bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 111: Whatsapp for diabetes self management education (DSME) in type 1 diabetes mellitus: A randomized controlled trial
Authors: Gupta Parul , Shukla Ravindra
Published: August 2024

Background: WhatsApp can be used for Diabetes Self Management Education (DSME) in Type 1 diabetes mellitus.

Objectives: A randomized controlled trial to study the effect of WhatsApp based DSME on glycemic status, knowledge, quality of life and coping skills.

Results: Type 1 diabetes patients (15-40 years) with WhatsApp were randomized into “Intervention” (n=28) who received weekly educational WhatsApp messages and “Sham” (n=28) who received weekly greeting messages. In addition, patients without access to WhatsApp formed “Control” group (n=10). The mean baseline HbA1c was 10.69±2.74. The primary objective was change in HbA1c from baseline at 16 week and 28 weeks in all 3 groups. The difference was significant between WhatsApp group and control group (P 0.003, mean square 1.453) but not significant between Intervention and Sham group. Knowledge improved significantly in the intervention group (p value 0.001) but there was no significant difference in the coping skills or quality of life score or hypoglycemia among 3 groups.

Conclusion: Use of WhatsApp for DSME improves the HbA1c as compared to those who don’t use WhatsApp. Active WhatsApp intervention improved the knowledge but did not translate into improvement in glycemic control, coping skills or quality of life.
Abstract 112: Post-COVID vaccination ASIA syndrome (autoimmune/inflammatory syndrome induced by adjuvants) and thyroid dysfunction
Authors: Singhal Vaibhav , Gupta Sushil Kumar
Published: August 2024

Background: ASIA syndrome is an entity that incorporates diverse autoimmune conditions after exposure to various adjuvants in vaccines. There is limited literature available regarding development of thyroid disorders after covid 19 vaccination.

Aims and Objectives: Retrospective case series of patients diagnosed with thyroid disease within 2 months of covid-19 vaccination. History, examination, relationship with covid infection and vaccination, onset of symptoms, thyroid function tests, TRAb, Anti-TPO, ESR, CRP, Tc99-thyroid scan were recorded for each of the patient.

Results: We observed 9 subjects (females 5, males 4; age range 22-63 yrs) with thyrotoxicosis. The onset of symptoms after vaccination ranged from 2 days to 60 days. Six subjects had Graves’ disease (GD) while 3 had subacute thyroiditis (SAT). Two subjects had acute onset of thyroid associated opthalmopathy; one patient needed glucocorticoids (GC). All subjects with GD were treated with antithyroid drugs while subjects with SAT were treated with NSAIDS; none required GC.

Conclusions: SAT and GD may develop as a manifestation of ASIA syndrome after covid 19 vaccine. Long-term multicentric observational studies are needed to establish the natural history of ASIA syndrome following covid vaccination.
D2 MTE3 Case 9: A case of hirsutism…
Authors: Reddy Harshita
Published: August 2024

A 21-year young lady is under our follow up for last three years. Initially, she presented with oligomenorrhea, hirsutism and acne for 2 years. She had weight gain of 10 kgs She was on OCP 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 approx. 20 kgs over the last 2 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? What is the management plan?
D2 MTE4 Case 10: Dilemma of diagnosis
Authors: Singh Anshika , Bhattacharyya Shaila
Published: August 2024

14 year 6 month child presented to us with complaints of polyuria and polydipsia for 3 months. He was morbidly obese (116 kg) and had lost 22 kg in last 1.5 months. There was history of dental abscess 1 month back for which he was prescribed Tablet Wysolone (5 mg BD) for 5 days. He had normal perinatal and developmental history. Mother had history of gestational diabetes. There was history of DM, dyslipidemia and hypertension in both the parents. On examination: His height and weight were 173 cm (+1.25 SDS) and 92.9 kg (+4.1 SDS), respectively with a BMI of 31.04 kg/m2 and a waist hip ratio of 0.93. He had acanthosis nigricans over neck, axilla and thighs. His SMR staging was A2 P3 TV 12/12 ml SPL of 7 cm along with lipomastia. Rest of the systemic examination was normal. Investigations: His investigations showed fasting blood glucose of 316 mg/dl with HbA1c of 16.4% and no acidosis on blood gas. Urinary glucose was +++ and ketone bodies +++ along with urine microalbumin of 81.8 mg/L. He also had dyslipidemia with normal thyroid functions. His C-peptide level was 2.15 ng/ml and HOMA IR 2.96. He also had Vitamin D and Vitamin B12 deficiency.
D2 MTE4 Case 11: Adult CAH, how do I optimize treatment?
Authors: Prasad Trupti
Published: August 2024

