bluuebunny/crossref_metadata_2025_split huggingface dataset:
FRI113 Increased Body Fat Is Associated With Heart Failure Of Ischemic Cause
Authors: Bandeira Francisco , Oliveira Lucian B , Siqueira Mariana A F M , Gadelha Rafael B M , Correia Alice R P , Garcia Jessica M A , Victor Bandeira Francisco , Paula Bandeira Maria 
Published: October 2023

Abstract
Disclosure: F. Bandeira: None. L.B. Oliveira: None. M.A. Siqueira: None. R.B. Gadelha: None. A.R. Correia: None. J.M. Garcia: None. F.V. Bandeira: None. M.P. Bandeira: None.
Introduction: Adiposopathy is a relevant cardiovascular risk factor, being related to the onset of endothelial dysfunction and atherosclerotic disease, and has also been identified as a factor that may contribute to the onset or progression of heart failure (HF). Objective: To evaluate percent body fat (%BF) in patients hospitalized for HF and its relationship with cardiometabolic parameters and with HF etiology. Methods: Cross-sectional study was conducted in a Cardiology center, with patients aged 40 to 64 years hospitalized with HF. %BF was assessed by whole-body dual-energy x-ray absorptiometry (DXA), using the cutpoint of 25% for men or 35% for women. Coronary ischemia was confirmed by imaging tests or coronary angiograms. Results: A total of 109 patients were evaluated, of which 50.5% were female. The medians of age, length of hospital stay and left ventricular ejection fraction (LVEF) were 58 years (interquartile range [IQR] 53-61), 20 days (11-32) and 48% (34-60), respectively. 48.6% had preserved LVEF (≥50%), 11.0% mildly reduced LVEF (41-49%), and 40.4% reduced LVEF (≤40%). According to the New York Heart Association Functional Classification (NYHA-FC), 33% had NYHA-FC I-II and 67% NYHA-FC III-IV. Most patients had dysglycemia (32.1% prediabetes and 57.7% diabetes; hemoglobin A1c [HbA1c] median: 6.4% [5.8-8.4]). HF of ischemic cause was present in 57.8% of the patients. High %BF was present in 67.9%, while body mass index (BMI) in the obesity range was observed in 41.3%. High %BF was associated with ischemic HF (77.8% high %BF in ischemic HF vs. 54.3% in non-ischemic HF, p=0.010). Ischemic etiology was also associated with higher BMI (29.4 ± 5.0 vs. 26.8 ± 5.6 kg/m², p=0.012). %BF was not associated with gender (67.3% of women vs. 68.5% of men, p=0.889) or NYHA-FC (75.0% of those with NYHA-FC I-II vs. 64.4% of those with NYHA-FC III-IV, p=0.264). It was associated with higher LVEF (50.5% [36.8-62.0] vs. 37.0% [27.0-59.0], p=0.023), shorter hospital stays (18.0 [9.3-28.0] vs. 24.0 days [13.0-35.0], p=0.028), and higher serum triglycerides (139.0 [98.8-199.3] vs. 91.0 mg/dL [70.0-140.0], p=0.001). There were no associations between high %BF and HDL-cholesterol (35.0 [26.8-45.3] vs. 37.0 mg/dL [29.3-47.9], p=0.601), total cholesterol (166.0 [139.0-189.3] vs. 164.0 mg/dL [129.0-193.5], p=0.594) or HbA1c levels (6.25% [5.8-8.4] vs. 6.5% [5.6-8.7], p=0.990). Conclusion: Our data demonstrated larger increases in body fat from patients admitted with HF of ischemic cause, which was associated with shorter hospital stay and higher serum triglycerides concentrations.
