POS1398 RHEUMATOLOGICAL PATIENTS PERFORMING BLOOD SELF-SAMPLING FOR DMARD THERAPY SAFETY: A PROOF OF CONCEPT STUDY COMPARING WITH VENOUS BLOOD SAMPLES

Background:Regular blood sampling is a requirement for rheumatological patients receiving csDMARD, bDMARD or tsDMARD therapies (1). The frequent blood sampling affects the patient’s life as they use a substantial amount of time at hospitals or by the general practitioner. Often visits are time-consuming with transport, waiting time, and for some patient’s costly long travels. Giving patients the option of taking the blood samples themself in their own home, as part of a patient-centred monitoring approach, could provide the patient much higher degree of independence. Further, it may increase the quality of life, cause higher compliance with taking the control samples and possibly reduce health care costs.Objectives:1. To investigate if rheumatological patients can take capillary blood samples and describe patient-reported outcomes (PRO) about the procedure. 2. Compare the venous and capillary samples’ results. 3. Test if the laboratory automated analysis equipment can handle the small capillary samples.Methods:21 rheumatological patients, underwent capillary and venous blood sampling at up to 4 occasions (1-2 months between). Instructions were available on a pictogram. PRO data were assessed by questionnaires. The patient performed blood extraction to the capillary samples from a finger after using a device making a small incision (2 mm depth and 3 mm width). Two capillary tubes (one Microtainer K2-EDTA and one Microtainer lithium heparin with gel) were filled with a total volume of approximately 1.0 mL blood. A phlebotomist took the venous sample. Blood samples were analyzed for alanine aminotransferase (ALAT), albumin, alkaline phosphatase (ALP), calcium, C-reactive protein (CRP), creatinine, potassium, lactate dehydrogenase (LDH), urate, hemolysis index, erythrocyte corpuscular volume (MCV), haemoglobin, leukocytes, differential count and platelets.Results:A total of 53 paired capillary (C) and venous (V) samples were taken. The average perceived pain of the procedure of C sampling was VAS: 10.3 (SD:14.4) (0-100) versus V sampling VAS: 8.5 (SD:11.7). 90% of patients would accept it as a future form of blood sampling.Differences in blood samples (C versus V) were: CRP (-3.4%); Hemoglobin (-1.4%); Creatinine (-4.4%), ALAT (-2.9%), neutrophils (1.43%), platelets (-16.9%).The index of hemolysis was on average 128.9 mg/dL (SD: 203) in C versus 6.7 mg/dL (SD: 4.6) in V. Results was evaluated by a rheumatologist, and 92.5% of capillary samples could be used to evaluate the safety of DMARD treatment based on the most critical samples for this: ALAT, creatinine, neutrophils and platelets (1). The 7.5 % not accepted were all due to aggregated platelets leading to low platelet count. There was hemolysis in 18% of the samples, but the analysis results could be used despite this.Conclusion:In the majority of rheumatological patients, capillary self-sampling is well tolerated.We show that it is possible to extract the needed results from the capillary samples to evaluate DMARD treatment safety, despite higher hemolysis index. Using capillary samples taken at home could be a central instrument in future rheumatological patient-centred monitoring.References:[1]Rigby WFC et al. Review of Routine Laboratory Monitoring for Patients with Rheumatoid Arthritis Receiving Biologic or Nonbiologic DMARDs. Int J Rheumatol. 2017Disclosure of Interests:None declared

Association between hypoxia-inducible factor-1 alpha rs11549465 (1772 C>T) polymorphism and metabolic syndrome

Objectives: To find the association of single nucleotide polymorphism of hypoxia-inducible factor-1 alpha, rs11549465 (1772 Cytosine > Thymine) with metabolic syndrome, and to compare the anthropometric and biochemical variables in different genotypes of hypoxia-inducible factor-1 alpha. Methods: The cross-sectional comparative study was conducted at the University of Health Sciences, Lahore, Pakistan, from July 2016 to April 2019, and comprised patients of metabolic syndrome selected from the Sheikh Zayed Hospital, Lahore. Healthy controls were also enrolled. Fasting venous sample was taken for the determination of study parameters. The genetic variant of hypoxia-inducible factor-1 alpha was analysed by restriction fragment length polymorphism polymerase chain reaction. Data was analysed using SPSS 22. Results: Out of 400 subjects, 200(50%) each were patients and controls. The frequency of CC genotype of hypoxia-inducible factor-1 alpha Cytosine > Thymine in patients was 166(83%) and in controls 147(73.5%); CT genotype was 34(17%) and 53(26.5%) respectively, while TT genotype was not observed. There was a significant association of the C allele and CC genotype (p=0.03) with the increased risk of metabolic syndrome (p=0.02). On comparison of study variables in the two genotypes, systolic blood pressure, anthropometric and lipid parameters were significantly higher in the wild CC genotype compared to CT in the control group (p<0.05), but there was no significant difference in the patients (p>0.05). Conclusion: Major allele C of hypoxia-inducible factor-1 alpha 1772 Cytosine > Thymine was found to be associated with increased risk of metabolic syndrome. Continuous...

