Including Diabetes Mellitus Type Research Articles

5116 Postmenopausal Hyperandrogenism due to Rare Ovarian Tumor

Abstract Disclosure: M. Salim: None. S. Dasaraju: None. Y. Lee: None. S. Afzal: None. B.K. Erickson: None. M.A. Khalifa: None. L.A. Burmeister: None. Background: Hyperandrogenism in postmenopausal women may arise from either ovarian or adrenal source and can pose challenging diagnostic dilemma. Clinical Case: A 66-year-old multigravida, post-menopausal woman presented with a 3-month history of worsening alopecia. Her past medical history included diabetes mellitus type 2 and breast cancer. Menarche was at age 12. There was no history of infertility. Menopause was in her 40’s. She had been shaving her upper lip and chin hair every 3 days for the past 10 years. Scalp hair loss had accelerated in the last 3 months, with loss of the bangs. Physical exam was significant for body mass index 34, deep voice, and clitoromegaly. Laboratory tests showed testosterone 160 ng/dL, (8-60 ng/dL), free testosterone 3.37 ng/dL (0.06-0.38 ng/dL), androstenedione 2.196 ng/mL (0.13-0.82 ng/mL), sex hormone binding globulin (SHBG) 31 nmol/L (30-135 nmol/L), dehydroepiandrosterone-sulfate (DHEAS) 86 ug/dL (13-130 ug/dL), 17-hydroxy progesterone 96 ng/dL (<51 ng/dL), inhibin A 1.1 pg/mL (<6.9 pg/mL), inhibin B <10 pg/mL (<16 pg/mL), adrenocorticotropic hormone 38 pg/mL (<47 pg/mL), and cortisol 12.2 ug/dL (4-22 ug/dL). Response to 1 mg overnight dexamethasone suppression test demonstrated persistently elevated testosterone (160 ng/dL), and incomplete suppression of androstenedione (0.827 ng/mL) and cortisol (2.4 ug/dL). Computerized tomography (CT) scan showed a left adrenal nodule (12 mm, 5 Hounsfield units, stable compared to imaging 2 years prior) and unremarkable appearance of the ovaries. Pelvic ultrasound did not show ovarian tumor on the right and left ovary was not seen. Adrenal and ovarian vein sampling suggested the ovaries as the source of the testosterone. Given the ovarian vein sampling results, a multidisciplinary discussion between endocrinology and gynecologic oncology concluded that bilateral salpingo-oophorectomy (BSO) was the next best step for diagnosis and management. Laparoscopic BSO was performed. Intraoperatively, the ovaries appeared grossly normal with the exception of dilated ovarian veins. Histopathology showed bilateral Leydig cell tumors (left: 1.5 cm; right: 2.0 cm) and a 0.7 cm left ovarian Brenner tumor. At 1-year postoperative follow-up, alopecia had resolved. Laboratory evaluation showed normalization of the testosterone (23 ng/dL), free testosterone (0.47 ng/dL). Androstenedione (1.023 ng/mL) was lower than before surgery but higher than reference range. Conclusion: The presented rare case of postmenopausal virilization is even more unique due to the synchronous presence of 2 rare ovarian tumors, both capable of causing hyperandrogenism, including bilateral ovarian Leydig cell tumor, Brenner tumor and adrenal incidentaloma. Despite normal appearing ovaries on imaging studies, BSO was ultimately necessary for diagnosis and management. Presentation: 6/3/2024

