Serum and aqueous humor adiponectin levels correlate with diabetic retinopathy development and progression

Purpose To compare adiponectin (APN) levels in the serum and aqueous humor (AH) and evaluate their association with the development/progression of diabetic retinopathy (DR). Methods Diabetic patients with (group 3; n = 59) and without (group 2; n = 39) DR and age- and sex-matched normal subjects (group 1; n = 35) were compared. Duration of diabetes, body mass index, serum HbA1c, vascular endothelial growth factor (VEGF), APN, pentraxin 3 (PTX3), platelet derived growth factor (PDGF), intercellular adhesion molecule-1 (ICAM-1), and APN were measured and analyzed. Results One hundred and thirty-three participants were included. Compared to patients without diabetes, diabetic patients with DR had significantly elevated average serum APN levels (5.99±3.89 μg/ml versus 3.51±1.44 μg/ml, P = 0.002) and average AH APN levels (10.94±11.74 ng/ml versus 3.65±3.33 ng/ml, P<0.001). Serum APN was significantly correlated with AH APN (R = 0.512, P<0.001) and AH VEGF (R = 0.202, P = 0.020). The log serum APN was significantly correlated with intraocular cytokines, including log APN, log VEGF, log ICAM, log leptin, log PTX3, log PDGF, angiopoietin, C-reactive protein, and interleukins (IL)-5 and IL-10 (P<0.001, P = 0.020, P<0.001, P<0.001, P = 0.001, P<0.001, P = 0.008, P = 0.009, P<0.001, and P = 0.046, respectively). Log serum VEGF showed a significant correlation only with log AH VEGF (P = 0.001). Multivariate logistic analysis was performed to evaluate the association of DR progression and cytokine concentrations; log Serum APN and log AH APN showed good correlation with the DR progression in each model. Conclusions AH APN levels correlated well with DR development and progression. Serum APN could be a better marker for estimating intraocular cytokines, including both intraocular APN and VEGF concentrations in clinical field, than serum VEGF in DR patients.

Hormonal state of breeding bulls after a long winter period of operation in the conditions of the Udmurt Republic

Relevance. The study will help to identify new perspectives in breeding; get new data about the biological processes occurring in the body of animals according to the endogenous hormones of breeding bulls. The hormonal-immunobiological relationship in the body of bulls and their adaptive ability in different climatic conditions is a very important issue today.Methods. The work was performed in a temperate continental climate with a long, snowy winter and warm summer in the conditions of the Udmurt Republic in the period from 2020 to 2021 on breeding bulls (n = 27) of modern breeding at the age of 15–69 months. The state of endogenous hormones testosterone, estradiol, thyroxine and cortisol after a long winter period was studied, depending on the age, breed and selection in the normal physiological functioning of breeding bulls. The average serum values of estradiol — 0.517 nmol/l, testosterone — 25.7 nmol/l, thyroxine — 74.7 nmol/l, cortisol — 420 nmol/l, and their cholesterol precursor at the level of 3.2 nmol/l were established in the blood of breeding bulls located in this region. It was found that, depending on age, there are differences in all the studied indicators, however, there is a reliability for thyroxine and cortisol. The concentration of cortisol by selection significantly differs in imported bulls of European selection from the Netherlands at the level of p > 0.05, which characterizes the presence of a certain stress adaptation factor in this group. In terms of variability, a significant difference between min and max indicators was noted for the concentration of testosterone, which varied between 2.4 nmol/l and 60 nmol/l, indicating the individuality of these hormones in breeding bulls in this region.Results. Based on the data obtained, the need to take these data into account when operating breeding bulls and analyzing sperm products, taking into account the concentration of these hormones, as well as the implementation of appropriate preventive measures, is revealed.

