bluuebunny/crossref_metadata_2025 huggingface dataset:
IoT and Blockchain Integration for Enhanced AI-Driven Business Intelligence
Authors: Kalinaki Kassim
Published: August 2024

The Internet of Things (IoT) amalgamation with Blockchain technologies holds immense potential to augment Artificial Intelligence (AI)-driven Business Intelligence (BI) capabilities. As data-driven decision-making becomes paramount, this convergence presents organizations with unprecedented opportunities to enhance their BI systems. This study explores the foundational concepts, technological frameworks, and real-world applications underpinning IoT, Blockchain, and AI fusion within BI ecosystems. Examining the synergies between these cutting-edge technologies elucidates potential benefits, such as fortified data security, heightened transparency, and streamlined operational efficiencies. Concurrently, the study delves into the associated challenges, including interoperability complexities and scalability concerns. This study examines current trends, emerging developments, and future directions in AI-powered BI integrated with IoT and Blockchain. It offers key insights for researchers, practitioners, and decision-makers working in this field.
Social Media Insights Into Consumer Behavior
Authors: Shafik Wasswa
Published: August 2024

The link between social media and consumer behavior shows how digital landscapes affect consumer choices. From social media's constant change, organizations learn valuable lessons. Critically analyzing user-generated material and applying creative analytics reveal customer preferences and habits. Social media analytics and indicators help organizations understand audience engagement and online interactions. Influencer marketing, transient digital content, and smart technology elevate this exploration. These phases show that evaluation demands flexibility, a customer-centric approach, and the capacity to draw practical conclusions from enormous data sets. Future technologies like natural language processing and expert systems will enable more customization and customer emotion understanding. This analysis goes beyond consumer behavior to highlight agility, resilience, and honesty in devising techniques that appeal to the ever-discerning electronic client. Social media analysis demonstrates the evolving role of customer awareness and strategic company orchestration in the digital age.
Elevating Medical Imaging
Authors: Vijayalakshmi A. , Joshi Hemlata
Published: August 2024

Artificial Intelligence (AI) applications in the realm of computer vision have witnessed remarkable advancements, reshaping various industries and solving complex problems. In this context, this research focuses on the use of convolutional neural networks (CNNs) for classifying brain tumors - a crucial domain within medical imaging. Leveraging the power of CNNs, this research aimed to accurately classify brain tumor images into “No Tumor” and “Tumor” categories. The achieved test loss of 0.4554 and test accuracy of 75.89% exemplify the potential of AI-powered computer vision in healthcare. These results signify the significance of AI-driven image analysis in assisting healthcare professionals with early tumor detection and improved diagnostics, underlining the need for continuous refinement and validation to ensure its clinical effectiveness. This research adds to the expanding research and applications that harness AI and computer vision to enhance healthcare decision-making processes.
Unveiling the Potential of Large Language Models
Authors: Varghese Nisha , Ramasamy Gobi
Published: August 2024

Generative Artificial Intelligence (GenAI) and Large Language Models (LLMs) are transforming industries by fostering innovation, automating tasks, and enhancing creativity. By enabling personalized user interactions, sophisticated content creation, and advanced data analytics, they are revolutionizing industries such as healthcare, education, and customer service. As these technologies evolve, they can fundamentally change communication and decision-making processes and incorporate AI into everyday life. The objective of this book chapter is to examine the architecture and components, features, functionality, domain-specific applications, recent advances, and future developments of LLMs. Ongoing research aims to reduce biases, increase energy efficiency, and facilitate interpretation. As LLMs continue to evolve, they have the potential to transform many industries, including education, customer service, content creation, and more. As a result, they will be essential for the development of future AI-powered applications.
Climate Change
Authors: Rebelo Joana , Vieira Jorge
Published: August 2024

The surface temperature of the Earth has increased, and it is evident that even greater warming is expected in the coming decade. Banks have to manage their financial exposure and support sustainable initiatives that are crucial in mitigating the impact of global warming. This study aims to identify the primary effects of integrating climate change into the management and the challenges faced by the financial sector. A comprehensive and systematic literature review was conducted, analysing articles published between January 2016 and March 2023, published in highly respected journals. The final selection consists of 14 articles that provide a comprehensive overview of the current state of research in this field. Numerous challenges were identified, including limitations on the action of central banks, the need for climate performance metrics, accurate and comprehensive data collection, techniques for measuring physical risks, structural adaptations, and the reformulation of strategies. Moreover, this study highlights potential avenues for future research.
Navigating the Technological Frontier
Authors: Leitão Paulo , Marques Margarida Bessa , Almeida Tiago
Published: August 2024

Globalization and technological evolution have compelled organizations to rethink their operational structures, technological infrastructures, and the ways their employees engage with work. Similarly, leaders face new challenges that require the reconfiguration of their mental models and leadership approaches. This chapter examines how self-leadership and complexity leadership theory provides a comprehensive and effective framework for strategic leadership actions tailored to the demands of today's competitive and fast-paced environment. Furthermore, recognizing the significant contribution of these leadership strategies to the field of innovation and to the more efficient use of team dynamics, this chapter proposes conceptual links to demonstrate how these frameworks can influence technology adoption through the lenses of the TOE and UTAUT models. This approach allows for greater organizational efficiency and resilience by enhancing the digital transformation capabilities of organizations.
The Key to Entrepreneurial Innovation
Authors: Ranjan Sandeep
Published: August 2024

