Vaccination coverage in children with juvenile idiopathic arthritis, inflammatory bowel diseases, and healthy peers: Cross-sectional electronic survey data

BACKGROUND

Patients with immune-mediated diseases, such as juvenile idiopathic arthritis (JIA) and inflammatory bowel disease (IBD) are at increased risk of developing infections, due to disease-related immune dysfunction and applying of immunosuppressive drugs.

AIM

To evaluate vaccine coverage in patients with IBD and JIA, and compare it with healthy children.

METHODS

In the cross-sectional study we included the data from a questionnaire survey of 190 Legal representatives of children with JIA (n = 81), IBD (n = 51), and healthy children (HC, n = 58). An electronic online questionnaire was created for the survey.

RESULTS

There were female predominance in JIA patients and younger onset age. Parents of JIA had higher education levels. Employment level and family status were similar in the three studied groups. Patients with JIA and IBD had lower vaccine coverage, without parental rejection of vaccinations in IBD, compare to JIA and healthy controls. The main reason for incomplete vaccination was medical conditions in IBD and JIA. IBD patients had a lower rate of normal vaccine-associated reactions compared to JIA and HC. The encouraging role of physicians for vaccinations was the lowest in JIA patients. IBD patients had more possibilities to check antibodies before immune-suppressive therapy and had more supplementary vaccinations compared to JIA and HC.

CONCLUSION

JIA and IBD patients had lower vaccine coverage compared to HC. Physicians' encouragement of vaccination and the impossibility of discus about future vaccinations and their outcomes seemed the main factors for patients with immune-mediated diseases, influencing vaccine coverage. Further investigations are required to understand the reasons for incomplete vaccinations and improve vaccine coverage in both groups, especially in rheumatic disease patients. The approaches that stimulate vaccination in healthy children are not always optimal in children with immune-mediated diseases. It is necessary to provide personalized vaccine-encouraging strategies for parents of chronically ill children with the following validation of these technics.

Water Uptake as a Crucial Factor on the Properties of Cryogels of Gelatine Cross-Linked by Dextran Dialdehyde

We investigated the water sorption properties of macroporous cryogels of gelatine (Gel) and dextran dialdehyde (DDA) prepared via cryogelation at 260 K and following the freeze drying processes. Water vapour sorption isotherms for aerogels were studied at 293 K by two independent methods: static-gravimetric and dynamic vapour sorption (DVS) over a water activity range of 0.11-1.0. Experimental data were fitted by use of the Brunauer-Emmett-Teller (BET) and Guggenheim-Anderson-de Boer (GAB) models. The BET model (for a water activity range of 0.1 ≤ p/po ≤ 0.5) was used to calculate the sorption parameters of the studied cryogels (the monolayer capacity, surface area and energy of interaction). In comparison with BET, the GAB model can be applied for the whole range of water activities (0.1 ≤ p/po ≤ 0.95). This model gave an almost perfect correlation between the experimental and calculated sorption isotherms using nonlinear least squares fitting (NLSF). Confocal Laser Scanning Microscopy (CLSM) was used to confirm the structural differences between various DDA:Gel cryogel compositions. Thermogravimetric analysis and DSC data for aerogels DDA:Gel provided information regarding the bonded water loss, relative remaining water content of the material and the temperature of decomposition. Estimation of the amount of bound water in the cryogels after the freeze drying process as well as after the cycle of treatment of cryogels with high humidity and drying was performed using DSC. The results of the DSC determinations showed that cryogels with higher gelatin content had higher levels of bonded water.

The Modulation of Functional Status of Bovine Spermatozoa by Progesterone

Simple Summary

Progesterone is an endogenous steroid hormone, which can induce capacitation and/or acrosome reactions in semen of certain mammalian species. Our study aimed to investigate the effect of progesterone on the functional status of fresh bovine spermatozoa using a chlortetracycline fluorescent probe. Results showed that heparin induced capacitation in spermatozoa incubated with or without progesterone. The destruction of microfilaments by an inhibitor of cytochalasin D blocked the stimulating effect of heparin. Steroid hormone in mixture with prolactin stimulated the acrosome reaction in spermatozoa, which was blocked by an inhibitor of microtubule polymerization (nocodazole). At the acrosome stage, prolactin provided the undergoing of acrosome reaction in male gametes. This effect was noted both in the presence and absence of progesterone and inhibited by nocodazole. The supplementation of dibutyryl cyclic adenosine monophosphate during the acrosome reaction to progesterone-untreated spermatozoa did not cause changes in proportion of acrosome-reacted cells. However, when progesterone was added during capacitation, a significant increase in the proportion of capacitated cells was noted, which was inhibited by nocodazole. Thus, progesterone under the action of prolactin and dibutyryl cyclic adenosine monophosphate determines the functional status of fresh spermatozoa, which indicates progesterone-modulating effect on the indicators of post-ejaculatory maturation of male gametes.

Abstract

The aim of this study is to identify the effects of progesterone (PRG) on the capacitation and the acrosome reaction in bovine spermatozoa. The fresh sperm samples were incubated with and without capacitation inductors (heparin, dibutyryl cyclic adenosine monophosphate (dbcAMP)), hormones (prolactin (PRL), PRG), inhibitors of microfilaments (cytochalasin D) and microtubules (nocodazole) during capacitation and acrosome reactions. The functional status of spermatozoa was examined using the chlortetracycline assay. Supplementation of heparin stimulated capacitation in the presence and absence of PRG. Cytochalasin D blocked the stimulating effect of heparin on capacitation. The addition of PRL during capacitation (without PRG) did not affect the functional status of spermatozoa, while in PRG-treated cells PRL stimulated the acrosome reaction. PRL (with and without PRG) increased the acrosome reaction in capacitated cells. These PRL-dependent effects were inhibited by nocodazole. During the acrosome reaction, in presence of dbcAMP, PRG decreased the proportion of acrosome-reacted cells compared to PRG-untreated cells. This effect in PRG-treated cells was canceled in the presence of nocodazole. In conclusion, PRG under the action of PRL and dbcAMP determines the changes in the functional status of native sperm cells, which indicates PRG modulating effect on the indicators of post-ejaculatory maturation of spermatozoa.

The Case of a Glucocorticoid-Induced Myopathy & Myasthenia Gravis Combination: Is There a Border?

