Effect of rumen-protected choline on dairy cow metabolism, immunity, lactation performance, and vaginal discharge microbiome

Rumen-protected choline (RPC) promotes benefits in milk production, immunity, and health in dairy cows by optimizing lipid metabolism during transition period management and early lactation. However, the RPC success in dairy cows depends on choline bioavailability, which is affected by the type of protection used in rumen-protected choline. Therefore, our objectives were to determine the effects of a novel RPC on dry matter intake (DMI), identify markers of metabolism and immunity, and evaluate lactation performance. Dry Holstein (n = 48) cows at 245 ± 3 d of gestation were blocked by parity and assigned to control or RPC treatment within each block. Cows enrolled in the RPC treatment received 15 g/d of CholiGEM (Kemin Industries, Cavriago RE, Italy) from 21 d prepartum and 30 g/d of CholiGEM from calving to 21 d postpartum. During the transition period, DMI was measured daily, and blood was sampled weekly for energy-related metabolites such as β-hydroxybutyrate (BHB), glucose, and nonesterified fatty acids (NEFA), as well as immune function markers such as haptoglobin (Hp) and lipopolysaccharide-binding protein (LPB). Vaginal discharge samples were collected at the calving and 7 d postpartum and stored in microcentrifuge tubes at -80°C until 16S rRNA sequencing. The main responses of body condition score, body weight, DMI, milk yield, milk components, and immune function markers were analyzed using the GLIMMIX procedure of SAS with the effects of treatment, time, parity, and relevant covariates added to the models. The relative abundance of microbiome α-diversity was evaluated by 3 indexes (Chao1, Shannon, and Simpson) and β-diversity by principal coordinate analysis and permutational multivariate ANOVA. We found no differences in DMI in the pre- and postpartum periods. Cows fed RPC increased the yields of energy- and 3.5% fat-corrected milk and fat yield in primiparous and multiparous cows, with an interaction between treatment and parity for these lactation variables. However, we found no differences in milk protein and lactose up to 150 DIM between treatments. Glucose, NEFA, and BHB had no differences between the treatments. However, RPC decreased BHB numerically (control = 1.07 ± 0.13 vs. RPC = 0.63 ± 0.13) in multiparous on the third week postpartum and tended to reduce the incidence of subclinical ketosis (12.7% vs. 4.2%). No effects for Hp and LPB were found in cows fed RPC. Chao1, Shannon, and Simpson indexes were lower at calving in the RPC treatment than in the Control. However, no differences were found 7 d later for Chao1, Shannon, and Simpson indexes. The vaginal discharge microbiome was altered in cows fed RPC at 7 d postpartum. Fusobacterium, a common pathogen associated with metritis, was reduced in cows fed RPC. Rumen-protected choline enhanced lactation performance and health and altered the vaginal discharge microbiome which is a potential proxy for uterine healthy in dairy cows. The current study's findings corroborate that RPC is a tool to support adaptation to lactation and shed light on opportunities for further research in reproductive health.

Effect of 200 μg of gonadorelin hydrochloride at the first GnRH of a CIDR Synch program on ovulation rate and pregnancies per AI in Holstein heifers

The initial ovulatory response during synchronization programs is often low in dairy heifers, largely due to follicular dynamics and hormonal dynamics. Specifically, the progesterone concentration (P4) at the time of the first GnRH treatment in a breeding program can influence the LH response, often resulting in a suboptimal ovulatory response. The objective of this study was to determine the effect of the highest label dose 200 μg (100 μg vs. 200 μg) of GnRH (50 μg gonadorelin hydrochloride per mL; Factrel®; Zoetis Inc. Madison, NJ) at the first GnRH of a 6-d CoSynch plus P4 device program on ovulatory response and pregnancy per AI (P/AI) in first service in Holstein heifers. A total of 1308 Holstein heifers were randomly allocated at the beginning of a 6-d CIDR-Synch program, Day 0, to receive either i.m. treatment of 100 μg (2CC, n = 655) or 200 μg (4CC, n = 653) of GnRH. Also, at Day 0, heifers received an intravaginal insert with 1.38 g of P4 (Eazi-Breed CIDR® Cattle Insert; Zoetis Inc., Madison, NJ). On Day 6, the insert was removed, and i.m. treatment of 25 mg of PGF2α (12.5 mg dinoprost tromethamine/mL; Lutalyse® HighCon Injection Zoetis) was administered. On Day 7, a second i.m. treatment of 25 mg of PGF2α was given, followed on Day 9 by concurrent i.m. treatment of 100 μg of GnRH and timed AI (TAI). A subset of 396 heifers had their ovaries scanned to evaluate ovulatory response, and blood samples were collected to measure the serum concentration of P4 at Day 0 and Day 6 of the study. The P4 concentrations at Day 0 were categorized as Low (≤3ng/mL) or High (>3ng/mL). The ovulatory response was greater for heifers receiving 4CC than 2CC at Day 0 (54.7% vs. 42.8%). The ovulatory response was greater for Low P4 than High P4 at Day 0 (54.3% vs. 37.8%). However, there was not an interaction between treatment and P4 concentrations (Low P4 2CC = 48.6% vs. High P4 2CC = 30.0%; Low P4 4CC = 60.0% vs. High P4 4CC = 45.5%). The ROC curve analysis indicates that P4 concentrations at Day 0 treatment could predict the ovulatory response, although the area under the curve was only 0.6. As expected, heifers that ovulated had increased P/AI (No = 55.6% vs. Yes = 67.7%); however, there was no effect of treatment on P/AI (2CC = 63.3% vs. 4CC = 59.6%), nor interactions between treatment and ovulation and treatment and P4 (HIGH vs LOW) for pregnancy outcomes. In summary, P4 concentration and increasing the dose of GnRH at Day 0 positively impacted ovulatory response in Holstein heifers. However, there was no interaction between treatment and P4 on ovulation and no subsequent impact of GnRH dose on P/AI.

