bluuebunny/crossref_metadata_2025 huggingface dataset:
Strongyloides hyperinfection syndrome precipitated by immunosuppressive therapy for rheumatoid arthritis and COVID-19 pneumonia
Authors: Hamze Hasan , Tai Teresa , Harris David
Published: October 2023

The COVID-19 pandemic has posed clinical and public health challenges worldwide. The use of corticosteroids has become an evidence-based practice to reduce the hyperinflammatory process involved in severe COVID-19 disease. However, this can result in the reactivation of parasitic infestations, even with a short course. We report the case of a 64-year-old Cuban born patient who passed away from S. stercoralis hyperinfection syndrome following treatment with dexamethasone for severe COVID-19 disease on a background of prolonged immunosuppression for rheumatoid arthritis. Clinicians should be aware of the risk of strongyloidiasis as a complication of the treatment for severe COVID-19 and other immunosuppressive therapies. We recommend empiric Strongyloides treatment for those who are from, or who have accumulated risk by travelling to endemic areas, and are being treated with corticosteroids for severe COVID-19 disease.
Metric and morphological features of the ear in sex classification
Authors: Sezgin Nurdan , Ersoy Gökhan
Published: October 2023

Background

The human face can reveal a great deal about a person’s identity. Age, sex, and ethnicity differences can be recognized, classified, and analyzed using facial features, which give a scientific basis for personal identification and recognition. Sex, like age and ethnicity, has a significant influence on outer ear morphology. The shape and size of the auricle, which is one of the defining features of the face, are affected by age, sex, and ethnicity. Variations in the outer ear are known to be sufficient for identification in a forensic case and can help in determining whether the suspect is guilty or not. The aim of this research is to determine whether such metric and morphological features of the ear can be used to estimate sex and how dimorphic they are. After ear measurements with ImageJ 1.52a program, statistical data was recorded and analyzed in SPSS.

Results

This study, which analyzed 350 people’s facial images, provides significant information for forensic applications. Among the analyzed ear morphology data, the helix and ear lobe form showed sex differences. Except for the T-PCC distance, all measurements differed significantly between sexes.

Conclusions

Model 1 has the greatest accuracy rate (88%) among the models created for sex estimation. Sex estimation can be performed as an effective method when the morphological and metric parameters of the ear are analyzed together.
Fabrication, design, and in vivo investigation of mesoporous silica-based docetaxel trihydrate nanoparticles for colonic drug delivery
Authors: Majumdar Subhabrota , Mondal Mohini , Bose Anirbandeep , Kar Ayan Kumar , Mazumder Rana
Published: October 2023

Background

Mesoporous silica-loaded docetaxel trihydrate nanoparticles are the potential to target drug delivery toward a specific region with high stability and predictable release at the target region. They have large surface areas and mesoporous structures with large pore volumes, leading to high bioavailability and therapeutic efficacy at the disease site. This study demonstrates how nanoparticles can be prepared using an emulsion technique.

Results

The ratios of eudragit S100 to eudragit L100 polymers, along with phosphatidylcholine, were varied according to the response surface methodology. Differential scanning colorimetry and fluorinated transmitted infrared spectroscopy studies showed that mesoporous silica particles were successful. All formulations had average particle sizes ranging from 70.65 to 143.01 nm, with a range of zeta potential from 17.6 ± 026 to 21 ± 011. In vitro drug delivery studies were achieved for all formulations with a zeta potential of 17.6 ± 026 to 21 ± 011. As per the statistical optimization by RSM that response model for percentage drug loading (Y1) was found to be 0.0002 which is p-value < 0.05. Hence, the model is significance. Accordingly percentage drug release at 6 h. (Y2) p-value was found to be 0.0001 and percentage drug release at 10 h (Y3) p-value was found to be 0.0002, respectively. So all the models are significant. After oral administration of the docetaxel, plasma levels were measured in vivo bioavailability testing of docetaxel. Docetaxel nanosuspension had a significantly higher Cmax amount than docetaxel microsuspension (98.03 ± 23.40 ng/ml and 213.67 ± 72.21 ng/ml, respectively, with tmax 45 min). Docetaxel was more bioavailable in nanosuspension formulations, according to a bioavailability test of rats.

Conclusion

The results suggested that the mesoporous silica could be a great potential nanocarrier in colonic delivery with optimal drug content and controlled release docetaxel trihydrate.
Sugarcane: an unexpected habitat for black yeasts in Chaetothyriales
Authors: Costa Flávia de F. , Souza Rafael S. C. de , Voidaleski Morgana F. , Gomes Renata R. , Reis Guilherme F. , Lima Bruna J. F. de S. , Candido Giovanna Z. , Geraldo Marlon R. , Soares Jade M. B. , Schneider Gabriela X. , Trindade Edvaldo da S. , Bini Israel H. , Moreno Leandro F. , Bombassaro Amanda , Queiroz-Telles Flávio , Raittz Roberto T. , Quan Yu , Arruda Paulo , Attili-Angelis Derlene , de Hoog Sybren , Vicente Vania A.
Published: October 2023