28 years, female, born of non-consanguineous marriage, assigned female gender had genital ambiguity and seizures on day 10 of life. She presented to us at 9 years with genital ambiguity and hyperpigmentation. Tanner stage A3P4B2, external genitalia: phallic like structure 4.5 cm, posterior labial fusion, single opening, no palpable gonads. Unstimulated 17 OHP 192 ng/ml, testosterone and DHEAS elevated, low basal cortisol, other biochemical parameters normal, CT scan- bilateral adrenal enlargement, so a diagnosis of simple virilizing type of congenital adrenal hyperplasia was made and was started on T. Hydrocortisone and T. Fludrocortisone, after which pigmentation decreased. Gender role and identity as female. Underwent clitoral reduction and vaginal reconstruction. She had spontaneous puberty with pubarche at 7 years, thelarche at 10.5 years and menarche at 12.5 years. Her 17 OHP remained elevated and had early epiphyseal fusion leading to short stature. She had hirsutism at 16 years so she was started on T. Dexamethasone but was again changed to Hydrocortisone as she developed cushingoid features after 2 years. She is married for past 3 years and is eumenorrhic but now presents with primary infertility. Recent investigations revealed 17 OHP 50 ng/ml (Target: 4-12 ng/ml) and T 6.3 nmol/l. Currently on T. Hydrocortisone divided in 5 doses and T. Fludrocortisone 150 mcg. How to further manage fertility and long-term complications.?
Abstract 114: WFS1 gene associated diabetes phenotypes and identification of a novel founder mutation in Southern India
Authors: Chapla Aaron , Johnson Jabasteen , Korula Sophy , Nisha M , Ahmed Anish , Varghese Deny , Parthiban R , Ravichandran Lavanya , Jebasingh Felix , Asha H S , Mathai Sarah , Simon Anna , Thomas Nihal
Published: August 2024

Background: Wolfram Syndrome (WFS) is a rare, autosomal recessive, progressive disorder characterized by childhood-onset diabetes mellitus (DM), diabetes insipidus, optic atrophy, and sensorineural hearing loss (DIDMOAD). The confirmed early diagnosis of WFS is challenging due to the progressive nature of the disease and WFS1 rare heterozygous variants reported in young-onset DM, the need for comprehensive genetic screening for the early diagnosis of WFS and to characterize the phenotypic spectrum associated with diabetes mellitus.

Aims and Objectives: To screen a comprehensive panel of seventeen monogenic diabetes genes in patients with DM, with a clinical suspicion of WFS/non autoimmune T1DM/Young onset DM patients who were tested negative for a MODY panel.

Results: Fourteen patients positive for WFS1 variants identified by Next-generation sequencing. Ten patients were positive for homozygous WFS1 mutations, which includes a novel founder mutation WFS1 (NM_006005.3): c.1107_1108insA (p.Ala370SerfsTer173) in three families from south India. We have also identified rare heterozygous WFS1 variants in four patients with young onset diabetes.

Conclusion: These findings project the need for NGS-based parallel multigene testing for early diagnosis of WFS and to identify heterozygous WFS1 variants implicated in young onset DM.
Abstract 116: Clinical and biochemical predictors in early pregnancy for development of gestational diabetes mellitus
Authors: Manglunia Ankit , Kanwar JayaBhanu , Mangaraj Swayamsidha , Swain Jayshree , Sahoo Abhay , Sahu Manisha , Pati Tapasi , Mishra Sujata , Pattnaik Tapan , Das Sasmita , Panigrahy Rajashree , Gochhait Somanyoya
Published: August 2024

Background: Early prediction of GDM is vital. Current risk prediction models are based on maternal and clinical parameters, lacking a strong predictive value.

Objective: To identify clinical and biochemical parameters in early pregnancy for prediction of GDM.

Methods: In this prospective cohort study, we screened 581 consecutive healthy women with singleton pregnancy for GDM during their first antenatal visit. Fasting blood samples were collected and stored at -800C. Detailed history and clinical assessment were done for each patient and findings were noted in a pre-specified proforma. GDM was diagnosed as per IADPSG criteria at 24-28 weeks. During prospective follow up, 55 patients developed GDM. A total of 110 age and BMI matched controls were recruited for comparison. We measured OGTT, fasting insulin, HbA1c, hsCRP, uric acid and Lipid Profile. HOMA-IR, HOMA-β and QUICKI were used to estimate insulin sensitivity and β-cell function.

Results: Significant higher proportion of subjects in GDM cohort had presence of Acanthosis nigricans, positive family history of T2DM in 1st degree relative. GDM cohort had significantly higher waist circumference, 2 hr plasma glucose, HbA1c, fasting insulin, HOMA-IR, uric acid and serum triglyceride levels. The area under the curve were as follows: HbA1c - 0.71 (95%CI: 0.628–0.793), Fasting Insulin - 0.748 (95%CI: 0.671–0.826), hsCRP - 0.634 (95%CI: 0.546 - 0.722) and Uric acid - 0.693 (95%CI: 0.606–0.780). Multiple regression analysis revealed HbA1c (OR 4.225; 95%CI – 1.421-12.561), 2 hr PPG (OR 1.026; 95%CI – 1.003-1.049), Insulin (OR 1.057; 95%CI – 1.006-1.111) and uric acid (OR 1.039; 95%CI – 1.026-2.793) to be independently associated with GDM outcome.

Conclusions: Fasting Insulin, HbA1c, HOMA-IR, hsCRP and Uric acid levels are significantly altered in early pregnancy in individuals who develop GDM subsequently. Hence utilization of these parameters may identify at risk group in routine clinical care and help in improving feto-maternal outcome.
Abstract 117: Uncommon presentation of a common disease
Authors: Shruthi B
Published: August 2024

Background: Autoimmune thyroid disorders, particularly Graves’ disease presenting as generalized pruritus is uncommon.