Design and field procedures for the clinical reappraisal of the Composite International Diagnostic Interview version 3.3 in Qatar's national mental health study

BACKGROUND

The Composite International Diagnostic Interview (CIDI) has been clinically reappraised in several studies conducted mainly in the US and Europe. This report describes the methodology used to conduct one of the Middle East's largest clinical reappraisal studies. The study was carried out in conjunction with the World Mental Health Qatar-the first national psychiatric epidemiological study of common mental disorders in the country. This study aimed to evaluate the diagnostic consistency of core modules of the newly translated and adapted Arabic version of the CIDI 5.0 against the independent clinical diagnoses based on the Structured Clinical Interview for DSM-5 (SCID-5).

METHODS

Telephone follow-up interviews were administered by trained clinicians using the latest research edition of the SCID for DSM-5. Telephone administered interviews were key in the data collection, as the study took place during the COVID-19 pandemic.

RESULTS

Overall, within 12 months, 485 interviews were completed. The response rate was 52%. Quality control monitoring documented excellent adherence of clinical interviews to the rating protocol.

CONCLUSIONS

The overall methods used in this study proved to be efficient and effective. For future research, instrument cultural adaptation within the cultural context is highly recommended.

Deranged Liver Function Test After COVID 19 Vaccination: A Rare Presentation With Review Of Literature

Word Health Organization declared COVID 19 infection as pandemic in 2020. Since then different countries had started working on vaccination. After multiple trials different vaccinations got approved. The first vaccine to be received in Pakistan was Sinopharm and was provided to nearly all health care professionals on priority basis. The safety profile of different vaccines were satisfactory and there were very few side effects reported till date. We are reporting the first case in Pakistan where a female health care professional developed vaccination induced deranged liver function test with delayed but complete recovery. Extensive workup was done to rule out all other differentials of deranged liver function test.

Dandy–Walker malformation and intermittent explosive disorder: A case report

Dandy–Walker malformation is a group of brain malformations that sometimes present with psychotic features, violent and impulsive behavior, or mood symptoms. Here, we present a case report of a patient with Dandy–Walker malformation who presented with intermittent explosive disorder. A young man, aged 18 years, was brought to the author’s hospital [Hamad Medical Corporation] with anger outbursts, irritable mood, and violent behavior. His magnetic resonance imaging scans showed typical alterations of Dandy–Walker malformation. He also had mild intellectual disabilities and epilepsy. After a few weeks of treatment with sodium valproate 1000 mg/day and risperidone 2 mg/day, his condition improved, and his violent behavior was significantly reduced in 3 months, 6 months, and 1 year of follow-up. There is broad consensus that Dandy–Walker malformation is associated with psychosis and other behavioral abnormalities because of a possible disruption in the prefrontal, thalamic, and cerebellar circuits. The link between Dandy–Walker malformation and intermittent explosive disorder may help us understand this type of brain malformation as a potential psychiatric comorbidity.

Does drinking water with raised fluoride content affect the thyroid hormone status: A study from Tharparker Pakistan

OBJECTIVE

To determine the effect of consuming water with high fluoride content on thyroid hormone status.

METHODS

The comparative cross-sectional study was conducted at Sammu Rind village of district Tharparkar, Pakistan, where ground water was the only source of drinking and had fluoride content >6-8mg/dL, and another set of people from Gadap Town, Karachi, where ground water had fluoride level of 0.3mg/L. Thyroid profile, including serum thyroid stimulating hormone, free triiodothyronine and free thyroxine, were checked for both the exposed and the unexposed groups, and data was cross-tabulated with thyroid profile to check statistical significance. Data was analysed using SPSS 20.

RESULTS

Of the 242 subjects, 121(50%) each were in the exposed and the unexposed group. Among the exposed, 15(12.4%) people had hypothyroidism, 104(86%) had euthyroid and 2(1.6%) had hyperthyroid. Corresponding values in the unexposed group were 10(8%), 105(87%) and 6(5%). The difference was not statistically significant (p>0.05).