Presentation: Friday, June 16, 2023
FRI153 Genetic Variant In Armadillo Repeat Containing 5 Gene (ARMC5) Associates With Salt Sensitivity Of Blood Pressure And Aldosterone In A Caucasian Cohort
Authors: Parksook Wasita W , Heydarpour Mahyar , Pojoga Luminita , Gaye Amadou , Gibbons Gary H , Williams Gordon H , Williams Jonathan S 
Published: October 2023

Abstract
Disclosure: W.W. Parksook: None. M. Heydarpour: None. L. Pojoga: None. A. Gaye: None. G.H. Gibbons: None. G.H. Williams: Advisory Board Member; Self; Cereno. Consulting Fee; Self; Alnylam, Crinetics, Damian, KBP bioscience, Paxel, Relapsa, Unicycive. Grant Recipient; Self; NIH 2 grants. J.S. Williams: Advisory Board Member; Self; Mellicell, Inc.
Background: Genetic alterations of ARMC5 have been reported in various adrenal disorders, particularly in primary bilateral macronodular adrenal hyperplasia. Increasing evidence shows that polymorphic variants in ARMC5 are also associated with blood pressure (BP), hypertension, and the renin-angiotensin-aldosterone-system (RAAS) in individuals of African descent; however, little is known about these relationships in Caucasians. Herein, we conducted a deep phenotyping study to assess the association of ARMC5 variants with BP, salt sensitivity of BP (SSBP), and components of the RAAS in Caucasians. Methods: Normotensive and hypertensive, non-diabetic, non-chronic kidney disease, Caucasian participants underwent two dietary interventions at 5-7 days apart (200 mmol/day and 10 mmol/day sodium) to assess SSBP and other hormonal parameters. All participants were genotyped using a Multi-Ethnic-Genotyping-Array. Association analysis and the quality control of the genomic data were assessed by PLINK. Participants with complete data for SSBP and hormonal parameters, who were in salt balance, were included in the analysis (n= 306). Multiple linear regression models were used to assess the association between the genetic variant and outcome parameters. Results: There were 5 single nucleotide polymorphisms in the ARMC5 region. rs4889660 was significantly associated with SSBP in additive and dominant models when adjusted by Bonferroni correction. In a candidate gene analysis, rs4889660 risk allele carriers had greater SSBP than non-risk allele homozygotes (β= 4 mmHg, P= 0.03). Following dietary sodium restriction, rs4889660 risk allele carriers had lower serum aldosterone levels in an upright position (β= -6.9 ng/dl, P= 0.04) and serum aldosterone levels after angiotensin II stimulation (β= -3.0 ng/dl, P= 0.02). There were no differences between plasma renin activity, serum and urinary cortisol levels, and renal plasma flows between genotypes. Conclusions: There was an association between the ARMC5 rs4889660 variant and SSBP in Caucasians. With dietary sodium restriction, aldosterone responses to both upright posture and angiotensin II infusion were lower in the risk allele carriers. The reduced aldosterone responses suggest that an alteration in the RAAS system is not the cause of the SSBP, but is in response to a defect in another sodium-mediated homeostatic mechanism.
Presentation: Friday, June 16, 2023
THU247 Characterizing Inpatient Cases Of DKA Precipitated By SGLT2 Inhibitor Use
Authors: Aslamy Arianne , Nazemi Reza , Tseng Conrad , Kim Steve , Gianchandani Roma 
Published: October 2023

Abstract
Disclosure: A. Aslamy: None. R. Nazemi: Speaker; Self; Eli Lilly & Company, AstraZeneca. C. Tseng: None. S. Kim: None. R. Gianchandani: None.
