Comprehensive Management Research Articles

Bridging early life trauma to difficult-to-treat depression: scoping review.

Accumulating evidence suggests that early life trauma (ELT) initiates and perpetuates a cycle of depression, leading to challenges in management and achieving remission. This scoping review aimed to examine the intricate relationship between ELT and difficult-to-treat depression (DTD). An extensive literature search from 1 January 2013 to 21 October 2023 was conducted using the Cochrane Library, PubMed, Scopus, PsycINFO and OpenGrey. Our review identified scientific literature illustrating the multifaceted link between ELT and DTD, highlighting the dual impact of ELT on therapeutic resistance and clinical complexity. This complexity hampers management of patients with DTD, who are characterised by limited pharmacological responsiveness and heightened relapse risk. While exploring the ELT-DTD nexus, the review revealed a paucity of literature on the impact of ELT within DTD. Findings underscore the profound link between ELT and DTD, which is essential for comprehensive understanding and effective management. Tailoring treatments to address ELT could enhance therapeutic outcomes for patients with DTD. Future studies should use larger samples and well-defined diagnostic criteria and explore varied therapeutic approaches.

Unraveling the complexities of ısolated cecal necrosis: a comprehensive presentation clinical symptoms, management strategies, and outcomes in a series of patients

Isolated cecal necrosis (ICN) represents a rare yet clinically significant variant of ischemic colitis, characterized by ischemic injury to the cecal region due to prolonged disruption of intestinal blood flow. While ICN can arise from various causes, including atherothrombotic occlusions in cecal arteries and non-occlusive factors such as shock or chronic diseases, its pathogenesis remains multifactorial. Clinical presentation often mirrors acute appendicitis, with patients typically presenting with sudden right lower quadrant abdominal pain. Prompt diagnosis and surgical intervention are paramount to mitigate the risk of cecal perforation and improve patient outcomes. However, preoperative diagnosis can be challenging due to non-specific radiological findings, necessitating urgent surgical resection of the affected intestine. Despite documented cases in the literature, knowledge regarding ICN remains limited, underscoring the importance of detailed case reporting to enhance disease understanding and refine diagnostic and therapeutic approaches. Here, we present a retrospective analysis of 7 ICN cases diagnosed in our hospital between 2019 and 2024, aiming to contribute insights into the clinical spectrum, management strategies, and outcomes associated with ICN. Our study revealed a diverse array of clinical presentations, radiological features, surgical interventions, and pathological findings among ICN patients. Hypertension and diabetes mellitus emerged as common comorbidities, with acute abdomen and abdominal pain being predominant symptoms. Radiologically, cecal wall thickening was frequently observed. Surgical management predominantly involved right hemicolectomy, with varying techniques employed. Pathological examination unveiled histological alterations indicative of ischemic necrosis, inflammation, and perforation. Our findings underscore the importance of considering ICN in the differential diagnosis of acute abdominal pain, particularly in elderly patients with predisposing risk factors. Further research efforts are warranted to elucidate its pathophysiological mechanisms and optimize therapeutic approaches.

The Effect of Menstrual Hygiene Management on Girl Child School Attendance at St Marys Girls Vocational School in Kamukuzi Division, Mbarara City

This study assessed the effects of menstrual hygiene management on school attendance among female adolescent students at St. Mary's Girls Vocational School in Kamukuzi Division, Mbarara City. The researchers employed systematic random sampling to select 45 respondents from Form One and Form Two, as these students were expected to have experienced their menstrual periods. The majority of the respondents were aged 13-14 years. While some girls used handkerchief cloths or hand towels as menstrual management materials, most of them used sanitary pads and disposed of them in the toilets. The researchers conducted a Pearson correlation coefficient analysis in SPSS to examine the relationship between menstrual hygiene management and school attendance. The analysis revealed a weak positive correlation coefficient of 0.210, indicating a weak relationship between menstrual hygiene management and school attendance. However, the p-value of 0.167 suggested that the results were not statistically significant. The study concluded that there is an impact of menstrual hygiene management on school absenteeism, as girls who experienced longer periods tended to miss more school days. However, the weak relationship and lack of statistical significance indicate that other factors may also contribute to school attendance among adolescent girls, and menstrual hygiene management alone may not be the sole determinant. This study provides valuable insights into the challenges faced by adolescent girls in managing menstruation and its potential impact on their school attendance. It highlights the need for comprehensive menstrual hygiene management education and support programs in schools to ensure that girls have access to appropriate materials and facilities. By addressing these challenges, schools can create a supportive environment that promotes regular attendance and educational opportunities for all female students, even during menstruation

