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Determination of 1p/19q co-deletion status is important for the classification, prognostication, and personalized therapy in diffuse lower-grade gliomas (LGG). We developed and validated a deep learning imaging signature (DLIS) from preoperative magnetic resonance imaging (MRI) for predicting the 1p/19q status in patients with LGG. The DLIS was constructed on a training dataset (n = 330) and validated on both an internal validation dataset (n = 123) and a public TCIA dataset (n = 102). The receiver operating characteristic (ROC) analysis and precision recall curves (PRC) were used to measure the classification performance. The area under ROC curves (AUC) of the DLIS was 0.999 for training dataset, 0.986 for validation dataset, and 0.983 for testing dataset. The F1-score of the prediction model was 0.992 for training dataset, 0.940 for validation dataset, and 0.925 for testing dataset. Our data suggests that DLIS could be used to predict the 1p/19q status from preoperative imaging in patients with LGG. The imaging-based deep learning has the potential to be a noninvasive tool predictive of molecular markers in adult diffuse gliomas. The authors developed a deep learning model predictive of 1p/19q status from preoperative imaging in 555 lower-grade gliomas (LGG), and achieved an area under the curve (AUC) of 0.983 in the testing dataset. They reveal that developing deep learning imaging signatures could be a noninvasive tool for predicting molecular markers in LGG.

Background: Obesity and metabolic syndrome (MetS) are growing problems in type 1 diabetic patients; these can influence clinical complications and also treatment regimens. Visceral adipose tissue i...

Background: Well controlled blood pressure (BP) is associated with decreased risk of kidney disease progression, cardiovascular events and death. Patients with chronic kidney disease (CKD) are frequently seen to have low rates of BP control. This study aimed to find out the proportion of adult type 2 diabetic CKD patients with hypertension achieving the goal of target blood pressure. Methods: This cross-sectional study included 105 hypertensive subjects having type 2 diabetes and CKD at the outpatient department of Nephrology, BIRDEM General Hospital in Dhaka, Bangladesh from May to August, 2012. Results: The mean age was 55.6 years and maximum numbers of patients were in the age group of 39-66 years. Among 105 subjects, 52.3% were male and rest 47.7% were female. The mean duration of diabetes, CKD and hypertension were 6.73 (±3.22), 3.12 (±2.47) and 3.1 (±1.77) years respectively. The study revealed that ischemic heart disease (30.5%), dyslipidemia (56.1%) and stroke (13.3%) were associated comorbidity along with diabetes and CKD. Mean estimated glomerular filtration rate was 52.19 ml/min. Mean serum creatinine level was 3.4 mg/ dl. It was observed that majority (49.5%) of the study subjects were prescribed at least two drugs to control hypertension. Three anti-hypertensive medications were given in 35.2% subjects. Among 105 study subjects, 25.7% were found to have high systolic blood pressure and 8.8% high diastolic blood pressure. It was observed that only 40% subjects achieved target systolic blood pressure and 68.6% reached the target diastolic pressure for CKD with diabetes. In correlation analysis, it was observed that both systolic and diastolic blood pressure was significantly correlated with age of the subject, duration diabetes and duration of HTN. Conclusion: From the present study it was seen that both the target systolic and diastolic blood pressure were correlated with numbers of medications used for controlling hypertension but only diastolic blood pressure control was significantly correlated with number of medication used in this present study. BIRDEM Med J 2021; 11(3): 212-217

Background Type 2 diabetes mellitus (T2D) has become a global health challenge. Diabetic peripheral neuropathy (DPN) is one of the common comorbidities of T2D that may affect the ability to perform diabetes self-care. Purpose To compare self-care practices between adult T2D patients with and without comorbid DPN and identify factors predicting self-care practices. Methods In this cross-sectional study, conducted at tertiary hospitals in Ethiopia, a total of 216 (108 with DNP and 108 without DNP) participants completed an interviewer-administered questionnaire including measures of diabetes self-care practices, self-evaluated peripheral neuropathy, self-efficacy, diabetes knowledge, and social support. Results Adult T2D patients with comorbid DPN had lower dietary (P< 0.001), exercise (P< 0.001), blood glucose testing (P = 0.001), and foot (P = 0.007) self-care practice than those without DPN. Social support is a significant predictor of dietary self-care in both groups while predicting foot self-care and blood glucose testing in those with comorbid DPN. Moreover, occupation, education, and having a glucometer are significant predictors of diabetes self-care practice in both groups. Conclusion This study found that adult T2D patients with comorbid DPN have poorer diabetes self-care practice than those without comorbid DPN. Interventions should focus on addressing social support and access to a glucometer in order to improve diabetes self-care practices in adult T2D patients with comorbid DPN.

Background Annular pancreas (AP) is a rare congenital abnormal rotation of the pancreas. AP rarely occurs in adults. Pancreatic tumors and ampullary tumors are related to AP, so the discovery and treatment of AP are essential. Case summary This study investigated the clinical manifestations, imaging features, complications, and treatment of six patients diagnosed with AP at the Department of Hepatobiliary and Pancreatic Surgery, First Hospital of Jilin University from January 2010 to June 2020. There were four males and two females, with an average age of 56.00 ± 9.86 years old. In this study, abdominal pain and jaundice were the main clinical manifestations. Imaging can show the "crocodile jaw sign" or "double bubble sign". Conclusion For patients with duodenal or biliary obstruction, physicians should give priority to AP when imaging examinations suggest that the duodenum is wrapped with tissue similar to the density of the pancreas. Symptomatic patients should actively undergo surgical treatment.

