bluuebunny/crossref_metadata_2025 huggingface dataset:
Il doppio ‘doppio legame’ delle persone transgender e le vie per un suo possibile superamento
Authors: Frati Fulvio
Published: August 2024

Nei loro percorsi di affermazione della propria identità di genere, le persone transgender possono a volte trovarsi ‘invischiate’ in una sorta di ‘doppio doppio legame’, di cui uno fondato sulla percezione della contrapposizione tra il proprio sesso anatomico e la propria identità di genere e l’altro provocato dalla divergenza tra le proprie aspettative di genere individuali e quelle che verso di esse sono invece manifestate dal proprio ambiente familiare e sociale. Per cercare di aiutare queste persone a superare questa situazione, spesso fonte per esse di sofferenze soggettive non trascurabili, l’autore propone in questo lavoro un trattamento psicologico o di psicoterapia, ascrivibile al cosiddetto ‘modello affermativo di genere del consenso informato’ e fondato essenzialmente sul modello della Psicoanalisi della Relazione italiana integrato da contributi provenienti dalla ‘Teoria dei sistemi complessi dinamici nonlineari’, dalla Infant Research, dai contributi di vari altri autori di ambito psicoanalitico, dalla Neurofenomenologia e, infine, dal concetto di campo psicoanalitico come introdotto nel secolo scorso dai coniugi Baranger e in seguito sviluppato da vari autori anche italiani.
Effectiveness of Predicted Low-Glucose Suspend Pump Technology in the Prevention of Hypoglycemia in People with Type 1 Diabetes Mellitus: Real-World Data Using DIA:CONN G8
Authors: Yoo Jee Hee , Kim Ji Yoon , Kim Jae Hyeon
Published: August 2024

We evaluated the effectiveness of the predictive low-glucose suspend (PLGS) algorithm in the DIA:CONN G8. Forty people with type 1 diabetes mellitus (T1DM) who used a DIA:CONN G8 for at least 2 months with prior experience using pumps without and with PLGS were retrospectively analyzed. The objective was to assess the changes in time spent in hypoglycemia (percent of time below range [%TBR]) before and after using PLGS. The mean age, sensor glucose levels, glucose threshold for suspension, and suspension time were 31.1±22.8 years, 159.7±23.2 mg/dL, 81.1±9.1 mg/dL, and 111.9±79.8 min/day, respectively. Overnight %TBR <70 mg/dL was significantly reduced after using the algorithm (differences=0.3%, from 1.4%±1.5% to 1.1%±1.2%, P=0.045). The glycemia risk index (GRI) improved significantly by 4.2 (from 38.8±20.9 to 34.6±19.0, P=0.002). Using the PLGS did not result in a change in the hyperglycemia metric (all P>0.05). Our findings support the PLGS in DIA:CONN G8 as an effective algorithm to improve night-time hypoglycemia and GRI in people with T1DM.
Different Associations between Lipid Levels and Risk for Heart Failure according to Diabetes Progression
Authors: Lee Seung-Hwan , Lee Kyu Na , Youn Jong-Chan , Kim Hun Sung , Han Kyungdo , Kim Mee Kyoung
Published: August 2024

Background: The relationship between circulating lipid levels and the risk for heart failure (HF) is controversial. We aimed to examine this association, and whether it is modified by the duration of diabetes or treatment regimens in people with type 2 diabetes mellitus.Methods: Individuals (n=2,439,978) who underwent health examinations in 2015 to 2016 were identified from the Korean National Health Information Database. Subjects were categorized according to the duration of diabetes (new-onset, <5, 5–10, or ≥10 years) and number of antidiabetic medications. Incident HF was defined according to the International Classification of Diseases, 10th Revision (ICD-10) code I50 as the primary diagnosis during hospitalization. The risk for HF was estimated using multivariate Cox proportional hazard analysis.Results: During a median follow-up of 4.0 years, 151,624 cases of HF occurred. An inverse association between low-density lipoprotein cholesterol (LDL-C) levels and incident HF was observed in the new-onset diabetes group, with an approximately 25% lower risk in those with LDL-C levels of 100–129, 130–159, and ≥160 mg/dL, compared to those with levels <70 mg/dL. However, J-shaped associations were noted in the long-standing diabetes group, with a 16% higher risk in those with LDL-C level ≥160 mg/dL, compared to those with levels <70 mg/dL. Similar patterns were observed in the relationship between total cholesterol or non-high-density lipoprotein cholesterol and the risk for HF, and when subjects were grouped according to the number of antidiabetic medications instead of diabetes duration.Conclusion: Different associations between lipid levels and the risk for HF were noted according to disease progression status among individuals with diabetes.
T-Cell Senescence in Human Metabolic Diseases
Authors: Nga Ha Thi , Nguyen Thi Linh , Yi Hyon-Seung
Published: August 2024

