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This prospective, observational study investigated changes in sleep and the effect on energy intake, gestational weight gain, and cardiometabolic health across pregnancy in 52 healthy pregnant women with obesity. Habitual sleep was assessed by wrist-worn actigraphy (time spent in bed; TIB, total sleep time; TST, and sleep efficiency) in early (13(0)-15(6) weeks) and late (35(0)-36(6)) pregnancy. A change to habitual sleep was defined as change of one-half of the standard deviation of TIB and TST across six consecutive nights from early pregnancy. Energy intake and changes in weight, fasting glucose, insulin, and lipids across pregnancy were compared between women who changed sleep. During early pregnancy, TIB was 9:24±0:08h and varied by 1:37±0:07h across the six nights. TST and sleep efficiency significantly declined from early to late pregnancy (7:03±0:08h to 6:28±0:09h, p

Background: The most commonly received specimen in any histopathology laboratory is cholecystectomy specimen. The majority of the cholecystectomies are done for Cholelithiasis. Inflammation may be acute, chronic or acute on chronic. It almost always occurs in association with gallstones, which is responsible for carcinoma and if the diagnosed early prognosis of the carcinoma gall bladder is good. Histopathological examination is therefore a must for diagnosis of early carcinomas. Subjects and Methods: 100 cholecystectomy specimens from patients of all ages were included. All specimens were subjected to gross and microscopic assessment. Different histological findings were noted in various layers of the gall bladder. The study includes all radiologically confirmed inflammatory pathologies of including metaplastic changes of the gall bladder epithelium, irrespective of age and sex. The study excludes patients with evident gallbladder malignancy, cases with known secondaries from gall bladder, traumatic rupture of gallbladder. Results: The age of patients varied from 16 to 70 years, with a maximum number of patients (25%) belong to 31 to 40 years. Gall stones were associated with 59% cases of cholecystitis. Pigment stones were most common (74%). Histopathologically the most common diagnosis was chronic cholecystitis (69%). Conclusion: Almost all of the gallbladder lesions are inflammatory in origin, of which the most common disease being chronic cholecystitis. Chronic cholecystitis was found to be most probable diagnosis in a female of 30-40 years. Pigmented gall stones were found to be the most common etiology of chronic cholecystitis. Prompt detailed histopathological analysis will help to confirm the benign nature of the disease or to detect any precursors of malignancy.

Objectives: The objective of this study is to assess clinical characteristics, obstetric and perinatal outcome of pregnant women with H1N1 infection. Methods: A retrospective observational study was conducted at a tertiary care teaching hospital. All clinically suspected, probable as well as confirmed cases of swine flu, in pregnancy were included. We analyzed the presenting complaints, condition on admission, criteria for admission in ICU, abnormalities in laboratory reports, course of illness and perinatal outcome. Results: A total of 52 patients in pregnancy and postpartum period were admitted with fever or acute respiratory illness over the period of two years from March 2017 to February 2019. Mean age of patients was 25.88 years. 32 patients were H1N1 positive. In which, 29 were pregnant and 3 patients were postpartum. Mean gestational age was 31weeks. Out of 32 patients, 11 patients were admitted in intensive care unit. There were 4 deaths due to H1N1 illness and all were in 3rd trimester. Conclusion: Acquiring infection in late trimester, late initiation of antiviral treatment and presence of co-morbid illness were high risk factors for developing critical illness. We emphasize that high index of suspicion, early diagnosis; early antiviral therapy and immunization to pregnant women are to reduce the complications, ICU admissions and mortality in this group.

Introduction: Chronic suppurative otitis media (CSOM) is a common health problem in countries with low socio-economic strata because of poor nutrition, population burden, low hygienic condition, insufficient health care, and repeated upper respiratory tract infection (URTI). Untreated cases of CSOM result in complications ranging from persistent otorrhoea, mastoiditis, labyrinthitis, facial nerve palsy to intracranial abscesses or thromboses. Microbiological profile and their antibiotic sensitivity pattern are essential to enable proper treatment of this disease and preventing the development of complications. Material and Methods: The current study was designed to identify the pathogenic agents causing CSOM and to understand their antimicrobial resistance pattern who attended ENT Department of this hospital between July 2017 to June 2019. Results: Among 496 clinical samples, microbes were seen in 329 (66.3%) cases with predominant male (66.3%) distribution and age group of 11-20 years (31%). Pseudomonas spp. (50.7%) is predominantly isolated. It showed resistance to aminoglycosides and fluoroquinolones but was found sensitive to carbapenems with a resistance rate of 1.2%. ESBL (Extended-spectrum β- lactamase) detection was seen in 30.9% of GNB while MBL (Metallo β- lactamase) was detected in 2.7% of cases. S.aureus was highly resistant to first-line antibiotics with MRSA (Methicillin-resistant S.aureus) rate of 64.1%, however, all were sensitive to glycopeptides. Conclusions: There should be a minimum gap between the onset of symptoms and the treatment provided to prevent complications of CSOM and also the complicated cases should be referred to specialized centers for better management.

Although insufficient sleep is associated with increased cardiovascular risk, evidence of a causal relationship is lacking. We investigated the effects of prolonged sleep restriction on 24-hour ambulatory blood pressure (BP) and other cardiovascular measures in 20 healthy young participants (aged 23.4±4.8 years, 9 females), who underwent a randomized, controlled, crossover, 16-day inpatient study consisting of 4 days of acclimation, 9 days of sleep restriction (4 hours of sleep/night) or control sleep (9 hours), and 3 days of recovery. Subjects consumed a weight maintenance diet with controlled nutrient composition throughout. A 24-hour BP (primary outcome) and cardiovascular biomarkers were measured repeatedly. Polysomnographic monitoring was continuous. Comparing sleep restriction versus control sleep, 24-hour mean BP was higher (adjusted mean difference, day 12: 2.1 mm Hg [95% CI, 0.6–3.6], corrected P =0.016), endothelial function was attenuated ( P P =0.011). Despite increased deep sleep, BP was elevated while asleep during sleep restriction and recovery. Post hoc analysis revealed that 24-hour BP, wakefulness, and sleep BP increased during experimental and recovery phases of sleep restriction only in women, in whom 24-hour and sleep systolic BP increased by 8.0 (5.1–10.8) and 11.3 (5.9–16.7) mm Hg, respectively (both P