A randomised controlled trial of a novel tramadol chewable tablet: pharmacokinetics and tolerability in children

Tramadol is a bitter atypical opioid analgesic drug and is prescribed to treat postoperative pain in children. However, in many countries there is no licensed paediatric tramadol formulation available. We have formulated a novel chewable chocolate-based drug delivery system for the administration of tramadol to children. This pilot, single-centre, open-label, randomised clinical study assessed the taste tolerability and comparative population pharmacokinetics of the novel tramadol chewable tablet against a compounded tramadol hydrochloride oral liquid, at a dose of 1 mg.kg^-1 . A 5-point facial hedonic scale was used by the children, parents and nurses to assess tolerability. One hundred and forty-one children aged 3-16 years were given tramadol 30 min before general anaesthesia. Blood samples were taken following the induction of anaesthesia and for up to 5 h following tramadol administration. Tramadol and its active metabolite O-desmethyltramadol were analysed using reversed-phase high-performance liquid chromatography. A population pharmacokinetic model was built using non-linear mixed effects modelling. The relative bioavailability for the tablet was 1.25 times higher (95%CI 1.16-1.35) than for tramadol hydrochloride oral liquid, while the absorption rate constant for the tablet was significantly lower (1.97 h^-1 vs. 3.34 h^-1 , p < 0.001). Larger inter-individual variability in absorption rates were observed with the liquid tramadol. The tramadol chewable tablet was more acceptable in taste to children when assessed by the children, parents and nurses (all p < 0.001). We conclude that the novel tramadol chewable tablet has favourable acceptability and more reliable relative bioavailability in children compared with tramadol hydrochloride oral liquid.

No association of anti-osteoporosis drugs with COVID-19-related outcomes in women: a nationwide cohort study

This study was performed to evaluate whether the use of drugs in the treatment of osteoporosis in women is associated with COVID-19 outcomes. The results showed that the risk of hospitalization, intensive care unit admission, and mortality was not altered in individuals taking anti-osteoporosis drugs, suggesting no safety issues during a COVID-19 infection.

INTRODUCTION

Whether patients with COVID-19 receiving anti-osteoporosis drugs have lower risk of worse outcomes has not been reported yet. The aim of this study was to evaluate the association of anti-osteoporosis drug use with COVID-19 outcomes in women.

METHODS

Data obtained from a nationwide, multicenter, retrospective cohort of patients diagnosed with COVID-19 from March 11th to May 30th, 2020 was retrieved from the Turkish Ministry of Health Database. Women 50 years or older with confirmed COVID-19 who were receiving anti-osteoporosis drugs were compared with a 1:1 propensity score-matched COVID-19 positive women who were not receiving these drugs. The primary outcomes were hospitalization, ICU (intensive care unit) admission, and mortality.

RESULTS

A total of 1997 women on anti-osteoporosis drugs and 1997 control patients were analyzed. In the treatment group, 1787 (89.5%) women were receiving bisphosphonates, 197 (9.9%) denosumab, and 17 (0.9%) teriparatide for the last 12 months. Hospitalization and mortality rates were similar between the treatment and control groups. ICU admission rate was lower in the treatment group (23.0% vs 27.0%, p = 0.013). However, multivariate analysis showed that anti-osteoporosis drug use was not an independent associate of any outcome. Hospitalization, ICU admission, and mortality rates were similar among bisphosphonate, denosumab, or teriparatide users.

CONCLUSION

Results of this nationwide study showed that preexisting use of anti-osteoporosis drugs in women did not alter the COVID-19-related risk of hospitalization, ICU admission, and mortality. These results do not suggest discontinuation of these drugs during a COVID-19 infection.

Anxiety and depression among chronic obstructive pulmonary disease

Objective. To evaluate anxiety and depression among chronic obstructive pulmonary disease. Material and methods. Descriptive cross-sectional study, from 1st October 2019 to 30th March 2020, at Department of Medicine Dow University Hospital Karachi. All diagnosed cases of COPD on the basis of GOLD criteria with no other comorbidities were included. A questionnaire was designed for data collection, comprising of sociodemographic characteristic and hospital anxiety and depression scale (HADS). Results. The total number of participants was 370, out of whom 80% (n = 296) were male. 97% (n = 359) were smoker and among all 55% (n = 204) were diagnosed COPD for more than 10 years. The frequency of depression in COPD was 10.8% (n = 40) while frequency of Anxiety was found to be 32.2% (n = 119). Conclusions. Our study demonstrates a comparatively higher frequency of anxiety as compared to depression in the studied population .we also observed that depression and anxiety among COPD patients was more associated with high BMI and longer duration of COPD rather than other demographic factors. Therefore special emphasis should be paid towards early screening for anxiety and depression in COPD patient as timely intervention can dramatically improve the quality of life.

