The Impact of Gender and Body Mass Index on Lipid Profile of Diabetic Patients Treated in Royal Medical Services

Introduction

Diabetes is a systematic disease and its impacts various organs and systems in the body among which is the cardiovascular system. Diabetes is a real risk for cardiovascular diseases and significantly associated with increasing rates of mortality and morbidity among diabetics [1] (Omotoye and Fadupin). Diabetes mellitus is considered as a chronic disease that needs continuous medical care and special attention to cope with possible occurrence of its complications [2]. Dyslipidemia is one of risk factors that are associated with cardiovascular diseases [3]. Dyslipidemia is more likely to be encountered in patients with diabetes mellitus because insulin related problems such as deficiency and resistance have effects on lipid metabolism [4]. Dyslipidemia among diabetics has the following pattern: Increased levels of triglycerides, low levels of high-density lipoprotein and increased levels of low-density lipoproteins. Diabetic dyslipidemia is associated with heart diseases and it is expected that abnormal levels of serum lipids to contribute in the occurrence of coronary artery disease [1]. The rates of obesity have increased overtime, particularly in developed countries and this was observed to go side by side with increased diabetic prevalence [5]. From epidemiologic point of view, obese individuals (body mass index >35) have larger probabilities compared with non-obese persons to develop diabetes mellitus [6]. However, body mass index is considered as an important predictor of cardiovascular disease and diabetes mellitus [7]. The definition of obesity depends on the level of Body Mass Index (BMI) > 30 kg/m2 [8].

Study Objectives

The main objective of this study is to investigate the impact of gender and body mass index on lipid profile of diabetic patients treated in the outpatient clinics at King Hussein Medical Center, Royal Medical Services, Jordan

Methods and patients

Study design: A retrospective study was conducted.

Study sample: A total of 62 diabetic profiles were included in this study for analysis.

Study procedure: After the study had been approved by Institutional Review Board (IRB) of Royal Medical Services, Jordan, the research team started reviewing patient files. Files were valid if medical information of interest were completely involved such as gender, diabetic status, body mass index, and lipid profile. Data were collected from files and entered excel sheet to keep raw data. Following the data collection, data were analyzed using SPSS version 21. Various statistical analyses were performed. Descriptive analysis was firstly applied to describe data which were presented as frequency and percentages for categorized variables such as gender. Other non-categorized variables were presented as means and standard deviations. T test was carried out to investigate the relationships between body mass index and lipid profile variables including cholesterol, triglycerides, high density lipoproteins, and low-density lipoproteins. The relationships between gender and lipid profile variables were carried out using One Way Anova. The correlation between study variables was conducted using Pearson correlation. The significance was considered at α≤0.05.

Results

As shown in Table 1, the general characteristics of study participants showed that the mean age was 57±12 years. A total of 33 (53.2%) of participants were males. The mean of BMI was 31.5±21 kg/m2, the mean of glucose was 239±85 mg/dl, the cholesterol mean was 218±52 mg/dl, the mean level of triglyceride was 247±172 mg/dl, the mean level of HDL was 46±13 mg/dl, and the mean level of LDL was 118±41 mg/dl.

Table 1:General characteristics of participants.

The Relationship between BMI and Lipid Profile: We investigated the relationship between BMI and lipid profile variables using T test. The results showed that there were significant relationships between BMI and Cholesterol (p< 0.001), BMI and triglycerides (p< 0.001), BMI and HDL (p< 0.001), BMI and LDL (p< 0.001) (Table 2).

Table 2: The relationship between BMI and lipid profile.

The Relationship between Gender and Lipid Profile: To investigate the impact of gender on lipid profile variable, One Way Anova test was used. The results as shown in Table 3 did not reveal any significant impact of gender on any of lipid profile variables (p>0.05).

Table 3: The relationship between gender and lipid profile (One Way Anova).

Correlation between Study Variables: We investigated the possible correlations in study variables using Pearson correlation. We found positive and significant correlation between age and LDL (r=0.276, p=0.045), cholesterol and triglycerides (r=0.487, p< 0.001), cholesterol and HDL (r=0.283, p=0.036), and cholesterol and LDL (r=0.626, p< 0.001) (Table 4).

Table 4:Correlation between study variables.

