bluuebunny/crossref_metadata_2025 huggingface dataset:
Digital Transformation in Recrutment and Selection Processes Managing
Authors: Reis Isabel Pinto , Passareiro Jorge , Sampaio Marta Correia , Santos Vasco , Martinho Filipa , Marcão Ricardo
Published: August 2024

Digital transformation is incessantly composing a new technological reach. This study explores the impact of digital transformation on recruitment and selection. A study was carried out with a quantitative approach, through an online questionnaire, with a sample size calculation of 340 participants. According to the results obtained, the authors can confirm that the digital transformation has impacted the recruitment and selection processes and practices. Although the need for the digital environment is inevitable, it is not certain that the change will bring value to the organization. Therefore, there is a need to manage this process successfully. The present study concluded that looking for the right job for the right people is the strategy for finding happiness for everyone involved. It was understood that the digital transformation is used more for young people, or there are more and more websites for job search to ease the problem and also the constant search for innovation and meeting new ways of recruiting and including talent.
Exploring Untapped Market Niches With Deep Learning Models
Authors: Yadav Mohit , Mittal Arun , Jayarathne P. G. S. Amila
Published: August 2024

The paper looks at how deep learning models work, analyse emerging and hidden markets, and apply the information to discuss how to develop business development strategies. Applying deep learning in market research involves demonstrating methodologies such as Systematic Literature Review (SLR) and PRISMA. By going over how neural networks compute, determining which business sectors to target, and illustrating how deep learning can help in market analysis, this paper shows businesses how these will be able to discover and thus dominate specific niches. Therefore, the summative integration of artificial intelligence and comprehensive data analysis methods offers an initial prototype design of the reference architecture to be used by organisations to improve strategic market designs and optimise incremental modifications necessary to build markets. The optimistic trend regarding DL in the market analysis is connected to the new prospects and potentialities that can offer new opportunities for deepening the learning process to cover the market and create enhanced models.
SME Marketing Entrepreneurship in AI-Shaped Business Environments
Authors: Yurdagel Mine , Baycur Gözde
Published: August 2024

Artificial intelligence (AI) has been a subject of interest among scientists since the 1950s, when Turing made his speech on intelligent machines. However, getting into the discussion of the general public has been realized within the last years and the speed of developments in the domain shows that AI would be a keeping its substance in the future. In business, AI can foster different sectors such as agriculture, health, e-commerce, and manufacturing. Whatever the sector is, a company can benefit from AI at almost all functions. Small and medium-sized enterprises (SMEs) can also utilize AI technologies to grow their businesses as well as big firms. The aim of the proposed chapter is to cover the potential advantages and difficulties of AI utilization at SMEs. As SMEs build up the backbone of the many economies worldwide in terms of employment and contribution to country GDPs, they need to be promoted and supported to get share within the new economy shaped by AI. In specific for SMEs, the study will focus on innovations gained by AI in marketing and offer exemplary utilization areas.
Next-Generation Management on Exploring AI-Driven Decision Support in Business
Authors: Raju P. , Arun R. , Turlapati Venkata Ramaiah , Veeran Lavanya , Rajesh Shamitha
Published: August 2024

Algorithmic decision support (ADS), driven by AI fueled by machine learning, is increasingly becoming an essential element in diverse processes across sectors. Organizations implement Advanced Decision Support (ADS) systems to improve the efficiency of decision-making and make the most use of data. Nevertheless, the advancement of ADS entails a multitude of human choices that can inject intricacies and ambiguities into the procedure. These decisions encompass the selection of areas to use ADS, as well as the choices made during its creation and the subsequent utilization of its outputs for decision-making. Conclusions derived from ADS outputs are typically applied in organizational settings without adequately assessing the consequences of the decision support. This study explores the difficulties related to the creation and implementation of ADS, with a focus on the significance of taking behavioural aspects into account while adopting ADS in businesses.
Depth Sensing in AI on Exploring the Nuances of Decision Maps for Explainability
Authors: Elayaraja C. , Rahila J. , Velavan P. , Rajest S. Suman , Shynu T. , Rahman Md Mehdi
Published: August 2024

The integration of depth-sensing technologies is revolutionizing a multitude of AI applications, from robotics to healthcare. This study delves into the intricacies of decision maps derived from depth data, with a particular emphasis on enhancing explainability. Our findings, corroborated with real-world applications, underscore the vast potential of depth sensing in offering a dual advantage: enhanced AI performance coupled with improved explainability, ensuring stakeholders can trust and understand AI outputs. Depth sensing technologies have ushered in a new era of possibilities in AI applications. This research explores the use of depth data to create decision maps that enhance the explainability of AI systems. Decision maps provide valuable insights into why AI models make specific decisions, which is crucial for trust, accountability, and regulatory compliance. Our study showcases the practical advantages of utilizing depth sensing for explainability. We demonstrate how these technologies can be applied in fields such as robotics, medical imaging, and autonomous vehicles. By improving our understanding of AI decision-making, we can unlock the full potential of these applications while ensuring their safety and reliability. This research highlights the transformative impact of depth sensing in AI applications. By focusing on the nuances of decision maps, we not only enhance AI performance but also provide stakeholders with the transparency and understanding necessary to trust and embrace AI technologies fully.
Coupling Relationship Between Rural Eco-Environment and Tourism Economic Development Based on Data
Authors: Fan Hanwei , Li Chunyu
Published: August 2024

