Significance of Levothyroxine Treatment on Serum Lipid in Pregnant Women With Subclinical Hypothyroidism

BackgroundThere is no consensus reference range for serum lipid levels during pregnancy. The benefit of levothyroxine (L-T4) on serum lipid levels are unclear among pregnant women with subclinical hypothyroidism (SCH).ObjectiveTo determine the recommended reference ranges for serum lipid concentrations during pregnancy and effects of L-T4 treatment on serum lipids in pregnant women with SCH. Designcohort study.MethodsA analysis of 20365 women in the first trimester was conducted at Beijing Obstetrics and Gynecology Hospital, Capital Medical University during 2018–2020. After excluding women with adverse pregnancy outcomes, we determined the reference range of serum lipid in the first and third trimesters of pregnancy by using median and quartile to determine appropriate percentiles. Next, we divided into three groups as follows: SCH L-T4 treatment group (n=319), SCH non-intervention group (n=103) and the control group(n=9598).ResultsThe recommended reference range for serum lipids in the first trimester of pregnancy should be: TC < 5.33 mmol/L, TG < 1.73 mmol/L, LDL-C < 3.12 mmol/L and HDL-C> 1.1 mmol/L, and in third trimester of pregnancy should be: TC < 8.47 mmol/L, TG < 4.86 mmol/L, LDL-C < 5.3 mmol/L and HDL-C >1.34 mmol/L.There are significant differences in TC and LDL-C levels between SCH treatment group and SCH non-intervention Group (P=0.043, P=0.046; respectively).ConclusionsWe determine the recommended reference ranges for serum lipid concentrations during pregnancy. TC and LDL-C levels in pregnant women with SCH could improve after L-T4 treatment.

Organophosphate poisoning from inappropriate topical use of malathion pesticide: A case report

A 43-year-old male with no past medical history presented to our emergency department with vomiting, diarrhea, and abdominal pain of 3 h’ duration. Upon further questioning, he revealed that he had been applying malathion pesticide over his body for the past 3 days for self-diagnosed scabies. He was otherwise afebrile and hemodynamically stable, and the physical examination was unremarkable. The patient was diagnosed with organophosphate poisoning and treated symptomatically due to the lack of worrying cardiorespiratory or neurologic sequelae. He was subsequently admitted to the general ward, where his symptoms abated within 4 h. Serum and red blood cell cholinesterase tests sent on admission returned on day three and were significantly decreased (serum cholinesterase 2131 U/L, reference range 4700–12000 U/L; red blood cell cholinesterase 3365 U/L, reference range 7700–14600 U/L). He was discharged home well and stable on day 5 of admission, with outpatient psychiatric follow-up for likely delusional parasitosis.

Physical Performance and Non-Esterified Fatty Acids in Men and Women after Transcatheter Aortic Valve Implantation (TAVI)

Background: Men and women with valvular heart disease have different risk profiles for clinical endpoints. Non-esterified fatty acids (NEFA) are possibly involved in cardio-metabolic disease. However, it is unclear whether NEFA concentrations are associated with physical performance in patients undergoing transcatheter aortic valve implantation (TAVI) and whether there are sex-specific effects. Methods: To test the hypothesis that NEFA concentration is associated with sex-specific physical performance, we prospectively analysed data from one hundred adult patients undergoing TAVI. NEFA concentrations, physical performance and anthropometric parameters were measured before and 6 and 12 months after TAVI. Physical performance was determined by a six-minute walking test (6-MWT) and self-reported weekly bicycle riding time. Results: Before TAVI, NEFA concentrations were higher in patients (44 women, 56 men) compared to the normal population. Median NEFA concentrations at 6 and 12 months after TAVI were within the reference range reported in the normal population in men but not women. Men but not women presented with an increased performance in the 6-MWT over time (p = 0.026, p = 0.142, respectively). Additionally, men showed an increased ability to ride a bicycle after TAVI compared to before TAVI (p = 0.034). NEFA concentrations before TAVI correlated with the 6-MWT before TAVI in women (Spearman’s rho −0.552; p = 0.001) but not in men (Spearman’s rho −0.007; p = 0.964). No association was found between NEFA concentrations and physical performance 6 and 12 months after TAVI. Conclusions: NEFA concentrations improved into the reference range in men but not women after TAVI. Men but not women have an increased physical performance after TAVI. No association between NEFA and physical performance was observed in men and women after TAVI.