Challenges in Managing Insulinomas and Hyperparathyroidism in MEN1: A Clinical Case Study

Pancreatic insulinoma is an uncommon neuroendocrine tumor with an incidence of approximately 1 per million people annually. While the majority of insulinomas are sporadic, a minority are associated with Multiple Endocrine Neoplasia type 1 (MEN1), a rare genetic disorder transmitted in an autosomal dominant pattern. MEN1 is characterized by the presence of hyperplastic or adenomatous parathyroid glands, pancreatic islet cell tumors, and pituitary tumors. The disorder can also involve lesions in the duodenum, adrenal glands, thymus, and bronchi. We report a case of MEN1 presenting with multiple insulinomas in a 37-year-old male, who exhibited symptoms of intermittent hypoglycemia over a decade. Diagnostic workup included biochemical assays , and imaging studies that revealed elevated insulin and C-peptide levels and hypervascular pancreatic lesions, , and pathological findings consistent with MEN1. Surgical intervention involved the enucleation of insulinomas and distal pancreatectomy, followed by removal of parathyroid adenomas. The postoperative evolution was marked by the resolution of hypoglycemic episodes and the persistence of primary hyperparathyroidism. This case underscores the complexity of diagnosing and managing insulinomas within the context of MEN1. It highlights the importance of a multidisciplinary approach to treatment and the need for ongoing surveillance to address both endocrine manifestations and psychological impacts. The findings advocate for comprehensive management strategies and support systems to improve patient outcomes and quality of life.

Holistic Information Security Management and Compliance Framework

The growing complexity of cybersecurity threats demands a robust framework that integrates various security domains, addressing the issue of disjointed security practices that fail to comply with evolving regulations. This paper introduces a novel information security management and compliance framework that integrates operational, technical, human, and physical security domains. The aim of this framework is to enable organizations to identify the requisite information security controls and legislative compliance needs effectively. Unlike traditional approaches, this framework systematically aligns with both current and emerging security legislation, including GDPR, NIS2 Directive, and the Artificial Intelligence Act, offering a unified approach to comprehensive security management. The experimental methodology involves evaluating the framework against five distinct risk scenarios to test its effectiveness and adaptability. Each scenario assesses the framework’s capability to manage and ensure compliance with specific security controls and regulations. The results demonstrate that the proposed framework not only meets compliance requirements across multiple security domains but also provides a scalable solution for adapting to new threats and regulations efficiently. These findings represent a significant step forward in holistic security management, indicating that organizations can enhance their security posture and legislative compliance simultaneously through this integrated framework.

An Evaluation of the Sediment Reduction Benefits of Soil and Water Conservation Measures under Extreme Rainfall Conditions in the Loess Plateau in China Based on a Distributed Soil Erosion Model

Since the 1970s, comprehensive control measures on soil erosion in the headwater region of the Loess Plateau have been carried out. Quantitative evaluation of the benefits of soil and water conservation measures during extreme rainstorms is of great significance for the comprehensive management of the catchments. In this study, a systematic modeling methodology for evaluating the effects of soil and water conservation measures on sediment reduction was developed based on a distributed soil erosion model (DSEM). Taking the Chabagou basin in the Loess Plateau as the study area, the tested DSEM was used to simulate soil erosion and sediment yield during an extreme rainstorm under two scenarios, the uncontrolled condition and the controlled condition with soil and water conservation measures implemented. The results showed that DSEM could successfully simulate soil and water losses and evaluate the effects of soil and water conservation measures during extreme storm events. The evaluated results showed that each soil and water conservation measure had the specific function of sediment reduction. And under rainstorm conditions, the effect of engineering measures on sediment reduction was greater than that of forest and grass measures.

7291 From Vaginal Bleeding to Genetic Complexity: McCune Albright Syndrome in a Toddler; Emphasizing Atypical Manifestations, Diagnostic Challenges, and Comprehensive Management

