bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-26 Recurrent diabetic ketoacidosis-like symptoms and factitious hyperglycemia as a Munchausen syndrome in diabetes mellitus type 1: A case report
Authors: Niafar Mitra , Erensoy Habib , Tekantapeh Sepideh Tahsini 
Published: January 2024

Abstract

Introduction
Factitious disorder (FD) is diagnosed by pretending to be sick with no abnormal examination or paraclinical study in the presence of psychiatric symptoms which also is named Munchausen's syndrome. The prevalence of the disease among hospitalized patients is approximately 9%.

Clinical Case
A 17-year-old girl with type 1 diabetes mellitus was referred to endocrinology clinic with uncontrolled diabetes, dizziness, abdominal pain, nausea and vomiting. She was treated with multiple daily insulin during 4 years but in last 8 months her self-monitoring of blood glucose ranges was out of control and have BG (blood glucose) different ranges of 40-560mg/dl. She was admitted to control her brittle diabetes with insulin infusion but even with high dose insulin infusion up to 20 IU/hr mostly her BS were above 400mg/dl. The notable point was that BG level was measured by laboratory was lower than glucometer. She also complained of severe abdominal pain and nausea during admission that mimics diabetic ketoacidosis in the presence of hyperglycemia despite the lack of ketonuria and metabolic acidosis. She admitted to hospital several times over the last year to control high level of BG. In psychiatric examination, she has good cooperation in response to questions. Mental Status Examination was not normal. Her mood was depressive and behavior was aggressive. Mild depressive symptoms and borderline features were seen in her Rorschach test. Finally because of high suspicion to associated psychiatric problems, to find the cause of high BG despite high insulin dose prescription, patient behaviors were monitored insensible. We found that she impregnated her finger to the date palm a few minutes before blood glucose check with glucometer devices at times when she is alone in the room. The patient had different deceptive behaviors depending on the method of treatment. But the answer to the question of why the patient was not suffering from hypoglycemia despite high doses of insulin injection is, when insulin infusion by pump was started to control high BG, intravenous cannula secretly separated from insulin infusion set and insulin thrown away. Also she secretly eats fruit juice and jam to prevent hypoglycemic attack for high-dose insulin injection. She took the water into the insulin pen instead of insulin and injected so that the nurses did not notice. Frauds were changed by switching the treatment methods. HbA1c was requested last week of hospitalization which shows 8%. Although all BGwas above 300 mg/dl during this prolonged hospitalization, it did not match with chronic hyperglycemia.

Conclusion
The main purpose of this article was in relation to a diabetic patient with brittle diabetes, difficulty in control BG level, discrepancies between patient symptoms and sings, factitious disorder or Munchausen syndrome should always be in our mind.
P-27 Sweet moves - Hemichorea associated with non-ketotic hyperglycemia
Authors: Martins João Dinis , Pina Henrique , Silveira Débora , Duarte Miguel Saianda , Féria Rita Palma , Ribeiro Ana Cláudia , Guerra Sílvia , Valadas Cristina 
Published: January 2024

Abstract

Introduction
Hemichorea is a movement disorder characterized by involuntary, irregular, and often violent movements of one hemibody, typically caused by dysfunction in the basal ganglia. There are several potential causes of hemichorea, namely vascular lesions, autoimmune conditions, structural lesions, drugs, or metabolic disturbances, among others.
Hemichorea associated with non-ketotic hyperglycemia is a rare condition with a reported prevalence of 1 in 100.000. Although its exact mechanisms are not fully understood, it is believed to be linked to metabolic changes and vascular abnormalities associated with diabetes and its management involves optimizing blood sugar levels.

Clinical Case
This is the case of a female patient, 76 years old, caucasian with known medical history of hypertension, type 2 diabetes, and dyslipidemia. The woman, admitted to the Neurology department, presented with involuntary movements of the left hemibody and face, with sudden onset, one day before admission. There was no history of visual changes, headache, dizziness, syncope, or other symptoms and there were no recent changes in her usual medication. The neurological examination didn't show any defects other than the choreic movements of the left hemiface and hemibody. Blood tests revealed an HbA1c level of 9.3% and a glucose level of 254 mg/dL.
A brain CT scan revealed a possible hypodensity of the right insula, besides signs of microangiopathic leukoencephalopathy. A brain MRI was ordered and showed, on the right putamen, hyperintensity on T1, mild hyperintensity on Flair (Fig.1), and mild hypointensity on T2, without areas of diffusion restriction suggesting ischaemic vascular damage - radiologic findings consistent with hemichorea associated with non-ketotic hyperglycemia. Strict glycemic control was achieved in cooperation with the Endocrinology department, with complete resolution of symptoms.