Discussion

The present study was conducted to investigate the impacts of gender and body mass index on lipid profile of diabetic patients. The results of the present study showed that the mean level of glucose was 239±85 mg/dl. The purpose of various diabetic treatments is to keep glucose level ≤130 mg/dl [9,10]. The mean level of body mass index was 31.5±21 which implies that the participants were obese, and this finding agrees with other reported studies in literature in which the obesity was considered if the level of Body Mass Index (BMI) is more than 30 kg/m2 [8]. Other studies have confirmed that obesity and body mass index are risk factors for developing diabetes and cardiovascular diseases [6,7]. All values of lipid profile were abnormal although patients received lipid lowering agents such as atorvastatin. We examined the impact of body mass index on profile lipids of diabetic patients using T test. The results pointed to significant relationships between BMI and all lipid profile parameters (p< 0.001 for all). These findings are not surprising because dyslipidemia is more likely to occur in patients with diabetes mellitus due to insulin related problems such as deficiency and resistance that have effects on lipid metabolism [4]. The values of lipid parameters in our study are in consistent with other studies in which dyslipidemia among diabetics is associated with increased levels of triglycerides, low levels of high-density lipoprotein and increased levels of low-density lipoproteins [1,4]. The impact of gender on lipid profile of diabetic patients was examined using One Way Anova test. There was no significant relationship between gender and lipid profile parameters (p>0.05, for all parameters). Our findings do not agree with other studies that reported diabetic women had higher risk factors for developing cardiovascular disease compared with their men counterparts [11,12]. We conducted Pearson correlation between study variables. The results showed that there was a positively significant correlation between age and low-density lipoprotein (r=0.276, p=0.045). This finding may be explained by decreased physical activity as age increased. This is in line with other studies such as the study of Joshi et al. Cholesterol was also positively and significantly correlated with triglycerides, high density lipoprotein and low-density lipoprotein. This implies that the lipid metabolism is under control of insulin deficiency or resistance as mentioned previously [4].

Conclusion

The present study showed that obesity as represented by high body mass index has impacts on lipid profile of diabetic patients. On the other hand, gender had no impact on lipid profile of the same patients. Pearson correlation was positively and significantly between age and low-density lipoprotein and between cholesterol and triglycerides, high density lipoprotein and low-density lipoprotein which showed the effect of insulin insufficiency.

Acute Sensory Neuropathy and Progressive Dysphagia with Anti-GQ1b Antibody Positive: A Case Report-https://biomedres01.blogspot.com/2020/11/acute-sensory-neuropathy-and.html

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Acute Sensory Neuropathy and Progressive Dysphagia with Anti-GQ1b Antibody Positive: A Case Report

Introduction

Anti-GQ1b antibody is associated with ophthalmoplegia, ataxia, and areflexia, resulting in the development of Guillain-Barré Syndrome (GBS) with ophthalmoplegia, Miller Fisher Syndrome (MFS), and Bickerstaff brainstem encephalitis which are collectively called “Anti-GQ1b Antibody Syndrome” [1-3].

Case Report

A 43-year-old male presented with a ten-day history of flu-like symptoms. Five days after the onset of flu-like symptoms, he developed numbness in distal part of all extremities. Two days after this, he developed loss of balance. No impairment of consciousness, diplopia, dysphonia, dysphagia and motor weakness. On admission, the vital signs were found normal. The results from the pinprick test showed decreased of sensation in both sides, worse on the distal parts. Distal deep tendon reflexes were decreased. Limb strength with Grade V on the Medical Research Council scale and plantar responses were bilaterally flexor. Cerebellar tests were shown ataxic limbs. Routine blood tests including complete blood count, renal function test, glucose, electrolytes, calcium, magnesium, phosphorus were found normal. The radiological examination including cranial and cervical spine Magnetic Resonance Imaging (MRI) scans were found normal. Cerebrospinal Fluid (CSF) studies including cell count, biochemical and cytology were found normal; the CSF was clear colorless, with normal opening pressure. Electroneuro physiological examination was undergoing appointments. The most likely differential diagnosis was overlapping between GBS and MFS.

