Relationship Between Glycated Haemoglobin and Carotid Atherosclerotic Disease Among Patients with Acute Ischaemic Stroke

Objectives: This study aimed to determine the relationship between glycaemic control and carotid atherosclerotic disease among patients with acute ischaemic stroke (AIS). Methods: This retrospective cross-sectional study took place in the Neurology Department of King Fahad Hospital of University, Khobar, Saudi Arabia, from April to October 2017. Data were collected from the medical records of 244 patients with a diagnosis of AIS confirmed by computed tomography. Doppler ultrasounds of the carotid artery were performed to determine the presence of increased carotid intima media thickness (CIMT) and plaques. Results: Significantly higher mean glycated haemoglobin (HbA1c) levels were noted in cases with high CIMT values (P = 0.002), but not in cases with carotid plaques (P = 0.360). In addition, there was a significant association between diabetes mellitus (DM) and high CIMT (P = 0.045), but not with carotid plaques (P = 0.075). Finally, while dyslipidaemia and age were independently correlated with high CIMT values (P = 0.034 and 0.050 each). Conclusion: High HbA1c levels were associated with high CIMT values, but not with carotid plaques. Therefore, HbA1c levels may be useful as an indirect marker of the initial stages of carotid artery atherosclerosis. Keywords: Glycated Hemoglobin A1c; Diabetes Mellitus; Carotid Intima-Media Thickness; Atherosclerotic Plaque; Stroke

190 - Fistulous Complication and Successful Revision of a Continent Catheterizable Channel in a Patient with Neurogenic Bladder

Introduction: Continent catheterizable channels (CCCs) are a viable option for patients with neurogenic bladder who cannot perform intermittent self-catheterization (ISC) due to severe urethral pathology or when accessing the urethra is nearly impossible (1). These channels provide an alternative drainage route via an abdominal stoma, which is often located at the umbilicus for both cosmetic reasons and ease of catheterization. CCCs are typically constructed using the appendix (Mitrofanoff procedure) (2), a re-tubularized short or double intestinal segment (Yang-Monti or Casale methods)(3), or similar techniques employing the efferent limb of a Kock or Indiana pouch. In cases requiring more extensive surgical intervention, CCCs may be combined with augmentation cystoplasty and bladder neck closure. Despite their effectiveness, data on the use of CCCs in spinal cord injury (SCI) patients are limited.One of the potential complications of CCCs is the formation of fistulas, which are abnormal connections that can develop between the bladder and other organs or tissues. This can result from surgical techniques, tissue ischemia, or infection. Fistula formation can lead to leakage, infections, and significant patient discomfort, requiring further surgical intervention to repair.We present a case of fistulous complication of CCC that resulted in urinary leakage through the diversion requiring revision of the CCC with successful outcome. Design: A 25-year-old lady with history of myelomeningocele and neurogenic bladder had undergone ileo-cystoplasty and CCC in our center 6 years prior to presentation. The CCC was done using a tailored ileal segment implanted in an S-shaped pouch through a serous lined extramural tunnel.The patient used to have good continence and to catheterize through the umbilical stoma with average output around 500 ml/ cath. For the 6 months prior to presentation, the patient noticed recurrent urinary leakage through the stoma and a decrease in the output to about 250 cc.Cystoscopy showed a fistulous tract opening between the mid part of the channel and the main pouch. The opening seemed to be a result of a false passage during catheterization. The patient was counseled for exploration of the augmented bladder and possible revision of the CCC. Results: Under general anesthesia, Foley’s catheter size 16 Fr inserted through the CCC. Through a lower mid line incision around the stoma tract, dissection done revealing the augmented bladder. The augmented bladder was opened showing a fistulous tract extending between the middle of the CCC into the bladder cavity. The fistula was repaired in two layers. The CCC was examined to show easy passage of the catheter and intact tract lining. Indwelling catheter was kept on the CCC for two weeks. On follow up the patient had excellent continence outcome with no leakage through the CCC. Flexible cystoscopy showed good healing of the fistulous tract. Conclusion: CCCs offer a practical solution for patients unable to perform ISC, though they carry risks such as fistula formation. Careful follow up of such patients is essential to mitigate complications and achieve favorable outcomes.Funding The authors of this video abstract received no funding. Clinical Trial No Subjects Human Ethics Committee Hamad Medical Corporation Helsinki Yes Informed Consent Ye

95 - What Patients Discuss Online About Sacral Neuromodulation: A Qualitative Study of Peer-Shared Experiences and Misconceptions