Sugarcane (Saccharum officinarum, Poaceae) is cultivated on a large scale in (sub)tropical regions such as Brazil and has considerable economic value for sugar and biofuel production. The plant is a rich substrate for endo- and epiphytic fungi. Black yeasts in the family Herpotrichiellaceae (Chaetothyriales) are colonizers of human-dominated habitats, particularly those rich in toxins and hydrocarbon pollutants, and may cause severe infections in susceptible human hosts. The present study assessed the diversity of Herpotrichiellaceae associated with sugarcane, using in silico identification and selective isolation. Using metagenomics, we identified 5833 fungal sequences, while 639 black yeast-like isolates were recovered in vitro. In both strategies, the latter fungi were identified as members of the genera Cladophialophora, Exophiala, and Rhinocladiella (Herpotrichiellaceae), Cyphellophora (Cyphellophoraceae), and Knufia (Trichomeriaceae). In addition, we discovered new species of Cladophialophora and Exophiala from sugarcane and its rhizosphere. The first environmental isolation of Cladophialophora bantiana is particularly noteworthy, because this species up to now is exclusively known from the human host where it mostly causes fatal brain disease in otherwise healthy patients.
The novel approach for non-invasive diagnostic biomarkers from an early stage of NAFLD to advanced fibrosis
Authors: Dudeja Pooja , Pal Taishee , Sharma Aman
Published: October 2023

Background

Non-alcoholic fatty liver disease (NAFLD) is a spectrum of disorders that will be started from more than or equal to 5% of fats deposited into the liver hepatocyte cells and progressively leads to steatosis, further increment in fat deposition, and signature of inflammatory markers which cause the non-alcoholic steatohepatitis (NASH) condition. Due to a lack of diagnosis and effective treatment, NASH is converted into liver cirrhosis or hepatocarcinoma, which indicates the irreversible stage of the disease and finally recommends liver transplantation for patient survival. However, nowadays, several clinical biomarkers are identified, and most of the new biomarkers are in the developmental stage, but still the diagnosis of each stage of fatty liver is unaccomplished. So, in this review article, we try to present all current mechanistic perspectives to find the non-invasive biomarkers which could be the best approach in the future to diagnose fatty liver disease in each stage.

Main text

NAFLD is a growing phase disease if properly not taken care of by the patient. There are certain factors that can make fast progress in the disease stage like NAFLD to advance liver fibrosis or hepatocarcinoma. We describe to the best extent how different types of disease stages in the case of the fatty liver could be diagnosed using non-invasive biomarkers. A certain type of mechanistic pathophysiology approach is used to differentiate each stage of fatty liver disease like serum biomarkers (inflammatory cytokines), lipoproteins, micro-RNAs, gut microbiome-associated biomarkers, lipid droplet-associated perilipins, apolipoprotein E, the role of dihydroceramide, and gene expression studies.

Conclusions

Recent advancements in diagnostic biomarkers research focused on non-invasive methods, but the diagnosis of different stages of fatty liver disease is still inconclusive. We tried to cover all the potential non-invasive biomarkers in our manuscript. This review helps the researchers to develop possible diagnostic biomarkers for each stage of liver disease.
The implications of the COVID-19 pandemic on hepatitis B and C elimination programs in Egypt: current situation and future perspective
Authors: Elsharkawy Aisha , Samir Reham , Abdallah Mohamed , Hassany Mohamed , El-Kassas Mohamed
Published: October 2023

Hepatitis B virus (HBV) and hepatitis C virus (HCV) are amongst the most common causative agents of viral hepatitis with its severe complications, including liver cirrhosis, decompensation, and hepatocellular carcinoma (HCC). Elimination of viral hepatitis, a significant challenge, has become an adopted global goal with certainly designed targets set by the World Health Assembly to be met by 2030. While many countries, including Egypt, have started executive plans for viral hepatitis elimination and achieved remarkable progress, the emergence of the COVID-19 pandemic has markedly affected all the machinery of the healthcare systems and specifically laid countries off their track in their viral hepatitis elimination process. The pandemic disrupted most healthcare services, and health staff and hospital resources were recruited mainly for managing the crisis, which significantly negatively impacted the management of other less severe diseases, including viral hepatitis. Social distancing and restrictive measures applied by most countries to contain the pandemic have affected medical services offered to patients with hepatitis. All supply chains of medications and vaccinations concerned with treating and preventing viral hepatitis have been markedly compromised. Many efforts and strategies are required to combat the severe and deleterious implications of the pandemic on the management of viral hepatitis worldwide in an attempt to get the situation under control and resume the pathway towards viral hepatitis elimination.
Trends and critical points of Aspergillus contamination along Ethiopian chili postharvest value chain
Authors: Tolera Tariku Hunduma , Tesfaye Anteneh , Alemu Melaku
Published: October 2023

Background

Chili is the most commonly grown spice in Ethiopia and is a high-value crop for household consumption and sale both at domestic and export markets. However, an unsafe level of fungal toxins is becoming a problem leading to challenges in exporting. This study assessed trends, possible points of Aspergillus contamination, and contamination risk factors along the Ethiopian chili postharvest value chain (PVC).

Methods

Chili handling practices, value chain actors, and their respective roles were investigated along the PVC through an exploratory type of research, a participant unstructured observation. A total of 214 individual sample units composed of multiple subsamples consisting of aseptically picked matured red pods (PiPP), dried red pods (DPP), crushed chili (CP), unpacked (UpPPo), and packed chili powder (PaPPo) were randomly collected along the PVC from different major chili growing localities of Ethiopia during 2017/2018 main cropping season. Individual sample units were further homogenized into a fine powder and composited. Aspergillus was analyzed using Aspergillus flavus and parasiticus agar medium. To monitor Aspergillus contamination, trend analysis was done using the mean of count data and biological inference was made in association with stages of operations and postharvest handling practices.

Results

Aspergillus was detected in 44% of PiPP, all (100%) of DPP, CP, UpPPo, and PaPPo. Counts were in the range of 5.00 × 103 to 2.10 × 105 CFU g−1 up along the PVC with fold changes of 19.6, 30, 42, and 38-fold in DPP, CP, UpPPo, and PaPPo, respectively. Nigri (99%), Flavi (85%), and Circumdati (56%) were the most detected sections with relative densities of 50, 29, and 14%, respectively. Postharvest handling practices such as harvesting, sun-drying, and transporting were generally found poor and unhygienic.

