bluuebunny/crossref_metadata_2025_split huggingface dataset:
THU132 Pediatric Diabetes Virtual Visit Quality And Outcome Not Associated With Social Determinants Of Health
Authors: Bastien Laurence , Zuijdwijk Caroline , Goldbloom Ellen , Webster Richard , Sucha Ewa 
Published: October 2023

Abstract
Disclosure: L. Bastien: None. C. Zuijdwijk: None. E. Goldbloom: None. R. Webster: None. E. Sucha: None.
Word count: 350 Title: Pediatric diabetes virtual visit quality and outcome not associated with social determinants of health Authors: Laurence Bastien, Ellen Goldboom, Ewa Sucha, Richard Webster, IvanTerekov, Caroline Zuijdwijk Objectives: Social determinants of health (SDH) impact diabetes short- and long-term outcomes. In response to COVID-19, virtual care has become a solution to ensure ongoing healthcare access. However, socially disadvantaged groups have less access and skills related to technology, leading to potential increases in health disparities. We aimed to determine the association between SDH and physician-perceived virtual visit quality and outcome in pediatric diabetes patients. Methods: Retrospective chart review of patients who attended a scheduled virtual diabetes follow-up visit at a pediatric tertiary care centre from December 1, 2020 to March 31, 2021. During this time, a quality improvement study required physicians to rate the quality (same/better or worse than in-person) and outcome (successfully replaced in-person visit or not) of each virtual visit. These data, along with patient characteristics, were extracted from the electronic health record. Institut national de santé public du Québec Material and Social Deprivation Index and the Ontario Marginalization Index (Ethnic Concentration) were used to determine SDH based on postal code. Statistical analysis tested for an association between deprivation index quintiles and virtual visit quality and outcome. Results: Data were obtained for 447 patients with mean age 12.7±3.8 years; 47.7% female; 93.1% type 1 diabetes; and mean glucose management indicator 7.96±1.41%. During the study period, 17.9% visits were evaluated as worse than in person, 13.1% visits were unsuccessful in replacing an in-person visit, and 20.7% were rated worse or unsuccessful. The odds of having a worse or unsuccessful visit were not different in those with the highest vs. lowest degree of material deprivation (odds ratio [OR] 1.59, 95% confidence interval [CI] 0.53, 4.76), social deprivation (OR 1.36, 95%CI 0.48, 3.83), or ethnic concentration (OR 0.30, 95%CI 0.30, 1.77). Conclusion: In our pediatric diabetes population, virtual visit quality and outcome were not associated with material or social deprivation. These results show promising success in equitable access and delivery of high quality virtual diabetes care for patients regardless of socioeconomic status, which is important in the context of the current pandemic and sustainable widespread integration of virtual care. Further studies are required to assess this association in other populations.
Presentation: Thursday, June 15, 2023
THU135 Maternal Obesogenic Diet Exposure Affects Post-natal And Pathologic Hepatocyte Proliferation In Offspring
Authors: Ramavath Naresh Naik , Hinrichs Holly , Young Monica , Thompson Michael 
Published: October 2023

Abstract
Disclosure: N. Ramavath: None. H. Hinrichs: None. M. Young: None. M. Thompson: None.
