Normal Rate Research Articles

Evolution of Flame Displacement Speed Within Flame Front in Different Regimes of Premixed Turbulent Combustion

A transport equation for the flame displacement speed evolution in premixed flames is derived from first principles, and the mean behaviours of the terms of this equation are analysed based on a Direct Numerical Simulation database of statistically planar turbulent premixed flames with a range of different Karlovitz numbers. It is found that the regime of combustion (or Karlovitz number) affects the statistical behaviour of the mean contributions of the terms of the displacement speed transport equation which are associated with the normal strain rate and curvature dependence of displacement speed. The contributions arising from molecular diffusion and flame curvature play leading order roles in all combustion regimes, whereas the terms arising from the flame normal straining and reactive scalar gradient become leading order contributors only for the flames with high Karlovitz number values representing the thin reaction zones regime. The mean behaviours of the terms of the displacement speed transport equation indicate that the effects arising from fluid-dynamic normal straining, reactive scalar gradient and flame curvature play key roles in the evolution of displacement speed. The mean characteristics of the various terms of the displacement speed transport equation are explained in detail and their qualitative behaviours can be expounded based on the behaviours of the corresponding terms in the case of 1D steady laminar premixed flames. This implies that the flamelet assumption has the potential to be utilised for the purpose of any future modelling of the unclosed terms of the displacement speed transport equation even in the thin reaction zones regime for moderate values of Karlovitz number.

The Effects of Process Parameters on Workpiece Roundness in the Shoe-Type Centerless Grinding Operation for Internal Raceway of Ball Bearings

One of the most important indices of bearing raceway, roundness, has an important influence on the life and performance of the bearing. Currently, shoe-type centerless grinding (STCG) is a core process for the fabrication of the raceway surface. Some researchers have carried out studies in this field; however, the reason and extent of the influence of process parameters on the workpiece roundness in the STCG operation for the internal raceway of the 6208 ball bearings are not clear up to now. In this paper, new research on the effects of process parameters on workpiece roundness in the STCG operation for the internal raceway of the 6208 ball bearings is presented. The influence of the angular placement of the two shoes, as well as the technology parameters including the offset between the rotational centers of the workpiece and the magnetic drivehead (e), the normal feed rate (Snf), the speed of the workpiece (nw), and the grinding depth (af), on the roundness of the raceway surface were investigated both theoretically and experimentally to solve the difficulties in the STCG operation to ensure the roundness of the raceway surface. Based on the research results, a guideline for selecting initial process parameters is introduced to ensure the roundness of the bearing raceway in the STCG operation for the internal raceway of 6208_ball bearings on the 3MK136B grinder.

Oxidative stress and inflammatory markers in ovarian follicular fluid of women with diminished ovarian reserve during in vitro fertilization

BackgroundFollicular microenvironment has been proposed as an important factor for oocyte grown and maturation. We sought to evaluate the oxidative stress and inflammatory levels in follicular fluid (FF) and association with embryo quality in patients with diminished ovarian reserve (DOR).MethodsThe current research included 46 DOR cases and 56 normal ovarian reserve (NOR) cases. Twelve representative oxidative stress markers and eight representative inflammatory factors were measured in the FF.ResultsOxidative stress markers total GSH (T-GSH) was decreased in the FF from women with DOR compared with that in NOR group (P = 0.041). More modest differences were observed for reduced GSH (rGSH) and rGSH/GSSG. Women with DOR compared to controls had higher level of TNF-α (P = 0.000) and lower level of IL-18 (P = 0.013). Correlation analysis revealed that GSSG was negatively correlated with normal fertilization rate in NOR group (r = -0.358, P = 0.008), and reduced GSH was negatively correlated with normal fertilization rate in DOR group (r = -0.299, P = 0.049). Moreover, as the regression analysis data showed, the GSSG level was significantly associated with embryo quality indicator.ConclusionsThe FF in DOR patients was accompanied by increased oxidative stress and inflammatory levels. Follicular development of women with DOR might be influenced by unusual IL-18 and TNF-α levels in FF. And oxidative stress marker GSSG in NOR group was a negative predictor for embryo quality.