With the rapid development of economy, the contradiction between the ecological environment and economic development has become increasingly serious. The ecological environment is the foundation and prerequisite for the development of rural tourism, which promotes the rural ecological environment. The coordinated development of the two is of great significance to the sustainable development of rural tourism and the construction of rural ecological civilization. On the basis of combing the existing related research results, by constructing a rural tourism-ecological environment evaluation index system, using a coupling coordination degree evaluation model, this paper makes a comparative analysis of coupling degree and coordinated scheduling. The results show that there are obvious inter-annual differences in the coupling and coordination of rural tourism and the ecological environment in the county, and the overall development trend is positive. However, the coupling degree and coordination between the two is still at a relatively low level.
Stochastic Resilience in Operations Management Using Ito Diffusion and Gamma Catastrophe Processes
Authors: Al-Husain Raed , Al-Eideh Basel
Published: August 2024

This study introduces a novel Ito diffusion model for operations management, addressing the challenge of maintaining resilience in supply chains and production networks against unpredictable disruptions. The model incorporates a general catastrophe process with a low occurrence rate, using stochastic methods to represent disruption magnitudes as gamma distribution variables. It provides an analytical framework detailing the process's mean, variance, and sample path. Applying this model across various operational scenarios demonstrates its practical significance. By examining the impacts of disruptions on operational efficiency, the model offers insights into disruption dynamics, crucial for resilience planning and risk mitigation. The findings enhance logistics networks' resilience and efficiency, aiding decision-makers in navigating disruptions. This research presents a practical tool for decision-making in operations management and sets the stage for future research with complex variables and emerging technologies to enhance predictive strength in a dynamic environment.
A Comparative Study of Online Consumer Reviews Among Mainstream and Niche Products
Authors: Kundu Supratim , Chakraborti Swapnajit
Published: August 2024

The purpose of the paper is to understand the variations in the online consumer reviews among product categories across geographies and cultures. We consider the cases of mainstream products and their lesser-known niche counterparts providing similar utilities across emerging and developed markets. We find reviews vary in terms of characteristics and sentiments across the two categories and markets. The reviews for the niches contain in-depth discussions on some topics. We apply mixed method approach of quantitative analysis, topic modeling, sentiment analysis, and network analysis to arrive at the conclusion. The quantitative analyses confirm the variations, while the qualitative approach enables us to create a typology/ontology for the reviews. Based on the observations, we could successfully map various motives and cultural dimensions related to online reviews to our hierarchical typology. Managers may find our study interesting to boost their online review strategy according to the product category in a specific geography.
Shionone Inhibits Glomerular Fibirosis by Suppressing NLRP3 Related Inflammasome though SESN2-NRF2/ HO-1 Pathway
Authors: Xiao Tian , Zhao Hanzhen , Wang Yucong , Chen Mengyin , Wang Cong , Qiao Chen
Published: August 2024

Background: Diabetic nephropathy (DN) is the most common and serious complication of diabetes mellitus. Shionone (SH), an important triterpenoid compound in the root extract of Aster, might exert a protective effect in DN mice and high glucose cultivated glomerular podocytes. The current study aimed to unravel the underlying mechanism by which SH mitigates DN. We postulate that SH stimulates the expression of sestrin-2 (SESN2), a pivotal stress-inducible protein in the anti-inflammasome machinery.Methods: We utilized high-fat diet combined with streptozotocin (55 mg/kg intraperitoneal) for DN mice model, and high glucose (30 mM, 48 hours) cultured glomerular podocytes for DN cell model to evaluate the effect of SH. We also preformed experimentation on SESN2 deficiency models (SESN2 knockout mice and SESN2 siRNA in cells) to further prove our hypothesis.Results: The results demonstrated that SH effectively suppressed glomerular fibrosis, induced adenosine monophosphate-activated protein kinase (AMPK) phosphorylation, and inhibited NLR family pyrin domain containing 3 (NLRP3) activation. Furthermore, our findings revealed that SH exerted its anti-inflammatory effect through Sesn2-dependent nuclear factor erythroid 2-related factor 2 (Nrf2) nuclear translocation and subsequent activation of its downstream target heme oxygenase-1 (HO-1).Conclusion: In summary, our findings suggest that SH serves as a promising therapeutic agent for the treatment of DN-related glomerular fibrosis. SH enhances the expression of SESN2, attenuates α-smooth muscle actin accumulation, and suppresses NLRP3-related inflammation through the Nrf2/HO-1 signaling pathway.
Metabolic Dysfunction-Associated Steatotic Liver Disease and All-Cause and Cause-Specific Mortality
Authors: Oh Rosa , Kim Seohyun , Cho So Hyun , Kim Jiyoon , Lee You-Bin , Jin Sang-Man , Hur Kyu Yeon , Kim Gyuri , Kim Jae Hyeon
Published: August 2024

