo were observed on the effect of mastic on BP parameters. FMD dropped with time in the placebo group, whereas in the mastic group it was preserved [-1.2 (2.7) vs -0.2 (0.8) | pinteraction = 0.010]. Conclusions: Chios mastic supplementation leads to improved night-time diastolic blood pressure and preserved endothelial function in patients with well-controlled hypertension, suggesting that it may incrementally exert anti-hypertensive and vasculoprotective properties over anti-hypertensive medication.

A very wide complex tachycardia

A 74-year-old woman with a history of persistent atrial fibrillation, hypertension, and hyperlipidemia presented to the emergency department (ED) after 3 days of intermittent palpitations and presyncope. She had been treated for atrial fibrillation with flecainide (150 mg twice daily) and metoprolol succinate (25 mg daily) for more than 20 years. In the ED, her heart rate was 150 bpm, and her blood pressure was 102/87. The electrocardiogram (ECG) is shown in Figure 1. The ECG obtained after a 150-mg bolus of intravenous amiodarone followed by a 200-J biphasic direct current shock is shown in Figure 2A . The ECG recorded soon after administration of 100 mEq of hypertonic sodium bicarbonate is shown in Figure 2B. What is the most likely cause of the wide complex tachycardia (WCT)? Figure 2A: Electrocardiogram with normal sinus rhythm and prolonged PR, QRS, and corrected QT intervals following direct current cardioversion. B: Electrocardiogram after treatment. View Large Image Figure Viewer Download Hi-res image

The Case Files

The Case Files

Field Synopsis of Environmental and Genetic Risk Factors of Sporadic Early-Onset Colorectal Cancer and Advanced Adenoma.

To systematically appraise and synthesize available epidemiologic evidence on the associations of environmental and genetic factors with the risk of sporadic early-onset colorectal cancer (EOCRC) and early-onset advanced colorectal adenoma (EOCRA). Multiple databases were comprehensively searched to identify eligible observational studies. Genotype data from UK Biobank were incorporated to examine their associations with EOCRC in a nested case-control design. Meta-analyses of environmental risk factors were performed, and the strength of evidence was graded based on predefined criteria. Meta-analyses of genetic associations were conducted using the allelic, recessive, and dominant models, respectively. A total of 61 studies were included, reporting 120 environmental factors and 62 genetic variants. We found 12 risk factors (current overweight, overweight in adolescence, high waist circumference, smoking, alcohol, sugary beverages intake, sedentary behavior, red meat intake, family history of colorectal cancer, hypertension, hyperlipidemia, and metabolic syndrome) and three protective factors (vitamin D, folate, and calcium intake) for EOCRC or EOCRA. No significant associations between the examined genetic variants and EOCRC risk were observed. Recent data indicate that the changing patterns of traditional colorectal cancer risk factors may explain the rising incidence of EOCRC. However, research on novel risk factors for EOCRC is limited; therefore, we cannot rule out the possibility of EOCRC having different risk factors than late-onset colorectal cancer (LOCRC). The potential for the identified risk factors to enhance the identification of at-risk groups for personalized EOCRC screening and prevention and for the prediction of EOCRC risk should be comprehensively addressed by future studies.

(350) Narcotic Requirements and Operative Outcomes of a Pudendal Nerve Block Prior to Primary Inflatable Penile Prosthesis Implantation in a Multiethnic Population