5116 Postmenopausal Hyperandrogenism due to Rare Ovarian Tumor

Abstract Disclosure: M. Salim: None. S. Dasaraju: None. Y. Lee: None. S. Afzal: None. B.K. Erickson: None. M.A. Khalifa: None. L.A. Burmeister: None. Background: Hyperandrogenism in postmenopausal women may arise from either ovarian or adrenal source and can pose challenging diagnostic dilemma. Clinical Case: A 66-year-old multigravida, post-menopausal woman presented with a 3-month history of worsening alopecia. Her past medical history included diabetes mellitus type 2 and breast cancer. Menarche was at age 12. There was no history of infertility. Menopause was in her 40’s. She had been shaving her upper lip and chin hair every 3 days for the past 10 years. Scalp hair loss had accelerated in the last 3 months, with loss of the bangs. Physical exam was significant for body mass index 34, deep voice, and clitoromegaly. Laboratory tests showed testosterone 160 ng/dL, (8-60 ng/dL), free testosterone 3.37 ng/dL (0.06-0.38 ng/dL), androstenedione 2.196 ng/mL (0.13-0.82 ng/mL), sex hormone binding globulin (SHBG) 31 nmol/L (30-135 nmol/L), dehydroepiandrosterone-sulfate (DHEAS) 86 ug/dL (13-130 ug/dL), 17-hydroxy progesterone 96 ng/dL (<51 ng/dL), inhibin A 1.1 pg/mL (<6.9 pg/mL), inhibin B <10 pg/mL (<16 pg/mL), adrenocorticotropic hormone 38 pg/mL (<47 pg/mL), and cortisol 12.2 ug/dL (4-22 ug/dL). Response to 1 mg overnight dexamethasone suppression test demonstrated persistently elevated testosterone (160 ng/dL), and incomplete suppression of androstenedione (0.827 ng/mL) and cortisol (2.4 ug/dL). Computerized tomography (CT) scan showed a left adrenal nodule (12 mm, 5 Hounsfield units, stable compared to imaging 2 years prior) and unremarkable appearance of the ovaries. Pelvic ultrasound did not show ovarian tumor on the right and left ovary was not seen. Adrenal and ovarian vein sampling suggested the ovaries as the source of the testosterone. Given the ovarian vein sampling results, a multidisciplinary discussion between endocrinology and gynecologic oncology concluded that bilateral salpingo-oophorectomy (BSO) was the next best step for diagnosis and management. Laparoscopic BSO was performed. Intraoperatively, the ovaries appeared grossly normal with the exception of dilated ovarian veins. Histopathology showed bilateral Leydig cell tumors (left: 1.5 cm; right: 2.0 cm) and a 0.7 cm left ovarian Brenner tumor. At 1-year postoperative follow-up, alopecia had resolved. Laboratory evaluation showed normalization of the testosterone (23 ng/dL), free testosterone (0.47 ng/dL). Androstenedione (1.023 ng/mL) was lower than before surgery but higher than reference range. Conclusion: The presented rare case of postmenopausal virilization is even more unique due to the synchronous presence of 2 rare ovarian tumors, both capable of causing hyperandrogenism, including bilateral ovarian Leydig cell tumor, Brenner tumor and adrenal incidentaloma. Despite normal appearing ovaries on imaging studies, BSO was ultimately necessary for diagnosis and management. Presentation: 6/3/2024

9243 Postmenopausal Hyperandrogenism due to Rare Ovarian Tumor

Abstract Disclosure: M. Salim: None. S. Dasaraju: None. Y. Lee: None. S. Afzal: None. B.K. Erickson: None. M.A. Khalifa: None. L.A. Burmeister: None. Background: Hyperandrogenism in postmenopausal women may arise from either ovarian or adrenal source and can pose challenging diagnostic dilemma. Clinical Case: A 66-year-old multigravida, post-menopausal woman presented with a 3-month history of worsening alopecia. Her past medical history included diabetes mellitus type 2 and breast cancer. Menarche was at age 12. There was no history of infertility. Menopause was in her 40’s. She had been shaving her upper lip and chin hair every 3 days for the past 10 years. Scalp hair loss had accelerated in the last 3 months, with loss of the bangs. Physical exam was significant for body mass index 34, deep voice, and clitoromegaly. Laboratory tests showed testosterone 160 ng/dL, (8-60 ng/dL), free testosterone 3.37 ng/dL (0.06-0.38 ng/dL), androstenedione 2.196 ng/mL (0.13-0.82 ng/mL), sex hormone binding globulin (SHBG) 31 nmol/L (30-135 nmol/L), dehydroepiandrosterone-sulfate (DHEAS) 86 ug/dL (13-130 ug/dL), 17-hydroxy progesterone 96 ng/dL (<51 ng/dL), inhibin A 1.1 pg/mL (<6.9 pg/mL), inhibin B <10 pg/mL (<16 pg/mL), adrenocorticotropic hormone 38 pg/mL (<47 pg/mL), and cortisol 12.2 ug/dL (4-22 ug/dL). Response to 1 mg overnight dexamethasone suppression test demonstrated persistently elevated testosterone (160 ng/dL), and incomplete suppression of androstenedione (0.827 ng/mL) and cortisol (2.4 ug/dL). Computerized tomography (CT) scan showed a left adrenal nodule (12 mm, 5 Hounsfield units, stable compared to imaging 2 years prior) and unremarkable appearance of the ovaries. Pelvic ultrasound did not show ovarian tumor on the right and left ovary was not seen. Adrenal and ovarian vein sampling suggested the ovaries as the source of the testosterone. Given the ovarian vein sampling results, a multidisciplinary discussion between endocrinology and gynecologic oncology concluded that bilateral salpingo-oophorectomy (BSO) was the next best step for diagnosis and management. Laparoscopic BSO was performed. Intraoperatively, the ovaries appeared grossly normal with the exception of dilated ovarian veins. Histopathology showed bilateral Leydig cell tumors (left: 1.5 cm; right: 2.0 cm) and a 0.7 cm left ovarian Brenner tumor. At 1-year postoperative follow-up, alopecia had resolved. Laboratory evaluation showed normalization of the testosterone (23 ng/dL), free testosterone (0.47 ng/dL). Androstenedione (1.023 ng/mL) was lower than before surgery but higher than reference range. Conclusion: The presented rare case of postmenopausal virilization is even more unique due to the synchronous presence of 2 rare ovarian tumors, both capable of causing hyperandrogenism, including bilateral ovarian Leydig cell tumor, Brenner tumor and adrenal incidentaloma. Despite normal appearing ovaries on imaging studies, BSO was ultimately necessary for diagnosis and management. Presentation: 6/3/2024

