The relationship between long-term blood pressure variability and cortical thickness in older adults

High blood pressure variability (BPV) is a risk factor for cognitive decline and dementia, but its association with cortical thickness is not well understood. Here we use a topographical approach, to assess links between long-term BPV and cortical thickness in 478 (54% men at baseline) community dwelling older adults (70-88 years) from the ASPirin in Reducing Events in the Elderly NEURO sub-study. BPV was measured as average real variability, based on annual visits across three years. Higher diastolic BPV was significantly associated with reduced cortical thickness in multiple areas, including temporal (banks of the superior temporal sulcus), parietal (supramarginal gyrus, post-central gyrus), and posterior frontal areas (pre-central gyrus, caudal middle frontal gyrus), while controlling for mean BP. Higher diastolic BPV was associated with faster progression of cortical thinning across the three years. Diastolic BPV is an important predictor of cortical thickness, and trajectory of cortical thickness, independent of mean blood pressure. This finding suggests an important biological link in the relationship between BPV and cognitive decline in older age.

Trajectories of body mass index from early adulthood to late midlife and incidence of total knee arthroplasty for osteoarthritis: findings from a prospective cohort study

OBJECTIVE

To examine the association between body mass index (BMI) trajectories from early adulthood to late midlife and risk of total knee arthroplasty (TKA) for osteoarthritis.

METHODS

24,368 participants from the Melbourne Collaborative Cohort Study with weight collected during 1990-1994, 1995-1998, and 2003-2007, recalled weight at age 18-21 years, and height measured during 1990-1994 were included. Incident TKA from 2003 to 2007 to December 2018 was determined by linking cohort records to the National Joint Replacement Registry.

RESULTS

Using group-based trajectory modelling, six distinct trajectories (TR) of BMI from early adulthood (age 18-21 years) to late midlife (approximately 62 years) were identified: lower normal to normal BMI (TR1; 19.7% population), normal BMI to borderline overweight (TR2; 36.7%), normal BMI to overweight (TR3; 26.8%), overweight to borderline obese (TR4; 3.5%), normal BMI to class 1 obesity (TR5; 10.1%), overweight to class 2 obesity (TR6; 3.2%). Over 12.4 years, 1,328 (5.4%) had TKA. The hazard ratios for TKA increased in all TR compared to TR1 [from TR2: 2.03 (95% CI 1.64-2.52) to TR6: 8.59 (6.44-11.46)]. 28.4% of TKA could be prevented if individuals followed the trajectory one lower, an average weight reduction of 8-12 kg from early adulthood to late midlife, saving $AUS 373 million/year. Most reduction would occur in TR2 (population attributable fraction 37.9%, 95% CI 26.7-47.3%) and TR3 (26.8%, 20.0-31.2%).

CONCLUSIONS

Prevention of weight gain from young adulthood to late midlife in order to reduce overweight/obesity has the potential to significantly reduce the cost and burden of TKA.

Association between weight gain and knee osteoarthritis: a systematic review

OBJECTIVE

Although weight loss is recommended to manage knee osteoarthritis (KOA), adults tend to gain weight with age which may affect KOA symptoms and progression. We conducted a systematic review and data synthesis to investigate the association between weight gain and KOA, defined by clinical features, structural progression, and total knee replacement (TKR).

DESIGN

MEDLINE and EMBASE were systematically searched for controlled trials and cohort studies of participants with (or at risk of) KOA examining the relationship between weight gain and KOA clinical features (pain, function, quality of life), structural progression, and TKR. Risk of bias was assessed using the ROBINS-I tool. Results were organised by outcome, with meta-analyses performed where appropriate.

RESULTS

Twenty-three studies were included. Results showed significant detrimental effects of weight gain on pain (4 of 7 studies), stiffness (2 of 2 studies), function (5 of 6 studies), and the single studies examining quality of life, and clinical and radiographic KOA. Weight gain adversely affected cartilage (6 of 9 studies), bone marrow lesions (1 of 4 studies), meniscal damage (1 of 3 studies) and effusion/synovitis (1 of 1 study). Weight gain significantly increased TKR (3 of 6 studies): meta-analysis of 2 with available data demonstrated significant increases in TKR/5 kg weight gain in women, HR 1.34 (95% CI 1.18-1.51), and in men, HR 1.25 (95% CI 1.16-1.34).

CONCLUSIONS

Weight gain in adults is associated with increased clinical and structural KOA and TKR. Prevention of weight gain should be considered to improve outcomes in KOA.

Metformin as a potential disease-modifying drug in osteoarthritis: a systematic review of pre-clinical and human studies

OBJECTIVE

Osteoarthritis causes significant pain and disability with no approved disease-modifying drugs. We systematically reviewed the evidence from both pre-clinical and human studies for the potential disease-modifying effect of metformin in osteoarthritis.

METHODS

Ovid Medline, Embase and CINAHL were searched between inception and June 2021 using MeSH terms and key words to identify studies examining the association between metformin use and outcome measures related to osteoarthritis. Two reviewers performed the risk of bias assessment and 3 reviewers extracted data independently. Qualitative evidence synthesis was performed. This systematic review is registered on PROSPERO (CRD42021261052 and CRD42021261060).

RESULTS

Fifteen (10 pre-clinical and 5 human) studies were included. Most studies (10 pre-clinical and 3 human) assessed the effect of metformin using knee osteoarthritis models. In pre-clinical studies, metformin was assessed for the effect on structural outcomes (n = 10); immunomodulation (n = 5); pain (n = 4); and molecular pathways of its effect in osteoarthritis (n = 7). For human studies, metformin was evaluated for the effect on structural progression (n = 3); pain (n = 1); and immunomodulation (n = 1). Overall, pre-clinical studies consistently showed metformin having a chondroprotective, immunomodulatory and analgesic effect in osteoarthritis, predominantly mediated by adenosine monophosphate-activated protein kinase activation. Evidence from human studies, although limited, was consistent with findings in pre-clinical studies.

