Endocrine Problems Research Articles

Relationship between Osteoarthritis and Endocrine Disease in KSA: A Cross-Sectional Study

Background: Osteoarthritis (OA), the most common kind of arthritis, affects millions of people throughout the world. This problem occurs when the protective cartilage that cushions the ends of the bones wears away over time. The goal of this study was to draw attention to the link between osteoarthritis and a number of endocrine illnesses in the Saudi population.
 Methods: This was a cross-sectional research with the goal of shedding light on the link between osteoarthritis and endocrine problems. The research was conducted in Saudi Arabia at colleges, hospitals, and shopping centers. During the months of June to November 2021, data was collected from patients and the general public.
 Results: The study included 743 participants. Among them, there were, 519 females (69.9%) and 224 males (30.1%). The most prevalent age group was 20-30 years (n= 354, 47.6%). Majority of study participants were Saudi (n= 713, 96%) and the rest were non-Saudi. The mean body mass index (BMI) among study participants was 29.47 + 7.53 with median BMI of 30 kg/m2. It was found that 85 participants took anti-inflammatory drugs for more than twice per week during the last three months (11.4%). It is noticed that the prevalence of autoimmune disease among study participants is low. However, female participants were higher in hypothyroid (P= 0.001).
 Conclusion: Finally, it appears that weight, rather than IR, explains the relationship between endocrine disease and knee OA. Individuals with arthritic knee pain may benefit from endocrine disease therapy since the accumulation of endocrine disease components is connected to a higher degree of knee discomfort, independent of age, sex, or weight.

AACE2021-A-1082: Primary Hyperparathyroidism: A Case Report of Management with Extra Ordinary Low Dose of Cinacalcet in an Elderly Male

Primary Hyperparathyroidism is a common cause of Hypercalcemia and is often seen in endocrine clinics. Majority of patients are found to have solitary parathyroid adenomas which may be associated with other endocrine problems. Common systemic complications are secondary osteoporosis, renal stones, pancreatitis and peptic ulcers. Surgery remains the mainstay of treatment for correction of pathology, however patients who do not meet the criteria or in whom surgery is contraindicated are managed conservatively and with calcimimetic agents such as cinacalcet. Case report and literature review. We are reporting a case of a 73 years old male who was referred to the endocrine clinic for work up of hypercalcemia. His past medical history was significant for well controlled Type 2 Diabetes and Hypertension. During his work up, he was found to have elevated serum calcium of 11.7 mg/dl, elevated serum PTH of 767 ng/L and 24 hours urinary calcium excretion of 446 mg/dl. Renal functions and 25 hydroxy vitamin D levels were within normal limits and the ultrasound and DEXA scan were negative for presence of any renal stone or osteoporosis. His two elder brothers also had a history of parathyroidectomy. He was reluctant for surgery and therefore imaging for the neck was also omitted. He was started on cinacalcet 15 mg/ day with an initial presumption of increase in dose requirement afterwards. However his serum calcium levels showed a remarked improvement and within one month they dropped to 9.9 mg/dl. The second subsequent test showed a serum calcium of 8.9 mg/dl after which the dose was reduced to 15 mg every alternate day. A presumption of tumor necrosis was made but the calcium levels rose higher on stopping cinacalcet and again went back to normal on the extra ordinary low dose of 15 mg every alternate day. His 3 years follow up to our clinic on this maintenance dose has shown steady calcium levels, improvements in serum PTH with fluctuations between 260 – 380 ng/L and no subsequent complication. Primary Hyperparathyrodism is a common cause of hypercalcemia which if left untreated can have serious systemic complications. Surgery remains the mainstay of treatment but in patients not meeting the criteria or in whom surgery is contraindicated, medical therapy is an option which includes dietary measures, bisphosphonates and calcimimetics like cinacalcet. The usual dose of cinacalcet is between 30 – 90 mg/day. Our case represents an unusual story of improvement on a very low dose of calcimimetic. More cases need to be evaluated and tested on low dose and may-be we can have a change in the recommendations in future.

What Every Internist-Endocrinologist Should Know about Rare Genetic Syndromes in Order to Prevent Needless Diagnostics, Missed Diagnoses and Medical Complications: Five Years of ‘Internal Medicine for Rare Genetic Syndromes’

Patients with complex rare genetic syndromes (CRGS) have combined medical problems affecting multiple organ systems. Pediatric multidisciplinary (MD) care has improved life expectancy, however, transfer to internal medicine is hindered by the lack of adequate MD care for adults. We have launched an MD outpatient clinic providing syndrome-specific care for adults with CRGS, which, to our knowledge, is the first one worldwide in the field of internal medicine. Between 2015 and 2020, we have treated 720 adults with over 60 syndromes. Eighty-nine percent of the syndromes were associated with endocrine problems. We describe case series of missed diagnoses and patients who had undergone extensive diagnostic testing for symptoms that could actually be explained by their syndrome. Based on our experiences and review of the literature, we provide an algorithm for the clinical approach of health problems in CRGS adults. We conclude that missed diagnoses and needless invasive tests seem common in CRGS adults. Due to the increased life expectancy, an increasing number of patients with CRGS will transfer to adult endocrinology. Internist-endocrinologists (in training) should be aware of their special needs and medical pitfalls of CRGS will help prevent the burden of unnecessary diagnostics and under- and overtreatment.