Abstract Introduction There are various analgesic regimens for post-operative pain control following inflatable penile prosthesis (IPP) implantation. Specifically, post-operative pain control with opioids is a common practice, but efforts to minimize narcotic usage are vital given the current opioid epidemic in the United States. Pudendal nerve block (PNB) provides regional perineal and penile anesthesia and represents an attractive option to maximize pain control while minimizing post-operative narcotic use. However, there is a paucity of studies describing whether utilization of PNBs decreases intra- and post-operative narcotic requirements following IPP implantation. Objective To determine whether PNB utilization in a multiethnic population undergoing primary IPP implantation can decrease rates of post-operative opiate usage. Secondary objectives were to assess PNB utilization on intra-operative and 30-day safety outcomes. Methods A single institution retrospective study was conducted of patients who underwent primary IPP implantation between December 2015 and February 2022. Demographic data, intra-operative characteristics, and outcome measures were extracted from electronic medical records. Baseline characteristics of PNB (yes or no) were summarized and analyzed using a Student’s t-test, Chi-square test, or Mann-Whitney U for non-normally distributed variables. PNB usage and PACU opioid administration (yes or no) were analyzed using binary logistic regression for univariate and multivariate analysis. Results A total of 363 patients were included, 294 (81.0%) in the PNB group and 69 (19.0%) in the non-PNB group. The majority of patients were of Hispanic race (62.3%). History of chronic pain (17.7% vs. 7.2%, p=0.03) and hyperlipidemia (52.0% vs. 34.8%, p=0.01) were more prevalent in the PNB group. Significantly more IPPs in the PNB group had cylinders measuring 20 centimeters or greater (57.1% vs 41.2, p=0.017). Estimated blood loss of 50ml or greater (43.1% vs. 20.0%, p<0.001), PACU narcotic usage (61.6% vs. 75.4%, p=0.040) and time (minutes) spent in the PACU (144 [111-185] vs. 238 [162-307], p<0.001) were all significantly lower in the PNB group. There were no significant differences in postoperative and 30-day safety outcomes. On univariate analysis, both PNB (OR=0.52, p=0.043) and age above 65 (OR=0.53, p=0.004) were associated with a lower likelihood of receiving opiates in the PACU, while only age remained significant (OR=0.53, p=0.006) on multivariate analysis. Conclusions Pre-operative PNB decreases intra-operative estimated blood loss, post-operative opioid analgesic requirements and time spent in PACU in patients undergoing a primary IPP implantation. Thus, PBN represents a potentially attractive, non-opioid means of analgesia in patients undergoing primary IPP surgery. Disclosure No

Clinical Image: Contrast-Induced Encephalopathy Mimicking Subarachnoid Hemorrhage

A 72-year-old female with a history of hypertension and hyperlipidemia presented to the emergency department from an outside hospital with acute confusion and global amnesia immediately following cervical epidural steroid injection with fluoroscopic guidance for radiculopathy relief. On exam, she was oriented to self, but disoriented to place and situation. Otherwise, she was neurologically intact with no deficits. Head computed tomography (CT) revealed diffuse subarachnoid hyperdensities most prominent in the parafalcine region concerning for diffuse subarachnoid hemorrhage and tonsillar herniation concerning for intracranial hypertension. CT angiograms of head and neck were negative for vascular abnormalities. Dual-energy head CT was subsequently performed 4hours later without IV contrast. The 80kV sequence revealed prominent diffuse hyperdensity throughout the cerebrospinal fluid spaces in bilateral cerebral hemispheres, basal cisterns, and posterior fossa consistent with the initial CT, but these corresponding regions were relatively less dense on the 150kV sequence. These findings were consistent with contrast material in the cerebrospinal fluid spaces without evidence of intracranial hemorrhage or transcortical infarct. Three hours later, the patient's transient confusion resolved, and she was discharged home the next morning without any neurological deficit.

Influencing factors of mild cognitive impairment among the Chinese elderly: a meta-analysis

Objective: To conduct a meta-analysis on the influencing factors of mild cognitive impairment (MCI) in the Chinese elderly. Methods: The literature related to the influencing factors of MCI in Chinese elderly population was retrieved through CNKI, Wanfang, VIP, PubMed, Embase and Web of Science databases up to March 13, 2022. Stata17.0 software was used to calculate the combined risk ratio (RR) with the 95% confidence interval (CI), test the heterogeneity, and assess the publication bias. Results: A total of 2 450 articles were retrieved, and 49 articles met the inclusion criteria, including 5 cohort studies and 44 case-control studies. Meta-analysis results showed that male (RR=0.778, 95%CI: 0.696-0.870, I2=73.1), education>6years (RR=0.428, 95%CI: 0.374-0.490, I2=86.9) and regular exercise (RR=0.496, 95%CI: 0.421-0.585, I2=81.5) were protective factors for MCI, while age≥70 years (RR=2.431, 95%CI: 2.086-2.833, I2=79.3), family history of dementia (RR=3.228, 95%CI: 2.140-4.867, I2=0.0), smoking (RR=1.214, 95%CI: 1.098-1.342, I2=78.8), alcohol consumption (RR=1.165, 95%CI: 1.047-1.297, I2=68.2), solitary living (RR=2.816, 95%CI: 2.123-3.736, I2=42.0), insomnia (RR=1.402, 95%CI: 1.093-1.799, I2=41.3), overweight/obesity (RR=1.431, 95%CI: 1.207-1.696, I2=75.9), hypertension (RR=1.731, 95%CI: 1.589-1.886, I2=67.1), hyperlipidemia (RR=1.722, 95%CI: 1.541-1.924, I2=63.9), diabetes mellitus (RR=1.495, 95%CI: 1.341-1.666, I2=71.6), cardiovascular diseases (RR=1.671, 95%CI: 1.446-1.932, I2=74.6) and cerebrovascular diseases (RR=2.309, 95%CI: 2.040-2.613, I2=76.3) were risk factors of MCI. Conclusion: The present study indicates that male, junior high school education or above and regular exercise are protective factors of MCI, while age≥70 years, family history of dementia, smoking, alcohol consumption, living alone, insomnia, overweight/obesity, hypertension, hyperlipidemia, diabetes, cardiovascular diseases and cerebrovascular diseases are risk factors of MCI.