Background: SGLT2 inhibitors are a unique class of anti-hyperglycemic medications that can increase the risk of DKA in patients with diabetes (1). The overall incidence of DKA precipitated by SGLT2 inhibitor use is estimated to be 0.1%, however, this is likely higher in practice with increasing usage of these medications for treatment of heart failure and renal dysfunction. Herein, we characterize inpatient admissions with SGLT2 inhibitor induced DKA to further understand associated risk factors. Clinical Case: Euglycemic and hyperglycemic DKA cases (n=7) over a four-month period were identified, all of whom had been on SGLT2 inhibitors for an average of 8.5 (± 5.4) months prior to presentation. Six patients had T2D and one patient had known T1D. The average patient age was 69 (±8) years. The average A1c was 9.2% (±1.9%). Patients on dapagliflozin (n=3) had significantly higher A1c on admission compared to those on empagliflozin (n=4) (p=0.017). Average glucose on presentation of the six T2D patients was 206.5 (± 55.61) mg/dL (euglycemic DKA range) while the T1D patient presented with glucose of 605 mg/dL. All seven patients had elevated anion gap (mean 25.5 ± 7.2mEq/L), low bicarbonate (mean 8.9 ± 4.1 mmol/L), pH less than 7.4, and evidence of either ketonemia or ketonuria. Five out of the seven cases had a concurrent infection, and the remaining two cases were readmissions after recent cardiac surgery. All patients were treated with intravenous/subcutaneous insulin and intravenous dextrose with resolution of DKA within 24 hours. SGLT2 inhibitors were immediately discontinued. Average length of stay was 9 (±6) days, and was higher in the postcardiac surgery patients. Notably, the type of SGLT2 inhibitor (dapagliflozin vs. empagliflozin), age, sex, A1c on presentation, number of comorbidities, presence of infection, prior insulin usage, duration of diabetes, and duration of SGLT2 use had no significant effect on length of stay. Conclusion: Clinical characteristics of SGLT2 inhibitor induced DKA cohort were older age, uncontrolled diabetes (A1c &gt;7), and concurrent infections or recent major surgery. Resolution of DKA was quick and length of stay longer for major surgery. When placed on SGLT2 inhibitors, diabetes patients should be warned of these potential clinical scenarios that can increase their risk of DKA. Reference: (1) Blau JE, Tella SH, Taylor SI, Rother KI. Ketoacidosis associated with SGLT2 inhibitor treatment: Analysis of FAERS data. Diabetes Metab Res Rev. 2017 Nov; 33
Presentation: Thursday, June 15, 2023
THU249 Use Of The Pittsburgh Sleep Quality Index In People WithT2DM: Initial Results Of The Diabetes Sleep Assessment (DSA) Study
Authors: Shaikh Shehla , Shaikh Salomi , Shaikh Shayaan , Shaikh Asma , Shaikh Mehvish , Memon Zaid , Sayed Rainah 
Published: October 2023

Abstract
Disclosure: S. Shaikh: None. S. Shaikh: None. S. Shaikh: None. A. Shaikh: None. M. Shaikh: None. Z. Memon: None. R. Sayed: None.
Background: The Pittsburgh Sleep Quality Index (PSQI) is a well-known, validated, and reliable instrument used to measure the clinical construct of sleep quality. PSQI &gt; 5 indicates poor sleep quality. Aim: To evaluate PSQI for psychometric properties through glycemic and anthropometric parameters, in T2DM who are on regular follow-up for glycemic care Method: We examined 236 known T2DM in the Diabetes Sleep Assessment (DSA) study, an ongoing observational study examining the effect of control of diabetes and metabolic parameters on the quality of sleep Results: The glycemic and anthropometric parameters were age 55 years (±11, 95% CI 53 to 56), BMI 28 kg/m2 (±5.8, 95% CI 28 to 29), FPG 140 mg/dl (±50, 95% CI 134 to 147), PPG 197 mg/dl (±76, 95% CI 188 to 207), HbA1c 7.4% (±1.2, 95% CI 7.1 to 7.6), duration of diabetes 9.2 years (±, 7.5 95% CI 8.3 to 10), neck circumference 36 cm (±6.2, 95% CI 36 to 37), waist circumference 117 cm (±17, 95% CI 114 to 119). 