Background: Obesity is a complex metabolic syndrome associated with a wide range of abnormalities in liver known as non-alcoholic fatty liver diseases (NAFLD). Evidence supports that maternal obesity/obesogenic diet exposure programs increased NAFLD offspring. The liver responds to lipotoxic hepatocyte injury through hepatocyte proliferation. It is not clear whether maternal obesogenic diet exposure affects the capacity of offspring hepatocytes to proliferate. We hypothesized that early impact of maternal/ obesogenic diet exposure in early life or utero exposure enhances hepatocyte proliferation capacity in offspring. Methods: Female mice were fed chow or high fat-fructose-cholesterol (HFFC) diet for 6 weeks and bred with lean males Liver and serum samples were collected at different postnatal time periods 5, 10, 15, 20, 25, and 30 days to analyze histological and molecular markers for liver proliferation. In addition, a small group of offspring from each group were weaned to the HFFC diet for 7 weeks to analyze progression of NAFLD (non -alcoholic fatty liver diseases). Results: No significant difference between neonatal body weight and liver weight was observed; however, the liver weight/body weight was increased at day 20 in HFFC offspring compared to chow offspring. The number of ki-67 positive hepatocytes peaked in both groups at day 15. An increase in ki-67 positive hepatocytes was observed at 15, 20, and 30 days in HFFC offspring compared to chow offspring. After 7 weeks of HFFC diet feeding, the number of Ki-67 positive hepatocytes was higher in HFFC offspring in comparison with Chow offspring. Conclusion: Maternal obesogenic diet exposure affected post-natal and NAFLD-associated hepatocyte proliferation in offspring with an increase in hepatocyte proliferative capacity. This could have implications for the ability of maternal obesity exposed offspring to respond to hepatic injury and potential for development of hepatic cancer.
Presentation: Thursday, June 15, 2023
THU139 The Triglyceride-glucose Index Combined With Alanine Aminotransferase Is A Superior Predictor Of The Severity Of Nonalcoholic Fatty Liver Disease In Children And Adolescents
Authors: Yoon Jong Seo , Hwang Il Tae 
Published: October 2023

Abstract
Disclosure: J. Yoon: None. I. Hwang: None.
Background: The triglyceride–glucose (TyG) index is significantly associated with the presence of nonalcoholic fatty liver disease (NAFLD). Alanine aminotransferase (ALT) has been commonly used to screen for NAFLD. Ultrasound fatty liver indicator (US-FLI) is proposed as a non-invasive, semi-quantitative method for predicting NAFLD and accurately identifies histological severity. Objects: We hypothesized that the combination of TyG and ALT would increase the sensitivity and specificity in determining the severity of NAFLD. We evaluated the usefulness of a newly proposed TyG-ALT index for differentiating NAFLD severity and compared it with TyG index. Methods: ALT was used as the screening method for NAFLD (&gt;26 IU/L in boys and &gt;22 IU/L in girls), and the US-FLI was performed on children who met these criteria. US-FLI is a new scoring system ranging 2-8 based on the intensity of liver/kidney contrast, posterior attenuation of ultrasound beam, vessel blurring, difficult visualization of gallbladder wall, difficult visualization of the diaphragm and areas of focal sparing. NAFLD is diagnosed by the minimum score ≥2. The TyG index and the TyG–ALT index were calculated as follows: TyG index=ln(fasting TG [mg/dL]×fasting glucose [mg/dL]/2) and TyG–ALT index= ln(fasting triglyceride [mg/dL]×fasting glucose [mg/dL]×ALT [IU/L]/2). Healthy children of normal weight (body mass index 5-85th percentile) without metabolic comorbidities and no steatosis on ultrasound participated as a control group. Results: A total of 130 NAFLD patients (90 boys and 40 girls) included in this study, with mean age of 11.5±2.29 years. The control group consisted of a total of 28 subjects (17 boys and 11 girls) with mean age of 8.39±1.60 years. Multiple linear regression analysis showed that TyG-ALT index were significantly associated with US-FLI (β=0.356, p&lt;0.001) after controlling for sex, age, and BMI. TyG-ALT index was independent risk factor for NAFLD (odds ratio: 4.218, 95% confidence interval: 1.366-13.020) after controlling for sex, age, and BMI. In the receiver operating characteristic analysis, the area under the curve (AUC) of TyG index was 0.681(p&lt;0.001), 0.681(p&lt;0.001), and 0.782(p&lt;0.001), and AUC of TyG-ALT index was 0.797, (p&lt;0.001), 0.797(p&lt;0.001), and 0.813(p&lt;0.001) in US-FLI ≥4, ≥5, and ≥6, respectively. Conclusions: The TyG–ALT index showed consistently superior detection ability than the TyG index at all severity levels of NAFLD. Further studies are needed to determine its potential role as a noninvasive method for NAFLD screening.
