bluuebunny/crossref_metadata_2025 huggingface dataset:
Integrated Magnetic Carbon-Based Materials as Promising Adsorbents for the Removal of Heavy Metals
Authors: Vishnu Dhanya , Lawrence Lazarus Vijune , Pal Swagata
Published: August 2024

Heavy metal toxicity is an alarming challenge, since these metals exhibit negative impacts on ecosystem and human health. Carbon-based materials hold the promising, alternative, and effective material to eliminate pollutants in contaminated soils as it acts as a heavy metal adsorbent in soil remediation. Interestingly, carbon-based materials integrated with magnetic particles possess an enhanced absorption capacity in the heavy metal removal and it also removes the other organic contaminants. Moreover, new approaches are developed by using carbon-based materials integrated with magnetic particles for their long-term, cost effective, and sustainable prospects to environmental pollution. This chapter focused on the role and conspicuousness of carbon-based materials integrated with magnetic particles taking into account in heavy metal removal. Moreover, this chapter ultimately grasped the highlights of contemporary advances in these materials as adsorbents. Carbon-based materials eventually reduce the heavy metal toxicity besides being as a soil rejuvenators.
From Data to Decisions on Artificial Intelligence's Influence on Digital Marketing Research
Authors: Arun R. , Bhakar Shilpa , Turlapati Venkata Ramaiah , Shanthi P. , Saikumari V.
Published: August 2024

Digital marketing is transforming, spurred by the development of computers and algorithms capable of cognitive behavior, autonomous decision-making, and human oversight. The primary element behind this shift is artificial intelligence (AI). The potential of customizing artificial intelligence software to meet the individual needs and objectives of an organization can greatly benefit online enterprises. Despite being a nascent technology, artificial intelligence poses problems for firms seeking to distinguish themselves in fiercely competitive industries. However, its potential for being highly advantageous remains unchanged. If businesses lack a comprehensive understanding of the deployment of artificial intelligence, they may not be able to exploit its potential fully. Ongoing research is being conducted to enhance the dependability and ethical standards of artificial intelligence (AI) systems in response to concerns over ethics and privacy in AI.
Insights Into AI Systems for Recognizing Human Emotions, Actions, and Gestures
Authors: Padmaja S. , Mishra Sunil , Mishra Arjyalopa , Tembra Juan José Varela , Paramasivan P. , Rajest S. Suman
Published: August 2024

The capacity of AI systems to recognize and interpret human emotions, actions, and gestures is reshaping numerous sectors, from entertainment to security. This chapter offers a comprehensive review of the current state-of-the-art technologies in this domain, shedding light on their strengths, potential limitations, and avenues for improvement. In recent years, systems capable of recognizing and understanding human emotions, actions, and gestures have shown remarkable progress. They are deployed in diverse applications, including virtual reality, healthcare, and human-computer interaction. However, understanding their capabilities and limitations is crucial to harness their potential fully. Our research provides a deep dive into the strengths of existing AI systems, showcasing their ability to accurately decipher complex human expressions, movements, and emotional states. We also critically examine potential limitations, such as bias in training data or challenges in recognizing subtle cultural nuances.
Exploring Motivations for Fast-Food Consumption at Global Chains in Sri Lanka: The Mediating Role of Social Influence
Authors: Dassanayake D. M. C.
Published: August 2024

This exploratory sequential mixed-methods study examines the motives for dining at international fast-food restaurants in Sri Lanka, leveraging online data collection for both qualitative and quantitative phases. The initial qualitative phase, administered through an open-ended question online involving 356 participants, identified a range of motives informing the structured questionnaire that was used in the quantitative phase, which yielded 153 responses. The exploratory factor analysis highlighted four principal motives: Perceived Value and Quality, Personal Enjoyment and Variety, Social Influence, and Convenience, which align with the Consumption Value Theory to the greatest extent. The multiple regression analysis revealed the significant mediating role of social factors in determining the behavioral intention toward fast-food consumption. These findings show that in Sri Lanka's fast-food sector, consumer choices and preferences are multifacetedly shaped by a combination of personal preferences and social influences. The study's insights are crucial for international fast-food chains, underscoring the need to develop marketing strategies that align with the unique socio-cultural dynamics of the Sri Lankan market.
TLR3/TRIF and MAVS Signaling Is Essential in Regulating Mucosal T Cell Responses during Rotavirus Infection
Authors: Zhang Rong-Rong , Yang Xue-Yao , Yang Yong-Lei , Guo Tian-Kui , Huang Jing-Shu , Yang Ying-Shi , Shi Chun-Wei , Yang Gui-Lian , Huang Hai-Bin , Wang Jian-Zhong , Jiang Yan-Long , Cao Xin , Wang Nan , Zeng Yan , Yang Wen-Tao , Wang Chun-Feng
Published: August 2024

The functions of the natural dsRNA sensors TLR3 (TRIF) and RIG-I (MAVS) are crucial during viral challenge and have not been accurately clarified in adaptive immune responses to rotavirus (RV) infection. In this study, we found that RV infection caused severe pathological damage to the small intestine of TLR3−/− and TRIF−/− mice. Our data found that dendritic cells from TLR3−/− and TRIF−/− mice had impaired Ag presentation to the RV and attenuated initiation of T cells upon viral infection. These attenuated functions resulted in impaired CD4+ T and CD8+ T function in mice lacking TLR3-TRIF signaling postinfection. Additionally, attenuated proliferative capacity of T cells from TLR3−/− and TRIF−/− mice was observed. Subsequently, we observed a significant reduction in the absolute number of memory T cells in the spleen and mesenteric lymph node (MLN) of TRIF−/− recipient mice following RV infection in a bone marrow chimeric model. Furthermore, there was reduced migration of type 2 classical dendritic cells from the intestine to MLNs after RV infection in TLR3−/− and TRIF−/− mice. Notably, RV infection resulted in attenuated killing of spleen and MLN tissues in TRIF−/− and MAVS−/− mice. Finally, we demonstrated that RV infection promoted apoptosis of CD8+ T cells in TRIF−/− and TLR3−/−MAVS−/− mice. Taken together, our findings highlight an important mechanism of TLR3 signaling through TRIF in mucosal T cell responses to RV and lay the foundation for the development of a novel vaccine.
Soggetti che si amano. La vita della coppia dal miele dell’amore romantico all’acido del calo del desiderio e oltre
Authors: Frati Fulvio
Published: August 2024