CONCLUSION

We found consistent evidence across pre-clinical and human studies to support a favourable effect of metformin on chondroprotection, immunomodulation and pain reduction in knee osteoarthritis. Further high-quality clinical trials are needed to confirm these findings as metformin could be a novel therapeutic drug for the treatment of osteoarthritis.

POS1119 EFFICACY OF CORTICOSTEROIDS FOR HAND OSTEOARTHRITIS - A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Background

Hand osteoarthritis (OA) is a prevalent joint condition, causing disabling pain, reduced mobility, impaired daily functioning and quality of life (1-2). Corticosteroids are anti-inflammatory medications frequently used in musculoskeletal diseases. There is some evidence that corticosteroids may have a beneficial effect in hand osteoarthritis (3-4).

Objectives

To examine the efficacy of corticosteroids on symptoms and structural outcomes in hand osteoarthritis.

Methods

Ovid MEDLINE, Embase and Cochrane Central Register of Controlled Trials were searched from inception to October 2021 for randomized controlled trials investigating the efficacy of corticosteroids in hand osteoarthritis. Two authors independently screened records, extracted data, and assessed risk of bias using the RoB 2 tool. Standardized mean difference (SMD) or mean difference was calculated, and random-effects meta-analyses were performed.

Results

Of 13 included trials, three examined oral and ten examined intra-articular injection of corticosteroids on clinical outcomes. In meta-analysis, oral corticosteroids reduced pain (SMD=-0.53, 95%CI -0.79 to -0.28) and improved function (SMD=-0.37, 95%CI -0.63 to -0.12) at 4-6 weeks, and intra-articular corticosteroid injection improved function (SMD=-0.48, 95%CI -0.90 to -0.06) at 4-6 weeks. Corticosteroids had no significant effects on pain and function over 3 months and 6-12 months. Two trials evaluated joint structure at 4-6 weeks: one study showed oral corticosteroids reduced synovial thickening, neither showed an effect on synovitis.

Conclusion

There was low-certainty evidence for a medium effect of oral corticosteroids on pain relief and small-to-medium effect on functional improvement at 4-6 weeks. Intra-articular corticosteroids showed low-certainty evidence for a medium effect on functional improvement at 4-6 weeks. Corticosteroids had no significant effect on any outcomes over longer term. No trials examined the effect of corticosteroids on disease progression. The role of corticosteroids in hand osteoarthritis is limited.

References

[1]Zhang Y, Niu J, Kelly-Hayes M, Chaisson CE, Aliabadi P, Felson DT. Prevalence of Symptomatic Hand Osteoarthritis and Its Impact on Functional Status among the Elderly: The Framingham Study. American Journal of Epidemiology. 2002;156(11):1021-7.

[2]Kjeken I, Dagfinrud H, Slatkowsky-Christensen B, Mowinckel P, Uhlig T, Kvien TK, et al. Activity limitations and participation restrictions in women with hand osteoarthritis: patients’ descriptions and associations between dimensions of functioning. Annals of the rheumatic diseases. 2005;64(11):1633-8.

[3]Kroon FPB, Kortekaas MC, Boonen A, Böhringer S, Reijnierse M, Rosendaal FR, et al. Results of a 6-week treatment with 10 mg prednisolone in patients with hand osteoarthritis (HOPE): a double-blind, randomised, placebo-controlled trial. Lancet. 2019;394(10213):1993-2001.

[4]Kloppenburg M, Kroon FPB, Blanco FJ, Doherty M, Dziedzic KS, Greibrokk E, et al. 2018 update of the EULAR recommendations for the management of hand osteoarthritis. Annals of the Rheumatic Diseases. 2019;78(1):16.

Disclosure of Interests

None declared

AB0979 Recommendations for weight management in osteoarthritis: a systematic review of clinical practice guidelines

Background

Weight loss interventions are often recommended to target overweight and obesity in the clinical practice guidelines (CPGs) for the management of osteoarthritis. This is despite evidence from meta-analyses of clinical trials that significant weight loss results in modest improvements in symptoms and minimal effects on disease progression1,2. There is evidence that weight gain is associated with increase in knee pain3,4. In countries such as USA, adults gain on average 0.5 to 1 kilogram per year from early to middle adulthood Preventing weight gain is easier to achieve and sustain than losing weight.

Objectives

Given that weight loss is accepted as fundamental to osteoarthritis management, we systematically reviewed the recommendations and approaches for weight management in all current osteoarthritis CPGs.

Methods

Nine databases were searched (1st January 2010 to 30th September 2021) to identify guidelines informing the non-pharmacological management of osteoarthritis. Three reviewers appraised guidelines according to the AGREE II instrument, and independently extracted data on their characteristics. One author extracted and summarised guideline recommendations on weight management. This systematic review is registered on PROSPERO (CRD42021274195).

Results

Fifteen CPGs from developed and developing countries were included. Weight loss was recommended for knee (12 of 13 guidelines) and hip (10 of 11 guidelines) but not hand osteoarthritis (0 of 4 guidelines). Combination approaches of diet and/or exercise were recommended for overweight or obese individuals (knee: 8 of 12; hip: 4 of 10), with 2 guidelines specifying ≥5% weight loss for knee and hip osteoarthritis. One of 15 guidelines specified strategies for weight loss and maintenance of lost weight. Two of 15 guidelines recommended controlling body weight for osteoarthritis, regardless of obesity status.