During his admission in ward, major changes in his symptoms occurred other than the limb numbness and impaired balance becoming progressive. He experienced dysarthria, difficulty swallowing saliva and difficulty breathing when lying on his back. Neurological examination in the state of progressive condition at that time found that he had a weakness in the bilateral facial muscles without ophthalmoplegia. The gag reflex was decreased bilaterally. Intravenous Immunoglobulin (IVIG) therapy (0.4g/kg/day for five days) was started for the treatment of clinical suspected of GBS. After the treatment, the facial movements improved, dysphagia slowly resolved, and limb numbness disappeared. The deep tendon reflexes were present but still hypoactive in the lower limbs. Two weeks later, an elevated titer of IgM anti-GQ1B was reported. Four weeks after the onset of his symptoms, he had no complaints and the results from his neurologic examination were found normal.

Discussion

At present, the diagnosis of GBS is based on the diagnostic criteria of Asbury and Cornblath [4] and MFS which is a clinical trial of total external ophthalmoplegia, ataxia, and areflexia [5]. Although the symptoms and signs of the case presentation were not clearly separated between GBS and MFS. The most common initial symptoms and signs of anti-GQ1b antibody are also accompanied by antecedent illness in upper respiratory infection, diplopia, gait disturbance and external ophthalmoplegia, however this patient was considered a variant of GBS, because it is reported that patients presented with MFS may progress to GBS [6]. Over 90% of MFS cases have acute phase anti-GQ1b ganglioside antibody which is particularly associated with ophthalmologic disease such as botulism [7]. MFS has been described as an unusual variant of GBS with a benign prognosis. In overlapping MFS and GBS, there have been reports of symptoms and signs that are rarely found, including dysesthesia, dysarthria, facial weakness, bulbar palsy, decreased deep tendon reflex and sensory dysfunction which are similar to this patient’s condition [6].

Conclusion

Serum anti-GQ1b antibody is not intended to be used as a laboratory diagnosis alone, but recognition of anti-GQ1b antibodyrelated disease is useful for understanding the etiological relation among the various illnesses and for introducing the established treatments with unusual clinical presentations [8,9].

The Pediatric Neurosurgery in Northeast Brazil – Recife Has Become a Reference Centre-https://biomedres01.blogspot.com/2020/11/the-pediatric-neurosurgery-in-northeast.html

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The Pediatric Neurosurgery in Northeast Brazil – Recife Has Become a Reference Centre

Opinion

Brazil is the biggest Latin American country, with approximately 8,500,000Km², almost 195,000,000 inhabitants, close to 23 inhabitants perKm², 36% under 19 years old, with an infant mortality rate of 20.7 per 1000 live births and the life expectancy at birth reaching 73 years. Brazil is a democratic federal republic formed by 26 States and a FD (Brasilia). One of the Brazilian states, located in the northeast, is Pernambuco which capital is Recife. Since the time of the Portuguese colonization, Pernambuco has had a very important cultural and economic role. Pernambuco has an area of around 98,000Km², with a population of almost 9 million, of which 1,5 million live in the city of Recife and close to 5,000,000 in the metropolitan area. Despite the intense process of industrialization in recent years, Pernambuco’s economy still depends on the production and exportation of sugar and alcohol. Pernambuco has three public and five private universities, with four schools of medicine, which apart from medical graduation offer specialized courses, residence of different medical specialities, Masters of Science and Ph.D. Four university hospitals allow students contact with medical practice.

History of Medicine

The history of medicine in Brazil and Pernambuco has been written together from the beginning. Unofficial records relate that the first medical care organization in Brazil was created in Olinda, neighbour city of Recife, Santa Casa de Olinda, in 1539. The first hospital in Pernambuco was founded in 1560 and called Santa Casa de Misericórdia de Olinda. The first Brazilian scientific medical research were performed in Pernambuco during the Dutch occupation, resulting in the first book about Brazilian medicine, De Medicina Brasiliense, by Guilherme Piso and published in Amsterdam in 1648. In the same time a book named Historia Naturalis Brasiliae, was published and written by George Maecgrave. José Correia Picanço, born in Pernambuco, a royal doctor during the reign of Dom João VI, king of Portugal, was the founder of medical education in Brazil, that influenced the creation of the first two medical schools in Bahia and Rio de Janeiro, in 1808. In 1817, the Military Hospital was created in Recife, where the Practical Surgery School was established. The doctor who is considered the father of Brazilian neurology and strongly influenced the creation of Brazilian neurosurgery as an independent medical speciality was born in Recife, Antonio Austregésilo Rodrigues Lira. In 1928 he invited the general surgeon Alfredo Alberto Pereira Monteiro and the young doctor Jose Ribe Portugal to develop this new medical speciality. In 1938, Prof. Ulysses Pernambucano de Melo Sobrinho, the main teacher of neurology department of Recife Medical School, founded the Revista de Neurobiologia, the oldest medical magazine in South America, which still been published nowadays.

