Single Morning Research Articles

Comparison of cortisol, depression and stress hormone levels in primary dysmenorhore adolescents with the application of a combination of facial acupressure with classic music therapy

<p><strong>Background :</strong><em> Constant chronic dysmenorrhea pain, should be screened with a single morning serum cortisol concentration. Uncontrolled pain (acute and chronic) initially indicates high serum cortisol concentrations. Then, one of the factors that can influence pain during menstruation is stress. </em></p><p><strong>Objectives :</strong><em> This study aims to assess non-pharmacological interventions for facial acupressure (BL-2, Yin Tang, GV 23, GB 15, Tai Yang, GB 14, Ex Hn4, TE 23, Sang Ming , LI-20, Ex Hn 8, ST-3, Si 18, Du 26, REN 24, JiaCenjiang, SJ21, SJ17, GB-2) combined with Mozart classical music in reducing cortisol levels, depression and stress in dysmenorrhea primary. </em></p><p><strong>Methods:</strong><em> This is quantitative research with a quasi-experimental design. The research approach used is pre-post test design. In November 2021-January 2022 at Megarezky University Makassar. There were 42 Adolescents with Primary Dysmenorrhea for respondents to this research. The sample in this study was divided into three groups, namely an intervention group (combination of facial acupressure with classical music) and 2 control groups which were only given classical music and facial acupressure treatment. Data collected included depression and stress. In addition, cortisol levels were checked using an ELISA Kit. Then the data was analyzed using the Paired T-test, while to see the differences if it was normally distributed using the One Way Anova test and if it was not normally distributed using Kruskal-Wallis. </em></p><p><strong>Results:</strong><em> The results of the study found that there was a decrease in cortisol levels, depression and stress when given facial acupressure and classical music, but the reduction was more effective if a combination of facial acupressure and classical music.</em></p><p><em></em><strong>Conclusions:</strong><em> Among the variables of cortisol levels, depression and stress, the combination of facial acupressure and classical music was significantly more effective in improving stress than just giving facial acupressure and classical music. </em></p>

#472 Cardiorenal relations in patients with chronic heart failure

Abstract Background and Aims To study the functional state of the kidneys and cardiorenal relationships in patients with chronic heart failure, depending on the representation of components of metabolic syndrome Method To achieve the objectives, 227 male patients with chronic heart failure (CHF) of ischemic origin of functional class II-III according to NYHA, aged 40-60 years with a history of myocardial infarction of 6 months, were examined up to 5 years. Depending on the presence of MS components, 3 groups of patients were identified: group I (n=80), patients without MS (CHF FC II—42, CHF FC III—38 patients); Group II (n=77) patients with various combinations of dyslipidemia (HDL-C <1.03 mmol/l; LDL-C >3.0 mmol/l) with abdominal obesity (AO), hypertension and hypertriglyceridemia (HTG) (CHF FC II—40, CHF FC III—37 patients); Group III (n=75) patients with various combinations of dyslipoproteinemia (DLP) and type 2 diabetes mellitus (DM2) with AO, hypertension and hypertriglyceridemia (CHF) (CHF FC II—36, CHF FC III—39 patients). When diagnosing MS, the International Diabetes Federation diagnostic criteria for MS were used (IDF, 2009). The study of the functional state of the kidneys included determination of the level of serum creatinine, urinary albumin excretion (determination of microalbuminuria (MAU ≥300 mg/l) in a single morning urine using indicator strips (Biosensor AN, Russia), glomerular filtration rate (GFR), calculated by the formula GFR EPI, which takes into account race, sex, age, serum creatinine. To calculate GFR using the CKD-EPI formula, you can use special applications for mobile devices (QxMDCalculator). Results When studying the parameters of the functional state of the kidneys in patients with group 1 CHF, 20 patients (25%) out of 80 were diagnosed with MAU. Serum creatinine clearance in this group was 89.0 ± 8.49 μmol/L, and the GFR level was 88.58 ± 8.36 ml/min. With the development of MS in group II patients, 41 out of 77 patients had MAU (53.2%). A decrease in GFR by 19.3% (P<0.01) was also found with an increase in serum creatinine levels by 22.7% (P<0.01), in contrast to the data from group I of the study. Further analysis of the parameters of renal function in CHF group III revealed a significant decrease in GFR (by 29.8%; P<0.001) with a significant increase in blood creatinine levels (by 31.8%; P<0.001) in relation to the data of group I. Also in group III of patients with CHF and MS (+DM2), microalbuminuria was detected in 47 patients (74.6%) out of 75. When comparing indicators of renal function between study groups II and III, there was a significant difference in the level of blood creatinine clearance and glomerular filtration rate by 21.3% and 20.1% (P<0.005), respectively. According to the classification of CKD, in group I of patients with CHF, stage I CKD was detected in 39.3%, in group II in 28.6% and in group III in 19.4%. CKD stage II was detected in group I in 46.4%, in group II in 50% of patients. 46.9% had CKD stage II of the disease in group III of the study. Also, in group II, 21.4% and group III, 43.7% were diagnosed with stage III CKD. V In group I, 35% had a high risk, 53.6% had a moderate and 14.3% had a low combined risk of developing cardiovascular complications in cardiorenal syndrome. Conclusion Thus, MS in patients with CHF aggravates renal dysfunction, which developed as one of the main pathogenetic links of CHF. It has been established that as MS progresses (addition of type 2 diabetes to other components of MS), the phenomena of functional renal failure increase. Violation of the functional state of the kidneys, the severity and nature of this dysfunction depends on the presence and nature of the representation of MS components.