Conclusion

Most CPGs for knee and hip osteoarthritis include recommendations for weight loss in those with overweight or obesity as key to managing osteoarthritis, despite evidence of modest at best effect of weight loss on symptoms and no effect on joint structure1,2. Given obesity is a major risk factors for osteoarthritis, the prevention of weight gain may be more effective and practical in improving clinical outcomes for osteoarthritis, and hence should be considered as part of the key management in osteoarthritis.

References

[1]Chu IJH, Lim AYT, Ng CLW. Effects of meaningful weight loss beyond symptomatic relief in adults with knee osteoarthritis and obesity: a systematic review and meta-analysis. Obes Rev. 2018;19(11):1597-1607.

[2]Daugaard CL, Hangaard S, Bartels EM, Gudbergsen H, Christensen R, Bliddal H, et al. The effects of weight loss on imaging outcomes in osteoarthritis of the hip or knee in people who are overweight or obese: a systematic review. Osteoarthritis Cartilage. 2020;28(1):10-21.

[3]Tanamas SK, Wluka AE, Davies-Tuck M, Wang Y, Strauss BJ, Proietto J, et al. Association of weight gain with incident knee pain, stiffness, and functional difficulties: a longitudinal study. Arthritis Care Res (Hoboken). 2013;65(1):34-43.

[4]Teichtahl AJ, Wluka AE, Tanamas SK, Wang Y, Strauss BJ, Proietto J, et al. Weight change and change in tibial cartilage volume and symptoms in obese adults. Annals of the rheumatic diseases. 2015;74(6):1024-1029.

[5]Zheng Y, Manson JE, Yuan C, Liang MH, Grodstein F, Stampfer MJ, et al. Associations of Weight Gain From Early to Middle Adulthood With Major Health Outcomes Later in Life. JAMA. 2017;318(3):255-269.

Disclosure of Interests

None declared

OP0226 TRAJECTORIES OF BODY MASS INDEX FROM EARLY ADULTHOOD TO LATE MIDLIFE AND INCIDENCE OF TOTAL KNEE ARTHROPLASTY FOR OSTEOARTHRITIS: FINDINGS FROM A PROSPECTIVE COHORT STUDY

Background

There is limited evidence regarding the association between trajectories of body mass index (BMI) across adulthood and knee osteoarthritis.

Objectives

We examined the association between body mass index (BMI) trajectories across early adulthood to midlife and risk of total knee arthroplasty (TKA) for osteoarthritis.

Methods

This study examined 24,368 participants (40-70 years at recruitment) in the Melbourne Collaborative Cohort Study who had weight collected at 1990–1994, 1995–1998, and 2003–2007 and recalled weight at age 18–21 years. BMI trajectories were derived using weight data at the four timepoints. Incidence of TKA after 2003–2007 until December 2018 was determined by linking cohort records to the National Joint Replacement Registry.

Results

Using group-based trajectory modelling, six distinct trajectories (TR) of BMI from early adulthood to late midlife were identified: lower normal to normal BMI (TR1: BMI at age 18-21 years to BMI at approximately 62 years (kg/m2), 20.0±1.9 to 22.1±1.7; 19.7%); normal BMI to borderline overweight (TR2: 21.5±2.3 to 25.8±1.7; 36.7%), normal BMI to overweight (TR3: 22.0±2.2 to 29.5±1.9; 26.8%), overweight to borderline obese (TR4: 28.5±2.7 to 30.5±2.3; 3.5%), normal BMI to class 1 obesity (TR5: 22.8±2.5 to 34.3±2.3; 10.1%), and overweight to class 2 obesity (TR6: 25.6±3.9 to 39.2±2.9; 3.2%). Over 12.4 years, 1,328 (5.4%) participants had TKA. The hazard ratios for TKA increased in all TR compared with TR1: TR2 2.03 (95% CI 1.64-2.52), TR3 4.00 (3.19-4.91), TR4 5.17 (3.77-7.10), TR5 7.00 (5.54-8.80), and TR6 8.59 (6.44-11.46). It is estimated that 28.4% TKA would be reduced if individuals followed the trajectory that was one lower, a national health system savings of $AUD 373 million. Most of this reduction would occur in TR2 (population attributable fraction 37.9% (26.7%-47.3%) and TR3 PAF 26.8% (20.0%, 31.2%) (Table 1).

Table 1.

Reduction in TKA if individuals followed the trajectory that was one lower

Population counterfactualsPopulation at risk, n (%)TKA under the original scenario, n (%)TKA under the new scenario*, n (%)Difference in risk, n (%)PAF** (95% CI), %TR14811 (19.7)124 (2.6%)No change 124 (2.6%)0-If TR2 followed TR1 trajectory and rate of TKA*8943 (36.7)378 (4.2%)2.6% of 8943 = 233145 (10.9)37.9 (26.7, 47.3)If TR3 followed TR2 trajectory and rate of TKA*6526 (26.8)416 (6.4%)4.2% of 6526 = 274142 (10.7)26.8 (20.0, 31.2)If TR4 followed TR3 trajectory and rate of TKA*845 (3.5)64 (7.6%)6.4% of 845 = 5410 (0.8)3.1 (0, 6.0)If TR5 followed TR4 trajectory and rate of TKA*2466 (10.1)253 (10.3%)7.6% of 2466 =18766 (5.0)20.2 (0, 36.3)If TR6 followed TR5 trajectory and rate of TKA*777 (3.2)93 (12.0%)10.3% of 777 = 8013 (1.0)0.4 (0.0, 10.0)Total population243681328952376 (28.4)-

*if the trajectory is changed, ** PAFs and related 95%CIs were calculated by the Stata punafcc package using the formula ∑pKRi[(HRi − 1)/HRi], where pKRi is the proportion of total knee replacements observed in the ith obesity trajectory and HRi is the hazard ratio (HR) associated with that category. PAFs were calculated using pKRi and HRi estimated from the entire sample. All HRi values were generated from Cox proportional hazards regression models adjusted for covariates (age at baseline, sex, country of birth, physical activity, smoking history, and comorbidity) and postestimation analyses.

