scholarly journals The Impact of Cirrhosis and Prescription Medications on QTc Interval Before and After Liver Transplantation

2017 ◽  
Vol 32 (1) ◽  
pp. 48-53 ◽  
Author(s):  
Andrew D. Santeusanio ◽  
Kevin G. Dunsky ◽  
Stephanie Pan ◽  
Thomas D. Schiano
Keyword(s):  
Liver Transplantation ◽  
Liver Transplant ◽  
Qtc Interval ◽  
Prescription Medications ◽  
Qtc Prolongation ◽  
Before And After ◽  
Group 2 ◽  
Transplant Candidates ◽  
The Impact ◽  
Group 1

Background: Higher rates of corrected QT (QTc) prolongation have been reported in patients with cirrhosis. The impact of liver transplantation and prescription medications on the natural history of QTc prolongation has yet to be well characterized. Methods: This was a single-center review of patients receiving (group 1) or listed for (group 2) a liver transplant during 2014. Patients in group 1 were followed prospectively from the date of transplantation to assess rates of QTc normalization posttransplant. In group 2, patients were evaluated from the date of listing up until December 2015 to assess the prevalence of QTc prolongation among liver transplant candidates. Results: In group 1, 22 (75.9%) patients with QTc intervals >460 milliseconds at the time of transplant established normal baseline QTc intervals following transplantation. The median time to this QTc normalization was 17 days. In group 2, 30 (16.9%) patients had at least 1 documented QTc interval >500 milliseconds with prevalence rates of 42.9%, 19.0%, and 10.2% in patients with natural model of end-stage liver disease scores of >30, 16 to 30, and <16, respectively ( P < .01). Overall, 49.4% of patients in group 1 and 47.5% of patients in group 2 were prescribed QTc prolonging medications. Conclusion: QTc prolongation will resolve following transplantation in the majority of patients and generally occurs within the first several weeks. Among the listed liver transplant candidates, higher rates of clinically significant QTc prolongation may be observed in patients with more severe underlying cirrhosis. QTc prolonging medications are commonly prescribed in this population and warrant monitoring following initiation.

scholarly journals To compare the effects of intra vaginal prostaglandin E1 and intra-cervical prostaglandin E2 for prelabour ripening of unfavorable uterine cervix in nulliparous women

2017 ◽  
Vol 6 (8) ◽  
pp. 3381 ◽  
Author(s):  
Shikha A. Jain ◽  
Nisha C. Chakravarti
Keyword(s):  
Prostaglandin E2 ◽  
Uterine Cervix ◽  
Prostaglandin E1 ◽  
Neonatal Outcome ◽  
Induction Of Labour ◽  
Nulliparous Women ◽  
Before And After ◽  
Group 2 ◽  
The Impact ◽  
Group 1

Background: Induction of labour by use of prostaglandins improves the obstetric outcome in complicated cases such as prolonged deliveries. The aim of the present study was to compare the effect of prostaglandin E1 (PGE1) and prostaglandin E2 (PGE2) for prelabour ripening of unfavourable uterine cervix in nulliparous women, to study the effect of PGE1 and PGE2 on duration of labor and to evaluate the obstetrical and neonatal outcome of induction of labour using prostaglandins E1 and E2.Methods: This was a prospective study conducted on 50 nulliparous women with singleton pregnancy with gestational age ≥37 weeks during the period from August 2008 to October 2010 in the Department of Obstetrics and Gynaecology of Bombay Hospital Institute of Medical Sciences and Allied Hospitals, Mumbai. All the 50 patients were divided into two groups. Group-1 containing 25 patients received intravaginal PGE1, (Tablet Misoprostol 25 mcg) inserted in the posterior vaginal fornix under all aseptic precautions. Group-2 containing 25 patients received intracervical PGE2, (Dinoprostone gel, 0.5 mg). Analysis and comparison of various parameters like induction- delivery interval, Bishops score before and after administration of drug, mode of delivery, neonatal outcome, foeto-maternal complications between the two groups were noted and analysed the data statistically by using Chi-square, continuity correction, Fisher's exact test and Mann-Whitney tests.Results: Majority of the patients in both the groups were under the age of 23-27 years. Post-datism was the common indication noticed in 18 (72%) and 13 (52%) patients of both the groups respectively. Maximum patients had a Bishop’s score of 3 in PGE1 (56%) and PGE2 groups (48%) respectively. The improvement in Bishop’s score in both the groups before and after drug administration was 6.20 and 6.76 respectively. Maximum patients in both the groups went into active labour within six hours of induction of labour. The most common side effects seen in our study was nausea and vomiting in both groups. Majority (23) were born with Apgar score 8-10 in group 1 and 21 for group 2 patients.Conclusions: Both the drugs had similar efficacy and safety in induction of labour. Prospective research is required to fully evaluate the impact of AMOR-IPAT on nulliparous birth outcomes.