Conclusions

Counts of Aspergillus showed gradually increasing trends up along the PVC. The poor and unhygienic handling practices probably contributed to the contamination. Harvesting and direct open sun-drying were likely initial and critical points of contamination while wetting and tight stacking likely contributed to aggravated growth and proliferation of aspergilli leading to further consecutive buildup. Intervention at these stages would make a significant difference.
Evaluation of a 12-week app-guided exercise intervention in patients with knee osteoarthritis (re.flex): a study protocol for a randomized controlled trial
Authors: Dieter Valerie , Martus Peter , Janssen Pia , Krauss Inga
Published: October 2023

Background

Current health care demonstrates an insufficient provision and utilization of physical exercises despite their recommendation as a first-line treatment in clinical guidelines for patients with knee osteoarthritis (OA). Mobile health (m-health) technologies offer new opportunities to guide and monitor home-based exercise programs by using mobile devices and inertial sensors in combination with a digital application (app). This study will evaluate patient benefits resulting from the use of the specific digital health application re.flex for patients with knee OA.

Methods

This monocentric, two-arm, randomized controlled parallel-group trial will evaluate the effectiveness of the app- and sensor-guided exercise program re.flex for patients with moderate-to-severe knee OA. We aim to recruit 200 participants via newspapers, newsletters and information events. Participants will be randomly allocated to the intervention group and the control group in a 1:1 ratio. Participants in the control group will not receive any study intervention or instruction for any change to their previous health care utilization. Despite this, they are allowed to make use of usual care provided by their treating physician. The intervention group comprises a 12-week home training program with three sessions per week in addition to usual care. Exercises will be guided and monitored by use of the training app (re.flex) and two accelerometers that are attached proximally and distally to the affected knee joint. Pre- and postmeasurements will take place at baseline (t0) and after 12 weeks (t1). Primary outcomes will be osteoarthritis-specific pain and physical function measured with the Knee Osteoarthritis Outcome Score (KOOS) subscales Pain and Function in daily living (ADL). Second, further self-reported health outcomes, a performance measurement, app logfiles and safety will be assessed. Intervention effects will be calculated by baseline-adjusted analysis of covariance (ANCOVA) using an intention-to-treat approach. Multiple imputation will be applied.

Discussion

Re.flex can bridge part of the gap between recommendations for strengthening exercises in patients with knee OA and the insufficient actual care situation. This randomized controlled trial is designed to provide conclusions on the effectiveness of the health application re.flex for the population under study and will provide further insight into adherence rates and the safety of its use.

Trial registration

The trial was registered on 20/01/2023 at www.drks.de (ID: DRKS00030932).
Is mental health in South Africa moving forward?
Authors: Morar Tejil , Breedt Jozef Erasmus , Mdaka Nokuthula , Maaroganye Kagisho , Robertson Lesley
Published: October 2023

A landmark South African Mental Health Conference took place in April 2023, marking the first national collaborative conference between government and mental health professionals. The theme was Join the Movement, and a ‘whole of society’ approach was emphasised, imploring various sectors to collaborate in relieving the country's burden of mental illness. Challenges in mental health were raised and possible solutions presented. This article discusses the conference, aspects of psychiatric care in South Africa, South Africa's health system issues and the importance of moving forward measurably.
THU029 Subcutaneous Self-injections Of Lanreotide Is a Good Alternative For Acromegalic Patients With Long COVID Treated With Anticoagulants
Authors: Rosa Isabella Naves , Naves Luciana Ansaneli
Published: October 2023

Disclosure: I.N. Rosa: None. L.A. Naves: None.

Background: Acromegaly control during pandemics was an important challenge. Telemedicine was a resource to provide health care, associated to electronic prescription sent directly to central pharmacy and drugs delivered to patients' home avoided treatment disruption in 2020 and 2021. The concomitant use of anticoagulants in Covid patients is a major concern because of risk of muscle hematomas. We describe here the replacement of Octreotide LAR to Somatuline Autogel in long Covid acromegalic patients with thromboembolic co-morbidities. Methods: We describe a sample of acromegalic patients, diagnosed with long Covid and thromboembolic co-morbidities. All patients were previously submitted to transsphenoidal surgery for somatotropic tumors and were controlled by mensal injections of octreotide LAR. Outpatient management was remodeled to simplify access to care by (1) adoption of virtual meetings; (2) collection of blood samples at home; (3) abolishment of printed prescription and provision of electronic files directly to central pharmacy; and (4) replacement of intramuscular injections for subcutaneous self injection of Lanreotide- Autogel. Results: From our cohort of 128 acromegalic patients, coronavirus disease (COVID-19) was confirmed in18%, although, long COVID, and use of anticoagulant drugs for more than 4 months was observed in 8 cases, 5 women, median age 68 years. Patients adopted self injections monthly and maintained disease control in 75% of cases with good adherence. Local side-effects, as injection-site pain, equimosis were observed less frequently than reported by the patients in previous use of Octreotide LAR. Conclusion: Telemedicine was a feasible tool in acromegalic patients with Long Covid. The replacement of intramuscular injections of Octreotide LAR for Lanreotide Autogel self injected subcutaneously allowed stability of disease control and provided an alternative to injections administered in the health care

Presentation: Thursday, June 15, 2023
FRI348 Ectopic Posterior Pituitary As A Cause Of Panhypopituitarism Presenting With Hyponatremia
Authors: Min Choo Charlotte Hui
Published: October 2023

Disclosure: C. Choo: None.