Historical Aspects of Neurosurgery

In 1947, the Hospital Pedro II’s Neurological Clinic (Enfermaria São Miguel) was founded, and with that began the history of neurosurgery in Recife in the hands of its founder Professor Manoel Caetano Escobar de Barros. He organized the first neurosurgery team, with other precursors, as Mussa Hissa Hazin, Célio F Spinelli and Aluizio Freire, influencing a lot of young doctors to do the specialization in neurosurgery. One of then, Professor Hildo Rocha Cirne de Azevedo Filho, reached the position of General Secretary of World Neurosurgical Federation. The history of paediatric neurosurgery in our continent is not very old. The known worldwide argentine Dr. Raul Carrea, is recognized as the father of the paediatric neurosurgery in the Latin American. In Brazil, in the early 70s, some neurosurgeons developed interesting in paediatric patients; among other names as Dr. Gilberto Machado de Almeida, Dr. Leo Fernando da Silva Dietzel, Dr. Jorge Facure, Dr. Jose Pindaro Pereira and Dr. Nelson Martelliin. In the early 90s, many surgeons who made their paediatric neurosurgery specialization in different parts of the world got together to develop the Paediatric Department of Brazilian Society of Neurosurgery, that later became the Brazilian Society of Paediatric Neurosurgery. This group was formed by José Francisco Salomão, Hamilton Matushita, Benicio Oton de Lima, Helio Machado and Sergio Cavalheiro, and quickly grow. Reaching nowadays more than 200 surgeons dedicate to paediatric cases.

Pediatric Neurosurgery in Recife

In 1980, Dr. Helio Van Der Linden, ex-resident of Pitié-Salétrière Hospital in Paris, established the first Paediatric Neurosurgery Service in the Instituto Materno Infantil de Pernambuco, and worked there until his tragic death in 1987. In 1986, it’s created the Paediatric Neurosurgery Ward in the Hospital da Restauração, under responsibility of Dr. Ana Lucia Avila. In 1991, returning from Radcliffe Clinic Oxford and Middlesbrough General Hospital, England, Dr. Geraldo José Dantas Furtado assumes the paediatric neurosurgery department in the IMIP. In 1992, Dr. Artur Da Cunha returned from Germany and joined Dr. Furtado in the IMIP. He was five years in Germany while one year by Professor Nielsen Sörense in the Paediatric Neurosurgery Department of Neurosurgery Clinic of University of Würzburg. With help from a Germany foundation, Globana Stiftung, he brought a lot of modern neurosurgery instruments like a modern Leica Neurosurgery Microscopy, Bipolar and Cranitomy devices. In 2000, Dr. Da Cunha was add to the paediatric neurosurgery team of Hospital da Restauração (HR) and created another paediatric neurosurgery Department in the Hospital Barão de Lucena (HBL), this with main interest in neonatology neurosurgical patients. The department of Pediatric Neurosurgery of the HBL lasted only 8 years, being closed by changes in the administrative policy of the Secretary of Health of Government of the State of Pernambuco.

Nowadays, Recife has 2 hospitals with paediatric neurosurgery department: IMIP and Hospital da Restauração. The first one is a private institution and the others are public hospitals. We have only 5 neurosurgeons dedicated to paediatric patients, with about 1000 procedure per year. The patients come from metropolitan area and neighbour states as well. We have been seen some change in the rate of our pathological cases. Since 1994, with the routine introduction of neuroendoscopy technic, less shunt implant was done and avoiding the shunt complication. Another very important change was in the spinal malformation rates. We have observed a decline in the number of cases, from 70 operated cases per year in 1992-1993 to almost 30 cases per year in 2009. The economic and social improvement in the last years, along with a better nutrition, could be the reason for this change. The more important Paediatric Neurosurgery Service in Recife is part of the Departament of Neurological Surgery located at the Hospital da Restauração. The HR lodges about 180 neurosurgical patients which over 30 are paediatric. It has the biggest Emergency in the city with the main paediatric trauma centre. About 40 cases with CNS paediatric trauma has been caring per day.