scholarly journals 1520. Respiratory Syncytial Virus Hospitalizations (RSVH) and All-Cause Bronchiolitis Hospitalizations (BH) Among Children Aged ≤ 24 Months at the Start of RSV Season With Bronchopulmonary Dysplasia/Chronic Lung Disease of Prematurity (BPD/CLDP) Before and After the 2014 American Academy of Pediatrics (AAP) Policy

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S762-S762
Author(s):  
Jaime Fergie ◽  
Tara Gonzales ◽  
Mina Suh ◽  
Xiaohui Jiang ◽  
Jon Fryzek ◽  
...  
Keyword(s):  
Health Information System ◽  
International Health ◽  
International Classification Of Diseases ◽  
Data Set ◽  
Before And After ◽  
Classification Of Diseases ◽  
Group 2 ◽  
Syncytial Virus ◽  
The Impact ◽  
Group 1

Abstract Background The AAP, in 2014, stopped endorsing palivizumab for use in children with BPD/CLDP born at &lt; 32 weeks’ gestational age (wGA) between the ages of 12 to 24 months not requiring medical support during the 6 months before the start of RSV season and all children with BPD/CLDP born at &gt; 32 wGA. We sought to understand the impact of the guidance change on RSVH and BH in children no longer advised for RSV immunoprophylaxis with palivizumab. Methods Children with BPD/CLDP aged ≤ 24 months at the RSV season start and hospitalized for RSV or bronchiolitis during the 2010-2017 RSV seasons (November-March) were studied. RSVH, BH, and BPD/CLDP were defined by International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and ICD-10-CM codes. ICD-9 codes for wGA combine 31 and 32 wGA into one code. Therefore, for BPD/CLDP, we classified group 1 as children aged 12 to 24 months who were born at &lt; 31 wGA and group 2 as those born at ≥ 31 wGA. The Children’s Hospital Association’s Pediatric Health Information System® (PHIS) data set was used to describe frequency and characteristics of RSVH and BH and disease severity (including intensive care unit [ICU] admission and mechanical ventilation [MV]) before and after the 2014 AAP policy. Statistical analyses were done using z-tests; SAS version 9.4. Results Among children with BPD/CLDP, RSVH rates were 1.7% (1035/59,217) before 2014 and 2.1% (973/45,470) after 2014 (P&lt; 0.0001). RSVH rose after the policy change vs before among children with BPD/CLDP in both group 1 (0.40% vs 0.26%; P&lt; 0.0001) and group 2 (0.22% vs 0.14%; P=0.002). Similarly, BH also increased for both group 1 (P&lt; 0.0001) and group 2 (P=0.002) after the guidance change vs before. Although ICU admissions increased significantly for children with BPD/CLDP in both group 1 (P&lt; 0.0001) and group 2 (P=0.0004), use of MV (P=0.002) increased after 2014 for children with BPD/CLDP in group 1 only. Similar results were observed for BH. Conclusion This analysis highlights the increase in RSVH, BH, and associated severity among BPD/CLDP subgroups within the PHIS health system after 2014. Further study of long-term complications associated with RSVH in these children is warranted. Disclosures Jaime Fergie, MD, AstraZeneca (Speaker’s Bureau)Sobi, Inc. (Speaker’s Bureau) Tara Gonzales, MD, Sobi, Inc. (Employee) Mina Suh, MPH, International Health, EpidStrategies (Employee) Xiaohui Jiang, MS, EpidStrategies (Employee) Jon Fryzek, PhD, MPH, EpidStrategies (Employee) Adam Bloomfield, MD, FAAP, Sobi, Inc. (Employee)