Hypothesis / aims of study: Sacral neuromodulation (SNM) is a well-established therapy for refractory overactive bladder (OAB) and urinary incontinence, yet patient perceptions and concerns about the procedure remain poorly understood. Online discussions related to SNM therapy represent an important source of information and peer to peer education. This study is the first study to evaluate SNM discussions and patient post market experiences. The primary aims were to (1) qualitatively analyze patient-reported experiences with SNM, (2) identify common concerns and uncertainties, and (3) evaluate the quality of peer to peer education material. By examining these factors, the study seeks to provide insights that could enhance clinical counseling and patient-centered care. Study design, materials and methods: A qualitative content analysis was conducted using publicly available discussions from the Reddit subreddits r/OveractiveBladder and r/Incontinence. The Reddit API was employed to extract the top 100 threads containing keywords “sacral neuromodulation,” “Axonics,” “InterStim,” and “sacral nerve stimulation.” Two independent researchers performed iterative coding using inductive thematic analysis, with inter-rater reliability assessed via Cohen’s kappa. Themes were categorized into (1) patient experiences after therapy and reported complications, (2) pre-procedural concerns, and (3) misconceptions about therapy. Results: After excluding duplicates and irrelevant content, 464 threads and 3,413 comments were analyzed. Analysis of the discussions revealed that only 6.8% represented firsthand patient experiences with SNM, while 2.4% were inquiries from potential therapy candidates. The remaining 90.78% consisted of general discussions and opinions. Among those sharing postoperative experiences, 60% reported positive outcomes, endorsing the therapy for symptom relief, while 20% advised against it due to complications such as nerve pain, device discomfort, and the need for revision surgeries. The remaining 20% expressed mixed or neutral views.———————–For non-SNM users, prevalent concerns included doubts about therapy efficacy, fear of postoperative pain, financial and insurance barriers, doubts related to post-market supplier services, and mistrust in medical expertise. Common misconceptions involved expectations of a complete cure for bladder symptoms, fears of permanent disability post-surgery, incompatibility with MRI and metal detectors, and potential effects on sexual function. Interpretation of results: The findings underscore a disconnect between clinical success rates of SNM and patient perceptions shared online. While many patients benefit from the therapy, negative experiences and misconceptions dominate discussions, potentially deterring others from considering SNM. The low proportion of firsthand accounts suggests that patients may turn to online forums due to inadequate preoperative education or unresolved concerns. The prevalence of financial and procedural fears further indicates systemic barriers to SNM adoption. Concluding message: This study reveals that online platforms like Reddit serve as critical spaces for patients to seek peer support and information about SNM, yet they also propagate uncertainties and misinformation. Clinicians must address these concerns by integrating patient-reported experiences into preoperative counseling, developing accessible educational materials, and fostering transparent discussions about risks and benefits. Medical device manufacturers should prioritize patient feedback to enhance device design and post-market support. By bridging the gap between clinical evidence and patient perceptions, healthcare providers can empower individuals to make informed decisions, ultimately improving satisfaction and outcomes with SNM therapy.Funding None Clinical Trial No Subjects Non

P.092 The effect of the timing of surgery on outcomes for incidental low-grade gliomas: a systematic review

Background: Although previous research has suggested that patients with incidentally discovered low-grade gliomas (iLGG) who undergo surgery prior to the appearance of symptoms have improved outcomes compared to those who are symptomatic, an ideal approach to managing iLGG is not well-established. The purpose of this systematic review is to identify all cases of iLGG in the literature and characterize the effect of the timing of surgery on survival. Methods: We searched EMBASE, MEDLINE, and PubMed for articles related to iLGG. After duplicates were removed, the articles were then screened based on strict inclusion and exclusion criteria. Results: We retrieved 24/1377 unique articles with a total of 175 patients who underwent surgery for iLGG prior to symptoms appearing. The average age was 29.1yrs (range 1-62) and the mean follow-up period was 56 months (range 1-234months). Unfortunately, only 6/24 articles reported progression-free survival (average 32.4months) and only 1/24 reported 10-year survival. Conclusions: The articles we identified favored an early intervention for iLGG, however, there was a considerable lack of long-term follow-up and survival data to justify such a claim. Further studies need to be performed with adequate follow-up data in order to determine the optimal timing of surgical intervention for these patients.</jats:p

The role of RNA metabolism in neurological diseases

Neurodegenerative disorders are commonly encountered in medical practices. Such diseases can lead to major morbidity and mortality among the affected individuals. The molecular pathogenesis of these disorders is not yet clear. Recent literature has revealed that mutations in RNA-binding proteins are a key cause of several human neuronal-based diseases. This review discusses the role of RNA metabolism in neurological diseases with specific emphasis on roles of RNA translation and microRNAs in neurodegeneration, RNA-mediated toxicity, repeat expansion diseases and RNA metabolism, molecular pathogenesis of amyotrophic lateral sclerosis and frontotemporal dementia, and neurobiology of survival motor neuron (SMN) and spinal muscular atrophy