Soggetti che si amano. La vita della coppia dal miele dell’amore romantico all’acido del calo del desiderio e oltre is the latest book publishedby Giuseppe D'Amore (Psychologist, Psychotherapist and Psychoanalyst, MemberOrdinary of the Italian Society of Relationship Psychoanalysis). Released at the beginning of 2023, it represents at least in part the ideal continuation of the previous volume by the same author, 'Subjects that meet.From the relationship with others to the relationship with oneself... and vice versa',printed in 2021 also with the same publisher and whose review was published in No. 3, Year XXXIII, 2022 of Ricerca Psicoanalitica(pp. 637-641). [...]
Recensione ‘Settant’anni tra psicoanalisi e dintorni. Dialoghi e interviste’
Authors: Pellegrini Pietro
Published: August 2024

Un libro inatteso ma molto gradito che raccoglie nove interviste pubblicate dal 1984 al 2022 da Pier Francesco Galli, medico, psicologo clinico e psicoanalista. Le interviste sono editate in ordine cronologico, subito dopo quella iniziale di Francesco Merini del 2001 nella quale, come scrive Paolo Migone nell’introduzione, «sono intrecciati, in modo coinvolgente, aspetti sia professionali che personali» (p. 7).
La lettura delle interviste, una dopo l’altra, consente in una visione d’insieme di cogliere i diversi rimandi e collegamenti, e tante sono le possibili chiavi di lettura. Una è quella che va dal locale, cioè dalle radici dell’Autore, nocerine, ma anche un po’ marchigiane e poi bolognesi, fino all’internazionale, non solo Milano, Basilea e Zurigo ma una rete di contatti con intellettuali e clinici di vari Paesi (Germania, Francia, Brasile, Regno Unito, Stati Uniti). Un ‘glocal’ ante litteram che porta Galli a costruire e diffondere cultura tramite quella che Valeria Babini (2009) chiamerà l’’università dei libri’ fondata da Galli, riferendosi alla collana ‘Biblioteca di Psichiatria e di Psicologia Clinica’ pubblicata da Feltrinelli, al ‘Programma di Psicologia, Psichiatria e Psicoterapia’ di Boringhieri e alla rivista Psicoterapia e Scienze Umane. Testi molto preziosi che all’epoca colmarono un divario della cultura italiana rispetto a quella europea e nordamericana, determinato dalla dittatura fascista e da molteplici resistenze sia in ambito religioso che accademico. Testi che oggi sono in molti casi esauriti e che sarebbe molto importante riproporre a studenti e lettori.[...]
Prendersi cura della sofferenza all’interno di una famiglia
Authors: Abbruzzese Mariacarmela , Vincenti Enrico
Published: August 2024

Nel nostro studio, ci siamo posti l’arduo compito di coniugare la complessità delle relazioni familiari con l’unitarietà del singolo individuo, riconoscendo che la sofferenza umana è intrecciata inestricabilmente con l’ambiente in cui ci si sviluppa. Abbiamo fondato il ‘Centro Studi Famiglia e Gruppo - Il Pruno’, con l’obiettivo di esplorare e comprendere le molteplici manifestazioni del disagio e della sofferenza umana in tutti i loro contesti e forme. Il nostro approccio non cerca di semplificare o categorizzare i fenomeni, ma piuttosto di abbracciare la loro complessità e unicità. Ogni richiesta di aiuto viene accolta con attenzione e curiosità, senza dare per scontato il percorso che ne seguirà. Il nostro modello clinico si basa su una visione non riduzionistica del soggetto, che va oltre la sintomatologia e la diagnosi patologica. Inoltre, riteniamo che l’essere umano si sviluppi continuamente in un ‘presente continuo’, organizzandosi in base ai suoi elementi costitutivi e interagendo costantemente con il proprio ambiente. Questo processo avviene in modo implicito, attraverso relazioni auto-regolatorie che definiscono la sua singolarità. Nella nostra società occidentale, la famiglia gioca un ruolo primario nella formazione e nell’attuazione del sé. Pertanto, le soluzioni adottate dal soggetto riflettono anche l’influenza dei genitori, della cultura e dell’ambiente familiare. Per illustrare il nostro approccio clinico, consideriamo una situazione tipo, nella quale ci impegniamo ad accogliere il soggetto sofferente nella sua unicità e complessità, esplorando le dinamiche familiari e individuali per trovare modalità di intervento appropriate e personalizzate.
Commento al caso clinico di Abbruzzese e Vincenti
Authors: Magnoli Raffaelina
Published: August 2024

Quando ci viene fatta una richiesta di aiuto le prime fasi della consultazione possono darci degli elementi essenziali per la costruzione di un’ipotesi esplicativa della funzione del sintomo e del tipo di setting più adatto.
Per prima cosa prendiamo in esame la domanda: chi chiede aiuto? Chi manifesta un sintomo? Chi ne soffre? Non sempre queste tre caratteristiche appartengono ad un’unica persona.
Poi ci chiediamo qual è la fase del ciclo vitale che sta attraversando la persona che chiede aiuto e gli altri componenti la sua famiglia; perché chiede aiuto adesso?
E quindi, qual è la domanda latente inconscia sottostante alla domanda manifesta? [...]
Role of ACE2 and TMPRSS2 polymorphisms in clinical severity and outcomes of COVID-19 in Egypt
Authors: Samy Walaa , Gaber Osama A. , Amer Rania M. , El-Deeb Nahawand A. , Abdelmoaty Ahmed A. , Sharaf Ahmed L. , El-Gebaly Ahmed M. , Mosbah Rasha , Alsadik Maha E. , Fawzy Amal , Ahmed Alshymaa A.
Published: August 2024