Conclusion
Although rare, hyperglycemia should be considered as a potential cause of hemichorea, as correction of the underlying condition will lead to rapid improvement of the movements and is the most important feature for diagnosis. This case shows the myriad of clinical presentations that a person living with Diabetes can have.Figure 1.Brain MRI scan.Brain MRI scan showing, on the right putamen, mild hyperintensity on Flair.
P-52 Our objective was to present a case with secondary hypophysitis
Authors: Soltanova Lala , Sahin Serdar , Alay Murat , Kadıoğlu Pınar 
Published: January 2024

Abstract

Clinical Case
A 36-year-old male patient was admitted to an external center with weakness, sexual dysfunction, polydipsia and polyuria. The Laboratory analysis showed partial hypopituitarism (Table 1).
The sella MR imaging was performed to determine the etiology. It was showed that the thickness of the pituitary gland was thinner than normal (3 mm, Partially Empty Sella). The pituitary stalk was also significantly enlarged, measuring up to 7.5 mm, and there was an increase in contrast enhancement, as shown in Figure 1. The patient was subsequently started on Prednisolone, L-thyroxine, testosterone propionate, and Desmopressin acetate to treat panhypopituitarism.
The ACE level was within the normal range, and tests including quantiferon, vasculitis markers (c-ANCA, P-ANCA, ANA), AFP, Beta hCG, LDH, and beta2 microglobulin all yielded negative results. Given these findings and considering primary hypophysitis, a pulse steroid therapy of 1 gram was administered over a span of 2 days (Figure 1).
In the control pituitary MRI 3 months after the treatment: Heterogeneous contrast-enhancing thickening of approximately 16×10mm in the pituitary stalk and a lesion of approximately 22×10mm in the diameter of the epiphysis with heterogeneous contrast enhancement were observed (Figure 2). During this period, the patient was considered to have hypophysitis again, and 1 gr of pulse steroid treatment was administered for 2 days. (Figure 2)
Six months after the start of the treatment, the patient was admitted due to sudden onset of double vision and headache. In the pituitary MRI, he was referred to our center upon detection of a 22×13×10 mm contrast-enhancing bilobular lesion that slightly compresses the optic chiasm, and also a 15×10 mm lobulated lesion in the pineal gland (Figure 3).
An emergency operation was planned for the lesion, who was compressing the optic chiasm and whose progressing mass size was, for diagnostic and therapeutic purposes. The patient underwent surgery. Preoperative b hCG was negative, and AFP was 2.6 (&lt;13). The histopathological examination revelaed germinoma.

Conclusion
Hypophysitis is a rare inflammatory disease that affects the pituitary gland and infundibulum as a result of autoimmune, infiltrative, infectious, neoplastic, drug-induced or sometimes unknown pathogenic processes. Some authors recommend a biopsy if the pituitary stalk size is &gt;6.5 mm or if new lesions develop on the stalk. Germinomas, one of the causes of secondary hypophysitis, usually present with a hypothalamic/pineal mass and isolated stalk thickening and has been reported in only a few cases. Serologically, beta human chorionic gonadotropin (β-hCG) and alpha-fetoprotein (85-90%) may be normal in brain germinomas. Therefore, normal negative results of AFP and B-hCG do not exclude germinoma.
Table 1
O-10 Lymph node ACTH washout determined the source of ACTH secretion in a patient with Cushing's Syndrome due to medullary thyroid cancer
Authors: Onur İşler Alperen , Nahit Şendur Süleyman , Gönül İremli Burçin , Ünlütürk Uğur , Cennet Ömer , Bülent Doğrul Ahmet , Gürlek Alper 
Published: January 2024

Abstract

Introduction
Ectopic ACTH syndrome constitutes 18% of Cushing's syndrome cases, and in rare cases, ACTH secretion from medullary thyroid cancer cells is the source of ectopic ACTH production. Here we report a catastrophic Cushing's syndrome case owing to medullary thyroid cancer in which the source of ACTH production was demonstrated by lymph node ACTH washout.

