An overview of Treatment options for urinary stones

Urolithiasis has become a worldwide problem with the prevalence of the disease increasing over the past few decades. While various treatment modalities have evolved over the years, discrepancies exist regarding the clinical indications and the efficacy of each of these treatment options. In the present review, we aim to review the current treatment modalities for urinary tract stones to provide a better understanding on the therapeutic approaches as well as their clinical indications

The association between Solar Lentigines and Type-2 Diabetes

Background: Limited information exists between the associations of diabetes mellitus (DM) and solar lentigo (SL); a benign, common skin lesion characterized by hyperpigmented macules. Methods: This study was conducted on 90 patients diagnosed with DM and their age and sex matched controls who were referred to the Departments of Endocrinology at Babol University of Medical Science in Northern of Iran from January 2013 to December 2015. All demographic data including age, gender, occupation, family history of DM, estimated average sun exposure and presence of skin lesions were collected and analyzed. Results: Presence of SL was significantly higher among patients with DM compared to controls (61.9% vs 33.6%, P<0.001). After adjusting for age, sex and sun exposure rate, results indicated that DM was independently associated with the presence of SL (p=0.002). Stratifying patients based on gender, indicated that DM was significantly associated with SL in females (p=0.03), but not in male patients (p=0.06). Conclusion: The findings of the present study indicate that DM is an independent risk factor for the occurrence of SL lesions. These findings could represent a novel association between DM as a chronic oxidation state and SL as an early sign of aging

Complement deficiency in pediatric-onset systemic lupus erythematosus

BACKGROUND: Pediatric-onset systemic lupus erythematosus (pSLE) accounts for about 10%-20% of all patients with SLE. Deficiencies in early complement components of the classical pathway are the strong genetic risk factor for the development of SLE. In this study, clinical and laboratory manifestations of both complement-deficient and normal complement pSLE patients were compared. MATERIALS AND METHODS: To investigate clinical and immunological manifestations of pSLE in Iran, 36 consecutive pSLE patients (onset before 18 years) who were followed up over a period of 2 years, were studied. Complement C1q and C2 levels were measured using radial immunodifusion assay and complement C3 and C4 levels were measured using nephelometry. Medical records were retrospectively evaluated from patient database of Children Medical Center Hospital. Data were assessed through descriptive analysis (confidence interval = 95%), paired t-test, and Pearson correlation test. RESULTS: Twenty-one patients (58%) had at least one component of complement deficiency. Ten patients (27%) had low C1q level, 11 patients (30.5%) had low C2, nine patients (25%) had low C3, and four patients (11%) had low C4 level. Serum level of complement in pSLE was significantly lower than the control group, except C4 (P = 0.005). The low C1q patients had an earlier age of onset of disease (P < 0.0001). The cutaneous manifestations were more frequent and much more severe in pSLE with low complement (100% vs. 73%). The frequency of renal and musculoskeletal symptoms was equal, but renal morbidity was more common in pSLE with low complement. Positivity for anti-ds-DNA was less common in pSLE with low complement (71% vs. 86%). CONCLUSION: In pSLE patients with early disease onset and more aggressive SLE manifestations and negative anti-ds-DNA test, complement deficiency should be considered