OBJECTIVE To examine childhood BMI, fasting glucose, and insulin in relation to incident adult type 2 diabetes mellitus (T2DM). RESEARCH DESIGN AND METHODS We used data from the International Childhood Cardiovascular Cohort (i3C) Consortium. Data included childhood (age 3–19 years) measurements obtained during the 1970s–1990s; a health questionnaire, including self-report of adult T2DM (occurrence age, medication use) obtained at mean age 40 years; and a medical diagnosis registry (Finland). RESULTS The sample included 6,738 participants. Of these, 436 (6.5%) reported onset of T2DM between ages 20 and 59 (mean 40.8) years, and 86% of them reported use of a confirmed antidiabetic medication. BMI and glucose (age and sex standardized) were associated with incident T2DM after adjustment for cohort, country, sex, race, age, and calendar year of measurement. Increasing levels of childhood BMI and glucose were related to an incrementally increased risk of T2DM beginning at age 30 years, beginning at cut points CONCLUSIONS Childhood BMI and glucose are predictors of adult T2DM at levels previously considered to be within the normal range. These easy-to-apply measurements are appealing from a clinical perspective. Fasting insulin has the potential to be an additional predictor.

Background and objectives This study aims at examining the potential survival benefits of primary versus secondary surgery of children diagnosed with advanced infantile (iFS) and adult-type fibrosarcoma (aFS). Methods Treatment and outcome of 89 children with FS treated within prospective Cooperative Studiengruppe (CWS) trials (1981–2016) were analyzed retrospectively. Results Localized disease (LD) was diagnosed in 87 patients: 64/66 patients with iFS (≤ 2 years) and 23 with aFS (> 2 ≤ 18 years). Two patients (iFS) had metastatic disease. Resection was the mainstay of therapy of patients with LD resulting in microscopically complete (R0, IRS group I) (n = 29/87, 33%), microscopically incomplete (R1, IRS group II) (n = 17/87, 20%) and macroscopically incomplete (R2, IRS group III) (n = 41/87, 47%). Advanced LD (IRS group III) was present in 32/64 (50%) patients with iFS and in 9/23 (39%) with aFS. Chemotherapy was added predominantly in patients with advanced disease and an assessable objective response to CHT was seen in 71% iFS and 75% aFS. The 5-year event-free survival (EFS) of patients with iFS and aFS was 81% (± 10, 95% CI) and 70% (± 19, 95% CI) (p = 0.24); the 5-year overall survival (OS) was 98% (± 3, 95% CI) and 82% (± 16, 95% CI) (p = 0.02). Primary resection was no prognostic factor. Secondary R0/ R1 resection in patients with advanced disease improved 5-year EFS and OS in aFS (p = 0.002 and p = 0.000) but not in infants. Conclusions Secondary resection improves outcome in advanced aFS but not in infants. Mutilating surgery in infants should be avoided. Type of study and level of evidence Treatment study: patients were enrolled in five prospective studies and one registry, prognosis study: retrospective study. Level of evidence II/ III. Mini-abstract Fibrosarcoma is a very rare malignant tumor. Little is known about differences of local treatment of advanced infantile and adult-type. Data of 89 patients registered in five prospective trials and one registry of the Cooperative Weichteilsarkom Studiengruppe (CWS) (1981–2016) were analyzed.

In type 2 diabetic patients, blood lipids and lipid ratios have been provento beassociated with atherosclerosis risk; however, results about the effect of gender differences had not been fully conclusive.In thistransversal comparative study, a total of 129 adult type 2 diabetic patients (54 men and 75 women), from north western Algeria, was included to highlight the impact of gender differences on atherosclerosis risk (assessed by lipid ratios) according to their diabetic profile. Comparing between the two genders, no significant differences (p>0.05) were notedon diabetes duration, central obesity, body mass index and blood pressures. Moreover, the basic biochemical parameters of both glycaemic and lipid metabolism were not meaningfully divergent. However, higher significant values (p

Adult type granulosa cell tumours are extremely rare. Albeit mostly benign, 10% have malignant potential associated with unfavorable pathological features. The present case with the longest history duration, shows that size alone may not necessarily be unfavorable prognosticator when not associated with other factors., Adult‐type granulosa cell tumors are extremely rare. Albeit mostly benign, 10% have malignant potential associated with unfavorable pathological features. The present case with the longest history duration shows that size alone may not necessarily be unfavorable prognosticator when not associated with other factors.

BACKGROUND India is emerging as worlds’ diabetic capital. The cases of diabetic retinopathy are also increasing. We wanted to determine whether contrast sensitivity can be used as early indicator in diabetic retinopathy and also to measure and compare the contrast sensitivity in adults with type 2 diabetes mellitus with retinopathy and post-laser photocoagulation and correlate the contrast sensitivity in patients without diabetic retinopathy. METHODS This cross-sectional study included 50 diabetic patients with and without retinopathy and also 30 patients who had undergone laser photocoagulation who were above 30 years. Detailed history was obtained; ocular examination, and measurement of contrast sensitivity with Pelli Robson E and alphabet chart were done. Statistical analysis was done using Spearman’s coefficient of correlation, analysed using Epi Data / SPSS. RESULTS Contrast sensitivity was found to be reduced in post laser photocoagulation group and retinopathy group when compared to no retinopathy group. CS value between ‘No Retinopathy’ and ‘Post Laser’ groups, the p value by unpaired t test was found be statistically significant (p

Aims: To analyze prevalence and clinical effect of continuous subcutaneous insulin infusion (CSII) in adult type 1 diabetes mellitus (T1DM) patients in a public health system real-world sc...

