European Federation         of Internal MedicineAbstracts Book7 Congress  thRome, Italy, Aurelia Convention Centre & Expo ...
European Federation of Internal MedicineScientific SecretariatG. LicataG. Gasbarrini, M.D. CappelliniG. Parrinello, A. Pin...
SUMMARYORAL COMMUNICATIONSWednesday, May 7, 2008RHEUMATOLOGY                           1PUBLIC HEALTH                     ...
Oral CommunicationsWednesday, May 7, 2008   RHEUMATOLOGY
1. ISCHEMIC HEART DISEASE AS THE PRESENTING FEATURE OF TAKAYASU’                                             2. PROLIFERAT...
5. THE ASSESSMENT OF A GROUP OF PATIENTS WITH FIBROMYALGIA FROM                                                  6. INTRAR...
Oral CommunicationsWednesday, May 7, 2008   PUBLIC HEALTH
1. PATIENTS OPINION ON THE QUALITY OF CARE OFFERED IN OUT PATIENT                                             2. ROUTINE A...
5. ASSOCIATIONS BETWEEN SMOKING, NUTRITIONAL STATUS AND CLINICAL                                            6. SAN FRANCIS...
Oral Communications  Thursday, May 8, 2008CARDIOVASCULAR DISEASE
1. HUMAN PARAOXONASE GENE POLYMORPHISM AND CORONARY                                                        2. PSYCHOLOGICA...
5. MEDICAL CO-MORBIDITIES: AN OBSTACLE TO GUIDELINES                                                          6. THE DIAGN...
9. EFFECTS OF LOW-GRADE SYSTEMIC INFLAMMATION ON                                                                10. HCV IN...
Oral Communications Thursday, May 8, 2008    PNEUMOLOGY
1. ANEMIA IN COPD PATIENTS AS A PREDICTIVE FACTOR OF HOSPITALARY                                                2. EVALUAT...
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Abstracts book of EFIM Rome 2008
Upcoming SlideShare
Loading in …5
×

Abstracts book of EFIM Rome 2008

5,736 views

Published on

Abstract book

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
5,736
On SlideShare
0
From Embeds
0
Number of Embeds
16
Actions
Shares
0
Downloads
26
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Abstracts book of EFIM Rome 2008

  1. 1. European Federation of Internal MedicineAbstracts Book7 Congress thRome, Italy, Aurelia Convention Centre & Expo May, 7-10, 2008
  2. 2. European Federation of Internal MedicineScientific SecretariatG. LicataG. Gasbarrini, M.D. CappelliniG. Parrinello, A. Pinto, R. Scaglione, A. TuttolomondoSocietà Italiana di Medicina Interna - SIMIViale dell’Università 25 • 00185 Rome (Italy)Phone (+39) 06 44340373 • Fax (+39) 06 44340474Presidents of the Congress Council of the Italian SocietyG. Licata Italy of Internal Medicine (SIMI)G. Gasbarrini Italy G. Abbita Erice M.D. Cappellini MilanoHonorary Presidents G.R. Corazza PaviaU. Carcassi Italy G. Crippa PiacenzaF. Dammacco Italy A. D’Avanzo AvellinoM. Sangiorgi Italy R. Lauro Roma G. Licata PalermoSteering Committee G. Mancuso Lamezia TermeW. Bauer Switzerland E. Mannarino PerugiaC. Davidson England P.M. Mannucci MilanoJ.W.F. Elte The Netherlands V. Marigliano RomaF. Ferreira Portugal M.A. Monti MilanoG. Gasbarrini Italy R. Nuti SienaG. Licata Italy M. Pagani MilanoS. Lindgren Sweden G. Palasciano BariP.M. Mannucci Italy F. Rossi Fanelli RomaD. Sereni France A. Sacco Matera M.B. Secchi MilanoEFIM Executive Committee G. Traisci PescaraW. Bauer Switzerland F. Violi RomaC. Davidson EnglandJ.W.F. Elte The Netherlands SIMI Executive SecretaryF. Ferreira Portugal F. Pepe RomaS. Lindgren SwedenD. Sereni France SIMI Administrative Secretary S. Pescetelli Roma EFIM Assistant Secretary I. Huis in t Veld The NetherlandsOrganizing SecretariatAristea GenovaSalita di Santa Caterina 4 • 16123 Genoa (Italy)Phone (+39) 010 583224 • Fax (+39) 010 5531544E-mail efim2008@aristea.com • www.aristea.com/efim2008
  3. 3. SUMMARYORAL COMMUNICATIONSWednesday, May 7, 2008RHEUMATOLOGY 1PUBLIC HEALTH 4Thursday, May 8, 2008CARDIOVASCULAR DISEASE 7PNEUMOLOGY 11GASTROENTEROLOGY 15HAEMATOLOGY AND ONCOLOGY 19CLINICAL CASES 23PUBLIC HEALTH 27MISCELLANEOUS 31CLINICAL CASES 35Fryday, May 9, 2008IMMUNOLOGY 39STROKE 42HEART FAILURE 45HYPERTENSION 48INFECTIOUS DISEASE 51GERIATRICS 55GASTROENTEROLOGY 59ENDOCRINOLOGY, DIABETES, NUTRITION 63Saturday, May 10, 2008ENDOCRINOLOGY, DIABETES, NUTRITION 66CLINICAL CASES 69CARDIOVASCULAR DISEASE 72EMERGENCY MEDICINE 75CLINICAL CASES 78NEPHROLOGY 83POSTER PRESENTATIONSWednesday, May 7, 2008 86Thursday, May 8, 2008 143Friday, May 9, 2008 201Saturday, May 10, 2008 257Summary Oral Communications 316Summary Poster Presentations 322
  4. 4. Oral CommunicationsWednesday, May 7, 2008 RHEUMATOLOGY