Adipose Tissue Dysfunction and the Role of Adipocyte-Derived Extracellular Vesicles in Obesity and Metabolic Syndrome.

Obesity is a major public health issue that is associated with metabolic diseases including diabetes mellitus type 2 and metabolic syndrome. This pathology leads to detrimental cardiovascular health and secondary effects, such as lipotoxicity, inflammation, and oxidative stress. Recently, extracellular vesicles (EVs) have been highlighted as novel players participating in human physiology and pathophysiology. In obesity, adipose tissue is related to the active shedding of adipocyte-derived extracellular vesicles (AdEVs). The current review explores and highlights the role of AdEVs and their cargo in obesity and metabolic syndrome. AdEVs are proposed to play an important role in obesity and its comorbidities. AdEVs are biological nanoparticles mainly shed by visceral and subcutaneous adipose tissue, acting in physiological and pathophysiological conditions, and also carrying different cargo biomolecules, such as RNA, microRNA (miRNA), proteins, and lipids, among others. RNA and miRNA have local and systemic effects affecting gene expression in target cell types via paracrine and endocrine actions. State of the art analyses identified some miRNAs, such as miR-222, miR-23b, miR-4429, miR-148b, and miR-4269, that could potentially affect cell pathways involved in obesity-related comorbidities, such as chronic inflammation and fibrosis. Similarly, AdEVs-proteins (RBP4, perilipin-A, FABP, mimecan, TGFBI) and AdEVs-lipids (sphingolipids) have been linked to the obesity pathophysiology. The current knowledge about AdEVs along with further research would support and reveal novel pathways, potential biomarkers, and therapeutic options in obesity.

Olive oil, fruit and leaves in diabetes mellitus type 2 treatment

The Mediterranean dietary pattern, where extra virgin olive oil (EVOO) takes the central spot, is related to longer life expectancy and lower risk of a number of non-communicable diseases, including cardiovascular, diabetes, dementias, and cancer. Positive effect of olive oil on a broad spectrum of diseases, including diabetes mellitus type 2 (DMT2), is usually attributed to its fatty acid content (e.g., oleic acid). Yet, in the last two decades researchers confirmed that, the phenolic compounds (e.g., oleuropein) also significantly alter on glycaemic regulation. Other unprocessed parts of olive plant (fruit and leaves) showed positive impact on glycaemic variability among individuals living with DMT2. The present review focuses on the available research findings on the effect of olive oil, fruits, and leaves on DMT2 treatment. Specifically, the focus is on polyphenols and fats of olive oil, fruits, and leaves with regard to their antidiabetic biological activities.

Ursodeoxycholic Acid Does Not Improve COVID-19 Outcome in Hospitalized Patients.

Ursodeoxycholic acid (UDCA) was demonstrated to reduce susceptibility to SARS-CoV-2 infection in vitro and improve infection course in chronic liver diseases. However, real-life evidence is lacking. We analyzed the impact of UDCA on COVID-19 outcomes in patients hospitalized in a tertiary center. Between January 2020 and January 2023, among 3847 patients consecutively hospitalized for COVID19, 57 (=UDCA group) were taking UDCA. The UDCA and the control groups (n = 3790) did not differ concerning comorbidities including diabetes mellitus type 2 (15.8% vs. 12.8%) and neoplasia (12.3% vs. 9.4%). Liver diseases and vaccination rate were more common in the UDCA group (14.0% vs. 2.5% and 54.4% vs. 30.2%, respectively). Overall mortality and CPAP treatment were 22.8 % and 15.7% in the UDCA, and 21.3% and 25.9% in the control group. Mortality was similar (p = 0.243), whereas UDCA was associated with a lower rate of CPAP treatment (OR = 0.76, p < 0.05). Treatment with UDCA was not an independent predictor of survival in patients hospitalized for COVID-19.

