University of Maryland Medical Center Midtown Campus

39 Background: Prostate cancer is a leading cause of cancer-related death among men in the United States (U.S). Despite therapeutic advances, racial disparities persist, with African American men experiencing higher incidence and poorer survival. Data on racial differences in inpatient outcomes, particularly in-hospital mortality, remain limited. This study evaluated racial and ethnic variations in in-hospital mortality among patients hospitalized with malignant prostate cancer (MPC) in the U.S. Methods: The U.S National Inpatient Sample (NIS) from 2016 to 2020 was queried for patients diagnosed with MPC. We used International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS) code “C61” to identify patients who were hospitalized for MPC. The study was exempt from institutional review board approval as the NIS database contains deidentified patient information. Multivariable regression analysis was performed to determine the odds of in-hospital mortality among patients with MPC. Multivariable logistic regression followed by marginal effects was used to plot yearly trends in in-hospital mortality. All the outcomes were adjusted for age, gender, Charlson comorbidity index (CCI) and hospital characteristics. All Statistical analyses were conducted using STATA 19 software. Results: The current retrospective study analyzed 98,000 patients hospitalized for MPC between 2016 to 2020. The racial distribution among study patients included: Whites (68,000; 69.4%), African Americans (17,738; 18.1%), Hispanics (7,154; 7.3%), and other minorities (5,098; 5.2%). African Americans were more likely to be hospitalized at a relatively younger age, and with a higher co-morbidity burden (mean age: 69.4 years; mean CCI: 5.5; p<0.01) when compared to Whites (mean age: 73 years; mean CCI: 4.8), Hispanics (mean age: 71.1 years; mean CCI: 5.1) and other minorities (mean age: 71.5 years; mean CCI: 5.0). A total of 3,626 (3.7%) patients died during the study period. On multivariable analysis, a higher absolute in-hospital mortality was observed in African Americans (OR: 1.14, 95% CI: 1.07 – 1.22, p <0.01) and other minorities (OR: 1.19, 95% CI: 1.06 – 1.34, p <0.01), when compared to Whites (OR: reference). Similarly, an increasing trend of in-hospital mortality was observed in African Americans (from 1.6% mortality per annum in 2016 to 2.0% in 2020; trend p <0.01) and Hispanics (from 1.1% mortality per annum in 2016 to 1.6% in 2020; trend p = 0.02). No change in mortality was observed among Whites (trend p = 0.171) and other minorities (trend p = 0.479) during the study period. Conclusions: Racial disparities persist in in-hospital outcomes among patients with MPC in the U.S. African American and Hispanic patients experienced increasing in-hospital mortality over time, highlighting the need for targeted interventions to address inequities in access, comorbidity management, and inpatient care.

Disclosure: B. Zaidan: None. M. Pennant: None.Background: Maple Syrup Urine Disease (MSUD) is an autosomal recessive disorder caused by a defect in the branched-chain alpha-ketoacid dehydrogenase (BCKAD) complex, essential for metabolizing branched-chain amino acids (BCAAs): isoleucine, leucine, and valine. These amino acids are crucial for cellular signaling, cholesterol synthesis, energy production, and mTOR pathway regulation. Leucine activates mTORC1, affecting insulin sensitivity (1). Excessive BCAA intake can elevate mTORC1 activity, leading to insulin resistance and type 2 diabetes (2,3). Case-control studies link BCAA metabolism to insulin resistance and diabetes risk (4). Though HbA1c data in MSUD adults is limited, a case report describes a 4-year-old with MSUD and type 1 diabetes, managed with dietary changes and insulin (2,3). Case description: A 40-year-old male with a medical history of maple syrup urine disease (MSUD), anxiety, and prediabetes has experienced multiple hospitalizations due to MSUD crises. His most recent admission was complicated by acute leucine encephalopathy, raising concerns about the progression to type 2 diabetes mellitus (T2DM). The underlying triggers for these metabolic crises have often been unclear. During hospitalization, the patient adhered to a strict dietary regimen, limiting protein intake to a maximum of 45 grams per day. He was maintained on MSUD-specific formulas, such as Ketonex, designed to provide essential nutrients while minimizing leucine, isoleucine, and valine intake. His glucose intolerance was closely monitored even before the T2DM diagnosis through HbA1C and blood glucose measurements. Over the years, his HbA1C levels varied, 5.4%, 6.5%, and most recently 5.6%. While his early glucose values were within the normal range, prior to and around the time of T2DM diagnosis, a higher reading with an average of 126 mg/dL, with the highest of 418 mg/dL and a lowest of 72 mg/dL (normal range: 74-109 mg/dL). What made this case unique was the challenge of managing his impaired glucose tolerance without worsening MSUD. Individuals with MSUD require pure starch and simple sugars to maintain balanced branched-chain amino acids (BCAA) levels. During this hospitalization, we adopted a dietary strategy that maintained adequate simple carbohydrate intake while continuing Ketonex supplementation. Conclusion: This case underscores the necessity of timely and appropriate management in patients with MSUD to prevent severe complications. A multidisciplinary treatment approach is crucial to navigate the intricacies of the disease, dietary adherence, and psychological health. Future efforts should focus on improving care coordination and patient education to enhance the quality of life for individuals with this complex condition.Presentation: Monday, July 14, 2025

Drug-induced immune hemolytic anemia (DIIHA) is a rare complication of drug treatment. The clinical presentation involves rapid dropping of hemoglobin secondary to hemolysis leading to potentially fatal consequences. Over 100 drugs have been reported to cause DIIHA, most commonly cephalosporins. Here, we present a case of vancomycin-induced immune hemolytic anemia. The diagnosis was challenging due to the limited reports of hemolytic anemia induced by vancomycin in the setting of multiple antibiotic administration history. Hemolysis improved after vancomycin cessation and diagnosis was made with positive serological confirmation. Literature review was performed with four reported cases of vancomycin-induced immune hemolytic anemia identified and summarized. Our goal is to promote awareness of vancomycin as an uncommon cause of DIIHA for better management in clinical practice.