Background: Given the association between nonalcoholic fatty liver disease and metabolic risks, a new term, metabolic dysfunction- associated steatotic liver disease (MASLD) has been proposed. We aimed to explore the association between MASLD and all-cause, cause-specific mortalities.Methods: We included individuals with steatotic liver disease (SLD) from the Korean National Health Insurance Service. Moreover, SLD was defined as a fatty liver index ≥30. Furthermore, MASLD, metabolic alcohol-associated liver disease (MetALD), and alcoholic liver disease (ALD) with metabolic dysfunction (MD) were categorized based on alcohol consumption and MD. We also analyzed all-cause, liver-, cancer-, hepatocellular carcinoma (HCC)- and cardiovascular (CV)-related mortalities.Results: This retrospective nationwide cohort study included 1,298,993 individuals aged 40 to 79 years for a mean follow-up duration of 9.04 years. The prevalence of MASLD, MetALD, and ALD with MD was 33.11%, 3.93%, and 1.00%, respectively. Relative to the “no SLD” group, multivariable analysis identified that MASLD (adjusted hazard ratio [aHR], 1.28; 95% confidence interval [CI], 1.26 to 1.31), MetALD (aHR, 1.38; 95% CI, 1.32 to 1.44), and ALD with MD group (aHR, 1.80; 95% CI, 1.68 to 1.93) have a significantly higher risk of all-cause mortality. Furthermore, MASLD, MetALD, ALD with MD groups showed higher liver-, cancer-, and HCC-related mortality than “no SLD” group. While all-cause specific mortalities increase from MASLD to MetALD to ALD with MD, the MetALD group shows a lower risk of CV-related mortality compared to MASLD. However, ALD with MD group still have a higher risk of CV-related mortality compared to MASLD.Conclusion: SLD is associated with an increased risk of all-cause, liver-, cancer-, HCC-, and CV-related mortalities.
Pre-service teachers’ use of the jump strategy on the empty number line for mental computation
Authors: Lovemore Tarryn S. , Graven Mellony
Published: August 2024

Background: South African teachers’ mathematical knowledge for teaching and number sense are markedly low, evidenced in national and international research. There is a call for supporting teachers in developing their knowledge and confidence in teaching mathematics.Aim: The aim of this article is to share how pre-service teachers (PSTs) used the empty number line (ENL) to demonstrate the jump strategy (JS) for efficient mental computation, related to the national Mental Starters Assessment Project (MSAP).Setting: This study was conducted at a tertiary institution in the Eastern Cape province of South Africa, with 40 first-year intermediate phase PSTs, during their mathematics didactics course.Methods: The data comprised 40 micro-teaching videos, analysed thematically, following an analytical model for video-recorded data. Videos were categorised according to the way they faithfully followed or departed from the MSAP teacher resources.Results: Findings suggest that more than 70% of the PSTs faithfully followed the teacher resources to teach the JS on the ENL, with regards to use of at least three of the four key elements, namely: ENL, jumps, gesturing, and key phrases and terminology.Conclusion: We suggest PSTs receive explicit instruction on the above-mentioned key elements for teaching mental calculation strategies with the ENL and opportunities to practise teaching these to their peers.Contribution: Most PSTs successfully used the ENL to demonstrate the JS for efficient mental computation, enabled by the opportunity to engage in developing (and reflecting on their) micro-teaching videos.
Abstract 16: Urinary metabolic signatures for differential diagnosis of diabetic and non-diabetic kidney disease
Authors: Basu Madhurima , Islam1 S K Ramiz , Neogi Subhashis , Pulai2 Smartya , Banerjee Mainak , Sengupta3 Sanghamitra , Mukhopadhyay Pradip , Bhattacharyya Nitai Pada , Roychoudhury2 Arpita , Manna1 Soumen Kanti , Ghosh Sujoy
Published: August 2024

Background: Renal involvement in T2DM can be due to diabetes per se (Diabetic Kidney Disease) or causes other than diabetes (Non-diabetic kidney disease). Currently available clinical, biochemical and radiological markers fail to differentiate DKD from NDKD and renal biopsy remains gold standard for correct diagnosis. While urinary signatures may provide a non-invasive alternative to that end, no study has been reported on urinary metabolomics of biopsy-confirmed DKD and NDKD subjects.

Aims: To identify the expression of urinary metabolic signatures as putative marker for differentiation of biopsy-confirmed DKD and NDKD subjects.

Methods: Consecutive patient with renal involvement were subjected to biopsy and classified as per ISN/RPS Classification. Morning urine sample were collected for analysis by Gas Chromatography and mass spectrometry. Features were extracted and analysed using appropriate statistical method.

Results: Urinary metabolites (M1, M2, M3, M4) were found to be depleted in patients with kidney disease (P < 0.004, <0.006, and < 0.01, <0.03 respectively). M5 was exclusively depleted in NDKD (n=16). The level of M6 (<0.01), M7 (<0.03) increased and M8 (<0.05), M9 (0.03), M10 (0.02) were decreased in DKD subjects (n=34) .

Conclusion: Our pilot study suggests that urinary metabolomics analysis may help to distinguish DKD and NDKD subjects. Our results warrant validation in another cohort.

JOURNAL/ijeam/04.03/02223308-202203001-00028/table1/v/2022-10-03T190107Z/r/image-tiff
Abstract 20: Bidirectional link between diabetes mellitus and coronavirus disease 2019 leading to cardiovascular disease: A narrative review. World journal of diabetes
Authors: Viswanathan V , Puvvula A , Jamthikar A D , Saba L , Johri A M , Kotsis V , Khanna N N , Dhanjil S K , Majhail M , Misra D P , Agarwal V , Kitas G D , Sharma A M , Kolluri R , Naidu S , Suri J S
Published: August 2024

