Type 1 diabetes mellitus (T1DM) is multifactorial in origin. Pathogenesis of T1DM involves destruction of pancreatic beta-cells by autoantibodies. The data on disease-causing autoantibodies is sparse in Indian children. This study primarily aims to study the profile of autoantibodies causing T1DM. It is a cross-sectional study involving 74 T1DM children from age 1 to 18 years, with less than 4 years of duration of T1DM. Antibodies against glutamate decarboxylase-65 (GADA-65), zinc transporter-8 (ZnT8A), insulinoma-associated protein – 2 (IA-2A), islet cell (ICA), and insulin autoantibodies (IAA) were estimated by the ELISA method. DKA at the onset of T1DM was correlated with autoantibody positivity. Early morning serum sample was investigated for TSH and T4 levels by the CLIA method to detect hypothyroidism and correlated with autoantibody positivity. Autoantibodies were detected in 41 (55.4

Children with thalassemia often suffer from complications such as muscle weakness, bone fragility, fatigue and reduced physical endurance. As strengthening exercises have the potential to enhance physical function, increase independence, and improve overall quality of life for thalassemic child and Closed Kinetic Chain (CKC) exercises are proven to be beneficial due to their ability to engage multiple muscle groups simultaneously, leading to improved muscle strength and balance. Therefore the aim of the study was to determine the effect of closed kinetic chain exercises via telerehabilitation on muscle strength, balance, fatigue, and haemoglobin levels in Beta Thalassemia Major children This study involved 32 children aged 8–15 years with Beta thalassemia major, divided into experimental group (n = 16) receiving CKC exercises via telerehabilitation for 30–40-minutes, twice a week for 8 weeks, the control group (n = 16) receiving education on importance of being physically activity. Outcome measures were assessed at baseline, 4th week and 8th week which included balance using Bruininks-Oseretsky Test of Motor Proficiency (BOT-2); muscle strength, measured via hand-held dynamometer; fatigue levels by (PQL-MFS); and haemoglobin levels via the spectrophotometric method The experimental group showed significant improvements in balance (p < 0.001), muscle strength (p < 0.001), and fatigue reduction (p < 0.005), but no significant changes were observed on haemoglobin levels. An 8-week CKC exercise program delivered via telerehabilitation significantly enhanced balance, muscle strength, and reduced fatigue in children with Beta Thalassemia Major, though it did not affect haemoglobin levels.

Background Diabetes mellitus type 2 T2DM is the most typical endocrine disorder. Vitamin B-12 is essential for haemopoietin neurocognitive cardiovascular and DNA synthesis. A deficiency in vitamin B-12 leads to megaloblastic anaemia peripheral neuropathy dementia delirium and cognitive dysfunction.Aim The present study aimed to find the prevalence of vitamin B-12 deficiency in patients with T2DM and study the association of age gender body mass index diet glycaemic control metformin use and alcoholism in T2DM patients.Methods This cross-sectional study included 105 T2DM patients from September 2021 to August 2022. Each study participants clinical history physical examination and routine laboratory investigations were recorded. The blood sample in the fasting state was drawn to estimate the serum vitamin B-12 levels by the electro-chemi-luminescence-immunoassay method ECLIA. The serum values of 200 pgmL were defined as vitamin B-12 deficiency and the Chi-square test and t-test were used for statistical analysis.Results The mean duration of diabetes was 10.34 years. The prevalence of vitamin B-12 deficiency was 22.85 with a mean level of 164.87 pgmL. The gender-specific prevalence was significant in males 27.39 and females 12.50 with P lt0.094. The association between vitamin B-12 and BMI was also substantial with Chi-square 8.57 and P lt0.014.Conclusion Serum vitamin B-12 deficiency was prevalent in 22.85 of T2DM patients. Patients with T2DM can be screened routinely for vitamin B-12 deficiency during their visits to healthcare facilities. Treatment of vitamin B-12 deficiency could be one of the modalities while treating T2DM patients.