Neuropsychiatric Involvement in Juvenile-Onset Systemic Lupus Erythematosus

Objective. Systemic lupus erythematosus (SLE) is a complex autoimmune disorder characterized by multisystem involvement, including the nervous system. In the present study, we aimed to assess neuropsychiatric manifestations in juvenile-onset systemic lupus erythematosus (JSLE) in Iran. Methods. One hundred and forty-six pediatric onset patients with SLE who had registered in our pediatric rheumatology database were evaluated prospectively and cross sectionally within 2013-2015. Data including sex, age, age at the time of diagnosis, age at the time of study, physical examination, laboratory review, and neuropsychiatric inventory were extracted from this database. Classification of neuropsychiatric JSLE was according to the 1999 American College of Rheumatology (ACR) neuropsychiatric manifestations of SLE case definitions. Result. A total number of 41 patients with neuropsychiatric symptoms were selected. The patients’ average age was 12.2 years. The most common neuropsychiatric symptoms were seizures, migraine, and depression. The mean age at the onset of symptoms was 10.2 ± 3 years. Mean follow-up period was 57±34 (range: 12-120) months. From 41 SLE patients, 18 (43.9) presented symptoms at the time of diagnosis. In thirteen (31.7%) patients, neurological symptoms were developed more than 1 year after SLE diagnosis. Headache was the most common feature (13%), followed by seizure (9.5%) and chorea (3.4%). Other neurological manifestations included cranial nerve involvement (0.7%), loss of consciousness (2.7%), and impaired deep tendon reflex neuropathy (2.5%). The least common neuropsychiatric JSLE manifestation was aseptic meningitis seen in only one patient (0.7%). Conclusion. The presence of headache, mood disorders, psychosis, depression, and other neuropsychological manifestations in a patient with JSLE should prompt investigations into diagnosis of the primary nervous system involvement in order to reduce mortality and morbidity

1022-P: Trends in Glucagon Fill Rates among U.S. Adults with Diabetes and End-Stage Kidney Disease on Dialysis

Patients with diabetes (DM) and end-stage kidney disease (ESKD) on dialysis have a high risk of severe hypoglycemia and more than 70% are treated with insulin therapy. While not all hypoglycemic events can be prevented, glucagon is recommended for patients at high risk for hypoglycemia to revert and prevent hospitalization with severe hypoglycemic events. Prior studies have shown low rates of glucagon utilization, but excluded patients with ESKD who are at highest risk for these events. We used the USRDS, the most comprehensive nationwide database of patients with ESKD in the US, to examine the quarterly rates of glucagon fills among U.S. adults with DM and ESKD receiving dialysis. Among 254,195 adults (≥18 years) with ESKD and type 1 DM (N=27,538) or type 2 DM (N=226,657), with 76.9% using insulin therapy, between 2013-2017. Fewer than 2% of patients with type 2 DM and fewer than 4% of patients with type 1 DM filled a glucagon prescription, with declining fill rates over time among patients with type 2 DM and stable rates among patients with type 1 DM. Clinical Characteristics and trends in glucagon prescriptions are shown in Table 1. Our findings suggest an urgent and critical need for education of clinicians, patients, and caregivers to improve the prescribing and use of glucagon: a life-saving rescue medication. Disclosure R.J.Galindo: Consultant; Novo Nordisk, Eli Lilly and Company, Sanofi, Pfizer Inc., Bayer Inc., WW (Weight Watchers), Research Support; Novo Nordisk, Eli Lilly and Company, Dexcom, Inc. S.Inselman: None. B.Moazzami: None. M.K.Ali: Advisory Panel; Bayer Inc., Eli Lilly and Company, Research Support; Merck & Co., Inc. G.Umpierrez: Research Support; Abbott, Dexcom, Inc., Baxter. R.G.Mccoy: Consultant; Emmi

957-P: Continuous Glucose Monitoring in Patients with End-Stage Kidney Disease and Burnt-Out Diabetes

Patients with long-standing type 2 diabetes and end-stage kidney disease (ESKD) on dialysis may experience resolution of their hyperglycemia, as defined by an HbA1c 6 months. All subjects wore a blinded Dexcom G6 CGM for 10 days. Their clinical characteristics and CGM metrics are shown in Table 1. Conclusion: CGM provides better assessment of glycemic excursions, compared to HbA1c, in patients with ESKD and diabetes. Most patients with burnt-out diabetes (HbA1c <6.5%, off therapy) have frequent and significant hyperglycemic excursions as detected by CGM. Further research will need to examine whether these excursions require pharmacotherapy. Disclosure C.Kaminski: None. R.J.Galindo: Consultant; Novo Nordisk, Eli Lilly and Company, Sanofi, Pfizer Inc., Bayer Inc., WW (Weight Watchers), Research Support; Novo Nordisk, Eli Lilly and Company, Dexcom, Inc. Z.E.Zabala: None. B.Moazzami: None. A.Y.G.Gerges: None. R.G.Mccoy: Consultant; Emmi. L.Peng: None. G.Umpierrez: Research Support; Abbott, Dexcom, Inc., Baxter. Funding Jacob's Fund for Educatio