Coronavirus disease 2019 (COVID-19) is a global pandemic where several comorbidities have been shown to have a significant effect on mortality. Patients with diabetes mellitus (DM) have a higher mortality rate than non-DM patients if they get COVID-19. Recent studies have indicated that patients with a history of diabetes can increase the risk of severe acute respiratory syndrome coronavirus 2 infection. Additionally, patients without any history of diabetes can acquire new-onset DM when infected with COVID-19. Thus, there is a need to explore the bidirectional link between these two conditions, confirming the vicious loop between “DM/COVID-19”. This narrative review presents (1) the bidirectional association between the DM and COVID-19, (2) the manifestations of the DM/COVID-19 loop leading to cardiovascular disease, (3) an understanding of primary and secondary factors that influence mortality due to the DM/COVID-19 loop, (4) the role of vitamin-D in DM patients during COVID-19, and finally, (5) the monitoring tools for tracking atherosclerosis burden in DM patients during COVID-19 and “COVID-triggered DM” patients. We conclude that the bidirectional nature of DM/COVID-19 causes acceleration towards cardiovascular events. Due to this alarming condition, early monitoring of atherosclerotic burden is required in “Diabetes patients during COVID-19” or “new-onset Diabetes triggered by COVID-19 in non-Diabetes patients”.
Abstract 24: NR5A1 mutation: A single centre experience from South India
Authors: Franklin F Joel , Praveen V P , Nisha B
Published: August 2024

Background: Inactivating mutations involving Nuclear receptor subfamily 5 group A member (NR5A1) or steroidogenic factor 1 (SF1), is increasingly being recognized as an important cause of 46XY DSD and rarely 46XX DSD. Myriad of presentations include undervirilized male with or without peripubertal virilization, ovotesticular DSD and premature ovarian failure. With the widespread availability of genetic testing it has been found that it constitutes atleast 15% of cases of 46XY DSD.

Aims and Objective: To describe the clinical presentation of a series of patients with genetically confirmed SF1 mutations from a south Indian tertiary care centre.

Result: Extreme undervirlization was noted in one subject whereas prepubertal virilization was noted in two subjects reared as females. Hormonal investigations revealed various varying degrees of Sertoli cell dysfunction (elevated FSH and low inhibin B), poor Leydig cell function in prepubertal subjects (HCG stimulated testosterone <0.087 nmol/l) and apparent recovery of Leydig cell function in peripubertal period (2.04 & 2.94 ng/ml). Exon Variants-Exon 2 c.58G>T(p.Val20Leu), Exon 5 c.940delinsACGGCAAGG (p.Gin314ThrfsTer23) and Exon 3 c.223A>C (p.Thr75Pro) were noted .

Conclusion: 46XY DSD due to inactivating NR5A1 variants can present in unusual ways characterized by extreme undervirlization at birth with apparent recovery of Leydig cell function later on.
Abstract 26: To compare the efficacy and safety of 5 days a week levothyroxine verses daily replacement therapy in hypothyroid patients; experience from a tertiary care centre in Central India
Authors: Khare Jaideep , Jindal Sushil , Pamnani Harsha , Bansal Shaifali
Published: August 2024

Background: Hypothyroidism is a common endocrine disorder and associated with several complications if not diagnosed and managed. Levothyroxine replacement therapy is the treatment of choice. Traditionally the levothyroxine is given daily empty stomach. Levothyroxine has a long half-life of 6- 7 days and hence can be given 5 days a week keeping the weekly dose same.

Aims and Objectives: To compare the efficacy and safety of 5 days a week levothyroxine verses daily replacement therapy in hypothyroid patients and to identify patient's satisfaction level at the end of trial.

Methods: Patient diagnosed with hypothyroidism and having stable thyroid function in last 6 months with minimum 2 normal thyroid profile report on same LT4 dose will be shifted to 5 days a week regimen after informed consent. Biochemical analysis for thyroid profile was done at 12 and 24 weeks or SOS according to clinical judgement.

Result: 75 Hypothyroid patients were included in the study with male to female ratio of 3:22. The mean age of our patients was 41.6 years. Mean duration of hypothyroidism was 7.6 years. The mean TSH, T4, T3 at baseline was as, 3.12 μIU/ml, 8.6μg/dl, 0.91ng/ml and at 12 weeks and 24 weeks were as 3.72 μIU/ml, 8.1μg/dl, 1.1ng/ml and 3.31 μIU/ml, 8.2μg/dl, 0.83 ng/ml respectively. There was no significant difference in thyroid profile.

63 patients did not require any dose adjustment. In 7 patients dose increment was required while in 5 patients dose reduction was done.

41 patients were more satisfied with 5 days a week, 11 patients were more satisfied with traditional daily dosing while 23 had no preferences and were like just will follow as per treating doctor.

Conclusion: 5 days a week levothyroxine replacement regimen is non-Inferior to daily levothyroxine replacement regimen in treating hypothyroid patients.
Abstract 30: A randomized control trial comparing myoinositol based therapy in combination with metformin versus metformin monotherapy on the clinical and hormonal parameters in obese reproductive age women with polycystic ovarian syndrome
Authors: Nazirudeen Roshan , Natarajan Vasanthiy , Jayaraman Sangumani , Subbiah Sridhar
Published: August 2024

Introduction: Insulin resistance is central to the pathogenesis of polycystic ovarian syndrome (PCOS). Metformin and myoinositol are insulin sensitizers which may act synergistically.

Aims and Objectives: To study and compare the efficacy of Myoinositol based therapy with Metformin vs metformin monotherapy on clinical and hormonal parameters in young obese women with PCOS.

Methods: All PCOS patients 17-40 years with BMI≥23 attending our department from December 2020 to December 2021, after excluding secondary causes and recent treatment, were randomized into intervention group: Metformin 500 mg BD + Myoinositol 1.1 g with D-Chiroinositol 27.6 mg BD and active comparator group: Metformin 500 mg BD. Weight, BMI, Waist Circumference (WC), modified Ferriman-Gallwey score (mFG), global acne score (GAS), fasting insulin, HOMAIR, serum testosterone, sex hormone binding globulin, free androgen index (FAI), LH:FSH ratio, anti-Mullerian hormone, ovarian volume were studied at baseline and after 3months of therapy. Changes in these variables were assessed and compared between the groups.

