6-month Period Research Articles

Signalment, clinical characteristics and outcomes of an Australian population of dogs with steroid responsive meningitis-arteritis (SRMA) - 124 cases (2013-2023).

Variations in canine breeds presenting with steroid responsive meningitis-arteritis (SRMA) have been observed across different geographical regions internationally. However, there are no published studies describing affected dogs in an Australian population to date. This descriptive study aimed to characterise the signalment, as well as the clinical characteristics and outcomes in an Australian population of client-owned dogs with SRMA. Medical records from five veterinary referral hospitals in the state of New South Wales between 2013 and 2023 were retrospectively reviewed. One hundred and twenty four dogs were included in the study. The breeds which presented with SRMA most commonly included Golden Retriever (19/124, 15.3%), Italian Greyhound (11/124, 8.8%), Boxer (8/124, 6.5%), "Cavoodle" (Cavalier King Charles Spaniel x Poodle) (8/124, 6.5%), Corgi (7/124, 5.6%), Border Collie (6/124, 4.8%) and Australian Kelpie (5/124, 4.0%). The disease was observed more commonly in males, representing 79/124 (63.7%) of dogs. Presenting concerns, examination findings and laboratory abnormalities were otherwise consistent with international studies. The frequency of ≥1 relapse for dogs with a ≥6-month follow-up period was 32/85 (37.6%). A higher frequency of ≥1 relapse was seen in female dogs and in Corgi and Italian Greyhound breeds. All Corgis who relapsed demonstrated multiple relapses. In conclusion, this study observed a variation in breeds presenting with SRMA compared to international publications, which may reflect both differences in breed popularity, as well as varying interbreed susceptibility dependent on geographical location.

Predictive Value of Physiological Values and Symptom Scores for Exacerbations in Bronchiectasis and Chronic Obstructive Pulmonary Disease With Frequent Exacerbations: Longitudinal Observational Cohort Study.

COPD (chronic obstructive pulmonary disease) and bronchiectasis are common, and exacerbations contribute to their morbidity and mortality. Predictive factors for the frequency of future exacerbations include previous exacerbation frequency and airway colonization. Earlier treatment of exacerbations is likely to reduce severity. This study tested the hypothesis that, in a population with bronchiectasis, COPD, or both who have frequent exacerbations and airway colonization, changes in symptom scores or physiological variables within 10 days prior to an exacerbation would allow the prediction of the event. We performed a 6-month, longitudinal, observational, cohort study among 30 participants with bronchiectasis, COPD, or both; at least 2 exacerbations per year; and colonization with Pseudomonas aeruginosa or Haemophilus influenzae. Daily symptom and physiological data were collected, comprising pulse rate, blood pressure, oxygen saturation, peak flow rate, step count, weight, and temperature. Exacerbations (defined as the onset of new antibiotic use for respiratory symptoms) were collected, and predictive values for abnormal values in the 10 days prior to an exacerbation were calculated. A total of 30 participants were recruited, collecting a total of 39,534 physiological and 25,334 symptom data points across 5358 participant-days; these included 78 exacerbations across 27 participants, with the remaining 3 participants not having exacerbations within the 6-month observation period. Peak flow rate, oxygen saturation, and weight were significantly different at the point of exacerbation (all P<.001), but no significant trends around exacerbation were noted and no clinically beneficial predictive value was found in the overall or individually adjusted model. Symptom scores tended to worsen for 10 days on either side of an exacerbation but were of insufficient magnitude for prediction, with area under the receiver operating characteristic curve values of ranging from 0.4 to 0.6. Within this small cohort with bronchiectasis, COPD, or both and airway colonization, physiological and symptom variables did not show sufficient predictive value for exacerbations to be of clinical utility. The self-management education provided as standard of care may be superior to either of these approaches, but benefit in another or larger cohort cannot be excluded. RR2-10.2196/resprot.6636.

Rehabilitation and functional outcomes of COVID-19 patients in a rehabilitation hospital in Qatar.

