bluuebunny/crossref_metadata_2025_split huggingface dataset:
ODP195 EUGLYCEMIC DIABETIC KETOACIDOSIS AFTER BARIATRIC SURGERY IN ASSOCIATION WITH USE OF SGLT2I.
Authors: Vaghasia Nishit , Bononi Patricia , Custodio Paul 
Published: November 2022

Abstract

Introduction
The risk of euglycemic DKA (EuDKA) is well-known with use of SGLT2i. We present two cases where EuDKA occurred despite discontinuing SGLT2i one week prior to bariatric surgery.

Case 1
A 43 year old male with type II diabetes mellitus and obesity class III presented with nausea and vomiting two weeks following gastric sleeve surgery. Preoperatively, the patient was taking glargine, lispro, empagliflozin and metformin. Empagliflozin was discontinued seven days before surgery. After surgery, patient was discharged on empagliflozin only. Labs showed blood glucose 266 mg/dl, anion gap (AG) 32 mmol/L, HCO3 11 mmol/L and betahydroxybutyrate &gt; 6 mmol/L. He was admitted to the ICU and managed according to the guidelines for DKA. On discharge, his empagliflozin was discontinued.

Case 2
31 year old female with type II diabetes, obesity class III developed nausea and vomiting a day after Roux-en-Y gastric bypass surgery. Preoperatively patient was taking glargine, metformin, dulaglutide and empagliflozin. Patient discontinued empagliflozin seven days before surgery. Labs showed glucose 232 mg/dl, AG 23 mmol/L, HCO3 6 mmol/L and betahydroxybutyrate 6.96 mmol/L. She was admitted to the ICU and managed according to the guidelines for DKA. Empagliflozin was discontinued on discharge.

Discussion
In case 1, EuDKA occurred two weeks postoperatively. In case 2, EuDKA occurred one day postoperatively. In both cases the SGLT2i was discontinued seven days before the surgery. The use of SGLT2i is a cause of EuDKA. The pathophysiology of EuDKA is not clear but thought to be related to a relative carbohydrate deficit, increased glucosuria and low insulin levels. Additionally, SGLT2i may directly stimulate glucagon release leading to increased lipolysis. There have been number of case reports suggestive of EuDKA after gastric bypass surgery in association with use of SGLT2i. Bariatric surgery causes changes in incretin pathways which in turn changes insulin: glucagon ratio and responses to blood glucose in immediate post-operative period. Additionally, preoperatively these patients are on water or ketogenic diet causing ketogenic state. However, in our cases the SGLT2i were discontinued seven days before surgery. It is not known if the use of SGLT2i therapy in the preoperative period might pose an increased risk of EuDKA due to changes in incretin based pathways associated with weight loss surgery and SGLT2i.

Conclusion
It is important to recognize that use of SGLT2i in setting of bariatric surgery perioperatively increases the risk of EuDKA. Our cases suggest two things. One it may be necessary to discontinue SGLT2i more than seven days before bariatric surgery and second initiating SGLT2i for patients with history of bariatric surgery should be considered an additional risk factor for EuDKA due to permanent changes in incretin based pathways and other mechanisms.
Presentation: No date and time listed
ODP206 High Burden of Chronic Kidney Disease in Young Adults with Type 1 Diabetes
Authors: Favel Kristen , Elliott Thomas , Panagiotopoulos Constadina , Mammen Cherry 
Published: November 2022

Abstract

Background
Type 1 diabetes (T1D) increases the risk of chronic kidney disease (CKD). We sought to assess the burden of CKD and albuminuria, and risk factors contributing to CKD development.

Methods
This retrospective cohort study (1996-2020) involved Canadian adults diagnosed with T1D before 30 years of age, followed in a sub-speciality clinic in British Columbia. CKD was defined as an estimated GFR &lt;60 ml/min/1.73 m 2 and persistent albuminuria was defined as a urine albumin-to-creatinine ratio (ACR) ≥2 mg/mmol (≥2 measurements over 6 months). Logistic regression was used to describe the relationship between CKD and diabetes-related risk factors.

