Serum Laboratory Tests Research Articles

Falsely Abnormal Serum Protein Electrophoresis after Administration of Intravenous Immunoglobulins (IVIG): A Retrospective Cohort Study

Intravenous immunoglobulin (IVIG) therapy, used in several neurologic, hematologic, immunologic and dermatologic conditions, is known to interfere with the results of some serum laboratory tests. We analyzed the potential interference of IVIG on serum protein electrophoresis (SPEP) by reviewing more than a decade of SPEP studies performed by the clinical immunology laboratory of the Johns Hopkins Hospital. Of the total 100,350 SPEP performed between January 1, 2013 and December 31, 2023, 395 contained the keyword IVIG in the pathologist report, contributed by 348 patients confirmed to have received IVIG by chart review. Of the 348 patients, 20 (6%) had a M-spike on SPEP suggestive of monoclonal gammopathy, while 328 (94%) did not have it. Of the 20 patients, 14 received IVIG within 30 days from the SPEP collection date, while 6 received beyond 30 days. Serum immunofixation electrophoresis (SIFE) and clinical follow up showed no evidence of monoclonal gammopathy in 5 of the 14 patients. Overall, this 11-year retrospective cohort study showed that 5 of 348 (1.4%) patients treated with IVIG and tested by SPEP had a false M-spike, that is a spike not confirmed to be caused by a monoclonal gammopathy by subsequent studies. Although small, the false positive rate of 1.4% suggests that integrating knowledge of recent IVIG administration into the pathologist report would reduce SPEP misdiagnosis.

Comparison of Systemic Exposure Between Epinephrine Delivered via Metered-Dose Inhalation and Intramuscular Injection.

Background: Primatene® MIST, an epinephrine metered-dose inhaler (MDI), has long been questioned by some medical professionals for asthma treatment despite having been approved by the Food and Drug Administration. One of the primary reasons for their concerns stemmed from potential cardiovascular complications following epinephrine administration. However, the majority of documented cardiovascular complications seemed to occur following the injection route of the epinephrine. The aim of this study was to evaluate the systemic exposure of epinephrine delivered through different administration routes and to understand its relationship with cardiovascular effects. Since albuterol inhalers are commonly recommended for asthma, albuterol was also studied as a comparator drug. Method: A randomized, evaluator-blinded, three-arm crossover study was conducted in 28 healthy adult subjects to compare the profiles of systemic exposure for epinephrine delivered by MDI versus epinephrine intramuscular (IM) injection and albuterol MDI. Serially sampled plasma epinephrine and albuterol levels were measured and compared between treatment groups. Safety was assessed by adverse events, serial vital signs, electrocardiograms (ECGs), and clinical laboratory tests obtained at each crossover dosing visit. Results: Systemic exogenous drug exposure for inhaled epinephrine MDI (39 pg/mL × hour) was ∼9 times lower than that of epinephrine IM (435 pg/mL × hour) and 122 times lower than that of albuterol MDI (3453 pg/mL × hour) after dose normalization. The Cmax in epinephrine MDI (345 pg/mL) was approximately half of that of epinephrine IM (816 pg/mL) and that of albuterol MDI (681 pg/mL). Plasma drug concentrations for epinephrine MDI dropped rapidly to baseline (∼0.6 hour), while epinephrine IM took ∼8 hours, and albuterol MDI required more than 24 hours. Epinephrine MDI and albuterol MDI resulted in minimal, clinically insignificant changes in vital signs and ECGs, whereas epinephrine IM led to mild transient increases in systolic blood pressure, heart rate, and corrected QT interval. Conclusion: Epinephrine MDI (Primatene MIST) had ∼9 times lower systemic drug exposure (SDE) than that of epinephrine IM and ∼122 times lower than that of albuterol MDI. The lower SDE of inhaled epinephrine also correlated with reassuring safety findings, with no significant cardiovascular adverse effects found, compared with transient effects seen after IM epinephrine. Clinical trial registration number: NCT04207840.

Visual morbidity in macroprolactinoma: A retrospective cohort study.