Background: The clinical presentations of coronavirus disease 2019 (COVID-19) exhibit significant variation, ranging from asymptomatic cases to mortality resulting from severe pneumonia. Host genetics can partially explain this variation.Objective: This study evaluated possible associations between severity and outcome of COVID-19 and single nucleotide polymorphism (SNP) rs2285666 in the ACE2 gene and SNP rs2070788 in the TMPRSS2 gene.Methods: The study included a sample of 100 consecutive adult patients admitted to the COVID-19 Isolation and Intensive Care Units of the Zagazig University Hospitals, Zagazig, Egypt from July 2021 to November 2021. For rs2285666, polymerase chain reaction-restriction fragment length polymorphism was carried out. For rs2070788, real-time polymerase chain reaction was performed.Results: For rs2285666, the GA genotype was the most frequent among female patients (39% [16/41]) and the A genotype was more prevalent among male patients (54.2% [32/59]). For rs2070788, the AA genotype was the most frequent among all patients (46% [46/100]). No rs2285666 or rs2070788 genotypes or allele frequencies had significant associations with either severity or outcomes of patients.Conclusion: This study found no significant associations of COVID-19 severity or outcomes of patients with genotypes or allele frequencies of the rs2285666 SNP in the ACE2 gene or the rs2070788 SNP of the TMPRSS2 gene. The search for other genetic associations with COVID-19 infection is still required.What this study adds: The study reveals that host genetics explain the variation observed in the disease. Specific genetic variants can confer either increased susceptibility or resistance to the disease.
Reasons for premature removal of progestogen implant among women in a community in Pretoria
Authors: Moeletsi Wanda M. , Nyalunga Suzan L.N. , Ramochele Margaret M.M. , Bongongo Tombo
Published: August 2024

Background: Implanon is widely used in South Africa and around the world. However, a significant number of users discontinue it prematurely. The current study aims to explore the reasons for women’s early removal of the progestogen implant, known as Implanon, in a Pretoria community.Methods: This was a qualitative study applying a descriptive phenomenological design, with nine one-on-one interviews done at Temba Community Health Centre among women who had their Implanon implants removed sooner than the intended length of time.Results: Four major themes emerged from the data collection: reasons for choosing Implanon, side effects of Implanon, the social impact of Implanon and public attitudes towards Implanon. These four themes were further explored through 13 subthemes.Conclusion: The participants acknowledged and valued the benefits of Implanon, but they also encountered undesirable side effects such headaches, bleeding, breast pain and enlargement, decreased libido, and mood swings. The primary causes of the implant’s early removal were these side effects, among which bleeding was the most frequently reported problem.Contribution: Implanon-induced bleeding has an impact on the economics of households and the sexual lives of women, as it requires the purchasing of sanitary products and other medications.
Abstract 13: Isolated bicarbonaturia: A rare case of proximal renal tubular acidosis
Authors: Kachroo Varsha , Wangnoo Subash Kumar , Siddiqui Mohammad Asim
Published: August 2024

Case Report: A 9 years old girl presented to us with progressive bowing of legs since 2 years of age and failure to gain height since 5 years of age. She had previously received calcium and Vitamin D supplements multiple times since the age of 2 years. Her parents noticed knock knees since 5 years of age. She had undergone corrective surgery for deformity before admission. On examination, Bone age <Height age< Chronological age. Height was less than 3rd percentile and weight was 50th percentile. On evaluation, she had hyperchloremic normal anion gap metabolic acidosis and positive urinary anion gap, no evidence of nephrocalcinosis. She was having bicarbonaturia but no glucosuria, aminoaciduria, phosphaturia. So possibly a case of isolated bicarbonaturia. For this, a more common candidate gene SLC4A4 mutation was tested but was negative. Since there can be many other candidate genes involved, testing each and every potential gene couldn’t be done. Meanwhile patient was started on sodium bicarbonate, calcitriol, calcium and vitamin D supplementation.

Conclusion: As an isolated defect for bicarbonate transport, proximal RTA is rare and is more often associated with Fanconi syndrome. Many candidate genes could be involved in the etiology yet to be discovered.
Abstract 14: Cause of PTH independent hypercalcemia other than malignancy and granulomatous disorders
Authors: Kachroo Varsha , Wangnoo Subash Kumar , Siddiqui Mohammad Asim
Published: August 2024

Case Report: We report cases of five patients. All females in the age group of 75 to 80 years. They presented to us in altered sensorium. Underlying comorbidities were hypertension and diabetes. After ruling out most probable diagnosis which was stroke, next differential was dyselectrolytemia. We found hypercalcemia in all the patients which was PTH independent with S. Calcium value >12 mg/dl. Prolonged intake of calcium and Vit D supplements was ruled out Keeping age in consideration, the most common differential of PTH independent hypercalcemia malignancy followed by granulomatous disease were ruled out in all the patients by doing PET CT/MR. Activated Vit D and ACE levels were also negative. No evidence of hyperthyroidism or adrenal insufficiency. We managed on the lines of acute hypercalcemia. 4 patients responded well and 1 continued to be in altered sensorium due to superadded sepsis. So excluding other causes, we had made an impression of uncommon cause of hypercalcemia which is immobilization. Although these females had not undergone any trauma. They were mostly bed bound. The pathophysiology of Immobilization related hypercalcemia (IH) is unclear. It is said that muscle activity transmits signal for bone formation through osteocytes and with immobility, mechanical stimulation is reduced, causing unopposed resorption.