Many adults receive inadequate sleep, which elevates obesity and type 2 diabetes risk and may hinder benefits of calorie restriction (CR). We hypothesized that short sleepers would experience less weight loss and diminished glycemic benefits compared to adequate sleepers during CR. We performed secondary analyses in participants randomized to 25% CR in the Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy- Phase 2 (CALERIE 2) trial. Body weight, dual-energy x-ray absorptiometry-measured body composition, fasting glucose, insulin, and HOMA-IR were assessed at baseline, 12, and 24 months. Self-reported sleep duration identified participants with stable sleep as short (≤7 hrs, n=45) or adequate sleepers (>7 hrs, n=65). Sex, BMI, weight, and race-adjusted linear mixed models identified differences over time and between sleepers. Short and adequate sleepers had similar body weight and composition values at all timepoints and experienced equivalent CR-induced reductions over time. Baseline HOMA-IR (1.2 vs. 1.0; P=0.047) was higher in short sleepers, with trends noted for glucose (81.7 vs. 83.5 mg/dL; P=0.093) and insulin (5.7 vs. 4.9 µU/mL; P=0.077). Both phenotypes demonstrated enhanced glycemic control relative to baseline at 12 and 24 months. While there were no 12-month differences in absolute glycemic values between sleepers, initial differences re-emerged at 24 months, with higher HOMA-IR (0.9 vs. 0.7; P=0.01) and insulin concentrations (4.3 vs. 3.4 µU/mL; P Disclosure K. K. Hoddy: None. P. Singh: None. J. L. Dorling: None. R. A. Beyl: None. J. P. Kirwan: None. K. Huffman: None. S. B. Racette: None. S. Das: None. C. K. Martin: Advisory Panel; Self; EHE Health, Board Member; Self; NaturallySlim, Other Relationship; Self; ABGIL, Academy of Nutrition and Dietetics, Research Support; Self; American Society for Nutrition, Leona M. and Harry B. Helmsley Charitable Trust, Lilly, National Institutes of Health, Patient-Centered Outcomes Research Institute, U. S. Department of Agriculture, WW. Funding National Institute on Aging (U01AG022132, U01AG020478, U01AG020487, U01AG020480, R01AG060499, U24AG047121, U24AG047121); Agricultural Research Service (1950-51000-071-01S); American Heart Association (20POST35210907); National Institute of Diabetes and Digestive and Kidney Diseases (5P30DK07247615); National Institute of General Medical Sciences (U54GM104940)

Periodic limb movements in sleep (PLMS) are associated with adverse outcomes in patients with heart failure (HF). The aim of this study was to investigate whether PLMS change in response to adaptive servo-ventilation (ASV) for central sleep apnea (CSA) in patients with HF. We examined polysomnographic studies conducted between 2010 and 2014 at Mayo Clinic, Rochester, Minnesota (n = 14,444). In those, 314 of 579 patients with CSA completed the sleep study with a protocol that began with diagnostic polysomnography, followed by continuous positive airway pressure, and, for persistent CSA, by ASV titration. Patients with HF (n = 118) had a significantly higher median PLM index compared with those without HF (n = 196): 33.7 versus 6.1 events/h (p0.001). HF was associated with a significant PLM arousal index (PLMAI) increase from diagnostic trial to ASV (odds ratio [OR] = 1.79, p = 0.032) after adjusting for demographics, co-morbidities and medications. In patients aged68 years, HF was associated with PLMI and PLMAI increases during ASV (OR = 2.16, p = 0.016 and OR = 2.05, p = 0.024), which persisted in multivariable models (OR = 2.36, p = 0.025 and OR = 2.33, p = 0.026). In multivariable analysis, patients with ejection fraction ≤45% had higher odds of increased PLMAI during ASV than those with ejection fraction45% (OR = 1.98, p = 0.022). In conclusion, PLMS may increase in HF patients after suppression of CSA by ASV. Whereas the clinical significance of increased post-ASV PLMS in HF prognosis needs to be determined, these increases may contribute to worsening outcomes in HF patients with CSA treated with ASV.

Background: Research analyzing COVID-19 symptom screening has primarily focused on adult patients. In efforts to safely reopen schools, symptom screeners are being widely utilized. However, pediatric-specific outpatient data on which symptom combinations best identify children with COVID-19 are lacking. Such data could refine school symptom screening by improving screener sensitivity and specificity. In this study, we assessed the frequency of symptoms and symptom combinations in children tested for SARS-CoV-2 in outpatient settings. We aim to contribute to the optimization of pediatric COVID-19 screening questionnaires, to ultimately minimize both COVID-19 transmission in schools and missed school days. Methods: We conducted a retrospective analysis of outpatient symptoms screens, SARS-CoV-2 test results, and demographics of children (≤18 years) tested for SARS-CoV-2 between March 30 and November 30, 2020, at 3 UCSF-affiliated COVID-19 outpatient screening clinics in northern California. Those with incomplete symptom screens, >7 days between symptom documentation and test, and invalid test results were excluded. Results: Of 473 children tested at 1 site, 21 children had positive SARs-CoV-2 results and 452 children had negative results (4.4% positivity rate). Moreover, 85.7% of SARS-CoV-2–positive children had a known exposure to COVID-19 (Table 1). Of SARS-CoV-2–positive children, 61.9% had >1 symptom. Also, 52.4% of SARS-CoV-2–positive children had at least 1 symptom (fever, cough, or loss of taste or smell) versus 62.8% of SARS-CoV-2–negative children (Table 2). Runny nose or nasal congestion was the most frequently reported symptom in the SARS-CoV-2–positive group (47.6%) as well as the SARS-CoV-2–negative group (58.6%). Also, 14.3% of SARS-CoV-2–positive children had eye redness or discharge versus 3.1% of SARS-CoV-2–negative children. Isolated runny nose presented in 10.8% of SARS-CoV-2–negative versus 9.5% of SARS-CoV-2–positive children. All children with isolated diarrhea (n = 5), isolated headache (n = 3), and isolated rash (n = 2) tested negative. Preliminary symptom data based on 176 children from a second site showed that 9.9% of symptomatic children had a positive test result. Conclusions: Runny nose or nasal congestion was the most frequently reported symptom in all children tested for SARS-CoV-2. However, isolated runny nose or nasal congestion identified 2 cases of COVID-19 in our cohort. Eye redness or discharge may be an important symptom to screen for COVID-19 in children. Further research with a larger number of positive cases is needed to make conclusions about improving efficiency and efficacy of symptom screeners for COVID-19 in children.Funding: NoDisclosures: None

Objective To identify markers associated with in-hospital death in patients with coronavirus disease 2019 (COVID-19)–associated pneumonia. Patients and Methods A retrospective cohort study was conducted of 140 patients with moderate to critical COVID-19–associated pneumonia requiring oxygen supplementation admitted to the hospital from January 28, 2020, through February 28, 2020, and followed up through March 13, 2020, in Union Hospital, Wuhan, China. Oxygen saturation (SpO2) and other measures were tested as predictors of in-hospital mortality in survival analysis. Results Of 140 patients with COVID-19–associated pneumonia, 72 (51.4%) were men, with a median age of 60 years. Patients with SpO2 values of 90% or less were older and were more likely to be men, to have hypertension, and to present with dyspnea than those with SpO2 values greater than 90%. Overall, 36 patients (25.7%) died during hospitalization after median 14-day follow-up. Higher SpO2 levels after oxygen supplementation were associated with reduced mortality independently of age and sex (hazard ratio per 1-U SpO2, 0.93; 95% CI, 0.91 to 0.95; P Conclusion In this cohort of patients with COVID-19, hypoxemia was independently associated with in-hospital mortality. These results may help guide the clinical management of patients with severe COVID-19, particularly in settings requiring strategic allocation of limited critical care resources. Trial Registration Chictr.org.cn Identifier: ChiCTR2000030852