Abstract Disclosure: A.G. Martinez Sanchez: None. N. Fernandez: None. C.L. Bustamante Escobar: None. Background: McCune Albright Syndrome (MAS) is a rare genetic disorder characterized by a triad of peripheral precocious puberty, irregular café-au-lait spots, and bone fibrous dysplasia. It is often caused by post-zygotic somatic mutations in the GNAS1 gene. We present a case of a patient initially presenting with precocious puberty, whose diagnostic journey revealed MAS with atypical manifestations. Presentation: A 23-month-old girl was brought to the emergency department after her mother noticed vaginal bleeding during a diaper change; denied any trauma, fever, rash, or dysuria. Patient developed accelerated growth about six months earlier, followed by pubic hair three months prior and bilateral thelarche two weeks before presentation. The patient had no exposure to endocrine disruptors. The physical examination revealed a well-developed child, in the 92nd percentile for weight and 97th for height. Additionally, breast buds, fine hair on the labia, and minimal blood at the vaginal introitus, with no apparent signs of trauma. Initial laboratory findings showed prepubertal LH and FSH levels, elevated estradiol 120 pg/ml (prepubertal range <10) and advanced bone age (4.2 years). Normal levels of testosterone, 17-hydroxyprogesterone, and DHEA sulfate. Pelvic ultrasound demonstrated an enlarged uterus (5.6 x 1.8 x 2.4 cm) and a large cystic lesion (4.4 cm) on the right ovary. During a follow-up at the endocrinology department one week later, a meticulous examination identified an irregular café-au-lait spot measuring about 2cm over the occipital right side of her scalp. Further tests, including GnRH stimulation test, tumor markers (LDH, b-HCG, CEA, and Ca19-9), brain MRI and bone scan, yielded normal findings. Given the presentation consistent with Peripheral precocious puberty, Letrozole was initiated at 1.25 mg daily. Three months later, her growth velocity remained accelerated. However, there was a decrease in both breast tissue and uterus size (4.2 x 1.2 x 1.7 cm), and the ovarian cyst was resolved. Genetic testing in blood indicated no mutations. To conduct a thorough assessment, the insulin-like growth factor (IGF-1) level was measured and found to be 200 ng/mL (normal range 56-144 ng/mL). Unfortunately, obtaining prolactin levels was challenging due to difficult intravenous (IV) access. Conclusion: This case reveals the complexity of MAS in precocious puberty, emphasizing atypical features that add complexity to the diagnosis. Identifying an irregular café-au-lait spot served as a diagnostic indicator, revealing the diverse clinical presentations. The challenges of relying solely on genetic testing for diagnosis are evident due to the mosaic nature and tissue-specific distribution of the mutation, as highlighted by the absence of mutations in this patient. Long-term management requires ongoing monitoring and a multidisciplinary approach for optimal patient outcomes. Presentation: 6/1/2024

Comprehensive Ayurvedic Management of Cerebral Palsy: A Case Study of Integrated Treatment Approaches

Comprehensive Ayurvedic Management of Cerebral Palsy: A Case Study of Integrated Treatment Approaches

Unveiling trends in late diagnosis among 22,504 people living with HIV in Hunan, China.

This study examined the prevalence of HIV late diagnosis (LD) and identified associated factors with LD among people living with HIV (PLWH). We extracted sociodemographic, epidemiological, and immunological information between 2018 and 2021 in Hunan, China from the HIV/AIDS Comprehensive Response Information Management System of China. The chi-squared test and multivariable logistic regression model were used to identify the factors associated with LD. Among 22,504 PLWH, 14,988 (66.6%) were diagnosed late. PLWH aged 50 and older had a higher proportion of LD (71.2%) than the younger group (60.0%). Older age, being male, Han ethnicity, being registered in Western Hunan, being transferred from health facilities, and being infected through heterosexual intercourse were associated with LD. Among PLWH younger than 50 years, apart from the factors mentioned above, individuals who had primary school or lower education, were non-student, and were divorced or widowed were more likely to be diagnosed late. Unlike younger PLWH, these factors were not associated with LD in the older group. But regional disparities in LD were more significant among them. LD in PLWH remains a severe issue, especially among older people. The study findings provided valuable insights into designing programs targeting groups at higher risk of LD to reduce its prevalence.

Infodemic Management in Senegal: Processes, Results and Community Contribution

This article examines Senegal's response to the Coronavirus Disease 2019 (Covid-19) pandemic, with a particular focus on the management of infodemic, or the proliferation of rumours and misinformation. The advent of social media has precipitated a surge in the proliferation of rumours, rendering it a significant challenge for effective management. In response, the Risk Communication and Community Engagement Commission (RCCE) devised a comprehensive rumour management guide and conducted training for key informants from the community. The primary outcomes demonstrate an enhancement in rumour management and the accessibility of the rumour register. These outcomes were attained through robust community involvement in all processes and elevated mobile connectivity. Integrating the infodemic management mechanism into the national health and social information system remains a significant challenge, as does mobilizing resources for nationwide implementation. The principal insight gained is that effective infodemic management necessitates community involvement and coordinated multi-sectoral efforts.. (Abstract)

