ASYMPTOMATIC OCULAR MANIFESTATIONS OF ACERULOPLASMINEMIA IN TWO ADULT WHITE SIBLINGS: A MULTIMODAL IMAGING APPROACH.

PURPOSE: To report ocular manifestations of aceruloplasminemia in two adult White siblings. METHODS: The ocular findings were investigated using a multimodal imaging approach including color fundus photography, fluorescein angiography, autofluorescence imaging, and spectral-domain optical coherence tomography. RESULTS: A 43-year-old woman and a 39-year-old man were diagnosed with aceruloplasminemia based on clinical symptoms, laboratory tests, liver biopsy, and genetic examination of the ceruloplasmin gene confirming the homozygotic mutation G708S. Both patients had no ophthalmologic symptoms, unremarkable anterior segment, and visual acuity of 20/20 in both eyes. Indirect ophthalmoscopy of the fundus revealed subtle yellowish color with punctate inhomogeneous pigmentation in the whole retina. The autofluorescence images demonstrated remarkable punctate hyperfluorescence involving the central and peripheral retina. Spectral-domain optical coherence tomography images showed normal retinal structure in the macular area with intact outer retinal layers. Fluorescein angiography showed a slightly inhomogeneous pattern of hypofluorescence and hyperfluorescence from the early until late angiography phase. CONCLUSION: We describe two adult cases of ocular manifestations of a rare hereditary condition with systemic iron overload. Retinal degeneration in aceruloplasminemia might be overlooked on a routine ophthalmic examination and requires at least an autofluorescence image because initial damage at the level of retinal pigment epithelium is not always visible on ophthalmoscopy.

Obesity and COVID-19: What are the Consequences?

Obesity is an increasing health problem all over the world. In combination with the current COVID-19 pandemic, this has turned into a massive challenge as individuals with overweight and obesity at all ages show a significant increase in their risk of getting severe COVID-19. Around 20% of all patients that were hospitalized for COVID-19 suffered from obesity alone, whereas obesity in combination with other metabolic comorbidities, such as type 2 diabetes and hypertension, account for up to 60% of all hospitalizations in relation to COVID-19. Therefore, it is of immense importance to put the spotlight on the high incidence of obesity present already in childhood both by changing the individual minds and by encouraging politicians and the whole society to commence preventive interventions for achieving a better nutrition for all social classes all over the world. In the current review, we aim to explain the different pathways and mechanisms that are responsible for the increased risk of severe COVID-19 in people with overweight and obesity. Furthermore, we discuss how the pandemic has led to weight gains in many people during lockdown. At the end, we discuss the importance of preventing such an interface between a non-communicable disease like obesity and a communicable disease like COVID-19 in the future.

Real-World, Non-Interventional, Retrospective Study (SAMPLE) of Tolvaptan in Patients with Hyponatraemia Secondary to the Syndrome of Inappropriate Antidiuretic Hormone Secretion.

INTRODUCTION: The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the most common cause of hyponatraemia in hospital inpatients. We present data on treatment setting, patient characteristics, and outcomes for patients treated with tolvaptan for SIADH across a range of real-world settings in Germany and Spain. METHODS: This was a non-interventional, observational, retrospective chart review study. Management was at the discretion of the treating physician, with tolvaptan prescribed according to local clinical practice. Hospital notes and/or medical charts were reviewed from treatment initiation for 6 weeks. Follow-up data were collected when patients were discharged early. Patients were eligible for inclusion if they were ≥ 18 years of age and had been treated with ≥ 2 doses of tolvaptan for one episode of hyponatraemia secondary to SIADH in 2014. RESULTS: The Full Analysis Set comprised 100 patients from 8 centres. The mean age of patients was 73.9 years. The primary endpoint of the mean increase in serum sodium level from baseline to hospital discharge, or to final available measurement, was 10.3 mmol/L (SD 6.4; 95% CI 9.0, 11.6), from 123.0 mmol/L (SD 6.0) to 133.3 mmol/L (SD 4.9). Seventy-seven patients (77.0%) achieved sodium normalisation within 6 weeks of tolvaptan initiation. Mean daily dose of tolvaptan was 12.7 mg (SD 9.2), and mean treatment duration 28.0 days (SD 16.5). Tolvaptan at off-label doses (< 15 mg/day) was prescribed to 72 patients at some point. A favourable safety and tolerability profile was reported. CONCLUSIONS: Tolvaptan was well tolerated and effectively corrected sodium levels in hospitalised adults with hyponatraemia secondary to SIADH in real-world settings. CLINICALTRIALS. GOV IDENTIFIER: NCT02545101.