23 - Outcomes of sequential anti-stress urinary incontinence procedures

Hypothesis / aims of study: This retrospective cohort study aims to evaluate the outcomes of individuals undergoing two or more anti-stress urinary incontinence procedures, specifically assessing urinary retention rates, voiding difficulties, and new-onset urge incontinence in patients who receive a mid-urethral sling after Bulkamid injections or Bulkamid injections after a mid-urethral sling. Study design, materials and methods: The study was approved by the institutional review board with no ethical concerns. This retrospective cohort study assessed urinary symptoms outcomes in patients undergoing both Bulkamid injections and mid-urethral sling placement for stress urinary incontinence. A matched control cohort was created based on age and BMI, with a 1:8 ratio for the sling-first group and 1:4 for the Bulkamid-first group. Data were extracted from the electronic medical record, with manual chart review of all patients to confirm eligibility and define outcomes. Urinary retention, voiding difficulties and new onset/worsening overactive bladder were assessed based on postoperative follow-up. Statistical analysis included descriptive statistics, chi-square tests, and logistic regression models to evaluate factors influencing urinary outcomes. Results: Nineteen patients underwent mid-urethral sling placement preceded by Bulkamid injections (bulkamid-first), compared to 160 patients who received a sling alone. The bulkamid-first group had a higher prevalence of preexisting OAB (47.4% vs. 9.4%, p7 days) indwelling catheterization, self-catheterization, or experienced persistent voiding difficulties. Retention rates did not differ between patients receiving Bulkamid after a sling and those undergoing Bulkamid alone. Concluding message: Patients undergoing a mid-urethral sling after a prior Bulkamid procedure are at increased risk of short-term urinary retention. No difference in retention rate was noted in patients undergoing Bulkamid after a prior mid-urethral sling.Funding None Clinical Trial No Subjects Human Ethics Committee Cleveland Clinic Institutional Review Board Helsinki Yes Informed Consent Ye

Finerenone in Patients with Nondiabetic Chronic Kidney Disease&mdash;A Retrospective Study

Background &amp; Objectives: Data on the efficacy and adverse effects of finerenone in patients with nondiabetic chronic kidney disease (CKD) are limited, particularly regarding ethnic diversity. This study aimed to evaluate the outcomes of finerenone in patients with nondiabetic CKD previously treated with standard therapies and investigate associated adverse effects, including hyperkalemia and hypotension. Methods: This is a retrospective exploratory study. It is a single-center study including patients with nondiabetic CKD who visited King Fahad Medical City in Riyadh, Saudi Arabia. The primary exposure was finerenone treatment, assessing its effects on albuminuria, kidney function, and blood pressure (BP), following prior use of renin&ndash;angiotensin&ndash;aldosterone system and sodium&ndash;glucose transport protein 2 inhibitors. The measured outcomes were the urine albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR). The UACR (primary endpoint) was calculated as the mean of two morning spot urine samples collected consecutively 1 day apart. During each 4-week treatment period, secondary endpoints included changes in UACR, as determined by a 24 h urine sample, BP, and eGFR. The Wilcoxon signed-rank test was used to compare changes in continuous variables before and after therapy initiation. Statistical significance was set at p &lt; 0.05. Results: This study included 16 patients with nondiabetic CKD (median age, 38.5 years [range, 35&ndash;50 years]; 56.3% male). The baseline eGFR was 66 mL/min/1.73 m2 (47&ndash;82.5), with a UACR of 90.0 mg/g (58.8&ndash;132.5). No hyperkalemia was observed (potassium level, 4 mmol/L [3.8&ndash;4.4]). However, significant reductions in systolic and diastolic BPs were observed. Albuminuria improved significantly: the UACR decreased from 90.0 to 39.3 mg/g (p = 0.04). No adverse events, including hyperkalemia or hypotension, were reported. Conclusions: Finerenone showed promise in reducing albuminuria and blood pressure among patients with nondiabetic chronic kidney disease, with no significant adverse effects reported. These findings suggest potential benefits for this patient population, warranting further investigation

THE ROLE OF RNA METABOLISM IN NEUROLOGICAL DISEASES

ABSTRACT Neurodegenerative disorders are commonly encountered in medical practices. Such diseases can lead to major morbidity and mortality among the affected individuals. The molecular pathogenesis of these disorders is not yet clear. Recent literature has revealed that mutations in RNA-binding proteins are a key cause of several human neuronal-based diseases. This review discusses the role of RNA metabolism in neurological diseases with specific emphasis on roles of RNA translation and microRNAs in neurodegeneration, RNA-mediated toxicity, repeat expansion diseases and RNA metabolism, molecular pathogenesis of amyotrophic lateral sclerosis and frontotemporal dementia, and neurobiology of survival motor neuron (SMN) and spinal muscular atrophy