8637 Pituicytoma mimicking Craniopharyngioma

Abstract Disclosure: O. Araoye: None. T. Delibasi: None. A. Chaugule: None. S.K. Dhillon: None. C. Fuller: None. Pituicytoma, a rare low-grade glial tumor originating from the neurohypophysis or infundibulum of the pituitary gland, poses diagnostic challenges due to its propensity to mimic other sellar or suprasellar lesions. We present a case of a 51-year-old male with a history of a suprasellar mass initially suggested to be a craniopharyngioma, incidentally discovered. Opting for elective surgery, the patient underwent transsphenoidal resection, revealing a highly vascular tumor adherent to the optic chiasm and pituitary stalk. While the tumor was successfully removed, sacrifice of the pituitary stalk led to postoperative complications, including cerebrospinal fluid (CSF) leak and central diabetes insipidus (DI).Histopathological examination characterized the tumor as oncocytic pituicytoma/spindle cell oncocytoma, a subtype of pituicytoma. The anti-mitochondrial antibody staining at an external laboratory displayed diffuse granular cytoplasmic staining supporting oncocystic pituicytoma/spindle cell oncocytoma.Postoperatively, the patient developed central DI treated initially with desmopressin (DDAVP), complicated by subsequent hyponatremia necessitating salt tablets and fluid restriction. Additionally, central adrenal insufficiency was managed with hydrocortisone, and central hypothyroidism with levothyroxine. A history of testosterone deficiency was addressed through testosterone injections every 10 weeks.Pituicytoma's diagnostic complexity arises from nonspecific radiological features, requiring reliance on histology and immunohistochemistry for definitive diagnosis. The expression of TTF1 emerges as a characteristic marker. Surgical resection, the primary treatment modality, proves curative in most cases, albeit with associated morbidity including CSF leak, DI, and panhypopituitarism. The role of adjuvant radiotherapy remains uncertain, potentially considered in cases of incomplete resection or recurrence.This case emphasizes three key aspects: first, the potential misdiagnosis of a lobulated suprasellar mass as craniopharyngioma when it could be pituicytoma; second, the development of postoperative DI due to pituitary stalk involvement; and third, the importance of considering pituicytoma in the differential diagnosis of sellar and suprasellar masses.In conclusion, pituicytoma, though rare, demands a nuanced diagnostic approach and comprehensive postoperative management to address potential complications and optimize patient outcomes. Presentation: 6/2/2024

12338 Risk Of Retinopathy In Patients With Type 2 Diabetes On Semaglutide

Abstract Disclosure: A. Gupta: None. M. Nassar: None. H. Ghanim: None. Title: Risk of Retinopathy in Patients with Type 2 Diabetes on SemaglutideBackground: The use of semaglutide in patients with diabetic retinopathy (DR) has raised safety concerns. While previous studies, including a meta-analysis and the SUSTAIN trial, suggested an association between rapid HbA1c reduction and retinopathy progression, recent data question the increased risk with semaglutide. Our study investigates this risk of intensive therapy benefits for the prevention of DR. Methods: This retrospective cohort study utilized TriNetX electronic health records, analyzing 117,693,426 patients with type 2 diabetes mellitus (T2DM) on anti-hyperglycemic drugs. We divided patients into those with and without a history of retinopathy, further subdividing them by treatment (Semaglutide, Sitagliptin, and Empagliflozin). After matching for confounders, we analyzed the incidence and progression of retinopathy among 336,338 Semaglutide, 578,117 Sitagliptin, and 434,552 Empagliflozin patients without a history of DR, as well as a cohort with history. Results: In patients without a prior history of DR, semaglutide showed a significant reduction in DR incidence over three years compared to sitagliptin and empagliflozin (p<0.0001). However, in those with a history, the reduction was not statistically significant (p > 0.05). Patients with mild DR on Semaglutide experienced fewer progressions to severe stages (p<0.0001), while outcomes in severe cases were inconclusive.Discussion: Semaglutide may lower the risk of developing DR in patients with T2DM without a prior history of DR and potentially stabilize or improve mild conditions without worsening severe retinopathy. The observed effects could influence treatment choices, emphasizing the need for individualized patient management. Conclusion: Semaglutide appears safe regarding retinopathy risk in patients with T2DM, offering protective benefits in those without history and not exacerbating conditions in those with prior DR. This underscores the drug's potential for comprehensive diabetes management without compromising ocular health. Presentation: 6/3/2024

