Day 1 :
- Diabetes Mellitus Type 2 | Endocrinology Diabetes Diseases Disorders | Diabetes Research | Diabetes Research in Clinical Practice
Katrina M. Piczon
Cardinal Santos Medical Center, Philippines
Title: A taint of sugar: A case report on diabetic ketoacidosis in two adolescents with type 2 diabetes mellitus
Katrina M. Piczon is a registered medical technologist and completed her degree in Doctor of Medicine at the University of Santo Tomas Faculty of Medicine and Surgery in the year 2017. She had her post graduate internship from year 2017-2018 in Veterans Memorial Medical Center. She completed her three-year Pediatric residency training from year 2018 to 2021 from Cardinal Santos Medical Center in the Philippines. She plans to further pursue her studies and fellowship training in Pediatric endocrinology.
There have been recent investigations on the perceptions, challenges and experience of health care professionals managing children and adolescents with diabetes worldwide during COVID-19 pandemic. Several studies showed a higher incidence of new onset diabetes with DKA. Several practitioners noted that caregivers fail to contact their endocrinologist during the pandemic. The consequences of the pandemic diagnosed diabetics and those at risk could be based on less exercise, changes in dietary habits, restrictions in routine visits to the physician, and decreased availability of oral hypoglycemic agents in some areas. Overall, these events contributed to the delay in seeking medical care until the severity of presentation was dire.
Based on the Philippine Pediatric Registry, comparing the cases of Diabetic Ketoacidosis (DKA) from pre pandemic January to August 2018-2019 from 2020-2021, there has been a drop in cases of diabetic ketoacidosis. Although, local data showed a decrease in trend pre and post pandemic, some studies based on international data prove otherwise. There is an unusual increase in our cases in Cardinal Santos Medical Center, a private tertiary hospital, which had a total of 3 DKA cases in a span of 11 months since November of 2020.
A case of C.M., a 13-year-old male with new onset Diabetes mellitus type 2 and a case of D.S., an 18-year-old female a known case of Diabetes mellitus type 2 will be discussed [Figure 1]. This case series on adolescent diabetic ketoacidosis during the pandemic aims to discuss and compare the clinical presentation [Figure 2], diagnosis, course of management, risks and follow up, to compare the treatment outcomes [Figure 3], complications and length of hospital stay. The patients underwent hemodialysis and hemoperfusion due to intractable metabolic acidosis and renal involvement.
Diabetic education is a continuous team-based approach and is essential to provide the best quality of care.
National Institute of Gerontology and Geriatrics "Ana Aslan", Romania
Title: Utility of CholIndex and Castelli risk indices in diabetes mellitus assessment
Simona Opris is Senior Scientific Researcher and Medical Principal Biochemist with expertise in biology of aging. Her Research fields: correlation of oxidative stress in normal and pathological aging; immunological investigation methods by ELISA; elucidation of induce age-modifications at cardiovascular pathology; assessment criterion of biological age by identification of some specific biological markers. She published 86 scientific papers (70 first authors) in national and international scientific journals (ISI-12), 170 international congresses and 60 national congresses, 8 national research programs also, Editor Assistant at Romanian Journal of Gerontology and Geriatrics, member of OBBCSR and member of Romanian Society of Gerontology and Geriatrics.
Statement of the problem: Beyond classical lipid profile, there are new predicting risk fractions, which are investigated in the Diabetes Mellitus (DM) clinical setting, such as CholIndex, Castelli Risk index I (CRI) and Castelli Risk Index II (CRII). The aim of the study was to find if CholIndex, CRI and CRII could be useful biomarkers in DM assessment.
Methodology: Observational cross-sectional study was on 419 patients, over 65 years, of which 238 DM and 181 healthy control patients. CholIndex was calculated as LDL-HDL (TG<400 mg/dL); LDL-HDL +1/5 of TG (TG ≥ 400 mg/dL). CRI was calculated by TC/HDL and CRII by LDL/HDL. Cut-off limits: CholIndex<2.07; CRI<3; CRII<3.3.