ABSTRACT Introduction Hyperglycemia in pregnancy, including gestational diabetes mellitus (GDM) and pregestational diabetes, significantly impacts maternal and neonatal outcomes, necessitating effective management strategies. Insulin is the first-line therapy; however, adherence barriers, cost, and route of administration challenges have driven interest in oral agents like metformin and glyburide. These agents offer practical alternatives but raise questions about long-term safety and fetal exposure. Areas covered This review evaluates the pharmacokinetics, pharmacodynamics, and clinical outcomes of metformin and glyburide, focusing on their roles in GDM, pregestational diabetes, polycystic ovary syndrome (PCOS), and obesity. Maternal outcomes, neonatal impacts, and long-term offspring health were assessed to determine the safety of these therapies. Expert opinion Metformin reduces insulin dependency and weight gain during pregnancy but raises concerns about short and long-term offspring impacts, such as increased SGA rates (22% vs. 5%), altered growth patterns, and offspring neurocognition. Glyburide is effective for glycemic control but carries higher neonatal hypoglycemia risks and lacks robust long-term safety data. Both agents hold promise as alternatives to insulin, particularly in resource-limited settings. However, further research is needed to address knowledge gaps, optimize their use, and ensure safe integration into clinical practice.

Immune checkpoint inhibitors (ICIs) have become the first-line treatment of unresectable hepatocellular carcinoma (HCC). The prognostic value of immune-related adverse events (irAEs) in these patients remains controversial. We aimed to investigate the association between irAEs and clinical outcomes in patients with HCC treated with ICIs. We searched the PubMed, Scopus, Web of Science, and Central Register of Controlled Trials databases for articles published from inception to June 2024, using keywords including ICI, HCC, and irAEs. Statistical analysis was performed with a random effects model. Of 3,028 studies, 24 (4,127 patients) met the criteria for inclusion. Atezolizumab plus bevacizumab was the most common treatment regimen (n = 10 studies). IrAEs were associated with an increased objective response rate (pooled relative ratio: 1.73; 95% confidence interval [CI]: 1.36-2.21, I 2 = 41%), a higher disease control rate (pooled relative ratio: 1.45; 95% CI: 1.21-1.74, I 2 = 74%), and longer progression-free survival (pooled hazard ratio [HR]: 0.66; 95% CI: 0.52-0.84, I 2 = 71%). There was a trend toward longer overall survival for patients with irAEs compared with those without (pooled HR: 0.84; 95% CI: 0.63-1.12, I 2 = 73%). Subgroup analysis indicated a survival benefit for patients with grade 1-2 irAEs (pooled HR: 0.50; 95% CI: 0.36-0.67, I 2 = 0%) and for those with endocrine irAEs (pooled HR: 0.63; 95% CI: 0.48-0.83, I 2 = 12%). The development of irAEs is associated with favorable clinical outcomes in HCC, including improved progression-free survival and higher objective response rate. Overall survival benefit was noted in patients with mild irAEs but not those with severe irAEs.

Introduction:Endoscopic submucosal dissection (ESD) is a technique for removing dysplastic lesions in the gastrointestinal tract but carries risks like pain and perforation. Dexmedetomidine, an α2-receptor agonist, offers potential benefits as an adjunct sedative during ESD by providing anxiolysis and analgesia. This systematic review and meta-analysis assesses its efficacy and safety.Methodology:We searched databases including Embase, Medline/PubMed, Scopus, and Web of Science up to April 21, 2024, following PRISMA guidelines. Eligible studies used dexmedetomidine with other sedatives for ESD. We analyzed outcomes such as en-bloc and complete resection rates, sedation duration, and adverse events, using RevMan for meta-analysis with a random-effects model.Results:The initial search retrieved 216 studies and after screening, eight studies were included in the final analysis. Dexmedetomidine showed no significant difference in en-bloc or complete resection rates compared to controls. Sedation and procedure times were similar between the two groups as well. Dexmedetomidine significantly reduced restlessness (OR 0.15, 95% CI:0.07 to 0.29) and increased bradycardia (OR 7.15, 95% CI 3.17 to 16.11) compared to controls. Upon subgroup analysis, Dexmedetomidine plus Propofol, and Dexmedetomidine plus Midazolam, revealed the same findings regarding restlessness and bradycardia compared to controls which confirmed the adjunctive effects of Dexmedetomidine.Conclusion:Dexmedetomidine as an adjunctive sedative appears safe and effective in ESD, reducing restlessness without significant adverse events. The risk of bradycardia is increased, which may be reflective of reduced physiological stress. Future studies should explore optimal dosing and compare Dexmedetomidine with other sedatives in diverse populations