Background and aim Musculoskeletal abnormalities are common in individuals with Type 1 Diabetes Mellitus T1DM often causing pain functional limitations and structural issues like foot ulcers and disabilities. Age and advanced glycation end products are believed to contribute to collagen accumulation and the development of such abnormalities. Early detection is crucial to prevent mobility-related complications microvascular damage and nerve impairments. This study aimed to explore these abnormalities and stress the importance of early identification in reducing associated risks.Methods A total of 107 patients aged 5 to 25 years with T1DM were recruited from KLES Diabetes Centre Belagavi India. Data included age sex diabetes duration and musclejoint pain intensity. Physical assessments comprised bilateral range of motion ROM measurements in upper and lower limbs and the DASH questionnaire for upper limb restrictions.Results Structural foot abnormalities were prevalent 50.46 with hallux valgus bunion being the most common 44.44 followed by pes planus flat feet 29.60. Knee abnormalities were less common 7.49 with genu valgus and varum found in 7.49 of cases. Muscle wasting in the thenar and hypothenar regions and muscle pain were observed in 13.91 and 20.56 of cases respectively. Spinal abnormalities like spinal stenosis were noted in 2.8 of cases. Skin and nail issues due to neuropathy and circulatory problems included callus 10.7 hyperkeratosis 8.56 foot ulcers 4.28 and open wounds 2.80.Conclusion Our study underscores the high prevalence of musculoskeletal abnormalities in children and adolescents with T1DM emphasising the need for proactive screening and management. Long-term monitoring of musculoskeletal health alongside strict glycemic control is crucial to alleviate the burden of these complications and improve the overall well-being of T1DM patients.nbsp

Objective: The objective of the study was to evaluate prothrombin time/international normalized ratio (PT) along with activated partial thromboplastin time (APTT) and its association with platelet and red blood cell (RBC) cell population data for initial assessment of thrombotic tendencies. Materials and Methods: Blood samples of 43 patients diagnosed with a beta-thalassemia major who were transfusion dependant were taken for assessment of mean platelet volume (MPV), plateletcrit (PCT), and platelet distribution width (PDW) along with RBC distribution width and correlated with APTT. Results: Elevated APTT and PT were noted among patients with thalassemia along with elevated PCT and red cell distribution width-coefficient of variation (RDW-CV). Reduced PDW was noted. Elevated APTT was positively associated with RDW and MPV and negatively associated with PDW and PCT. Conclusion: In our study, elevated levels of PCT RDW CV, PT, and APTT were observed. Elevated levels of APTT were also noted to be positively correlated with MPV and RDW CV.

Glycemic variability GV pertains to the variations in blood glucose levels throughout a period. In diabetes it specifically refers to the wide swings in blood sugar levels experienced by diabetic patients. Normally blood glucose levels vary during the day in reaction to various factors including food consumption physical activity stress and hormone release. Nevertheless individuals with poorly managed blood sugar levels often encounter more substantial and frequent fluctuations in their glucose levels a phenomenon prevalent in both type 1 and type 2 diabetes. The assessment of glucose variability GV involves various methods encompassing short term measures such as within-day and between-day variations as well as long-term GV typically determined by sequential measurements over an extended period incorporating values such as HbA1c fasting and postprandial plasma glucose levels. Strategies to address glycaemic variability in individuals with diabetes include lifestyle adjustments medication continuous glucose monitoring CGM insulin pump therapy and diabetes education and support.

Background Type 1 diabetes T1D presents as a severe chronic disorder affecting 5-10 of diabetes cases typically emerging earlier in life compared to type 2 diabetes T2D. Despite advancements the global incidence of T1D continues to rise posing significant short-term and long-term implications. Characterised by the destruction of pancreatic beta cells T1D results in absolute insulin deficiency with most cases attributed to autoimmune-mediated loss of beta cells type 1a and a minority stemming from idiopathic beta cell destruction or failure type 1b. Although traditionally perceived as predominant in children and adolescents T2D diagnoses in youth are increasingly prevalent.Methods This prospective study was conducted on thirty-one individuals diagnosed with T1D and seeking treatment at the KLES Diabetes Centre Belagavi Karnataka India. A single fasting blood sample approximately 10 mL was collected from each participant via peripheral venipuncture. According to the manufacturers instructions serum C-peptide levels were measured in all samples using a validated Chemiluminescent Immuno-Assay CLIA kit.Results The mean C-peptide levels were significantly higher 1.12 ngmL in participants with disease onset between 11 and 15 years than in those with onset between 0 and 5 years 0.57 ngmL. The participants had a mean disease duration of 6.93 years ranging from 3 to 15 years with 14 45.1 having a disease duration of 0-5 years 7 22.8 with 6ndash10 years and 10 32.2 with 11ndash15 years of type 1 diabetes.Conclusion This study investigated the relationship between C-peptide levels disease duration and age at onset in individuals with Type 1 Diabetes T1D. Our findings suggest a potential link between later diseaseonset 10-15 years and higher C-peptide levels which might indicate a slower disease progression in older individuals diagnosed with T1D.nbsp However a longer disease duration was positively correlated with a gradual decline in C-peptide levels.

