Single-Cell Landscape and a Macrophage Subset Enhancing Brown Adipocyte Function in Diabetes (Diabetes Metab J 2024;48:885-900).

Erratum to the article: Aldosterone synthase deficiency due to homozygous CYP11B2 pathogenic variant with coexisting celiac disease: A case study and literature review. Pediatr Endocrinol Diabetes Metab 2025; 31 (3): 133-140. DOI: https://doi.org/10.5114/pedm.2025.155104.

Association of Uterine Leiomyoma with Type 2 Diabetes Mellitus in Young Women: A Population-Based Cohort Study (Diabetes Metab J 2024;48:1105-13).

Abstract Disclosure: J. Ocampo Mascaro: None. P. Wax: None. M. Al Mukaddam: Grant Recipient; Self; Ipsen, Incyte Research Funding. Background: Hypophosphatasia (HPP) is a genetic disease characterized by low activity of the tissue non-specific alkaline phosphatase. It has a broad range of clinical phenotypes, with adults usually presenting with an incidental low alkaline phosphatase (ALP) finding. Differentiating this from other causes of low ALP is challenging, especially when treating osteoporosis, as antiresorptive therapy such as denosumab and bisphosphonates may cause low ALP and carry the potential of increasing risk of atypical femoral fractures in patients with undiagnosed HPP. Clinical Case: A 64-year-old woman with history of nephrolithiasis, hypercalciuria, and osteoporosis (screening DXA lowest T-score -3.3 in femoral neck (FN)) but no prior fractures or dental issues was seen in clinic. Initial bloodwork showed normal range calcium, 25-OH vitamin D, and intact PTH. Pre-treatment ALP was 42 IU/L (N 39-117). Work up for secondary causes of osteoporosis was negative. Three yearly doses of IV zoledronic acid resulted in +4.2% BMD increase in lumbar spine (LS) but no changes in FN. She had no side effects but was found to have a decrease in ALP to 33 IU/L. This normalized back to 42 IU/L during a three-year drug holiday. Follow up DXA noted significant decline in BMD, hence denosumab was initiated. ALP decreased back to the 30-35 IU/L range. Fasting Vitamin B6 level (off B6 supplements for 1 week) was 23.4 ng/ml (N 2.1-21). Urine phosphoethanolamine was mildly elevated at 5 mmol/mol creatinine (N ≤4). Genetic testing evidenced a pathogenic ALPL variant (Exon 6, c.575T>C (p.Met192Thr), heterozygous) compatible with HPP. She had tolerated three doses of denosumab by then with BMD improvement of 5.0% in LS but no changes in FN and no atypical femoral fracture. Denosumab was stopped. Abaloparatide was started for osteoporosis with close monitoring for worsening hypercalciuria. Conclusion: This case demonstrates that adult HPP patients may present with subtle findings and lower range of normal ALP and may tolerate short courses of antiresorptive agents. There is a need for better screening and diagnostic criteria for adult HPP patients whose ALP levels may not be initially low before initiating antiresorptive drugs for osteoporosis. The risk of adverse effects from therapy will likely vary significantly based on the clinical severity/presentation of HPP as some adults with lower ALP ranges might be more susceptible to developing atypical femur fractures (1). Balancing atypical femur fracture risk with the benefits of antiresorptive treatment in decreasing risk of osteoporotic fractures highlights the need for better risk stratification to prevent undertreatment of osteoporosis. Reference: 1. Warren AM, Ebeling PR, Grill V, Seeman E, Sztal-Mazer S. Bilateral atypical femoral fractures during denosumab therapy in a patient with adult-onset hypophosphatasia. Endocrinol Diabetes Metab Case Rep. 2021 Sep 1;2021:21-0096. Presentation: 6/2/2024

Association of Measures of Glucose Metabolism with Colorectal Cancer Risk in Older Chinese: A 13-Year Follow-up of the Guangzhou Biobank Cohort Study-Cardiovascular Disease Substudy and Meta-Analysis (Diabetes Metab J 2024;48:134-45).