Introduction: Glucocorticoid-induced myopathy is the sign of Cushing’s syndrome in 83%, but can also be consequence of exogenous administration of glucocorticoids. The patients with the compromised neuromuscular system (for example, because of myasthenia gravis) have a higher risk of this complication. Differential diagnosis of glucocorticoid-induced myopathy is challenging. Clinical case. A 77-year woman complained of difficulty in the act of breathing, swallowing, weakness in the limbs, inability to self-service, ptosis. Due to the growing complaints the patient was hospitalized to ICU. From anamnesis: She was diagnosed with myasthenia gravis 2 months ago. The presence of autoantibodies to the nicotine acetylcholine receptor was confirmed. Pyridostigmine bromide 60 mg/day, Methylprednisolone 20 mg/day were prescribed for 5 days. The patient noted some improvement. After the next neurologist’s examination the dose of Methylprednisolone was doubled. (It is not known for certain whether the doctor wanted to reduce the dose and the patient misunderstood.) She noted some worsening: weakness and speech difficulties increased. She returned to the previous dose after 3 days, but there was no improvement. Objectively: hypersthenic body type, BMI 39 kg/m2, predominant deposition of adipose tissue in the abdomen and face. Breathing without a ventilator. BP 250/100 mm Hg, heart rate 87 BPM. Laboratory tests revealed hyperkalemia of 8.76 mmol/l (3.5–5), creatinine of 481 mmol/l (44–124), hyperglycemia of 16 mmol/l. Glucocorticoid-induced myopathy was suspected, the administration of methylprednisolone was cancelled. The improvement of the condition was noted in 3 days. Blood pressure, glycaemia, levels of potassium and creatinine returned to normal. A biopsy of muscle revealed: atrophy of type I and II muscle fibers. There were no signs of necrosis, regeneration or inflammation. Thereby the diagnosis of glucocorticoid-induced myopathy was confirmed. Conclusion. Glucocorticoid-induced myopathy may look like a decompensation of neuromuscular disease. Since there are no accurate diagnostic tests nowadays the main argument of diagnosis is the paradoxical reaction after increasing the dose of glucocorticoids as well in this case. Even a short period of use of these drugs can lead to the development of side effects. It is necessary to regularly monitor the dynamics of the condition of such patients.

105 Increasing fertility of interspecific hybrid males using biotechnological approaches

The results of AI depend on many factors, with the quality of semen being one of the most important. Not all male hybrids can meet the requirements for semen quality, because they often have reduced fertility following cryopreservation. Thus, it is necessary to improve semen processing before use in AI. The aim of the study was to evaluate the effectiveness of using the “swim-up” flotation method to improve sperm quality of hybrid males of the Ovis genus. Semen from interspecific hybrid rams (1/4 Argali×3/4 Romanov, n=15; 1/8 Argali×7/8 Romanov, n=15) was freshly obtained, frozen–thawed, and processed by the swim-up method. Evaluation of sperm motility was determined using computer-assisted semen analysis. Statistical analysis was performed using SPSS vs.15.0 (ANOVA and t-test; SPSS Inc.). Semen was collected during the breeding season (October–December) via artificial vagina. Assessment of acrosome integrity was determined using differential staining with a Diachem diff-quick kit (NPF ABRIS+). The degree of sperm DNA fragmentation was determined using the acridine-orange test. The sperm freezing/thawing cycle was accompanied by sperm damage and an increase in the proportion of immobile sperm from 10 to 58%, with non-progressive movement increasing from 9 to 19.3%. The number of spermatozoa with abnormal morphology doubled, and the DNA fragmentation index increased from 16 to 26%. Use of the swim-up procedure allowed us to sort progressively motile spermatozoa. The content of progressively motile spermatozoa in the samples obtained from the supernatant was 86%, which was 2.3 times higher than in frozen–thawed sperm (P≤0,01). The obtained results show the effective use of the swim-up procedure to determine the quality of semen in hybrid rams. These studies were carried out with financial support from the Russian Science Foundation, grant No. 18-16-00079 and the Ministry of Science and Higher Education of the Russian Federation.

104 The effect of interspecific hybridization on the development of testes in genus Ovis males

Interspecific hybrids, especially males, are sterile or have reduced fertility. The structure and development of reproductive organs is species-specific. The study of development stages, morphology and biometric parameters in the male testes, the characterisation of species features, and the development of assisted reproductive technologies is of great importance. The aim of this research was to study morphometric parameters of the testes of interspecific hybrids of Argali with sheep of the Romanov breed compared with the original Romanov breed. The objects of research were purebred males of the Romanov breed (n=8) and hybrid males with the following genotypes: 1/4 Argali×3/4 Romanov (Group I, n=10), 1/8 Argali×7/8 Romanov (Group II, n=12). The collection of testes from purebred and hybrid animals was carried out at castration (age=12 months). Testicular tissue was fixed in Bouin’s solution. The following metrics were evaluated: weight and morphometric parameters of the testis, diameter of the seminiferous tubules, and the number of spermatogenic cells in the seminiferous tubule. Statistical analysis (comparison between groups with t-test and ANOVA) was performed using SPSS vs.15.0 (SPPS Inc.). The weight of testes in purebred Romanov males averaged 393±41g. In hybrid animals from groups I and II, this indicator was lower compared with that of purebred animals, by 58% and 41% (P<0.01), respectively. The average circumference of the testes in purebred animals and hybrids of groups I and II was 26±2, 19±3 and 20±3cm. The diameter of the seminiferous tubules in purebred animals and in hybrids of groups I and II was 215±3, 121±2 and 170±6µm, respectively. The number of spermatogenic cells inside the seminiferous tubules affects their size. In purebred animals, this value reached 90±3 cells. Hybrid animals in Groups I and II were inferior to their purebred peers in the number of spermatogenic cells in the seminiferous tubules by 31% (P<0.01) and 9%, respectively. The obtained results indicate the influence of individual characteristics of males on testicular morphology, including the number of spermatogenic cells in the seminiferous tubules. The studies were carried out with financial support from the Russian Science Foundation, grant No. 18-16-00079 and the Ministry of Science and Higher Education of the Russian Federation.

WITHDRAWN:Effect of Nd:YAG Laser Goniopuncture Timing on the Long-term Efficacy of Non-penetrating Deep Sclerectomy

Ahead of Print article withdrawn by publisher.

PSII-35 The age-related characteristics of spermatogenesis in gander

Cryopreservation of testicular stem cells - spermatogonia is of interest along with the creation of semen cryobanks. During transplantation into recipients’ testes, spermatogenic cells can create a significant population of germ cells in the process of differentiation. The knowledge about spermatogenesis course in males is necessary for the effective selection spermatogenic cells. The research aim was to study the age-related characteristics of spermatogenesis in geese. The histostructure of gander testes (n = 35) at the age of 1 to 7 months was studied. The diameter of seminiferous tubules, and the types and number of spermatogenic cells in them were evaluated. From each gander at least 30 seminiferous tubules were examined. At the age of 1 month, the diameter of the seminiferous tubules was 51±1 μm. In subsequent age periods, this indicator increased and amounted to 63±2, 65±3, 66±2, 79±3, 98±6 and 170±5 μm at the age of 2, 3, 4, 5, 6 and 7 months, respectively. Diameter increase with the age was associated with an increase of spermatogenic cells number inside tubules. At the 1 months age, the number of spermatogenic cells in one seminiferous tubule did not exceed 22±1. At the age of 2, 3, 4, 5, 6, and 7 months, this indicator increased by 2.1, 2.7, 3.1, 6.4, 8.5 and 21.2 times. At the age from 1 to 3 months, the main cells types were Sertoli and spermatogonia cells. Primary and secondary spermatocytes from 4 months of age and spermatids from 5 months of age were visualized in the seminiferous tubules. Sperm were detected in the seminiferous tubules at 6 months old, the number of which increased towards the age of 7 months. The study was supported by RSF within Project №16–16–04104.

