Serum copper decrease and cerebellar atrophy in patients with nitrous oxide-induced subacute combined degeneration: two cases report

Background Subacute combined degeneration (SCD) is a neurological complication commonly associated with vitamin B12 deficiency. It can result from nitrous oxide (N2O) abuse and cause neuropsychiatric symptoms. However, there has been no literature regarding alterations of serum copper and cerebellum in SCD patients. Case presentation We reported two cases of young SCD patients with histories of N2O abuse. In these cases, elevated homocysteine, macrocytic anemia, spinal cord abnormalities, and peripheral nerve injuries were detected. In addition, decreased serum copper level and cerebellar atrophy were reported for the first time. The patients’ symptoms improved after withdrawal of N2O exposure and vitamin B12 supplements. Conclusion We reported two SCD cases with serum copper alteration and cerebellar atrophy after N2O abuse for the first time. These might be crucial complements to the diagnosis of SCD.

Establishment and Validation of Prognostic Nomograms Based on Serum Copper Level for Patients With Early-Stage Triple-Negative Breast Cancer

Background: Altered copper levels have been observed in several cancers, but studies on the relationship between serum copper and early-stage triple-negative breast cancer (TNBC) remain scare. We sought to establish a predictive model incorporating serum copper levels for individualized survival predictions.Methods: We retrospectively analyzed clinicopathological information and baseline peripheric blood samples of patients diagnosed with early-stage TNBC between September 2005 and October 2016 at Sun Yat-sen University Cancer Center. The optimal cut-off point of serum copper level was determined using maximally selected log-rank statistics. Kaplan-Meier curves were used to estimate survival probabilities. Independent prognostic indicators associated with survival were identified using multivariate Cox regression analysis, and subsequently, prognostic nomograms were established to predict individualized disease-free survival (DFS) and overall survival (OS). The nomograms were validated in a separate cohort of 86 patients from the original randomized clinical trial SYSUCC-001 (SYSUCC-001 cohort).Results: 350 patients were eligible in this study, including 264 in the training cohort and 86 in the SYSUCC-001 cohort. An optimal cut-off value of 21.3 μmol/L of serum copper was determined to maximally divide patients into low- and high-copper groups. After a median follow-up of 87.1 months, patients with high copper levels had significantly worse DFS (p = 0.002) and OS (p < 0.001) than those with low copper levels in the training cohort. Multivariate Cox regression analysis revealed that serum copper level was an independent factor for DFS and OS. Further, prognostic models based on serum copper were established for individualized predictions. These models showed excellent discrimination [C-index for DFS: 0.689, 95% confidence interval (CI): 0.621–0.757; C-index for OS: 0.728, 95% CI: 0.654–0.802] and predictive calibration, and were validated in the SYSUCC-001 cohort.Conclusion: Serum copper level is a potential predictive biomarker for patients with early-stage TNBC. Predictive nomograms based on serum copper might be served as a practical tool for individualized prognostication.

Study on serum zinc and copper levels in pulmonary tuberculosis patients before starting Directly Observed Treatment, Short-course

Background: Tuberculosis is a major public health concern throughout the world including Bangladesh. The prevalence of tuberculosis (TB) is increasing day by day. Around one-third of world population is infected with M. tuberculosis. Still pulmonary tuberculosis (PTB) remains one of the important causes of mortality throughout the world with economic burden. Objective: To evaluate levels of the serum zinc and serum copper in smear positive PTB patients before starting Directly Observed Treatment, Short-course (DOTs) therapy. Methods: This was a cross-sectional type of observational study. A total of 100 subjects were included in this study. Among them 50 were smear positive PTB patients denoted as case group and 50 were apparently healthy individuals denoted as control group. Biochemical tests were carried out in the department of biochemistry of Mymensingh Medical College, Mymensingh. All the statistical analyses were performed by using SPSS version 21. Results were evaluated by using Student’s t-test. Results: After careful evaluation there was significant decrease in serum zinc level along with significant increase in serum copper level among the case group when compared with the control group. The mean values of serum zinc level were 93.96±10.04 μg/dl and 72.84±7.73 μg/dl in control and case group respectively. Serum zinc level decreased significantly (p <0.001) in PTB patients. The mean values of serum copper were 111.81±21.26 μg/dl and 125.99±27.93 μg/dl in control and case group respectively. There was significant (p <0.001) rise of serum copper level in PTB patients. Mediscope 2021;8(2): 122-127

Association of Serum Magnesium, Copper and Zinc with Severity of Coronary Artery Disease – A Cross-Sectional Study from Salem, India