Clinical Case
A 23 year-old male was admitted to other clinics with complaints of inability to lose weight despite diet and exercise, and weight gain of approximately 40 kg, which had been going on for the last two years. At his application, his weight was 160 kg and his body mass index was 42.51 kg/m2. On physical examination, clinical stigmata suggesting Cushing's syndrome such as moon face, buffalo hump, supraclavicular fat deposition, acanthosis nigricans, centripedal obesity, purple striae on the abdomen were noted. The biochemical and hormonal evaluation confirmed ACTH-dependent Cushing's syndrome (Table 1). To establish the source of excess ACTH, first, a pituitary MRI was performed which revealed a 4×2 mm adenoma on the left side of the gland. In PET-CT, a 24×20 mm hypoechoic nodule in the inferior of the right thyroid lobe, and several pathological lymph nodes at the right side of the neck were detected. Serum calcitonin levels were high (6528 ng/L) and fine-needle aspiration biopsy from the thyroid nodule documented medullary thyroid cancer. The patient underwent bilateral total thyroidectomy and right cervical lymph node dissection. The pathology report was compatible with metastatic medullary thyroid cancer.
After surgery, the remission of hypercortisolemia was not achieved and the patient was started on metyrapone treatment before the permanent treatment plan. Postoperative Gallium-68 DOTA PET-CT indicated residual disease and increased uptake in retropharyngeal, bilateral cervical level 2-4, right level 3, bilateral central, and bilateral lower cervical lymph nodes. The persistence of hypercortisolemia after surgery was most likely attributed to residual disease, however, it was considered that pituitary adenoma may also be the cause of ACTH secretion. Therefore, to confirm the source of ACTH secretion, ACTH washout samples were taken from the cervical lymph nodes and were found to be high as 958 ng/L. Reoperation was performed for recurrent mass and lymph node metastases.

Conclusion
Medullary thyroid cancer should definitely be considered in cases of ectopic ACTH syndrome. ACTH washing from the suspected lymph node may be an option for diagnostic purposes. In addition to the patient's primary tumor, hypercortisolism should also be treated.Table 1.Cushing's assessment tests
P-73 A case of malignant struma ovary
Authors: Abbasgholizadeh Anna , Yavuz Dilek 
Published: January 2024

Abstract

Introduction
Germ cell malignancies originate from primordial gonadal and infrequently extragonadal germ cells. Germ cell tumors account for approximately 15–20% of all ovarian neoplasms, of which only 2% to 3% are malignant. Teratomas make up 95% of these malignancies. Struma ovarian teratomas are tumors in which thyroid tissue accounts for more than half of the bulk.

Clinical Case
A 42-year-old female patient with abdominal distress was admitted to the obstetrics and gynecology outpatient clinic. An examination of the pelvis revealed a palpable mass in the region of the right adnexa. On ultrasound examination, a 4.5 cm hypoechoic cyst and a 5 cm septal anechoic cyst were detected in the right adnexal region. The dynamic contrast-enhanced abdominal MRI, observed for additional evaluation, revealed dimensions of 12*5*9 cm within the right adnexal region, specifically the right lateral region, with a cystic dominant lesion measuring 5 cm in diameter and a 5 cm solid component. The laboratory analysis revealed normal hemogram and transaminase levels. Thyroid function assays revealed TSH concentrations of 1.61 mIU/L (reference range: 0.48-4.81),ft4 concentrations of 1.26 ng/dL (reference range: 0.78-1.51), and ft3 concentrations of 3.15 ng/dL (reference range: 2.04-4.42). In addition, LH was 3.69 IU/L, FSH was 9.42 IU/L, and E2 was 20.70 ng/L. All tumor markers fell within normal limits. TAH BSO plus lymph node dissection plus omentectomy plus peritoneal lavage was performed. The histopathological examination revealed a 4 cm diameter tumor consistent with thyroid papillary carcinoma tissue in the right ovary. BRAF V600 was negative. Thyroid USG revealed two 5 mm hypoechoic nodules, and a fine needle aspiration biopsy of the thyroid revealed atypical follicular epithelium (AUS Bethesda 3). She underwent a total thyroidectomy. The histopathological analysis was consistent with multifocal thyroid papillary microcarcinoma.