PSX-27 The influence of technological stress on the biochemical status of lambs with different genotypes

Sheep breeding is accompanied by various technological processes, some of them are stress factors, and one of these factors is the weaning of lambs from mothers. The goal was to study the effect of technological stress on the biochemical status and growth indicators of lambs with different genotypes. Lambs were divided into three groups: pure-bred Romanov (n = 18), Katahdin (n = 7) and Argali hybrids (¼Argali × ¾Romanov, n = 17). Before weaning and 15 and 30 days after weaning, the lambs live weight was determined and the blood serum biochemistry analysis was conducted. Statistical analysis of the data was performed using the SPSSv.23. The effects of genotype and technological stress on body weight and biochemical status are statistically significant (P ≤ 0.001). The live weight of the lambs before weaning was: Romanov 15.88±1.20kg, Katahdin 22.23±0.91kg, and hybrids 14.32±1.03kg. The differences between hybrids with Katahdins and Romanovs were 55% and 39.9% (P ≤ 0.05). The average daily gain (ADG) before weaning in Romanov lambs was 153.0±12.0g, Katahdins 203.0±8.0g and hybrids 119±11.0g. As a result of lambs weaning from mothers, technological stress was accompanied by an increase urea blood serum level in lambs. In hybrids it averaged 6.61mmol/L, which is 57% more than before weaning (P ≤ 0.05). In Katahdin, Romanov and hybrid lambs during the adaptation period was observed an increase the blood cholesterol level by 7.08%, 23% and 18% respectively, and ADG in all groups was decreased and amounted in hybrids 72±5.0g, in Romanovs 83±5.6g and in Katahdins 110±4.3g. The results of the study showed that the reaction of lambs to technological stress depends on the genotype of the animal, and the adaptation process after weaning is accompanied by a decrease in growth intensity. Supported by the Russian Science Foundation (project №18–16–00079) and the Ministry of Science and Higher Education of Russia (theme №АААА-А18-118021590132-9).

PSII-36 The application of busulfan to inhibit the spermatogenesis in quail testis

The use of testicular stem cells (spermatogonia) is of most interest for obtaining individuals with predetermined traits and genome genetic modification and for conservation of poultry gene pool. A significant population of mature donor germ cells (sperm) is formed upon successful spermatogonia cells transplantation into the testes of male recipients. Obtained sperm can be used to produce offspring with the desired traits. A key step in this technology is the removal of own spermatogenic cells (inhibition of spermatogenesis) in male recipients. The aim of research was to develop and optimize methodological approaches to inhibit the spermatogenesis in quail using busulfan. This drug was injected directly into the testes parenchyma of mature males by multiple injection at the concentration from 20 to 100 mg per 1kg of body weight (n = 25). Histological preparations of testes from the experimental quails were obtained to study composition of spermatogenic cells in the seminiferous tubules after busulfan administration. The male peers who were not injected with busulfan were used as a control. Experimental quails showed a decrease in the number of spermatogenic cells in the seminiferous tubules 32, 75, 111, 119 and 118 times compared with the control when using busulfan in concentrations 20, 40, 60, 80 and 100 mg/kg of weight, respectively (P < 0.001). The cells composition in the seminiferous tubules from experimental quails was represented mainly by Sertoli cells and spermatogonia. After busulfan introduction at the concentrations 20, 40, 60, 80 and 100 mg/kg, the percentage of spermatogonia was 55±5 %, 24±4 %, 6±2 %, 5±2 % and 4±1 %, respectively. The use of busulfan at the concentration of 80–100 mg/kg led to high mortality of quails. Thus, it was found that the optimal busulfan concentration for elimination of quail spermatogenic cells was 60 mg/kg. Supported by RFBR within Project №18-29-07079.

Impact of early and delayed Nd:YAG laser goniopuncture on results of deep sclerectomy (5-years follow up period)

Purpose:

To report on impact of Nd:YAG laser goniopuncture (LGP) timing on hypotensive efficacy of deep sclerectomy (DS) for open-angle glaucoma (OAG) patients.

Methods:

228 patients who underwent DS followed by Nd:YAG LGP between January 2010 and December 2013, (follow up – 5 years) were enrolled into a single-center, retrospective, non-randomized, consecutive study. Subjects were divided into two groups (1 – delayed LGP, n = 116; 2 – early LGP, n = 112). Demographic variables, preoperative glaucoma medications, preceding surgeries and glaucoma severity were analyzed. Intraoperative and postoperative complications, intraocular pressure (IOP), ultrasound biomicroscopy (UBM) values were recorded. Success rate was analyzed using Kaplan-Meier curve. UBM data were the criteria for early or delayed LGP.

Results:

LGP was performed 3.46 ± 1.9 (1.5–6.7) months after DS in group 1, 1.12 ± 0.08 (0.9–1.5) months in group 2 ( p = 0.0001). Mean IOP before LGP in group 1 was 18.5 ± 4.7 (11.2–22.9) mm Hg; 15.7 ± 4.1 (9.1–18.5) mm Hg in group 2 ( p = 0.001). Choroidal effusion occurred in 8.6% of group 1 and 3.5% of group 2 ( p = 0.0001). Postoperative IOP: 15.6 ± 4.6 (group 1) and 15.7 ± 4.3 mm Hg (group 2) at 12 months ( p = 0.98), 16.7 ± 4.3 and 14.9 ± 1.6 mm Hg at 24 months ( p = 0.004), 16.8 ± 3.9 and 14.5 ± 3.2 mm Hg at 60 months, respectively ( p = 0.0001). Complete success rates: 68.07% and 92.59% at 12 months, 40.7% and 75.8% at 24 months, 15.2% and 48.93% at 36, 48, 60 months in groups respectively ( p = 0.0001).

Conclusion:

Early LGP after DS excludes TDM influence on further formation of intrascleral canal cavity and outflow pathways demonstrating pronounced hypotensive success in a long-term follow-up.

MON-439 Graves’ Disease and Papillary Thyroid Cancer: A Rare Clinical Case?

