Lower Mean Serum Research Articles

Response to treatment and low serum vitamin D levels in North Indian patients with treatment-naive category I and multi-drug resistant pulmonary tuberculosis

Background Tuberculosis (TB) is a bacterial infection that usually affects the lungs, although it can also affect other parts of the body. Vitamin D deficiency and response to treatment have been demonstrated in patients with active TB in several studies, but not in MDR-TB patients, which is a new observation in the present study. Objective To study the time to initial sputum culture conversion and to associate baseline vitamin D levels and response to treatment in patients with PTB Cat I and MDR-TB. Methods A total of 897 North Indian participants were recruited and divided into three groups: treatment-naïve PTB Cat I, MDR-TB, and healthy controls. Serum biochemistry, including 25-hydroxyvitamin D and calcium, was measured in all participants with PTB, Cat I, and MDR-TB. Results PTB Cat I patients had high bacillary load grading at baseline compared to 2nd month followed by 6th month of treatment. More severe chest radiographic features, such as cavitation and the presence of bilateral disease at baseline. Mean sputum smear conversion times were 0.95 ± 0.7 months and culture conversion to negative occurred at a mean time of 0.8 ± 0.7 in PTB Cat I patients compared to MDR-TB patients on average sputum smear and time of 2.4 ± 3 months. Significantly lower mean serum 25-hyroxyvitamin D concentration was found in the 6th month than in the 2nd month and baseline in PTB Cat I. Conclusion Low serum vitamin D deficiency was observed in both groups during treatment and is one of the important factors responsible for susceptibility to TB in both groups; however, its significance is uncertain. Patients with continuous positive sputum for multidrug-resistant tuberculosis (MDR-TB) had a worse prognosis than those with sputum bacteriology conversion. Two months into a treatment regimen, sputum smear conversions may be a useful indicator of an MDR-TB patient’s prognosis.

Lower total cholesterol and triglyceride levels in ankylosing spondylitis than non-inflammatory rheumatic disease controls in a 1978-98 study: a potential effect of increased physical energetics in manual occupations in the pre-2000 chronologic era.

No article on serum lipids in ankylosing spondylitis (AS) and control subjects has been reported from USA. The primary aim of this study was to determine if any difference occurred in serum lipid levels in AS and control rheumatic disorders in two time periods, 1978-98 and 2000-10. The secondary aim was to investigate variables associated with lipid levels and if a difference was found between AS and control disorders. The AS patients were compared to non-inflammatory rheumatic disorders (NIRDs) in 1978-98 and 2000-10 surveys and to rheumatoid arthritis (RA) in the 2000-10 survey. Patients were matched within 5 years of age, sex, and clinic or hospital source. In the 1978-98 survey, entry mean (SEM) serum cholesterol level [mg/dL] was highly (p<0.001) significantly lower in 69 AS [179.0 (4.8)] than 69 matched NIRD controls [208.0 (5.6)]. In 29 pairs of AS and NIRD subjects having manual labour occupations, mean (SEM) cholesterol level was additionally lower in AS [156.7 (5.9)] and higher in 29 NIRD controls [213.3 (8.6)] (p<0.001). In manual labour workers, mean (SEM) serum triglyceride was significantly lower (p=0.004) in 15 AS [110.3 (14.1)] than 14 NIRD controls [185.2 (19.3)]. In the 2000-10 survey, no lipid difference was found between AS vs. NIRD control patients. In the 1978-98 survey, AS had significantly lower mean serum cholesterol and triglyceride levels than NIRD control patients. Associated manual labour occupations may have significantly contributed to results, possibly related to increased energy expenditures from physical activity in the pre-2000 era.

Effects of the COVID-19 pandemic on serum vitamin D concentration in Korean children.

Social distancing policies and school closures in South Korea induced by coronavirus disease 2019 have raised concerns about a lower chance of exposure to sunlight in children and adolescents. This study investigates changes in the vitamin D status of children and adolescents following the pandemic. This retrospective study includes healthy children aged 3-18 years who visited Hanyang University Hospitals in Seoul or Guri during pre-coronavirus disease 2019 (COVID-19) and post-COVID-19 pandemic periods. August 2017 to July 2019 is defined as the pre-COVID-19 pandemic period, while the period from July 2020 to July 2021 is defined as post-COVID-19 or "during the pandemic." Propensity scores were used to match the prepandemic and pandemic groups 1:1 based on age, sex, season of blood collection, and body mass index z-score to compare vitamin D status among subjects. Among 786 eligible children, 506 were matched using propensity scores. There were no significant differences in mean serum 25-hydroxyvitamin D (25(OH) D) levels (20.1±6.5 ng/mL vs. 19.9±6.3 ng/mL, P>0.05) or vitamin D deficiency rates (53.0% vs. 54.9%, P>0.05) between the prepandemic and pandemic groups. Seasonal analysis revealed lower mean serum 25(OH)D levels during the pandemic in winter/spring seasons in comparison to these levels in subjects in prepandemic winter/spring seasons (19.1±3.8 ng/mL vs. 17.2±3.7 ng/mL, P=0.006). During the COVID-19 pandemic, Korean children and adolescents showed similar serum 25(OH)D levels and vitamin D status to the prepandemic period, with a significant decrease in these measures observed in winter/spring seasons only. Prolonged confinement, such as in pandemic circumstances, underscores the need for vigilant monitoring of vitamin D status and supplementation, particularly in high-risk seasons.