Patients recovering from severe COVID-19 infections have experienced prolonged cognitive, physical, and psychological sequelae, including cardiorespiratory and motor deconditioning, neurological deterioration, anxiety, and depression. The impact of rehabilitation post-acute COVID-19 infection was recognized in the literature, but studies assessing and quantifying specific functional outcomes were lacking. This study aims to describe the characteristics and quantify the changes in functional outcomes of patients admitted to Qatar Rehabilitation Institute (QRI) for inpatient rehabilitation (IPR) post-COVID-19 infection during a 10-month period in 2021. This is a retrospective observational cohort study, which included individuals over 18 years of age with a documented COVID-19-positive diagnosis who were admitted to QRI for IPR due to COVID-19 complications. Data was collected by the investigators from January 1, 2021, until October 30, 2021. A total of 243 patients were included in this study. The changes in functional rehabilitation outcomes were assessed and quantified at both the patient's baseline (on admission to QRI) and after completion of IPR (on discharge). The duration of the IPR program varied based on each patient's baseline assessment. Patients were given a total of 8-12 weeks to achieve their rehabilitation goals and were discharged once those goals were met. Several validated tools were utilized in this study including Functional Independence Measure (FIM), Berg Balance Scale (BBS), Dynamic Gait Index (DGI), Modified Medical Research Council (mMRC) Dyspnea Scale, Mini-Mental State Examination (MMSE), and Right- and left-Hand Grip Strength. In addition, patients' diet, the need for respiratory support, and the presence of a tracheostomy tube before and after IPR were also recorded. In total, 84.4% of the included patients were males (n = 205); with a mean age of 52.44 ± 12.99 years. The most commonly reported comorbidities were type 2 diabetes (62.1%) and hypertension (49.8%) with 83.5% of patients experiencing critical illness neuromyopathy. The average patients' length of stay in QRI was 33.92 ± 27.72 days. A statistically significant improvement in all functional outcome scales was noted following the completion of the IPR program (p = 0.001). The number of patients requiring modification to their diet or feeding via nasogastric tube (NGT) significantly decreased by 35% and 93%, respectively (p = 0.001). Patients requiring respiratory support decreased by 98% (p = 0.001) and the need for a tracheostomy tube among patients was reduced by 95% (p = 0.001). IPR following COVID-19 infection was associated with significant functional, motor, and cardiorespiratory improvement. Dedicating clinics for post-COVID-19 rehabilitation would ensure improved patient outcomes and enhanced recovery.

The effect of MIND diet on sleep status, anxiety, depression, and cardiometabolic indices in obese diabetic women with insomnia: study protocol for a randomized controlled clinical trial {1}

BackgroundThe Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet is a plant-based and anti-inflammatory diet that has the ability to protect and manage cardiovascular and nervous system diseases. Regarding that insomnia and cardiovascular problems are x`common in type 2 diabetes mellitus (T2DM), the present study will assess the effectiveness of the MIND dietary pattern on sleep quality, cardiometabolic indicators, and other psychological indicators.MethodsForty-four overweight/obese T2DM women with insomnia, aged 30–65 years, will voluntarily participate in this randomized controlled trial and will be randomized to receive either a MIND low-calorie diet (MLCD) or a low-calorie diet (LCD) over a 3-month period. Before and after the study, sleep quality, some biochemical and cardiometabolic indices, cortisol, brain-derived neurotrophic factor (BDNF), high-sensitivity C-reactive protein (hs-CRP), and oxidative stress indicators will be assessed.DiscussionThe use of dietary interventions in the management of T2DM complications is practical and safe. This research seeks to investigate the capacity of the MIND diet in the management of insomnia and cardiovascular problems of DM. It is expected that the results of this research will provide new perspectives on using an ideal dietary regimen to treat these health conditions.Trial registrationIRCT20181111041611N8. Registered on August 7, 2023. https://www.irct.ir/trial/71772

Mechanism of injury, resource utilisation and outcomes for patients admitted with head injuries under General Surgery.

There has been a noticeable change in Irish hospitals in the demographics of patients sustaining head injuries that now includes many older patients suffering head injuries from low impact trauma. This study sought to define the demographic nature of patients admitted with head injuries over a 3-month period to Beaumont Hospital and to determine the mechanisms of head injuries sustained, resource utilisation during the inpatient admission and the outcomes for these patients. All head injuries admitted between December 1, 2023, and February 29, 2024, were captured and data pertaining to patient demographics, mechanism of injury, resource utilisation and outcomes were assessed. A comparison between patients under the age of 70 and over the age of 70 was also undertaken. Thirty six patients were admitted in the 3-month period. 52.8% (n = 19) were over the age of 70. The mechanism of injury in the older cohort had a tendency to be low impact trauma, often with mechanical falls from standing height The median length of stay was 4.5days. The older cohort was more likely to have a history of previous falls, to require input from allied health and social care professionals and were less likely to be discharged directly home. Older patients requiring hospital admission for head injuries have significantly different care needs to younger patients admitted with head injuries. A national pathway for older patients who sustain head injuries needs to be implemented to ensure they get timely access to the investigations and specialists required.

"Y appearance" infarction: caused by essential thrombocythemia.