Penalized sieve estimation of zero‐inefficiency stochastic frontiers

SummaryStochastic frontier models for cross‐sectional data typically assume that the one‐sided distribution of firm‐level inefficiency is continuous. However, it may be reasonable to hypothesize that inefficiency is continuous except for a discrete mass at zero capturing fully efficient firms (zero‐inefficiency). We propose a sieve‐type density estimator for such a mixture distribution in a nonparametric stochastic frontier setting under a unimodality‐at‐zero assumption. Consistency, rates of convergence and asymptotic normality of the estimators are established, as well as a test of the zero‐inefficiency hypothesis. Simulations and two applications are provided to demonstrate the practicality of the method.

Development and Performance Evaluation of Home-Made Electric and Kerosene Lump Egg Incubator

This study was carried out to develop and evaluate the performance of home-made electric and kerosene lump egg incubator capable of incubating 150 eggs at predetermined temperature and humidity. The fabricated incubator consists of an egg cabinet made from MDF and plywood, egg tray made from mesh wire, TS-C700 temperature controller, hygrometer, a kerosene lump, water pan, and cooling fan system. The performances were evaluated in terms of hatchability rate, chick normality, fertility, and embryonic mortality rate. The experimental design used was simple descriptive statistics against the biological performance of the incubator. Naturally mated stock koekoek chicken eggs were used for evaluation of the developed incubator. The investigation revealed that the machine was evaluated at temperature of 37.50C and 60% relative humidity for the first 18 days of incubation and then temperature was lowered to 36.50C and increasing relative humidity to 65%. The ambient temperature of egg incubator has more effect on the interior temperature making the interior temperature varied. The average hatchability rate, fertility, embryonic mortality rate, and chick normality were 77.60%, 57.02%, 9.61% and 91.96% at average temperature of 37.240C and 60.75% of relative humidity were observed during incubation test. Depending on the performance results of the the incubator, it is concluded that the constructed incubator machine can be effectively and efficiently used by small and medium-scale poultry farmers.

Medication profiling in women with type 1 diabetes highlights the importance of adequate, guideline-based treatment in low-risk groups

Effective treatment may prevent kidney complications, but women might be underprescribed. Novel, data-driven insights into prescriptions and their relationship with kidney health in women with type 1 diabetes may help to optimize treatment. We identified six medication profiles in 1164 women from the FinnDiane Study with normal albumin excretion rate based on clusters of their baseline prescription data using a self-organizing map. Future rapid kidney function decline was defined as an annual estimated glomerular filtration rate (eGFR) loss > 3 ml/min/1.73 m2 after baseline. Two profiles were associated with future decline: Profile ARB with the highest proportion of angiotensin receptor blockers (odds ratio [OR] 2.75, P = 0.02) and highly medicated women in profile HighMed (OR 2.55, P = 0.03). Compared with profile LowMed (low purchases of all), profile HighMed had worse clinical characteristics, whereas in profile ARB only systolic blood pressure was elevated. Importantly, the younger women in profile ARB with fewer kidney protective treatments developed a rapid decline despite otherwise similar baseline characteristics to profile ACE & Lipids (the highest proportions of ACE inhibitors and lipid-modifying agents) without a future rapid decline. In conclusion, medication profiles identified different future eGFR trajectories in women with type 1 diabetes revealing potential treatment gaps for younger women.

Endoscopic sleeve gastroplasty as an early tool against obesity: a multicenter international study on an overweight population

Background and aimsEndoscopic sleeve gastroplasty (ESG) is an effective, minimally invasive gastric remodeling procedure to treat mild and moderate obesity. Early adoption of ESG may be desirable to try to halt progression of obesity, but there are few data on efficacy and safety for overweight patients. MethodsThis was a multicenter, international, analytical case series. Six American, one Brazilian, one Mexican, and one Indian center were included. Overweight patients according to local practice undergoing ESG were considered eligible for the study. The endpoints were %total weight loss (%TWL), BMI reduction, rate of BMI normalization, and adverse events rate (AEs). ResultsOne hundred eighty-nine patients with a mean age of 42.6±14.1 years old and a mean BMI of 27.79±1.17kg/m2 were included. All procedures were successfully accomplished and there were 3 intraprocedural AEs (1.5%). The mean %TWL was 12.28±3.21%, 15.03±5.30%, 15.27±5.28%, and 14.91±5.62% at 6, 12, 24, and 36 months, respectively. At 12 and 24 months, 76% and 86% of patients achieved normal BMI with a mean BMI reduction of 4.13±1.46kg/m2 and 4.25±1.58kg/m2. There was no difference in mean %TWL of the first quartile versus the fourth quartile of BMI in any of the time points. However, the BMI normalization rate was statistically higher in the first group at 6 and 12 months (6m: 100% vs. 48.5%, p<0.01; 12m: 86.2% vs. 50%, p<0.01; 24m: 84.6% vs. 76.1%, p=0.47; 36m: 86.3% vs. 66.6%, p=0.26). ConclusionESG is safe and effective in treating overweight patients with high BMI normalization rates. It could help halt or delay the progression to obesity.

