Provision of Diet, Exercise, Cholesterol and Hemoglobin A1C Testing in Office Based Medical Visits Among Normal, Overweight, Obese, and Morbidly Obese Individuals in the US

Objectives: Obesity is a global epidemic and leads to complications such as diabetes and dyslipidemia. The objective of this study was to examine the provision of diet, exercise, cholesterol and HbA1c testing in office based medical visits among normal, overweight, obese, and morbidly obese individuals in the US. Method(s): The 2018 National Ambulatory Medical Care Survey data was used to conduct the study. Main outcome was provision of diet/nutrition, exercise, weight-reduction counseling, cholesterol and HbA1c testing in normal (BMI:18-25), overweight (BMI:25-30), obese (BMI:30 - 40), and morbidly obese (BMI:40+) individuals. A logistic regression model was fit to examine main outcomes by BMI status. Survey weights are assigned to the sample visits to obtain national estimates. All models were adjusted for confounders: race, ethnicity, age, gender, MSA, and insurance status. Odds ratios are reported to describe differences in overweight, obese, and morbidly obese patients compared to normal weight patients. Result(s): The weighted study sample consisted of 496,622,621 outpatient visits primarily white (84%), male (58%), covered by private insurance (57%). Multivariate analysis reveals that overweight, obese, and morbidly obese individuals received more HbA1c tests (OR, 1.02;CI, 1.01-1.03;OR, 3.47;CI, 2.31-5.2;OR, 9.01;CI, 4.88-16.66), and lipid profile tests (OR, 1.56;CI, 1.01-2.41;OR, 1.88;CI, 1.32-2.67;OR, 2.16;CI, 1.20-3.90) compared to normal weight patients. Similar trends were observed in the provision of diet/nutrition, exercise, and weight reduction counseling services (OR, 3.31;CI, 1.49 -7.35;OR, 7.51;CI, 2.85 -19.76;OR, 18.47;CI, 7.40- 46.10). Conclusion(s): Our study findings suggest that at risk individuals receive more weight-related services, such as testing for diabetes, cholesterol, diet, exercise, and weight reduction education compared to normal weight individuals. This study forms a baseline to examine disparity in provision of such services post-Covid (2019 and beyond) era given the disruption in the scarcity of health care professionals for such basic preventive services.Copyright © 2023

Primary care network (PCN) based 'type 2 diabetes optimisation clinics' run by primary care clinicians are a cost effective and efficient way of improving treatment targets for patients with poorly controlled diabetes, despite the constraints of the Covid-19 pandemic

Background: Approximately 10% of people living with type 2 diabetes in Waltham Forest (WF) who are treated with oral hypoglycaemic agents (OHA) alone and not under specialist care have an HbA1c > 75mmol/mol. No optimisation clinic exists at PCN level in WF, despite maximum capacity reached in specialist community and secondary care clinics. Aim(s): To establish a remote PCN based optimisation clinic during the Covid-19 pandemic, using motivational and patient empowerment interviewing techniques. Improvement in HbA1c, blood pressure and lipid profile underpinned the study. The 'behaviour change model' was also used to assess patient engagement. Method(s): We identified and consulted with 43 patients using an extended consultation of 25 min. Engagement and recall after 3 months were facilitated by a dedicated administrator and optimal care was ensured via monthly remote consultant input. Result(s): 38 patients were optimised with oral hypoglycaemic agents (OHA) alone and completed the pilot. 31/38 patients had an HbA1c reduction of more than 11mmol/ mol, with a significant overall median reduction across the whole cohort (pre 88mmol/mol vs 70mmol/mol, p < 0.0001). There was also a significant median reduction in triglyceride level (pre 1.56mmol/l vs 1.20mmol/l, p = 0.0247). In terms of behaviour change, all but one patient improved their behaviour towards their diabetes significantly. The approximate cost of the pilot per patient was 263 (excluding medication). Conclusion(s): A PCN based optimisation clinic using active recall is a cost effective and efficient method for significantly improving glycaemic control in people living with type 2 diabetes.

PLASMA LIPIDS AND AMINO ACIDS LINKED TO LOW SARS-CoV-2 SUSCEPTIBILITY

Background: The mechanisms driving SARS-CoV-2 susceptibility remain poorly understood, especially the factors determining why a subset of unvaccinated individuals remain uninfected despite high-risk exposures. Method(s): We studied an exceptional group of unvaccinated healthcare workers heavily exposed to SARS-CoV-2 ('nonsusceptible') from April to June 2020, who were compared against 'susceptible' individuals to SARS-CoV-2, including uninfected subjects who became infected during the follow-up, and hospitalized patients with different disease severity providing samples at early disease stages. We analyzed plasma samples using different mass spectrometry technique and obtained metabolites and lipids profiles. Result(s): We found that the metabolite profiles were predictive of the selected study groups and identified lipids profiles and metabolites linked to SARS-CoV-2 susceptibility and COVID-19 severity. More importantly, we showed that non-susceptible individuals exhibited unique metabolomics and lipidomic patterns characterized by upregulation of most lipids -especially ceramides and sphingomyelin-and amino acids related to tricarboxylic acid cycle and mitochondrial metabolism, which could be interpreted as markers of low susceptibility to SARS-CoV-2 infection. Lipids and metabolites pathways analysis revealed that metabolites related to energy production, mitochondrial and tissue dysfunction, and lipids involved in membrane structure and virus infectivity were key markers of SARS-CoV-2 susceptibility. Conclusion(s): Lipid and metabolic profiles differ in 'nonsusceptible' compared to individuals susceptible to SARS-CoV-2. Our study suggests that lipid profiles are relevant actors during SARS-CoV-2 pathogenesis and highlight certain lipids relevant to understand SARS-CoV-2 pathogenesis. (Figure Presented).

