bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 102
Authors: Nagarajan Vetrivel Babu , Juul Anders , Backeljauw Philippe , Kawai Masanobu , Linglart Agnès , Zuckerman-Levin Nehama , Horikawa Reiko
Published: February 2023

Treatment of short stature in children born small for gestational age (SGA) requires daily growth hormone (GH) injections that can be burdensome for patients and caregivers. Once-weekly somapacitan is a long-acting GH in phase 3 development for replacement therapy in children with GH deficiency. We report the 52-week results of the first phase 2, multinational, randomised, open-label, controlled, dose-finding trial (NCT03878446) investigating efficacy and safety of somapacitan as treatment for short stature in children born SGA compared with daily GH (Norditropin®, Novo Nordisk A/S). Sixty-two (62; 35.5% female) GH-treatment-naïve, prepubertal children received 0.16, 0.20 or 0.24 mg/kg/week subcutaneous (s.c.) somapacitan, or 0.035 or 0.067 mg/kg/day s.c. GH. All children were subsequently included in a long-term safety extension trial.

At week 52, the observed mean height velocity (HV) was 8.5, 10.3 and 10.6 cm/year for 0.16 (n = 12), 0.20 (n = 13) and 0.24 mg/kg/week (n = 12) somapacitan, respectively, versus 9.4 and 11.2 cm/year for 0.035 (n = 11) and 0.067 mg/kg/day (n = 13) GH, respectively. The effect of the three somapacitan doses vs. GH on HV was not statistically significantly different. A similar pattern as seen for HV was observed for changes from baseline in height standard deviation score (SDS) and HV SDS. Dose-dependent increases in IGF-I SDS were observed with somapacitan and GH, and significant exposure-response relationships to HV were established for somapacitan. Among the somapacitan doses investigated, 0.24 mg/kg/week provided an IGF-I response most similar to that of 0.067 mg/kg/day GH.

All somapacitan doses were well tolerated; no safety concerns were identified. Reported AEs were mild to moderate; most were evaluated as unlikely related to treatment by the investigator. The tolerability profile was favourable and consistent with that of GH. Low-titre non-neutralizing hGH anti-drug antibodies were detected in one child in the GH 0.067 mg/kg/day arm; none were detected in other treatment arms. One patient treated with somapacitan 0.20 mg/kg/week developed type 1 diabetes mellitus. This event was evaluated as not related to the treatment. Otherwise, there were no clinically relevant findings with respect to glucose metabolism.

In conclusion, these data support that 0.24 mg/kg/week somapacitan appears most efficacious of the somapacitan doses investigated in short children born SGA after 52 weeks of treatment. Furthermore, the safety and tolerability profiles of this dose are similar to those of 0.067 mg/kg/day GH.
Abstract 107
Authors: Jamwal Juhi , Ganaie Ashraf , Shah Sonaullah , Qadri Syed Mudasir
Published: February 2023

Objectives: While presence of diabetes has been frequently associated with severe Corona virus Disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARSCoV-2), new onset hyperglycemia had been common phenomenon seen in these patients and associated with poor outcomes. Less is known about determinants of this and its long-term outcomes.

Materials and Methods: This were a retrospective and prospective hospital based; observational study and a total of 302 patients who suffered from COVID 19 illness from January 2021 to January, 2022 were included after fulfilling inclusion criteria and procuring informed consent. Patients with diabetes mellitus were excluded from the study. Hyperglycemia was defined as BGF ³ 126 mg/dl or BGR ³ 200 mg/dl or Hba1c ³6.5% on admission or anytime during hospital stay.

Results: Average age of study population was 51.82 ± 18.33 years and male to female ratio was 1.7:1. Out of 302 patients, 40 had mild disease and 262 had moderate to severe disease. 27 patients developed hyperglycemia during their admission and all the patients had suffered severe COVID 19 illness. They were managed with Insulin therapy. One patient had presented with Diabetic ketoacidosis and later diagnosed with Type 1 diabetes mellitus. The major determinants of hyperglycemia were age, BMI, Severity of illness, use of steroids especially methylprednisolone and family history of diabetes. On follow up at 1 year, no new appearance of hyperglycemia was seen in euglycemic subjects and 6 out of 27 patients persisted with diabetes and were managed with oral antidiabetics.

Conclusion: The incidence of new onset diabetes is increased in patients with COVID 19 however, the mechanism of how SARS-CoV-2 might lead to incident diabetes is likely complex and could differ by type 1 and type 2 diabetes. Monitoring of long-term metabolic consequences of COVID 19 illness including Diabetes mellitus is required.
Abstract 115
Authors: Kulhari Akanksha , Phillis-Tsimikasathena  , Dcruzjohn  , Sivarathinasamiramsathish  , Blockchristophe De
Published: February 2023

Background and Aims: TIR (blood glucose 70-180 mg/dl), measured by continuous glucose monitoring (CGM), provides a more comprehensive picture of glycemic control than A1c alone. Derived TIR (dTIR), a calculated estimate of TIR, is useful when CGM data are unavailable. This post hoc analysis of DUAL I investigated the correlation between dTIR and TIR in patients with CGM data.

Materials and Methods: In DUAL I, people with T2D uncontrolled on oral antidiabetic drugs (n = 1663) were randomized 2:1:1 to IDL, degludec or liraglutide, for up to 52 weeks. CGM data were collected using IPro1 and IPro2 (Medtronic). dTIR was calculated from 9-point self-measured blood glucose (SMBG) profiles (minimum 6 points). The Pearson correlation coefficient was used to assess correlation between dTIR and TIR at baseline, and at weeks 26 and 52. Also assessed were the correlation between change in dTIR and change in TIR, from baseline to end of trial (EOT), and the proportion of patients achieving a ³5% increase in TIR or dTIR at weeks 26 and 52.