Vascular dysfunction and insulin resistance (IR) are associated with obstructive sleep apnea (OSA), which is characterized by frequent episodes of nocturnal intermittent hypoxia (IH). While it is recognized that the balance between vasoconstrictive (endothelin-1) and vasodilatory molecules (nitric oxide, NO) determine vascular profile, molecular mechanisms contributing to vascular dysfunction and IR in OSA are not completely understood. Caveolin-1 is a membrane protein which regulates endothelial nitric oxide synthase (eNOS) activity which is responsible for NO generation and cellular insulin-signaling. Hence, we examined the effects of IH on caveolin-1, eNOS, and endothelin-1 in human coronary artery endothelial cells in the context of IR. Chronic 3-day IH exposure up-regulated caveolin-1 and endothelin-1 expression while reducing NO. Also, IH altered insulin-mediated activation of AKT but not ERK resulting in increased endothelin-1 transcription. Similarly, caveolin-1 overexpression attenuated basal and insulin-stimulated NO synthesis along with impaired insulin-dependent activation of AKT and eNOS, with no effect on insulin-stimulated ERK1/2 phosphorylation and endothelin-1 transcription. Our data suggest that IH contributes to a vasoconstrictive profile and to pathway-selective vascular IR, whereby insulin potentiates ET-1 expression. Moreover, IH may partly mediate its effects on NO and insulin-signaling via upregulating caveolin-1 expression.

BackgroundDespite increasing neonatal antibiotic stewardship efforts, understanding of interhospital variation in neonatal antibiotic use is limited.MethodsA retrospective cohort study was conducted among primarily academically affiliated hospitals participating in the Vizient Clinical Database/Resource Manager. Neonatal discharges were identified by admission age ResultsThe 118 included hospitals represented 184 716 neonatal discharges; 22 hospitals with low NCC, 56 with medium NCC, and 40 with high NCC. Mean antibiotic DOT/1000 pd was 363 (standard deviation [SD], 94) in high NCC hospitals, 243 (SD, 88) in medium NCC hospitals, and 184 (SD, 122) in low NCC hospitals. Increasing NCC was associated with higher antibiotic use, with an incidence rate ratio (IRR) of 1.95 (95% confidence interval [CI], 1.55 to 2.47) for high vs low NCC and IRR 1.31 (95% CI, 1.05 to 1.64) for medium vs low NCC. Increasing case mix index was associated with higher antibiotic use (IRR 1.86 per unit increase; 95% CI, 1.50 to 2.31).ConclusionsAggregate antibiotic use among hospitalized neonates varies based on care complexity. Substantial variation despite stratification by complexity suggests incomplete risk adjustment and/or avoidable variation in care.

Objective To examine whether experimentally induced weight gain raises ambulatory blood pressure (BP) in healthy subjects and identify any relationship between changes in BP and changes in regional fat distribution. Patients and Methods Twenty-six normal weight subjects were randomized to 8 weeks of weight gain through overfeeding (n=16; age, 30.4±6.6 years) or to weight maintenance (controls; n=10; age, 27.1±7.7 years) between July 2004 and August 2010. Measures of body composition via dual energy X-ray absorptiometry and computed tomography, circulating biomarkers, and 24-hour ambulatory BP were obtained at baseline and after the 8-week experimental phase. Results Overfeeding resulted in 3.7 kg (95% CI, 2.9-4.5) increase in body weight in weight gainers, with increments in total (46.2 cm2; 95% CI, 27.6-64.9), visceral (13.8 cm2; 95% CI, 5.8-21.9), and subcutaneous fat (32.4 cm2; 95% CI, 13.5-51.3). No changes occurred in the maintenance group. Increases in 24-hour systolic BP (4 mm Hg; 95% CI, 1.6-6.3), mean BP (1.7 mm Hg; 95% CI, 0.3-3.3), and pulse pressure (2.8 mm Hg; 95% CI, 1.1-4.4) were evident after weight gain in the experimental group, whereas BP remained unchanged in controls. Changes in mean BP correlated only with changes in visceral fat (ρ=0.45; P=.02), but not with changes in other body composition measures. Conclusion Modest weight gain causes elevation in 24-hour BP in healthy subjects. The association between increased BP and abdominal visceral fat accumulation suggests that visceral deposition of adipose tissue may contribute specifically to the enhanced risk of hypertension associated with weight gain.

Background: The rise of antimicrobial resistance has made it critical for clinicians to understand antimicrobial stewardship principles. We sought to determine whether the opportunity to participate in an American Board of Pediatrics Maintenance of Certification Part 4 (MOC4) quality improvement (QI) project would engage pediatricians and improve their knowledge about antimicrobial stewardship. Methods: In August 2019, a new clinical algorithm for acute appendicitis, spearheaded by the antimicrobial stewardship program (ASP), was implemented at UCSF Benioff Children’s Hospital Oakland to standardize care and optimize antimicrobial use. Medical staff were invited to participate in a QI project evaluating the impact of this algorithm. Data were collected for the 2 quarters preceding implementation (baseline), for the quarter of implementation (transition period), and for the quarter after implementation. Participants were offered MOC4 credit for reviewing these 3 cycles of data and associated materials highlighting information about antimicrobial stewardship. An initial survey was given to participants to assess their baseline knowledge via 4 questions about antimicrobial use in surgical patients (Table 1). At the conclusion of the QI project, another survey was conducted to reassess participant knowledge and to evaluate overall satisfaction with the project. Results: In total, 150 clinicians completed the initial survey. Of these, 44% were general pediatricians and 56% were pediatric subspecialists. Based on years out of training, their levels of experience varied: >20 years in 24%, 11–20 years in 32.7%, 0–10 years in 34.7%, and currently in training in 8.7%. Of the 150 initial participants, 133 (89%) completed the QI project and the second survey. Between surveys, there was significant improvement in knowledge about the appropriate timing and duration of surgical antibiotic prophylaxis (Table 1). Moreover, 88% of participants responded that the QI project was extremely effective in helping them learn about antimicrobial stewardship principles and about ASP interventions. Conclusions: Participation in this MOC4 QI project resulted in significant improvement in knowledge about antimicrobial use in surgical patients, and the activity was perceived as a highly effective way to learn about antimicrobial stewardship. QI projects that leverage MOC4 credit can be a powerful tool for engaging pediatricians and disseminating education about antimicrobial stewardship.Funding: NoDisclosures: None

Aim: New-onset diabetes after kidney transplant (NODAT) adversely impacts kidney allograft and patient survival. Epigenetic alterations in adipose tissue like DNA methylation may play a contributory role. Methods: Adipose tissue DNA of the patients with NODAT and their age, sex and BMI matched controls (nine each) were sequenced by reduced representation bisulfite sequencing. Differentially methylated CpGs (DMCs) and differentially methylated regions (DMRs) were studied. Results: Adipose tissue from the patients had reduced DNA methylation in intergenic and intronic regions. DMCs were found to be more hypomethylated in repeat regions and hypermethylated in CGIs and promoter region. About 900 DMRs were found and their associated genes were significantly enriched in 32 pathways, the top ones of which were associated with insulin resistance and inflammation. Some DMR or DMC genes have known T2DM associations. Conclusion: Changes in DNA methylation in adipose tissue may be suggestive of future NODAT.