Essential thrombocythemia (ET) is a myeloproliferative malignancy caused by the excessive proliferation of megakaryocytes in the bone marrow, resulting in the overproduction of peripheral platelets. ET can lead to thrombotic events, such as ischemic stroke (IS), though it is a rare cause of IS. Bilateral medial medullary infarction (BMMI), also known as "Y appearance" infarction due to its distinctive imaging morphology, is a rare clinical subtype of IS which typically has a poor prognosis and a high mortality rate. Herein, we report the case of a 43-year-old male with a history of ET. The patient's platelet count was poorly controlled, and he did not receive regular treatment. After developing symptoms such as dizziness, dysphagia, choking on water, slurred speech, blurred vision, and bilateral limb numbness. Head magnetic resonance imaging revealed a "Y appearance" infarction in the bilateral medial medulla. After admission, the patient was administered intravenous antiplatelet therapy with tirofiban. However, when he was switched to oral aspirin after three days, he experienced decreased muscle strength and worsening symptoms. Therefore, tirofiban was continued for 14 days. Upon discharge, the patient experienced residual limb numbness. His National Institutes of Health Stroke Scale score was 1, Modified Rankin Scale score was 0, and platelet count had decreased to the normal range. During the 9-month follow-up period after discharge, the patient still had only mild limb numbness. Our report presents a special case of "Y appearance" infarction due to ET. Owing to fluctuations in the patient's condition, he received long-term high-dose tirofiban, which ultimately led to a significant improvement in his symptoms.

Effect of a novel cannulation device for vascular access on AVF maturation in a goat carotid-jugular fistula model.

The Ark is a 3-D printed titanium device designed to be implanted around the draining vein of an arteriovenous fistula (AVF) to facilitate vascular access. The purpose of this study was to assess AVF maturation after Ark implantation in a large animal model. End-to-side AVFs were created between the carotid artery and jugular vein in nine pygmy goats that included three control (AVF only) and six experimental (AVF and Ark device) animals. For experimental animals, an Ark device was implanted approximately 10 cm downstream of the anastomosis at the time of AVF creation. Postoperative ultrasounds and cannulations of the jugular vein fistula were performed over 12 months. At the conclusion of the study, the AVF was ligated and Ark devices along with a segment of the arterialized vein and surrounding tissues were explanted for gross and histological assessment. The control and experimental Ark groups exhibited increased dilation and flow as well as diminished depth underscoring the parallel developments in vascular attributes and AVF maturation between the two groups. Gross pathology, histology, and micro-CT imaging revealed intact endothelium, mature tissue integration throughout the porous Ark device, and no underlying stenosis. No adverse events such as foreign body reaction, skin or vessel erosion were identified. The study showed maturation without stenosis of the fistula in all animals. This study confirmed that the Ark device functions as a scaffold around the access vein, allows fistula maturation, and can be consistently cannulated without infiltrations over a 12-month period in a large animal model.

12355 An Adolescent Female With Congenital Lipodystrophy Presenting With Repeated Acute Metabolic Decompensations Rescued By A Novel Leptin Receptor Agonist

Abstract Disclosure: D.M. Chambers: None. Y. Chan: None. M.K. Crocker: None. Patient SH is a now 17-year-old female treated for generalized congenital lipodystrophy with a course complicated by severe hypertriglyceridemia, type 2 diabetes mellitus, hypertension, hepatosteatosis, and intermittent menstrual irregularity. She had been managed successfully with metreleptin for 2 years, but in 2022-2023, she developed repeated episodes of pancreatitis (4 times over a 14-month period) secondary to severe hypertriglyceridemia (serum triglycerides &amp;gt;8000 mg/dL). During her admissions, she had markedly increased insulin requirements (up to 12 units/kg/day) with refractory hyperglycemia despite maximal treatment with metreleptin, empagliflozin, and oral semaglutide. In the clinical context of her acute metabolic worsening, she was suspected of having a neutralizing antibody against metreleptin. Serum leptin was undetectable 1 hour after observed metreleptin doses; direct measurement of neutralizing antibodies is pending. She was transitioned from metreleptin to mibavademab, an investigational leptin receptor agonist, on an expanded use IND. She subsequently experienced significant improvements in her fasting triglyceride levels (&amp;lt;300 mg/dL) with no subsequent episodes of pancreatitis since starting therapy in August 2023. She has also had improvements in other aspects of her metabolic health including decreased insulin requirements with decreasing hemoglobin A1c, decreased need for adjunctive lipid and hypertension therapy, and improving menstrual regularity. Her clinical course demonstrates: 1) clinical indicators of a rare but serious loss of efficacy of metreleptin therapy; 2) adjunctive options for management of generalized lipodystrophy; and, 3) an individual experience with a novel leptin agonist therapy in the treatment of generalized lipodystrophy. Presentation: 6/3/2024

Plant organ rather than cover crop species determines residue incorporation into SOC pools

