bluuebunny/crossref_metadata_2025_split huggingface dataset:
FRI641 Assessing Insulin Prescription Adequacy At Hospital Discharge And Its Association With Characteristics Of Diabetic Patients
Authors: Akcan Tugce , Sharma Shivy , Liu Junting , Jayarangaiah Amog , Gilani Muhammad , Surendran Alumparambil , Imamudeen Nasvin , Gabor Rachel , Pathak Ram D 
Published: October 2023

Abstract
Disclosure: T. Akcan: None. S. Sharma: None. J. Liu: None. A. Jayarangaiah: None. M. Gilani: None. A. Surendran: None. N. Imamudeen: None. R. Gabor: None. R.D. Pathak: None.
Diabetes is becoming increasingly prevalent, and appropriate insulin therapy during the post-discharge period is essential to improve glycemic control and reduce readmissions. Despite extensive research on insulin use during hospitalization, little is known about insulin dosing at discharge and patient factors that affect post-discharge needs. Therefore, this retrospective study aimed to evaluate the adequacy of insulin dosing at hospital discharge for diabetic patients and identify patient characteristics impacting post-discharge insulin requirements. Using a retrospective study design, we identified 350 patients meeting the inclusion criteria. The results showed that 19.1% of patients required a decrease in insulin total daily dose (TDD) at follow-up, 50.9% experienced no change, and 30.0% necessitated an increase. Factors found to impact insulin dose adjustments post-discharge include BMI, CKD, discharge TDD, and HbA1c levels. The multivariate analysis revealed that CKD was associated with a decrease in insulin TDD at follow-up (95% CI: -9.65- -0.47, p=0.031). Additionally, insulin TDD at discharge was negatively associated with follow-up dose, with a 0.37 unit decrease (95% CI: -0.44- -0.30, p&lt;0.001) in insulin TDD for each additional unit prescribed. Finally, there was a marginal significance observed in the discharge regimen. Patients on a premixed regimen had a decrease in insulin TDD at follow-up compared to those on a basal-bolus regimen (95% CI: -21.85- 0.27, p=0.057). Our study findings suggest the need for improved estimation of insulin doses at discharge and emphasize the importance of short-term follow-up for insulin titration post-discharge. Patient factors such as body weight, kidney disease, insulin dose at discharge, and HbA1c levels influence these changes. These findings have significant implications for optimizing patient outcomes and reducing hospital readmissions, underscoring the importance of carefully evaluating these factors when tailoring individualized insulin regimens.
Presentation: Friday, June 16, 2023
FRI647 Hemiballismus - A Rare Presentation Of Uncontrolled Diabetes Mellitus Type 2
Authors: Lontoc Macrohon Calvin , Landicho Kanapi Maria Princess 
Published: October 2023

Abstract
Disclosure: C.L. Macrohon: None. M.L. Kanapi: None.
Background: Diabetic Striatopathy is a rare disease with a prevalence of 1 in 100,000 and is more commonly seen in elderly women with poor glycemic control. It is an acute movement disorder characterized by sudden, non-purposeful jerking movements secondary to non-ketotic hyperglycemia. This is associated with high-intensity signals on T1-weighted magnetic resonance imaging of the brain noted at the basal ganglia. Case: We have a case of an 80-year old female who came in due to a four-day history of persistent involuntary, non-purposeful jerking of her right upper extremity accompanied by episodes of agitation and visual hallucinations. She has Diabetes Mellitus Type 2 for the past 20 years on Glibenclamide and Metformin. However, self-monitoring of blood glucose revealed fasting glucose levels as high as 300mg/dl. She was asymptomatic hence did not have regular follow-up with her primary care physician. She had no history of previous cerebrovascular disease. Family history was unremarkable. Upon examination, she was disoriented to place but answers appropriately to questions and did not have any speech abnormalities. On inspection it was noted that she had high amplitude involuntary flailing of the right upper extremity accompanied by non-purposeful jerking of her right lower extremity. Initial blood glucose level was 354mg/dl with an Hba1c of 13.7%. Serum ketones was within normal limits with a value of 0.1mmol/L. A plain Magnetic Resonance Imaging of the brain was done which showed a region of T1 weighted hyperintensity with no corresponding abnormal restricted diffusion nor increased susceptibility signals involving the left lentiform nucleus with no evidence of acute infarction nor intracranial hemorrhage noted. At this time, patient was co-managed by Endocrinology and Neurology service with an impression of a Diabetic Striatopathy. For the hemiballism and other neurologic manifestations such as agitation, visual hallucinations and disorientation patient was given risperidone and clonazepam. Blood glucose was then managed through cautious insulin therapy as well as hydration. On the third hospital day, there was noted resolution of right-sided hemiballismus and at this time glycemic control was improved. Conclusion: Proper identification and diagnosis is essential in managing Diabetic striatopathy. Although this may be a rare presentation of uncontrolled diabetes mellitus, clinicians should be aware of the possibility of an acute movement disorder as an unveiling symptom. This shows the importance of prompt blood glucose measurement in these acute cases. Once identified, adequate glycemic control through insulin therapy remains to be the center and most effective therapeutic management for the resolution of these hyperkinetic symptoms.
Presentation: Friday, June 16, 2023
SAT046 Canagliflozin Leads To Less Weight Gain, Confers Changes In The Gut Microbiota And Extends Life Span In Male C57BL6 Mice
Authors: Habeos Evagelia E , Filippopoulou Fotini , Kanakis Menelaos , Habeos George I , Belmokhtar Naima , Stathopoulou Panagiota , Tsiamis George , Taraviras Stavros , Lagoumintzis George , Chartoumpekis Dionysios V 
Published: October 2023