Immunosenescence denotes a state of dysregulated immune cell function characterized by a confluence of factors, including arrested cell cycle, telomere shortening, markers of cellular stress, mitochondrial dysfunction, loss of proteostasis, epigenetic reprogramming, and secretion of proinflammatory mediators. This state primarily manifests during the aging process but can also be induced in various pathological conditions, encompassing chronic viral infections, autoimmune diseases, and metabolic disorders. Age-associated immune system alterations extend to innate and adaptive immune cells, with T-cells exhibiting heightened susceptibility to immunosenescence. In particular, senescent T-cells have been identified in the context of metabolic disorders such as obesity, diabetes, and cardiovascular diseases. Recent investigations suggest a direct link between T-cell senescence, inflammation, and insulin resistance. The perturbation of biological homeostasis by senescent T-cells appears intricately linked to the initiation and progression of metabolic diseases, particularly through inflammation-mediated insulin resistance. Consequently, senescent T-cells are emerging as a noteworthy therapeutic target. This review aims to elucidate the intricate relationship between metabolic diseases and T-cell senescence, providing insights into the potential roles of senescent T-cells in the pathogenesis of metabolic disorders. Through a comprehensive examination of current research findings, this review seeks to contribute to a deeper understanding of the complex interplay between immunosenescence and metabolic health.
Lessons learnt from assessing and improving accuracy and positive predictive value of the national HIV testing algorithm in Nigeria
Authors: Mpamugo Augustine O. , Iriemenam Nnaemeka C. , Bashorun Adebobola , Okunoye Olumide O. , Bassey Orji O. , Onokevbagbe Edewede , Jelpe Tapdiyel , Alagi Matthias A. , Meribe Chidozie , Aguolu Rose E. , Nzelu Charles E. , Bello Segun , Ezra Babatunde , Obioha Christine A. , Ibrahim Baffa S. , Adedokun Oluwasanmi , Ikpeazu Akudo , Ihekweazu Chikwe , Croxton Talishiea , Adebajo Sylvia B. , Okoye McPaul I.J. , Abimiku Alash’le
Published: August 2024

Background: HIV testing remains an entry point into HIV care and treatment services. In 2007, Nigeria adopted and implemented a two-test rapid HIV testing algorithm of three HIV rapid test kits, following the sequence: Alere Determine (first test), UnigoldTM (second test), and STAT-PAK® as the tie-breaker. Sub-analysis of the 2018 Nigeria HIV/AIDS Indicator and Impact Survey data showed significant discordance between the first and second tests, necessitating an evaluation of the algorithm. This manuscript highlights lessons learnt from that evaluation.Intervention: A two-phased evaluation method was employed, including abstraction and analysis of retrospective HIV testing data from January 2017 to December 2019 from 24 selected sites supported by the United States President’s Emergency Plan for AIDS Relief programme. A prospective evaluation of HIV testing was done among 2895 consecutively enrolled and consented adults, aged 15–64 years, accessing HIV testing services from three selected sites per state across the six geopolitical zones of Nigeria between July 2020 and September 2020. The prospective evaluation was performed both in the field and at the National Reference Laboratory under controlled laboratory conditions. Stakeholder engagements, strategic selection and training of study personnel, and integrated supportive supervision were employed to assure the quality of evaluation procedures and outcomes.Lessons learnt: The algorithm showed higher sensitivity and specificity in the National Reference Laboratory compared with the field. The approaches to quality assurance were integral to the high-quality study outcomes.Recommendations: We recommend comparison of testing algorithms under evaluation against a gold standard.What this study adds: This study provides context-specific considerations in using World Health Organization recommendations to evaluate the Nigerian national HIV rapid testing algorithm.
Abstract 12: Prediction of rise in alkaline phosphatase at different vitamin D levels
Authors: Pathak Vaibhav , Gutch Manish , Mandal Uday Kumar , Dwivedi Manjari
Published: August 2024

Background: Vitamin D deficiency with rickets and tetany are common in young infants in India. The data on vitamin D status of healthy term breastfed Indian infants and mothers are scant. In fact the correlation of Vitamin D deficiency and alkaline phosphatase (ALP) are inaccurate in many studies.

Aim and Objective: To determine whether serum vitamin D levels are correlated with serum levels of alkaline phosphatase or not and to study the point at which ALP surge occurs in Vitamin D deficiency.

Results: At 9 months out of 96 samples, 16 had mild Insufficient (≥15 – 20 ng/mL) (20.8%), 42 had moderate Deficient (<15 ng/mL) (54.5%) and 0 had severe Severe deficient (<5 ng/mL) vitamin D deficiencies. All of the patients in the three groups had alkaline phosphatase within normal limits and The ROC curve demonstrated that low vitamin D level is predicted by a high ALP cut off of ALP is 190.90 IU/L with reasonable sensitivity and specificity The correlation coefficient of alkaline phosphatase and serum vitamin D3 levels was r =0.501 (p =0.001).

Conclusion: Serum vitamin D3 levels correlated well with increased serum alkaline phosphatase levels but the level at which the ALP surge occur was on lower side.
Abstract 17: Spontaneous hypoglycaemia due to insulin autoimmune syndrome in five cases, response to steroid therapy and rituximab
Authors: Batra C M , Jain1 Savita , Kumar2 P Kiran , Goyal3 Monika , Kachroo4 Varsha
Published: August 2024

Insulin autoimmune syndrome, a rare autoimmune syndrome known as Hirata's disease, was first described by Dr. Hirata of Japan in 1970. It presents as spontaneous recurrent hypoglycaemic attacks. The characteristic presence of anti-insulin auto-antibodies (IAA), increased serum insulin and c peptide levels are the hallmark of this syndrome. It is the third most common cause of spontaneous endogenous hypoglycaemia in Japan. It is triggered by either viruses or sulfhydryl group containing drugs in patients with a genetic predisposition. However, in some cases, no triggering factor is found. In 82% cases, it is a self-emitting disorder treated with the withdrawal of triggering agents and diet therapy. Challenges are observed in refractory cases whose management is still under evolution. Though it is common in Japanese patients, the incidence is increasing in Caucasian and Indian patients. This paper has discussed a series of 5 cases of IAS and approach to diagnosis and different agents used in the management and new patient monitoring techniques.
Abstract 19: A case of fragility fractures due to hypophosphatemic osteomalacia and adult Fanconi syndrome
Authors: Delampady Kishan , Ganesh H K , Rohan R G
Published: August 2024

Background: Fanconi syndrome is attributed with renal proximal tubular dysfunction leading to the wasting of phosphate, amino acids, glucose, and bicarbonate. This result in hypophosphatemic osteomalacia and fragility fractures.

