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Introduction: The most common causes of congenital abnormalities reported in newborns is duodenal obstruction. There are several conditions which may lead to worsen the patient’s prognosis are prematurity, type of obstruction and the type of surgery performed. The major objective of the present study was to summarise our clinical experience with 34 infants with duodenal atresia who underwent surgical procedures over the past 20 years. Materials and Methodology: Of the total of 96 patients, those who were reported with the diagnosis of duodenal atresia were included in the study. And this group comprised of 34 patients. The group was compared in terms of sex, birth weight, age at the time of the operation and morbidity rates. All patients were assessed by neonatal and other relevant specialists when observed to be presented with additional anomalies. Data were analysed using SPSS software (ver. 15.0; SPSS Inc., Chicago, IL, USA). Results: Of the 34 patients, 22 were males and 12 females, with a mean birth weight of 2.282.92 ± 592.98 (range, 1,180-3,400) g. The average age at the time of the operation was 6.98 ± 5.09 (range, 1-38) days.

The Diversity, Equity, and Inclusion (DEI) committee of the American Association of Clinical Endocrinology (AACE) performed a survey whose aim was to explore characteristics of our membership, members' definitions, perceptions, and experiences with DEI in the endocrinology community, and future directions for the organization in this arena.A cross-sectional study was conducted consisting of an anonymous, self-administered online questionnaire that captured members' demographic and professional data and assessed their responses to questions about DEI in the endocrinology community. The questionnaire was sent to all AACE members (n=4,079) during May and June 2021. A descriptive analysis was performed, and variables were cross-tabulated to find significant associations.Four hundred thirty members completed the survey (response rate, 10.5%). Respondents considered a wide array of demographic variables in their definition of diversity, and most perceived the endocrine community to be diverse. Almost half of respondents reported discrimination in their workplace, with women being more likely to report it. Respondents prioritized addressing health care inequities, providing a mentorship program, and providing educational material and resources about DEI as the highest priorities for the organization in this space.AACE DEI survey data revealed a diverse AACE membership. Member perspectives will aid in creating a roadmap to broaden DEI among the greater endocrine community.

Introduction: Though the upper gastro-intestinal bleeding is relatively uncommon condition in children who are admitted in paediatric intensive care unit (PICU) but it continues to pose a critical challenge in the management. This present study was undertaken to assess the prevalence of gastrointestinal bleeding due to stress and its associated risk factors. Materials and Methodology: All the available medical records of the children who are younger than 15 years admitted to the PICU were retrospectively studied. The basic indications for the in-patient admission comprised of respiratory/cardiovascular failure, shock, coma, post-operative care and patients requiring intensive monitoring. Demographic data, indications for PICU admission and principal diagnosis as well as basic laboratory investigations were recorded. Cross-tabulations were analysed using the chi square test, represented as the odds ratio and 95% confidence interval, in which P < 0.05 was considered statistically significant. Results: A total of 200 charts were eligibly reviewed. There were 89 males (52.4%) with an average age of 3.8 years. The most common indication for PICU admission was respiratory failure (48.8%). GI bleeding complicated 43.5% of cases admitted to the PICU and 5.3% had clinically significant bleeding.

Objective: The objective of this Expert Consensus Statement is to assist clinicians in achieving remission of type 2 diabetes (T2D) in adults using diet as a primary intervention. Evidence-informed statements agreed upon by a multi-disciplinary panel of expert healthcare professionals were used. Methods: Panel members with expertise in diabetes treatment, research, and remission followed an established methodology for developing consensus statements using a modified Delphi process. A search strategist systematically reviewed the literature, and the best available evidence was used to compose statements regarding dietary interventions in adults 18 years and older diagnosed with T2D. Topics with significant practice variation and those that would result in remission of T2D were prioritized. Using an iterative, online process, panel members expressed levels of agreement with the statements, resulting in classification as consensus, near-consensus, or non-consensus based on mean responses and the number of outliers. Results: The expert panel identified 131 candidate consensus statements that focused on addressing the following high-yield topics: (1) definitions and basic concepts; (2) diet and remission of T2D; (3) dietary specifics and types of diets; (4) adjuvant and alternative interventions; (5) support, monitoring, and adherence to therapy; (6) weight loss; and (7) payment and policy. After 4 iterations of the Delphi survey and removal of duplicative statements, 69 statements met the criteria for consensus, 5 were designated as near consensus, and 60 were designated as no consensus. In addition, the consensus was reached on the following key issues: (a) Remission of T2D should be defined as HbA1c Conclusion: Expert consensus was achieved for 69 statements pertaining to diet and remission of T2D, dietary specifics and types of diets, adjuvant and alternative interventions, support, monitoring, adherence to therapy, weight loss, and payment and policy. Clinicians can use these statements to improve quality of care, inform policy and protocols, and identify areas of uncertainty.