scholarly journals The Impact of Comorbidity on Quality of Life in Chronic Myeloid Leukemia Patients with Deep Molecular Response Who Stopped Therapy By Tyrosine Kinase Inhibitors: Results of the RU-SKI Trial

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 2925-2925
Author(s):  
Tatyana Ionova ◽  
Tatiana Nikitina ◽  
Natalia Porfirieva ◽  
Anna Petrova ◽  
Ekaterina Yu. Chelysheva ◽  
...  
Keyword(s):  
Social Functioning ◽  
Physical Functioning ◽  
Kinase Inhibitors ◽  
Molecular Response ◽  
Sf 36 ◽  
Before And After ◽  
Group 2 ◽  
Comorbidity Status ◽  
The Impact ◽  
Group 1

Background The data on quality of life (QoL) in chronic myeloid leukemia (CML) patients (pts) with deep molecular response (DMR) in the treatment-free remission (TFR) studies are limited. The influence of comorbidities on QoL in CML pts before and after tyrosine kinase inhibitors (TKIs) discontinuation has not been studied. Aim We aimed to study the impact of comorbidities on QoL in CML pts before and after the stop therapy by TKIs. Patients and methods The chronic phase (CP) CML pts who had received therapy by any TKI ≥3 years (yrs) with sustained DMR (BCR-ABL ≤0.01% IS) during ≥2 yrs were enrolled into the prospective TFR study RU-SKI. A regular qPCR with BCR-ABL IS evaluation was performed after TKI cessation. TKI were resumed in pts with major molecular response loss (MMR loss, BCR-ABL>0,1%). The QoL was evaluated by RAND SF-36 questionnaire at baseline before TKI stop and at 1, 3, 6, 12 mo during TFR. Eight functional scales were assessed: physical functioning, role limitations physical, bodily pain, general health perceptions, energy/vitality, social functioning, role limitations emotional, mental health. The Integral QoL Index (IQoLI) was calculated based on the scales. Mann-Whitney test, paired Wilcoxon test χ2 were used for the statistical analysis. Molecular relapse free survival (MRFS) was evaluated by Kaplan-Meier method, log-rank test was used for comparison. Results The analysis was performed in the group of 97 CML pts. Median (Me) age was 47±14.5 (yrs), 48.5% were males. The TKI before treatment cessation were as follows: imatinib and second-generation (2G) TKIs in 67 (70%) and 30 (30%) pts accordingly; 9 (30%) pts received 2G TKIs in 1st line and 21 (70%) pts in 2nd line. Me time of observation was 25 mo (range 12-42). Comorbidities were present in 81 pts (82%) at baseline. The most frequent comorbidities were cardiovascular (38.4%), gastroenterological (29.3%) and musculoskeletal disorders (27.3%). First we compared baseline QoL in 2 pts groups: group 1 - pts with acute comorbidity status at baseline (n=42), group 2 - pts with stable comorbidity status (n=29) and with no comorbidity (n=16). QoL in group 1 was significantly worse by all functional scales, except mental health (p<0.05). The IQoLI at baseline was significantly lower in group 1 vs group 2: 0.477 vs 0.589 (p<0.001). Then we evaluated QoL at 3 mo after TKI stop in 72 available pts, as acute status comorbidity remained in 30 pts. The majority of pts exhibited QoL improvement or stabilization by all SF-36 scales. The most pronounced positive changes were observed by SF-36 scales in pts with acute comorbidity status (group 1).The proportion of pts with QoL improvement at 3 mo after TKI stop was higher in group 1 as compared to group 2 by physical functioning (57% vs 29%), role physical functioning (30% vs 5%) and social functioning (40% vs 24%), p<0.05. Increasing of social functioning was statistically significant: ∆20.2 in group 1 vs ∆12.6 in group 2 (p=0.005). The proportion of pts with QoL worsening at 3 mo after TKI stop was similar in both groups. MRFS at 24 mo was 62% (CI 46-77%) and 45% (CI 32-58%) in groups 1 and 2 respectively, with no significant differences between the groups (p=0.107). Conclusion CML pts with DMR and acute comorbidity status had a worse QoL before TKI therapy cessation compared to pts without comorbidity or with comorbidity in remission. The majority of pts exhibited QoL improvement or stabilization in early terms after TKI stop. Pts with acute comorbidity status had more pronounced positive QoL changes after treatment cessation than other pts. Possible explanation is that TKI therapy could increase the clinical symptoms manifestation by overlapping with the treatment toxicity effects. The molecular relapse rate was similar in pts with and without acute comorbidity status. Thus, comorbidity is not a factor which may have negative impact on the outcomes of stop TKI therapy in CML pts. Disclosures Ionova: Takeda, BMS: Other: Principal Investigator of IISR, Research Funding. Chelysheva:Novartis: Consultancy, Honoraria; Fusion Pharma: Consultancy. Shukhov:Novartis: Consultancy; Pfizer: Consultancy. Turkina:Novartis: Consultancy, Speakers Bureau; Pfizer: Consultancy; Bristol Myers Squibb: Consultancy; fusion pharma: Consultancy; Novartis: Consultancy, Speakers Bureau.

