bluuebunny/crossref_metadata_2025_split huggingface dataset:
LBODP038 Metformin-Associated Severe Lactic Acidosis: A Case Study Of The Perfect Storm
Authors: Maki Marwa K , Manivannan Niveditha 
Published: November 2022

Abstract

Background
Metformin carries a rare risk of lactic acidosis. Medications that can increase the concentration of metformin in the serum can increase the risk of lactic acidosis. Similarly, kidney dysfunction leads to decreased clearance of the drug, hence potentiating its adverse effects.

Clinical Case
A 62-year-old male with HIV (undetectable viral load) on dolutegravir, atazanavir/cobicistat, rilpivrine, type 2 DM (A1C 7.2%) on metformin and dulaglutide presented with 1 day history of dyspnea. He had a respiratory rate of 28 and heart rate of 131. Blood glucose was 43 mg/dL (nl 74-99 mg/dL). Labs were also notable for lactate 23.6 mmol/L (nl 0.4-2 mmol/L), severe anion gap metabolic acidosis with pH &lt;6.8, bicarbonate 5 mmol/L (nl 21-32 mmol/L). Creatinine was 2.29 mg/dL (nl 0.5-1.3 mg/dL) with a normal baseline kidney function. Beta-hydroxybutyrate was elevated at 0.73 mmol/L (nl 0. 02-0.27 mmol/L). Osmolar gap was 17.3 mOsm, ethanol level was 22 mg/dL (nl &lt;10 mg/dL), ethylene glycol was not detected. Patient reported drinking four beers daily but endorsed binge drinking the previous night with associated emesis. Review of records showed that the patient was started on dulaglutide recently and he endorsed nausea and diarrhea with initiation of the medication. He otherwise had no changes in his metformin dose or antiretroviral regimen. He was admitted to the ICU for further management of his severe lactic acidosis. Patient's antiretroviral regimen, dulaglutide, and metformin were held on admission. Medical toxicology was consulted, and metformin associated lactic acidosis was suspected. He was initiated on dialysis and his lactic acidosis resolved within 24 hours. His antiretroviral regimen was resumed prior to discharge when his creatinine improved to 1.38 mg/dL. Metformin was discontinued and he was discharged on dulaglutide with endocrinology follow up.

Conclusion
This case demonstrates how multiple factors such as alcohol use, kidney injury, and other medications can increase the, otherwise rare, risk of lactic acidosis in patients taking metformin. The patient had experienced GI losses due to emesis from his increased alcohol intake as well as diarrhea with the initiation of dulaglutide leading to dehydration and acute kidney injury. The latter can give rise to decreased metformin clearance. In addition, dolutegravir increases metformin plasma exposure. Together, the constellation of factors had likely led to increased metformin plasma levels and associated severe lactic acidosis. Patients should be counseled on the use of alcohol while taking metformin. Additionally, drug interactions should be monitored, and dose reductions of metformin should be considered in patients taking dolutegravir.
Presentation: No date and time listed
LBODP045 Correlation Of Acetone Breathing Level In Serum Ketone Bodies Level Of Diabetes Ketoacidosis By Non-invasive Acetone Gas Analysis Device (g-breath) Multicenter Study
Authors: Niramitmahapanya Sathit 
Published: November 2022

Abstract

Background
Diagnosis of ketosis associated with DKA can be difficult due to variability in the metabolic state of DKA patients beta–hydroxybutyrate (BHB) are the main forms of ketone and followed by acetoacetic acid (AcAc) and acetone.

Objective
Find the correlation between breath acetone and serum BHB, AcAc and acetone during treatment duration of DKA.

Materials and Methods
We use metal Oxide Semiconductor (MOS) methods called G-Breath for measurement of exhaled acetone compared with serum BHB, AcAc and acetone level during treatment of DKA, in patients with hyperglycemia and suspected DKA. Exhaled acetone concentration will be represent as two electrical signal parameters breath acetone breath (ppmv) and total volatile organic compound (VOC).