Abstract Disclosure: A. Aslamy: None. R. Nazemi: Speaker; Self; Eli Lilly & Company, AstraZeneca. C. Tseng: None. S. Kim: None. R. Gianchandani: None. Background: SGLT2 inhibitors are a unique class of anti-hyperglycemic medications that can increase the risk of DKA in patients with diabetes (1). The overall incidence of DKA precipitated by SGLT2 inhibitor use is estimated to be 0.1%, however, this is likely higher in practice with increasing usage of these medications for treatment of heart failure and renal dysfunction. Herein, we characterize inpatient admissions with SGLT2 inhibitor induced DKA to further understand associated risk factors. Clinical Case: Euglycemic and hyperglycemic DKA cases (n=7) over a four-month period were identified, all of whom had been on SGLT2 inhibitors for an average of 8.5 (± 5.4) months prior to presentation. Six patients had T2D and one patient had known T1D. The average patient age was 69 (±8) years. The average A1c was 9.2% (±1.9%). Patients on dapagliflozin (n=3) had significantly higher A1c on admission compared to those on empagliflozin (n=4) (p=0.017). Average glucose on presentation of the six T2D patients was 206.5 (± 55.61) mg/dL (euglycemic DKA range) while the T1D patient presented with glucose of 605 mg/dL. All seven patients had elevated anion gap (mean 25.5 ± 7.2mEq/L), low bicarbonate (mean 8.9 ± 4.1 mmol/L), pH less than 7.4, and evidence of either ketonemia or ketonuria. Five out of the seven cases had a concurrent infection, and the remaining two cases were readmissions after recent cardiac surgery. All patients were treated with intravenous/subcutaneous insulin and intravenous dextrose with resolution of DKA within 24 hours. SGLT2 inhibitors were immediately discontinued. Average length of stay was 9 (±6) days, and was higher in the postcardiac surgery patients. Notably, the type of SGLT2 inhibitor (dapagliflozin vs. empagliflozin), age, sex, A1c on presentation, number of comorbidities, presence of infection, prior insulin usage, duration of diabetes, and duration of SGLT2 use had no significant effect on length of stay. Conclusion: Clinical characteristics of SGLT2 inhibitor induced DKA cohort were older age, uncontrolled diabetes (A1c >7), and concurrent infections or recent major surgery. Resolution of DKA was quick and length of stay longer for major surgery. When placed on SGLT2 inhibitors, diabetes patients should be warned of these potential clinical scenarios that can increase their risk of DKA. Reference: (1) Blau JE, Tella SH, Taylor SI, Rother KI. Ketoacidosis associated with SGLT2 inhibitor treatment: Analysis of FAERS data. Diabetes Metab Res Rev. 2017 Nov; 33 Presentation: Thursday, June 15, 2023

Abstract Disclosure: A. Bazhenov: None. I. Alpertunga: None. Background When hyperprolactinemia is a well-known side effect of antipsychotic medications1, the link between prolonged treatment with dopamine antagonist and the development of lactotroph adenomas is still unclear4. Treating a patient with prolactinoma and psychotic disorder may pose a challenge. Antipsychotic agents can cause increases in prolactin levels. Additionally, treatment of prolactinoma with dopamine agonists may worsen psychotic symptoms. Case presentation We present a case of 56 yo male with a PMH of bipolar disorder with psychotic features who was found to have a macroprolactinoma after 18 years of treatment with antipsychotic medications. At age 30, the patient was diagnosed with Bipolar Disorder with psychotic features. The course of the disease was complicated by numerous hospitalizations and frequent changes to the treatment plan, with different combination of second-generation antipsychotic, haloperidol and antiseizure medications. The patient’s prolactin level was 50 ng/ml at the time. 18 years after the diagnosis, the patient developed severe headaches. An MRI revealed a pituitary macroadenoma measuring 1.3 cm, and a repeat prolactin level resulted in 729 ng/ml. He was started on cabergoline 0.5 mg twice a week. As a result, the prolactin level dropped to 32 ng/ml and the macroprolactinoma size decreased to 1.1 cm. Unfortunately, the patient was lost to follow up. Once he re-established his care, he was started on Olanzapine 15 mg daily, Lamotrigine 200 mg daily and cabergoline 0.5 mg twice a week. After reinitiating cabergoline, the patient developed three maniac episodes, two of which required hospitalization. The dose of the cabergoline was decreased to avoid future maniac episodes. Neurosurgery will be consulted for possible surgery treatment. Discussion The treatment of a patient with prolactinoma and a psychotic disorder poses a particular challenge. We believe that care of these patients requires a multidisciplinary approach, and surgical treatment should be considered for those who cannot tolerate dopamine-agonist therapy. Literature 1. Bostwick JR, et al. Antipsychotic-induced hyperprolactinemia. Pharmacotherapy. 2009;29(1):64-73. 2. Lertxundi U et al. Antipsychotics and pituitary tumors. Int Clin Psychopharmacol. 2019;34(2)89. 3. Andrade EH, et al. Insights in the management of antipsychotics. Case Rep Med. 2010;2010. 4. McCarren M,et al. Follow-up study of a pharmacovigilance signal. J Clin Psychopharmacol. 2012;32(6)743. 5. Bakker IC, et al. Successful treatment of a prolactinoma on antipsychotic drug. Endocrinol Diabetes Metab Case Rep. 2016. 6. The challenges in managing prolactinomas SFEBES2009 Accessed April 11 2023. https://endocrine-abstracts.org 7. Howes OD et al. The role of dopamine in schizophrenia. Biol Psychiatry. 2017;81(1)9. 8.Bamarinejad A, et al. Schizophrenia and Macroprolactinoma: Adv Biomed Res. 2020;9(1)38. Presentation: Saturday, June 17, 2023