Cross-sectional association between vitamin B12 status and probable postpartum depression in Indian women

Background Vitamin B12 is an essential micronutrient for neurological function, as it leads to the regeneration of methionine from homocysteine, which is precursor of biologically active molecule S-Adenosyl Methionine (SAM). Pregnancy is a state of increased demand and delayed postpartum repletion of nutrients may predispose women to depression. Methods We included women who visited the hospital at 6-weeks postpartum for a regular checkup. Inclusion criteria were age (18–50 years), and willingness to donate venous sample for analysis. Exclusion criteria included previous history of mood disorders or antidepressant medication use, and any systemic illness like hypothyroidism, epilepsy, diabetes, and hypertension. Based on EPDS score of 10 as a cutoff, 217 women with probable postpartum depression (PPD) and equal number of age and BMI matched controls were included. Plasma total vitamin B12, holotranscobalamin (holotc), homocysteine (hcy), methyl malonic acid (MMA), 5-methyl tetrahydrofolate (THF), SAM and serotonin levels were estimated using commercially available ELISA kits. Combined B12 (cB12) score was calculated from study parameters. Multivariate analysis was performed to assess the risk of probable postpartum depression. Results Total vitamin B12 and combined B12 score were found to be significantly lower (p = 0.001) and MMA (p = 0.002) and 5-methyl THF (p < 0.001) levels were higher in women with probable depression than women without probable PPD. Women in the lowest vitamin B12 quartile had 4.53 times higher likelihood of probable postpartum depression (p < 0.001). Multivariate analysis demonstrated that decreasing vitamin B12 (OR = 0.394; 95% CI: 0.189–0.822) and cB12 (OR = 0.293; 95% CI: 0182–0.470) and increasing MMA (OR = 2.14; 95% CI: 1.63–2.83) and 5-methyl THF levels (OR = 3.29; 95% CI: 1.59–6.83) were significantly associated with the risk of probable PPD. Conclusion Low vitamin B12 may contribute to depressive symptoms in vulnerable postpartum period.

Adipose tissue micrograft in a scaffold of plasma-gel combined with platelet-derived growth factors in dermal wrinkle regeneration

Background: The dermal aging process and the formation of deep wrinkles are a biological involution that also involves the regeneration system of cells immersed in the extracellular matrix and the papillary dermis. The progressive loss of niches of adult stem cells (MSCs) is more evident after the first third of life; it increases the phenotypic expression and the characteristics of the tissue senescence process. The purpose of this study was to clinically demonstrate that in viable micrograft there may be an improvement of deep wrinkles and surrounding tissues. Methods: This study involved 11 female patients who underwent the correction of deep dermal wrinkles through a suspension containing 0.8 mL of viable micrografts in a 5 mL plasma gel scaffold, obtained from the centrifugation of a 20 cc venous sample peripheral blood, gelled by heat in a dry steriliser and the buffy coat coming from the same venous sample, in order verify overtime the improvement of the interested anatomical area. Individual signs of wrinkles and the degree of correction obtained for each treatment and each area were objectively evaluated by using a 10-0 visual analog scale (VAS), Modified Vancouver scale and Berardesca's scale. Results: With this technique excellent results were obtained. In fact, wrinkles were improved, as well as surrounding tissues, even after 60 days, as shown by the Berardesca's, VAS and Modified Vancouver scales. Conclusion: This retrospective clinical evaluation allowed us to consider the excellent clinical results obtained with this method for the treatment of deep wrinkles and surrounding tissues, through a suspension of progenitors with MSCs derived from adipose tissue (ADSCa) in a not inflammatory plasma gel scaffold combined with buffy coat.

