Biochemical profiles and organ dysfunction in neonates with hypoxic-ischemic encephalopathy post-hoc analysis of the THIN trial

BACKGROUND

Therapeutic hypothermia for infants with moderate to severe hypoxic-ischemic encephalopathy is well established as standard of care in high-income countries. Trials from low- and middle-income countries have shown contradictory results, and variations in the level of intensive care provided may partly explain these differences. We wished to evaluate biochemical profiles and clinical markers of organ dysfunction in cooled and non-cooled infants with moderate/severe hypoxic-ischemic encephalopathy.

METHODS

This secondary analysis of the THIN (Therapeutic Hypothermia in India) study, a single center randomized controlled trial, included 50 infants with moderate to severe hypoxic-ischemic encephalopathy randomized to therapeutic hypothermia (n = 25) or standard care with normothermia (n = 25) between September 2013 and October 2015. Data were collected prospectively and compared by randomization groups. Main outcomes were metabolic acidosis, coagulopathies, renal function, and supportive treatments during the intervention.

RESULTS

Cooled infants had lower pH than non-cooled infants at 6-12 h (median (IQR) 7.28 (7.20-7.32) vs 7.36 (7.31-7.40), respectively, p = 0.003) and 12-24 h (median (IQR) 7.30 (7.24-7.35) vs 7.41 (7.37-7.43), respectively, p < 0.001). Thrombocytopenia (< 100 000) was, though not statistically significant, twice as common in cooled compared to non-cooled infants (4/25 (16%) and 2/25 (8%), respectively, p = 0.67). No significant difference was found in the use of vasopressors (14/25 (56%) and 17/25 (68%), p = 0.38), intravenous bicarbonate (5/25 (20%) and 3/25 (12%), p = 0.70) or treatment with fresh frozen plasma (10/25 (40%) and 8/25 (32%), p = 0.56)) in cooled and non-cooled infants, respectively. Urine output < 1 ml/kg/h was less common in cooled infants compared to non-cooled infants at 0-24 h (7/25 (28%) vs. 16/23 (70%) respectively, p = 0.004).

CONCLUSIONS

This post hoc analysis of the THIN study support that cooling of infants with hypoxic-ischemic encephalopathy in a level III neonatal intensive care unit in India was safe. Cooled infants had slightly lower pH, but better renal function during the first day compared to non-cooled infants. More research is needed to identify the necessary level of intensive care during cooling to guide further implementation of this neuroprotective treatment in low-resource settings.

TRIAL REGISTRATION

Data from this article was collected during the THIN-study (Therapeutic Hypothermia in India; ref. CTRI/2013/05/003693 Clinical Trials Registry - India).

Lactation stages modulate the hematological, serum biochemical, and endocrinological profiles and oxidative stress markers in crossbred cows under tropical humid island ecosystem of Andaman and Nicobar Islands

The present study was designed to assess the interrelationship between hematological, serum biochemical, and endocrinological profiles and oxidative stress markers and lactational stages in crossbred (CB) dairy cows of Andaman and Nicobar Islands (ANI). Healthy (n = 6) CB cows (50-62.50% exotic inheritance; Holstein Friesian × Andaman local) of 4^th parity with age of 7-9 years and body weight of 350-400 kg were selected from Cattle Breeding Farm, ICAR-Central Island Agricultural Research Institute (ICAR-CIARI), Port Blair, ANI. These experimental cows were synchronized with Ovsynch protocol, and parturition was planned to happen in the month of May-June. Lactation was allowed for 305 days. Hematological profiles, serum biochemical profiles, oxidative stress markers and endocrinological profiles were measured at a 15-day interval from day 07 to 305 of lactation (after 6 days of colostrum). The lactation period was divided into first (day 07 to 90), second (day 91 to 180), and third (day 181 to 305) stage of lactation. Average daily milk yield (L) did not vary among the stages of lactations; however, first (8.56 ± 1.26) and second (9.79 ± 0.87) stages had higher milk yield compared to third (7.93 ± 0.79) stage of lactation. Hematological profiles did not vary among the stages of lactation; however, these values were within the range of bovine species at lactation. Serum glucose, triglyceride, total cholesterol, total protein, globulin, and blood urea nitrogen (BUN) increased (P < 0.05) and albumin and creatinine decreased (P < 0.05) gradually as lactation stages advanced. Activity of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase (ALP) and concentration of calcium, phosphorous, and magnesium were nearly similar among the stages of lactation. Similarly, triiodothyronine (T3), and thyroxine (T4) increased and prolactin and cortisol decreased (P < 0.05) gradually as stages of lactation advanced. Total antioxidant capacity (TAC) increased and malondialdehyde (MDA) decreased (P < 0.05) as lactation stages advanced. The results of the present study indicated that the lactating CB cows suffered nutritional stress (deficiency of protein, carbohydrate, lipids, and minerals), physiological stress (higher cortisol), oxidative stress (higher MDA and deficiency of total antioxidant capacity), and hormonal imbalance (higher prolactin and cortisol and deficiency of thyroid hormones) during the early stages of lactation. Thus, the first and second stages are more stressful events compared to the third stage of lactation in the CB cows in ANI. Therefore, regular monitoring of blood components and accordingly suitable feeding strategies with balanced nutrients and minerals, supplementation of suitable antioxidants, and appropriate management practices need to be implemented to mitigate these stresses and to prevent metabolic disorders with maximum milk production during different stages of lactation in CB cows under humid tropical island ecosystem of Andaman and Nicobar Islands.

