bluuebunny/crossref_metadata_2025 huggingface dataset:
Destiny and the Future
Authors: Colebrook Claire
Published: February 2023

It might appear as though all the dire warnings regarding end times would only yield despair, nihilism, resignation and the paralysis of panic. This would certainly be the case if the world we live in now were the best of all possible worlds, and if the 'we' of the Anthropocene were
an unavoidable point of view generated by the common calamity of the future. There is, however, another virtual 'we' that is made possible by the dire warnings of 'our' end. Rather than one's possible non-being amounting to the determinism of a death sentence, freedom emerges and is made possible
by imagining life beyond the point of view of what has come to call itself 'the human'.
Kainos Anthropos: Existential Precarity And Human Universality in the Earth System Anthropocene
Authors: Zimmer Daniel
Published: February 2023

One of the most consistent critiques of the Anthropocene among humanities scholars has been that its putativeAnthroposignores difference to encompass all human beings universally in terms of their essential human nature. Trace the conceptual history of the term, however, and it quickly becomes clear that theAnthroposof the Anthropocene takes shape as not simply a sly return of Enlightenment Man to be dismantled once more by academic antihumanists, but something far stranger. What follows works backwards from Paul Crutzen's public introduction of the term in 2000, through the Earth System science of the 1980s and the systems ecology of the 1960s, to contend that the conceptual precursors of the Anthropocene arose in the crucible of the 1950s. It was there that the novel prospect of 'universal death' by thermonuclear weapons fused with the relational ontology of cybernetics to produce a paradigmatically distinct approach of conceiving human beings in their totality – the 'Kainos Anthropos'. Born under the shadow of its own extinction, theKainos Anthroposdoes not seek to define what all human beings essentiallyare(as Enlightenment Man did), but to account for what it is that all human beings collectivelydo. Rather than claim that this is inherently better or worse, the point is that it is categorically different, introducing new kind of theoretical challenges and opportunities that warrant being treated on their own terms rather than reflexively dismissed as yet another form of spurious universalism.
Gouverner une assemblée citoyenne . Le rôle du Comité de gouvernance de la Convention citoyenne pour le climat
Authors: Fourniau Jean-Michel
Published: February 2023

« Qui gouverne une assemblée citoyenne ? » La question vise les conditions qui permettraient de pérenniser et d’institutionnaliser ce type d’exercice démocratique. Cet article en témoigne : en France, même les approches qui voient dans les assemblées citoyennes tirées au sort une nouvelle forme de représentation démocratique ont répondu à cette question selon les schèmes anciens de la participation du public. Ceux-ci ont conduit à penser la « souveraineté » de la Convention citoyenne pour le climat (CCC) dans les termes d’un pilotage indépendant de l’exécutif, et non comme la prérogative d’un Parlement des citoyen·nes. Les travaux internationaux sur les mini-publics abordent quant à eux la question en termes d’autonomie de la délibération citoyenne, qui doit être protégée par des règles de fonctionnement et encouragée par l’animation. Cela conduit à des dispositifs très différents, concentrant en France dans un comité de gouvernance les fonctions de pilotage stratégique, de conseil scientifique et d’organisation, plus souvent distribuées à l’étranger entre différentes instances. Cet article retrace la genèse et certains aspects du fonctionnement du Comité de gouvernance de la CCC. Son fil directeur est de considérer que les enjeux de pouvoir révélés par le pilotage et l’organisation d’une assemblée citoyenne engagent le regard que l’on porte sur ces exercices – participation à l’élaboration des décisions publiques ou fabrique de la loi –, qui conditionne à son tour la manière d’aborder leur gouvernance.
La parlementarisation de la démocratie délibérative : Pourquoi est-ce que les élu·es institutionnalisent la participation citoyenne au sein de leur parlement ?
Authors: Reuchamps Min , Sautter Ann-Mireille
Published: February 2023

Un nombre croissant de parlements expérimentent des modèles délibératifs permettant aux citoyennes et citoyens de participer activement à la prise de décision parlementaire. Leur institutionnalisation est particulièrement visible en Belgique, où quatre parlements ont instauré de manière permanente la démocratie délibérative. Nous étudions les raisons derrière cette institutionnalisation en utilisant une méthode mixte pour établir, quantitativement d’abord, si une différence de soutien peut être observée entre les parlements ayant institutionnalisé ou non de tels dispositifs. Puis nous analysons qualitativement comment les parlementaires conçoivent ces dispositifs délibératifs et pourquoi elles et ils optent pour un modèle spécifique.
La Convention citoyenne pour le climat : un dispositif hors norme parmi les assemblées citoyennes sur le climat ?
Authors: Smith Graham , Fourniau Jean-Michel , Deshautel Lise
Published: February 2023

La Convention citoyenne pour le climat, qui s’est tenue en France entre 2019 et 2021, se situe au sommet de ce que l’OCDE appelle la « vague délibérative ». Si elle présente un fort air de famille avec les autres assemblées climatiques, cela peut masquer des différences significatives. En comparant la Convention avec les cinq autres assemblées nationales pour le climat qui ont achevé leurs travaux à la fin de 2021, l’unicité du phénomène des assemblées pour le climat est remise en question. Grâce à cette comparaison, il apparaît clairement que certains aspects de la commande, de la gouvernance, de la conception et de l’impact de la Convention citoyenne pour le climat la distinguent des autres assemblées climatiques. Il s’agit d’une « donnée aberrante » en termes de sciences sociales. Et ce statut d’exception peut jouer un rôle important dans la remise en question des principes établis pour la pratique des mini-publics délibératifs.
Investigating the relationship between green supply chain purchasing practices and firms’ performance
Authors: Pinto Luísa
Published: February 2023