The management of visual field damage in patients with macroprolactinomas is a major therapeutic challenge. We aimed to study the visual morbidity associated with macroprolactinoma and its outcomes following medical and surgical treatment. We aimed to identify predictors of visual recovery. We retrospectively reviewed patient's data including clinical presentation, serial pituitary magnetic resonance imaging, laboratory tests, visual symptoms and neuro-ophthalmologic examination, visual field tests and optical coherence tomography tests. The main outcome was complete visual field recovery. Descriptive analyses were conducted. Predictors of visual recovery were investigated. The study cohort included 150 patients with macroprolactinoma [median follow-up, 6.0 years (interquartile range (IQR) 2.9-10.6)]. At diagnosis, visual field defects were evident in 40 patients (26.7%). At the end of follow-up, 24 out of 39 available visual field tests (61.5%) exhibited complete recovery. Patients that achieved complete visual recovery had smaller macroadenomas at diagnosis [30.5 mm (15.0-80.0) vs. 42.0 mm (30.0-85.0), p < .01], lower baseline serum prolactin levels [1414 mcg/L (489-3586) vs. 4119 mcg/L (2715-6315), p < .01], lower rates of central hypogonadism (78.3% vs. 93.3%, p = .05) and central hypothyroidism (20.8% vs. 53.3%, p = .04), lower rates of compressive optic neuropathy (35.3% vs. 87.5%, p = .02) and a better visual acuity (better than 6/8 in both eyes, 93.7% vs. 28.6%, p < .01). In our cohort of 150 patients with macroprolactinoma, 40 patients (26.7%) presented with visual field defects, of which 61.5% achieved complete visual recovery with treatment. Patients that achieved complete visual recovery presented with smaller macroadenomas, lower serum prolactin levels, lower rates of central hypogonadism and central hypothyroidism, lower rates of compressive optic neuropathy and better visual acuity.

Association between serum anion gap and risk of in-hospital mortality in patients with acute heart failure

A high serum anion gap (AG) at the time of patient admission can lead to the deterioration or even death; data are lacking for patients who suffer acute heart failure (AHF). The present study aimed at exploring the impact of serum AG (SAG) levels on the in-hospital mortality in AHF patients. The study conducted retrospective analysis on the data from the medical information mart for intensive care (MIMIC-IV) database in severe AHF cases. Serum AG, age, sex, concomitant diseases and laboratory tests were collected from patients at admission. Multivariate Cox proportional hazard regression model together with Kaplan Meier (K–M) survival curve served for analyzing the relationship of serum AG with the hospital all-cause mortality (ACM). In addition, subgroup analysis assisted in assessing the concordance. Data from 2774 AHF patients were collected in the study. The hospital ACM rate was 9.2% (254/2774). After correcting potential confounders, multivariate analysis compared the high serum AG level (≥ 16 mmol/L) and the low serum AG level (< 16 mmol/L) (hazard ratio (HR): 1.89 [95% CI 1.42–2.51]). In a similar way, K–M survival curve indicated that hospital survival was lower in patients with high serum, suggesting that high serum AG level could lead to poor AHF prognosis. In patients with AHF, high serum AG level could increase the hospital ACM.

Improving care practices of the patient with type 2 diabetes in community health centers.

Diabetes ranks seventh in morbidity and mortality in the United States. In addition, more than 25 million Americans living with diabetes depend on community health centers (CHCs) for primary care. Preimplementation data in a group of CHCs indicated poor adherence to standards of care practices as recommended by the American Diabetes Association (ADA) with quarterly A1c (33.1%), annual serum laboratory tests (66.6%), and annual urine microalbumin (26.5%). Using a pre- and postimplementation comparison method, a NP-led practice improvement project was conducted in a group of CHCs, which sought to (1) identify adherence to ADA care standards; (2) determine whether an intervention could affect adherence to ADA standards; and (3) compare pre- and postimplementation occurrences of hemoglobin A1c greater than 7.1% and greater than 9%. Intervention composed of an educational component, standing orders to facilitate care practice changes, and electronic health record utilization changes. Postimplementation data reveal statistically significant improvements in quarterly hemoglobin A1c (93.6%), annual serum laboratory tests (96.5%), and annual urine microalbumin screening (85.5%). Improvements in translation to care for standardized guidelines facilitate improvements in health outcomes for patients. This project demonstrated improvements that can decrease the morbidity and mortality experienced by persons living with diabetes and being seen within a CHC. In addition, this project demonstrated that advanced practice nurses have the training and occupy a unique position within health care to spearhead initiatives for translation of evidence into care practices.