HCC Liver Transplantation Wait List Dropout Rates Before and After the Mandated 6-Month Wait Time

2020 ◽  
Vol 86 (11) ◽  
pp. 1592-1595
Author(s):  
Julio Sokolich ◽  
Jacentha Buggs ◽  
Michael LaVere ◽  
Kobe Robichaux ◽  
Ebonie Rogers ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Transplant ◽  
Organ Procurement ◽  
Wait Time ◽  
Dropout Rate ◽  
Dropout Rates ◽  
Wait List ◽  
Recurrence Rates ◽  
Before And After ◽  
The Impact

Background Studies have shown significant improvement in hepatocellular carcinoma (HCC) recurrence rates after liver transplantation since the united network of organ sharing (UNOS) implementation of a 6-month wait period prior to accrued exception model for end-stage liver disease (MELD) points enacted on October 8, 2015. However, few have examined the impact on HCC dropout rates for patients awaiting liver transplant. Our objective is to evaluate the outcomes of HCC dropout rates before and after the mandatory 6-month wait policy enacted. Methods We conducted a retrospective cohort study on adult patients added to the liver transplant wait list between January 1, 2012, and March 8, 2019 (n = 767). Information was obtained through electronic medical records and organ procurement and transplant network (OPTN) publicly available national data reports. Results In response to the 2015 UNOS-mandated 6-month wait time, dropout rates in the HCC patient population at our center increased from 12% pre-mandate to 20.8% post-mandate This increase was similarly reflected in the national dropout rate, which also increased from 26.3% pre-mandate to 29.0% post-mandate. Discussion From these changes, it is evident that the UNOS mandate achieved its goal of increasing equity of liver organ allocation, but HCC patients are nonetheless dropping off of the wait list at an increased rate and are therefore disadvantaged.

Comparison of 24-Hour Electrocardiogram Parameters in Patients with Graves Disease Before and After Anti-Thyroid Therapy

2020 ◽  
Vol 20 ◽  
Author(s):  
Gamze Akkuş ◽  
Yeliz Sökmen ◽  
Mehmet Yılmaz ◽  
Özkan Bekler ◽  
Oğuz Akkuş
Keyword(s):  
Treatment Group ◽  
Medical Treatment ◽  
Surgical Therapy ◽  
Graves Disease ◽  
Before And After ◽  
Euthyroid Status ◽  
Ectopic Beats ◽  
Group 2 ◽  
Electrocardiographic Parameters ◽  
Group 1