Conclusion

Our study suggests that prevention of weight gain from young adulthood to midlife in order to reduce overweight and obesity could have a major impact on reducing the burden of severe knee osteoarthritis and associated healthcare costs.

Figure 1.

A. Proportion of Total Knee Arthroplasties in each trajectory category B. Speculated patters and associated percentages represents the proportion of Total Knee Arthroplasties that could be avoided in each trajectory category if the participants followed the lower trajectory category i.e. TR2 followed TR1

Disclosure of Interests

None declared

POS1118 METFORMIN AS A POTENTIAL DISEASE-MODIFYING DRUG IN OSTEOARTHRITIS: A SYSTEMATIC REVIEW OF PRE-CLINICAL AND HUMAN STUDIES

Background

Osteoarthritis causes significant pain and disability with no approved disease-modifying drugs. There is evidence emerging from pre-clinical and human studies suggesting metformin may have disease-modifying properties in osteoarthritis1-5. Given its pleiotropic effects and safety profile, metformin has the potential to be a novel therapy for osteoarthritis.

Objectives

We systematically reviewed the evidence from both pre-clinical and human studies for the potential disease-modifying effect of metformin in osteoarthritis.

Methods

Ovid Medline, Embase and CINAHL were searched between inception and June 2021 using MeSH terms and key words to identify studies examining the association between metformin use and outcome measures related to osteoarthritis. Two reviewers performed the risk of bias assessment and 3 reviewers extracted data independently. Qualitative evidence synthesis was performed. This systematic review is registered on PROSPERO (CRD42021261052 and CRD42021261060).

Results

Fifteen (10 pre-clinical and 5 human) studies were included. Most studies (10 pre-clinical and 3 human) assessed the effect of metformin using knee osteoarthritis models. In pre-clinical studies, metformin was assessed for the effect on structural outcomes (n=10); immunomodulation (n=5); pain (n=4); and molecular pathways of its effect in osteoarthritis (n=7). For human studies, metformin was evaluated for the effect on structural progression (n=3); pain (n=1); and immunomodulation (n=1). Overall, pre-clinical studies consistently showed metformin having a chondroprotective, immunomodulatory and analgesic effect in osteoarthritis, predominantly mediated by adenosine monophosphate-activated protein kinase activation. Evidence from human studies, although limited, was consistent with findings in pre-clinical studies.

Conclusion

We found consistent evidence across pre-clinical and human studies to support a favourable effect of metformin on chondroprotection, immunomodulation and pain reduction in knee osteoarthritis. Further high-quality clinical trials are needed to confirm these findings as metformin could be a novel therapeutic drug for the treatment of osteoarthritis.

References

[1]Li H, Ding X, Terkeltaub R, Lin H, Zhang Y, Zhou B, et al. Exploration of metformin as novel therapy for osteoarthritis: preventing cartilage degeneration and reducing pain behavior. Arthritis Res Ther. 2020;22(1):34.

[2]Li J, Zhang B, Liu WX, Lu K, Pan H, Wang T, et al. Metformin limits osteoarthritis development and progression through activation of AMPK signalling. Ann Rheum Dis. 2020;79(5):635-645.

[3]Na HS, Kwon JY, Lee SY, Lee SH, Lee AR, Woo JS, et al. Metformin Attenuates Monosodium-Iodoacetate-Induced Osteoarthritis via Regulation of Pain Mediators and the Autophagy-Lysosomal Pathway. Cells. 2021;10(3).

[4]Lu CH, Chung CH, Lee CH, Hsieh CH, Hung YJ, Lin FH, et al. Combination COX-2 inhibitor and metformin attenuate rate of joint replacement in osteoarthritis with diabetes: A nationwide, retrospective, matched-cohort study in Taiwan. PLoS ONE [Electronic Resource]. 2018;13(1):e0191242.

[5]Wang Y, Hussain SM, Wluka AE, Lim YZ, Abram F, Pelletier JP, et al. Association between metformin use and disease progression in obese people with knee osteoarthritis: data from the Osteoarthritis Initiative-a prospective cohort study. Arthritis research & therapy. 2019;21(1):127.

Disclosure of Interests

Yuan Lim: None declared, Yuanyuan Wang: None declared, Mahnuma Estee: None declared, Jawad Abidi: None declared, Maushmi Udaya Kumar: None declared, Sultana Monira Hussain: None declared, Anita Wluka: None declared, Christopher Little Grant/research support from: CBL receives research funding from pharmaceutical companies (Fidia Farmaceutici, Cynata Therapeutics, Ceva Animal Health Pty Ltd and Regeneus Pty Ltd) to investigate efficacy of novel osteoarthritis therapeutics in pre-clinical models, through specific services/testing-contract research agreements between and managed by The University of Sydney or the Northern Sydney Local Health District, Flavia Cicuttini: None declared

Effects of Se nanoparticles supplementation on growth performance, hematological parameters and nutrient digestibility of Labeo rohita fingerling fed sunflower meal based diet