Presentation: Thursday, June 15, 2023
THU144 Highs And Lows: Trends In The Incidence Of Pediatric Type 2 Diabetes Mellitus Related To The COVID 19 Pandemic
Authors: Goroff Julia , Hanley Patrick , Gannon Anthony , Grunwald Tal 
Published: October 2023

Abstract
Disclosure: J. Goroff: None. P. Hanley: None. A. Gannon: None. T. Grunwald: None.
The COVID 19 pandemic and associated lock downs resulted in a definitive change in lifestyle that has had multiple associated outcomes for child health. There has been report of dramatic increases in the incidence of Type 2 Diabetes in the months and years immediately following the start of the pandemic. However, whether this demonstrates an overall upward trend in disease burden, or a discrete spike has yet to be described. In this retrospective cohort study patients younger than 21 years old diagnosed with Type 2 Diabetes from January 2017 to December 2022 at a large stand-alone children’s hospital were compared. Chart review was conducted at participants’ first endocrinology office visit or inpatient hospital stay for new onset Type 2 Diabetes. Diagnosis was confirmed with anti-body status for each participant. Statistical significance between incidences was determined using standard descriptive statistics. A total of 213 new onset Type 2 Diabetes cases were included. The average incidence of Type 2 Diabetes from 2017 to 2019 was 19 cases per year; compared to 65.5 cases per year from 2020 to 2021 representing a statistically significant increase in the incidence of Type 2 Diabetes (p&lt;0.001). 2022 saw a fall in incidence to 25 cases per year. This was a significantly lower incidence rate than 2020 to 2021 (p=0.01). There was no difference in incidence rate of Type 2 Diabetes from 2017 to 2019 and 2022 (p=0.39). These results support a significant increase in Type 2 Diabetes diagnoses with the onset of the COVID 19 pandemic. This may be secondary to sedentary lifestyle, increased mental health and psychosocial stressors or increased BMI. However, we demonstrate that two years after the onset of the pandemic there was a return to pre-pandemic incidences of Type 2 Diabetes. Type 2 Diabetes continues to pose a significant health threat to the pediatric population and burden for the medical system as they age. Nevertheless, if this trend continues and is reflected across other institutions, it is reassuring and may offer insight into modifiable risk factors yet to be investigated.
Presentation: Thursday, June 15, 2023
THU192 Prevalence Of Brain Abnormalities In Children With Central Precocious Puberty
Authors: Bastos Aline Almeida , Machado Canton Ana Pinheiro , Macena Larissa Baracho , Pedrosa Ludmila Fernandes , Mendonca Berenice Bilharinho , Brito Vinicius Nahime , Latronico Ana Claudia 
Published: October 2023

Abstract
Disclosure: A.A. Bastos: None. A.P. Machado Canton: None. L.B. Macena: None. L.F. Pedrosa: None. B.B. Mendonca: None. V.N. Brito: None. A. Latronico: None.