Conclusion
Due to the presence of a tumor focus greater than 10 mm in the struma ovary, the patient was deemed high risk and adjuvant RAI therapy was planned. Close surgical margin, &gt;10 mm PTC focus in the struma ovary, presence of aggressive histopathology, lymphovascular invasion, and presence of BRAF/RAS mutation are histopathological high-risk indicators.
P-76 Down Syndrome and Thyroid hormone levels - how low can you go?
Authors: Martins João Dinis , Pina Henrique , Silveira Débora , Féria Rita Palma , Guerra Sílvia , Valadas Cristina 
Published: January 2024

Abstract

Introduction
Down syndrome (DS) is the most common chromosomal condition among live-born infants. It is associated with intellectual disability as well as medical issues ranging from congenital heart disease, obstructive sleep apnea, celiac disease, to endocrinopathies, namely thyroid disorders. The spectrum of thyroid dysfunction in patients with DS include congenital hypothyroidism, subclinical hypothyroidism, acquired hypothyroidism, and hyperthyroidism.
Identifying medical comorbidities in these patients can be crucial to optimize their quality of life.

Clinical Case
This is the case of a male patient, 30 years old, caucasian, institutionalized, with DS and known medical history of esophageal dilation, macroglossia, valvular heart disease with mild aortic insufficiency and left ventricular moderated hypertrophy, macrocytic anemia, and pulmonary embolism 10 months earlier.
Due to pallor, somnolence, fatigue, thin and fragile hair, and bradycardia, blood tests were requested and revealed an elevated TSH (385.20 mUI/L, N 0.27-4.20) with undetectable free T4 levels (&lt;0.5 pmol/L, N 12.0-22.0), macrocytic anemia (Hb 11.4 g/dL; MCV 102 fL), renal dysfunction (creatinine 1.73 mg/dL) and hypercholesterolemia (total cholesterol 310 mg/dL; LDL 236 mg/dL). The chest X-ray revealed an heart silhouette enlargement and the echocardiogram showed left ventricular hypertrophy with preserved ejection fraction, diastolic dysfunction, and mild pericardial effusion. The thyroid ultrasound revealed a globally reduced gland, with diffuse hyperechogenicity and heterogeneity, suggesting thyroiditis.
The patient was referred to the emergency department and the additional study revealed the presence of anti-TPO and anti-TG antibodies and a severe CK elevation (9280 UI/L, N 46-171). The patient, although lethargic, presented with normal blood pressure, heart rate, and body temperature during the hospital admission. Searching our national health system database, it was found the patient already had TSH elevation with undetectable free T4 levels at least 12 years before, in another hospital, but had lost follow-up there after the blood tests, and therefore remaining undiagnosed and untreated.
Oral levothyroxine reposition was started, first with 50 micrograms and then 100 micrograms and the patient was discharged after 5 days with follow-up at the Endocrinology department. Two months later, there were already clinical and laboratory changes, with improved level of consciousness and normalized free T4 levels.

Conclusion
Although hypothyroidism is a common and widely recognized condition, this case emphasizes how challenging the diagnosis can be in a person with DS.
Knowing that this syndrome is associated with several organic dysfunctions, namely endocrine disorders with non-specific clinical manifestations, there must be a high level of suspicion in order to screen, diagnose, and treat the comorbidities that may appear.
Dopamine Agonists as a Novel “Cure” for Autoimmune Diabetes
Authors: Sahota Shaan , Cooper Lorcan , Sirkova Anelia , Stojanovic Nemanja 
Published: January 2024

Abstract
We present a patient who, when treated for macroprolactinoma with a dopamine agonist (DA), was able to stop insulin treatment of his autoimmune diabetes for 2 years. The patient was diagnosed with autoimmune diabetes after presenting to emergency services in diabetic ketoacidosis aged 50 years. On presentation, he had high titers of autoantibodies associated with pancreatic islet cell destruction and a high level of glycated hemoglobin. On review in the endocrinology clinic, he displayed signs and symptoms of hypogonadism. Subsequent investigations revealed low testosterone and high prolactin with a pituitary macroadenoma on magnetic resonance imaging. He was diagnosed with a macroprolactinoma and treated with DA. This treatment reversed his insulin requirement and he achieved excellent glycemic control without any hypoglycemic agent. At this point, his diagnosis was revised to latent autoimmune diabetes of adults. Two years after commencing the DA, insulin had to be restarted. We hypothesize that in addition to autoimmune destruction of the pancreatic β cells, there were several other causes of hyperglycemia in this patient, including hyperprolactinemia and hypogonadism. The correct diagnosis led to significant weight loss and appropriate therapy, with a dramatic improvement in quality of life.
Multi-monoubiquitylation controls VASP-mediated actin dynamics
Authors: McCormick Laura E. , Suarez Cristian , Herring Laura E. , Cannon Kevin S. , Kovar David R. , Brown Nicholas G. , Gupton Stephanie L. 
Published: January 2024