SUDDEN LOSS OF VISION: A RARE PRESENTATION OF DIABETIC KETOACIDOSIS IN THE ICU

ATYPICAL PRESENTATION OF MUCORMYCOSIS IN A NONSEVERE COVID-19 PATIENT

39-Year-Old Woman With Severe Weakness

Journal of Prescribing PracticeVol. 4, No. 5 News AnalysisCauses and treatment of urge incontinence in womenAysha MendesAysha MendesE-mail Address: [email protected]Freelance journalist specialising in health, psychology and nursingSearch for more papers by this authorAysha MendesPublished Online:13 May 2022https://doi.org/10.12968/jprp.2022.4.5.186AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View article References Artusi CA, Romagnolo A, Ledda C et al. COVID-19 and Parkinson's disease: what do we know so far? J Parkinsons Dis. 2021;11(2):445–454. https://doi.org/10.3233/JPD-202463 Google ScholarAustralian Menopause Society. Stress and urge incontinence info sheet. 2013. https://www.menopause.org.au/images/stories/infosheets/docs/AMS_Stress_and_urge_incontinence.pdf (accessed 29 April 2022) Google ScholarBritish Medical Journal. Best Practice: Urinary incontinence in women. 2020. https://bestpractice.bmj.com/topics/en-gb/169 (accessed 29 April 2022) Google ScholarKołodynska G, Zalewski M, Rozek-Piechura K. Urinary incontinence in postmenopausal women – causes, symptoms, treatment. Prz Menopauzalny. 2019;18(1): 46–50 https://doi.org/10.5114/pm.2019.84157 Google ScholarNational Institute for Health and Care Excellence. Clinical Knowledge Summary: Incontinence, urinary, in women. 2019a. https://cks.nice.org.uk/incontinence-urinary-in-women#!scenario:1 (accessed 29 April 2022) Google ScholarNational Institute for Health and Care Excellence. Urinary incontinence and pelvic organ prolapse in women: management. NICE guideline [NG123]. 2019b. https://www.nice.org.uk/guidance/ng123 (accessed 29 April 2022) Google ScholarZhou Y, Chi J, Lv W, Wang Y. Obesity and diabetes as high-risk factors for severe coronavirus disease 2019 (Covid-19). Diabetes Metab Res Rev. 2021;37(2):e3377. https://doi.org/10.1002/dmrr.3377 Google Scholar FiguresReferencesRelatedDetails 2 May 2022Volume 4Issue 5ISSN (print): 2631-8385ISSN (online): 2631-8393 Metrics History Published online 13 May 2022 Published in print 2 May 2022 Information© MA Healthcare LimitedPDF download

DEVELOPMENT OF TELEMEDICINE APPLICATION BASED ON ARTIFICIAL INTELLIGENCE IN THE HANDLING OF DIABET FOOT

52-Year-Old Woman With Palpitations, Abdominal Distension, and Severe Abdominal Pain

Natural Competence for Transformation in Lactobacili

COVID-19-INDUCED NEW ONSET DIABETES MELLITUS

EUGLYCEMIC DIABETIC KETOACIDOSIS MASQUERADING AS TOXIC ALCOHOL INGESTION

Review of Strategies to Overcome Brain Insulin Resistance Through Mild Nutritional Ketosis for Alzheimer’s and Mild Cognitive Impairment