Conclusion: IH is an unknown complication in immobile patients. If untreated, patients can land up with complications of hypercalcemia.
Abstract 64: Clinical and hormonal profile of congenital adrenal hyperplasia from a tertiary centre in India
Authors: Harshitha B , Kalra Pramila
Published: August 2024

Background: Congenital adrenal hyperplasia (CAH) is a group of autosomal recessive disorders due to defect in enzymes involved in adrenal steroidogenesis with varied clinical presentations.

Aims and Objectives: To understand the clinical and hormonal profile of individuals with CAH.

Results: Twenty nine patients were included in this cross sectional study ( males (n) =15 (51.7%)) and females (n=14 (48.3%)) (adults=11) (born out of consanguineous marriage = 22 and 3 pairs of siblings). Thirteen patients had salt wasting (SW) phenotype, 14 had simple virilizing (SV) and 2 had non classical CAH (NCCAH). The presentation of SW phenotype was salt wasting crisis in males and ambiguous genitalia in females. The presentation of SV phenotype was clitoromegaly in females; precocious puberty and premature adrenarche in males. All the patients with NCCAH were females with virilization and primary amenorrhea. Majority of patients are on hydrocortisone (82.7%), the rest on prednisolone (13.7%) and dexamethasone (3.4%). Adult females with SV and NCCAH phenotypes had higher 17OHP levels at follow up. Mean adult height of patients with NCCAH was better than SV patients (154.5 cms vs 145.2 cms)

Conclusions: The presentation of CAH may be varied but a screening at birth will help us to detect it early.
Abstract 70: High dose intravenous therapy augments complete anterior pituitary hormoanl recovery in primary autoimmune hypophysitis
Authors: Brijesh K , Shah Ravikumar , Memon Saba , Patil Virendra , Lila Anurag , Shah Nalini , Bandgar Tushar
Published: August 2024

Background: Glucocorticoid treatment of primary autoimmune hypophysitis (PAH) is well established; however, dose, route, and recovery predictors are not well-defined.

Aims: Systematic review of published literature for use of glucocorticoids as first line of management in PAH- to analyze treatment protocol, baseline and post-treatment clinical, hormonal, and radiological features.

Results: 152 cases (females-69.8%; age-41±13.9 years) with PAH [(94-oral steroid group (OSG); 58-intravenous steroid group (IVSG)] were included. Clinical recovery [headache, 79% vs.97%; visual deficits, 58% vs.90%; cranial nerve palsy, 50% vs.87%] between OSG and IVSG were comparable. Complete anterior pituitary hormonal (APH) recovery was significantly higher in IVSG (39.02% vs.20.89%, p=0.04) predominantly due to corticotroph axis recovery (56.7% vs. 27.3%), whereas recovery of other APH axes were not different. Persistent APH deficit was higher in OSG (52.2% vs. 29.3%, p=0.02). Radiologically, regression of pituitary enlargement (72% vs. 64%) and resolution of stalk thickening (76% vs. 64%) between groups was not different. Trend towards lesser recurrence in IVSG (19.3% vs. 32.9%) was seen. Prednisolone equivalent dose (mg)/day was significantly higher in IVSG [30 (24-65) vs. 136 (73-136)] with similar treatment duration (weeks) [8 (8-20) vs. 10 (6-10)]. Reported major adverse effects did not differ between groups. DI predicted poor hormonal recovery in IVSG, while no other parameter affected recovery.

Conclusion: High-dose pulse IVS leads to better APH recovery and may decrease recurrence. Preserving the cortisol axis prevents long-term hormone replacement and adrenal crisis in future.
Abstract 73: A case report of mitochondrial diabetes. arthrogryposis multiplex congenita, diabetes and deafness
Authors: Haritha G , Vani M N Satya , ch Ella Reddy
Published: August 2024

Background: Mitochondrial diseases are caused by genetic defects that occur in either the mitochondrial DNA or the nuclear DNA. The heterogeneity, variable expressivity, age independence, and multiorgan system involvement all often lead to delayed diagnoses. Multiple endocrine complications can arise with mitochondrial disease. Foremost is diabetes, which has a prevalence of 11% to 15% in mitochondrial disorders. Age of diagnosis on average is 32 to 38 years but is variable. Arthrogryposis multiplex congenita refers to a group of conditions including multiple congenital contractures in varied areas of the body. We report a case of 16 years female with Arthrogryposis multiplex congenita who presented with diabetes.

Case Report: A 16 years female presented with weight loss, polyuria and random blood sugar of 253 mg/dl. Born to non-consanguineous parents. Antenatal history of mother was uneventful. History of bony contractures was present since birth. There was delay of gross motor development. Intelligence is normal. Height is 132 cm (<3rd centile). Attained menarche at 13 years. Cycles are regular. History of bilateral hearing loss was present since childhood. She was started on basal bolus insulin therapy. The clinical features are pointing towards a form of mitochondrial diabetes with GFM2 mutation, Leigh syndrome.
D1 MTE2 Case 6: A child with metabolic myopathy
Authors: Bonny Lavanya
Published: August 2024

A 15-year-old boy, born to 3rd degree consanguineously married couple presented with complaints of abnormal waddling gait and outward bowing of legs since 1-year, joint pains and difficulty in climbing stairs since 6 months. Had normal developmental motor milestones and was of average height compared to peers. No h/o muscle pains. There was no symptomatic relief with vitamin D supplementation. On examination child had large low set ears, mal aligned teeth with widened wrists and ankles, double malleoli and genu varum. There was also evidence of proximal myopathy in the lower limbs. Initial investigations revealed serum calcium of 10.6 mg/dl, Po4 of 2 mg/dl, ALP 3322 IU/L, vitamin D3 10.2 ng/ml and serum PTH of 1448 pg/ml.
Abstract 77: BMD, TBS and HSA in chronic glucocorticoid users attending a tertiary centre in Southern India
Authors: Hussain Anwar
Published: August 2024

Background: Glucocorticoids (GC) are used for various chronic medical conditions and is one of the most abused drugs in India. Despite widespread GC use, there is lack of knowledge among physicians regarding assessment and management of glucocorticoid induced osteoporosis (GIO). This study was performed to assess bone mineral density (BMD), trabecular bone score (TBS) and hip structural analysis (HSA) in chronic steroid users.

