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We developed a pandemic telephone outreach protocol to identify risk for social isolation, health destabilization, medication issues, inadequate services and supports, and caregiver stress among older adults at high risk of destabilization. Screening, conducted between April 1, 2020, and May 8, 2020, was targeted to those who had previously been screened as frail or who were identified as vulnerable by their family physician. This study describes the implementation and results of this risk screening protocol and describes patient, caregiver, and health professional perceptions of this outreach initiative. Mixed methods included satisfaction surveys and interviews completed by patients/caregivers (N = 300 and N = 26, respectively) and health professionals (N = 18 and N = 9, respectively). A medical record audit collected information on patient characteristics and screening outcomes. A total of 335 patients were screened in the early weeks of the pandemic, of whom 23% were identified with at least one risk factor, most commonly related to the potential for health destabilization and medication risk. Follow-up referrals were made most frequently to physicians, a pharmacist, and a social worker. The outreach calls were very well received by patients and caregivers who described feeling cared for and valued at a time when they were socially isolated and lonely. The outreach calls provided access to trusted COVID-19 information and reassurance that health care was still available. The majority of health professionals (>86%) were “very” or “extremely” satisfied with the ease of completing the screening via telephone and value for time spent; for 79% the protocol was “very” or “extremely” feasible to implement. Health professional interviews revealed that patients were unaware they could access care during the pandemic lockdown but were reassured that care was available, potential crises were averted, and they supported future implementation. Risk screening provides a significant opportunity to provide information, support, and mitigate potential risks and is an important and feasible component of pandemic planning in primary care.

The Case-finding for Complex Chronic Conditions in Adults 75+ (C5-75) involves annual frailty screening in primary care using dual-trait screening measures of handgrip strength and gait speed, with additional screening for co-existing conditions in those deemed frail.To identify low-risk individuals who could be screened for frailty every 2 years, rather than annually.This study examined a prospective cohort of patients who completed at least two annual C5-75 screenings between April 2014 and December 2018. Handgrip strength and gait speed on initial assessment were categorized based on proximity to frailty thresholds and were used to predict frailty risk on the second assessment. We used Fisher's exact test to assess differences in risk. Logistic regression models tested associations between independent variables of age, patient activity level, falls history, grip strength and gait speed on first assessment and dependent variable of frailty on subsequent assessment.Analyses included 571 patients with two annual assessments. Frailty risk on the second assessment was significantly higher for patients who had gait speed or grip strength within 20% of the frailty threshold (5.7%), compared with the other categories (0.7%, 0.9%, 0%; P = 0.002); 60% of patients fell within these lower risk categories. Controlling for grip strength and gait speed, no other measures had significant associations with frailty risk.Our results demonstrate that 60% patients are at low risk (1%) of transitioning to frailty by the next annual assessment. Reducing screening frequency from annually to every 2 years may be appropriate for these patients.Frail older adults are at greater risk for illness, functional decline, increased health service use and institutionalization. Adults 75 years of age and older should be screened regularly for frailty to provide early treatment for co-occurring conditions that may impact frailty but that may also be affected by frailty. Walking (gait) speed and handgrip strength are feasible measures of frailty to use on an annual basis in primary care. This study assesses the transition to frailty over a 1-year time period for the purpose of streamlining frailty screening in primary care for those patients who do not require annual screening. We found that when patients’ grip strength and gait speed scores were 20% higher than the point at which people are identified as frail, they are at low risk for becoming frail by their next annual assessment. Frailty screening every 2 years may be appropriate for these patients. This streamlined screening process may make it more feasible for busy family practices to implement this type of frailty screening.

Research Objectives To proactively identify risks that may be exacerbated by the pandemic and mitigate them where possible, a primary care outreach program was developed. Design The screening algorithm was developed by our interdisciplinary Mobility Clinic team, and focuses on 5 domains: health destabilization, mental health, access to services and supports, social isolation, and caregiver stress. The algorithm was administered by phone and any risks identified received further investigation by the team. We used the opportunity to educate patients about the risks of COVID-19 and protective measures. Follow-up continued every 6-8 weeks throughout the duration of the pandemic. Setting The program was developed and implemented in a primary care Mobility Clinic. Participants The algorithm was administered by phone to individuals identified as past and current Mobility Clinic patients. A total of 107 unique patients were contacted, 76 who were male and 31 who were female. 74 patients were identified as having a spinal cord injury (SCI). Interventions Not applicable. Main Outcome Measures An evaluation of this outreach program involved a description of the patient population contacted, the identification of common risks for patients, and patient satisfaction with the program. Results Some of the most common questionnaire responses by patients with SCI included feelings of stress and/or anxiety and a reduction in Personal Support Worker services leading to increased caregiver stress. Conclusions The outreach program helps us to proactively identify risks for individuals with SCI, including stress, anxiety, and decreased Personal Support Worker services. Through the program, we are able to address these concerns and provide follow-up. Risk assessment and care at the primary care level can mitigate adverse events and hospitalizations, which is especially important during a pandemic situation when healthcare and hospital resources are limited. Author(s) Disclosures Dr. James Milligan would like to disclose a relationship with Eisai Pharmaceuticals. Please see the attached disclosure forms for more details. No other authors have any conflicts to disclose.