Abstract
Disclosure: E.E. Habeos: None. F. Filippopoulou: None. M. Kanakis: None. G.I. Habeos: None. N. Belmokhtar: None. P. Stathopoulou: None. G. Tsiamis: None. S. Taraviras: None. G. Lagoumintzis: None. D.V. Chartoumpekis: None.
Introduction: SGLT2 inhibitors (SGLT2i) are widely prescribed drugs for the treatment of diabetes. Their beneficial health effects appear to be pleiotropic and are not limited to the amelioration of glycemic profile. The SGLT2i-induced glycosuria is suggested to provoke a metabolic shift that mimics the fasting response. Since calorie restriction has been shown to enhance longevity in mice, we hypothesized that treating mice with SGLT2i would also increase their life span. Methods: To this end, 4-months old male C57BL6 mice were fed with a standard chow diet (Control, n=83) or a diet supplemented with 200 mg/kg canagliflozin (Cana, n=92) and were observed up to the natural end of their life. Results: The canagliflozin-treated mice gained less weight over time. For instance, at the age of 10 months, the body weight of control mice was higher (means ± SEM: 33.1 ± 0.26 g) than the body weight of their canagliflozin-treated counterparts (means ± SEM: 31.4± 0.21 g; p&lt;0.01). The development and severity of age-related cataracts were also examined at the age of 14 months, but no statistically significant difference was found in the severity score between the 2 groups. The survival curves of the control and the Cana mice diverged significantly, with the median survival of the control being 107.5 weeks versus 112.5 weeks of the Cana group (p=0.011). As the gut microbiome is known to change with age and be associated with the development of age-related diseases, feces were collected from 17-month-old mice (n=10 per group) and analysis of fecal bacterial 16S rRNA sequences was performed. Differences in beta diversity (diversity of bacterial species across samples) and relative abundance of bacterial species were noted between the Control and the Cana groups. Conclusions-Discussion: Our study highlights the effect of SGLT2i on longevity in a widely used mouse model (C57BL6). The underlying mechanisms leading to the enhancement of longevity are not clear yet. Some microbiota changes associated with the SGLT2i treatment, as described in other mouse models with enhanced longevity, warrant further investigation and analysis. It would be useful to extend these studies employing various SGLT2i with different potencies and selectivity against SGLT so as to determine if the observed effect on longevity is independent of the type of the drug.
Presentation: Saturday, June 17, 2023
SAT102 Natural History Of Type 1 Diabetes In Humanized Mouse Model
Authors: Aldasouqi Ahmad , Rafiqi Shafiya Imtiaz , Jaume Juan Carlos , Imam Shahnawaz 
Published: October 2023