Renal Salt Wasting: Earliest Manifestation of Rhabdomyolysis, Supreet/Mehandru Syndrome

Acute kidney injury is a feared and common complication of rhabdomyolysis, occurring in 10-40% of hospitalized patients with mortality rate as high as 59% in critically ill patients. However, there is a lack of information in the literature on renal salt wasting in rhabdomyolysis. We report 3 cases of rhabdomyolysis who developed renal salt wasting in presence of normal glomerular filtration rate. To the best of our knowledge, this is the first case report in humans displaying this phenomenon. Authors noted that all the three patients had urine pH of over 7.0. Literature reveals, patients with rhabdomyolysis and urine pH&lt;6.5 develop acute kidney injury whereas urine pH&gt;7.0 experienced renal salt wasting in presence of normal glomerular filtration rate. All 3 cases, previously not known to have hypertension, were noted to have elevated blood pressure during acute phase of rhabdomyolysis. Animal studies have shown that increase in blood pressure causes increase in renal interstitial pressures that results in naturesis and diuresis. All 3 cases had increased levels of plasma renin activity and aldosterone. There is a direct proportionality between increased blood pressure and naturesis. Clinicians should be aware of salt wasting as an early renal manifestation in patients with rhabdomyolysis

Comprehensive evaluation of treating drinking water for laying hens using slightly acidic electrolyzed water

Slightly acidic electrolyzed water (SAEW) is well-known for its highly potent antibacterial properties and safe residue-free nature. In this study, a comprehensive evaluation was conducted on 2 disinfection methods for waterline cleaning in poultry houses: (1) continuously add SAEW into the waterline and (2) the conventional waterline disinfection method, which includes regular use of high-concentration chemical disinfectant for soaking the waterline and flushing with water. The evaluation focused on the effects of these methods on bacteria levels in laying hens' drinking water, the fecal normal rate of laying hens, egg quality, as well as the economic costs and water footprint associated with each method. The results show that the inhibition rate of the control group was 52.45% to 80.36%, which used 1500 mg/L sodium dichloroisocyanurate (DCCNa) for soaking and then flushing with water. The bacterial levels in the waterline returned to pre-treatment levels 26 h after cleaning. However, the experimental group with an available chlorine concentration (ACC) of 0.3 mg/L SAEW showed a higher inhibition rate (99.90%) than the control group (P < 0.05) and exhibited a sustained antimicrobial effect. Regarding eggshell thickness, eggshell strength, and Haugh units of the egg, there were no significant differences between the experimental and control groups. However, the experimental group had higher egg weight and darker yolk color (P < 0.05) than those of the control group. Besides, the experimental group exhibited a higher fecal normal rate and a lower water footprint than those of the control group. Hence, SAEW represents a favorable choice for disinfecting drinking water in poultry houses due to its ease of preparation, lack of residue, energy efficiency, and efficient antibacterial properties. To ensure adequate sanitation, it is recommended to incorporate SAEW with an ACC of 0.3 mg/L into the daily management of the drinking water system for laying hens.

Uniformly strong consistency and the rates of asymptotic normality for the edge frequency polygons

In this paper, we primarily focus on the edge frequency polygon estimator of f ( x ) , which represents the probability density function of a sequence of φ-mixing random variables { X i , i ≥ 1 } . We establish the uniformly strong consistency and the convergence rate of asymptotic normality for the edge frequency polygon estimator under suitable conditions. Notably, the convergence rate achieves O ( n − 1 / 6 ) , which is more precise compared to the corresponding rate mentioned in the existing literature. Additionally, we present simulation studies to validate the theoretical results.