Introduction: Thyroid hormone resistance is a genetic mutation resulting in decreased receptor responsiveness. We present a case of thyroid hormone resistance with concurrent papillary thyroid cancer.Clinical Case: A 34-year-old man with a history of papillary thyroid carcinoma status post total thyroidectomy and radioactive iodine. He had transferred his care after moving to our area. He presented with persistently elevated TSH despite ongoing treatment with Levothyroxine 400 mcg daily. Upon presentation the patient reported intermittent palpitations and tremor. Vital signs revealed height of 74 inches, weight of 235 pounds, blood pressure of 112/64, and heart rate of 48. Physical examination revealed a well -healed scar on the neck without palpable lymphadenopathy. Bloodwork revealed TSH of 15.28 mIU/L and Free T4 of 2.8 ng/dL. The patient was maintained on Levothyroxine 400 mcg daily and educated on proper administration of the medication. Two months later, bloodwork revealed a TSH of 9.22 mIU/L with a Free T4 of 3.3 ng/dL. MRI of the pituitary revealed a 4mm hyper-intensity which likely represented a microadenoma. Resistance Thyroid Hormone (RTH) Mutation analysis was ordered which revealed a heterozygous mutation for the Thyroid Hormone Receptor (THR)-Beta gene. The mutation was detected at pArg438His indicating a single nucleotide substitution leading to the replacement of arginine by histidine at the p.438 of the translated protein on exon 10. The patient was maintained on Levothyroxine at 400 mcg daily.Discussion: Thyroid hormone resistance describes a constellation of symptoms from decreased tissue responsiveness to thyroid hormones. Literature reveals the prevalence of THR to be 1 in 40,000 individuals. It occurs due to mutation on the thyroid hormone receptor, most often found on the alpha or beta subunit. Frequently patients present with tachycardia and hyperactivity but it can also present with symptoms suggestive of hypothyroidism and goiter. Risk factors include family history of RTH mutation often with an autosomal dominant inheritance pattern. Patients with an elevated Free T4 with a non-suppressed TSH should be investigated with a genetic analysis of Resistance Thyroid hormone. A positive mutation would confirm the diagnosis. Close monitoring of symptoms as well as thyroid function tests should guide treatment. The concurrent diagnosis of thyroid hormone resistance in conjunction with papillary thyroid carcinoma in our patient is unique and makes management a challenge. The literature reveals few cases reported.Reference: DynaMed. (2018, November 30). Thyroid Hormone Resistance. Retrieved October 2, 2020, from https://www-dynamed-com.arktos.nyit.edu/topics/dmp~AN~T912485Igata M, et al. Coexistence of resistance to thyroid hormone and papillary thyroid carcinoma. Endocrinol Diabetes Metab Case Rep. 2016;2016:160003. doi:10.1530/EDM-16-0003

Введение. Состояние системы гемостаза при COVID-19 детально исследовано. Вместе с тем совершенно не изучено состояние гемодинамики и вариабельность сердечного ритма (ВСР) у больных COVID-19 в разгар заболевания и в процессе реабилитации. Цель исследования: изучить состояние микроциркуляции и ВСР у больных с тяжелым течением COVID-19 в процессе заболевания, после выписки из стационара и после прохождения курса реабилитации. Материалы и методы. Наши наблюдения проведены на 43 пациентах, получавших лечение в ГУЗ «ГКБ № 1» (Чита), перепрофилированной для терапии больных COVID-19, а также на курорте «Дарасун» (Забайкальский край), предназначенном для реабилитации больных, перенесших COVID-19. Контрольную группу составили 69 человек, сопоставимых по полу возрасту и сопутствующим заболеваниям. Состояние кровотока и ВСР изучали с помощью датчика mDLS (Dynamic Light Scattering, Rehovot, Israel) и использования оригинального алгоритмического подхода. При этом сигнал разлагался на частотные компоненты, связанные с гемодинамическими источниками различной скорости сдвига слоев крови (гемодинамические индексы), в значительной степени отражающих состояние системы гемостаза. Результаты. У больных COVID‑19 абсолютные значения гемодинамических индексов оказались значительно выше, чем в контроле, что свидетельствует об усилении микроциркуляторной динамики. Особенно резко возрастали значения HI1и HI2, что связано с усилением пристеночного (эндотелиального) и промежуточного кровотока. Об этом же свидетельствует увеличение у тяжелобольных почти в 4 раза соотношения HI1/HI3, которое не восстанавливалось после выздоровления, а также после реабилитации. Одновременно в разгар заболевания происходило значительно усиление пульсовых (PULSE 1 и 2) и резкое снижение респираторных (RESP1, 2 и 3) осцилляторных индексов, значения которых оставались стабильными как у выздоровевших пациентов, так и у прошедших курс реабилитации. Заключение. У больных COVID-19 в разгар заболевания отмечаются выраженные сдвиги со стороны микроциркуляции и ВСР, обусловленные повышением тонуса симпатического отдела автономной нервной системы, и сохраняющееся после выписки из стационара и прохождения курса реабилитации. Background. Hemostasis in COVID‑19 has been studied in detail. The state of hemodynamics and heart rate variability (HRV) in patients with COVID‑19 at the height of the disease and during rehabilitation has not been fully studied. Objectives: to study microcirculation and HRV in patients with severe COVID-19 during the course of the disease, after discharge from the hospital and after rehabilitation course. Patients/Methods. We examined 43 patients with COVID‑19 treated at City Clinical Hospital № 1 (Chita) and underwent rehabilitation at Darasun resort (Trans-Baikal Territory). The control group consisted of 69 people of same sex, age and concomitant diseases. Blood flow and HRV were studied using mDLS sensor (Dynamic Light Scattering, Rehovot, Israel) and an original algorithmic approach. The signal was decomposed into frequency components associated with hemodynamic sources of different shear rates of blood layers (hemodynamic indexes) that largely reflected hemostasis state. Results. In patients with COVID-19, the absolute values of hemodynamic indexes were significantly higher than in controls, it was the evidence of microcirculatory intensification. The HI1 and HI2 values increased especially sharply, that was associated with increased endothelial and intermediate blood flow. This was also evidenced by an almost 4‑fold increase in the HI1/HI3 ratio in seriously ill patients that does not restored after recovery, as well as after rehabilitation. At the same time, at the height of the disease, there was a significant increase of pulse (PULSE 1 and 2) and a sharp decrease of respiratory (RESP1, 2 and 3) oscillatory indexes, that remained stable both in recovered patients and in those who underwent a course of rehabilitation. Conclusions. In patients with COVID-19 at the height of the disease pronounced shifts in microcirculation and HRV are noted due to increased tonus of sympathetic nervous system that persisted after discharge and rehabilitation.