Abstract
Disclosure: A. Aldasouqi: None. S. Rafiqi: None. J.C. Jaume: None. S. Imam: None.
Type 1 diabetes (T1D) is an autoimmune disease caused by an imbalance in T-regulatory and T-effector cells characterized by the destruction of insulin-producing beta cells by T-effector cells, leading to insulin deficiency and complexities like diabetic nephropathy, retinopathy, and neuropathy. Researchers at The University of Toledo have developed a humanized mice model which spontaneously develops T1D at 3-5 weeks of age and mimics human T1D. This study aims to monitor blood glucose levels before the onset of T1D (preweaning stage mice) and track the dynamics of immune cells using flow cytometry throughout the progression of the disease. Our results show that T-regulatory cells constitute 4.773% ± 0.81% cells at preweaning which drops to 2.60± 0.35 (%) in males and 1.78 ± 0.58 (%) in females at the 10th week while CD8+ T cells producing interferon-gamma (cytotoxic lymphocytes, CTLs) constitute 3.32 ± 0.60 (%) at preweaning, which increased to 27.625± 1.43 (%) in males and 21.13± 2.87 (%) in females as the disease progresses. This reduction in T-regulatory cells and enrichment of CD8s and CTLs leads to the destruction of beta cells as seen in humans as well. Dysregulation of immune responses can be correlated with the progression of diabetes in terms of blood glucose levels which increased from 147mg/dl (preweaning), peaked to 373mg/dl in 5th week, and was observed in partial remission stage around the 8th week as observed in human T1D ‘honeymoon period’. This study will help us to understand the immune dynamics in the progression of T1D as it helps us to present a better picture of the status of immune cells in a human-like immune system and provides benchmark data of the interplay of the immune system.
Presentation: Saturday, June 17, 2023
SAT105 Frequent Monitoring Of Blood Glucose Levels Via A Remote Patient Monitoring System Helps Improve Glycemic Control
Authors: Sachmechi Issac , Amini Masoud , Salam Sanna , Khan Rubba , Spitznogle Andrew , Belen Tasheena 
Published: October 2023

Abstract
Disclosure: I. Sachmechi: None. M. Amini: None. S. Salam: None. R. Khan: None. A. Spitznogle: None. T. Belen: None.
Objective: This study aims to evaluate the effectiveness of the Vivovitals telehealth platform on improving glycemic control and reducing A1C in patients with uncontrolled type II diabetes mellitus by providing more accessible and frequent patient care under the monitoring by their physician. Methods: This 12-week, prospective, pragmatic, single-center, double-arm study assessed the impact of the Vivovitals diabetes platform on glycemic control among 78 adults ≥ 18 years of age, with A1C ≥ 7.5% (58 mmol/mol) at baseline. The participants were randomized into two groups. The control group received standard care, while the intervention group was assisted to install the application on their smartphones and connect it to a Bluetooth Glucometer, and access to an online data portal. Blood glucose measurements were transmitted to the provider daily. Patients were contacted twice weekly regardless of their blood sugar measurements and additional call was made if blood glucose levels were &lt;70 mg/dL or &gt;180 mg/dL and modifications were made to diet and medication. The control group was allowed to call the provider if they have questions regarding their blood sugar levels or their medications. The two groups were compared at baseline and 12 weeks using nonparametric tests with p&lt;0.05 considered statistically significant. Results: The mean A1C in the intervention group (n=39) was 9.53 (81 mmol/mol) +1.68 at baseline. Post-trial, mean A1C decreased to 7.99 (64 mmol/mol) + 1.40 (p &lt; 0.001). In comparison, the mean A1C in the control group (n=39) was 9.63 (64 mmol/mol) + 1.47 at baseline with little change in post-trial mean A1C averaging 9.16 (77 mmol/mol) + 1.51 (p = 0.87). Discussion: In this study, patients who utilized the Vivovitals platform saw a significant decrease in A1C at an average of 1.56% compared to the non-significant 0.47% A1C reduction in the control group participants. We believe the A1C-reducing effect in the intervention group was due to the more frequent interactions with the physician and subsequent medication adjustments based on the data provided. The Vivovitals platform allows an affordable closer monitoring of blood glucose levels, identification of the direction of glycemic trends, and earlier intervention. While not explored in this study, it is reasonable to believe that the use of the Vivovitals diabetes platform could reduce Emergency Department visits and inpatient hospitalizations for hypoglycemia or hyperglycemia as the clinician can intervene before a patient becomes symptomatic. Conclusion: We conclude that the Vivovitals platform may help to reduce A1C in adults with uncontrolled type 2 diabetes mellitus in conjunction with lifestyle modifications and anti-diabetic medications.
Presentation: Saturday, June 17, 2023
Radiosurgery With Prior Embolization Versus Radiosurgery Alone for Intracranial Arteriovenous Malformations: A Systematic Review and Meta-Analysis
Authors: Maroufi Seyed Farzad , Fallahi Mohammad Sadegh , Khorasanizadeh MirHojjat , Waqas Muhammad , Sheehan Jason P. 
Published: October 2023