Case Presentation: A 38-year-old male presented with increasing bony pains, proximal muscle weakness and fragility fractures of long bones. On evaluation he was detected to have hypophosphatemia, hypokalaemia, metabolic acidosis with normal anion gap, renal phosphate wasting with low with TMP/GFR. His serum parathormone, 25 hydroxyvitamin D, 1, 25- dihydroxyvitamin D, fibroblast growth factor 23 (FGF-23) levels were normal. Serum Protein Electrophoresis was normal. X-Ray showed loozers zone and fractures. He was treated with oral supplements of calcium, bicarbonate, calcitriol and phosphate. After treatment patient's fractures were healed, he regained muscle strength and was able to ambulate with support.

Conclusion: This case describes presentation of pathological fractures due to type 2 (proximal) renal tubular acidosis with Hypophosphatemic osteomalacia.
Abstract 29: Effect of gonadotropin releasing hormone analog treatment on final adult height in children with congenital adrenal hyperplasia complicated by central precocious puberty
Authors: Priyanka R , Subbiah Sridhar
Published: August 2024

Background: Congenital Adrenal Hyperplasia (CAH) is complicated by central precocious puberty in children which may compromise the final height.

Aim: We aim to evaluate the effect of gonadotropin analog (GnRH) therapy on final height in children with CAH.

Results: 8 children with CAH with advanced height and bone age and LH, either basal or stimulated, in pubertal range were included in study. GnRH analog 3.75 mg was administered every 4 weeks. Median follow up period was for 2 years. Height age and bone age was noted every 6 months and predicted adult height was calculated at the beginning and end of the treatment using Bayley and Pinneau method. Median growth velocity was 4 cm and 3.75 cm at the end of first and second year. Predicted adult height was increased by 10 cms at the end of 2 years of treatment.

Conclusion: GnRH therapy significantly augments linear growth and bone age advancement in children with CAH complicated by central precocious puberty.
Abstract 31: Etiology of pathological short stature – A tertiary care centre experience
Authors: Prasad G Surendra
Published: August 2024

Background: Short stature is one of the commonest clinical entities encountered by an endocrinologist in day-to-day practice. Only few studies from India have specifically focussed on the etiology of pathological short stature.

Aim and Objective: To look for different causes of pathological short stature and to compare this data with other parts in India and worldwide.

Results: A retrospective analysis of 222 patients (≤18 years) presenting with pathological short stature over last 5 years was done. The mean age of presentation was 10.98±4.88 years with a height SDS of -3.34±1.03, male to female ratio of 0.85 (102/120). The most common cause of short stature was type-1 Diabetes mellitus (DM) (21.1%) followed by primary hypothyroidism (16.2%), metabolic bone disease (13.5%), multiple pituitary hormone deficiency (11.3%), Turner syndrome (6.3%) and isolated growth hormone deficiency (4.8%). Idiopathic short stature was seen in 8 cases (3.6%). Overall, endocrine causes accounted for 82.9% cases. Commonest age group to present was 10-15 years (38.2%).

Conclusion: Endocrinological abnormalities was the most common cause of short stature in our study possibly due to referral bias. Unfortunately, most of the children presented late, thereby limiting the scope of optimal treatment.
Abstract 33: Clinical exome sequencing in XY DSD
Authors: Das Debaditya , Chowdhury Subhankar
Published: August 2024

Background: XY DSD presents as a diagnostic dilemma, making genetic tests essential for diagnosis.

Aims and Objectives: Determine diagnostic yield of clinical exome sequencing in XY DSD patients &Ascertain concordance between clinical diagnosis and genetic diagnosis in case of XY DSD.

Results: 39 patients were included in this observational study. Mean age at presentation was 7.5 years. Consanguinity was present in 23 cases (59%) and 24 (61.5%) were reared as males. The median External Masculinization Score was 3/12. Commonest clinical/biochemical and genetic diagnosis was partial androgen insensitivity syndrome in 17 Patients (43.6%) and 5 patients (22.7%) respectively. Clinical Exome detected mutation in 22 cases (56.4%). In 10 cases (45.45%) the variant was pathogenic. 4 (18%) cases showed a likely pathogenic variant and 8 cases (36%) showed variant of unknown significance. Discordance between clinical and genetic diagnoses was seen in 6 (27.27%) of cases. In 17 (43.6%) cases, we failed to detect any genetic abnormalities.

Conclusion: Although clinical exome sequencing picked up 56.4% of cases, it led to change in diagnosis in 27.27% cases which potentially could alter management and improve clinical outcomes. However clinical exome failed to detect mutations in significant proportion of patients.
Abstract 35: A study on serum irisin levels in type 2 diabetes mellitus
Authors: Gumpina Srinivas Susheel
Published: August 2024

Background: Newer concepts & mechanisms in the pathogenesis of Type 2 Diabetes Mellitus are being explored constantly and could provide new insights into the disease and might facilitate better management. Irisin is one such molecule and is highly expressed in skeletal muscle, heart, adipose tissue, and liver.

Aims and Objectives: To estimate the circulating levels of Irisin in patients with Type 2 Diabetes Mellitus. To compare the levels of serum Irisin in patients with type 2 Diabetes Mellitus with non-Diabetic controls. To study the Correlation of Serum Irisin levels with clinical, anthropometric and biochemical parameters.