  5. 5. 1. ISCHEMIC HEART DISEASE AS THE PRESENTING FEATURE OF TAKAYASU’ 2. PROLIFERATIVE MYOSITIS ARISING IN THE STERNOCLEIDOMASTOIDARTERITIS MUSCLELorenzo Dagna, Fulvio Salvo, Emanuel Della Torre, Mattia Baldini, Enrica Bozzolo, Joaquin Campos-Franco, Nieves Mallo-Gonzalez, Raimundo Lopez-Rodriguez,Elena Baldissera, MariaGrazia Sabbadini Paula Barros Alcalde, Ihab Abdulkader, Rosario Alende-Sixto, Arturo Gonzalez-QuintelaTakayasu’s arteritis (TA) is an inflammatory disease that affects the aorta and/or its major branches. INTRODUCTION Proliferative myositis is an uncommon benign condition affecting skeletal mu-Cardiac involvement from TA is often underestimated: the heart can be directly involved by TA scle and characterized by the presence of ganglion-like giant cells within a myofibroblastic back-or be affected as a consequence of its systemic vascular manifestations. Primary cardiac involve- ground. Usually involves muscles of the trunk and extremities but the localization of this conditionment causing ischemic heart disease (IHD) can be the presenting feature of TA. We studied 60 in head and neck is rare. We report a case of proliferative myositis involving the sternocleidoma-consecutive patients (56F, 4M) with TA followed at San Raffaele Scientific Institute in Milan. Seven stoid muscle. CASE REPORT A 70-year-old woman was admitted to the hospital complaining of(6F, 1M, mean age 35.8 y) out of the 60 TA patients (11.7%) showed symptoms of IHD on pre- a five days painful mass in the neck. On physical examination, the patient was afebrile, with ansentation. Among them, 6 presented with exertion angina and 1 with an acute myocardial infar- arterial blood pressure of 115/70 mmHg, and showed a firm and painful mass of approximatelyction. A coronary angiography was performed in 6 patients and showed severe stenosis of both 2.5x1.5 cm arising from the sternal head of the right sternocleidomastoid muscle, just upon thecoronary ostia in 2 patients, whereas distal coronary artery stenoses were present in 3 patients; manubrium sterni. The rest of the physical examination was normal. A cervical and chest CT-scancoronary angiography was negative in a patient who had a positive ECG-stress test and a posi- showed a poorly demarcated enlargement of the right sternocleidomastoid muscle and there wastive stress myocardial perfusion study. The last patient had positive ECG- and myocardial perfu- no collection or lymphadenopathy. Adjacent bone was normal. A fine-needle-aspiration-biopsy ofsion imaging-stress tests, but didn’t undergo a coronary angiography. Interestingly, none of the the mass was performed and cytological smears obtained from lesion showed two populations ofpatients had known risk factors for IHD (only one was a mild smoker). Other signs and symptoms cells, fat cells and amorphous metachromatic material. The most prominent feature of the smearof TA were recognized on presentation in 4 out of 7 patients and a diagnosis of TA was consi- was a population of large polygonal cells resembling ganglion cells. The second population ofdered. In the 3 remaining patients, other signs of vascular involvement appeared later: the mean cells was composed of smaller oval to spindle-shaped cells with oval or bacillary-shaped nuclei. Thedelay in diagnosing TA was 38.7 months. Three patients were treated with CABG, 1 with a PTCA pathological diagnosis of the mass was proliferative myositis. No adjuvant therapy was admini-with stenting, 1 with a proximal aortoplasty. The other 2 patients were diagnosed with TA on pre- stered. After three weeks, the mass decreased and nearly disappeared. Actually, the patient issentation and received immunosuppressive therapy, with a marked improvement in IHD mani- asymptomatic. DISCUSSION PM is a benign tumor of the soft tissue that may mimic malignancy.festations. TA can present with signs and symptoms of IHD in many patients. Even though TA is Occur primarily in adults between 30 and 70 years and is extremely rare in children. The etio-rare, a vasculitic etiology of IHD should be considered in particular in young females with no logy is unknown, but trauma has been proposed as a possible precipitating factor suggesting anknown risk factors. An early diagnosis could allow prompt treatment and prevent possible com- inflammatory mechanism. Supporting this hypothesis, approximately one third of patients reportsplications. a history of recent trauma to the affected area. It usually appears as a solitary (exceptionally mul- tiple)rapidly growing mass that may be painful. The lesion is generally firm, non tender, fixed to muscle underneath, and without inflammatory signs. PM may present in shoulder, trunk, thigh, and head and neck. Presentation of PM as a sternocleidomastoid mass is rare and in a recent re- view considering only the English-language literature, eight cases have been described. Local ex- cision is curative and following biopsy, the lesion usually disappears as in our case. Some cases of PM were confounded with sarcoma, attributed to the unusual cellularity and alarming rate of growth, and radical surgery were performed (occasionally in conjunction with lymphadenectomy, chemotherapy and radiation therapy), even with fatal consequences. Recurrence is extremely rare. The diagnosis can be made on needle aspiration cytology alone, as many authors proposed. Re- cognition of this condition is important in order to avoid a misdiagnosis of a malignant tumor, par- ticularly high-grade sarcoma. Consultation with an experienced pathologist, conservative management and a careful clinical evaluation (watch and wait policy) can spare unnecessary sur- gery in these patients. The case described here is unusual because of its location in the sterno- cleidomastoid muscle.3. DIAGNOSTIC UTILITY