Prevalence and Maternal Effects of Hypothyroidism in Pregnancy

Background: Thyroid disorders are among the common endocrine problems in pregnant women. It is now well established that not only overt but subclinical thyroid dysfunction also has adverse effects on maternal and fetal outcome. There are few data from Bangladesh about the prevalence of thyroid dysfunction in pregnancy. With this background, this study aims to find prevalence of thyroid dysfunction in pregnancy and its impact on obstetrical outcome.
 Materials and methods: It is an observational study done in a Combined Military Hospital (CMH) Chattogram during the period from February to December 2020 on 130 hypothyroid mothers to observe maternal effects of hypothyroidism. Patients were collected as per inclusion and exclusion criteria after informed written consent. Data was compiled and analyzed and presented.
 Results: Among 1148 total patients,1018(89%) were normal and 130(11%) were diagnosed as hypothyroid.Among all the patients, 35% patientsare from inside the Chattogram and 65% are from outside. Among 130 hypothyroid cases age range revealed 20-45 years and 20 -30 years age group were 82(63.07%), 30-40 years age group was 40(30.76%) and >40 years age group were 8(6.15%). Primigravida was 48(36.92%) cases and multigravida was 82(63.08%) cases, anemia was present in 40(30.76%) cases, 10(7.69%) patients had hypertension, GDM and DM was found in 20(15.38%)and 3(2.30%) cases respectively, preconception hypothyroidism was found in 10(7.69%) and on Levothyroxine during ANC was 120(92.30%).Among all, 63(48.46%) cases were underwent vaginal delivery and 67(51.53%) cases underwent cesarean section. Untreated and irregular treatment in hypothyroidism are associated with pregnancy complications like spontaneous miscarriage 40(30.76%), maternal anaemia 55(42.30%), pre-eclampsia 4(3.07%), pre term birth 16(12.30%), postpartum haemorrhage 3(2.30%).
 Conclusion: Hypothyroidism is a common clinical condition during pregnancy and it causes variable pregnancy outcome
 Chatt Maa Shi Hosp Med Coll J; Vol.20 (2); July 2021; Page 18-21

Assessment of serum vitamin D level in women with polycystic ovary syndrome

Back ground: PCOS is the commonest endocrinopathy among women of reproductive age. Its worldwide prevalence has been estimated between5-10%. Rotterdam criteria is known to be the most important in such patients.Vitamin D, a fat-soluble vitamin, can be produced in two ways: by intestinal absorption and endogenous synthesis from a precursor of 17-hydroxyl cholesterol on the skin with sufficient exposure to ultraviolet sunlight. Most references consider a serum 25(OH) vitamin D of < 20 ng/ml as vitamin D deficiency. Aim of the work: The aim of this work is assessment of the level of vitamin D in female have polycystic ovary syndrome & healthy female. Patient and methods: This is a case control study held in Misr Al-Gadeda Military Hospital in gynecology outpatient clinic from May 2020 - May 2021.Patients selected from attendees of the outpatient gynecological clinic and inpatient gynecological ward at Misr Al-Gadeda Military Hospital. Group A: 45 women diagnosed with PCO based on Rotterdam Criteria 2003. Group B: 45 fertile women without PCOS . Results: The results indicated that 25(OH) vitamin D was significantly lower in PCOS group than in control group. There were no significant correlations between 25(OH) vitamin D and age and BMI. Conclusion: PCOS is known to be one of the commonest endocrine problems between female of the reproductive age.25 (OH) Vitamin-D was significantly lower in PCOS group than in the control group.No significant difference was found in Vitamin D level related to age group and body mass index.

Determination of the particle size of the catiazine substance by laser difraction

Aim. To determine the particle size distribution of the new original substance cathiazine by laser diffraction. Materials and methods. The substance cathiazine was synthesized on the basis of d,l-camphoric acid and 2-aminothiazoline at the Institute of Endocrine Pathology Problems. The sperm-modulating effect of the new compound was proven in experimental animals. Its low toxicity at rather high efficiency was also confirmed. Determination of the particlesize of the powder of the substance cathiazine was performed by laser diffraction. The study was conducted on three laboratory batches. Optical microscopy was used to compare and confirm the results. Results and discussion. It was found that the average median particle size of the powder of the substance cathiazine was: for batch 1 – 38 μm, for batch 2 – 33 μm, for batch 3 – 53 μm. The maximum size for 80 % of particles of batch 1 was 115 μm, batch 2 – 90 μm, batch 3 – 125 μm. Microphotographs of three batches of the substance cathiazine obtained by optical microscopy were presented. This method also confirmed that the size of the registered particles did not exceed 200 μm. This was in good agreement with the previous studies, in which the recommended average particle size should not exceed 100 μm, and the mass fraction of larger fractions was proposed to be controlled. Conclusions. The particle size values of the powder substance cathiazine for three laboratory batches have been obtained. It has been found that the particle size and their size distribution in all laboratory batches of the substance cathiazine do not differ significantly. The data obtained can be used to normalize particle sizes in technology whendeveloping drugs