Case Report: This is a case report of 42 y old male driver presented with generalized pruritus at the primary care clinic. His symptoms didn’t resolve on taking antihistamines. The patient was referred to higher center. Pruritus was not associated with any food or fabric allergy, no past history of bronchial asthma, eczema, renal or hepatic disease. On examination, he is not looking jaundiced or pale. Apart from superficial scratch marks on his trunk and all 4 limbs, there were neither skin eruptions, burrows, vesicles, nor scaly lesions to suggest scabies orfungal infection. Incidental findings of tachycardia and a goiter led to the investigations of his thyroid status. There was no exophthalmos, organomegaly or dermopathy. General laboratory investigations were performed and elevated total T4 and suppressed TSH hormone values were found in his thyroid function tests. Tc 99 thyroid scintigraphy showed diffuse increased uptake. He was diagnosed with Graves’ disease and treated with carbimazole. His itching subsided on follow up.

Conclusion: A thorough and complete physical examination is of paramount importance in making an accurate diagnosis.
Abstract 118: Primary hyperaldosteronism presenting as subarachnoid hemorrhage
Authors: Panikar Krish , Ganesh1 H K
Published: August 2024

Background: Primary hyperaldosteronism (PA) develops due to abnormality in the zona glomerulosa of the adrenal gland which results in excessive production of aldosterone. Primary hyperaldosteronism remains an important cause of secondary hypertension. Subarachnoid hemorrhage is a pathological condition in which the blood enters the subarachnoid space.

Case Presentation: A 32 year old female presented with complains of uncontrolled hypertension on antihypertensive drugs. She gives history of a subarachnoid hemorrhage Examination revealed a BP of 170/100 mmhg which was not controlled on antihypertensive agents. Blood test showed a potassium level of 2.7 mmol/l [3.5-5 mmol/l], creatinine 0.9 mg/dl [0.7-1.4], Hb 10.5 gm/dl on the basis of the preliminary blood tests a serum Aldosterone levels were asked which showed 23.7 ng/dl [2-9 ng/dl] A CECT abdomen was done which revealed a lesion in the medial limb of the right adrenal gland.

Conclusion: Primary hyperaldosteronism is an under diagnosed entity and has a higher mortality and morbidity when compared to individuals with essential hypertension. PA should be suspected in all individuals with resistant hypertension even those on multiple drugs and who develop hypokalemia.
Abstract 119: Management of newly diagnosed type 2 diabetes mellitus with HBA1C > 10% in patients reluctant to take insulin
Authors: Panikar Krish , Rai Devdas , Shetty Sumedh
Published: August 2024

Background: Diabetes is pandemic in both developed and developing countries. In India there is great hesitancy to start insulin therapy either due to lack of knowledge, lack of storage facilities or financial constraints. Hence its important to find appropriate management protocols for the same.

Aims and Objectives: To evaluate the efficacy of oral combination therapy with OHAs in newly diagnosed type 2 diabetes patients with HbA1c >10%.

Result: We have observed a significant decrease in the HbA1c levels of both males and females at subsequent visits (p < 0.0001). The HbA1c values showed a statistically significant decrease from baseline to Follow up visit 1 for Males at 12.20 ± 1.99 to 6.67 ± 1.4 and for females from 12.36 ± 2.23 to 6.46 ± 1.76.

Conclusion: Use of initial aggressive oral combination therapy with OHAs helped to achieve early optimal glycemic control. Initial HbA1c >10 % can be controlled with synergistic combinations of appropriate OHAs.initiation of insulin may not be required as suggested by all guidelines.
Abstract 122: Central hypothyroidism presenting with myxedema coma – Two case reports
Authors: Kaur Kirandeep , Kadian Kavita , Batra Nisha , Sridharan Kalyani
Published: August 2024

Background: Myxedema can present with mild cognitive impairment to psychosis to coma. Majority of cases reported are of primary hypothyroidism with few case reports in central hypothyroidism. We report two case reports of myexedema in secondary hypothyroidism.

Case Presentation: A 57-year-old man diagnosed as panhypopituitarism following a road traffic accident 8 years back, presented with hypotension and slurring of speech after stopping hormone supplements. He was started on intravenous steroids for adrenal crisis and previous dose of thyroxine but soon developed a rigid akinetic state followed by coma. He responded well to a loading dose of thyroxine and was discharged on oral steroids, thyroxine and depot testosterone. A 36-year-old female presented with altered sensorium, bradykinesia and shock. After last child birth 1 year back, she developed lactational failure and amenorrhea. Hormonal investigations showed panhypopituitarism. She improved with loading dose of thyroxine and intravenous steroids. Although empty sella is the usual finding in Sheehan's syndrome, neuroimaging in this patient revealed normal sized pituitary with multiple necrotic areas suggesting possible prolonged necrosis.

Conclusion: Myxedema coma in central hypothyroidism is complicated by co-existing pituitary hormone deficiencies and early treatment initiation is important.
Abstract 123: 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 124: Study of lipid profile pattern in type 2 diabetes
Authors: Hegde Sakinya , Shetty Sahana
Published: August 2024

Background: Dyslipidaemia is one of the major risk factors for cardiovascular disease in diabetes mellitus. There is paucity of data on lipid profile pattern in Type 2 Diabetes (T2DM) from our ethnicity.

Aims and Objectives: To determine the prevalence and patterns of dyslipidaemia in T2DM.