Results
Serum parameters to diagnostic DKA especially ketone metabolites were significant higher in DKA group when compared with hyperglycemic group; serum acetone in DKA group was 67.65±79.52 vs 4.20±4.12 mg/L in hyperglycemic group by p value=0. 004, serum BHB in DKA group was11.19±12.96 vs 1.73±1.34 mg/dL in hyperglycemic group by p value=0. 007, serum AcAc was 31.90±16.98 vs 5.87±7.58 µg/mL in hyperglycemic group by p value&lt;0. 001. In breath analytic parameters we found acetone in breath was significant higher DKA group 5.20±1.34 vs 1.18±1.77 in hyperglycemic group with p-value 0. 040. The correlation study acetone in breath was significant to all ketone metabolite of DKA such as serum acetone, The cut of point, sensitivity, specificity and Area under the Curve (AUC) we found serum acetone was the best test for diagnosis DKA with 100% sensitivity, 99.93% specificity AUC=0.987 with p&lt;0. 001. The breath acetone for diagnosis of DKA at cut of point 2.15, sensitivity 100%, specificity 71.4% (AUC=0.847, p=0. 003) Conclusions: This study shown that acetone measurement in exhale with non-invasive device call G-breath can be used in part of DKA diagnosis with comfortable and can be warning diabetes for serious emergency condition. Keywords: Breath biomarkers, Breath acetone, Diabetic ketoacidosis, correlation
Presentation: No date and time listed
LBSUN154 Baseline Albuminuria May Protect Against Severe Covid-19 In Type 2 Diabetes Patients
Authors: Bashkin Amir , Shehadeh M , Shbita L , Namoura K , Haiek R , Kuyantseva E , Boulos Y , Zur A , Nodelman M , Kruzel-Davila E 
Published: November 2022

Abstract

Background
Diabetes is considered as one of the leading risk factors for severe COVID-19. We aimed to characterize the differences between type 2 diabetic patients after hospitalization in medical departments at our medical center due to COVID-19 or other diseases. Among the patients with COVID-19, we explored clinical parameters that were associated with severe disease. Method: This is a case-control study of diabetic patients after medical department hospitalization between 09/2020-05/2021. Patients with COVID-19 were compared to those without COVID-19. Patients were defined as COVID-19 negative if the SARS-CoV- 2 polymerase chain reaction and serology were negative and COVID-19 positive, according to a positive SARS-CoV- 2 polymerase chain reaction. Baseline albuminuria was defined as urine albumin to creatinine ratio ≥ 30 mg/gr before hospitalization. Patients that had COVID-19 were recruited after their discharge while other diabetic patients were recruited during hospitalization. Multivariable logistic regression was used to determine the risk factors for severe or critical COVID-19, as compared to mild or moderate disease. In the multivariable analysis: the severity of COVID-19 was the dependent variable, while the following variables were independent variables: eGFR, HbA1C and albuminuria before hospitalization, age and polymorphonuclear(PMN) /lymphocytes (NLR max) during hospitalization, and BMI and gender during recruitment.

Results
65 diabetic patients after COVID-19 and 144 diabetic patients who were hospitalized in the Medical department due to other reasons were recruited. Patients after hospitalization due to other diagnoses (not COVID-19) were older than patients after COVID-19: (p=0. 005), had longer duration of diabetes (p=0. 03), lower eGFR (p=0. 03) and lower C-reactive protein (CRP) at admission (p&lt;0. 001). In addition, baseline albuminuria was more common in patients without COVID-19 (54.9% versus 30.8%, p= 0. 002). In a multivariate logistic regression analysis that included only patients after COVID-19 infection, a higher body mass index (BMI) was significantly associated with severe COVID-19 pneumonia, OR 1.24 (95% CI 1. 01-1.53, P=0. 04). Similarly, a higher maximal ratio of NLR- Max was significantly associated with severe COVID-19 OR 1.2 (95% CI 1. 06-1.37, P=0. 005). Surprisingly, the presence of albuminuria before hospitalization was associated with a reduced risk for severe COVID-19 OR 0. 09 (95% CI 0. 014-0.62, P=0. 015).

Conclusions
These findings suggest that the presence of albuminuria in diabetic patients, may serve as a protective factor for severe COVID-19 pneumonia. Further studies are needed to explore this association and the implication to treatment intervention.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
LBSUN292 Learning Lesson From A Case of Fulminant Type 1 Diabetes Mellitus Shortly After Pembrolizumab Treatment
Authors: Phan Van , Nguyen Quan , Phan Vien , Erenler Feyza , Pittas Anastassios 
Published: November 2022

Abstract

Background
Immune checkpoint inhibitors (ICIs) in cancer treatment are considered one of the major breakthroughs in the past decade. Pembrolizumab (PBL) is one of the immune checkpoint inhibitors that targets the programmed cell death protein-1 (PD-1) receptor in order to block its interaction with programmed cell death ligand-1 (PD-L1) and programmed cell death ligand-2 (PD-L2). By inhibition of these molecules, PBL helps increase T-cell activation against cancer cells. Unfortunately, this inhibition also enhances autoimmunity against normal cells, leading to immune-related adverse events (irAEs) including endocrinopathies. Unlike other irAEs, endocrinopathies are usually irreversible upon diagnosis. While hypophysitis, hypo/hyperthyroidism, and adrenal insufficiency are more commonly reported, type 1 diabetes mellitus (T1DM) is also seen around 0.9 to 1.9% of cases. Unfortunately, it can become fatal if not being promptly recognized. To raise awareness about this life-threatening adverse event, we are reporting a case of new onset T1DM, presenting with diabetic ketoacidosis (DKA) only after 22 days of the first PBL infusion.