Promoting entrepreneurship and innovation is essential for societal advancement and economic prosperity in today's quickly changing world. Developing an entrepreneurial attitude and giving people the skills they need to spot opportunities and turn ideas into profitable businesses are two important roles that education plays. With the development of artificial intelligence (AI), educators now possess a potent instrument that can completely transform the process of generating and nurturing entrepreneurial ideas in educational environments. This chapter aims to investigate the relationship between artificial intelligence (AI) and entrepreneurship education, with a particular emphasis on how AI might be used to improve idea-generating processes.
Carbon-Based Technologies for Water Purification
Authors: Waidi Yusuf Olatunji
Published: August 2024

Carbon's unique properties—abundance, affordability, and exceptional surface area—make it a cornerstone of water purification. Across household filters and large-scale plants, it tackles contaminants like chlorine, heavy metals, and organic pollutants. Researchers constantly improve carbon's water purification capabilities from traditional activated carbon to cutting-edge nanomaterials. This chapter explores various carbon-based materials, their effectiveness against contaminants, and the advantages and limitations of these technologies. The ultimate goal is to enrich the readers with sustainable and efficient methods for clean water access for all.
Graphene Oxide Nanocomposites as a Promising Photocatalyst in the Degradation of Organic Dyes
Authors: Vishnu Dhanya , Pal Swagata , Lawrence Lazarus Vijune
Published: August 2024

Globally, water pollution is a crucial environmental issue. Research has indicated the presence of chemicals in the aquatic environment, which includes dyes, antibiotics, and insecticides. Presently, there are numerous techniques available for the degradation of dyes which include physicochemical, chemical, biological, electrochemical, and membrane technologies along with sustainable techniques such as photocatalysis. The remarkable photocatalytic activity of graphene oxide nanocomposites is one of its most notable features. Graphene oxide's photocatalytic ability outperforms many traditional techniques, offering a quick and efficient way to remove dye. The detailed mechanism of graphene induced materials in the degradation of organic dyes was highlighted in the present study. Also, the current integration of graphene with plant sources and their usage as the photocatalysts are discussed. The present study could provide a nominal insight on the current trends in graphene-based bioremediation techniques and its efficacy as a pollutant removal system.
Comprehensive Intrusion Detection and Classification Using Deep Learning Techniques With Preprocessing and Feature Extraction
Authors: Saranya R. , Priscila S. Silvia
Published: August 2024

For efficient identification of intrusions, this paper suggests computing techniques like recurrent neural networks (RNN), k-nearest neighbors (KNN), and convolutional neural networks (CNN) for classifying and predicting intrusions. Min-max scalability is used in preprocessing to normalize mathematical properties and guarantee consistency at various degrees. Linear discriminant analysis (LDA) extracts characteristics to increase the capacity for raw information discrimination. In addition, an innovative fusion of LDA and Min-Max scalability is investigated to maximize the depiction of features. Using CNN with extracted and feature-extracted data, this investigation expands the analysis to use the spatial organization of the convolutional CNN layers record. The tool used is Jupyter Notebook, and the language used is Python. Experiments on an incursion dataset show that the suggested mix of CNN, LDA, and Min-Max scaling operates dependably better than any of the distinct approaches regarding accuracy, precision, and recall.
Sertão, espaço de germinação poética topofílica e biofílica em Patativa do Assaré: uma abordagem ecocrítica
Authors: Rosa Rosani Saleti da , Soares Samuel Ronobo , Zanon Ângela Maria , Bignotto Thais Souto
Published: August 2024

Frente aos problemas ambientais enfrentados em nossa contemporaneidade, socioambientalistas de todo mundo se mobilizam com o objetivo de pensar a relação ser humano-natureza. Em vista disso, surgiram estudos sistemáticos e interdisciplinares na tentativa de questionar a condição utilitarista dos bens naturais como recursos não renováveis. Desse modo, pretendeu-se ampliar as discussões sobre a Ecocrítica como articuladora desta interdisciplinaridade. O conceito da teoria literária Ecocrítica contribuiu para as análises de nossa pesquisa. Para tal feito, o objetivo desta pesquisa foi analisar a relação ser humano-natureza na poética de Patativa do Assaré, a qual tematiza a Literatura e a Ecologia, pautadas na corrente crítica Ecocrítica. Assim, as análises poéticas concorrem para a compreensão sobre o sertão nordestino como espaço onde brotam a semente e as rimas que expressam os sentimentos topofílicos e biofílicos. Como resultados obtidos a partir das análises das poesias, pôde-se observar que a poética patativiana se consolidou como espaço sertanejo no qual floresce rimas no mesmo ritmo que a natureza floresce e, por fim, uma literatura topofílica e biofílica e, para tal, uma nova ressignificação da relação sujeito-natureza. Concluiu-se que a Ecocrítica se tornou uma importante ferramenta de análise do texto literário, permitindo perceber uma ressignificação do ser humano-natureza. Em específico, a poética de Patativa do Assaré permite olhar o lugar, o ser e a existência numa unicidade, sendo assim, em um tríplice aspecto indissociável.
Autoria feminina na literatura anglo-canadense: das pioneiras às pós-modernistas
Authors: Romero Lis Doreto , Rapucci Cleide Antonia
Published: August 2024