Results: A Retrospective study of lipid profile pattern of 476 T2DM patients (men-282, women-197) was performed. The Mean age was 55.6+10.7 years with mean HbA1Cof 9.17+2.07. Sixty percent had BMI>25 kg/m2. The Prevalence of dyslipidaemia was 93.5% (97% in women and 91% in men). Hypertriglyceridemia was seen in 61.5%, decreased HDL-C in 65.6% and increased LDL-C in 69.9%. Isolated raised LDL, Low HDL and raised TG was seen in 18.1%, 13.6% and 2.7% respectively. Mixed Dyslipidemia (Raised TG, Low HDL and high LDL) was seen in 13.6%. Increased LDL and decreased HDL was the most common combined dyslipidemia (15.4%) followed by Abnormal TG and LDL in 13.6% and Elevated TG with low HDL in 2.7%.

Conclusions: There was a high prevalence of Dyslipidaemia with Two thirds of T2DM having abnormal lipid profile. Dyslipidaemia was more common in women as compared to men. Elevated LDL- C was the most common abnormality followed by decreased HDL-C and hypertriglyceridemia in our population.
Abstract 126: Myriad endocrine manifestations of a rare syndrome
Authors: Togarla Srujana , Sahay Rakesh , Neelaveni
Published: August 2024

Background: McCune-Albright syndrome (MAS) is a rare disorder of striking complexity with a prevalence of 1 in 100,000. It arises from somatic, gain-of-function mutations in GNAS.

Aims and Objectives: The Present case series highlights varied manifestations of Mc Cune Albright syndrome.

Case Details: C1: 6 y/o female presented with bleeding per vaginum, breast development. H/o pain in Right hip with difficulty in walking since 3 years. C2: 8 y/o female, presented with progressive genu varum and multiple dental caries. H/o vaginal bleeding and breast enlargement. C3: 6 y/o girl presented with inability to walk, bony pains. H/o multiple fractures with trivial trauma. C4: 16 year boy presented with acral enlargement, coarsening of facial features accelerated height gain. Clinical examination revealed acromegaloid features, gynaecomastia, expressive galactorrhea, goiter. Investigations showed elevated GH, IGF1, PRL. MRI brain showed pituitary enlargement. Clinical examination revealed multiple café au lait macules in all the cases and rachitic changes, hypophosphatemia with low TmP GFR in C2, C3; subclinical hyperthyroidism in C3. Hormonal profile was suggestive of GIPP. Bone scan showed polyostotic fibrous dysplasia.

Conclusion: The broad phenotypic spectrum can make MAS a challenging disorder. All endocrinopathies should be evaluated and managed accordingly.
Abstract 128: Thyroid function abnormalities in hospitalized patients with COVID-19 infection – A cross-sectional study
Authors: Rashmi K G , Patel Deepika , Naik Dukhabandhu , Kamalanathan C Sadishkumar , Sahoo Jayaprakash , Tamilarasu Kadhiravan
Published: August 2024

Background: Thyroid gland expresses ACE-2 receptors. It is thus a potential target for involvement by the COVID virus. Also, the cytokine storm and various drugs used in the treatment for COVID-19 can affect the thyroid function tests.

Aim: To study thyroid function abnormalities in hospitalized patients with COVID19 infection.

Objective: To study the proportion of patients with thyroid function abnormalities in hospitalized patients with COVID-19 infection.

Results: Total 271 Covid -19 patients were included in the study, of which 27 were asymptomatic, 158 mild, 39 moderate and 47 severe categories classified according to the MOHFW criteria. The mean age was 49 ±17 years, 64.9% were male. Abnormal thyroid function test was present in 37.2% (101/271) patients. Low fT3, low fT4 and low TSH were present in 21.03%, 15.9% and 4.5%, respectively. Mean fT3 and fT3/fT4 ratio decreased with increasing severity of COVID-19 illness (p=0.000). In multivariate analysis, low fT3 was associated with increased risk of mortality (OR 12.36, 95% CI: 1.23-124.19; P=0.033).

Conclusion: Low fT3 and fT3/fT4 ratio helps to predicts disease severity. Low fT3 is associated with increased risk of mortality.
Abstract 131: Evaluation of left ventricular systolic function using global longitudinal strain by 2D speckle tracking echocardiography in patients with acromegaly
Authors: Singh Nameirakpam Dhanachand , Acharya Himamshu , Hegde1 Anupama V , Kalra Pramila
Published: August 2024

Background: Acromegaly is a rare disease resulting from Growth hormone excess. It is associated with an increased risk of cardiovascular mortality and morbidity. Global Longitudinal Strain (GLS) analysis by 2D Speckle tracking echocardiography (STE) offers a more sensitive assessment of myocardial contractility, which may help to identify patients with subclinical LV systolic dysfunction. We report a series of 10 subjects with Acromegaly comparing GLS using 2D STE and ejection fraction by the conventional method.

Results: Ten subjects (Male=7, Female=3) with Acromegaly irrespective of their disease activity were included. The mean age was 44.1±7.6. All the subjects had normal ejection fraction, and the mean ejection fraction was 58±2.05%. STE revealed four subjects having abnormal GLS; two had mild, and two had moderately abnormal GLS values. The mean Left Ventricular Mass index was 87.92±23.64 g/m2, and the mean Left Atrial Volume index was 23.2±3.73 ml/m2.

Conclusion: In spite of having normal left ventricular ejection fraction, GLS measured by STE were abnormal among four subjects indicating subclinical LV systolic dysfunction revealing decreased myocardial contractility. This study explores the potential application GLS by 2D STE in subjects with Acromegaly.
Abstract 133: Correlation of inflammatory markers with metabolic and hormonal parameters in first degree relatives of PCOS patients
Authors: Pradhan J , Baliarshinha A K , Choudhury A K , Mishra I
Published: August 2024

Background: PCOS is a state of chronic low-grade inflammation. There is familial clustering of PCOS. Relatively few studies have investigated inflammatory markers in the first-degree relatives of PCOS patients.