The Department of Neurological Surgery is direct by Professor Doctor Hildo Rocha Cirne de Azevedo Filho, and three surgeons form the paediatric team, Dr. Artur Da Cunha, Dr. Suzana Serra and Dr. Igor Faquini. We house the more important residents training program in the northern part of the country, that receive three residents per year for a program of five years, with a rotation program in the paediatrics neurosurgery. The HR has been selected by the WFNS Foundation as International Training Centre and entitled to receive a resident per year to be incorporated to our fiveyear program. Recife is not only a neurosurgical care and education centre. Our daily experience has been filling papers, books, courses and congress participation. We have a very important role in the Brazilian Society of Paediatric Neurosurgery foundation, and in March 2003 Recife hosted the V Congress of the SBNPed. Two of us were President of our paediatric neurosurgery society, Dr. Geraldo Jose Dantas Furtado and Dr. Artur Da Cunha. In the international area, we gave an enormous contribution to founding and developing of the Paediatric Chapter of Latin American Federation of Neurosurgical Societies. Dr. Artur Da Cunha was General Secretary in 2000 - 2002 and President of this Chapter in 2002-2004. He also, in November 2009 organized in Recife, the Third Latin American Congress of Pediatric Neurosurgery. Thus, Recife has been firming as one of the main centers of pediatric neurosurgery in the Brazilian and international scenario.

Calculation of Rotational Barriers of 4-Acyloxy-4’-N-N-Butylcarbamyloxy-Biphenyls by Molecular Calculation and Linear Free Energy Relationships-https://biomedres01.blogspot.com/2020/11/calculation-of-rotational-barriers-of-4.html

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Happy Thanksgiving

 

Happy Thanksgiving from our Biomedical Journal of Scientific & Technical Research

Calculation of Rotational Barriers of 4-Acyloxy-4’-N-N-Butylcarbamyloxy-Biphenyls by Molecular Calculation and Linear Free Energy Relationships

Calculation of Rotational Barriers of 4-Acyloxy-4’-N-N-Butylcarbamyloxy-Biphenyls by Molecular Calculation and Linear Free Energy Relationships

 Introduction

One of the paradoxical results in Chemistry was that the rotational barriers of biphenyls obtained from experiments were significant different to those calculated by quantum mechanism. In the gas-phase experiments, Bastiansen and Samdal estimated the barriers from ground state (dihedral angle, φ= 450) to φ= 00 and φ= 90o to be 0 6.02.1E=Δ±kJ/mol and 90 6.52.E₀Δ=±kJ/mol, respectively [1]. Theoretical calculation for rotation barriers of biphenyl by different levels of basis sets of quantum mechanism was always active in this field since the second half of last century. Tsuzuki and Tanabe reported E₀Δ = 13.93 kJ/mol and 9E₀Δ= 6.32 kJ/mol from HF/6-31G** level of quantum mechanism calculation [2]. Rubio et al. found E₀Δ= 12.93 kJ/mol and 9E₀Δ= 6.40 kJ/mol from 4s3p1d/2s1p basis set level of quantum mechanism calculation [3]. Karpfen et al. estimated that the E₀Δvalues were 13.8, 16.3, and 8.4 kJ/mol and that the 9E₀Δvalues were 6.3, 7.5, and 10.0 kJ/mol by SCF, MP2, and B3LYP methods, respectively [4].

Values of E₀Δwere 13.0 and 8.4 kJ/mol and 9E₀Δwere 5.0 and 7.3 kJ/mol using the 6-311++G(d,p) basis set for SCF and B3LYP, respectively. By MP2/cc-pVQZ//MP2/6-31G* calculation, Tsuzuki et al. obtained E₀Δ and 9E₀Δwere 9.54 and 8.91 kJ/mol, respectively [5]. The best calculated values from Johansson and Olsen by coupled cluster including single and double excitations as well as triples correlations (CCSD(T)) from density functional theory (DFT) were ΔE0 = 7.96 kJ/mol and ΔE₉₀ = 8.79 kJ/mol, respectively [6]. In general, ΔE₉₀ of biphenyl could be calculated to be very close to the experimental result by low level of quantum mechanism calculation. However, high level of quantum mechanism calculation made ΔE₉₀ of biphenyl away from the experimental data. Thus, HF/6-31G** level was good enough for calculation of ΔE₉₀ of biphenyl.