Results
Of the 268 adults followed in the clinic, 63.4% were male, and the median age at diagnosis of T1D was 13.7 years (IQR 11.9 years). Over a median duration of T1D of 27.1 years (IQR 21.2 years), 8.2% of the adults developed CKD and 32.5% developed albuminuria (19.8% ACR 2-20 mg/mmol, 12.7%≥20 mg/mmol). Five adults went on to develop end-stage renal disease within the follow-up period. A longer duration of T1D (≥30 years) was associated with 4-fold increase in the odds of developing CKD (odds ratio 4. 09, 95% CI 1.37-15.10). History of medical and psychiatric comorbidities, A1C≥7%, systolic blood pressure ≥130 mmHg, and ACR ≥2 mg/mmol were also associated with greater odds of developing CKD.

Conclusion
In this contemporary Canadian cohort of young adults with T1D, CKD and albuminuria are common. Contributing risk factors include comorbid medical and psychiatric conditions, suboptimal glycemic control, systolic hypertension, and albuminuria.
Presentation: No date and time listed
ODP220 Latent Autoimmune Diabetes of Adults and PCOS - an Unusual Combination
Authors: Pisklakova Alexandra , Nagrani Mark , Mohanachandran Saurabh , Abraham James 
Published: November 2022

Abstract

Introduction
Latent autoimmune diabetes of adults (LADA) is an adult-onset subtype of autoimmune type 1 diabetes mellitus (T1DM), that is often misdiagnosed as T2DM. We present a case of LADA that was diagnosed in a young female with PCOS (polycystic ovaries syndrome) previously unsuccessfully managed as a T2DM patient.

Case report
20-years-old female with past medical history of hyperlipidemia, newly diagnosed PCOS and suspected T2DM, presented to the PCP office for a routine follow up. Patient medication regimen consisted of Metformin 500 mg BID, Spironolactone 50 mg daily and oral contraceptive. Her BMI was 27.1. Routine blood work resulted in A1C 12.6% (estimated average glucose of 306 mg/dL), total cholesterol 278 mg/dL, triglycerides 1216 mg/dL, HDL cholesterol 31 mg/dL. She was also found to be Vitamin D deficient (Vitamin D, 25-OH 9.8 ng/mL). Based on a very young age and unusually elevated A1C she was assessed for LADA and found to have glutamic acid decarboxylase antibody (GAD-65) titer greater than 28.9 IU/mL (normal 0 - 5. 0 IU/mL), C-peptide of 0.8 ng/mL (normal 0.8-3.5 ng/mL) and negative anti pancreatic islet cells antibody level. Based on those results, she was diagnosed with LADA and initiated on insulin therapy (long acting and short - acting mealtime insulin). Metformin and OCP were discontinued given very high cholesterol level, but she started on Fenofibrate 160 mg daily, Vitamin D supplements and continued with Spironolactone 50 mg daily. Within 3 months her HbA1c decreased to 6.9% and she is doing remarkably well with the new medication regimen.

Discussion
LADA shares similar genetic and autoimmune profiles with T1DM, however LADA insidious presentation overlaps with T2DM, often resulting in misdiagnosis and delaying diagnosis and adequate treatment. Insulin resistance appears to underlie many of the endocrine features of PCOS in most of the patients. The risk of T2DM among PCOS patients is 5- to 10-fold higher than normal, however there is no clear correlation established between PCOS and T1DM, including LADA. Our case warrants newly diagnosed young adults with diabetes should be screened for LADA if there are atypical findings (such as very young age, remarkably elevated A1C, close to normal BMI). Among the anti-islet antibodies, GAD-65 are the most sensitive self-antigen-antibody markers of autoimmune diabetes. Early insulin therapy preserves residual β-cell function, improves glycemic control, and reduces the risk of long-term complications.
Presentation: No date and time listed
ODP255 Woman With Maturity-Onset Diabetes of the Young Type 2 (MODY2) Mistakenly Diagnosed and Treated as Type 2 Diabetes Mellitus
Authors: Nacache Deborah Sasha Bernardes , Neto Eriberto , Vasques Jobert , Fayad Paulo 
Published: November 2022