Coronavirus disease (COVID 19), a highly transmissible disease, originated in China in December 2019 and spreads to 200 countries prompting the World Health Organization to declare it as a pandemic on March 11, 2020.[1] The number of cases <20 years are susceptible to COVID-19 infection and account for 10%–20% of the diagnosed cases according to Women and Child Welfare department. COVID-19 disease can cause severe manifestations in people with comorbidities particularly with diabetes, where outcomes may be poor. COVID-19 is a multisystem inflammatory state. It is theoretically possible that any organ with the angiotensin-converting enzyme 2 receptors in abundance might be a source of some clinical manifestation. Endocrine and exocrine dysfunction of the pancreas may be a result of the same.[2] Viral infections are well known to develop pancreatic autoantibodies, leading to type-1 diabetes (T1D) in genetically predisposed individuals and coronaviruses identified as incriminating pathogens in the TEDDY study.[3] Most of the research and outcomes are done in type-2 diabetes with COVID-19. T1D constitutes about 5%–10% of all diagnosed cases of diabetes, and its global incidence is increasing at about 3% every year.[4] The total number of T1D in children and adolescents between 0 and 19 years in India is 95,600, and several new cases (incidence) of T1D per year are 16,800.[5] Management of T1D requires a multispecialty approach and needs continuous care. In a country like India, with its high-density population and a significant number of people with T1D, the risk of COVID-19 infection is high. Although lockdown is effective in controlling this virus community transmission, the lockdown has many challenges being faced by the children and adolescents living with T1D during this lockdown listed below. Diabetes self-management (DSM) is essential to improve or maintain glycemic control, minimize the risk of complications, and improve quality of life.[6] DSM management includes multiple insulin injections with appropriate technique, blood glucose monitoring regularly, healthy diet, physical exercise, problem solving, and healthy coping.[6] DSM helps adolescents become self-reliant in the management of diabetes and gives them confidence. Unfortunately, people on insulin with poor glycemic control or recurrent hypoglycemia require self-monitoring of blood glucose at least 4 times/day more so during sick days. The regular supplies of glucose meter strips to children and adolescents are affected due to lockdown. Insulin injections are essential for the survival of children with T1D mellitus (T1DM), and they require multiple injections daily.[7] Many of these children are depended on a regular supply of insulin and glucose monitoring equipment, which are supported by programs free insulin treatment (FIT) program initiated in our hospital by the National Diabetes Foundation, Changing diabetes in children, and life of a child. This supply can be disrupted due to the closure of hospital and travel restrictions. Sick day management in diabetes is an important aspect that must be taken care of during the pandemic. Infections can reduce oral intake and increase the release of stress hormones which can alter the blood glucose levels, leading to risk of both hyperglycemia, hypoglycemia, and diabetic ketoacidosis (DKA).[7] Diet Access to vegetables, fruits, and other grocery required to prepare a healthy diet is reduced, and the healthy eating plan of these children may be affected. Along with this drawback, there may be reduced availability of junk foods, which will impact the insulin requirements. There is generally high consumption of carbohydrate-rich foods in resource-limited settings. Exercise Since the children are home bond and have restrictions of outdoor physical activity, due to closure of gyms, parks, and play grounds. This may lead to uncontrolled diabetes, psychological disturbances, and change in sleep pattern. Emergency Preparedness Due to nonavailability of intensive care unit (ICU) beds in emergency situations in the current COVID-19 epidemic will result in panic and may worsen their glycemic control with consequent DKA. Management and diagnosis of comorbidities such as hypothyroidism, diabetic neuropathy, retinopathy, and nephropathy may be delayed. Psychological Problems Adolescents with diabetes have a 3 folds increased risk of psychiatric disorders such as depression, anxiety, suicidal attempts, and eating disorder. These disorders can be further aggravated by the lockdown due to the closure of schools and colleges.[89] Financial Issues Many families can suddenly reduce their earnings due to the restrictions and expenditure on the child's medication. Management of Type-1 Diabetes Mellitus during COVID-19 Endemic Increase in the incidence of T1D development has been related to coronavirus infection, and thus, practitioners have to be aware of the development of T1D in this epidemic. Furthermore, there are reports where DKA symptoms were masked by COVID-19 symptoms. Therefore, COVID-19 infection might increase the risk of DKA in known cases or delay in diagnosis of new-onset T1D leading to severe DKA. The reason could be that doctors preoccupied with COVID-19 might not consider DKA in the differential diagnosis with Kussmaul's respiration and a fruity odor in the breath. There has been an increase in chloroquine and hydroxychloroquine for the prophylaxis and treatment of COVID-19. However, both these agents can cause hypoglycemia in patients with and without diabetes. Therefore, close monitoring for hypoglycemia and their insulin dose adjustment is required. The following messages should reach the family and T1D children through a dedicated helpline managed by specialists. Parents and children should learn sick day management Do not stop insulin completely and continue the usual carbohydrate intake Management of DKA: T1D patients should keep in contact with their treating doctor if they have symptoms of vomiting lasting more than 2 h, nausea, vomiting, abdominal pain, breathlessness, drowsiness, and confusion. If blood glucose (BG) is more than >270 mg/dl check for urine ketones with ketone strips every 2–4 h, if blood ketone meter is not available. Intravenous (IV) insulin infusion is standard for DKA management but may be difficult nowadays, as it often requires admission to the ICU. Due to the current COVID scenario, wherein ICU admission is difficult, the patient should be guided to manage mild-to-moderate DKA without ICU bed with subcutaneous (SC) insulin. In uncomplicated DKA hourly or 2-h SC, rapid-acting insulin analog (insulin lispro or insulin aspart) or SC regular insulin is an alternative if rapid-acting analog is unavailable. This is safe and may be as effective as an IV regular insulin infusion. Starting dose is 0.8–1 unit/kg/24 h, and the dose is divided by 6 to provide an insulin dose injected every 4 h. Doses are increased or decreased by 10%–20% based on the blood glucose level before the next insulin injection.[10] Plenty of oral fluids should be advised to prevent dehydration. If the glucose level is falling below 180 mg/dL, sugar-containing fluids should be considered to decrease the risk of starvation ketosis. Patients should be advised to maintain BG between 110 and 180 mg/dL. Once the patient is able to take orally and DKA subsides basal insulin should be initiated. Diet Restriction in food supplies and closure of markets during the lockdown might force people with DM to alter their dietary habits. A balanced diet containing proportionate nutrients with adequate protein intake is important. Carbohydrate 50%–55%, fat 30%–35% (up to 20% total energy), protein 10%–15%, and fiber-age in years + 5 grams/day should be advised. In collaboration with local health authorities, local support groups and nongovernment organizations, arrangement for regular milk, vegetables, fruits, and other essentials during lockdown will be beneficial. Children and adolescents should follow information booklets and the dietician's advice related to healthy diet. Hypoglycemia can be a significant issue amid the ongoing pandemic. Signs and symptoms of hypoglycemia such as tremors, anxiety, sweating, chills, clamminess, irritability, confusion, tachycardia, dizziness, hunger, nausea, and pallor should be made aware to the T1D children. Skipping of meals should be discouraged as this predisposes to hypoglycemia. In case of a hypoglycemia, one should eat or drink 15–20 g of fast-acting carbohydrates such as soft drinks, honey, or sugary candy. For those with resources, check blood sugar levels 15 min after treatment and if they are still under 70 mg/dL, eat or drink another 15–20 g of fast-acting carbohydrate, and recheck the blood sugar level again in 15 min, repeat these steps until the blood sugar is above 70 mg/dL. Now, concentrated sugar tablets are available. Sick Day Management Every child and adolescent with T1D should be educated about sick day management protocols. Vomiting reduces appetite leading to hypoglycemia. Stress of illness increases counter-regulatory hormone response causing hyperglycemia. Frequent monitoring of BG is recommended. If hypoglycemic, administer glucose and reduce the dose of the next insulin. If hyperglycemic/kenotic, administer 5%–20% of the total daily dose as short-acting insulin. Physical Activity Regular physical exercise 30–40 min/day is recommended. Other alternative physical activity programs can be undertaken within the safe confines of home by educating them through online tools and social media. Motivate children for indoor plays and exercises. Yoga and meditation may be practiced with involvement of family members. Psycho-Social Issues and Stress Management Patients should utilize telecommunication in discussing psychological problems with their caregivers during these times. Caregivers should also inquire about the mental health of patients. Social support can also help alleviate the distress imposed by the COVID-19 disease and its multifaceted effects. Appropriate family involvement and diabetes support groups can help. Technical Support People having T1DM should be provided with 24/7 technical support for sick day management. Dedicated customer care helpline may assist them in better T1D management, thereby reducing the risk of DKA and subsequent hospitalization. Steps Were Taken in Our Diabetes Center to Manage 350 Children with Type-1 Diabetes Mellitus during the COVID-19 Pandemic We have given a 24/7 helpline number to all the children with T1DM Two days of the week, we do online consultation free of cost We supply free insulin under the FIT program We have recognized persons from certain areas to collect insulin from our center with cold chain for distribution in that surrounding areas We send educative titbits through short message service messages to all the children 2 times a week regarding care and management Our hospital is opened for out-patient department and admissions 24/7 We have managed many DKA and new-onset T1D during COVID-19 epidemics. Our motto is that no child should suffer from a lack of insulin or die during the COVID situation. Conclusion Children with T1D are at a higher risk of contracting COVID-19 and having worsening symptoms if they contract infection. Prevention is mainly through meticulous diabetes self-care and general prevention practices for COVID-19. In addition, it is essential to reemphasize health education on glycemic control to minimize the devastating effects of COVID-19 among populations.