A literatura canadense, ou CanLit, tem uma história singular. As mulheres imigrantes que foram para a New Land, colônia britânica na época, e que possuíam aspirações literárias, não se pouparam da pena: produziram obras, porém não sem dificuldade, as quais, a princípio, tiveram suas características literárias negligenciadas. As pioneiras, tempos depois, tiveram suas obras revisitadas e utilizadas como fonte de inspiração para autoras do século XX que objetivavam subverter e transgredir as normas. Assim, fazendo uso da crítica feminista, que tem como um de seus objetivos analisar o conteúdo das produções das mulheres e evidenciar autoras que obtiveram pouco ou nenhum destaque, este artigo busca apresentar um recorte sobre autoras canadenses desde as pioneiras até as pós-modernistas e relacionar suas produções. Tal relação considera os aspectos metaficcionais das produções pós-modernas em que o retorno ao passado se coloca como um desejo de transformação. Além do exposto, o presente artigo também procura aproximar a cultura canadense do público brasileiro, uma vez que as pesquisas acerca da literatura produzida pelas canadenses são limitadas na academia brasileira.
Generative artificial intelligence in healthcare: current status and future directions
Authors: Ouanes Khaled
Published: August 2024

Generative artificial intelligence (GAI) is rapidly transforming the healthcare landscape, offering innovative solutions in areas such as medical imaging, drug discovery, and clinical decision support. This comprehensive review examines the current role of GAI in healthcare, its potential benefits, drawbacks, challenges, and future research directions. By synthesizing recent literature and expert perspectives, this review provides a critical analysis of GAI’s impact on healthcare delivery, patient outcomes, and ethical considerations. While GAI shows promise in enhancing diagnostic accuracy, accelerating drug development, and improving healthcare efficiency, it also faces significant challenges related to data privacy, regulatory compliance, and ethical implementation. This review aims to inform healthcare professionals, researchers, and policymakers about the current state and future potential of GAI in healthcare, emphasizing the need for responsible development and deployment of these technologies.
Abstract 25: Glycemic variability of oral semaglutide versus empagliflozin: A post hoc analysis of PIONEER 2
Authors: Shabeer D , Montanya E , Abildlund M T , Kreiner E B , Mosenzon O , Rosenlund S , Vilsbøll T
Published: August 2024

Glycemic variability is associated with markers of microvascular and macrovascular complications and impacts quality of life in patients with type 2 diabetes. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have been shown to both improve HbA1c concentration and reduce glycemic variability in patients with type 2 diabetes. GLP-1RAs increase insulin secretion and suppress glucagon in a glucose-dependent manner, which may partly explain their ability to reduce glycemic variability. However, it is not clear if HbA1c influences the effect of GLP-1RAs on glycemic variability. Oral semaglutide, the first GLP-1RA available as an oral formulation, is effective at reducing HbA1c vs a range of comparators, but its effect on glycemic variability needs to be understood. Therefore, we have assessed the change in glycemic variability and its possible relationship with HbA1c in a 52-week randomized, open-label trial (PIONEER 2) comparing oral semaglutide with the sodium-glucose co-transporter-2 (SGLT2) inhibitor empagliflozin in patients with type 2 diabetes uncontrolled on metformin. The seven-point self-measured blood glucose profile (7-point SMBG) was assessed at baseline and at weeks 26 and 52 in the PIONEER 2 trial. The standard deviation (SD) of the measurements in the 7-point SMBG profile was used as a measure of glycemic variability. An additional post-hoc mediation analysis was performed to explore the indirect effect of HbA1c concentration on the direct relationship between treatment and glycemic variability (the SD of the 7-point SMBG) at weeks 26 and 52. The results showed that the SD of the 7-point SMBG at baseline for the once-daily oral semaglutide 14 mg (N=411) and empagliflozin 25 mg (N=410) treatment arms was 2.06 and 2.05 mmol/l, respectively. The change from baseline in the SD of the 7-point SMBG in the oral semaglutide and empagliflozin arms was -0.67 and -0.44 mmol/l, respectively, at week 26, and -0.69 and -0.49 mmol/l, respectively, at week 52. The treatment differences (95% CI) for the SD of the 7-point SMBG for oral semaglutide vs empagliflozin at weeks 26 and 52 were -0.23 (-0.33, -0.12; p<0.0001) and -0.20 (-0.31, -0.09; p=0.0003) mmol/l, respectively. The mediation analysis showed that the indirect effect of HbA1c accounted for -0.06 (-0.10, -0.02; p=0.0029) and -0.03 (-0.06, 0.00; p=0.08) mmol/l of the treatment difference for the SD of the 7-point SMBG at weeks 26 and 52, respectively. In conclusion the oral semaglutide significantly reduces glycemic variability, as assessed by the SD of the 7-point SMBG, compared with empagliflozin, and most of this effect was not explained by an indirect effect of HbA1c.

Clinical Trial Registration Number: NCT02863328
Abstract 32: Acute suppurative thyroiditis in HIV – Non typhoidal salmonella: Case report and review of the literature
Authors: Delampady Kishan , Ganesh K , Meghana
Published: August 2024

Background: Acute suppurative thyroiditis is a rare disease of thyroid gland. Incidence is less than 1% in immunocompromised hosts. Most common pathogens isolated are Gram positive aerobic cocci. Infections with Gram negative facultative aerobes such as Salmonella are rare.

Case Presentation: A 39-year-old retropositive female presented with rapid enlargement of swelling in front of neck, fever and weight loss x 2 weeks. Examination revealed symmetric diffuse swelling that moved with degglutition with overlying erythema and tenderness. Relevent investigations done and CT neck revealed thyroid abscess, covid -19 RAT positive status, microcytic hypochromic anemia. A needle aspiration for symptomatic and diagnostic purposes was performed. Cultures grew Nontyphoidal salmonella. She was treated with 4-week course of oral antibiotics.

Conclusion: A thyroid abscess is rare, potentially life threatening disease. However, a high index of suspicion is required to make diagnosis and differentiate from subacute thyroiditis a relatively benign condition. Management is directed at minimizing morbidity. The mainstay treatment is medical, but surgery is sometimes necessary to achieve adequate source control, particularly when complications arise.