Results: Mean serum irisin level in Type 2 Diabetes mellitus (n=43) is 26.38±6.33 ng/ml and 59.12±42.03 ng/ml in non diabetic individuals (n=43). Serum irisin levels strongly correlated with weight, BMI, waist circumference, W/H ratio, Triglycerides, fasting plasma glucose & insulin, HOMA IR, QUICKI and HOMA beta

Conclusion: Serum Irisin levels were increased in obese non-diabetic subjects, while decreased in Type 2 Diabetes mellitus patients. Moreover, serum Irisin levels correlated with various anthropometric and metabolic parameters of obesity and T2DM. Irisin could be explored as a therapeutic target in Type 2 Diabetes mellitus in the future.
Abstract 36: Unusual presentions of primary infertility in females
Authors: Nalla Smitha , Alekya V
Published: August 2024

Female infertility occurs in about 37% of all infertile couples and is upto 50% of them could have ovulatory disorders. Common causes of anovulation include polycystic ovarian syndrome, hypothalamic amenorrhea or premature ovarian insufficiency. Very rarely, women with disorders of sex development do not present until later age with this complaint. Here, we describe two cases of women with underlying endocrine conditions, with first presentation of primary infertility. Case 1 was diagnosed with premature ovarian insufficiency, adrenal insufficiency and subclinical hypothyroidism. Case 2 was diagnosed with 46 XY gonadal dysgenesis. Both women underwent Assisted Reproductive Technology (ART) after optimisation of their endocrine conditions and successfully conceived. With this, we would like to emphasise the importance of endocrine evaluation of women presenting with primary infertility.
D1 MTE1 Case 2: Young male with chronic hepatitis and bony deformity
Authors: Konsam Biona
Published: August 2024

19 years old gentleman presented with deformity of lower limbs noticed two years back. Significant past h/o jaundice at 8 years of age, h/o fracture of right femur at 17 years of age following fall from bicycle and an atraumatic fracture at the same site one year later. He underwent cataract surgery one year back where he was found to have bilateral renal stone disease with elevated creatinine. He had short stature with scoliosis and apparent genu valgum on right. Biochemical evaluation showed CrCl of 40 ml/min/m2 with increased liver enzymes. He had hypophosphatemia with low-normal s.calcium, elevated ALP, elevated PTH (242 pg/ml) and normal 25(OH)D3. Urine evaluation showed impaired acidification along with glycosuria and phosphaturia in the presence of systemic acidosis and normoglycemia. Skeletal survey showed generalized rarefaction; DXA showed osteopenia. MBD secondary to RTA was considered. Ultrasound showed coarsened liver echotexture. Suspecting Wilson's disease, s.ceruloplamin and 24hrs urinary copper was done but was normal and KF ring was absent. Therefore, liver biopsy was done suggesting chronic hepatitis with dry weight copper of 127.23 mcg/gm (normal < 45 mcg/g) which was <4ULN needed for diagnosis. Can the diagnosis of Wilson's disease be made from the above findings or else, any alternative diagnosis to be considered?
Abstract 43: Prevalence of islet-autoantibodies and monogenic diabetes in children with recent onset type 1 diabetes mellitus: A multicenter study
Authors: Jayakrishnan C , Archana  , Singh Pratibha , Singh1 Preeti , Seth1 Anju , Mittal2 Medha , Garg3 Atul , Kanga4 Uma , Verma5 Shivendra , Singh6 S K , Bhatia Eesh
Published: August 2024

Background: Previous smaller studies have shown higher prevalence of islet-antibody negative Type 1 diabetes mellitus (T1DM) among Indians compared to Caucasians. Islet-antibody negative (Type 1B) diabetes is not well characterized.

Aims and Objectives: To study the prevalence of islet-autoantibodies, characterize type 1B diabetes, and determine the role of enterovirus infections and monogenic diabetes in children and adolescents with recent onset T1DM.

Results: Among 111 patients, frequency of islet-autoantibody positivity were: GAD65-73%, IA2-35% and ZnT8-34%. 20 (18%) were negative for all 3 islet-autoantibodies. There were no significant clinical, biochemical or HLA allelic frequency differences between antibody negative and positive group. None of the ninety subjects tested showed evidence of enterovirus infection in serum by RT-PCR. Of the seven Type 1B patients without ketoacidosis tested, 2 had pathogenic mutations: one each in WFS 1 [homozygous c.2006A>G (p.Tyr669Cys)] and HNF4a [heterozygous c.998G>A (p.Arg333His)] loci. An additional 2 subjects had mutations of uncertain significance: one each in WFS 1 [heterozygous c.1522_1523del (p.Tyr508CysfsTer34)] and ABCC 8 [Heterozygous c.3784G>A (p.Ala1262Thr)] loci.

Conclusions: A significant proportion of patients with T1DM were negative for islet antibodies at onset, but did not differ clinically or biochemically. Monogenic diabetes was found in a proportion of patients with type 1B diabetes.
Abstract 44: Persons living with diabetes in India – Their experiences and expectations from the physician
Authors: Selvan Chitra , Lathia1 Tejal , Chawak2 Shweta , Katdare3 Praneeta , Chittam2 Mahati
Published: August 2024

Background and Aims: Research in India underscores the need for and the benefits of communication skills training for physicians treating patients with Type 2 Diabetes Mellitus (T2DM). Yet, none of this research emerges from patients’ perspectives on physician communication. Therefore, this study explored the experiences of and expectations from the physician among persons living with T2DM.

Methods: Using convenience sampling, 11 patients (female=7; mean age=48 years) participated in a focus group discussion. The questions were aimed at eliciting patients’ narratives regarding their interactions with their physician during the medical encounter, with specific focus on the latter's communication. The transcribed data was analysed using conventional content analysis.

Results: Two broad themes were developed: (i) patients know what they want from their physician and (ii) plethora of negative feelings: the effects of verbal and nonverbal communication styles.