BACKGROUND AND OBJECTIVES:
The addition of adjuvant embolization to radiosurgery has been proposed as a means of improving treatment outcomes of intracranial arteriovenous malformations (AVMs). However, the relative efficacy and safety of radiosurgery with adjuvant embolization vs radiosurgery alone remain uncertain. Moreover, previous systematic reviews and meta-analyses have included a limited number of studies and did not consider the effects of baseline characteristics, including AVM volume, on the outcomes. This systematic review aimed to evaluate the efficacy of preradiosurgery embolization for intracranial AVMs with consideration to matching status between participants in each treatment group.

METHODS:
A systematic review and meta-analysis were conducted by searching electronic databases, including PubMed, Scopus, and Cochrane Library, up to January 2023. All studies evaluating the utilization of preradiosurgery embolization were included.

RESULTS:
A total of 70 studies (9 matched and 71 unmatched) with a total of 12 088 patients were included. The mean age of the included patients was 32.41 years, and 48.91% of the patients were female. Preradiosurgery embolization was used for larger AVMs and patients with previous hemorrhage (P < .01, P = .02, respectively). The obliteration rate for preradiosurgery embolization (49.44%) was lower compared with radiosurgery alone (61.42%, odds ratio = 0.56, P < .01), regardless of the matching status of the analyzed studies. Although prior embolization was associated higher rate of cyst formation (P = .04), it lowered the odds of radiation-induced changes (P = .04). The risks of minor and major neurological deficits, postradiosurgery hemorrhage, and mortality were comparable between groups.

CONCLUSION:
This study provides evidence that although preradiosurgery embolization is a suitable option to reduce the AVM size for future radiosurgical interventions, it may not be useful for same-sized AVMs eligible for radiosurgery. Utilization of preradiosurgery embolization in suitable lesions for radiosurgery may result in the added cost and burden of an endovascular procedure.
Physical Activity Associates with T1rho MRI of Femoral Cartilage Following Anterior Cruciate Ligament Reconstruction
Authors: Davis-Wilson Hope C. , Thoma Louise M. , Franz Jason R. , Blackburn J. Troy , Longobardi Lara , Schwartz Todd A. , Hackney Anthony C. , Pietrosimone Brian 
Published: October 2023

ABSTRACT

Purpose
Less physical activity has been associated with systemic biomarkers of cartilage breakdown following anterior cruciate ligament reconstruction (ACLR). Yet, previous research lacks analysis of deleterious cartilage compositional changes and objective physical activity following ACLR. The purpose of this study was to determine the association between physical activity quantified via accelerometer-based measures of daily steps and time in moderate-to-vigorous physical activity (MVPA), and T1rho magnetic resonance imaging (MRI) of the femoral articular cartilage, a marker of proteoglycan density in individuals with ACLR.

Methods
Daily steps and MVPA were assessed over 7 days using an accelerometer worn on the hip in 26 individuals between 6-12 months following primary unilateral ACLR. Resting T1rho MRI were collected bilaterally, and T1rho MRI inter-limb ratios (ILR: ACLR limb/contralateral limb) were calculated for lateral and medial femoral condyle regions of interest. We conducted univariate linear regression analyses to determine associations between T1rho MRI ILRs and daily steps and MVPA with and without controlling for sex.

Results
Greater T1rho MRI ILR of the central lateral femoral condyle, indicative of less proteoglycan density in the ACLR limb, was associated with greater time in MVPA (R2 = 0.178, P = 0.032). Sex-adjusted models showed significant interaction terms between daily steps and sex in the anterior (P = 0.025), central (P = 0.002), and posterior (P = 0.002) medial femoral condyle.