Background: Nodules on the background of Graves’ disease are less common among men than among women, but more than one in three patients have carcinoma. Despite the improvement of diagnostic methods, most often thyroid cancer is a random histological finding after thyroidectomy for Graves’ disease. Clinical case: A 55-year women complained of discomfort in the neck, sweating, irritability, palpitation. From anamnesis: in 2012 she was diagnosed with thyrotoxicosis syndrome. For 5 years, the patient was treated with thyrostatics, but when trying to reduce the dose, the syndrome of thyrotoxicosis recurred. In March 2017, the patient’s condition worsened, at the time of treatment she took Thyrosol 30 mg/day. Objectively: hypersthenic body type, BMI 33 kg/m2. Thyroid gland visually was increased in volume, dense with palpation, homogeneous, mobile. Elevated titer of antibodies to the TSH receptor was discovered, according to the ultrasound - increase thyroid gland 30.2 cm3, hyperechogenic formation of the left lobe 10х10х9 mm with hypoechoic rim, clear smooth contours, intranodular blood flow. As a result, the Graves’ disease, goiter grade 2, manifest thyrotoxicosis was verified, surgical treatment was recommended. Thyroidectomy, histological examination was performed: Graves’ disease was confirmed, papillary microcarcinoma with metastasis to 1 regional lymph node was revealed. Diagnosed: papillary thyroid cancer I st (pT1aN1aM0x), 2 clinical group. The patient was prescribed suppressive therapy with L-thyroxine 100 µg/day, against which after 3 months TSH reached the target values (0.2–0.5 Mme/l). Taking into account the histological characteristics of the tumor, the nature and volume of the lesion, age, the patient belongs to the group of intermediate cancer risk of progression of cancer. According to scintigraphy residual functioning thyroid tissue (20x15 mm) was detected. Radioiodine therapy was carried out in a specialized hospital. Suppressive therapy of L-thyroxine 150 µg/day, target values of TSH 0.1 - 0.5 Mme/l was recommended. After 6 months, TSH reached target values, and according to the results of ultrasound of thyroid gland no data for structural relapse was found. Conclusion: Patients with long-existing, often recurrent Graves’ disease and questionable effect of conservative therapy, in the presence of nodular formation should be assigned to the risk group for the presence of thyroid cancer and carefully examined, because the need for further surgery depends on it.

MON-594 The Peculiarity of the Gut Microbiota in Patients with Different Phenotypes of Obesity (Pilot Study)

Recent studies have shown that obesity is not a homogeneous condition and that there is a subgroup of people with obesity, but without metabolic disturbance. This phenotype of obesity is called “metabolically healthy obesity” (MHO) [1]. More and more data are appearing in the scientific literature, indicating that quantitative and qualitative changes in the gut microbiota (GM) can be a trigger in the development of obesity and metabolic disorders [2]. In order to study the role of GM in the development of various types of obesity, 37 patients were examined, divided into 3 groups: group 1 (n = 11) - healthy people without obesity and overweight (control), group 2 (n = 13) - patients with MHO, group 3 (n = 13) - patients with metabolically unhealthy obesity (MUHO). The basic metabolic parameters were determined for all of them and a quantitative assessment of the condition of the GM was performed using the Real-time PCR method. Results: 1. In people from the control group (group 1) in the GM, compared with formal normative indicators, the number of Lactobacillus spp., Bifidobacterium spp., B. thetaiotaomicron was reduced (p<0.05) and indicators of the total bacterial mass and Enterobacter spp./Citrobacter spp. were increased (p<0.05). 2. In subjects with MHO (group 2), GM changes similar to group 1 were observed. However, in comparison to group 1, Klebsiella spp. and Proteus spp. were recorded in feces in quantities exceeding the formal regulatory. In patients with MUHO (group 3), in addition to changes detected in group 2, C. difficile was found in feces, as well as a significant (p <0.05) decrease in F. prausnitzii and an increase (p <0.05) in the detection frequency of banal E.coli, as well as the more diverse composition of the microbiota. Thus, the data obtained as a result of a pilot study certainly indicate changes in the GM in people with different phenotypes of obesity and in healthy ones. Further study of the GM in patients with various types of obesity, but in a larger groups, is required. Reference: 1) Phillips C.M. Metabolically healthy obesity across the life course: epidemiology, determinants and implications. Ann N.Y. Acad Sci 2017 Mar;139(1):85-100.doi:10.1111/nyas.13230. 2). Giovanna Muscogiuri, Elena Cantone, Sara Cassarano, Dario Tuccinardi, Luigi Barrea, Silvia Savastano, Annamaria Colao & on behalf of the Obesity Programs of nutrition, Education, Research and Assessment (OPERA) group. Gut microbiota: a new path to treat obesity. International Journal of Obesity Supplements 2019 Apr;9(1):10-19. doi: 10.1038/s41367-019-0011-7

SAT-219 Allgrove Syndrome: How to Suspect a Problem?

Background: Allgrove syndrome (triple A syndrome) is a rare autosomal recessive multisystem disease characterized by adrenal insufficiency, alacrimia and achalasia. It is caused by a mutation in the AAAS gene (12q13) encoding the protein ALADIN (1). This syndrome is often associated with neurological dysfunction disorders, amyotrophy, in such cases, it is named 4A and 5A syndrome, but sometimes there is also 2A syndrome. Prevalence:<1/1000000. The first description was in 1978. Clinical case: A 18-year patient A. complained of fatigue, weakness, darkening of the skin. From anamnesis of life: born from the first pregnancy without complications, weight 3200g. Parents often turned to the pediatrician with complaints: lethargy, frequent regurgitation, ARVI up to 6–7 times a year. Slow weight gain, dyspeptic syndrome (nausea, vomiting) was noted objectively. At the age of 3, the boy entered the surgical department with acute abdomen, fever, vomiting. Achalasia was revealed, reconstructive surgery was carried out. In the diagnostic search for the causes of body weight loss he was directed to the endocrinologist. There were an increase in ACTH 470 pg/ml (0,0-46 pg/ml), cortisol 0.05 µg/DL. Diagnosis: primary chronic adrenal insufficiency; the dose of hydrocortisone 10 mg/day did not change with age. An in-depth anamnesis found: the patient never cried with tears. Objectively: asthenic body type, BMI 16.5 kg/m2, hyperpigmentation of the palms, armpits; weakness in the proximal muscles of the limbs. Laboratory studies: ACTH 95 PG/ml, cortisol 0.1 µg/DL (3.7–19.4 µg/DL). The secretion of mineralocorticoids was evaluated: plasma aldosterone and renin levels were within the reference values. Ophthalmologist: injected conjunctiva, sclera. Schirmer’s test: mild alacrimia. It allowed to make the diagnosis: “Primary chronic adrenal insufficiency. Condition after surgery for achalasia (1997). Alacrimia. Allgrove Syndrome.” The dose of hydrocortisone was increased to 17.5 mg/day. In 2019, the patient complained of a sharp deterioration of health, darkening of the skin. The dose of hydrocortisone was increased to 25 mg/day (15 mg at 8.00, 10 mg in the afternoon). The ophthalmologist noted an increase in the severity of alacrimia, artificial tear drops was recommended. The diagnosis was confirmed by pathogenic mutation c.43C>T of the AAAS gene. Discussion: Despite the full clinical picture, the right diagnosis was made only after 14 years. We shown the difficulty of diagnosis is due to the lack of awareness of clinicians about the disease, the importance of interdisciplinary interaction, as well as the need for follow-up of such patients. Reference: (1) Handschug K, Sperling S, Yoon SJ, et al. Triple A syndrome is caused by mutations in AAAS, a new WD-repeat protein gene. Human Molecular Genetics. 2001;10:283–290.