Conclusions: The physician-patient interaction elicited a range of negative experiences from the patient, including anger, anxiety, stress and fear. Patients were, nonetheless, able to identify clear expectations of their physician for both verbal and nonverbal communication which would be better received and result in improved patient adherence. Therefore, this study points to the need for, benefits of a communication skills training programme for Indian physicians.
Abstract 47: A case of Post-COVID-19 thyrotoxicosis and a cavalcade of complications
Authors: Lobo Aaron Charles , Choudhury Ratnamala , Idiculla Jyothi
Published: August 2024

Thyroid dysfunction has been reported following COVID-19 infection in the recent past. A 50 year old hypertensive female with no previous thyroid illness, developed features of thyrotoxicosis two weeks after a COVID-19 infection. There was no thyromegaly, neck pain or fever and her ESR was 15 mm/hour. She was initiated on propranolol and methimazole in an outside hospital. Ten days later, she presented to our hospital with fever, sore throat, cough and breathing difficulty. On evaluation she was found to be in neutropenic sepsis (WBC -820 cells/mm3, ANC-6 cells/mm3). Evaluation of thyroid functions showed: TSH- <0.00025 IU/ml, free T3 - 4.17 pg/ml, free T4- 3.59 ng/ml and Thyroid Receptor Antibody Levels (TRAb)- 2.53 IU/L. Following treatment with colony stimulating factors and antibiotics she recovered. The patient was commenced on lithium bicarbonate and cholestyramine, along with propranolol. On follow up in the OPD she is euthyroid with free T4 1.43 ng/ml (normal) levels. Post COVID-19 thyrotoxicosis in this case is likely due to Graves’ disease. Thyrotoxicosis following COVID-19 is now being recognised and is possibly due to infection induced molecular mimicry with activation of immune pathways causing autoimmune disorders.
Abstract 49: Insulin resistance syndrome presenting with diabetic ketoacidosis – A rare case presentation
Authors: Kaur Kirandeep , Batra Nisha , Nisarga Nanda , Joshi Kriti , Sridharan Kalyani
Published: August 2024

Background: Insulin Resistance Syndrome (IRS) occurs either due to mutation or auto-antibodies to insulin receptor. Presentation as diabetic ketoacidosis (DKA) although rare has been reported in few case reports. We report a young male presenting with DKA with very high insulin requirement.

Case Presentation: A 17-year-old male, with untreated diabetes mellitus diagnosed at 12 years of age, presented with vomiting and kussmaul breathing. On examination he was emaciated, had short stature; severe acanthosis nigricans and hypertrichosis. At admission, his plasma glucose was 470 mg/dl, HCO3 6 mEq/L with positive ketones. He was diagnosed as severe DKA and treated with insulin with dose requirement of 120 units/day for adequate glycemic control. GAD-65 antibodies were negative and he had dyslipidemia but no organomegaly. Genetic test was sent for a suspicion of insulin resistance or lipodystrophy which showed homozygous mutation in INSR gene previously described in Rabson Mendenhall syndrome. The child was treated with insulin, metformin and pioglitazone.

Conclusion: Type 1 DM is the most common etiology for DKA. But in patients with very high insulin requirement and signs of insulin resistance, possibility of IRS should be kept and genetic testing offered.
Abstract 52: Clinical efficacy of dapagliflozin in patients with newly diagnosed type 2 diabetes
Authors: Patil Surekha Mahesh
Published: August 2024

Background: The world is facing epidemic of diabesity (diabetes and obesity). Treating both the conditions can be difficult. There are limited available medicines that can treat both diabetes and obesity. Dapagliflozin (SGLT2 Inhibitor) is one such drug which can decrease body weight and obesity in diabetes patients. In present study we have tried to study the clinical efficacy and safety of dapagliflozin 10 mg used alone in patients with new onset diabetes and obesity.

Aims and Objectives: To detect the clinical efficacy of dapagliflozin on newly diagnosed type 2 diabetes patients. To evaluate the adverse effects associated with dapagliflozin.

Results: We studied the efficacy of dapagliflozin 10 mg in 50 newly diagnosed type 2 diabetes patients with overweight and obesity for 1 year duration. 30 patients had BMI >30, 10 had BMI 28-30, and 10 had BMI 25-28. All patients had hba1c>9% on diagnosis. Dapagliflozin 10 mg od resulted in reduction of hba1c of around 2% over 1 year duration. Weight reduction was about 5-10 kg in all patients. More weight reduction was found in patients with high BMI >30. BP decreased by about 20 mm of systolic and 10 mm hg of diastolic in patients with hypertension. Major adverse effects were genitourinary candidiasis in 10 patients and uncomplicated uti in 5 patients.

Conclusion: Dapagliflozin 10 mg od used in newly diagnosed obese and overweight type 2 diabetes patients was very useful in reducing weight of about 5-10 kg and hba1c of about 2%. It was also found to be useful in reducing blood pressure and reducing number of other antihypertensive medicines.
Abstract 53: Acute thyrotoxic bulbar myopathy: An unusual presentation of hyperthyroidism
Authors: Kar Nilanjan , Devi Sujata , Dey Anupam , Sahoo Debananda
Published: August 2024

Background: Acute bulbar palsy manifested as thyroid storm is a rare presentation of hyperthyroidism.

Aims and Objectives: We present a case of 22 year male presented with gradually progressive symmetrical weakness involving proximal muscles of both limbs since 1 year and new onset bulbar symptoms for last 15 days. It was associated with low grade intermittent fever, chronic diarrhea and significant weight loss. He was diagnosed as primary hyperthyroidism outside 6 months back but he discontinued medication since last 1 month. On presentation, he looked confused with staring look; skin was warm and moist with profuse sweating. Pulse rate was 140 beats per minute, regular; fine tremor was noted in both hands. Power was 3/5 in proximal muscles of both limbs with all reflexes diminished and flexor plantar.

Results: On evaluation, FT4 was high 2.5 ng/dl, TSH was low 0.006 microIU/L, raised Anti TPO antibody (>1300 U/ml). Radio iodine uptake scan showed diffuse homogeneously increased tracer uptake in thyroid gland. CSF analysis, RNST, Anti cholinesterase antibody, NCS, EMG, and Neuroimaging were normal. He improved with antithyroid medication, beta blocker and steroid.