Indirect Effects of the Herbicide Glyphosate on Plant, Animal and Human Health Through its Effects on Microbial Communities

The herbicide glyphosate interferes with the shikimate pathway in plants and in major groups of microorganisms impeding the production of aromatic amino acids. Glyphosate application on plants results in a slow death, accelerated by reduced resistance to root pathogens. Extensive glyphosate use has resulted in increasing residues in soil and waterways. Although direct glyphosate effects on animals are limited, major concerns have arisen about indirect harmful side effects. In this paper, we focus on indirect effects of sublethal concentrations of glyphosate on plant, animal and human health due to shifts in microbial community compositions in successive habitats. Research results of glyphosate effects on microbial communities in soil, rhizosphere and animal guts have been contradictory due to the different integration levels studied. Most glyphosate studies have tested short-term treatment effects on microbial biomass or general community composition at higher taxonomic levels in soil, rhizosphere or animal intestinal tracts, and found little effect. More detailed studies showed reductions in specific genera or species as well as biological processes after glyphosate application. Plant growth promoting rhizobacteria and beneficial intestinal bacteria often are negatively affected, while pathogenic bacteria and fungi are enhanced. Such shifts in microbial community composition have been implicated in enhanced susceptibility of plants to Fusarium and Rhizoctonia, of birds and mammals to toxic Clostridium and Salmonella species, and of bees to Serratia and Deformed Wing Virus. In animals and humans, glyphosate exposure and concentrations in urine have been associated with intestinal diseases and neurological as well as endocrine problems, but cause-effect relationships need to be determined in more detail. Nevertheless, outbreaks of several animal and plant diseases have been related to glyphosate accumulation in the environment. Long-term glyphosate effects have been underreported, and new standards will be needed for residues in plant and animal products and the environment.

Gestational diabetes mellitus: Major risk factors and pregnancy-related outcomes: A cohort study.

BackgroundGestational diabetes mellitus (GDM) is a major pregnancy endocrine problem that has several confirmed risk factors and is associated with adverse pregnancy-related outcomes (PRO).ObjectiveTo evaluate the relationship between GDM diagnosis and the associated risk factors of PRO (maternal, intrapartum, perinatal, and neonatal) in accordance with International Association of Diabetes and Pregnancy Study Groups criteria.Materials and MethodsThis prospective cohort study was performed with 531 singleton parturient (265 GDM and 266 non-GDM). They were selected consecutively from referral hospitals, and the maternal, intrapartum, perinatal, and neonatal outcomes were assessed.ResultsThe major risk factors influencing the GDM diagnosis were maternal age, obesity, family history of diabetes, previous history of GDM, and previous history of macrosomia. In the comparison of PRO between the groups, significant associations were detected for emergency cesarean delivery, preeclampsia, polyhydramnios, premature rupture of membrane, preterm delivery, and neonatal hyperbilirubinemia in the GDM group. In the multivariate logistic regression analysis, a previous history of stillbirth was significantly associated with maternal and perinatal outcomes. The odds ratios (CI 95%) of the PRO in the women with a GDM diagnosis were: maternal = 2.43 (1.51-3.90), intrapartum = 2.05 (1.35-3.11), perinatal = 2.00 (1.29-3.10), and neonatal = 1.68 (1.08-2.62). The PRO was significantly correlated with GDM diagnosis, but not with the risk factors.Conclusion The adverse pregnancy outcomes were significantly correlated with GDM diagnosis, and the outcomes were not directly affected by the risk factors. Given the related adverse outcomes for mothers and offspring, early screening and management of GDM is necessary especially in Asians and in low-/middle-income countries.

Diagnosis and treatment of primary hyperparathyroidism (20 years of own experience and literature review)

Background. Currently, primary hyperparathyroidism (pHPT) is the third most common endocrine disease after thyroid gland pathology and diabetes mellitus. Untimely diagnosis leads to a severe course of the disease with the development of disabling deformations — osteoporotic fractures, recurrent stone formation in the urinary tract, gastrointestinal bleeding, etc., as well as to an increased risk of premature death. The purpose of the study is to assess the dynamics of detection of thyroid disease (thyroid) for the period 2000–2019. Materials and methods. Since 2000, based on the surgical department of the clinic of the State Institution “V. Danilevsky Institute for Endocrine Pathology Problems of the National Academy of Medical Sciences of Ukraine”, 205 surgeries have been carried out for pHPT (in 188 women and 17 men: 91.7 and 8.3 %). Results. Since 2008, there has been a steady increase in the number of cases. The incidence of pHPT in women increases with age and becomes significantly higher at the age of 50–69 years. At the same time, the gap between women and men is widening, the reason for which needs to be studied. The proportional ratio of the number of patients with asymptomatic and clinically pronounced course persists for 20 years and is approximately 2 : 1. In countries where blood calcium screening has been introduced, the proportion of asymptomatic forms reaches 80 %. The obtained data confirm the fact of untimely diagnosis of pHPT in Ukraine, which requires the introduction of large-scale population screening in the form of a questionnaire survey and study of serum calcium. Conclusions. A positive contribution to the timely detection of pHPT can be made by activating the work of postgraduate (continuous) education institutions in this direction, primarily the departments of endocrinology based on endocrinological clinics with surgical departments.