Flaxseed oil modulates testicular biometrics, hormone, libido, antioxidant and semen profiles in endangered Teressa goat of Andaman and Nicobar Islands

Teressa goat is a unique goat breed in Andaman and Nicobar Islands (ANI) of India. Effects of Flaxseed oil (FSO) supplementation in body weight (BW), scrotal circumference (SC), testicular volume (TV) and testicular weight (TW), endocrinological profiles, sex behavioural profiles (SBPs), oxidative stress markers and semen production and its quality profiles in rainy and dry summer season were studied in Teressa goat. Male goats (n = 12) of 3-4 years old were equally divided into control and treated groups. Treated animals received 25 mL FSO per day. Oral drenching of FSO was done in the morning before feeding the concentrate ration. Body weight, scrotal circumference, TV and TW were measured in bucks of FSO treated and untreated during rainy and dry summer seasons. Blood follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone, thyroid stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4), cortisol and prolactin, total antioxidant capacity (TAC), superoxide dismutase (SOD), catalase (CAT), glutathione (GSH) and malondialdehyde (MDA) were measured in bucks of FSO treated and untreated during rainy and dry summer seasons. Libido score (LS), mating ability score (MAS) and sex behavioural score (SBS) were estimated at time of semen collection in bucks of FSO treated and untreated during rainy and dry summer seasons. Semen samples (n = 100; 50 semen samples from each season; each 25 semen samples from control and treatment groups per season) were collected and analysed for semen quality profiles. One-way ANOVA (control rainy, control dry, treated rainy and treated dry) revealed that BW, SC, TV and TW, FSH, LH, testosterone, TSH, T3 and T4 were higher (P < 0.05) and cortisol and prolactin were lower (P < 0.05) in FSO treated bucks of rainy season followed by untreated bucks of rainy season, FSO treated bucks of dry summer season and were lower (P < 0.05) in untreated bucks of dry summer season. Similarly, TAC, CAT, SOD and GSH, LS, MAS and SBS, and volume, pH, sperm concentration, mass activity, total motility (TM), viability, acrosomal integrity (AcI), plasma membrane integrity (PMI) and nuclear integrity (NI) were higher (P < 0.05) and MDA and TSA were lower (P < 0.05) in FSO treated bucks of rainy season followed by FSO treated bucks of dry summer season, untreated bucks of rainy season and were lower (P < 0.05) in untreated bucks of dry summer season. The results of the present study indicated that the breeding bucks suffered physiological stress (higher cortisol), oxidative stress (higher MDA and deficiency of antioxidants), hormonal imbalance (higher prolactin and cortisol and deficiency of gonadotropins, gonadal hormone and thyroid hormones) and infertility due to poor libido and poor semen production and its quality profiles during dry summer season. Thus, dry summer was more stressful season compared to rainy season for the goat bucks. FSO supplementation mitigated these stresses and improved the scrotal and testicular biometrics, libido, antioxidants, hormones and semen quality profiles in Teressa goat bucks. The current study concluded that FSO effectively improved the hormones, libido, antioxidant profiles, and scrotal and testicular biometrics with cascading beneficial effects on semen quality profiles in Teressa goat bucks under humid tropical island ecosystem of Andaman and Nicobar Islands.