9379 From Diagnosis To Treatment: A Comprehensive Approach To Pregnancy-Related Osteoporosis With Teriparatide

Abstract Disclosure: C. Hubers: None. M. Renzu: None. V. Mehta: None. A. Manzoor Qazi: None. A.M. Satei: None. D.K. Yerasuri: None. Introduction: Pregnancy and lactation related osteoporosis (PLO) is a rare but serious condition with significant consequences for maternal and fetal health. Teriparatide's efficacy in treating this condition is promising, particularly given concerns about bisphosphonate use in this population. Clinical Case: A 26-year-old white female sought evaluation for concerns arising after her first pregnancy. Following delivery via Cesarean section, she experienced acute back pain, instability while walking and frequent falls. A subsequent bone scan showed superior end plate fractures of T9, T11, T12, and L1, while an MRI of the lumbosacral spine showed mild acute to subacute compression deformities involving the superior endplates of the L2-L5 vertebral bodies. Despite having Factor V Leiden disease, her medical history is unremarkable for significant chronic conditions or comorbidities affecting bone health. Bone density scans revealed a Z-score of -2.4 in the lumbar spine and -1.6 in the total hip, with a femoral neck Z-score of -1.3. Her lumbar spine T-score was reported as -2.8, reflecting significant bone mineral density (BMD) loss with a BMI of 20.67. She underwent thorough testing to rule out other potential contributory conditions, such as celiac disease and hemochromatosis, but was eventually diagnosed with PLO. Treatment was initiated with teriparatide, administered as a daily 20 µg subcutaneous injection. The patient demonstrated an excellent response, with marked improvements in pain and enhanced ability to perform daily activities. After treatment with teriparatide, the patient’s c-telopeptide also improved. Discussion: PLO is a very rare manifestation of osteoporosis, mainly affecting women with lower BMI and advanced age. The etiology involves hormonal changes, increased calcium demands during pregnancy and lactation, and decreased BMD. Our patient's history and clinical course highlight a compelling instance of PLO, likely attributed to decreased estrogen exposure secondary to amenorrhea and breastfeeding, resulting in increased bone turnover. While bisphosphonates are often recommended for PLO, concerns about safety in pregnant and lactating women underscore the need for alternative treatments like teriparatide. Potential effects on gestational age, neonatal birth weight, and neonatal calcium levels have been observed in newborns with maternal exposure to bisphosphonates. Teriparatide is a synthetic form of parathyroid hormone that works primarily by stimulating osteoblast activity, leading to increased bone formation and BMD. It also enhances calcium and phosphate absorption in the kidneys and intestines, further contributing to its bone-building effects. Our patient's response to teriparatide emphasizes its potential as a safer option in managing PLO, warranting further research to establish comprehensive management guidelines. Presentation: 6/3/2024

Optic Nerve Head in Case of Increased Intraocular Pressure, High Intracranial Pressure and Increased Intracranial Pressure with Simultaneous Intraocular Pressure

The optic nerve, as part of the central nervous system, is surrounded by meninges and cerebrospinal fluid (CSF). This review discusses the effects of increased intraocular pressure (IOP), elevated intracranial pressure (ICP), and the simultaneous rise in both pressures on the optic nerve head (ONH). Increased IOP, caused by the balance of aqueous humor production and drainage, can lead to glaucomatous optic neuropathy, particularly through mechanical and ischemic damage to the lamina cribrosa. Elevated ICP, characterized by increased CSF pressure, can result in optic nerve edema, impairing axonal transport and blood flow. The complex interactions between IOP and ICP are critical for understanding their combined impact on ONH deformation and glaucomatous damage. It is essential to consider both pressures in clinical evaluations and treatment strategies for optic nerve-related diseases. Recent studies suggest that both IOP and ICP influence the optic nerve head morphology and pathology, highlighting the importance of comprehensive management approaches. Further research is needed to elucidate the intricate dynamics of IOP and ICP in the pathogenesis of optic nerve diseases.