Turning waiting time into treatment time: Weight reduction by a lifestyle intervention programme for patients with obesity before fertility treatment

AbstractAimTo evaluate the effects of offering a clinic‐driven lifestyle intervention programme in the waiting time before fertility treatment to women and men with obesity (body mass index [BMI] ≥ 30 kg/m2).MethodsThis prospective intervention study was conducted at a public Danish fertility clinic. All consecutive patients, both women and men, referred to the clinic between May 2020 and March 2021 with a BMI ≥ 30 kg/m2 were offered a 6‐month lifestyle intervention programme consisting of monthly motivational dialogues and counselling with a certified nutritionist nurse. Weight loss maintenance was evaluated at a 1‐year follow‐up visit conducted 6‐months after completion of the programme. The primary outcomes were absolute weight loss (kg) and relative weight loss (percent compared with weight at inclusion) upon completing the 6‐month programme and at the 1‐year follow‐up. Secondary outcome measures were effects on biochemical metabolic markers.ResultsForty‐five participants were enroled in the study, of which 38 completed the 6‐months lifestyle intervention programme and 33 participated in the 1‐year follow‐up. The participants' mean weight loss was 5.4 kg (95% confidence interval [CI]: 3.3, 7.5) after the 6‐month programme (30 of 38 participants lost weight) and 4.4 kg (95% CI: 1.4, 7.3) at the 1‐year follow‐up compared with baseline. Previously undiagnosed metabolic conditions were revealed in 61% of the participants, including four cases (11%) of undiagnosed diabetes mellitus type 2.ConclusionA clinic‐driven lifestyle intervention programme offered to patients with obesity in the waiting time for fertility treatment can successfully reduce weight in a high number of patients with stable results at 1‐year follow‐ups. Metabolic conditions, including diabetes mellitus type 2, are likely underdiagnosed in this group of patients, but further studies are needed.

MicroRNAs in the Regulation of NADPH Oxidases in Vascular Diabetic and Ischemic Pathologies: A Case for Alternate Inhibitory Strategies?

Since their discovery in the vasculature, different NADPH oxidase (NOX) isoforms have been associated with numerous complex vascular processes such as endothelial dysfunction, vascular inflammation, arterial remodeling, and dyslipidemia. In turn, these often underlie cardiovascular and metabolic pathologies including diabetes mellitus type II, cardiomyopathy, systemic and pulmonary hypertension and atherosclerosis. Increasing attention has been directed toward miRNA involvement in type II diabetes mellitus and its cardiovascular and metabolic co-morbidities in the search for predictive and stratifying biomarkers and therapeutic targets. Owing to the challenges of generating isoform-selective NOX inhibitors (NOXi), the development of specific NOXis suitable for therapeutic purposes has been hindered. In that vein, differential regulation of specific NOX isoforms by a particular miRNA or combina-tion thereof could at some point become a reasonable approach for therapeutic targeting under some circumstances. Whereas administration of miRNAs chronically, or even acutely, to patients poses its own set of difficulties, miRNA-mediated regulation of NOXs in the vasculature is worth surveying. In this review, a distinct focus on the role of miRNAs in the regulation of NOXs was made in the context of type II diabetes mellitus and ischemic injury models.

32573 Pyoderma gangrenosum: Ulcerative to pustular variety

Pyoderma gangrenosum (PG) is a chronic, rare, noninfectious neutrophilic dermatosis of unknown etiology. Four clinical variants of PG have been described: ulcerative, bullous, vegetative, and pustular. Pustular pyoderma gangrenosum is an uncommon variant where the evolution from pustules to ulcers may occur. Although most PG patients present only a single clinical variant, the coexistence of different varieties has been reported in the literature. A 50-year-old woman presented with a 2-year history of multiple painful pustules on her trunk and four extremities. The patient reports having started with an ulcer with dark reddish undermined edges on her right leg. The pustules progressed to hemorrhagic crusts and some of them to ulcers. The dermatosis occurred in periods of exacerbation and remission. The patient presented a positive pathergy sign. Her medical history included diabetes mellitus type 2, arterial hypertension, and deep venous thrombosis. A biopsied specimen from the pustule showed an intraepidermal unilocular pustule containing abundant polymorphonuclear cells, red blood cells, and plasma cells. The dermis exhibits a perivascular mixed inflammatory infiltrate composed of neutrophils, lymphocytes, and some eosinophils. Immunofluorescence was negative. Laboratory examination showed C-reactive protein 31 mg/dL and sedimentation velocity 38 mg/dL. Treatment based on prednisone was given with a good response. This is a rare case of pustular PG that showed the evolution from ulcerative to pustular PG. It is important to recognize to make an early diagnosis and prevent the progression of pustular PG.