HPLC-UV assay of tramadol and O-desmethyltramadol in human plasma containing other drugs potentially co-administered to participants in a paediatric population pharmacokinetic study

Multimodal analgesia is employed in paediatric pain management to maximise analgesia and minimise side effects. Tramadol is dosed at 1-1.5 mg/kg to treat severe pain in children but the assay for tramadol in plasma samples for pharmacokinetic and toxicology studies does not often consider concurrently administered medications. In this study we developed and validated an HPLC-UV method to quantify tramadol and its main metabolite (O-desmethyltramadol) in human plasma in the presence of seven potentially interfering drugs. Sample preparation method was developed by combining liquid-liquid extraction and protein precipitation. Chromatographic separation was achieved on a BDS-Hypersil-C18 column (5 µm, 250 × 4.6 mm) using a double gradient method. The limit of quantification was 6.7 ng/ml for both tramadol and ODT. The precision and accuracy were in compliance with ICH guidelines. This method was successfully employed to analyse the blood samples of 137 paediatric participants in a tramadol pharmacokinetic trial.

Effect of drinking high fluoride water on liver enzymes a comparitive cross-sectional study

Objective: The aim of this study is to determine the effects of drinking water with high fluoride level on liver functions. Method: This is a descriptive comparative cross-sectional study conducted at Sammu rind village where the drinking water has increase fluoride content. The comparative area was Gadap town where the drinking water has normal fluoride level. Sampling was done randomly and sample size was calculated by WHO calculator and found to be 121 each for exposed and unexposed population. Blood samples taken for liver functions included bilirubin, AST, ALT, Alkaline phosphate, Gamma GT, total protein, albumin and globulin. SPSS version 16 was used for analysis. Mean and SD calculated for quantitative variable and the two comparative groups were cross-tabulated. To check the statistical significance t-test was applied. Results: There was no statistically significant difference with consideration to serum bilirubin, ALT, and AST. However, statistically significant difference was established with respect to alkaline phosphatase, Gamma GT total proteins and A/G ratio between two groups. Conclusion: In our study, there was no evidence of impaired liver function tests in subjects drinking water with high fluoride content.

Frequency of Comorbidities in Admitting COVID-19 Pneumonia Patients in a Tertiary Care Setup: An Observational Study

Background

The novel coronavirus disease 2019 (COVID-19) is a highly infectious and pandemic disease with a variable mode of action. Patients with underlying illnesses such as diabetes, hypertension, and other diseases are more prone to infection. An understanding of the different comorbidities that place patients at the highest risk of COVID-19 pneumonia and other fatal complications associated with COVID-19 is necessary for healthcare professionals. This study aimed to determine the frequency of different comorbid illnesses among COVID-19 patients admitted to a tertiary care hospital in Karachi, Pakistan.

Methodology

All patients diagnosed with COVID-19 who required admission for the care of their symptoms were included in this observational, cross-sectional study conducted from May 1 to July 30, 2020. The patients were treated at a specialized COVID-19 isolation ward built at the Dow University of Health Sciences at the Ojha campus. The patients were referred from the emergency department, medical and allied wards, and COVID-19 screening units. A detailed history and clinical examination were performed, and comorbidities were evaluated.

Results

A total of 212 patients were admitted during the study with a mean age of 52 ± 16 years. The study population consisted of 120 (56.6%) males and 92 (43.39%) females, and the most common comorbidities were uncontrolled diabetes with hypertension (n = 56; 26.4%), controlled diabetes (n = 22; 10.37%), obstructive airway disease (n = 16; 7.5%), and interstitial lung disease (n = 14; 6.6%). A total of 48 (22.64%) patients had no comorbidities.

Conclusions

Most COVID-19-positive patients with pneumonia were male, and common comorbidities included uncontrolled diabetes, hypertension, and obstructive and restrictive lung disease. The presence of comorbidities was associated with a marked increase in the risk of morbidity and mortality. Further studies are warranted to confirm these findings.

SARS-CoV-2 and immune-microbiome interactions: Lessons from respiratory viral infections

By the beginning of 2020, infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had rapidly evolved into an emergent worldwide pandemic, an outbreak whose unprecedented consequences highlighted many existing flaws within public healthcare systems across the world. While coronavirus disease 2019 (COVID-19) is bestowed with a broad spectrum of clinical manifestations, involving the vital organs, the respiratory system transpires as the main route of entry for SARS-CoV-2, with the lungs being its primary target. Of those infected, up to 20% require hospitalization on account of severity, while the majority of patients are either asymptomatic or exhibit mild symptoms. Exacerbation in the disease severity and complications of COVID-19 infection have been associated with multiple comorbidities, including hypertension, diabetes mellitus, cardiovascular disorders, cancer, and chronic lung disease. Interestingly, a recent body of evidence indicated the pulmonary and gut microbiomes as potential modulators for altering the course of COVID-19, potentially via the microbiome-immune system axis. While the relative concordance between microbes and immunity has yet to be fully elucidated with regards to COVID-19, we present an overview of our current understanding of COVID-19-microbiome-immune cross talk and discuss the potential contributions of microbiome-related immunity to SARS-CoV-2 pathogenesis and COVID-19 disease progression.