OF ANTI-CYCLIC CITRULLINATED PEPTIDE AND 4. THE INFLUENCE OF ADIPOKINES ON BONE MINERAL DENSITY INANTI-MODIFIED CITRULLINATED VIMENTIN ANTIBODIES IN RHEUMATOID ELDERLY MENARTHRITIS Stefano Gonnelli, Carla Caffarelli, Katie Del Santo, Alice Cadirni, Carmine Guerriero,Goksal Keskin, Ali Inal, Lek Keskin, Aysel Pekel, Ozan Baysal, Ufuk Dizer Loredana Tanzilli, Stella Campagna, Ranuccio NutiPURPOSE: Several autoantibodies found in RA are directed to epitopes in citrullinated proteins. Body weight is commonly considered a significant predictor of bone mineral density (BMD). Adi-One of them is anti modified citrullinated vimentin (Anti-MCV). We tested the value a newly de- ponectin, an adipocyte-derived hormone, could modulate BMD. Moreover recent studies repor-veloped ELISA for the detection of antibodies againts a genetically modified citrullinated vimen- ted that ghrelin, an orexigenic peptide secreted by the stomach, is able to stimulate bonetin (anti-MCV) in comparison with an anti-CCP based ELISA system for the diagnosis of RA. formation. This study aimed to investigate whether there is any association between ghrelin levels,MATERIALS AND METHODS: Thirty-five patients with RA (mean age; 42.6 ± 10.87 years, mean adiponectine levels, body composition and BMD in elderly men. We studied 117 men aged 55disease duration; 9.37 ± 3.98 years) were enrolled in this study. Twenty –five ankylosing spondylitis years and older (mean age: 67.4  5.4 yrs) who were participating in an epidemiological(mean age; 35.88 ± 6.64 years, mean disease duration; 10.25 ± 4.61 years), and 19 healthy sub- study. In all subjects we evaluated ghrelin, adiponectin, parathyroid hormone (PTH), 25-hydro-jects (mean age; 40.26 ± 5.11 years) served as controls. Anti-CCP antibodies and Anti-MCV an- xyvitamin D (25OHD), bone alkaline phosphatase (B-ALP) and the carboxy-terminal telopeptidetibodies were measured using ELISA. RESULTS: In all RA patients, mean anti- CCP level was of type I collagen (CTX). BMD was assessed at lumbar spine (BMD-LS), at femoral neck (BMD-69.07 ± 90.43 U/ml and anti-MCV level was 665.77 ± 1040.19 U/ml. In patients with AS, the FN) and at total femur (BMD-TF). Body composition (fat mass and lean mass) was assessed bymean anti-CCP level was 10.7 ± 5.22 U/ml and anti-MCV level was 40.54 ± 20.15 U/ml. In he- using a DXA device (Prodigy, Lunar GE). A Food Frequency Questionnaire was used for calcula-althy controls, the mean anti-CCP level was 11.11 ± 7.65 U/ml, anti-MCV level was 23.12 ± 12.04 tion of dietary calcium intake. The values of ghrelin were lower in osteoporotic men than in osteo-U/ml. In patients with active RA, the mean serum anti-CCP level was 100.54 ± 98.07 U/ml and penic and normal men but the difference did not reach the statistical significanceanti-MCV level was 998.74 ± 1154.93 U/ml. In patients with inactive RA, the mean serum anti- (737.582.4; 825.3112.5 and 853.6136.8 pg/ml, respectively). A si-CCP level was 8.77 ± 1.55 U/ml and anti-MCV level was 27.59 ± 23.10 U/ml. According to these gnificant correlation was found between ghrelin and lean mass (r=0.20; p<0.05) but not betweenresults; In patients with RA, the mean serum anti-MCV and anti-CCP levels were significantly ghrelin and fat mass. Ghrelin showed positive correlations with BMD-FN and with BMD-F whichhigh compared to patients with AS and healthy controls (p=0.002, p=0.001, p=0.002, p=0.001 re- remained significant after adjustment for BMI and calcium intake (r= 0.24; p< 0.05 and r=0.22;spectively). The mean serum anti-MCV and anti- CCP levels were significantly higher in active pa- p<0.05, respectively). The correlation between adiponectin and BMD at all skeletal sites were ne-tients with RA than in inactive patients with RA patients (p=0.001 and p=0.001 respectively). In gative, but not significant. The correlation between adiponectin and B-ALP (r=0.249; p<0.01) re-inactive patients with RA, the mean serum anti-MCV and anti-CCP levels were similar in patients mained significant also after adjusting for confounding variables. In conclusion our study suggestswith AS and healthy controls patients (p=0.484, p=0.308, p=0.09 and p=0.222 respectively). The that in elderly men adiponectin significantly influences bone formation and that ghrelin is signifi-mean serum anti-MCV levels were correlated with DAS 28 (r=0.531, p=0.001), VAS score cantly, even though marginally, associated with BMD. Further studies are needed to elucidate(r=0.332, p=0.01), ESR (r=0.458, p=0.001), serum CRP levels (r=0.568, p=0.01), serum RF levels the role of adipokines on bone metabolism.(r=0.529, p=0.001), swollen joints number (r=0.525, p=0.001) and tender joints number (r=0.638,p=0.001). CONCLUSION: As a result; measurement of serum anti-MCV levels is useful for dia-gnosis of RA and combined use of anti-MCV and RF may be more useful prognostic factor thaneither method alone, RF and anti-CCP. 2