Association between the metabolic score for insulin resistance (METS-IR) and arterial stiffness among health check-up population in Japan: a retrospective cross-sectional study.

This study examined the association between the metabolic score for insulin resistance (METS-IR), a novel surrogate indicator of insulin resistance, and brachial-ankle pulse wave velocity (baPWV) in Japanese health check participants. A cross-sectional research was conducted involving individuals in a program of medical health screening at the Medical Health Check-up Center in Japan. The study assessed the connection between METS-IR and baPWV in 912 participants who joined the program between 3/1/2004 and 12/31/2012. Serum laboratory tests and lifestyle surveys were the covariates. Multivariate linear regression analysis and subgroup analyses were performed. 912 participants were involved in this cross-sectional study. Adjusted for age, sex, BMI, AST, UA, HDL, eGFR, ankle-brachial index (ABI), alcohol consumption, and smoking status, multivariate linear regression analysis showed that METS-IR and baPWV showed a significant positive association (adjusted β=15.3, 95% confidence interval (CI): 6.61~23.98) with METS-IR as a continuous variable. When converting METS-IR to quartile categorical variables, higher quartile METS-IR indices had longer baPWV (Q3 vs Q1, β=86.14, 95% CI: 23.45~148.83; Q4 vs Q1, β=125.41, 95% CI: 39.99~210.84). In subgroup analysis, METS-IR was associated with baPWV in people with eGFR > 60 ml/min (adjusted β= 14.44, 95% CI: 5.61~23.26, P=0.001), none or light alcohol consumption (adjusted β=16.92, 95% CI: 6.85~27, P=0.001), non-smokers (adjusted β=15.48, 95% CI: 5.86~25.1, P=0.002), non-regular exercisers(adjusted β=17.34, 95% CI: 8.03~26.65, P<0.001), non-fatty liver (adjusted β=17.65, 95% CI: 5.92~29.39, P=0.003), and non-hypertensive (adjusted β=16.13, 95% CI:8.45~23.8, P<0.001). METS-IR are remarkably associated with baPWV among health check-up participants in Gifu, Japan. As a simple, easily calculated predictor of arterial stiffness, METS-IR could be considered for primary care as a monitoring tool to identify people with high risk of cardiovascular disease in order to intervene early on risk factors. Future prospective, large-sample researches are still needed to confirm this.

Menopause and metabolic syndrome: anthropometric, lipid, and dietary profiles.

The aim of this study was to characterize the anthropometric, lipid, and dietary profiles of postmenopausal women with metabolic syndrome attending a public health service and compare them with a group of women without metabolic syndrome. A cross-sectional study was conducted with 60 postmenopausal women who were divided into two groups: control group and metabolic syndrome group, attending the Climacteric Outpatient Clinic at Santa Casa de São Paulo Hospital, Brazil, between February 2019 and December 2021. Participants were evaluated using a validated semi-quantitative food frequency questionnaire, body mass index, waist circumference, and serum laboratory tests. Significant differences were observed between the groups regarding body mass index and all parameters of metabolic syndrome. The nutritional profile revealed an imbalance in the number of food portions consumed, particularly in the intake of carbohydrates in the form of flour and sweets, which was higher in the metabolic syndrome group. The analysis of the three profiles of postmenopausal women revealed significant imbalances, particularly in the metabolic syndrome group, highlighting the importance of regular adjustments and evaluations during this phase of a woman's life.

Cerebral hypometabolism mediates the effect of stroke volume on cognitive impairment in heart failure patients.