MULTILOCULAR PURE LEYDIG CELL TUMOR OF OVARY, FALLOPIAN TUBE, AND EXTRAOVARIAN SOFT TISSUE.

OBJECTIVE: Leydig cell tumors (LCTs) of the ovary may produce androgens and cause virilization. Although they are generally benign, these tumors are typically very small, making them hard to detect by imaging processes. METHODS: We report a case of a multilocular LCT involving the ovarian stroma, fallopian tube, and extra-ovarian soft tissue. It was diagnosed by catheter blood sampling of ovarian and adrenal venous blood. RESULTS: A 63-year-old female presented to the endocrinology department with progressive hirsutism and male pattern alopecia occurring within 1 year. Laboratory tests revealed high serum testosterone. Diagnosis of an androgen-producing tumor was considered, however computed tomography and magnetic resonance imaging scans did not show any conspicuous results. Gynecological examination showed slightly enlarged ovaries. Ovarian and adrenal venous blood sampling was performed via catheter for further diagnostics. The testosterone concentration from the right ovarian vein was highly elevated. The patient was admitted for surgery to the gynecological department and bilateral adnexectomy was performed. Microscopic examination showed a multilocular LCT of the right ovary which was located in the ovarian stroma, the fallopian tube, and the extraovarian soft tissue. Following the surgery, her hirsutism disappeared and serum testosterone decreased to normal levels. CONCLUSION: LCTs typically present with postmenopausal virilization. Catheter blood sampling is a reliable method for diagnosis. Furthermore, follow up is essential as ovarian LCTs often have multilocular presentation.

Gadolinium-uptake by aquatic and terrestrial organisms-distribution determined by laser ablation inductively coupled plasma mass spectrometry.

Gadolinium (Gd) based contrast agents (CA) are used to enhance magnetic resonance imaging. As a consequence of excretion by patients and insufficient elimination in wastewater treatment plants they are detected in high concentrations in surface water. At present, little is known about the uptake of these species by living organisms in aquatic systems. Therefore the uptake of gadolinium containing chelates by plants and animals grown in exposed water or on soil irrigated with exposed water was investigated. For this purpose two types of plants were treated with two different contrast agents. The uptake of the Gd contrast agents was studied by monitoring the elemental distribution with laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS). This technique allows the multi-elemental analysis of solid samples with high resolution and little sample preparation. The analysis of L. minor showed that the uptake of Gd correlated with the concentration of gadodiamide in the water. The higher the concentration in the exposed water, the larger the Gd signal in the LA-ICP-MS acquired image. Exposure time experiments showed saturation within one day. The L. minor had contact with the CAs through roots and fronds, whereas the L. sativum only showed uptake through the roots. These results show that an external absorption of the CA through the leaves of L. sativum was impossible. All the analyzed parts of the plant showed Gd signal from the CA; the highest being at the main vein of the leaf. It is shown that the CAs can be taken up from plants. Furthermore, the uptake and distribution of Gd in Daphnia magna were shown. The exposure via cultivation medium is followed by Gd signals on the skin and in the area of the intestine, while the uptake via exposed nutrition algae causes the significantly highest Gd intensities in the area of the intestine. Because there are hints of negative effects for human organism these findings are important as they show that Gd based CAs may reach the human food chain via plants and animals growing in contaminated water or plants growing in fields which are irrigated with surface water.

[Syndrome of inadequate ADH secretion: pitfalls in diagnosis and therapy]. / Das Syndrom der inadäquaten ADH-Sekretion (SIADH).