Frequency of Neurological Presentations of Coronavirus Disease in Patients Presenting to a Tertiary Care Hospital During the 2019 Coronavirus Disease Pandemic

Background Coronavirus disease 2019 (COVID-19), caused by infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), usually presents clinically with cough, fever, shortness of breath, and loss of taste and/or smell. COVID-19 can also present with neurologic signs and symptoms, including headache, hyposmia/anosmia, encephalopathy, meningoencephalitis, Guillain-Barré syndrome, stroke, and seizure. Viral transmission occurs through aerosols generated when an infected person coughs, sneezes, or exhales and by direct touching of contaminated surfaces. The present study evaluated the frequency of neurologic presentations of coronavirus disease in patients presenting at a tertiary care hospital during the COVID-19 pandemic. Methodology This cross-sectional study included 350 inpatients and outpatients (self-isolated) with polymerase chain reaction-confirmed SARS-CoV-2 infection who presented at Dow International Medical College of Karachi between March and June 2020. Of these 350 patients, 68 (18.9%) presented with neurological signs and symptoms and were further evaluated. The data were analyzed statistically using IBM Statistical Product and Service Solutions (SPSS) for Windows, version 20.0 (IBM Corp., Armonk, NY). Results The 350 patients with SARS-CoV-2 infection included 245 (70%) men and 105 (30%) women; of these, 262 (74.9%) were married, and 88 (25.1%) were unmarried. Patients ranged in age from 17 to 88 years (mean ± standard deviation, 49.5 ± 17.4 years), with 68 (18.9%) having neurological manifestations. Headache was the most frequent neurological symptom, reported in 21 (6%) patients, followed by vertigo in 12 patients (3.4%), numbness/paresthesia in 11 (3.1%), altered level of consciousness in seven (2%), hyposmia/anosmia in five (1.4%), and encephalitis in three (0.9%). Other symptoms included sudden hemiparesis (stroke) in two patients (0.6%), flaccid paralysis due to Guillain-Barre syndrome in one (0.3%), and seizure in one (0.3%). Conclusion Neurological involvement is not infrequent in patients with COVID-19. Neurologic manifestations should be carefully monitored in infected patients. COVID-19 should be suspected in patients presenting with neurological abnormalities and should be included in the differential diagnosis to prevent further virus transmission.

Atomoxetine improves hippocampal cell proliferation but not memory in Doxorubicin-treated adult male rats

Atomoxetine (ATX) is a noradrenaline reuptake inhibitor used to treat Attention deficit hyperactive disorder (ADHD), or improve cognition in normal subjects. Cancer patients treated with systemic adjuvant chemotherapy have described experiencing deterioration in cognition. Doxorubicin (DOX, Adriamycin) is one of the anthracycline families used in chemotherapy, which has a deteriorating effect on both cognition and proliferation. The cognitive effects of ATX require inputs from the hippocampus. The aim of this study was to examine spatial memory and proliferation in the subgranular zone (SGZ) of the DG in adult Lister Hooded rats treated either alone or with a combination of Atomoxetine (30 mg kg⁻¹ day⁻¹, six i.p. doses, one injection every other day) and Doxorubicin (DOX) ( 2 mg kg⁻¹ day⁻¹, six i.p. doses, one injection every other day). Spatial memory was tested using the Novel location recognition (NLR) test, and proliferation of hippocampal cells was quantified using immunohistochemistry for the proliferative marker Ki67. Results showed that ATX treatment has improved the NLR task and increased cell proliferation in the SGZ of the DG, compared with saline‐treated controls. Animals treated with DOX only showed deficits in NLR task, and co‐administration of ATX along with DOX did not improve their performance. DOX chemotherapy caused a significant reduction in the number of proliferating cells in the SGZ of the DG compared with saline‐treated controls. This reduction was reversed by co‐administration of ATX. The above findings suggest that DOX can negatively affect both cell proliferation and memory and ATX co‐administration improves proliferation, but not memory in the adult male rat hippocampus.