The present study aimed to phenotype the cerebral structural and glucose metabolic alterations in patients with heart failure (HF) using simultaneous positron emission tomography (PET)/magnetic resonance (MR) and to investigate their relationship to cardiac biomarkers and cognitive performance. Forty-two HF patients caused by ischaemic heart disease (mean age 67.2±10.4, 32 males) and 32 age- and sex-matched healthy volunteers (mean age 61.3±4.8, 18 males) were included in this study. Participants underwent simultaneous cerebral fluorine-18 (18 F) fluorodeoxyglucose PET/MR followed by cardiac MR scan, and neuropsychological scores were obtained to assess cognitive performance. The grey matter volume (GMV) and standardized uptake value ratio (SUVR) were calculated to examine cerebral structural and metabolic alterations. Cardiac biomarkers included cardiac MR parameters and cardiac serum laboratory tests. Mediation analysis was performed to explore the associations among cerebral alterations, cardiac biomarkers, and cognitive performance. HF patients demonstrated notable cognitive impairment compared with normal controls (P<0.001). Furthermore, HF patients exhibited regional brain hypometabolism in the bilateral calcarine cortex, caudate nucleus, thalamus, hippocampus, precuneus, posterior cingulate cortex, lingual and olfactory cortex, and GMV reduction in bilateral thalamus and hippocampus (cluster level at P<0.05, Gaussian random field correction). The SUVR of the hypometabolic brain regions was correlated with the Montreal Cognitive Assessment (MoCA) scores (r=0.55, P = 0.038) and cardiac stroke volume (r=0.49, P=0.002). Cerebral hypometabolism played a key role in the relationship between the decreased stroke volume and MoCA scores, with a mediation effect of 33.2%. HF patients suffered cerebral metabolic and structural alterations in regions associated with cognition. The observed correlation between cardiac stroke volume and cognitive impairment underscored the potential influence of cerebral hypometabolism, suggesting that cerebral hypometabolism due to chronic systemic hypoperfusion may significantly contribute to cognitive impairment in HF patients.

Nutritional Status of Children with Newly Diagnosed Food Allergies.

Most published pediatric guidelines on food allergy highlight the importance of nutritional counseling and dietary adequacy to avoid either growth retardation or nutritional deficiencies. The aim of the study was an assessment of the nutritional status of children with IgE-mediated food allergies. 45 patients with newly diagnosed food allergy (FA) and 33 healthy controls were analyzed (aged 6 to 72 months, 60.2% boys). The nutritional status was assessed using anthropometric measurements (body weight and length) and serum laboratory tests. The results were analyzed with the Statistica 12 software (Tulsa, OK, USA). 82%, 40%, 8.8%, and 6.6% of the studied children demonstrated allergy to hen's egg, cow's milk, pork meat, and wheat/rye, respectively. Z-score BMI < -2SD was more often found in the FA subjects under 30 months of age than in the controls (p = 0.04). As many as 77.8% of the FA subjects and 78.8% of the controls were of normal height (hSDS: -0.23 ± 1.74 and -0.31 ± 1.49, respectively, p = 0.8). Retinol binding protein four serum concentration was significantly lower in the FA group (17.01 ± 3.84 mg/L) than in the controls (20.47 ± 4.87 mg/L, p < 0.001). No statistically significant differences were observed between the FA group and the controls (either in the younger or the older age group) (p > 0.05) for the serum concentrations of total protein, total cholesterol, thyroxin-binding prealbumin (TBPA), 25(OH)D, hemoglobin level or white blood cells. In patients under 30 months of age, one of the symptoms of food allergy may be body weight deficiency, while short stature is less common at the time of diagnosis.

Sinonasal Organizing Hematoma: Demographics, Diagnosis, and Treatment Outcomes of 112 patients.