Conclusions: Acute bulbar palsy is an uncommon but treatable complication of thyrotoxicosis that requires immediate intervention.
Abstract 57: Effect of successful parathyroidectomy on metabolic parameters in patients with primary hyperthyroidism
Authors: Bhat Moomin Hussain , Masoom Injeela , Bashir Mir Iftikhar , Misgar Raiz Ahmad , Shah Zafar Amin , Wani Arshad Iqbal
Published: August 2024

Background: Primary hyperparathyroidism (PHPT) had been associated with metabolic abnormalities including dysglycemia, hyperuricemia and dyslipidemia. The data regarding the effect of curative parathyroidectomy on metabolic variables is controversial.

Aims and Objectives: To assess the metabolic parameters, including insulin resistance in patients with PHPT. To study the effect of curative parathyroidectomy on these metabolic parameters.

Methods: Prospective observational, hospital based study involving 50 consecutive PHPT patients over a period of one year. We studied clinical and biochemical variables including, body mass index (BMI), an oral glucose tolerance test (OGTT, 75 g), fasting lipid profile, uric acid (UA), liver function test, fasting insulin levels and HOMA IR (excluding 8 diabetic patients) in all patients. Three months after curative surgery all the parameters were repeated.

Results: The mean BMI, total cholesterol (TC), LDL, triglycerides (TG), UA, creatinine (Cr), fasting blood glucose (FBG) and 2hr post OGTT (PPBG) was 23±4.4 kg/m2, 160.81±44.64 mg/dl, 95.27± 36.81 mg/dl, 140.24±57.2 mg/dl, 5.07±1.57 mg/dl, 0.97 mg/dl, 86.88±11.2 mg/dl and 122.93±28.1 respectively. The mean HOMA-IR was 35.05±32.7. After surgery there was no significant change in TC (161.38± 45.85) LDL (91.1±34.51), TG (144.64±90.94), UA (4.43± 1.46), Cr (0.76± 0.34), FBG (90.52± 22.26) and PPBG (125.4±39.83 mg/dl). There was significant increase in BMI (23.9± 4.28 kg/m2) and significant decrease in HOMA-IR (14.76±10.43).

Conclusion: Our follow-up of patients with operated PHPT revealed there was no significant change in metabolic parametres except for decrease in HOMA IR.
Abstract 65: Effects of gender affirming hormone therapy on metabolic health and body composition in gender dysphoria
Authors: Kiran Baratam Hari , Kalra1 Pramila
Published: August 2024

Background: Gender affirming hormone therapy (GAHT) may impact metabolic health and body composition in individuals with gender dysphoria.

Aims and Objectives: The aim of this cross-sectional study was to investigate the effects of GAHT on metabolic health (HOMA2-IR and lipid parameters) and body composition [BIA (Bioelectrical impedance analysis)] in transgender individuals. They were divided into 4 groups: Group 1 (n=38) and Group 3 (n=12) consisted of treatment naïve transwomen and transmen while group 2 (n=7) and group 4 (n=22) consisted of transwomen and transmen on treatment for at least 6 months, respectively.

Results: The groups 1 and 4 showed significant differences in FBG (fasting blood glucose), whole-body and subcutaneous fat and skeletal muscle percentages; (p<0.005) (cisgender setting). The visceral, subcutaneous fat and skeletal muscle percentages were also found to be different (p<0.01) (transgender setting). When groups 2 and 3 were compared, differences between TG, VLDL, subcutaneous fat and skeletal muscle percentages (cisgender setting) (p<0.05) were significant.

Conclusions: Transmen on GAHT were found to have lower fasting glucose, skeletal muscle mass and higher whole-body and subcutaneous fat as compared to natal men. Transwomen on GAHT were found to have higher TG, VLDLC, skeletal muscle mass and lower subcutaneous fat compared to natal women.
Abstract 66: Spectrum of sleep abnormalities in primary hypothyroidism
Authors: Acharya Himamshu , Kalra1 Pramila , Dharmalingam2 Mala
Published: August 2024

Background: The spectrum of sleep abnormalities in hypothyroidism includes daytime sleepiness, sleep apnoea, rapid eye movement sleep disorder, restless leg syndrome and periodic limb movement disorder.

Aims and Objectives: To assess daytime somnolence, risk of sleep apnoea, quality of sleep, depression, and anxiety in subjects with primary hypothyroidism using Epworth Sleepiness Score (ESS), Berlin questionnaire, Pittsburgh Sleep Quality Index (PSQI), Patient Health Questionnaire-9 (PHQ-9) and Hamilton Anxiety Rating Scale (HAM-A).

Results: This was a questionnaire-based cross-sectional study that included 55 subjects (females=44, males=11), both treatment naïve (N=41) and on treatment (N=14), who had TSH >4.5 mIU/L. The mean age was 37.09±12.49. Median TSH was 13.5 (IQR-19.781). The Median ESS score was 3/24 (IQR-7), three subjects had severe excessive daytime sleepiness. Seventeen individuals were predisposed to sleep apnoea as assessed by the Berlin Sleep questionnaire. Twenty subjects had a PSQI score of >5, indicating poor sleep quality. The median PHQ-9 score was 4/27 (IQR-7), one individual had severe, and one had moderately severe depression. The Median HAM-A score was 6/56 (IQR-11); two had severe anxiety.

Conclusion: Individuals with hypothyroidism need to be screened for sleep abnormalities like sleep apnea, daytime somnolence, REM sleep disorders and neuropsychiatric manifestations like anxiety and depression.
Abstract 74: Utility of inferior thyroid artery blood flow velocities to differentiate between gestational transient thyrotoxicosis and Graves’ disease in pregnancy – A pilot study
Authors: Afzal Mohd Abdul Mujeeb , Lodha Piyush , Bandiwad Chandrashekar , Rao Srinivas , Danda Vijay Sheker Reddy
Published: August 2024

Background: Thyrotoxicosis is seen in up to 0.1% to 0.5% of pregnancies. Thyrotoxicosis mimics common physiologic changes in pregnancy leading to difficulty in diagnosis. Role of thyroid blood flow velocities to differentiate between Graves disease (GD) and gestational transient thyrotoxicosis (GTT) is not well explored.