Association of matrix metalloproteinase-8 gene promoter polymorphisms with type II diabetes mellitus in Syrian population

ObjectivesMatrix metalloproteinase (MMP)-8 is an enzyme that cleaves extracellular matrix (ECM). It is involved in many diseases' pathology including diabetes mellitus type II (DM). In MMP-8 gene promoter region, there are many polymorphisms with an important role in gene transcription modifying and protein production. -381A/G and -799 C/T SNPs are the most effective polymorphisms, and our study is the first work aimed to evaluate the association between these polymorphisms and DM susceptibility in Syrian population. Designstudy sample included 140 subjects allocated into two groups: H= healthy control, DM= diabetes mellitus. MMP-8 SNPs were determined by restriction fragment length polymorphism-polymerase chain reaction (RFLP-PCR) technique. ResultsThe frequencies of genotypes were significantly different between study groups (adjusted OR =3.621, 95% CI: 1.391-9.428, P = 0.008 for -381GG genotype), and (OR =4.941, 95% CI: 1.640-14.890, P = 0.005 for -799TT genotype). Subjects with minor alleles seem to be more likely to develop DM more than those with the major alleles (OR=2.842, P = 0.01 for G) and (OR =3.995, P = 0.001 for T). ConclusionThis study data has illustrated that there could be a remarkable association between MMP-8 gene promoter polymorphisms -381A/G and -799C/T and diabetic susceptibility in Syrian population.

Celiac Disease in Juvenile Idiopathic Arthritis and Other Pediatric Rheumatic Disorders.

Celiac Disease (CD) is an immune-mediated and gluten-related disorder whose prevalence is higher in children affected with other autoimmune disorders, including diabetes mellitus type 1, autoimmune thyroiditis, and others. As regards Juvenile Idiopathic Arthritis (JIA) and other pediatric rheumatic disorders, there is no clear recommendation for CD serological screening. In this review, we analyze all the available clinical studies investigating CD among children with JIA (and other rheumatic diseases), in order to provide objective data to better understand the necessity of CD serological screening during the follow-up. Based on the present literature review and analysis, >2.5% patients with JIA were diagnosed with CD; however, the CD prevalence in JIA patients may be even higher (>3–3.5%) due to several study limitations that could have underestimated CD diagnosis to a variable extent. Therefore, serological screening for CD in children affected with JIA could be recommended due to the increased CD prevalence in these patients (compared to the general pediatric population), and because these JIA patients diagnosed with CD were mostly asymptomatic. However, further research is needed to establish a cost-effective approach in terms of CD screening frequency and modalities during the follow-up for JIA patients. Conversely, at the moment, there is no evidence supporting a periodical CD screening in children affected with other rheumatic diseases (including pediatric systemic lupus erythematosus, juvenile dermatomyositis, and systemic sclerosis).

S674 Incidence of Gastrointestinal Hemorrhage in Hospitalized COVID-19 Patients and Subsequent Clinical Outcomes

Introduction: SARS-CoV-2 infection (COVID-19) is known for its pathologic effects on micro-vasculature and is proposed to afflict the gastrointestinal tract via the ACE2 receptors. We hypothesize that there is a higher incidence and an increased risk of mortality among Covid-19 patients with gastrointestinal bleeding (GIB). Methods: This retrospective study included 2,711 patients ages 18 years or older who tested positive for Covid-19 between March 2020 through March 2021 at a public hospital in New York City. GIB was documented based on clinical criteria and a decrease in hemoglobin level. Patients were divided into two groups, GIB and non-GIB. We examined baseline characteristics of sex and age, as well as comorbidities including diabetes mellitus type 2, chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), coronary artery disease (CAD), hypertension (HTN), heart failure (HF), and proton pump inhibitor (PPI) use. We used T-test for statistical analysis of age and Pearson's chi-squared test for the primary outcome of all-cause mortality and the secondary outcomes of acute kidney injury, vasopressor use, and mechanical ventilation. Results: Of 2,711 patients, 205 (incidence of 8.18%) developed GIB. Overall sample characteristics included mean age of 71.15 (SD = 16.36) and 63.36 (SD = 19.26) for GIB and non-GIB groups, respectively. Males comprised 54.6% of the GIB group and 54.1% of the non-GIB group. Baseline clinical characteristics except for sex significantly differed between groups (p< 0.05). The odds of all-cause mortality (OR: 2.604, 95% CI: 1.947, 3.482, p < 0.001) were significantly higher in the GIB group. For secondary outcomes, patients with GIB had increased unadjusted odds for acute kidney injury (OR: 3.238, 95% CI: 2.387, 4.392, p < 0.001), vasopressor use (OR: 3.004, 95% CI: 2.242, 4.023, p< 0.001), and mechanical ventilation (OR: 2.806, 95% CI: 2.079, 3.787, p< 0.001). Conclusion: GIB is associated with increased odds for all-cause mortality, mechanical ventilation, vasopressor use, and acute kidney injury compared to patients without GIB. Despite having largely differing baseline characteristics, these findings support studies that suggest a correlation between GI symptoms and Covid-19 disease severity. Future research with a larger sample size is needed. Subsequently, supportive care is key to decreasing morbidity and mortality amongst these patients.