Keywords: Acute suppurative thyroiditis, COVID 19 infection, retrovirus, Salmonella sp., thyroid abscess
Abstract 34: Time spent in glycemic control after initiating treatment with oral semaglutide versus empagliflozin: An exploratory analysis of the PIONEER 2 trial
Authors: Prakash Prashanth S , Rosenstock Julio , Cariou Bertrand , Christiansen Erik , Hertz Christin l , Montanya Eduard , Nielsen Morten Abildlund , Knop Filip K
Published: August 2024

A standard objective in the management of T2D is the achievement and maintenance of HbA1C targets, but the duration of time that patients spend within glycemic control targets has not been previously reported for oral semaglutide (sema). In this exploratory analysis, the duration of time that patients were in glycemic control (HbA1C <7.0% and <6.5%) during the 52-week PIONEER 2 trial (NCT02863328) was assessed. Patients with uncontrolled T2D (N=822; HbA1C 7.0─10.5%) were randomized to oral sema 14 mg once daily or empagliflozin (empa) 25 mg once daily. Both drugs underwent dose escalation, with oral sema starting at 3 mg, increasing to 7 mg after 4 weeks, and 14 mg after 8 weeks. Empa was initiated at 10 mg and escalated to 25 mg after 8 weeks. For this analysis, outcomes were evaluated using the on-treatment without rescue medication observation period, in all randomized patients. Baseline characteristics were similar between treatment arms. Mean baseline HbA1C for both arms was 8.1%. A greater proportion of patients receiving oral sema vs. empa achieved HbA1C <7.0% at some point during the study (78% vs. 60%), and for the following lengths of time that HbA1C remained <7%: ≥14 weeks (65% vs. 48%); ≥26 weeks (56% vs. 38%); and ≥38 weeks (46% vs. 28%). During treatment, the overall mean duration of time spent at HbA1C <7.0% and <6.5% was 27 weeks and 16 weeks, respectively, for oral sema, and 19 weeks and 7 weeks for empa. Based on the trial product estimand, the odds of patients achieving HbA1C <7.0% at both week 26 and 52 were significantly greater with oral sema vs. empa (estimated odds ratio 4.12 [95% CI 2.94, 5.76]; p<0.0001). In conclusion, despite an 8-week dose escalation schedule and a mean baseline HbA1C of 8.1%, nearly half of patients receiving oral sema achieved glycemic control (HbA1C <7.0%) for more than 70% of the 52-week treatment duration. These data suggest that patients spend more time in glycemic control during treatment with oral sema vs. empa.
Abstract 55: Ultrasonography as an imaging modality in congenital hypothyroidism – A descriptive study
Authors: Jog Komal , Nagaraju R , Vasanthiy N , Subbiah Sridhar
Published: August 2024

Background: 99mTc-pertechnetate scanning is considered ideal for etiological diagnosis of congenital hypothyroidism, but it leads to radiation exposure and financial burden. Also exogenous thyroxine replacement interferes uptake in scintigraphy studies. Ultrasonography is a relatively simple and noninvasive procedure but may miss ectopic thyroid tissue and dyshormonogenesis.

Aims: To evaluate the use of sonography as the primary imaging modality in congenital hypothyroidism.

Results: In this cross sectional study of fifteen patients, 73% (n=11) were female and 26% (n=4) male. The mean age of the patients was 1.84 years. The Thyroid Stimulating Hormone levels at diagnosis ranged from 40-404 mIU/ml. Ultrasonography studies were available for 100% (n=15) patients and scintigraphy studies for 26% (n=4) patients. Ultrasonography studies showed normal thyroid gland size in 46% (n=7) patients, hypoplasia of gland in 6% (n=1) patient, and gland was not visualized in 46% (n=7) patients. 99mTc-pertechnetate scanning was done in 4 patients, of which 75% (n=3) patients showed features of dyshormonogenesis, and in all these patients the thyroid was visualized normally on ultrasonography. 25% (n=1) patient had ectopic thyroid gland and thyroid on uptake studies.

Conclusion: Ultrasonography is an important tool in the diagnosis of congenital hypothyroidism when Radionuclide uptake studies are not feasible, or when the patient is already on exogenous thyroid replacement.
Abstract 58: Favourable outcomes with therapeutic glucocorticoid regimen compared to replacement glucocorticoid regimen in primary hypophysitis
Authors: Das Liza , Agrawal Kanhaiya , Dutta Pinaki , Gupta1 Kirti , Ahuja2 Chirag Kamal , Singh2 Paramjeet , Tripathi3 Manjul , Sahoo3 Sushant Kumar , Sood4 Ashwani
Published: August 2024

Background: Primary hypophysitis (PH) is most commonly treated with glucocorticoids. But there is considerable variation in the treatment regimens.

Aims and Objectives: We aimed to compare the outcomes of therapeutic versus replacement glucocorticoid regimens in PH. Therapeutic regimen (TR) comprised oral prednisolone (1mg/kg/d) for 6-12 weeks followed by tapering. Replacement regimen (RR) comprised standard hydrocortisone. Response was defined as complete recovery of all pituitary axes, without any requirement of hormonal replacement.