Purpose: This research aims to investigate which are the green purchasing practices that Portuguese manufacturing companies have been using and the relationship with company overall performance. This paper focuses on green-purchasing practices, such as green products, green suppliers, environmental collaboration with suppliers, green packaging, and reverse logistics, to ensure sustainable practices in the supply chain, and the influence of those practices on firm’s performance was investigated from the perspective of managers perception.Design/methodology/approach: A qualitative approach was adopted, based on eight case studies. Data was collected from semi-structured interviews with procurement managers from Portuguese manufacturing industry and from reports, websites and companies’ internal documentation. To analyze the impact of green purchasing practices on company overall performance a conceptual model was proposed.Findings: The results support three out of five propositions of this research, and evidence reveals that green purchasing practices improves company overall performance. Provides evidence that the implementation of those practices positively influences overall company performance, it also identifies the most frequent green purchasing practices that may help businesses in adopting environmental initiatives.Research limitations/implications: While the sample included organizations from several economic sectors, it was based on just a sample of eight case studies and the findings may not be valid in different sectors. This research focuses on green procurement from a country's perspective, which reduces the ability to generalize the findings to other countries.Practical implications: Managers might utilize the results of this study to develop and implement green purchasing practices and enhance organizations' overall performance via their adoption.Social implications: This research contributes to the current discussion in green supply chain literature.Originality/value: This study contributes to the existing body of research on the effects of implementing green purchasing practices into the procurement function.
Global dynamics of multiple delays within-host model for a hepatitis B virus infection of hepatocytes with immune response and drug therapy
Authors: Yosyingyong Pensiri , Viriyapong Ratchada
Published: February 2023

In this paper, a mathematical model describing the hepatitis B virus (HBV) infection of hepatocytes with the intracellular HBV-DNA containing capsids, cytotoxic T-lymphocyte (CTL), antibodies including drug therapy (blocking new infection and inhibiting viral production) with two-time delays is studied. It incorporates the delay in the productively infected hepatocytes and the delay in an antigenic stimulation generating CTL. We verify the positivity and boundedness of solutions and determine the basic reproduction number. The local and global stability of three equilibrium points (infection-free, immune-free, and immune-activated) are investigated. Finally, the numerical simulations are established to show the role of these therapies in reducing viral replication and HBV infection. Our results show that the treatment by blocking new infection gives more significant results than the treatment by inhibiting viral production for infected hepatocytes. Further, both delays affect the number of infections and duration i.e. the longer the delay, the more severe the HBV infection.
A blend of thyme and rosemary powders with poultry by-product meal can be used as a natural antioxidant in broilers
Authors: Nameghi Alireza Hesabi , Edalatian Ommolbanin , Bakhshalinejad Reza
Published: February 2023

A total of 500, 14-d old male Ross 308 broilers were allocated into five treatments (4 replicates each) including: a negative (NC) and positive control diet (PC) which supplemented without and with 7% poultry by-product meal (PBPM), respectively and three levels of additive supplementation of thyme and rosemary powders in the basal diets: 0.750% rosemary powder (PCR); 0.375% thyme powder + 0.375% rosemary powder (PCRT), and 0.750% thyme powder (PCT) rosemary powder. The PCRT diet improved (p <0.05) average daily gain and feed conversion ratio by 5.62 and 10.37% compared to PC, respectively. The serum concentration of lipids (triglycerides, cholesterol, high-density lipoprotein, and low-density lipoprotein) was decreased while the ileal villus height and ratio of villus height to crypt depth as well as ileal microbiota population were improved (p <0.05) in response to inclusion PCRT diet compared to PC diet. The blood serum concentration of malondialdehyde was statistically decreased (p <0.05) by supplementation of PCRT in broiler diets. Our results suggested that supplementation of a blend of thyme and rosemary powders at the level of 0.375% of each into broiler diet during d 14-42 has merit to be used as a natural antioxidant in diets formulated by PBPM.
Water parameters correlated with the zootechnical performance of shrimp Litopenaeus vannamei grown in oligohaline waters
Authors: Cavalheiro Thiago Brandão , Carvajal Juan Carlos Letelier , Lucena Reinaldo Farias Paiva de , Nascimento Carlos Vinícius Carvalho do , Ribeiro Thais Teresa Brandão Cavalheiro
Published: February 2023

The present study aimed to correlate the influence of water quality, cultivation time, area, and density of ponds on the zootechnical performance of shrimp Litopenaeus vannamei in oligohaline waters. It was demonstrated that, under the conditions of this research, better control of temperature, pH and water alkalinity can be employed. Ammonia levels were within the normal range and correlated positively with the growth rate (ρ = 0.69859) and production (ρ = 0.66362) of the ponds. There was also a positive correlation between cultivation time and pond density with shrimp weight (ρ = 0.75305 and 0.68933) and pond productivity (ρ = 0.74763 and 0.79367, respectively). Negative correlations were observed between: I) pH with shrimp survival (ρ = -0.73238) and pond production (ρ = -0.68696); II) alkalinity and pond production (ρ = -0.66162). The results show that the cultivation of shrimp L. vannamei in oligohaline waters is viable and there is potential for increased productivity associated with better hydrological monitoring and use of higher density and cultivation time by some producers.
Glyphosate in oat desiccation for haylage harvest at different wilting times
Authors: Horst Egon Henrique , Neumann Mikael , Carneiro Murilo Klosovski , Czelusniak Cherlyson , Bueno Antônio Vinicius Iank , Venancio Bruno José , Seller Maria Eduarda Cozechen , Cesar Paulo Victor Pinheiro
Published: February 2023