In spite of advances in chelation therapy and screening of blood, mortality associated with the most common life-threatening noncommunicable disease of children in India, transfusion-dependent thalassemia (TDT), remains poorly defined. This study aims at estimating death rates and mortality risk factors associated with TDT. The clinical records of 1087 patients from 5 thalassemia centers in India were retrospectively analyzed from 2011 to 2018. Median patient age was 8.5 years, with 107 patients older than 18 years; 656 patients were male and 431 were female. Demographic details and clinical parameters were analyzed at presentation and at last visit. With 41 recorded deaths, actuarial survival at 26.9 years was 50%, and under-5 mortality was 7 times higher than in the general population. Patients with transfusion-transmitted infections (TTIs) had 3.4 times higher risk for death (P = .031). Serum ferritin higher than 4000 ng/dL had 4.6 times higher risk for mortality compared with ferritin lower than 1000 ng/dL (P = .00063). A hemoglobin drop lower than 2 g/dL per week had 7.7 times higher mortality risk compared with a drop of less than 1 g/dL per week (P < .0001). Social determinants (sex, economic status, and distance from center), splenectomy, and even cardiac complications were not associated with higher mortality risk. Main causes of death were infection, iron overload, TTIs, and allo-immunization. Patients who received more than 4 years of adequate care had more than 66% mortality risk reduction (P < .0001). TDT in India continues to result in high mortality. Ineffective transfusion, TTIs, and chelation continue to be the most significant risk factors. Comprehensive care in dedicated day care centers from early age is likely to improve outcomes.