The aim of the present study is to assess the effects of selenium nanoparticles on the growth, hematology and nutrients digestibility of Labeorohita fingerlings. Fingerlings were fed with seven isocaloric sunflower meal-based diet supplemented with different concentrations of nanoparticles naming T1 to T7 (0, 0.5, 1, 1.5, 2, 2.5, and 3 mg/kg), with 5% wet body weight while chromic oxide was used as an indigestible marker. After experimentation for 90 days T3 treated group (1mg/kg -1Se-nano level) showed the best result in hematological parameters (WBC's 7.97 ×103mm-3, RBC's 2.98 ×106 mm-3 and Platelet count 67), nutrient digestibility (crude protein: 74%, ether extract: 76%, gross energy: 70%) and growth performance (weight gain 13.24 g, weight gain% 198, feed conversion ratio 1.5, survival rate 100%) as compared to the other treatment groups. Specific growth rates were found significantly higher in T5 than in other groups. The present study indicated positive effect of 1 mg/kg Se-nanoparticles on growth advancement, hematological parameters, and nutrients digestibility of L. rohita fingerlings.

Studies on parasitic prevalence in pet birds from Punjab, Pakistan

During this one year study, blood and fecal samples of doves (Zenaida asiatica), ducks (Anas platyrhynchos), pigeons (Columba livia), partridges (Alectoris chukar), turkeys (Meleagris gallopavo) and goose (Chen caerulescens) were collected to assess the parasitic prevalence in these birds. The birds were kept at Avian Conservation and Research Center, Department of Wildlife and Ecology, University of Veterinary and Animal Sciences, Lahore. All these avian species were kept in separate cages and their entire body was inspected on regularly basis to record external parasites. For internal parasites, 100 blood and 100 fecal samples for each species were analyzed. During present study, two species of ectoparasites i.e. fowl ticks (Args persicus) and mite (Dermanyssus gallinae) while 17 species of endoparasites; three from blood and 14 from fecal samples were identified. Prevalence of blood parasites was Plasmodium juxtanucleare 29.3%, Aegyptinella pullorum 15% and Leucoctoyzoon simond 13%. Parasitic species recorded from fecal samples included 6 species of nematodes viz. Syngamus trachea with parasitic prevalence of 50%, Capillaria anatis 40%, Capillaria annulata 37.5%, Heterakis gallinarum 28.3%, Ascardia galli 24% and Allodpa suctoria 2%. Similarly, two species of trematodes viz. Prosthogonimus ovatus having parasitic prevalence of 12.1% and Prosthogonimus macrorchis 9.1% were also recorded from fecal samples of the birds. Single cestode species Raillietina echinobothrida having parasitic prevalence of 27% and 3 protozoan species i.e. Eimeria maxima having prevalence 20.1%, Histomonas meleagridis 8% and Giardia lamblia 5.3% were recorded. In our recommendation, proper medication and sanitation of the bird's houses and cages is recommended to avoid parasites.

Partial replacement of fish meal with Moringa oleifera leaf meal in practical diets of Cirrhinus mrigala fingerlings

Fish protein is serving as a source of nutrition for protein starving world. However, sustainable aquaculture products require inexpensive plant by-products due to finite sources of fish meal. Therefore, this study was conducted to examine nutrient utilization, growth performance and hematological indices of Cirrhinus mrigala fingerlings fed on Moringa oleifera leaf meal (MOLM) based diets. Fish were fed with six isonitrogenous and isoenergetic diets having MOLM as a substitute of fish meal (FM) at the levels of 0%, 10%, 20%, 30%, 40% and 50% for the period of 90 days. Fingerlings having initial weight 6.35±0.04g were reared in triplicate tanks at the stocking density of 15 and hand fed at the rate of 5% of total biomass twice regularly. Chromic oxide inclusion level was 1% in diets. After analysis, maximum growth performance and improved digestibility of nutrients were found in fish fed with diet at 10% replacement level as compared to fish fed on control diet and other test diets. Additionally, it was found that the red blood cells, white blood cells, hemoglobin and mean corpuscular hemoglobin concentration of fish showed a significantly (p<0.05) inverse correlation with the increase in MOLM. In present research, it was concluded that MOLM has good potential to be used as a FM substitute in C. mrigala diet with maximum effect at 10% showing positive hematological indices.

Efficacy of acidified phytase supplemented cottonseed meal based diets on growth performance and proximate composition of Labeo rohita fingerlings

The growth of aquaculture sector is strongly dependent upon the continuous supply of inexpensive fish feed with balanced nutritional profile. However, fish meal (FM) is unable to satisfy this demand due to its scarce supply and high cost. In order to test the potential of cottonseed meal (CSM) as a fish meal replacer, a feeding trial of 12 weeks was conducted to check growth performance and proximate composition of Labeo rohita fingerlings. The protein ration of the test feed was satisfied by replacing FM with CSM at 0, 25, 50 and 75%. Sixteen test diets viz., TD1 (control), TD2, TD3, TD4, TD5, TD6, TD7, TD8, TD9, TD10, TD11, TD12, TD13, TD14, TD15 and TD16 were supplemented with citric acid (CA; 0 and 2.5%) and phytase (PHY; 0 and 750 FTU/kg) in a completely randomized design with 3×3 factorial arrangement. The highest weight gain (11.03g), weight gain% (249.21%), specific growth rate (1.39) and best feed conversion ratio (1.20) were recorded by fish fed with TD12. Furthermore, the same level increased the crude protein (59.26%) and fat (16.04%) being significantly different (p<0.05) than that of control. Conclusively, the addition of acidified phytase (CA; 2.5%, PHY; 750 FTU/kg) in TD12 (CSM=50%) led to the improved growth and proximate composition of L. rohita fingerlings.