T1D accounts for 10% of all diabetes and DKA accounts for 8.1 per 1,000 hospitalizations. Glycemic outcomes have not been reported for adults with specifically T1D. We describe hospital glycemic outcomes for patients with T1D with and without DKA. Individual-level data from the Glytec Inpatient Database was examined for glycemic outcomes based on pre-specified target blood glucose (BG) ranges (Table 1). All patients were treated with Glucommander IV. Data was extracted from 154 hospitals located in 17 different states in the United States (2015-2020). T1D was determined based on ICD E10.XX. The DKA group (n=4592) included patients with age > 18 years met criteria for DKA: bicarbonate 250 mg/dl, and anion gap >12 mEq/L. The non DKA group (n=10,886) included patients who did not meet the DKA criteria. Prevalence of hypoglycemia and time to target (TTT) BG were stratified by target BG ranges. In patients with DKA, % BG This largest descriptive analysis of adult T1D patients with DKA and without DKA showed that Glucommander IV can safely get patients into prespecified target range, with minimal rates of hypoglycemia. Disclosure J. Messler: Employee; Self; Glytec, LLC. P. Vellanki: Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc. B. W. Bode: Advisory Panel; Self; Eli Lilly and Company, Consultant; Self; Bigfoot Biomedical, Inc., Companion Medical, Lexicon Pharmaceuticals, Inc., Medtronic, Novo Nordisk Inc., Zealand Pharma A/S, Research Support; Self; Abvance Therapeutics, Dexcom, Inc., Diasome Pharmaceuticals, Inc., Dompe, Eli Lilly and Company, Eyenuk, Inc., Insulet Corporation, Jaeb Center for Health Research, Medtronic, Nova Biomedical, Novo Nordisk, Provention Bio, Inc., REMD Biotherapeutics, Sanofi, Senseonics, Viacyte, Inc., vTv Therapeutics, Xeris Pharmaceuticals, Inc., Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, MannKind Corporation, Medtronic, Novo Nordisk, Sanofi, Stock/Shareholder; Self; AgaMatrix, Aseko, Inc., Glytec, LLC. R. Booth: Employee; Self; Glytec, LLC. J. Clarke: Employee; Self; Aseko, Inc., Stock/Shareholder; Self; Aseko, Inc.

The aim of this study is to assess the effect of meal size on glycemic control for T1D patients equipped with Diabeloop’s DBLG1 Closed Loop System[1], based on data from DBLG1 System Commercial Launch. The Soft Launch dataset comprises 34 adult type 1 diabetes patients with an average duration of 206 days for a total of 7011 days of treatment. Only days with ≥70% available CGM data were included in the analysis (97.3 % of total). To assess the effect of patient meal size (the daily sum of CHO declared by each patient on his device) on glycemic control, we compute the difference in percentage point between patient daily value and patient daily mean value of both Time In Range (TIR) (Figure 1) and Time In Hyperglycemia (TIHYPER) and plot it against each daily CarboHydrates (CHO) as a percentage of the mean daily CHO for this patient. This way we can observe the effect of bigger and smaller than average meals and determine if they tend to increase or decrease TIR and TIHYPER. As presented on Figure 1, days with increased CHO consumption are not linked to a drop in TIR. We observe no correlation between the TIR and the daily amount of CHO ingested (r=0.01), nor between the TIHYPER and the daily amount of CHO ingested (r=-0.12). In conclusion, Diabeloop’s DBLG1 Closed Loop System’s performance is not altered by the variations in daily amount of carbohydrates ingested by T1D patients. Disclosure P. Gimenez: Employee; Self; Diabeloop SA. S. Lachal: Employee; Self; Diabeloop SA. Y. Tourki: Employee; Self; Diabeloop SA. S. Franc: Advisory Panel; Self; Diabeloop SA, Board Member; Self; Novo Nordisk, Other Relationship; Self; Abbott Diabetes, Research Support; Self; Merck Sharp & Dohme Corp., Stock/Shareholder; Self; Diabeloop SA. C. Amadou: Other Relationship; Self; AstraZeneca, Diabeloop SA, Lilly Diabetes. A. Penfornis: Board Member; Self; Medtrum Technologies, Merck Sharp & Dohme Corp., Mundipharma International, Sanofi-Aventis, Other Relationship; Self; Medtrum Technologies, Speaker’s Bureau; Self; Amgen Inc., Lilly Diabetes, Merck Sharp & Dohme Corp., Novo Nordisk, Sanofi-Aventis. G. Charpentier: Other Relationship; Self; Diabeloop. P. Y. Benhamou: Consultant; Self; Diabeloop SA, Eli Lilly and Company, Insulet Corporation, Other Relationship; Self; Abbott Diabetes.

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), also known as Bland-White-Garland syndrome (BWGS) is a rare variant of the congenital anomalies of the coronary arteries. Two forms, the infantile (most common) and the adult types (rare) of these syndromic manifestations have been reported in the literature. Affected infants present with myocardial infarction and congestive heart failure. Few of them survive the first year of life, without appropriate surgical intervention. Adult type ALCAPA syndrome is one of the important causes of malignant cardiac arrhythmias, acute coronary syndromes, valvular pathologies and sudden cardiac death in young adults and adults. Asymptomatic adult type ALCAPA is uncommon, much more so its coexistence with bicuspid aortic valve (BAV). We present a 65-year-old patient with ALCAPA and BAV, who was largely asymptomatic. She had ligation of the ALCAPA, and aortic valve replacement, with a very good outcome.

Objective: Islet autoantibodies at diagnosis are not well studied in older-adult onset (>30years) type 1 diabetes due to difficulties of accurate diagnosis. We used a type 1 diabetes genetic risk score (T1DGRS) to identify type 1 diabetes aiming to evaluate the prevalence and pattern of autoantibodies in older-adult onset type 1 diabetes. Methods: We used a 30 variant T1DGRS in 1866 white-European individuals to genetically confirm a clinical diagnosis of new onset type 1 diabetes. We then assessed the prevalence and pattern of GADA, IA2A and ZnT8A within genetically consistent type 1 diabetes across three age groups ( 30years (n=588)). Findings: In autoantibody positive cases T1DGRS was consistent with 100% type 1 diabetes in each age group. Conversely in autoantibody negative cases, T1DGRS was consistent with 93%(56/60) of 30years having type 1 diabetes. Restricting analysis to genetically consistent type 1 diabetes showed similar proportions of positive autoantibodies across age groups (92% 30years)[p=0.87]. GADA was the most common autoantibody in older-adult onset type 1 diabetes, identifying 95% of autoantibody positive cases versus 72% in those

A 43-year-old male patient complained with atypical chest pain and dyspnea on exertion since six months ago. In heart physical examination, S1, S2, and III/VI systolic murmur in left sternal border was detected. In transthoracic echocardiography, mild LV enlargement with severe systolic dysfunction, EF=30% was reported. Patient was candidate for selective coronary angiography. Based on coronary angiography, Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) syndrome was confirmed and referred to cardiac surgeon to manage his condition.