Abstract

Background
MODY2 is a rare, monogenic form of diabetes, caused by mutations in the glucokinase gene (GCK), and is often misclassified as type 2 diabetes. Clinical case: A 37-year-old woman, during childhood, at the age of 9, was characterized as overweight and had a poor diet, despite being physically active. Her pediatrician diagnosed her with DM2 and started treatment with metformin. However, there was no improvement in fasting glucose levels, so the family decided to stop the medication on their own. In 2008, the patient became pregnant, presenting fasting glucose levels between 120-130 mg/dl (n&lt;99 mg/dl), and continued without hypoglycemic treatment. In 2010, she resumed treatment for glycemic control having used: metformin, sulphonylurea, IDDP4, and basal insulin. Despite the various treatments tested, there was altered fasting glycemia, in the 130mg/dl range. In 2012, she increased her physical activity by training for a half marathon run. At the peak of her form, but maintaining hyperglycemia (always measuring while fasting), she started liraglutide 1.8mg. In 2019, she presented episodes of malaise during training, being indicated by her physician, to discontinue liraglutide, then starting dapagliflozin, but there was still no improvement of blood glucose levels. In August 2019, she was instructed to take the following medications: insulin degludec, liraglutide, and dapagliflozin. Current weight was 53kg, height 1,57cm and a BMI 21,5kg/. Laboratory exams were requested with the following results: A1C 6,6% (n: &lt;5,7%), mean glycemia 143mg/dL (n: 70-99 mg/dL), fasting glycemia 127mg/dL (n: &lt;100mg/dL), urea 24mg/dL (n: 13-43 mg/dL), creatinine 0,83mg/dL (n: 0,8-1,3 mg/dL), AST 16U/L (n: 10-34 U/L), ALT 17U/L (n 10-130 U/L), LDL 109mg/dL (n&lt;100mg/dl), HDL 80mg/dL (n&gt;60 mg/dL), TG 90mg/dL (n&lt;150 mg/dL), total cholesterol 207mg/dL (&lt;200 mg/dL). Faced with the suspicion of diabetes with different behavior than DM1 and DM2, genetic testing was requested for confirmation. In September 2019, the result arrived, pointing out a genetic change in heterozygosis in the GCK gene. This is a rare mutation that results in the depletion of the phenylalanine amino acid at position 150 of the protein glucokinase. This result confirmed the diagnose of MODY type 2. The patient was oriented to discontinue anti-hyperglycemic agents, maintain a low glycemic index diet, and daily physical exercises. Thus, she has been maintaining excellent glycemic control and adequate weight.

Conclusion
Suspicion and characterization of MODY through clinical history, and confirmation of diagnosis through genetic testing, is essential to avoid unnecessary or inefficient treatments, and to ensure a better quality of life for the patient.
Presentation: No date and time listed
PSUN222 Prevalence of Vitamin B12 Monitoring Among Patients Receiving Metformin in a Public Hospital
Authors: Blanco Gerardo , Fayfman Maya , Ghiya Ronak D 
Published: November 2022

Abstract

Background
Metformin reduces intestinal absorption of Vitamin B12 in up to 30% of patients and lowers serum Vitamin B12 concentrations in 5-10%. The dose and duration of metformin use correlates with the risk of Vitamin B12 deficiency. Low serum levels may be detected as early as 3-4 months after starting metformin; however, symptomatic deficiency is more likely to present after 5-10 years of metformin therapy. In 2017, the American Diabetes Association (ADA) updated its treatment guidelines to recommend patients taking metformin undergo regular monitoring of Vitamin B12 levels. To better understand acceptance and application of these guidelines, we undertook an assessment of such monitoring within a single hospital center serving the low-income population in Atlanta, GA to assist in guiding optimal monitoring and patient management.

Methods
Data was collected from a single hospital center using electronic medical records (EMR) and the SlicerDicer tool to identify all outpatients for whom metformin was prescribed either as a single agent or in combination therapy during January 1 – December 31, 2021 and then measure Vitamin B12 prescribing among two cohorts during the same time period: primary care patients and patients followed by the diabetes center.

Results
During the period studied, of the total 2,336,914 patients documented in the EMR, 30,803 (0.01%) were outpatients whom metformin had been prescribed either as a single agent or in combination therapy. Of these, 816 patients (2.6%) had Vitamin B12 levels ordered and measured. The prevalence of Vitamin B12 levels ordered and measured was greater among primary care patients (673 of 8,971 [7.5%]) when compared with patients followed by the diabetes center (25 of 1,081 [2.3%]) (chi-square p&lt;0.001). A second analysis determined that Vitamin B12 levels were abnormally low among 172 (23.7%) primary care patients and 25 (28%) patients followed by the diabetes center (chi-square p=0.78).