The implementation of cover crops has emerged as a promising approach to improve soil organic carbon (SOC) stocks, with particular emphasis on the perceived higher carbon use efficiency displayed by high-quality residues such as from leguminous plants. In this study, we explored how different cover crop residues, specifically from a legume and a grass cover crop, affects SOC formation and its distribution across various soil carbon pools. Over a 7-month period, we incubated 14C-labeled winter rye and hairy vetch residues in microcosms containing soils of varying soil fertility levels from a long-term field trial. We tracked the fate of carbon into free and occluded particulate organic matter (fPOM, oPOM), mineral-associated organic matter (MAOM), and carbon deposited outside the detritusphere.Despite notable differences in C:N ratio, chemical composition, and turnover rate, similar SOC formation efficiency between vetch and rye within each plant organ (shoots and roots) was observed. Interestingly, the plant organ appeared to exert a greater influence on the fate of cover crop carbon than whether the crop was leguminous or non-leguminous. This phenomenon seemed to be closely related to the lignin content.At medium soil fertility, we found that the largest proportion of cover crop residue C remained as MAOM (20% for shoots, 15–18% for roots), followed by fPOM (5–6% for shoots, 10–12% for roots) and oPOM (2.7–3.0% for shoots, 1.5–1.6% for roots). Notably, fPOM and oPOM exhibited opposite responses to residue quality, indicating functional distinctions between these often-pooled POM pools.Soil fertility exerted minimal influence on overall respiration rate patterns or SOC formation, although it did affect oPOM formation efficiency, likely due to differences in soil aggregation.In conclusion, our findings challenge the assumption regarding the superiority of N rich leguminous cover crop residues for enhancing SOC accrual in C pools believed to have longer persistence.

7316 A Unique Presentation of Diabetes Mellitus in an 8-Year-Old Male Positive For 3 Different Mutations Related to MODY

Abstract Disclosure: R. Senguttuvan: None. A. Pamfil: None. Background: Maturity-Onset Diabetes of the Young (MODY) is the most common form of inherited non-autoimmune diabetes mellitus, characterized by autosomal dominant inheritance, young age at onset and beta cell dysfunction. There are at least 14 MODY mutations and we present a pediatric case not meeting criteria for type 1[T1DM] or type 2 diabetes mellitus[T2DM], who tested positive for mutations in 3 different genes known to cause MODY. Case: An 8-year-old male, born full term, 2776 grams and 48.3 cm, without history of neonatal hypoglycemia or hyperglycemia, was referred for new onset diabetes mellitus management. While undergoing evaluation for abdominal pain and constipation, he was found to have a fasting glucose of 126 mg/dL (7 mmol/L) and hemoglobin A1C of 6.5%. He endorsed polyuria, but no polydipsia. He had no clinical signs of insulin resistance (e.g., acanthosis nigricans) and a BMI of 23.65 kg/m2, at the 97th percentile. Family history is positive for diabetes mellitus requiring insulin, in father (diagnosed at 11 years) and paternal grandmother and T2DM in paternal aunt. Laboratory evaluation was negative for all 5 antibodies (GAD, IA-2, Anti-islet cell antibody, Zinc Transporter 8 and Insulin antibodies) and revealed an insulin level of 15.9 uIU/mL (RR: &amp;lt;2.0-13.0) and C peptide: 2.3 ng/mL (RR: 1.1-4.4). Lacking diagnostic criteria for T1DM or T2DM, genetic testing was performed. Patient tested heterozygous for mutations in 3 genes known to cause MODY: GCK [(c.350 G&amp;gt;T p. (G117V)], ABCC8 [(c.2270 C&amp;gt;G p.(T757R)], and HNF1B [(c.68A&amp;gt;G p.(K23R)], all variant of uncertain significance. Over an 8-month period, patient's weight decreased from 98 lbs. (44.9 kg) to 90 lbs. (41.1 kg) after meeting with our dietician and implementing healthy dietary changes, and his beta cell function markers improved from diagnosis: Fasting insulin (4.5 uIU/mL), C peptide (1.3 ng/mL), and glucose 119 mg/dL; Hemoglobin A1C remained relatively stable at 6.1%. A kidney ultrasound was normal. No medical intervention were started yet, and patient is being monitored clinically and biochemically every 3-4 months. Discussion: Clinical monitoring over time, genetic testing in the parents, are critical in this patient’s long-term treatment plan and prognosis. To our knowledge, this may be the first case of diabetes mellitus in a pediatric patient, positive for mutations in 3 different genes known to cause MODY. South Texas has one of the highest incidences of T2DM in the USA. In addition to screening for genetic forms of diabetes, in patients with negative T1DM antibodies and atypical phenotype for T2DM, we should consider genetic screening in mildly obese pediatric and young adult patients without significant acanthosis nigricans, who were already diagnosed as T2DM. Presentation: 6/1/2024

9356 Occurrence Of Dyslipidemia During Modified Atkins Diet In Children With Intractable Epilepsy And Effect Of Lipid-Lowering Agents On Dyslipidemia