On the other hand, the calculated ΔE₉₀ of biphenyl was difficult to match with the experimental data. Complicated levels of calculations not only lowered 0 ΔE of biphenyl yet increased ΔE₉₀ of biphenyl. Therefore, ΔE₉₀ (rotational barrier of biphenyl from φ = 450 to φ = 900) and 0 ΔE (rotational barrier of biphenyl from φ = 45o to φ = 00) might be dominated by two different mechanisms. In order to test this ideal, ten 4,4’-disubstituted biphenyls [1-10] (Figure 1) [7-9], which were potent inhibitors of acetylcholinesterase, butyryl cholinesterase’s and lipase, were chose to calculated 0 ΔE and ΔE₉₀ by HF/6-311G(d,p) method [10]. The reason why we chose 4,4’-disubstituted biphenyls for this study was because steric effects from 4,4’-positions for these compounds were most insignificant while the electronic or polar effect from these positions were important for these conformational (rotational) changes.

Figure 1: Chemical structures of compounds 1-10.

Materials and Methods

4-Acyloxy-4’-N-n-butylcarbamyloxy-biphenyls (1-10) were synthesized from biphenyl [7-9]. All DFT calculations were preformed from B3LYP method and basis function of 6-311G(d,p) by Gaussian 03 [10]. MM-2 energy minimization was performed by CS Chem 3D (version 6.0). Origin (version 6.0) was used for linear and nonlinear least-squares curve fittings ΔE₉₀ .

Results and Discussion

The minimized energies (Emin’s) of compounds 1-10 (except 9) calculated by HF/6-311G(d,p) method (Table 1) were linearly correlated with Hansch electronic values [11] (Figure 2). Thus, all electronic effects of all substituents were taken into consideration in HF/6-311G(d,p) calculation. Similar to the rotational spectroscopy for end-over-end rotation, rotational energy (EJ) was quantized as Eq. (1), where J and I were rotation quantum number (J= 0, 1, 2, 3,…) and moment of inertia, respectively [12].

Table 1: Dihedral angles (φ ’s) and minimized energies (Emin’s) for the ground states of biphenyls and energy barriers for rotations of biphenyls from φ = -450 to 450 through 00( 0 ΔE ) and from φ = 450 to 1350 through 900 ( ΔE₉₀ ) about the center axis.

The moment of inertia (I) might be written as Eq. (2), where R and m’ were rotated distance and reduced mass, respectively.

was linearly correlated with the inverse of reduced mass (1/m’) (Figure 3). Therefore, rotation of biphenyl from dihedral angle of 45∘to 90∘was just a simple physical rotation of an object about its center axis. Hence, both electronic and steric effects were insignificant in this mode of rotation.

Figure 3: A linear correlation between ΔE₉₀ and 1/m’ of biphenyl and compounds 1-10 ΔE₉₀ = (5.63±0.05)+(31±4)/m’ (kJ/mol) ; R=0.92355; residual sum of squares=0.03515.

On the other hand, DE0 of biphenyl was not a simple physical rotation of an object about its center axis. A chemical reaction namely atropisomerization was occurred since the symmetry of the molecule is changed during this rotation as the conversion of R- to S-1,1’-bi-2-naphthyl-2,2’-diol. 0 ΔE was fairly correlated with Hammett substituent constant (σ * ) [13] (Figure 4). Therefore, the electronic effect played a role in this mode of rotation as those in six molecules with one ratable dihedral angle: ethane, methylamine, methanol, hydrazine, hydroxylamine, and hydrogen peroxide [14]. Negative ρ *value (-0.13) for this correlation indicated that the transition states (φ = 0o) were more positive charges than ground states (φ = 450) for these rotations. Electronwithdrawing substituents at the 4 or 4’ position of biphenyls would facilitate these rotations. Small absolute value of ρ * implied that the electronic effect occurred far away from the pivot bond of the rotation (C(1)-C(1’)).

Figure 4: A linear correlation between ΔE0 and σ * 0 ΔE = (14.28±0.02)-(0.13±0.04) Δ* (kJ/mol); R=0.70694; residual sum of squares=0.0220.