Conclusion
Our study determined that among two outpatient cohorts who were prescribed metformin there was suboptimal adherence to the ADA's recommendation for regular monitoring of Vitamin B12 levels. The findings of this study will be used to develop approaches for increasing and optimizing ordering and monitoring Vitamin B12 levels for patient care management. Increased awareness of the relationship between metformin and Vitamin B12 deficiency and standardized approaches to monitoring are needed.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
Intraoperative Prediction of Long-Term Remission in Acromegaly
Authors: Zachariah Marcus A. , Bozer Jordan J. , Cua Santino , Prevedello Luciano M. , Ghalib Luma M. , Hardesty Douglas A. , Carrau Ricardo L. , Kirschner Lawrence S. , Prevedello Daniel M. 
Published: November 2022

BACKGROUND:
The features of long-term remission in acromegaly adenomectomy are incompletely understood. An intraoperative predictor for long-term outcome would be valuable for assessing resection of growth hormone (GH)–secreting tumors in real-time.

OBJECTIVE:
To evaluate whether intraoperative GH measurement could predict long-term outcomes for acromegaly.

METHODS:
In 47 patients, peripheral blood GH levels were measured thrice intraoperatively: once before tumor dissection, once during tumor dissection, and once after tumor dissection. Long-term remission was defined by age-appropriate, normalized insulin-like growth factor-1 at most recent follow-up and a random GH less than 1.0 ng/mL. Patients were only considered to be in long-term remission without the use of postoperative medical therapy for acromegaly or radiation therapy.

RESULTS:
The median length of follow-up was 4.51 (range: 0.78-9.80) years. Long-term remission was achieved in 61.7% (29/47) of operations. Like previous studies, cavernous sinus invasion (odds ratio [OR]: 0.060; 95% CI: 0.014-0.260; P value < .01), suprasellar extension (OR: 0.191; 95% CI: 0.053-0.681; P value<.01), and tumor size greater than 1 cm (OR: 0.177; 95% CI: 0.003-0.917; P value = .03) were associated with not being in long-term remission. The minimum GH measured intraoperatively predicted long-term outcome (area under the curve: 0.7107; 95% CI: 0.537-0.884; P value < .01). The odds ratio of remission in patients with the lowest quartile minimum intraoperative GH compared with patients with the highest quartile minimum intraoperative GH was 27.0 (95% CI: 2.343-311.171; P value < .01).

CONCLUSION:
Minimum intraoperative GH may predict long-term outcome for acromegaly, which in principle could provide the pituitary neurosurgeon with real-time feedback and inform intraoperative decision making.
Causes and Consequences of Truancy Among in School Adolescents in Oyo North Senatorial District Nigeria
Authors: Bolu Steve Foluke Nike , Fadipe Rasaq Abimbola , Charles Kayode Olajide 
Published: November 2022

Background: The need to increase the mastery of Information and Computer Technology (ICT) in teaching and learning activities is essential and urgent, especially during the COVID-19 pandemic. The PowerPoint application is a popular application for creating learning content, but most teachers are only at the level of "powerpointers". SMK Negeri Windusari, as a vocational high school, requires an increase in the level of its educators, namely those who can increase learning outcomes, one of which is by developing multimedia content based on PowerPoint. This training was in collaboration with UNIMMA Informatics Engineering. It was attended by twenty-four teachers starting with a pre-test and ending with a post-test to measure the level of success.
Contribution: Improving the quality of content to support learning outcomes.
Method: The training on the use of ICT for learning begins with observation through a pre-test and ends with a presentation of the training results, and then measures progress using a post-test.
Results: The results of the training showed that most of the participants showed improvement.

Conclusion: This training is expected to be sustainable as a form of support for improving the quality of learning content.
Conceptions of Learning and Teaching and Their Relation to Educational Variables During Teaching Second Language
Authors: Chen Tim , C. Crosbie Robert , Anandkumarb Azita , Melville Charles , Nguyen N , Chen J 
Published: November 2022

Background: People who choose to study a second language like English face an emotional charge that affects directly to the learning process. Regarding the writing production, learners create short compositions about specific topics with instructions based on grammatical structures. Once it is done, learners receive feedback on their work. However, some learners do not want to write any text because the teacher puts more attention to their mistakes rather than their successes. Without taking into account their needs, topics of interest or motivation for carrying out the exercise
Contribution: Therefore, it is set to identify the emotions that are generated by the corrections made to our learners’ written work.
Method: The research was carried on with university students aged between 18 and 25 years old who are attending classes at the center of university language classroom. This research during the April- August 2016 term.
Results: It has been found that the emotions (positive and negative) play an important role or have a great impact that causes aversion towards language learning. Therefore, it is necessary that teachers provide adequate feedback for language learning.