Health Status and Stress in Different Categories of Racing Pigeons

The influence of different stress parameters in racing pigeon flocks, such as the presence of diseases and environmental conditions at the time of the races, were described. A total of 96 racing pigeons from 4 pigeon flocks were examined, and health monitoring was carried out. No helminth eggs and coccidia were found. Trichomonas sp. was confirmed in subclinical form. Paramyxoviruses and avian influenza viruses were not confirmed, but circovirus infections were confirmed in all flocks. Chlamydia psittaci was confirmed in one flock. Blood samples were collected, and HI antibody titers against paramyxoviruses before and 25 days after vaccination were determined. To improve the conditions during racing and the welfare of the pigeons, critical points were studied with regard to stress factors during the active training season. Serum corticosterone levels were measured in the blood serum of four different categories of pigeons from each flock. Corticosterone levels were almost twice as high in pigeons from the category that were active throughout the racing season, including medium- and long-distance racing, compared to the other three categories that were not racing actively. Within five hours of the finish of a race, the average serum corticosterone level was 59.4 nmol/L in the most physically active category. The average serum corticosterone level in this category remained at 37.5 nmol/L one month after the last race.

A screening method to spot biomarkers that may warn of serious events in a chronic disease – illustrated by cardiological CLARICOR trial data

Objectives To develop a crude screening method for detecting biomarkers which frequently exhibit a rise (or fall) in level prior to a serious event (e.g. a stroke) in patients with a chronic disease, signalling that the biomarker may have an alarm-raising or prognostic potential. The subsequent assessment of the marker’s clinical utility requires costly, difficult longitudinal studies. Therefore, initial screening of candidate-biomarkers is desirable. Methods The method exploits a cohort of patients with biomarkers measured at entry and with recording of first serious event during follow-up. Copying those individual records onto a common timeline where a specific event occurs on the same day (Day 0) for all patients, the baseline biomarker level, when plotted against the patient’s entry time on the revised timeline, will have a positive (negative) regression slope if biomarker levels generally rise (decline) the closer one gets to the event. As an example, we study 1,958 placebo-treated patients with stable coronary artery disease followed for nine years in the CLARICOR trial (NCT00121550), examining 11 newer biomarkers. Results Rising average serum levels of cardiac troponin T and of N-terminal pro-B-type natriuretic peptide were seen prior to a fatal cardiovascular outcome. C-reactive protein rose prior to non-cardiovascular death. Glomerular filtration rate, seven lipoproteins, and nine newer cardiological biomarkers did not show convincing changes. Conclusions For early detection of biomarkers with an alarm-raising potential in chronic diseases, we proposed the described easy procedure. Using only baseline biomarker values and clinical course of participants with coronary heart disease, we identified the same cardiovascular biomarkers as those previously found containing prognostic information using longitudinal or survival analysis.

Higher Serum Levels of Lactate Dehydrogenase Before Microsurgery Predict Poor Outcome of Aneurysmal Subarachnoid Hemorrhage

Introduction: We explored whether higher preoperative serum levels of lactate dehydrogenase (LDH) predicted outcome 3 months after surgery in patients with aneurysmal subarachnoid hemorrhage (aSAH) treated using microsurgical clipping in our institution.Methods: Patients with aSAH treated at our institution between 2010 and 2018 were enrolled. The following parameters were recorded: age, sex, smoking and drinking history, medical history, Hunt–Hess and Fisher grades, aneurysm location, aneurysm size, surgical treatment, delayed cerebral ischemia (DCI), intracranial infection, hydrocephalus, pneumonia, and preoperative serum LDH levels within 24 h of aSAH. We investigated whether preoperative serum LDH levels were associated with Hunt–Hess grade, Fisher grade, and functional neurological outcome.Results: In total, 2,054 patients with aSAH were enrolled, 874 of whom were treated using microsurgical clipping. The average serum LDH level (U/L) was significantly lower in the good outcome group (180.096 ± 50.237) than in the poor outcome group (227.554 ± 83.002; p &lt; 0.001). After propensity score matching, the average serum LDH level (U/L) was still lower in the good outcome group (205.356 ± 76.785) than in the poor outcome group (227.119 ± 86.469; p = 0.029). The area under the receiver operating characteristic (ROC) curve was 0.702 (95% confidence interval [CI]: 0.650–0.754; p &lt; 0.001). Based on the ROC curve, the optimal cutoff value for serum LDH levels as a predictor of poor 3-month outcome (modified Rankin Scale score &gt; 2) was 201.5 U/L. The results revealed that Hunt–Hess grade, Fisher grade, DCI, pneumonia, and serum LDH (&gt;201.5 U/L) were significantly associated with poor outcome. After propensity score matching, serum LDH levels &gt; 201.5 U/L were still considered an independent risk factor for poor outcome (odds ratio: 2.426, 95% CI = 1.378–4.271, p = 0.002). Serum LDH levels were associated with Hunt–Hess and Fisher grades and were correlated with functional neurological outcomes (p &lt; 0.001).Conclusions: Our findings showed that higher preoperative serum levels of LDH correlated with Hunt–Hess grade, Fisher grade, and neurological functional outcome, and predicted the outcome of aSAH treated by microsurgical clipping at 3 months, which was involved in the related mechanisms of early brain injury and showed its potential clinical significance in patients with aSAH.