Mornings with the highest non‐rainfall water during 2 years of measurements in the Negev–Ecological implications

AbstractBy providing water during the long dry rainless season, non‐rainfall water (NRW), principally dew and fog, is commonly thought to serve as an important water source for arid soil biocrusts, which require water threshold of 0.05 (for lichens) and 0.1 mm (for cyanobacteria) for growth. Such values are commonly reported in the literature. Moreover, values of >0.45 mm/d (considered as the practical theoretical threshold for dew) are also reported. Following an analysis of limited (29 days) dewy mornings, it was recently reported that dew is incapable of forming on the soil surface. Being of limited scope, we therefore analyse days that yielded the highest amounts of NRW during 2 years (2021–2023) of measurements (22 days with NRW ≥0.15 mm). We conducted measurements at 1 m above ground, cobbles, rocks, and the soil surface, and compared them to the cloth‐plate method. Additionally, periodical temperature measurements were conducted, and the dewpoint temperature (Td) was calculated. Our findings indicate that (a) dew yield never surpassed 0.4 mm, (b) while the water threshold amounts were reached on the rocks and especially on the cobbles, these thresholds were seldom reached on soil (a single morning with 0.1 mm and 3 days with ≥0.05 mm), (c) in comparison to air temperatures at 0.05 m and especially at 1 m‐height above ground, surface nocturnal soil temperatures were 2–3°C warmer, thus eliminating possible vapour condensation. Our data cast doubt on values of >0.45 mm reported from various deserts. Additionally, while supporting the view that NRW may provide water for the growth of rock‐dwelling lichens, NRW in the Negev does not provide the soil biocrusts with sufficient water for growth.

The Significance of Equipment Availability and Anesthesia Educational Conferences to Decision-Making for EKG Lead V5 Abnormalities.

Introduction To predict postoperative myocardial infarction rates in patients who undergo noncardiac surgery, the Canadian Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment and Management recommends assessment of brain natriuretic peptide (BNP) in certain patients. Serial troponins are measured if the BNP level is elevated. In certain cases, Revised Cardiac Risk Index (RCRI) alone does not perform well, for example, during vascular surgery. Cardiac events occur in 20% of all vascular surgery patients. The odds ratio for such events is 9.2 if ST segments were depressed by 1 mm intraoperatively (relative to the PR interval) within the first 48 hours postoperatively. Increasing the number of cables and pads from three to five for electrocardiogram (EKG) increases the sensitivity from around 30% to over 80% for ischemic events relative to a formal EKG stress test, and then the monitor continuously displays not only lead II but also lead V5. Methods Our hypothesis was that raising awareness about diagnostic and therapeutic options to reduce the risk of postoperative myocardial infarction would increase the use of five pads. We conducted open-ended surveys at six hospitals to assess the reasons for choosing three pads. In our university hospital practice, we measured a cross-sectional incidence of using three pads before and, once again, a month after an intervention during a single morning. Several resident conferences encouraged the use of five pads. Education included weekly lectures and informal discussions with other staff during surgery, demonstrating that using five pads allows interrogation of an entire 12-lead EKG. In comparison, three pads only allow viewing three leads. Results At baseline, only three pads were available in 96% of our 23 operating rooms. Five cables were available in eight of those surgeries, but two were taped off to the side. Surveys unveiled scarcity of equipment and, more importantly, disempowerment (i.e., knowing how to diagnose or when to treat ischemia). After several conferences, the prevalence of equipment availability of only three pads fell to 47%. Conclusions Education enumerated details of recognizing ischemic configurations of ST depression. Next, education revealed methods to interrupt the progression of ischemia to infarction such as elevated blood pressure and hematocrit, reducing heart rate, and calling a cardiology consultant if the anesthesiologist wishes to draw serial troponins. Barriers to implementing an enhanced recovery after surgery (ERAS) pathway began with a need for more access to manage stress tests or optimize blood pressure medications after a preoperative anesthesia evaluation. The intraoperative barrier was knowing what to do if ST depression occurs. Therefore, we began raising awareness by encouraging the addition of an element of a future ERAS pathway, adding a cost of only $1 to monitor lead V5. Future ERAS pathways can include preoperative stress tests and consults, as found in published guidelines.