Conclusion: Corrections generate aversion towards the learning process. Regarding the feedback students receive from their teachers, it generates emotional charge (positive and negative) which should be followed
Knowledge of the Effects of UV Radiation and Blue Light on the Skin, the Proper use of Protective Cosmetics and Usage Patterns in Latvia
Authors: Nesterenko Renata , Pleša Demija , Bataraga Elga 
Published: November 2022

UV (ultraviolet) radiation is a significant risk factor for the development of skin cancers such as melanoma, basal cell carcinoma, and squamous cell carcinoma, and can contribute to other skin lesions.
Objectives: The aim of the study was to find out knowledge on the effects of UV radiation and blue light on the skin, the correct use of protective equipment, and their using habits in the Latvian population.
Materials and Methods: An anonymous questionnaire was used, which included 31 questions and 307 participants in the age group from 18 to 60 years, randomly selected were surveyed (243 (79%) - women, 64 (21%) - men).
Results: Comparing the knowledge about the effects of UV radiation and the blue light on the skin between the age groups, a statistically significant difference was found between the age groups 21-25 and 51-60 (p <0.001), as well as between 26-30 and 51-60 (p <0.001). Analyzing the data, a statistically significant difference was obtained in the gender groups who didn’t sunbathe - men did not sunbathe statistically significantly less than women (p <0.05). Only 21.2% of respondents were using SPF protective creams daily. 8.1% of respondents believe that the effects of tanning on the skin are negative.
Conclusion: The level of knowledge on UV radiation, blue light and proper use of protectives are influenced by age, gender and occupation in Latvian population.
Platelet-rich plasma injection for acute Achilles tendon rupture
Authors: Keene David J. , Alsousou Joseph , Harrison Paul , O’Connor Heather M. , Wagland Susan , Dutton Susan J. , Hulley Philippa , Lamb Sarah E. , Willett Keith ,   on behalf of the PATH-2 Trial group
Published: November 2022

Aims To determine whether platelet-rich plasma (PRP) injection improves outcomes two years after acute Achilles tendon rupture. Methods A randomized multicentre two-arm parallel-group, participant- and assessor-blinded superiority trial was undertaken. Recruitment commenced on 28 July 2015 and two-year follow-up was completed in 21 October 2019. Participants were 230 adults aged 18 years and over, with acute Achilles tendon rupture managed with non-surgical treatment from 19 UK hospitals. Exclusions were insertion or musculotendinous junction injuries, major leg injury or deformity, diabetes, platelet or haematological disorder, medication with systemic corticosteroids, anticoagulation therapy treatment, and other contraindicating conditions. Participants were randomized via a central online system 1:1 to PRP or placebo injection. The main outcome measure was Achilles Tendon Rupture Score (ATRS) at two years via postal questionnaire. Other outcomes were pain, recovery goal attainment, and quality of life. Analysis was by intention-to-treat. Results A total of 230 participants were randomized, 114 to PRP and 116 to placebo. Two-year questionnaires were sent to 216 participants who completed a six-month questionnaire. Overall, 182/216 participants (84%) completed the two-year questionnaire. Participants were aged a mean of 46 years (SD 13.0) and 25% were female (57/230). The majority of participants received the allocated intervention (219/229, 96%). Mean ATRS scores at two years were 82.2 (SD 18.3) in the PRP group (n = 85) and 83.8 (SD 16.0) in the placebo group (n = 92). There was no evidence of a difference in the ATRS at two years (adjusted mean difference -0.752, 95% confidence interval -5.523 to 4.020; p = 0.757) or in other secondary outcomes, and there were no re-ruptures between 24 weeks and two years. Conclusion PRP injection did not improve patient-reported function or quality of life two years after acute Achilles tendon rupture compared with placebo. The evidence from this study indicates that PRP offers no patient benefit in the longer term for patients with acute Achilles tendon rupture. Cite this article: Bone Joint J 2022;104-B(11):1256–1265.