LONG-TERM RESULTS OF THE BIRMINGHAM HIP RESURFACING IMPLANT IN THE UNITED STATES: AN UPDATED ANALYSIS OF A SINGLE INSTITUTION'S EXPERIENCE

We previously reported the five to ten-year results of the Birmingham Hip Resurfacing (BHR) implant. The purpose of this study was to evaluate the survivorship, radiographic results, and clinical outcomes of the BHR at long-term follow-up.We retrospectively reviewed 250 patients from the original cohort of 324 BHRs performed from 2006 to 2013 who met contemporary BHR indications. Of these, 4 patients died and 4 withdrew. From the 242 patients, 224 patients (93%) were available for analysis. Modified Harris hip score (mHHS) and University of California, Los Angeles (UCLA) scores were collected and compared to a matched total hip arthroplasty (THA) cohort. Mean follow-up was 14 years.Survivorship free of aseptic revision was 97.4% and survivorship free of any revision was 96.0% at 15 years. Revisions included 3 periprosthetic joint infections, 2 for elevated metal ions and symptomatic pseudotumor, 2 for aseptic femoral loosening, and 1 for unexplained pain. The mean mHHS was 93 in BHR patients at final follow-up, similar to the THA cohort (p=0.44). The UCLA score was significantly higher for BHR patients (p=0.02), however there were equal proportions of patients who remained highly active (UCLA 9 or 10) in both groups, 60.5% and 52.2% (p=0.45) for BHR and THA respectively. Metal ion levels at long term follow-up were low (mean serum cobalt 1.8±1.5 ppb and mean serum chromium 2.2±2.0 ppb).BHR demonstrated excellent survivorship in males less than 60 years of age at time of surgery. Clinical outcomes and activity levels were similar to THA patients. Failures related to the metal-on-metal bearing were rare and metal levels were low at long-term follow-up.Level of evidence: IIIKeywords: survivorship; hip arthroplasty; activity; metal-on-metalSurface Replacement Arthroplasty demonstrates low revision rates and similar activity level compared to total hip arthroplasty at long-term follow-up.

Nephrocalcinosis and kidney function in children and adults with X-linked hypophosphatemia: baseline results from a large longitudinal study.

In patients with X-linked hypophosphatemia (XLH), conventional therapy with oral phosphate salts and active vitamin D has been associated with nephrocalcinosis. However, the nature of the relationships among XLH, its treatment, nephrocalcinosis, and kidney function remain poorly understood. Renal ultrasounds were performed and glomerular filtration rates were estimated (eGFR) at baseline in burosumab-naïve patients with XLH who participated in burosumab clinical trials (NCT02181764, NCT02526160, NCT02537431, NCT02163577, NCT02750618, NCT02915705) or enrolled in the XLH Disease Monitoring Program (XLH-DMP; NCT03651505). In this cross-sectional analysis, patient, disease, and treatment characteristics were described among patients with and without nephrocalcinosis. The analysis included 196 children (mean [SD] age 7.6 [4.0] yr) and 318 adults (40.3 [13.1] yr). Mean (SD) height z-score was -1.9 (1.2) for children and -2.3 (1.7) for adults. Nearly all children (97%) and adults (94%) had previously received conventional therapy. Nephrocalcinosis was detected in 22% of children and 38% of adults. In children, reduced eGFR <90mL/min/1.73m2 was more prevalent in those with nephrocalcinosis (25%) than in those without (11%), a finding that was not observed in adults. Children with nephrocalcinosis had lower mean values of TmP/GFR (p<.05), serum 1,25(OH)2D (p<.05), and eGFR (p<.001) and higher mean serum calcium concentrations (p<.05) than did those without nephrocalcinosis. Adults with nephrocalcinosis had lower mean serum phosphorus (p<.01) and 1,25(OH)2D (p<.05) concentrations than those without. Exploratory logistic regression analyses revealed no significant associations between the presence of nephrocalcinosis and other described patient or disease characteristics. Nephrocalcinosis was observed in nearly one-quarter of children and more than one-third of adults with XLH. Further study is needed to better understand the predictors and long-term consequences of nephrocalcinosis, with surveillance for nephrocalcinosis remaining important in the management of XLH.