Phytochemical Characterization and In Vitro Evaluation of the Anti-Sickle Cell Activity of Aqueous and Ethanolic Extracts of Two Medicinal Plants from Niger: Flueggea virosa (Roxb. ex Willd.) Royle and Kigelia africana (Lam.) Benth.

Sickle cell anaemia is a hereditary blood disorder that attacks the red blood cells and deforms them, giving them a sickle shape. Sickle cell anaemia is a serious health problem in the West African country of Niger. Moreover, the cost associated with medical care is very high. The main objective of this study is to contribute to the valorisation of Flueggea virosa (Roxb. ex Willd.) Royle (aerial part), Kigelia africana (lam), and Benth (leaves) from Niger were used to treat sickle cell disease using aqueous and ethanolic extracts of phytochemical compounds. To achieve this objective, the evaluation of anti-sickle cell activity was carried out in vitro using the Emmel technique through the normalisation rate. The analyses showed that the aqueous and ethanolic extracts contained various classes of bioactive substances known for their valuable biological activities. The chemical composition rich in bioactive compounds led to very good results in biological assays. Thus, from a dose of 0.05 mg/mL, the ethanolic extracts of the two plants normalised up to 75% of the sickle cells. As the rate of normalisation was shown to be dose-dependent, at a dose of 10 mg/mL, the ethanolic extracts showed the best rates of sickle cell normalisation, with 95% for F. virosa and 93% for K. africana. Phytochemical screening was used to correlate the secondary metabolite and anti-sickle cell activities of the extracts from the two plants. These results may justify the use of these two species in traditional medicine for the treatment of sickle cell disease in Niger. The inclusion of these plants in phytomedicines could provide significant relief to people suffering from sickle cell disease.

Flexural Behavior of Normal and High Strength Self-Curing Self- Compacted Concrete Beams of Local Materials

In some construction industries, there are difficulties in achieving the required concrete compaction, Self-compaction is an alternative option. Working with self-compaction self-curing concrete requires a unique approach. This study aims to examine the possibility of producing self-compacting concrete with normal and high self-cure rates. This research observed how both the self-curing and self-compacting concrete behaved under normal and high-strength conditions. Two stages were prepared for this investigation. The first stage of this research studied the effect of a curing agent on the fundamental characteristics of both normal-strength and high-strength self-compacting concrete, with the aim of achieving self-curing self-compacting concrete. The primary variables of this study include the grade of concrete, the type of curing agent, the reinforcing bars, and the dosage of these variables. In the second stage, reinforced concrete beams were cast with one of the two proposed concrete types, and their behavior was studied. The findings were analyzed in terms of the beginning cracking loads, the ultimate loads, and the crack patterns of the testing beams. According to the results, both the normal-strength and the high-strength varieties of self-curing self-compacting concrete are effective in providing structural features, which are absent from the processes of curing and compacting. Curing chemicals are utilized to mitigate the process of water evaporation in self-compacting concrete, hence enhancing the water retention capabilities of self-compacting concretes that possess enough hardened concrete characteristics.

Normal birth rates before and after the merging of mixed-risk and low-risk maternity wards in Iceland: A retrospective cohort study on the impact of inter-professional preventative measures.

In 2014, the National University Hospital of Iceland (NUHI) merged a mixed-risk birth unit and a midwifery-led low-risk unit into one mixed-risk unit. Interprofessional preventative and mitigating measures were implemented since there was a known threat of cultural contamination between mixed-risk and low-risk birth environments. The aim of the study was to assess whether the NUHI's goal of protecting the rates of birth without intervention had been achieved and to support further development of labor services. A retrospective cohort study of all women who had singleton births at NUHI birth units in two 2-year periods, 2012-2013 and 2015-2016. The primary outcome variables, birth without intervention, with or without artificial rupture of membranes (AROM), were adjusted for confounding variables using logistic regression analysis. Secondary outcome variables (individual interventions and maternal and neonatal complications) were analyzed using descriptive statistics, t test, and Chi-square test. The rate of births without interventions, both with and without AROM, increased significantly after the unit merger and accompanying preventative measures. The rates of AROM, oxytocin augmentation, episiotomies, and epidural analgesia decreased significantly. The rate of induction increased significantly. There were no significant differences in maternal or neonatal complication rates. Interprofessional preventative measures, implemented alongside a mixed-risk and low-risk birth unit merger, can increase rates of births without interventions in a mixed-risk hospital setting. However, it is necessary to maintain awareness of the possible effects of a mixed-risk birth environment on the use of childbirth interventions and examine the long-term effects of preventative measures.