HIV and other sexually transmitted infections among female sex workers in Moscow (Russia): prevalence and associated risk factors

To estimate the prevalence and factors associated with HIV and five other STIs among outdoor female sex workers (OSFW) and indoor FSW (IFSW).

METHODS

Cross-sectional survey using respondent-driven sampling methodology. Participants answered a bio-behavioural questionnaire and were tested for Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), Trichomonas vaginalis (TV), syphilis (lifetime contact) and Mycoplasma genitalium (MG). Weighted HIV and other STIs prevalence and 95% CIs were calculated. Weighted multivariate logistic regression was performed to identify factors associated with having at least one STI (including HIV).

RESULTS

Between October 2017 and July 2018, 385 FSW participants were recruited, among whom 206 (53.5%) were IFSW and 179 (46.5%) were OFSW. The mean age was 31.4 years. Weighted HIV prevalence was 3.1% (95% CI 1.5 to 7.0). Weighted prevalence of other STIs was: 4.1% (95% CI 2.2 to 8.0) for NG, 8.8% (95% CI 5.9 to 13.0) for CT, 12.7% (95% CI 8.6 to 18.0) for TV, 13.9% (95% CI 9.9 to 19.0) for syphilis (lifetime contact) and 14.9% (95% CI 10.5 to 21.0) for MG. STI prevalence was significantly higher among OFSW for CT, TV and MG (p<0.001). In total, 43.2% of the participants had at least one HIV/STI. Factors associated with having HIV/STI were being an OFSW (OR 3.29; 95% CI 1.72 to 6.27); being registered in another Russian region (2.61 (95% CI 1.05 to 6.48)); having never been tested for HIV (2.51 (95% CI 0.98 to 6.41)) and having a low level of knowledge regarding HIV transmission (4.88 (95% CI 0.96 to 24.78)).

CONCLUSION

Prevalence of HIV and STIs was high among FSW in Moscow. OFSW were more vulnerable to STIs. There is an urgent need to tailor programmes for sexual and reproductive health for FSW in Russia.

Screening of fungal strains of the genus Beauveria for their ability to form endophytic relations with Phaseolus plants

Screening of 11 strains of Beauveria fungi based on their colonization rate (endophytic activity) on bean plants showed that all the cultures tested belonging either to Beauveria bassiana or Beauveria pseudobassiana are able to colonize the plants. Significant differences were revealed between the strains in their endophytic activity. Three strains of fungi with the highest endophytic activity were found and a slight growth-stimulating effect was revealed for the four strains. The relative increase in plant height was significantly higher compared to both control and other fungal cultures.

Novel Cryopreservation Approach Providing Off-the-Shelf Availability of Human Multipotent Mesenchymal Stromal Cells for Clinical Applications

Cryopreservation is the only established method to provide long-term storage and fast availability of cellular product for therapeutic applications. The overwhelming majority of cryopreservation media contain toxic concentrations of dimethyl sulfoxide (DMSO) limiting the possibility for the direct administration of cryopreserved cells to the patients. Here, we propose a novel approach for nontoxic xeno-free cryopreservation of human multipotent mesenchymal stromal cells (MSCs) aimed at ensuring high viability, ready-to-use availability, and localized delivery of the cell-based graft into damaged tissues. For MSC cryopreservation, we applied sucrose pretreatment procedure and xeno-free cryoprotective medium containing human platelet-poor blood plasma (PPP), sucrose, and nontoxic concentration of DMSO. Using the combination of PPP, 0.2 M sucrose, and 1% DMSO, the recovery rate of cryopreserved MSCs reached 73% of the values obtained for noncryopreserved cells. Moreover, the presence of PPP in the cryoprotective medium provided the possibility to create a ready-to-use 3D hydrogel for the localized delivery and additional support of MSCs in vivo. In a proof-of-concept study, we assessed the regenerative capacity of cryopreserved MSCs in a full-thickness wound model in mice. The positive impact of MSCs within 3D gel on wound healing rates was confirmed by morphometric and histological examinations. Our results demonstrate the possibility to apply cryopreserved cells immediately after thawing using a cryoprotective medium as the vehicle solution.

MON-398 Clinical Case Of Retroperitoneal Paraganglioma

Background: Paraganglioma is a rare neuroendocrine tumor from extra-adrenal chromaffin cells of the sympathetic paravertebral ganglia of thorax, abdomen, and pelvis. In most cases paragangliomas produce catecholamines in large concentrations and the lack of treatment can lead to cardiovascular and cerebral catastrophes [1]. That is why early diagnosis of this tumor is so important and, consequently, knowledge of its diagnostic criterion, too. Clinical case: A 59-year-old man was presented to a cardiologist for rapid increasing of blood pressure (up to 220/120 mmHg), which was accompanied by severe headache and epigastric pain in September 2017. From anamnesis it is known: the disease began suddenly and had paroxysmal flow. The first attack lasted for about 3 minutes and finished itself. Then such attacks occured with different frequency (from 1 per month to several times per week) and were connected with physical activity. The cardiologist suspected diagnosis of pheochromocytoma. The result of urinary fractionated metanephrines measurement showed its levels higher than normal rage but did not confirm suspected diagnosis reliably, so antihypertensive therapy was prescribed to minimize the symptoms. Despite this, the attacks persisted and the patient referred to a surgeon in May 2018. On the basis of patient’s complaints on epigastric pain during the attacks and the neck inflection of the gallbladder revealed by the ultrasound examination, it was decided to carry out cholecystectomy. A week after the operation the patient referred to the endocrinologist because of the continuing attacks. The diagnosis of pheochromocytoma was suspected again, the urinary fractionated metanephrines measurement was repeated, which revealed elevated normetanephrine level (1008 µg/day). A CT of retroperitoneal space revealed a spherical mass sized about 17х16х18 mm in paraaortal region under the left renal vein. The retroperitoneal tumor was removed laparoscopically in August 2018. Pathological examination of the removed mass showed a paraganglioma with uncertain potential of biological behaviour. BP was normal and remained within range without the need of any antihypertensive medication until discharge from hospital. The patient is asymptomatic and normotensive during his follow-up visits. Conclusion: This clinical case shows how a tumor with bright and specific symptoms can be revealed only in several years and after referring to several specialists. Also, this case highlights the importance of knowledge of diagnostic process of different diseases. In the present case the paraganglioma would have been revealed earlier if only the CT of retroperitoneal space had been done just after getting the results of free metanephrines, which were higher than normal. References: (1) Pheochromocytoma and Paraganglioma: An Endocrine Society Clinical Practice Guideline - the Endocrine Society, 2014.