DFT calculated this activation energy by calculation of the energy difference between ground (dihedral angle, φ = 450) and transitional (dihedral angle, φ = 00) states. In other words, this method calculated the reaction as a concerted one-step reaction through a single transition state without a dramatic change in bond length of the C(1)-C(1’) pivot bond (Table 2) and (Figure 5). Therefore, 0 ΔE was equal to Δ E90 (rotation energy from physical properties) plus Δ E_vib, where Δ E_vib was the vibrational energy at the mass center near φ = 00.

Figure 5: one side of the fenced permanent plot (photo by Giday, 2013 left and Gebremichael Yiebyo on 19/11/2016 right).

Table 2: Calculated the C(1)-C(1’) bond lengths of biphenyls for dihedral angles φ = 00, 450, and 900and the maximum bond length difference ( Δ x) for the C(1)-C(1’) bond stretching at φ = 00 (in Å).

However, the transition state of any reaction could not be actually detective by any method because the life time of the transition state was too short. Thus, ΔE0 of biphenyl from experiment was not the activation energy for a single step atropisomerization reaction (Figure 5). Instead, a two-step (two transition states and one intermediate) reaction was proposed for the rotation of biphenyl about its center axis from φ = -450to 450 through 00. At dihedral angle near 0∘, the principle of least motion [13] predicted that vibration (or stretching) of the pivot axis, the C(1)-C(1’) bond would be more favorable than twisting of the bond. Vibrational energy (E_vib) could be expressed as Eq. (4), where Δ and k were the vibrational quantum number ( Δ = 0, 1, 2, 3, …) and force constant, respectively [12].

Thus, vibrational energy was inversely proportional to the root of reduced mass. A linear correlation between 0 ΔE₉₀ − ΔE and (1/m’)1/2 of biphenyl and compounds 1-10 was observed (Figure 6). Hence, both physical rotation and vibration (or stretching) of the C(1)-C(1’) bond played important roles for rotation of biphenyl about the C(1)-C(1’) pivot bond from φ = -450 to 450 near φ = 00. The differences in the C(1)-C(1’) bond lengths for the stretching of biphenyl and compounds 1-10 near φ = 00(x’s) were calculated to be 0.027-0.046 Ǻ according to Hooke’s law, (1/ 2) vib ΔE = k Δ x2 (Table 2). Hence, the equilibrium C(1)-C(1’) bond length of the intermediate for rotation from φ = -450 to 450 near 0∘was about 1.53 Å (Figure 5). Thus, experimental 0 ΔE value of biphenyl (6.0 kJ/ mol)1 was the about the calculated ΔE₉₀ value (6.4 kJ/mol).

Figure 6: A linear correlation between 0 ΔE₉₀ − ΔE and (1/m’)1/2 of biphenyl and compounds 1-10. ( ) ( )( )1/2 0 ΔE₉₀ − ΔE = 9.4 ± 0.2 − 11.5 ±1.5 1/ m’ (kJ/mol); R=0.9187; residual sum of squares=0.08063.

Acute Exotropia Revealing Lyme Neuroborreliosis in an 8 Years‐Old Child-https://biomedres01.blogspot.com/2020/11/acute-exotropia-revealing-lyme.html

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Acute Exotropia Revealing Lyme Neuroborreliosis in an 8 Years‐Old Child