Background: Ovarian granulosa cell tumors that originate from the sex cord-stromal cells represent 2% to 5% of all ovarian cancers. These tumors constitute two subgroups according to their clinical and histopathological features: juvenile granulosa cell tumors (JGCT) and adult granulosa cell tumors (AGCT). Granulosa cell tumor (GCT) is considered to be a low-grade malignancy with a favorable prognosis. Methods: This case series includes four patients who admitted to our university hospital and had an MRI examination within 5 years. Results: The histopathological subtype of granulosa tumor was the adult type in 3 patients and juvenile type in 1 patient. Even though it is extremely rare, bone metastases were present in one of our patients. Liver metastases were also detected in one patient. The MRI examination of tumors revealed a heterogeneous solid mass that contained cystic components in 3 patients. In one of our patients, the tumor had a multiseptated cystic feature, and all of the tumors were ovoid or round with smooth margins. T1 signal hyperintensity, not suppressed on fat saturation sequences, was observed in 3 patients, which represents its hemorrhagic content. Conclusion: Even though granulosa cell tumor shows a wide spectrum in terms of tumor appearance, some common findings have been shown and especially a hemorrhagic content could be a clue for us. The tumor is known to have a good prognosis, but it may have an unpredictable clinical course, so close follow-up is greatly important.

Lactose intolerance (LI) is characterized by the presence of symptoms, mainly gastrointestinal, due to the colonic fermentation of lactose not absorbed by lactase enzyme deficiency. Lactase deficiency can be primary, congenital, or adult type lactase deficiency, and secondary to other pathologies that involve a loss of enzyme activity. The prevalence of adult type lactose malabsorption varies depending on ethnicity and geographic location. In Europe it is related to the presence of two single nucleotide polymorphisms (SNP C / T-13910 and G / A-22018). What is the best technique for its diagnosis, especially with what dose the provocation should be done and for how long it should be performed, is still under discussion. The clinical symptomatology in lactose intolerance is modified by the load of the lactose substrate, the activity of the lactase enzyme, the speed of intestinal transit, the rate of gastric emptying and colonic compensation. Some LI do not present symptoms after usual amounts of milk intake, mainly of yogurt and cheese. In addition, the intestinal microbiota will also modify the presence and severity of symptoms. So the modification of this with biotics could be a possibility of treatment and to promote dairy products consumption.

We report a case of testicular granulosa cell tumor of adult type in a 65-year-old male patient who has presented with hepatic metastasis. Although, this type of sex cord stromal tumor is relatively common in the ovaries, it is extremely unusual in the testis, and it probably represents the rarest type of testicular sex cord stromal tumor.

Background Depression is associated with chronic physical illnesses and negatively affects health outcomes. However, it often goes undiagnosed and untreated. We investigated the prevalence of depression among adult type 2 diabetes mellitus (T2DM) patients attending non-communicable diseases (NCD) clinics in Lilongwe, Malawi, and estimated the level of routine detection by NCD clinicians. This study set out to determine the prevalence of major depression and its detection among adult type 2 diabetes mellitus (T2DM) patients attending NCD clinics in Lilongwe, Malawi. Methods In a cross-sectional study design, 323 T2DM patients aged ≥ 18 years were screened for depression with the Patient Health Questionnare-9 (PHQ-9) followed by diagnostic assessment with the Structured Clinical Interview for DSM-IV (SCID). We analysed the association between presence of major depression and sociodemographic factors using logistic regression. Results Three quarters of the participants (76%) were females. The participants’ ages ranged from 21–79 years. Of the 323 participants, 58 (18%) met criteria for DSM-IV major depression. None of the cases of major depression had been identified by the NCD clinicians. Major depression was found not to be significantly associated with any of the sociodemographic factors. Conclusions We found that depression is common among NCD clinic attendees with T2DM in Malawi, and poorly detected by NCD clinicians. Given the high prevalence and challenges in clinical identification, integration of depression screening with a standardized validated tool should be a high priority so as to link patients to appropriate services.

Amaç: Türkiye’de Çocukluk Çağı Ulusal Bağışıklama Programının kapsayıcılığı yüksektir; bu programda yer almayan rotavirüs, human papilloma virüs, meningokok, influenza ve erişkin tip boğmaca aşılarının uygulaması bağışıklama ile ilgili uzmanlar tarafından önerilmesine rağmen yaygın değildir. Bu çalışmada bu aşıların uygulanma oranının ve nedenlerinin belirlenmesi hedeflendi.Yöntemler: Ankete dayalı kesitsel bir çalışma olarak planlanan bu çalışma Orta Kuzey Anadolu’da küçük bir il merkezinde aile hekimleri ile yürütüldü. Katılımcılar tarafından elektronik posta veya telefon görüşmeleri ile sosyodemografik ve mesleki özelliklerini, Çocukluk Çağı Ulusal Aşı Programı dışındaki aşılar konusunda tutumlarının sorulduğu anket formları dolduruldu. Bulgular: Çalışmaya 108 aile hekiminin 78’i (%72) katıldı. Rotavirus aşısı hem günlük çalışma hayatında, hem de Ulusal Aşı Takvimi’ne dahil edilme önerisi konusunda en yaygın aşı idi. Tdab her iki durumda da en az önerilen aşı idi. Takvimde olmayan aşıların uygulanmaması konusunda en sık neden olarak hekimlerin konuyla ilgili bilgi ve deneyimlerinin yetersiz olması saptandı.Sonuç: Aşılar enfeksiyon hastalıklarından korunmanın en güvenilir ve ucuz yoludur, bu hizmetlerin sahada yürütülmesini sağlayan kaptanlar aile hekimleridir. Onların bağışıklama ile ilgili güncel bilgi ve gelişmelere ulaşmasını sağlamak için eğitim programları düzenlenmelidir. Çocuk sağlığı izlemelerinde Sosyal Pediatri hekimleri bağışıklama konusunda danışmanlık verebilir. Ek olarak, bu aşılar sosyal güvenlik sisteminin geri ödeme kapsamına alınmalıdır., Aim: The National Immunization Schedule (NIS) of Childhood has high coverage, but the administration of non-NIS vaccines (rotavirus, human papilloma virus, meningococcal, influenza, adult type pertussis vaccines [Tdap]) is not widespread in Turkey, despite recommendations by immunization experts. This report intended to explore the administration rates of these vaccines and their reasons in this province. Methods: This questionnaire based cross-sectional study was conducted in a small city in middle northern Turkey. The target population was the family physicians of this city. The participants filled a survey containing questions about their sociodemographic and professional features and attitudes about non-NIS vaccines via email or telephone interviews.Results: Seventy-eight (72%) of 108 physicians were enrolled in the study. The most and least recommended vaccines in daily practice and for addition to NIS were rotavirus and Tdap vaccines, respectively. The main reason of not administrating non-NIS vaccines was lack of knowledge and experience.Conclusion: Vaccination is the safest and cheapest way of protecting from infectious diseases. Family physicians are the leaders of these procedures in the field. Education should be provided to help them reach current knowledge regarding immunizations. Community pediatricians can provide expert consultation. These vaccines should be covered by social security.