Methods: Observational study done from 2013-2020. Details of patients were obtained through archived medical records. Bone biochemical parameters and densitometric variables that included bone mineral density (BMD), trabecular bone score (TBS) and hip structural analysis (HSA) were assessed by a DXA scan.

Results: A total of 74 subjects (56 females, 45/56 postmenopausal) with a mean (SD) age and BMI of 49.5 (12.5) years, 29.0 (6.9) kg/m2 were studied. Vitamin D deficiency was present in 33/74 (44.6%) of subjects. 15 subjects (20.3%) had sustained fragility fractures. At baseline, the prevalence of osteoporosis at NOF and lumbar spine was 24/74 (32.4%) and 34/74 (45.9%) respectively. Degraded trabecular microarchitecture as defined by a TBS <1.200 was present in 32/74 (43.2%) of the subjects. Among those with normal BMD at the lumbar spine, 13/40 (32.5%) had a low TBS. Buckling ratio (BR) at the narrow (NN) neck > 10 was seen in 57/74 (77%) of subjects. Among subjects with normal BMD at the femoral neck, 33/50 (66%) had a BR at NN >10, which indicates high fracture risk.

Conclusion: GIO continues to be prevalent among steroid users. TBS and HSA may confer additional benefit regarding bone health, not conveyed by conventional BMD assessment in chronic glucocorticoid users.
Abstract 78: Pituitary stalk interruption syndrome (PSIS) is rare disease
Authors: Diwaker Chakra , Memon Saba , Patil Virendra , Lila Anurag , Shah Nalini , Bandgar Tushar
Published: August 2024

Background: Pituitary stalk interruption syndrome (PSIS) is rare disease characterized by breech, hypoglycemia, micropenis/cryptorchidism at birth, short stature in childhood and later with delayed puberty.

Aims: Single centre study to characterize- the clinical, biochemical and radiological features, treatment and follow up of PSIS patients; phenotypic difference in patients with PSIS-Isolated GHD (IGHD) and PSIS-combined pituitary hormone deficiency (CPHD) by comparing with GHRHR, and POU1F1, PROP1 (combined) mutated cases respectively.

Result: Of 56 PSIS (all sporadic; males-80%) cases, 36 were CPHD. Most common presentation was short stature (64.3%). Overall PSIS has higher breech presentation (36% vs. 6%) on comparing with genetically positive cases of IGHD/CPHD. Neonatal hypoglycemia was more frequent in CPHD (22% in both PSIS-CPHD and genetically positive CPHD) as compared to IGHD (0%:PSIS-IGHD and 1.9%:GHRHR-IGHD). Similarly, neonatal jaundice was more common in CPHD (42%:PSIS-CPHD and 22.2%:genetically positive CPHD) as compared to IGHD (5% in PSIS-IGHD and 1.9%:GHRHR-IGHD). Extra-pituitary malformation and skeletal anomalies were exclusively seen in PSIS cohort (CPHD>IGHD). Absent pituitary stalk and hyperprolactinemia was more frequent in PSIS-CPHD than PSIS-IGHD cohort. 75% IGHD and 83% CPHD males failed to achieve spontaneous puberty on follow up.

Conclusion: Late presentation with short stature and delayed puberty is common. Breech presentation was higher in PSIS than other mutation positive cases. Radiological and skeletal abnormalities were only seen in PSIS cohort.
Abstract 79: Adrenal insufficiency in the elderly population
Authors: Joseph Neal , Laviena  , Idiculla Jyothi
Published: August 2024

Background: In India the proportion of geriatric population is steadily rising. The symptoms of adrenal insufficiency (AI) may overlap with aging. This study aims to describe the profile of AI in the elderly.

Aims and Objectives: To describe the demographic profile, clinical features and laboratory parameters in elderly individuals with biochemically proven adrenal insufficiency and to identify the indications for prolonged steroid therapy in subjects with tertiary AI.

Results: 50 adults aged > 60 years were enrolled for the study, this included 29 males (58%), 21 females (42%), with a mean age of 69.27. The symptomatology of the patients were, abdominal pain (14/7:p<0.05), anorexia (60/30:p<0.05), joint pains (66/33:p<0.05) dizziness (18/9), lack of energy (80/40), myalgia (44/22), fatigue (83/43), in terms of signs proximal myopathy was found to be more in males (p< 0.05). In this study 72% of the population had history of steroid usage, most commonly for joint pains.

Conclusions: Steroid usage was a common cause for AI in the geriatric population. AI in the elderly can present with vague symptoms. A high index of suspicion is indispensable to test and diagnose this, the carers and HCWs should be cautioned about the ill effects of unprescribed and prolonged steroid medication.
Abstract 85: Can OSTA be used as a pan-Indian screening tool in predicting osteoporosis in postmenopausal women? A validation study
Authors: Jose Antresa
Published: August 2024

Background: The gold-standard for diagnosing osteoporosis-DXA (Dual Energy X-ray Absorptiometry) scan is scarce in India. OSTA score (Osteoporosis Self-Assessment Tool for Asians) = (weight – age)*0.2 predicts risk of osteoporosis and can be used as reference tool for DXA. At a cut-off of≤ 1, OSTA predicted femoral neck osteoporosis with a sensitivity of 88% in a previous study among south-Indian postmenopausal women. This study was done to validate OSTA in postmenopausal women across India.

Methodology: A cross-sectional study in 5356 postmenopausal women from four zones of India -South, East, North& West. Bone mineral density (BMD) and trabecular bone score (TBS) were assessed by DXA. Performance of OSTA in predicting BMD & TBS was assessed using ROC curve.