A primer for the student joining the adult cardiac surgery service tomorrow: Primer 1 of 7

A primer for the student joining the adult cardiac surgery service tomorrow: Primer 1 of 7

Abstract #1407180: Drug Induced Acute Pancreatitis Secondary to Ezetimibe

Drug induced acute pancreatitis (DIAP) is a rare clinical entity with incidence of <2% in general population. Most cases are typically mild and have excellent prognosis but prompt diagnosis and cessation of offending drug is important to avoid adverse outcomes. A 58-year-old female former smoker with history of COPD and hyperlipidemia presented to the hospital with sudden onset abdominal pain radiating to the back associated with nausea and vomiting for 12 hours. On arrival vitals were normal and physical examination showed epigastric tenderness with negative murphy’s sign. Labs showed normal CBC and CMP with elevated serum lipase (2469 U/L – Normal 16 - 61 U/L) concerning for acute pancreatitis. CT abdomen and pelvis showed normal biliary tract. US of the abdomen showed no evidence of gall stone or biliary sludge. Serum lipid panel showed total cholesterol of 193, HDL of 66, LDL of 111 and triglyceride of 87. Serum Calcium was normal. Detailed history revealed no alcohol but that patient recently started ezetimibe 10 mgs daily 8 weeks prior to present due to history of statin intolerance. Her only other medication was inhaled Albuterol taken as needed. Immune panel include IgG-4 was negative. Patient was diagnosed with drug induced acute pancreatitis secondary to ezetimibe, and was managed conservatively cessation of ezetimibe, pain meds and bowel rest. Her overall condition improved in 48 hours and diet was progressed. She was discharged with outpatient follow up. Serum lipase dropped to 74 U/L prior to discharge. Drug induced pancreatitis account for ∼ 5% of all cases of pancreatitis. There is limited data on the exact mechanism by which drugs can induce pancreatitis as most evidence is bases on case reports or meta-analysis. On the basis of these case reports drugs are classified from class I-IV depending on the probability to cause pancreatitis. Some proposed mechanisms include immunologic reactions, direct toxic effect, accumulation of a toxic metabolite, ischemia, intravascular thrombosis, and an increased viscosity of pancreatic juice. Though most cases are mild the identification of the offending drug is crucial to prevent ongoing damage and recurrence. However, in most instances the diagnosis of drug induced pancreatitis and identification of offending drug can be challenging due to the presence of multiple agents. Current proposed criteria for identification include: 1) Pancreatitis develops during treatment with the drug, 2) Other likely causes of pancreatitis are not present 3) Pancreatitis resolves upon discontinuation of the drug and 4) Pancreatitis usually recurs upon re-administration of the drug. Our patient fulfilled 3 of the above criteria which suggest Ezetimibe induced Pancreatitis. Prior to this case there is one more case reported cases of Ezetimibe induced Pancreatitis but in both the cases there is no re-challenge of Ezetimibe which makes it a Class IV drug to cause pancreatitis.