Genetic variants in the TNF pathway impact TNFi response in a mixed population with rheumatoid arthritis

Rheumatoid arthritis (RA) is a multifactorial autoimmune inflammatory disease that mainly affects the joints, on reducing functional capacity and impacting quality of life. Cytokines such as tumor necrosis factor (TNF) and interleukin 6 (IL-6) are crucial in the pathogenesis and treatment of this disease. Some patients using TNF inhibitors (TNFi) do not respond or lose their response to these medications. Clinical, sociodemographic, and genetic data were used to evaluate the associations of single nucleotide polymorphisms (SNP) in TNF, TNFRSF1A, and TNFRSF1B genes with the diagnosis of RA, standardized score results, laboratory tests, and response to TNFi. In one subsample, TNF and IL-6 serum levels cytokines were performed. A total of 654 subjects (360 healthy controls and 294 diagnosed with RA) were included in the analysis. Higher levels of TNF have been found in individuals diagnosed with RA. IL-6 levels were higher in individuals who did not respond to TNFi treatment, while responders had levels comparable to those without the disease. No associations were found between the SNPs studied and the diagnosis of RA; however, rs767455-C seems to play a role in the response to golimumab treatment, being related to better therapeutic response and lower mean serum leukocyte levels. In addition, rs1061622-G was associated with poorer functional capacity and rs1800629-A was associated with higher leukocyte values and serum transaminase levels. The rs1061622-G and rs767455-C may play a role in the response to TNFi treatment, especially for patients using golimumab, although they do not seem to be associated with the diagnosis of RA. Polymosphisms in the TNF pathway may impact baseline levels of immune cells and markers of renal and hepatic function in RA patients. Our results highlight the importance of evaluating the impact of these polymorphisms on TNFi response and safety, particularly in larger-scale studies.

P-376 Letrozole to minimise exposure to elevated serum estradiol during superovulation for breast cancer patients prior to chemotherapy. Real world experience from a statewide oncofertility service

Abstract Study question How effective is co-treatment with letrozole in supressing peak E2 in a real world setting? Summary answer We observed greater than anticipated supra-physiological serum estadiol concentrations in our cohort. What is known already Breast cancer occurs frequently in women of reproductive age, many of whom request oocyte or embryo cryopreservation before chemo/radiotherapy. Oncofertility treatment requires superovulation with resultant elevation of serum estradiol above concentrations seen physiologically. In order to avoid possible stimulation of estrogen receptor positive breast cancers, co-administration of letrozole is frequently recommended. A 67% lower mean serum estradiol in a letrozole treated group compared with an untreated superovulated comparison group has been reported in the literature, suggesting a protective mechanism. Peak E2 concentration across 4 cohorts of patients co-treated with letrozole has been reported to be 103 – 2350 (mean 564). Study design, size, duration We performed a retrospective cohort study of women referred for fertility preservation following diagnosis of breast cancer to the Fertility Research Centre at The Royal Hospital for Women, Sydney between Jan 2020 and Jan 2024. Women were identified from hospital outpatient paper and electronic medical records. 145 new referrals were received by our centre, with 88 patients undergoing 107 cycles. Participants/materials, setting, methods 145 women aged between 19 and 44 with newly diagnosed breast cancer were referred to our Statewide, multidisciplinary, public oncofertility service for consideration of treatment and review at our fertility multidisciplinary team meeting. Our oncofertility database and outpatient clinical records were used to identify new referrals to the service. Electronic and paper medical records including the ART database were used to obtain cycle information, blood results and demographic information Main results and the role of chance Peak estradiol concentrations (pMol/L) 35% of cycles resulted in peak E2 &amp;gt; 2000. 11% of cycles resulted in peak E2 &amp;gt; 4000 and 2% of cycles resulted in peak E2 &amp;gt; 7000. We calculated a mean E2 of 1837. The mean anti-mullerian hormone was 20.3 pMol/L and mean antral follicle count 19.7. The mean BMI was 24.7. The average stimulation length was 13 days (7-16 days) with an average cumulative gonadotrophin dose of 2769 IU. Average number of MII oocytes per cycle was 7.2. 16 % of patients elected to preserve embryos. The fertilisation rate was 50%, with 61% of fertilised eggs resulting in frozen blastocytes. There have been 2 pregnancies and one live birth to date. 32% of cycles had a germline genetic result prior to OPU, with 20% having a positive BRCA gene mutation. Breast cancer hormone status 56% were Estrogen Receptor positive. 38 % were Progesterone Receptor positive, 18% were HER2 positive, 24% were hormone receptor negative Complications 5% of cycles were cancelled prior to OPU, 8% of cycles resulted in no oocyte or embryo available for freezing. 3% of cycles were reviewed for OHSS symptoms with 2 confirmed cases of OHSS secondary to administration of Zoladex &amp;lt;24hrs following OPU. Limitations, reasons for caution This is a retrospective cohort study in a single academic centre. Our current study duration is too short to permit determination of recurrence rates of breast cancer in the letrozole treated cohort. Wider implications of the findings The impact of short, transient elevation of circulating estradiol during superovulation is uncertain, however it is prudent to try to minimise exposure of ER positive breast cancers to estrogen. Alternative strategies for limiting this phenomenon should be explored, more evidence is needed on oncological and fertility outcomes in this population. Trial registration number N/A