SAT241 Severe Hypercalcemia Secondary To Likely Sarcoidosis

Abstract Disclosure: N. Nair: None. A 42 year old gentleman with no known past medical history initially presented to the Endocrinology office referred from his primary care provider for the evaluation of severe hypercalcemia. He initially presented to his PCP with 8 months of progressive tachycardia, shortness of breath and persistently elevated blood pressures but was noted with a serum calcium of 14.9. On my initial evaluation, patient was well appearing, tachycardic with normal rate and rhythm with otherwise no abnormal findings. His blood pressure was elevated to 150s systolic from a baseline of less than 120. Based on the severity of the initial hypercalcemia, an extensive workup was sent to rule out potential etiologies for his hypercalcemia including Vitamin D, PTH, PTHrp, serum free and light chains, CMP, ionized calcium, and serum protein electrophoresis. The initial workup revealed a calcium improved to 12.1 from the initial 14.9, with significant elevation in ionized calcium. PTH and 25 hydroxyvitamin D were suppressed, ruling out primary hyperparathyroidism. Interestingly, 1,25 dihyroxyvitamin D levels were within the upper limit of normal, raising the possibility of granulomatous disease. PTHrp was elevated. Serum protein electrophoresis had revealed mild elevations in beta immunoglobulins. Based on the findings of the initial workup, concern remained for granulomatous disease and malignancy, and a CT of the chest, abdomen and pelvis was ordered. CT showed bilateral perihilar interstitial nodules, mildly enlarged mediastinal and hilar lymph nodes, and splenomegaly with ill defined splenic lesions. No mass or tumor was identified in this study. Although the potential for monoclonal gammopathies and malignancy remain in the differential diagnosis, his presentation, CT scan, and lab findings may be explained by sarcoidosis. While the normal 1,25 Vitamin D levels in the setting of suppressed PTH and 25 Vitamin D may be more classically associated with granulomatous disease, significant renal impairment, elevations in PTHrp and immunoglobulins are not uncommon, making sarcoidosis a likely explanation for his symptoms short of obtaining a biopsy. He was subsequently referred to pulmonology to evaluate for sarcoidosis and to oncology to evaluate further the elevations in serum immunoglobulins. This patient presentation is unique as it is not common to encounter cases of severe hypercalcemia in the outpatient setting. Here, it is important to note that PTHrp elevations and elevations in light chains may be seen in sarcoidosis as well as malignancy. This case illustrates the importance of a wide differential diagnosis in order to avoid the pitfall of prematurely determining a working diagnosis. Presentation: Saturday, June 17, 2023

THU053 Partial Third Nerve Palsy As A Presentation Of Prolactinoma, A Case Report

Abstract Disclosure: M. Ahmad: None. I. Iqbal: None. M. Khan: None. A. Estepa: None. U. Siddiqui: None. Introduction: Prolactinomas in men are often found when they are quite advanced, large and cause compression of surrounding structures. This compression causes patients to present with symptoms of hypogonadism, headaches, and vision changes. Uncommonly, pituitary adenomas have been shown to cause vision changes associated with third nerve palsy. We describe the case of a 21-year-old male presenting with vision changes and headaches who was found to have a large prolactinoma causing partial third nerve palsy. Case description: A 21-year-old male with no significant past medical history presented to the emergency department (ED)after being sent from his primary care provider’s office for headaches. The patient had been suffering from left sided headaches and blurry vision for the past two months. On physical examination the patient was normotensive (128/61 mmHg), afebrile (37.3 degrees Celsius) with a normal respiratory rate and heart rate (18 breaths per minute and 73 beats per minute respectively). He was noted to have left eyelidptosis with his left pupil being slightly more dilated than his right pupil at 5 mm and was slowly reactive. The patient’s blood work was significant for the following: sodium 141 mmol/L, potassium 4.4 mmol/L,bicarbonate 24 mmol/L, hemoglobin 13.4 g/dL, TSH 2.21 uIU/mL, free T4 0.9 ng/dL, prolactin &amp;gt;4700ng/mL, adrenocorticotrophin hormone &amp;lt;9 pg/ml, cortisol 0.9 mcg/dL, follicle-stimulating hormone 2.5uIU/ml, luteinizing hormone 4.7 uIU/ml, free testosterone 3.4 pg/ml, and total testosterone 19 ng/dL. The patient underwent brain imaging with his CT angiogram demonstrating a large sellar mass extending superiorly, causing displacement of the internal carotid artery. An MRI of the brain described the mass to be 3.4 x 2.7 cm in dimensions. The patient was first started on dexamethasone 4 mg intravenously every 6hours, tapered over a week, along with once weekly cabergoline which was eventually titrated up to 1 mg weekly. The patient had rapid clinical improvement with his symptoms resolving in four days, and was eventually discharged. He now follows with endocrinology as an outpatient. Discussion: Prolactinomas can present with a wide range of symptoms in men including headache, infertility, decreased libido and vision changes. Rarely, prolactinomas have been associated with third nerve palsy with proposed mechanisms including compression of the nerve in the cavernous sinus or compression of the nerve’s vascular supply. Through this case we hope to highlight this uncommon presentation of prolactinoma and propose it be considered in the workup for third nerve palsy. Presentation: Thursday, June 15, 2023