Essential fatty acid and lipoprotein status in pediatric cystic fibrosis: Impact of cystic fibrosis transmembrane conductance regulator modulators

Background: Dyslipidemias and essential fatty acid deficiencies (EFADs) are well established complications of cystic fibrosis (CF). In the general population, a diet high in saturated fat is associated with hyperlipidemia and greater risk of cardiovascular disease and type 2 diabetes. Increasing life expectancy in CF brings concern about the risks of the "legacy" high-fat CF diet. The impact of CFTR modulators on CF-related dyslipidemia and EFAD is not known. Previous studies reported dyslipidemia in people with CF (PwCF) using traditional lipid measures. This study aimed to evaluate the lipoprotein and fatty acid profiles in children and adolescents with CF and to correlate biochemical results with clinical and molecular findings. Plasma and red blood cell (RBC) samples were studied to compare the ability of each method to identify EFAD markers. Method(s): Blood samples (n = 171) were obtained from 142 (78 female) children with CF aged 9.8 +/- 4.7 (range 4 months to 18 years) during routine laboratory draws at pediatric CF center clinic visits. Pancreatic insufficiency was present in 92% and glucose intolerance or diabetes in 14%. Body mass index percentile (BMI%ile) for age z-scorewas 0.23 +/- 0.89 (range -2.4-2.6). F508del mutation was homozygous for 56% and heterozygous for 41%. CFTR modulator therapy had been initiated 3 or more months before for 62% of samples. Sample collection began in September 2019, paused during the COVID-19 pandemic, and resumed in July 2021. An accredited, regional laboratory with expertise in fatty acid analysis processed all samples. Serum was separated and refrigerated for lipoprotein analysis, plasmawas separated and frozen, and RBCs were washed and frozen for fatty acid analysis. Nuclear magnetic resonance lipoprotein assayswere conducted to determine particle number and size of lipoprotein classes. Triglyceride, total cholesterol, and high-density lipoprotein cholesterol (HDL-C) were measured directly (Roche). Low-density lipoprotein cholesterol (LDL-C) and very low-density lipoprotein cholesterol (VLDL-C) were calculated. To correlate laboratory results with clinical findings, medical records were reviewed, and a CF clinic dietitian conducted 24-hour dietary recalls concurrent with study labs. Result(s): Of PwCF homozygous F508del/F508del, 43% tested positive for EFAD biomarkers (RBC linoleic acid, RBC mead acid, RBC triene/tetraene ratio), compared with 13% of PwCF heterozygous F508del ( p <=0.01) (Figure 1). There was no significant difference in concentrations of fatty acid and EFAD biomarkers between those who had or had not initiated CFTR modulator therapy. Lipoprotein abnormalities were identified in 69% of samples with low HDL-C and 39% with large HDL-C, 87% with large VLDL-C particle size and 52% with large VLDL-C particle number, and 5% with high LDL-C or small LDL-C particle numbers. High total cholesterol was found in 15% and high triglycerides in 17%. HDL-C was low in 24%, and 3% had high LDL-C. (Figure Presented) Figure 1. Differences in concentrations of red blood cell (RBC) linoleic and mead acids and triene/tetraene (T/T) ratio between F508del homozygous and F508del heterozygous individuals Conclusion(s): Despite clinical advances and use of CFTR modulator therapy, EFAD remains prevalent and underrecognized in the pediatric CF population. Of PwCF, those homozygous for f508del may have a higher risk of EFAD. Limitations of this study (four different CFTR modulator therapies and small sample sizes in each group) may have precluded significant findings for EFAD and lipid profiles, but PwCF receiving modulator therapy appear to have healthier lipid profiles than those not receiving therapy. Lipids and fatty acid are not routinely evaluated in PwCF, but evaluation should be included in the standard of care for timely dietary interventionsCopyright © 2022, European Cystic Fibrosis Society. All rights reserved

Persistence to long-term PCSK9 inhibitors treatment and its effectiveness in familial hypercholesterolemia: Data from the SAFEHEART study