Results: 260 patients had CGM data. Using dTIR calculated from patients with ³6-point SMBG profiles, a strong correlation was between dTIR and TIR at baseline (n = 207 observations; correlation 0.8838), with a moderate correlation also seen at week 26 (n = 165; correlation 0.5512) and week 52 (n = 152; correlation 0.5184). Change in dTIR and change in TIR, from baseline to EOT, were also correlated (n = 137; correlation 0.7686). Similar results were seen using dTIR calculated using ³7- or ³8-point SMBG profiles. A numerically greater proportion of patients achieved a ³5% increase in dTIR vs. TIR at weeks 26 and 52 (78% vs. 54% and 62% vs. 50%, respectively), perhaps due to missed nocturnal hypoglycemia, and limited data points, measured by SMBG.

Conclusion: These data support the use of dTIR as a surrogate endpoint when CGM data are unavailable, to provide additional information on glycemic control.
Abstract 116
Authors: Singal Arbinder Kumar , Kalra Sanjay , Lathia Tejal , Verma Ritika , Bhatt Javal , Rao K. Vasudeva
Published: February 2023

Background: Digital therapeutics (DTx) platforms can provide evidence-based therapeutic interventions using digital channels to promote long-term behavior change. This study evaluates the real-world data obtained from the Fitterfly Diabetes Program among people with T2DM.

Methods: De-identified data of 287 participants with T2DM (Mean age: 47.38 ± 12.19 years, gender: 61.67% (177/287) female, mean duration of diabetes: 2.70 ± 5.78 years was analyzed. All participants completed 90-days on the Fitterfly Diabetes Program, which offered a combination of mobile application enabled digital logging of meals and physical activity, remote lifestyle coaching, and live video consultations by experts (psychologist, physiotherapist and nutritionist). The outcomes were analyzed at the beginning (baseline) and end of the program. Wilcoxon signed rank test was used for analysis with p < 0.05 considered as statistically significant. All data has been shown as median (IQR).

Results: After completion of the program, a significant median reduction in HbA1c by -1.00 (-2.20, -0.30) % from the baseline of 7.90 (6.90, 9.50) % was observed (p < 0.0001). HbA1c levels were reduced in 86.75% (249/287) participants, among them 57.02% (142/249) participants showed HbA1c reduction of >1%. Among users who started with HbA1c above recommended level (>7%), 51.50% (103/200) reduced their HbA1c in the recommended range. A significant median reduction in body weight by -3.00 (-5.00, -1.00) kg from the baseline of 75.00 (67.00, 84.00) kg was observed (p < 0.0001 for both). Reduction in weight was observed in 82.58% (237/287) participants, among them 44.72% (106/237) showed minimum 5% weight loss. A significant median reduction in waist circumference, fasting blood glucose (FBS), and postprandial blood glucose (PPBS) by -3.00 (-7.00, -1.00) cm, -25.00 (-50.00, -10.00) mg/dL and -52.00 (-91.00, -23.00) mg/dL from a baseline of 99.00 (91.00, 108.00) cm, 138.00 (115.00, 165.00), and 190.00 (157.00, 239.00) mg/dL respectively was observed (p < 0.0001 for all).

Conclusion: Significant improvement in glycemic control was observed after the completion of the program. Participants showed clinically significant reduction in waist circumference and weight. Thus, the Fitterfly Diabetes program can help in effective T2DM management by improving glycemic control and reducing T2DM-related complications. Fitterfly Diabetes Program (a digital therapeutics program) can be an effective tool as an add-on to the doctor’s prescription in addressing the care gaps in T2DM management.
Abstract 122
Authors: Garg Varun , Aroda Vanita R. , Eliasson Johanna , Malling Brian , Meier Juris J. , Nielsen Lasse L. , Vilsbøll Tina , Khunti Kamlesh
Published: February 2023

Background and Aims: Therapies that address multiple risk factors may help patients with type 2 diabetes (T2D) to improve their cardiometabolic risk profile. This exploratory analysis aimed to evaluate the efficacy of oral semaglutide in improving multiple cardiometabolic risk factors vs comparators.

Materials and Methods: In the PIONEER phase 3a clinical trial programme, patients with T2D were randomised to oral semaglutide 14 mg/flex (flexible dose adjustment for PIONEER 7 only) or comparators (empagliflozin 25 mg, sitagliptin 100 mg, liraglutide 1.8 mg or placebo [pbo]). This post hoc analysis evaluated the proportion of patients who achieved specific cardiometabolic endpoints (reductions in HbA1c ³ 1%, body weight ³ 5%, systolic BP ³ 5 mmHg or LDL cholesterol ³ 0.5 mmol/L or an increase in eGFR ³ 0 mL/min/1.73 m2) by the end of the PIONEER 1-8 trials, and the proportion achieving 2,3 and 4 or more of these endpoints. Data were analysed using a logistic regression model with treatment, strata (PIONEER 3-8), interaction strata (PIONEER 5 and 8) and region as categorical fixed effects and baseline value as covariate for the on–treatment without rescue medication data for all randomised patients.