8034 Putting the Pieces Together: Carney Complex, A Hyper-Rare Congenital Neoplastic Syndrome

Abstract Disclosure: G. Fontanazza: None. A.R. Conforti: None. K. Bird: None. M. Caplan: None. Intro: Carney complex (CNC) is an autosomal dominant disorder characterized by multisystem neoplasia that primarily affects the thyroid, pituitary, and adrenal glands. Its prevalence is not well established, as only 750 cases have been reported worldwide. This condition arises when an inactivating PRKAR1A gene mutation results in dysregulated cell proliferation and tumorigenesis. Complications include the potential for malignant transformation and systemic manifestations, necessitating comprehensive management and ongoing surveillance of disease progression. Case: The patient is a 58-year-old woman who initially presented as a teenager with complaints of hirsutism, truncal obesity, and violaceous abdominal striae. Initial workup revealed a low-dose dexamethasone suppression test that resulted in a non-suppressed cortisol levels. She also had undetectable adrenocorticotropic hormone (ACTH) levels. Imaging revealed no pituitary masses and demonstrated slight bilateral adrenal enlargement without adenomas. Despite these results, she was empirically treated for presumed pituitary-dependent Cushing's disease and received external beam radiation. Despite treatment, she continued to have episodes of hypercortisolism that were apparent clinically and biochemically. Over time, she developed a cardiac myxoma with six cerebrovascular accidents and multiple benign tumors. As an adult, she underwent extensive endocrine evaluation, which revealed urine cortisol excretion that paradoxically rose in response to dexamethasone. ACTH levels were always undetectable, even when she was significantly hypercortisolemic. Genetic testing revealed a homozygous mutation in the melanocortin-2 receptor (MC2R). Accordingly, she elected to have a bilateral adrenalectomy and was started on hydrocortisone and fludrocortisone. Discussion: The patient exhibited ACTH-independent micronodular adrenal hyperplasia and its most frequent variant, primary pigmented nodular adrenocortical disease. Bilateral pigmented nodular hyperplasia is a finding which can occur in association with CNC and cause episodic hypercortisolism. These patients have been shown to respond to dexamethasone with a paradoxical increase in glucocorticoid excretion. While management requires ongoing surveillance, this patient had not been diagnosed until later in life and did not have regular screening. When speculating on the late detection, her story reflects the parable of the blind men and the elephant: endocrinology managed Cushing's disease, cardiology managed atrial myxoma, and oncology managed osteochondromyxomas. Limited perspective with specialized management and an inability to see the whole picture led to prolonged diagnosis with unfortunate sequelae. This report encourages physicians to develop perspective awareness and to consider the entire picture when treating patients. Presentation: 6/2/2024

12394 "Sugar And Tumors: A Case Report On New-onset Diabetes In Metastatic Pheochromocytoma With Elevated Dopamine Levels"

Abstract Disclosure: B. Agrawal: None. V. mehta: None. R. naseem: None. M. Renzu: None. R. rashid: None. Introduction: Metastatic pheochromocytoma is a rare neuroendocrine tumor with potential complication of new-onset diabetes mellitus (DM). We present a case highlighting the challenges in managing a patient with metastatic pheochromocytoma and concurrent DM. Case presentation: A 66-year-old male with a history of hypertension and gout initially presented in 2010 with an adrenal mass, later identified as pheochromocytoma and resected. In 2018, he presented with bilateral leg pain, revealing metastatic disease-causing spinal cord compression along with metastatic lung nodules and metastasis in adrenalectomy bed. Despite interventions including T6,7,8 laminectomy in 2020 and radiation therapy, metastases persisted. In 2024, he presented with polyuria, polydipsia, and hyperglycemia (blood glucose >500 mg/dL). Laboratory findings showed elevated a1c of 15 in addition to elevated normetanephrines, metanephrines, and dopamine with levels of 3880, 48 and 488 respectively. He was diagnosed with new-onset DM and started on insulin therapy in addition to metformin and jardiance. Discussion: Secondary diabetes mellitus (DM) in secretory pheochromocytoma occurs in approximately 50% of cases, manifesting from mild insulin resistance to severe presentation like DKA. Epinephrine-secreting tumors contribute to glucose intolerance by activating beta receptors, thereby stimulating gluconeogenesis. Patients with higher levels of epinephrine and preoperative glucose intolerance were more prone to developing postoperative hypoglycemia, requiring close monitoring during the postoperative period. Additionally, research by DiSalvo et al. Epinephrine-secreting tumors have a more significant impact on hyperglycemia by impairing insulin secretion and stimulation GLP-1. Tumor resection has been found to be more effective effective in restoring normal glucose homeostasis in these patients. Dopamine-secreting pheochromocytomas are rare neoplasms characterized by the presence of immature catecholamine vesicles that inhibit dopamine conversio owing to localized dopamine beta hydroxylase. Typically presenting around the age of 48, these tumors often lack excess catecholamines, leading to atypical symptoms such as local discomfort or pain from tumor compression. These neoplasms are less detectable on metaiodobenzylguanidine (MIBG) scans, necessitating positron emission tomography (PET) for accurate diagnosis. Surgical resection is the treatment, with preoperative management involving metyrosine instead of alpha blockers. These tumors are frequently diagnosed late, often in a malignant stage, contributing to poor prognosis Conclusion: Overall, understanding the complex interplay between catecholamines and glucose metabolism is crucial for the comprehensive management of patients with pheochromocytoma and secondary DM. Presentation: 6/1/2024