Sinonasal organizing hematoma (OH) is a rare, nonneoplastic lesion that often presents with epistaxis, a reddish mass, and destruction of the involved sinonasal structures. Due to its rarity, the demographics, diagnostic modalities, treatment strategies, and outcomes have not yet been studied in a large, long-term study. Retrospect cohort of 112 sinonasal OH patients treated between 1997 and 2020 in a tertiary, university hospital were evaluated. Demographics, systemic comorbidities, sinonasal surgery history, serum laboratory tests, radiological findings, and treatment results were collected. The present study aimed to assess the accuracy of preoperative computed tomography (CT), Gadolinum-enhanced magnetic resonance (MR), and punch biopsies in detecting sinonasal OH as the most likely diagnosis. In addition, incidental differences by age and year of diagnosis were calculated using the Poisson log-linear regression model. The median age was 44, and 58% were male. Fewer than 20% of these cases had a chronic systemic comorbidity, bleeding tendency, or sinonasal surgery history. MR had the highest accuracy of (87%) to detect sinonasal OH as the most likely diagnosis, compared with contrast-enhanced-CT (53%), punch biopsy (49%), and non-enhanced-CT (16%) (all <0.05). Sinonasal OH incidence did not vary by age, but the yearly rate significantly increased by 1.05 times over 23 years (p < 0.05). Notably, 84% of 112 patients received surgical removal through the assistance of an endoscope, and none had substantial bleeding without preoperative embolization. Sinonasal OH was observed regardless of age, sex, systemic comorbidities, bleeding tendency, prior sinonasal surgery, or trauma. Preoperative MR gives the highest accuracy for detecting this disease. Sinonasal OH may be safely managed with endoscopic-assisted surgery removal without embolization. 4 Laryngoscope, 134:1581-1590, 2024.

The use of serum alkaline phosphatase as a choledocholithiasis marker to mitigate the cost of magnetic resonance cholangiography.

To assess the predictive value of preoperative serum laboratory test results for identifying choledocholithiasis and reduce the use of cholangioresonance and its inherent costs. Patients aged 21-69 years who underwent preoperative cholangioresonance examination at our institute were included. Patients with a history of fluctuating jaundice or biliary pancreatitis, bile duct dilatation on ultrasonography, and elevated levels of canalicular enzymes (alkaline phosphatase >100U/L and gamma-glutamyl transferase >50U/L) underwent cholangioresonance-guided surgery. Cases of choledocholithiasis confirmed by cholangioresonance were compared with those without choledocholithiasis. Serum laboratory data were evaluated and the diagnostic capabilities of these examinations were analyzed. A total of 104 patients were included. For detecting choledocholithiasis using alkaline phosphatase, the cut-off point was 78U/L, sensitivity was 97.6% (95%CI: 87.4-99.9), and specificity was 72.6% (95%CI: 59.8-83.1). In the binary logistic regression analysis, age (OR= 0.92; 95%CI: 0.86-0.98) and alkaline phosphatase level (OR= 1.02; 95%CI: 1.01-1.05) were selected for the final model. Serum alkaline phosphatase levels may aid preoperative diagnosis of asymptomatic choledocholithiasis. After a global clinical assessment of the patient, serum laboratory findings may contribute to a reduction in cholangioresonance-related heathcare costs.

Recommendations for the study of monoclonal gammopathies in the clinical laboratory. A consensus of the Spanish Society of Laboratory Medicine and the Spanish Society of Hematology and Hemotherapy. Part II: Methodological and clinical recommendations for the diagnosis and follow-up of monoclonal gammopathies

Abstract Monoclonal gammopathies (MG) are a group of clinical entities characterized by the clonal expansion of monoclonal immunoglobulin (M-protein) secreting plasma cells (PC). This document presents the consensus recommendations of the Spanish Society of Laboratory Medicine (SEQCML) and the Spanish Society of Hematology and Hemotherapy (SEHH) for the study of MG. The recommendations were established based on scientific evidence and the opinion of experts in MG from the clinical laboratory and clinical hematology fields. Recommendations are proposed for the diagnosis of MG and for patient follow-up according to the type of MG and whether or not the patient is undergoing treatment, and to monitor the disease stability, response to therapy and disease progression. With respect to the diagnosis, we describe the most recent criteria and classification established by the International Myeloma Working Group (IMWG) for multiple myeloma (MM), smoldering MM, monoclonal gammopathy of undermined significance (MGUS) and other related entities. Indications are given about the analytical requirements and application of the different serum and urine laboratory tests (study, detection, identification and measurement of M-protein) and the bone marrow study. Recommendations on the clinical laboratory results report model are established to harmonize and ensure that all relevant information is available, including its content, expression, and interpretive comments.

Associations of blood biomarkers with arterial stiffness in patients with diabetes mellitus: A population-based study.