Effect of Carica Papaya Leaves Juice on Plasma Leakage and Platelet Count among Children with Dengue Fever and Dengue Haemorrhagic Fever

Background: Over the last 10-15 years, dengue fever (DF) and dengue hemorrhagic fever (DHF) have become the leading causes of hospitalization and death among both children and adult. Carica papaya leaves juice is said to be increase platelet count and improve haematocrit. Objective: This study aimed to determine the effect of Carica papaya leaf juice on plasma leakage and platelet count in child patients with DF and DHF. Methods: This randomized controlled trial was conducted among 77 children with DF and DHF. Patients were purposively selected from the inpatient department of Dhaka Shishu hospital from July 2018 to December 2019. Patients were randomly allocated in group A and group B. Group A patients received standard treatment along with a bottle containing C. papaya leaves juice 10 ml single morning dose 15 minutes after breakfast for three consecutive days and group B patients received only standard management as per the National Guideline for Clinical Management of Dengue Syndrome, 2018. Three patients in group A and two patients in group B dropped out from the study. Results: There was no significant difference between the groups regarding age, sex, mean duration, type and severity of fever between the groups (p>.05). In group A, the mean platelet count increased from 105000.00/ mL to 152428.57/mL after 48 hours and it reached to 212228.57/mL at 72hrs. In group B, the mean platelet count initially decreased from 129485.71/ mL to 91114.28/mL after 48 hours and then it increased to 96142.85/mL at 72 hours. There was highly significant statistical difference between group A and group B at 48 hours and at 72 hours regarding mean platelet count as p<.001. Haematocrit values become significantly normal in group A then group B by 72 hours and p˂.05. There was highly significant statistical difference between group A and group B regarding mean hospital stay as p<.001. Conclusion: Administration of Carica papaya leaf juice increase platelet count, maintain .......

Effect of Carica Papaya Leaves Juice on Duration of Hospital Stay among Children with Dengue Fever and Dengue Haemorrhagic Fever

Background: Over the last 10-15 years, dengue fever (DF) and dengue hemorrhagic fever (DHF) have become the leading causes of hospitalization and death among both children and adult. Carica papaya leaves juice is said to increase platelet count, reduce complication and duration of Hospital stay. Objective: This study aimed to determine the effect of Carica papaya leaf juice on duration of Hospital stay in child patients with DF and DHF. Methods: This randomized controlled trial was conducted among 77 children with DF and DHF. Patients were purposively selected from the inpatient department of Dhaka Shishu hospital from July 2018 to December 2019. Patients were randomly allocated in group A and group B. Group A patients received standard treatment along with a bottle containing C. papaya leaves juice 10 ml single morning dose 15 minutes after breakfast for three consecutive days and group B patients received only standard management as per the National Guideline for Clinical Management of Dengue Syndrome, 2018. Three patients in group A and two patients in group B dropped out from the study. Results: There was no significant difference between the groups regarding age, sex, mean duration, type and severity of fever between the groups (p>.05). In group A, the mean platelet count increased from 105000.00/ mL to 152428.57/mL after 48 hours and it reached to 212228.57/mL at 72hrs. In group B, the mean platelet count initially decreased from 129485.71/ mL to 91114.28/mL after 48 hours and then it increased to 96142.85/mL at 72 hours. There was highly significant statistical difference between group A and group B at 48 hours and at 72 hours regarding mean platelet count as p <0.001. Haematocrit values become significantly normal in group A than group B by 72 hours and p value ˂0.05. There was highly significant statistical difference between group A and group B regarding mean hospital stay as p <0.001. Conclusion: Administration of Carica papaya leaf juice shorten hospitalization in patients with Dengue fever and Dengue haemorrhagic fever.

Demographic Charecterstics of Children with First Attack Idiopathic Nephrotic Syndrome with Relapse- A Hospital-Based Observational Study

Background: Idiopathic nephrotic syndrome (INS) is a common childhood illness with or without relapses. So, the objectives of this study is to find out such children who are prone to develop frequent relapse and the demographic characteristics responsible for relapse. This retrospective study was conducted in the Department of Pediatric Nephrology, Bangabandhu Sheikh Mujib Medical University, from September 2016 to August 2017.
 Methods: A total of 75 patients of idiopathic nephrotic syndrome (INS) with the initial attack, aged 1–18 years, were enrolled in this study. All patients were treated with prednisolone 60 mg/m2/day, single morning dose for 6 weeks, followed by 40 mg/m2 every alternate day for another 6 weeks and were analyzed and followed up for a minimum period of six months to identify the risk factors related to relapses.
 Results: Among them, 50 (66.7%) were males, 25 (33.3%) were females, with a male: female ratio of 2:1. 10 (13.3%) children had no relapse, 18 (24.0%) had infrequent relapse, and 40 (53.3%) had frequent relapse. Children responding between 2 and 4 weeks after the start of treatment had a higher chance of relapse (P = 0.002) than those who responded less than 1 week. Early age at onset, male gender, rural inhabitants, low socioeconomic status and atopy, though statistically not significant, are strongly associated with frequent relapses.
 Conclusion: Young age at diagnosis of INS, male gender, low serum albumin, and infections were predictive risk factors of multiple relapses. So, physicians should be vigilant to monitor these patients closely and counsel the families of nephrotic children regarding the prediction of subsequent relapses and outcomes.