Results: Mean age of the cohort (n=30) was 37.8 ± 10.4 years with a female preponderance (79.3%). Response to glucocorticoids was present in 23.3% of the cohort, all on TR. There was no difference between responders and non-responders in terms of age, gender, duration of symptoms or follow-up (p>0.05). Headache was more frequent in responders than non-responders (100% vs 57.1%, p<0.05). Secondary hypocortisolism (100% vs 71.4%), hypothyroidism (71.4% vs 52.4%), hypogonadism (71.4% vs 42.8%), hyposomatotropism (57.1% vs 25%) and hyperprolactinemia (85.7 vs 57.1%) were more common among responders (p<0.05). Diabetes insipidus was not different (42.3% vs 38%, p=0.56). Pituitary enlargement (100% vs 76.2%) and absent posterior pituitary bright spot (PPBS) (71.4% vs 57.1%) were more frequent among responders (p<0.05). Asymmetric enlargement was more common in non-responders (23.8% vs 0, p<0.05). Stalk thickening (80.9% vs 85.7%) and T2 parasellar dark intensity (28.5% each) were not different (p>0.05). The mass regressed in 85.7% in responders and 57.1% of non-responders at a mean follow-up duration of 4.6 ± 2.7 years.

Conclusion: Response in PH is optimal with TR. Multiple hormone deficiencies, hyperprolactinemia, symmetric pituitary enlargement and absent PPBS portend favourable response, whereas asymmetric pituitary enlargement is more common among non-responders.
Abstract 59: Prenatal predictive factors and prevalence of early postpartum maternal dysglycemia in patients with gestational diabetes
Authors: Bhat Javaid Ahmad , Mir Shahnaz Ahmad
Published: August 2024

Background: Women with gestational diabetes mellitus (GDM) have increased risk of postpartum diabetes which may be further exacerbated by fat accretion during pregnancy and post-partum deterioration in lifestyle behaviours.

Aims and objectives: To determine prenatal predictive factors and prevalence of maternal dysglycemia at 6-12weeks postpartum in patients with GDM.

Results: In this prospective cohort study, of 118 subjects recruited initially, only 83 (81.3%) followed for postpartum screening. Among them 38.56%, 22.89% and 8.43% had family history of Diabetes Mellitus, Previous history of GDM and PCOD respectively. We observed that 62.7% reverted to NGT postpartum, however; 8.4%, 3.6%, 10.8% and14.5% had IFG, IGT, IFG+IGT and overt DM respectively.

In univariate analysis, BMI (p=0.001), family history of DM (p=0.008), PCOD (p=0.012), impaired fasting glucose (p<0.001), HbA1c at diagnosis (p<0.001) and fetal macrosomia (p=0.019) were the risk factors for postpartum diabetes. However on Multivariate analyses, only HbA1c at diagnosis, Family history of DM and BMI showed statistically significant association with postpartum diabetes.

Conclusion: GDM patients have a high prevalence of postpartum glucose intolerance and diabetes. The prenatal risk factors identified could be useful for prenatal risk stratification for early detection and interventions to reduce the risk of progression and complications of diabetes mel.
Abstract 75: Prediction score for malignancy in thyroid nodule
Authors: Soumya S , Jabbar P K , Jayakumari C , Nair Abilash , Gomez Ramesh , Ajeesh T
Published: August 2024

Background: In India, prevalence of differentiated thyroid cancer (DTC) is 0.1% and incidence has increased over past decade by 55%.

Aims and Objectives: To formulate a scoring system for prediction of malignancy in thyroid nodule using clinical risk factors, ultrasound and FNAC characteristics. Consecutive subjects >10 years, with palpable or ultrasound-revealed thyroid nodule who presented to outpatient department underwent ultrasonography for determination of 2017-ACR-TIRADS. All nodules >1 cm maximum diameter and those with TIRADS score of 4 or 5 with maximum diameter >5 mm underwent ultrasound-guided FNAC. All Bethesda 4, 5 and 6 nodules underwent thyroidectomy. Patients with Bethesda 3 nodules were given option of close follow up or surgery.

Results: Present study found age and TSH to be significantly different between benign and malignant nodules. Hence a prediction score (Trivandrum prediction score (TiPS)) was formulated with four variables namely age, TSH, 2017 ACR TIRADS and Bethesda score, for predicting risk of malignancy in nodule. Each of the four variables were stratified and weightage points assigned. Age (in years) >40;0, <40;1. TSH (mIU/L)< 2;0, >2;1. TiPS=age score+TSH score+[TIRADS-1]+[Bethesda -2]x2. Final outcome variable was considered as the gold standard and was defined as FNAC report of Bethesda2 or all other nodules which had undergone surgery and histopathology (HPR) is available. Nodules with either Bethesda 2 report on FNAC or a benign HPR report were considered benign. HPR report of malignancy was considered malignant. 226/240 nodules included in study had final outcome variable. ROC curve was analysed for cut off value of total prediction score. Total score >6 had a sensitivity of 96.2% and specificity of 97.5% in predicting malignancy.

Conclusions: Cumulative scoring system had high diagnostic accuracy for prediction of malignancy risk and can be a useful tool in clinical practice for selecting thyroid nodules for surgery, especially indeterminate nodules.
Abstract 81: A case report of elevated TSH, elevated T3 and low T4 levels and mutation in SLCA5A gene: A diagnostic dilemma
Authors: Kolla Bharathi , Kalra1 Pramila
Published: August 2024

Background: Iodide transport defect (ITD) is one of the causes of thyroid dyshormonogenesis. It is an uncommon disorder which is mediated by NIS mutations. They present with hypothyroidism and goitre due to the absence of active transport of iodide into the thyroid gland. The clinical presentation of patients with ITD due to different mutations of NIS gene has been described: including T354P, G395R, Q267E, and G543E mutations.