Nonfunctional adrenal adenomas and impaired glucose metabolism: a systematic review and meta-analysis.

Evidence on nonfunctioning adrenal incidentaloma's (NFAI) associated comorbidities and in particular, glucose disorders, is unclear in contrast to adrenal tumors with mild autonomous cortisol secretion. The current systematic review and meta-analysis aimed to assess the burden of impaired glucose metabolism including diabetes mellitus type 2 (T2DM), fasting blood glucose (FBG), and fasting blood insulin (FBI) levels in patients with NFAI and 1-mg overnight dexamethasone suppression test (ODST) ≤ 1.8 μg/dl across published studies. We searched PubMed, Cochrane, and Scopus databases for identifying studies published between 1956 and March 2021. Twenty-five studies met the selection criteria including prospective, retrospective, and case-control studies. Two reviewers independently extracted studies, participants' characteristics and outcome data in a total pooled sample of 1548 patients. Patients with NFAI had twofold [(odds ratio (OR) (95% confidence interval (CI)): 2.03 (1.39-2.98)] increased odds to present T2DM as well as higher FBG [weighted mean difference (WMD) (95% CI): 3.85 (1.96-5.74)] and homeostasis model assessment (HOMA) [WMD (95% CI): 0.68 (0.23-1.12)] with respect to controls. On the contrary, the WMD of FBI levels did not differ between the two groups. The incidence of T2DM in a subgroup analysis of patients with NFAI without glucose disorders at baseline was 6% [pooled incidence (95% CI): 0.06 (0.04-0.09)]. Patients with NFAI and 1-mg ODST ≤ 1.8 μg/dl presented higher odds of T2DM and higher levels of FBG and HOMA index than healthy controls.

The ability to assess the state of the fundus in patients with lens opacities of varying intensity, including patients with type 2 diabetes mellitus, using quantitative analysis of images made with a fundus camera. А pilot study

Purpose . To evaluate a quantitative method for grading the blurriness of ocular fundus images in patients with varying degrees of cataract including diabetes mellitus type II in order to improve the quality of fundus examination when it is affected by opacification of the crystalline lens, and to develop an objective method for measuring severity of cataract. Material and methods . We studied 16 patients (32 eyes) with a range of lens opacities and etiologies, including diabetes mellitus type II (12 patients). Age range was 70.19 ± 7.9 years. Degree of transparency of the lens was graded on the LOCS III system. Visual acuity was determined with 20/200 ETDRS at a distance of 4 m (ESV-3000). Images of the fundus were taken with a Topcon Mark II TRC retinal camera NW7SF Type IA. Image Resolution was 8 TIFF. An image processing algorithm that combined bandpass filtering, entropy analysis. and power spectral integration was used to quantify image haziness in terms of two inversely-related scales: “Blur Score” and “Clarity Score”. Data were analyzed via Spearman's rank correlation coefficient. Results . In order to better fix the details of the fundus images with lens opacities using a computer algorithm with a filter system, evaluation scales have been developed – the clarity score scale and the blur score scale. The two scales provide similar information, but in opposite directions. LOCS III lens opacities (NC and C) showed a positive correlation with Blur Score and negative correlation with Clarity Score. This indicates that a lower Blur Score, or higher Clarity Score, correlates with better visual acuity. The values of LOCS III NO and P, on the other hand, showed no reliable correlation with Blur or Clarity scores. Conclusions . A computer quantitative image analysis method originally developed to determine the opacities of the vitreous body can be used to analyze fundus images of patients with different stages of cataract when processing original images from a fundus camera. The proposed algorithm can be used to develop an objective method.