Anemia continues to affect one-third of the global population and is one of the most common reasons for large-scale morbidity and mortality especially among women. The importance of iron-rich diet has always been the backbone of preventing iron deficiency anemia (IDA) in vulnerable age groups followed by oral iron therapy and parenteral iron therapy as the next options in management of iron deficiency.Objective of this survey was to assess the knowledge, attitude and practices of obstetricians and gynaecologists relevant to anemia in pregnancy and identify the practice gaps in management of anemia in pregnancy.This was a knowledge, attitude and practice (KAP) survey involving obstetricians and gynaecologists (ObGyns) across India. A validated questionnaire of twenty questions was used to assess knowledge, attitude and practice about anemia and its management. Results were expressed as percentages.1974 ObGyns participated in the survey. 88.7% ObGyns screen anemia in first trimester, 53.7% ObGyns perform CBC along with RBC indices. Majority of ObGyns estimate Hb thrice during antenatal period. 50% ObGyns do not consider thalassemia screening routinely and deworming regularly. 92.4% ObGyns believe that iron supplementation is required even if Hb 11 g/dL. Majority of them prefer low-dose iron therapy, 59.9% prefer to use 100 mg oral iron daily. Almost half of ObGyns prefer to change iron salt when patients do not respond, instead of escalating to injectable iron. Interestingly 52% ObGyns evaluate serum ferritin before starting intravenous iron therapy. 43.5% perform Hb estimation as early as 2 weeks after IV iron therapy. Majority (82.2%) of ObGyns prefer blood transfusion as a treatment of choice when Hb 5 g/dl at 34 weeks gestation. Only 40.5% of participants are aware of the exact cut-off for diagnosing postpartum anemia. Majority of the ObGyns are aware of the iron prophylaxis in postpartum period till 3-6 months. More than 90% ObGyns consider intravenous iron for severe anemia of postpartum period.The present KAP survey highlights the observation, perception and the practicing behaviour of obstetricians and gynaecologists on anemia in pregnancy and identifies practice gaps in anemia management.

Despite the effectiveness of COVID-19 vaccination in reducing the severity of the disease, the demand for booster is increasing in vulnerable populations like elderly and immunocompromised individuals especially with each new wave of COVID-19 in different countries. There is limited data on the sustained immunity against COVID-19 in patients with liver cirrhosis. The study was aimed to compare the T-cell and humoral immune response after one year of ChAdOx1nCoV-19 Vaccine in patients with liver cirrhosis and healthy health-care workers (HCW). This was a prospective observational study including 36 HCW,19 liver cirrhosis patients and 10 unvaccinated individuals. Anti-SARS-CoV-2S antibody, neutralizing antibody and memory T-cell subsets were evaluated by ELISA and flow cytometry respectively in all three groups after one year of initial vaccination. Compared to HCW and unvaccinated individuals, liver cirrhosis patients had significantly depleted T-cells, although CD4:CD8+ T-cell ratio was normal. Significant difference was noted in various memory subsets [effector memory RA (P= 0.141, P= 0.000), effector memory (P= 0.000, P= 0.00), central memory (P= 0.000, P= 0.00), stem cell memory (P= 0.009, P= 0.08) and naïve (P= 0.000, P= 0.02)] of CD4+T and CD8+T respectively. However, on post-hoc analysis no difference was noted in the extent of memory T-cells between cirrhotic patients and HCW. Patients with liver cirrhosis developed comparable memory T-cells after vaccination which can evoke sustainable immune response on reinfection. Therefore, additional vaccine doses may not be necessary for cirrhosis patients.