76.2% (n=180) had PSQI &gt;5. The mean PSQI was 8.3 (±3.7, minimum 0, maximum 19, 95% CI 7.8. to 8.8). No significant correlation was found between PSQI and glycemic and anthropometric parameters. The greatest dysfunction (&gt;3 component score) was reported to get up to go to the bathroom by 66.9% (n=158), followed by waking up in the middle of the night or early morning by 49.1% (n=116). The median time to go to bed and wake in the morning was 11 pm and 7 am, respectively. The median no. of hours to fall asleep, for actual sleep and in bed were 1, 6.5, and 8, respectively. Mean PSQI in the group with inadequate glycemic control (HbA1c &gt;7, n=130), was 8.4 (±3.9) as compared to the group with adequate glycemic control (HbA1c ≤7, n=106), which had a mean PSQI 8.1 (±3.5), was comparable, p=0.56 (ns). Conclusion: Our results reveal that the anthropometric parameters have no significant impact on the quality of sleep and are independent of the glycemic control in T2DM. The need to go to the bathroom at night and wake up in the night or early morning were the largest contributors to the poor quality of sleep. The result of our study needs large-scale, multi-centric collaboration to further address the gaps and challenges to improve the quality of sleep in T2DM
Presentation: Thursday, June 15, 2023
THU255 Tirzepatide-induced Weight Loss In A Type 2 Diabetic Taking Oral Contraceptives
Authors: Arunachalam Amar , Nguyen Andy , Shah Neel L 
Published: October 2023

Abstract
Disclosure: A. Arunachalam: None. A. Nguyen: None. N.L. Shah: None.
Obesity is a global health challenge which can lead to type 2 diabetes, hypertension, cardiovascular disease, and decreased life expectancy. In addition to lifestyle intervention, pharmacotherapy to sustain weight loss has remained limited due to effectiveness, cost, and adverse effects. Tirzepatide is a dual glucose-dependent insulinotropic polypeptide and glucagon-like-peptide-1 receptor agonist currently approved for type 2 diabetes treatment. Tirzepatide-induced weight loss may provide new options for treatment of obesity. We report a 32-year-old female with a history of T2DM and PCOS originally on metformin who was started on semaglutide 0.25 mg, which was uptitrated to 0.5mg weekly for 6 months. She lost 25 lbs with no side effects. Semaglutide and OCPs were discontinued due to fertility with her weight and hemoglobin A1C rebounding off medication. She was started on tirzepatide 2.5mg weekly. At that time, she weighed 223 lbs with a hemoglobin A1C 8.2%. She was counseled to resume OCPs and improve glucose control and weight reduction prior to attempting to conceive. Once increased tirzepatide dosing to 5mg weekly, she endorsed severe nausea and intermittent epigastric abdominal pain on day of injection. She attempted to increase dose to 7.5mg weekly, but dose was reduced due to complaints of constipation and worsened abdominal pain requiring bowel regimen. She remained on tirzepatide for a total of 4 months prior to becoming pregnant while on oral contraceptives. Her weight decreased from 223 to 212 lbs with reduction in hemoglobin A1C from 8.2% to 6.1%. While initially studied for use in type 2 diabetes, tirzepatide was found to induce clinically significant weight reduction. The recent SURMOUNT-1 trial, which studied the effects of tirzepatide in non-diabetics, demonstrated that once-weekly tirzepatide at three different doses demonstrated substantial and sustained weight reduction in patients with obesity. In trials involving patients with once-weekly injectable semaglutide, the mean reduction in hemoglobin A1C was 1.8 percentage points and reduction in mean body weight was 6.5 kg. In the SURPASS-2 trial, reductions in body weight were greater with tirzepatide when compared to semaglutide with mean estimated treatment difference −1.9kg, -3.6kg, and -5.5 kg respectively based on dosing of 5mg, 10mg, and 15mg. The adverse events most commonly reported in patients on tirzepatide include nausea, vomiting, and diarrhea, which occurred most commonly during dose-escalation. Mounjaro is known to reduce the efficacy of oral contraceptive pills due to delayed gastric emptying. This delay is largest after the first dose so recommended to switch from oral to non-oral contraceptives for the first four weeks when tirzepatide is initiated. It is important to counsel patients on the decreased efficacy of oral contraceptives while on tirzepatide.