Results: Total 32 patients were included, 16 in each group. One patient in each group became pregnant, two patients in metformin group discontinued due to adverse effects. WC and GAS decreased significantly in both groups. There was significant reduction in mFG, testosterone and FAI in patients receiving myoinositol and in weight, BMI, fasting insulin and HOMA IR in the metformin monotherapy group.

Conclusion: Metformin alone and in combination with myoinositol based therapy have beneficial effect on clinical and hormonal parameters in PCOS.
Abstract 37: Adolescent primary hyperparathyroidism masquerading as rickets
Authors: Mathew Anu
Published: August 2024

Introduction: Primary hyperparathyroidism (PHPT), is a rare disorder in pediatric age-group, with an estimated incidence of 2–5 cases in 100,000 live births. Around 80% children are symptomatic with renal or gastrointestinal manifestations. Presentation with skeletal symptoms is rare with less than 30 reported cases with most cases being misdiagnosed and treated as rickets.

Case Synopsis: 14 year old boy presented with pain in both the legs and knock knees for 1 year. He was treated as nutritional rickets with oral calcium and vitamin D supplements for 1 month. He subsequently developed abdominal pain and recurrent vomiting. He was diagnosed to have abdominal tuberculosis and was started on empirical Anti- tubercular treatment. He continued to worsen symptomatically and was send to Endocrinology for evaluation of worsening leg deformity- ? Resistant Rickets

On examination his weight was <3rd centile, height 3-10th centile, waddling gait with genu valgum. Other systemic examination was normal.

Investigations showed, corrected S. Calcium of 14.9 mg/dl, Phosphorus -2.9 mg/dl, ALP- 1277 IU/L, iPTH- 1900 pg/ml, 25(OH)D – 17 ng/dl, S. Creatinine -0.4 mg/dl and Hb-9.7 gm/dl. Ultrasound neck showed a 30 x19 x13 mm left parathyroid lesion with concordance in the Tc 99 Sestamibi scan. A clinical Exome sequencing for young onset PHPT was negative. He underwent a Left inferior parathyroidectomy and histopathology showed parathyroid adenoma. 4 months post-surgery, his S. calcium is 9.1 mg/dl on oral Calcium 500 mg twice a day. He gained 8 kilos and his bone pain and proximal myopathy has improved with persistent genu- valgum.
Abstract 39: Exosomal long non-coding RNA help differentiate diabetic kidney disease from non-diabetic kidney disease
Authors: Neogi S , Ghosh S , Mukhopadhyay P , Basu M , Bhattacharyya1 S
Published: August 2024

Aims and Objective: To analyze the difference in expression of different exosomal long non-coding RNA in subjects with DKD vs NDKD.

Methodology: Second morning urine sample was collected from histologically confirmed 33 DKD and 30 NDKD patients. Exosomes were isolated using precipitation method and characterised by Nanoparticle Tracker Analysis (Nanosight NS 300) and Atomic Force Microscopy (Pico Plus 5500 ILM). RNA was isolated using trizole method. Expression of long Noncoding RNA (PVT1, MALAT1, NEAT1, HOTAIR, GAS5) were analysed by Real time PCR with respect to endogenous control (18s and B actin).

Result: Expression of long non-coding RNA MALAT1 was 1.9 fold higher (p<0.005), NEAT (0.7 times) and PVT (0.9 times) in DKD and there was reduced expression of GAS5 and HOTAIR compared to NDKD.

Conclusion: Exosomal long non-coding RNA MALAT1 expression is significantly higher and can serve as future target of research to differentiate DKD from NDKD.
Abstract 46: Karyotype and phenotype correlation in Turner syndrome in South India
Authors: Raja B Rameez , Natarajan Vasanthiy , Subbiah Sridhar
Published: August 2024

Background: Phenotypic and karyotypic features of Turner syndrome (TS) varies significantly which leads to challenges for the clinicians in diagnosis and management. There are only few committed studies from India regarding TS. This current study analyzes karyotype – phenotype differences among patients with TS.

Objectives: To assess the correlation between karyotype and phenotypic features in patients with TS.

Methods: This is a cross sectional study of 10 patients diagnosed with Turner syndrome (Jan 2021–Nov 2021). These patients were divided into 4 groups according to their karyotype: Classic (45X, Mosaics (45,X/46,XX), IsochromosomeXq (46,X,iXq and 45,X/46,X,iXq mosaics), others (45,X/46,XY mosaics and structural defects), and analyzed for various phenotypic features.

Results: Majority (40%) had classic karyotype followed by mosaic Turner (30%), isochromosomeXq (20%). Age at diagnosis was 16.7 ± 2.5 years, with 8 girls were adolescence and 2 were adult at diagnosis. Short stature and delayed puberty were the most common presenting feature (100%). Cardiac anamoly and renal anamoly were most commonly seen in classic TS (1/10, 10%). Subclinical hypothyroidism (SCH) occurred in patient with classic Turner (1/4, 25%) and patient with isochromosomeXq (1/2, 50%).