PREVALENCE OF MALARIA, THE EFFECT OF PARASITAEMIA ON BLOOD PARAMETERS AND IRON LEVEL OF INFECTED CHILDREN UNDER FIVE YEARS OF AGE IN ITU, SOUTH-SOUTH, NIGERIA

Malaria is a devastating public health concern in Itu with varied haematological and biochemical implications. This study seeks to crystalize the prevalence of malaria, the effect of parasitaemia on some haematological parameters, and serum iron level of infected children under 5 in Itu Local Government Area, Nigeria. The study adopted a cross-sectional study involving 430 children. Blood samples were obtained from consented caregivers. Malaria prevalence and parasitaemia level were diagnosed microscopically. Haematology auto-analyzer was used to determine haematological parameters. Malaria prevalence of 41.08% was recorded in the study. The highest prevalence (42.86%) was reported among the female subjects. The difference in the infection rate between males and females was statistically significant (p&lt;0.05). The infected children tended to have significantly lower mean haemoglobin, packed cell volume, red blood cell level, lymphocyte, monocytes, and eosinophil count, (p &lt; 0.005) and a higher mean neutrophil, as well as white blood cell count (p &lt; 0.05) compared to the non-infected subjects respectively. A weak correlation between the level of parasitaemia and Hb (r= 0.108), PCV(r=0.247), RBC (r= o.074), and a weak negative with WBC (r = -0.063) was also reported. The study also recorded a higher mean serum ferritin level (648 ng/ml) compared to non-infected, lower mean serum transferrin (6.41 ng/ml) compared to normal, and mean serum iron (54.40 ng/ml) was higher than normal. It is essential to pay keen attention to the evaluation of haematological and biochemical parameters in the management of malaria infection in children living in malaria-endemic areas.

Serological diagnosis of IL-1β and IL-6 associated with Urinary tract infections among pregnant women in Thi-Qar Governorate

Urinary tract infections (UTIs) are considered the most prevalent infectious disorders. They can affect the entire urinary tract or specific a portion of it and are mostly brought on by bacteria that are found in the intestine. The present study included 82 pregnant women whom age ranged from 17 to 40 (mean ± SD: 27.44 ± 6.66) and divided to 13 in the first trimester, 9 in the second, and 60 in the third. Also, the study included 56 apparently healthy pregnant women as a control, with age (mean ± SD: 27.11 ± 5.59). Patients with UTIs had lower mean serum levels of IL-6 (12.08 ±16.35 pg/ml) compared to control group (42.19 ± 28.0 pg/ml). Also, the same patients showed had lower mean serum levels of IL-1β (6.91 ± 11.78 pg/ml) compared to control group (43.32 ± 34.62 pg/ml). The conclusions, UTIs continues to be one the most socio-health problems that need a lot of care diagnosis and treatment. Both IL-6 and IL-1β in UTIs pregnant women identification may contribute as Diagnostic marker tools for associated infections.

Assessment of cardiac function in farmers occupationally exposed to pesticides in gboko local government area, benue state

Any compound or combination of substances meant to prevent, eradicate, repel, or mitigate any pest is known as a pesticide. Despite the benefits of using pesticides for pests, weeds, and disease control, there have been concerns about adverse effects of these compounds on the human health. This cross-sectional study was designed to assess the cardiac function of farmers occupationally exposed to pesticides, in Gboko Local Government Area, Benue State, Nigeria.One hundred ten (110) participants comprising 70 farmers and 40 controls were recruited for the study using a multi-stage random sampling technique. They were aged between 20-60 years and were age-matched. Five (5) ml of fasting blood samples were collected from each participant for the determination of Apolipoprotein A1 (ApoA1), Apolipoprotein B-100 (ApoB100) and Troponin I level using standard laboratory methods. Also, the body mass index (BMI), systolic blood pressure (SBP) and diastolic blood pressure (DBP) of the participants were also determined. The results showed significantly lower mean BMI (23.02±3.94 Vs 24.94±3.12; p= 0.031) and serum ApoA1 (150.73±13.52 Vs 167.27±15.65; p=0.024) while the mean SBP (140.49±19.34 Vs 119.75±10.30; p=0.000), DBP (82.86±12.16 Vs 77.53±7.76; p=0.014) and mean serum Troponin-I (3.11±5.46 Vs 1.38±0.15; p=0.049) levels were significantly higher in the farmers compared to control respectively. However, there was no significant difference in the mean serum ApoB-100 level in the farmers when compared to the control group (p=0.104). : This study showed that the farmers had lower body mass index and higher serum levels of apoA-I, apoB-100, and Troponin I, as well as systolic and diastolic blood pressure, as compared to the control group. Nonetheless, in both the test and control groups, these results fell within the typical reference ranges. Further longitudinal research is required to gain a deeper understanding of the effects of pesticide exposure on cardiac function in farmers.