Introduction: Brain magnetic resonance imaging (MRI) is the main tool used to investigate the etiology of central precocious puberty (CPP) in children. A systematic review study showed an overall prevalence of 9% of brain lesions in girls with CPP. Aim: To assess the frequency brain lesions in children with CPP. Patients and Methods: In this retrospective study, we recruited data of 163 brain MRI of children with CPP (140 girls,86%; and 23 boys, 14%) followed in a pediatric endocrinology unit from 1990 to 2022. Brain lesions were classified as congenital or acquired, and causative of CPP or incidental. Results: In girls, normal brain MRI was found in 82/140 (59%). Abnormal brain MRI was identified in the remaining 58 girls (41%), with 26 presenting congenital lesions causative of CPP (11 hypothalamic hamartoma, 7 hydrocephalus, 3 optic pathway gliomas, 2 corpus callosum agenesia, 1 pinealoma, 1 tuberous sclerosis, 1 choroid plexus papilloma), and 32 with incidental findings (microadenomas, pituitary stalk deviation, pituitary hyperplasia, rathke cleft cyst, hippocampal alterations). The overall frequency of incidental findings was 20.8%. In addition, the frequency of brain MRI pathological abnormalities in girls older than 6 years without neuro ophthalmological symptoms was 12%(n=7). In boys, normal brain MRI was found in 6/23 (26%). Abnormal brain MRI was identified in the remaining 17 boys, with 14 presenting congenital lesions causative of CPP (9 hypothalamic hamartoma, 4 hydrocephalus, 1 pineal teratoma) and 1 with acquired lesions (1 pilocytic astrocytoma). Incidental findings were detected in only 2 brain MRI (1 pineal cyst and 1 microadenoma). Incidentalomes were more frequent in girls and lesions that can be associated with CPP were more common in boys. Conclusion: The frequency of pathological brain lesions was higher in CPP boys. Hypothalamic hamartoma was the most frequent congenital lesion identified in both sexes. Based on the frequency of pathological brain alterations in girls older than 6 years we recommend to perform brain MRI in all CPP girls.
Presentation: Thursday, June 15, 2023
THU204 Serum Vascular Endothelial Growth Factor-A Levels According To Pubertal State And Body Weight In Children
Authors: Nam Hyo-Kyoung , Kang Eungu , Rhie Young-Jun , Lee Kee-Hyoung 
Published: October 2023

Abstract
Disclosure: H. Nam: Grant Recipient; Self; Supported by a Korea University Grant. E. Kang: None. Y. Rhie: None. K. Lee: None.
Objectives: Childhood obesity may lead to early puberty in girls, however, it remains unclear whether early thelarche in overweight girls is related to central activation of the gonadotropin releasing hormone-gonadotropin axis. Vascular endothelial growth factor-A (VEGF-A) is essential for governing angiogenesis in adipose tissue. We assessed serum VEGF-A level according to pubertal state and weight in girls. Patients and Methods: Total 165 girls were classified as prepuberty (n=40), puberty with peak LH &lt;5.0 IU/L (n=60), and puberty with peak LH ≥5.0 IU/L (n=65). Serum VEGF-A, sex hormone, gonadotropin level and bone age were analyzed according to pubertal state and overweight including obesity. We measured serum level of VEGF-A using ELISA kit. Results: Their chronological age were similar (7.8±1.2, 7.9±0.8, and 8.0±0.9 years, p=0.410 in prepuberty, puberty with peak LH &lt;5.0 IU/L, puberty with peak LH ≥5.0 IU/L, respectively). The mean VEGF-A level was higher in puberty girls (399.3±206.2, 633.5±473.0, 605.7±392.4 pg/mL, P=0.009) and was significantly correlated with Tanner stage (r=0.224, p=0.004), BMI SDS (r=0.191, p=0.014), and weight SDS (r=0.202, p=0.009). When sub-analysis with the degree of obesity, VEGF-A level (802.2±556.0 pg/mL) was highest in overweight puberty girls with peak LH &lt;5 IU/L and was significantly correlated with peak LH (r=0.397, p=0.044) and peak LH/FSH (r=0.409, p=0.038). Conclusions: Our study showed higher VEGF-A levels in overweight puberty girls. Obesity-associated VEGF-A rise may involve in the progression of precocious puberty. Further studies related to pathophysiological mechanism are needed.
Presentation: Thursday, June 15, 2023
THU230 Consumptive Hypothyroidism Secondary To Hemangioma
Authors: Thirunagari Rajeev , Taha Doris R 
Published: October 2023

Abstract
Disclosure: R. Thirunagari: None. D. Taha: None.