Optimizing Albuminuria Assessment in Patients with Sickle Cell Disease: Insights from the Sikamic Study

Background Patients with sickle cell disease (SCD) are at increased risk of developing renal complications, making early detection and management of these issues critical. Albuminuria has been identified as a relevant biomarker associated with chronic kidney disease (CKD) progression in SCD, as demonstrated in several studies (Gonzalez et al., 2017; Guasch et al., 2018). Quantification of albuminuria is typically performed using the urine albumin-to-creatinine ratio (ACR). However, this measurement is not without its challenges, as variability in results can occur due to several factors, including analytical method, varying sampling conditions, and biological and medical factors such as physical activity, diurnal changes, diet, and hydration, which require the collection of multiple consecutive first morning samples. Studies have shown that the use of ACR from first morning urine samples provides results comparable to the gold standard 24-hour urine collection, with improved precision and less intra-individual variability than random urine samples typically collected during clinic visits (Witte 2009, Jermendy 2001, Lambers 2008). Collecting more urine samples generally improves precision and statistical power, but Kröpelin et al (2025) showed that collecting more than three consecutive urine samples does not significantly improve precision. Material and method The ongoing SIKAMIC study is a phase IIb, international (France and Africa), double-blind, randomized, placebo-controlled trial. The study aims to determine the effect of hydroxycarbamide on albuminuria level after 6 months of treatment in SCD adult patients. Here, we analyzed the variability of ACR in all patients pre-selected for the study. Microalbuminuria is commonly considered the first clinical indicator of glomerular damage in SCD. As per the KDIGO (Kidney Disease: Improving Global Outcomes), microalbuminuria is characterized by an ACR ranging from 3 to 30 mg/mmol, while macroalbuminuria refers to an ACR greater than 30 mg/mmol. For SIKAMIC study, patients with an ACR above 3 mg/mmol and below 100 mg/mmol were included. ACR was measured in first morning urine samples over three consecutive days. Patients were instructed to collect these samples at home, which were either collected by a hospital courier or brought to the hospital/laboratory by the patient for analysis. Estimated glomerular filtration rate (eGFR) was calculated using the CKD EPI formula without ethnic criteria. Means and standard deviations of the three measurements were calculated per patient, and a reproducibility test was performed using Mixed Effect Model and Bland Altman analyses (Graphpad Prism 9). Results Out of the initial 179 patients pre-selected for the study (59 from France and 120 from Africa) 99 patients (34 in France and 65 in Africa) met the inclusion criteria and were enrolled in the SIKAMIC study. Pre-selected patients from Africa were younger than patients from France with a mean age of 28.3 years and 33.8 years respectively (p<0.001). However, the mean ACR did not differ between groups (11.8 vs 12.7 mg/mmol; p=0.8) as observed for the mean eGFR value (123 vs 120.9; p=0.75). Additionally, the sex ratio was similar between groups (0.62 vs 0.67). For all patients, the mean ACR was 14.6, 17.3 and 15.6 mg/mmol on days 1, 2 and 3, respectively, with no significant difference (p=0.43; Figure 1 : A). The mean standard deviation of ACR between day 1, 2 and 3 was 6.8 mg/mmol, suggesting good consistency and reproducibility of the ACR measurements over the three days. Bland-Altman plots are shown in Figure 1 for the total population (n=161; 1B), microalbuminuric (1C; n=86) and macroalbuminuric (1D; n=11) patients, illustrating the agreement of ACR measurements within these subgroups. Conclusion : The SIKAMIC study contributes valuable insights into the evaluation of albuminuria in SCD patients. The reproducibility of the ACR appears to be sufficient to allow satisfactory monitoring on a single morning measurement in SCD routine care, both in Africa and Europe population of SCD patients.

Circadian organization of lipid landscape is perturbed in type 2 diabetic patients

Lipid homeostasis in humans follows a diurnal pattern in muscle and pancreatic islets, altered upon metabolic dysregulation. We employ tandem and liquid-chromatography mass spectrometry to investigate daily regulation of lipid metabolism in subcutaneous white adipose tissue (SAT) and serum of type 2 diabetic (T2D) and non-diabetic (ND) human volunteers (n= 12). Around 8% of≈440 lipid metabolites exhibit diurnal rhythmicity in serum and SAT from ND and T2D subjects. The spectrum of rhythmic lipids differs between ND and T2D individuals, with the most substantial changes observed early morning, as confirmed by lipidomics in an independent cohort of ND and T2D subjects (n= 32) conducted at a single morning time point. Strikingly, metabolites identified as daily rhythmic in both serum and SAT from T2D subjects exhibit phase differences. Our study reveals massive temporal and tissue-specific alterations of human lipid homeostasis in T2D, providing essential clues for the development of lipid biomarkers in a temporal manner.