The objective was to evaluate the ruminal disappearance rate of dry matter and NDF of black oat haylage subjected to mechanical and chemical dehydration and six wilting periods in the field, as follows: 0, 3, 6, 9, 12 and 15 days. Forage haylages were ensiled and stored in PVC mini-silos for 60 days until opening for in situ evaluations. The pre-set ruminal incubation times were: 0, 6, 12, 24, 36 and 48 hours. Regardless of the dehydration time, forage subjected to mechanical dehydration showed ruminal disappearance rates of dry matter and NDF, thus DISDM-48h and DISNDF-48h were superior for this method compared to the chemical method. There was a reduction in DISDM-48h and DISNDF-48h with advancing time of wilting in the field for haylage dehydrated by the chemical method. In general, the chemical dehydration method seems to be more related to better haylage making practices than nutritional factors, where the haylage obtained by mechanical dehydration is superior.
Quality of milk fat obtained from cows and buffaloes fed a diet supplemented with flaxseed or soybean oils
Authors: Shazly Ahmed Behdal , Hassan Laila Khaled , Kholif Abd El-Kader Mahmoud , Sayed Ahmed Farouk , Abd El-Aziz Mahmoud
Published: February 2023

The experiment was carried out to evaluate the quality of anhydrous milk fat (AMF) of cows and buffaloes supplemented with flaxseed oil (FO), soybean oil (SO), or their mixture (FSO). Lactating crossbred cows and buffaloes were fed with control diet or with one of three supplements: 2% FO, 2% SO, and 2% FSO according to a double 4 x 4 Latin Square Design. The diets with FO, SO, or FSO reduced saturated FA, mainly C4:0, C14:0 and C16:0, while increased the unsaturated FA C18:1 and C18:2 in milk from cows and buffaloes. Cholesterol content decreased in cow's AMF while increased in buffalo's AMF when a diet supplemented with FO, SO, or FSO. The diet with SO or FSO increased the content of vitamin E in AMF obtained from cows (25.06 and 17.89 mg 100 g-1) and buffaloes (28.48 and 30.32 mg 100 g-1) compared with the control diet (11.02 and 15.68 mg 100 g-1), respectively, which correlated positively with scavenging activity for DPPH• (r2 = 0.66) and ABTS• (r2 = 0.67) radicals. Solid fat content (SFC) was high for cow’s AMF, with 58.12-60.37% at 5°C compared to that of buffalo's AMF, with 52.37-56.98%, but was low for cow's AMF at >15°C. Finally, supplementing a diet with vegetable oils, particularly SO, improves the quality of AMF; increases USFA/SFA ratio, vitamin E content, and antioxidant activities
An Evaluation of ANFIS Models for Predicting the Oil Flotation Behavior in a Stable Oil-Water Emulsion
Authors: Ku Ishak Ku Esyra Hani , Ayoub Mohammed Abdalla , Ahmad Aminuddin Muhammad Irman Khalif
Published: February 2023

This work's main objective is to investigate the flotation process's efficiency in removing the oil from a stable oil-water emulsion containing surfactant (MFOMAX) and polymer (GLP-100). A total of 45 flotation tests were carried out with varying factors such as gas bubble flowrate, MFOMAX and GLP-100 concentration, as well as the flotation time. These factors have become the model's input, and the effluent's oil concentration calculated in term of flotation efficiency (%) has been the model’s output. 75% of the total data was used for training and 25% was used for testing. Coefficient of determination (R2) and average absolute percentage error (AAPE) was used as the models' performance indicators. A high R2 value (0.956) was given by the ANFIS model and AAPE of 10.14%, indicating that the predicted data agrees well with the actual data. Potential optimization to the flotation equipment on separating oil-water in the stable emulsion containing MFOMAX and GLP-100 have been discussed.
Progressive Freeze Concentration: Optimization of Trichlorophenol Removal in Wastewater via Response Surface Methodology
Authors: Jamal Ikhsan Ikhmal Zariq Al Imran , Bakar Muhamad Noor Faqeh , Hamizlan Hariz Asyraf , Mazzam Anwar Addini , Ab Hamid Farah Hanim
Published: February 2023

2,4,6- Trichlorophenol (TCP) is a toxic, mutagenic, and carcinogenic compound found in the emission from fossil fuel combustion, municipal waste incineration, and water disinfection for domestic usage. TCP has been classified as one of the primary pollutants that should be treated for inland water discharge. This study aims to introduce a new approach to remove the TCP in wastewater through the simple and cost-effective progressive freeze concentration (PFC) method. The effect of coolant temperature and circulation flow rate in the PFC method was investigated, and its effectiveness was characterized by calculating the effective partition constant (K) and the TCP reduction (TR). Optimisation was performed to determine the optimum condition for the TCP removal using Response Surface Methodology (RSM). The best circulation flow rate and coolant temperature for the one-variable-at-a-time (OVAT) experiment were found to be 900 rpm and -5 °C. Based on ANOVA, the PFC system was predicted to produce a low K value and high TR with temperature in the range of -4.5 °C to -5 °C and circulation flow rate in the range of 900 rpm to 1000 rpm.
Abstract 100
Authors: Selvan Chitra , Bhagat Madhura , Mandlekar Anuradha , Tiwaskar Mangesh , Manohar K. N. , Thakur Darshana
Published: February 2023

Background and Objective: Exercise intervention can be personalized and delivered digitally to achieve better outcomes in people with diabetes. The study aim was to analyse the effect of supervised exercise prescription delivered as part of Fitterfly diabetes digital therapeutics program in people with diabetes (PWD) after completion of the program.

Method: De-identified data of 150 participants (mean age 45.29 ± 10.53 years, 39.3% females) who completed the 90-day program was analyzed. Structured virtual physiotherapy consultations and personalized exercise prescriptions were provided by physiotherapists along with expert-led care by a multidisciplinary team. Participants received access to Fitterfly mobile application for digital logging of meals and physical activity, regular follow-ups from physiotherapists to ensure adherence to the personalized prescription and for reviewing the goals to be achieved during the course of the program. Wilcoxon test was used for the statistical analysis with p < 0.05 considered statistically significant.