90 Establishment and characterization of Day 30 equine chorionic girdle and allantochorion cell lines

Establishing cell lines is a good model for experimental applications to study molecular mechanisms and cell-specific gene expression. Equids have a diffuse epitheliochorial placenta, where the invasive trophoblast is represented by the chorionic girdle (CG) and the noninvasive trophoblast by the allantochorion (AC). Embryonic CG cells are unique to horses and have a crucial role in equine chorionic gonadotropin (eCG) production and maintenance of pregnancy during the first trimester. This study had three objectives: (1) establishing a stable cell line from Day 30 CG cells and AC using lentivirus encoding hTERT; (2) characterisation of Day 30 CG cells and AC cell morphology and expression of eCG α (eCGA) and β (eCGB) subunits, major histocompatibility complex class II (MHCII), and Kisspeptin receptor (KISS1R) in CG and AC cells; (3) investigating eCG protein production invitro from Day 30 CG and AC cells. Three mares (n=3) were used to collect Day 30 conceptuses by non-surgical uterine lavage on Day 30 of pregnancy. All 3 conceptuses were dissected for CG and AC cells then cultured invitro to confluency in cell culture plates. Second-generation lentiviral particles were generated using a three-vector system including transfer vector pLV-hTERT-IRES-hygro, and human telomerase reverse transcriptase (hTERT) lentivirus was utilised to establish stable hygromycin-resistant equine embryonic cell lines. Reverse-transcription PCR (RT-PCR) was used to study gene expression in cells and radioimmunoassay was used to investigate protein presence in the media. We established a hygromycin-resistant Day 30 CG and AC cell lines that express eCGA, eCGB, and hTERT and confirmed using RT-PCR yielding the predicted bands. The cell lines were maintained for 16 passages (7±2 days/passage), 10 of which were cultured after the lentiviral infection steps. Also, we characterised CG cells as fast-growing, large, binucleated, and epithelioid, and AC cells as rapid-growing showing smaller, squamous, mononucleate, epithelioid, and elongated fibroblastic cells. The RT-PCR results showed eCGA and eCGB subunits are expressed by both Day 30 CG and AC cells, but MHCII and KISS1R genes were not expressed in either of cells. Moreover, radioimmunoassay results showed that Day 30 CG cells did produce eCG protein (35.42ngmL−1) invitro earlier than what previous literature has shown. However, Day 30 AC cells did not produce eCG protein (0.042ngmL−1) invitro, and both CG and AC cell lines stopped secreting eCG in the media after the lentiviral infection. To conclude, establishing stable and hygromycin-resistant cell lines from Day 30 equine CG and AC cells using lentivirus encoding pLV-hTERT-IRES-hygro is attainable. Also, equine chorionic gonadotropin eCG protein is produced invitro as early as Day 30 from CG cells.

Quantitative analysis of facial soft tissue perfusion during hypotensive anesthesia using laser-assisted indocyanine green fluorescence angiography

The aim of this study was to quantitatively evaluate the efficacy of induced hypotensive anesthesia in decreasing facial soft tissue perfusion during orthognathic surgery using laser-assisted indocyanine green fluorescence angiography. This retrospective study involved the evaluation of 16 patients who underwent orthognathic surgery. Data collection included facial tissue perfusion of the bilateral cheeks and chin at normotension and with pharmacologically induced hypotensive anesthesia. There were statistically significant differences in the facial tissue perfusion at normal and depressed levels of blood pressure (P<0.001). This study used an objective measure to demonstrate the long-standing belief that hypotensive anesthesia is efficacious in reducing tissue perfusion in the surgical field. The data suggest that pharmacologically depressing the level of mean arterial pressure by 18% may result in a 41-52% decrease in facial soft tissue perfusion. This study reports a novel method of quantitative analysis.

Augmentation of the infraorbital rim in orthognathic surgery

Mid-face augmentation via a Le Fort I osteotomy is a commonly performed operation. Advancement of the upper jaw and associated structures (nose, lower cheek areas) can certainly improve function as well as facial aesthetics and harmony. Often, in patients with severe mid-face deficiency, hypoplasia of the maxilla extends all the way up to the infraorbital rims. The receding infraorbital rim contributes to the negative vector of the globes. In patients with this level of mid-face hypoplasia, while advancing the maxilla at the Le Fort I level satisfies all of the requirements for orthognathic surgery, the deficient infraorbital rim remains unchanged and can actually accentuate the negative vector of the globes. This article explains our approach in augmentation of the deficient infraorbital rim using alloplastic silicone implants at the time of a Le Fort I osteotomy.

Comparison of GnRH antagonist and agonist mini-dose long protocols in infertile cases undergoing controlled ovarian hyperstimulation

AIM

The purpose of the present study was to determine if there is a difference between multi-dose gonadotropin releasing hormone (GnRH) antagonist protocol and long GnRH agonist protocol.

MATERIALS AND METHODS

This retrospective study compared the data pertaining to patients chosen as per predetermined acceptance criteria, 113 of whom were administered multi-dose antagonist protocol for controlled ovarian hyperstimulation (COH) while 133 were administered long agonist protocol for COH at Suleymaniye Teaching Hospital of Obstetrics and Gynecology.

RESULTS

While cancellation rate was found to be significantly higher in antagonist group (17.7% vs 11.28%), the number of follicles > 14 mm and > 16 mm, E2 level, and the number of retrieved oocytes on the day of hCG trigger were significantly lower in the same group. However, there was no difference between fertilization rates and embryonic development rates. The pregnancy rates per transfer and per cycle were found to be 40.9% and 31.7%, respectively; in the antagonist group they were lower, though not significantly, when compared to agonist group (44.1% and 39.1%, respectively). Ongoing pregnancy rates were found to be similar between the groups.

CONCLUSION

GnRH antagonist treatment protocol has a level of efficacy similar to agonist treatment protocol in terms of pregnancy results for all groups.