Hypertension (HPT)is most common co-morbidity among type-2 diabetes mellitus (T2DM) patients which ominously increased their morbidity and mortality from cardiovascular disease (CVD)

Introduction: Although childhood obesity is related to incident adult type 2 diabetes (T2DM), whether other childhood risk factors relate to T2DM is not clear and no childhood risk score has been established to help with prediction of T2DM. Methods: We examined childhood risk factors in The International Childhood Cardiovascular Cohort (i3C) Consortium with a goal of developing a risk score for predicting adult T2DM. The pooled datasets included childhood measurements during the 1970s to 1990s. Participants were re-contacted at mean age 40 yr and completed a health questionnaire including self-report of adult T2DM (occurrence age, medication use). Results: N = 4,425 i3C participants with measurements during ages 3-19 yr. 225 (5.1%) reported onset of T2DM between ages 20-55 (mean 38.4) years (82% reported use of a valid antidiabetic medication). After stepwise regression, age-sex standardized deviates (mean of all repeated measures during ages 3-19 yr) of body mass index (BMI), glucose and ln(insulin) were associated with incident T2DM; the unadjusted risk curves visibly steepened at about 0.75 standard deviates (Figure, top panel). In multivariable models, BMI, glucose and ln(insulin) in a single model were associated with adult T2DM after adjustment for sex, race, cohort, and individual mean childhood age and calendar year. Prediction of incident T2DM was directly related to the number of the three risk factors with levels above +0.75 standard deviates (0: 3.2% (96/2966), 1: 6.2% (63/1,012), 2: 14.3% (56/392), 3:18.2% (10/55); the corresponding adjusted HR (95%CI) for the counts were 1 (reference), 1.8 (1.3, 2.4), 4.7 (3.3, 6.5), and 6.7 (3.5, 13.1), respectively). The +0.75 standard deviates in natural units are given in the Figure (bottom panel), e.g. about 92 mg/dL for glucose at age 12-14. Conclusion: The study suggests that a childhood risk score composed of BMI, glucose and insulin is a strong predictor of adult T2DM. Provisionally suggested cutpoints are lower than currently defined normal.

Purpose Patients with diabetes and health care professionals (HCPs) play important roles in effective application of injectable antidiabetic therapies (IATs). However, their concerns and opinions on IATs are rarely investigated in China. This study aims to assess unmet medical needs of IATs regarding patient concerns, patient satisfaction, aspects that need improvement, and training burden from patient and HCP perspectives. Methods This cross-sectional survey was conducted in 12 representative Chinese cities from December 2018 to January 2019. Patients with adult type 2 diabetes who were receiving IAT currently and had received IAT continuously for at least 1 month before the survey, endocrinologists with ≥5 years of experience and prescribing IAT in the past 1 month, and nurses with ≥3 years of experience and providing IAT training in the past 1 month were eligible participants. The patient survey assessed concerns of initiating IAT, satisfaction with IAT, aspects of IAT that need improvement, and IAT training received. The HCP survey evaluated patient concern of initiating IAT, aspects of IAT that need improvement, experience of providing IAT training, and self-reported burden of training. Descriptive statistical analysis was performed. Findings In total, 500 patients, 200 endocrinologists, and 100 nurses were surveyed. The mean (SD) age of patients was 55.1 (11.8) years, with a disease duration of 7.6 (6.4) years. Of all patients, 391 (78.2%) were insulin users and 109 (21.8%) were glucagon-like peptide 1 receptor agonist users. Of the top 4 concerns about initiating IAT, both patients and endocrinologists reported inconvenience of daily injection (58.0% of patients and 68.5% of endocrinologists), worries about insulin dependence (42.6% of patients and 62.5% of endocrinologists), and fear of injection (37.0% of patients and 66.5% of endocrinologists). Medical expenses, convenience of drug portability and storage, and injection site reactions were the top 3 aspects that need improvement according to both patients and HCPs. High injection frequency was also one of the most urgent aspects for improvement (mean urgency score, 3.8 for physicians and 4.0 for nurses). A typical IAT training session took a mean (SD) of 14.1 (9.7) minutes. Both patients and HCPs considered injection operation after dose is set and symptoms and treatment for adverse effects as the 2 most time-consuming training contents. In addition, 97.1% of endocrinologists who provided training and 97.0% of nurses thought a more user-friendly IAT would reduce their training burden. Implications Study results indicate that the IATs with more convenient drug portability and storage, fewer injection site reactions and adverse events, less injection frequency, more user-friendly design, and fewer steps for injection might help improve patient experience with self-injection and reduce HCPs’ training burden.