Gastrointestinal NursingVol. 19, No. Sup2 Guest EditorialMotivational huddles to support team wellbeing through COVID-19Vicky RinglandVicky Ringland(E-mail Address: [email protected])Endoscopy Lead Practitioner, University Hospitals of Derby and BurtonSearch for more papers by this authorVicky RinglandPublished Online:19 Mar 2021https://doi.org/10.12968/gasn.2021.19.Sup2.S3AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Action for Happiness. Action calendar. 2021. www.actionforhappiness.org/media/968363/february_2021.jpg (accessed 9 March 2021) Google ScholarBehan C. The benefits of meditation and mindfulness practices during times of crisis such as COVID-19. Ir J Psychol Med. 2020; 37(4):256–258. https://doi.org/10.1017/ipm.2020.38 Crossref, Google ScholarFredrickson BL. The role of positive emotions in positive psychology. Am Psychol. 2001; 56(3):218–226 Crossref, Google ScholarHarn A. Make sense of your moods and emotions for clarity, confidence and wellbeing. London: Welbeck; 2015 Google ScholarHills L. The art of the morning huddle: how to use this simple tool to build your team. J Med Pract Manage. 2016; 32(3):202–206 Google ScholarLevitt T. Daily calm 10 minute mindfulness meditation. 2016. www.youtube.com/watch?v=ZToicYcHIOU (accessed 9 March 2021) Google ScholarOshikanlu R. Maintaining motivation under pressure. Independent Nurse. 23 April 2015. www.independentnurse.co.uk/professional-article/maintaining-motivation-under-pressure/75955 (accessed 18 February 2021) Google ScholarSunny Present. Tools for a better life. 2015. www.sunnypresent.com (accessed 9 March 2021) Google ScholarVizheh M, Qorbani M, Arzaghi SM et al. The mental health of healthcare workers in the COVID-19 pandemic: A systematic review. J Diabetes Metab Disord. 2020; 19(2):1967–1978. https://doi.org/10.1007/s40200-020-00643-9 Crossref, Google ScholarWalton M, Murray E, Christian MD. Mental health care for medical staff and affiliated healthcare workers during the COVID-19 pandemic. Eur Heart J. 2020; 9(3):241–247. https://doi.org/10.1177/2048872620922795 Google Scholar FiguresReferencesRelatedDetails 1 March 2021Volume 19Issue Sup2ISSN (print): 1479-5248ISSN (online): 2052-2835 Metrics History Published online 19 March 2021 Published in print 1 March 2021 Information© MA Healthcare LimitedPDF download