Findings: Data revealed an increase of CholIndex (p<0.05), CRI and CRII (p<0.0001) at DM patients vs. control; low levels of HDL (p<0.0001) and high of TG (p<0.0001). Linear regression equations showed a positive correlation of CholIndex with CRI and CRII (p<0.0001) at DM patients, besides also positive correlation with lipid panel. Diagnostic evaluation for CRI indicated: 62.77% assay accuracy, 82.77% sensitivity, 36.46% specificity, 56.80% disease prevalence and relative risk estimate=1.3. For CRII: 50.6% assay accuracy, 25.63% sensitivity, 83.43% specificity, 56.80% disease prevalence and relative risk estimate=2.06. Multivariate logistic regression analysis showed that patients with high CRI are 2.75 times more likely to have DM compared to those with low risk [OR 2.75,95% CI: 1.75-4.33; p<0.0001]. Also, patients with high risk CRII have 1.73 times to develop DM [OR 1.73,95% CI: 1.06-2.82; p<0.005]. At DM, even if TC and LDL were in reference range, risk indices were high.
Conclusion: There is a certain correlation between CholIndex, CRI, CRII and DM, the higher the risk the more likely it is to develop DM. So, studied indices could be useful and reliable biomarkers for DM assessment.
Kenya Medical Training College, Kenya
Title: Fruits as a key medicine towards fighting diabetes type 2
Maxwel Aneyia is affiliated to the Kenya Medical Training College, Kenya.
Diabetes Type 2 is a chronic disease that occurs when the body cannot effectively use the insulin it produces. Diabetes is among the top cause of disability and mortality around the globe. Diabetes and other non-communicable diseases hinder the implementation of sustainable development goals in low income countries.
Prevention of diabetes type 2: Avoid consuming junk food since they lack nutritional value to our body diet change to focus on greens rather than processed foods that contain high rates of fats.
Engage ourselves in active physical activities for example jogging, running and walking which helps in controlling our body weight.
Avoid tobacco use to reduce the risk of contracting other non-communities best medicine towards treatment of diabetes type 2 the globe cable diseases.
Fruits are should focus on the vitamins and important contents in the fruits to use as medicine.
Examples of fruits that prevent diabetes:
- Blue barriers
- Thorn melons
Roles of health promotion in the prevention of diabetes type 2 in Kenya:
- Carry out research on the best ways of preventing diabetes among the public.
- Health education on proper diet and behavior change among the members of the community to prevent diabetes.
- Implementation health promotion strategies to improve the living standards of community members.
- Monitoring and evaluation of health projects such diabetes projects.
- Advice diabetic patients' on insulin injection and medication to prevent severity of the disease.
- Carry out social mobilization campaign to create awareness on prevention of diabetes.
Nermeen Saad El-Beltagy
Alexandria University, Egypt
Title: Effect of maternal serum triglycerides and high density lipoprotein ratio on fetal macrosomia in non-diabetic patients
Nermeen El Beltagy MD, PhD, MS, MPH, Professional C is a Professor of in the Department of Obstetrics and Gynecology, Alexandria University, Egypt. She is a member of the International weight management in pregnancy (I-WIP collaborators of the European Union). She received her medical degrees from Egypt, but the PhD in environmental health and MPH in epidemiology degrees were from Saint Louis University in the USA. She earned her Professional Certificate in women's heath from Exeter University, UK. She participated in the Risk Communication Challenges workshop”, Harvard School of Public Health, Boston, Massachusetts, May 2003 and attended “Evidence Based Public Health workshop”, CDC, March 2003. She received the award of the best poster for the 1st International Conference in Quality in Obstetrics, Lyon France, 2011. She authored and coauthored over 10 peer reviewed publications mainly on the subjects of Causes and recommendations of maternal mortality and morbidity in Egypt, preeclampsia, maternal obesity and contraception. She is an editor of the American journal of cancer prevention.
Background: Maternal lipids have a crucial role in fetal growth and development. An abnormal lipid profile is found throughout gestation. This abnormal elevation of maternal plasma lipids has been linked with various adverse outcomes during pregnancy including: fetal macrosomia, gestational hypertension and preterm birth. Fetal macrosomia is a major public health problem worldwide. Although there is a clear correlation between fetal macrosomia and maternal diabetes mellitus, most of macrosomic infants are born to women without diabetes. The ratio of TGs/HDL is a commonly used marker for lipid disturbance.