Background: Most patients with heterozygous familial hypercholesterolemia (FH) do not achieve current LDL-C goals proposed by European guidelines with conventional lipid-lowering therapy (LLT). Chronic use of PCSK9 inhibitors (PCSK9i) have shown to reduce LDL-C levels up to 61% on top of statins. Persistence to chronic LLT is important to reduce the burden of atherosclerotic cardiovascular disease (ASCVD). Purpose(s): To analyze persistence and effectiveness of PCSK9i in clinical practice setting in FH patients from the SAFEHEART register with longterm follow-up. Method(s): SAFEHEART is an open, long-term prospective study of a cohort of subjects with molecular diagnosis of FH. Follow-up is carried out every year through a standardized phone-call to collect clinical conditions, persistence to medications, lipid profile, and cardiovascular events. This study analyses subjects >=18 years of age on stable LLT who have received PCSK9i. Result(s): 696 individuals (46% females), median age 56.4 years (IQR 49- 66) started with PCSK9i (49% alirocumab and 51% evolocumab). Out of them 38% had history of ASCVD, and 89% were on maximum LLT. Median LDL-C at the moment of starting PCSK9i was 145 mg/dL (IQR, 123- 177), representing a poor 2016 & 2019 ESC/EAS guidelines achievement (3% and 0.1% respectively). After a median follow-up of 3.7 years (IQR, 2.3-4.8), 669 patients (96%) remained on PCSK9i treatment during entire follow-up. Only 27 patients (4%) discontinued, 5 temporarily (0.7%) and 22 permanently (3.2%). Most common reasons for PCSK9i treatment interruption were medical decision (n=6), adverse event (AE) (n=5), patient decision not related with AE (n=5) and comorbidity (n=5). Median time to permanent discontinuation was 15 months (IQR, 4-33). Median LDL-C levels observed and % of LDL-C reduction obtained after 1 year of treatment and in the last follow-up visit were: 63 mg/dL (IQR, 43- 88), 61 mg/dL (IQR, 44-82), 57.6% (IQR, 39.5-69) and 58% (IQR, 44-68), respectively. 2016 ESC/EAS guidelines LDL-C goals was achieved by 70% of patients at year 1 and 77% in the last follow-up visit after the introduction of PCSK9i (p<0.001). 2019 ESC/EAS goals were achieved by 44.5% and 48% (p=0.1). Conclusion(s): Long-term persistence to PCSK9i treatment in FH patients is very high (96%) and reasons for discontinuation are diverse. This study shows that COVID-19 pandemic did not affected persistence to treatment. Effectiveness in LDL-C reduction and LDL-C goal achievement improved significantly with introduction of PCSK9i in clinical practice setting.

Successful Treatment of Subclavian Artery Thrombosis by Catheter-Based Thrombus Aspiration and Thrombolytic Therapy: A Case Report

Clinical Information Patient Initials or Identifier Number: BP4****/22 Relevant Clinical History and Physical Exam: A 55 Y / Female C/C : Pain, numbness, cold sensation & weakness of left upper limb for 2 hours. Risk Factor : Hypertension, diabetes mellitus O/E : Pale, cold and absent of radial, ulnar, brachial pulse of left upper limb. Muscle power 3/5 left side. So2 86%, BP undetectable. Right upper limb were normal. BP 160/90 mm of hg, pules : 112 b/min, RR : 26/min. Body Temperature 37.5 C [Formula presented] [Formula presented] Relevant Test Results Prior to Catheterization: CBC : WBC 7450, HB % 10.8 g/dl, ESR 20mm in 1st hour, Platelets : 262000, SARS Cov2 Antigen : Negative PT 14.3 sec, INR : 1.07 APTT : 32.4 sec. blood group: O positive Serum Creatinine : 1.1 mg/dl Plasma glucose 9.7 mmmol/l HIV Ab : Negative HBs Ag : Negative Anti-HCV : Negative Urine R/E : Normal lipid profile : Cholesterol 280mg/dl Vascular duplex ultrasound of left upper limb : A dilated echogenic thrombus had blocked the left subclaviav artery lumen. Relevant Catheterization Findings: Conventional angiography with the lowest amount of contrast agent through the right femoral artery, revealed that left subclavian artery thrombosis with total occlusion distal to Left internal mammary artery. [Formula presented] [Formula presented] [Formula presented] Interventional Management Procedural Step: A5Fr MPA catheter with side holes was negotiated through a right femoral sheath and was placed in the left subclavian artery. Initially thrombus aspiration was done with Eliminate aspiration catheter (TERUMO) with no success. Then suction was done with the MPA catheter itself with partial removal of thrombus. Then a 5Fr Pigtail catheter was placed inside the thrombus and kept in situ. For residual thrombus 250,000u of Inj. Streptokinase as a thrombolytic drug was given through the Pigtail catheter as bolus over 30 min. The maintenance dose 100,000 u per hour was given over 24 hours through the Pigtail catheter via infusion pump. After 24 hours of thrombolytic therapy, her pain was reduced, the left hand became slightly warm, and distal pulses were feebly palpable. Moreover, the skin colour returned to near normal with improvement of pallor. Bleeding was well controlled at the catheter site. Doppler sounds revealed partial improvement of arterial flow. After evaluation of partial improvement, a low dose 1000 iu per hour of heparin (UFH)was infused intravenously for 24 hours. After 48 hours, repeat angiography via the inserted catheter at the site did not reveal any atherosclerotic plaque and confirm the thrombosis-dissolution. The latter practice demonstrated a good blood flowto the left upper distal limb leaving a little thrombus in the superficial palmer arch. [Formula presented] [Formula presented] [Formula presented] Conclusion(s): Catheter-based thrombus aspiration and thrombolytic therapy is primarily reserved for patients with acute viable limb ischemia. As observed in the presented case, thrombus aspiration and thrombolytic therapy is recommended to be considered as an alternative therapeutic method for patients with arterial thrombosis due to the rapid response, shorter treatment time and lower cost, compared to common and sometimes unsuccessful therapies.Copyright © 2023

Short term impact of COVID19 pneumonia on cardiovascular profile

Introduction: COVID19 pneumonias have significantly contributed to short and long-term patient morbidity. Their impact on patients' cardiovascular profile following hospital discharge remains unclear. Aim(s): To investigate the short-term impact of COVID19 pneumonias on patients' atheromatic index (AI), Pulmonary Artery Systolic Pressure (PASP) and lipid profile at 4 weeks following hospital discharge. Material(s) and Method(s): We prospectively reviewed patients in our postCOVID19 outpatient clinic at 4 weeks following hospital discharge. All patients were previously admitted due to COVID19 pneumonia. Thoroughly review of all medical records and the local registry followed. Result(s): 237 patients attended their first outpatient appointment at 4 weeks post discharge (11.2020-12.2021) (103 males, 134 females, mean age 54 years). We reviewed 3 cardiovascular parameters: AI (chol/HDL), PASP and lipid profile. Increased PASP (30> mmHg) was reported in 7.17% (17/237) who were previously PASP naive and increased AI (>3.5) was reported in 37.7% (61/237 patients) who were also previously AI naive. Only 62% patients were compliant in undergoing a lipid profile investigation and 64% of them presented with increased levels of cholesterol (>200mg/dl), triglycerides (>150mg/dl), LDL (>150mg/dl). Conclusion(s): COVID19 pneumonia leaves a cardiovascular footprint at 4 weeks post hospital discharge in cardiovascular naive patients. Overall, these patients seem to be at an increased risk for cardiovascular diseases that increases with age. Our study is prospectively continued to investigate the impact at 3 and 6 months post hospital discharge.