Study on thyroid function test in pregnancy in a tertiary care hospital

Thyroid disorder is a very common endocrine problem encountered by pregnant women. Maternal thyroid dysfunction is associated with adverse outcome both in mother and fetus.&#x0D; The aim of the study: to find out the prevalence of various thyroid disorders in pregnant women attending antenatal clinic.&#x0D; Materials and methods. This prospective cross-sectional study was carried out in the Department of Obstetrics and Gynecology, F.M. Medical College &amp; Hospital, Balasore, Odisha from June 2020 to May 2021. 220 women with uncomplicated singleton pregnancy were included. Serum Thyroid-stimulating hormone (TSH), free T4 (FT4) and free T3 (FT3) were estimated by using electro-chemiluminescence immunoassay technique.&#x0D; Results. Out of 220 pregnant women screened for thyroid dysfunction, 68 were found to have thyroid disorders. 27.3 % of pregnant women had subclinical hypothyroidism, 1.4 % had overt hypothyroidism, 1.8 % had subclinical hyperthyroidism and 0.5 % had overt hyperthyroidism. Prevalence of subclinical hypothyroidism was 6.36 % when the upper reference limit of TSH level taken as 4 mIU/L. Prevalence of thyroid disorder among pregnant women in the age groups 18–25 years, 26–30 years and 31–40 years were 28.9 %, 32.1 % and 38.9 % respectively. There were 35.5 %, 28 % and 26 % pregnant women with thyroid disorders in the first, second and third trimester respectively. Prevalence of both subclinical and overt hypothyroidism were more in multigravida compared to primigravida.&#x0D; Conclusion. Our study revealed high prevalence of thyroid disorders in pregnant women and maternal subclinical hypothyroidism was the most common pattern.

Metabolic and Endocrin Complications of Pediatric, Adolescent and Young Adult Acute Lymphoblastic Leukemia: Single Centre Experience

Introduction: Metabolic and endocrine complications are common complications in the treatment of Acute Lymphoblastic Leukemia (ALL). Inappropriate anti-diuretic hormone (ADH) syndrome, diabetes mellitus, hypoglycemia, surrenal failure, hypercalcemia may ocur during the treatment. Obesity, growth retardation or pause and osteopenia are the most common complications. These complications are usually due to combined chemotherapeutic agents used during the treatment. In this study, we present the metabolic/endocrine complications which are observed during treatment of ALL patients at our center.Material -Metod: One hundred and ten patients who were diagnosed with ALL and treated with the ‘Children's Oncology Group’ (COG) protocol and follow-up in the Pediatric Hematology / Oncology Department of the Istanbul University Institute of Oncology were included in the study. We retrospectively analyzed the demographic characteristics of the patients and presence of metabolic/endocrin problems (hyperglycemia, hypoglycemia, hypothyroidism, hypercholesterolemia, obesity) during all treatment stages were recorded. Forty-five (40.9%) of the patients were female and 65 (59.1%) were male. Ninety-seven (88.2%) patients were pre-B-cell ALL, 1 (0.9%) patients were mature B-cell ALL, 11 (10%) patients were T-cell ALL and 1 (0.9%) patients were biphenotypic ALL. The median age of the patients were 7 years (range:1,5-23).Results: One hundred of the 110 patients whose all clinical data were obtained were included for the evaluation of the metabolic and endocrin complications. The metabolic and endocrine problems were detected in 16 (16%) patients in any phases of the treatment and 84 (84%) patients did not have any metobolic or endocrine problems during the treatment. Twelve (12%) of the 16 patients with metabolic and endocrine problems were in 1 phase and 4 (4%) in 2 phases. Totally, 23 problems were detected. All metabolic / endocrine problems that arise during treatment are shown in Table 1. Seven of them (30.4%) were in induction, 2 of them were in consolidation (8.8%), no problems were found in interim maintenance 1, 7 (30.4%) were in delayed intencification, Interim maintenance 2 and delayed intencification 2 did not show any problems, and 7 (30.4%) were seen in maintenance.Conclusion: In the treatment of ALL, endocrine and metabolic problems are frequently seen during and after treatment. In our study, 23 metabolic problems (hyperglycemia, hypoglycemia, hypothyroidism, hypertriglyceridemia, hypercholesterolemia, osteoporosis, obesity, hyperferritinemia, metabolic syndrome) were recorded in 16 (16%) of the patients. Our resuts suggest that metabolic complications that may occur in ALL treatment should be considered as well as the remission of the disease. Therefore, patients should be carefully evaluated for metabolic and endocrin problems in ALL treatment. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Awareness of diagnosis, treatment and risk of late effects in Chinese survivors of childhood cancer in Hong Kong.