Growing evidence indicates that periodic limb movements of sleep (PLMS) may be related to increased risk of developing cardiovascular disease. However, the association of PLMS with atrial fibrillation (AF) is unclear, especially in patients with sleep-disordered breathing (SDB). This study sought to investigate whether PLMS were associated with increased AF prevalence, independent of established risk factors.We performed a cross-sectional study of patients who underwent attended polysomnography at Mayo Clinic from 2011 to 2014. The association of PLMS with AF prevalence was estimated by using logistic regression models.15,414 patients were studied, 76.3% of individuals with SDB defined by apnea-hypopnea index (AHI) ≥5/h, and 15.3% with a diagnosis of AF. In univariate logistic modelling, individuals with periodic limb movement index (PLMI) ≥30/h had higher odds of AF (odds ratio [OR] 1.96, 95% confidence interval [CI]1.79-2.16, p0.001) when compared to patients with PLMI15/h. After multivariate adjustment (for age, race, sex, history of smoking, hypertension, diabetes, coronary artery disease, heart failure, cerebrovascular disease, renal disease, iron deficiency anemia, chronic obstructive pulmonary disease, AHI, arousal index), in mild SDB patients, a PLMI ≥30/h or periodic limb movement arousal index (PLMAI) ≥5/h had significantly higher odds of AF than those with PLMI15/h (OR 1.21, 95% CI 1.00-1.47, p=0.048) or PLMAI1/h (OR 1.27, 95% CI 1.03-1.56, p=0.024).Frequent PLMS are independently associated with AF prevalence in patients with mild SDB. Further studies are needed to better understand the relationship with incident AF.

Introduction African Americans are at a greater risk for cardiovascular disease and inadequate sleep than are corresponding whites. Age-associated declines in sleep duration, cardiovascular health, and physical activity highlight the need to understand the relationship among these variables in this population. While physical activity is thought to be beneficial for promoting sleep quality, it remains unknown how habitual short sleep during a physical activity intervention influences the intervention response in this population. Methods Sedentary older African Americans (n=27; 65-85 years old; 74% female) participating in the intervention arm of a 12-week randomized controlled physical activity trial (NCT03474302) were categorized as short (n= 15) or adequate (n=12) sleepers, defined as sleeping 6 hours/night on average during the intervention. Participants wore validated activity monitors at baseline and 12 weeks, and commercially available sleep monitors were worn daily. Differences in cardiovascular outcomes at baseline and 12 weeks were assessed between sleep categories using sex-adjusted linear mixed models. Results The intervention increased accelerometer derived steps (p=0.04) with no between group differences (p=0.78). Moderate to vigorous activity (MVA) duration increased (p0.05). Significant differences or trends between adequate and poor sleepers were observed (-10.5 mmHg; p=0.096; -30 mg/dL p=0.044; -21 mg/dL; p=0.095, respectively). Conclusion Adequate sleep during a physical activity intervention may be important to elicit cardiovascular benefits. Thus, research evaluating sleep extension complementary to increased physical activity is warranted in short sleepers. Support BrightFocus (A20175472); National Institute of General Medical Sciences of the National Institutes of Health (U54-GM104940)

Background Despite strenuous public health efforts, obesity rates continue to rise globally, and contribute importantly to increased cardiometabolic morbidity and mortality. Dietary habits play a k...

Background Osteoporosis, a condition associated with decreased bone density, contributes significantly to morbidity and mortality. Importantly, the incidence and economic burden of osteoporosis is ...

Obstructive sleep apnea (OSA) is a common sleep disorder associated with obesity. Emerging evidence suggest that OSA increases the risk of cardiovascular morbidity and mortality partly via accelerating the process of cellular aging. Thus, we sought to examine the effects of intermittent hypoxia (IH), a hallmark of OSA, on senescence in human white preadipocytes. We demonstrate that chronic IH is associated with an increased generation of mitochondrial reactive oxygen species along with increased prevalence of cells with nuclear localization of γH2AX & p16. A higher prevalence of cells positive for senescence-associated β-galactosidase activity was also evident with chronic IH exposure. Intervention with aspirin, atorvastatin or renin-angiotensin system (RAS) inhibitors effectively attenuated IH-mediated senescence-like phenotype. Importantly, the validity of in vitro findings was confirmed by examination of the subcutaneous abdominal adipose tissue which showed that OSA patients had a significantly higher percentage of cells with nuclear localization of γH2AX & p16 than non-OSA individuals (20.1 ± 10.8% vs. 10.3 ± 2.7%, Padjusted

Inadequate sleep is increasingly pervasive, and the impact on health remains to be fully understood. The cardiovascular consequences alone appear to be substantial. This review summarizes epidemiologic evidence regarding the association between extremes of sleep duration and the prevalence and incidence of cardiovascular diseases. The adverse effects of experimental sleep loss on physiological functions are discussed, along with cardiovascular risk factors that may underlie the association with increased morbidity and mortality. Current data support the concept that inadequate sleep duration confers heightened cardiovascular risk. Thus implementation of preventative strategies may reduce the potential disease burden associated with this high-risk behavior.

Introduction: Endothelial cell migration and proliferation play an important role in the growth and development of new blood vessels and endothelium healing. This process occurs in response to injury, inflammation and immune reactions. Dysfunction of the endothelium may play a significant role in development and progression of cardiovascular disease related to sleep-disordered breathing. The aim of our study was to evaluate the chemo-attractant activity of serum from obstructive sleep apnea (OSA) and normal subjects on coronary artery endothelial cell migration. Material and methods: We studied 12 severe OSA patients, free of other co-morbidities and on no treatment, along with 12 age-, body mass index, and gender matched healthy controls. Blood was collected at three time points: at 21:00 before sleep, at 6:00 after waking from sleep, and at 11.00 (after 5 h of normal daytime activity). Serum chemo-attractant activity for human coronary endothelial cells was assessed using a colorimetric cell migration assay kit. Results : In healthy subjects, serum chemo-attractant activity peaked in the morning after waking from sleep (p = 0.02). This early morning increase was blunted in severe OSA subjects, in whom chemo-attractant activity was weaker than in normal controls (p = 0.02), and did not change significantly at the different time-points (p < 0.001 vs. controls). Conclusions : Chemo-attractant activity of the serum from OSA patients is lower compared to serum from healthy subjects, especially in the morning. Altered chemo-attractant serum activity may conceivably contribute to the impairment of endothelial function in obstructive sleep apnea patients.