Case-Finding for Complex Chronic Conditions in Seniors 75+ (C5-75) is a systematic approach to identify frailty using gait speed and hand-grip strength and to screen for co-morbid conditions. We identified the C5-75 features offering the highest yield for identifying frailty and to streamline the screening program. Analyses included 1,948 C5-75 assessments completed from 2013 to 2018. Age 85 or older, less than regular physical activity, and more than two falls in the previous six months had the strongest associations with frailty. Exempting patients under 85 who reported regular physical activity and less than two falls excluded 39.1 per cent of the cohort while maintaining a sensitivity of 95.2 per cent and a negative predictive value of 99.4 per cent for frailty. These findings provide insight into optimizing screening for frailty, making it more feasible to implement and to identify co-existing conditions that may contribute to or be affected by frailty.

Congenital hyperinsulinism is a rare but significant cause of severe and persistent hypoglycaemia in infancy. Although a biphasic phenotype of congenital hyperinsulinism in infancy followed by Maturity-Onset Diabetes of the Young (MODY) in later life has been established for HNF4A, the existence of a similar phenotype for a related MODY gene, HNF1A, is less clear. We describe two cases of congenital hyperinsulinism in association with dominantly inherited variants in HNF1A. They presented in the early neonatal period with unequivocal biochemical evidence of congenital hyperinsulinism and persistence into childhood with ongoing need for medical therapy. Both cases inherited HNF1A variants from a parent with a diabetes phenotype consistent with MODY, without obesity, insulin resistance or other metabolic syndrome features. In the first case, a paternally inherited novel c.-230_-101del variant was found that deletes the minimal promoter region presumably required for HNF1A expression. In the second case, a maternally inherited missense variant (c.713G>T, p.(Arg238Met)) was identified. This variant is predicted to cause haploinsufficiency via aberrant splicing and has previously been associated with MODY but not congenital hyperinsulinism. Our cases further strengthen the evidence for HNF1A as a CHI-causing gene requiring long-term follow-up.

Due to non-affordability of GnRH analogues (GnRHa), Medroxy Progesterone Acetate (MPA) is still used as a treatment option in girls with CPP in India. The aim here is to study the clinical features of girls with CPP in respect to the age at presentation, etiology and outcome as per the medication used for their treatment (GnRHa vs MPA). Retrospective study of 38 girls with CPP(19 idiopathic) treated with either MPA or GnRHa (Luprorelin or Triptorelin) were followed up for period varying from 1 to 8 years. The progression of growth parameters in relation to their age, etiology and medication used for the treatment was studied. Statistical analysis was done using one way ANOVA, unpaired t-test and Pearson correlation tests. Mean age at onset of puberty in girls with idiopathic ICPP(n=19), neurogenic NCPP(n=12) and hypothalamic hamartoma(HH)(n=7) were 4.68±2.83, 5.32±2.20 and 1.76±1.44 years, respectively(P 0.003). Mean height sds at presentation of all girls was higher (0.51±1.80) with comparison to MPH sds (0.90±1.19)(P=0.0021). 70% of the girls presented with SMR stage 3. Bone age was more advanced as compared to height age in all (P=0.0001) and this trend continued till last follow up. At presentation, girls with ICPP were significantly heavier and taller as compared to NCPP and HH (P=0.002 for weight SDS and 0.022 for height SDS). Mean baseline LH, FSH and estradiol were 3.05±2.49 mIU/ml, 4.75±2.29 mIU/ml and 29.43 pg/ml; respectively. At presentation, bone age was more advanced in HH(BA/CA P=0.0001 with BA/HA P=0.03) and LH levels significantly higher(5.6±2.26; P=0.02). At last follow up, there was no significant difference in weight sds(p=0.285), height sds(p=0.074) and PAH sds(p=0.056) in girls of different age groups and etiologies. After 4 years of follow up, height sds was better with GnRHa(1.80±0.98) as compared to MPA(P=0.01) but height sds with MPA was also good(0.49±0.81). Due to prevalence of CNS infections, the proportion of NCPP(31.57%) is higher in our set up, as compared to industrialized countries. With financial constraints, MPA can be considered as a treatment option for CPP.