Results: Across trials, greater proportions of patients achieved each endpoint with oral semaglutide vs comparators. Reductions in HbA1c ³ 1% occurred in 47.3-77.1% with oral semaglutide vs 32.8-51.4% with active comparators or 8.5-23.7% with pbo. Reductions in body weight ³ 5% occurred in 30.8-49.8% with oral semaglutide vs 12.7-41.0% with active comparators or 5.4-16.3% with pbo. Reductions in systolic BP ³ 5 mmHg occurred in 47.9-62.5% with oral semaglutide vs 48.8-59.7% with active comparators or 40.1 – 57.9% withpbo. Reductions in LDL cholesterol ³ 0.5 mmol/L occurred in 20.2-27.4% with oral semaglutide vs 13.7-21.1 with active comparators or 12.7-21.7% with pbo. Increases in eGFR ³ 0 mL/min/1.73 m2 occurred in 45.1-54.6% with oral semaglutide vs 37.0-50.0% with active comparators or 32.4-44.5% with pbo. Significantly greater proportions of patients achieved improvements in 2,3 or 4 or more endpoints with oral semaglutide vs comparators across all trials, except for achievement of 2 endpoints with oral semaglutide 14 mg vs liraglutide 1.8 mg in PIONEER 4.

Conclusion: Multifactorial risk factor management is fundamental to long-term risk reduction in patients with T2D. Oral semaglutide was more effective at improving multiple cardiometabolic risk factors vs comparators, indicating its potential to help address the full cardiometabolic profile for patients with T2D.
Abstract 128
Authors: John Anulekha Mary , Reshmy S. Kumar , Francis Anju K , Ann MariyaBinu , David Alice
Published: February 2023

Background: Undiagnosed depression is common and is known to affect various aspects of medical care.

Objective: To comparea) medication adherence, b) glycaemic control, c) adherence to lifestyle modifications and, d) self-careamong diabetic patients with depression as against those without.

Methods: A cross-sectional study was done among outpatients in 2019, who met the inclusion criteria and consented. Malayalam version of PHQ 9, a validated scale was used for screening for depression. All patients who were diagnosed or treated for any psychiatric illness, on psychotropic or with recent stressor were excluded. Enrolled were assessed regarding diabetes self-care practices, medication adherence, glycaemic control, and lifestyle modifications. Baseline blood work including HbA1c was performed. Self-monitoring of blood glucose charts was assessed. A comparison was done based on the acquired data between depressed and non-depressed. All the statistical analysis were performed using SAS ODA software. Suitable statistical tests like chi-square test, and Odds ratio were performed. A p-value < 0.05 was considered to be statistically significant.

Results: Total of 140 patients with 67 (47.8%) females were evaluated. Mean age was 46.5 ± 10.8 years. Mean duration of diabetes was 11.8 ± 8 8.8 years. Mean HbA1c was 9.0 ± 1.92%. There were 79 (56.42%) patients who had depression and among them 37 (26.42%) had moderate to severe depression. Women were 3 times more at risk of depression than men. Those with low adherence to medications had 3.9 times higher chance of being depressed. Depression was not associated with the self-care score but was associated with many aspects of self-care such as regular exercise, eating on time and adherence to medication. Lack of adherence was due to forgetfulness not a wilful decision to not comply.

Conclusion: There was unexpectedly high levels of moderate to severe undiagnosed depression among our diabetic patients. It is important to implement effective screening programs for all diabetic patients and to initiate early intervention programs for high-risk patients. This will help to prevent future complications arising from poor self-care activities and non-compliance to medication as seen in those diabetic patients with undiagnosed depression.
Abstract 145
Authors: Mehta Niragi , Dahale Siddhant , Maldar Aasim , Shah N. F. , Chadha Manoj , Chauhan Phulrenu
Published: February 2023

Background: Wolfram syndrome is an inherited condition that is typically associated with childhood-onset insulin-dependent diabetes mellitus and progressive optic atrophy. Another name for the syndrome is DIDMOAD, which refers to diabetes insipidus, diabetes mellitus, optic atrophy, and deafness. The primary symptoms of Wolfram syndrome (diabetes mellitus, optic atrophy, diabetes insipidus and hearing loss) can emerge at different ages and change at different rates. The exact prevalence of Wolfram syndrome is unknown but a rate of one in 770,000 as estimated in a UK study. In our study, we highlight 4 cases of confirmed and 1 suspected case of Wolfram syndrome from a single center.

Methods: Retrospective study of patients with Wolfram syndrome was done. 5 patients – 4 confirmed (as per EURO-WABBdiagnostic criteria) and 1 suspected from year 2007 – 2020 were isolated. Their clinical profile was studied in detail.

Results: All patients visited our centre in view of hyperglycemia, diagnosis of Type 1 Diabetes Mellitus was done. Age of Diagnosis of DM ranged from 1.5 to 6 years. Optic atrophy was seen inthree cases. Age of onset of Optic atrophy was 6 to 15 years. Hearing loss was recorded infour cases. Age of onset of SNHL ranged from birth to 10 years. Features of Polyuria & Diabetes Insipidus was seen in one patient. Other features like neuropsychiatric symptoms, GIT features, symptoms of hypogonadism and screen for autoimmune disease was also done. Two patients had neuropsychiatric features, one had gastrointestinal symptoms, coeliac disease screen was negative in all patients, one patient had hypothyroidism. Autoimmune screen for type 1 diabetes was positive in two patients. Genetic screening was done in only one patient and Wolfram syndrome was confirmed.

Conclusion: Cases with Wolfram should be followed all their lives. In these cases, rehabilitation to a normal social life is possible with good follow-up and treatment. Due to variability of symptoms, Wolfram syndrome may be overlooked. The condition should be evaluated in a multidisciplinary manner and specific tests are necessary tomake a precise diagnosis and disclose all components of the syndrome. This enables timely rehabilitation of treatable systemic manifestations and allows the detection of carrier state via pre-conceptual counselling and sibling genetic analysis.
Abstract 150
Authors: Sah Umesh
Published: February 2023

Aims and Objectives: To study the clinical spectrum & psychological well-being in Turner’s syndrome. To evaluate bone health with assessment of BMD.