Whether measures of central obesity, such as waist-to-hip ratio (WHR), provide additional information beyond body mass index (BMI) in defining mortality risks is unclear. This study examined data f...

Background Levofloxacin prophylaxis in pediatric oncology patients with chemotherapy-induced severe prolonged neutropenia has been shown to reduce risk for febrile neutropenia and systemic infections. With increased use of prophylaxis there is concern for development of antibiotic-resistant infections. We analyzed bloodstream infections (BSI) in pediatric oncology patients exposed to levofloxacin prophylaxis during prolonged severe neutropenic episodes to determine the rate of antibiotic resistance Methods We performed a retrospective chart review of pediatric oncology patients who received levofloxacin prophylaxis between January 2015 – December 2019. Patients were placed on levofloxacin prophylaxis based on institutional guidelines for patients at risk for severe prolonged neutropenia (i.e., absolute neutrophil count [ANC] < 500 cells/µL for >7 days). Demographic information, start and end dates for levofloxacin prophylaxis, and all BSI episodes within 2 months after exposure to the fluoroquinolone were collected Results Thirty-five patients were identified who received levofloxacin prophylaxis. There were 32 BSI in 12 patients. Twenty-five BSI involved gram-positive organisms (GP), including nine (36%) due to coagulase negative Staphylococcus and seven (28%) due to viridans Streptococcus. Seven BSI episodes involved gram-negative (GN) organisms with 4 (57%) from E.coli. Resistance to fluroquinolones was noted in 42% and 48% of BSI from GN and GP organisms respectively. The vast majority (85%) of viridans Streptococcus isolates were resistant to levofloxacin. In contrast, 8% of viridans Streptococcus isolates were resistant to fluoroquinolones from the same time frame per our hospital antibiogram. Conclusion In this recent cohort of pediatric oncology patients with BSI after exposure to levofloxacin prophylaxis, there was a high percentage infected with fluoroquinolone-resistant organisms.This contrasts with some of the earlier published data from adults which reported low rate of fluoroquinolone resistance. This case series highlights the need for close monitoring for development of antibiotic resistance as utilization of prophylactic levofloxacin increases in pediatric oncology patients. Disclosures All Authors: No reported disclosures

Body fat distribution contributes to obesity-related metabolic and cardiovascular disorders. Visceral fat is more detrimental than subcutaneous fat. However, the mechanisms underlying visceral fat-mediated cardiometabolic dysregulation are not completely understood. Localized increases in expression of the renin angiotensin system (RAS) in adipose tissue (AT) may be implicated. We therefore investigated mRNA and protein expression of RAS components in visceral versus subcutaneous AT using paired samples from individuals undergoing surgery (N = 20, body mass index: 45.6 ± 6.2 kg/m2, and age: 44.6 ± 9.1 years). We also examined RAS-related proteins in AT obtained from individuals on renin angiotensin aldosterone system (RAAS) targeted drugs (N = 10, body mass index: 47.2 ± 9.3 kg/m2, and age: 53.3 ± 10.1 years). Comparison of protein expression between subcutaneous and visceral AT samples showed an increase in renin (p = 0.004) and no change in angiotensinogen (p = 0.987) expression in visceral AT. Among proteins involved in angiotensin peptide generation, angiotensin converting enzyme (p = 0.02) was increased in subcutaneous AT while chymase (p = 0.001) and angiotensin converting enzyme-2 (p = 0.001) were elevated in visceral fat. Furthermore, visceral fat expression of angiotensin II type-2 receptor (p = 0.007) and angiotensin II type-1 receptor (p = 0.031) was higher, and MAS receptor (p < 0.001) was lower. Phosphorylated-p53 (p = 0.147), AT fibrosis (p = 0.138) and average adipocyte size (p = 0.846) were similar in the two depots. Nonetheless, visceral AT showed increased mRNA expression of inflammatory (TNFα, p < 0.001; IL-6, p = 0.001) and oxidative stress markers (NOX2, p = 0.038; NOX4, p < 0.001). Of note, mRNA and protein expression of RAS components did not differ between subjects taking or not taking RAAS related drugs. In summary, several RAS related proteins are differentially expressed in subcutaneous versus visceral AT. This differential expression may not alter AngII but likely increases Ang1-7 generation in visceral fat. These potential differences in active angiotensin peptides and receptor expression in the two depots suggest that localized RAS may not be involved in differences in visceral vs subcutaneous AT function in obese individuals. Our findings do not support a role for localized RAS differences in visceral fat-mediated development of cardiovascular and metabolic pathology.

Background: Incidence of heart disease in pregnancy is about 1%. Pregnant patient with cardiac disease can present with lot of challenges for the obstetrician, paediatrician and the cardiologist. With improvement in diagnostic, medical, surgical management, more patient with cardiac diseases especially congenital are able to reach reproductive age. Therefore, still a cardiac disease remains a significant cause of maternal death. Maternal and fetal prognosis both is affected by the care given and the skills used in the treatment of the individual patient. Hospital has resulted in majority of cardiac disease patient being managed in a tertiary care center and this provide an opportunity to report on clinical experiences of pregnancy with cardiac disease, their management and obstetrical outcomes.Methods: This was a retrospective study, with all the patients detailed demographic information, diagnosis, course in the hospital, management, maternal and fetal outcome was obtained from the medical records and files.Results: Incidence of cardiac disease was found to be 0.7%, 47% of pregnant women fell in age group of 26-30 years, 38.2% were primigravida, only 23.53% were booked, and half of them belonged to NYHA II class. 73.5% had Rheumatic heart disease and the most common obstetrics complications were preterm labor and anemia. LSCS was done in 29.4% cases and 38.2% of the newborns were premature.Conclusions: Prematurity anaemia, IUGR, are the common obstetrical complication in pregnant patient with cardiac disease which can be taken care with increased awareness and pre-conceptional counselling especially in patient with congenital heart disease. For optimization of maternal and neonatal outcomes in these patients, dedicated team of obstetrician, fetal medicine specialist, pediatricians, cardiologist and anesthesiologist is the prime requirement.