  6. 6. 5. THE ASSESSMENT OF A GROUP OF PATIENTS WITH FIBROMYALGIA FROM 6. INTRARENAL COLOR DOPPLER SONOGRAPHY IN STUDYING PATIENTSORADEA (ROMANIA) USING THE FIBROMYALGIA IMPACT QUESTIONNAIRE AFFECTED BY SYSTEMIC SCLEROSISFelicia Tirlea, Dorina Maria Farcas, Ligia Burta, O.Burta, Corina Moldovan M. Sperandeo, G. D’Amico, G. Sperandeo, M.L. Piattelli, S. Muscarella, A. Varriale, A. De Cata, F. Prigigallo, M.A. Annese, G. VendemialeObjective: to assess the responsiveness of a group of patients with fibromyalgia from Internal Me-dicine Department of Oradea, Romania, using the Fibromyalgia Impact Questionnaire (FIQ). Ma- Systemic sclerosis is a generalized disorder which affects the connective tissue of the skin and in-terial&Methods: We studied a group of 89 patients with fibromyalgia from Medical Clinic of ternal organs and is associated with alterations of the microvasculature. Scleroderma renal crisisOradea,. The patients fulfilled the ACR criteria for fibromyalgia. All of the them underwent spe- involves almost 50% of patients with a 25% of which developing renal failure. In our study wecific treatment for 14 days including: medication(analgesics, pregabalin, tricyclic antidepressants), evaluated utility of intrarenal quantitative parameters (Resistive Index: R.I; Pulsatility Index: P.I.)kinetotherapy and massage. They were assessed with Fibromyalgia Impact Questionnaire (FIQ) during renal color Doppler sonography, as prognostic indicators of renal involvement in systemicat baseline, discharge, at 6, 12month. Effects were analysed with sensitivity statistics(effect size, ES). sclerosis. In a period of 60 mounths, we examinated 78 patients (69 females and 9 males) affec-Results: In our group of study the general score had an moderate ES=0.64 until discharge. The ted by systemic sclerosis and 92 controls. All patients underwent intrarenal color Doppler sono-effect remained moderate at 6 month(ES=0.47) and it decreased at 12 month (ES=0.38) . Con- graphy with evaluation of R.I. and P.I. every 12 mounths. We then correlated these parameters withclusion:Decreasing the pain level, fatigue, sleep disturbances and psychological distress, and also renal functional values (creatinine clearance and GFR), microalbuminuria and urine test. We foundincreasing function are the main goals for treatment in patients with fibromyalgia. Our study sho- a significantly higher R.I. (average 0.83±10) in 52 patients (51 females and 1 male) in respect towed a beneficial effect of treatment in such patients. Future research should focus on compre- controls (p<0.05). Even if our preliminary findings have to be confirmed in larger patient groups,hensive treatment programs for maintaining beneficial effects over time. our results suggest that evaluation of R.I. by color Doppler sonography in patients with systemic sclerosis could allow a selection of those patients at risk of developing renal vascular involvement and, by consequence, renal crisis as complication of systemic sclerosis.7. TAKAYASU´S ARTERITIS: ANALYSIS OF 9 PATIENTSJunco García, A.; Muñoz López de Rodas, M.C.; de Andrés Moro, F.; Sáinz Herrero, A.;Hernández Blanco, C.; del Río Ibáñez, R.; Cigüenza Gabriel, R.; Antolín Arias, J.INTRODUCTION: Takayasu´s arteritis is a chronic inflammatory disease afecting large vessels, pre-dominantly the aorta and its main branches with a prevalence of 1,2-2,6 million person. OBJEC-TIVES: 1. Review of Takayasu’s arteritis cases admitted to our hospital from 1996 to 2006. 2.Determination of the most frequent clinical manifestations. 3. Gain knowledge of the importanceof angio-Magnetic Resonance (angioMR) in the diagnosis and follow-up. 4. Analysis of the me-dical services implied in this disease. PATIENTS AND METHOD: We carried out a retrospective,descriptive, stadistical study of 9 cases of Takayasu’s arteritis admitted to the Hospital Clínico SanCarlos from January 1996 to December 2006. Data on clinical manifestations, biological tests andimage results (arteriography, angioMR, and Doppler echography) were gathered. Diagnosis wasestablished according to the classification criteria of the American College of Reumathology (ACR)in 1990. RESULTS: Anthropometric data:Women:78%;Men:22%. Media age at diagnosis was46 years (SD:14) Clinical Manifestations; Malaise:78%; Hypertension:56%; Pain in affected ves-sels:44%; Aortic insufficiency:44%; Dyspnea:44%; Atypical chest pain:33%; Acute myocardial in-faction:33%; Weight loss:33%, seasickness, syncope, acute cerebrovascular accident, heart failure,arthralgie, anorexia, Raynaud phenomenon, visual disorders:22.2%. Transient ischemic attack(TIA),abdominal pain and fever (Tª >37.8% ºC):11.1%. Biological criteria: ERS increase (>20):89%; ane-mia (Hb<12):56%; renal failure (Cr. >1.2):33%, ANA+:22% Classification criteria: abnormal arte-riography:100%, diminished brachial pulses:78%, vascular bruits:67%, claudication of lowerlimbs:67%, difference of blood pressure between arms >10mmHg:33%. Age <40:33% Abnor-mal arteriographies (parietal thickening, stenosis, occlusion and dilatation): subclavian:78%, caro-tid-vertebral:56%, infrarenal aorta-iliac:44%, mesenteric-celiac branch:44%, coronary:33%,renal:33% Distribution according to hospital services: Internal Medicine:3 cases (34%), Reuma-thology:2 cases(22%), Cardiology:2 cases (22%), Gynecology:1 case (11%), Intensive Medicine:1case (11%). Follow-up according to image tests: AngioMR:56%, Doppler echo:44%. Treatment:medical (corticoesteroids or immunossuppresives):56%; angioplasty or by-pass:11%; Combinedmedical-surgical:33%. Progression or re-stenosis:44.4% CONCLUSIONS: 1. The most frequentclinical manifestations were cardiovascular and neurological. Blood tests expressed increased ESR,anemia, and renal failure. 2. The most affected vessels were the subclavian artery, carotid andvertebral territory, infrarenal aorta-iliac and mesenteric-celiac arteries. 3. Diagnosis was establi-shed by arteriography, follow-up by angioRM and Doppler echo. 4. Admittance was carried outby Internal Medicine, Reumathology and Cardiology. Follow-up is multidisciplinary. 3