Comprehensive management of degloving soft tissue injuries of the extremity: A 12-year retrospective study

BackgroundDegloving soft tissue injuries (DSTIs) of the extremities, which are often underestimated in terms of their severity, present significant challenges to reconstructive surgeons. We propose a comprehensive management protocol to standardize the reconstructive approach, aiming for successful treatment of these devastating injuries. MethodsWe retrospectively analyzed data from consecutive patients with extremity DSTIs over a 12-year period. Patients were categorized into three age groups (0–17, 18–65, and >65 years) to highlight the different treatment options based on age. Various surgical techniques were employed depending on the injury pattern. Treatment strategies for each patient were individualized based on age, underlying conditions, and injury type. Wound healing, complications, and functional outcomes were recorded. ResultsOf the hospitalized patients, 20 were lost to follow-up, and 105 were included in the analysis. The mean age at the time of injury was 40 ± 44.9 years, with a mean follow-up of 30.1 ± 12.7 months. Furthermore, 19 % of patients were aged 0–17 years, 61 % were aged 18–65 years, and 20 % were aged >65 years. Treatment plans were personalized based on injury characteristics, with numerous patients being treated with a combination of multiple surgical techniques. Older patients had significantly longer wound healing times and delayed return to activities of daily living compared to the other age groups. Overall, patients were generally satisfied with their outcomes. The total complication rate was 46.7 %, with 79.5 % being categorized as major complications. Each complication was addressed with a tailored treatment plan. ConclusionThe management of DSTIs should be individualized, taking into account the specific characteristics of each injury. Age and medical fitness play crucial roles in determining both the surgical approach and prognosis. An accurate initial evaluation and thorough debridement are essential for optimal outcomes.

Seasonal variability of microplastic contamination in marine fishes of the state of Gujarat, India.

Seasonal variation in microplastics abundance, occurrence, and distribution in pelagic and demersal fishes was observed in this study during December 2021 to November 2022. One hundred percent presence of microplastic in inedible (gut and gills) tissue, while 82% and 54% in edible tissue (muscle) of pelagic and demersal fishes respectively were seen. Post-monsoon period showed high prevalence of microplastics followed by monsoon and the least during pre-monsoon in both pelagic and demersal fishes. In pelagic fishes, the edible tissue had microplastics abundance of 1.56 to 13.34 numbers per 10g of tissue whereas inedible tissue had 3.36 to 16.67 numbers per 10g of tissue. In demersal fishes, the edible tissue had microplastics abundance of 1.04 to 5.26 numbers per 10g of tissue while it was 2.67 to 8.34 numbers per 10g of inedible tissue. There was significant variation in abundance of microplastic in edible and inedible tissue of all the fishes (Mann-Whitney test, p < 0.05). The most dominant microplastics size was 0.005-0.05mm followed by 0.05-0.5mm and the least of greater than 0.5mm in pelagic and demersal fishes respectively. Taking microplastic shape into consideration, the most dominant was fiber followed by fragment and the film in inedible tissue of all the fishes. The edible tissue of all the fishes had only fiber in them (100% occurrence). The dominance of blue color microplastics was observed followed by red, green, yellow, and orange at least in edible as well as inedible tissues of the fishes. More than 99% microplastics polymer observed in this study include polyethylene (PE), polypropylene (PP), and polystyrene (PS); only less than 1% was unidentified. This is the first study done on seasonal variation of microplastic in the marine fish population of Gujarat waters, Northeast Arabian Sea. The study highlights the nature of micro-pollutant in marine environments, emphasizing the need for comprehensive monitoring and management strategies.

Comprehensive management of gestational diabetes mellitus: practical efficacy of exercise therapy and sustained intervention strategies.