Clinical case
A 19-year-old male was recently diagnosed with NUT (nuclear protein in testis) carcinoma of the left floor of mouth with high PD-L1 score. NUT carcinoma is a rare type of squamous cell cancer with chromosomal rearrangement in the nuclear protein in testis gene (NUTM1) that makes the cancer aggressive and resistant to standard therapy, hence requiring a multimodal approach. This patient underwent surgery followed by concurrent cisplatin-radiation and PBL. Two weeks after his first PBL infusion, he suddenly developed polydipsia, polyuria, and nausea. He continued to receive the second PBL dose on day 20 and developed DKA on day 21. His work-up revealed a plasma glucose of 856 mg/dL, anion gap of 20 (H), CO2 of 17 mEq/L (L), and beta-hydroxybutyrate of 3.35 mmol/L (H), while hemoglobin A1C of only 5.5% suggesting his fulminant progression. He was immediately treated with DKA protocol with clinical improvement. The patient was discharged on basal bolus insulin regimen. He had non-detectable C-peptide (&lt;0.10 ng/mL) and high GAD Antibody (&gt;250 IU/mL) levels, which was consistent with PBL induced T1DM.

Conclusion
PBL use has been linked to multiple endocrinopathies and even though rare, DKA can also be seen in setting of T-cell mediated irreversible damage to pancreas beta cells. Due to life threatening potential of DKA, clinicians should monitor patients receiving immune checkpoint inhibitors closely and should be aware symptoms of hyperglycemia for earlier intervention. | Keywords: pembrolizumab, NUT carcinoma, diabetic ketoacidosis
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
ODP236 Reducing length of Hospital Stay and Mortality in COVID-19 Patients with Diabetes
Authors: Bokhari Samia , Khan Patan , Shareef Muneera A , Safwat Rania , Galal Mohamed , Qadi Hamdi , Alzahrani Ameerah , Boraie Rehab A , Zahrani Sara 
Published: November 2022

Abstract

Introduction: & Background
Diabetes in COVID-19 patients is individual risk factor and documented in worldwide studies to contribute to disease severity, increased length of stay and higher mortality (fig-1). Aggressive management of blood sugars and acute diabetic complications reduce the length of stay and mortality.

Methods
Randomly selected 200 patients admitted with diabetes and COVID-19 studied. The unified treatment protocol (fig-2) applied for all patients and blood sugars monitored closely and optimized. Data collected on bimonthly basis and analyzed. Patients’ characteristics taken from data extraction tool (Oasis) of hospital. Median values for length of stay and post discharge FBS and RBS were calculated Microsoft Excel tool. Mortality rates calculated by percentages.

Results
200 patients studied in the 4 months study period. The median length of stay was 3 days. The mortality rate was 2.5% (fig-3,4). The median FBS and RBS in the patient group monitored in the post discharge clinic was 130 mg/dl and 170 mg/dl respectively. The results compared with the standard international studies.

Discussion
Diabetes in COVID-19 patients posed great challenge as increased severity and mortalities reported compared to non-diabetic. Taking a pre-emptive strategy to combat this problem by aggressively manage diabetes help in reducing length of stay and morbidity. The length of stay in studded population was 3 days as compared to 13 days in a major international study(Ref: 1) . Financial saving come from rapid turnover of beds. The mortality was 2.5% compared to reported 7.3% in a major study (Ref: 2), reflecting the implications of aggressive management of diabetes. Regular follow-up and support by running post-discharge clinic definitely help reducing readmissions and acute complications of uncontrolled diabetes.

Conclusion
Aggressive management of diabetes in COVID-19 patients by tailored treatment protocols and dedicated teams will help to decrease the morbidity and mortality.
Presentation: No date and time listed
ODP237 Relation Between Long Term Glycemic Variability (LTGV) and HbA1c Time-In-Range in Diabetic Patients.
Authors: Delgado-Vazquez Angel Jesus , Garcia-Alcala Hector , Marin-Corte Juan Carlos Alberto 
Published: November 2022

Abstract

Background
LTGV has become, aside with mean Hba1c level, a new measure of glycemic control. Despite the burden of information about its association to long term diabetic complications, in real-life is uncertain its relation to glycemic control.