Clinical Study of Palasha Pushpa (Butea Monosperma (Lam.) Kuntze) in the Management of Vatarakta (Gouty arthritis)

Objectives: This study was conducted to evaluate the effectiveness of Palashapushpa churna in the Management of Vatarakta (Gouty Arthritis). Materials and Methods: A single blind clinical trial was conducted at Department of Dravyaguna, Dr.B.R.K.R Govt. Ayurvedic Hospital, Erragadda, Hyderabad. 30 patients were selected and trial drug was advocated in a dose of 3 gm Palashapushpa churna twice a day with water as Anupana. Treatment was given for 45 days with the result assessment recorded at every 15 days. Subjective and objective parameters were analyzed before and after the treatment. In subjective parameters Shula, Daha, Shotha, Raga, Sthabdata are taken, while Serum uric acid levels is considered as objective parameter. Results: Out of 30 patients, Sula, Daha, Shotha, Sthabdata was found in all patients, Raga was found in 6 patients, which suggests the severity of condition. After treatment it was observed that Sula is found to be relieved by 93.33% of patients, Daha and Shotha is found to be relieved by 60%, Raga is found to be relieved by20% of patients, Sandhi stabdata is found to be relieved by 80% of patients . It is observed that Sandhi shula and Sandhi sthabdata was got good relief, Sandhi daha and Sandhi shotha was got moderate relief. Sandhi raga was got mild relief. The average serum uric acid levels in the patients of Vatarakta before the treatment is 2.13 after the treatment with administration of Palashapushpa churna orally it was brought down to the average of 1.13. The average decrease in the levels of uric acid with highly significant (P<0.001). Conclusion: Palasha pushpa churna prepared as per the textual standards is highly effective in Vatarakta and showing a way out to the individual suffering from this chronic disease. The study confirmed the effect of trial drug in Vatarakta (Gouty arthritis) in improving the quality of life of patients without any untoward effects.

P–128 Audit of testicular sperm in assisted conception for non-azoospermic infertile couples