Objective Obesity is globally recognized as a critically important disease by professional medical organizations in addition to the World Health Organization and American Medical Association, but the health care systems, medical teams, and the public have been slow to embrace this concept. Methods American Association of Clinical Endocrinology (AACE) staff drafted the survey, and two endocrinologists independently reviewed the survey questions and modified the survey instrument. The survey included inquiries related to practice and patient demographics, awareness of obesity, treatment of obesity, barriers to improving obesity outcomes, digital health, cognitive behavioral therapy, lifestyle medicine, anti-obesity medications, weight stigma, and social determinants of health. The survey was emailed to 493 endocrinologists, with 305 completing the study (62%). Results Ninety-eight percent of the responders agree that obesity is a disease, while 2% neither agree nor disagree. 53% of respondents are familiar with the term "adiposity-based chronic disease." 13% of the respondents are certified by the American Board of Obesity Medicine (ABOM). 57% of the respondents use published obesity guidelines as a resource for treating patients with obesity. Most endocrinologists recommend dietary and lifestyle changes, but fewer prescribe anti-obesity medication (AOM) or recommend bariatric surgery. ABOM-certified endocrinologists are more likely to use a multidisciplinary approach. Conclusion Self-reported knowledge and practices in the management of obesity highlight the importance of a multimodal approach to obesity and foster collaboration among healthcare professionals. It is necessary to raise awareness about obesity among clinicians, identify knowledge gaps and create educational tools to address those gaps.

OBJECTIVE The objective of this study was to develop a simple and practical guide for discussing and managing obesity in primary care settings. METHODS This study convened representatives from 12 primary care and obesity specialty organizations for a series of roundtable meetings to discuss the key components of obesity treatment in primary care. Attendees identified the need for a guide for primary care providers that outlined the key steps for discussing obesity with patients and managing their care while recognizing the significant time constraints on such provider/patient encounters. RESULTS Prevailing themes from the roundtable sessions suggested that the key components of addressing obesity in primary care settings are obtaining patient permission, addressing weight bias, providing a diagnosis, and emphasizing shared decision-making. A modified "6A" framework with the steps "Ask," "Assess," "Advise," "Agree," "Assist," and "Arrange" was deemed appropriate to organize the process of weight management in primary care. An algorithm was developed to provide a script for the patient/provider encounter. CONCLUSIONS The expert panel developed a short, accessible, practical, and informative guide for obesity management by primary care clinicians. Efforts are under way to disseminate the guide to primary care providers through the 11 participating organizations that have endorsed it.

Background and objectives Iodine plays a critical role in fetal brain development and hence has immense importance during pregnancy. Even mild to moderate iodine deficiency in pregnancy has adverse effects on obstetric and neonatal outcome. So, the aim of this study was to assess the trimester-wise urinary iodine status of pregnant women in rural areas and determine their iodine intake. Methods A cross-sectional study was conducted in Sarojini nagar, which is a rural block of Lucknow, Uttar Pradesh from August 2016 to July 2017. All married pregnant women (15–45 years) of different trimesters attending the primary health centre (PHC) for antenatal check-up were enrolled in the study after written consent. Total 300 pregnant women were interviewed for Knowledge, Attitude and Practice (KAP) survey. Urine and salt sample was taken from 200 of them for biochemical analysis of iodine. Estimation of iodine in urine was done by wet digestion method and in salt by iodometric titration. Results The median urinary iodine concentration of the rural pregnant women was 246.5 μg/L with IQR of 194.9–383.4 μg/L. On comparing the urine iodine levels in the three trimesters, maximum deficiency was observed in first trimester (39.5%) followed by third trimester (31.6%) and a dip was seen in the second trimester (28.9%). The median urinary iodine levels did not show a significant difference across the three trimesters. Conclusion Iodine insufficiency was observed among pregnant women. Maximum deficiency was observed in first trimester which is the most vulnerable period of gestation responsible for organogenesis and fetal brain development.