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare cardiac malformation accounting for 0.25% of congenital heart diseases with reported incidence of 1 in 300,000 live births. It frequently occurs as an isolated defect and is associated with early infant mortality and sudden death in adults. Surgical repair is the treatment of choice and should be done soon after diagnosis. We report the case of a 38-year-old female, presenting as cardiac arrest and being finally diagnosed as adult ALCAPA. Successful surgical repair was performed using the trap door technique. The patient had an uneventful recovery.

Bakground and objective: To compare the efficacy of two strategies of blood pressure (BP) measurement-based follow-up in hypertension and albuminuria control. Patients and methods: Multicentre, prospective, randomized, open trial with a parallel-group design. Nineteen primary care centres and a hospital clinic participated. Adult type 2 diabetics with systolic BP ≥140 mmHg without relevant renal disease were randomized to one of two follow-up strategies: (1) standard follow up, with a clinic BP target

Background and aim The aims of this study were to establish consensus on service delivery models for management of Type III intestinal failure (IF) and home parenteral nutrition (HPN) within the Australian health-care system and to identify barriers and enablers in moving towards this ideal model. Methods A modified Delphi methodology was utilized to survey experts working in Type III IF HPN. The panel comprised physicians, dietitians, nurses, and pharmacists from 18 of the 20 adult Type III IF HPN centres across Australia. The study consisted of two rounds of email administered questionnaires developed around four key areas of health service delivery: access to services, clinical care, service guidance, and models of care. Open-ended responses were evaluated via an inductive thematic approach to identify areas of consensus. Experts reviewed the final report to consolidate consensus and validity. Results There was >80% consensus that an ideal team should consist of a physician, nurse, dietitian, pharmacist, and access to psychological support. Consensus supported the need for updated guidelines (75%) and a hub and spoke model of care (82%). However, further consultation is required in order to establish consensus around the use of HPN in the palliative oncology setting (69%). Conclusions This consensus provides a framework within which health professionals, managers, policy-makers, and consumer groups can move towards optimal management for Type III IF HPN patients. Advocacy and a review of service delivery across Australia are now required to facilitate the ideal model of care identified.

Late-onset Pompe disease (LOPD) is an adult type of classical Pompe disease and presents without cardiomyopathy. Neuroimaging in LOPD is typically limited to posterior circulation and involves dilative arteriopathy, especially dolichoectasia and intracranial aneurysms. We report an interesting case of an established diagnosis of asymptomatic LOPD in a young man with a restrictive-variant pattern in posterior vasculature. We discuss the clinical presentation, neuroimaging, existing literature, and prognosis in vascular variants of LOPD.

Background: Paediatric HIV infection is different from the adult type of disease in many ways, including transmission routes, clinical findings and treatment strategies. Aims: To evaluate clinical data of paediatric patients with HIV disease. Study Design: Retrospective cross-sectional study. Methods: The charts of 22 paediatric patients diagnosed with HIV infection in our clinic during a 14 year period through 2001-2015 were retrospectively analysed. Clinical data, laboratory findings, treatment modalities and outcomes were recorded. Results: The mean age of diagnosis 61.9±49.2 months and the mean follow-up period was 60.3±37.5 months. Seven patients (31.8%) were foreigners and the most common transmission route was vertical transmission (n=16, 72.7%). The most common presenting symptom and the sign were history of recurrent upper respiratory tract infections (n=8, 36.4%) and lymphadenopathy (n=12, 54.5%), respectively. Recurrent pneumonia (n=6, 27.3%), prolonged fever (n=5, 22.7%), recurrent otitis media (n=4, 18.2%), and gastroenteritis (n=4, 18.2%) were other clinical symptoms. Other than bacterial sinopulmonary infections, tuberculosis was the most frequent opportunistic infection (n=3, 13.6%). Mortality occurred in two patients (9.1%). Conclusion: Although mostly vertically transmitted, HIV infection may be diagnosed throughout the childhood. Frequently encountered signs and symptoms may be the reason for doctor admission. High clinical suspicion together with detailed anamnestic data and physical findings constitute the basis for pediatric HIV diagnosis.

Background: Diabetes mellitus (DM) is a complex multi-system disorder that may lead to diabetes specific complications and target organ damage which can be prevented or delayed by good or strict glycemic control. Our aims were to evaluate the glycemic status of adult type 2 DM (T2DM) patients on different anti-diabetic management, to evaluate role of education and economic status on glycemic control and to correlate glycemic status with complications.Methods: This cross-sectional study was conducted in BIRDEM General Hospital from November 2013 to April 2015. Data were collected in a pre-formed data collection form, purposively and consecutively from 300 T2DM patients who were diagnosed as diabetic for 3 months or more and were compliant, after face to face interview and undergoing the required physical examinations. Then data were compiled and analyzed accordingly.Result: Neither the educational level nor the monthly income had any influence on glycemic control. Only 17% of the patients had good glycemic control (HbA1c

Neonates are given anaesthesia for multiple surgeries, however coupling neonatal physiology with child physiology is a common error made. Circulation changes at birth from the foetal to adult type, but neonates are prone to revert to foetal circulation with disastrous effects. This phenomenon is known as flip flop or YoYo circulation. We report a case of a premature neonate, being operated for intestinal perforation, with Yo Yo circulation intraoperatively. Keywords: Neonate anaesthesia, Flip flop circulation, Yo Yo circulation, Neonatal surgery, Desaturation, Hypoxia.

Histopathologically adult extracardiac rhabdomyoma is a benign tumour of mature striated muscle. It is a slow- growing tumour with predilection to occur in head and neck region. They appear mainly as a solitary lesion, and about 15% of them can be multicentric. A 56-year-old man presented to us with the floor of mouth swelling persisted for one year and the right neck swelling for three years mimicking a plunging ranula. Radiological imaging revealed enhancing mass at the floor of mouth and submandibular region. The mass represented a nonvascular benign tumour. Subsequently, the patient underwent excision of the mass via transcervical and transoral method. Histopathological examination revealed adult type of extracardiac rhabdomyoma. Adult type of extracardiac rhabdomyoma should be considered in the differential diagnosis for the head and neck masses. A complete excision will reduce the risk of recurrence.