Alexithymia in Diabetes Mellitus

Background

Diabetes mellitus is a chronic, progressive disease with complex therapy protocols requiring major coping efforts from patients to achieve and maintain glycaemic control in order to reduce risk of diabetic complications. Disease coping strategies including good knowledge of diabetes and high ability of self-care have been reported to be impaired by alexithymic features. Alexithymia is a psychological construct characterised by inability to express emotions verbally, poor imagination and operational thinking, leading to failure in psychological self-regulation.

Objective

To compare prevalence of alexithymia and mean Toronto Alexithymia Scale-26 (TAS-26) scores in diabetic patients with non-diabetic controls; to investigate the association of alexithymia with glycemic control in diabetes.

Method

In this cross- sectional study, TAS-26 scores of 193 diabetic patients and 49 non-diabetic controls were compared. Disease related factors were obtained from patient records. Alexithymia was used as a continuous (mean TAS-26 scores) and semi-quantitative (dichotomised into non-alexithymic 11>TAS-26 scores>11 and alexithymic individuals) variable. Descriptive data are presented as mean±SD, median (range) or %. Differences in means were compared via Independent-Samples T Test and One-Way ANOVA. Proportions were analysed with chi-square test and odds ratios (OR) were calculated via cross tabulation with a confidence interval (CI) of 95%. P<0.05 was considered statistically significant.

Results

The control group was similar with respect to age, gender and education with the diabetic group. In the diabetic study population (n=193, male/female: 42/58%, age 54.2±14.0 years, median diabetes duration 7 years (1-32 years), postprandial blood glucose (PBG) 243±110 mg/dl, HbA1c 7.3±3.6%) prevalence of alexithymia was significantly higher than in the control group (65 % in diabetics vs. 45 % in controls, p=0.011; mean TAS-26 score 12.3±3.7 vs. 10.6±3.6, p=0.004, respectively). Poor postprandial glycaemic control (p=0.002), female gender (p=0.026), combination therapy (p=0.037) and poor educational level (p=0.005) were positively associated with TAS-26 scores in diabetic individuals. Alexithymic diabetic patients were less educated (OR=1.2, p=0.046) and under worse glycaemic control (OR=2.4, p=0.005) compared to their non-alexithymic counterparts.

Heart Rate Variability in Diabetes Patients

Diabetes mellitus can cause cardiovascular autonomic neuropathy and is associated with increased cardiovascular deaths. We investigated cardiovascular autonomic neuropathy in diabetics and healthy controls by analysis of heart rate variability. Thirty-one diabetics and 30 age- and sex-matched controls were included. In the time domain we measured the mean R-R interval (NN), the standard deviation of the R-R interval index (SDNN), the standard deviation of the 5-min R - R interval mean (SDANN), the root mean square of successive R - R interval differences (RMSSD) and the percentage of beats with a consecutive R - R interval difference > 50 ms (pNN50). In the frequency domain we measured high-frequency power (HF), low-frequency power (LF) and the LF/HF ratio. Diabetes patients had lower values for time-domain and frequency-domain parameters than controls. Most heart rate variability parameters were lower in diabetes patients with chronic complications than in those without chronic complications.

An aesthetic approach in the repair of anterior frontal sinus fractures

The management of upper facial trauma is a common responsibility of surgeons taking care of maxillofacial injuries. Historically, the most commonly used surgical approach has been the bi-temporal (coronal) incision. As is well known, the coronal incision carries some inherent complications such as hair loss, long scars, and increased length of hospital stay. The purpose of this article is to describe an aesthetic approach, similar to an endoscopic brow lift, for the repair of anterior wall fractures of the frontal sinus without the need for long incisions or fixation devices.

Assessment of perioperative, early, and late postoperative complications of the inside-out transobturator tape procedure in the treatment of stress urinary incontinence

OBJECTIVE

To evaluate the complications of urinary incontinence surgery with transobturator tape (TVT-O) system and to describe its diagnosis and management.

MATERIALS AND METHODS

A total of 156 patients who were diagnosed as having stress incontinence and mixed incontinence with stress predominance underwent a TOT operation under spinal anesthesia by one surgeon or two surgeons (MB, AEY) from the team. TVT-obturator inside out material was used in the operation. Urodynamic tests and pad tests were done on all the patients. This is a prospective and retrospective study of the complications of TVT-O. The operation was performed under regional anesthesia, as described by Deval et al. Patients were excluded from the study if they had been operated under general or local anesthesia, had undergone any vaginal operations except for anterior repair (cystocele), wanted to have a baby, had severe systemic diseases or had been diagnosed as having urge incontinence in urodynamic tests. These situations may affect the rate of complications, the authors also excluded slings that had materials other than monofilament polypropylene, and patients who were suspected of having neurologic bladder conditions. The bladder and urethra were evaluated using cystoscopy. The durations of the TOT procedure, cystoscopy, and if performed, the cystocele operation, were recorded. Perioperative, early, and late postoperative complications were analyzed by follow-up visits (after two months to four years).