OBJECTIVES: To evaluate β-hCG concentration in vaginal fluid as a biochemical marker for PPROM in suspected cases and its correlation with onset of labour. MATERIALS AND METHODS: This is a prospective case–control study carried out in tertiary care centre in 1 year. Total 150 pregnant women of gestational age 28–36 week + 6 days were included and were divided into two groups: control (Group 1) (n = 50) normal antenatal patients. Group 2 cases with history of leaking per vaginum subdivided into two groups—Group 2A—(n = 50) with no detectable leakage of amniotic fluid present on per speculum examination and Group 2B—(n = 50) with minimal leaking per vaginum present upon per speculum examination (frank leaking were excluded). β-hCG level was measured by chemiluminescent microparticle assay, and all women were followed till onset of labour. RESULTS: Mean β-hCG level in vaginal fluid was measured as 6.10 ± 8.52 mIU/mL, 57.10 ± 30.86 mIU/mL and 111.35 ± 36.01 mIU/mL in Group 1, Group 2A and Group 2B, respectively. By taking 21.5 mIU/ml as cut-off, receiver operating characteristic curve shows sensitivity 100%, specificity 92.0%, positive predictive value 92.6%, negative predictive value 100% and diagnostic accuracy 96%. Regarding the correlation of β-hCG level with onset of labour if the β-hCG level is 75 mIU/ml. CONCLUSION: β-hCG in vaginal fluid is a reliable biochemical marker for diagnosing suspected cases of PPROM and is well correlated with onset of labour.

This chapter explores the unfocused paradigm of language as a tool to bring transparency to the teaching-learning framework focusing on the unique context of India. Insights are provided on how the language used as a medium of instruction within higher educational institutions can hinder students' learning experiences and how transparency dimensions can enhance students' learning and performances. Recent developments in India, including New Education Policy 2020 and the opines of stakeholders such as educational administrators, faculty, and students, are integrated to further broaden perspectives pertaining to transparency, language, and students' learning and performances.

Background Microbiology is a critical and expansive topic that many medical schools’ curriculum must teach in a constrained time frame. We implemented a microbiology question bank smart phone app enhanced with game elements and clinical pearls during a microbiology course for first-year medical students. We hypothesized that these enhancements and clinical pearls would engage the students meaningfully and increase their knowledge base. Methods Though use was optional, students’ game play was recorded through the app, which was compared to test grades retrospectively. A player efficiency rating (PER) was calculated as a function of question response, accuracy, and engagement. Students were separated into tertiles of PER and median exam grades were compared using a non-parametric Kruskal–Wallis (KW) test. An anonymous satisfaction and usability feedback survey was also administered. Results One hundred eighty-one of the 189 students (96%) answered at least one question, and 165 (87%) completed all 56 questions. The average PER was 84.75. We received feedback surveys from 61 (34%) students in the course, with positive responses regarding the perceived impact on learning microbiology. The KW test found a positive correlation for median exam scores of the player groups when divided into tertiles by PER (p = 0.0002). Conclusions We leveraged gamification and clinical pearls to design a supplemental microbiology question bank. We found high engagement overall and higher class exam scores associated with greater use of the question bank.

The concept of blockchain is prevalent globally in today's times. It has shown remarkable growth and has shown a lot of achievement by executing systems of peer-to-peer cryptocurrency. The cryptocurrency was introduced in 2009 but created hype about digital currency around the world in 2017. Blockchain works on the concept of a “distributed ledger/database.” The transactions are recorded and replicated to all the participating parties chronologically. Blockchain has verified to be immutable and provides accountability, integrity, and quite a lot of confidentiality through a pair of private and public keys. Various sectors have started using blockchain due to its salient features. Asset management is also one of the areas where blockchain can reduce transaction costs, approval waiting time, and increase transparency. The complicated processes of asset management can be automated by unifying permissioned and permissionless blockchain. This chapter discusses how asset management firms can use blockchain opportunities to harness its benefits.

Artificial intelligence is already here in all facets of work life. Its integration into human resources is a necessary process which has far-reaching benefits. It may have its challenges, but to survive in the current Industry 4.0 environment and prepare for the future Industry 5.0, organisations must penetrate AI into their HR systems. AI can benefit all the functions of HR, starting right from talent acquisition to onboarding and till off-boarding. The importance further increases, keeping in mind the needs and career aspirations of Generation Y and Z entering the workforce. Though employees have apprehensions of privacy and loss of jobs if implemented effectively, AI is the present and future. AI will not make people lose jobs; instead, it would require the HR people to upgrade their skills and spend their time in more strategic roles. In the end, it is the HR who will make the final decisions from the information that they get from the AI tools. A proper mix of human decision-making skills and AI would give organisations the right direction to move forward.