Results: After completion of the program, significant median improvement in 6-minute walk test and total fitness score by 5.35% (p < 0.001) and 46.86% (p < 0.001) respectively was observed. Participants were categorized based on their activity levels at the beginning of the program, 26% (39/150) of participants were in the sedentary category, 55% (82/150) were in the aerobic category and 19% (29/150) were in the strength training category. After completion of the program, all the participants were following strength training as part of their exercise regimen. Median exercise duration per week in these participants improved by 180 (135,270) min, 70 (0,141.25) min and 60 (0, 142.50) min respectively. Post-program, median HbA1c reduction by -0.8 (-2.00, -0.38) % was observed, with 87.33% (131/150) of the participants showing significant HbA1c reduction. Median weight reduction was found to be -2.5 (-1.00, -4.50) kg and median waist circumference reduction was -4.00 (-7.00, -0.08) cm. Among users who started with HbA1c above recommended level (>7%), 48.39% (45/93) reduced their HbA1c in the recommended range after completion of the program.

Conclusion: The study demonstrated improvement in cardiorespiratory and physical fitness, exercise duration and incorporation of strength training in the exercise regimen of the participants. Significant improvement in glycemic control and a significant reduction in body weight and waist circumference was also observed. Virtual supervised exercise guidance as a part of Fitterfly diabetes digital therapeutics program can help in improving safety and adherence to physical activity among people with T2DM for effective diabetes management.
Abstract 106
Authors: Jamwal Juhi
Published: February 2023

Case Report: A 45 years male married with 3 kids, former smoker and no underlying comorbidities presented to medical emergency with sudden onset heaviness of head in occipital area and lightheadedness at around 8 pm. It was followed by excessive generalised sweating and altered sensorium in the form of unresponsiveness that lasted for 5- 10 minutes. During same period he developed urinary incontinence. He had no episode of abnormal body movements. His Blood pressure was 140/100 mmHg, GCS was 15/15, Pupils Bilateral normal size with reaction to light present. Systemic examination was normal. Random Blood glucose was 92 mg/dl. Noncontrast CT brain was advised that showed 13.8 X 9.3 mm well- delineated hyperdense lesion in the region of sella [Fig. 1] with Subarachnoid haemorrhage. MR angiography was done that showed narrow neck giant aneurysm at C5 segment of distal ICA and ophthalmic artery is arising from base of the aneurysm. Cerebral angiogram was performed that confirmed the findings and after that balloon assisted coiling of aneurysm was done and flow diverter was placed across left Internal carotid artery – terminal [ophthalmic] segment. Check angiogram revealed no filling or recurrence of aneurysm with good filling of ophthalmic artery. He developed transient mild hyponatremia post procedure and got improved with normal saline.

After 15 days from discharge from hospital, he started with dryness of mouth, increase in thirst and craving for cold water. Also he noticed increased frequency of micturition so much so that he had to get up 4-5 times during night to pass urine. His appetite also decreased. No associated nausea or vomiting. He also developed cold intolerance and erectile dysfunction over one-and-a-half-month period. With these complaints, he visited Outpatient department. Hormone evaluation revealed, Total T4 7.63 mcg/dl, Cortisol 0.72 mcg/dl, FSH 1.23 IU/L, LH 0.87 IU/L, Testosterone 28.28 ng/dl, Prolactin 16.74 ng/ml, Serum Sodium 148, Potassium 3.78, 24 hour urinary volume 4.5 litres. Serum osmolality 304 mosml/l, Urine osmolarity 121 mosm/l. He was started on prednisolone 5 mg, Thyroxine 50 mcg, Desmopressin 0.1 mg bedtime and testosterone injections 100 mg Intramuscular every 21 days. He noticed improvement in his symptoms within 3 days of starting treatment and hypernatremia also settled. Contrast MRI sella was done after 3 months from procedure and noted 15 X 10 mm T1/T2 hypointense area in suprasellar location likely thrombosed aneurysm causing mass effect on pituitary stalk and pituitary bright spot not seen.
Abstract 108
Authors: Nitin T L N , Sagar Reddy S L , Dhananjaya MS , Sarathi Vijaya
Published: February 2023

Background and Objective: A comprehensive review in 2003 reported adrenal incidentaloma (AI) prevalence of 0.6 (0.35-varies from 0.6 to 1.5% on computed tomography (CT)-based studies. However, a few subsequent studies reported higher (4.4-7.3%) prevalence, which is often cited as the prevalence of AI and is attributed to a greater detection rate with modern imaging. Hence, we performed a systematic review and meta-analysis to evaluate the prevalence of AI.

Methods: The Pubmed database was searched for literature published between the years 2000 and 2021, without language restriction and selection of articles was performed as per the PRISMA guidelines. The data was analysed via meta-analysis for proportions using MedCalc Statistical Software version 19.2.6.

Results: The meta-analysis included 22 studies of which 20 were retrospective. Pooled AI prevalence rates were 1.36% (95% CI: 1.33-1.39) and 2.19% (95% CI: 1.77-2.65) with I2 of 99.1% (99-99.3%) (Fig 1). The pooled (fixed effect model) AI prevalence rates were 3.89% (95% CI: 3.34-4.51) in smaller studies (n: < 1000) and 3.76% (95% CI: 3.35-4.2) in studies with selected population (screening for lung cancer, type 2 diabetes mellitus and living potential kidney donors). In larger studies (n: > 1000) including unselected population, the pooled AI prevalence rates were 1.34% (95% CI: 1.31-1.36) and 1.43% (95% CI: 1.03-1.89) with I2 of 99.5% (99.4-99.6%).