Split cord malformation (SCM) is a rare form of spinal dysraphism wherein the spinal cord is divided longitudinally into two distinct hemicords. Surgery is usually performed in children while management in adults, who rarely manifest symptoms, remains controversial. Both expectant management and prophylactic surgery have been variously advocated. The present article describes our experience in two adult patients with predominant pain-related complaints who underwent surgical excision of type 1 SCM lesions. A comprehensive review of the literature on SCM in adults is also provided. While pain, disability, and quality of life scores improved in these two patients, further larger studies will be required to define the role of surgery in adults with type 1 SCM and a pain-dominant presentation.

Author(s): Nianogo, Roch A; Arah, Onyebuchi A | Abstract: BACKGROUND:The contribution of childhood obesity to adult type 2 diabetes (T2DM), not through adult adiposity, as well as the causal pathways through which childhood obesity increases adult T2DM risk are not well understood. This study investigated the contribution of childhood obesity to incident T2DM including pathways not through adult adiposity, and explored whether race modified this contribution. METHODS:We used data from the Virtual Los Angeles Cohort, an agent-based longitudinal birth cohort composed of 98,230 simulated individuals born in 2009 and followed until age 65 years. We applied the parametric mediational g-formula to the causal mediation analysis investigating the impact of childhood obesity on the development of adult T2DM. RESULTS:The marginal adjusted odds ratio (aOR) for the total effect of childhood obesity on adult T2DM was 1.37 (95% CI = 1.32, 1.46). Nearly all the effect of childhood obesity on adult T2DM was mostly attributable to pathways other than through adult obesity; the aOR for the pure direct effect was 1.36 (95% CI = 1.31, 1.41). In all racial subpopulations, a similar 3% of the total effect of childhood obesity on adult T2DM was attributable to its effect on adult obesity. CONCLUSIONS:Childhood obesity remains a risk factor for adult T2DM separate from its effects on adult obesity. This study emphasizes the potential benefits of early interventions and illustrates that agent-based simulation models could serve as virtual laboratories for exploring mechanisms in obesity research.

Background: Coronary artery disease is a major cause of morbidity and mortality globally as well as in Pakistan. The objective of the study was to compare the frequency of triple-vessel coronary artery disease (triple-vessel CAD) in adult type 2 diabetics versus non-diabetics in coronary artery disease (CAD) population of Islamabad, Pakistan. Materials and Methods: This cross-sectional study was conducted in Department of Cardiology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan from June 21, 2016 to December 20, 2016. 300 patients were selected from population including adult CAD patients who were candidates for coronary angiography. Those with conduction defects, renal failure and prior CABG surgery were excluded. 150 diabetics and 150 non-diabetics were subjected to coronary angiography. Age, sex and presence of triple-vessel CAD were research variables. Age was analyzed by mean and SD while sex and presence of triple-vessel CAD were analyzed by count and percentage for each group separately. Confidence interval for proportion was calculated at 80% confidence level for each group. Frequency of presence of triple-vessel CAD in two groups was compared using McNemar chi-square test at alpha 0.5. Results: Mean age was 55.02±8.48 for diabetics and 54.02±24.4 years for non-diabetics. Out of 300 patients with CAD, 184 (61.33%) were men and 116 (38.67%) were women. Triple-vessel CAD was present in 60/150 (40%) cases in diabetics and in 3/150 (2%) cases in non-diabetics. Frequency of triple-vessel CAD was significantly higher in adult type 2 diabetics versus non-diabetics in CAD population of Islamabad, Pakistan (p

Introduction: The role of infant fat growth in childhood obesity and adult type 2 diabetes is not clear. We have previously used latent class analysis (LCA) to identify four distinct fat mass (FM) growth patterns in early infancy. Here we examine their associations with adiposity and cardiometabolic outcomes at 5 years (y) of age. Methods: Air Displacement Plethysmography (ADP) was used to repeatedly measure FM from 0-6 months of age in a cohort of 314 healthy urban-living Ethiopian infants and LCA was used to identify FM growth patterns (catch-up, accelerated, average and delayed) (Figure 1). At 5y of age, cardiometabolic outcomes were obtained from ADP and blood samples. Multiple linear regression was used to examine associations between infant FM growth patterns and cardiometabolic outcomes at 5y, adjusted for gender, birthweight, breastfeeding, maternal age and education and SES. Results: Overall mean (SD) BMI at 5y was 14.98 (1.19) kg/m2. Compared to children with an “average fat” growth pattern, children with a "catch-up fat" pattern had significantly higher BMI (0.79 kg/m2 [95% CI, 0.04; 1.54]) and FMI (0.69 kg/m2 [95% CI, 0.06; 1.37]), but not FFMI (0.05 kg/m2 [-0.51; 0.62]) at 5y of age (Figure 1). There were no differences in any other cardiometabolic outcomes. Conclusions: Fat catch-up growth in early infancy was associated with a higher BMI in childhood, which was almost entirely fueled by increased adipose tissue. Disclosure G.S. Andersen: Stock/Shareholder; Self; Novo Nordisk Inc. R. Wibaek: None. B. Admassu: None. D. Vistisen: Stock/Shareholder; Self; Novo Nordisk A/S. M.E. Jørgensen: Research Support; Self; Amgen Inc., AstraZeneca, Danish Diabetes Association, Sanofi-Aventis. Stock/Shareholder; Self; Novo Nordisk A/S. K.F. Michaelsen: None. J.C. Wells: None. H. Friis: Research Support; Self; Arla Food for Health. Funding Danish Council for Strategic Research; Danida (104.Dan.8-1207); Danish Diabetes Academy; Innovation Fund, Denmark