Using a fingerstick test for haematological monitoring in patients treated with clozapine

Background Treatment with clozapine requires regular blood monitoring in order to minimise the risk of agranulocytosis. The demands on patients and clinicians associated with monitoring may be reduced by using point-of-care, as opposed to lab-based assessments. We assessed the utility of a device that can measure white blood cell (WBC) and neutrophil counts by capillary fingerstick blood. Method The performance of a small, portable device (HemoCue® WBC DIFF System) was compared with that of a widely used laboratory analyser (ADVIA® 2120i) for measuring WBC and neutrophil counts. Patients with schizophrenia who were being treated with clozapine ( n = 201) provided a fingerstick capillary sample and a venous sample for the respective assays. Results WBC counts and neutrophil counts from venous blood as determined by ADVIA 2120i, ranged from 3.0 × 109/l to 19.5 × 109/l, and 1.2 × 109/l to 15.9 × 109/l, respectively. There was a strong correlation between the results from venous and the capillary sample methods (WBC: R = 0.89, neutrophil: R = 0.92). By Passing–Bablok regression analysis, the slope of the association between ADVIA® 2120i and HemoCue WBC DIFF for WBC was 1.0 [95% confidence interval (CI) 0.944–1.086], with intercept at −0.9 (95% CI −1.43 to −0.45). For neutrophils, the slope was 0.870 (95% CI 0.817–0.923), with intercept at −0.19 (95% CI −0.43 to 0.02). Overall, mean biases of −0.95 × 109/l for WBC, and −0.91 × 109/l for neutrophils were observed for the capillary blood method compared with the venous blood method. Below the clinical cutoff intervals for clozapine monitoring WBC (<3.5 × 109/l) and neutrophils (<1.5 × 109/l) these biases were −1.1 × 109/l for WBC, and −0.25 × 109/l for neutrophils. Conclusion Results from the capillary blood HemoCue WBC DIFF analyser compared well with the venous blood ADVIA 2120i analyser for determining WBC and neutrophil counts. There was a slight overall bias, with the capillary method reporting lower values for both measures. Fingerstick point-of-care analysis is suitable for monitoring blood counts in patients on clozapine, although confirmatory standard venous testing is recommended for test results falling below accepted thresholds.

Cross-sectional association between vitamin B12 status and probable postpartum depression in Indian women

BackgroundVitamin B12 is an essential micronutrient for neurological function, as it leads to the regeneration of methionine from homocysteine, which is precursor of biologically active molecule S-Adenosyl Methionine (SAM). Pregnancy is a state of increased demand and delayed postpartum repletion of nutrients may predispose women to depression.MethodsWe included women who visited the hospital at 6-weeks postpartum for a regular checkup. Inclusion criteria were age (18 -50 years), and willingness to donate venous sample for analysis. Exclusion criteria included previous history of mood disorders or antidepressant medication use, and any systemic illness like hypothyroidism, epilepsy, diabetes, and hypertension. Based on EPDS score of 10 as a cutoff, 217 women with probable postpartum depression (PPD) and equal number of age and BMI matched controls were included.Plasma total vitamin B12, holotranscobalamin (holotc), homocysteine (hcy), methyl malonic acid (MMA), 5-methyl tetrahydrofolate (THF), SAM and serotonin levels were estimated using commercially available ELISA kits. Combined B12 (cB12) score was calculated from study parameters. Multivariate analysis was performed to assess the risk of probable postpartum depression.ResultsTotal vitamin B12 and combined B12 score were found to be significantly lower (p=0.001) and MMA (p=0.002) and 5-methyl THF (p<0.001) levels were higher in women with probable depression than women without probable PPD. Women in the lowest vitamin B12 quartile had 4.53 times higher likelihood of probable postpartum depression (p < 0.001). Multivariate analysis demonstrated that decreasing vitamin B12 (OR = 0.394; 95% CI: 0.189-0.822) and cB12 (OR=0.293; 95% CI:0182-0.470) and increasing MMA (OR = 2.14; 95% CI: 1.63-2.83) and 5-methyl THF levels (OR = 3.29; 95% CI: 1.59-6.83) were significantly associated with the risk of probable PPD.ConclusionLow vitamin B12 may contribute to depressive symptoms in vulnerable postpartum period.