Background: Peripheral Hypothyroidism also known as consumptive hypothyroidism has been rarely described in association with vascular tumors such as hemangiomas. It is due to excessive production of type 3 iodothyronine deiodinase (D3) enzyme by the hemangioma leading to increased rate of deiodination of T4 and T3 to inactive forms. Clinical case: We report a 4-year-old girl who was diagnosed with consumptive hypothyroidism at the age of 2 months. She was born at full term via scheduled C-section. Mother has hypothyroidism. She was admitted to NICU for respiratory distress and needed oxygen supplementation. She had a large hemangioma covering most of her back on exam. An ultrasound of the head/neck soft tissue showed an ill-defined lobular heterogeneous mass measuring 3.4 x 1.2 x 4.5 cm, markedly hypervascular with both arterial and venous flow likely consistent with hemangioma. At follow up plastic surgery clinic she had respiratory distress which necessitated readmission to the NICU for further workup and possible initiation of Propranolol. An abdominal ultrasound showed enlargement of the right adrenal and on further dedicated ultrasound a right suprarenal lobulated mass as well as intrathoracic soft tissue mass were found. MRI of the abdomen and thorax, revealed multiple large bilateral paraspinal masses throughout the thoracic and lower cervical spine(largest measuring 3.3 x 7 x 15 cm AP) invading the neural foramen at multiple levels, and causing mass effect on the spinal cord which is displaced to the left. There was mass effect on adjacent vascular structures without significant vascular compromise. Biopsy was consistent with hemangioma. Thyroid Newborn screening result was normal. Thyroid evaluation done at 3 months age revealed, free T4 level of 1.04 ng/dL and TSH level of 11.3 µIU/mL. She was started on Levothyroxine 50 mcg daily. Reverse T3 was elevated at 139.2 ng/dl (reference range 13-107 ng/dl) 2 weeks after treatment initiation. She was initiated on propranolol and was followed up by plastic surgery and oncology. She had a very good response to Propranolol. Follow up MRI at 4 years shows almost complete resolution of the mass. She continues to be on Levothyroxine but is requiring smaller dose. Conclusion: Infantile hemangiomas can express high levels of type 3 iodothyronine deiodinase (D3), an enzyme that catalyzes the inner-ring deiodination of T4 to reverse T3 (rT3) and of T3 to 3,3'-diiiodothyronine (T2), both of which are biologically inactive. The hypothyroidism is a result of degeneration of thyroid hormones at rates that exceed the synthetic capacity of the infant's thyroid gland. Our case illustrates the importance of closely monitoring thyroid function tests in infants with large hemangiomas even if newborn thyroid screening result is normal. Some infants may require higher Levothyroxine doses than usual. Hypothyroidism usually resolves after resolution of the mass.
Presentation: Thursday, June 15, 2023
THU241 Novel PPARG Pathogenic Gene Variant In Newly Diagnosed Familial Partial Lipodystrophy With Childhood Onset
Authors: Chang Eric K , Greve Katherynne , Escobar Luis 
Published: October 2023

Abstract
Disclosure: E.K. Chang: None. K. Greve: None. L. Escobar: None.