RESULTS

Of the 156 patients included in the study, 100 (64.1%) had pure stress urinary incontinence and 56 (35.9%) had mixed incontinence, 20 (12.8%) had previous incontinence surgery. The mean duration of follow up was 30.3 ± 7.4 (range 17-42) months. The mean age of the patients was found to be 48.43 ± 6.24 years (range 42-68). The mean parity of the patients was 5.24 ± 2.86 (range 2-13), and mean body mass index was found to be 23.7 ± 4.8. Mean maximum detrusor pressure was 10.30 ± 4.08 and the mean ALP value was 80.80 ± 25.57. Mean operative time was found to be 13.8 ± 5.16 min in patients who underwent only TOT and TOT-anterior repair. Vaginal injury including to the lateral fornix (4.4%), hemorrhaging of more than 200 ml (3.2%), vascular damage (1.9%), hematoma on the leg (1.9%), hemorrhaging of more than 500 ml (0.064%), and bladder perforation (1.2%) were detected as perioperative complications. Urethral injury and perioperative nerve and intestinal injury did not occur. The most common complication in early postoperative period was inguinal pain extending the legs (30.7%), followed by headaches (23.7%), fever (12.8%), urinary tract infection (5.7%), and urinary retention (3.2%), respectively. Late postoperative complications included vaginal erosion (4.4%), de novo urge incontinence (8.9%), de novo dyspareunia (7.1%), perineal pain (4.4%), and worsening urgency (8.9%).

CONCLUSION

Although the TVT-O technique is a minimal invasive surgery method applied to treat the urinary incontinence surgically, it does not imply that it is a complication-free surgical procedure. Despite the low incidence of intraoperative complications, there is a mild risk of early and late postoperative complications. Fortunately these complications can be taken under control by either conservative and simple medical treatments or surgical procedures.

Troponin I and D-Dimer levels in preeclampsia and eclampsia: prospective study

OBJECTIVE

The aim of this study was to evaluate serum cardiac troponin I and D-Dimer (D-Di) levels in preeclampsia (PE), eclampsia (E), and normotensive healthy pregnant women in third trimester in order to define their diagnostic value.

MATERIALS AND METHODS

The study group consisted of 42 preeclamptic patients and 16 eclamptic patient; 108 healthy normotensive pregnant women in third trimester who were chosen from outpatients clinic and examined regularly used as a control group. Serum cardiac troponin I and D-Di levels were measured using an immunoassay.

RESULTS

The average levels of troponin I were 0.0134 ± 0.0091, 0.017 ± 0.0085, 0.180 ± 0.136 in control group, preeclamptic, and eclamptic patients, respectively. The levels of troponin in eclamptic patients were statistically higher than the normotensive and preeclamptic group (p = 0.016, p = 0.014). There were no differences in terms of troponin I level between preeclamptic group and normotensive pregnant women in third trimester (p = 0.089). The average D-Di levels were 634 ± 228 ng/ml, 1426 ± 430 ng/ml, 2067 ± 580 ng/ml in control group, preeclamptic, and eclamptic patients, respectively. The levels of D-Di in preeclamptic and eclamptic patients were found significantly higher than the control groups (p = 0.034, p = 0.020).

CONCLUSION

Serum troponin I levels increased in eclamptic patient because of myocardial damage. An increased level of troponin was not detected in preeclamptic patients. However; D-Di level increased in preeclamptic and eclamptic patients.

The A1 chieve study - an observational non-interventional study of patients with type 2 diabetes mellitus initiating or switched to insulin analogue therapy: subgroup analysis of the Gulf population

AIM

To evaluate the safety and effectiveness of insulin analogues (insulin aspart, insulin detemir and biphasic insulin aspart 30, alone or in combination) in type 2 diabetes mellitus (T2DM) patients in routine clinical practice in the Gulf as a subgroup of the A(1) chieve multi-national study.

METHODS

A total of 10,704 T2DM Gulf patients with uncontrolled T2DM on oral antidiabetics ± insulins other than insulin aspart, insulin detemir or biphasic insulin aspart 30, who initiated or switched to study insulins were included and followed up for 24 weeks in the context of the A(1) chieve study.

RESULTS

Baseline HbA(1c) (± SD) was poor: 9.7 ± 1.7%. At Week 24, an improvement in HbA(1c) of -2.3 ± 1.6% was observed in the entire cohort, and -2.4 ± 1.5% and -2.1 ± 1.7% for insulin-naïve patients and prior insulin users respectively. Overall, rates of hypoglycaemia increased in those new to insulin therapy, whereas a reduction was observed in those switching from other insulins. A marginal reduction in body weight (-0.8 ± 4.4 kg) was noted in the entire cohort, whereas the overall lipid profile and systolic blood pressure (-6.2 ± 15.3 mmHg) improved.

CONCLUSIONS

Initiating or switching to insulin analogues was well tolerated and resulted in significant improvements in glycaemic control in T2DM patients in the Gulf.