Abstract Disclosure: J. Yoo: None. S. Kim: None. H. Chae: None. Introduction: The Modified Atkins Diet (MAD), as a type of Ketogenic diet (KD) therapy, is utilized as a treatment for intractable epilepsy. Compared to the classic KD, it has a lower ratio of fat to carbohydrate plus protein, resulting in higher compliance among patients. Dyslipidemia is known as a major complication of KD, but when it comes to MAD, there is a scarcity of long-term studies investigating lipid level alterations in children.In this study, our objective is to examine the impact of the MAD on serum lipid levels in children and adolescents with intractable epilepsy. Method: A total of 106 patients with intractable epilepsy aged under 19 who initiated MAD from January 2016 to December 2021 and maintained MAD for a minimum of 12 months were enrolled. Laboratory test for lipid level were conducted at baseline, 1 month, 3 months, 6 months, and subsequently at 6-month intervals after initiation of MAD. The prevalence rate of dyslipidemia and lipid levles by period after MAD was analyzed. Dyslipidemia is defined as having any one of the following criteria: total cholesterol ≥200 mg/dL, LDL (Low-density lipoprotein) ≥130 mg/dL, HDL (High-density lipoprotein) &amp;lt;40 mg/dL, and triglyceride ≥100 mg/dL for children aged 0-9 and ≥130 mg/dL for adolescents aged 10-18.3. Result: The prevalence rate of total dyslipidemia observed at baseline, 1 month, 3 months, 6 months, 12 months, 18 months, 24 months, 30 months, and 36 months, were 31.1%, 67.6%, 69.5%, 68.2%, 59.5%, 60.5%, 53.7%, 47.1%, and 31.3%, respectively. When the average value and prevalence rate for each type of dyslipidemia were analyzed, total cholesterol and LDL levels showed an increase from the 1-month period compared to the baseline, peaked at the 3-month period, and gradually decreased from the 6th month with statistical significance. In the case of triglycerides, the prevalence rate of hypertriglyceridemia was highest at 3 months, but the average value was highest at 1 month with statistical significance. However, in HDL, both the average value and the prevalence rate of hypo-HDL cholesterolemia did not exhibit a significant difference over the entire period. Conclusion: MAD increases the incidence of dyslipidemia until three months after initiation, but in most cases, it tends to decrease even without treatment after six months. Presentation: 6/1/2024

6745 Complete Remission of Type 1 Diabetes and the Honeymoon Phase: A Case Report

Abstract Disclosure: D. Krinsky: None. E. Brutsaert: None. J.A. Mullally: None. Introduction: Type 1 Diabetes (T1D) is a chronic autoimmune disease resulting in insulin deficiency from pancreatic beta-cell destruction. Recent evidence suggests that it can be a partially relapsing and remitting disease, with some patients with T1D being able to briefly discontinue insulin early in the disease course. This phenomenon has been referred to as the “honeymoon phase.” While this period tends to be short, on the order of weeks to months, we describe a unique case of a patient with T1D with a long remission, lasting about five years. Clinical Case A 21-year-old Mexican-American male (BMI 26) with past medical history of T1D presented with polyuria and a 50-pound unintentional weight loss over a 6-month period. He was first diagnosed with T1D at age 14 years when his Hemoglobin A1c (HbA1C) was 13.3% (normal range 4.0-5.6%) in the setting of hospitalization for diabetic ketoacidosis (DKA). All antibody testing done at that time was negative, but islet cell antibodies were later found to be positive. Insulin therapy was started, weaned, and then completely discontinued at age 16 when the patient’s HbA1c was normal at 5%. The patient had no symptoms of diabetes until 6 months prior to presenting, seven years after his original diagnosis. He was found to be in DKA with a HbA1c &amp;gt;14%. Additionally, insulin (&amp;lt; 3.0; normal range 6-27) and c-peptide (0.43; normal range 0.81-3.85) were low with an elevated glucose of 366. Insulin autoantibody, GAD-65 antibody, and islet cell antibody were negative. His DKA resolved and he was discharged on basal and nutritional insulin. Conclusion: The physiology of the honeymoon phase is not well understood and there is not a clear definition, although stimulated C-peptide levels, insulin requirements, and calculating insulin dose adjusted A1c (IDAA1c) have been commonly used. There is variability in reports of the prevalence of partial remission (PR), estimated to occur in 22-60% of patients, with an average duration of 9 months. Our case is unique in that the patient was diagnosed with T1D at the age of 14 years but was able to discontinue all insulin for five years. His presentation is consistent with a complete remission with insulin independence and normal glycemic control (HbA1C &amp;lt;6%) without the use of hypoglycemic agents. Complete remission has a prevalence of only 6.5%. Prior data has shown factors associated with diabetes remission include male sex, postpubescent age of diabetes onset, and fewer than two positive antibodies; factors seen with our patient. Our case highlights a very long remission of T1D, and a better understanding of the immunologic and metabolic factors at play in the honeymoon phase may pave the way for novel T1D prevention and treatment strategies. Presentation: 6/2/2024

Radiation dose to the eye of physicians during radio frequency catheter ablation: a small-scale study.