Euvolemic hyponatremia is most frequently caused by the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Causes of SIADH-induced hyponatremia are myriad and include tumors, pulmonary diseases or central nervous system disorders. SIADH can also be induced by a broad spectrum of drugs such as antidepressants and antiepileptics. The unfavorable prognostic relevance of hyponatremia is often underestimated. SIADH therapy focuses on the treatment of the underlying disease. Thus, a thorough differential diagnostic assessment of the genesis of SIADH is crucial. Therapy options for euvolemic hyponatremia include fluid restriction, administration of hyperosmolar saline solution in case of severe symptoms, or therapy with tolvaptan. Tolvaptan is a selective, oral vasopressin-V2-receptor-antagonist that inhibits ADH-induced retention of electrolyte-free water in the connecting duct of the kidney. This inhibition results in an increased serum sodium level. Close monitoring of serum sodium levels and volume status is imperative, especially during the initial phase of therapy. Fluid restriction is unnecessary during tolvaptan therapy; a previously prescribed fluid re-striction should be stopped when therapy begins. Treatment with tolvaptan can often result in a rapid and controlled improvement of the symptoms. Different cases presented in this article illustrate the diversity of SIADH in clinical practice relating to its diagnosis and its therapy as well as difficulties in identifying the underlying cause in clinical practice.

Analysis of gadolinium-based contrast agents in tap water with a new hydrophilic interaction chromatography (ZIC-cHILIC) hyphenated with inductively coupled plasma mass spectrometry.

Hydrophilic interaction chromatography (HILIC) coupled with inductively coupled plasma mass spectrometry (ICP-MS) were optimised for the direct determination of gadolinium-based contrast agents in tap water. In comparison to our previous work, a new developed zwitterionic HILIC column (ZIC-cHILIC) was used for speciation of Gd-containing contrast agents. The limit of quantification (LOQ) for the five contrast agents Gd-BOPTA, Gd-DPTA-BMA, Gd-BT-DO3A, Gd-DOTA and Gd-DTPA are in the range of 5-12 ng Gd per litre. Additionally, a new internal standard, Pr-DOTA, was investigated to correct intensity drifts, minor and major changes in the sample volumes and possible matrix effects. With the speciation method described, tap water samples from the area of Berlin were analysed and for the first time, three Gd species, Gd-BT-DO3A, Gd-DOTA and Gd-BOPTA, were found in tap water samples at concentrations of about 10-20 ng Gd per litre. These are the same Gd species which have been previously detected predominantly in surface waters of the Berlin area.

Speciation of gadolinium in surface water samples and plants by hydrophilic interaction chromatography hyphenated with inductively coupled plasma mass spectrometry.

Hydrophilic interaction chromatography (HILIC) coupled with inductively coupled plasma mass spectrometry (ICP-MS) was optimized for speciation analysis of gadolinium-based contrast agents in environmental samples, in particular surface river waters and plants. Surface water samples from the Teltow channel, near Berlin, were investigated over a distance of 5 km downstream from the influx of a wastewater treatment plant. The total concentration of gadolinium increased significantly from 50 to 990 ng L(-1) due to the influx of the contrast agents. After complete mixing with the river water, the concentration remained constant over a distance of at least 4 km. Two main substances [Dotarem(®) (Gd-DOTA) and Gadovist(®) (Gd-BT-DO3A)] have been identified in the river water using standards. A gadolinium-based contrast agent, possibly Gd-DOTA (Dotarem(®)), was also detected in water plant samples taken from the Teltow channel. Therefore, uptake of contrast agents [Gadovist(®) (Gd-BTDO3A), Magnevist(®) (Gd-DTPA), Omniscan(®) (Gd-DTPA-BMA), Dotarem(®) (Gd-DOTA), and Multihance(®) (Gd-BOPTA)] by plants was investigated in a model experiment using Lepidium sativum (cress plants). HILIC-ICP-MS was used for identification of different contrast agents, and a first approach for quantification using aqueous standard solutions was tested. For speciation analysis, all investigated contrast agents could be extracted from the plant tissues with a recovery of about 54 % for Multihance(®) (Gd-BOPTA) up to 106 % for Gadovist(®) (Gd-BT-DO3A). These experiments demonstrate that all contrast agents investigated are transported from the roots to the leaves where the highest content was measured.