  7. 7. Oral CommunicationsWednesday, May 7, 2008 PUBLIC HEALTH
  8. 8. 1. PATIENTS OPINION ON THE QUALITY OF CARE OFFERED IN OUT PATIENT 2. ROUTINE ADMISSION CHEST X-RAY DOES NOT MAKE AN EFFICIENTCLINICS IN A SPANISH TEACHING HOSPITAL SETTING CONTRIBUTION TO THE DIAGNOSIS OR TREATMENT OF HOSPITALIZEDWikman Ph, Peris J.M, Safont P, Gracia M, Calabuig E, Botas M, Mj.,Monge Mj, Merino J. PATIENTS Ami Schattner Gabi Duek, , Nick Beilinson, Vladimir Neogolani, Alon Basevitz, Marina Somin,INTRODUCTION - Modern clinical practice tries to be very high in quality and has placed the Joel Cohen, Stephen Malnick.patient as the centre of all sanitary activities. That is why it is very important to know their viewon the care we offer them. This is the aim of this study, to detect our insufficiencies and then to Routine admission chest X-ray does not make an efficient contribution to the diagnosis or treat-establish an intervention program to correct them. MATERIAL/ METHODS. - Observational study ment of hospitalized patients. Oral communication. Ami Schattner Gabi Duek, , Nick Beilinson,of a random sample of patients treated in the outpatient clinics at our Hospital (n=64) through the Vladimir Neogolani, Alon Basevitz, Marina Somin, Joel Cohen, Stephen Malnick. Department oflast two terms of 2007. For this purpose we have designed a form with 14 items using a 5 steps Medicine, Kaplan Medical Centre, Rehovot and the Hebrew University Hadassah School of Me-likkert scale. The forms have been offered by a health care professional to the attending patients dicine, Jerusalem, Israel. Introduction. In many departments of medicine a chest x-ray (CXR) is per-in our out-patients clinics, to be filled out anonymously. Results are offered in percentage. Pa- formed routinely on admission. There are meager data on the diagnostic yield of routine admissiontients may choose one of the following options to evaluate:: 1. too much/very well, 2. much / CXR reflecting current changes such as the increasing age and severity of patients, the higher pre-well, 3. neutral, 4 poor/ badly, 5. very poor/ bad. 6, no answer. RESULTS .- N was 64 , 38,7% valence of immunosuppressed patients and resurgence of tuberculosis. Methods. Consecutivewere male, 61,2% women, mean age was 59,45 years, for the 26,5 % it was the first visit and 73,5 patients admitted to a single department of medicine during a two month period were studied.had been attended previously a. The waiting time to be attended has been: 0; 10.9; 46,8; 25; 7,8, The discharge summaries were screened for all relevant clinical data and then reviewed by two9,3. b. The time the doctor offered was: 7,8 ; 39; 48; 0; 0; 0; 4.6. c. the humanistic approach the senior clinicians who were not involved in the care of these patients. The clinical indication for thedoctor offered was: 62,5; 26,5; 7,8; 0; 0, 3,1. d. the technical or professional approach the doc- performance of a CXR was assessed as well as the contribution of the CXR to clinical manage-tor offered was : 62,5; 29,6; 6,2; 0; 0; 1,5. e. the information on the disease or treatment offered ment (major positive, major negative, minor positive or no contribution). Logistic regression ana-by the doctor has been: 23,4; 46,8; 23; 0;0 6,2. f. the information on complementary examina- lysis was performed with the SPSS 12 software program. Results. There were 675 patients whosetions needed was: 53,1; 32,8; 6,2; 0;0; 7,8. g. at the time of arrival at the clinic the attention re- mean age was 64.5 + 17.2 years. Their presenting complaints included chest pain (18%), dyspneaceived from other sanitary or administrative professionals was: 51,5; 20,3; 3,1; 0; 0; 25. (12%), weakness (10.5%), fever (9%), abdominal pain (8%), and neurological complaints (7.5%).COMMENTS.