Successful Outpatient Management of Severe Ionized Hypercalcemia Secondary to Cholecalciferol Ingestion in a Puppy

ABSTRACT A 4 mo old female intact boxer was presented because of polyuria, lethargy, and vomiting after ingestion of cholecalciferol rodenticide roughly 3 days prior. Blood work revealed an ionized hypercalcemia 2.23 mmol/L (reference range 1.04–1.33 mmol/L) on presentation. Because of financial limitations, the patient was unable to be hospitalized for standard of care. She was treated with a pamidronate infusion and discharged with medical management to include oral prednisone, furosemide, and subcutaneous fluids. The dog’s signs, body weight, and biochemical parameters were serially monitored over 3 wk as the ionized hypercalcemia resolved. To the authors’ knowledge, this is the first published report documenting a successful outpatient medical protocol for potentially life-threatening hypercalcemia secondary to cholecalciferol toxicosis in a puppy.

Does foetal gender influence maternal thyroid parameters in pregnancy?

Objective It is unknown if foetal gender influences maternal thyroid function during pregnancy. We therefore investigated the prevalence of thyroid disorders and determined first-trimester TSH reference ranges according to gender. Methods A cross-sectional study involving 1663 women with an ongoing pregnancy was conducted. Twin and assisted pregnancies and l-thyroxine or antithyroid treatment before pregnancy were exclusion criteria. Serum TSH, free T4 (FT4) and thyroid peroxidase antibodies (TPOAb) were measured at median (interquartile range; IQR) 13 (11–17) weeks of gestation. Subclinical hypothyroidism (SCH) was present when serum TSH levels were >3.74 mIU/L with normal FT4 levels (10.29–18.02 pmol/L), and thyroid autoimmunity (TAI) was present when TPOAb were ≥60 kIU/L. Results Eight hundred and forty-seven women were pregnant with a female foetus (FF) and 816 with a male foetus (MF). In women without TAI and during the gestational age period between 9 and 13 weeks (with presumed high-serum hCG levels), median (IQR range) serum TSH in the FF group was lower than that in the MF group: 1.13 (0.72–1.74) vs 1.24 (0.71–1.98) mIU/L; P = 0.021. First-trimester gender-specific TSH reference range was 0.03–3.53 mIU/L in the FF group and 0.03–3.89 mIU/L in the MF group. The prevalence of SCH and TAI was comparable between the FF and MF group: 4.4% vs 5.4%; P = 0.345 and 4.9% vs 7.5%; P = 0.079, respectively. Conclusions Women pregnant with an MF have slightly but significantly higher TSH levels and a higher upper limit of the first-trimester TSH reference range, compared with pregnancies with a FF. We hypothesise that this difference may be related to higher hCG levels in women pregnant with a FF, although we were unable to measure hCG in this study. Further studies are required to investigate if this difference has any clinical relevance.

Proposal of the Measurement Conditions for Hanji–Determination Folding Endurance

This study aims to optimize the measurement conditions of handmade Hanji paper to reduce the time required for measurement while meeting folding endurance standards, for various basis weights. Thirteen types were selected, including 12 types of Hanji with grammages of 17 g/m2, 30 g/m2, and 45 g/m2, and one type of 75 g/m2 copy paper, and 24 sheets were prepared in the laid and chain directions. Subsequently, folding endurance experiments at different load (14.72 N, 9.81 N, 4.91 N) and specimen width conditions (15 mm, 10 mm, 5 mm) were performed, using a 4-MIT folding endurance tester. The results showed that, for specimen widths of 15 mm and 10 mm under a load of 4.91 N, the folding endurance falls within the reference range (10∼10000 times). In particular, reduced folding endurance range and measurement time were observed at a width of 10 mm under a load of 4.91 N. Moreover, the endurance trend lines based on the average values of load and specimen width ranges enabled the prediction of the folding endurance within those ranges, according to the decreasing slope. Furthermore, for a specimen width of 15 mm under a load of 4.91 N, the folding endurance in the comparison group (35 to 17723 times) significantly exceeds the upper limit of the reference range (10∼10000 times). Therefore, the measurement conditions of 4.91 N with a specimen width of 10 mm are proposed.