Aims: To determine the role of inferior thyroid artery- blood flow velocities, assessed by colour-flow Doppler ultrasonography to differentiate between GTT and GD in pregnancy.

Methodology: The present cross-sectional study, conducted at Department of Endocrinology, Gandhi Medical College, for a duration of 6 months. 28 subjects participated in the study - 8 with GD and 10 with GTT and 10 Euthyroid pregnant women. The inferior thyroid artery- peak systolic velocity (ITA-PSV) and end-diastolic velocity (EDV) of both right and left sides were evaluated using color doppler ultrasonography.

Results: The ITA-PSV and EDV in patients with GTT were significantly lower than those of pregnant patients with GD and significantly higher than those in euthyroid pregnant women. The most appropriate cut off values were obtained by the ROC curve. The optimal cut-off points of ITA-PSV to differentiate between GTT and GD, was 34.5 cm/s, with sensitivity and specificity of 83.42% and 92.43% respectively.

Conclusion: Thus ITA-PSV appears to provide excellent sensitivity and specificity to differentiate between GD and GTT, where thyroid scintigraphy is contraindicated.
D1 MTE2 Case 5: An adrenal mass...
Authors: Kolli Sumanas Gopal Datta
Published: August 2024

A 35-year-old woman presented with weight gain (10kg), increased appetite, hirsutism, amenorrhoea, and deepening of voice for 8 months. On examination, blood pressure was 180/110 mm Hg, wide (1.5-2 cm), purple striae over anterior abdomen, hirsutism (mFMG score: 14), temporal baldness, clitoromegaly and proximal myopathy were noticed. Investigations revealed loss of circadian rhythm of cortisol with markedly elevated 24h- urinary cortisol (1371 μg) and serum testosterone (212.20 ng/dl) suggesting adrenocortical carcinoma (ACC). A non-contrast CT Abdomen showed a 65*63 mm well-defined hypo-dense left adrenal mass with homogeneous enhancement. She underwent laparoscopic left adrenalectomy and histopathology confirmed ACC with mitotic activity of 2-3/10 HPF. Post-operatively patient had features of adrenal insufficiency which was managed appropriately and discharged on oral prednisolone 5mg/day and fludrocortisone 100 μg/day. She discontinued medications a year later. Ten years later, she presented to us with similar complaints for 6 months. Her blood pressure was 112/86 mm Hg and mFGS score was 8. There were no striae, bruises, mycotic lesions, or proximal muscle weakness. Investigations revealed suppressed ONDST cortisol (9.55 μg/dl), elevated DHEAS (549.9 μg/dl), elevated total testosterone (143.16 ng/dl) and suppressed plasma ACTH (7.7 pg/ml). A CECT abdomen showed normal right adrenal with no evidence of recurrent or residual lesions in the abdomen. But, FDG-PET CT scan showed an FDG avid heterogeneously enhancing soft tissue mass of 9.3*7.5*8.7 cm (max SUV: 9.5) in the omentum-mesentry of the left middle quadrant of abdomen, likely representing metastasis. Patient underwent laprotomy and lesion was excised, which was confirmed to be low-grade ACC (mitotic activity: 6-8/10 HPF). Post-operatively, serum 8:00am cortisol was 0.43 μg/dl, DHEAS was 6.8 μg/dl and total testosterone < 10 ng/dl suggesting complete remission. She was replaced with glucocorticoids. Mitiotane therapy was offered but the patient deferred. She had documented remission at 1 year follow-up.
D2 MTE3 Case 8: Diagnosing diabetes mellitus in children
Authors: Gupta Manisha
Published: August 2024

An eight-year boy

Height: 134.9 cms

Weight: 47 kgs

BMI: 26 kg/m2Positive Family history of T2DM (mother)

Pubertal status: A1, P1, TV 3 ml bilateral

No signs of insulin resistance

No osmotic symptoms

RBS: 284 mg/dl

Blood ketones: 0.1 mmol/l.

Laboratory investigation:

Reports revealed Fasting blood sugar 130 mg/dl with HbA1c 7.4% and TSH 42.63 μIU/ml. He was advised the following treatment:

Levothyroxine 75 mcg

Calcium and vitamin D

On follow up visit after 30 days and 60 days.

Fasting blood glucose readings were ranging between 95-221 mg/dl and Post prandial 96-396 mg/dl. C-peptide 1.12 ng/ml (2 hours post meal) and Serum GAD 65 IgG (IU/ml) >2000. After thyroid hormone replacement TSH came down to 4.11 (μIU/ml). No significant finding in abdominal ultrasound.

Points to ponder:

Inconclusive diagnosis

Below normal C-peptide with highly elevated GAD suggested some beta cell dysfunction.

Line of treatment?
Abstract 82: Rare case of 46XY OVO testicular DSD
Authors: Naushad Altaf Ali , Manjunath P R , Sourabh Sagar
Published: August 2024

A 5-month-old term baby was referred for ambiguous genitalia. Examination showed a right descended gonad, and an empty scrotum and an inguinal swelling on the left, no phallus and single external urogenital opening in the perinium with an EMS score of 2.5. Possibilities considered included ovo-testicular DSD, PAIS and testosterone biosynthetic defects. Beta HCG Stimulation test ruled out synthetic defects and with good testosterone response. USG abdomen/scrotum showed left inguinal undescended testes. Post Acton prolongatum stimulated cortisol was 43 mcg/dL and the Karyotyping was 46 XY. Diagnostic laparoscopy showed a left sided ovotestes with fallopian tube-like structure attached; and biopsy of gonad confirmed both ovarian and testicular tissue. Hence diagnosis of 46 XY Ovo testicular DSD was made; one which accounts for 3-10% of total DSD. We report this instance where absence of phallic structure is a rare presentation among cases of 46XY Ovo testicular DSD.
Abstract 96: Etiological profile of thyroid disorders in neonates at a tertiary care hospital in South India
Authors: Fatima Afsar , Vikas  , Tirupathae Sunanda , Kumar Dileep
Published: August 2024

Background: Thyroid disorders are commonest endocrine disorder in India, studies reveal a high prevalence. Normal thyroid function is critical for early neurocognitive development, which emphasizes strict neonatal screening.