Background: Abdominal fat elevates while lower-body (LB) fat diminishes cardiovascular risk. However, molecular mechanisms differentiating the two fat depots are not completely understood. MicroRNA (miRNA) are important regulators of gene expression with widespread effects on several proteins. Objective: To explore miRNA differences between the two fat depots using unbiased next-generation sequencing (NGS) approach. Methods: Total RNA isolated from paired subcutaneous (sc) fat tissue obtained from abdomen (ABD) and LB (femoral) region of 12 healthy subjects (7 male; age: 27 ± 5 years; BMI: 23.5 ± 3.2 kg/m 2 ) was used to quantify miRNA expression. Body fat distribution was determined using dual-energy X-ray absorptiometry and abdominal computed tomography scans. RNA was prepped using the NEBNext small RNA library prep kit and sequenced using Illumina HiSeq 2000. Raw sequence data were processed using CAP-miRSeq pipeline. miRNA expression between the two depots was evaluated using EdgeR. Relationship between miRNA and regional fat depots were examined using Spearman’s correlation. Adjusted or unadjusted P value Results: Using NGS, 383 ± 55 known miRNA with ≥5 raw reads were detected in the study samples. Principal component analysis including all miRNAs showed no any clear separation between ABD or LB fat tissue. However, 37 miRNAs were found to have altered expression in the two depots. miR-196a-5p (log2FC=1.138, p Conclusions: Several miRNAs are differentially expressed between ABD and LB fat tissue which may partly contribute to depot specific alterations in adipose tissue function and consequent cardiometabolic risk. Furthermore, the associations between miRNA and regional fat depots suggest a functional role of these miRNA in fat distribution.

Background: Leptin contributes to obesity-related cardiometabolic pathology. While the role of adipose tissue dysfunction in altering metabolic profile in obesity is recognized, the direct effects of leptin signaling in adipose tissue are not completely understood. Among factors impacting adipose tissue function in obesity, adipocyte death is associated with increased inflammation with consequent adipose tissue insulin-resistance. Furthermore, apoptosis of adipocyte progenitor cells (preadipocytes) is important as it lowers adipose tissue capacity to maintain and expand fat storage. Objective: To determine the effects of leptin on regulation of proteins important to apoptotic pathways in cultured human white preadipocytes (HWP) and differentiated HWP (dHWP). Methods: Cells were exposed to increasing concentrations of leptin to evaluate the role of leptin on regulation of anti-apoptotic Bcl2, and pro-apoptotic Bax and CD95 expression. Next, we examined if pre-exposure to leptin attenuated TNF-α and FasL induced apoptosis. Results: Leptin upregulated transcription of Bcl2 (p=0.02) and down-regulated transcription of Bax (p=0.02) and CD95 (p=0.04) in a leptin-concentration dependent manner in dHWP. Leptin dependent increases in Bcl2 (p=0.004) and decreases in Bax (p=0.003) and CD95 (P=0.03) protein expression were also observed. Furthermore, 24 hour pre-exposure to leptin protected cells from TNF-α (p=0.01; p=0.006) and FasL (p=0.03; p=0.007) induced apoptosis in dHWP and HWP respectively. Additionally, leptin attenuated TNF-mediated activation of the p53 pathway, suggesting another mechanism by which leptin mediates its inhibitory effects on TNF-induced apoptosis. Conclusion: Leptin regulates the expression of proteins involved in the apoptotic pathway such that it decreases the apoptotic potential of adipose tissue by increasing anti-apoptotic Bcl2 and decreasing pro-apoptotic Bax and CD95 protein expression. In contrast to our in-vitro findings, prior studies in adipose tissue from obese humans report decreased Bcl2 and increased Bax protein expression, along with high leptin expression. This suggests that increased adipose tissue apoptosis in obesity may at least in part be secondary to altered leptin signaling.

Background Excessive daytime sleepiness ( EDS ), a common symptom among patients with sleep‐disordered breathing, is closely associated with the development of cardiovascular diseases, but its long‐term prognostic value is not completely understood. The aim of this study was to investigate whether EDS would be an independent prognostic factor after myocardial infarction. Methods and Results We prospectively recruited 112 post–myocardial infarction patients. The Epworth Sleepiness Scale was completed before polysomnography, and EDS was defined as a score ≥11. After exclusion of 8 patients who accepted treatment with continuous positive airway pressure, 104 patients were followed up for 48 months. The primary composite end point was major adverse cardiac events. Patients with EDS had higher rates of major adverse cardiac events (48.4% versus 27.4%, χ 2 =5.27, P =0.022) and reinfarction (29.0% versus 5.5%, χ 2 =13.51, P =0.0002) compared with those without EDS . In the Cox proportional hazards model, patients with EDS had 2.15 times (95% confidence interval, 1.08–4.18; P =0.030) higher crude risk of major adverse cardiac events, with prognostic significance persisting after adjusting for age, diabetes mellitus, depression, left ventricular ejection fraction, apnea–hypopnea index, and nocturnal nadir oxygen saturation (hazard ratio: 2.13, 95% confidence interval, 1.04–4.26, P =0.039). Furthermore, among participants with moderate to severe sleep‐disordered breathing, the presence of EDS was associated with higher risk of major adverse cardiac events than those without EDS , after adjusting for age and nadir oxygen saturation (hazard ratio: 3.17, 95% confidence interval, 1.22–7.76, P =0.019). Conclusions EDS may be an independent prognostic factor of adverse outcome in post–myocardial infarction patients with moderate to severe sleep‐disordered breathing. Evaluation of EDS may shed new light on risk stratification and identify treatment responders for this patient population.

Statin use is associated with increased calorie intake and consequent weight gain. It is speculated that statin‐dependent improvements in lipid profile may undermine the perceived need to follow lipid‐lowering and other dietary recommendations leading consequently to increased calorie intake. However, increases in calorie intake in statin users may also be related to statin‐dependent decreases in satiety factors such as leptin, an adipocyte‐derived adipokine. The objective of our study was to examine the direct effects of statins on leptin expression. Adipocytes are the main source of circulating leptin. Therefore, we examined the effects of atorvastatin and simvastatin on leptin expression in cultured human white adipocytes. We show that treatment of white adipocytes with simvastatin and atorvastatin decreases leptin mRNA expression (simvastatin: P = 0.008, atorvastatin: P = 0.03) and leptin secretion (simvastatin: P = 0.0001, atorvastatin: P = 0.0001). Both simvastatin and atorvastatin mediate decreases in leptin expression via extracellular‐signal‐regulated kinases 1/2 and peroxisome proliferator‐activated receptor gamma pathways (simvastatin: P = 0.01, atorvastatin: P = 0.026). Additionally, statin treatment also induced expected increases in adiponectin, while decreasing monocyte chemoattractant protein 1 (MCP1) mRNA. Furthermore, statins increased secretion of both total as well as high molecular weight adiponectin while decreasing MCP1 secretion. To conclude, statins act directly on human white adipocytes to regulate adipokine secretion and decrease leptin expression. Leptin is an important satiety factor. Hence, statin‐dependent decreases in leptin may contribute, at least in part, to increases in food intake in statin users.