Conclusion: A significant proportion of girls presented with short stature and or delayed puberty have TS. Phenotypic features including renal malformations, cardiac disease, and dysmorphic features are more prevalent in Classic TS and correlated with degree of X chromosome loss. Thyroid disorders were more common in TS with isochromosomeXq. Mean age at diagnosis of TS is relatively late, a situation which could be improved by providing appropriate awareness among general practitioners and school teachers.
Abstract 50: Central hypothyroidism presenting with myxedema coma – Two case reports
Authors: Kaur Kirandeep , Kadian Kavita , Batra Nisha , Sridharan Kalyani
Published: August 2024

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

Case Presentation: A 57-year-old man diagnosed as panhypopituitarism following a road traffic accident 8 years back, presented with hypotension and slurring of speech after stopping hormone supplements. He was started on intravenous steroids for adrenal crisis and previous dose of thyroxine but soon developed a rigid akinetic state followed by coma. He responded well to a loading dose of thyroxine and was discharged on oral steroids, thyroxine and depot testosterone. A36-year-old female presented with altered sensorium, bradykinesia and shock. After last child birth 1 year back, she developed lactational failure and amenorrhea. Hormonal investigations showed panhypopituitarism. She improved with loading dose of thyroxine and intravenous steroids. Although empty sella is the usual finding in Sheehan's syndrome, neuroimaging in this patient revealed normal sized pituitary with multiple necrotic areas suggesting possible prolonged necrosis.

Conclusion: Myxedema coma in central hypothyroidism is complicated by co-existing pituitary hormone deficiencies and early treatment initiation is important.
Abstract 54: Clinical and biochemical outcomes of gonadotropin -Releasing hormone analogue therapy in a cohort of children with central precocious puberty from Kerala
Authors: Bhandarkar Akhila , Bhavani Nisha , Praveen V P , Kumar Harish
Published: August 2024

Background: Large scale studies of outcomes of Gonadotropin-releasing hormone analogue (GnRHa) therapy for Central Precocious puberty (CPP) are not available from our part of the country.

Aim: To evaluate the efficacy of GnRHa with clinical and biochemical parameters in a cohort of children with CPP.

Methodology: Retrospective analysis of case records of 33children (30 females and 3 males) diagnosed with CPP on GnRHa (Leuprolide acetate depot) was done.

Results: CPP was idiopathic in 20 and organic in 13 children. Median age at onset of puberty was 6.75years (range 0.75 – 8.9 years) and at start of treatment was 7years. The Median duration of therapy was 2.75years (range= 5months-9years). 52% attained LH Suppression in one year and 81% in two years. 92% patients had regression in tanner's stage by a median of 11months. BA was advanced by a median of 4.45 SD which reduced to 2.8SD at the end of therapy. Duration of therapy had significant effect in halting BA progression (p=0.004). The median height centile of 86.25 at presentation normalised in 89% at treatment completion.

Conclusion: GnRHa therapy in our cohort of CPP children was effective in reversing puberty and slowing bone age advancement despite a late age of onset of treatment.
Abstract 63: A case report of friedreich ataxia (FA) associated with diabetes mellitus and hypertrophic cardiomyopathy “A tri prong approach in the management of insulin autoimmune syndrome”
Authors: Kumar N S Praveen , Modi K D , Padhy Bimal Prasad , Soumya
Published: August 2024

Introduction: Friedreich ataxia (FA) is a multisystem autosomal recessive disease with progressive involvement of the central and peripheral nervous system, and endocrine system. Diabetes mellitus (DM) is one typical non-neurological manifestation. Diabetes is due to insulin resistance and progressive beta cell dysfunction.

Case Report: 11 years old girl was suspected of Friedreich ataxia when presented with difficulty of walking, getting up, and recurrent falls. Examination revealed positive Romberg's test, areflexia with bilateral extensor plantar reflexes. Genetic analysis of the Frataxin gene confirmed the expanded trinucleotide GAA repeats +250. At the age of 16 years, she presented to ER with diabetic ketoacidosis. At18years, follow-up evaluation showed hypertrophic cardiomyopathy. She had progressive neurodegeneration and is wheelchair-bound with severe sensory-motor peripheral neuropathy. Presently, she is 21 years and on the basal-bolus insulin regimen with a TDD of 96 units and beta-blockers for cardiomyopathy.

Discussion: Mitochondrial dysfunction at the liver, muscles, adipocytes are associated with insulin resistance. β cell dysfunction with eventual loss of Islets of Langerhans causing diabetes in FA. Mortality in FA is secondary to diabetes or related complications and cardiomyopathy.

Conclusion: Currently, no effective treatment is available for FA. Optimal Diabetes and cardiomyopathy management is essential in the management of FA.
Abstract 67: Oral: Plantar temperature and pressure distribution in subjects with diabetes mellitus and chronic charcot arthropathy – A case control study
Authors: Paul Jinson , Jebasingh K Felix , Bhattacharji1 Suranjan , Devasahayam2 Suresh , Cheriyan Kripa Elizabeth , Thomas Nihal
Published: August 2024

Background: Chronic Charcot Arthropathy is a potentially limb- threatening complication of diabetes mellitus.

Aim: To assess the plantar temperature and pressure variation on graded ambulation in subjects with diabetes mellitus and chronic Charcot arthropathy in comparison to healthy subjects.

Results: A total of 24 cases and 26 controls were included. The mean forefoot temperature was significantly higher in the Charcot's foot of patients when compared to the controls at baseline, after 50, 100 and 200 steps. Graded ambulation resulted in reduction in the mean temperature at all regions. The mean plantar pressure was significantly higher in the Charcot's foot of the patients when compared to the controls at baseline at all three sites.