Impact of dietary leaf extracts of Black pepper Piper nigrum L. on the growth, hematological and immunological parameters of Labeo rohita (Hamilton, 1822) cultured in glass aquaria

A study was conducted to evaluate the effect of Piper nigrum (black pepper) leaf extract on on the growth performance, proximate composition, hematological parameters, and immune response of Labeo rohita fingerlings with an average weight of 22.14 ± 0.98g. Aftrer acclimation for two weeks, fish (n=25) were randomly selected and placed in four glass aquaria (T0, T1, T2 and T3) at constant water temperature (30.0 ± 1.0 °C), pH (7.50 ± 0.5) and total hardness (200 ± 2.0 mgL,-1) for a period of 12 weeks, with three replicates each. Fish were fed with P. nigrum leaf extract supplemented feed @ 0.0%, 1.0%, 2.0% and 3.0% in T0, T1,T2 and T3, respectively. At the end of experiment, five fish were randomly selected from each aquaria for proximate composition, gut and skin microbial load, hematological parameters. Total proteins, albumins, and globulins were also recorded to evaluate immunological memory. The result revealed that fish in T2 showed better growth performance with an average weight gain of 56.11 ± 0.51 g. Thus, it had been concluded that Piper nigrum, a medicinal plant, can also be used to enhance the growth performance and immune response of Labeo rohita as attractive alternatives against antibiotics and vaccines and has shown no negative side effects on fish health as well as on its environment.

Variations in nutritional profile of honey produced by various species of genus Apis

The medicinal attributes of honey appears to overshadow its importance as a functional food. Consequently, several literatures are rife with ancient uses of honey as complementary and alternative medicine, with relevance to modern day health care, supported by evidence-based clinical data, with little attention given to honey's nutritional functions. The moisture contents of honey extracted from University of Veterinary and Animal Sciences, Lahore honey bee farm was 12.19% while that of natural source was 9.03 ± 1.63%. Similarly, ash and protein contents of farmed honey recorded were 0.37% and 5.22%, respectively. Whereas ash and protein contents of natural honey were 1.70 ± 1.98% and 6.10 ± 0.79%. Likewise fat, dietary fiber and carbohydrates contents of farmed source documented were 0.14%, 1.99% and 62.26% respectively. Although fat, dietary fiber and carbohydrates contents of honey taken from natural resource were 0.54 ± 0.28%, 2.76 ± 1.07% and 55.32 ± 2.91% respectively. Glucose and fructose contents of honey taken out from honeybee farm were 27% and 34% but natural source were 22.50 ± 2.12% and 28.50 ± 3.54%. Glucose and fructose contents of honey taken out from honeybee farm were 27% and 34% but natural source were 22.50 ± 2.12% and 28.50 ± 3.54%. Similarly, sucrose and maltose contents of farmed honey were 2.5% and 12% while in natural honey were 1.35 ± 0.49% and 8.00 ± 1.41% respectively. The present study indicates that such as moisture, carbohydrates, sucrose and maltose contents were higher farmed honey as compared to the natural honey. In our recommendation natural honey is better than farmed honey.

Use of phytase and citric acid supplementation on growth performance and nutrient digestibility of Cirrhinus mrigala fingerlings fed on canola meal based diet

Fishmeal; being a limited and costly feed ingredient is continuously been substituted with locally available plant proteins. However, the occurrence of anti-nutritional factors in plant meal suppresses its potential to be fully replaced. Therefore, in this study we aimed to study the synergistic effects of dietary additives like citric acid and phytase enzyme supplementation on growth performance and nutrient digestibility of Cirrhinus mrigala fingerlings. Canola meal (CM) was used as a test ingredient to replace fishmeal (FM) as; 0%, 25%, 50% and 75%. These four diets were further supplemented by varying levels of phytase (0 and 750 FTU kg-1) and citric acid (0% and 2.5%) to formulate total sixteen test diets as T1, T2, T3, T4, T5, T6, T7, T8, T9, T10, T11, T12, T13, T14, T15 and T16. Each treatment contained three replicates; applied to fish groups having 15 fingerlings each; following 3×3 factorial arrangement. 1% of chromic oxide was added as an inert marker. Maximum weight gain% (288%) and the lowest value of FCR (1.07) were recorded when fish was fed on diet T12 as compared to fish fed control diet (T1). Similarly, optimum nutrient digestibility values such as crude protein (77%), crude fat (84%) and gross energy (70%) were noted on same level. It was concluded that 50% canola meal can optimally replace fishmeal when supplemented with phytase and citric acid at the levels of 750 FTU kg-1 and 2.5%, respectively.

Characterization and distribution of microplastics in estuarine surface sediments, Kayamkulam estuary, southwest coast of India

The present study aims to formulate the characterization and distribution of microplastic in the estuarine surface sediments of Kayamkulam estuary, southwest coast of India. The sediments were dominated by fibre and film shaped microplastic substances. The surface sediments were dominated by <1000 μm microplastics. The composition of microplastics in descending order was as follows: polyester > polypropylene > polyethylene. The distribution of microplastics was significantly higher than that observed in the other study regions, except for Pearl river estuary and Guanabara Bay. The distribution of microplastics was chiefly controlled by estuarine inundating water and the distance of the sampling site from the open sea.