This study was conducted to examine the difference between the industry expectations for management graduates and provides practical recommendations for strategically aligning management curricula with the proficient curricula. By identifying specific skills essential for profession success, universities can provide an improved service for their graduates and the management industry. The respondents consist of students in various fields like Business analytics, finance, Human Resources, marketing, operations, information technology etc.

Background Agranulocytosis, defined as absolute neutrophil count (ANC) < 500/µL due to antithyroid drugs (ATDs), methimazole, carbimazole, and propylthiouracil (PTU), is a rare but serious complication with an occurrence of 0.1- 0.5%. ATDs induced agranulocytosis occurs abruptly, usually in the first three months of treatment but can occur any time after initiation of treatment, and although it is more common with a higher dose of methimazole > 30 mg/day, it can also occur with lower dosages. We present a rare case of agranulocytosis in a patient with Amiodarone-induced Thyrotoxicosis (AIT) with an ANC of 0/µL. Clinical Case A 68-year-old male with atrial fibrillation and heart failure was diagnosed with AIT when he presented to ED with thyrotoxicosis. Amiodarone was discontinued. Methimazole 40 mg daily with prednisone 20 mg daily was initiated. The ANC was 4360/µL. After nine weeks on methimazole, he presented with fever and tremors. The laboratory tests during this admission revealed WBC 1310/µL (4000-11000/µL) with granulocytes 0% (35%-80%), ANC 0/µL (1820-7420/µL), TSH < 0.01 (0.45-5.3mIU/mL), free T4 5.5 (0.58-1.64 ng/dL), free T3 4.4 (2.8-4.4 pg/dL). Methimazole was discontinued and antibiotics started. He received six doses of Granulocyte colony-stimulating factor (G-CSF) Filgrastim 480 mcg with an improvement of WBC to 6370/µL with a granulocyte count of 60% on the 6th day of admission. He eventually underwent thyroidectomy for treatment of the thyrotoxicosis. Discussion The proposed mechanism of agranulocytosis with ATDs is twofold. First, there is a direct toxic effect on mature circulating neutrophils and stem cells. The second is complement-mediated antibodies against granulocytes. Furthermore, AIT is associated with a higher risk for ATD induced agranulocytosis, although the mechanism remains elusive. The most common manifestations are fever and sore throat. The management includes discontinuation of ATD and starting antibiotics. G-CSF is used to treat agranulocytosis as it decreases the recovery time, the rate of infectious complications, and the mortality rate. Patients with ANC < 100/µL have a greater risk of infectious and fatal complications than patients with ANC > 100/µL. After resolution of agranulocytosis, methimazole or any other thionamides are generally not recommended due to concern for recurrence due to cross-reactivity among thionamides. Thyroidectomy or radioiodine therapy should be considered for definitive treatment of the hyperthyroidism in this circumstance. Conclusion Due to the low incidence and abruptness of agranulocytosis from ATDs, controversy exists over the value of routine monitoring of WBC count. This case emphasizes routine WBC monitoring could be considered in patients on higher doses of methimazole, especially in the first three months, due to the increased risk of agranulocytosis. Patient education on the life-threatening complication of ATD induced agranulocytosis is vital. It helps patients recognize early symptoms and seek medical care promptly, which aids in early intervention and reduces morbidity and mortality. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Introduction The presence of rheumatism is well recognized in primary hypothyroidism. Dehydroepiandrstenedione sulphate (DHEAS) is associated with rheumatological diseases like rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). This study aims to explore relationship between joint pains and DHEAS levels in primary hypothyroidism. Methods Retrospective study of 78 subjects with subclinical hypothyroidism, with TSH within reference range. The joint pains were evaluated by European Union League against rheumatism (EULAR-CSA) score and compared with serum DHEAS, RA factor, Anti-TPO antibody, highly sensitive C-recative protein (hsCRP), vitamin D levels. Result DHEAS levels Conclusion Lower DHEAS predicts clinical features of imminent RA in subjects with primary hypothyroidism. This is akin to low DHEAS seen in many rheumatological disease with possibly similar mechanism. Another possibility is low DHEAS alters hepato-hypothalamo pituitary adrenal axis in presense of cytokines and induces a hitherto unrecognized state of pre rheumatoid arthritis like syndrome. Future studies on primary hypothyroidism should focus on role of lower DHEAS levels in inducing symptoms of fatigue and joint pains.