Conclusions: Pooled AI prevalence in the meta-analysis is around 1.35%. Studies that are smaller or include selected population may overestimate the AI prevalence. However, larger, prospective studies are required to verify whether it is overestimation in smaller studies or underestimation in larger, retrospective studies.
Abstract 109
Authors: *Chirag LU , Dharmalingam Mala , Ganavi Yamasandhi P , Manjunath PR , Ganavi Yamasandhi P , Selvan Chitra , Kalra Pramila
Published: February 2023

Background: Subclinical thyrotoxicosis is a condition in which serum thyroid hormone levels are within the reference range, but serum thyrotropin (TSH) levels are subnormal. It is not known whether differences in patterns of thyroid hormone levels between endogenous and exogenous subclinical thyrotoxicosis result in disparate effects on the skeletal system. There is a paucity of data on patients with subclinical thyrotoxicosis and their bone health status.

Objectives: To estimate bone mineral density in patients with subclinical thyrotoxicosis in patients due to different aetiologies in premenopausal women.

Methods: This cross-sectional study was conducted at Ramaiah medical college for a period of one year. A total of twenty-six patients were included. Demographical data was analysed by descriptive statistics and expressed as mean with standard deviation. Bone mineral density was measured by hologic v2.0.

Results: A total of 26 individuals were included in the study. The mean age of the study population was 34.2 ± 8.1 years. The etiology for subclinical thyrotoxicosis was Graves’ disease in 11 (42.3%), multi-nodular goiter 4 (15.3%), toxic adenoma 3 (11.6%), and iatrogenic in 8 (30.7%) patients. The mean BMI was 25.8 ± 7.2 kg/m2. The mean corrected calcium was 9.15 ± 0.26 mg/dl and phosphorus was 2.98 ± 0.36 mg/dl. The mean 25 hydroxy vitamin D level was 30.3 ± 4.41 ng/dl. Mean BMD at hip and spine was 0.96 ± 0.14 g/cm2 and 0.90 ± 0.06 g/cm2 respectively. No patient had a Z score of <-2 S.D in the hip and spine. The mean Z score at the hip and spine was +0.55 ± 0.88 and +0.22 ± 0.75 respectively. There was no significant difference between the endogenous and exogenous etiology subgroup in BMD at the hip or spine [p = 0.668 CI (-0.0629 - 0.0429)] and [p = 0.604 CI (-0.0879 - 0.1479)].

Conclusion: There was no significant reduction in bone mineral density at the hip or spine as measured by DXA in our cross-sectional study of premenopausal women with subclinical thyrotoxicosis of both endogenous and exogenous etiology. In young females with adequate serum25 hydroxy-vitamin Dlevels, endogenous subclinical thyrotoxic state may not have a deleterious effect on bone health in the short term.
Abstract 121
Authors: Ali Syed Farooque , Sunanda T , Vijaya Sarathi H A , Anudeep G , Rakesh Venkata , Ravindra Shruthi
Published: February 2023

Introduction: Neonatal Diabetes mellitus in first 6 months of life is usually monogenic and is usually referred to as neonatal diabetes mellitus. The incidence of neonatal diabetes is extremely rare and varies from 1:89000 to 1:400000 live births. The most common cause of permanent neonatal diabetes is heterozygous activating mutation in the KCNJ11 gene encoding kir 6.2.

Case Report: we report a 1 month 25 days male infant presented to our hospital with complaints of excessive inconsolable cry, up rolling of eyes, staring look, difficulty in breathing, refusal of feeds and repeated seizures, diagnosed outside as diabetic ketoacidosis (GRBS- 600 mg/dl, PH- 6.96, HCO3- 2.1, PCO2- 10) and managed accordingly with IV fluids, insulin and antiepileptic. Referred to our hospital for further management. On evaluation diagnosed as neonatal DM. 4th hourly GRBS was done and insulin Glargine given as basal regimen. Bolus doses of regular insulin was given based on GRBS. C peptide levels were low. Genetic study revealed heterozygous missense variation in exon1 of KCNJ11 gene (pArg201Cys).

After genetic analysis baby was admitted to change over from insulin to sulfonylurea treatment. The patient was put on CGMS (Medtronic) on day2 of admission. Baby was started on Tab. Glibenclamide (0.1 mg/kg/dose) BD and gradually increased to 1 mg/kg/dose BD. Gradually regular insulin was tapered to 0.5 units sos and Inj. Glargine was reduced from 3 units BD to 0.5 units BD and blood sugars were under control.

He was gradually transitioned from insulin to glibenclamide. He is presently 3.5 years with a weight of 12 kgs and height of 94.5 cms. He is presently in good glycaemic control, with the tablets being given twice a day.

Conclusion: This genetic diagnosis has therapeutic implications as patients can switch from insulin therapy to sulphonylurea, as described in this case report. Most of the children with a KCNJ11 gene mutation have an overall good prognosis with good glycaemic control attained with oral sulphonylurea therapy.
Abstract 127
Authors: John Anulekha Mary , Santhosh Shanty , G Deepti , Francis Anju K.
Published: February 2023

Background: Management of diabetes needs regular blood tests and insulin injections. Various kinds of medical instruments like insulin pens, needles, syringes, lancets etc are used as part of self-care. While sharp disposal is strictly regulated in most hospital settings, this is not the case in community.

Objective: To assess the awareness and practices regarding the disposal of sharps among diabetic patients.

Methods: Over 3-month period diabetic patients were interviewed regarding sharps disposal, using a structured questionnaire. Assuming 95%lack of awareness, 20% relative precision, 5% type 1 error, sample size calculated was 456. Descriptive statistics were used.