Case Report: A 10-year-old boy born out of non – consanguineous marriage, with no antenatal, postnatal complications presented with history of goitre for 7 years. The child had a history of ADHD, average scholastic performance, and history of weight gain of 4-5 kilograms over past 2 months. Mother was diagnosed to have hypothyroidism during pregnancy. His Thyroid profile showed FT4 – 0.413 ng/dL, FT3 – 6.06 pg/mL, TSH – 12.75 mIU/mL and USG neck showed mild thyromegaly. A genetic analysis was done which revealed a homozygous mutation on Exon 7 in SLC5A5 gene. Child was started on Levothyroxine supplementation.

Conclusion: The clinical picture is suggestive of hypothyroidism with elevated free T3 levels. This genetic mutation needs to be followed up in the global data base to ascertain its significance in future.
Abstract 95: Cushings: The tale of a great mimicker and its conundrums
Authors: Fatima Afsar , Tirupathae Sunanda , Kumar Dileep
Published: August 2024

Background: Cushing's syndrome is a rare endocrine disorder comprising of large group of signs and symptoms resulting from chronic exposure to state of endogenous hypercortisolemia or exogenous steroids. It is a gamut of clinical manifestations with varying presentation and indecisive diagnosis.

Aim: We hereby present a case of 28-year-male with signs and symptoms of florid and rapid onset hypercortisolemia of 1 year duration.

Objectives and Results/Case Details: Case was referred from psychiatry for weight gain. Clinical history and profound proteo-catabolic signs pointed towards rapid onset cushings. On evaluation hypercortisolism was non-suppressible by 1 mg dexamethasone (DST) and had high ACTH suggesting ectopic ACTH syndrome or pituitary origin. He had a history of watery diarrhea, recalcitrant hypokalemia, multiple hyper-pigmented acne, and striae with secondary superficial mycosis which compelled us to rule out ectopic, but CT chest & abdomen were inconclusive. MRI pituitary showed 4 mm adenoma, cortisol was suppressed following 8 mg DST. He underwent Trans-sphenoidal surgery (TSS), following which cortisol levels normalized within 1week with regression of symptoms.

Conclusion: Throughout the course, several diagnoses were entertained like perceptive disorder due to depression and bizarre paresthesia (hypocalcemia), carcinoid syndrome secondary to diarrhea and dys-electrolytemia, ectopic ACTH source due to clinical profile, coincidental lung lesion, but ultimately proven as ACTH producing pituitary tumor out of the blue. Use of a more pragmatic approach makes this case a challenging one.
Abstract 105: A case of transient neonatal thyrotoxicosis
Authors: Appaiah Sonali , Vishwanath S , Bantwal Ganapathi , Ayyar Vageesh , George Belinda
Published: August 2024

A 2 months old male infant born at 37 weeks of gestation to a mother with Grave's disease on therapy who had a failed radioactive iodine ablation in the past, presented to us with history of failure to gain weight, excessive cry and increased feeding frequency since 1st week of life. On examination he was irritable, weighed 3.5 kg (<5th centile, CDC charts) and had no goiter. The thyroid profile showed TSH <0.0025 IU/l, free T3 5.43 pg/ml, free T4 1.57 ng/dl and elevated TRAb levels (3.66 IU/l). The mother had high TRAb levels (40 IU/l) and the child was diagnosed with neonatal thyrotoxicosis, both the mother and the child were treated with carbimazole. The child received tapering dose of carbimazole during follow-up and achieved TRAb negative status by 8 months. The child is healthy currently and is off treatment.
Abstract 107: Klinefelter's syndrome presenting with ambiguous genitalia
Authors: George Belinda , Vishwanath S , Bantwal Ganapathi , Ayyar Vageesh , Appaiah Sonali
Published: August 2024

A first-born child born out of non-consanguinity, with term delivery and low birth weight was brought at 1 year 4 months of age with left undescended testis and ambiguity. Antenatal, perinatal and developmental history were uneventful. There was no h/o failure to thrive or generalized hyperpigmentation. On examination there was bifid scrotum with rugosities and palpable testis on the right with left testis in the inguinal canal. The shaft measured 2 cm with penoscrotal hypospadias. On evaluation the stimulated T: DHT was 127.3 and T: A was 13.42, suggestive of 5-alpha reductase deficiency. However, the karyotyping revealed 47XXY karyotype. Clinical exome sequencing did not reveal any mutations. Ambiguity is a rare presentation in patients with Klinefelter's syndrome.
Abstract 110: Prevalence of asymptomatic bacteriuria in patients with type 2 diabetes mellitus
Authors: Kolli Sumanas Gopal Datta , Sarathi H A Vijaya , Reddy S L Sagar , Dhananjaya M S
Published: August 2024

Introduction: A Recent meta-analysis showed higher prevalence of asymptomatic bacteriuria (ASB) in diabetics compared to healthy controls (12.2% vs 4.5%). Especially women with type 2 diabetes mellitus (T2DM) are prone to develop asymptomatic bacteriuria. A recent study done in northern India estimated the prevalence of ASB as 17.5% in diabetics. In addition, an association between poor glycemic control and higher prevalence of ASB has been reported.

Materials and Methods: This is a retrospective cross-sectional study including 2843 patients with T2DM who had visited Endocrinology out-patient services from June 2018 to May 2020 and underwent diabetic medical health check which includes urine chemistry and microscopy.

Results: A total of 11.3% (322/2843) of patients were found to have ASB with a higher prevalence among women than men (20% vs 6.9%, p<0.0001). The mean HbA1c of patients with ASB was significantly higher than those without ASB in the total study population (8.64 vs 8.23%, p= 0.003), men (9.02 vs 8.28%; p= 0.0001) but not in women (8.38 vs 8.12%; p=0.168).