Evaluation of serum folic acid level in patients with type 2 diabetes mellitus

Background and objectives: Type-2 diabetes mellitus is a metabolic disorder. Diabetic patients with low folic acid, high homocysteine levels, have a higher chance of developing coronary heart disease based on previous studies. Therefore, this study aimed to investigate the serum levels of folic acid and homocysteine in type-2 diabetes mellitus patients and their association with insulin resistance. Methods: This cross-sectional study has been conducted on 138 participants from February 2nd 2022 to August 3rd 2022, at Azadi teaching hospital/clinical biochemistry department- Duhok, Kurdistan region, Iraq. The participants were composed of two groups, 70 patients with type-2 diabetes mellitus, and 68 apparently healthy control. Both groups have been investigated for serum folic acid level, serum glucose, serum insulin, serum homocysteine, glycosylated hemoglobin, and Homeostatic Model Assessment for Insulin Resistance. Results: The mean age for type 2 diabetic patients was (51.24 years) with males predominant (64.29%). Type 2 diabetic patients showed a low level of mean serum folic acid concentrations (2.73 ng/ml) in comparison with healthy subjects (5.91 ng/ml) (p&lt;0.001), and the mean serum homocysteine concentration was (13.493 ?mol/L) among type 2 diabetic patients compared to healthy subjects (10.041 ?mol/L) (p&lt;0.001). Significant correlation was found between serum folic acid and serum homocysteine levels, and glycosylated hemoglobin (p&lt;0.05 and p&lt;0.001, respectively). Conclusion: Patients with type-2 diabetes mellitus were associated with low mean serum folic acid levels and high mean serum homocysteine levels.

Hypovitaminosis D is A Biological Vulnerability for Depressive Symptoms in Major Depression at the Era of the Coronavirus Disease Outbreak

Abstract Background: Major depressive disorder (MDD) is a prevalent mental health condition causing substantial global issues. Emerging evidence indicates that depression rates have risen during the coronavirus disease (COVID-19) pandemic. Insufficient vitamin D levels have been linked to increased psychological problems and heightened responses to stress. Objectives: This study aims to investigate the connection between serum vitamin D levels and depressive symptoms in individuals with MDD compared to healthy controls during the COVID-19 pandemic. Materials and Methods: This cross-sectional study included 90 MDD patients diagnosed according to Diagnostic and Statistical Manual of Mental Illnesses (DSM)-5 criteria version 7.0.2, assessed using the Mini International Neuropsychiatric Interview. During COVID-19 lockdown measures, participants completed the Patient Health Questionnaire depression module (PHQ-9) to assess depressive severity. Blood samples were collected for vitamin D assays. Statistical analyses were conducted using Statistical Package for the Social Sciences (SPSS), including receiver operating characteristic (ROC) curve analysis to predict depressive symptom severity. Results: Patient and control groups had similar mean age and body mass index (BMI), with most participants classified as obese (BMI &gt; 30 kg/m2). Female patients were predominant in the study. MDD patients exhibited significantly lower mean serum vitamin D levels compared to controls (10.3 ± 6.2 vs. 18.1 ± 9.6 ng/mL). Female patients had higher vitamin D levels than males. Correlations among serum vitamin D levels, BMI, MDD duration, and age were insignificant. ROC curve analysis indicated that lower vitamin D levels moderately predict MDD presence (area under curve [AUC] = 0.750) and, to a lesser extent, severe MDD (AUC = 0.739). Conclusion: The study suggests an inverse association between serum vitamin D levels and clinical depression during the COVID-19 era. However, the evidence is not entirely conclusive, prompting the need for further randomized trials to determine whether this relationship is causal.

Mediterranean diet effects on vascular health and serum levels of adipokines and ceramides.