Aims and Objectives: The aim of the current study was to estimate the levels of inflammatory markers in first degree relatives of PCOS patient and its correlation with various Metabolic and Hormonal parameters.

Results: Total 66 (41 female and 25 male) first degree relatives of PCOS patients were included. Mean age was 39.3±9.5 years. 22.7% of patient had normal BMI while 48.4% were overweight and 28.7% were obese. The mean hsCRP was 2.47±1.07 mg/L, IL-6 was 3.53±1.07 pg/ml and TWBC was 7.24 x 103/ul. The mean hsCRP was >2 mg/L in all three BMI subgroups. There was significant positive correlation of LH with hsCRP (r=0.428, p<0.001), IL-6 (r=0.680, p<0.001) and TWBC (r=0.738, p<0.001) and significant negative correlation of SHBG levels with hsCRP (r= -0.325, p<0.001), IL-6 (r= -0.560, p<0.001) and TWBC (r= -0.465, p<0.001). There was no correlation of inflammatory markers with weight, BMI, waist circumference, SBP, DBP, FPG, LDL, HDL and HOMA IR.

Conclusion: High mean hsCRP levels suggests that first degree relatives of PCOS patient are at increased risk of future CVD and the higher levels were independent of BMI category. There was significant correlation between the inflammatory markers and SHBG and LH levels but not with metabolic parameters. So, first degree relatives of PCOS patient have chronic low-grade inflammation.
Abstract 137: Improved glycemic control among people with type 2 diabetes with a digital therapeutics approach in collaboration with clinicians
Authors: Singal Arbinder , Verma Ritika , Khader Mohammed Abdul , Tanna Snehal , Lakhani Om , Chavan Ravi , das Rabindra , Modi Alok , Patange Sonali , Ranadive Ruchira , Malde Forum , Guntur Saimala
Published: August 2024

Background: Due to poor diabetes self-management awareness as well as heavy patient burden, management of diabetes in India is challenging for clinicians. Digital therapeutics platforms provide accessible and cost-efficient care through evidence-based guidance for lifestyle and behavioural modifications.

Aim and Objectives: To evaluate the effectiveness of Diabefly® digital therapeutics platform for glycemic control among people with type 2 diabetes.

Results: De-identified data of 144 participants referred by physicians (mean age: 46.42 years, 54.54 % females) on the 90 days Diabefly® program was analyzed. A mean significant reduction in HbA1C was observed by 1.56% (P< 0.001) from baseline 8.59%. Similarly, mean weight and BMI significantly reduced by 2.39 kg and 0.84 kg/m2 (P<0.001 for both) from a baseline of 75.63 kg and 27.34 kg/m2 respectively. Complete FBS and PPBS readings were provided by 56 and 39 participants respectively. A mean reduction in FBS and PPBS was observed by 53.93 mg/dL and 99.25 mg/dl (P < 0.001 for both) from a baseline of 168.2 mg/dL and 234.7 mg/dl respectively.

Conclusion: Significant reduction in HbA1c, weight, BMI, FBS and PPBS was observed after participation in the Diabefly® program. The study thus showed significant improvement in glycemic control in people with diabetes after participation.
Abstract 140: Significant reduction in HbA1c levels among participants with poorly controlled type 2 diabetes on diabefly® digital therapeutics program using multidisciplinary approach
Authors: Singal Chitra Selvan Arbinder , Khader Mohammed Abdul , Verma Ritika , Kalra Sanjay , Samudra Kirti , Thakkar Piya Ballani , Lakhani O M , Thakur Santosh , Shinde Jaydeep , Chitnis Nikhil , Kothari Sneha , Joshi Shilpa
Published: August 2024

Background: Long-term hyperglycemia is a potential risk factor for both macro and microvascular complications in Type 2 diabetes. Digital therapeutics platform can be a highly accessible and cost-effective way in helping these patients with dietary, behavior change and fitness advice aimed towards better glycemic control.

Aims and Objectives: To evaluate the effectiveness of Diabefly® digital therapeutics program using multidisciplinary approach in participants with type 2 diabetes mellitus having HbA1c ≥9%.

Results: De-identified data of 49 participants using Diabefly® platform was analysed. The mean age was 46.12 years and 57.14% were females. At the end of 90 days, a significant mean reduction in HbA1C, body weight and body mass index (BMI) by 3.34%, 2.41 kg and 0.82 kg/m2 (p<0.001 for all) was observed respectively. 26 participants with complete data on waist circumference (WC) showed significant mean reduction by 4.89 cm (p<0.001). Among 21 participants with dietary data a significant mean reduction in carbohydrate and total calorie intake was observed after completion of the program (p<0.001).

Conclusion: This study highlighted that the participants had a significant reduction in their HbA1c, body weight, BMI, WC, and intake of carbohydrate and total calories at the completion of the 90 days Diabefly® program thus making Digital therapeutics an indispensable tool for implementing lifestyle related behaviour change.
Abstract 144: Height adjusted lumbar spine BMD in Turner syndrome: A case control study
Authors: Gargari Piyas , Mukhopadhyay Satinath , Chowdhury Subhankar
Published: August 2024

Background: Short stature may confound results of areal BMD (aBMD) in Turner's Sydrome (TS). Use of Bone Mineral Apparent Density (BMAD) and Height-for –age Z-score (HAZ) adjusted aBMD are recommended for children with short stature. Conflicting results are obtained regarding BMAD of lumbar spine in TS from previous studies.