BACKGROUND Coronary artery disease (CAD) remains the principal cause of death and disability in both developed and developing countries. Factors that cause endothelial dysfunction have received increased attention as a potential contributor for atherogenesis. Micronutrients play an important role in maintaining endothelial function as it act as cofactors for number of enzymes. The purpose of this study was to determine plasma level of copper, zinc and magnesium in CAD patients and its correlation with severity of coronary artery disease. METHODS Study group consisted of angiographically positive CAD patients (n = 30) and age and sex matched controls (n = 30). Severity of the CAD was assessed based on the number, location and percentage of stenosis of coronary vessels involved and SYNTAX score was calculated. CAD patients were classified into grade I, II and III based on SYNTAX score. Level of copper, zinc and magnesium in plasma and hemolysate was analysed using atomic absorption spectrometry. Plasma nitric oxide level was also analysed. RESULTS In our study, Plasma copper level was found to be significantly high and zinc copper ratio, hemolysate Mg level were found to be significantly low in CAD patients. The latter parameters were found to have a significant negative correlation with severity of the diseases and with the level of nitric oxide. CONCLUSIONS Even though a number of confounding factors can influence the copper, zinc and magnesium levels in the body, our study shows that levels of these elements have a significant association with severity of coronary artery diseases. KEY WORDS Coronary Artery Disease, Endothelial Dysfunction, Syntax Score

Case Report: Using basic liver function tests as a guide to suspected Wilson’s disease

We present a case of a 36-year-old female patient who presented with subacute liver disease with a history of alcohol abuse. On basic liver function tests (LFT), she had aspartate transaminase / alanine transaminase > 2.2 and alkaline phosphatase / total bilirubin < 4. This pattern in acute liver failure patients signifies Wilson’s disease. Its presence in our patient with subacute liver disease also prompted us to suspect Wilson’s disease and we extended the liver disease screen to include slit lamp eye examination for Kayser-Fleischer rings, serum ceruloplasmin and 24-hour urinary copper level, which led to the diagnosis. She improved clinically and biochemically with zinc acetate therapy. As screening for rare diseases is not always possible in low-income countries, this case demonstrates the usefulness of the basic LFT as a guide for suspecting Wilson’s disease in patients with liver disease.

Serum Copper Level and Polycystic Ovarian Syndrome: A Meta-Analysis

<b><i>Introduction:</i></b> The association of serum copper with polycystic ovarian syndrome (PCOS) has been studied for years, but no definite conclusion is drawn. Therefore, we conducted a meta-analysis to investigate serum copper concentrations in PCOS subjects compared with healthy controls. <b><i>Methods:</i></b> Electronic search was performed in PubMed, Google Scholar, and Scopus up to June 30, 2020, without any restriction. Standardized mean differences (SMDs) with corresponding 95% CIs in serum copper levels were employed with random-effects model. <i>I</i>² was applied to evaluate heterogeneity among studies. <b><i>Results:</i></b> Nine studies, measuring plasma copper levels in 1,168 PCOS patients and 1,106 controls, were included. Pooled effect size suggested serum copper level was significantly higher in women with PCOS (SMD = 0.51 μg/mL, 95% CI = [0.30, 0.72], <i>p</i> &#x3c; 0.0001). The overall heterogeneity was not connected with subgroups of the country, but derived from the opposite result of 1 study. <b><i>Conclusion:</i></b> Our research generally indicated circulating copper level in PCOS sufferers was significantly higher than normal controls. Large-scale studies are still needed to elucidate the clear relation between copper status and etiology of PCOS.

Comprehensive assessment of certain trace elements, hormones and enzymes in patients with exogenous-constitutional obesity in predicting transition to metabolic syndrome

Aim. To study the relationship between the trace element status (chromium, zinc and copper) and hormonal activity (insulin, leptin) in women with metabolically healthy and unhealthy obesity phenotypes, depending on the type and severity of obesity. Methods. A cross-sectional study was conducted to compare 288 women with exogenous-constitutional obesity aged 2545 years and healthy women of similar age (n=38). The comparative analysis was carried out in groups of patients with android and gynoid ECO types and varying degrees of obesity. The study was conducted in the NUZ Department Clinical Hospital of the Kazan station of JSC Russian Railways between 2016 and 2020. Along with clinical laboratory tests, the indicators of carbohydrate and lipid metabolism (including the determination of hormones), the activity of enzyme systems and trace element content were determined. The statistical significance of the differences was assessed by using the non-parametric Spearman's rank correlation test. Results. It was revealed that the type of obesity associated with the indicators of lipid and carbohydrate metabolism, the activities of catalase and peroxidase, and trace element content. In patients with abdominal obesity, the concentration of copper was higher than in the comparison group, and chromium and zinc lower than in patients with gynoid obesity and in the control group. In patients with android obesity, a high correlation was found between the serum copper level (r=0.98) and body fat percentage (r=0.74) compared with patients with gynoid type obesity. The correlation of chromium level with the level of blood glucose (r=0.58), triglycerides (r=0.66), cholesterol (r=0.60) and catalase enzyme activity (r=0.54) as well as correlation of zinc level with the level of blood glucose (r=0.74), cholesterol (r=0.77), triglycerides (r=0.90), catalase (r=0.57), and peroxidase (r=0.59) were revealed. Also, significant differences in the level of trace elements in patients with varying degrees of obesity were found. Conclusion. An increase in copper concentration and a decrease in the concentration of chromium and zinc are unfavorable signs in obese patients associated with the activation of oxidative stress, hyperplastic processes and a high risk of developing a metabolic syndrome.