A randomized clinical trial to evaluate the effect of a Mediterranean-style diet on vascular health indices such as endothelial function indices, serum lipid and ceramide plasma and some adipokine serum levels. We recruited all consecutive patients at high risk of cardiovascular diseases admitted to the Internal Medicine and Stroke Care ward at the University Hospital of Palermo between September 2017 and December 2020. The enrolled subjects, after the evaluation of the degree of adherence to a dietary regimen of the Mediterranean-style diet, were randomised to a Mediterranean Diet (group A) assessing the adherence to a Mediterranean-style diet at each follow up visit (every three months) for the entire duration of the study (twelve months) and to a Low-fat diet (group B) with a dietary "counselling" starting every three months for the entire duration of the study (twelve months).The aims of the study were to evaluate: the effects of adherence to Mediterranean Diet on some surrogate markers of vascular damage, such as endothelial function measured by means of the reactive hyperaemia index (RHI) and augmentation index (AIX), at the 6-(T1) and 12-month (T2) follow-ups; the effects of adherence to Mediterranean Diet on the lipidaemic profile and on serum levels of ceramides at T1 and T2 follow-ups; the effects of adherence to Mediterranean Diet on serum levels of visfatin, adiponectin and resistin at the 6- and 12-month follow-ups. A total of 101 patients were randomised to a Mediterranean Diet style and 52 control subjects were randomised to a low-fat diet with a dietary "counselling". At the six-month follow-up (T1), subjects in the Mediterranean Diet group showed significantly lower mean serum total cholesterol levels, and significantly higher increase in reactive hyperaemia index (RHI) values compared to the low-fat diet group. Patients in the Mediterranean Diet group also showed lower serum levels of resistin and visfatin at the six-month follow-up compared to the control group, as well as higher values ​​of adiponectin, lower values of C24:0, higher values of C22:0 and higher values of the C24:0/C16:0 ratio. At the twelve-month follow-up (T2), subjects in the Mediterranean Diet group showed lower serum total cholesterol levels and lower serum LDL cholesterol levels than those in the control group. At the twelve-month follow-up, we also observed a further significant increase in the mean RHI in the Mediterranean Diet group, lower serum levels of resistin and visfatin, lower values of C24:0 and of C:18:0,and higher values of the C24:0/C16:0 ratio. The findings of our current study offer a further possible explanation with regard to the beneficial effects of a higher degree of adherence to a Mediterranean-style diet on multiple cardiovascular risk factors and the underlying mechanisms of atherosclerosis. Moreover, these findings provide an additional plausible interpretation of the results from observational and cohort studies linking high adherence to a Mediterranean-style diet with lower total mortality and a decrease in cardiovascular events and cardiovascular mortality. ClinicalTrials.gov Identifier: NCT04873167. https://classic.clinicaltrials.gov/ct2/show/NCT04873167.

Serum sclerostin as a biomarker of disease activity in ankylosing spondylitis in correlation with radiographic imaging

BackgroundThe wingless signaling pathway of bone development is inhibited by sclerostin, which may contribute to the etiology of ankylosing spondylitis.AimThe study aimed to evaluate serum sclerostin levels in ankylosing spondylitis patients and investigate how it correlated with radiographic damage using the Spondylo-arthritis Research Consortium of Canada index (SPARCC), disease activity, and functional impairment.ResultsThis cross-sectional case–control study revealed a significantly lower mean serum sclerostin (11.28 ng/ml) in AS patients compared with controls (101.25 ng/ml). Serum sclerostin levels showed a significant negative correlation with each of Bath Ankylosing Spondylitis Metrology Index (BASMI) (p = 0.043), sacroiliac joints SPARCC, spine SPARCC, and overall SPARCC scores (p = 0.012, p = 0.036, and p = 0.007). The detection of AS, serum sclerostin levels ≤ 20 ng/ml showed 100% sensitivity and specificity.ConclusionSerum sclerostin had good discriminating power between ankylosing spondylitis cases and healthy control individuals and was correlated with subclinical activity status on magnetic resonance imaging.

Hypophosphatemia in Chronic Obstructive Pulmonary Disease Patients Requiring Mechanical Ventilation and Its Impact on Weaning in an Intensive Care Unit of a Tertiary Care Hospital in Eastern India.

Background Hypophosphatemia, defined as a serum phosphate level less than 2.5 mg/dL, is a frequent finding in patients with chronic obstructive pulmonary disease (COPD) and has been speculated to negatively affect weaning outcomes. This study aimed to determine the incidence of hypophosphatemia in COPD patients requiring mechanical ventilation and evaluate the predictive role of hypophosphatemia as an indicator of successful weaning from mechanical ventilation in such patients admitted to the intensive care unit (ICU) in a tertiary care hospital in eastern India. Methodology This prospective observational study included 60 adult patients aged 18 to 75 years with acute exacerbations of COPD on mechanical ventilation in the ICU who were planned to undergo a weaning trial. Serum phosphate levels were assessed at the time of admission and before each weaning attempt. Weaning outcomes at each attempt, length of ventilator and ICU stay, and mortality were recorded. Data collection was initiated after approval of the Institutional Ethics Committee. Receiver operating curve (ROC) analysis was done to identify the cut-off value of serum phosphate which predicted successful weaning. Results Of 60 participants, hypophosphatemia on admission was present in 15 (25%) patients. Despite the correction, 13 (21.7%) patients had hypophosphatemia before the first weaning attempt. Only 22 patients out of 60 were successfully weaned off from mechanical ventilation in the first trial, accounting for a success rate of 36.7%, of whom 20 were normophosphatemic (90.9%). In the second and third weaning trials, hypophosphatemia was significantly associated with weaning failure. Overall differences in mean serum phosphate levels among those who failed to wean in each weaning trial and the successful attempt were statistically significant (p < 0.001). On ROC analysis of serum phosphate level before the first weaning trial, a cut-off value of ≥3.0 mg/dL was identified to have 86.4% sensitivity, 55.3% specificity, 52.8% positive predictive value, 87.5% negative predictive value, and 66.7% diagnostic accuracy in predicting weaning success. Five patients died, accounting for a mortality rate of 8.3%. Lower mean serum phosphate levels before the first weaning trial, higher mean age, and longer ventilator and ICU days were significantly associated with mortality among our study participants (p < 0.05). Conclusions Our findings suggest that maintaining normal serum phosphate levels is critical to successfully weaning off patients with COPD from ventilator support.