Epicardial adipose tissue (EAT) has been recognized as a sensitive marker of cardiometabolic risk. Recent evidence suggests efficacy of long-term statin therapy in reducing EAT in patients with coronary artery disease. Whether short-term statin therapy is associated with changes in the volume of EAT is currently unknown. A cohort of patients with atrial fibrillation who underwent pulmonary vein isolation were randomized to receive either 80 mg/day of atorvastatin (n = 38, 32 men, age 56 ± 11 years) or placebo (n = 41, 33 men, age 56 ± 10 years) for a 3-month period. EAT volume was assessed by cardiac computed tomography at baseline and at follow-up. Patients randomized to statin treatment exhibited a modest but significant decrease in median EAT volume (baseline vs follow-up: 92.3 cm(3) [62.0 to 133.3] vs 86.9 cm(3) [64.1 to 124.8], p0.05), whereas median EAT remained unchanged in the placebo group (81.9 cm(3) [55.5 to 110.9] vs 81.3 cm(3) [57.1 to 110.5], p = NS). Changes in median systemic inflammatory markers and lipid profile were also seen with statin treatment: C-reactive protein (2.4 mg/L [0.7 to 3.7] vs 1.1 mg/L [0.5 to 2.7], p0.05), total cholesterol (186 mg/dL [162.5 to 201] vs 123 mg/dL [99 to 162.5], p0.001), and low-density lipoprotein cholesterol (116 mg/dL [96.5 to 132.5] vs 56 [40.5 to 81] mg/dL, p0.001) diminished, whereas median body mass index did not change (27.8 kg/m(2) [25 to 30] versus 27.6 kg/m(2) [25.7 to 30.5], p = NS). No variations occurred in the placebo group. In conclusion, short-term intensive statin therapy significantly reduced the volume of EAT in patients with atrial fibrillation.

Background/Objective Adiponectin exerts beneficial effects by reducing inflammation, and improving lipid metabolism and insulin-sensitivity. Although adiponectin is lower in obese individuals, whether weight gain reduces adiponectin expression in humans is controversial. We sought to investigate the role of weight gain, and consequent changes in leptin, on altering adiponectin expression in humans. Methods/Results Forty four normal-weight healthy subjects were recruited (mean age 29 years; 14 women) and randomized to either gain 5% of body weight by 8-weeks of overfeeding (n=34) or maintain weight (n=10). Modest weight gain of 3.8 ± 1.2 kg resulted in increased adiponectin (p=0.03) while weight maintenance resulted in no changes in adiponectin. Further, changes in adiponectin correlated positively with changes in leptin (p=0.0085). In-vitro experiments using differentiated human white preadipocytes showed that leptin increased adiponectin mRNA and protein expression, while a leptin-antagonist had opposite effects. To understand the role of leptin in established obesity, we compared adipose tissue samples obtained from normal weight versus obese subjects. We noted, first, that leptin activated cellular signaling pathways and increased adiponectin mRNA in adipose tissue from normal-weight participants, but did not do so in adipose tissue from obese participants; and second, that obese subjects had increased caveolin-1 expression, which attenuates leptin-dependent increases in adiponectin. Conclusions Modest weight gain in healthy individuals is associated with increases in adiponectin, which correlate positively with changes in leptin. In-vitro, leptin induces adiponectin expression which is attenuated by increased caveolin-1 expression. Additionally, adipose tissue from obese subjects shows increased caveolin-1 expression, and impaired leptin signaling. This leptin signal impairment may prevent concordant increases in adiponectin in obese subjects despite their high levels of leptin. Therefore, impaired leptin signaling may contribute to low adiponectin expression in obesity and may provide a target for increasing adiponectin expression, hence improving insulin sensitivity and cardio-metabolic profile in obesity.

Objective To determine whether leptin is related to all-cause and cardiovascular (CV) mortality in older adults. Patients and Methods Participants 60 years and older with plasma leptin level measurements from the National Health and Nutrition Examination Survey III (1988-1994) and mortality data linked to the National Death Index were included. We created sex-specific tertiles of leptin (men: 4.2-7.7 μg/L; women: 11.5-21.4 μg/L) to identify the effect of leptin on all-cause and CV mortality. We also determined whether leptin predicted mortality in patients with obesity. We classified obesity using 4 possible definitions: body mass index 30 kg/m 2 or greater; body fat 25% or more in men and 35% or more in women; waist circumference 102 cm or greater in men and 88 cm or greater in women; and waist-hip ratio 0.85 or higher in women and 0.95 or higher in men. Sex-specific proportional hazard models were used to assess the effect of leptin on all-cause and CV mortality. Results Of 1794 participants, 51.6% were women; the mean age was 70.3±0.4 years, and the follow-up period was 12.5 years with 994 deaths (469 were CV deaths). All-cause mortality in the highest leptin tertile was significant neither in men (hazard ratio [HR], 1.23; 95% CI, 0.93-1.63) nor in women (HR, 0.97; 95% CI, 0.68-1.40). CV mortality was the highest in the highest leptin tertile in men (HR, 1.69; 95% CI, 1.06-2.70) but not in women (HR, 1.21; 95% CI, 0.73-1.98). Evaluating the effect of leptin in subgroups of different obesity definitions, we found that high leptin levels as predict CV mortality in men as measured by waist circumference or body fat. Conclusion Elevated leptin level is predictive of CV mortality only in men. Leptin may provide additional mortality discrimination in obese men.

Obstructive sleep apnea (OSA) is associated with cardiometabolic diseases. Telomere shortening is linked to hypertension, diabetes mellitus, and cardiovascular diseases. Because these conditions are highly prevalent in OSA, we hypothesized that telomere length (TL) would be reduced in OSA patients. We identified 106 OSA and 104 non-OSA subjects who underwent polysomnography evaluation. Quantitative PCR was used to measure telomere length in genomic DNA isolated from peripheral blood samples. The association between OSA and TL was determined using unadjusted and adjusted linear models. There was no difference in TL between the OSA and non-OSA (control) group. However, we observed a J-shaped relationship between TL and OSA severity: the longest TL in moderate-to-severe OSA [4,918 ± 230 (SD) bp] and the shortest TL in mild OSA (4,735 ± 145 bp). Mean TL in moderate-to-severe OSA was significantly longer than in the control group after adjustment for age, sex, body mass index, hypertension, dyslipidemia, and depression (β = 96.0, 95% confidence interval: 15.4–176.6, P = 0.020). In conclusion, moderate-to-severe OSA is associated with telomere lengthening. Our findings support the idea that changes in TL are not unidirectional processes, such that telomere shortening occurs with age and disease but may be prolonged in moderate-to-severe OSA. NEW & NOTEWORTHY Here, we show that moderate-to-severe obstructive sleep apnea is associated with longer telomeres, independent of age and cardiovascular risk factors, challenging the hypothesis that telomere shortening is a unidirectional process related to age/disease. A better understanding of the mechanisms underlying telomere dynamics may identify targets for therapeutic intervention in cardiovascular aging/other chronic diseases.