Conclusion: Prevalence of ASB was higher in women than men with T2DM. However, the association of ASB with poor glycemic control was observed only men with T2DM.
D2 MTE4 Case 12: A case of neonatal diabetes…
Authors: Kolla Bharathi , Kalra Pramila
Published: August 2024

A 2-month-old baby girl (DOB 11/6/21) was diagnosed to have diabetes and was referred for further management. She was born out of non-consanguineous marriage, full term normal vaginal delivery with uneventful antenatal and perinatal period. Her birth weight was 2.3 kgs, small for gestational age, with catch up growth postnatally. Baby was apparently normal till the age of 1 month when she was hospitalised for fever and dehydration. Investigations revealed high blood glucose (450 mg/dl), HbA1c -10.5 %, serum acetone 80 mg/dl, HCO3 was 3 mEq/L. Child was discharged on regular insulin 1-0-1 and NPH 1-0-1and had multiple hypoglycaemic episodes as per SMBG. There was a history of suspicious seizure like activity as per parents. In the last 1 week, despite continuing same dose of insulin SMBG readings were 300-400 mg/dl. Child was admitted and was started on insulin infusion at 0.02 ml/kg/hr. Glibenclamide was started at a dose of 0.1 mg/kg. However, the response to Glibenclamide was partial with blood glucose in the range of 300-400 mg/dl without insulin. Child was discharged on Lispro 1-1- 0.5 and detemir 1-0-0. Genetic analysis revealed two variants of uncertain significance in KCNJ11 gene and INSR gene. She was restarted on Glibenclamide 1 mg at follow up and insulin was tapered and stopped. Currently she is on Glibenclamide 2 mg without insulin with blood glucose levels < 250 mg/dL and no hypoglycaemic episodes. The child has occasional hyperglycemic episodes with glucose values of 400 to 450 mg/dl.
Abstract 134: Clinical profile of AAA syndrome a case series: A retrospective study
Authors: Venkatesh  , Prasad Aravind , Roy Ayan , Kamalanathan Sadishkumar , Naik Dukhabandhu , Sahoo Jayaprakash , Durgia Harsh , Palui Rajan , Patel Deepika , Thomas Nihal , Chapla Aaron , Ravichandran Lavanya
Published: August 2024

Background: AAA syndrome is a rare cause of primary adrenal insufficiency associated with alacrimia, achalasia and neurological dysfunction. The existing literature consists mostly of case series. Here we describe the series of cases who presented to our hospital.

Aims and Objectives: To describe the clinical charecteristics of patients with AAA syndrome.

Results: A total 8 cases were analysed. Median age of presentation was 4.5 years. Alacrima, achalasia, adrenal insuffciency were present in 8,7, and 5 patients respectively. 4 patients presented with achalasia and 4 with adrenal insufficiency. None of the patients had salt wasting. 3 out of 8 patients had neurological signs and 6 out of 8 patients had autonomic dysfunction. Associated primary hypothyroidism, developmental delay, skin conditions were seen in 3/8, 3/8, and 2/8 of total patients respectively. Genetic evaluation was done in 7 patients and two showed homozygous mutations, one of which was novel. Genetic evaluation pending in one patient.

Conclusion: We present here the retrospective data showing the the clinical charecteristics of patients with AAA syndrome.
Abstract 153: Bone microarchitecture, bone mineral density and bone turnover in association with glycemia and insulin action in women with prior gestational diabetes
Authors: Kubihal Suraj , Gupta Yashdeep , Goyal Alpesh , Kalaivani Mani , Tandon Nikhil
Published: August 2024

Background: Increased fracture risk is seen in T2DM despite higher bone mineral density (BMD) due to poor bone microarchitecture. Recent studies suggest bone health may be affected early in the natural history of diabetes and women with prior gestational diabetes mellitus (GDM) would be ideal population to study this as precise information on glycemic status in the near past is available.

Objective: The aim of this cross-sectional study was to comprehensively assess bone health in women with prior gestational diabetes mellitus, including bone microarchitecture (TBS), bone mineral density (BMD) and bone turnover (osteocalcin).

Results: A total of 240 women (mean age: 33.3 ± 5.0 years; median postpartum duration: 34 [interquartile range 13.0-54.5] months were evaluated. At the current visit, 115 (47.9%) and 36 (15%) women had prediabetes and diabetes, respectively. Women with dysglycemia (diabetes/prediabetes) had a higher BMD at all three sites, compared to those with normoglycemia; however, the difference was not statistically significant. Women with dysglycemia had a significantly lower TBS (1.32 ± 0.09 vs. 1.35 ± 0.09; p = .038). Women with dysglycemia had significantly lower serum osteocalcin levels (18.6 ± 8.5 ng/ml vs. 21.5 ± 9.7 ng/ml; p = .018). HOMA-IR (r = -.285, p < .001) was negatively correlated, while Matsuda index (r = .274, p < .001) and disposition index (r = .159, p = .016) were positively correlated with serum osteocalcin levels.