SAT312 CT-guided Cryoablation Of Hereditary Pheochromocytoma

Abstract Disclosure: E. Griffing: None. B. Reading: None. F. De Luca: None. Background: Guidelines surrounding the management of hereditary pediatric pheochromocytomas (PHEO) are lacking. This is the first report of a pediatric patient with bilateral hereditary PHEO treated with right adrenalectomy and computed tomography (CT) percutaneous-guided cryoablation (CRA) of the left-sided lesion.Clinical case: A previously healthy 15 years-old male presented to a tertiary care hospital with a months-long history of episodic chest pain, flushing, shortness of breath, diaphoresis, and tremulousness. Paternal family history was significant for PHEO and brain stem hemangioblastoma in grandmother and PHEO in the great-grandfather. Targeted familial mutation analysis of the von Hippel-Lindau tumor suppressor gene was positive for pathogenic mutation c.500G&amp;gt;A (p.R167Q). Plasma free normetanephrine level was 4,625 pg/mL (nl: &amp;lt;145 pg/mL), while free metanephrines were normal. Magnetic-resonance imaging of the abdomen visualized a 4.4 x 3.4 x 5.3 cm right adrenal mass and a 1.4 x 1.4 x 1.4 cm left adrenal mass, consistent with bilateral PHEO. He underwent right adrenalectomy after initiation of alpha-receptor blockade and later addition of beta-receptor blockade due to heart rates in the 150’s. After discussion with parents, it was decided to observe the smaller left-sided adrenal lesion. Plasma free normetanephrines initially decreased to 338 pg/mL, but then increased to 507 pg/mL five months post-operatively. Six months after surgery, due to the persistence of hypertension with systolic blood pressure in the 140’s as well as tachycardia with heart rates in the 150’s, he underwent CT-guided CRA of the left-sided PHEO. A 12-minute freeze, 5-minute thaw, and 10-minute freeze, followed by an active thaw were performed. There was an increase in blood pressure during the initial thaw with systolic blood pressure in the 230s, accompanied by bradycardia to the 30s, treated with nitroprusside, phentolamine, and increased sedation. He required continuation of nitroprusside infusion for five hours post-procedure. He was discharged the following day with normal blood pressure and heart rate. He was able to completely wean off anti-hypertensive medications within one month and symptoms of chest pain and tachycardia resolved. In the four years since his procedure, he has not had a recurrence of PHEO nor development of adrenal insufficiency. Plasma free normetanephrines and metanephrines have remained within normal limits. Conclusion: Percutaneous ablation of hereditary PHEO has not been reported before in the pediatric population and may represent a novel treatment strategy that reduces the risk of adrenal insufficiency. Presentation: Saturday, June 17, 2023