Evaluating Acetate as a Renoprotective Agent After Kidney Ischemia in a Porcine Model.

Objective: Renoprotection from reperfusion injury appears to be conferred by HIF-2a activation, which can be stimulated by exogenous acetate administration. The study objective was to assess whether administration of acetate in a porcine model can mitigate kidney injury related to ischemia-reperfusion after renal hilar occlusion. Methods: A porcine single-kidney model was created by performing a laparoscopic nephrectomy followed by animal recovery. After 2 days, the animals underwent laparoscopic hilar dissection. Block randomization was used to assign pigs into one of four experimental groups. One treatment block of pigs received 150 mEq of sodium acetate intravenously during 90 minutes of en bloc occlusion of the renal hilum (herein noted as "cross-clamping"). Another block received 0.75 g/kg of oral sodium acetate for 3 days prior to cross-clamping. A third block received no acetate and underwent hilar dissection without cross-clamping (negative control). The final block received no acetate and underwent cross-clamping (positive control). Serum creatinine was used to estimate renal function post-nephrectomy. Results: A total of 16 animals (4 pigs in each group) completed the study protocol. Median pig weight was 34.6 kg. One pig receiving IV acetate was excluded from the final analysis because of unrecoverable renal failure after cross-clamping. There was a significantly lower mean serum creatinine for the IV acetate group compared with the positive control group 72 hours after cross-clamping (p = 0.012). The same effect was not observed for the pigs receiving oral acetate. By day 7, renal function had recovered without significant difference in all groups. Conclusions: We observed that the administration of intravenous acetate conferred a significant renoprotective benefit in our single kidney ischemia-reperfusion porcine model 72 hours after hilar occlusion. This work is hypothesis-generating, and further work in human subjects undergoing renal hilar occlusion during partial nephrectomy is warranted.

Significance of QTc interval in chronic hypoparathyroidism and its correlates.

Hypocalcemia predisposes patients with chronic hypoparathyroidism (cHypoPT) to an increased risk of QTc prolongation and life-threatening arrhythmias. Information on clinical and biochemical correlates of QTc in cHypoPT is limited. Observational cohort study at tertiary-care-center. Eighty-eight non-surgical cHypoPT (mean age 44.1 ± 15.4 years, 45 males) were assessed for QTc interval and its possible correlates including arrhythmic symptoms (palpitation/giddiness/syncope), serum total-calcium, phosphate, 25(OH)D and iPTH. The mean QTc in HypoPT cohort was 428 ± 34 ms with 13.6% having prolonged QTc. There was a significant inverse correlation between QTc interval and serum total-calcium measured on the same day (r = -0.43, p < 0.001). The mean serum total-calcium was significantly lower in patients with prolonged QTc (7.05 ± 1.94 vs. 8.49 ± 1.01 mg/dL, p = 0.02). 21.6% of cHypoPT patients had arrhythmic symptoms. They had significantly higher mean QTc (p = 0.02) and also tended to have lower mean serum total-calcium during follow-up (p = 0.06). In multivariable regression, female gender, higher current-age, higher BMI, and low serum total-calcium showed significant association with prolonged QTc. For every mg/dL decrease in serum total-calcium, QTc increased by 13 ms. Receiver-operating-characteristic analysis revealed serum total-calcium at cut-off of 8.3 mg/dL discriminated prolonged QTc with area-under-curve being 0.72 [95% CI: 0.51,0.93]. One-fifth of cHypoPT had arrhythmic symptoms and a significant proportion had prolonged QTc. This highlights the need for close monitoring of cHypoPT patients for arrhythmic symptoms and QTc prolongation. The serum total-calcium should be maintained to at least 8.3 mg/dL to minimize the risk of potentially life-threatening arrhythmia in cHypoPT.

Exploring TSLP and IL-33 Serum Levels and Genetic Variants: Unveiling Their Limited Potential as Biomarkers for Mild Asthma in Children.