- This protocol is easy to carry out, and allows us to detect insufficiencies in the care In 19.6% (130 cases) the CXR was not done or the result was not obtainable. CXR findings in-we offered, so we can go forward with interventions in order to correct them. In our case the re- cluded congestion in 19.4%, an infiltrate in 12.4% and a space occupying lesion in 2.5%. The CXRsults are quite satisfactory. was reported to be normal in 38.6% of the cases. Physical examination of the chest was normal in 585 (87%) of the cases and abnormal in 87 (13%). The examination of the heart was normal in 518 (77%) and abnormal in 129 (19%). Of the 545 x-rays done, 260 (48%) were normal. In only 116 (21.5%) was there a major positive contribution of the admission CXR to diagnosis or tre- atment. In 140 (26%) it provided a minor positive contribution and in 56 (10%) - a major nega- tive contribution. In 184 patients (34%) there was no contribution of the CXR to either diagnosis or management of the patient. We found that the CXR made a major positive contribution to ma- nagement in patients for whom there was an indication for performing the x-ray (OR 10.3, p<0.0005) and in those in whom there was a finding on auscultation of the chest (OR 1.63, p=0.110). For a major negative contribution of the CXR to management, the indication for the in- vestigation was also very important (OR 72.9, p< 0.005). Conclusion. A routine admission CXR has a significant impact on patient management only in those patients in whom there are au- scultatory findings on physical examination of the chest or a clinical indication for performing the test. The policy of routine CXR on admission needs to be reassessed.3. PATIENTS CLAIMS AS A METHOD FOR SELF ASSESSEMENT OF QUALITY IN 4. QUALITY AND COMFORT OF FACILITIES OFFERED TO PATIENTS IN ANAN INTERNAL MEDICINE DEPARTMENT INTERNAL MEDICINE DEPARTMENT IN A SPANISH TEACHING HOSPITALMatarranz M , Wikman P, De Juan M A, Rugero M J., Segui Jm, , Martinez Baltanas A., Peris J., Lopez Calleja E, Wikman Ph, Peris J.M, Safont P, Gracia M, Calabuig E, Monge M J,Ramirez M I., Merino J. De Juan M A, Muela F., Merino J.BACKGROUND. - Quality of care offered, doing it in a cost efficient way and the care offered INTRODUCTION - Modern clinical practice tries to be very high in quality and has placed thebeing very sure for patients are the cornerstone of modern clinical practice. Patients self assessment patient in the centre of all sanitary activities. That is why it is very important to know about his viewof the quality in clinical practice offered is an efficient way to asses the quality of care. We have on the comfort and the quality of facilities we offer him. Looking for detecting our insufficienciescollected information about the claims presented by patients admitted in the internal medicine de- on this field and then to establish an intervention program to correct them is the aim of this study.partment the last 5 years and we analyze them to detect insufficiencies and to prepare an inter- METHODS.- Observational study on a random sample of patients cared in the outpatient clinicsvention plan to correct them. METHODS. - Descriptive study. We have elaborated a protocol to (n=64 ) or in the wards (n= 70 ) of our Hospital through the last two terms of 2007. For this pur-collect the information we find out. Claims were classified as presented verbally or in a written for pose we have designed some forms with 12 and 24 items. In some cases using a likkert scale.and we used a check list including 60 possibilities for the claims contents. The clinical activity for These have been offered to be anonymously filled by patients attending our wards and out pa-IM department was obtained from the Hospital’s Clinical Documentation Department RESULTS.- tients clinics. We include information from claims related to the items the patients have presen-The absolute number or written claims for 2003 and following years has been: 2-1-4-5 and 5; ted to the “Patient support Department” in our hospital. Results are offered in percentage ofand for verbal claims: 8-5-16-24-31. The 62% of them were presented by women: Mean age answers. RESULTS.- In out patients clinics: n 64, mean age 59,4. You consider that the facilitieswas 57,7 y: . The no. of IM claim’s in relation of those claims presented at the whole hospital have available: waiting room, clinics, material, are: very good 9,3%, good 43,75%, normal 21,8%, badbeen: for 2003: 0,34, , and for the following years: 0,19; 0,8; 0,1 and 0,9, and for oral claims: 0%, very bad 0%, n.a. 25%. In the wards: n 70, male %, mean age 57,2 y. answering patients 300,248; 0,136; 0,405;044 and 0,57. In 2007 IM written claims have been 5, related activity have % or their family 60%: n.a. 10%.. You consider inadequate the quality of: mattress: 12,8%, bedbeen: % for number of patients recovered: 0,3; % for the department’s occupancy during the year 12,8; toilet 12,8; wall painting11,4%, cleaning 7,1%; arm chair for companion 32,4% , clothes for0.038 ; and % for total of patients cared in outpatient clinics: 0,1 , There were 4 doctors and 1 bed or bath 10% , time for visiting patients 4,3%, availability to watch TV programmes 20%,nurse involved, on the remaining 12 were no sanitary professionals. This figures for verbal claims room temperature 14%. In relation with the food service: the amount was small (4,28), with fewwere: 31; 2,2 ; 0,23 and 0,6, and there were involved 7 doctors; for the remaining 77 there were variability (11,4) , to be bad prepared (8,5) , has been served cold (14,28), or in adequate timeno sanitary professionals involved. The subjects of the written claims were related courtesy, in- (4,28) , with dishes different from those you have asked for (8,57), to be bad presented (8,57),sufficient personal, non acceptance of rules, and for verbally: waiting list for clinical procedures or or it was inadequate for your disease(1,42). Information about the patient’s claims is also included.out patient clinics or bad information. COMMENTS: We underline the importance of this type COMMENTS.