Fe-Chelating Activity of Conocarpus lancifolius Engl. Leaf Extracts and 1H-NMR Based Metabolite’s classification

Abstract The purpose of the work was to evaluate the Fe-chelating activity of freeze drying assisted ultrasonicated hydroethanolic leaf extracts of Conocarpus lancifolius Engl. along with 1H-NMR based classification of metabolites in most active extract. The finding revealed that 60% ethanolic extract was the most active fraction regarding Fe-chelating activity with value of 75.4 ± 0.6% followed by 80% ethanolic extract having chelating value of 69.24±1.02%. The least Fe-chelating activity was exhibited by aqueous extract. The statistical analysis revealed that the Fe-chelating activity by 60% ethanolic extract was significantly higher than other fractions except EDTA which was used as standard chelating agent. The 1HNMR technique predicted the presence of aromatic secondary metabolites of polyphenolic origin due to numerous peaks in respective regions. The peaks in carbohydrate and organic acid regions were also observed. The research outcomes suggested that C. lancifolius may be workable choice to move further for the development of cure and management practices for iron load based oxidative stress oriented diseases including diabetes mellitus type II.

Vitamin D in autoimmune bullous disease.

Numerous epidemiological studies have suggested a link between vitamin D deficiency and the development of various autoimmune diseases, including diabetes mellitus type 1, rheumatoid arthritis, inflammatory bowel disease, multiple sclerosis or systemic lupus erythematosus. More recently, such a link has been also proposed for autoimmune bullous diseases (AIBD). This is a relatively rare and potentially life-threatening, organ-specific group of inflammatory skin diseases characterized by the presence of tissue-bound and circulating autoantibodies against various molecules present in desmosomes (in pemphigus diseases) or hemidesmosomes (in pemphigoid diseases). In addition to the well-known role of vitamin D in calcium and phosphate homeostasis, the hormonally active vitamin D metabolite, 1,25-dihydroxyvitamin D3 (calcitriol), exerts potent effects on cellular differentiation and regulation of immune responses via binding to the vitamin D receptor present in most cells of the immune system. Since cells of both, the innate and adaptive immune systems, are known to be relevant in AIBD, the role of vitamin D analogues in the treatment of patients with these disorders deserves much attention. This mini-review summarizes recent epidemiological and experimental studies on vitamin D involvement in the autoimmune bullous diseases.

2744 A Scary Case of Gastroenteritis

INTRODUCTION: Gas in the gastric venous system or the portal venous system is a critical finding and can be from a life threatening abdominal catastrophe as well as from benign conditions. CASE DESCRIPTION/METHODS: A 52 year old gentleman presented with nausea, vomiting and diarrhea for 2 days. He had multiple episodes of non bloody diarrhea for past two days and had an episode of vigorous non bilious/ non bloody vomiting. No fevers, chills or weight loss was reported. His medical history included diabetes mellitus type 2, hypertension, obstructive sleep apnea, depression and anxiety. On admission, his vitals were stable. The physical examination was completely benign. His laboratory data revealed mild leukocytosis of 13.3. Lactate was normal. There was no anemia or microcytosis. A CT scan of his abdomen was done which revealed gas in the gastric veins and the peri-gastric veins, which was very concerning. Urgent Surgical consultation was placed. The patient was admitted to step down unit and conservative management with hydration, anti emetics and supportive care was initiated. In the next 4 hours, the patient started feeling better and became asymptomatic. The CT of the abdomen was repeated. The entire patient care team was on high alert for a possible abdominal catastrophe/ischemia and need for emergent surgery. The repeat CT scan was done 6 hours later which revealed linear lucencies within the peripheral aspect of the left lobe of the liver, consistent with gas within the portal venous system. Urgent Infectious Disease consultation was called and piperacillin-tazobactam was initiated. At this time, the patient was asymptomatic, his vitals were stable, the lactate remained normal and the leukocytosis had resolved in the repeat laboratory analysis. Close monitoring was continued. The next day, the patient remained in the stable and asymptomatic. A third repeat CT scan of the abdomen revealed complete resolution of all the gas in the gastric and the portal venous system. The diet and activity were advanced gradually and the patient was discharged the same day. DISCUSSION: It is important to recognize that there are many benign causes of gastric venous gas and portal venous gas such as gastroenteritis. We believe that the mechanical trauma of retching and vigorous vomiting may have lead to this finding.

Plant Extracts and Reactive Oxygen Species as Two Counteracting Agents with Anti- and Pro-Obesity Properties.

Obesity is a complex disease of great public health significance worldwide: It entails several complications including diabetes mellitus type 2, cardiovascular dysfunction and hypertension, and its prevalence is increasing around the world. The pathogenesis of obesity is closely related to reactive oxygen species. The role of reactive oxygen species as regulatory factors in mitochondrial activity in obese subjects, molecules taking part in inflammation processes linked to excessive size and number of adipocytes, and as agents governing the energy balance in hypothalamus neurons has been examined. Phytotherapy is the traditional form of treating health problems using plant-derived medications. Some plant extracts are known to act as anti-obesity agents and have been screened in in vitro models based on the inhibition of lipid accumulation in 3T3-L1 cells and activity of pancreatic lipase methods and in in vivo high-fat diet-induced obesity rat/mouse models and human models. Plant products may be a good natural alternative for weight management and a source of numerous biologically-active chemicals, including antioxidant polyphenols that can counteract the oxidative stress associated with obesity. This review presents polyphenols as natural complementary therapy, and a good nutritional strategy, for treating obesity without serious side effects.