Results: The mean (SD) age was 61.6 (7.6) years. The performance of OSTA in predicting osteoporosis was fair (P<0.001) with AUC of 0.727 (95% CI 0.705-0.749) in zone 1, 0.693 (95% CI 0.664-0.723) in zone 2, 0.730 (95% CI 0.700-0.759) in zone 3 and 0.703 (95% CI 0.672-0.735) in zone 4. At a cut-off of 1.0, sensitivity was 76-84% & specificity was 45-50% in diagnosing osteoporosis. In predicting degraded microarchitecture, the AUC was 0.500-0.600.

Conclusion: OSTA may be used as a screening tool for women at high risk of osteoporosis.
Abstract 89: Correlation between serum Vitamin D3 levels and severity of COVID-19 infection
Authors: Sanamandra Prudwiraj
Published: August 2024

Background: It is postulated that Vitamin-D deficiency is associated with poor prognosis of COVID-19.

Aims and Objectives: To study the correlation between Serum 25-hydroxy-Vitamin D (25OHD) levels and COVID-19 disease severity and outcomes in Indian population.

Results: We prospectively recruited 200 consenting COVID-19 positive adults from a COVID-19-dedicated centre and assessed their 25OHD status on day1- 2 of admission. Disease severity was classified as per NIH guidelines and patients were followed till recovery or death. Our cohort had 11% asymptomatic, 14% mild, 14.5% moderate, 37.5% severe and 22% critical patients and their mean 25(OH)D levels were 24.09 ng/ml, 18.97 ng/ml, 15.81 ng/ml, 19.46 ng/ml and 16.45 ng/ml respectively. 89% (n=178) patients recovered (mean 25(OH)D 18.9 ng/ml) and 11% (n=22) succumbed (mean 25(OH)D 16.88 ng/ml). There was no significant correlation between baseline Vitamin-D levels with clinical severity or outcome. Oxygen requiring patients had slightly more proportion of severely Vitamin-D deficient population (<10 ng/ml) (24.03% Vs 19.71%) however it was not statistically significant (p-0.484). Low 25OHD levels had significant inverse association with inflammatory markers like NLR (Neutrophil-Lymphocyte Ratio) (p-0.004) and IL-6 (p-0.006).

Conclusion: Baseline Vitamin-D levels were not correlated with clinical severity or outcome but inversely correlated with inflammatory markers (NLR, IL-6) in COVID 19 patients.
Abstract 91: ACTH stimulated salivary cortisol is a better indicator of adrenal insufficiency compared to stimulated serum cortisol in subjects with cirrhosis liver
Authors: Karthik V , Jabbar P K , Jayakumari C , Nair Abilash , Gomez Ramesh , Basheer Shameer
Published: August 2024

Background: There are no reliable methods in clinical practice to diagnose adrenal insufficiency (AI) in patients with cirrhosis due to variably decreased cortisol binding protein levels. This leads to unreliable results on ACTH stimulated serum cortisol test.

Aims and Objectives: To estimate the Long Acting (LA)-ACTH stimulated salivary cortisol levels of patients in different stages of cirrhosis using 2nd generation electrochemiluminescence and to find the prevalence of adrenal insufficiency in them.

Results: LA-ACTH stimulated serum and saliva samples of 135 non-critically ill patients with cirrhosis (45 each from CHILD A, B and C) and 40 normal subjects were collected at baseline, 60 and 120-minutes. In healthy subjects, the 2.5th centile of 2 hr ACTH stimulated serum and salivary cortisol were 19.8 μg/dl and 0.97 μg/dl, which were used as cut-offs for defining AI based on serum and saliva respectively. The median (interquartile-range) 2-hour stimulated salivary cortisol in Child A,B,C categories and controls were 1.36 (1.23-2.38), 1.46 (1.18-2.22), 1.72 (1.2-2.2) and 2.12 (1.42-2.72) μg/dl respectively. 7 subjects (5.1%) were diagnosed to have AI based on stimulated salivary cortisol cut-off, whereas 39 (28.9%) cirrhosis subjects had inadequately stimulated serum cortisol. Three (symptomatic) subjects required steroid replacement.

Conclusions: ACTH stimulated serum cortisol is a poor test to diagnose AI in patients with cirrhosis. ACTH stimulated salivary cortisol has a high reliability for the same.
Abstract 97: Lipoid congenital adrenal hyperplasia in a boy with primary adrenal insufficiency with normal male external genitalia
Authors: Nishchitha K
Published: August 2024

Background: Lipoid congenital adrenal hyperplasia (CAH) commonly manifests as atypical genitalia or apparent female external genitalia in 46, XY whereas rarely, it may present with normal male external genitalia. Hence, we report the first Indian case of lipoid CAH with normal male external genitalia.

Case Presentation: A 8-year-old boy born of a third-degree consanguineous marriage, presented in 2018 with generalized hyper-pigmentation. Serum 8:00 am cortisol was 2.78 μg/dl and plasma 8:00 am ACTH was 1260 pg/ml. He was diagnosed to have primary adrenal insufficiency and started on oral hydrocortisone 12 mg/m2/d and fludrocortisone (100 μg/d). He had developed hypokalemia on 100 μg/d and also, on 50 μg/d susequently. Hence, his fludrocortisone had been stopped. On review visit after 3 years (at present), his height and weight were appropriate for age and Tanner's sexual maturity rating was P3, SPL-7 cm and TV-15 cc bilateral. His ACTH-stimulated steroid profile showed low serum cortisol (0.15 μg/dL) and aldosterone (3.48 ng/dL) whereas direct renin concentration was elevated (167.5 μIU/mL). Subsequent genetic analysis revealed homozygous pathogenic variant c.574C>T (p.Arg192Cys) in STAR. The patient was restarted on fludrocortisone 25 μg/d.