Aims and Objectives: To assess BMAD and HAZ-adjusted lumbar spine aBMD Z scores in Indian girls with TS.

Methodology: BMD using GE LUNAR DXA machine was performed in 33 TS (age 13-21 yrs) & 11 age matched healthy females (Operator CV-1.2%) BMAD and HAZ-adjusted BMD Z scores were calculated from previously published methods from BMDCS study.

Results: Although unadjusted BMD at lumbar spine suggested a significant reduction in TS (p=0.0148) compared to controls, there was no significant difference in BMAD (p=0.2051) or HAZ-adjusted aBMD (p=0.4826).

Conclusion: Lumbar spine BMAD and HAZ-adjusted aBMDs are not significantly lower in Paediatric Indian TS population. Further studies involving more patients are necessary.
Abstract 145: Etiological profile of precocious puberty: A JIPMER experience
Authors: Suryadevara Varun , Patel Deepika , Rashmi K G , Sahoo Jayaprakash , Kamalanathan Sadishkumar , Naik Dukhabandhu
Published: August 2024

Background: Precocious puberty (PP) is defined as the appearance of secondary sexual characteristics before 8 years in girls and 9 years in boys. The data on the etiological spectrum of precocious puberty from India is limited. Here, we present the analysis of retrospective data of children who presented with PP to the Department of Endocrinology, JIPMER from 2015 to 2021.

Aims and Objectives: To describe the etiological profile of children presenting with PP.

Results: A total of 26 children (16 girls) presented during this period with PP. 17 children presented with central PP (CPP). The median age of presentation was 6 years (range 2.5-8 years). The most common etiology for CPP was idiopathic CPP [n=7 (females-6)]) followed by congenital adrenal hyperplasia (CAH) with CPP (n=5) and hypothalamic hamartoma (n=3). One child developed CPP after surgery and radiotherapy for astrocytoma and another child developed CPP after surgery for Leydig cell tumour. 13 children had peripheral PP (PPP). The median age of presentation was 5 years (range 0.8-8 years). 2 cases each were due to adrenal neoplasms and gonadal neoplasms. 2 girls were diagnosed with Mccune Albright syndrome. 6 children (2 girls) had poorly controlled CAH with peripheral PP. 4 of them had progressed to central PP after optimising the GC medication. A girl was diagnosed with Van Wyk-Grumbach syndrome.

Conclusion: We present here the retrospective data showing the etiological spectrum of precocious puberty from a tertiary medicare centre. The most common cause of CPP was idiopathic CPP whereas the most common cause of peripheral PP was CAH.
Abstract 146: Cleidocranial dysplasia: A rare cause of severe short stature
Authors: Sruthi M Navya , Vivekanand B , Subrahmanyam K A V , Ramesh Jayanthy
Published: August 2024

Background: Cleidocranial dysplasia (CCD) is a rare autosomal dominant skeletal dysplasia due to Runx 2 mutation with 1:1,000,000 incidence, characterized by hypoplastic clavicles, delayed closure of the cranial sutures, dental abnormalities, and short stature.

Aims and Objectives: We report a case of 11year old boy presenting with short stature and classical features of cleidocranial dysplasia.

Results: A 11 year boy with poor height gain since 2 years of age, was found to have severe disproportionate short stature with deciduous teeth, supernumerary teeth, midfacial hypoplasia, flattened nasal bridge, hypertelorism, high arched palate, short thumbs, clinodactyly and anterior apposition of shoulders. Skeletal survey confirmed these findings, along with Brachycephaly with open fontanelles, clavicular hypoplasia, bell shaped thorax, hypoplasia of the pelvis with widened symphysis pubis, coxa vara, pseudoepiphysis of 2nd metacarpal and severe dental anomalies.

Conclusion: A thorough history and examination with radiological support will help in timely diagnosis of CCD in children and adequate treatment.
Abstract 147: The diagnostic accuracy of portable, non-contact, handheld retinal camera in screening diabetic retinopathy
Authors: Ajeesh T , Jabbar P K , Das Darvin V , Indira V , Jayakumari C , Gomez Ramesh , Nair Abilash , Soumya S
Published: August 2024

Background: Hand-held retinal camera (HRC) is a portable device which require less expertise and training with less image acquisition time in identifying diabetic retinopathy (DR).

Aims and Objectives: To find out the diagnostic accuracy of HRC in identifying DR in comparison to the table top fundus camera (TTFC).

Materials and Methods: Adults with diabetes mellitus irrespective of the type and duration, attending the ophthalmology clinic were randomly selected and initially subjected to retinal photography with TTFC on a dilated eye individually by an expert ophthalmologist followed by retinal photography with HRC by a trained resident. The best images of both the devices were graded by ophthalmologist according to the ETDRS classification with proper blinding of the photographs.

Results: 101 subjects (191 eyes) with mean age of 56.86 + 10.75 years were evaluated. 45 eyes with Non Proliferative DR (NPDR) and 1 eye with Proliferative DR (PDR) were diagnosed with TTFC among which HRC identified retinopathy in 34 eyes (33 NPDR & 1 PDR). All 19 cases of Diabetic Macular edema (DME) were identified by HRC. HRC had sensitivity and specificity of 79.9% and 99.3% in diagnosing DR with a positive predictive value of 97.1%.