Methodology: Diagnosis of Turner syndrome was done by karyotyping, involving a study of at least 50 metaphases and including G banding. All clinical features & laboratory investigation noted. Areal BMD using HOLOGIC DXA machine was performed inTurner syndrome&both height adjusted & unadjusted BMD Z scores were calculatedfor all the patients. After 20 years of age Z scores (Height unadjusted) were only taken into consideration. GAD 7 & PHQ9 questionnaire are used for psychological assessment if child age (³11 years). GAD 7 score is used for anxiety assessment. PHQ9 questionnaire score were used for depression.

Results: Most common karyotype is 45x (53.3%) followed by 45Xi (Xq) (13.3%). 46XY/45X (6.7%) underwent oophorectomy in view of malignant potential of gonads. The median age of diagnosis of Turner syndrome is 14 Year 3 months; Range (4Y-29Y). The main presenting complaints are short stature (98%) & delayed puberty (91%) including primary amenorrhea. Spontaneous puberty has occurred in 4.5%. Mean height SDS -3.45 and 98% has height below -2 SDS. Mean height SDS change with GH therapy is 1.19 (pvalue:<0.05). 68.2% has low BMD (Z score £-2) without height adjustment &median age of patients having low BMDwithout height adjustment 17 years 5 months (11-29 Years) while 9.1% patient has low BMD (Z score £ -2) with height adjustment. Mild, moderate & severeanxiety are present in 19.4%, 16.7% & 2.8% respectively. Mild, Moderate & severe depression are present in 13.9%, 22.2%, 5.6% respectively. Mild conductive, mild sensorineural & moderate sensorineural hearing loss in right ear is present in 11.1%,11.1% & 2.2% of the patients whilemild conductive & mild sensorineural hearing loss in left ear is present in 4.4% & 8.9% of the patients. Among other clinical stigmata in Turner syndrome includes webbed neck (60%), low hair line (64.4%), wide carrying angle (80%), high arch palate (73.3%), multiple nevi (33.3%), clinodactyly (20%), scoliosis (6.7%). Among cardiovascular complication bicuspid aortic valve (13.3%) & Coarctation of aorta (4.4%). Among ocular manifestation include lateral ptosis (6.2%)& squint (3.2%). Other clinical parameters include kidneyabnormalities (8.8%), hypothyroidism (8.9%), coeliac disease (1.6%) & type 1 DM (1.6%). Among laboratory parameters mean corrected calcium (9.54 mg/dl), mean phosphorous (4.1%) & ALP (199.9 u/l). Impaired glucose tolerance present in Turner syndrome based on FBSL (7.8%), PPBSL (10.4%) & HBA1C (19.3%).

Conclusion: Height adjusted aBMDs are not low in Indian TS population while height unadjusted aBMD is low in Turner patients. Primary amenorrhea & short stature are most common manifestation which often leads to late diagnosis of the syndrome. Early detection and management is important for height outcomes, bone health and psychosocial support. Assessment of comorbidities is important to prevent further complication.
Abstract 155
Authors: Ravindra Shruthi
Published: February 2023

Pituitary stalk interruption syndrome (PSIS) is a rare congenital pituitary anatomical defect that leads to a variable degree of pituitary hormone deficiency. The classic neuroimaging findings of this condition include thin or interrupted stalk, absent or ectopic posterior pituitary, and hypoplastic anterior pituitary gland. The reported incidence of PSIS is 0.5 per 1,00,000 live births. The exact pathophysiology of this syndrome is not fully understood, but chromosomal microdeletions and perinatal asphyxia have some established roles in the literature as primary miscreants.

Here we report a case of an adolescent male child who presented with complaints of short stature and absent secondary sexual characters development, diagnosed with PSIS following an MRI.

A 16-year-old male child was referred to the endocrinology department for the evaluation of short stature and delayed secondary sexual character development. This patient was born out of a non-consanguinous marriage and delivered at term by the vaginal route, with no other significant perinatal or family history. Psychomotor milestones were attained appropriately as per age but had poor linear growth. On examination, he had short stature - height 146 cms (-2.7 SDS), weight: 53.5 kg BMI: 23.5 Kg/m2 with normal vitals. Head-to-toe examination revealed immature facies, deep-seated eyes, broad nasal bridge, bilateral lipomastia, high-pitched voice, Tanner stage: A1P1, SPL:4 cms, the testicular volume of 3cc bilaterally, with rest of the system-wise examinations being normal. Routine laboratory investigations (CBC, RFT, LFT, Electrolytes) were within normal limits. Bone age: 13 years. The hormonal assessment showed central hypothyroidism, hypocortisolemia, and GH insufficiency, with pre-pubertal gonadotropin levels- suggestive of pan-hypopituitarism (Table 1). MRI pituitary showed anterior pituitary hypoplasia with interrupted stalk, and ectopic posterior pituitary, with no other brain anomalies which is consistent with the diagnosis of PSIS. The patient was initiated on hormone replacement therapy, currently taking hydrocortisone, growth hormone, levothyroxine, and testosterone.

PSIS is a rare condition, that can present with various spectrum of clinical features. Signs and symptoms may not be evident in the neonatal and infancy period, therefore diagnosis is often delayed. Early diagnosis and treatment are crucial for preventing adverse effects of long-term hormonal deficiencies and improving the quality of life.
Abstract 191
Authors: Agrawal Rashi , Pavithran Praveen V , Bhavani Nisha , Kumar Harish , Nair Vasantha , Menon Usha
Published: February 2023

Traditionally pharmacological Growth Hormone Stimulation Tests (GHSTs) have been used to distinguish true GHD from ISS and CDGP in pediatric endocrine clinics. However these tests are not physiological and subject the patients to unnecessary stress of multiple samplings and risk of hemodynamic instability. Various clinical and biochemical findings if studied appropriately can predict the need to perform GHSTs in such patients and minimize unnecessary testing.