ABSTRACT
The actin cytoskeleton performs multiple cellular functions, and as such, actin polymerization must be tightly regulated. We previously demonstrated that reversible, non-degradative ubiquitylation regulates the function of the actin polymerase VASP in developing neurons. However, the underlying mechanism of how ubiquitylation impacts VASP activity was unknown. Here, we show that mimicking multi-monoubiquitylation of VASP at K240 and K286 negatively regulates VASP interactions with actin. Using in vitro biochemical assays, we demonstrate the reduced ability of multi-monoubiquitylated VASP to bind, bundle, and elongate actin filaments. However, multi-monoubiquitylated VASP maintained the ability to bind and protect barbed ends from capping protein. Finally, we demonstrate the electroporation of recombinant multi-monoubiquitylated VASP protein altered cell spreading morphology. Collectively, these results suggest a mechanism in which ubiquitylation controls VASP-mediated actin dynamics.
Health effects of cold water immersion and swimming and its influence on the human body
Authors: Lipińska Justyna , Kowalczuk Maria , Lipiński Łukasz , Kopeć Izabela , Margas Mikołaj 
Published: January 2024

Introduction
Immersing and swimming in cold water is an increasingly popular sport that has recently become a fashionable form of recreation in the winter months. People who regularly swim in cold water mention the many benefits associated with it.
Aim of the study
This review aims to present the current state of knowledge about immersion and swimming in cold water and to answer questions about the impact of this phenomenon on the human body and its health benefits.
Materials and methods
The PubMed database was used in this study.A literature review was conducted using the keywords “ice swimming,” “winter swimming,” “cold water swimming,” and “cold water immersion.”
Results
Much research has been done on the effects of cold water swimming, both positive and negative. Ice swimming affects many systems of our body, including the circulatory system, the immune system, and the endocrine system, and also affects metabolic and mental changes in our body, as shown in the work below.
Summary
A single immersion in cold water causes a stress reaction in the human body, while regular swimming in cold water causes the body to develop many positive physiological changes. Despite the benefits, it is still important to remember the risks involved, and more research should be done to minimize these dangers.
Selling Quality-Differentiated Products in a Markovian Market with Unknown Transition Probabilities
Authors: Keskin N. Bora , Li Meng 
Published: January 2024

How to Price a Product Line When Customer Preferences Change over Time Quality-differentiated products can help sellers increase their profits through market segmentation. However, in many business applications, such as online search and consumer lending, customer preferences evolve over time, making it difficult for sellers to use market segmentation. In their study “Selling Quality-Differentiated Products in a Markovian Market with Unknown Transition Probabilities,” Keskin and Li analyze dynamic pricing of a vertically differentiated product line when customer preferences for quality can shift over time. Keskin and Li show that data-driven learning is essential when operating in a changing market with unknown customer heterogeneity. Keskin and Li also develop a bounded learning policy that implements near-optimal data-driven learning in a Markov-modulated demand environment.
Detection of Ascosphaera apis, causing chalkbrood disease in the colonies of European honey bee, Apis mellifera in West Bengal, India
Authors: Das Rakesh , Kumar Ritesh , Kunal Gautam , Goldar Suraj , Dutta Subrata , Jha Shantanu 
Published: January 2024

The decline of honey bee (Apis mellifera L.) populations is of great concern around the world. Among the several key drivers, dissemination of pests and pathogens is potential one. Chalkbrood is very common fungal disease of honey bee, caused due to Ascosphaera apis. In the present study, survey was conducted regarding the prevalence of diseases in A. mellifera beekeeping in Gangetic plains of West Bengal, India. Results confirmed the occurrence of chalkbrood disease in different apiaries, where dead and mummified bee larvae with cotton like chalky white or greyish-black covering were found as physical symptoms of the disease. From three surveyed apiaries, a total of 16 hives out of 113 hives were found to be infected with the diseases; and 46 frames out of 132 frames from the infected 16 hives were found to be affected by the pathogen. Microscopic examination reflected that nearly 87% of the samples collected from the infected frame were found to be positive for the spore of Ascosphaera. The fungus associated with the disease was isolated on Potato Dextrose Agar medium, pure cultured and its genomic DNA was isolated to perform PCR and based on 18s rDNA sequencing by using specific primer pair of ITS-1 and ITS-4, the fungus was identified as Ascosphaera apis.
Keywords: 18s rDNA, Bees, Necrotrophs, Phylogeny