PO-04-055 ATRIAL FIBRILLATION EDUCATION GONE WRONG: THE INTERSECTION OF PATIENT EDUCATION, ANXIETY, AND AMBIGUITY IN AN ATRIAL FIBRILLATION PATIENT

Atrial fibrillation (AF) patients have significant symptom burden resulting in uncertainty and distress. Patients often seek out medical information from their healthcare team, online resources, and significant others to better understand their experience and diagnosis. We report a case of an AF patient referred for an ablation complicated by influx of information across settings and iatrogenic anxiety. Patient presented to the Cardiac Psychology Service with poor understanding, high anxiety, and uncertainty that led to paralysis of the recovery process. A 60-year-old White married female with medical history of AF, hypertension, diabetes, hyperlipidemia, PVCs, and former smoker presented for distress related to her AF diagnosis. Prior visits with a cardiologist triggered questions about her condition, anti-coagulation use, possible loop recorder insertion, LAAO devices, and long-term prognosis. Interactions with her healthcare team led to increased anxiety, hypervigilance of symptoms, uncertainty of medical decisions, and fears about AF recurrence and progression. This prompted online investigation of her treatment options, frequent healthcare utilization, and internet inquires for “Dr. Google” resulting in decision to postpone the ablation. The patient was treated by cardiac psychology to help restore a sense of control, reinforce shared-decision making and understanding. Focuses included disentangling alarming medical information from medical advice and existence of multiple treatment options. Given this was her first significant health concern and the episodic nature of AF, ambiguity and associated fears were normalized to further increase confidence navigating information presented. Behavioral changes and a self-management model were emphasized to promote less vigilance adversity and more attention to both appropriate psychological and physical health concerns. Psychological treatment combined with education from her EP addressed the lack of comprehensive medical information which led to improved adherence, decreased anxiety, and pursuit of recommended ablation. The present case highlights the potential implications of uncertainty and overabundance of information on AF treatment. Early recognition of anxiety by the EP physician should prompt a referral to a cardiac psychologist for comprehensive multidisciplinary care to minimize impact of misinformation on patient experience.

Could hyperlipidemia be a risk factor for corticobasal syndrome? - a pilot study.

Corticobasal syndrome (CBS) is a specific clinical manifestation shared by multiple pathologies. The exact mechanism of this phenomenon remains unclear. Differential diagnosis of CBS in everyday clinical practice is challenging, as this syndrome can overlap with other entities, especially progressive supranuclear palsy Richardson-Steele phenotype (PSP-RS). Several papers have suggested a possible role of vascular pathology as a linking factor in the pathogenesis of CBS based on different neuropathologies. This paper analyses differences in the occurrence of the most common vascular risk factors such as hypertension and lipid profile with respect to dietary habits among patients who fulfill the diagnostic criteria for probable/possible CBS and PSP-RS. Seventy (70) patients in total were included in the study. Exclusion criteria comprised hydrocephalus, stroke in the past, the presence of marked vascular changes in white matter defined as the presence of vascular change ≥ 1 mm in 3T MRI, medical history of hyperlipidemia or the use of drugs that could impact upon lipid metabolism before the initiation of the neurodegenerative disease, and neoplastic focuses in the central nervous system. Patients with diabetes, or with BMI exceeding 18-25, or who were smokers, or who were affected by chronic stress were also excluded. Data was analysed statistically using the Shapiro-Wilk test, the U Mann-Whitney test for group comparison, and a Bonferroni correction to control the false discovery rate (FDR). Our obtained results indicated a statistically significantly higher level of total cholesterol in the CBS group (p = 0.0039) without a correlation with dietary habits. The results obtained in our study may suggest a possible role of vascular pathology in CBS development. This issue requires further research.

Clues on Optical Coherence Tomography Leading to Diagnosis of Primary CNS Lymphoma (P2-9.012)