Aim: To estimate the prevalence, clinical profile and associated co-morbidities of thyroid dysfunction in neonates.

Materials and Methods: A cross-sectional observational study was conducted at a tertiary care hospital in south India. Neonates referred to Endocrinology department with diagnosed thyroid dysfunction were included. Demographic data, clinical features, thyroid profile and relevant investigations of the recruited children were noted.

Results: A total of 180 neonates (105 female) with thyroid function abnormalities were included with prevalence of 8/1000 over 6 years study. Graves was noted in 6, majority of the hypothyroidism was due to Hashimoto's (111), subclinical (27), congenital central (11), ectopic thyroid and dys-hormonogenesis in 6 each, transient hypothyroidism in 4. A host of co-morbidities, developmental delay and maternal risk factors were identified.

Conclusion: There is a high occurrence of autoimmune hypothyroidism in paediatric age group in south India and need for similar studies from different regions of the country covering larger population are in dire need as early diagnosis may abate subsequent residual sequelae.
Abstract 98: Hirsutism under evaluation
Authors: Harshita B , Selvan Chitra
Published: August 2024

A twenty one year young lady is under our follow up for the past three years. Initially, she presented with oligomenorrhea, hirsutism and acne for 2 years. She had weight gain of 10 kgs. She was on OCPs for oligomenorrhea and underwent laser therapy for hirsutism. On examination, she was obese with acanthosis. Her modified FGS was 16/36, with acne over face and upper back. She did not have any signs of virilization. Her initial hormonal profile in 2018 showed an elevated total testosterone (92 ng/dl) free testosterone (2.13 ng/dl) and DHEAS (720 mcg/dl). She has lost twenty kgs over the last two years with life style modifications. She has regular menstrual cycles since one year. However her hirsutism has not improved. Repeat DHEAS is >1000 mcg/dl. Ultrasound abdomen and pelvis showed multiple follicles in both ovaries. Her thyroid profile, Prolactin and 17 OH progesterone are normal. In view of high, tumoral range DHEAS, CT abdomen and pelvis was done which was normal. She was given Inj Leuprolide 3.75 mcg SC and repeat DHEAS showed significant drop to 400 mcg/dl. Should we have done Dexamethasone suppression test first? Are these group of patients a distinct phenotype of PCOS, with unique clinical and hormonal profile?
Abstract 100: Knowledge on their illness and practices among patients with adrenal insufficiency: A survey
Authors: Vishwanath S , Appaiah Sonali , Bantwal Ganapathi , Ayyar Vageesh , George Belinda
Published: August 2024

Introduction: Averting an adrenal crisis reduces the mortality and substantial economic burden on patients and public health care facilities. So, it is imperative to educate patients on their illness.

Aims and Objectives: To assess the adrenal insufficiency (AI) patients on their understanding of the illness and need for uninterrupted therapy by administering questionnaires.

Results: 27 patients with AI were surveyed which included 13 females and 14 males. None of them identified all the common symptoms of AI and 4 (15%) were unaware of the symptoms. Eight patients (16%) were unaware about stress dosing. Two patients (7%) felt stress dosing is not required while 2 (7.4%) felt glucocorticoid replacement is not important for survival. Six patients (22%) had stopped therapy on their own. Three patients (11%) had hospitalization with adrenal crisis by missing medications.

Conclusion: Our study shows that majority of the patients with AI have lacunae in their knowledge on illness, which raises a serious concern that needs to be addressed by continued and frequent education.
Abstract 104: A case of large adrenal teratoma: Masquerading as adrenal myelolipoma
Authors: Tamminedi Nitin
Published: August 2024

Introduction: Teratomas are neoplasms which have their origin from one or usually all three germ cell layers, i.e., ectoderm, mesoderm, and endoderm. Most common sites involved are gonads. Other common extra-gonadal sites are mediastinal, sacro-coccygeal and pineal regions. Among the retroperitoneal teratomas, primary adrenal teratomas are very rare with an incidence rate of 0.13%. Here, we report a case of large adrenal teratoma which was misdiagnosed radiologically as adrenal myelolipoma.

Case Presentation: A 40-year-old female presented to Endocrinology out-patient services with left hypochondriac pain for the last one year. Her clinical examination was normal. Contrast-enhanced computed tomography of abdomen revealed a left sided large adrenal mass measuring 11.2 x 10 x 10 cm showing fat attenuating lesion with enhancing soft tissue component, internal septation, and coarse calcifications and was reported as adrenal myelolipoma by the radiologist. However, the review by Endocrinologist lead to suspicion of adrenal teratoma as the areas of calcification, in fact, had typical bone formation with cortex and medullary components. Patient underwent left adrenalectomy. Histopathological examination confirmed the lesion as mature cystic teratoma with microscopic foci of papillary carcinoma of thyroid and neuro endocrine tumour.

Conclusion: Even though adrenal teratomas are usually benign, malignant transformation may occur. Hence, it is important to make a proper diagnosis of the condition for appropriate management. Imaging characteristics of medullary component in the calcification areas should suggest the possibility of adrenal teratoma over other adrenal lesions with calcifications.