Study question What live birth rate do we see when we use testicular sperm in ART for non-azoospermic couples after at least one previous failed cycle? Summary answer In our cohort of couples 24% had a live birth using testicular sperm and therefore was not higher than national average ART rates. What is known already There is increased interest in using testicular sperm in assisted reproduction technology (ART) to improve outcomes after previous failed cycles. Mehta et al. reported results of a 50% live birth rate using testicular sperm in the first cycle for couples with oligospermia and a history of failed cycles with ejaculated sperm. We aim to audit our results in a similar population of couples. Study design, size, duration St Peters Andrology Centre in London, United Kingdom completed 128 surgical testicular sperm retrievals reviewed between the two-year period of 2018–2019. We conducted a retrospective audit of their paper-based records to identify those couples with injectable sperm on their semen analysis and who had previous cycles attempts using ejaculated sperm. Participants/materials, setting, methods We identified 27 couples who underwent testicular sperm extraction despite having an ejaculated semen analysis with injectable sperm and at least one previous failed cycle. A systematic review of their paper and electronic medical record was conducted to assess live birth rates and fertilization rates from ART. Main results and the role of chance Couples had an average male age of 41 (range 31–60) and an average female age of 38 (range 30–45). The men had an average serum testosterone of 15 nmol/L (range 8–35 nmol/L) and an average serum FSH of 8.9 IU/L (range 1.7–30 IU/L). 59% (n = 17) of men had a DNA fragmentation index completed with an average score of 41% (range 31%–51[Y1]%). In the women the mean serum anti-Müllerian hormone (AMH) was 15.8 pmol/l (range 1–64 pmol/l). With ejaculated sperm the fertilization rate was 59% (95% CI [27%, 59%]) and blastocyst conversion rate was 43% (95% CI [50%, 69%]). There was no statistical significance with testicular sperm where the fertilization rate was 58% (95% CI [51%, 65%]) and blastocyst conversion rate was 54% (95% CI [40%, 67%]). Overall, there were 7 clinical pregnancies in this population of couples. Of these clinical pregnancies, 2 miscarried and 5 progressed to a live birth. This audit yielded a live birth rate per cycle of 15% and a live birth rate per couple of 24%. Limitations, reasons for caution Limitations of the study are low number of patients and absence of a control group. Wider implications of the findings: We recommend caution and further analysis going forward using testicular sperm in ART where ejaculated sperm in available. Trial registration number Not applicable

Stress-response during the Nuss procedure under the combination of general anesthesia with different regional blocks

The perioperative stress-response is a dynamic process under the influence of patient-specific, surgical and anaesthesiologic factors. Purpose – to evaluate stress response during the correction of pectus excavatum by Nuss under the combination of general anesthesia with different variants of the regional block. Materials and methods. The observative prospective study included 60 adolescents (boys/girls=47/13) undergone Nuss procedure under the combination of general anesthesia and regional blocks. The patients were randomized into three groups (n=20 in each) according to the perioperative regional analgesia technique: standard epidural anesthesia (SEA) in Th5–Th8, high epidural anesthesia (HEA) in Th2–Th3, and bilateral paravertebral anesthesia (PVA) in Th5–Th8. The serum cortisol and glycemia were analyzed at three stages: 1 – baseline before surgery, 2 – during bar rotation, and 3 – after surgery finished. Results. The average serum cortisol level among all patients before surgery was 342.4 [282.1–415.0] nmol/L. At stage 2 the plasma cortisol decreased up to 223.1 [174.9–282.3] nmol/L (p<0.000001). After the surgery and anesthesia finished the average plasma cortisol was 279.6 [216.7–312.6] nmol/L (p<0.000001 vs baseline). During surgery serum cortisol decreased in group SEA by 41%, in group HEA – by 30%, and in group PVA – by 31% compared with baseline levels. After surgery, the serum cortisol was lower than baseline measurements in group SEA by 28%, in group HEA – by 20%, and in group PVA – by 26%. The average baseline glycemia among all patients before surgery was 4.62 [4.01–5.05] mmol/L. At stage 2 glycemia decreased significantly up to 4.05 [3.86–4.62] mmol/L (p=0.00018). After the surgery finished the average serum glucose among all patients was 4.24 [4.09–4.99] mmol/L (p=0.7). At stage 2 serum glucose decreased in group SEA by 11%, in groups HEA and PVA – by 5% compared with the baseline level. The dynamics of serum cortisol and glycemia were similar in all groups with statistically insignificant intergroup differences at all three stages. Conclusions. Serum cortisol and glycemia during the Nuss procedure under the combination of general anesthesia with regional blocks decreased significantly. After surgery finished glycemia returned to baseline level, but serum cortisol was lower than baseline measurement. The changes in serum cortisol and glycemia were more pronounced in patients under standard epidural analgesia in Th5–Th8 compared with the high epidural in Th2–Th3 and paravertebral blocks. The study was conducted in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the institution. Informed consent of parents and children was obtained for the study. The author declares no conflict of interest. Key words: cortisol, glycaemia, pectus excavatum, Nuss procedure, regional anaesthesia.