Objectives: To study the effect of maternal serum triglycerides and serum high density lipoprotein ratio on fetal macrosomia in non-diabetic patients at El-Shatby Maternity University Hospital.
Subjects and methods: A case control study was performed from December 2021 to May 2022 on 160 pregnant women at EL-Shatby Maternity University Hospital who were admitted for delivery. Patients were divided into two groups, Group (A): 80 cases with macrosomic fetus, Group (B): 80 cases with average sized fetus. The two groups were matched according to age, obstetric history and mode of delivery. Maternal pre-pregnancy BMI, weight at delivery, maternal serum TG/HDL ratio, estimated fetal weight and neonatal birth weight were assessed.
Results: A strongly positive correlation was found between neonatal birth weight and TG/HDL ratio in women with macrosomic infants where (R=0.725) [Figure 1] and there was moderate correlation in the group of women with normal birth weight infants where correlation coefficient was (R=0.395) [Figure 2]. Also, there was a significant higher triglyceride concentration in women with macrosomic infants than the group of women with normal birth weight infants (P=0.04).
Figure 1. Correlation between TG to HDL ratio and Neonatal weight in control group.
Figure 2. Correlation between TG to HDL ratio and Neonatal weight in case group.
Conclusion: High serum TG concentrations and serum TGHDL ratio at late gestation were associated with an increased risk of fetal macrosomia in non-diabetic women.
Gowhar Ahmad is Sr. Consultant Ophthalmologist, Florence hospital, Chanapora Srinagar Kashmir, India. He has done MBBS MS ophthalmology fellowship in pediatric ophthalmology from Moorfields Eye Hospital, London, fellowship in oculoplasty and neurophthmology from King Khaled Eye Specialist Hospital-Riyadh, Saudi Arabia. He has more than 40 years of experience in the field of ophthalmology. He is a National and international speaker, has many international publications on JOJO and MSOR posted more than 17000 and b1700 articles on Docplexus and LinkedIn respectively till dat. He is an influencer on Curofy, Icon Curofy of year 2021. He is an Editor in chief international journal of scientific research, member scientific committee of world congress of clinical pediatrics and neonatology member, scientific committee of world congress of d m and pediatric endocrinology, member international journal of ophthalmology and advanced research, reviewer researcher and board member of many international journals has attended many international webinars as speaker member KOS Ophthalmic society.
Squint is a very common Occular condition characterized by abnormal occular deviations with absence of normal Occular paralesum and paucity of binocular vision which is kind of Simultaneous perception, Simultaneous fusion and stereopsis. Main aim of squint management is not only to correct the abnormal occular deviation but to ensure normal' visual status. For this early and prompt diagnosis and management is very important so it is very important for every parent to seek the advice of pediatric ophthalmologist if they observe any abnormal occular deviations of their kids. In past in underdeveloped Asian countries squint was considered to be a kind of stigma especially in girls, So by the time they were shown to ophthalmologist amblyopia had already been in action so treatment was only cosmetic squint correction. However at present with better education and awareness prognosis of squint is very good. Since we have different Ophthalmic subspecialists 3 basic things have to be done in every case of squint VA assessment, Mydriatic refraction and fundus examination because we have some occular conditions like Retinoblastoma and coats disease which cause squint Can be commitant in commutant, Accommodative non accommodative, Paralytic non paralytic, bilateral alternating infantile esotropia, Paralytic squint presents as diminishing of vision impairment of occular movements diplopia turning the head towards the direction of action of paralysed muscle. Primary deviation is greater than sec deviation false orientation false perception abnormal head tilt ocular torticollis vertigo, bilateral alternating infantile, ESOTROPIA presents as Crossed fixation, uncrossed fixation, Broad angle, Av pattern. Covering the dominant eye will make child to cry. 6 months old male twins were seen by me in my clinic some time ago with parents having noticed bilateral inward occular deviations of both eyes both twins full term normally delivered make twins no history of exposure to oxygen or jaundice no other Cong abnormalities. In exam both twins had bilateral alternating infantile esotropia of 20 to 25 degrees, VA assessment mydriatic refraction and fundus examination was normal. So under BILTERAL 5 mm medial recti recessions was done. Since we do not cut muscles so this procedure not only ensures a good correction of angle of squint but eye reaction is minimal.