Comparison of Hematological and Biochemical Results Derived from Arterial and Venous Blood Samples in Post-Anesthetic Dogs

Collecting blood from an indwelling arterial catheter may reduce stress from repeated venipuncture in patients requiring serial monitoring, but the use of arterial blood for hematological and biochemical testing remains understudied. Here, we compared hematological and biochemical results of arterial and venous blood and evaluated their clinical interchangeability. Blood samples from dogs who had recovered from anesthesia, collected by both arterial catheterization and venipuncture, were analyzed. To assess clinical acceptance between paired samples, the limit of agreement between the values derived from the arterial and venous blood samples was compared with the allowable total error (TEa) recommended for each parameter. We found no significant differences between the arterial and venous sample results for red/white blood cell and platelet counts and hematocrit, blood urea nitrogen, phosphate, total protein, albumin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, gamma-glutamyl transpeptidase, total bilirubin, sodium, potassium, and chloride levels, whereas hemoglobin, glucose, creatinine, and calcium levels differed significantly (p < 0.05). Moreover, only gamma-glutamyl transpeptidase and potassium exceeded the recommended TEa. Hematological and biochemical results derived from venous and arterial blood samples are clinically interchangeable in post-anesthetic dogs, with the exception of gamma-glutamyl transpeptidase and potassium; thus, these values should be used with caution.

Study of serum adenosine deaminase levels in head and neck malignancies

<p><strong>Background:</strong> Head and neck malignancies are the malignancies occurring at various sites like scalp, ear, nose and paranasal sinuses, nasopharynx, oral cavity, oropharynx, hypopharynx, larynx, and salivary glands. There are various biomarkers which aid in early diagnosis and management of head and neck malignancies. In order to study various parameters aiding in early diagnosis, this study has been taken up to estimate serum adenosine deaminase levels among these patients.</p><p><strong>Methods: </strong>Eighty-eight clinically diagnosed head and neck malignancy patients of both genders were included in this study on simple random basis. After obtaining the written informed consent from the patient, a peripheral venous sample of blood was taken and serum ADA levels were estimated. Data was analyzed using IBM SPSS Version 22.</p><p><strong>Results: </strong>Serum ADA levels are found to be statistically significant with respect to various stages of head and neck malignancies including malignancy of unknown origin. Mean ADA level in this study was 30.33 IU/l. Mean ADA levels in MUO, primary tumor with neck secondaries were 37 IU/l, 38.7 IU/l respectively. Mean ADA levels in patients with primary tumor without neck secondaries was 27.9 IU/l.<strong></strong></p><p><strong>Conclusions: </strong>The Serum ADA levels among head and neck malignancy patients including MUO is a simple, inexpensive diagnostic biomarker enzyme which is easy and rapid to estimate. This study emphasizes on using Serum ADA levels as a prognostic indicator among head and neck malignancies who are on various modalities of treatment.<strong></strong></p>

Effectiveness of diabetes in pregnancy study group India diagnostic criterion in detecting gestational diabetes mellitus: a rural Bangalore study

Background: The oral glucose tolerance test (OGTT) is considered the current standard for diagnosis of gestational diabetes mellitus (GDM). International association of diabetes and pregnancy study groups (IADPSG) recommends OGTT, with fasting, one-hour and two-hour venous blood samples drawn after intake of 75g oral glucose. In the Indian context, diabetes in pregnancy study group in India (DIPSI) recommends glucose challenge test (GCT), where 75 g glucose is given irrespective of the fasting state, and a single venous sample is drawn after two-hour. Diagnosis of GDM is made, if any cut-off value is met or exceeded. This prospective study was conducted to compare the DIPSI and IADPSG criteria for diagnosis of GDM.Methods: Pregnant women between 24 to 28 weeks of gestation were subjected to non-fasting GCT. Capillary sample were also drawn simultaneously using Accu check active glucometer. These women were counselled to undergo a standard 75gram OGTT, within a week of recruitment.Results: According to IADPSG criteria, 17.6% (18/102) of our participants had GDM, as compared to 19.6% (20/102) by DIPSI criteria using venous samples, and 25.3% (25/99) by capillary sample method. Sensitivity and specificity of GCT using venous sample was 72.22% and 91.67%, and using capillary sample was 70.59% and 84.15% respectively. DIPSI criteria using venous samples wrongly labelled 8.3% women as GDM, and capillary samples wrongly labelled 15.9% women as GDM. More importantly DIPSI criteria using venous samples labelled 27.8% women as false-negative and capillary samples labelled 29.4% women as false-negative for GDM. Almost one quarter of women with GDM will be missed if DIPSI criteria is used as a universal screening modality.Conclusions: We suggest that the IADPSG criteria be used for diagnosis of GDM in antenatal women in India.