Background: Immune mediated diabetes mellitus (DM) is a rare complication of immune checkpoint inhibitor (ICI) therapy, with an incidence of less than 1%. We present a case of immune-mediated DM with nivolumab therapy presenting as diabetic ketoacidosis (DKA). Case: A 74-year-old Caucasian male with no history of DM or autoimmune disease was diagnosed with stage III metastatic melanoma and started on treatment with nivolumab, an ICI. He tolerated treatment well and had no evidence of endocrine dysfunction on routine laboratory monitoring. Shortly after completing his 14th cycle of nivolumab therapy, he presented to the emergency department with a one-week history of fatigue, poor appetite, polydipsia, and polyuria. He was found to have DKA with serum blood glucose 446 mg/dL, anion gap 20 mEq/L, serum bicarbonate 14 mEq/L, arterial pH 7.23, and 4+ urine ketones. His hemoglobin A1c was 7.3%, increased from 5.4% one year earlier. He was treated with intravenous insulin then transitioned to basal-bolus subcutaneous insulin therapy, which was continued at discharge. Evaluation in the outpatient setting revealed no measurable GAD65 antibodies or anti-insulin antibodies, but his serum c-peptide was found to be <0.10 ng/mL with corresponding serum blood glucose level 214 mg/dl. This supported a diagnosis of endocrine pancreatic insufficiency, in his case likely immune mediated due to nivolumab therapy. He completed an additional 6 cycles of nivolumab with no further complications. Meanwhile his DM became well-controlled with subcutaneous insulin injections, and he was eventually transitioned to insulin pump therapy. Discussion: ICIs such as nivolumab are known to cause multiple autoimmune complications that can appear at any point during treatment. The underlying mechanisms of beta cell immunotoxicity are incompletely understood, but progression to insulin-dependency appears to be rapid. It is important to recognize new or worsening DM early to avoid life-threatening complications such as DKA. Disclosure S.M.Iqbal: None. C.Houston: None.

Objectives. Patients with inflammatory bowel disease have an increased risk of developing oral health problems. The aim of this study was to investigate whether oral diseases in these patients are related to inflammation of the intestine and if there is a correlation between inflammatory bowel diseaseÀspecific health-related quality of life (IBD-HR-QOL) and oral health problems. Study Design. The study was a cross-sectional survey and analysis of self-reported oral health of individuals with a stoma for Crohn's disease (CD), ulcerative colitis (UC), and treated colon cancer (CC). Validated international questionnaires were sent to members of the Stoma Federation of The Netherlands. Because there was an unequal distribution of male and female patients with CD and CC, data of 169 age-matched female patients with CD, UC, and CC with a stoma were analyzed. Results. Patients with CD had significantly more oral health problems compared with those with UC or CC. Patients with CD and UC both had significantly more gingival-related problems compared with patients with CC. There was a significant negative correlation between IBD-HR-QOL and oral health problems. Conclusions. In the 3 distinguishable groups of patients with a stoma, patients with CD had an increased risk for oral health problems, independently from surgical removal of (a part of) the inflamed intestine, suggesting a general increased susceptibility of patients with CD for oral health problems. (Oral Surg Oral Med Oral Pathol Oral Radiol 2020;130:e80Àe86) Statement of Clinical Relevance Patients with inflammatory bowel disease, particularly those with Crohn disease, have an increased risk for oral health problems, which remains after surgical removal of (a part of) the inflamed intestine, necessitating special attention to their oral health from gastroenterologists and dentists.

Purpose: This study aims to examine the impact of Corporate Social Responsibility (CSR) image on customer satisfaction in the context of the banking sector of Pakistan. Further, the intervening role of customer trust and customer loyalty in the relationship between CSR image and customer satisfaction is also examined. Design/Methodology/Approach: Present research is quantitative in nature and collects the data through structured questionnaires. By employing the Smart PLS technique to test the proposed hypothesis. Findings: This study reveals the following salient findings: 1) the response of CSR image to customer satisfaction is positive (p<0.01); 2) customer trust and customer loyalty both significantly mediates the impact of CSR image on customer satisfaction. Implications/Originality/Value: Based on novel findings, the current study will help the organizations to realize the significance of CSR practices to enhance the customers’ satisfaction level.