Aim: To study the role of IGF-1 levels as a predictor of and positive GHSTs in children and adolescents presenting with short stature (SS).

Materials and Methods: Medical records of children and adolescents presenting with SS were retrieved and their demographic data, IGF-1 centiles and results of GHSTs were studied. A positive GHST was taken as peak GH level (<7 ng/ml). Correlation of IGF-1 centile for chronological age and bone age with GHST results was studied and ROC curves were drawn to study the sensitivity and specificity of IGF-1 centiles in predicting positive GHST.

Results: Data of 199 patients presenting with growth failure from 1st January 2010 to 31st March 2021 was collected. 65 females and 134 males were included. Mean age of the cohort was 11 years 4months and mean IGF-1 level was 132.8ng/ml. 166 patients had IGF-1 levels < 30th centile for chronological age. The remainder 33 patients who had IGF-1 centiles > 30th centile for chronological age consistently had negative GHST thus indicating unnecessary pharmacological testing.

Conclusion: GHSTs can thus be avoided in children who have IGF-1 centile >30th centile for chronological age and thus avoid unnecessary stress and risk to the patients.
Abstract 193
Authors: Mukherjee Nilanjan , Borphukan Sawjib , Gogoi Girindranath
Published: February 2023

Introduction: Thyroid hormones (TH) are essential for an adequate growth and development of the kidney. Conversely, the kidney is not only an organ for metabolism and elimination of TH, but also a target organ of some of the iodothyronines’ actions. Thyroid dysfunction causes remarkable changes in glomerular and tubular functions and electrolyte and water homeostasis.

Aim and Objective: To study the kidney function in hypothyroid patients.

Materials and Methods: This observational cross-sectional study includes 38 known diagnosed case of primary hypothyroidism admitted in medicine wards and attending OPD in our hospital excluding pregnant woman, T2DM, patient with known renal disease, patients taking any drugs which can alter renal function & patients suffering from any illness that affect renal function. The collected blood and urine samples from the study population have been estimated for the study parameters. eGFR calculated by MDRD equation.

Results: With a female preponderance of hypothyroidism, urine ACR <30mg/dl was seen in 58% cases, microalbuminuria in 30% cases while macroalbuminuria in 12% cases. High creatinine values seen in 42% cases, stage 2,3 CKD found in 46%,48% cases. A significant positive correlation between urinary Na, K, ACR, Urea, Creatinine with TSH level while an inverse relationship with eGFR and serum Na level. While Free T3 & T4 showing reverse relationship. eGFR was significantly higher, serum creatinine & blood urea is lower in patients who were on treatment.

Conclusion: So in untreated hypothyroid patients, significant alteration in kidney functions occurs. TSH values are negatively correlated with eGFR and positively with microalbuminuria & other kidney functions. Free T3 & T4 have reverse relationship of serum TSH. Hypothyroid patients have higher urinary Na, K loss low eGFR higher serum creatinine, blood urea & albuminuria. It is recommended to check for kidney function in every hypothyroid patient to avoid early derangement of kidney function and to take necessary measure to prevent it.
Abstract 23
Authors: Thaduri Krishna Reddy , Reddy Sandeep Devi , Verpula Madhavi
Published: February 2023

Background: Ectopic thyroid tissue is a rare developmental abnormality due to aberrant embryogenesis of the thyroid gland during its passage from the floor of the primitive foregut to its final pre-tracheal position. Intrathoracic ectopic thyroid is a rare occurence of ectopic thyroid, accounting for about 1% of all mediastinaltumours. They are usually euthyroid and present with pressure symptoms.

Case History: A 40-year-old lady presented with swelling in neck and thyrotoxic features. Biochemistry showed suppressed thyrotropin level with raised triiodothyronine and thyroxine levels. Ultrasound neck showed bulky left lobe with a well-defined isoechoic nodule with a few cystic areas in the lower pole. Technetium scan revealed avid uptake in thymus with suppressed uptake in right lobe of thyroid and non-uniform uptake in left lobe with a cold nodule in left inferior pole of thyroid gland. FNAC of cold nodule showed benign hyperplastic nodule of Bethesda category 2. She was started on methimazole and became euthyroid over following six months. She is under follow-up. Video assisted thoracoscopic biopsy of ectopic thyroid tissue is planned.

Conclusion: Ectopic thyroid tissue is rare and a hyperfunctioningmediastinal thyroid tissue is an even rarer phenomenon. It is important to identify ectopic tissue. Thyroid Scintigraphy plays an important role in diagnosis as highlighted in our case. Follow up for any malignant transformation and management thereof needs special attention requiring multi-disciplinary team approach.
Abstract 30
Authors: Nangadda Narmada , Khadilkar Kranti , Setty Kiranmayi , Lawania Tanuj , Vikneswaran G , Kannan Subramanian
Published: February 2023

Objective: Gestational Diabetes mellitus (GDM) is diagnosed in the second or third trimester of pregnancy that was not clearly present prior to gestation. It is associated with increased maternal and foetal morbidity including increased risks of preeclampsia, large for gestational age newborns, and cesarean birth. Predicting the risk of GDM early in the first trimester will help in appropriate nutritional and life style changes in the mother. Various prediction models using maternal age, family history of DM, BMI, and material glucose and triglycerides have been studied. Using the first trimester Antenatal Ultrasound (AUS) to get data on liver fat, subcutaneous fat thickness (SFT) and visceral fat thickness (VFT), we attempt to build a predictive model for the subsequent risk of GDM.