Leptin-deficient animals hyperventilate. Leptin expression by adipocytes is attenuated by atrial natriuretic peptide (ANP). Increased circulating natriuretic peptides (NPs) are associated with an increased risk of central sleep apnea (CSA). This study tested whether serum leptin concentration is inversely correlated to NP concentration and decreased in patients with heart failure (HF) and CSA.Subjects with HF (N = 29) were studied by measuring leptin, NPs, CO2 chemosensitivity (Δminute ventilation [V.e]/Δpartial pressure of end-tidal CO2 [Petco2]), and ventilatory efficiency (V.e/CO2 output [V.co2]) and were classified as CSA or no sleep-disordered breathing by polysomnography. CSA was defined as a central apnea-hypopnea index ≥ 15. The Student t test, Mann-Whitney U test, and logistic regression were used for analysis, and data were summarized as mean ± SD; Plt; .05 was considered significant.Subjects with CSA had higher ANP and brain natriuretic peptide (BNP) concentrations (Plt; .05), ΔV.e/ΔPetco2 (2.39 ± 1.03 L/min/mm Hg vs 1.54 ± 0.35 L/min/mm Hg, P = .01), and V.e/V.co2 (43 ± 9 vs 34 ± 7, Plt; .01) and lower leptin concentrations (8 ± 10.7 ng/mL vs 17.1 ± 8.8 ng/mL, Plt; .01). Logistic regression analysis (adjusted for age, sex, and BMI) demonstrated leptin (OR = 0.07; 95% CI, 0.01-0.71; P = .04) and BNP (OR = 4.45; 95% CI, 1.1-17.9; P = .05) to be independently associated with CSA.In patients with HF and CSA, leptin concentration is low and is inversely related to NP concentration. Counterregulatory interactions of leptin and NP may be important in ventilatory control in HF.

Background Effective environmental surface cleaning plays a vital role in reducing transmission of hospital-acquired infections. There remains a paucity of data in the pediatric literature regarding environmental pathogen reduction utilizing UV-C light. The objective of this study was to evaluate the reduction of environmental pathogens using UV-C light (Clorox Optimum-UV) as an adjunct to terminal cleaning in a free-standing tertiary pediatric hospital. Methods Upon patient discharge, a subset of patient rooms were tested for pathogens. Surface swabs were collected from high touch surfaces (call button, telemetry monitor, door handle, flush handle of toilet, faucet, bed rail, phone, keyboard pad, mouse, side table, dresser, and light switch). After terminal cleaning of the room, per hospital protocol the Clorox Optimum-UV completed one or two cycles of 5 minutes each depending on the dimensions of the room. Post-UV-C surface swabs were obtained from the same high touch areas in the room. Total colony count was reported from each of the surfaces swabbed. Swabs were streaked onto non-selective agar and incubated at 30-35oC for 72–96 hours. Mean plate colony count was determined manually and reported as CFU/swab. Data analysis was performed in Minitab 18.1. Fisher least significant difference (LSD) test was used to describe the difference between total bacterial counts at each time point (Pre-clean: dirty room, Post-clean: pre-UV-C/post-terminal clean, Post-UV: post UV-C light cycle). Results Mean total colony counts prior to cleaning the room was 92.3 CFU (33 surfaces), Pre-UV-C light 45.6 CFU and post-UV-C light 5.8 CFU (64 surfaces). Total bacterial counts are represented in Graphs 1 and 2. Upon multivariate analysis, the time the sample was taken (preclean, postclean, or post-UV) was the single explanatory variable for the differences seen in the means of total bacterial counts (P = 0). Conclusion Our study demonstrates that UV-C disinfection is a highly effective adjunctive cleaning method with standard terminal cleaning to reduce bacterial burden from environmental surfaces. Disclosures A. Lucas, Clorox: Research Contractor, Grant recipient. M. Nayakwadi Singer, Clorox: Grant Investigator, Grant recipient.

Telomere length (TL) is associated with cardiovascular disease (CVD) and cancer. Obstructive sleep apnea (OSA) is also linked to higher risk of CVD and cancer, and to TL. We investigated the association between TL and risk of major adverse cardiac events (MACE) and cancer in OSA patients. We studied 210 individuals undergoing sleep-related studies between 2000 and 2007. Baseline characteristics and follow-up data (available in 164 subjects) were obtained from clinic records. Incidence rates were calculated for the entire group and by OSA status. Hazard ratios were calculated to estimate effects of OSA and TL on risk of MACE and cancer. In total, 32 individuals (20%) developed MACE and/or cancer during 12.7-year follow-up. The OSA group had a higher likelihood of cancer (16.0 vs. 4.9 events per 1000 person-years, P = 0.044) but no clear evidence of an elevated incidence of MACE (10.8 vs. 4.8 events per 1000 person-years, P = 0.293) compared to the non-OSA group. There was no association between TL and MACE- (HR = 1.01, 95% CI 0.78&ndash, 1.28), or cancer-risk (HR = 1.18, 95% CI 0.96&ndash, 1.43). Our study warrants further investigation of any modulating effect of OSA on TL and the risk of MACE and cancer.

Periodic limb movements in sleep (PLMS) are associated with adverse outcomes in patients with heart failure (HF). The aim of this study was to investigate whether PLMS change in response to adaptive servo-ventilation (ASV) titration for central sleep apnea (CSA) in patients with HF. We examined

Background and Objective: Incidence of gestational diabetes mellitus (GDM) varies globally from 2% to 14%. These cases in India are also increasing and emerging as a major public health problem. The prevalence of GDM among urban population of India has been reported as 16% and 17.8%, respectively. We conducted this study at three different regions of North India to estimate the prevalence of GDM. Materials and Methods: This pilot prospective cross-sectional study was conducted at three centres of North India with a base at Max Super Speciality Hospital, Saket, New Delhi, over a period of 10 months (December 2015–October 2016). Pregnant females attending gynaecology clinic at these centres were screened and enrolled as per the study inclusion criteria, after taking informed consent. Medical records were reviewed for recent haemoglobin levels, fasting blood sugar levels and other clinical parameters. Results: A total of 230 participants were enrolled in this study with 65 from Muzaffarpur, 65 from Bhilai and remaining 100 from Delhi, which include a mixed population. The overall prevalence of GDM was observed as 10%, with a regional prevalence of 10.77% at Bhilai, lower prevalence at Muzaffarpur (3.07%) and 14% in Delhi with a mixed population. A significant difference (P < 0.01) was observed in the mean age and body mass index of participants at Bhilai, Muzaffarpur and Delhi. Conclusion: Although there was a variable sample size at these three centres, we could conclude from this pilot study that there is a high prevalence of GDM at Bhilai district while very low prevalence at Muzaffarpur and Bihar. Large-scale studies are required to be done to estimate the prevalence in these regions, which would ultimately create awareness among clinicians to screen all females for GDM.