Grodno State Medical University, Belarus
Title: Anatomical variations in origin of middle circumflex femoral artery
Rashina Shanani is a 4th year student with English medium, majoring in General Medicine at Grodno State medical University, Belarus. She has passion in improving the health and wellbeing. She determined to find new knowledge based on clinical experience. She would like to pursue a career centered on internal medicine and operative surgery.
MCFA has a wide variety of origin in the femoral segment. The majority derived from PFA, 60% on the left and 40% on the right. 50% on the right side and 35% on the left side derived from CFA. The least percentage is followed by CFA as a common trunk with PFA 10% on right and 5% on left . Nasr et al.  portrayed that most common origin from PFA 60% each on male and female followed by origin from CFA 14% on male and 17.5% on female, CFA as a common trunk with PFA 18% on male and 15% on female, Superficial Femoral Artery (SFA) 8% on male and 10% on female exhibit 5 varieties in the origin of MCFA [Table 1]. The majority emerge from PFA 78.3%. The second highest begins from the CFA 11.7%, 5% arises from the SFA. Origination from CFA as a common trunk with PFA and from CFA as a common trunk with LCFA have 1.6% each . A cadaveric study exhibited 7 varieties in origin of MCFA. 50.2% got from PFA followed by CFA as a common trunk with PFA 14.6%, common femoral artery 13.1%, CFA with PFA and LCFA 9%, SFA 2.5%, CFA as a common trunk with LCFA 1.9% and 0.6% cases its absent . The origin of MCFA from PFA is in its 64.6% cases. In 32.2% of the lower extremities, it originate from CFA followed by SFA in 1% of cases and 0.5% are absent. Rare form of variation 0.4% origin is from external iliac artery . Most recognized side of beginning of MCFA is the medial side. Besides, concluded 2 variation sides as posteromedial and posterior 25% on right, 15% on left and 15% on right, 10% on left respectively . Medial side aspect described in 60% on right and 75% on left , 58.9% , Samarawickrama et al. 62% , Siddharth et al. 63% . Awareness of these origins will allowMCFA has a wide variety of origin in the femoral segment. The majority derived from PFA, 60% on the left and 40% on the right. 50% on the right side and 35% on the left side derived from CFA. The least percentage is followed by CFA as a common trunk with PFA 10% on right and 5% on left . Nasr et al.  portrayed that most common origin from PFA 60% each on male and female followed by origin from CFA 14% on male and 17.5% on female, CFA as a common trunk with PFA 18% on male and 15% on female, Superficial Femoral Artery (SFA) 8% on male and 10% on female exhibit 5 varieties in the origin of MCFA [Table 1]. The majority emerge from PFA 78.3%. The second highest begins from the CFA 11.7%, 5% arises from the SFA. Origination from CFA as a common trunk with PFA and from CFA as a common trunk with LCFA have 1.6% each . A cadaveric study exhibited 7 varieties in origin of MCFA. 50.2% got from PFA followed by CFA as a common trunk with PFA 14.6%, common femoral artery 13.1%, CFA with PFA and LCFA 9%, SFA 2.5%, CFA as a common trunk with LCFA 1.9% and 0.6% cases its absent . The origin of MCFA from PFA is in its 64.6% cases. In 32.2% of the lower extremities, it originate from CFA followed by SFA in 1% of cases and 0.5% are absent. Rare form of variation 0.4% origin is from external iliac artery . Most recognized side of beginning of MCFA is the medial side. Besides, concluded 2 variation sides as posteromedial and posterior 25% on right, 15% on left and 15% on right, 10% on left respectively . Medial side aspect described in 60% on right and 75% on left , 58.9% , Samarawickrama et al. 62% , Siddharth et al. 63% . Awareness of these origins will allow