MON-540 Familial Hypocalciuric Hypercalcemia Diagnosed in a 63-Year-Old Female

Background Familial Hypocalciuric Hypercalcemia (FHH) is a rare autosomal dominant genetic disorder which causes impaired calcium sensing receptor (CaSR) function which is located in the parathyroid and kidneys. This disorder leads to hypercalcemia, hypocalciuria and normal to moderately elevated parathyroid hormone (PTH). Here we present a case of asymptomatic FHH diagnosed in the seventh decade of life. Case description A 63-year old Caucasian female was referred to the endocrinology clinic for evaluation of her hypercalcemia. Patient had elevated blood calcium levels (ranging from 10.5-11 mg/dl) since the age of 55. She denied any history of kidney stones, osteoporosis, fracture or malignancy. There was no family history of hypercalcemia. Her other medical history included diabetes mellitus type 2, hypertension, hyperlipidemia and depression. Medications were Metformin, insulin, enalapril, simvastatin, fluoxetine. Laboratory workup revealed calcium 10.1mg/dl, PTH 77.3 pg/ml, 25 OH Vit D 22 ng/ml, Initial urine 24-hour calcium 0mg/24 hr, creatinine 1.2 mg/dl, 24-hour urine creatinine 1.1 mg/dl. DEXA scan with normal bone mineral density. Vitamin D was supplemented and subsequent repeat urine 24-hour calcium had improved but was still low at 29mg/24 hour with urine calcium/creatinine ratio of 0.029. Follow-up blood calcium levels showed fluctuations ranging from 9.4-10.3. Patient was subsequently referred for genetic testing which returned positive for heterozygous mutation in the CASR gene. Discussion FHH is an inherited disorder with prevalence of 1 in 78,000 and presents as benign, lifelong, persistent hypercalcemia and hypocalciuria without hypercalcemic related complications. Patients are mostly asymptomatic but there have been cases of pancreatitis, gall stones and chondrocalcinosis noted in literature from FHH. Conclusion Distinguishing FHH from primary hyperparathyroidism is important as the former is benign and does not require any surgical intervention while latter is cured with parathyroidectomy. This case identifies the role of primary care physicians in timely detection of hypercalcemia and subsequent diagnosis which can prevent unnecessary parathyroid surgical procedures as well as complications from hypercalcemia in patients with primary hyperparathyroidism.

Influenza outbreak - how best to prevent beyond vaccination?

Background: Influenza vaccination, is the cornerstone of influenza epidemics prophylaxis, but there is some evidence of its lower efficacy in the elderly and in some other high-risk groups of the population.Aims and Methods: We analysed the demographic characteristics of the patients (pts) hospitalized in an internal medicine ward (IMw) during the 2016-17 flu season, investigating whether there had been previous prevention, and overall how the infection progressed. All pts admitted to our hospital center, with positive nasopharyngeal swab, from the 1st October 2016 to the 28th February 2017 were recorded (n = 221), from which the inpatient IMw subgroup (31 pts) was selected.Summary of results: Of the 31 selected IMw pts, 61.3% were female and 38.7% male. Their chronic main medical condition included diabetes mellitus type 2 (32.3%) and heart failure (22.6%). Although more than half was previously vaccinated with that year’s vaccine (65.5%), all pts required hospitalization, with a high average length of stay (11.3 ± 5.2 days). H3N2 was the predominant subtype (90.3%). Flu symptoms at admission were present in 80.6% of the pts, and their mean PaO2/FiO2 ratio was 288.9 ± 40.7. We observed an increased in infection severity in patients with asthma, obesity and chronic kidney disease (when compared to controls) with PaO2/FiO2 ratio 284.0 ± 58.7, 95%CI 229.9-338.6, PaO2/FiO2 ratio 242.5 ± 12.0; 95%CI 134.5-350.5 and PaO2/FiO2 ratio 263.0 ± 33.9; 95%CI -41.9-567.9 respectively. No transfers were needed to intensive care, and one only patient required non-invasive mechanical ventilation.Conclusions: During a flu epidemic, there is a constant need for health staff to perform the influenza test in all seeking care pts with respiratory / generalized pains complaints. Preventive use of oseltamivir by the most vulnerable contacts exposed to the virus, even if previously vaccinated, appears to be justifiable.