Conclusion: Plantar temperature measurement with Infrared camera could be used as a surrogate marker for shear force in patients with chronic CA to see the hot spots which can be a preceding event for foot ulcer.
Abstract 68: Hypertriglyceridemia-induced acute pancreatitis – Experience from a single center of 20 patients
Authors: Shafiq Syed , Patil Mallikarjun , Devarbhavi Harshad , Gowda Vinod
Published: August 2024

Background and Aim: Although hypertriglyceridemia (HTG) is a well-established cause of acute pancreatitis (AP), there are no clear-cut therapeutic guidelines. Furthermore, studies regarding treatment and outcome of hypertriglyceridemia-induced acute pancreatitis (HTGAP) in comparison to non-HTGAP are scarce. The present study was aimed to determine the frequency and outcome of HTGAP in comparison to non-HTGAP.

Materials and Methods: All patients admitted with AP from January 2017 to August 2021 at St. John's Medical College Hospital, Bengaluru were included, and data were collected prospectively. Patients with HTGAP and non-HTGAP were compared.

Results: Of 964 patients admitted with AP, 20 (2.12%, M: F -13:7) were HTG related. The mean age was 39.05 years and the mean triglyceride levels were 3620.8 mg/dl (range 1094 - 11,991). Patients with HTGAP in comparison to non- HTGAP had significantly (p <0.05) high BMI (29.22 v/s 25.69), high severity scores (BISAP and CT severity score, 2.6 v/s 2.06 and 7.5 v/s 4.80) and required prolonged hospitalization (12.9 v/s 6.5 days). 16 patients were treated with insulin infusion and rest conservatively.

Conclusion: HTGAP occurred in young patients with high BMI and was associated with more severe disease and required prolonged hospitalization in comparison to patients with non-HTGAP.
Abstract 69: A novel variant of MTHFR homozygous mutation causing hyperhomocystinemia in a case presenting as tall stature
Authors: Pande Arunkumar R , Jha Ashish
Published: August 2024

Background: Tall stature is an important challenge in clinical practice.

Case Report: We report case 2 brothers, Elder one 17-year-old boy presented with tall stature and mental retardation; his height was 178 cm (90 centile) with MPH of 164 (10 centile). Upper segment to lower segment rati of 0.85. He had high arch palate, arachnodactyly, with chest deformity, scoliosis, genu valgum. His intelligence quotient was 58. His Serum Homocystine level was 199.95 micromol/L (normal range 5.45 -16.2). His younger brother, who had the same mutation, had 165 cm (90 centile) height at the age of 13 years. The younger one serum homocystine levels was 166 micromol/L. Whole exome sequencing revealed a homozygous novel missense mutation in the MTHFR gene in exon 12 (c.1874A>C (p.Lys625Thr)). Methylenetetrahydrofolate reductase (MTHFR) deficiency is a rare inborn error of metabolism that cause hyperhomocysteinemia with homocystinuria, or mild hyperhomocysteinemia, which in turn leads to mental retardation, psychiatric disturbances, thromboembolic phenomena, and skeletal abnormalities such as osteoporosis, and tall stature.

Conclusion: We report two brothers with novel variant of MTHFR homozygous mutation causing hyperhomocystinemia in a case presenting with tall stature.
Abstract 87: Novel mutation in leptin receptor causing monogenic obesity
Authors: Bonny Lavanya , Bantwal Ganapathi , Ayyar Vageesh , George Belinda , Appaiah Sonali
Published: August 2024

Hereby we present a case of monogenic obesity in a 3 ½ year old boy. Child was born of third degree consanguinity with birth weight of 3kg. He had excessive weight gain since five months of age with food seeking behaviour, recurrent upper respiratory tract infections since infancy, renal calculi and features of obstructive sleep apnoea. He had normal developmental milestones. His 5 ½ year old sister also had obesity since infancy with a present BMI of 41.64 kg/m2 and recurrent upper respiratory tract infections. No other similar family history. On examination, his height was 103 cm (SDS 0.98). He weighed 40 kg with BMI of 37.7 kg/m2 (Z score +6.9). General examination showed grade 4 acanthosis nigricans, low set ears, and café au lait spot on the abdominal wall. Bone age was appropriate for chronological age. Investigations revealed dyslipidemia and fatty hepatomegaly. Screening tests for secondary causes were negative. In view of strong suspicion of genetic etiology, clinical exome sequencing was done which showed a novel mutation c.850-1G>A in Intron 7 of LEPR suggestive of leptin receptor defect.
Abstract 92: Contemporaneous association of pheochromocytoma with Cushing's syndrome
Authors: Acharya Himamshu , Ganavi1 Y P , Suryanarayana2 K M , Selvan3 Chitra , Kalra4 Pramila
Published: August 2024

Background: Pheochromocytomas are catecholamine secreting tumours of the adrenal gland. We report a rare case of adrenocorticotropic hormone-secreting pheochromocytoma.

Case Report: A twenty-five-year-old male presented with excessive fatigue for one year. He had pain abdomen two weeks prior to the presentation. On examination, he was pale, emaciated, had tachycardia with normal blood pressure. Abdominal ultrasound revealed a right adrenal mass. There were no stigmata of Cushing's disease. His urinary metanephrine was 469.8 μg/24 hours, and nor-metanephrine was 3676.5 μg/24 hrs. Androstenedione, DHEA-S were normal. The 8 am cortisol was not suppressed with overnight 1mg dexamethasone. He had elevated ACTH (253.9 pg/mL). Calcium, phosphorous, prolactin levels were normal. He underwent laparoscopic resection of the tumour after adequate alpha and beta-blockade. The tumour measured 9x8.5x6 cm with no capsular or vascular invasion. Histopathology revealed tumour cells with round to irregular nuclei arranged in the Zellballen pattern. Tumour cells were diffusely positive for chromogranin A. Ki-67 index was 1-2%. Post-operatively 24-hour urinary metanephrine, normetanephrine and ACTH levels were normalized.