Background: Successful models of information and communication technology (ICT) applied to cost-effective delivery of quality care in low- and middle-income countries (LMIC) are an increasing necessity. Severe thalassemia is one of the most common life-threatening noncommunicable diseases of children globally. Objective: The aim was to study the impact of ICT on quality of care for severe thalassemia patients in LMIC. Methods: A total of 1110 patients with severe thalassemia from five centers in India were followed over a 1-year period. The impact of consistent use of a Web-based platform designed to assist comprehensive management of severe thalassemia (ThalCare) on key indicators of quality of care such as minimum (pretransfusion) hemoglobin, serum ferritin, liver size, and spleen size were assessed. Results: Overall improvements in initial hemoglobin, ferritin, and liver and spleen size were significant (P<.001 for each). For four centers, the improvement in mean pretransfusion hemoglobin level was statistically significant (P<.001). Four of five centers achieved reduction in mean ferritin levels, with two displaying a significant drop in ferritin (P=.004 and P<.001). One of the five centers did not record liver and spleen size on palpation, but of the remaining four centers, two witnessed a large drop in liver and spleen size (P<.01), one witnessed moderate drop (P=.05 for liver; P=.03 for spleen size), while the fourth witnessed a moderate increase in liver size (P=.08) and insignificant change in spleen size (P=.12). Conclusions: Implementation of computer-assisted treatment planning and performance assessment consistently and positively impacted indexes reflecting effective delivery of care to patients suffering from severe thalassemia in LMIC.