Radio frequency catheter ablation (RFCA), a treatment for arrhythmia, requires a long fluoroscopy time that increases the radiation exposure dose to the physician, particularly to the lens of the eye. It is recommended that a lens-specific dosimeter such as DOSIRIS® is used to measure the dose to the lens. In this study, we investigated whether conventional glass badges can be used as an alternative to lens dosimeters. The doses to the lenses of two physicians (physician A, main operator; physician B, assistant; physician B was further away from the patient than physician A) were measured for 126 RFCA procedures performed over a 6-month period (fluoroscopy rate of 3.0 p/s with use of a ceiling-hanging shield). The cumulative value measured by a lens dosimeter attached to the inside of Pb glasses (0.07-mm dose equivalent) next to the left eye was 4.7mSv for physician A, and 0.8mSv for physician B. The reading on the glass badge worn on the left side of the neck was 4.7mSv for physician A and 1.3mSv for physician B. Lens dosimeter and glass badge values showed a good correlation for the left eye and left neck (r = 0.86, p < 0.01). We show that glass badges may be a viable alternative to lens-equivalent dosimetry when using low-pulse fluoroscopy and a ceiling-hanging shield.

8378 Disparities In Telemedicine Use In Latinx Patients With Diabetes: Real Life Observations

Abstract Disclosure: S. Kim: Consulting Fee; Self; Signos, Inc.. Grant Recipient; Self; The Diabetes Link. P. Thedki: None. L.A. Wright: None. Background and Aims The Latinx population is disproportionately affected by diabetes and related complications and face greater challenges to accessing medical care than white patients. Telemedicine, a novel strategy for addressing such lack of access has not been evaluated in the Latinx population affected by diabetes.We aimed to assess telemedicine use in Latinx patients with diabetes compared to non-Latinx, within the same diabetes clinic (same care team and access to same digital platform). Secondary aims: HbA1c and use of CGM. Methods: All patients were offered telemedicine services and were considered users if they completed =/&amp;gt;1 telemedicine visit during the 3-month study period. Demographics, race/ethnicity, telemedicine use, language, type of diabetes: type 1(T1D), type 2(T2D) or other; HbA1c(+/- 3 months from visit) and use of CGM at the time of visit were extracted. Results: Latinx patients: n=61, 42 Spanish speaking only; mean age 52.4; 32 female; 46 with T2D. Non-Latinx: n=81, mean age 53.2; 43 female; 43 had T1D. Telemedicine use was 22% in Latinx vs 39% in non-Latinx patients, p=0.007. Mean A1c was 7.4% in Latinx vs 7.1% in non-Latinx, p=0.04 CGM use was more common in non-Latinx patients, p=0.01. Conclusions T2D was more common and telemedicine use was lower in Latinx compared to non-Latinx patients, most were Spanish speaking only, they had higher HbA1c and less CGM use. While telemedicine has the potential to increase access to care, social determinants of health, such as digital literacy, access to device and/or reliable internet are likely barriers that contribute to health inequalities in this population. Presentation: 6/2/2024

7269 Interim Analysis of Gonadotropin-Releasing Hormone Agonist (GnRHa) Treatment in Children with Central Precocious Puberty: Focus on FMV Urinary LH Levels and Clinical Outcomes