Evaluation of Copper Status and Some Red Cell Parameters of Pregnant Women in Enugu State, South Eastern Nigeria

Copper is an essential trace mineral (micronutrient) that is naturally present in some foods and is available as a dietary supplement. Pregnancy, also known as gestation, is the time during which one or more offspring develops inside a woman.This study was desiged to assay the copper level of pregnant women in urban area and to evaluate the effect of the obtained valves on some blood parameters of the pregnant women. In this study, a total of 100 subjects and 50 controls was used. subjects were pregnant women while the controls were non-pregnant women. The copper level in subject was assayed with a serum copper test kit using automation with Bio E-lab fully automated chemistry analyzer and result of the complete blood count was gotten using Mindray Hematology analyzer. The mean for subjects (M=102.83±1.38) and control (M=102.68±0.94), p = 0.71. These results suggest that the difference between the copper level for subjects and controls is not really much.. The variables copper level and MCV were found to be slightly correlated, r(150) = ..018., p > .005. Additionally, copper levels in the subjects was also found to negatively correlated with MCH, r(150) = .907, p > .005. One-way analysis of variance showed that the correlation of copper levels was not significant on all of the red bloodcell parameters in the serum of the pregnant women.

Spontaneously Occurring Chronic Copper Toxicosis in Pattanam Breed of Sheep

Background: Copper (Cu), an essential trace element, is toxic if consumed in excessive amounts. Ruminants, particularly sheep, are highly susceptible to chronic copper poisoning and cause acute death. Spontaneous copper poisoning in sheep was reported from many parts of the world however limited reports are available from India. Hence the present investigation was undertaken to report the occurrence of chronic copper poisoning in an intensively maintained Pattanam breed of sheep flock and its therapeutic management. Methods: An investigation was carried out to ascertain the possible cause of increased mortality in an intensively maintained 130 male lambs aged between 8 to 10 month old belongs to Pattanam breed during the month of September 2020 following death of 21 animals within a period of 15 days. Affected flock was inspected and samples were collected for biochemical analysis, toxicological, bacteriological and pathological examination.Result: Affected animals showed depression, anorexia, jaundice, hemoglobinurea and accelerated breathing. At necropsy, the dead animals showed generalized icterus, lung edema, yellow to orange coloured liver and gun metal kidney. Histopathological lesions include lung edema, centrilobular hepatic necrosis, bile stasis, renal tubular necrosis and formation of tubular cast. Toxicological analysis of liver revealed the copper level of 781 mg/kg dry matter basis. Source of copper was identified as a commercial mineral mixture supplement intended for cattle was supplemented along with concentrate feed. The flock was treated with chelating agent (D-penicllamine) and supportive therapies.

Nursing piglet ionomics-metabolome responses to different dietary copper levels in antibiotic-free creep feed

Background: Ionomics is a novel method to investigate the mechanism underlying the cross-talk and homeostasis of trace elements in animals. Research has not yet determined the composition and distribution of trace elements in piglets and their variations under diverse dietary high-level copper. Results: In this study, the growth performance was calculated from 180 nursing piglets which access to antibiotic-free creep feed including different copper level: 6, 20, and 300 mg·kg-1 Cu (CuSO4), and offered ad libitum from d 14 until weaning at 40 days of age. In HC (300 mg·kg-1 Cu ) group, the average daily gain (ADG) and average daily feed intake (ADFI) increased during d 14 to 28, but ADG was decreased with extension of feeding time (d 29 to 40). The ionomics profiles (hair, serum, and feces) and the correlations with serum and fecal metabolites were further analyzed. The hair Na, K, Cu, and fecal Cu concentrations were increased in HC group than other groups. The hair Na and K were negatively correlated with serum TNF-α and fecal inosine, while positively correlated with serum insulin-like growth factors-1 (IGF-1); the hair Cu was negatively correlated with serum malondialdehyde (MDA), total bile acid (TBA) and fecal putrescine, glucose-6-phosphate, fumaric acid; the fecal Cu was positively correlated with serum growth hormone, negatively correlated with fecal methionine, pantothenic acid, and uracil. Further metabolic pathway enrichment analysis showed that the hair Cu was negatively correlated with phenylalanine and tyrosine metabolism and mitochondrial electron transport chain pathways; fecal Cu was negatively correlated with betaine metabolism, and pantothenate, and CoA biosynthesis pathways. Conclusions: Dietary 300 mg·kg-1 copper promoted growth in the short term, and altered the ion balance, further affected the metabolic homeostasis, harm to the health of piglets; dietary 20 mg·kg-1 copper maintain ion homeostasis due to preservation of the interactions between macro and micro elements and suitable to meet the nutritional needs of nursing piglets. These results may benefit people to understand the molecular mechanism of ionomics effects on human and piglets’ health.