Aims To examine the effect of pump vs injection therapy on the lipid profile of children with Type 1 diabetes mellitus. Methods A cross-sectional analysis of the lipid profile of children aged <= 18 years with Type 1 diabetes mellitus from SWEET, an international diabetes registry, was conducted with a focus on the effect of treatment regimen. Dyslipidaemia was defined as LDL cholesterol >= 2.6 mmol/l or non-HDL cholesterol >= 3.1 mmol/l. LDL and non-HDL cholesterol values among 14 290 children (52% boys, 51% receiving pump therapy) from 60 SWEET centres were analysed by linear and logistic regression analysis adjusted for sex, age, diabetes duration, HbA(1c) and BMI-standard deviation score group, region, and common interactions between age, sex, HbA(1c) and BMI. Results This study confirmed the established associations of increased lipids with female sex, age, diabetes duration, HbA(1c) and BMI. LDL and non-HDL cholesterol levels were lower in the pump therapy group compared to the injection therapy group [LDL cholesterol: injection therapy 2.44 mmol/l (95% CI 2.42 to 2.46) vs pump therapy 2.39 mmol/l (95% CI 2.37-2.41), PHDL cholesterol: injection therapy 2.88 mmol/l (95% CI 2.86 to 2.90) vs pump therapy 2.80 mmol/l (95% CI 2.78-2.82), both P<0.0001]. Similarly, the odds ratios for LDL cholesterol >= 2.6 mmol/l [0.89 (95% CI 0.82-0.97)] and non-HDL cholesterol >= 3.1 mmol/l [0.85 (0.78 to 0.93)] were significantly lower in the pump therapy group, even after all adjustments. Conclusions Our results indicate that pump therapy is associated with a better lipid profile.

BACKGROUND:Frequent use of modern diabetes technologies increases the chance for optimal type 1 diabetes (T1D) control. Limited reimbursement influences the access of patients with T1D to these modalities and could worsen their prognosis. We aimed to describe the situation of reimbursement for insulins, glucometers, insulin pumps (CSII) and continuous glucose monitoring (CGM) for children with T1D in European countries participating in the SWEET Project and to compare data from EU countries with data from our previous study in 2009.METHODS:The study was conducted between March 2017 and August 2017. First, we approached diabetes technology companies with a survey to map the reimbursement of insulins and diabetic devices. The data collected from these companies were then validated by members of the SWEET consortium.RESULTS:We collected data from 29 European countries, whereas all types of insulins are mostly fully covered, heterogeneity was observed regarding the reimbursement of strips for glucometers (from 90 strips/month to no limit). CSII is readily available in 20 of 29 countries. Seven countries reported significant quota issues or obstacles for CSII prescription, and two countries had no CSII reimbursement. CGM is at least partially reimbursed in 17 of 29 countries. The comparison with the 2009 study showed an increasing availability of CSII and CGM across the EU.CONCLUSIONS:Although innovative diabetes technology is available, a large proportion of children with T1D still do not benefit from it due to its limited reimbursement.