Albuminuria as a marker of atherosclerosis burden and a possible predictor of adverse events in patients with polyvascular disease

The role of albuminuria as a marker of the atherosclerosis burden and a predictor of prognosis in patients with polyvascular disease (PD) has been little studied. To evaluate the prevalence, association with atherosclerosis burden, and prognostic value of albuminuria in relation to cardiovascular and bleeding complications in patients with PD. The data was obtained from the prospective registry REGATA-1 (NCT04347200). Seventy four patients (75.7% males, median age 67 [61-69] years) with PD (CAD and peripheral arterial disease) were enrolled. All patients received aspirin and rivaroxaban 2.5 mg. The albumin-creatinine ratio in a single morning urine sample, estimated glomerular filtration rate (eGFR), and von Willebrand factor levels were determined. Mild albuminuria (10-29 mg/g) was detected in 45.9% of patients, moderate and severe (≥30 mg/g) - in 29.7%; eGFR<60 ml/min - in 21.7%, chronic kidney disease (CKD) according to the full KDIGO criteria (eGFR and/or albuminuria ≥30 mg/g) - twice as often (39.2%). The frequency of nephroprotective therapy prescription was insufficient. The level of albuminuria did not correlate with von Willebrand factor (endothelial dysfunction marker), but was associated with affecting of 4-5 vascular beds (ROC AUC 0.775; p=0.011). During the follow-up (12 [8-18] months) 3 patients developed MACE, 11 - BARC 2-3 bleedings. Neither albuminuria nor eGFR were predictors of MACE, bleeding, or net clinical benefit. CKD (KDIGO) was also not associated with bleedings. CKD (KDIGO) was independent predictor of MACE (in significant multiple regression model beta - coefficient for CKD was 0.097; p=0.042), however, the small number of end points allows us to speak only of a hypothesis-generating trend. The implementation of CKD (KDIGO) has increased the predictive value of the REACH score. Albuminuria is highly prevalent in patients with PD. It is a marker of atherosclerosis burden. CKD, diagnosed taking into account the level of albuminuria, can be used in a comprehensive assessment of cardiovascular risk in this category of patients.

The utility of a baseline morning cortisol measurement, in the screening for adrenal insufficiency amongst non-critically ill hospital inpatients

BackgroundSerum cortisol levels vary according to the daily circadian cycle, with peak levels seen in the morning. There is evidence in ambulatory patients that a morning cortisol level can predict an adequate cortisol response to Synacthen (tetracosactide) stimulation. AimThe aim of this study is to determine the utility of baseline analysis of the serum cortisol levels in the morning “baseline morning cortisol”, determined using a newer immunoassay, in the screening for adrenal insufficiency amongst non-critically ill hospital inpatients. MethodsThis is a retrospective cross-sectional cohort study. Results64 adult inpatients had undergone a short Synacthen test (SST) (measurement of serum cortisol levels 30 and 60 min after administration of tetracosactide) during the study period. 17 patients returned an abnormal SST result. The measured level of cortisol in the morning correlated to both the 30 min and 60 min stimulated cortisol values (r = 0.612, p < 0.001 and r = 0.639, p < 0.001). After inspecting the receiver operating characteristic curve, a cortisol concentration of 200nmmol/L measured in the morning was selected as a threshold for predicting the SST result. Using this cut off, sensitivity for predicting a normal SST was 100 %, specificity 56 %, positive predictive value 45 % and negative predictive value 100 %. ConclusionA morning cortisol measurement, determined using a newer immunoassay, is sufficient in most cases to screen for adrenal insufficiency amongst non-critically ill hospital inpatients. Use of clinical judgement in conjunction with single morning cortisol measurement is likely to reduce the need for SST testing amongst inpatients.

SAT595 A Successful Long-time Experience Of A Dose-finding Approach For The Treatment Of Central Adrenal Insufficiency (CAI) With Prednisone