Conclusion: HRC using mydriasis has good diagnostic accuracy in preliminary DR screening.
Abstract 150: Whole exome sequencing of siblings identifies a novel variant p.A399fs in ANOS1 gene associated with Kallman syndrome
Authors: Sahlot Rahul
Published: August 2024

Background: Kallman Syndrome is an uncommon condition characterised by absent pubertal development and abnormalities of smell, secondary to GnRH deficiency and aplasia or hypoplasia of the olfactory bulb. Kallman Syndrome is the most common cause of isolated hypogonadotropic hypogonadism, but in the majority of cases, genetic diagnosis remains elusive. The arrival of Next-generation Sequencing (NGS) in the clinical landscape has revolutionised genomic research and helped in the expansion of the genetic repertoire of Kallman Syndrome.

Objectives: Identification of the genetic mutation in two siblings with Kallman syndrome.

Methods: Whole exome analysis was performed to identify the genetic defect. The variants were prioritized using standard open-source computational pipelines.

Results: Whole-exome sequencing and computational analysis identified a novel frameshift mutation (c.1195_1196insG) in exon 8 of the ANOS1 (KAL1) gene. The absence of dental agenesis, synkinesis and renal agenesis in one sibling otherwise commonly seen with ANOS1 variants suggest the p.A399fs variant is associated with a milder phenotype.

Conclusions: To the best of our knowledge, this is the first report describing Kallman syndrome due to novel frameshift ANOS1 gene mutations. The report also exemplifies the utility of whole-exome sequencing in cases of atypical presentation of rare diseases.
Abstract 154: Correlation of quality of life and metabolic syndrome using WHO QOL BREF version
Authors: Pathak Vaibhav , Dwivedi Manjari , Gutch Manish
Published: August 2024

Background: The metabolic syndrome has been linked to psychosocial stress along with poor quality of life in a number of studies.

Materials and Methods: The present study conducted in tertiary care health centre of northern India to study the correlation of Metabolic syndrome with quality-of-life assessment. The WHOQOL-BREF (Field Trial Version) produces a quality-of-life profile.

Results: Difference in WHO Quality of Life score of Cases and controls with Central obesity, raised Blood Pressure, reduced HDL cholesterol and raised fasting plasma glucose were found to be statistically significant, however Difference in WHO Quality of Life score of Cases and controls with raised triglyceride levels was found to be statistically non-significant.

Conclusion: Central obesity and raised blood pressure were associated with significantly poorer quality of life with respect to all the 4 domains while reduced HDL Cholesterol and raised fasting plasma glucose levels were associated with poorer quality of life with respect to physical health and psychological domains only.
Abstract 156: Nutrition therapy: Evaluating relevant interactions for therapeutic success
Authors: Mahesh D M , Sridhar C B , Raj Rebecca , Raj Tony , Kurpad Anura V
Published: August 2024

Background: Clinical nutrition services focus on calories and when a patient looses weight, it may result in both fat and protein loss. There is a lacunae in incorporating anthropometric data as part of nutritional services.

Aim: To evaluate nutritional therapy in Diabetes with anthropometric data beyond weight.

Materials and Methods: A total number of 847 diabetes patients in age group 35-71 years referred to Division of Nutrition, St. John's Medical College Hospital, Bangalore were recruited from 2015 to 2017. Anthropometric measurements including Body-Mass-Index (BMI), Waist-circumference (WC), Waist–Hip Ratio (WHR), Mid-ArmCircumference (MAC) were carried out on the patients on the first visit and subsequently on every other visit. A 24-hour dietary and physical activity recall was done by a nutritionist and a specific individualised plan was provided based on current intake. Wherever applicable paired ‘t’ test & univariate regression analysis were carried out between anthropometric, biochemical and dietary variables. The mean follow up was 12 months.

Results: There was a significant positive association between BMI, percent body fat and WC, but not with WHR. On 24-hour dietary recall done during follow up, individuals in all the BMI groups consumed diets that closely matched international dietary recommendations for diabetes in terms of fibre intake, carbohydrate:protein:fat ratio. Patient's blood glucose profiles improved with a decrease in fat intake, without significant weight-loss. The mid-arm-circumference remained same through the study period.

Conclusion: Clinical nutrition programs should utilize anthropometric data like WC & MAC along with dietary recall. Appropriate counselling with balanced diet beyond calories should be provided to achieve a decrease in fat mass without a decrease in mid-arm-circumference to maintain the protein mass. This data compares favourably with the Finnish Diabetes Prevention Study (DPS).
Abstract 157: Early onset VUR: A rare feature of Wolfram syndrome
Authors: Mahesh D M , Reddy Govardhan , Sowmya R
Published: August 2024