Background: Ectopic posterior pituitary gland (EPP) can occur from defective embryogenesis affecting neuronal migration, or from neurodegeneration of the hypothalamic nuclei. While isolated growth hormone deficiency is most common, it is also associated with pan-hypopituitarism. The posterior pituitary function is often preserved. Clinical Case: We report a case of pan-hypopituitarism from congenital EPP, presenting with hyponatremia. A 63-year-old male with hyperlipidemia was admitted for gastroenteritis. Serum sodium was 106mmol/L [reference range 136-146mmol/L] on admission but he was otherwise asymptomatic and haemodynamically stable. This initially improved with intravenous fluids, however subsequently stagnated at 121mmol/L despite achieving euvolemia. Thyroid and cortisol axes were evaluated in view of persistent hyponatraemia. 8am cortisol was low at 119nmol/L with inappropriately normal ACTH 13.9 pg/mL [reference range 7.2 – 62.3 pg/mL]. Thyroid function test showed central hypothyroidism consistently on repeat testing with a low fT4 of 6.1 pmol/L and 7.7 pmol/L [reference range 8.8-14.4pmol/L] and inappropriately normal TSH of 2.98MU/L and 2.41MU/L respectively [reference range 0.65-3.70MU/L]. 1mcg short synacthen test done following suspicion of hypocortisolism peaked at 468 nmol/L. He had no symptoms or signs of hypocortisolism or hypothyroidism. He was a bachelor and had clinical features of hypogonadism including short stature (142cm), high-pitched voice, scarce sexual hair and pubescent sized testes. His mid-parental height is unknown as his parents were deceased. FSH, LH, testosterone and IGF-1 were all undetectable. Prolactin was otherwise normal 9.4ug/L [reference range 4.2-16.4ug/L]. Radiographs of the forearm showed unfused epiphyseal plates at the distal radius and ulna. Thus, the diagnosis of pan-hypopituitarism was made. Magnetic resonance imaging of the pituitary revealed a T1 hyperintense nodule at the floor of the third ventricle, suggestive of ectopic posterior pituitary. There was otherwise minimal normally enhancing tissue in the pituitary fossa, and the posterior pituitary bright spot and infundibulum were absent. He was started on hydrocortisone and subsequently levothyroxine replacement, with resolution of hyponatraemia (serum sodium 139nmol/L). He did not develop polyuria or polydipsia to suggest diabetes insipidus. Due to financial concerns however, he declined growth hormone and testosterone replacement therapy. Conclusion: Most reports of EPP are in the pediatric population often presenting with short stature. This was a seemingly ordinary case of hyponatraemia initially deemed to be from hypovolaemia. His atypical clinical features led to the eventual diagnosis of EPP with panhypopituitarism at a rather late age, highlighting the importance of a thorough clinical examination necessitating further evaluation.

Presentation: Friday, June 16, 2023
FRI391 A Metabolomics Analysis Of Moderate Energy Restriction In Healthy Lean Women
Authors: Levine Lindsay , Overdahl Kirsten , Molsberry Samantha , Shekhar Skand , Jarmusch Alan , Hall Janet E
Published: October 2023

Disclosure: L. Levine: None. K. Overdahl: None. S. Molsberry: None. S. Shekhar: None. A. Jarmusch: None. J.E. Hall: None.

Introduction: Metabolomics can elucidate metabolic responses to dietary interventions and has been used in energy restriction studies, primarily in overweight/obese men and women. Although the menstrual cycle affects the metabolome, most dietary intervention studies have not controlled for menstrual cycle phase, nor have they examined the effect of moderate, short-term energy restriction on the metabolic profile of healthy, normal-weight women. Objective: To characterize metabolomic changes in response to a 55% reduction in dietary intake during the early follicular phase of the menstrual cycle. Methods: Study participants included 19 healthy women aged 18-28 years who were of normal BMI and fitness, not restricting nutritional intake and with biochemically confirmed regular ovulatory menstrual cycles. Participants underwent 5-day dietary interventions in the early follicular phase of two menstrual cycles. The first diet consisted of neutral energy availability (NEA; 45 kcal/kg*lean body mass/day) and the second of deficient energy availability (DEA; 20 kcal/kg*lean body mass/day) without changes in macronutrient composition. On the 5th day of each diet, serum was collected at ∼8am following an overnight fast, and immediately before and every 10 minutes for 60 minutes after the consumption of a standardized isocaloric snack at ∼4pm. Untargeted metabolomic profiling was performed using ultra-high performance liquid chromatography/mass spectroscopy. Univariate statistics were performed on all metabolites, using t-tests with Benjamini-Hochberg false discovery rate adjusted p-values to account for multiple testing (p-value ≤ 0.05). Log2-fold change was calculated for all chemical features. Results: At baseline, participants had a weight of 61.9±2.75 kg (mean±SEM), BMI of 23.96±0.69 kg/m2 (mean±SEM), and percent body fat of 28.01±1.61% (mean±SEM). DEA resulted in a 1.25±0.13 kg (mean±SEM) decrease in body weight (p<0.01). While few statistically significant differences were present between fasted NEA and DEA samples, numerous chemical features were significantly upregulated in DEA post-snack samples. Specifically, 11 carnitines, 7 phosphocholines, and 8 fatty acids or fatty acid intermediates exhibited a log2fold change of 0.5 or higher (>40% increase; p ≤ 0.05) in post-snack DEA samples compared to NEA samples. Conclusion: These results strongly suggest that following isocaloric intake, moderate energy restriction in normal-weight, healthy women is associated not only with the use of fat as an energy source, but also with cellular membrane breakdown.

Presentation: Friday, June 16, 2023
FRI395 Ovary-derived Hydrogels Elucidate The Matrisome Properties That May Influence Folliculogenesis
Authors: McDowell Hannah B , Henning Nathaniel , Laronda Monica M
Published: October 2023

Disclosure: H.B. McDowell: None. N. Henning: None. M.M. Laronda: None.