Background: We aimed prospectively investigate the laboratory and electrocardiographic parameters (hearth rate, QRS, QT, QTc, Tpe, Tpe/QTc, arrhythmia prevalance) in patients with graves disease before and after antithyroid therapy. Methods: 71 patients (48 female, 23 male), age between 18-50 (mean±SD: 36.48±12.20 ) with GD were included into the study. Patients treated with antithyroid therapy (thionamids and/or surgical therapy) to maintain euthyroid status. Patients were examined in terms of electrocardiographic parameters before and after the treatment. Results: Mean TSH, free thyroxin (fT4) and tri-iodothyrionine (fT3) levels of all patients were 0.005±0.21, 3.27± 1.81, 11.42±7.44, respectively. While 9 patients (group 2) underwent surgical therapy, had suspicious of malignant nodule or large goiter and unresponsiveness to medical treatment; the other patients (n=62, group 1) were treated with medical therapy. Patients with surgical therapy had more increased serum fT4 (p=0.045), anti-thyroglobulin value (p=0.018) and more severe graves orbitopathy (n=0.051) before treatment when compared to medical therapy group. Baseline Tpe duration and baseline Tpe/QTc ratio and frequency of supraventricular ectopic beats were found to be significantly higher in group 2 when compared to group 1 (p=0.00, p=0.005). Otherwise baseline mean heart rate, QRS duration, QTc values of both groups were similar. Although the patients became their euthyroid status, group 2 patients had still suffered from more sustained supraventricular ectopics beats than group 1. Conclusion: Distinct from medical treatment group, surgical treatment group with euthyroidism at least 3 months had still suffered from an arrhythmia (Tpe, Tpe/QTc, supraventricular and ventricular ectopic beats).

CD34 immunostain increases sensitivity of the diagnosis of fetal vascular malperfusion in placentas from ex-utero intrapartum treatment

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Jerzy Stanek
Keyword(s):  
Statistical Significance ◽  
Treatment Procedure ◽  
Fetal Survival ◽  
Ex Utero Intrapartum Treatment ◽  
Life Threatening ◽  
Group 2 ◽  
Cd34 Immunostain ◽  
The Impact ◽  
Diaphragmatic Hernias ◽  
Group 1

AbstractShort CommunicationsEXIT (ex-utero intrapartum treatment) procedure is a fetal survival-increasing modification of cesarean section. Previously we found an increase incidence of fetal vascular malperfusion (FVM) in placentas from EXIT procedures which indicates the underlying stasis of fetal blood flow in such cases. This retrospective analysis analyzes the impact of the recently introduced CD34 immunostain for the FVM diagnosis in placentas from EXIT procedures.Objectives and MethodsA total of 105 placentas from EXIT procedures (48 to airway, 43 to ECMO and 14 to resection) were studied. In 73 older cases, the placental histological diagnosis of segmental FVM was made on H&E stained placental sections only (segmental villous avascularity) (Group 1), while in 32 most recent cases, the CD34 component of a double E-cadherin/CD34 immunostain slides was also routinely used to detect the early FVM (endothelial fragmentation, villous hypovascularity) (Group 2). 23 clinical and 47 independent placental phenotypes were compared by χ2 or ANOVA, where appropriate.ResultsThere was no statistical significance between the groups in rates of segmental villous avascularity (29 vs. 34%), but performing CD34 immunostain resulted in adding and/or upgrading 12 more cases of segmental FVM in Group 2, thus increasing the sensitivity of placental examination for FVM by 37%. There were no other statistically significantly differences in clinical (except for congenital diaphragmatic hernias statistically significantly more common in Group 2, 34 vs 56%, p=0.03) and placental phenotypes, proving the otherwise comparability of the groups.ConclusionsThe use of CD34 immunostain increases the sensitivity of placental examination for FVM by 1/3, which may improve the neonatal management by revealing the increased likelihood of the potentially life-threatening neonatal complications.

scholarly journals The negative effects of COVID-19 and national lockdown on emergency surgery morbidity due to delayed access