- This type of questionnaire allows us to get a better known on the patients viewof studies to assure quality of care. We can feel quite comfortable with our results. MATERIAL/ on the facilities available and to act for improving them.METHODS. - Observational study on a random sample of patients cared in the wards of our Ho-spital (n=70) through the last two terms of 2007. For this purpose we have designed a form with14 items using a likkert scale. The form has been offered to the patients recovered in our wardsto be anonymously filled and deposed at nurses’ desk. The 30% of the forms were filled out bypatients, 60% by their companions, (we ignore 10%). Mean age of those answering was 57, 2years. 60% of them knew their doctors name and 55, 7% knew his medical speciality. Results areoffered in percentage of answer for each item, being 1: very satisfactory, 2. satisfactory, 3. neu-tral, 4 unsatisfactory, 5. very unsatisfactory. a. The technical o professional approach by doctorshas been: 68,6; 26,9; 4,5; 0;0, b. The humanistic approach: 71,6; 24;4,5;0;0; c. The informationthey offered about patient´s disease has been: 56,2; 37,5; 4,7; 1,6,0. d. Their information on com-plementary exams patients needed: 53; 39,; 3; 4.5;0 . e. Information on treatment offered d:57,1; 34,9; 6,3; 11,6; 0. f. Nurses care has been: 52,9; 35,3; 10,3; 0,0.; Humanistic approach bynurses and other sanitary professionals : 52,2; 40,3; 4,5; 2,98; COMMENTS.- This type of que-stionnaire offers us a better understanding of how patients think about the care we offer and al-lows us to initiate intervention programs to improve the quality of our care. In our case the resultwas quite satisfactory. 5
  9. 9. 5. ASSOCIATIONS BETWEEN SMOKING, NUTRITIONAL STATUS AND CLINICAL 6. SAN FRANCISCO SYNCOPE RULE, OESIL RISK SCORE AND CLINICALOUTCOME FOLLOWING ACUTE ILLNESS JUDGMENT IN THE ASSESSMENT OF SHORT TERM OUTCOME OF SYNCOPESalah Gariballa, Sarah Forster Franca Dipaola., Giorgio Costantino, Francesca Perego, Marta Borella, Andrea Galli., Giulia Cantoni, Giuseppina Pisano, Franca Barbic., Francesco Casella, Pier Giorgio Duca, Raffaello FBackground Although smokers have poor health and consequently poor dietary intake compa-red with nonsmokers no study has examined the effects of smoking on nutritional status during Objectives To compare the effectiveness of the OESIL (Osservatorio Epidemiologico sulla Sin-acute illness. Objective The aim of this study was to measure the effect, if any of smoking on nu- cope del Lazio) and SFSR (San Francisco Syncope Rule) risk scores and the Clinical Judgment intritional status in hospitalized patients. Design 434 randomly selected hospitalised patients had assessing the short-term prognosis of syncope. Methods We enrolled 488 patients consecutivelytheir nutritional status assessed from anthropometric, haematological and biochemical data within seen for syncope at 2 Emergency Department (ED) between 23rd of January and 31st of July72 hours of admission and at 6 weeks. Nutritional status was compared between current smo- 2004. Sensitivity, specificity, predictive values, positive and negative likelihood ratios (LR) for short-kers, ex-smokers and those who never smoked. Using multiple logistic regression analysis we term severe outcomes were computed for each decision rule and the Clinical Judgment. Resultsmeasured the association between smoking and nutritional status and mortality respectively after OESIL risk score was characterized by a sensitivity of 88%, specificity of 60%, negative predictiveadjusting for poor prognostic indicators including age, disability, chronic illness, medications, and value of 99%, positive and negative LR of 2.19 and 0.19, respectively. In line with OESIL score,tissue inflammation. Results Smoking status affected both anthropometric and nutritional bio- 43% of patients would have been admitted. SFSR sensitivity was 81%, specificity 63%, negativechemical measurements. For example, body weight, body mass index (BMI), mid-upper arm cir- predictive value 98%, positive LR 2.16 and negative LR 0.31. According to SFSR criteria, 40% ofcumference, Triceps skinfold thickness, serum albumin and plasma ascorbic, red-cell folate and patients seen in the ED would have been admitted. To prevent one event among discharged sub-vitamin B12 concentrations were all lower in current smokers compared with those who never jects, OESIL and SFSR risk scores would have admitted 15 and 29 more patients than clinical judg-smoked. After adjusting for age, disability and co-morbidity in a multivariate analysis, smoking sta- ment (admitted 34%). In addition, according to both decision rules no discharged patient wouldtus had a significant and independent effect on important anthropometric and biochemical nu- have died. Conclusions the OESIL and SFSR risk scales performed similarly in recognizing patientstritional assessment variables. For