Results: There were a total of 479 patients, with 252 (52.61) women. There were 303 (63.25%) patients on insulin and 98 (32.34%) of them used pen devices. Mean age was 60.4 ± 11.5 and mean duration of diabetes was 13.5 ± 8.9 years. Mean HbA1c was 9.3 ± 2.1%. Most of our patients 437 (91.81%) were not aware of proper ways to dispose sharps. 359 (75.26) deposited in common household trash. 320 (66.81) eventually disposed in their backyard and 137 (29%) burned it.

Conclusions: Inappropriate disposal of sharps pose risk not only to scavengers but also to our environment. It is necessary to educate our patients regarding sharps disposal. Policy makers should be made aware in order to establish facilities for proper disposal of such hazardous sharps in the community and implement the same.
Abstract 141
Authors: Dematapitiya Chinthana , Perera Chinthana , Dissanayake Preethi , Athukorala Tharaka , Pathmanathan Sivatharshya , Sumanatilleke Manilka
Published: February 2023

Background: Diabetic retinopathy is a microvascular complication that can eventually lead to potential blindness. Timely interventions result in favourable outcomes in preserving eye-sight among patients with diabetic retinopathy, thus improving quality of life. Detectioin of diabetic retinopathy is done by ophthalmologists based on advance symptoms, however, a landmark for early detection has been of variable debate. The aim of the study was to identify the assocation between abnormalvibration perception threshold and presence of retinopathy in patients with type 2 diabetes.

Methods: A total of 1662 participants with type 2 diabetes mellitus (595 males, 1067 females) were recruited using a systematic sampling technique, from the endocrinology clinic at the National Hospsital of Sri Lanka. Each participant was assessed for vibration perception threshold using a biothesiometer, and a diabetes retinopathy evaluation was done by a trained medical officer, using retinal photography. A biothesiometer reading of >25 Hz on either leg, was considered as loss of vibration perception. Data were analysed, where associations were assessed using Chi square test at a 5% significance level.

Results: The mean (SD) age of the study participants was 58.7 (10.47) years. The sample had a mean (SD) fasting blood sugar level of 156 (66.4) mg/dl and HbA1c value of 8.9% (5.46). 1025 participants had a positive biothesiometer reading, of which, 331 (32.3%) had evidence of diabetic retinopathy. Loss of vibration perception was significantly associated with the presence of diabetic retinopathy (p < 0.05). Subgroup analysis based on sex revealed a significant association between loss of vibration perception among males and females, and the presence of diabetic retinopathy (p < 0.05). Multivariate regression analysis for controlling confounding factors showed a HbA1c >7% (p < 0.05) and a positive vibration perception test (p < d0.05) were significant.

Conclusions and recommendations: Vibration perception threshold is an easy assessment that can be carried out in limited resource settings, and can be used as an early sign of referral, to screen for diabetic retinopathy which requires more complex technical expertise. Further evaluation on the association between the two is required to generalize the findings to the local population.
Abstract 142
Authors: Athukorala Tharaka Gayaththri , Silva Nipun Lakshitha De , Pathmanathan Sivatharshya , Sumanatilleke Manilka , Somasundaram Noel
Published: February 2023

Introduction: Craniopharyngioma is a rare tumour with a complex management approach. Available data in the SouthAsian region is limited and knowledge from the locality can improve the approach to patients.

Objective: To determine characteristics, management methods and long-term outcomes of patients withcraniopharyngioma followed up at a tertiary care hospital.

Method: This cross-sectional study was conducted at the Endocrine Clinic, National Hospital of Sri Lanka fromJanuary 2021 to August 2022. All consenting patients with craniopharyngioma attending the clinic were recruited consecutively. Data were collected via medical records and an interviewer-administered questionnaire.

Results: Out of 45 participants, 31 (66.9%) were males. The median age at diagnosis was 21 (Range: 3-66) years whereas the median age at the last follow-up was 37 (Range: 13-75) years. The Median follow-up duration was 8 years. At presentation, headache, vomiting and seizures were recorded in 30 (66.7%), 13 (28.9%), and 5 (11.1%) respectively. Short stature, Diabetes Insipidus, Visual impairment and hydrocephalus wereobserved in 16 (35.6%), 14 (31.1%), 31 (68.9%) and 15 respectively. The mean maximum tumour diameter was 3.17 cm (±2.08). A suprasellar component was seen in 32 (71.1%). Fifteen patients had VP shunt placement before initial tumour resection. All underwent tumour resectionat least once (craniotomy: 35, trans-sphenoidal: ten), whereas nine had two surgeries and three had redosurgery twice. Histology was available in 38 patients and 36 of them were adamantinomatous grade 1 tumours. Residual tumour was observed in 15 (33.3%) after the first surgery and five receivedradiotherapy. Recurrence was observed in fourteen after the residual-free first surgery, and three after radiotherapy. Currently, 25 are tumour free. Panhypopituitarism, diabetes insipidus and visual impairment was observed in 19 (42.2%), 29 (64.4%) and 32 (71.1%) patients following surgery, respectively. Eight patients received growth hormonepostoperatively. Twenty-one (46.7%) experienced weight gain and 5 (11.1%) had behavioural changes.

Conclusion: A high recurrence rate even after complete tumour excision suggests the need for careful long-termfollow-up. Post-surgical metabolic, hormonal and structural complications were also observed, indicatingthe requirement for multidisciplinary long-term follow-up and the need to study further on quality of life.
Abstract 143
Authors: Sriramaneni Nikitha , Selvan Chitra
Published: February 2023

Background and Objectives: With chronological aging there is decline inestrogen concentration during and after menopausal transition with potential vasomotor, physical, psychosocial, and sexual health consequences. The loss of muscle mass, strength, and function, known as sarcopenia is common in postmenopausal women. The primary objective of the study is to assess menopausal symptoms in postmenopausal women and its association with sarcopenia.