Abstract Disclosure: P.F. Santos-Neto: None. S.R. Correa-Silva: None. B.M. Mascarenhas Nakano: None. J. Abucham: None. Introduction: In patients with CAI, hydrocortisone (HC) is considered the preferred treatment. Recommended daily doses are based on estimates of daily cortisol production which have recently been decreased. Doses in the upper part of the previously suggested range have been associated with higher cardiovascular morbimortality. Currently recommended HC replacement doses have been reduced. In our country, HC has never been commercially available in tablets, but prednisone, an intermediate action glucocorticoid available in 5mg and 20mg tablets (lower doses are available elsewhere) is easily found, at low cost, and doesn't need prescription. Aim: To analyze our experience with prednisone in patients with CAI using the same dose-finding protocol established four decades ago. Patients: Data were extracted from electronic files. After applying inclusion/exclusion criteria, 72 out of 96 patients entered the study. Inclusion criteria: &amp;gt;18y, last consultation &amp;lt;2y, stable and same daily doses of prednisone, stable replacement of thyroid and sex hormone deficits in the last year. Exclusion criteria: Cushing´s disease, alternating prednisone doses, non-controlled acromegaly, intestinal malabsortion, other diseases requiring glucocorticoid, hepatic insufficiency. Dose-finding Protocol: Starting doses of prednisone in outpatients are usually 2.5mg or 5.0mg. Thereafter, dose adjustments are done according to clinical signs and symptoms and a pre-defined minimal dose of 2.5mg is attempted in all patients. Patients requiring &amp;gt;2.5mg are changed to 5.0mg, and then suggested to decrease to 3.75mg (3/4 of a 5.0mg tablet). If 3.75mg doses are judged insufficient, we return to 5.0mg; if unpractical, we suggest to alternate doses or to return to 5.0mg. Statistical Analysis: Patients were divided in two groups according to the prednisone daily dose. Group comparisons: Student´s t-test and Fisher´s exact test. P&amp;lt;0.05 was set as significant. Results: Fifty-four patients were on 2.5mg (75%) and 18 patients were on 5.0mg (25%) of prednisone. None was on GH replacement. The 5mg group tended to be younger (P=0.06). No significant differences (0.10&amp;lt;P&amp;lt;1.0) were found in relation to sex, treatment duration, BMI (both at diagnosis and last visit), other hormone deficiencies, IGF-1 levels, diabetes mellitus, dyslipidemia, and hypertension between the two groups. Conclusions: Adult patients with CAI are successfully treated with a single daily morning dose of prednisone determined by a dose-finding approach. In the absence of GH replacement, most patients stay at 2.5mg and the remaining ones at 5.0mg. The lack of difference between doses in parameters of excessive glucocorticoid exposure indicates that our approach is able to adjust prednisone doses close to individual requirements. A broader range of doses from &amp;lt;2.5mg including intermediate doses &amp;lt;5mg should be tried if low dose tablets are available. Presentation: Saturday, June 17, 2023

Tolerability of bedtime diuretics: a prospective cohort analysis

ObjectivesWe sought to validate, or refute, the common belief that bedtime diuretics are poorly tolerated due to nocturia.DesignPrespecified prospective cohort analysis embedded within the randomised BedMed trial, in which hypertensive...

IL-6 Enhances the Negative Impact of Cortisol on Cognition among Community-Dwelling Older People without Dementia

There is growing evidence that high basal cortisol levels and systemic inflammation independently contribute to cognitive decline among older people without dementia. The present cross-sectional study examined (a) the potential synergistic effect of cortisol levels and systemic inflammation on executive function and (b) whether this effect is more prominent among older people with mild cognitive impairment (MCI). A sub-sample of 99 patients with MCI and 84 older people without cognitive impairment (CNI) (aged 73.8 ± 7.0 years) were recruited from a large population-based cohort in Crete, Greece, and underwent comprehensive neuropsychiatric and neuropsychological evaluation and a single morning measurement of cortisol and IL-6 plasma levels. Using moderated regression models, we found that the relation between cortisol and executive function in the total sample was moderated by IL-6 levels (b = -0.994, p = 0.044) and diagnostic group separately (b = -0.632, p < 0.001). Moreover, the interaction between cortisol and IL-6 levels was significant only among persons with MCI (b = -0.562, p < 0.001). The synergistic effect of stress hormones and systemic inflammation on cognitive status appears to be stronger among older people who already display signs of cognitive decline. Targeting hypercortisolemia and inflammation may be a promising strategy toward improving the course of cognitive decline.

ISH-PP-3: INTERNATIONAL SOCIETY OF HYPERTENSION POSITION PAPER: BEDTIME DOSING OF ANTIHYPERTENSIVE MEDICATIONS: SYSTEMATIC REVIEW AND CONSENSUS STATEMENT

Antihypertensive drug therapy is one of the most efficient medical interventions for preventing disability and death globally. Most of the evidence supporting its benefits has been derived from outcome trials with morning dosing of medications. Accumulating evidence suggests an adverse prognosis associated with night-ime hypertension, non-dipping blood pressure (BP) profile and morning BP surge, with increased incidence of cardiovascular events during the first few morning hours. These observations provide justification for complete 24-h BP control as being the primary goal of antihypertensive treatment. Bedtime administration of antihypertensive drugs has also been proposed as a potentially more effective treatment strategy than morning administration. This Position Paper by the International Society of Hypertension reviewed the published evidence on the clinical relevance of the diurnal variation in BP and the timing of antihypertensive drug treatment, aiming to provide consensus recommendations for clinical practice. Eight published outcome hypertension studies involved bedtime dosing of antihypertensive drugs, and all had major methodological and/or other flaws and a high risk of bias in testing the impact of bedtime compared to morning treatment. Three ongoing, well designed, prospective, randomized controlled outcome trials are expected to provide high-quality data on the efficacy and safety of evening or bedtime versus morning drug dosing. In august 2022 The TIIME study announced results of its first analysis in 12,104 treated hypertensives in UK who were randomized to take their tablets in the morning or the evening for &gt; 5 years. The study showed no difference in preventing heart attacks, strokes, or cardiovascular deaths. Thus, until more information is available, preferred use of bedtime drug dosing of antihypertensive drugs should not be routinely recommended in clinical practice. Complete 24-h control of BP should be targeted using readily available, long-acting antihypertensive medications as monotherapy or combinations administered in a single morning dose.