FRI571 Maternal Graves’ Disease With Foetal Thyrotoxicosis And Goitre

Abstract Disclosure: D. Fennell: None. J. Walsh: None. M. Hatunic: None. Background: Graves’ disease (GD) is an uncommon condition affecting 0.2% of pregnancies. Foetal and neonatal thyrotoxicosis occurs in between 1-5% of pregnant patients with a history of GD, typically beyond 20 weeks gestation. Given its potential for serious morbidity and mortality, prompt recognition and treatment of the condition is essential. Clinical case: A 34-year-old female was referred at 21+2 weeks’ gestation from another hospital due to concerning cardiac findings noted on routine prenatal ultrasound (US). Her medical history was significant for GD (TRAb positive) with moderate ophthalmopathy and total thyroidectomy ten months prior, on L-thyroxine 150 mcg daily. Foetal tachycardia 170-180bpm was noted, with US showing with right ventricular hypertrophy, small pericardial effusion and a 1.9 x 2.7 x 2.8cm neck mass, suspicious for foetal goitre. Maternal laboratory studies showed TSH 2.38mIU/L (0.27-4.2), FT4 16.0pmol/L (12-22), TPO antibody negative &amp;lt;3.0IU/ml and TRAb markedly elevated &amp;gt;30IU/L (0-1.8). A diagnosis of foetal thyrotoxicosis secondary to placental passage of maternal TRAb was made. She was commenced on carbimazole 20mg twice daily at 21+6 weeks’ gestation as treatment, with the goal of normalising foetal heart rate. Careful, weekly follow-up with US scanning noted gradual improvement in the foetus’ condition, with resolution of pericardial effusion and foetal heart rate normalisation. Maternal TFTs were monitored weekly and she remained euthyroid on increased dose L-thyroxine (200 mcg daily). Multidisciplinary team consensus was to proceed with elective Caesarean section at 34 weeks’ gestation, to avoid risk of airway obstruction from foetal goitre. A healthy male infant was born with spontaneous breathing and normal heart rate at delivery. Apgar scores were 9 and 9 at 1 and 5 minutes. Maternal carbimazole was immediately discontinued post-delivery and L-thyroxine reduced to 150 mcg daily. She had an uncomplicated recovery post-Caesarean section. The infant was closely monitored in the neonatal ICU. On day five of life, he became unwell, developing a supraventricular tachycardia. Thyrotoxicosis was confirmed on laboratory studies (FT4 &amp;gt;100pmol/L). Carbimazole, propranolol and Lugol’s iodine were all used as treatment. Thyroid hormone levels normalised within days, with gradual clinical improvement. He was discharged home well four weeks after birth, remaining on propranolol 0.3mg four times daily and carbimazole 0.5mg twice daily, with close paediatric outpatient follow-up planned. Conclusion: Foetal thyrotoxicosis is a rare condition, but can cause serious morbidity, as demonstrated here. First trimester maternal thyroid antibody testing is recommended for all patients with a history of GD, to identify those at risk. Management of the condition is complex, requiring multidisciplinary specialist input for favourable outcome. Presentation: Friday, June 16, 2023

THU667 Severe Hypothyroidism With Paradoxically Elevated Direct Free T4 Due To Anti-thyroxine Antibodies

Abstract Disclosure: O. Magvanjav: None. M.J. McPhaul: None. I. Choucair: None. E. Holt: None. Introduction Laboratory interference may cause abnormal thyroid function test (TFT) results, leading to misdiagnosis and inappropriate patient care. There are several major types of interference. Here, we describe a hypothyroid patient with an elevated thyroid stimulating hormone (TSH) level with a paradoxically elevated direct free thyroxine (FT4) level caused by interference from anti-thyroxine autoantibodies (THAAB). Clinical Case Our patient is a 38-year-old man who was found to have markedly elevated TSH and FT4 levels during an outpatient workup for Lyme disease. The patient was overall well-appearing but reported some symptoms suggestive of hypothyroidism including excessive fatigue, non-pitting edema, and dry skin. Physical exam was notable elevated blood pressure (systolic blood pressure of 150 mmHg and diastolic blood pressure of 95 mmHg), normal temperature, normal heart rate (72 bpm), regular heart rhythm, and normal body mass index. He had non-tender thyromegaly without nodules, non-pitting edema of bilateral hands and legs, decreased leg hair over bilateral shins, and coarse, dry skin of his hands. Initial TSH level was &amp;gt;150 mIU/ml, with a paradoxically elevated direct FT4 of 10 ng/dl (normal range 0.80-1.70 ng/dL). The FT4 level by equilibrium dialysis was &amp;lt;0.2 ng/dl. Outside laboratory testing to eliminate the effect of heterophile antibodies using two different assays again returned with elevated FT4 levels. Screening for macro TSH confirmed the markedly elevated TSH level. Further investigations at a second outside laboratory revealed that he had THAAB. A repeat FT4 level by dialysis confirmed the markedly low FT4 levels. He was empirically started on low dose levothyroxine and after increasing the levothyroxine dose, he showed improvement in clinical symptoms and the expected decline in TSH. Conclusions Here we present a rare case of THAAB that caused laboratory interference during thyroid function testing, leading to falsely elevated thyroid hormone levels on immunoassays. This case shows the importance of suspecting interference when there is a discrepancy between clinical symptoms and laboratory results or between results obtained from different testing methods. Our patient likely had a genetic predilection for autoimmunity, and Lyme disease is a known trigger for various autoimmune conditions. Our case also emphasizes the importance of taking a systematic approach to investigate the cause of the laboratory interference. This will help prevent misdiagnosis of thyroid disorders that may lead to additional unnecessary testing and treatment. Presentation: Thursday, June 15, 2023