Conclusion: We report the first genetically-proven case of lipoid CAH in a boy with normal male external genitalia in India presenting with primary adrenal insufficiency. The case emphasizes that the diagnostic possibility of lipoid CAH can not be excluded in 46,XY primary adrenal insufficiency with normal male external genitalia.
Abstract 113: Impact of COVID-19 on arterial stiffness
Authors: Sahay Rakesh Kumar , Nevin S
Published: August 2024

Background: Arterial Stiffness is a manifestation of endothelial dysfunction and it can be used as a prediction parameter and a target for therapies aimed at ameliorating endothelial cell dysfunction which is raised after Covid 19 infection.

Aims and Objectives: To evaluate arterial stiffness using carotid-femoral Pulse Wave Velocity (cfPWV) and to compare the difference in different groups among the study subjects.

Methods and Results: Observational single centre study was done after randomly selecting 170 subjects from Telangana State Police Department after excluding subjects with chronic inflammatory diseases on chronic steroid therapy and pregnant/lactating subjects. Analysis after dividing them into 4 groups based on the presence or absence of past history of COVID-19 infection and the presence or absence of Comorbidities (Diabetes Mellitus, Systemic Hypertension, CAD, CVA or CKD) showed mean increase in cfPWV was 76.21 cm/s in Group-A (Covid-ve & Comorbidity-ve), 126.5 cm/s in Group-B (Covid+ve & Comorbidity-ve), 210.1 cm/s in Group-C (Covid-ve & Comorbidity+ve) and 263.9 cm/s in Group-D (Covid+ve & Comorbidity+ve). Significant p values were obtained for intergroup differences in cfPWV.

Conclusions: The Arterial stiffness values of prior COVID-19 positive subjects were higher than the group of subjects without prior COVID-19 infection. Comorbidities also independently added to the risk. Pulse wave velocity can be considered as an easy non-invasive screening tool in post-COVID patients to identify possible high-risk candidates.
Abstract 115: Lean PCOS and IR: A sine QUA non?
Authors: Misra Sukirti
Published: August 2024

Background: There is conflicting evidence with regards to insulin resistance (IR) among lean and obese PCOS. There is a lack of consensus on optimal screening strategy for IR in lean PCOS.

Aims and Objectives: The objective was to compare indices of IR, insulin sensitivity and beta cell function (ßF) on a detailed 5 point OGTT (0,30,60,90,120 minute) between Obese (n= 52) and lean (n=28) (BMI ≥23/<23 kg/m2) PCOS and their age- and BMI-matched controls.

Results: The OGTT showed cases had higher insulin values and Area Under Curve (AUC) with similar glucose levels as compared to their respective controls (p<0.05). Lean PCOS were more hyperinsulinemic as compared to obese controls (p<0.05). Matsuda index was significantly higher while first and 2nd phase Glucose Stimulated Insulin Secretion (GSIS) with ßF though higher wasn’t significant in lean cases as compared to obese cases (p<0.009). Though both the groups were hyperinsulinemic, lean cases had preserved insulin sensitivity compared to the obese cases. On applying ROC to OGTT values, 90 minute insulin value (52.3 μIU/ml) had the best predictive power for IR. 40% subjects classified as non IR on the basis of fasting value were found to cross this threshold, with more lean cases demonstrating this phenomenon as compared to obese.

Conclusion: Increased IR was found in lean PCOS compared to lean and obese controls with 90 minute insulin value diagnosing additional IR missed on routine OGTT.
Abstract 125: Tropical hypopitutarism – Single centre experience
Authors: Kumar EGA Lakshman , Sahay Rakesh , Neelaveni K
Published: August 2024

Background: Etiology of hypopituitarism differs in tropical countries compared to the West and includes pituitary abscess, snake bite, HIV infection, Sheehan syndrome, road traffic accidents, iron overload states etc.

Aims and Objectives: The present case series highlights the spectrum of hypopituitarism in tropical countries.

Case Details: C1: 23 y/o female presented with loss of consciousness, unrecordable BP and hypoglycemia. H/O spontaneous pre term delivery at home with significant PPH with lactational failure. C2: 21 y/o male came with c/o poor height and weight gain and poor development of secondary sexual characteristics. Examination revealed a large healed scar over foot which developed after snake bite in past. C3: 41 y/o female with h/o recurrent episodes of altered sensorium. H/o PPH, lactational failure, amenorrhea following home delivery. C4: 30 y/o female presented with h/o delivery with PPH, followed by amenorrhea, lactation failure with sparse axillary, pubic hair. MRI pituitary was normal in C1 and showed empty sella for C2, C3 and C4.

Conclusion: The etiology and clinical features of hypopituitarism are variable. Awareness and early recognition in these cases is necessary for optimal management of the patient.
Abstract 130: Association between asymptomatic bacteriuria and serum Vitamin D in patients with type 2 diabetes
Authors: Nabi Tauseef , Rafiq Nadeema
Published: August 2024

Background: Patients with type 2 diabetes (T2D are more frequently have asymptomatic bacteriuria (ASB). Vitamin D could play a protective role against ASB and urinary tract infections (UTI).

Aims and Objective: To study the prevalence, clinical profile, and association between serum vitamin D level and ASB in T2D patients.

Methods: This was a hospital based cross sectional study of adult T2D patients having age >18 years. The study recruited 150 T2D patients with no symptoms of UTI. Various clinical and biochemical parameters were monitored. Urine examination and culture and 25 OHD Vitamin D were monitored.

Results: The mean age of the patients was 51.7±10.8 years, with mean glycated hemoglobin (HbA1c) of the subjects was 10.6±3.2%. The mean duration of diabetes was 8.2±4.1 years. The prevalence of ASB was 22 (14.7%) in T2D. ASB was significantly higher in females as compared to males. E. coli was the most common organism isolated from urine culture. The mean serum levels of 25 OHD among ASB patients was significantly lower than non-ASB (12.8±6.4 ng/ml vs 21.5±12.3 ng/ml; p < 0.001). No association was seen between ASB in males and vitamin D.