Abstract Disclosure: X. Luo: Advisory Board Member; Self; Takeda. L. Hou: Advisory Board Member; Self; Takeda. Y. Li: Advisory Board Member; Self; Takeda. Y. Sun: Advisory Board Member; Self; Takeda. X.K. Jin: Employee; Self; Takeda. Background: Central precocious puberty (CPP) refers to early activation of the hypothalamic–pituitary–gonadal (HPG) axis in children. There is an urgent need to understand the treatment pattern and clinical outcomes among children suffering from CPP. Studies have reported that first morning voided (FMV) urinary Luteinizing hormone (LH) and Follicle stimulating hormone (FSH) have substantial association with CPP tested in GnRH stimulation test and can be useful in diagnosis and management of CPP in children. Gonadotropin-releasing hormone agonists (GnRHa) such as Leuprolide acetate (LA) are the recommended treatment for children suffering from CPP. The current study aimed to provide the information on level of LH and FSH in FMV urine when CPP diagnosis at baseline and the present results may also revealed trend of FMV-LH and FMV-FSH change during LA intervention in children with CPP. Here we present interim results from this study. Methods: This is an open-label, multicentre, single arm, prospective study that enrolled 31 subjects with CPP. Individuals were administered LA depot 11.25 mg, subcutaneously every 12 weeks. The study comprises a screening period; a 6-month treatment period: 24 weeks; and a post-treatment follow-up period: 12 weeks. The FMV urinary LH and FSH were diagnosed by Clopper-Pearson method with a 95% confidence interval. Results: Due to the data collection time point for the interim analysis, only 8 female subjects reached the 12-week visit time point and had a 12-week visit for FMV urinary Gn testing. Therefore, for this interim analysis, only FMV Gn decline at week 12 of the 8 subjects who had a 12-week visit will be presented. At baseline, the mean value of FMV urinary LH and FSH is 0.58 IU/L and 2.27 IU/L respectively. The FMV Gn urinary LH was demonstrated a decrease in 87.5% (95% CI: 47.35,99.68) of the children after LA intervention. Additionally, urinary FSH value of FMV urinary Gn was found to decrease in 75.00% of the children (95% CI: 34.91,96.81) compared to baseline FSH value. Conclusion: The present study reveals a decreasing trend in FMV Gn urinary LH and FSH levels in CPP children treated with LA during interim analysis. LA was shown to be safe and effective in ameliorating the level of LH and FSH in children suffering from CPP. From the study, it can be concluded that urinary LH and FSH may act as a potential biomarker for diagnosis and management of CPP. Presentation: 6/3/2024

The continuous rise in orbital subperiosteal abscess incidence in the Iranian pediatric population

In this study, we aimed to follow up on the surprising increase in the incidence of orbital subperiosteal abscesses (SPA) reported in the Iranian pediatric population in the post-COVID era. Pediatric patients (≤ 18 years old) diagnosed with orbital SPA following acute sinusitis who were hospitalized between October 1st, 2023, and March 31st, 2024 in Farabi Eye Hospital, Tehran, Iran, were included. Demographic, clinical, microbiologic, and radiological characteristics of patients were reviewed. During the 6-month study period, 39 patients were admitted to our tertiary referral hospital. The average age of patients was 7.29 ± 4.13 years and 30 patients (76.92%) were male. The ethmoid sinus was involved in 100% of patients, and SPA involvement was in the medial wall in 27 patients (69.23%). The mean volume of SPA was 1.45 ± 1.77 cm3. Nineteen patients (48.72%) underwent surgical interventions, however, 20 patients (51.28%) received only medical treatment. The best corrected visual acuity of patients increased from 0.63 (0.20 LogMAR) on the first day of admission to 0.84 (0.07 LogMAR) according to the Snellen chart in the first month after treatment. It seems that the outbreak of orbital SPA in the Iranian children population in the post-COVID era is an increasing trend.

6545 Weekly Somapacitan Reduces Serum C-reactive Protein Levels in Adult Patients with Growth Hormone Deficiency

Abstract Disclosure: Y. Seki: None. S. Morimoto: None. M. Ikemoto: None. N. Takano: None. K. Yamashita: None. K. Bokuda: None. D. Watanabe: None. A. Ichihara: None. Background: Adult growth hormone deficiency (GHD) is known to be associated with increased inflammation. Our previous research revealed a significant association between GHD and elevated serum C-reactive protein (CRP) levels. Limited studies have demonstrated a significant association between GH replacement therapies and CRP levels; only two reports showed a significant reduction in serum CRP levels with daily somatropin. This study aimed to investigate the effects of weekly somapacitan on serum CRP levels in adult patients with GHD. Methods: We prospectively observed serum CRP levels as the primary outcome before and 6 months after somapacitan treatment in adult patients with GHD with no history of GH supplementation therapy within the past 6 months. Secondary outcomes included anthropometric data, IGF-1 levels, and kidney and liver functions. The somapacitan dose was titrated based on IGF-1 levels during the 6-month treatment period. Results: Eight adult patients (mean age 50±17, male 4 [50%]) with GHD received weekly somapacitan treatment. Of the patients, 2 (25%) had ACTH deficiency, 2 (25%) had TSH deficiency, and 2 (25%) had gonadotropin deficiency. Two patients (25%) were on glucocorticoid replacement. The somapacitan dose at 6 months was 1.9 (1.5-2.6) mg/week. Weekly somapacitan significantly increased serum IGF-1 level (48 [29-122] to 125 [63-205] ng/mL, P = 0.001) and IGF-1 SD score (-3.3 [-5.3-0.9] to -0.7 [-3.0-0.8], P = 0.008) and significantly decreased serum CRP level (0.243 [0.056-0.464] to 0.093 [0.036-0.290] ng/mL, P = 0.008). However, it did not affect body weight (80.6±11.6 to 79.8±10.5 kg, P = 0.67) or serum creatinine (0.74±0.13 to 0.68±0.21 mg/dL, P = 0.35) and alanine aminotransferase (60 [20-99] to 48 [21-85] U/L, P = 0.23) levels. Changes in CRP levels were significantly correlated with changes in IGF-1 levels (rs = -0.83, P = 0.010) and IGF-1 SD scores (rs = -0.79, P = 0.021). Conclusion: GH supplementation therapy with weekly somapacitan reduced serum CRP levels in adult patients with GHD without affecting body composition or kidney and liver functions. Presentation: 6/3/2024