Evaluation of lipid profile in patients with COVID-19 infection

Introduction: Patients with severe COVID-19 display dysregulated lipid metabolism. Dyslipidemia is associated with damage to the immune, respiratory, and cardiovascular systems, lipid dysregulation may contribute to morbidity and mortality from COVID-19 infection. Aim(s): to detect lipid changes in COVID-19 patients and their relation to patient's outcome Patients and Methods: The current study was conducted on patients with confirmed COVID 19 infection who were admitted at Minia cardiothoracic university hospital during the period from April to August 2021. Lipid profiles (LDH, HDL, Triglyceride, Cholesterol) were measured for all patients during the first 24 hours of admission. Patients were followed up till the time of hospital discharge. Result(s): Eighty patients were included in the study, 25 (31.2%) patients were classified to have moderate disease while 55(68.2%) patients had severe disease. Patients were divided into two groups according to their discharge condition, group I (survivor group) included 59(74%) patients and group II (non-survivor) which included 21(26%) patients. Comparing lipid profiles in both groups showed that;Triglyceride was significantly higher in group II 194.71+/-81.14 versus 149.78+/-50.68 in group 1 (P = 0.004). Also, LDH was significantly higher in group II 1254.38+/-691.47 versus 853.81+/-486.44 in group I ((P 0.005). No significant differences exist between both groups regarding, HDL, Cholesterol, and LDL (P= 0.982, 0.434, 0.996) respectively. Conclusion(s): Disturbance in Lipid metabolism occur in patients with COVID 19 infection and could be useful as a mortality predictor.,.

Altered lipid profile in patients with COVID-19 infection

Background: In this study, we aimed to investigate the pathological alterations of LDL-cholesterol, HDL-cholesterol, total cholesterol and triglycerides in COVID-19 patients during the acute phase of infection, and after recovery. Method(s): A retrospective study was performed to examine serum levels of LDL-cholesterol, HDL-cholesterol, total cholesterol and triglycerides on 55 COVID-19 patients who were hospitalized in our center between February and April 2020. The lipid profile and the hematological parameters were analyzed in the same group of patients before (Group before) and after clinical management (Group after). The laboratory tests results were compared between these two groups, as well as with a group of healthy subjects (Healthy controls), matched for age and sex and selected among the blood donors. Result(s): LDL-cholesterol, HDL-cholesterol, total cholesterol levels were significantly lower in COVID-19 patients (Group before) as compared with normal subjects (P<0.0001). Comparing healthy controls and the group after, statistically significant differences were observed for all parameters except for total cholesterol (P=0.9006). Total cholesterol, HDL-cholesterol, LDL-cholesterol and triglyceride were found to be significantly higher after recovery than during the acute phase of infection (P<0.0001). C-reactive protein levels were found to be inversely correlated with those of LDL-cholesterol (rs =-0573, P<0.0001), total cholesterol (r=-0.732, P<0.0001), and HDL-cholesterol (r=-0.700, P<0.0001). Conclusion(s): The results of our study seemingly attest that lipids, especially cholesterol, may play an important role in viral replication, internalization and immune activation in patients with COVID-19 infection. Moreover, lipid abnormalities observed during and after this infection could be used for assessing indirectly the response to clinical treatment.Copyright © Journal of Laboratory and Precision Medicine. All rights reserved.

Acute myocardial infarction in a 9-year-old boy due to multisystem inflammatory disease

Background and Aim: Myocardial infarction after coronavirus dis-ease 2019(COVID-19) is a quite uncommon clinical disease in children. We present a case about a 9-year-old boy with total occlusion of the right main coronary artery(RMCA) attending to the hospital with chest pain. It was related pediatric multisystem inflammatory disease (MIS-C). Method(s): It is a case presentation. Result(s): Case Presentation: The patient had no previous cardiac or family history. Electrocardiography(ECG) showed a definite elevation on the extremity derivatives(DI, DII, DIII, and aVF), and marked ST depression on the chest derivatives (V1 to V6) and aVR, aVL, all representing lateral inferior ischemia. Transthoracic echocardi-ography revealed left ventricular systolic dysfunction, and global wall hypokinesia. Existence of fever and two-body system involvement (cardiac, gastrointestinal), CRP rise, and prior SARS-CoV-2 exposure in a month, MIS-C was a foremost diag-nosis. The total antibody for SARS-CoV-2 was positive. Lipid profiles(LDL, HDL, VLDL, triglyceride), lipid electrophoresis, routine coagulation, and thrombophilia tests were evaluated for differential diagnosis and all were normal. Because of the possible MI, it was planned to visualize coronary arteries by angiography. Total occlusion of the right main coronary artery(RMCA) with a large thrombus was detected without any dilatation of the coro-nary arteries in the coronary angiography. Two coronary stents were implanted into the distal and proximal part of the RMCA. After the procedure, clopidogrel was added to acetylsalicylic acid for platelet inhibition. During the follow-up, LVEF rose to 55% and there was a little hypokinesia on the left inferior wall of ventricles. Conclusion(s):. It should be kept in mind that acute coronary throm-bosis could be an important complication of COVID-19 exposure or MIS-C. A coronary stent implantation is a good treatment option even in small children.