Objective
to describe in real-life conditions the relation between long term LTGV and glycemic control.

Methods
from our clinical laboratory data base we selected those patients who attended for HPLC´s determination of HbA1c for at least two times in 2 consecutive years. We discard those results from patients with anemia or kidney failure. To evaluate LTGV in all patients that fulfill the requirements HbA1c variation coefficient (VC) were calculated ((HbA1c SD/mean HbA1c)X100). Time in control range were assessed as the percent of results below 7% during follow up. Patients were categorized in quartiles according to VC and percent of determinations of Hba1c &lt;7%. (HbA1c&lt; 7). We compared the frequency low vs high VC (quartile 1 vs 4) in patients divided by HbA1c&lt; 7 quartiles and VC levels between hba1c&lt;7 quartiles.

Results
we studied 193 patients (52.8% men, 61.23 (12.81) years, 925(171) days of follow up).: Percent of patients with low vs high VC quartiles (1 vs 4 respectively) divided by HbA1c&lt;7 quartiles were: quartile 1: 57% vs 0. 0%, quartile 2: 19.6% vs 52.9%, quartile 3: 10.2% vs 57.1% and quartile 4: 18.3% vs 20%. (p&lt;0. 05 quartile 1 vs 2,3,4 and quartile 3 vs 4). VC level were (quartiles 1 to 4 respectively, mean (SD)): 5.42(3), 22(15), 21.34(11),13(7). (p&lt;0. 05 quartile 1 vs 2,3,4, quartile 2 vs 4, quartile 3 vs 4).

Conclusions
High glycemic variability is rare observed in patients with excellent glycemic control but seems very frequent in those with less than perfect controlled patients (quartiles HbA1c&lt;7, 2 and 3) even in comparison to patients never controlled (quartile 4). VC levels are also higher in those patients in intermediate Hba1c &lt;7 quartiles. It is very interesting that those patients never controlled(HbA1c&lt;7 quartile 4) has no either the higher level of VC or frequency of high VC.
Presentation: No date and time listed
ODP248 The Effects of Insulin-like Growth Factor-binding Protein-3 on Metabolism During Short Term Fasting in Mice in Vivo
Authors: Choi Iee H , Kim Minsun , Kim Sun-Young 
Published: November 2022

Abstract
IGFBP-3 is the main abundant circulating IGFBP and plays an important role in the metabolic effect of IGF-1. We investigated the effects of IGFBP-3 on metabolism in short-term fasting and found that when IGFBP-3 was added to mice, serum triglyceride concentration were significantly enhanced. Fasting also significantly enhanced triglyceride concentration in liver and serum to the same degree as IGFBP-3. IGFBP-3 transfection suppressed the expression of ketogenesis and beta oxidation genes in liver after 24 h fasting. Also, they were shown significantly increase oflipolysis related protein expression in peripheral adipocyte and decrease the adipocyte size. Additionally, fat accumulation was more increased in the liver transfected with IGFBP-3 after fasting than controls. These in vivo findings demonstrate that IGFBP-3 has potent lipid metabolism and fasting-antagonizing capability and suggest a role for IGFBP-3 in the pathogenesis and homeostasis control of metabolism.
Presentation: No date and time listed
OR24-1 Paracrine Growth Factor Signaling Regulates Muscle Regeneration in Aged Mice via microRNA 501
Authors: Krützfeldt Jan , Fahrner Alexandra 
Published: November 2022

Abstract

Background
Skeletal muscle is one of to the most dynamic and plastic tissues. The capacity to regenerate arises from adult muscle stem cells termed myogenic progenitors (MPs) that are activated in response to injury and differentiate to replenish damaged muscle fibers. The age-related loss of muscle mass is reflected in the reduced regenerative potential of MPs. The underlying mechanisms are still unclear and insights into alterations in adult muscle stem cells during ageing are urgently needed. We have previously identified a novel muscle-specific microRNA, miR-501-3p, that is enriched in activated MPs. Pharmacological inhibition of miR-501 during muscle regeneration promoted small-diameter neofibers. Here, we provide evidence for the regulation of miR-501 in skeletal muscle during aging and its effect on newly formed myofibers using genetic deletion in mice.

Methods
We analysed the regulation and upstream signalling pathways of miR-501 in primary myoblasts from mice and humans and in skeletal muscle from young and aged mice. We generated a novel Cre-loxP mouse model, which allowed for global and MP-specific deletion of miR-501. Skeletal muscle regeneration was induced using cardiotoxin (CTX) and assessed using immunofluorescence and transcriptomic analysis.