Introduction: An assessment of morbidity and mortality caused by transfusion dependent thalassemia in India has never really been done despite thalassemia being the most prevalent life threatening non-communicable disorder of childhood. There is little structured understanding identifying the key risk factors feeding into research and policy making for effective management of thalassemia. With an estimated 10,000-12,000 children born with thalassemia each year in India, in addition to increasing focus on early pregnancy targeted screening, it seems critical to increase our understanding of risk factors associated with early mortality and morbidity. This is also relevant to family counselling about management options. Methodology: A retrospective analysis of mortality key risk factors in patients suffering from thalassemia major from 5 thalassemia day care centres in India was carried out. This included a total of 1,087 patients (656 males and 431 females with a median age of 8.6 years) enrolled for care between 1 Jan 2010 - 31 Oct 2018 at these centres. These centres were set up by a non-profit organization in collaboration with blood banks and /hospital facilities with the objective to provide comprehensive thalassemia care; A common web-based application was employed (ThalCare™). This system was used to track information associated with treatment including disease history at enrolment, demographic data and follow-up information. All analyses were performed with R Statistical software (3.5.2). Survival analysis was done from the age at presentation to the centre till October 2018. The reasons for mortality were categorized. Overall survival was also separately analyzed for patients in their 1st,2nd, 3rd or subsequent decades of life. The Cnaan and Ryan approach was used as patients entered and left the study cohort (left censored and right truncated data) and observation began only at enrolment and not at disease onset Results: The median age at enrolment was 5.4 years and the median follow up at the centre was 2.5 years. A total of 86 patients were cured by bone marrow transplantation (BMT), 13 of them moved to other centres for care and 41 patients died during the study period (28 males and 13 females). The median age at death was 15.4 years. Actuarial survival at 26.9 years of age was 50% (Figure 1) and under-five mortality was 7 times higher than the general population. Patients with transfusion-transmitted infections (TTI) had 3.4 times higher risk of death (p=0.031). Serum ferritin >4,000 ng/dL was associated with 4.6 times higher risk of mortality compared to ferritin <1,000 ng/dL (p=0.00063). Hemoglobin drop >2 gm/dL/week had 7.7 times higher mortality risk compared to <1 gm/dL/week (p<0.0001). Social determinants (sex, economic status and distance from centre), splenectomy, age at first transfusion and even cardiac complications were not associated with higher mortality risk. Results are summarized in Table 1. A multivariable analysis of risk factors which emerged as univariately significant showed that Hb drop of > 2 gm/week (hazard ratio 5.58 ,p=0.0007) and lack of attention towards care for possible prevention from TTI (hazard ratio 2.86, p=0.0004) are factors independently associated with high mortality. Table 2 shows that in patients born after the year 2,000 overall survival is 85.2% compared to 29.4% for patients born earlier. Main causes of death were infection, iron overload, TTIs, and alloimmunization; In a quarter of patients the cause of death was unknown (Figure 2). Patients who received more than 4 years of adequate care had more than 66% mortality risk reduction (p<0.0001). Conclusion: Comprehensive care right from an early age at dedicated management centres is key to improving life expectancy of thalassemia patients in India. Optimizing blood transfusion, intensifying chelation and preventing TTIs seem particularly important. Sustained efforts in these areas coupled with increased prevention and access to safe BMT will ease the burden for both families and public healthcare. Disclosures No relevant conflicts of interest to declare.

Role of Prothrombin time International normalized ratio and activated partial thromboplastin time in beta thalassemia major: A cross sectional study - IJPO- Print ISSN No: - 2394-6784 Online ISSN No:- 2394-6792 Article DOI No:- 10.18231/j.ijpo.2019.047, Indian Journal of Pathology and Oncology-Indian J Pathol Oncol

Objective: To assess the prevalence of underweight (UW), overweight (OW), and obesity in children and adolescents with type 1 diabetes (T1D). Methods: An international cross-sectional study including 23026 T1D children (2-18 years, duration of diabetes >= 1 year)participating in the SWEET prospective, multicenter diabetes registry. Body mass index SD score (BMI-SDS) was calculated using the World Health Organization BMI charts. Children were categorized as UW (BMI-SDS<-2SD), OW (+1SD < BMI-SDS <= +2SD), and obese (OB) (BMI-SDS > +2SD). Hierarchic regression models were applied with adjustment for sex, age, and duration of diabetes. Results: The prevalence of UW, OW, and obesity was: 1.4%, 22.3%, and 7.3% in males and 0.6%, 27.2%, and 6.8% in females. Adjusted BMI-SDS was significantly higher in females than in males (meanSEM: 0.54 +/- 0.05 vs 0.40 +/- 0.05, P < 0.0001). In males, BMI-SDS significantly decreased by age (P < 0.0001) in the first three age categories 0.61 +/- 0.06 (2 to <10 years), 0.47 +/- 0.06 (10 to <13 years), 0.34 +/- 0.05 (13 to <16 years). In females, BMI-SDS showed a U-shaped distribution by age (P < 0.0001): 0.54 +/- 0.04 (2 to <10years), 0.39 +/- 0.04 (10 to <13 years), 0.55 +/- 0.04 (13 to <16 years). BMI-SDS increased by diabetes duration (<2years: 0.38 +/- 0.05, 2 to <5 years: 0.44 +/- 0.05, and 5years: 0.50 +/- 0.05, P < 0.0001). Treatment modality did not affect BMI-SDS. Adjusted HbA1c was significantly higher in females than in males (8.20% +/- 0.10% vs 8.06% +/- 0.10%, P < 0.0001). In both genders, the association between HbA1c and BMI-SDS was U-shaped with the highest HbA1c in the UW and obesity groups. Conclusions: The high rate of OW and obesity (31.8%) emphasize the need for developing further strategies to prevent and treat excess fat accumulation in T1D.