812-P: Tight vs. Standard Inpatient Glycemic Targets in Non–Critical Care Settings—A Propensity Scored–Matched Analysis of Insulin-Treated Patients with Type 2 Diabetes

Differing blood glucose (BG) targets are recommended by professional organizations in noncritical care settings. Previous Endocrine Society and ADA guidelines recommended a target BG of 70-140 and 140-180 mg/dl; however, the 2023 ADA Standards of Care recommends a target of 100-180 mg/dl. The lack of consensus is due to the lack of randomized clinical trials (RTC) to support a tight vs relaxed BG target. We performed a post-hoc analysis on 9 RCTs to assess hospital outcomes in non-critically ill insulin-treated subjects with T2D targeting BG 70-140 mg/dL vs. 140-180 mg/dL. Among 1446 patients, 640 were treated to a target of 70-140 mg/dl and 806 to a target of 140-180 mg/dL. Propensity score matching was used to reduce the bias including sex, HbA1c, and home insulin use, for a final count of 1,146 patients (573 subjects in each target group). Patients in the tight BG target group had lower mean BG (163.73±39.79 vs 170.15±39.94 mg/dL, p=0.004), less hyperglycemia (BG >180: 86% vs 92%, p=0.003; BG >240: 51% vs 62%, p200 mg/dL. Our results indicate that lower BG target of 70-140 mg/dl leads to lower mean daily BG, less severe hyperglycemia events, similar rates of hypoglycemia and glycemic variability, and lower length of stay and complication rates compared to a higher target of 140-180 mg/dl. RCTs are indicated to elucidate optimal glycemic targets in hospitalized patients with T2D. Disclosure J.Saling: None. A.L.Migdal: None. M.A.Urrutia: None. Z.Zabala: None. B.Moazzami: None. R.J.Galindo: Consultant; Novo Nordisk, Eli Lilly and Company, Sanofi, Pfizer Inc., Bayer Inc., WW (Weight Watchers), Research Support; Novo Nordisk, Eli Lilly and Company, Dexcom, Inc. M.Fayfman: None. A.A.Rashied: None. G.Umpierrez: Research Support; Abbott, Dexcom, Inc., Baxter. Funding Jacob Family Fund

Increased Levels of IL-23 in Peripheral Blood Mononuclear Cells of Patients With Chronic Heart Failure

Chronic heart failure (CHF) is a complex clinical syndrome that represents the end stage of various cardiac diseases and is characterized by the inability of the heart to meet metabolic demands of the body. Many physiological systems are involved in this disease. In particular, the activation of the immune system has received considerable interest in the last decade. Evidence from both experimental and clinical trials indicates that inflammatory mediators are of importance in the pathogenesis and progression of chronic heart failure. Excessive pro-inflammatory cytokines induce contractile dysfunction, hypertrophy, and fibrosis and cell death in Cardiac myocyte. We examined the expression of IL-23 in PBMCs between CHF patients and healthy controls. In this report, we used real-time PCR assay to compare the relative expression of IL-23 in peripheral blood mononuclear cells (PBMC) from CHF patients with various heart diseases (n=42, EF<45%, range of New York Heart Association (NYHA) 1 to 4) and matched healthy control subjects (n=42).We also determined the IL-23 concentrations of cell culture supernatant of PBMCs with ELISA. A total of 42 patients with CHF, with 42 age and sex-matched control group subjects were enrolled in the present study. The culture supernatant levels of IL-23 in PBMC of CHF patients were significantly higher (133.95±108.99 pg/mL) than in the control group (83.43±76.2 pg/mL) (P<0.05). The gene expression of IL-23 was also markedly upregulated in PBMC from CHF patients in comparison with the control group, but it was not statically significant 80. These results demonstrate that in patients with CHF and especially those with severe CHF, expression of pro-inflammatory cytokines and levels of IL-23 cytokine is markedly increased in PBMC. These finding suggested that IL-23 may play an important role in the progression of CHF among these patients