Arterial stiffness contributes to additional cardiovascular risks in diabetic patients by triggering the loss of vascular and myocardial compliance and promoting endothelial dysfunction. Thus, prevention of arterial stiffness is a public health priority, and the identification of potential biomarkers may provide benefits for early prevention. This study investigates the relationships between serum laboratory tests and pulse wave velocity (PWV) tests. We also investigated the associations between PWV and all-cause mortality. We examined a panel of 33 blood biomarkers among diabetic populations in the Atherosclerosis Risk in Communities Study. The carotid-femoral (cfPWV) and femoral-ankle PWV (faPWV) were measured using an automated cardiovascular screening device. The aortic-femoral arterial stiffness gradient (afSG) was calculated as faPWV divided by cfPWV. Biomarker levels were log-transformed and correlated with PWV. Cox proportional hazard models were employed for survival analysis. Among 1079 diabetic patients, biomarkers including high-density lipoprotein cholesterol, glycated hemoglobin, high-sensitivity troponin T, cystatin C, creatinine, and albuminuria were significantly correlated with afSG (R = 0.078, -0.193, -0.155, -0.153, -0.116, and -0.137, respectively) and cfPWV (R = -0.068, 0.175, 0.128, 0.066, 0.202, and 0.062, respectively). Compared with the lowest tertile of afSG, the risk of all-cause mortality was lower in the highest tertile (hazard ratio 0.543; 95% confidence interval 0.328-0.900). Certain biomarkers related to blood glucose monitoring, myocardial injury, and renal function significantly correlated with PWV, suggesting that these putative risk factors are likely to be important atherosclerosis mechanisms in diabetic patients. AfSG may be an independent predictor of mortality among diabetic populations.

Association of viral kinetics, infection history, NS1 protein with plasma leakage among Indonesian dengue infected patients.

Plasma leakage, a hallmark of disease in Dengue virus (DENV) infection, is an important clinical manifestation and is often associated with numerous factors such as viral factors. The aim of this study is to investigate the association of virus serotype, viral load kinetics, history of infection, and NS1 protein with plasma leakage. Subjects with fever ≤ 48 hours and positive DENV infection were included. Serial laboratory tests, viral load measurements, and ultrasonography examination to assess plasma leakage were performed. DENV-3 was the most common serotype found in the plasma leakage group (35%). Patients with plasma leakage demonstrated a trend of higher viral load and a longer duration of viremia compared to those without. This was significantly observed on the fourth day of fever (p = 0.037). We found higher viral loads on specific days in patients with plasma leakage in both primary and secondary infections compared to those without. In addition, we also observed more rapid viral clearance in patients with secondary infection. NS1 protein, especially after 4 days of fever, was associated with higher peak viral load level, even though it was not statistically significant (p = 0.470). However, pairwise comparison demonstrated that peak viral load level in the group of patients with circulating NS1 detected for 7 days was significantly higher than the 5-day group (p = 0.037). DENV-3 was the most common serotype to cause plasma leakage. Patients with plasma leakage showed a trend of higher viral load and a longer duration of viremia. Higher level of viral load was observed significantly on day 5 in patients with primary infection and more rapid viral clearance was observed in patients with secondary infection. Longer duration of circulating NS1 protein was also seen to be positively correlated with higher peak viral load level although not statistically significant.

Tools and factors predictive of the severity of COVID-19.

The outbreak of the novel coronavirus infection caused worldwide confusion. The problem with this infection is that it causes severe illness in some patients, resulting in a high rate of death if appropriate treatment is not given. If patients with severe illness that requires treatment are appropriately identified, treatment can be focused on these patients. However, in the early days of the COVID-19 outbreak, the inability to predict and diagnose the disease led to hospitals being overwhelmed. Therefore, various methods for the diagnosis of severe disease were developed early on, and various methods are still being investigated to predict high-risk patients. The currently available prediction methods are divided into those that predict the onset of severe disease and those used to determine the severity of the disease. Specifically, the main methods include genetic factors, serum humoral factors, laboratory tests, and diagnostic imaging. Since each of these factors has different features, using them in combination is likely to be advantageous.