Reporting a rare and treatable case of thiamine responsive Megaloblastic Anemia with Sensori-neural Hearing Loss with Diabetes Mellitus in a 6 year old child due to SLC19A2 mutation. Simple thiamine treatment is cost effective and can reverse this disorder except hearing loss.

Aims: The aim of this study is to investigate the effect of yoga therapy and its influence on blood glucose parameters in patients with type 2 diabetes mellitus. Materials and Method: This was a prospective study conducted at Diabetes Centre, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, India, from January 2016 to December 2016. A total of 1000 type 2 diabetic patients were enrolled in the study with informed consent. We assessed the patients for pre- and post-assessment blood parameters after a period of 12 months for fasting blood sugar (FBS), postprandial blood sugar (PPBS) levels, glycosylated hemoglobin (HbA1c), cholesterol, and triglycerides. A qualitative in-depth interview of the participants and therapist was conducted at baseline, end of 6 months, and end of 12 months. Statistical Analysis: The observations were recorded and analyzed for significance using SPSS version 20.0 statistical tool. Results: During pre-assessment, the results revealed an increase in the level of FBS (181.75 ± 71.47), PPBS (262.04 ± 97.23), HbA1c (10.30 ± 5.3), cholesterol (180.13 ± 47.1), and triglycerides (159.77 ± 110.39). However, the participants who completed the yoga therapy had significantly lower FBS (133.01 ± 46.98) (p < 0.0001), PPBS (187.67 ± 68.61) (p < 0.0001), and HbA1c (7.89 ± 1.6) (p < 0.0001) at the end of the 12th month. There was statistically significant positive correlation observed in yoga group as compared to the control group during postassessment blood parameters. Conclusions: The results of the present study demonstrated that yoga is effective in reducing the blood glucose levels in patients with type 2 diabetes mellitus. Our study also showed positive benefits of yoga in the management of diabetes with real impact on glycemic control and lipid profile.

• Participating centres seemed to achieved reasonable equity in delivery of transfusion therapy. • No sex based inequity is seen though fewer girls than boys get enrolled for treatment. • Centres offering transport support do not see the impact of distance from hospital on patient care. • Despite absence of inequity for the factors reviewed, chelation therapy remained sub-optimal.

•Mean pre-transfusion Hb was 8.8 g/dl.•99% of blood was available on-site.•Saline washing of red cells seems to be effective in controlling transfusion reactions.•Rate of transfusion reactions was 0.7% without pre-medication.•Low rates of transfusion-transmitted infections were seen.•Voluntary blood donation may reduce transfusion transmitted infections.•Median duration of entire day care stay was 8 h (IQR 6–8).

Aims: To determine the prevalence of Thyroid dysfunction among Type 2 Diabetes mellitus. Methodology: A cross-sectional hospital-based study is conducted to find out the prevalence of thyroid dysfunction. 713 type 2 diabetes mellitus (T2DM) subjects were enrolled in the survey. These subjects were investigated for fasting blood sugar (FBS), glycosylated haemoglobin (HbA1c), total triiodothyronine (T3), total thyroxine (T4), and thyroid-stimulating hormone (TSH). Results: Prevalence of thyroid dysfunction in T2DM was found in 16.2%. Gender-specific prevalence found higher in females (25%) compared to males (10.1%) (P < 0.001). Age-specific prevalence found higher in the age group >= 50 yrs. (19%) Compared to other age groups (P = 0.036). Subjects with poor glycaemic control demonstrated higher prevalence (27.9%) (P = 0.012). Subjects with long-standing T2DM had an increased risk for thyroid dysfunction (19.8%) though findings were not statistically significant. (P = 0.42). Conclusion: The prevalence of thyroid dysfunction with T2DM (16.2%) was high in females compared to males and especially hypothyroidism being more typical. Failure to recognise the presence of thyroid dysfunction among T2DM patients may be a primary cause of poor management of diabetes. We recommend universal screening and regular monitoring of thyroid dysfunction in T2DM patients. (C) 2016 Diabetes India. Published by Elsevier Ltd. All rights reserved.