BackgroundFor survivors of childhood cancer, awareness of personal health risks is a critical component of long‐term health management.ObjectiveTo evaluate the awareness of the diagnosis, treatment and risk of late effects among survivors of childhood cancer in Hong Kong.MethodsBetween June 2019 and March 2020, this cross‐sectional study recruited 155 adult survivors (mean age = 26.9, standard deviation [SD] = 6.4 years) and 45 parents of paediatric survivors (mean age = 11.1, SD = 3.6 years) from a long‐term follow‐up clinic. At >10 years post‐treatment (mean = 13.4, SD = 7.6 years), they completed a structured questionnaire to report their cancer‐specific knowledge. Multiple linear regression analysis was conducted to identify clinical, socioeconomic and behavioural factors associated with poor awareness.ResultsThe majority of participants accurately recalled their diagnoses (73.5%) and major treatment modalities (chemotherapy 92.4%, radiation 82.9% and surgery 88.2%). However, less than half (45%) of the participants recognized more than 25% of the total late effects for which they were at risk. The highest levels of awareness were reported for endocrine problems (49%), neurocognitive impairment (44%) and secondary cancers (43%), and the lowest for peripheral neuropathy (21%) and vision problems (23%). Compared with survivors of haematological malignancies, those of central nervous system (CNS) tumours (standardized estimate [B] = −9.33, 95% confidence interval [95% CI]: −13.41 to −5.26) and non‐CNS solid tumours (B = −8.47, 95% CI: −12.39 to −4.94) had less knowledge about their diagnosis. Retaining medical records (P < .0001) and better medical information‐seeking habits (P = .048) were associated with better awareness.ConclusionsSurvivors of childhood cancer in Hong Kong have deficient awareness of their personal health risks. They may benefit from the provision of a survivorship care plan and personalized education regarding treatment‐related late effects.Patient ContributionPatients contributed in designing the study tools. Results were presented at a non‐governmental organization.

Hormonal Effect of High Protein Diets Among Females

Abstract Objectives A diet high in protein and low in carbohydrates are common occurrences in the clinical practice. We explore the effect that those diets have on endocrine system among a sample from 5 continents. Methods Data from n = 8252 unique participants that completed a self reported Depression and Anxiety Assessment Test was used. From the n = 8252 sample, n = 5662 were females and that is the data that was used for the study they had an average age of 46.5 [SD 17]. The Depression and Anxiety Assessment Test (registration TX 7–398-022) is a an questionnaire of 85 questions that included questions of demographics, and also the question “Do you currently take part in a low carbohydrate diet, such as the Atkins diet?” the group was divided in two those that follow the low carbohydrate diet and those that didn't. The questionnaire also ask about alcohol abuse, thyroid problem, being an uncontrolled diabetic and having painful menstrual periods on a regular basis. Results Among the females n = 552 were following a low carbohydrate diet (LCD), those had an average age of 48.5 [SD 16]. The females that were not following a LCD had a mean age of 45.7 [SD 17]. Regarding thyroid problems, 8.6% of the LCD group had a thyroid problem compared to 6.5% of those not following a LCD. Regarding uncontrolled diabetes, 6.9% of the LCD group had uncontrolled diabetes compared to 3.8% not following a LCD. Regarding regular painful menstruation, 27.5% of the females following the LCD group had them compared to 23.5% of females not following a LCD. Regarding current alcohol abuse, 8.9% following the LCD had them compared to 7.6% of those not following a LCD. Conclusions It seems that females following a LCD tend to have more endocrine problems. A follow up with laboratories should be done to confirm the impact. Funding Sources Self funded.

Hospitalizations Among Chernobyl-Exposed Immigrants to the Negev of Israel, 1992-2017: A Historical Follow-Up Study.