<h3>Objective:</h3> NA <h3>Background:</h3> Vitreoretinal lymphoma is a rare variant of primary central nervous system lymphoma (PCNSL). Around 20% of the PCNSL patients develop concurrent ocular involvement in the retina, vitreous, or optic nerve head. However, only 50% of these patients report visual symptoms, thus making a detailed ophthalmic examination a necessity. <h3>Design/Methods:</h3> NA <h3>Results:</h3> A 65-year-old man with history of hypertension and hyperlipidemia, presented with progressive hypersomnia, confusion, intermittent horizontal binocular diplopia, tremors, and blood pressure fluctuations over a course of 9 months. A magnetic resonance imaging of the brain with and without gadolinium contrast showed multifocal confluent cerebral and cerebellar enhancing and non-enhancing white matter abnormalities. Lumbar puncture revealed borderline pleocytosis (WBC 5) with negative cytology. The patient was referred to neuro-ophthalmology to be evaluated for ocular signs that may help with the diagnosis. At that visit, he was noted to have severe vision loss (visual acuity of 7/200) in the left eye that was not noticed by the patient until the time of examination. There was a left relative afferent pupillary defect. Further exam was notable for vitreous cells and yellow retinal placoid deposits. The optic nerve was normal. Optical coherence tomography (OCT) revealed multiple, hyper-reflective foci in the outer layers of the left macula with patchy discontinuity in the ellipsoid and photoreceptor layers. A vitreous biopsy detected CD20+, MYD88+ large B-cell lymphoma, and patient was initiated on systemic chemotherapy. <h3>Conclusions:</h3> High-resolution OCT has enabled physicians to recognize unique features of different neoplasms such as PCNSL. Our case emphasizes the importance of detailed neuro-ophthalmologic examination and utilization of adjunct tests such as OCT in cases of progressive subacute leukoencephalopathy of unknown etiology. This would also lead to use of less invasive diagnostic methods such as vitreous biopsy instead of brain biopsy, earlier diagnosis, and treatment of patients with PCNSL. <b>Disclosure:</b> Dr. Moheb has nothing to disclose. Dr. Olsen has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for American Academy of Ophthalmology. Dr. Olsen has stock in Non-Medical, unrelated. The institution of Dr. Olsen has received research support from National Eye Institute (NEI). The institution of Dr. Olsen has received research support from Novartis. Dr. Olsen has received intellectual property interests from a discovery or technology relating to health care. The institution of Dr. Tobin has received research support from Mallinckrodt. Dr. Tobin has received personal compensation in the range of $500-$4,999 for serving as a Speaker with NeurologyLive. John J. Chen has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for UCB. John J. Chen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. John J. Chen has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Horizon.

Concomitant occurrence of Cerebral Hyperperfusion Syndrome (CHS) and Reversible Cerebral Vasoconstriction Syndrome (RCVS) after right Carotid Endarterectomy (CEA) (P2-5.018)

<h3>Objective:</h3> To describe an interesting case of CHS and RCVS occurring concomitantly following CEA <h3>Background:</h3> Both CHS and RCVS are known complications of CEA. On rare occasions both complications can occur concomitantly after CEA. <h3>Design/Methods:</h3> Case report <h3>Results:</h3> A 58-year-old female with long-standing history of smoking and hyperlipidemia presented to outside hospital (OSH) with pressure-like headache on top of her head and feeling of facial swelling. CT angiogram of head and neck (CTA) showed right internal carotid artery (ICA) stenosis of 85% and left ICA stenosis of 80%. Three months after the initial presentation she underwent right CEA. Immediately following procedure, she had severe throbbing headache on right side which responded to Toradol. Neurologic examination was otherwise unremarkable, and she was discharged home on dual anti-platelet therapy. After discharge, she continued to have headache. Ten days after the procedure, she developed left sided weakness and presented to an outside hospital where she had a seizure and was started on levetiracetam. MRI of the brain showed edematous changes on the right consistent with CHS without evidence of acute stroke. Right ICA was patent and there was segmental vasoconstriction and dilation of cerebral vasculature consistent with RCVS. Due to increased risk of hemorrhagic strokes with CHS and RCVS, left CEA was not recommended and maximal medical therapy was recommended. There was resolution of edematous changes in right cerebral hemisphere on MRI two months later. CTA at two months follow up showed resolution of segmental vasoconstriction and vasodilation, patent right ICA and unchanged left ICA stenosis. <h3>Conclusions:</h3> CHS and RCVS can occur concomitantly after CEA and can lead to devastating hemorrhagic strokes. In patients who develop CHS and RCVS concomitantly maximal medical therapy should be recommended for contralateral ICA stenosis. <b>Disclosure:</b> Dr. Anjum has nothing to disclose. Dr. Burton has nothing to disclose. Dr. Javalkar has nothing to disclose. Dr. Chernyshev has nothing to disclose.