Fanconi Bickel Syndrome is a rare, autosomal recessive, disorder of carbohydrate metabolism. Presence of hypercalciuria is rare.4.5-years-old boy presented with growth failure, hepatomegaly, rickets, fasting hypoglycemia with postprandial hyperglycemia, fanconi syndrome and hypercalciuria.A rare mutation in GLUT-2 gene suggestive of Fanconi Bickel Syndrome.Fanconi Bickel Syndrome may present with hypercalciuria with proximal renal tubulopathy along with fasting hypoglycemia and postprandial hyperglycemia.

Permanent Neonatal Diabetes Mellitus (PNDM), is a rare monogenic disorder, caused by activating mutations of the KATP channel. The most severe clinical form of PNDM presents as Developmental delay, Epilepsy and Neonatal Diabetes (DEND) syndrome. Diagnosis is confirmed by genetic mutation testing. Oral sulfonylurea therapy improves neurological outcome.

Obesity and decreased final height are described in children with CAH 21OHD. Of 119 children (50 M, 69F;79 Salt Wasters(SW), 40 Simple Virilizers (SV)) diagnosed over 24 years, various growth parameters were studied in 43 children with regular follow up for 5 years or more. Clinical data, anthropometry, genotype, hormonal and biochemical profile were evaluated at presentation. On follow up, growth and clinical characteristics, metabolic control (8am 17OH-Progesterone), bone age and replacement doses of gluco-corticoid (GC) and mineralo-corticoid (MC) were studied. Growth parameters were expressed as SDS. Obesity, defined as BMI SDS >/= 2 and short stature, defined as Ht SDS /=2 found in 32.6% cases (N=14/43: 2M, 12F; 8SW, 6SV) correlated positively with 17 OHP values (p=0.013). Girls were heavier than boys (p=0.006). Adiposity rebound occurred at 4 years for both the genders. At the time of study analysis, Ht SDS showed a distinct shift to the left and BMI SDS, a distinct shift to the right of mean of the reference population as cited [1]. In the present series, there was a higher incidence of obesity (32.6%) but short stature was noted in 27.9% only. Aggressive lifestyle management, dietary control, optimizing dose of therapy (GC) and regular monitoring should be an integral part of long term management of patients with CAH 21OHD.

Adhesive bonding to dentin can fail if the dentin is too wet during application of the bonding resin. This study compared the in vitro 24-hour microtensile bond strength of teeth restored at four different priming times at the gingival cavity wall of Class II resin composite restorations. After IRB approval, six pairs of extracted third molars (yielding 12 teeth) received a proximal Class II prep/restoration in each tooth. Each pair was from the same patient. Four treatment groups were randomly assigned for each pair. The treatment groups were: TM-primer applied and dried according to manufacturer's directions; T30-primer allowed to dry for an additional 30 seconds; T60-primer dried for an additional 60 seconds; T120-primer dried for an additional 120 seconds. The teeth were restored with 3M ESPE Scotchbond Multi-Purpose Dental Adhesive and 3M ESPE Z100 Restorative. Manufacturers' directions were followed except for the additional primer dwelling times. The teeth were sectioned to obtain rectangular specimens with a surface area of approximately 0.5 mm2. Samples were tested on the Instron at 1.0 mm/minute until failure. The results in megapaschals were TM (n=15) 25.5+/-12.2; T30 (n=14) 22.7+/-13.6; T60 (n=15) 28.1+/-14.7; T120 (n=20) 27.7+/-15.2. Samples that debonded during the preparation phase and could not be tested from each group were TM=5, T30=6, T60=5, T120=1. A one-way ANOVA found no statistically significant difference between groups. Ninety percent of the samples broke through the adhesive layer as observed under the scanning electron microscope at 2000x. A chi square analysis found no difference in the number of debonds between groups. Increasing the primer drying time did not increase the microtensile bond strength of adhesive bonded to the dentin gingival wall.