Methods: After Institutional Ethics committee approval, we conducted a prospective cohort study of all pregnant women who came for Antenatal visit in their first trimester at our institute between Jan 2019 to Oct 2020. A detailed history, anthropometric measurements including BMI, neck circumference, waist: hip ratio were noted. Blood was sent for random blood sugar (RBS) and/or HbA1c. Patients with pre-existing Diabetes, IVF pregnancies and those with liver disease or currently on hepatotoxic drugs were excluded. At 11-13 weeks SFT, VFT and liver fat was estimated using AUS. 75 gm OGTT was done after 24 weeks of gestation and IADPSG criteria were utilized for diagnosis of GDM. The data was divided into two groups based on the development of GDM in the second trimester and analyzed. Risk factors for GDM were tested using univariate analysis. Area under the ROC was constructed to study the accuracy of different variables for predicting GDM. Regression analysis using forward conditional method was used to develop risk prediction model. Goodness of fit of the model was assessed by Homer Lemeshow test. All statistical tests were done using SPSS software v21.

Results: A total of 265 singleton pregnancies were included in our study. The prevalence of GDM was found to be 22% (n = 59). Family history of DM (OR 2.3), history of PCOS (OR 3.5) and presence of Fatty Liver (OR 12.5) was associated with development of GDM (p value <0.01). The area under the curve (in parenthesis) for predicting GDM for BMI > 24.5 kg/m2 (0.82), WHR > 0.88 (0.67), Neck circumference > 32.5 cm (0.74), RBS > 110 (0.85), SFT > 2.5 (0.81), VFT > 4.75 (0.93), Fatty liver (0.6). A model including RBS, VFT and Liver fat gave the best prediction of GDM with an accuracy of 94%.

Conclusion: First trimester AUS is an economical and effective tool in combination with a random glucose to predict GDM.
Abstract 4
Authors: Rastogi Prasoon , Mittal Madhukar , Ganakumar Vanishri , Choudhary Gautam Ram , Kumar Rajesh , Garg M. K.
Published: February 2023

Background: Lithium, a drug that is predominantly used in psychiatric practice, also finds therapeutic use as a second-line agent in endocrine conditions like Graves’ disease and SIADH (Syndrome of Inappropriate Anti-Diuretic Hormone).

Case Report: We had a young female present to us with Graves’ disease and having a precarious renal function (solitary kidney). The patient developed hypersensitivity reaction and hepatotoxicity with methimazole, due to which the anti-thyroid drug had to be withdrawn. As an alternative option, lithium was used successfully to control her hyperthyroidism. Patient became euthyroid within 20 days of starting lithium. Subsequently, the patient underwent successful radioactive iodine ablation (RAIA) under lithium cover, tapering it gradually. Currently, the patient is euthyroid on levothyroxine. The renal functions remained normal. We illustrate this case to discuss therapeutic uses of Lithium in non-psychiatric conditions, specifically Graves’ disease.

Conclusion: Short-term lithium usage can serve as a valuable alternative medical therapy for effectively controlling hyperthyroidism, especially in certain subgroups like the presence of complications with thionamide use, cardiovascular disease, elderly population, and large goiters. It can also serve as an adjunct to RAI therapy, providing interim control of thyrotoxicosis and also enhancing the efficacy of RAI therapy with higher cure rates, faster control, and even attenuation of the surge in thyroid hormones post-RAIA.
Abstract 44
Authors: Agrawal Mayur , Kumar Sanjay , Agrawal Priyanka , Agrawal Shivali
Published: February 2023

Introduction

The Marine-Lenhart Syndrome (MLS) is a very rare condition in which patient has Graves’ disease (GD) along with autonomic functioning thyroid nodules. GD can have hepatic dysfunction either due to autoimmune etiology, hepatic congestion due to cardiovascular effect or hepatic involvement due to anti thyroid drugs. Here, we present the first ever reported case of MLS presenting as hepatitis. To the best of our knowledge, there are no previous case report on this rare condition with this rare presentation.

Case Presentation

A 51-year-old female presented with nausea, vomiting and abdominal pain for 3 weeks. She had decreased appetite, malaiseand jaundice for 10 days when presented to us. She has doubtful past history of taking some thyroid medication 5 years back which she took for about an year. Clinical examination revealed that she had icterus, fine tremors, goitre and looked emantiatied at her presentation. She had slight tenderness at right hypochondrium and looked dehyrated with raised temperature.

Evaluation

Her blood investigation reports also showed deranged Liver funtion tests. The conjugated bilirubin was raised (17 mg/dL). Both SGOT/SGPT (1184/636) and International normalized ratio INR (1.41) were also deranged. The CT scan results revealed the presence of mild hepatomegaly with liver parenchymal disease. The upper GI endoscopy and ECHO was normal. The endoscopic ultrasound reports revealed normal CBD and had no signs of an obstructive cause. HBsAg and HCV tests were negative. FT4 was 84 pmol/L (N 9-21) and TSH was <0.05 mIU/L. The thyrotropin receptor antibody (TRAb) was positive which confirmed the diagnosis of Graves’ disease.

USG guided biopsy of liver was performed in view of deranged liver funtion test. HPE showed acute liver hepatitis and mixed pattern like DILI. The ANA/ANF antibody and IgG antibodies levels were higher, 79.95 IU (N < 20 IU) and 2048 mg/dl (N 700-1600 mg/dl) respectively.

Her provisional diagnosis was GD with autoimmune hepatitis and patient was planned for RIA. Thyroid scan revealed AFTN (autonomous functioning thyroid nodule). Taken all these results together, our final diagnosis was a rare condition of marine Lenhart syndrome with graves’ disease and autoimmune hepatitis.