Correlation of Lipid Profile with Inflammatory Markers among COVID-19 Positive Patients: A Retrospective Study

Introduction: Lipids are fundamental biomolecules of the body. Infections like COVID-19 with intricate immune response in some patient’s leads to acute complications by affecting metabolic pathways at multiple levels. Metabolism of cholesterol, triglyceride and High Density Lipoprotein (HDL)-Cholesterol is deranged by cytokines and multiple inflammatory mediators. The sex differences in lipid metabolism may contribute in susceptibility, severity and outcome of Coronavirus Disease 2019 (COVID-19). Performing lipid profile in COVID-19 patient may help in assessing severity and prognosis of disease. Aim: To assess the relationship between lipid profile and inflammatory markers in COVID-19 patients and also to evaluate the gender wise differences in lipid parameters and their correlations with inflammatory markers. Materials and Methods: This retrospective study was conducted in Department of Biochemistry at SHKM, GMC, Mewat, Haryana, India (tertiary care health centre) on COVID-19 positive patients attending Outpatient Department (OPD) and Inpatient Department (IPD), from October 2020 to December 2020. The data of 85 patients with COVID-19 positive, confirmed by Reverse Transcription-Polymerase Chain Reaction (RT-PCR) and who were prescribed for lipid profile along with C-Reactive Protein (CRP) and serum ferritin were included in the study. Serum total cholesterol, triglyceride, HDL-Cholesterol, CRP and ferritin were measured in the subjects. Data was statistically analysed using Student’s t test and Pearson correlation coefficient. results: Total 85 (46 males and 39 females) COVID-19 patients were included in the study. Mean age in male and female patients were 43.02±15.52 years and 42.02±15.25 years, respectively with a range of 5-82 years. Mean value of Serum triglycerides, HDL-C and total cholesterol was 204.94±141.27 mg/dL, 42.97±13.38 mg/ dL and 187.058±45.75 mg/dL, respectively. Serum triglycerides were statistically significantly higher in males than females (p-value=0.0413). The HDL-C however was significantly higher in females than males (p-value=0.0006). In male patients, r-value between cholesterol and CRP was -0.3538, and p-value was 0.016. Ferritin had a significant negative correlation with HDL-C (r-value=-0.3578, p-value=0.00079). Weak Positive correlation was noted between triglyceride and ferritin (r-value= 0.2285, p-value=0.035). conclusion: High levels of serum triglycerides, low total cholesterol, and low HDL-cholesterol correlates with inflammatory markers like CRP and ferritin in COVID-19 patients. Lipid profile may be used as a potential marker in all COVID-19 patients in assessing prognosis of disease.

Quadriparesis after COVID-19 Vaccination: Two Cases with Different Diagnosis

Aim and objective: During the recent COVID-19 pandemic various vaccines have been developed and approved for emergency use, including adenovirus vector-based ChAdOx1 nCov-19. There are few reports of serious adverse events following immunization (AEFI). Materials and methods: Here, we report two cases of serious AEFI who required ICU admission. Results: Case 1: A 55-y-m hospitalized with complaints of giddiness for 4 days and onset of weakness of all four limbs with altered sensorium for 1 day. He had no history of any comorbidity, non-smoker and non-alcoholic, and no previous episodes of transient ischemic attacks. He was vaccinated with a second dose of adenoviral vector-based ChAdOx1 nCov-19 vaccine (8 days before the onset of first symptoms). After hospitalization, immediate intubation was done for airway protection. His neurological examination revealed blinking of eyes spontaneously, motor power of 0/5 in all four limbs, deep tendon reflex of +2, and mute plantar. MRI Brain was done on the next day (day of illness, DOI-4), which revealed acute infarct in the pons and bilateral cerebellar hemisphere. He was referred to our ICU on DOI-12. Repeat MRI Brain on DOI-16 showed subacute infarcts in the pons, bilateral middle cerebellar peduncles, and left cerebral hemisphere with thrombosed basilar artery. Lipid profile, homocysteine levels, auto-immune work-up were normal. Echocardiography showed normal LV function with no evidence of LA clot. Carotid Doppler showed normal carotid vessels. In view of ischemic stroke and basilar artery thrombosis anti-platelet agent and therapeutic anticoagulation continued. Over the next 3 weeks, he showed gradual improvement in motor power (3/5 in upper limbs and 2/5 in lower limbs) and weaned off from mechanical ventilation. Case 2: A 19-y-m hospitalized with complaints of acute onset paraesthesia and progressive weakness in both lower limbs for 4 days and difficulty in speech and swallowing for 1 day. He had no history of any comorbidity, and no history of preceding viral/bacterial infection except that he had received the first dose of the adenoviral vector-based ChAdOx1 nCov-19 vaccine (16 days before the onset of first symptoms). After hospitalization, he required intubation in view of pooling of oral secretions and respiratory distress. Clinical examination revealed bifacial weakness, severe neck muscle weakness, and flaccid areflexic quadriparesis with prominent proximal upper and lower limb weakness. Pin-prick sensation was distally reduced in both lower limbs with associated autonomic instability in the form of tachycardia and hypertension. MRI Brain was normal in the study. In further work, Guillain-Barré syndrome (GBS) was diagnosed. CSF showed albumin-cytologic dissociation (protein 1.14 g/L and nil cell), and bilateral motor nerve axonal neuropathy on nerve conduction study. Immunoglobulin (IVIG) therapy was started on DOI-6. He did not show significant improvement and was referred to our ICU for further management. During the 5th week of illness, the IVIG dose was repeated without any improvement and continuing requirement of mechanical ventilation. Conclusion: Though vaccination is one of the important public health interventions implemented to tackle the COVID-19 pandemic, there are known and unknown serious AEFI being reported. Both cases presented quadriparesis with different diagnoses, who received vaccination for COVID-19.