POS0525 ARTHRITIC PAIN AS A SURROGATE MARKER FOR ASYMPTOMATIC CARDIOVASCULAR RISK FACTORS: OFFERING PRACTITIONERS A ‘TEACHABLE MOMENT’

Background:

Cardiovascular diseases (CVD) are the number one cause of death worldwide. CVDs are linked to well established risk factors: obesity, hypertension (HTN), dyslipidaemia (DL) and diabetes mellitus (DM)1. While targeting risk factors reduces the burden of CVD, this is often challenging because they are largely asymptomatic and patients are therefore unlikely to seek medical attention. Arthritis, in contrast, causes pain and functional impairment prompting presentation to a healthcare practitioner. Patients with arthritis of varying aetiologies (such as osteoarthritis2, gout3, rheumatoid arthritis4) have been shown to have an increased risk of CVD.

Objectives:

To examine the relationship between arthritis and DM, HTN and DL in adults of all age groups. A secondary objective was to examine whether this relationship existed independent of obesity.

Methods:

Data from the 2017-18 Australian Bureau of Statistics National Health Survey included 13,776 participants, categorised into young (18-39 years), middle aged (40-64 years) and older (≥65 years) adults. Blood pressure, height and weight were measured. BMI was calculated and participants classified as obese (≥30 kg/m2) or non-obese. HTN was defined as > 140/90mmHg. Participants were asked if they had arthritis of any form, DL or DM diagnosed by a doctor. Logistic regression models estimated odds ratios with 95% CI for prevalence of arthritis associated with CVD risk factors.

Results:

Arthritis was reported by 3.9% of young adults, 28.8% of middle-aged adults, and 54.5% ofolderadults. In all three age groups, arthritis was associated with significantly increased odds of obesity, HTN, DL and DM. For example, in middle-aged adults, having arthritis was associated with increased odds of obesity (1.75, 95% CI 1.54-2.01), HTN (1.78, 1.60-2.04), DL (2.14, 1.84-2.49) and DM (1.64, 1.33-2.03). These associations remained statistically significant after adjustment for obesity.

Conclusion:

Compared to those without arthritis, adults with arthritis were at increased risk of obesity, HTN, DM and DL. The increased risk of HTN, DM and DL was independent of obesity and tended to be higher in younger adults. These data suggest that a patient’s presentation with symptomatic arthritis of any aetiology and at any age, may be used opportunistically as a “teachable moment” for screening for asymptomatic CVD risk factors in higher-risk individuals. This provides practitioners an opportunity to manage both arthritis and CVD risk in parallel, rather than in silos.

References:

[1]World Health Organisation. (2017). “Cardiovascular Diseases.” from https://www.who.int/en/news-room/fact-sheets/detail/cardiovascular-diseases(cvds).

[2]Wang, H., et al. (2016). “Osteoarthritis and the risk of cardiovascular disease: a meta-analysis of observational studies.” Scientific reports 6: 39672.

[3]Singh, J. (2015). “When gout goes to the heart: does gout equal a cardiovascular disease risk factor?” Annals of the Rheumatic Diseases 74: 631-634.

[4]England, B. R., et al. (2018). “Increased cardiovascular risk in rheumatoid arthritis: mechanisms and implications.” British Medical Journal 361: k1036.

Table 1.

Prevalence of CVD risk factors in adults with and without arthritis.

Young18-39 yoMiddle Aged40-64 yoOlder≥65 yoNo arthritisn = 3773Arthritisn = 157OR (95% CI)*adjusted for obesityNo arthritisn = 4055Arthritisn = 1638OR (95% CI)*adjusted for obesityNo arthritisn = 1891Arthritisn = 2262OR (95% CI)*adjusted for obesityObesity473322.07 (1.36-3.16)8685271.75 (1.54-2.01)3266101.89 (1.62-2.21)HTN131142.72 (1.53-4.84)2.35 (1.17-4.70)*7454961.78 (1.60-2.04)1.59 (1.37-1.84)73010911.48 (1.31-1.68)1.35 (1.18-1.55)*DM1945.7 (1.74-15.37)4.87 (1.34-17.69))*2361511.64 (1.33-2.03)1.37 (1.08-1.73)*2563991.37 (1.15-1.62)1.15 (0.95-1.39)*

Disclosure of Interests:

None declared

The COVID-19 Infodemic: A Quantitative Analysis Through Facebook

Background Social media is a crucial part of our daily life. Facebook, being the biggest social media platform, plays a significant role in the spread of information influencing the global response to the COVID-19 pandemic. Health care agencies like the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) use social media as a platform to impart information regarding COVID-19; simultaneously, there is a spread of misinformation on social media, masking the credible sources of information. Our research aims to assess the utility of Facebook in providing misinformation and testing its "fact-check policy." Methods An online search was conducted on Facebook by a newly created account to eliminate bias. The Facebook search bar was used to investigate multiple keywords. Data were tabulated in Microsoft Excel (Microsoft Corporation, Redmond, WA). Descriptive statistical analysis of Facebook accounts and posts was done using the Statistical Package for the Social Sciences (SPSS) version 26 (IBM Corp., Armonk, NY) while statistical importance was set a priority at a p-value of 0.05. Results Our study consisted of 454 Facebook posts. Most (22.5%) were posted by verified accounts and 23.9% by informal individual/group accounts. The tone for most (40.4%) COVID-19 information was serious while the most common (43.9%) topic was medical/public health. In total, 22.3% included misinformation, 19.6% were unverifiable, and 27.5% included correct information verifiable by the WHO or CDC. Conclusions Misinformation/unverifiable information related to the COVID-19 crisis is spreading at a distressing rate on social media. We quantified the misinformation and tested Facebook's "fact-check policy." We advise strict initiatives to control this infodemic and advise future researches to evaluate the accuracy of content being circulated on other social media platforms.