Background: Familial partial lipodystrophy (FPL) is characterized by progressive, selective body fat loss and is often associated with various metabolic complications including insulin resistance. In particular, FPL Type 3 due to PPARG (peroxisome proliferator-activated receptor gamma) mutations is a very rare subtype with a prevalence of less than 1 per 1,000,000 people overall. This case report describes a clinical case of a child presenting with genetic testing revealing a novel PPARG pathogenic gene variant. Clinical Case: A 9 year old female with history of adoption and unknown family history presented with severe abdominal pain and intractable emesis in the setting of COVID19 infection. Her hospital CT scan of the abdomen was remarkable for pancreatitis and hepatosplenomegaly. Glucose was elevated at 356 mg/dL with normal liver function tests. HgA1c was 11%. Triglycerides were above 4425 mg/dL. Her overall clinical picture was consistent with new onset diabetes mellitus and acute pancreatitis. Physical exam was notable for xanthomatosis and acanthosis nigricans. She was later noted to have partial subcutaneous fat loss of the upper and lower extremities, with preserved fat in the face, neck, and truncal region. She was initiated on insulin therapy and discharged to home once symptomatically improved from her pancreatitis with downtrending triglycerides to less than 450 mg/dL. Her diabetes autoantibodies (Glutamic acid decarboxylase, Islet Antigen-2, Zinc transporter 8 antibodies) resulted as normal, and she was able to discontinue insulin with HgA1c trending down to 4.8% within 4 months of hospital discharge. She underwent whole exome sequencing per recommendation of her lipid specialist and geneticist, which identified a likely pathogenic, previously undescribed variant of PPARG: c.1050_1054dup, p.(Glu352Alafs*12) and a variant of uncertain significance for MC4R: c.409A&gt;G, p.(Ile137Val). This particular variant of PPARG represents a frameshift mutation, resulting in a premature stop codon, likely leading to a loss of normal PPARG function. PPARG mutations are specific to FPL Type 3, which is reportedly associated with atypical fat distribution, diabetes mellitus, hypertriglyceridemia, hypertension, and pancreatitis, consistent with many features of this case. Conclusion: This is the first case to describe the unique PPARG variant c.1050_1054dup, p.(Glu352Alafs*12) which is associated with FPL Type 3. This child's clinical course and evaluation can help with identifying affected individuals of this very rare type of FPL.
Presentation: Thursday, June 15, 2023
SAT348 Changes In BMI Z-score After Presentation For Early Breast Budding Is Associated With Rapidly Progressive Puberty And Treatment With GnRH Analogues
Authors: Jung Hae Woon , Cho Ja Hyang , Shim Kye Shik 
Published: October 2023

Abstract
Disclosure: H. Jung: None. J. Cho: None. K. Shim: None.
Introduction: Childhood overweight and obesity are associated with earlier pubertal timing, especially in girls. We aimed to identify different body mass index (BMI) trajectories in patients presenting for breast budding between 5 and 7 years of age, and investigated whether the change in BMI z-scores during follow up is associated with rapid progression of puberty and eventual treatment with gonadotropin-releasing hormone (GnRH) analogues. Methods: We retrospectively reviewed girls who presented with breast budding at 5 to 7 years of age, between March 2016 and May 2021 at a single center. Those 206 girls, who had more than 3 follow up BMI measurements to more than 9 years of age were included in the study. The girls were grouped according to whether BMI z-scores increased or decreased/remain unchanged overall during follow-up. The BMI z-score changes over time (age) were also assessed for latent class trajectories. The risk of progression to rapid progressive puberty requiring treatment with GnRH analogues was analyzed according to overall changes in BMI z-scores and the different BMI trajectory groups, with adjustment for birthweight, gestational age, maternal menarche, maternal height, as well as the initial age, height, and bone age at presentation. Results: The mean age at presentation for breast budding was 7.1±0.7 years. A greater proportion of girls whose BMI z-scores increased during follow up, required treatment with GnRH analogues (n=53, 64%) compared to those whose BMI z-scores decreased or remained unchanged (n=54, 44%). Girls with increases in BMI z-scores during follow up (n=83) had increased risk (OR 4.68, 95% CI 1.88-11.63, p = 0.001) for rapid progressive puberty and treatment with GnRH analogues compared to those girls with decreases/no changes (n=123) in BMI z-scores, even after adjustment for covariates. Further analysis showed that increases in BMI z-scores even in those of normal weight status, were associated with increased OR (4.88) for treatment. Through latent class mixed modelling analysis, we identified 2 different trajectories (high and increasing BMI z-scores, n=72; and decreasing BMI z-scores, n=134). Risk for rapid progression of puberty and eventual treatment with GnRH analogues did not differ significantly between the different latent class trajectories. Conclusions: Increases in BMI z-scores during the follow up period after presentation for early breast budding may be associated with increased risk for rapid progression of puberty and treatment with GnRH analogues. Analysis of a larger group of patients may allow for better assessment of latent class BMI z-score trajectories.
Presentation: Saturday, June 17, 2023