On April 26th, 1986 the nuclear reactor at Chernobyl, Ukraine exploded, causing the worst radiation disaster in history. The aim was to estimate hospitalization rates among exposed civilians who later immigrated to Israel. We conducted a historical follow-up study, among persons exposed to Chernobyl (n = 1128) using linked hospitalization records from Soroka University Medical Center (SUMC), compared with immigrants from other areas of the Former Soviet Union (FSU) (n = 11,574), immigrants not from FSU (n = 11,742) and native-born Israelis (n = 8351), matched on age and gender (N = 32,795). Hospitalizations for specific ICD-10 coded diagnostic groups were analyzed by exposure and comparison groups by gender and age at accident. In addition, the rate of hospitalization, and the duration of hospital days and the number of hospitalizations for these selected diagnostic groups was also calculated. Hospitalizations for specific ICD-10 coded diagnostic groups and for any hospitalization in these diagnostic groups in general were analyzed by exposure and comparison groups and by covariates (gender and age at accident). The rate of any hospitalization for the selected diagnostic groups was elevated in the low exposure Chernobyl group (51.1%), which was significantly higher than the immigrant (41.6%) and the Israel-born comparison group (35.1%) (p < .01) but did not differ from either the high exposure group (46.9%) or the FSU comparison group (46.4%), according to the post-hoc tests. The total number of hospitalizations in the low exposure Chernobyl group (2.35) differed from the immigrant (1.73) and Israel comparison group (1.26) (p < .01) but did not differ from the FSU comparison group (1.73) or the high exposure group (2.10). Low exposure women showed higher rates of circulatory hospitalizations (33.8%) compared to immigrants (22.8%) and Israeli born (16.5%), while high exposure women (27.5%) only differed from Israelis (p < .01). Neither exposure group differed from FSU immigrant women on the rate of circulatory hospitalizations. Post-hoc tests showed that among women in the low exposure group, there was a significant difference in rate of hospitalizations for neoplasms (28.6%) compared to the three comparison groups; FSU (18.6%), immigrants (15.7%) and Israel (13.1) (p < .01). Those among the low exposure group who were over the age of 20 at the time of the accident showed the higher rates of circulatory (51.2%) and neoplasm hospitalizations (33.3%), compared to the other immigrant groups (p < .01). When controlling for both age at accident and gender, hospitalizations for neoplasms were higher among Chernobyl-exposed populations (RR = 1.65, RR = 1.77 for high and low-exposure groups, respectively) compared to other FSU immigrants (RR = 1.31) other immigrants (RR = 1.11) and Israeli born (RR = 1.0) after controlling for gender and age at accident. High RRs attributable to Chernobyl exposure were also found for circulatory diseases compared to other immigrants and Israeli born (RRs = 1.50, 1.47 for high and low exposure compared to 1.11. and 1.0, other immigrants and Israeli born, respectively). Endocrine problems and disorders of the eye also showed elevated RR compared to the immigrant comparison groups. Respiratory and mental disorders did not show any consistent association with Chernobyl exposure. The findings support unique Chernobyl morbidity associations only in some diagnostic groups, particularly for low exposure women. General immigration effects on hospitalizations compared to the Israeli born population were found on all diagnostic groups. There is a need to improve the services and medical follow-up for these Chernobyl exposed groups in specific diagnostic groups.

What Every Internist Should Know About Rare Genetic Syndromes in Order to Prevent Needless Diagnostics, Missed Diagnoses and Medical Complications: Five-Year Experience of Internal Medicine for Complex Rare Genetic Syndromes

Introduction: Patients with complex rare genetic syndromes (CRGS) have, by definition, combined medical problems affecting multiple organ systems. Intellectual disability (ID) is often part of the syndrome. During childhood, most patients with CRGS receive multidisciplinary (MD) and specialized pediatric care in tertiary centers. As improvement of medical care has improved life expectancy, more and more patients are now reaching adult age. While the complexity of the syndromes persist into adulthood, adequate multidisciplinary syndrome-specific care is rarely available for adults with CRGS. Although multiple organ systems are usually affected, internists are rarely involved. Pediatricians have expressed the urgent need for adequate, syndrome-specific, MD tertiary healthcare for adults with CRGS. Methods: In 2015 we have launched the Center for Adults with CRGS, a specialized MD outpatient clinic (MOPC) within the Endocrinology unit of the department of Internal Medicine. As adult manifestations are unknown for most CRGS, all CRGS patients who visit our MOPC undergo a systematic health screening (followed by treatment, if indicated). Before visiting the MOPC, caregivers fill out a medical questionnaire. We gathered the physical complaints, medication use and missed diagnoses of 726 adults with CRGS. Results: Between 2015 and 2020, 256 males and 470 females with over 60 syndromes visited the Center for Adults with CRGS. The main features of this population, as compared with general internal medicine patients, were intellectual disability, polypharmacy and use of psychotropic drugs. Missed diagnoses were common and many patients had undergone extensive diagnostic tests for symptoms that could actually be explained by their syndrome. Fatigue (52%), abdominal discomfort (23%) and hypertension (10%) were among the most frequent reasons for referral to Internal Medicine. Based on the literature and our clinical findings, 73% of the syndromes was associated with endocrine problems. We provide an algorithm for the clinical approach to CRGS adults, in order to prevent unnecessary diagnostics as well as missed diagnoses. Conclusion: Our overview of 726 adults with CRGS shows that missed diagnosed and needless invasive tests are common in this patient population. As more and more CRGS patients are now reaching adult age and transfer to Internal Medicine, internists and endocrinologists should be aware of the special needs of adults with CRGS and of the medical pitfalls. Knowledge about syndrome-specific health problems and multidisciplinary expert care is crucial to prevent the personal and financial burden of unnecessary diagnostics and under- and overtreatment.