Abnormal heart rate variability and its application in predicting treatment efficacy in patients with chronic migraine: An exploratory study.

This study aimed to investigate the extent of autonomic nervous system dysfunction in patients with chronic migraine using heart rate variability analysis. In addition, we explored the potential association between heart rate variability and treatment outcomes in patients receiving preventive treatment. In this cross-sectional and prospective study, we compared heart rate variability profiles in 81 preventive-naïve chronic migraine patients and 58 healthy controls. In addition, treatment responses of patients, who received a 12-week treatment with flunarizine, were assessed in relation to baseline heart rate variability. We observed that chronic migraine patients had a reduced heart rate variability, signifying autonomic dysfunction in comparison to healthy controls. Furthermore, patients presenting normal heart rate variability, characterized by a standard deviation exceeding 30 milliseconds in normal-to-normal RR intervals, experienced a superior response to flunarizine treatment. This improvement was exemplified by a significantly larger reduction in monthly headache days for patients with higher heart rate variability compared to those with lower heart rate variability: -9.7 (5.9) vs. -6.2 (6.0) days (p = .026). Autonomic dysfunction occurs in chronic migraine as evaluated by heart rate variability. A preserved function is associated with a better treatment outcome to flunarizine.Trial registration: Neurologic Signatures of Chronic Pain Disorders, NCT02747940. Registered 22 April 2016, https://clinicaltrials.gov/ct2/show/NCT02747940.

Variation in neutrophil levels and artemisinin-based combination therapy efficacy in West-Africa.

Polymorphonuclear neutrophils (PMN) are involved in pathogen clearance by phagocytosis. However, the role of PMNs in the efficacy of artemisinin-based combination therapy (ACT) is poorly understood. In a prospective longitudinal in vivo study, neutrophil rates were compared with malaria carriage after treatment with different ACTs: Artemether - lumefantrine (AL), Artesunate - amodiaquine (ASAQ), Dihydroartemisinin - piperaquine (DP) or Pyronaridine artesunate (PA). The study cases were classified as having neutropenia, normal neutrophil levels or neutrophilia depending on the level of neutrophils in the blood. This study included 3148 patients and was analyzed using R. On day 7, only four patients in the neutropenia group and treated with AL had a malaria positive blood smear based on microscopy. On day 28, the rate of recurrent parasitemia in the AL arm was significantly higher in neutropenia patients (50.9%) than in patients with normal rates of neutrophils (43.1%) or in those with neutrophilia (6.0%) (p < 0.001). In ASAQ arm, the rate of recurrent Plasmodium falciparum parasitemia was 58.8% in the neutropenia group versus 29.4% in patients with normal rates of neutrophils and 11.8% in patients with neutrophilia (p < 0.001). No patient treated with DP with normal neutrophil counts or neutrophilia was carrying malaria parasites on day 28. Among the 15 patients with parasitemia on day 28 in the PA arm, 11 (73.33%) had neutropenia while 4 (26.67%) had a normal neutrophil count (p < 0.001). Patients with neutropenia had higher rates of recurrent P. falciparum parasitemia after ACT.