Trends of Xpert MTB/RIF in the diagnosis of Mycobacterium tuberculosis and rifampicin resistance in Southwest Nigeria: A 4-year retrospective study

Objectives: In recent years, there has been an increased uptake of Xpert Mycobacterium tuberculosis/rifampicin (MTB/RIF) for the diagnosis of tuberculosis (TB), with added benefits for detecting rifampicin-resistant TB (RR-TB). We set out to determine the trends in notification of MTB and RR-TB over 4 years in a tertiary hospital in Southwest Nigeria. Materials and Methods: This is a retrospective analysis of single early morning sputum/gastric washing sample for presumed TB in a tertiary health center between January 2016 and December 2019. Xpert MTB/RIF was used to detect (MTB) and RR-TB. Results: The mean age of the 4625 presumptive TB patients was 43.4 (18.8) years, with the majority aged 31–45 (30.6%). Males totaled 2247 (49.6%). Human immunodeficiency virus (HIV) coinfection was found in 756 (16.7%) of them. Using the Xpert MTB/RIF assay, the overall MTB notification was 12.9% (584/4526) and was associated with HIV status, P &lt; 0.001. MTB notification trends increased from 5.6% in 2016 to 23.8% in 2019, P &lt; 0.001. The overall yield of RR-TB was 7.5%. The proportion of RR-TB from TB cases declined from 28% in 2016 to 4.6% in 2019. Forty-two of the 44 cases of the RR-TB (42/572; 7.3%, [95% CI: 5.31, 9.75]) were new cases, with TB treatment failure and relapse cases accounting for 10.1% (2/11; 10.1%, [95% CI: 0.35, 42.5]) of all RR-TB cases (P &lt; 0.01). RR-TB was associated with being older than 45 years (adjusted odds ratio = 2.046, [95% CI: 1.046, 4.004]). HIV infection status and gender had no effect on RR-TB status. Conclusion: This study found an increase in MTB detection with Xpert MTB/RIF utilization. Ages &gt;45 years have 2–4-fold increased risk of developing RR-TB and should be targeted for drug resistance prevention.

Predicting dry matter intake in mid-lactation Holstein cows using point-in-time data streams available on dairy farms.

Quantifying dry matter intake (DMI) in lactating dairy cows is important for determining feed efficiency; however, there are no methods for economically quantifying individual cow DMI on dairy farms where cows are group-fed. Attempts have been made to model DMI using cow factors, milk production, milk infrared spectra, and behavioral sensors with reasonable success. Other data streams are available on the farm that may contribute to DMI predictions. In this study, our objective was to model DMI with multiple linear regression using data from a single point-in-time that can easily be accessed on-farm. Candidate predictor variables included cow descriptors, milk yield and composition, milk fatty acid profile, and production and efficiency predicting transmitting abilities (PTA). Observations of DMI were obtained from 350 cows across 6 cohorts using individual feed bunks. The cow to bunk ratio was 2:1, with an overall bunk occupation rate of 32% throughout the day. The following models were developed sequentially with milk data obtained from a single morning milking and other data from the same day: model B (production, metabolic body weight, body condition score, lactation category, and week of lactation), model BC [model B + fatty acid (FA) content], model BY (model B + FA yield), model BPE (model B + production and efficiency PTA), model BYP (model BY + production PTA), model BYE (model BY + efficiency PTA), and model BYPE (model BY + production and efficiency PTA). Outcome variables predicted in these models were the DMI on the previous day or current day relative to the morning milk sample. The predictions for DMI on the previous day outperformed current day DMI in every model for which they were both determined. Addition of milk FA and PTA as candidate predictor variable types to the models resulted in enhanced predictive ability, with incremental enhancements when combined. The most robust model (BYPE) included cow descriptors, protein and FA yields, and PTA for milk and residual feed intake. Model BYPE described 21 to 32% more of the variation in DMI (based on concordance correlation coefficient) than when other common DMI models were applied to the same data set. Overall, reasonable performance of models including single point-in-time cow descriptors, milk and FA production, and production and efficiency PTA commonly available to dairy farmers through dairy herd improvement programs offer an opportunity for on-farm prediction of DMI, yet further improvement may be possible.