Introduction Vitamin D was associated with the pathogenesis, treatment and prognosis of type 1 and type 2 diabetes mellitus. The aim of this study is to assess vitamin D status of Turkish adult type 1 DM patients and compare them with health controls and also to assess the relationship of vitamin D and glycemic control. Method Study was designed as cross-sectional and conducted in a tertiary Hospital diabetes unit. 296 type diabetic patients and 151 healthy controls was included to the study. Venous samples were collected into plain tubes after overnight fasting. Serum 25-hydroxyvitamin D level was measured by radioimmunoassay technique. Statistical analysis was performed with SPSS 15.0. Results 25-Hydroxyvitamin D levels were similar between patients with type 1 diabetes (22, 9 ± 17, 4 ng/ml) and controls (24, 5 ± 19, 3 ng/ml) (p = 0,382). Most of the participants have 25-Hydroxyvitamin D deficiency. As shown in Table 2 serum 25-Hydroxyvitamin D level was not associated with most of the biochemical or anthropometric parameters. Conclusion As a result there were no difference between type 1 diabetics and healthy controls according to their vitamin D levels. Further studies with a larger sample of patients will improve our understanding of the relation of vitamin D and diabetes.

5567 Background: The FDA has separately approved pembrolizumab for all advanced solid tumors with either microsatellite instability or high tumor mutational burden (≥10 mutations per megabase), and homologous recombination deficiency is an established biomarker for response to poly ADP ribose polymerase inhibitors in epithelial ovarian cancer. The detection of these predictive biomarkers in adult-type ovarian granulosa cell tumors could identify novel treatment strategies in this rare disease. The primary objective of this study was to determine the prevalence of established predictive biomarkers among molecularly defined adult-type ovarian granulosa cell tumors. Methods: With institutional review board approval, we performed a cross-sectional study examining de-identified FoundationOne companion diagnostic molecular profiles for 423 women with molecularly defined (FOXL2 c.C402G positive) adult type ovarian granulosa cell tumors. The dataset was comprised of coding variants for up to 406 genes as well as genomic signatures including microsatellite instability, tumor mutational burden, and genome wide loss of heterozygosity. PD-L1 expression by immunohistochemistry was also available for a subset of tumors. Descriptive statistics were used for comparison between groups and all statistical tests were two-sided. Results: Women in this cohort had a mean age of 57 years (range 24-87) at the time of sample submission for molecular profiling. The median tumor mutational burden was 1.3 mutations per megabase [mut/Mb] (range 0-8.8 mut/Mb). TP53-mutated aGCT had a higher tumor mutation burden than TP53 non-mutated tumors (median 2.4 mut/Mb, 95% CI 1.7-3.0 mut/Mb vs median 1.3 mut/Mb, 95% CI 1.5-1.9 mut/Mb; P=.02). All 384 tumors with available microsatellite instability testing were microsatellite stable. Sixty-seven tumors had PD-L1 expression measured and of these 94% (63/67) were negative with the remainder “low positive.” No tumors were positive for genome wide loss of heterozygosity. Apart from FOXL2 c.C402G, the most frequent short variants were TERT promoter mutations (-124C>T: 190/423, 45.0%; -146C>T: 39/423, 9.2%). Other frequently observed variants included truncating mutations in KMT2D/MLL2 (71/423, 16.8%), pathogenic TP53 mutations (35/423, 8.3%), CDKN2A/B deletions (43/423, 10.2%), and activating PIK3CA mutations (23/423, 5.4%). Conclusions: No women with molecularly defined adult-type ovarian granulosa cell tumors in this large cross-sectional study would be eligible for FDA-approved pembrolizumab based on either microsatellite instability or high tumor mutational burden. No tumors exhibited evidence of homologous recombination deficiency and molecularly targetable mutations were rare. The development of novel precision treatment options remains a critical unmet need for this rare disease.

Objective. Adult-type ovarian granulosa cell tumors (AGCTs) have an unpredictable tendency to relapse. In a carefully validated patient cohort, we evaluated the prognostic factors related to AGCT recurrence. Methods. We identified all patients diagnosed with AGCT during 1956-2014 in Helsinki University Hospital, with a minimum follow-up of one year (n = 240). After a histological review supplemented with FOXL2 (402C G) mutation status analysis, we analyzed the clinical data for association with relapse. Results. The final cohort included 164 (68%) molecularly defined AGCTs (MD-AGCTs). The majority of the women were postmenopausal (63%), and 92% of tumors were stage I. The median follow-up time was 15.5 years. Fifty-two (32%) patients developed tumor recurrence, of whom 55% had successive recurrences. Multiple-site recurrences were common, and nearly half of the recurrences were asymptomatic. The median time to the first relapse was 7.4 years, and 75% of relapses occurred within ten years after primary diagnosis. The median disease-free survival was 11.3 years. Premenopausal status at initial diagnosis, FIGO stage Ic versus la, and tumor rupture associated with relapse. However, tumor rupture was the only independent predictive factor. Of the relapsed patients, 48% died of AGO' in a median time of 153 years. Conclusion. Tumor rupture is the strongest predictive factor for recurrence, and these patients might benefit from a more aggressive initial treatment approach. AGCT requires active follow up for 10 to 15 years after primary diagnosis, since recurrences may develop late, asymptomatically and in multiple anatomical locations. (C) 2016 Elsevier Inc. All rights reserved.

Purpose The purpose was to compare perceived self-management practices of adult type 2 diabetic patients after completing an American Diabetes Association (ADA) certified diabetes self-management education (DSME) program with unstructured individualized nurse practitioner led DSME. Methods Demographic questions and the Self-Care Inventory-Revised (SCIR) were given to two convenience sample patient groups comprising a formal DSME program group and a group within a clinical setting who received informal and unstructured individual education during patient encounters. A t -test was executed between the formal ADA certified education sample and the informal sample's SCI-R individual scores. A second t -test was performed between the two samples' SCI-R mean scores. Results A t -test determined no statistically significant difference between the formal ADA structured education and informal education samples' SCI-R individual scores. There was not a statistically significant difference between the samples' SCI-R mean scores. Discussion The study results suggest that there are not superior DSME settings and instructional approaches.