DNA topoisomerases have been described as ‘the magicians of the DNA world’, somehow allowing DNA strands to pass through each other. These ingenious enzymes are both essential and potentially dangerous, as any interruption in their DNA breakage-reunion reactions can lead to chromosome breaks and cell death. This has led to their development as important targets for antibacterial and anti-cancer chemotherapy.

Background: One of the common health problems affecting significant pediatric population is urinary tract infection (UTI). Due to the presence of non-specific signs and symptoms, it is very difficult to diagnose UTI in children. Objective: The objective of this study was to assess the clinical profile and risk factors of UTI among pediatric patients. Materials and Methods: It was a prospective study where a total of 50 children with UTI were included in the study. A self-framed questionnaire was given to all the pediatric subjects and their parents/guardians for recording the clinical profile and medical history. Various risk factors for the occurrence of UTIs were recorded and assessed. All the results were analyzed by SPSS software. Results: A total of 52% of the subjects were having rural residence. Hospitalization in the past 2 months was present in 10% of the patients. Constipation was a risk factor in 16% of patients. Reduced water and neglected cleaning habit were found to be a risk factor in 24% and 40% of patients. Common toilet was a risk factor in 18% of the patients. Conclusion: UTI represents a significant health problem among pediatric population. The use of common toilet, improper cleaning, and prolonged hospitalization is among the prominent risk factors associated with it.

Introduction: The opioid epidemic is a public health crisis and clinicians should be aware of the many under-recognized endocrinopathies associated with opioids. Herein, we present a case that exemplifies the endocrine-related adverse effects of methadone therapy. Clinical Case: A 43-year-old Caucasian female with chronic back pain with opioid dependence, high dose methadone use (195 mg daily), and diabetes presented with refractory hypoglycemia. She was diagnosed with ketone prone diabetes eight months prior. She had since been weaned off insulin and her most recent HbA1c was 4.2%. During this time, she had an intentional weight loss of 60 pounds. On examination, she had bilateral lower extremity pitting edema with scaly plaques on the extremities. Laboratory tests showed C-peptide of 0.8 (0.9–7.1 ng/mL), insulin level of < 2 (3–25 mcIntUnits/mL), proinsulin of 4.6 ( Discussion: The proposed mechanism of opioid-induced AI is the inhibitory effect on the hypothalamic-pituitary-adrenal axis, similar to the effect on the gonadal axis which causes hypogonadism. The risk for hypoglycemia is increased in patients taking more than 40 mg of oral methadone per day, and although the mechanism remains unclear, it is independent of adrenal function. Our patient had adrenal insufficiency and hypoglycemia related to methadone, which was further complicated by malnutrition. The glycogenic hepatopathy is a benign reversible condition that is believed to be a consequence of fluctuation in glucose levels. Conclusion: Given the life-threatening nature of adrenal crisis and the overlap in symptomatology with opiate overdose, clinicians should be prompt in evaluating for endocrinopathies in patients on chronic high dose opiates, and patients should be appropriately counseled on the potential consequences of methadone use. References: 1.Flory, J. H., et al. (2016). Methadone use and the risk of hypoglycemia for inpatients with cancer pain. JPSM, 51(1), 79–87.2.Li, T. et al. (2020). Prevalence of Opioid-Induced Adrenal Insufficiency in Patients Taking Chronic Opioids. JCEM, 105(10), dgaa499.