Acute Exotropia Revealing Lyme Neuroborreliosis in an 8 Years‐Old Child

Introduction
Neuro‐ophthalmological symptoms in Lyme disease remain rare but can occur, such as anterior uveitis, pan uveitis, acute ocular flutter, Adie’s syndrome, and peripheral facial palsy [1-3]. According to the European Guidelines in Lyme neuroborreliosis, two of the three following criteria must be fulfilled to diagnose LNB: neurological symptoms, cerebrospinal fluid pleocytosis, intrathecal specific antibody synthesis [4]. We report a case of isolated oculomotor nerve palsy due to Lyme disease with total resolution after antibiotic therapy.
Case Report
Clinical Features
An 8 years‐old boy was brought to emergencies for headaches, a left ptosis and a left exotropia (Figure 1). All clinical symptoms had occurred on awakening the same day after a strong fatigue the day before. No trauma was reported. His clinical history was marked by an Attention Deficit Hyperactivity Disorder (ADHD), diagnosed two years earlier and treated by Methylphenidate 20mg one time a day. Methylphenidate is a central nervous system stimulant, which might be associated with higher risk of strokes, though no further evidence of this association has been determined. History was eventful and revealed a tick bite about one year earlier during a hike in a forest followed by an erythema, non-migrant.
The child was living in a suburban area near a forest and his mother was working in a stable. Ophthalmic examination recorded a limitation in the field of the left medial rectus and an upper eyelid raising muscle impotence. There was no pupillary dysfunction. We noticed a conserved visual acuity (20/20 on both eyes); slit lamp bio microscopy, optic disc and retinal examination by indirect ophthalmoscopy disclosed no abnormality such as virtutis or posterior uveitis. Macular and papillary OCT B-scan (Heidelberg Spectral is) was normal on both eyes. A palsy of the third cranial nerve was confirmed by a Coordimètre Hess-Weiss test (Figure 2). Neurological examination, performed by a pediatrician, was normal.
Figure 1: Initial Hess-‐ Weiss Test.
Figure 2: Initial clinical picture.
Diagnostic findings
An emergency ocular and cerebral MRI scan was performed. Inflammation on the left third nerve was recorded on the MRI (Figure 3). Complete blood count was normal; Lyme serology was negative IgG 0,01 (ELFA) and IgM 0,02 (ELFA) such as other serological results (HSV 1 and 2, VZV, Enterovirus). A lumbar puncture was performed. Examination of the Central System Fluid (CSF) showed a lymphocytar pleocytosis (400 cells with 99% of lymphocytes/mm3). Glucose and lactate were normal. CSF anti‐ Borrelia burgdorferi IgG were negative (0,01 ELFA) and Lyme PCR was negative. Also Lyme western blot on CSF was positive.
Figure 3: Initial MRI (axial, coronal, sagittal).
Therapy and Clinical Course
The decision was made, in association with the pediatric department, to begin an oral treatment according to the patient’s weight with doxycycline 100 mg twice a day for 3 weeks. Methylphenidate was stopped and reintroduced one month later due to important behavior disorders. The ocular movement improved within a week of treatment and the Hess‐Weiss test was normalized two weeks later (Figure 4). Ptosis was the only remaining symptom but receding (Figure 5). The follow-up was marked by a return to normal two months after the end of the treatment with a normal elevator muscle function.
Figure 4:Follow-‐ up clinical picture, 1 month.
Figure 5:Follow-‐ up Hess-‐ Weiss Test, 2 months.
Discussion
In our case, no other cranial nerve was involved. Palsy was predominating on the upper eyelid elevator muscle and medial oculomotor muscle. Thus exotropia and diplopia were hidden. Indeed, third nerve gives innervation of the elevator muscle through its upper branch while its inferior branch innervates medial rectus. Lyme neuroborreliosis is listed as a differential diagnosis of acquired ocular motor disturbance but remains rare [5]. CSF pleocytosis and the clinical history of tick bite reported by the mother guided the diagnosis to Lyme neuroborreliosis. CSF pleocytosis allowed making the difference between LNB and orbital inflammation due to common Lyme disease. Orbital inflammation can also provide ptosis via mechanic conflict, but no abnormal findings are reported in CSF. Lumbar puncture is the gold standard for the diagnosis of LNB.
Though Lyme serologies were negative, it was not renewed during the follow up, and antibodies may be detected earlier in CSF than in serum especially in children [6]. The diagnosis of LNB must be based on a combination of various techniques; no correlation between levels of specific Borrelia Burgdorferi antibodies detected with recombinant antigen ELISA and the number of protein fractions developed with these antibodies by immunoblot has been showed [7]. Cerebral MRI is the imaging method of choice, but the raising of the nerve root is not always seen [8]. In our case, we excluded the diagnoses of stroke thanks to the early brain MRI. According to Schelleman and al, Methylphenidate is not statistically associated with an increased risk of stroke within adult population [9]. According to Shin and al, no increased risk was observed with methylphenidate exposure for ischemic stroke or heart failure, in children and young people (aged fewer than 17) treated for ADHD [10].
Conclusion
LNB can be responsible of acute ocular motor palsy, this infectious cause should be considered in children with acute ptosis for a prompt antibiotic treatment. Appropriate treatment allows a full recovery and persistent resolution. Exposure questioning must be recorded in the patient review.

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