Methods: This study was conducted from October 2021 to September 2022 in Endocrinology OPD, Ramaiah Hospital, Bengaluru. A total of 65 postmenopausal women with the onset of menopause at >45 years of age were included in the study. Menopausal symptoms, and risk of sarcopenia were assessed with Menopause Rating Scale (MRS) and SARC-F questionnaires respectively. Sarcopenia was defined and assessed according to the Asian Working Group for Sarcopenia guidelines 2019. Data analysis is done with the statistical software SPSS 22.0.

Results: The mean age of the participants was 58.83 ± 7.19 years and the mean age at menopause was 49.61 ± 2.73 years. Majority (75.4%) of the women had high MRS score (moderate-56.9%; severe-18.5%). Among the MRS domains, majority of women had mild somatic symptoms (35.4%), moderate psychologic symptoms (41.5%) and severe urogenital symptoms (53.8%). Urogenital symptoms were significantly high (p = 0.028) in older women. SARC-F score was low in 86.2% and high in 13.8% of women. In this study, 49.2% of women had sarcopenia, 26.2% had possible sarcopenia and 24.6% had no sarcopenia. Mean age is significantly (p = 0.022) high and mean weight and BMI were significantly low (p < 0.001) in women with sarcopenia. Mean height, weight and BMI was significantly less (p < 0.05) in women with severe sarcopenia. Among women with sarcopenia, majority had moderate somatic (43.8%) and psychologic (37.5%) and severe urogenital (62.5%) symptoms respectively. Hand grip strength was significantly low (p=<0.001) and MRS score was significantly high (p = 0.012) in women with low appendicular skeletal muscle mass index.

Conclusions: Most of the women (75.4%) had moderate to severe MRS score suggestive of a poor quality of life. Majority of the women (75.4%) had sarcopenia or possible sarcopenia. Most of the women (81.3%) felt they were strong (according to SARC-F score) despite having sarcopenia. There was no significant association between menopausal symptoms (MRS score) and sarcopenia. It is essential to assess for sarcopenia in all women ideally during perimenopause and thereby advise for improvement of muscle mass and strength. The limitations of this study are its cross-sectional nature and relatively small sample size.
Abstract 149
Authors: Keerthana Madineni , Sachan Alok
Published: February 2023

Background: Brown tumours are lytic lesions of bone that occur due to increased osteoclastic activity and are seen in group of parathyroid disorders (primary, secondary, tertiary). Tertiary hyperparathyroidism due to chronic kidney disease is a rare cause of brown tumours.

Case Report: A 22-year-old lady was diagnosed with chronic kidney disease in 2017. She was on maintenance hemodialysis. She developed swelling in left side of jaw 4 years ago. Swelling was progressively increasing in size and was painful. On evaluation, orthopantomogram showed a lytic lesion in left side of mandible. Later she developed more swellings in left elbow, right side of jaw.Serum calcium was 10 mg/dL, serum phosphorous was 4.8 mg/dL, PTH was 1565 pg/mL, serum alkaline phosphatase was 438 IU/L. Tc99m MIBI parathyroid scan could not detect any parathyroid adenoma, but showed lytic lesions in left part of mandible and right maxilla. F18 NaF bone scan showed lytic lesions in left part of mandible, right maxilla, left 9 th rib, left proximal ulna, left superior pubic ramus and proximal end of left tibia. She was started on tab cinacalcet 30 mg, but she had poor drug compliance. After 10 months her serum PTH was 926 pg/mL, but there was no decrease in size of jaw swelling. She was advised surgery for brown tumour excision injawandwasadvisedtocontinuecinacalcet.

Conclusion: Uncontrolled hyperparathyroidism for prolonged period leads to brown tumours. Brown tumour excision is required when size doesn’t decrease despite adequate medical management or when it is large enough to cause functional impairment.
Abstract 153
Authors: Phadte Aditya , Memon Saba , Budyal Sweta , Patil Virendra , Lila Anurag , Bandgar Tushar
Published: February 2023

Background: Gonadotropin-dependent precocious puberty (GDPP) is the most common cause of precocious puberty. Data on GDPP from Indian subcontinent is scarce.

Objectives: We aim to describe single centre experience of patients with GDPP.

Methods: The clinical, biochemical features and therapeutic outcomes of patients presenting with diagnosis of GDPP from Jan 2000 to July 2021 were analyzed.

Results: 78 patients (girls, n = 61, 78.2%) with GDPP were included. The median age of pubertal onset (29 vs. 75 months) and age at presentation (58 vs. 82 months) was earlier in boys than in girls. The commonest presenting symptom was genitalia growth (76.47%) in boys and breast development (75.4%) in females, followed by height spurt (boys: 17.6%, girls: 11.4%), pubic hair development (boys: 5.8%, girls: 6.5%) and vaginal bleeding (6.5%). The height at presentation and target height SDS were 1.02 and -0.77 in males and 0.75 and -0.82 in females, respectively.

In boys, median (range) basal serum FSH, LH and testosterone were 2.48 mIU/ml (0.42-5.7), 2.6 mIU/ml (0.52-10.01), and 3.75 ng/ml (0.1-8.27) respectively. In girls, the median (range) basal serum FSH and LH were 5.24 mIU/ml (1.03-19.8) and 2.2 mIU/ml (0.05-15.8); basal serum LH being <0.3 mIU/ml was seen in 11 females. The median post gonadotropin stimulated peak serum LH in the latter 11 females (age range: 82-99 months) was 9.37 mIU/ml (range: 5.42-19 mIU/ml). At 60 minutes, all except one patient reached a stimulated serum LH value of ³ 5 mIU/ml. The median (range) difference in bone age and chronological age was 33 months (-2.0 to 98) and 2.5 months (4.0 to 76) in boys and girls, respectively. Ultrasonogram pelvis was available for 38 females. Uterine length ³ 3.2 cm was found in 84.2% of patients.