Wolfram syndrome (WS), an autosomal recessive disorder is a form of monogenic diabetes that typically presents with insulin dependent diabetes mellitus in childhood and optic atrophy by the age of 16. Most with WS eventually develop diabetes insipidus and deafness, hence the acronym, DIDMOAD (Diabetes Insipidus (DI), Diabetes Mellitus (DM), Optic Atrophy (OA), and Deafness). Other Urological disorders (UD) & Neurological disorders (ND) usually develop at the beginning of the second decade (5% probability at 12–13 years for UD and 14–15 years for ND) and less than 1% have UD in the first decade. We describe one such a rare case of WS with early-onset urological disorder. A 10 year girl was diagnosed with type 1 diabetes at the age of 4 years and managed with basal bolus Insulin therapy. At the age of 6 years she developed urinary retention. Her sonogram & urinary flow studies revealed bilateral hydrouretreonephrosis with reflux uropathy. She was diagnosed with Vesico ureteric reflux (VUR) with neurogenic bladder dysfunction, in which outflow obstruction is induced by detrusor/sphincter dyssynergia. Due to frequent bedwetting a foley's catherter was inserted and remained insitu until she presented to us. For an year, she had polydipsia & polyuria (intake/output of 5-6L/day) despite fairly controlled blood glucose level. Water deprivation test confirmed the diagnosis of Diabetes Insipidus (DI). She had blurring of vision for around 6 months and ophthalmological evaluation revealed optic atrophy with visual acuity of 6/60 in both eyes. She has mild senorineuronal hearing loss. Our rare case with an early-onset urological disorder satisfies the EURO-WABB criteria (2 major+1 minor) for diagnosis of Wolfram (DIDMOAD) Syndrome. The genetic confirmation results are awaited. She is currently being managed with insulin and desmopressin.
Abstract 159: Glomus tumour presenting with oncogenic osteomalacia
Authors: Mathew Anu
Published: August 2024

Introduction: Tumour induced osteomalacia (TIO) is a rare paraneoplastic syndrome of mostly, benign mesenchymal tumours. Glomus tumours causing TIO is a very rare entity. We present a case of unresectable locally invasive glomus tympanicum with hypophosphatemic osteomalacia being misdiagnosed as bone metastases.

Case Synopsis: 55 year old man presented with difficulty walking for the 2 years and wheel chair bound for 3 months. Past medical history revealed multiple surgeries for recurrent glomus tympanicum -left ear in 2011, 2013 and 2015. Tumour recurred in 2019-unresectable. Due to his bone pain, a Tc 99 MDP scan done showed increased tracer uptake in multiple ribs bilaterally and iliac bones which was interpreted as metastasis - given radiation therapy and chemotherapy.
On examination- Lower limb power was 3/5 bilaterally. Other systemic examination was normal. Investigations showed S. Calcium of 8.5 mg/dl, S. phosphorus – 1.3 mg/dl with ALP- 424 IU/L, 25 (OH) D- 21 ng/ml, S. creatinine -0.9 mg/dl and iPTH-115 pg/ml. His 24 hour urine Calcium, Phosphorus and Creatinine were 107 mg, 588 mg and 1260 mg per day. Tubular reabsorption of phosphorus was 70% with TmP GFR of 1.1 suggesting renal phosphate wasting. MRI spine showed multiple vertebral compression fractures and insufficiency fractures of iliac bones suggestive of metabolic bone disease. FGF 23 was 555.6 RU/ml (0-150). Hence tumour induced osteomalacia was diagnosed. Ga DOTANOC showed only the Left glomus tumour and no other lesion. He was started on oral phosphate and Vitamin D. After 3 months his bone pains have reduced by 40-50%, he is walking independently and his S. Phosphorus levels have increased to 2.5 mg/dl.
Abstract 5: Similar hypoglycemia duration with once-weekly insulin icodec versus insulin glargine U100 in insulin naïve or experienced patients with T2D
Authors: Manjunath Aparna , Silver Robert J , Asong Marisse , Begtrup Kamilla , Koefoed Mette M , Heller Simon R , Rosenstock Julio
Published: August 2024

Insulin icodec* (icodec) is a novel once-weekly basal insulin analog in development. This post hoc analysis explored hypoglycemia duration using double-blinded CGM (Dexcom G6®) data from 2 phase 2, randomized, open-label, treat-to-target 16-week trials. One trial compared 3 titration algorithms of icodec vs. insulin glargine U100 (IGlar U100) in 205 insulin-naïve patients with T2D (NCT03951805), the other assessed 154 basal insulin-treated patients with T2D switching from any daily basal insulin to icodec with or without a 100% loading dose vs. IGlar U100 (NCT03922750). In line with ATTD guidelines, a hypoglycemic episode was defined as a CGM period of interstitial glucose (IG) <70 mg/dL for at least 15 min, ending when IG ≥70 mg/dL for at least 15 min. In the titration trial, hypoglycemia duration was similar across all arms: median overall hypoglycemic episode duration (IQR) was 35.0 (20.0, 70.0) min for icodec titrations A (SMBG 80-130 mg/dL ±21 U/wk) and B (80-130 mg/dL ±28 U/wk) and for IGlar U100 (80-130 mg/dL ±4 U/day), and 39.0 (24.0, 70.0) min for icodec titration C (70-108 mg/dL ±28 U/wk). The distribution pattern of hypoglycemic episodes by duration was similar across all treatment arms. Results were similar for nocturnal hypoglycemic episodes. Similarly, in the switch trial, the duration of hypoglycemia was similar between arms, irrespective of loading dose use: median overall hypoglycemic episode duration (IQR) was 40.0 (20.0, 75.0) min for icodec with loading dose, 40.0 (25.0, 80.0) min for icodec without loading dose, and 35.0 (20.0, 60.0) min for IGlar U100. The distribution pattern of hypoglycemic episodes by duration was similar across treatment arms. Similar results were seen for the nocturnal period.

In conclusion, CGM-derived hypoglycemic episode duration was similar with icodec vs. IGlar U100 in insulin-naïve and insulin-experienced patients with T2D, regardless of titration algorithm or initial loading dose use. *Proposed INN.