333 Associations Between Insomnia and Health Correlates in Nurses

Abstract Introduction Insomnia, shiftwork (i.e., circadian rhythm disruptions) and insufficient sleep are common among nurses and healthcare workers. Each of these sleep problems can contribute to physical (e.g., inflammation, musculoskeletal pain, cardiovascular disease and heart rate variability, indigestion, and menstrual cycle irregularity) and mental (e.g., depression, anxiety, suicidality) health problems as well as daytime fatigue and sleepiness among nurses and may contribute to burnout and job change. Methods Participants (N=458) were nurses recruited for a parent study, “Sleep and Vaccine Response in Nurses (SAV-RN)” (Taylor &amp; Kelly: R01AI128359-01). Most identified as female (90.5%), White/Caucasian (77.2%), and non-Hispanic (88.6%) with an average age of 39.03 (SD = 11.07). Participants completed baseline measures online via Qualtrics survey. The Sleep Condition Indicator (SCI; Espie et al., 2014) was used to identify a probable diagnosis of insomnia (score of ≤16 = Insomnia; endorsement of each of the primary DSM-5 criteria on the measure). In addition, a checklist of current major health conditions (high blood pressure, sleep apnea, GI issues, HIV/AIDS, cancer, etc.) was also completed. A Chi square test of Independence was conducted using SPSS to determine if insomnia detected by the SCI was associated with reported health conditions. Results At baseline, 25.4% of nurses had a probable insomnia diagnosis. Insomnia was associated with a greater likelihood of diagnosed sleep apnea, cancer (all types), high blood pressure, chronic pain, gastrointestinal problems, an autoimmune disease, and/or an endocrine problem at Month 11 of the study (all ps &amp;lt;.05). Data cleaning is ongoing, but similar analyses will be presented examining shift work sleep disorder and insufficient sleep (i.e., average &amp;lt; 6hrs per night) as individual and simultaneous predictors of physical and mental health at baseline and change from baseline to Month 11 (if available). Conclusion These results help to identify associations between insomnia and health conditions in nurses and may contribute to future research that supports evidence-based intervention and prevention strategies for this population. While evidence-based interventions for sleep disturbances and insomnia exist (CBT-I), accessibility and feasibility of scaling such interventions to reach the nursing community at large remains challenging. Support (if any):

To Evaluate the Relationship of Risk Factor Between Diabetes Mellitus and Thyroid Dysfunction (Thyrobetes)

Introduction: Type 2 diabetes and thyroid dysfunction are common endocrine disorder and shown mutually influence each other. As per the GOQii is a smart-tech enabled, integrated preventive healthcare platform headquartered in California, diabetes has increased from 7.1 to 12% this year. “The incidence of diabetes is highest among older adults at 23.81 per cent and seniors at 36.82 per cent.” As per the report, 13.5% of Indians have cholesterol issues. This past year, thyroid issues have increased from 6.8% to 10.7%. The thyrobetes illustrates relationship the between thyroid diseases and diabetes mellitus.Objective of the Study: This study’s objectives are as follows:To define the interrelation of factors responsible for the link between diabetes and thyroid disease development;To estimate thyroid hormone TSH, free T3, free T4, lipid profile, blood glucose fasting and PP, HbA1c, S. Insulin, ant-TPO antibodies, and USG neck for some thyroid patients;To describe each factor correlation between developing diabetes and thyroid diseases; andTo explain preventive measures for diabetes and thyroid diseases. Research problem of the studyThere are an increasing number of patients who experience diabetes mellitus, hypothyroidism and other types of thyroid dysfunction, but it is difficult to say which disease occurs first. This study seeks to identify the overlapping risk factor for diabetes and thyroid dysfunction. Review of literatureType 2 diabetes mellitus and thyroid dysfunction (TD) are two major public health endocrine problems. The status of iodine and thyroid with diabetic patients less studied. Materials and Methods: The study included 300 patients of diabetes and thyroid dysfunction. The questionnaires were used to record the findings on thyroid hormone TSH, free T3, free T4, lipid profile, blood glucose fasting and PP, and USG neck for some thyroid patients. Inclusion criteria:Sample size -300 patientsNo limit to the age groupNew or follow up cases of diabetic mellitus and thyroid diseaseExclusion criteria:Patients who had an acute illness that affects thyroid gland activityPatients who consumed drugs that could influence the thyroid hormone statusPatients who had feverData collection and tools for statistical analysisInstruments used for analyzing the samples that are availability at JNU hospital.Statistical Analysis: Statistical analysis will be performed by using SPSS software, student ‘t’ tests, and Pearson’s correlation; if the P* value < 0.005, then it will considered to be statistically significant. Conclusion: Thyroid disease and diabetes are two intertwined conditions. If you have a thyroid condition, you’re at an increased risk for developing diabetes, and if you have diabetes, you’re at an increased risk for thyroid disease.

Ethnobotany of the medicinal plants used by the ethnic communities of Kerman province, Southeast Iran