Conclusions
Lesser physical activity may be a risk factor for maintaining cartilage health following ACLR; additionally, the relationship between physical activity and cartilage health may be different between males and females.
Nursing Education for Pediatric Cardiac Care Centers in Developing Countries
Authors: Peterson Jennifer 
Published: October 2023

Summary
Pediatric cardiac programs achieve excellent patient outcomes through the teamwork of a highly capable interdisciplinary team. Nurses are key members of this team, and must possess and highly specialized set of skills and knowledge. A comprehensive nursing education program is needed to develop the necessary skills and knowledge to care for critically ill infants and children with heart disease who are often highly unstable, complex, and vulnerable. Orientation of novice nurses or those who are new to the unit begins with a needs assessment, resulting in a comprehensive plan to achieve required competencies. Nurse residency programs are one method to provide a comprehensive orientation to novice nurses, using a combination of didactic instruction, preceptored clinical experiences, and simulation. An ongoing nursing education plan is also important to refresh skills, especially with high-risk, low-volume procedures, as well as to meet regulatory requirements and develop new skills and knowledge. A key component of the pediatric cardiac nursing education plan is development of preceptors, who provide hands-on instruction to mentor new nurses to develop the needed skills and knowledge, while ensuring that patients receive safe care. Preceptor development can also provide experienced bedside nurses with opportunities to develop their own knowledge and to continue professional development, which helps to positively influence job satisfaction. Numerous resources are available to develop a curriculum or the pediatric cardiac program. Evaluation is also an important component of the nursing education program, to quantify individual as well as programmatic outcomes.
The interface between SARS-CoV-2 and non-communicable diseases (NCDs) in a high HIV/TB burden district level hospital setting, Cape Town, South Africa
Authors: Mnguni Ayanda Trevor , Schietekat Denzil , Ebrahim Nabilah , Sonday Nawhaal , Boliter Nicholas , Schrueder Neshaad , Gabriels Shiraaz , Cois Annibale , Tamuzi Jacques L. , Tembo Yamanya , Davies Mary-Ann , English Rene , Nyasulu Peter S. 
Published: October 2023

Background
COVID-19 experiences on noncommunicable diseases (NCDs) from district-level hospital settings during waves I and II are scarcely documented. The aim of this study is to investigate the NCDs associated with COVID-19 severity and mortality in a district-level hospital with a high HIV/TB burden.

Methods
This was a retrospective observational study that compared COVID-19 waves I and II at Khayelitsha District Hospital in Cape Town, South Africa. COVID-19 adult patients with a confirmed SARS-CoV-2 polymerase chain reaction (PCR) or positive antigen test were included. In order to compare the inter wave period, clinical and laboratory parameters on hospital admission of noncommunicable diseases, the Student t-test or Mann-Whitney U for continuous data and the X2 test or Fishers’ Exact test for categorical data were used. The role of the NCD subpopulation on COVID-19 mortality was determined using latent class analysis (LCA).

Findings
Among 560 patients admitted with COVID-19, patients admitted during wave II were significantly older than those admitted during wave I. The most prevalent comorbidity patterns were hypertension (87%), diabetes mellitus (65%), HIV/AIDS (30%), obesity (19%), Chronic Kidney Disease (CKD) (13%), Congestive Cardiac Failure (CCF) (8.8%), Chronic Obstructive Pulmonary Disease (COPD) (3%), cerebrovascular accidents (CVA)/stroke (3%), with similar prevalence in both waves except HIV status [(23% vs 34% waves II and I, respectively), p = 0.022], obesity [(52% vs 2.5%, waves II and I, respectively), p <0.001], previous stroke [(1% vs 4.1%, waves II and I, respectively), p = 0.046]. In terms of clinical and laboratory findings, our study found that wave I patients had higher haemoglobin and HIV viral loads. Wave II, on the other hand, had statistically significant higher chest radiography abnormalities, fraction of inspired oxygen (FiO2), and uraemia. The adjusted odds ratio for death vs discharge between waves I and II was similar (0.94, 95%CI: 0.84–1.05). Wave I had a longer average survival time (8.0 vs 6.1 days) and a shorter average length of stay among patients discharged alive (9.2 vs 10.7 days). LCA revealed that the cardiovascular phenotype had the highest mortality, followed by diabetes and CKD phenotypes. Only Diabetes and hypertension phenotypes had the lowest mortality.

Conclusion
Even though clinical and laboratory characteristics differed significantly between the two waves, mortality remained constant. According to LCA, the cardiovascular, diabetes, and CKD phenotypes had the highest death probability.