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Francesco A. Ciarleglio ◽  
Marta Rigoni ◽  
Liliana Mereu ◽  
Cai Tommaso ◽  
Alessandro Carrara ◽  
...  
Keyword(s):  
Emergency Department ◽  
Blood Transfusion ◽  
Emergency Surgery ◽  
Surgical Care ◽  
Close Correlation ◽  
Negative Effects ◽  
Group 2 ◽  
Retrospective Comparative Study ◽  
The Impact ◽  
Group 1

Abstract Background The aim of this retrospective comparative study was to assess the impact of COVID-19 and delayed emergency department access on emergency surgery outcomes, by comparing the main clinical outcomes in the period March–May 2019 (group 1) with the same period during the national COVID-19 lockdown in Italy (March–May 2020, group 2). Methods A comparison (groups 1 versus 2) and subgroup analysis were performed between patients’ demographic, medical history, surgical, clinical and management characteristics. Results Two-hundred forty-six patients were included, 137 in group 1 and 109 in group 2 (p = 0.03). No significant differences were observed in the peri-operative characteristics of the two groups. A declared delay in access to hospital and preoperative SARS-CoV-2 infection rates were 15.5% and 5.8%, respectively in group 2. The overall morbidity (OR = 2.22, 95% CI 1.08–4.55, p = 0.03) and 30-day mortality (OR = 1.34, 95% CI 0.33–5.50, =0.68) were significantly higher in group 2. The delayed access cohort showed a close correlation with increased morbidity (OR = 3.19, 95% CI 0.89–11.44, p = 0.07), blood transfusion (OR = 5.13, 95% CI 1.05–25.15, p = 0.04) and 30-day mortality risk (OR = 8.00, 95% CI 1.01–63.23, p = 0.05). SARS-CoV-2-positive patients had higher risk of blood transfusion (20% vs 7.8%, p = 0.37) and ICU admissions (20% vs 2.6%, p = 0.17) and a longer median LOS (9 days vs 4 days, p = 0.11). Conclusions This article provides enhanced understanding of the effects of the COVID-19 pandemic on patient access to emergency surgical care. Our findings suggest that COVID-19 changed the quality of surgical care with poorer prognosis and higher morbidity rates. Delayed emergency department access and a “filter effect” induced by a fear of COVID-19 infection in the population resulted in only the most severe cases reaching the emergency department in time.

scholarly journals QOL-49. THE IMPACT OF OTOTOXICITY AND VISUAL IMPAIRMENT ON EDUCATION IN CHILDREN TREATED FOR CNS TUMOURS

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii440-iii440
Author(s):  
Harriet Dulson ◽  
Rachel McAndrew ◽  
Mark Brougham
Keyword(s):  
Visual Impairment ◽  
Impaired Hearing ◽  
Cranial Radiotherapy ◽  
Radiotherapy Group ◽  
Platinum Based Chemotherapy ◽  
Cns Tumours ◽  
Group 3 ◽  
Group 2 ◽  
The Impact ◽  
Group 1

Abstract INTRODUCTION Children treated for CNS tumours experience a very high burden of adverse effects. Platinum-based chemotherapy and cranial radiotherapy can cause ototoxicity, which may be particularly problematic in patients who have impaired vision and cognition as a result of their tumour and associated treatment. This study assessed the prevalence of impaired hearing and vision and how this may impact upon education. METHODS 53 patients diagnosed with solid tumours in Edinburgh, UK between August 2013–2018 were included in the study. Patients were split into three groups according to treatment received: Group 1 – cisplatin-based chemotherapy and cranial radiotherapy; Group 2 - platinum-based chemotherapy, no cranial radiotherapy; Group 3 – benign brain tumours treated with surgery only. Data was collected retrospectively from patient notes. RESULTS Overall 69.5% of those treated with platinum-based chemotherapy experienced ototoxicity as assessed by Brock grading and 5.9% of patients had reduced visual acuity. Patients in Group 1 had the highest prevalence of both. 44.4% of patients in Group 1 needed increased educational support following treatment, either with extra support in the classroom or being unable to continue in mainstream school. 12.5% of Group 2 patients required such support and 31.3% in Group 3. CONCLUSIONS Children with CNS tumours frequently require support for future education but those treated with both platinum-based chemotherapy and cranial radiotherapy are at particular risk, which may be compounded by co-existent ototoxicity and visual impairment. It is essential to provide appropriate support for this patient cohort in order to maximise their educational potential.