Comorbid Contributors to Fatigue in Myasthenia Gravis (P7-8.010)

<h3>Objective:</h3> To characterize fatigue in patients with myasthenia gravis, identify other comorbid factors that contribute to it and propose routine screening recommendations. <h3>Background:</h3> Fatigue is a frequent complaint in patients with myasthenia gravis. However, it is non-specific and often associated with other medical conditions. Some of the most frequent causes of fatigue can be indirectly related to myasthenia and its treatment or another simultaneous condition. With this study, the goal is to guide providers on weather to routinely screen for comorbid, potentially treatable causes of fatigue in MG patients. <h3>Design/Methods:</h3> Patients were recruited from VCU Neurology clinics. Inclusion criteria were adults with a confirmed diagnosis of myasthenia gravis from positive antibodies or electrodiagnostic testing. Enrolled patients had a battery of serum laboratory tests collected that included B12, MMA, CBC, TSH and testosterone levels in men. They also filled out questionnaires including PSQI, Epworth Sleepiness Scale and Neurology QoL surveys for fatigue, depression and anxiety. Patients and their primary neurologists were notified of any abnormal lab results and their participation in the study did not have any influence on management of their disease. <h3>Results:</h3> 28 patients were enrolled in this study, completed the questionnaires and had laboratory studies collected. 19 patients were female and 9 were male. 68% of patients had an MGFA post-intervention status of MM3. 61% of patients had a fatigue severity scale &gt;36 and 68% scored &gt;50 on the fatigue portion on the QOL questionnaire. 43% of patients had abnormal laboratory results, mostly either anemia or vitamin D deficiency. Regarding sleep, 75% had a PSQI score &gt;5. For psychiatric comorbidities, 46% scored &gt;50 on the anxiety and 50% scored &gt;50 on the depression portion. <h3>Conclusions:</h3> The results of this study suggest that fatigue in patients with myasthenia gravis is multifactorial and routine screening for other causes is warranted. <b>Disclosure:</b> Dr. Gwathmey has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion Pharmaceuticals. Dr. Gwathmey has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Argenx. Dr. Gwathmey has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Argenx. Dr. Gwathmey has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Strongbridge. Dr. Gwathmey has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UCB. Dr. Gwathmey has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion Pharmaceuticals. Dr. Gwathmey has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Alexion Pharmaceuticals. Dr. Patel has nothing to disclose. Ms. Parolisi has nothing to disclose.

Patent Ductus Venosus in an early term infant with mild respiratory distress – Case report

Patent ductus venosus is an extremely rare form of congenital portosystemic shunt that results in the diversion of portal blood into the systemic circulation, decreasing hepatic blood flow and increasing blood volume and toxic substances in the systemic circulation. We present a clinical case of a male infant born at 37 5/7 weeks gestational age with patent ductus venosus. Because very few cases of patent ductus venosus have been reported, the prudent approach it would be to perform serial Doppler studies and laboratory tests to follow the course of the ductus venosus until closure and to intervene if the infant becomes unstable and symptomatic. The medical team decided that the conservative management in this case was a better choice, since the infant remained stable with good growth.

Issues of intensive care and liver transplantation tactics in fulminant liver failure

Fulminant liver failure is usually characterized as severe acute liver injury with encephalopathy and synthetic dysfunction (international normalized ratio [INR] ≥1.5) in a patient without cirrhosis or previous liver disease. Management of patients with acute liver failure includes ensuring that the patient is cared for appropriately, monitoring for worsening liver failure, managing complications, and providing nutritional support. Patients with acute liver failure should be treated at a liver transplant center whenever possible. Serial laboratory tests are used to monitor the course of a patient's liver failure and to monitor for complications. It is necessary to monitor the level of aminotransferases and bilirubin in serum daily. More frequent monitoring (three to four times a day) of blood coagulation parameters, complete blood count, metabolic panels, and arterial blood gases should be performed. For some causes of acute liver failure, such as acetaminophen intoxication, treatment directed at the underlying cause may prevent the need for liver transplantation and reduce mortality. Lactulose has not been shown to improve overall outcomes, and it can lead to intestinal distention, which can lead to technical difficulties during liver transplantation. Early in acute liver failure, signs and symptoms of cerebral edema may be absent or difficult to detect. Complications of cerebral edema include increased intracranial pressure and herniation of the brain stem. General measures to prevent increased intracranial pressure include minimizing stimulation, maintaining an appropriate fluid balance, and elevating the head of the patient's bed. For patients at high risk of developing cerebral edema, we also offer hypertonic saline prophylaxis (3%) with a target serum sodium level of 145 to 155 mEq/L (level 2C). High-risk patients include patients with grade IV encephalopathy, high ammonia levels (&gt;150 µmol/L), or acute renal failure, and patients requiring vasopressor support. Approximately 40 % of patients with acute liver failure recover spontaneously with supportive care. Predictive models have been developed to help identify patients who are unlikely to recover spontaneously, as the decision to undergo liver transplant depends in part on the likelihood of spontaneous recovery of the liver. However, among those who receive a transplant, the one-year survival rate exceeds 80 %, making this treatment the treatment of choice in this difficult patient population.