Chemotherapy treatments can be gonadotoxic and lead to loss of fertility and hormone function. Currently, the only pre-treatment strategy available to preserve fertility for prepubescent individuals is ovarian tissue cryopreservation (OTC) and the only option to restore fertility or hormone function is through ovarian tissue transplantation (OTT). Although in most cases OTT restores endocrine function, the tissue functions for an average of 2-5 years. To extend tissue function, the development of a bioengineered ovary that supports long-term follicle growth and endocrine function is critical. Tissue longevity depends on the number of primordial follicles (PMF) and their activation rate. While most PMFs survive the cryopreservation process, 80% are lost shortly after OTT. In bovine ovaries, the cortex, housing PMFs, is 8.5 times more rigid than deep medulla and is comprised of differential matrisome proteins. As mono-ovulatory animals, their ovaries closely mimic humans, making them a suitable model. Here, we developed decellularized extracellular matrix (dECM) hydrogels from bovine cortical tissue (c-dECM) and medullary tissue (m-dECM). Using atomic force microscopy, we determined that c-dECM and m-dECM did not display significantly different rigidities (537Pa, 468Pa). We found that the concentration of COL1, COL4, DCN, and VTN in the dECM hydrogels recapitulated what is seen in native bovine ovarian compartments. Therefore, we hypothesized that differences observed in downstream applications of these gels are due to differences in biochemical cues - or protein composition and relative abundance - in the ovarian ECM. The chemical and structural properties of ECM proteins play an integral role in cellular behavior. Therefore, we performed second harmonic generation scanning microscopy and determined that c-dECM hydrogels have significantly different fiber architecture when compared to m-dECM hydrogels. m-dECM hydrogels had significantly wider and longer fibers than c-dECM (6.22,6.419 and 38.22, 38.84 pixel/ppm microns) and displayed a lower fiber angle alignment (91.01°,87.95°). We assessed whether compartmental c-dECM and m-dECM hydrogels could drive differential expression patterns of downstream candidate genes. We then depleted our gels of proteins of interest using magnetic-activated protein filtration (MAPF). We found that our depleted gels modulate expression of genes associated with regulating follicle growth. Our work employed a novel method for examining the contribution of matrisome proteins in folliculogenesis. We anticipate our work to be influential in studying matrisome-dependent biochemical cues within other organ systems. IMPACT: Determining how the matrisome of the ovary can influence follicle activation will contribute critical data on how we can extend tissue function in OTT.

Presentation: Friday, June 16, 2023
FRI563 Subacute Thyroiditis Is An Uncommon Cause Of Pyrexia Of Unknown Origin
Authors: Luke Nathasha , Tay Donovan
Published: October 2023

Disclosure: N. Luke: None. D. Tay: None.

Introduction: Subacute thyroiditis is a rare self-limiting inflammatory thyroid disorder often follows a viral infection. It is a diagnosis that is made clinically when patients present with typical features of anterior neck pain and thyrotoxic symptoms. We share our experience in unraveling a diagnostic challenge of a patient with an atypical presentation of subacute thyroiditis presenting with pyrexia of unknown origin during the Covid 19 pandemic. Clinical case: A 29 years old previously healthy Burmese domestic helper was admitted to a hospital in Singapore for persistent fever of 2 weeks duration associated with persistent sore throat. She had a brief 3 days duration of cough at the onset of fever with no other localizing infective symptoms. She had a booster dose of COVID 19 Moderna vaccination 6 months prior to her presentation with 2 preceding doses of Pfizer-BioNtech vaccine 12 months prior. She was empirically treated for acute pharyngitis with a course of intravenous antibiotics without improvement of her fever. Extensive workup for the fever was performed. A complete blood count showed monocytosis. Blood and urine cultures, urinalysis, COVID polymerase chain reaction (PCR), CMV, EBV, and HIV testing were negative. Respiratory multiplex PCR was negative for adenovirus, coronavirus, influenza, parainfluenza, respiratory syncytial virus, metapneumovirus, rhinovirus, chlamydia, mycoplasma, and Bordetella. CT of the thorax, abdomen, and pelvis was normal. She denied heat intolerance, weight loss, diarrhea, palpitations, or hand tremors. Clinical examination revealed mild anterior neck tenderness but no thyrotoxic features. There were no signs of Graves ophthalmopathy or pre-tibial myxoedema. Thyroid function tests were performed in view of persistent tachycardia which showed elevated free T4 at 51.6 pmol/L (12.7-20.3) with suppressed TSH <0.005 mIU/L (0.3-4.2). TSH receptor stimulating antibody levels (TRab) was elevated at 5.23IU/L (<1.76) and ESR was markedly elevated (115 mm/hr). Thyroid ultrasound showed homogeneous thyroid echotexture with no discrete suspicious nodules or abnormal vascularity. She was started on non-steroidal anti-inflammatory drug (Etoricoxib) with resolution of her fever and neck pain Clinical lesson: Clinicians should be aware that subacute thyroiditis can be a rare cause of pyrexia of unknown origin even in the absence of typical features.