Conclusions: Bone health is affected early in the natural history of diabetes and is associated with an overall low bone turnover state.
Abstract 160: A tri prong approach in the management of insulin autoimmune syndrome
Authors: Kumar N S Praveen , Dev K Chethan , Kandula Srinivas , Reddy M Nithin
Published: August 2024

Insulin autoimmune syndrome (IAS) manifests as transient self-limiting endogenous hyperinsulinemic hypoglycemia. It is characterized by the presence of insulin autoantibodies which bind insulin and the unpredictable release of insulin from insulin-autoantibody complexes resulting in spontaneous hypoglycemia. It needs to be considered in patients with hypoglycemia (in non-diabetic individuals) to avoid unnecessary investigations and surgical interventions. Treatment of Insulin autoimmune syndrome has always been an enigma. We suggest a tri-prong approach, with the pharmacological cocktail of alpha glucose inhibitor, steroids, and diazoxide along with dietary modifications after the elimination of the culprit agent. The targeting of the three major pathogenetic mechanisms when initiated early holds the potential of earlier relief of symptoms and accelerated recovery in severe and refractory hypoglycemia.
Abstract 3: CGM-derived parameters for once-weekly insulin icodec versus once-daily insulin glargine U100 in insulin-Naïve patients with T2D
Authors: Kunder Sushil , Lingvay Ildiko , Bang Rikke Beck , Koefoed Mette M , Mader Julia K , Pettus Jeremy , Wagner Lily , Mathieu Chantal
Published: August 2024

JOURNAL/ijeam/04.03/02223308-202203001-00015/inline-graphic1/v/2022-10-03T190107Z/r/image-tiff

Insulin icodec (icodec) is a once-weekly basal insulin in development. This post hoc analysis used data from the NCT03951805 trial to investigate CGM-derived time in, above, below range (TIR, TAR, TBR) and glycemic variability measured as coefficient of variation (CV%). Insulin-naïve patients with T2D (N=205) received insulin glargine U100 (IGlar U100; pre-breakfast SMBG target 80-130 mg/dL, adjusted ±4U/day), icodec titration A (80- 130 mg/dL, ±21U/week), B (80-130 mg/dL, ±28U/week; most relevant comparator to IGlar U100), or C (70-108 mg/dL, ±28U/week). Treatments were titrated weekly. TIR (70-180 mg/dL), TAR (>180 mg/dL), TBR (<70 and <54 mg/dL) and CV% were calculated during the 2-week screening and the 16-week treatment periods using double-blinded Dexcom G6 CGM data. During the trial, across arms, TIR increased to >70% from weeks 7 and 8, TAR decreased to <25% from weeks 11 and 12, TBR and TBR remained below the recommended targets (<4% and <1). At weeks 15 and 16, proportion of patients achieving >70% TIR and TBR <4% were 63.3% for titration A, 80.0% for B, 66.0% for C and 64.0% for IGlar U100. CV% increased slightly over time but remained <36% in all arms. TIR increased during the trial across treatments, and similar or numerically higher proportion of patients achieved >70% TIR and TBR <4% with icodecvs. IGlar U100 at weeks 15 and 16
D1 MTE1 Case 1: Steroid refractory insulin autoimmune syndrome treated with rituximab and continuous glucose monitoring
Authors: Batra Chandar M , Kumar Kiran , Goyal Monica
Published: August 2024

A 67-year-old female presented with severe hypoglycaemia with a blood glucose of 34mg/dl 5 hours after having dinner. She did not have diabetes and had no access to oral hypoglycaemic agents, insulin, or any other drug known to cause hypoglycaemia. She was a known case of primary hypothyroidism euthyroid on treatment. The physical examination was unremarkable. Her liver, renal functions, thyroid, and adrenal functions were normal. At blood sugar of 23 mg/dl, her serum insulin was 24000uU/ml (normal<3uU/ml) and c-peptide was 16.2 ng/ml (normal 0-0.6ng/ml) which were very high. As the serum insulin levels were very high insulin autoimmune syndrome was suspected. Insulin autoantibodies were positive 87.2 units/ml (normal<12). Imaging with contrast-enhanced computerized tomography (CECT Abdomen), endoscopic ultrasonography, 68 gallium octreotide dotanoc whole-body PET -CT scan did not reveal any pancreatic or extra-pancreatic tumour. Autoimmune insulin syndrome (IAS) was diagnosed. She was started on high dose prednisolone, diazoxide and octreotide in addition to low carbohydrate meals. Hypoglycaemic episodes continued for 1 month despite this therapy. Remission was achieved only after 2 doses of Rituximab 1 gram infusion were given. Serum insulin levels were reduced to 230uU units from 24000uU/ml, and the patient's hypoglycaemic and hyperglycaemic episodes were normalized. We used continuous glucose monitoring using the Freestyle Libre glucose monitoring system, and the management of the patient was greatly facilitated with this.
The Interaction of Zinc as an Essential Trace Element with Leishmania Parasites: A Systematic Review
Authors: Aghaei Maryam , Aghaei Shahrzad , Kouhiyan Mahbobeh , Shahmoradi Zabihollah , Hejazi Seyed H.
Published: August 2024

Background:

The trace element of zinc (Zn) has shown great effectiveness in control of leishmaniasis infection. Hence, the present study conducted a systematic review of in vitro and in vivo studies evaluating the zinc effect in the treatment or prevention of leishmaniasis.

Materials and Methods:

A systematic literature search was performed of all articles published in PubMed, SciELO, ScienceDirect, Scopus, Google Scholar, and Web of Science databases (1997–2023). The search terms were “zinc” OR “cutaneous leishmaniasis (CL)” OR “visceral leishmaniasis (VL)”.

Results:

Initial search yielded 89 citations, and 59 subjects were included. Data showed the zinc serum level in CL patients was lower than controls. Also, in vitro studies of zinc were more effective against L. tropica and L. major promastigotes compared to the amastigotes. Moreover, in vivo studies did not show destructive effects of zinc on the mammalian cell viability like macrophages. Furthermore, zinc depletion by specific chelators affected L. donovani survival and growth through promoting apoptosis and reactive oxygen species-dependent mechanisms.

Conclusion:

The serum level determination of zinc could be useful for estimating the leishmaniasis pathophysiology. Environmentally or genetically determined increases in zinc levels might augment resístanse to CL. In contrast, zinc depletion using a zinc-specific chelator could be effective treatment of VL in endemic areas.