Abdominal Pain—An Ambiguous Pancreatic Cyst

Question: A 74-year-old man presented with vague abdominal pain. There was no personal history of malignancy or weight loss. Serum laboratory tests were significant for a total bilirubin of 3.4 mg/dL but direct bilirubin of 0.20 mg/dL. Liver enzymes, lactate dehydrogenase, carcino-embryonic antigen, and cancer antigen 19-9 were all within normal range. Computed tomographic (CT) imaging (Figure A and B) revealed a 6 × 2.9 × 2.7 cm pancreatic mass in the body of the pancreas with associated mesenteric and left-side retro-peritoneal para-aortic lymphadenopathy without significant ductal dilation. Endoscopic ultrasound (EUS) examination (Figure C and D) demonstrated a nearly completely cystic mass measuring 2.5 × 2.2 cm. A plane appeared to separate the cystic mass from the pancreatic body itself. Multiple abnormal, oval, hypo-echoic lymph nodes were visualized in the peri-gastric region as well. EUS-guided core biopsies were obtained from the cyst wall.

P168 Development of predictive model for early detection of Inflammatory Bowel Disease in Korea

Abstract Background Diagnostic delay in inflammatory bowel disease (IBD) was frequent and may be associated with poor outcomes. The aim of this study was to develop a predictive model for early diagnosis of IBD. Methods From March 2020 to January 2022, a 15-item Red Flags questionnaire was administered to all patients who visited outpatient clinic with gastrointestinal symptoms suspected of IBD. All patients underwent additional diagnostic tests to confirm IBD. We estimated a model that could predict the early diagnosis of IBD using questionnaire and laboratory test results. Results A total of 186 patients were enrolled in this study and 114 (61.2%) patients were finally confirmed with IBD. The logistic regression identified 4-item independently associated with a diagnosis of IBD. 1) Perianal fistula/abscess or perianal lesions (apart from hemorrhoids) (OR, 2.6; p=0.044). 2) Chronic abdominal pain/discomfort (&amp;gt;3 months) (OR, 0.3; p=0.013). 3) Rectal bleeding (OR, 7.4; p&amp;lt;0.001). 4) First-degree relative with confirmed IBD (OR, 12.0; p=0.033). A receiver operating characteristic curve was used to evaluate predictability of the model for diagnosis of IBD and each area under the curve was as follows. 1) Questionnaire only : AUC 0.831 (95% confidence interval; 0.766-0.896), 2) Questionnaire and serum laboratory tests including blood cell counts, erythrocyte sedimentation rate and C-reactive protein : AUC 0.885 (95% C.I.; 0.834-0.936), 3) Questionnaire, serum laboratory tests and fecal calprotectin : AUC 0.895 (95% C.I.; 0.845-0.944). This model confirmed that the predictive value was particularly excellent for early diagnosis of Crohn's disease. 1) Questionnaire only : AUC 0.891 (95% C.I.; 0.818-0.964), 2) Questionnaire and serum laboratory tests : AUC 0.960 (95% C.I.; 0.914-1.000), 3) Questionnaire, serum laboratory tests and fecal calprotectin : AUC 0.975 (95% C.I.; 0.944-1.000). Conclusion The predictive model for early diagnosis of IBD has a high predictive value. The model allows for early detection of IBD from non-IBD patients.