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Presentation: Thursday, June 15, 2023
THU258 Development Of A Clinical Dataset For Artificial Intelligence: A 30-Year Journey
Authors: Ramachandra Gumpeny Sridhar , Gumpeny Lakshmi 
Published: October 2023

Abstract
Disclosure: S.R. Gumpeny: None. L. Gumpeny: None.
Deep learning requires clean and machine-readable data for analysis. Currently there is a mismatch between the availability of accessible clinical data and the development of predictive modeling employing artificial intelligence. The scarcity is particularly acute in India. We describe the construction and evolution of electronic medical records (EMR) in an Endocrine Centre in India. December 1992 marked the end of paper documents at EDC, India. Ever since all records were stored as electronic medical records (EMR). Digitization was preceded by an analysis of work flow to ensure harmonious interaction between patient encounter and capture of data. Over years the EMR evolved across databases and was refined to improve ease of use. Rule based diagnoses, prescriptions, diet advice and auto-calculations were incorporated. Eventually it was set up on a networked platform to allow biographic, lab and anthropometric data to be entered before the patient came to the consultation chamber. Currently, the database has 90,000 individual records, including follow up data of patients with different endocrine disorders. We are at the cusp of linking the EMR with wearable sensors to make it more comprehensive. It is ripe to serve as a platform for deep learning, predictive modelling and artificial intelligence. Account sof its construction, as well as the potential for using AI in clinical care have been documented
References: (1). Sridhar GR. Expanding scope of information technology in clinical care. IGI Global. DOI: 10.4018/978-1-13479-3.ch131. (2) Sridhar GR, Lakshmi G. Artificial intelligence in medicine: diabetes as a model. In (Eds) Srinivasa KG et al. Artificial Intelligence for Information management: A healthcare perspective. Studies in Big Data 88. Doi.org/10.1007/978-981-16-0415-7_14
Presentation: Thursday, June 15, 2023
THU260 Development Of Plantar Thermography For Screening Of Diabetic Neuropathy
Authors: Panamonta Vipawee , Jerawatana Ratanaporn , Ariyaprayoon Prapai , Looareesuwan Panu , Ongphiphadhanakul Benyapa , Sriphrapradang Chutintorn , Ongphiphadhanakul Boonsong 
Published: October 2023

Abstract
Disclosure: V. Panamonta: None. R. Jerawatana: None. P. Ariyaprayoon: None. P. Looareesuwan: None. B. Ongphiphadhanakul: None. C. Sriphrapradang: None. B. Ongphiphadhanakul: None.