Gestational Diabetes Mellitus (GDM) affects 14.0% of pregnancies globally, with a 35% post-pregnancy relapse and a 60% risk of Type 2 Diabetes (T2D) within 5-10 years. Challenges in long-term management, especially postpartum, include adherence and follow-up difficulties. This study, based on a systematic review and meta-analysis, examined the practical effects of exercise therapy in the prevention, treatment, and prevention of progression from Gestational Diabetes Mellitus (GDM) to Type 2 Diabetes (T2D). Relevant research and clinical practices were retrieved from six major databases (PubMed, Scopus, Web of Science, Cochrane Library, MEDLINE, Science Direct). After analyzing the intervention effects of exercise therapy at different stages, factors favorably influencing the effectiveness of exercise intervention were identified during the more effective stages. Finally, a long-term and efficient exercise implementation plan for the comprehensive management of GDM was proposed. In GDM prevention, exercise reduced the post-intervention risk by 37% compared to the control group (Relative Risk (RR)=0.63; 95% Confidence Interval (CI): 0.54 to 0.72; p=0.01). Studies on GDM treatment showed improved glucose control in the exercise group post-intervention (Mean Difference (MD)=-0.10; 95% CI: -0.16 to -0.04; p=0.04/MD=-0.27; 95% CI: -0.36 to -0.19; p<0.0001). However, exercise therapy didn't significantly affect the incidence of T2D post-GDM (RR=0.88; 95% CI: 0.69 to 1.11; p=0.39) due to challenges in quantified exercise prescriptions and the complexity of postpartum programs. To enhance exercise therapy effectiveness in GDM management, the study recommends adopting an integrated model emphasizing personalized pregnancy plans, postpartum strategies, and long-term support. Leveraging frequent healthcare contact during pregnancy can establish and sustain exercise habits, fostering a lifelong pattern. While the study acknowledges limitations, this approach holds potential for improving glycemic metabolism and developing healthy exercise habits in subsequent generations. Future research should include longer follow-ups to validate the practical efficacy of this approach in preventing T2D after GDM. https://www.crd.york.ac.uk/prospero, identifier CRD42023463617.

A-330 Implementation of a Point of Care Emergency Preparedness policy: Are you ready for a disaster?

Abstract Background CAP Gen.73800 requires laboratories to have an Emergency Preparedness and Response policy. Hospital standards for Joint Commission Accreditation, EM.09.01.01, EM.12.02.09, and EM.16.01.01 require hospitals to have a comprehensive emergency management program including an ability to manage resources and assets during an emergency and conduct exercises to evaluate its plan. According to a survey of 27 POCT departments, only 35% have a POCT policy separate from the main lab and 50% of POCT programs are involved with emergency preparedness drills. With the continuing growth of POC testing, the University of Pittsburgh Medical Center (UPMC) POCT team recognized a need for a collaborative effort between main laboratories, the emergency management team, and POCT to develop a POCT emergency preparedness policy. Methods UPMC POCT team collaborated with emergency management to decide what details regarding POC tests and devices would be needed if the main laboratory was rendered not functional. Additionally, a hazard vulnerability review identified potential internal and external events that could impact patient care. POC coordinators from across the system supplied feedback as to what situations within POC could impact patient safety. Results An evaluation of hazards considered debilitating to the main laboratory included external events, such as weather emergencies or evacuation of the hospital due to safety concerns. Potential internal events including a loss of water or impeded functionality of an instrument platform were identified. Available POC tests may offer solutions to deficits in main lab testing. The POCT program is not immune to potential emergency situations. Connectivity/IT issues can require extensive troubleshooting. Supply chain disruptions that affect the availability of consumables may lead to a reverse scenario where emergency management may assist. On-line training modules are a consideration when labor strikes or staffing shortages require POCT programs to quickly onboard replacement workers as new operators. During pandemics, Coordinators may need to rapidly implement new testing. The UPMC Emergency Preparedness policy was developed as a guide to the POCT team to ensure the continuation of testing ability in these emergent situations and addresses the need for communication with Incident Command. The UPMC POCT Emergency Preparedness policy is linked to a Microsoft Form that can be quickly completed by POC coordinators throughout the system. Responses to the form can be exported to an Excel spreadsheet and will supply emergency management with POC device-specific information, listing devices as battery operated, wireless capable, tabletop or hand-held and provides test menus. This spreadsheet allows coordinators to decide the number of devices and consumables that could be pooled from all facilities within the system. Conclusions Ninety-three percent of survey respondents acknowledged that they could potentially benefit from a POCT emergency preparedness policy. Increasing the number of POCT programs involved in emergency preparedness drills would improve response to emergency management challenges. The UPMC POCT Emergency Management Policy guides POC coordinators through situations, allowing them to pool resources to allow for the continuity of testing necessary for quality patient care.