Distinguishing Peduncular Hallucinosis From Charles Bonnet Syndrome: A Case Report (P4-12.008)

<h3>Objective:</h3> To present a case of peduncular hallucinosis in the setting of macular degeneration, and compare and contrast the presentation of peduncular hallucinosis with that of Charles Bonnet syndrome. <h3>Background:</h3> Peduncular hallucinosis (PH) is characterized by vivid visual hallucinations occurring in fully lucid patients.¹ Injury to the basal ganglia, thalamus, midbrain, and pons have been implicated.^1,2 It is most often reported as a presenting symptom of various tumors, following stroke, and as a complication of neurosurgery.² Leading hypotheses involve the ARAS.³ On the differential is Charles Bonnet syndrome, which occurs due to reduced visual input secondary to ophthalmologic or vascular disease.⁴ <h3>Design/Methods:</h3> Verbal consent was obtained from the patient. <h3>Results:</h3> 76-year-old male with a past medical history of diabetes, hypertension, hyperlipidemia, and macular degeneration presented to the ED with hallucinations for one day. He fell one day prior to onset, but did not hit his head or lose consciousness. Immediately following the fall, he noticed human-like figures occupying his room. CT of the head was interpreted as negative and the patient was discharged. He returned three days later after no improvement. ROS, drug history, and family history were unremarkable. He could visualize, communicate with, and feel the touch of human-like figures, fully aware that these hallucinations were not real. Full neurological exam, including mental status, was unremarkable with the exception of visual fields and acuity. MRI of the head and neck confirmed a left pontine lacunar infarct and a diagnosis of PH was made. Aspirin and statin were initiated for secondary prevention of stroke and an echocardiogram was ordered. Two days later, the patient denied hallucinations. Ways to alleviate hallucinations and outpatient pharmaceutical intervention were discussed should symptoms return. <h3>Conclusions:</h3> PH is a rare cause of hallucinations, and work-up should be considered in any individual experiencing hallucinations with an otherwise unremarkable mental status exam. <b>Disclosure:</b> Ms. Alayon has nothing to disclose. Mrs. Goodis has nothing to disclose. Dr. Wirkowski has nothing to disclose.

Ataxic variant of Guillain-Barre syndrome, with positive GD1b antibodies in an elderly male: a case report (P10-5.005)

<h3>Objective:</h3> Discuss an atypical presentation of ataxic GBS with positive GD1b antibody. <h3>Background:</h3> The clinical spectrum of Guillain-Barre syndrome (GBS) ranges from asymptomatic to rapidly progressive and fatal. Ataxic GBS is one of the rare presentations. It is characterized by profound ataxia without ophthalmoplegia. We report a case of atypical presentation of GBS with rapidly progressive neurological deficits in an elderly male. <h3>Design/Methods:</h3> N/A <h3>Results:</h3> A 73-year-old right-handed male with past medical history of hypertension and hyperlipidemia presented with gait imbalance and distal extremity numbness for five days prior to presentation. He noted he was having difficulty walking but denied weakness. He reported “electricity” type pain in his arms and legs and perioral tingling. He denied any other neurological deficits. He denied recent illness or vaccination. Physical exam was remarkable for severe ataxia, areflexia, and mild nystagmus. An MRI of the brain, cervical and thoracic spine showed no pathology. Cerebrospinal fluid (CSF) sampling showed protein of 46 mg/dL and no cells with a negative CSF culture. An electromyogram showed motor-sensory non-length dependant non-axonal loss without demyelination. A diagnosis of variant Guillain-Barre syndrome was suspected, and the patient received a 5-day course of intravenous immunoglobulins (IVIG). Despite this the patient developed neuromuscular respiratory failure necessitating intubation. GD1b antibody titter was found to be elevated at 1:800 (reference &lt;1:100) <h3>Conclusions:</h3> The ataxic variant of GBS is a very uncommon disease pathology. This case highlights the importance of considering different subtypes and presentations of GBS and related disorders. Early diagnosis and treatment with IVIG are important for a good outcome. <b>Disclosure:</b> Dr. Valhuerdi Porto has nothing to disclose. Dr. Shnawa has nothing to disclose. Dr. Joseph has nothing to disclose. Dr. Scott has nothing to disclose.

Possible Incidental Parkinson's Disease following Asthma: A Nested Case-Control Study in Korea.

A connection between asthma and the occurrence of Parkinson's disease (PD) has been suggested, but the findings have been contentious and require verification. In this nested case-control study using data from the Korean National Health Insurance Service-Health Screening Cohort (2002-2019), which comprised 9029 participants with PD and 36,116 matched controls, we explored the relationship between asthma and incident PD. An overlap-weighted logistic regression model was used to measure the probability of asthma and PD. After adjusting for various covariates, we found that asthma was related to a 1.11-fold greater probability of PD (95% confidence interval: 1.06-1.16). A subgroup analysis showed that this effect was independent of age, sex, residential area, or alcohol consumption, and that it was still noticeable even among patients with a high income; those with a normal weight or obesity; those who were non-smokers or current smokers; and those with no history of chronic obstructive pulmonary disease, hypertension, hyperglycemia, hyperlipidemia, or anemia. Thus, these findings may indicate that asthma may slightly augment the likelihood of PD in the Korean adult population regardless of demographic or lifestyle factors, making it difficult to predict PD in asthma patients.