In boys, precocity-related MRI brain abnormality was seen in 80% whereas it was found in 23.6% of girls. Fifty-five patients were treated with injection leuprolide acetate depot [monthly 3.75 mg per (n = 2) or 7.5 mg (n = 1), three monthly 11.25 mg (n = 27) or 22.5 mg (n = 25)] whereas five patients were treated with triptorelin. Only one girl had an allergic reaction to leuprolide and was switched to triptorelin. In males, final height SDS was 0.16 (n = 2); in females, final height SDS was -0.25 (n = 20). MPH SDS in treated patients were -0.38 and -0.86 in boys and girls, respectively.

Conclusion: GDPP was more common in girls. Post gonadotropin stimulated peak serum LH ³5 mIU/ml at60 min aids in diagnosis in those with LH £0.3 mIU/ml. GnRH therapy helps in reducing height loss.
Abstract 157
Authors: Manu Chandrappa , Svehlikova Eva , NissArfelt Kristine , Cailleteau Roman , Deller Sigrid , Thomsen Karen Margrete , Hart Marlies , Mursic Ines , Pieber Thomas , Haahr Hanne
Published: February 2023

Background: People with diabetes may inject s.c. insulin in different body regions. To address if choice of injection region affects insulin icodec exposure and glucose-lowering effect, this study compared icodec administration in different s.c. injection regions.

Methods: In a randomized, open-label, three-period crossover trial, 25 individuals with T2D on basal insulin (22 males; mean ± SD age 60 ± 7 yrs, BMI 30.7 ± 4.6 kg/m2) received single s.c. icodec doses (5.6 U/kg) in the thigh, abdomen and upper arm (9-13 weeks washout). Blood was sampled for pharmacokinetics (PK) until 840 h (35 days) post-dose. Glucose-lowering effect was assessed at 36-60 h post-dose in an automated glucose clamp (target 135 mg/dL).

Results: Total icodec exposure (AUC0-∞,SD) was similar after single-dose s.c. injection in the thigh, abdomen and upper arm (Table). Maximum concentration (Cmax,SD) was higher for abdomen/upper arm vs. thigh. Extrapolation of PK profiles to steady state using a PK model showed smaller differences in Cmax,SS for abdomen/upper arm vs. thigh than after single dose. Partial glucose-lowering effect 36-60 h after single dose (AUCGIR,36-60h,SD) was comparable across injection regions (geom. mean [CV%] of 1961 [51], 2130 [52] and 2391 [40] mg/kg for thigh, abdomen and upper arm).

Conclusion: Insulin icodec can be administered s.c. in the thigh, abdomen or upper arm withessentially similar exposure and glucose-lowering effect.
Abstract 160
Authors: Maldar Aasim , Kulkarni Aniruddha , Chauhan Phulrenu , Misra B. K. , Shah N. F. , Chadha Manoj
Published: February 2023

Objective: To calculate the measures of diagnostic accuracy of BIPSS and determine the optimal cut-point values for central to peripheral ACTH ratios to differentiate between Cushing’s Disease (CD) and Ectopic Cushing’s Syndrome (ECS).

Methods: The initial diagnosis of Cushing’s Syndrome (CS) was made as per the endocrine society guidelines. Patients with s. ACTH > 15 pg/mL were considered to have ACTH-dependent CS. Baseline ACTH (both the inferior petrosal sinuses and peripheral) values were obtained, and since 2014, additionally stimulated ACTH values (5 and 10-minutes post one unit iv vasopressin) were obtained as standard protocol at our institute. Since the past few years, prolactin corrected ACTH ratios are also being calculated. The highest central to peripheral ACTH gradient > 2 in baseline samples (bC:P), >3 in samples after vasopressin stimulation (sC:P), and >0.8 in PRL-corrected ratios (pC:P) was used as reference value indicative of CD. An inter-petrosal gradient >1.4 was considered to be suggestive of an adenoma located on the side of the petrosal sinus with the higher ACTH concentration. To determine the final etiological diagnosis, histopathology (HP) and immunohistochemistry (IHC), as well as biochemical recovery after surgery were considered.

Results: 51 patients with ACTH-dependent CS underwent BIPSS from 2005 to 2020. Four patients with incomplete data/follow-up, one patient with unilateral petrosal sinus catheterization, one patient with Cortisol Resistance Syndrome were excluded from the analysis. Mean age of our cohort was 37.5 ± 15.1 years, with 77.8% females. 39 patients had CD (positive HP-IHC in 34, and remission post-surgery in additional 5 with hyperplasia), while 6 had ectopic CS (one each of bronchial carcinoid, lung NET, thymic NET, pancreatic NET; and two with undiagnosed ectopic source). The measures of diagnostic accuracy are shown in Table 1. On ROC analysis, cut-point ratio of 2.55 for bC:P value gave a sensitivity of 89.7% and specificity of 100% (AUC = 0.964); sC:P ratio of 2.95 had 96.3% sensitivity and 100% specificity (AUC = 0.991); 0.93 for pC:P ratio provided a sensitivity of 93.8% and specificity of 100% for diagnosis of CD (AUC = 0.984). 71.4% (10/14) patients with left sided adenoma, and 85% (17/20) patients with right sided adenoma were correctly lateralised on BIPSS. In patients whom adenoma was detected on pMRI, 66.7% (6/9) were correctly lateralised to the left side, and 94.1% (16/17) to the right side.

Conclusion: BIPSS provides high sensitivity and specificity to diagnose CD. Vasopressin stimulation improves the specificity, while prolactin correction improves the sensitivity of BIPSS, as compared to baseline ratios.