scholarly journals Association between serum oestradiol level on the hCG administration day and neonatal birthweight after IVF-ET among 3659 singleton live births

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yu Liu ◽  
Jing Li ◽  
Wanyu Zhang ◽  
Yihong Guo
Keyword(s):  
Birth Weight ◽  
Ovarian Stimulation ◽  
Group 4 ◽  
Group 6 ◽  
Group 3 ◽  
Group 5 ◽  
Group 2 ◽  
The Impact ◽  
Ivf Et ◽  
Group 1

AbstractOestradiol, an important hormone in follicular development and endometrial receptivity, is closely related to clinical outcomes of fresh in vitro fertilization-embryo transfer (IVF-ET) cycles. A supraphysiologic E2 level is inevitable during controlled ovarian hyper-stimulation (COH), and its effect on the outcome of IVF-ET is controversial. The aim of this retrospective study is to evaluate the association between elevated serum oestradiol (E2) levels on the day of human chorionic gonadotrophin (hCG) administration and neonatal birthweight after IVF-ET cycles. The data of 3659 infertile patients with fresh IVF-ET cycles were analysed retrospectively between August 2009 and February 2017 in First Hospital of Zhengzhou University. Patients were categorized by serum E2 levels on the day of hCG administration into six groups: group 1 (serum E2 levels ≤ 1000 pg/mL, n = 230), group 2 (serum E2 levels between 1001 and 2000 pg/mL, n = 524), group 3 (serum E2 levels between 2001 and 3000 pg/mL, n = 783), group 4 (serum E2 levels between 3001 and 4000 pg/mL, n = 721), group 5 (serum E2 levels between 4001 and 5000 pg/mL, n = 548 ), and group 6 (serum E2 levels > 5000 pg/mL, n = 852). Univariate linear regression was used to evaluate the independent correlation between each factor and outcome index. Multiple logistic regression was used to adjust for confounding factors. The LBW rates were as follows: 3.0% (group 1), 2.9% (group 2), 1.9% (group 3), 2.9% (group 4), 2.9% (group 5), and 2.0% (group 6) (P = 0.629), respectively. There were no statistically significant differences in the incidences of neonatal LBW among the six groups. We did not detect an association between peak serum E2 level during ovarian stimulation and neonatal birthweight after IVF-ET. The results of this retrospective cohort study showed that serum E2 peak levels during ovarian stimulation were not associated with birth weight during IVF cycles. In addition, no association was found between higher E2 levels and increased LBW risk. Our observations suggest that the hyper-oestrogenic milieu during COS does not seem to have adverse effects on the birthweight of offspring after IVF. Although this study provides some reference, the obstetric-related factors were not included due to historical reasons. The impact of the high estrogen environment during COS on the birth weight of IVF offspring still needs future research.

scholarly journals THU0227 CAFFEINE INTAKE MODULATES DISEASE ACTIVITY AND CYTOKINES LEVELS IN SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 340.2-341
Author(s):  
V. Orefice ◽  
F. Ceccarelli ◽  
C. Barbati ◽  
R. Lucchetti ◽  
G. Olivieri ◽  
...  
Keyword(s):  
Disease Activity ◽  
Lupus Erythematosus ◽  
Caffeine Intake ◽  
Caffeine Consumption ◽  
Group 4 ◽  
Group 3 ◽  
Group 2 ◽  
The Impact ◽  
Group 1