Treatment

Initially patient was given IV fluids and supportive care. As patient had a deranged LFT and thyrotoxicosis, Lithium at a dose of 300 mg/d was started and it was titrated according to the blood lithium levels. She was given steroids for autoimmune hepatitis. RIA was advised, butpatient did not give consentand Lithium was continued. Patient is euthyroid with normal LFT at present.
Abstract 45
Authors: Ganie Mohd Ashraf , Chowdhury Subhankar , Suri Vanita , Joshi Beena , Bhattacharya Prasanta Kumar , Agrawal Sarita , Malhotra Neena , Sahay Rakesh , Jabbar PuthiyaveettilKhadar , Rozati Roya , Shukla Amlin , Rashid Haroon , Wani Imtiyaz Ahmad , Nair Abilash , Arora Taruna , Kulkarni Bharati
Published: February 2023

Objectives: Clinical biochemistry reference intervals (RIs) are essential benchmarks to interpret patient test results and make clinical decisions. In this study, data on healthy women collected in an ongoing ICMR-National task force study was used to establish normative ranges for common biochemical analytes.

Methods: A total of 13,181 women of reproductive age (18-40 years) were recruited from different urban and rural regions of the country, of which 9,898 women who signed an informed consent were included. Among these, women having features of hyperandrogenism, menstrual cycle irregularities, and with comorbidities were excluded. RIs of 22 analytes were computed in remaining 938 women controls. The 95% of the reference distribution was estimated using 2.5th percentile and 97.5th percentile limits.

Results: The mean ± SD of age and body mass index (BMI) of participants was 30.12 ± 6.32 years and 22.8 ± 3.36 kg/m2 respectively. The median and 2.5th -97.5th percentiles of liver function parameters, lipid parameters, glycaemic parameters, and renal parameters were computed. No significant difference in analytes were observed in relation to the area of residence, and age groups except in albumin (p = 0.03). The distributions for most of the parameters were consistent with the various reference interval studies conducted in India as well as other countries.

Conclusion: This is the first study generating biochemical RIs data among a large representative sample of healthy reproductive age women recruited using a robust design across the country. The resource may serve as reference range for common biochemical analytes for future in this age group.
Abstract 66
Authors: Misra Sukirti , Gada Jugal , Bhagwat Nikhil , Varthakavi Premlata
Published: February 2023

Objective: There is a lack of consensus on the optimal screening strategy for insulin resistance (IR), particularly in lean PCOS. We, therefore, estimated glucose and insulin excursions, IR, insulin sensitivity (IS), and beta-cell function (ßF) and looked for surrogate markers of IR on a 5-point oral glucose tolerance test (OGTT) in PCOS subjects.

Design: Cross-sectional study

Patient(s): 80 PCOS subjects and 80 age and BMI - matched controls.

Intervention(s): 75-gram OGTT (0, 30, 60, 90,120 minutes) was performed after clinical and anthropometric evaluation, and glucose, insulin, and androgens were estimated.

Result(s): Cases had similar glucose but higher insulin and insulin-AUClevels as compared to their respective controls (p < 0.05). Lean PCOS were more hyperinsulinemic compared even to the obese controls (p < 0.05). Although ßF was comparable to obese cases, lean PCOS had better insulin sensitivity (p < 0.05). DHEAS and androstenedione decreased with increasing BMI in the lean cases and this correlated with deteriorating insulin sensitivity with exaggerated hyperinsulinemia. In obese PCOS only SHBG correlated negatively with BMI, hyperinsulinemia, and positively with insulin sensitivity. On applying ROC to glucose-stimulated insulin values, 90 minutes (insulin cut-off = 52.3 mIU/ml) had the best predictive power for IR. Forty percent of subjects classified as non-IR (based on fasting insulin, HOMA-IR, and QUICKI) crossed this threshold.

Conclusion(s): Lean PCOS had significant hyperinsulinemia and reduced insulin sensitivity compared to lean and obese controls. DHEAS and androstenedione may have a beneficial effect on insulin sensitivity and could be negative markers of IR in lean PCOS. Declining SHBG predicted worsening IR in obese PCOS.
Abstract 83
Authors: Kyatham Vivek , Palle Sharmila , Bhandiwad Chandrashekhar , raoPaidipally Srinivasa , Danda Vijay Sheker R.
Published: February 2023

Background: It is well known that the secretion of Growth Hormone (GH) is markedly reduced in obese individualscompared to age matched controls. Many central and peripheral factors have been implicated in GH suppression inobesity. In this study, we sought to know the effect of Body Mass Index (BMI) on GH secretion in obese adults. Using a cut-off of 3 ng/dl for Glucagon Stimulation Test (GST) in obese hypopituitary subjects will overdiagnose Growth Hormone Deficiency (GHD), which is important given the increasing prevalence of obesity inIndia. In this study we intended to determine the optimal peak GH cut-offs to diagnose GHD inoverweight/obese pituitary patients using the GST in South Indian population.

Methods: In this hospital based cross sectional study exogenous overweight/obese subjects and overweight/obese Hypo-pituitary patientsattending the Endocrinology OPD were taken for the study.

Results: Using a traditional GH peak cut-off of 3 ng/ml after GST would classify 30% (n = 3/20) of (overweight) OW/Obese subjects as GHD. Using a cut off of 1.5 ng/ml, 10% of OW/Obese subjects and 50% of hypo pituitarysubjects will be classified as GHD, when compared to 30% and 95% respectively if cutoff of 3 ng/ml is used.