SUN-386 Problems In Adrenal Incidentaloma Diagnostics In Clinical Practice

Background: Differential diagnosis of adrenal incidentaloma determines the tactics of both therapeutic treatment of the patient and surgical intervention [1]. However, even compliance with strictly regulated algorithms of differential diagnosis does not always allow the accurate diagnosis. Clinical case: A 39-year-old patient B. addressed the clinic about the lesion of the left adrenal gland. From the history it is known that since 2014 (35 years old) he has been suffering from arterial hypertension being on three-component hypotensive therapy with periodic crises up to 200/100 mmHg. In January 2018 as a result of the renal ultrasonography the lesion was verified in the projection of the upper pole of the left kidney. The adrenal CT with contrast confirmed the lesion of the left adrenal gland size 41*42*56 mm density at the native research 33 HU, absolute washout percentage of 30%. The patient was referred to an endocrinologist. Objectively: BMI-29 kg/m2, BP 160/90 mmHg, HR-80 per minute. A preliminary diagnosis was made - an incidentaloma of the left adrenal gland. The hormonal activity of the lesion was determined. According to the suppressive test with 1mg dexamethasone, plasma cortisol suppression did not occur. The levels of ACTH as well as the values of metanephrine and normetanephrine in daily urine were within normal limits. On the basis of normal values of metanephrine and normetanephrine in the urine daily as well as high-density CT values in the native phase and the delay of contrast in the delayed phase together with the large size of the lesion and high growth rate, pheochromocytoma was eliminated and glucocorticoid-producing adrenocortical cancer was verified. Laparoscopic adrenalectomy was performed on the left. However, according to the histological examination, pheochromocytoma was revealed. To confirm the diagnosis the biopsy material was sent to an expert-level institution, where pheochromocytoma/paraganglioma with a high risk of metastasis was also verified, Ki 67<1%. The patient was finally diagnosed with pheochromocytoma of the left adrenal gland glucocorticoid secreting. After the surgery, hemodynamic parameters stabilized. Conclusion: On the example of this case, we have demonstrated that compliance with strictly regulated algorithms of differential diagnosis does not always allow an accurate diagnosis. Thus, at the preoperative stage all the data indicated in favor of adrenocortical cancer while the immunohistochemical study after the operation verified pheochromocytoma. Thus, research should be continued to improve the diagnostic algorithm of incidentaloma of the adrenal gland. Reference: (1) Ierardi A.M., Petrillo M.,Patella F.,Biondetti P.,Pesapane F., Fumarolla E.M.,Angileri S.A., Pinto A., Dionigi G., Carrafiello G.Interventional radiology of the adrenal glands: current status. Gland Surg 2018;7(2):147-165.

SAT-114 Problems In Postoperative Hypothyroidism And Hypoparathyrosis Treatment Because Of Bariatric Surgery

Background: Bariatric surgery remains the most effective method of weight loss and can result in partial or complete resolution of multiple obesity-related comorbidities. Bariatric surgery should be performed in conjunction with a comprehensive preoperative assessment and a follow-up plan consisting of nutritional, behavioral, and medical programs. The bariatric surgical procedures are associated with significant long-term complications, primarily malnutrition. Clinical case: A 56-year-old woman was presented with complaints about tingling in her fingertips, painful muscle cramps, and difficulties with finger extension. It was found out from medical history that total thyroidectomy with parathyroidectomy because of papillary thyroid cancer was performed in 2007 and oral levothyroxine was prescribed. Bariatric surgery SADI-S (sleeve gastrectomy, duodeno-ileal anastomosis) was performed because of morbid obesity in September 2018. On physical examination Chvostek and Trousseau signs were noted. BMI was 39 kg/m2. Laboratory examination was carried out. Increased level of TSH and decreased value of calcium and 25-OH vitamin D were revealed. Laboratory results demonstrated postoperative hypothyroidism decompensation due to abnormal gastric acid secretion because of sleeve gastrectomy and postoperative hypoparathyrosis decompensation due to reduced calcium absorption because of duodeno-ileal anastomosis. So, the dosage of calcium, vitamin D and levothyroxine was increased. Also 10% calcium gluconate was prescribed. But compensation of postoperative hypothyroidism and hypoparathyrosis was not achieved. Thus, reconstructive operation was recommended due to ineffective medical treatment of hypothyroidism and hypoparathyrosis. Conclusion: This clinical case demonstrates that lack of comprehensive preoperative assessment indications to bariatric surgery leads to complication in compensation of comorbid states, such as postoperative hypothyroidism and hypoparathyrosis. Reference: (1) Nancy Puzziferri, MD, MS, Thomas B. Roshek III, MD, Helen G. Mayo, BS, MLS, Ryan Gallagher, BA, Steven H. Belle, PhD, MScHyg, and Edward H. Livingston, MD Long-term Follow-up After Bariatric Surgery: A Systematic Review. JAMA. 2014 September 3; 312(9): 934-942. (2) Improved levothyroxine pharmacokinetics after bariatric surgery. Thyroid 2013; 3; 23: 414-9.

INTERRELATION OF THE GENE 4DKN1A (RS 1801270) POLYMORPHIC STATE AND LEVEL OF DEVELOPMENT OF CARIES IN CHILDREN WITH DOWN SYNDROME

Study is devoted for rs1801270 polymorphism of CDKN1A gene due to the level of intensity of caries development in children with Down syndrome. The full development of oral cavity organs is ensured through a complex of genes whose protein products control different stages of this difficult process. Changes in gene structure, as well as disturbance of their expression may lead to abnormalities of development of teeth and periodontal tissues. Analysis of the polymorphism of CDKN1A gene Ser31Arg in children living in Kharkiv region has shown that the frequency of genotypes and alleles corresponds to the theoretically expected distribution by Hardy-Weinberg in the core (χ2=0.12) and control (χ2=1.29) groups. There is no significant differences in the frequency of alleles of CDKN1A gene in the group of healthy children and children with Down syndrome (p=0.978). There is an association of heterozygous option C/A of the studied marker Ser31Arg of CDKN1A gene with the level of intensity of caries development (by Leus) in children with Down syndrome under 10 years old.