Background: Magnesium plays a vital role in calcium homeostasis. Magnesium sulfate is used in obstetric populations for the management of preeclampsia and eclampsia. Hypocalcemia secondary to iatrogenic hypermagnesemia is an uncommon complication. We report a case of symptomatic hypocalcemia due to hypermagnesemia. Clinical Case: A 26-year-old female with type 1 diabetes at 33 weeks gestation was admitted for preeclampsia. She had severe hypertension and proteinuria, and the decision to induce labor was made. She was started on a magnesium sulfate drip and remained on the drip for 33 hours. Magnesium levels peaked at 7.5 mg/dL (1.7–2.5 mg/dL). The magnesium drip was suspended after delivery. She complained of mild tingling and numbness in her hands, feet, and perioral area. Shortly after delivery, she had a pre-syncopal event. The laboratory evaluation revealed a calcium of 5.9 mg/dL (8.4–10.4) with an albumin of 2.2 g/dL (3.7–5.5), magnesium of 4.2 mg/dL, phosphorus 2.2 mg/dL (2.3–4.6) and GFR above 60 mL/min/1.73m2 . Spot urine calcium to creatinine ratio was 0.17 mg/dL. The 25-hydroxy vitamin D level was low at 12 ng/mL (20–100). The parathyroid hormone (PTH) level was inappropriately normal at 21.7 pg/mL (12–88). She had no history of hypocalcemia, and calcium level obtained six months before the presentation was normal. She received one calcium gluconate infusion, was then started on a continuous calcium gluconate infusion for symptomatic hypocalcemia. She also received oral supplementation of calcium and vitamin D. The calcium levels normalized within 24 hours as the hypermagnesemia resolved from the discontinuation of the magnesium drip. The subsequent PTH level was 38.8 pg/mL. She was discharged on vitamin D supplements. She had no recurrence of hypocalcemia. Conclusion: Our case highlights the effect of magnesium infusion on the parathyroid gland leading to profound symptomatic hypocalcemia. Magnesium plays an essential role in the secretion of PTH. Transient hypoparathyroidism can occur due to hypomagnesemia and hypermagnesemia (tocolytic therapy). In hypomagnesemia, the parathyroid gland secretes insufficient PTH, and the renal and skeletal response to PTH is reduced. In hypermagnesemia, the magnesium activates the extracellular calcium-sensing receptor, subsequently causing inhibition of the parathyroid gland. Amelioration of hypermagnesemia leads to the normalization of parathyroid function. Health care providers should be aware of this phenomenon, especially in the obstetric population receiving magnesium infusion. The monitoring of calcium levels may be necessary for this patient population. The laboratory testing should include magnesium in the evaluation of hypocalcemia. References: 1. Shoback, D. (2008). Hypoparathyroidism. New England Journal of Medicine, 359(4), 391–403.

We report a case of acquired, progressive, and severe HDL cholesterol (HDL-C) deficiency that emerged in an individual with multiple myeloma. An 81 year-old white male presented with extremely low HDL-c (≤5 mg/dL). Between the ages of 69 - 73 years old, his annual lipid panels demonstrated HDL-c >70 mg/dL. At that point, his HDL-C levels progressively decreased until their virtual disappearance over a period of 12 years. During this time, he developed anemia, an IgG-kappa M-spike, and increased plasma cells on bone marrow biopsy, compatible with a diagnosis of multiple myeloma. Review of his medications, medical history, and metabolic status failed to identify a cause for his progressive decine of HDL-C. Parallel analyses of plasma samples using detergent to solubilize and release HDL-associated cholesterol (SYNCHRO LX, Beckman) and separation of non-HDL precipitated by dextran sulfate yielded HDL-C values of 5 mg/dL and 47 mg/dL, respectively. Furthermore, HDL-C levels of 52 mg/dL and 54 mg/dL were confirmed using ultracentrifugation and NMR-based methods, respectively. Serum apoAI concentration was 153 mg/dL, suggesting normal levels of HDL, in contrast with the ultra-low HDL-C reported in one method. The patient’s alpha migrating band on lipoprotein gel electrophoresis also appeared normal, suggesting the presence of roughly normal amounts of HDL. Methodological artifact alone, however, did not explain the significant “real” decrease in HDL-C (from the upper 70’s mg/dL to the 40’s mg/dL) recorded during 12 years of monitoring. Isolevuglandins (IsoLG) are highly reactive ketoaldehydes that interact with lysine residues of proteins and head groups of phosphatidylethanolamine. It was recently proposed that IsoLG adducts on HDL can result in deleterious structural and functional changes in the particle. Interestingly, the patient’s serum showed high titers of autoantibodies to IsoLG-apoAI, but low titers against native apoAI. We further studied the turnover of IsoLG-apoAI and native apoAI in mice. This case of artefactual and real HDL-C disappearance in a patient with multiple myeloma is likely due to paraprotein-related interference of HDL-C assays and increased plasma clearance of modified apoA1.