BackgroundTraditional medicine is a major component in the primary healthcare system in the southeast of Iran, which has a rich floral diversity. However, there is no comprehensive report on the use of medicinal herbs in this specific region. This traditional usage of medicinal plants by local communities could serve as a source for pharmacological and phytochemical studies. The main objective of this study was to identify ethnopharmacological knowledge on medicinal plant species and their local healing applications by the folk communities of Kerman province in the southeast of Iran.MethodsIn this cross-sectional study, data were collected from 217 herbal healers using semi-structured questionnaires, open interviews, and field surveys. Factors including use reports (UR) for each species, frequency of citation (FC), and informant consensus factor (ICF) were used to analyze the data. Plant species were identified by botanists through standard taxonomic methods.ResultsA total of 402 medicinal plants were used in healing practices by the local communities of Kerman province. These species belong to 273 genera of 73 families, among which 367 species are dicotyledons, 27 are monocotyledons, 7 species are cryptogam, and one species is gymnosperm. An important implication from the current study is the identification of the traditional medicinal use of 292 plant species in this region for the first time. Asteraceae, Apiaceae, Lamiaceae, and Fabaceae were the dominant medicinally utilized plant families, respectively. Leaf, flower, fruit, and seed were the most common plant parts used. Generally, crude drugs were used in the form of decoction, followed by poultice and infusion forms. Moreover, oral route is considered as the most common administration route followed by topical route. Endocrine (diabetes), dermatological, gastrointestinal, and respiratory problems were ranked as the most frequent ailment categories for which medicinal plants in this region were applied, respectively. Our findings suggested dominant use of Asteraceae and Apiaceae plants for the treatment of gastrointestinal disorders, Lamiaceae plants for respiratory and gastrointestinal ailments, and Apocynaceae plants for dermatological problems.ConclusionOur findings suggested that Asteraceae and Apiaceae plants were used for the treatment of gastrointestinal disorders, Lamiaceae plants for respiratory and gastrointestinal ailments, and Apocynaceae and Euphorbiaceae plants for dermatological problems. Among the medicinal plants with high UR and new ethnobotanical uses, Rhazya stricta was used for wound healing, Calotropis procera, Clematis ispahanica and Euphorbia spp. for eczema, Cionura erecta for the treatment of cough, Launaea acanthodes for the treatment of gastrointestinal parasites, Berberis integrrima as an antidiabetic medicinal herb, Dracocephalum polychaetum and Rydingia persica for various types of chronic diseases, Citrus limon and Citrus aurantium for the treatment of ocular diseases and making the traditional kohl, Calendula officinalis for the treatment of pterygium and Prosopis farcta for preventing nasal bleeding. The identified medicinal plants can be further evaluated for their pharmacological activity and underlying mechanisms of action.

CLINICAL PROFILE OF YOUNG ADULTS (18-24 YEARS) WITH POLYCYSTIC OVARY SYNDROME

Background: Polycystic Ovary Syndrome is a common endocrine problem with a heterogenous clinical picture. Early identication is essential to prevent metabolic problems and infertility. To estimate the prevalence of Objective: Polycystic Ovary Syndrome and depict the clinical prole of young adults (18-24 years) with Polycystic Ovary syndrome. A cross- Methods: sectional study of all the nursing students aged 18-24 years in Thiruvananthapuram District was conducted to self-screen for Polycystic Ovary Syndrome and Rotterdam criteria were applied. The study group comprised 529 subjects who were diagnosed to have the syndrome. The clinical and ultrasonographic characteristics and anthropometric variables of the study group were estimated and compared with 399 young adults without Polycystic Ovary Syndrome. Variables were expressed in terms of frequenci Statistical Analyses: es for categorical and mean (± SD) for continuous variables. Chi-square test was used for categorical and t- test for continuous variables. The prevalence of Polycystic Ovary Results: Syndrome was 13.1%. Irregular periods was seen in 74.7%, hirsutism in 57.1%, acne in 37.1%, acanthosis nigricans in 51% and alopecia in 2.5%. Overweight and obesity were found in 30.8%, increased waist circumference in 16.1% and hypertension in 27.8%. Polycystic Conclusion: Ovary Syndrome is a clinically heterogenous condition with an increased prevalence of irregular periods, hirsutism, acne and acanthosis. Overweight and obesity are signicantly increased. A younger age group of late adolescents or young adults is ideal to screen for the syndrome and institute lifestyle intervention to prevent metabolic problems.

Effect of Vitamin D Supplementation in Improving Pregnancy Rates in Infertile Women with PCOS

Polycystic ovarian condition (PCOS) is the most well-known endocrine problem that influences ladies in the youngster bearing period. The point of the current examination was to contemplate the impact of nutrient D supplementation in nutrient D inadequate PCOS ladies, as respects the clinical pregnancy and ovulation rates. Patient and techniques : This is a Randomized controlled clinical preliminary investigation included 100 nutrient D inadequate/lacking fruitless ladies with an analysis of PCOS. Serum 25-OH-VD levels were estimated and ladies were haphazardly partitioned into Vitamin D and placepo gatherings. Following 3 months of metformin ± nutrient D supplementation, all included ladies got ovulation enlistment by letrozole 2.5 mg. Sequential trans vaginal ultrasound was performed and evaluated. Results: Following nutrient D3 supplementation, the rate of continuous pregnancy demonstrated genuinely huge expansion in nutrient D gathering contrasted with fake treatment group(39.1% and 18.4%% separately) P = 0.025. Likewise measurably critical expansion in ovulation after the enlistment cycles in vit D gathering contrasted with the fake treatment gathering (p = 0.001, 0.001 and 0.045) through three continuous acceptance cycles . End: In subfertile ladies with PCOS, Vitamin D supplementation may have a possible adjuvant part to standard enlistment of ovulation regimens.