Fermented pork fat (Sa-um) and lifestyle risk factors as potential indicators for type 2 diabetes among the Mizo population, Northeast India

Over the last few decades, Mizoram has shown an increase in cases of type 2 diabetes mellitus; however, no in-depth scientific records are available to understand the occurrence of the disease. In this study, 500 patients and 500 healthy controls were recruited to understand the possible influence of their dietary and lifestyle habits in relation with type 2 diabetes mellitus. A multivariate analysis using Cox regression was carried out to find the influence of dietary and lifestyle factors, and an unpaired t test was performed to find the difference in the levels of biochemical tests. Out of 500 diabetic patients, 261 (52.3%) were males and 239 (47.7%) were females, and among the control group, 238 (47.7%) were males and 262 (52.3%) were females. Fermented pork fat, Sa-um (odds ratio (OR) 18.98), was observed to be a potential risk factor along with tuibur (OR 0.1243) for both males and females. Creatinine level was found to be differentially regulated between the male and female diabetic patients. This is the first report of fermented pork fat and tobacco (in a water form) to be the risk factors for diabetes. The unique traditional foods like Sa-um and local lifestyle habits like tuibur of the Mizo population may trigger the risk for the prevalence of the disease, and this may serve as a model to study other populations with similar traditional practices.

Associations between blood volatile organic compounds, and changes in hematologic and biochemical profiles, in a population-based study

OBJECTIVE

To investigate the influence of volatile organic compound (VOC) levels in blood, on hematological and serum biochemical parameters in the Canadian population.

METHODS

We tested the association between seven selected VOCs and hematological profiles and serum tests reflecting liver and kidney function and glucose metabolism using a cross-sectional study design in 3950 participants of the Canadian Health Measures Survey from 2012 to 2015. We used generalized linear mixed models adjusting for age, sex, smoking, alcohol consumption, BMI, education and household income.

RESULTS

An increase in blood concentration equivalent to the geometric mean for benzene, ethylbenzene, toluene, m-, p-xylenes, styrene, and total xylenes was associated with 0.68% (95% CI 0.36, 1.0) to 0.91% (95% CI 0.52, 1.3) increase in hemoglobin, and a 1.79% (95% CI 0.96, 2.62) to 4.11% (95% CI 3.11, 5.11) increase in total white blood cell count. Ethylbenzene, toluene, m-, p-xylenes and styrene were positively associated with increased platelet counts. A geometric mean increase for all VOCs was associated with decreases in creatinine. m- and p-xylenes were associated with a significant change in every measured blood cell count and liver function parameter, and in creatinine. Ethylbenzene was also positively associated with an increase in every measured hematologic parameter, two of the three liver function tests, and creatinine. Results were similar when stratified by age, but differed by smoking status and sex.

CONCLUSIONS

This study provides evidence that VOCs in blood, at levels found in the Canadian population, may influence blood cell counts and indicators of liver and kidney function, including an inverse association between serum VOC and creatinine. This novel finding merits further investigation to understand the impact of VOCs on human physiology and population health.

Missing data imputation via the expectation-maximization algorithm can improve principal component analysis aimed at deriving biomarker profiles and dietary patterns

Principal component analysis (PCA) is a popular statistical tool. However, despite numerous advantages, the good practice of imputing missing data before PCA is not common. In the present work, we evaluated the hypothesis that the expectation-maximization (EM) algorithm for missing data imputation is a reliable and advantageous procedure when using PCA to derive biomarker profiles and dietary patterns. To this aim, we used numerical simulations aimed to mimic real data commonly observed in nutritional research. Finally, we showed the advantages and pitfalls of the EM algorithm for missing data imputation applied to plasma fatty acid concentrations and nutrient intakes from real data sets deriving from the US National Health and Nutrition Examination Survey. PCA applied to simulated data having missing values resulted in biased eigenvalues with respect to the original data set without missing values. The bias between the eigenvalues from the original set of data and from the data set with missing values increased with number of missing values and appeared as independent with respect to the correlation structure among variables. On the other hand, when data were imputed, the mean of the eigenvalues over the 10 missing imputation runs overlapped with the ones derived from the PCA applied to the original data set. These results were confirmed when real data sets from the National Health and Nutrition Examination Survey were analyzed. We accept the hypothesis that the EM algorithm for missing data imputation applied before PCA aimed to derive biochemical profiles and dietary patterns is an effective technique especially for relatively small sample sizes.