Presentation: Friday, June 16, 2023
THU419 Comprehensive Evaluation Of Osteoporosis And Impaired Bone Micro Architecture In Patients With Transfusion Dependent Beta Thalassemia
Authors: Dutta Pinaki
Published: October 2023

Disclosure: P. Dutta: None.

comprehensive evaluation of osteoporosis and impaired bone micro architecture in patients with transfusion dependent beta thalassemia

Authors: Pinaki Dutta, Liza Das, Alka Khadwal, Pankaj Malhotra, Sanjay Kumar Bhadada, Vandana Dhiman, Vivek Sharma, Raman

Introduction: Thalassemia-related bone disease is an entity that includes low bone mass, fractures and impaired bone microarchitecture. The current study was designed to evaluate the prevalence and determinants of low bone mass, osteoporosis and microarchitectural parameters using high-resolution peripheral quantitative computed tomography (HR-pQCT) in patients with transfusion-dependent thalassemia (TDT). Patients and Methods TDT patients (n=42) and age- and BMI-matched controls (n=40) were recruited. Demographic, biochemical and hormonal parameters were assessed. Bone mineral density (BMD), T- and Z- scores were measured by DEXA using the HOLOGIC Discovery A Viewer 6 machine. Bone microarchitecture was estimated by HR-pQCT (XtremeCT II, Scanco Medical AG, Switzerland). Results: The mean age of thalassemia patients at recruitment was 26.9 ± 6.5 years and that of controls was 28.9 ± 7.9 years. The mean age of transfusion initiation was 7 months (IQR 3-18) and the median number of transfusions required was 24 (15-25) annually. Serum calcium in cases (8.87 ± 0.67mg/dl) was significantly lower than the controls (9.40 ± 0.45mg/dl), with 9 patients having hypocalcemia and 7 of these having hypoparathyroidism. Hypogonadism was present in 40.4% patients. Bone turnover markers (P1NP, β-CTX) were not significantly different between cases and controls, except alkaline phosphatase (ALP) which was higher in the cases (102.6 ± 60.7 U/l) as opposed to controls (78.2 ± 32.1 U/l). There was a significant correlation between ALP and liver dysfunction (alanine transaminase exceeding the upper normal limit) (r = 0.36, p=0.01) and 63.6% of those with elevated ALP had liver dysfunction. Low bone mass (Z ≤−2) was present in significantly greater proportion of patients versus controls at femoral neck (29.3% vs 2.4%) and at lumbar spine (52.4% vs 14.7%). Total, cortical and trabecular volumetric bone mineral density were significantly lower in cases as compared to controls(p<0.05). The trabecular number was significantly lower (p<0.0001) and trabecular separation significantly higher at radius and tibia (p<0.001). Cortical thickness at radius and tibia were also significantly lower in cases than controls (p<0.0001). Conclusion: Patients with transfusion-dependent thalassemia have significantly lower areal and volumetric BMD (both cortical and trabecular). The bone microarchitecture is also significantly impaired in terms of lower number and wider spacing of trabeculae as well as lower cortical thickness at both radius and tibia.

Presentation: Thursday, June 15, 2023
FRI651 Usage Of Modern Sulphonylureas And Metformin Fixed Dose Combination (fdc) In Type 2 Diabetes Mellitus (t2dm) Patients With Established Complications
Authors: M Aushili , Prasad Dr Ashish , Nagendra Lakshmi , Sinha Binayak , Bansal Beena , Shaikh Shehla
Published: October 2023

Disclosure: A. M: None. D. Prasad: None. D. Birla: None. L. Nagendra: None. B. Bansal: None. S. Shaikh: None.

Aim: To evaluate the usage of sulphonylureas (SUs) and metformin fixed dose combinations (FDC) in type 2 diabetes mellitus (T2DM) patients with established complications Background: Patients with T2DM are at an increased risk of developing macrovascular and microvascular complications due to inadequate glycemic control. Therefore, it is crucial to understand various management strategies used for achieving intensive glycemic control in patients with T2DM having established complications Methodology: This was a retrospective multi-centric, cross-sectional study conducted at 670study sites. Patients of either sex, age above 18 years who have developed microvascular (neuropathy, nephropathy, retinopathy, foot ulcers, or any other complications) and/or macrovascular complications (CAD, stroke/transient ischemic attack, peripheral artery disease or heart failure) receiving any strength of glimepiride and metformin FDC for the treatment of T2DM were included. Data were analyzed using StatisticalPackage for The Social Sciences (SPSS) software, version 23.0. A paired samplet-test was used for comparing the pre-and post-treatment HbA1c, FPG and PPG levels. A P<0.05 was considered statistically significant. Results: A total of 470 patients with a mean age of 53.6 years were included. The majority of patients were obese (68.1%). Macrovascular complications were observed in 101 (21.5%) patients withT2DM, with CAD being the most common, affecting 69 (14.7%) patients. Microvascular complications were present in 408 (86.8%) patients with T2DM.Neuropathy and retinopathy were the leading microvascular complications, each affecting40.6% of patients with T2DM. A total of 73.8% of patients received glimepiride and metformin FDC as a first-line therapy. The strength of glimepiride 2 mg and metformin 500 mg (30.2%) was the most commonly prescribed combination.

Presentation: Friday, June 16, 2023
SAT038 Dietary Trans-10,cis-12 Conjugated Linoleic Acid Regulates Glucose Levels In Mice With Severe Insulin Resistance: Potential Effects On The Liver Via HNF4α And FOX01
Authors: Man Lee Samuel , Trinidad Muratalla Jose , Wee Liew Chong , Cordoba-Chacon Jose
Published: October 2023

Disclosure: S.M. Lee: None. J.T. Muratalla: None. C.W. Liew: None. J. Cordoba-Chacon: None.