Risk Factors and Types of Presenile Cataract in Patients Attending a Tertiary Care Hospital in Kerala- A Retrospective Study

Background: Cataract is a major cause of blindness worldwide with a greater prevalence in developing countries like India. Presenile cataract refers to an onset of this disease below 50 years of age. Objectives: To study the factors associated with development of presenile cataract among the total cataract patients who attended out-patient clinic of Ophthalmology department from January 2016 to July 2017 and to find out the proportion of different types of presenile cataract. Method: The study includes patients who had undergone cataract surgery in the Department of Ophthalmology Government Medical College, Ernakulam from January 2016 and June 2017. Data was retrospectively entered and analysed. Results: There were 100 (49 males and 51 females) patients between the age 30 and 50 years. Around 70 study participants had co-morbidities. The average axial length was 22.5532mm, the average haemoglobin content was 13.01 g/dL, average total count was 8590.85, average BL urea was 22.755 mg/dL, average serum creatinine concentration was 0.9611 mg/dL and average GRBS concentration was 131.43 mg/dL. Drug history of 69 patients was observed in the current study. Conclusion: The most common type of cataract seen was posterior subcapsular cataract followed by mature cataract. Diabetes mellitus was the predominant risk factor in posterior subcapsular cataract. Keywords: Presenile cataract; Risk factors; Posterior subcapsular cataract.

AB0728 OSTEOGENESIS IMPERFECTA: ABOUT 12 CASES

Background:Osteogenesis imperfecta (OI), is a rare hereditary disease characterized by bone fragility and low bone mass. The clinical presenatation is various with varying severity skeletal signs and inconstant extra-skeletal signs. Type 1 is the most common form (60% of cases).Objectives:Our objective is to describe the various clinical features observed over a period of 15 years.Methods:This is a retrospective descriptive study including 12 patients followed for OI, hospitalized in the Rheumatology Department at Fattouma Bourguiba Hospital Monastir TUNISIA between 2006 and 2019. Files were collected and analyzed.Results:They are 9 boys and 3 girls with an average age of 14.9 ± 8.6 years. Consanguinity was reported in 25% of cases. The reason leading to consultation was, recurrent fractures (75%), blue sclera (16.7), and bone deformity (8.3%). The number of previous fractures was on average of 5, all of which were caused by a low energy trauma. Similar family cases were noted in 41.6%. The mean age of the first fracture was 4.41 ± 3.2 years. The most frequent fracture sites were respectively: femur (7/12), leg (6/12), tibia (3/12), humerus (4/12), ankle (2/12), and forearm (2/12). A deformity was noted in 58.3% of the cases: lumbar kyphosis (2), exaggerated dorsal kyphosis (2), femurs in parenthesis (2), and an anarchic deformity of 2 lower limbs (1). Imperfect dentinogenesis was found in 8.3% of cases, while ENT examination revealed conductive and sensorineural hearing loss in 2 patients each. The main radiological abnormalities were diffuse bone demineralization (9 patients), cortical thinning (5 patients), vertebral compression (3 patients), and fracture (2 patients). The bone densitometry showed a mean Z score of 3.49±1.4 in the lumbar spine. The average serum calcium level was 2.38±1.15, alkaline phosphatases were elevated in all cases with an average of 756±624.9. The vitamin D level was deficient in all cases with an average of 22.75±5.3. All patients received in addition to the vitamin-calcium supplementation, pamidronate intravenously at a dose of 9mg/kg/year with a mean number of 6 cures. The main side effects observed during the infusion were abdominal pain, polyarthralgia and asthenia (1 patient), chest pain (1 patient) and fever and chills (1 patient). The control bone densitometry showed a mean Z score of 1.81±1.2 in the lumbar spine.Conclusion:Despite advances in the OI diagnosis and treatment, more research is needed. Bisphosphonate treatment decreases long-bone fracture rates, but such fractures are still frequent. New antiresorptive and anabolic agents are being investigated but efficacy and safety of these drugs, especially in children, need to be better established before they can be used in clinical practice.References:[1]https://doi.org/10.1097/med.0000000000000367Disclosure of Interests:None declared