Effects of feeding green microalgae on ovarian activity, reproductive hormones and metabolic parameters of Boer goats in arid subtropics

The present study aimed to improve ovarian follicle development and plasma metabolites and hormone concentrations upon supplementation of Boer goats with green microalga (Dunaliella salina; 10 g/head/day) (N = 20; MAT group) compared to control (N = 10; not receive microalgae) in subtropics. Estrus was synchronized in all animals by two intramuscular administration of 12.5 mg dinoprost 11 days a part. MAT group was supplemented with Dunaliella salina for 11 days (from the day of first injection of dinoprost till the second injection). Ovarian performance, steroids, LH, FSH and blood metabolites were assessed every three days during the estrous cycle. Numbers and sizes of ovarian follicles and corpora lutea were significantly (P < 0.05) increased in MAT group. Progesterone, estrogen, FSH and LH were higher in MAT group during estrous cycle. Blood metabolites including glucose, total cholesterol and blood urea nitrogen were significantly (P < 0.05) increased upon D. salina administration. On the other hand, supplementation of D. salina resulted in significant decrease of plasma total protein, albumin, aspartate aminotransferase and alanine aminotransferase. In conclusion, supplementation with D. salina could improve ovarian follicle development and concentrations of plasma metabolites and hormones which subsequently improves reproductive performance of Boer goats.

Increased risks of cardiovascular diseases and insulin resistance among the Orang Asli in Peninsular Malaysia

Background

Despite the strategic development plan by the authorities for the Orang Asli, there are six subtribes of which their population numbers are small (less than 700). These minorities were not included in most of the health related studies published thus far. A comprehensive physiological and biomedical updates on these small subtribes in comparison to the larger subtribes and the urban Malay population is timely and important to help provide appropriate measures to prevent further reduction in the numbers of the Orang Asli.

Methods

A total of 191 Orang Asli from different villages in Peninsular Malaysia and 115 healthy urban Malays were recruited. Medical examinations and biochemical analyses were conducted. Framingham risk scores were determined. Data was analyzed using IBM SPSS Statistics, Version 20.0.

Results

A higher percentage of the Orang Asli showed high insulin levels and hsCRP compared to the healthy Malays denoting possible risk of insulin resistance. High incidences of low HDL-c levels were observed in all the Orang Asli from the six subtribes but none was detected among the urban Malays. A higher percentage of inlanders (21.1 % of the males and 4.2 % of the females) were categorized to have high Framingham Risk Score.

Conclusions

Orang Asli staying both in the inlands and peripheries are predisposed to cardiovascular diseases and insulin resistance diabetes mellitus. The perception of Orang Asli being healthier than the urban people no longer holds. We believed that this information is important to the relevant parties in strategizing a healthier community of the Orang Asli to avoid the vanishing of the vulnerable group(s).

Evaluation of hematological and biochemical profiles in dairy cows with left displacement of the abomasum

For the present study, 25 Holstein and crossbreed, 3 to 7-year-old cows diagnosed with left displacement of the abomasum and 15 healthy cattle as control groups over a period of 2 years were used. LDA diagnosis was based on clinical examinations (high-pitched bell-like sounds) and confirmed by laparoscopy. Two blood samples were collected from each case through the jugular vein including one tube containing EDTA for hematological parameters analysis and one tube without anticoagulant for biochemical analysis. Hematological parameters including Ca, P, Mg, Cl, AST, urea, and glucose concentrations were measured by routine procedures. Serum was determined by use of an atomic absorption spectrophotometer, and Na and K values were obtained using a flame photometer. The results of this study showed that Hb, percentage of PCV, total leukocytic, neutrophils, total protein count plus AST, urea, and glucose concentrations were significantly increased in the LDA cases compared to the control group, whereas a marked decrease in plasma electrolyte concentrations (hyponatremia, hypochloremia, hypokalemia, and hypocalcemia) was found in 88–92% of LDA cases. In conclusion, in the present study, it was shown that DA causes alterations in the clinical, hematological, and biochemical profiles and these alterations can be more severe when DA is concurrent with other diseases.