Does preoperative neuropathic-like pain and central sensitisation affect the post-operative outcome of knee joint replacement for osteoarthritis? A systematic review and meta analysis

BACKGROUND

Almost a third of those undergoing knee replacement for osteoarthritis have poor outcomes despite technically successful surgery. Preoperative neuropathic-like pain and/or pain sensitisation may increase the risk of pain following joint replacement.

OBJECTIVE

To examine whether preoperative neuropathic-like pain and pain sensitisation predicts pain, function and satisfaction following joint replacement for knee osteoarthritis.

DESIGN

Systematic review with meta-analysis.

METHODS

Medline, EMBASE and CINAHL were systematically searched until March 2020. Studies detecting neuropathic-like pain and/or sensitisation using self-report questionnaires prior to knee replacement for osteoarthritis, and relating this to post-operative outcomes were identified. Data extraction, risk of bias assessment and meta-analysis were performed, where appropriate.

RESULTS

Five manuscripts, including one preprint, examining six cohorts were included: four used painDETECT or modified painDETECT, one the Self-Report Leeds Assessment of Neuropathic Symptoms and Signs, and another the Central Sensitisation Inventory to identify preoperative characteristics. Three studies showed preoperative neuropathic-like pain or sensitisation was associated with more intense post-operative pain. All four studies examining the risk of significant pain after knee replacement suggested it was increased after >3 months. The only study examining patient satisfaction and function found reduced satisfaction, but no difference in function in those with preoperative sensitisation. Meta-analysis found the relative risk of increased pain following knee replacement in those with neuropathic-like pain (painDETECT ≥13) to be 2.05 (95% confidence intervals 1.51, 2.79).

CONCLUSION

These results provide consistent but limited evidence that self-report tools detecting neuropathic-like pain and/or pain sensitisation, predict patients at higher risk of pain following knee replacement.

A baseline study on elemental concentration and potential ecological risk status of the surface sediments of Ashtamudi Lake, south west coast of India

Element concentration (Fe, Mn, Pb, Zn, Cu, Cr, Ni and Co) in the surface sediments of Ashtamudi estuary, Southwest coast of India, has been analyzed to understand the spatial variation and potential ecological risk status. The sediment pollution index and Potential Ecological Risk index suggest that the northeastern part of the estuary exhibits low to moderate polluted sediments with moderate ecological risk. The results of correlation analysis indicate that the natural weathering process and river input play an important role in the distribution of the elements in the surface sediments of the estuary. The extracted factor results indicate that the fine sediment fractions supporting for accumulation of the trace elements, whereas the enriched level of Fe and Mn is chiefly controlled by the riverine process, and other elements are contributed by anthropogenic influences.

Relationship of weight and obesity with the risk of knee and hip arthroplasty for osteoarthritis across different levels of physical performance: a prospective cohort study

OBJECTIVE

To examine the association between obesity and knee and hip arthroplasty for osteoarthritis across a range of physical performance.

METHOD

The body mass index and physical performance (on the 36-item Short Form Health Survey) of 9135 Australian Diabetes, Obesity and Lifestyle Study participants were measured in 1999-2000. The incidence of knee and hip arthroplasty during 2002-2011 was determined by linking the cohort records to the Australian Orthopaedic Association National Joint Replacement Registry.

RESULTS

Over 9.1 ± 2.3 years (mean ± sd)) of follow-up, 317 participants had knee and 202 had hip arthroplasty for osteoarthritis. Using those with neither obesity nor significantly impaired physical performance as the reference group, participants with both obesity and significantly impaired physical performance had a higher knee arthroplasty risk [hazard ratio (HR) = 5.25, 95% confidence interval (CI) 3.85-7.14] than those with obesity alone (HR = 2.49, 95% CI 1.81-3.44) or impaired physical performance alone (HR = 2.19, 95% CI 1.59-3.02). Similar results were observed for hip arthroplasty (obesity and impaired physical performance: HR = 2.67, 95% CI 1.72-4.15; obesity alone: HR = 1.65, 95% CI 1.08-2.51; impaired physical performance alone: HR = 1.83, 95% CI 1.26-2.66). Among overweight/obese patients, 5 kg greater baseline weight increased the knee arthroplasty risk across all levels of physical performance, and hip arthroplasty risk in those with the highest level of physical performance.

CONCLUSION

Although impaired physical performance is an independent risk factor for knee and hip arthroplasty, greater weight increased knee arthroplasty for overweight/obese participants at all levels of physical performance, but hip arthroplasty only in those with good physical performance. Targeting weight loss has the potential to reduce the risk of knee arthroplasty and improve patient outcomes, even in those with poor physical performance.

Female hormonal factors and osteoarthritis of the knee, hip and hand: a narrative review

Osteoarthritis is a leading cause of disability with no cure. The incidence of osteoarthritis is sexually dimorphic: women have a higher rate of osteoarthritis than men after the age of 50. Research has investigated the contribution of sex hormones, reproductive factors and hormone supplementation to osteoarthritis. It has been recognized that different joints are susceptible to different risk factors for osteoarthritis. We reviewed the evidence for the effect of endogenous sex hormones, reproductive factors and hormone supplementation on joint-specific osteoarthritis of the knee, hip and hand. Although the role of these hormonal factors in the pathogenesis of osteoarthritis is complex, data suggest that endogenous hormones and reproductive factors have a role in the pathogenesis of osteoarthritis, especially knee osteoarthritis, with uncertainty for the effect of exogenous hormones. From the available data, it is hard to conclude whether this is a direct effect of hormonal factors, or whether other factors related to these hormonal factors, i.e. obesity and inflammation, have a role in this association. Further studies should consider the mediation effect of body weight and inflammation, change in body weight throughout life, circulatory levels of all endogenous hormones and circulatory levels of hormones after hormone supplementation in this complex relationship.