Background: Diabetic foot ulcers are a major complication of diabetes. They are also the leading cause of nontraumatic lower extremity amputation. The incidence of diabetic foot ulcers is highest in those patients with poor glycemic control and neuropathy. In people with diabetic neuropathy, the feet temperature may change due to decreased blood flow and nerve damage. Thermography has been proposed as a noninvasive modality to identify patients at risk for diabetic foot ulcers. In this study, we used thermography and deep learning to stratify patients with diabetes at risk for developing a foot ulcer. Methods: We prospectively record clinical data and plantar thermogram in adult diabetic patients underwent diabetic foot screening at outpatient clinics at Ramathibodi hospital, Bangkok, Thailand during September to December 2022. Altogether, there were 245 thermal images were analyzed using a deep learning algorithm to determine the risk for diabetic foot ulcers by transfer learning using the pre-trained VGG16 model which is a convolutional neural network for image recognition. Twenty percent of the images were set aside for testing purposes while 20% of the images served as the validation set during training of the neural network. The neural network was trained and weighed more toward higher sensitivity of identifying at risk feet for screening purpose. Results: The study sample consisted of individuals with a mean age of 62.5±12.5 years, 57.1% who had diabetes for more than 10 years. The majority of the participants were females (57.1%). The average body mass index (BMI) was 27.8±9.6 (kg/m2). There were 186 thermal images classified as category 0 and 59 images classified as categories 1 to 3 according to the American Diabetes Association risk classification. The trained neural network achieved 75 % accuracy with 95 % sensitivity and 67 % specificity for classifying thermograms as higher than normal risk in the training dataset. For the testing dataset, the sensitivity and specificity was 75% and 41%, respectively. The accuracy, however, decreased to 50% due mainly to the misclassification of normal thermograms from abnormal. Conclusions: These results suggest that thermography combined with deep learning could potentially be developed for screening purpose to stratify patients at risk of developing diabetic foot ulcers. Further research is needed to validate the results in larger datasets and to explore alternative algorithms for predicting diabetic foot ulcers.
Presentation: Thursday, June 15, 2023
THU261 Etiologic Factors, Contributors, And Associations For Exocrine Pancreatic Insufficiency
Authors: Romo Karina G , Noor Abdulla , Zia Abdul , Shu Sharon , Bhamre Sneha , West William A , Hoard Brandon M , Uwaifo Gabriel I 
Published: October 2023

Abstract
Disclosure: K.G. Romo: None. A. Noor: None. A. Zia: None. S. Shu: None. S. Bhamre: None. W.A. West: None. B.M. Hoard: None. G.I. Uwaifo: None.
Introduction: Exocrine pancreatic insufficiency (EPI) is a clinical condition which though presumed to be uncommon has grown in prominence and recognition in recent years. The fact that pancreatic enzyme replacement therapy (PERT) is available to ameliorate many of the metabolic and gastrointestinal sequelae of EPI makes its early recognition, diagnosis, and treatment very important. Since EPI appears uncommon, improved quantification of its prevalence and identification of associated etiologic factors could inform targeted screening in select patient populations. Our study is a retrospective chart analysis of a large multi-specialty, multi-institutional practice group covering much of Louisiana and seeks to provide needed information regarding EPI prevalence and etiologic factors. Methods: A retrospective review of the entire 1.3 million patient-practice of the Ochsner Health system in Louisiana was performed to cover the period from January 2017 to January 2020. All cases of documented EPI and patients on PERT were identified—these were then further interrogated including individual chart review to identify etiologic factors and obtain relevant cardiometabolic, demographic, vital sign data, and clinical course information. Results: A total of 677 EPI patients were identified with a prevalence of 0.525% among patients with diabetes (DM) and 0.051% in the general outpatient population. EPI, though uncommon, is thus ∼ 10x more prevalent among DM patients. The identified etiologic factors were Type 2 diabetes (T2DM) (44.6% of cases), general cancer (15.9%), secondary diabetes (11.5%), cystic fibrosis (12.9%), Type 1 diabetes (T1DM) (9.6%), pancreatic cancer (6.6%), idiopathic (6.2%), pancreatitis (5%), pancreatic surgery (2.95%), hemochromatosis-hemosiderosis (0.44%), and alpha-1 antitrypsin deficiency (0.15%). Several patients in the cohort had multiple identified etiologic factors. Discussion and Conclusions: While EPI is uncommon in the general population it is at least 10x more prevalent among DM patients. Etiologic factors provide a clinical pathway for targeted clinical and lab screening to enable early diagnosis and treatment. Since T2DM is the most common etiologic factor for EPI in our cohort and other reported series, there is need for further in-depth study to identify potentially modifiable factors and possible predictors in the progression of DM to EPI and whether PERT can ameliorate associated cardio-metabolic and ASCVD risk surrogates.
Presentation: Thursday, June 15, 2023