Trends in rifampicin resistance among patients with presumptive TB in the pre-COVID and COVID-era

BackgroundThe COVID 19 pandemic has had its impact on tuberculosis notification, incidence, and management, particularly in the context of rifampicin-resistant TB. We set out to determine the trends in rifampicin resistant tuberculosis between the pre-COVID and COVID era in a resource-constrained setting. MethodsThis was a retrospective review of single early morning sputum from presumed tuberculosis between January 2016 and May 2022 in a regional TB referral and treatment centre in South-western, Nigeria. We used a molecular beacon to detect Mycobacterium tuberculosis (MTB) and mutations in the rpoB gene using a real-time polymerase chain reaction (PCR). ResultsWe analyzed 19,892 of 20,589 presumptive TB with complete data. Most subjects were in the age group 18–45 years (10,594; 53.3 %) and were males (11,492; 57.8 %). Of the 19,892 presumptive TB, 4,526 (22.8 %) were in pre-COVID-19 era (Jan 2016-December 2019) and 15,366 (77.2 %) cases were in COVID-19 era (Jan 2020-May 2022). The MTB notification declined during the COVID-19 era compared with the pre-COVID-19 era (10.5 % vs 12.9 %, p < 0.001). The annual prevalence of MTB rose from 5.6 % (2016) to a peak of 23.2 % in 2019 (pre-COVID-19 era), followed by a decline to 12.8 % in 2020 and 8.6 % in 2022 (COVID-19 era), p = <0.001). The overall incidence of RR-TB was 3.8 %. The incidence of RR was higher during pre-COVID-19 than the COVID-19 era, 9.5 % vs 2.5 %, p = <0.001. The incidence of RR-TB declined substantially from 28.0 % in 2016 to 1.6 % in 2021 but rose exponentially to 5.4 % in 2022. After controlling for confounders, only the pre-COVID-19 status was associated with increased odds for RR (adjusted odds ratio 3.3, 95 % confidence interval, 2.049, 5.421). ConclusionThis study found a progressive decline in MTB notification since the COVID-19 pandemic's outbreak. Furthermore, RR-TB notification decreased gradually in the pre-COVID-19 era, with a resurgence in 2022. In the era of COVID-19, there is an urgent need to increase intervention efforts in order to halt the decline in MTB detection rates and the resurgence of RR-TB.

Biocontrol and Circadian Rhythms of Medfly larvae emergence and Monomorium subopacum ant foraging along the fruiting season in the Argan forest (Morocco)

To illuminate biocontrol traits between the Medfly pest and its predator Monomorium subopacum ant, we assessed the daily rhythm of ant foraging and Medfly larva emergence from host fruits in the argan forest. M. subopacum foraging activity and Ceratitis capitata larvae emergence were monitored in Essaouira argan forest during the fruiting season. Behavioral activities were quantified, and the circadian rhythms of the two species were determined. M. subopacum diel foraging was exhibited in a circadian bimodal rhythm with a principal morning peak and a secondary crepuscular one. Larvae’s emergence showed unimodal rhythmicity with a single morning peak with 86.42% of daily emergences. The studied behaviors of the two species showed a clear synchronization during their principal activity peaks, which suggests the importance of circadian timing in the temporal partitioning, and chance of encounters between the two species. Besides their adaptive and fundamental ecological values, the understanding of biological rhythms that govern the time of behavioral interactions and predict encounter schedules between pests and their natural enemies may provide a novel efficient tool in sustainable pest management.

Improving Calcium Status of Women: Results of a Study of Bio-Availability of Calcium From Slaked Lime Fortified Rice.

Fortification of rice with slaked lime is an acceptable and inexpensive way to combat calcium (Ca) deficiency. However, bioavailability of calcium after intake of slaked lime fortified rice is yet to be investigated. To measure the fractional absorption of Ca (FAC) from slaked lime fortified cooked rice. We conducted an experimental study using stable isotopes of Ca to measure FAC during a single morning test meal containing rice fortified with slaked lime. Participants (n = 22) were given slaked lime fortified rice 3 times a day for 4 days. On the morning of the fifth day, the participants were served the same amount of rice as previous the 4 days at the breakfast test meal with an accurately measured amount of 44Ca stable isotope oral tracer followed by an intravenous injection of 42Ca. Urine was collected over the next 24 hours in 3 consecutive 8-hour pools. Fractional absorption of Ca was calculated from the measurement of the relative enrichment of the of each administered tracer 44Ca and 42Ca using inductively coupled plasma mass spectrometry. The mean Ca concentration in the test meal was 879.5 ± 152.9 µg/g with a coefficient of variance (CV) of 17.2%. Although Ca absorption efficiency decreases with higher calcium intake, the total amount of calcium absorbed from test meal using FAC = 0.391 calculated from the third 8-hour urine pool was 69.0 (CV of 15.6) mg. We showed that one-fifth of daily calcium recommendation for women of reproductive age could be met by ingesting ∼200 g cooked slake fortified rice.