IDF21-0523 Hemoglobin A1c prognosticates for dyslipidemia: Correlation between lipid profile and HbA1c in diabetic heart disease

Background: Diabetes is one of the main non-communicable diseases with alarming prevalence in the world, including in Algeria. Diabetes is characterized by chronic hyperglycemia accompanied by a metabolic disorder of carbohydrates, lipids and proteins. A level of glycated hemoglobin (HbA1c) ≥ 6.5% was included as a diagnostic criterion for diabetes. The altered lipid profile is commonly present in type 2 diabetes. Patients with type 2 diabetes (T2DM) have an increased prevalence of dyslipidemia, which contributes to their high risk of cardiovascular disease (CVD). Aim: This study is an attempt to determine the correlation between the serum lipid profile and blood glucose and to assess the importance of HbA1c as an indicator of dyslipidemia. Method: This descriptive and analytical cross-sectional study was carried out during this Covid pandemic, at the level of the diabetic house and the Khemis Meliana hospital (North Algerian) over a period of 9 months. A total of 384 patients with T2DM aged 30 to 89 years were selected for this purpose. Dyslipidemia was defined according to the guidelines of the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III). Diabetes has been defined according to the criteria of the American Diabetes Association. The levels of fasting blood sugar, total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), triglycerides (TG) and glycated hemoglobin (HbA1c) were evaluated. Statistical analysis was performed by R studio software (Package for Social science software). The significance test was calculated by the unpaired Student “t” test. Correlation studies (Pearson correlation) have been performed between glycated hemoglobin (HbA1c) and lipid ratios and individual lipid indices. Significance was set at p <0.05. Results: The mean age ± standard deviation of the patients was 61.28 ± 10.04 years with a mean duration of diabetes was 14.32 ± 6.24 years. Significant positive correlations were observed between HbA1c and serum total cholesterol (p-value <10-6), triglyceride (p-value <10-3) and LDL-C (p-value = 0.002). In contrast, the correlation between HbA1c and HDL-C was negative and insignificant. Thus, the association between HbA1c and the atherogenicity index, especially the LDL-C / HDL-C ratio has been well established. Discussion: The study concluded that the HbA1c value correlated well with the lipid profile of diabetic patients. Thus, HbA1c can also be used as a predictor of dyslipidemia and therefore early diagnosis of dyslipidemia can be used as a preventive measure for the development of CVD in patients with T2DM.

Severe Hypertriglyceridemia as a Cause of Arterial Thrombosis with Peripheral Embolic Complications

Lead Author's Financial Disclosures: Nothing to disclose. Study Funding: None. Background/Synopsis: Extensive evidence exists in support of a causal association of elevated triglyceride-rich lipoprotein (TRL) levels with the risk of atherosclerosis progression. Hypertriglyceridemia has been established as a risk factor for venous thrombosis, including a 2- fold increase in the risk of venous thrombosis in postmenopausal women. However, there is limited data on the role of hypertriglyceridemia in the arterial thrombosis. Objective/Purpose: Not Applicable. Methods: Case description: A 51-year-old white female with hypertension and type 2 diabetes (hemoglobin A1C, 7.4%) was transferred for further management of newly diagnosed bilateral renal and splenic infarcts. No risky habits were elicited except for the use of combined hormonal contraceptives over the past two years to control menorrhagia. Family history was significant for hypertriglyceridemia. Her physical exam was unremarkable. Testing for COVID-19 was negative. An extensive hypercoagulable and autoimmune work-up was unremarkable. Fasting lipid profile was significant for elevated levels of triglycerides, 1,274 mg/dL (replicated on two separate occasions), very low-density lipoprotein-cholesterol, 255 mg/dL, and non-high-density lipoprotein-cholesterol, 214 mg/dL, directly measured low-density lipoprotein cholesterol, 39 mg/dL and lipoprotein(a), 6 mg/dL. There was no structural pathology on the echocardiogram, including no interatrial shunt or intracardiac thrombus. Her whole-body computed tomography angiography revealed a focal calcified protruding thrombus in the distal thoracic aorta. No significant plaque was seen elsewhere in the aorta. Results: Decision-making. The posterior thrombus in the distal thoracic and proximal abdominal aorta was determined as a culprit for the visceral organ infarcts. Over the course of the hospital stay her abdominal pain gradually resolved. Treatment with low dose aspirin and therapeutic dose of low-molecular weight heparin was initiated followed by apixaban and aspirin on discharge. She was started on atorvastatin 40 mg, fenofibrate 145 mg, icosapent ethyl 4 g, resulting in a 70% reduction in the triglycerides levels (306 mg/dL). In 3 months, her repeat CT angiography showed significant resolution of the aortic atherothrombosis with no signs of aortic wall inflammation. At the 6-month follow-up visit she was switched to dual antiplatelet therapy with a plan to repeat imaging in 6 months. Conclusions: This case illustrates challenges in managing patients with arterial thrombosis in the setting of familial hypertriglyceridemia. Apart from severely elevated triglycerides no other etiology was evident. We propose further investigation of the prothrombotic properties of TRL and the role of targeted triglyceride-lowering therapies on atherothrombotic outcomes.