Conclusion: This study suggests that there is likely over diagnosis of GHD in overweight and obese individuals using currently established peak GH cut off value of 3 ng/mL for the GST. Instead, a peak GH cut-off of 1.5 ng/mL allows for preserved sensitivity with much improved specificity for the diagnosis of GHD in overweight and obese hypopituitary patients. Larger studies are needed to confirm BMI-stratified peak GH cut-off levels to define adult GHD in this population.
Abstract 93
Authors: Rameez Raja B , Natarajan Vasanthiy , Sridhar Subbiah
Published: February 2023

Introduction: Pituitary stalk interruption syndrome (PSIS) is a rare congenital disorder with an estimated incidence rate of 5/1,000,000 births. Pituitary stalk interruption syndrome (PSIS) is characterized by a triad of a thin or interrupted pituitary stalk, aplasia or hypoplasia of the anterior pituitary, and absent or ectopic posterior pituitary (EPP) seen on magnetic resonance imaging (MRI). It can present either at birth or later in life. PSIS is very heterogeneous with respect to its hormonal, clinical, and radiological manifestations. In this study, we analyze the clinical, biochemical, and radiological characteristics of PSIS, in patients with growth hormone deficiency (GHD) cohort.

Materials and Methods: The study was conducted in 3000 bedded multi-specialtytertiary care centerin South Tamil Nadu between the year 2020 and 2022, after IEC approval. 75 short stature patients with GHDwere included in this study. Among them, 14 patients were diagnosed with PSIS. Their clinical, biochemical, and radiological characteristics and response to GH therapy were analyzed.

Results: 14 (18.6%) patients were diagnosed with PSIS. The mean age at diagnosis was 11.8 ± 2.6 years (Range 2.3-18 years). The male to female ratio was 2.5:1. The mean birth weight was 2.9 ± 0.4 kg. 21.4% of patients had a breech presentation. 4 (28.57%) patients had birth asphyxia, and one (7.14%) had micropenis and bilateral cryptorchidism at birth. Only one (7%) patient had midline clinical manifestations like cleft lip and cleft palate. In addition, two (14%) had bilateral squint with nystagmus. 8 (57.15%) patients had combined pituitary hormone deficiency (CPHD),5 (35.71%) had isolated growth hormone deficiency (IGHD) and only one (7.14%) had central diabetes insipidus. EPP was seen near median eminence in 6 (42.85%) patients, elsewhere (along the stalk, near the floor of the third ventricle, near the hypothalamus) in 4 (28.57%) patients, and absent in 4 (28.57%) patients. 2 (14.28%) patients had extra pituitary malformations (EPM) in MRI. PSIS cohorts who were receiving GH therapy had better growth response on an average of 10 cm per year when compared to other etiologies during the first 3 years of treatment.

Conclusion: Male gender, sporadic onset, breech presentation, and the presence of extra pituitary clinical manifestations like midline defects, and nystagmus are more common in patients with PSIS. Severe GHD as well as multiple pituitary hormone deficiency were more common but posterior pituitary involvement is very rare despite classical MRI findings. Clinical suspicion of these features in all short stature may lead to early diagnosis and prompt initiation of GH treatment. Hence individual hormonal sufficiency or deficiency should be established in all PSIS and based on MRIhormonal therapy should not be initiated.
Abstract 99
Authors: Bansal Ayushi , Kukrele Prianka
Published: February 2023

Background: International Diabetes federation 2021 states that approximately 537 million adults are living with DM and is expected to rise to 643 million by 20301. It also states that among 88 million people having diabetes in southeast Asia, 77 million belong to India, making India as diabetic capital of world1. DMis associated with severe microvascular and macrovascular complications leading to major implications on public health. DPN (Diabetic peripheral neuropathy) is one of the most common, earliest and serious complication of DM. However, limited data is available on prevalence of DPN in central part of the country, thus our study is focused on the prevalence of DPN in this part of country, where we mostly have rural population.

Methods: An observational study was conducted in T2DM patients presenting to tertiary care center in Jabalpur, MP. Sample size of 150 was calculated using formula n = z2pq/d2 with prevalence of DPN as 20%. T2DM patients presenting in OPD/IPD were examined using preformed questionnaire based on various signs and symptoms and confirmed by nerve conduction study (NCS) recorded using RMS Aleron 201 electromyography machine. NCS was recorded single handedly and reported by single neurologist to avoid bias.

Results: Among 150 patients, 102 (68%) developed DPN. Age of the patient is not found to be significant risk factor for DPN in our study (p value > 0.05). Patients presented with sensation of burn (25.33%) followed by numbness (18%), tingling (11.33%), pricking (2%), diabetic foot (2.6%). Surprisingly, 20% were asymptomatic even at the time of presentation. Significant correlation of DPN is found with duration of DM (p value < 0.05). As the duration of diabetes increases to >10 years’ prevalence of DPN increases to as high as 87.1%. Surprisingly, we also found that 54.5% patients already had neuropathy at the time of diagnosis. In our study, HbA1c is found to be a significant risk factor for DPN (p value < 0.0001) with prevalence of neuropathy to be as high as 90% where HbA1c > 10%.

Discussion: Indian Journal of community medicine estimates prevalence of DPN in India vary widely from 9.6% to 78% in different populations2 ranging from 29.2% in north India to 47% in south India whereas studies lack in central India. Though, our study was conducted in tertiary care center but included mainly referred rural population. Due to poor glycemic control and negligence of rural patients, our study shows prevalence of DPN to be as high as 68%. Most common symptom was found to be burn sensation while around 20% were asymptomatic at the time of presentation. Significant correlation of DPN is found with duration of DM and HbA1c. Thus, better glycemic control and early diagnosis of T2DM will reduce DPN related complications like foot ulcerations and amputations, gait disturbances.