Practical application of machine learning in energy and thermal management: Long-term data analysis of solar-assisted AC systems in portable cabins in Kuwait and Australia

Machine learning techniques are advancing rapidly in theoretical grounds, but their practical application and real evaluation in engineering disciplines are limited. This study investigates one-year of experimental data for indoor air conditions and energy monitoring of two identical portable cabins in Kuwait. Additionally, a 9-month period of solar photovoltaic energy production is experimentally obtained for assessing energy saving aspects of a solar assisted air conditioning system in one of the cabins. A transient system simulation tool model is developed and validated for the portable cabins. Both one-year experimental data and the validated simulation data are used for developing machine learning models for six case studies in Kuwait and Australia. In simulations, there are issues related to lack of access to real-time weather data from a locally installed weather station. In experimental works, there were issues related to disruption of data collection due to power or internet shutdowns. To resolve these issues, nineteen regression models are investigated. It was found that all models performed very well although the Matern 5/2 and Exponential gaussian process regression model performed slightly better, with all models achieving high accuracy, as indicated by R-squared values close to 1.0 in all six case studies. Overall, it was found that the photovoltaic solar-assisted air conditioning system could save annually 26.2 % and 75.7 % energy in Kuwait and Rockhampton, Australia, respectively.

Tooth loss in young mice is associated with cognitive decline and femur-bone mineral density.

Osteoporosis is a prevalent disease that is associated with increased hip fractures which cause significant decline in quality of life. Tooth loss affects systemic condition such as cognitive function through various mechanism, but the link between tooth loss and femoral bone mineral density is still uncertain. This study aims to investigate whether tooth loss in young mice affects memory function and femoral bone mineral density. Eight-week-old male C57BL/6J mice were allocated randomly into the control group with sham operation and the tooth-loss group extracted all maxillary molar. Step-through passive avoidance test as cognitive function test, micro-CT analysis and western blotting analysis were performed after 1- and 2-month observation period. Step-through passive avoidance test revealed that the tooth-loss group in 2-month observation period impaired cognitive function. Additionally, micro-CT analysis revealed a significant decrease in both the length of the mandible and bone mineral density in the femur of the tooth-loss group compared to the control group. Claudin-5 level in the hippocampus, which is one of the tight junction markers in blood-brain-barrier, was significantly decreased in the tooth-loss group. The findings of our present study suggested that tooth loss impair cognitive function accompanied by reduced tight-junction marker, mandibular growth and bone mineral density of femur.

A reduced carbohydrate diet improves glycemic regulation in hyperglycemic older people in a retirement home: The SAGE study.

Poor glucose regulation associated with gradual insulin resistance is a significant risk factor in several age-related chronic diseases. An eating plan that promotes a lower carbohydrate intake may have a beneficial effect on glucose metabolism. This study aimed to evaluate how a diet reduced carbohydrate by 32% (RCHO) over a 2-month period would influence the metabolic profile of older individuals (N = 24) living in a retirement home (RH). A continuous glucose monitor was used to measure blood glucose during four periods: the standard diet before (baseline) and after (washout) the intervention, during the 4 initial days of the RCHO diet (RCHO-early), and the final days of the 2-month intervention (RCHO-end). The blood metabolic profile was also measured (glucose, ketones, insulin, triglycerides and cholesterol). RCHO intake decreased average blood glucose compared to the standard diet in hyperglycemic participants: RCHO-early 7.8 ± 1.0 vs 7.5 ± 1.1 mM (p = 0.012) and RCHO-end 7.8 ± 1.0 vs 7.0 ± 0.9 mM (p = 0.050). In the hyperglycemic participants, the percentage of time spent in hyperglycemia (> 10.0 mM) decreased by 50% during the RCHO-early (p = 0.012) and by 66% at RCHO-end (p = 0.021) compared to baseline. Glycated hemoglobin was significantly lower at RCHO-end in both hyperglycemic and normoglycemic participants compared to baseline (p < 0.008). Plasma ketones increased 3-fold in hyperglycemic participants at RCHO-end compared to baseline (p < 0.028). This study shows that an RCHO diet has metabolic health benefits in an older population and confirms its safety, tolerability, and acceptability in a RH. (NCT06022094).