Association between Interlukine-6 with Serum Ferritin, D-dimer, and Lipid Profiles as Risk Factors in Patients with Coronavirus Disease 2019

Background:The current coronavirus disease 2019 (COVID-19) pandemic, which is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, has posed a significant public health concern throughout the world, putting millions of people at risk in an increasing number of nations.Due to the development of endothelial dysfunction, coagulopathy, cytokine storm, and plaque instability, COVID-19 is recognized as an independent risk factor for cardiovascular illnesses.The goal of this study was to look at blood levels of interleukin 6 (IL-6), lipid profiles, ferritin, C-reactive protein (CRP), D-dimer, lymphocytes, and neutrophils in COVID-19 patients, as well as the relationship between IL-6 and biochemical predictor values for COVID-19 severity. Materials andMethods: In this case-control study,total of 60 COVID 19 patients within 1 week of displaying COVID19 symptoms and SARS-CoV-2 specific RT-PCR was verified. of Nasopharyngeal (NP) swab specimen were recruited.ageranged between(30-50 years)To compare the results, (60) apparently healthy persons of the same ages and sexes were included in this study ascontrol group.All of the patents and healthy persons were made to suffer to the estimation of serume IL-6, D-Dimer, CRP, ferritin,lipid profiles, andanthropometric data were analyzed. Results:Serum IL-6 level was higher in covid-19 patients group compared to healthy control group (812.32± 147.76vs. 148.95± 51.59ng/ mLp = 0.0001). Ferritin,CRP, and D-dimer serum levels were also higher in covid-19 patients compared to control group (p = 0.0001). as well as TC,LDL-C,and VLDL-C When compared to healthy controls, COVID-19 patients exhibited a substantial reduction in the levels studied in this study. We also discovered that IL-6 levels were higher significantly associated with the serum ferritin,D-dimer,TC, LDL-C, and CRP levels. Conclusion:The level of IL-6 was shown to be the most important predictor of outcome and a useful tool for prognostic assessment. The prevalence of atherogenic dyslipidaemia during infection was linked to a poorer COVID-19 infection outcome in a robust and independent way. Low HDL cholesterol and high triglyceride levels seen in covid-19 patients are strong indicators of the disease's severity. 1.

Lipid profile of patients with arterial hypertension who underwent COVID-19: possibilities of drug therapy/ LEADER

Aim. To study the dynamics of the lipid profile of hypertensive patients with dyslipidemia who underwent COVID-19. Material and methods. Hypertensive patients with dyslipidemia who underwent COVID-19 [n=126;58 men and 68 women;median age 60 (56.0;65.5) years] examined. Patients were included into two groups: group 1 (n=64) received a single pill combination of lisinopril + amlodipine + rosuvastatin;2 groups (n=62) continued the previous drug treatment. Clinical, demographic, office blood pressure (BP), total cholesterol (TC), low density lipoprotein cholesterol (LDL-c), high density lipoprotein cholesterol, triglycerides, C-reactive protein (CRP) levels were assessed in all patients in 3 visits within 24 weeks. Results. The groups did not differ in prior antihypertensive therapy (except for more frequent use of angiotensin II receptor blockers in group 2, p<0.05), lipid profile and blood pressure parameters at study entry. A decrease in systolic (by 9.5%) and diastolic blood pressure (by 12.1%) after 24 weeks was found in group 1 compared with 4.29% and 5.56%, respectively, in group 2 (p<0.05). A decrease in the level of total cholesterol by 14.5% and LDL-c by 31.4% after 24 weeks was found in group 1 compared with 11.2% and 9.7%, respectively, in group 2 (p<0.05). The level of CRP during the observation period decreased by 53.7% in group 1 versus 43.4% in patients of group 2 (p<0.05). Conclusion. The single pill combination of lisinopril/amlodipine/rosuvastatin in hypertensive patients with dyslipidemia who underwent COVID-19 led to an improvement in lipid profile and blood pressure control.

Ezetimibe Evaluation as a Treatment of Hyperlipidemia in Patients with Covid-19: A Case Report

The current coronavirus disease known as (COVID-19) which has been declared by the World Health Organization (WHO) in December 2019 as a global health emergency and then after as a pandemic, represents a big challenge to all healthcare systems worldwide specially for managing the infection among patients who are hospitalized, acutely ill or elderly. The death rate caused by COVID-19 is not predictable but is increased by many factors including age, dyslipidemia, diabetes mellitus, obesity, and cardiovascular disorders. Since a lot of patients with these conditions are under lipid-lowering therapy, we carried out this case report study to understand the effectiveness, safety, and potential interactions between Ezetimibe, and patients with acute COVID-19 infection. In this study, the lipid profile, kidney functions, and glycated hemoglobin has been measured baseline and then after 25 days for patient with hyperlipidemia and suffers from acute COVID-19 infection. Serum cholesterol level, HDL, LDL and HDL risk factor were decreased in COVID case by 17%, 10%, 21%, and 7%, respectively. Interestingly, we observed a considerable increase in triglycerides concentration by 13.5%. These findings reveal that Sars-CoV-2 might be a factor interacting with hyperlipidemia-reducing therapy, and lower ezetimibe efficacy. However, larger cohort studies are required to confirm these findings.