Contraversive Ocular Tilt Reaction, Body Lateropulsion and Gaze-Evoked Nystagmus After Inferior Cerebellar Peduncle and Dentate Nucleus Stroke

Contraversive Ocular Tilt Reaction, Body Lateropulsion and Gaze-Evoked Nystagmus After Inferior Cerebellar Peduncle and Dentate Nucleus Stroke

Neutrophil-to-Lymphocyte Ratio Is an Independent Risk Factor for Coronary Artery Disease in Central Obesity.

Several inflammatory biomarkers were found to be associated with an increased risk of cardiovascular disease. Neutrophil-to-lymphocyte ratio (NLR) is a marker of subclinical inflammation that increases with the stress response. Visceral adiposity index (VAI) calculated as a combination of anthropometric and metabolic parameters reflects both the extent and function of visceral adipose tissue. Given the association of subclinical inflammation with both obesity and cardiovascular diseases, it is plausible that the inflammation-CVD association is modulated by the amount and function of adipose tissue. Thus, our aim was to examine the association between NLR and coronary artery calcium score (CACS), an intermediate marker of coronary artery disease in asymptomatic patients across VAI tertiles. Methods: Data from 280 asymptomatic participants of a cardiovascular screening program were analysed. In addition to the collection of lifestyle and medical history, a non-contrast cardiac CT scan and laboratory tests were performed on all participants. Multivariate logistic regression was conducted with CACS > 100 as the outcome and with conventional cardiovascular risk factors and NLR, VAI, and NLR by VAI tertile as predictors. Results: We found an interaction between VAI tertiles and NLR; NLR values were similar in the lower VAI tertiles, while they were higher in the CACS > 100 in the 3rd VAI tertile (CACS ≤ 100: 1.94 ± 0.58 vs. CACS > 100: 2.48 ± 1.1, p = 0.008). According to multivariable logistic regression, the interaction between NLR and VAI tertiles remained: NLR was associated with CACS > 100 in the 3rd VAI tertile (OR = 1.67, 95% CI 1.06-2.62, p = 0.03) but not in the lower tertiles even after adjustment for age, sex, smoking, history of hypertension, hyperlipidaemia, and diabetes mellitus, as well as high-sensitivity C-reactive protein. Our findings draw attention to the independent association between subclinical, chronic, systemic inflammation and subclinical coronary disease in obesity.

High serum magnesium is associated with lower risk of hepatocellular carcinoma among patients with nonalcoholic fatty liver disease.

Nonalcoholic fatty liver disease (NAFLD) is a major contributor to the rising incidence of hepatocellular carcinoma (HCC). Magnesium is a major cation in cellular activities. Epidemiological data on magnesium level and its relation to HCC are sparse. This study aimed to examine the associations between serum levels of magnesium and the risk of HCC among patients with NAFLD. A total of 26,053 patients with NAFLD were identified in the University of Pittsburgh Medical Center Electronic Health Records from 2004 through 2018. After an average of 5.15years of follow-up, 395 patients developed HCC after the first measurement of serum magnesium. Cox proportional hazards regression model was used to calculate hazard ratios (HRs) and 95% CIs of HCC incidence associated with quartile levels of serum magnesium after adjustment for age, sex, race, body mass index, diuretics use, history of type 2 diabetes, history of hypertension, history of hyperlipidemia, and tobacco smoking. Patients with NAFLD who developed HCC had a significantly lower mean (± standard deviation) serum magnesium (0.769±0.131mmol/L) than those who remained free of HCC (0.789±0.125mmol/L; p=.003). Compared with the lowest quartile, the HRs (95% CIs) of HCC second, third, and fourth quartiles of serum magnesium were 0.87 (0.67-1.12), 0.77 (0.57-1.04), and 0.73 (0.56-0.96), respectively, after adjustment for multiple potential confounders (P trend =.02). This finding suggests higher levels of serum magnesium were significantly associated with decreased risk of HCC among patients with NAFLD.