We report fabrication of a 4 mm thick, preassembled whispering gallery mode (WGM) sensor that can be repeatedly dipped into aqueous solutions and lifted. We built the viable photonic sensor assembly by bending an optical fiber by 90° and molding its tip into a sphere, thus, a long stem holding a submillimeter sensor at the end of a short arm of fiber, and positioning a pair of parallel cone-tipped tapers along the long stem so that the tips touch the sensor. Our sensor head is an optical fiber device just a few millimeters thick and yet has a sensitivity of the resonance wavelength shift comparable to the one obtained with conventional WGM sensors in a planar arrangement. Since dipping and lifting from the solution changes the temperature of the sensor, affecting the resonance wavelength, we enclosed a thermistor within the sensor head to monitor the temperature. We demonstrate that the resonance shift in repeated transfer of the sensor head between water and a solution of sucrose, after correction by the temperature change, is reproducible and agrees with a theoretical estimate of the shift for different concentrations.

INTRODUCTION: Understanding of family planning scenario among different societies and communities, which by and large reside in urban slum areas, might prove useful in increasing family planning acceptance by them and decreasing population growth. Unmet need is a valuable indicator for assessing the achievements of national family planning programs. OBJECTIVES: The present study was undertaken with the objectives to estimate unmet need for family planning among the married women of reproductive age group (15 - 49 years) in urban slums of Lucknow and to determine the various factors that influence the unmet need. METHODS: A community based cross - sectional study was conducted in slums of Lucknow City from February 2014 to September 2014. A total 452 married women in reproductive age group were interviewed through house to house survey with the help of a pre - designed, pre - tested and semi - structured questionnaire. RESULTS: The total unmet need for family planning was 69.0%. Multivariate logistic regression revealed socioeconomic status upper lower and below (OR 2.7; 95% CI 1.5 - 5.1; p = 0.00); duration of marriage less than 1 year (OR 1.8; 95% CI 1.1 - 2.9; p = 0.01); less number of live issues (OR 1.6; 95% CI 1.1 - 2.5; p = 0.00); working status of women (OR 1.9; 95% CI 1.1 - 2.9; p = 0.03); social class i.e. OBC and SC/ST (OR 2.3; 95% CI 1.1 - 4.6; p = 0.02) were found to be independent predictors of unmet need of family planning. CONCLUSION: The present study revealed that unmet need for family planning was quite high among women belonging to social class i.e. OBC and SC/ST, with low socioeconomic status, duration of marriage less than one year less number of live issues and working status of the women.

Background Health insurance in India is almost non-existent. Therefore all expenses incurred during illnesses are borne directly by the family and accurate estimates are not available. The primary objective of the study was to assess the proportion of households who incur out of pocket medical expenditure due to sickness of family members in an urban area in India. Secondary objectives were to quantify the direct and indirect medical expenditure incurred by families in the last 3 months and to assess the spending burden ratio (ratio of total medical expenditure to family income) among income quintiles. Methods This was a community based cross sectional study conducted in randomly selected administrative wards in Lucknow city, northern India. Results From December 2011 to March 2012, 400 families, having 2343 members were recruited from 16 wards. Mean family size was 5.86 members (SD = 2.13 members) and mean family income was INR 9622.25 (SD = 11,323.01) (US $1 = INR 50 approximately in mid-2012). In last 3 months, 115 households (28.75 percent) sought medical care for illness in one or more family members. Mean direct medical expenditure was INR 3406 (SD = 4657), mean indirect medical expenditure was INR 1449 (SD = 2685) and mean total medical expenditure was INR 6590 (SD = 13,333). The spending burden ratio in the lowest and highest income quintile was 0.57 ± 0.82 and 0.15 ± 0.30 respectively (p value=0.024). Conclusions Since more than one-fourth of households incur medical expenditure which are paid out of pocket from family income, and since the spending burden ratio is statistically significantly higher in the lowest income quintile when compared to highest, there is a need for introduction of health insurance of some sort for the urban population. This is especially needed for the poorer sections, with provision to absorb the indirect medical expenses if possible.