Background:Systemic lupus erythematosus (SLE) is an autoimmune disease mainly affecting women of childbearing age. The interplay between genetic and environmental factors may contribute to disease pathogenesis1. At today, no robust data are available about the possible contribute of diet in SLE. Caffeine, one of the most widely consumed products in the world, seems to interact with multiple components of the immune system by acting as a non-specific phosphodiesterase inhibitor2.In vitrodose-dependent treatment with caffeine seems to down-regulate mRNA levels of key inflammation-related genes and similarly reduce levels of different pro-inflammatory cytokines3.Objectives:We evaluated the impact of caffeine consumption on SLE-related disease phenotype and activity, in terms of clinimetric assessment and cytokines levels.Methods:We performed a cross-sectional study, enrolling consecutive patients and reporting their clinical and laboratory data. Disease activity was assessed by SLE Disease Activity Index 2000 (SLEDAI-2k)4. Caffeine intake was evaluated by a 7-day food frequency questionnaire, including all the main sources of caffeine. As previously reported, patients were divided in four groups according to the daily caffeine intake: <29.1 mg/day (group 1), 29.2-153.7 mg/day (group 2), 153.8-376.5 mg/day (group 3) and >376.6 mg/day (group 4)5. At the end of questionnaire filling, blood samples were collected from each patient to assess cytokines levels. These were assessed by using a panel by Bio-Plex assays to measure the levels of IL-6, IL-10, IL-17, IL-27, IFN-γ, IFN-α and Blys.Results:We enrolled 89 SLE patients (F/M 87/2, median age 46 years, IQR 14; median disease duration 144 months, IQR 150). The median intake of caffeine was 195 mg/day (IQR 160.5). At the time of the enrollment, 8 patients (8.9%) referred a caffeine intake < 29.1 mg/day (group 1), 27 patients (30.3%) between 29.2 and 153.7 mg/day (group 2), 45 patients (51%) between 153.8 and 376.5 mg/day (group 3) and 9 patients (10.1%) >376.6 mg/day (group 4). A negative correlation between the levels of caffeine and disease activity, evaluated with SLEDAI-2K, was observed (p=0.01, r=-0.26). By comparing the four groups, a significant higher prevalence of lupus nephritis, neuropsychiatric involvement, haematological manifestations, hypocomplementemia and anti-dsDNA positivity was observed in patients with less intake of caffeine (figure 1 A-E). Furthermore, patients with less intake of caffeine showed a significant more frequent use of glucocorticoids [group 4: 22.2%,versusgroup 1 (50.0%, p=0.0001), group 2 (55.5%, p=0.0001), group 3 (40.0%, p=0.009)]. Moving on cytokines analysis, a negative correlation between daily caffeine consumption and serum level of IFNγ was found (p=0.03, r=-0.2) (figure 2A); furthermore, patients with more caffeine intake showed significant lower levels of IFNα (p=0.02, figure 2B), IL-17 (p=0.01, figure 2C) and IL-6 (p=0.003, figure 2D).Conclusion:This is the first report demonstrating the impact of caffeine on SLE disease activity status, as demonstrated by the inverse correlation between its intake and both SLEDAI-2k values and cytokines levels. Moreover, in our cohort, patients with less caffeine consumption seems to have a more severe disease phenotype, especially in terms of renal and neuropsychiatric involvement. Our results seem to suggest a possible immunoregulatory dose-dependent effect of caffeine, through the modulation of serum cytokine levels, as already suggested byin vitroanalysis.References:[1]Kaul et alNat. Rev. Dis. Prim.2016; 2. Aronsen et alEurop Joul of Pharm2014; 3. Iris et alClin Immun.2018; 4. Gladman et al J Rheumatol. 2002; 5. Mikuls et alArth Rheum2002Disclosure of Interests:Valeria Orefice: None declared, Fulvia Ceccarelli: None declared, cristiana barbati: None declared, Ramona Lucchetti: None declared, Giulio Olivieri: None declared, enrica cipriano: None declared, Francesco Natalucci: None declared, Carlo Perricone: None declared, Francesca Romana Spinelli Grant/research support from: Pfizer, Consultant of: Novartis, Gilead, Lilly, Sanofi, Celgene, Speakers bureau: Lilly, cristiano alessandri Grant/research support from: Pfizer, Guido Valesini: None declared, Fabrizio Conti Speakers bureau: BMS, Lilly, Abbvie, Pfizer, Sanofi

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