As the burden of mild asthma is not well understood, the significance of expanding research in the group of patients with mild asthma is emphasized. Thymic stromal lymphopoietin (TSLP) and interleukin 33 (IL-33) are involved in the pathogenesis of atopy and the immune response to inhaled environmental insults, such as allergens, in asthmatic patients. Objectives: The objective of this study was to explore the correlation between specific polymorphisms within the genes encoding TSLP and IL-33, as well as the concentrations of TSLP and IL-33 in the serum, and the occurrence of pediatric mild asthma. Methods: The analysis encompassed 52 pediatric patients diagnosed with mild bronchial asthma, including both atopic and non-atopic cases, and a control group of 26 non-asthmatic children. Recruitment was conducted through a comprehensive questionnaire. Parameters such as allergic sensitization, serum levels of circulating TSLP and IL-33, and the identification of single-nucleotide polymorphisms in TSLP (rs11466750 and rs2289277) and IL-33 (rs992969 and rs1888909) were assessed for all participants. Results: Significantly lower mean serum TSLP concentrations were observed in asthmatic subjects compared to the control group, with atopic asthma patients showing even lower TSLP levels than non-atopic counterparts. No significant differences were found in mean serum IL-33 concentrations between the two groups. Considering the allele model, for both tested SNPs of IL-33, we observed that patients with asthma, atopic asthma, and atopy statistically less frequently possess the risk allele. Conclusions: Our study findings suggest that IL-33 and TSLP do not serve as ideal biomarkers for mild asthma in children. Their effectiveness as biomarkers might be more relevant for assessing disease severity rather than identifying asthma in pediatric patients. Further research focusing on the association between TSLP and IL-33 gene polymorphisms and asthma is expected to significantly advance disease management.

Distinguishing Clinical Features of Cannabinoid Hyperemesis Syndrome and Cyclic Vomiting Syndrome: A Retrospective Cohort Study

ObjectiveTo identify clinical characteristics that distinguish cannabinoid hyperemesis syndrome (CHS) from cyclic vomiting syndrome (CVS), two conditions marked by episodes of nausea, vomiting, and abdominal pain. Study designWe performed a retrospective chart review of patients admitted to a large children’s healthcare system from 2015 through 2022. CHS and CVS patients were identified by the electronic medical record using ICD-9/10 codes. ResultsOf 201 patients screened, 125 were included. CHS patients were older than those with CVS (mean [SD] 18.06 [1.41] vs. 14.50 [2.91] years, p<0.001). There were no significant differences in gender, race, ethnicity, or hospital length of stay between groups. CHS patients were more likely to have a positive urine drug screen (86% vs. 2.9%, p<0.001), lower mean (SD) serum potassium (3.62 [0.77] vs. 3.88 [0.49], p<0.001), and higher mean (SD) serum creatinine (0.83 (0.41) vs. 0.63 (0.17), p<0.001). The average (SD) systolic blood pressure (SBP) was significantly higher in CHS patients (SBP 124.46 [10.66] vs. 118.55 [10.99], p=0.032) compared with CVS children of comparable age range. Imaging was obtained in 36% of all patients and only 2.4% had abnormalities. ConclusionsClinical features including older age, higher systolic blood pressure, positive urine drug screen, and select electrolyte findings might distinguish CHS from CVS. Abdominal imaging in both conditions is of low yield. These findings may allow for early recognition and appropriate therapy in CHS patients.

The Effect of Unadjusted Mineral Supplementation on Bone Health of Preterm Infants Fed Fortified Human Milk: An Exploratory Analysis

Background: In standard fortification of human milk (HM), the HM macronutrient content is assumed, and a fixed amount of a multinutrient fortifier is added to achieve recommended nutrient intakes. In target fortification, the HM macronutrient content is regularly measured, guiding the addition of modular macronutrient supplements to the fortified HM, to achieve the nutritional targets more precisely. Objective: The study aimed to investigate whether this addition of modular supplements, unaccompanied by mineral supplementation, predispose to metabolic bone disease (MBD). Methods: This is a secondary analysis of a larger study of infants born with &lt;33 weeks gestational age. Fortifications based on the assumed (Group 1) or measured (Group 2) of the HM macronutrient content were compared, using low serum phosphate levels as an indicator of MBD, and length growth as a surrogate of bone growth. Results: Eighty-four infants were included, 35 in Group 1 and 49 in Group 2. During the exposure period, infants of Group 2 received higher mean fat (6.1 vs. 5.3 g/kg/day, P &lt; 0.001) and carbohydrate (13.0 vs. 11.7 g/kg/day, P &lt; 0.001) intakes; in addition, they exhibited lower mean serum phosphate (5.5 vs. 6.0 mg/dL, P = 0.022) and faster mean length velocity (1.06 vs. 0.89 cm/week, P = 0.003). Conclusions: These findings suggest that feeding fortified HM with extra fat and carbohydrate content, unaccompanied by mineral supplementation, promotes increased bone growth, as indicated by accelerated length growth, but with insufficiently mineralized osteoid, indicated by low serum phosphate levels. Intervention studies using direct biomarkers of bone mass content and mineral density are necessary to corroborate our findings.