Reduced glutathione increases quercetin stimulatory effects on HDL- or apoA1-mediated cholesterol efflux from J774A.1 macrophages

In our in vitro study, we analyzed the effects of incubation of J774A.1 macrophages with reduced glutathione (GSH) and quercetin on the extent of cellular cholesterol efflux by high-density lipoprotein (HDL) or apolipoprotein A1 (apoA1). This combination was the most potent one among other exogenous and endogenous antioxidant combinations, since it significantly increased the extent of HDL-mediated cholesterol efflux from macrophages by 47% versus control cells, whereas quercetin (20 μM) or GSH (200 μM) alone increased it by only 37% or 17%, respectively. Similarly, apoA1-mediated cholesterol efflux was increased by 11% or 22% in quercetin or quercetin + GSH-treated cells, respectively, versus control cells. These stimulatory effects were noted only after 20 h of cell incubation. The combination of quercetin + GSH demonstrated high scavenging capacity of free radicals versus quercetin or GSH alone. In addition, quercetin + GSH significantly decreased macrophage oxidative stress as measured by the scavenging capacity of free radicals in the cells, the formation of reactive oxygen species, and the levels of cellular glutathione and lipid peroxides. There was no significant effect of quercetin + GSH on cellular HDL binding, on ATP-binding cassette A1 (ABCA1) activity, or on ABCG1 messenger RNA (mRNA) levels. In contrast, mRNA levels for ABCA1 and peroxisome proliferator-activated receptor alpha (PPARα) were both significantly increased by 89% and 93%, respectively, in quercetin + GSH-treated cells versus control cells. Quercetin alone increased the mRNA levels for ABCA1 or PPARα by 42% or 77%, respectively, whereas GSH alone increased it by 22% or 28%, respectively. Mass spectra analysis revealed that oxidized quercetin reacts with GSH to form a new adduct product. We thus conclude that the stimulatory effects of quercetin + GSH on apoA1- or HDL-mediated macrophage cholesterol efflux are related to the ability of GSH to preserve quercetin in its reduced form.

Dyslipidemia and lipid-lowering therapy in the elderly

According to the current evidence, the fastest growing proportion of patient populations seeking healthcare is those over 65 years of age. Coronary artery disease and subclinical atherosclerosis are highly prevalent in this group of patients and are strongly linked to dyslipidemia, a well-established risk factor for atherosclerosis. Treating dyslipidemia in this group of patients requires specific knowledge and understanding of common dyslipidemias and the relative safety of various pharmacologic agents in the presence of possible multiple comorbidities. Lifestyle modification remains the first step in the treatment of dyslipidemia; however, it can be difficult to sustain and achieve acceptable compliance in the elderly and it is best used in combination with drug therapy. Statins are widely accepted as the first-line therapy. Several recent studies have demonstrated that statins are safe and effective in the elderly. However, it is important to note that there is very limited data regarding the effects of dyslipidemia treatment on morbidity and mortality in patients over 85 years of age. In summary, the clinicians must recognize that the presence of dyslipidemia in the elderly poses substantial risk of coronary events and stroke. The available evidence has demonstrated that in most elderly patients who are at increased risk for cardiovascular morbidity and mortality, treatment of dyslipidemia with appropriate therapy reduces the risk, and when used carefully with close monitoring for safety, the treatment is generally well tolerated. With increasing life expectancy, it is critical for physicians to recognize the importance of detection and treatment of dyslipidemia in the elderly.

Thermally decarboxylated sodium bicarbonate: Interactions with water vapour, calorimetric study

Isothermal titration calorimetry (ITC) was used to study interactions between water vapour and the surface of thermally converted sodium bicarbonate (NaHCO₃). The decarboxylation degree of the samples was varied from 3% to 35% and the humidity range was 54-100%. The obtained enthalpy values were all exothermic and showed a positive linear correlation with decarboxylation degrees for each humidity studied. The critical humidity, 75% (RH_o), was determined as the inflection point on a plot of the mean-ΔH kJ/mole Na₂CO₃ against RH. Humidities above the critical humidity lead to complete surface dissolution. The water uptake (m) was determined after each calorimetric experiment, complementing the enthalpy data. A mechanism of water vapour interaction with decarboxylated samples, including the formation of trona and Wegscheider's salt on the bicarbonate surface is proposed for humidities below RH_o.

Monocyte-macrophage membrane possesses free radicals scavenging activity: stimulation by polyphenols or by paraoxonase 1 (PON1)

In the current study, we analysed free radicals scavenging activity of monocytes-macrophages in the absence or presence of antioxidants such as polyphenols or paraoxonase 1 (PON1). THP-1 human monocytic cell line, murine J774A.1 macrophages, as well as human primary monocytes have the capability to scavenge free radicals, as measured by the 1-diphenyl-2-picryl-hydrazyl (DPPH) assay. This effect (which could be attributed to the cell's membrane) was cell number and incubation time dependent. Upon incubation of J774A.1 macrophages with acetylated LDL (Ac-LDL), with VLDL, or with the radical generator, AAPH, the cells' lipid peroxides content, and paraoxonase 2 (PON2) activity were significantly increased. While non-treated cells decreased DPPH absorbance by 65%, the Ac-LDL-, VLDL- or AAPH-treated cells, decreased it by only 33%, 30%, or 45%, respectively. We next analysed the effect of J774A.1 macrophage enrichment with antioxidants, such as polyphenols or PON1 on the cells' free radicals scavenging activity. Non-treated cells decreased DPPH absorbance by 50%, whereas vitamin E-, punicalagin- or PJ-treated cells significantly further decreased it, by 75%. Similarly, in PON1-treated cells DPPH absorbance was further decreased by 63%, in association with 23% increment in PON1 catalytic activity. In cells under oxidative stress [treated with AAPH-, or with oxidized LDL], PON1 activity was decreased by 31% or 40%, as compared to the activity observed in PON1 incubated with non-treated cells. We conclude that monocytes-macrophages possess free radicals scavenging activity, which is decreased under atherogenic conditions, and increased upon cell enrichment with potent antioxidants such as nutritional polyphenols, or PON1.