Results
miR-501 was upregulated in muscle cells by the paracrine growth factors platelet derived growth factor (PDGF) and vascular endothelial growth factor (VEGF) through the Janus tyrosine kinase (JAK)-signal transducer and activator of transcription-3 (STAT3) signalling axis. Expression levels of miR-501 as well as its upstream regulators Pdgf and Vegf were significantly reduced in skeletal muscle from aged mice (22 months) compared to young mice (3 months) by 67.8% (p&lt;0.001), 40.0% (p&lt;0.01) and 36.3% (p&lt;0.05), respectively. Genetic deletion of miR-501 in mice resulted in muscle fibers with decreased size in adult skeletal muscle and in newly formed myofibers during muscle regeneration. RNA-seq of regenerating muscle annotated a critical role for miR-501 in the organisation of muscle filaments. We identified a miR-501-dependent sarcomeric gene signature that involves genes such as myosin heavy chains, titin and tubulin polymerization-promoting protein. This was confirmed in vitro in myotubes from mice and humans in which miR-501 was deleted either genetically or pharmacologically using antagomirs. Altered sarcomeric gene expression correlated with an increased sarcomere length in myotubes lacking miR-501 (2.49 ± 0.08μm vs 3.22 ± 0.15μm, p&lt;0.01).

Conclusion
Our data indicate that paracrine growth factor signalling contributes to muscle fiber formation via miR-501 in myogenic progenitor cells and its effect on the sarcomere. Restoring the Pdgf+Vegf/miR-501 axis might have the potential to improve muscle formation during aging.
Presentation: Monday, June 13, 2022 11:00 a.m. - 11:15 a.m.
Relationship between Physical Activity and Pain in U.S. Adults
Authors: RAY BILLY MICHAEL , KELLERAN KYLE J. , EUBANKS JAMES E. , NAN NAN , MA CHANGXING , MILES DEREK 
Published: November 2022

ABSTRACT

Purpose
We sought to assess the relationship between physical activity (PA) and pain within the available sample, with secondary aims to assess prevalence of pain, PA levels, health care seeking behaviors, and impact of pain on daily activities and work.

Methods
We conducted an epidemiological cross-sectional observational study utilizing National Health Interview Survey data from 2020. We examined the self-reported adherence to current PA guidelines and the prevalence of pain. We hypothesized those dealing with pain were less likely to meet PA guidelines. The PA levels, pain prevalence, frequency, and intensity were assessed via the survey and relationships explored via modeling.

Results
Of 31,568, 46% were men and 53.99% women with mean age of 52.27 yr (±17.31 yr). There were 12,429 (39.37%) participants that reported pain on some days, 2761 (8.75%) on most days, and 4661 (14.76%) every day. The odds of engaging in PA decreased in a stepwise fashion based on frequency and intensity of pain reporting when compared with no pain. Importantly, PA is a significant correlate affecting pain reporting, with individuals engaging in PA (strength and aerobic) demonstrating two times lower odds of reporting pain when compared with those not meeting the PA guidelines.

Conclusions
There is a significant correlation between meeting PA guidelines and pain. Meeting both criteria of PA guidelines resulted in lower odds of reporting pain. In addition, the odds of participating in PA decreased based on pain frequency reporting. These are important findings for clinicians, highlighting the need for assessing PA not only for those dealing with pain but also as a potential risk factor for minimizing development of chronic pain.
Authentic leadership and innovative work behavior through organizational culture: A study in Indonesian state-owned enterprises
Authors: Indrayanti Indrayanti , Ulfia Nida 
Published: November 2022

Background: Innovation is one of the keys for organizations to win the competition and be able to survive. State-owned enterprises require employees to face the competition by showing innovative work behavior where leadership factors and organizational culture could influence this behavior. This study examines the role of authentic leadership in innovative work behavior through organizational culture as a mediator. Methods: Participants in this survey study were 272 employees of Indonesian state-owned enterprises, but only 153 employees from 17 work teams were involved in data analysis at the group level. The research instrument was adapted from the innovative work behavior scale, authentic leadership questionnaire, and the Indonesian state-owned enterprises culture scale, which consists of six core values: trustworthy, competent, harmonious, loyal, adaptive, and collaborative. Data collection in this study was carried out by distributing questionnaires in the form of a Likert scale online via a google form. The data were analyzed using partial-least square analysis. Results: The results showed that organizational culture mediated the relationship between authentic leadership and innovative work behavior. Conclusions: The group experience of the presence of an authentic leader can improve the implementation of organizational culture, which in turn may increase innovative work behavior at the group level.