Methods of objectivization of characteristics of cerebrospinal fluid and examples of their use

BACKGROUND: In modern research standards, a semi-quantitative evaluation scale with crosses is used to characterize turbid cerebrospinal fluid samples, where the absence of turbidity is evaluated as a clear cerebrospinal fluid (a variant of norm), and turbidity is evaluated, depending on the severity, by a different number of crosses. This approach is highly subjective. AIM: Development of a simple objective method for assessment of turbidity of the cerebrospinal fluid. MATERIALS AND METHODS: The optimal wavelength was determined by examination of the optical density of turbid samples of barium sulfate at various wavelengths on Stat Fax photometer (Awarenes, USA). Turbidity was standardized using Shank–Hoagland scale. The reference range was evaluated based on the results of 10 measurements of 10 samples of visually unchanged cerebrospinal fluid. At the same time, the stability and reproducibility of the measured parameters were evaluated. RESULTS: The optimal wavelength diabase is the range emitted by red light filter (λ = 670 nm). Stability of cerebrospinal fluid parameters is preserved for 2 hours after its obtaining. The reference range for normal cerebrospinal fluid samples does not exceed 0.1 units of turbidity on Shank–Hoagland scale. CONCLUSION: The presented methods demonstrate the importance and possibilities of objectivization of characterization of the properties of cerebrospinal fluid with use of the proposed method.

Assessing the haematology and serum chemistry of Uda rams fed different Kanwa based mineral licks

This study was conducted at the Department of Animal Science’s Teaching and Research farm of Usmanu Danfodiyo University, Sokoto to evaluate the effect of feeding different kanwa based mineral licks on blood profile of Uda rams. Blood of twenty (20) yearlings Uda rams aged by dentition were used to evaluate the effect of Kanwa¬-based mineral blocks. Four (4) animals were allotted to each treatment (Kanwa block) with each animal serving as a replicate. The Kanwa used were Kanwan Bai-Bai, Kanwan Kolo, Hogga, Balma and conventional mineral lick to represent treatment 1, 2, 3, 4 and 5 respectively. Data was collected at the end of the experiment. The result of haematological analysis showed significant (p<0.05) differences in all the parameters analysed except PCV, MCH, WBC and eosinophil; the result indicated that all the values where within the normal reference range except in MCHC where animals placed in T2 and T3 shows values slightly above the normal range. The result of serum biochemistry showed that all the values measured were within the normal reference range for sheep except the albumin of animals placed in T3 which had values slightly above the normal range. The serum mineral composition showed that Potassium levels were higher in T2 and lower in T4; however, there was no difference between animals placed in treatments 1, 2 and 3, so also between treatments 1, 3 and 4. The study concluded that Kanwa positively affected sheep production with no adverse effect on both haematological and serum chemistry, hence little health hazard is associated with feeding Kanwa-based blocks on growing Uda rams.

Triage Strategies Based on C-Reactive Protein Levels and SARS-CoV-2 Tests among Individuals Referred with Suspected COVID-19: A Prospective Cohort Study

C-reactive protein (CRP) has prognostic value in hospitalized patients with COVID-19; the importance of CRP in pre-hospitalized patients remains to be tested. Methods: Individuals with symptoms of COVID-19 had a SARS-CoV-2 PCR oropharyngeal swab test, and a measurement of CRP was performed at baseline, with an upper reference range of 10 mg/L. After 28 days, information about possible admissions, oxygen treatments, transfers to the ICU, or deaths was obtained from the patient files. Using logistic regression, the prognostic value of the CRP and SARS-CoV-2 test results was evaluated. Results: Among the 1006 patients included, the SARS-CoV-2 PCR test was positive in 59, and the CRP level was elevated (>10 mg/L) in 131. In total, 59 patients were hospitalized, only 3 of whom were SARS-CoV-2 positive, with elevated CRP (n = 2) and normal CRP (n = 1). The probability of being hospitalized with elevated CRP was 4.21 (95%CI 2.38–7.43, p < 0.0001), while the probability of being hospitalized with SARS-CoV-2 positivity alone was 0.85 (95%CI 0.26–2.81, p = 0.79). Conclusions: CRP is not a reliable predictor for the course of SARS-CoV-2 infection in pre-hospitalized patients. CRP, while not a SARS-CoV-2 positive test, had prognostic value in the total population of patients presenting with COVID-19-related symptoms.