A RECOMBINANT BIO-HDL (CER-001) CAN PREVENT SARS-COV2-INDUCED RENAL DYSFUNCTION BY RESTORING SR-BI SIGNALLING

BACKGROUND AND AIMS: Replication of the enveloped SARS-COV2 virus can alter lipidomic composition and metabolism of infected cells [1]. These alterations commonly result in a decline in HDL, total cholesterol and LDL, and an increase in triglyceride levels in COVID-19 patients. Furthermore, the 'cytokine storm' subsequent to release of inflammatory cytokines can severely impair lipid homeostasis. Importantly, decreased HDL-cholesterol correlates with severity of COVID-19 infection and represents a significant prognostic factor in predicting poor clinical outcomes [2]. Similarly, it has been observed that COVID-19 patients' recovery is accompanied by a rise in serum HDL levels. Pharmacological intervention that aims to restore ApoA-1 or functional HDL particles may have beneficial roles for clinical outcome of COVID-19 patients and has recently been approved for compassionate use [3]. SARS-CoV 2 spike proteins S1 and S2 can bind free cholesterol and HDL-bound cholesterol, facilitating virus entry by binding the ACE2 co-receptor Scavenger Receptor-BI (SR-BI) [4]. When activated at the trans-membrane level, SR-BI signalling culminates in Ser1173-eNOS phosphorylation with both anti-inflammatory and anti-apoptotic effect. We hypothesized that SARS-COV2 binding promoted SR-BI internalization, so that it could not exert its essential protective function. Therefore, the aim of this study is to evaluate the effects of CER-001, a mimetic HDL, in antagonizing this process. METHOD: Endothelial and tubular (RPTEC) cells were exposed to S1, S2 and S1 + S2 (50-250 nM) with or without CER-001 (CER-001 50-500 ug/mL) and cholesterol (10-50 uM). Apoptosis tests (MTT and AnnV/PI) were performed. Internalization of SR-BI, ACE2 with S1 and activation of eNOS was evaluated by FACS analysis. SR-BI and ACE2 expression were evaluated on kidney biopsies from COVID-19 patients. RESULTS: At concentrations used, the exposition of S1, S2 and S1 + S2 in the presence of CER-001 and cholesterol did not induce apoptosis of endothelial cells and RPTEC. Endothelial and tubular cells stimulated by S1, in presence of cholesterol, showed an increased intracellular level of SR-BI and ACE-2, with significantly reduced eNOS phosphorylation compared to baseline (P < 0.05). The treatment with CER-001 reversed trans-membrane SR-BI levels and eNOS phosphorylation to baseline values. The detection of S1 spike protein by endothelial cells immunohistochemistry revealed an increased level in S1-exposed cells with cholesterol and reduced S1 intracellular positive staining in CER-001-exposed cells (P < 0.05). Interestingly, S1-exposed cells without cholesterol appeared not to be capable of mediating S1 spike protein internalization. Consistent with in vitro results, analysis of renal biopsies from COVID-19 patients with proteinuria showed increased SR-BI and ACE-2 cytoplasmic signals and reduced expression at the apical domain of injured tubules. CONCLUSION: Our data confirmed the key role of lipid profile in SARS-COV2 infection, evaluating the molecular signalling involved in HDL metabolism and inflammatory processes, and could offer new therapeutic strategies for COVID-19 patients. (Figure Presented).

IDENTIFICATION of KEY BIOMARKERS for the PREDICTION of CRITICAL COVID-19 OUTCOMES

Background: Understanding the role of crucial biomolecules and mechanistic pathways supporting coronavirus disease 2019 (COVID-19) pathophysiology is essential to handle the immune dysregulation and complications driven by uncontrolled severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. Thus, we evaluated the proteomics, metabolomics and lipidomics plasma profile in a well-characterized cohort of COVID-19 patients ranging from asymptomatic to critical illness. Methods: This multicenter case-control study enrolled 273 adults with SARS-CoV-2 infection, confirmed by Polymerase chain reaction (PCR), who were recruited within the first 21 days of the infection during the first wave (March-May 2020) of COVID-19 pandemic. Participants were categorized into three groups of severity according to the inclusion criteria described in "Diagnosis and Treatment Protocol for COVID-19 Patients" and distributed as mild (n=77), severe (n=134) and critical (n=62). Serum profile of COVID-19 patients was characterized in the acute phase of the infection using a nontargeted multiomics approach. Univariate and multivariate analyses were performed to identify key molecules involved in critical COVID-19 and to evaluate their predictive power as biomarkers of COVID-19 severity. Results: COVID-19 critically ill patients presented a well-differentiated blood pattern for severe disease. The multiomic analysis identified specific alterations in pathways linked to complement and coagulation cascades, platelet activation, cell adhesion, acute inflammation, energy production (Krebs cycle and Warburg effect), amino acid catabolism and lipid transport as hallmarks of critical COVID-19. A new biomarker panel including the combination of selected proteins, metabolites and lipids predicted with high accuracy the most adverse COVID-19 outcomes (AUC: 0.994, 85.9% specificity and 100% sensitivity). Conclusion: The identification of predictive molecules related to critical COVID-19 outcomes provides a valuable tool for the rapid and efficient identification of clinical worsening in the early stage of SARS-CoV-2 infection. The association of a distinctive proteomic, metabolomic and lipidomic fingerprint with COVID-19 severity provides a better understanding of the immunopathogenesis and the host response to SARS-CoV-2 infection which could help in the identification of potential therapeutic targets.