Plasma trans-10 cis-12-conjugated linoleic acid CLA (t10c12-CLA) is inversely associated with increased risk of diabetes in humans. In mice, it is well-known that t10c12-CLA induces whole-body insulin resistance due to severe lipodystrophy (loss of whole-body adipose tissue). However, t10c12-CLA-fed mice show normal glucose levels and, t10c12-CLA improved glucose clearance in models with preexisting insulin resistance: Zucker fatty/diabetic rats, obese and insulin resistant Ldlr-/- mice, and diet-induced obese and insulin resistant male mice. In this study, we assessed whether supplementation of t10c12-CLA in a low-fat diet reduces glucose levels in adipocyte-specific insulin receptor knockout (IRFKO) mice, which is a mouse model of congenital lipodystrophy. In addition to lipodystrophy, IRFKO mice show liver steatosis and increased blood glucose levels that are consequences of whole-body insulin resistance and increased hepatic gluconeogenesis. Briefly, 5-6-week-old male and female control and IRFKO mice were fed with a low-fat diet supplemented with 0.8% t10c12-CLA for 5 weeks. In IRFKO mice, dietary t10c12-CLA did not reduce adipose tissue mass. However, dietary t10c12-CLA increased liver steatosis and plasma insulin levels. Surprisingly, dietary t10c12-CLA reduced glucose levels in both male and female IRFKO mice. Also, dietary t10c12-CLA reduced food intake and polydipsia, which were increased in IRFKO mice due to lipodystrophy and hyperglycemia, respectively. A transcriptomic analysis (RNA-seq) of livers of control and IRFKO male mice fed with a t10c12-CLA diet showed that t10c12-CLA reduced the expression of the key gluconeogenic and mitochondrial fatty oxidation genes. Previous studies have suggested that t10c12-CLA reduces the expression of Forkhead box 01 (Fox01) and Hepatocyte nuclear factor 4 alpha (HNF4α). Of note, the livers of t10c12-CLA-fed control and IRFKO male mice showed a downregulation of positive targets of FoxO1 and HNF4α. In addition, livers of t10c12-CLA-fed mice showed reduced total FOXO1 protein levels, and increased phosphorylation of FOXO1 in t10c12-CLA-fed IRFKO mice. These findings suggest that t10c12-CLA could be directly acting on the liver to alter HNF4α and FOXO1-dependent regulation of hepatic fatty acid oxidation and glucose production. These actions may explain why t10c12-CLA-fed mice do not show increased glucose levels and is potentially linked to the inverse association between t10c12-CLA levels and diabetes risk.

Presentation: Saturday, June 17, 2023
Intrathecal Opioid Use in Kidney Transplantation: An Observational Cohort Study
Authors: Hofer Ryan E. , Sims Charles R. , Dean Patrick G. , Portner Erica R. , Hanson Andrew C. , Warner Matthew A.
Published: October 2023

BACKGROUND:

Kidney transplant is the most common transplant operation performed in the United States. Although various approaches to pain management have been described, the optimal analgesic strategy remains undefined. Specifically, the role of intrathecal opioids in this patient population has not been comprehensively evaluated.

METHODS:

Using a retrospective cohort design, data from kidney transplant operations at a single tertiary care medical center between August 1, 2017, and July 31, 2022, were extracted. Inverse probability of treatment weighting (IPTW) was used to assess differences in clinical outcomes based on the presence or absence of intrathecal opioid administration before surgical incision. The primary outcome was total opioid exposure expressed in milligram morphine equivalents (MME) in the first 72 hours postoperatively, with secondary outcomes including total MME (intraoperative plus postoperative MME, postoperative pain scores, and the presence of postoperative nausea/vomiting [PONV], pruritus, or adverse events).

RESULTS:

A total of 1014 kidney transplants in 1012 unique patients were included, with 411 (41%) receiving intrathecal opioids preoperatively. Hydromorphone was the intrathecal opioid used in all cases with median dose of 100 µg (interquartile range [IQR], 100, 100; range 50–200). Subjects receiving intrathecal opioids had significantly lower postoperative opioid requirements at 72 hours (30 [0–68] vs 64 [22, 120] MME), with ratio of geometric means in the IPTW analysis (ratio of geometric means 0.34, 95% confidence interval [CI], 0.26–0.43; P < .001). Similar findings were observed for total opioids (45 [30–75] vs 75 [60–90] MME; ratio of geometric means 0.58, 95% CI, 0.54–0.63; P < .001). Maximum reported pain scores in the intrathecal group were lower at 24 hours (4 [2–7] vs 7 [5, 8]; OR, 0.28; 95% CI, 0.21–0.37 for experiencing a higher pain score with intrathecal opioids, P < .001) and 72 hours (6 [4–7] vs 7 [5–8]; OR, 0.41; 95% CI, 0.31–0.54; P < .001). Patients receiving intrathecal opioids were more likely to experience PONV (225 of 411 [55%] vs 232 of 603 [38%]; OR, 2.16; 95% CI, 1.63–2.86; P < .001).

CONCLUSIONS:

Intrathecal opioid administration was associated with improved pain outcomes in patients undergoing kidney transplantation, including lower opioid requirements and pain scores through 72 hours. However, this was accompanied by an increased risk of PONV.
Congenital Myasthenic Syndrome With Malignant Hyperthermia Susceptibility in a Child Undergoing Adenotonsillectomy for Obstructive Sleep Apnea: A Case Report
Authors: Kuo William , Le Sang , Kim Eugene , Lo Carl (Yuan-Feng)
Published: October 2023

Congenital myasthenic syndromes are rare genetic diseases involving pathologic proteins in the neuromuscular junction. Malignant hyperthermia susceptibility is a genetic disorder involving a hypermetabolic response to volatile anesthetics and depolarizing neuromuscular blocking agents. We present the first reported case of a 3-year-old boy with both congenital myasthenic syndrome and malignant hyperthermia susceptibility, resulting from a mutation in the ryanodine receptor type 1 gene, who underwent an adenotonsillectomy for severe obstructive sleep apnea. We discuss the anesthetic challenges in navigating these 3 comorbidities in the setting of airway surgery.
Incentivos a la producción y la productividad, 1969–1973: Debates y dilemas en la izquierda chilena
Authors: Rojas Flores Jorge , Villar Vásquez Gorka
Published: October 2023