Conclusion: This case report highlights the importance of complete biochemical evaluation in a patient with an adrenal mass even if biochemical evidence of pheochromocytoma is confirmatory.
Abstract 93: Ambulatory glucose profiles of children and adolescents with T1DM: Identification of factors affecting glycemic control
Authors: Tandon Ambica , Ali Zebish , Bhatia Vijayalakshmi
Published: August 2024

Background: Continuous glucose monitoring (CGM) provides information about glycemic control, beyond that provided by HbA1c and SMBG, including short-term glycemic variability, hypoglycemic and hyperglycemic events.

Aims and Objectives: To describe ATTD endorsed CGM derived glycemic variables from a cohort of T1DM, assess possible factors influencing glycemic control and study the association between HbA1c and these variables.

Results: 61 patients (age, 15.9 + 5), median duration of diabetes 6 years, wore the FreeStyle libre for a median of 14 days. Mean TIR was 46.3 + 15.5, TBR 16.7 + 13.5 and TAR 36.9 + 22.0. Mean glycemic variability (%CV) was 48% and 90% had high %CV. Those using NPH had a significantly higher %CV (P=0.007) compared to those on glargine. Females (n=34, P=0.05) and those using NPH (n=18, P=0.08) tended to spend a longer time in hypoglycemia. HbA1c showed a negative correlation with TIR (r=-0.441), TBR (r=-0.544), %CV (r=-0.335) and a positive correlation with TAR (r=0.656), mean glucose (r=0.714). On subgroup analysis, group with lowest HbA1c (<6.8%, n=16), although had highest TIR but also highest TBR.

Conclusion: Our findings demonstrate wide gaps between the recommended versus real world glycemic variables in children with T1DM and highlight the need to implement interventions for better glycemic control.

Acknowledgements: This work was supported by a grant from the Endocrine Society of India.
Abstract 102: Case series of tumor induced osteomalacia
Authors: Mudalagiri Manasa , Bantwal Ganapathi , Ayyar Vageesh , George Belinda , Appaiah Sonali
Published: August 2024

Tumor induced osteomalacia (TIO) is a rare paraneoplastic syndrome characterised by small mesenchymal tumors secreting phosphotonins resulting in musculoskeletal pains, proximal myopathy and pathological fractures.

Aims and Objectives: To describe clinical, biochemical characteristics and outcomes among TIO patients at our institute.

Results: Eight patients were included in this study (75% female). The mean age was 36.5, mean duration of illness was 5.25 years. All of them presented with musculoskeletal pains and proximal myopathy. Pathological fractures were seen in 6/8. Two of them were wheel chair bound and rest walked with support. Mean serum calcium was 8.78 mg/dl with, phosphate of 1.36 mg/dl, vitamin D of 39.41 ng/ml, PTH of 125.95 pg/dl, ALP of 353 U/L and TmP/GFR of 1.22 mg/dl. Mean pre-op FGF23 levels was 251 RU/ml (2/8 patients). Six patients underwent 68Ga DOTONAC PET CT, of which only 3 showed metabolically active lesion and underwent excision and showed improved functional status.

Conclusion: Our study shows that 50% of the patients did not have localization of tumor on functional scan at presentation. This requires long term follow-up with repeated scans.
Abstract 103: The pituitary apoplexy score (PAS) in the evaluation and management of pituitary apoplexy: A single centre experience
Authors: Mudalagiri Manasa , Ayyar Vageesh , Bantwal Ganapathi , George Belinda , Appaiah Sonali
Published: August 2024

Introduction: Pituitary apoplexy score (PAS) is a clinical tool, scored from 0 to10, consisting of GCS, visual acuity, visual field defects and ocular muscle function. It helps assess the clinical severity and outcome of patients with pituitary apoplexy (PA).

Aims and Objectives: To apply PAS score retrospectively and determine its usefulness in the management of our PA patients.

Results: Sixteen patients were included in the study (56.3% males) with mean age of 34.25 years. Presenting feature was headache in 87.5%, visual disturbance in 50%, seizures in 18.8% and focal deficit in 6.3%. The precipitating event was found in 3 (18.9%). The mean PAS in conservatively managed patients was 0.27 and in those surgically managed was 3.2. Emergent pituitary surgery was performed in 5 patients (31.3%) of which 4 had PAS of >3.

Conclusion: Clinical severity based on PAS ≥ 3 appeared to influence the management towards emergency surgical intervention and can be a useful tool to monitor conservatively managed patients and intervene.
Abstract 108: A case of familial acromegaly
Authors: Appaiah Sonali , Mudalagiri Manasa , Bantwal Ganapathi , Ayyar Vageesh , George Belinda
Published: August 2024

We present a 22-year-old female who complained of headache and coarsening of facial appearance over 3 years without any visual disturbance/galactorrhoea/menstrual disturbance. There was a similar history in her mother at 44 years of age who underwent surgery and radiotherapy. On examination she had clinical features suggestive of active acromegaly with unremarkable systemic examination. Biochemistry revealed high IGF-1 (891 ng/ml), non suppressed post glucose load GH (19.3 ng/ml) without other pituitary hormone deficits. MRI Sella showed sellar suprasellar lesion suggestive of pituitary macroadenoma with chiasmal compression. In view of strong family history, a clinical exome sequencing was done which showed a heterozygous nonsense variation in exon 6 of the AIP gene (chr11:g.67490910C>T).