249 THE DIRECT AND CUMULUS-MEDIATED EFFECTS OF PROLACTIN ON BOVINE OOCYTES

Prolactin (PRL) is an important regulator of female reproduction, as indicated using PRL receptor knockout mice (Bole-Feysot C et al. 1998 Endocrinol. Rev. 19, 225–268). The presence of PRL receptors or their mRNA has been shown in different follicular compartments of various mammalian species, including oocytes of sheep and mice (Picazo RA et al. 2004 Reproduction 128, 545–553; Kiapekou E et al. 2005 Reprod. Biomed. Online 10, 339–346). The aim of the present study was to characterize the direct and cumulus-mediated pathways of PRL signaling into bovine oocytes. The expression of PRL receptor mRNA in follicular cells was detected by reverse transcription polymerase chain reaction (RT-PCR) analysis. For oocytes, nested PCR was used. In addition, a total of 707 COC and 689 denuded oocytes (DO) from follicles 2 to 8 mm in diameter were cultured for 6 h (COC), 8 h (DO), or 24 h (COC and DO) in the presence or absence of 50 ng mL–1 bovine PRL (20 IU mg–1; Research Center for Endocrinology, Moscow, Russia). The following systems for COC and DO culture were used: (1) TCM-199 containing 10% fetal calf serum (system 1) and (2) DMEM containing 10 U mL–1 pregnant mare’s serum gonadotropin (PMSG), 5 U mL–1 hCG (Intervet Scandinavia, Copenhagen, Denmark), and 5% estrous cow serum (system 2). The nuclear status of oocytes was evaluated by Tarkowski’s cytogenetic method. After IVM in system 2, a portion of the oocytes (348 COC and 311 DO) underwent IVF and IVC, and the embryo development was tracked until the blastocyst stage. All treatments were repeated 4 to 7 times. Results were expressed as mean ± SEM. Arcsine-transformed data were analyzed by two-way ANOVA. Messenger RNA expression of long and short isoforms of PRL receptor was revealed in both bovine oocytes and cumulus cells. In system 1, PRL raised the rate of DO remaining at the diplotene stage by 8 h of culture (from 32.6 ± 3.0 to 47.5 ± 4.7%, P < 0.05), whereas there was no effect of PRL on the meiotic resumption in COC. By contrast, the hormone exerted a stimulatory action on the meiotic progression in the presence of cumulus cells by increasing the proportion of oocytes reaching the telophase I or metaphase II stages during 24 h of maturation (from 61.9 ± 1.2 to 73.5 ± 0.9%, P < 0.05). In system 2, PRL did not affect nuclear maturation of either cumulus-enclosed or cumulus-free oocytes, with the maturation rate varying between 93.9 ± 2.7 and 95.2 ± 2.4% (COC) and between 85.6 ± 3.0 and 83.0 ± 4.0% (DO). When added to IVM system 2, PRL raised the cleavage and blastocyst rates only in the case of COC (from 72.2 ± 2.4 to 80.2 ± 2.1%, P < 0.05, and from 20.5 ± 3.6 to 40.9 ± 4.2%, P < 0.01, respectively). These findings suggest functioning of the direct and cumulus-mediated pathways of PRL signaling into bovine oocytes, with the hormone affecting meiosis via both pathways. We thank A. D. Roed for expert technical assistance with IVF and IVC. This research was supported in part by RFBR (project no. 07-04-01485). I.L. was the recipient of an Erasmus Mundus fellowship.

High prevalence of multidrug-resistant tuberculosis in Georgia

BACKGROUND

Tuberculosis (TB) has emerged as a serious public health problem in the country of Georgia. However, little or no data exist on rates and risk factors for drug-resistant TB, including multidrug-resistant (MDR)-TB, in Georgia.

OBJECTIVE

To assess the prevalence and risk factors for drug-resistant TB.

METHODS

A cross-sectional prospective survey of patients with suspected pulmonary TB was carried out at four sentinel sites (Tbilisi, Zugdidi, Kutaisi, and Batumi) in Georgia between January 1, 2001 and December 31, 2004.

RESULTS

Among 1422 patients with suspected pulmonary TB, 996 (70.0%) were culture positive; 931/996 (93.5%) had drug susceptibility testing performed. Overall, 64.0% of patients (48.3% of new and 85.3% of retreatment cases) had positive cultures for Mycobacterium tuberculosis resistant to >or=1 first-line antituberculosis drugs. The overall prevalence of MDR-TB was 28.1% (10.5% of newly diagnosed patients and 53.1% of retreatment cases). In multivariate analysis, risk factors for MDR-TB included: being a retreatment case (prevalence ratio (PR)=5.28, 95% CI 3.95-7.07), history of injection drug use (PR=1.59, 95% CI 1.21-2.09), and female gender (PR=1.36, 95% CI 1.12-1.65).

CONCLUSIONS

MDR-TB has emerged as a serious public health problem in Georgia and will greatly impact TB control strategies.

Current Treatment Options for the Metabolic Syndrome

The metabolic syndrome is defined as a condition characterized by a set of clinical criteria: insulin resistance, visceral obesity, atherogenic dyslipidemia, and hypertension. The major risk factors leading to the epidemic of this syndrome in the United States are visceral obesity, physical inactivity, and an atherogenic diet. The available current evidence suggests that the first step in management of patients with metabolic syndrome should be focused on lifestyle modifications (eg, weight loss and physical activity). The treatment should be based on two major components: behavioral change to reduce caloric intake and an increase in physical activity. A realistic goal for weight reduction should be 7% to 10% over 6 to 12 months. The general dietary recommendations include low intake of saturated fats, trans fats and cholesterol, and diets with low glycemic index. Soy protein could be more beneficial than animal protein in weight reduction and correction of dyslipidemia. Physical activity is associated with successful weight reduction and these therapeutic lifestyle changes can reduce by half the progression to new-onset diabetes in patients with metabolic syndrome. Physical activity recommendations should include practical, regular, and moderated regimens of exercise, with a daily minimum of 30 to 60 minutes. An equal balance between aerobic exercise and strength training is advised. Medication therapy is a critical step in the management of patients with metabolic syndrome when lifestyle modifications fail to achieve the therapeutic goals. There is no single best therapy and the treatment should consist of treatment of individual component(s). Atherogenic dyslipidemia should be controlled with statins if there is concomitant increase in low-density lipoprotein cholesterol and if indicated with combination therapy, including fibrates, nicotinic acid, bile acid-binding resins, or ezetimibe. Drugs such as thiazolidinediones and renin-angiotensin system blockers are a few of the available agents in this category. Some evidence suggests that angiotensin-converting enzyme inhibitors and b blockers are more beneficial for treatment of hypertension in patients with metabolic syndrome. Patients with metabolic syndrome also have elevations in fibrinogen and other coagulation factors leading to prothrombotic state and aspirin may be beneficial for primary prevention in these patients. The new developments in the treatment of metabolic syndrome with drugs, such as peroxisome proliferator-activated receptor agonists, will broaden the horizons of the current treatment options in metabolic syndrome.

Pomegranate juice flavonoids inhibit low-density lipoprotein oxidation and cardiovascular diseases: studies in atherosclerotic mice and in humans

The beneficial health effects attributed to the consumption of fruit and vegetables are related, at least in part, to their antioxidant activity. Of special interest is the inverse relationship between the intake of dietary nutrients rich in polyphenols and cardiovascular diseases. This effect is attributed to polyphenols' ability to inhibit low-density lipoprotein (LDL) oxidation, macrophage foam cell formation and atherosclerosis. Pomegranate polyphenols can protect LDL against cell-mediated oxidation via two pathways, including either direct interaction of the polyphenols with the lipoprotein and/or an indirect effect through accumulation of polyphenols in arterial macrophages. Pomegranate polyphenols were shown to reduce the capacity of macrophages to oxidatively modify LDL, due to their interaction with LDL to inhibit its oxidation by scavenging reactive oxygen species and reactive nitrogen species and also due to accumulation of polyphenols in arterial macrophages; hence, the inhibition of macrophage lipid peroxidation and the formation of lipid peroxide-rich macrophages. Furthermore, pomegranate polyphenols increase serum paraoxonase activity, resulting in the hydrolysis of lipid peroxides in oxidized lipoproteins and in atherosclerotic lesions. These antioxidative and antiatherogenic effects of pomegranate polyphenols were demonstrated in vitro, as well as in vivo in humans and in atherosclerotic apolipoprotein E deficient mice. Dietary supplementation of polyphenol-rich pomegranate juice to atherosclerotic mice significantly inhibited the development of atherosclerotic lesions and this may be attributed to the protection of LDL against oxidation.