A lo largo del siglo xx, en el Tercer Mundo, la izquierda que se definía revolucionaria y permanecía en la oposición reivindicó una mejor distribución de la riqueza sin considerar el crecimiento económico ni los incentivos a la productividad. Cuando logró acceder al gobierno, debió enfrentar un dilema: desechar o promover incentivos al uso eficiente de los recursos y, junto con ello, definir si debía priorizar los estímulos morales por sobre los materiales. Así ocurrió con Salvador Allende en 1970. El debate y las acciones que desplegó durante tres años, hasta su caída en 1973, se nutrieron de la experiencia de otros países, tensionando distintas perspectivas sobre el carácter de las transformaciones y las posibles dosis de pragmatismo en la acción. Este artículo indaga los pormenores de esa discusión para el caso chileno, en un contexto de creciente complejidad, tomando como base las declaraciones de variadas vertientes de la izquierda.
Necrosectomy Versus Stand-Alone Suboccipital Decompressive Craniectomy for the Management of Space-Occupying Cerebellar Infarctions—A Retrospective Multicenter Study
Authors: Hernandez-Duran Silvia , Walter Johannes , Behmanesh Bedjan , Bernstock Joshua D. , Czabanka Marcus , Dinc Nazife , Dubinski Daniel , Freiman Thomas M. , Günther Albrecht , Hellmuth Kara , Herrmann Eva , Konczalla Juergen , Maier Ilko , Melkonian Ruzanna , Mielke Dorothee , Müller Sebastian Johannes , Naser Paul , Rohde Veit , Schaefer Jan Hendrik , Senft Christian , Storch Alexander , Unterberg Andreas , Walter Uwe , Wittstock Matthias , Gessler Florian , Won Sae-Yeon
Published: October 2023

BACKGROUND AND OBJECTIVES:

Space-occupying cerebellar stroke (SOCS) when coupled with neurological deterioration represents a neurosurgical emergency. Although current evidence supports surgical intervention in such patients with SOCS and rapid neurological deterioration, the optimal surgical methods/techniques to be applied remain a matter of debate.

METHODS:

We conducted a retrospective, multicenter study of patients undergoing surgery for SOCS. Patients were stratified according to the type of surgery as (1) suboccipital decompressive craniectomy (SDC) or (2) suboccipital craniotomy with concurrent necrosectomy. The primary end point examined was functional outcome using the modified Rankin Scale (mRS) at discharge and at 3 months (mRS 0-3 defined as favorable and mRS 4-6 as unfavorable outcome). Secondary end points included the analysis of in-house postoperative complications, mortality, and length of hospitalization.

RESULTS:

Ninety-two patients were included in the final analysis: 49 underwent necrosectomy and 43 underwent SDC. Those with necrosectomy displayed significantly higher rate of favorable outcome at discharge as compared with those who underwent SDC alone: 65.3% vs 27.9%, respectively (P < .001, odds ratios 4.9, 95% CI 2.0-11.8). This difference was also observed at 3 months: 65.3% vs 41.7% (P = .030, odds ratios 2.7, 95% CI 1.1-6.7). No significant differences were observed in mortality and/or postoperative complications, such as hemorrhagic transformation, infection, and/or the development of cerebrospinal fluid leaks/fistulas.

CONCLUSION:

In the setting of SOCS, patients treated with necrosectomy displayed better functional outcomes than those patients who underwent SDC alone. Ultimately, prospective, randomized studies will be needed to confirm this finding.
Risk of Subdural Hematoma Expansion in Patients With End-Stage Renal Disease: Continuous Venovenous Hemodialysis Versus Intermittent Hemodialysis
Authors: Ran Kathleen R. , Ejimogu Nna-Emeka , Yang Wuyang , Kilgore Collin B. , Nair Sumil K. , Monroy Trujillo Jose M. , Jackson Christopher M. , Mukherjee Debraj , Anderson William S. , Gallia Gary L. , Weingart Jon D. , Robinson Shenandoah , Cohen Alan R. , Bettegowda Chetan , Huang Judy , Tamargo Rafael J. , Xu Risheng
Published: October 2023

BACKGROUND AND OBJECTIVES:

Subdural hematoma (SDH) patients with end-stage renal disease (ESRD) require renal replacement therapy in addition to neurological management. We sought to determine whether continuous venovenous hemodialysis (CVVHD) or intermittent hemodialysis (iHD) is associated with higher rates of SDH re-expansion as well as morbidity and mortality.

METHODS:

Hemodialysis-dependent patients with ESRD who were discovered to have an SDH were retrospectively identified from 2016 to 2022. Rates of SDH expansion during CVVHD vs iHD were compared. Hemodialysis mode was included in a multivariate logistic regression model to test for independent association with SDH expansion and mortality.

RESULTS:

A total of 123 hemodialysis-dependent patients with ESRD were discovered to have a concomitant SDH during the period of study. Patients who received CVVHD were on average 10.2 years younger (P < .001), more likely to have traumatic SDH (47.7% vs 19.0%, P < .001), and more likely to have cirrhosis (25.0% vs 10.1%, P = .029). SDH expansion affecting neurological function occurred more frequently during iHD compared with CVVHD (29.7% vs 12.0%, P = .013). Multivariate logistic regression analysis found that CVVHD was independently associated with decreased risk of SDH affecting neurological function (odds ratio 0.25, 95% CI 0.08-0.65). Among patients who experienced in-hospital mortality or were discharged to hospice, 5% suffered a neurologically devastating SDH expansion while on CVVHD compared with 35% on iHD.

CONCLUSION:

CVVHD was independently associated with decreased risk of neurologically significant SDH expansion. Therefore, receiving renal replacement therapy through a course of CVVHD may increase SDH stability in patients with ESRD.