Conclusion: ASB is associated with low vitamin D in T2D patients, in particular females.
Abstract 136: Video-based supervised exercise intervention successfully improves fitness in people with Type 2 diabetes: Outcomes from Diabefly® digital therapeutics platform
Authors: Singal Arbinder , Bhagat Madhura , Mandlekar Anuradha , Kalra Sanjay , Tanna Snehal , Thakur Santosh , Saraf Amit , Ade Suresh , Ajmera Jitendra , Sarwate Ashish , Agnihotri Akshata , Shah Harsh
Published: August 2024

Background: Physical fitness is important in combating insulin resistance in type 2 diabetes. Supervised home-based exercise intervention can help in improving exercise adherence and reducing risk of injury leading to better diabetes management.

Aims and Objectives: The study aims at the analysis of physical fitness in people with type 2 diabetes (PWD) following video-based supervised exercise prescription delivered as part of Diabefly® digital therapeutics program.

Results: Over 90-days of program, 45 participants (mean age 45.33 ± 12.54 years, 42.2% females) received personalized home-based exercise plans based on their preliminary physical fitness assessment by qualified physiotherapists. The parameters assessed were: upper limb strength (1-min push-up test), lower limb strength (wall sit test), core strength (1-min sit-up test), flexibility (V-sit and reach test) and cardiorespiratory fitness (6-minute walk test (6MWT)) pre and post the program. Test performance was scored based on age and gender-based normative data. Statistical analysis demonstrated significant improvement in performance scores, 1-minute push-up test, wall sit test, 1-minute sit-up test, V-Sit and reach test and 6MWT by 40.17% (P<0.001), 36.61 % (P<0.001), 70.04% (P<0.001), 37.86 % (P< 0.001), and 249.25 % (P<0.001) and 7.24 % (P<0.05) respectively.

Conclusion: The study demonstrates the effectiveness of video-call based exercise prescription leading to significant improvement in overall physical and cardiorespiratory fitness in PWD.
Abstract 141: CGM-based measurements for once-weekly insulin icodec versus once-daily insulin glargine U100 in insulin-treated patients with type 2 diabetes: A post hoc analysis
Authors: Chandrappa Manu , Bajaj H S , Bang R Beck , Gowda A , Liu1 L , Senior2 P , Bergenstal R
Published: August 2024

Insulin icodec (icodec) is a once-weekly basal insulin in clinical development. In a phase 2 treat-to-target trial in patients with type 2 diabetes (T2D) switching from daily insulin (N = 154), icodec with an initial 100% loading dose (LD; doubling the first dose) showed greater time in range (TIR, 3.9-10 mmol/L) vs once-daily insulin glargine U100 (IGlar U100) at weeks 15 & 16 (primary endpoint), as measured by double-blinded Dexcom G6® continuous glucose monitoring (CGM). This post hoc analysis compared TIR, time above range (TAR, >10 mmol/L) and below range (TBR, <3.9 and <3.0 mmol/L) for icodec LD and icodec with no loading dose (NLD) vs IGlar U100, calculated using CGM data from the 2-week screening and the 16-week treatment periods. Over the 16 weeks, overall observed mean TIRs were 71.4% for icodec LD, 60.7% for icodec NLD and 64.3% for IGlar U100. TBR<3.9 mmol/L and TBR<3.0 mmol/L remained below the internationally recommended targets (<4% and <1%, respectively) in all groups over the 16 weeks. At weeks 15&16, the proportion of patients achieving a combination of >70% TIR and <4% TBR<3.9 mmol/L was 64.2% for icodec LD, 40.0% for icodec NLD and 45.8% for IGlar U100. Icodec LD prevented a mild transient increase in TAR observed during the switch with icodec NLD and appeared to lead to a lower TAR than IGlar U100 over the 16-week treatment period. Overall, switching to icodec LD appeared to result in higher TIR and lower TAR than IGlar U100 through 16 weeks. TBR remained within the recommended targets.

JOURNAL/ijeam/04.03/02223308-202203001-00153/inline-graphic1/v/2022-10-03T190107Z/r/image-tiff

JOURNAL/ijeam/04.03/02223308-202203001-00153/inline-graphic2/v/2022-10-03T190107Z/r/image-tiff
Abstract 143: The tale of three ladies with thyrotoxic storms
Authors: Aswini M , Varghese Johann , Brahmanandam L , Ramesh Jayanthy , Subrahmanyam K A V
Published: August 2024

Introduction: Patient A. 35 year old female presenting with jaundice and thyrotoxic crisis. Patient B. 28 year old female presenting with decompensated heart failure and thyrotoxic crisis Patient C. 36 year old female presenting with Diabetic Ketoacidosis and thyrotoxic crisis.

Aims and Objectives: To sensitize the treating team in utilization of the Burch-Wartofsky scoring system to better diagnose and manage cases of thyrotoxicosis.

Results: Patient A presented to the surgical department with abdominal pain, fever and jaundice. Incidentally detected to have a grade 2 goiter and tachycardia with thyrotoxicosis with a Burch-Wartofsky score of 52. Patient B, known case of Graves’ disease of 1 year, presented to the cardiology department with decompensated heart failure with a history of non-compliance to treatment, with Burch-Wartofsky score of 47. Patient C, known case of Graves’ disease since 3 years with T1DM, poorly controlled on anti-thyroid drugs with day 3 post-RAIA, presenting with Diabetic ketoacidosis and Burch-Wartofsky score of 62.

Conclusion: Prompt endocrinology consultations enabled the treating teams to diagnose these life threatening presentations of thyrotoxicosis utilizing the scoring system and instituting appropriate management strategies with successful outcomes.