example, being a current smoker was associated with lower with short term high risk syncope. Both decision rules were characterized by a good sensitivity andbody weight, MUAC and plasma vitamin C concentrations by 2.5 kg, 0.87 cm and 3.8 would have identified all patients who subsequently died. However, because of a low specificitymol/L respectively compared with those patients who never smoked. Logistic regression of OESIL and SFSR risk scales, more patients would have been admitted compared with the Cli-analysis showed that smoking and increasing age were significantly and independently related to nical Judgment.one year mortality, odds ratios (95% C.I) were 1.7 (95% C.I 1.003 – 2.87) and 3.5 (95% C.I 1.52-8.22) respectively Conclusion Smoking is independently associated with poor nutritional status inhospitalized patients. This may partly explain the poor clinical outcome associated with smoking.7. SHOULD AUTOMATED ESTIMATED GFR/CREATININE CLEARANCE BE USEDIN ALL PATIENTS BEFORE STARTING MEDICATIONSS Kadir, M Mahmood, I U DinINTRODUCTION: Kidney function is often assessed by serum creatinine alone, which howeveris insensitive in elderly. Its a known fact that equations estimating creatinine clearance/GFR basedon serum creatinine are more accurate than serum creatinine alone in predicting patients kidneyfunction, henceforth a better guide in prescription of medications. More and more hospital labo-ratories in the world are providing eGFR for their patients as a standard. METHODS: We calcu-lated estimated creatinine clearance/GFR of 74 inpatients with stable serum creatinine usingcockcroft-Gault equation via the free eGFR calculators available on the internet. To minimize anyerror, only one web calculator was used for all the patients. The medical prescriptions of all thesepatients were also reviewed and compared with British National Formulary advice along with thedoses. RESULTS: 85% of pts were above age 50. On using Serum Creatinine as a measure ofkidney function, 34%of patients had abnormal results with creatinine ranging from 111-184. Ho-wever when creatinine clearnce/GFR was used (estimated by CG equation)as a measure of kid-ney function 75% had abnormal results.More than half of these i.e 54% has moderate/severelyreduced creatinine clearnce.On reviewing their medication prescriptions 67 instances were iden-tified where these medications would have warranted a change based on calculated creatinineclearance/GFR. CONCLUSIONS: Estimated creatinine clearance/GFR should be available espe-cially when prescribing patients medications. Automated estimation of creatinine clearance/GFRshould be a standard practice in all the hospitals. A separate section on the medication charts foreGFR may help in avoiding nephrotoxic medications or nephrotoxic doses. 6
  10. 10. Oral Communications Thursday, May 8, 2008CARDIOVASCULAR DISEASE
  11. 11. 1. HUMAN PARAOXONASE GENE POLYMORPHISM AND CORONARY 2. PSYCHOLOGICAL FACTORS AND PROFILE ASSOCIATED WITHARTERY DISEASE RISK WHITE-COAT PHENOMENONR. Palma dos Reis, A.I. Freitas, A.C. Sousa, S. Gomes, P. Faria, A. Pereira, B. Silva, Giuseppe Crippa, Pierangelo Bertoletti, Ornella Bettinardi, Giovanna Calandra,M. Serrão, N. Santos, S. Freitas, I. Ornelas, A. Brehm, A. Cardoso Antonio Mosti and Pietro CavallottiBackground: Complex diseases such as coronary artery disease, hypertension or diabetes are White-coat phenomenon is characterised by striking increase in arterial blood pressure (BP) inusually caused by the individual susceptibility to multiple genes, environmental factors, and the hypertensive or non-hypertensive patients during BP measurement in the medical environment.interaction between them. The PON1 enzyme has been implicated in the pathogenesis of athe- This phenomenon can be detected comparing the high blood pressure value obtained in therosclerosis and coronary artery disease (CAD). Two common polymorphisms in the coding region medical environment with those obtained with a 24-hour ambulatory blood pressure monitoringof the PON1 gene which lead to a Gln (Q) /Arg (R) substitution at position192 and Leu /Met sub- (ABPM) or a series of BP measurement performed at home by the patients himself. Despite thestitution at position 55 influence PON1 activity. Aims: 1- To evaluate the PON1 polymorphisms common belief that anxious patients are prone to show this pressor response, it is unlikely that itsassociation and CAD risk. 2- To study the interaction between PON1polymorphisms and others presence, degree and duration can be routinely predict. Furthermore, no psychological variableslocated in different candidate genes. Methods: We evaluated in 298 CAD patients and 298 he- have thus far been inked to white-coat phenomenon in ad hoc designed formal analysis. To in-althy individuals the risk of CAD associated with PON1 192Q/R and 55 Leu/Met polymorphisms. vestigate the relationship between psychological profile and white coat phenomenon we haveThen, we evaluated the risk of the PON1 interaction with ECA DD; ECA 8 GG and MTHFR 1298 administered a series of validated psychometric tests to 85 subjects (46 females, mean age 52 ±AA. Finally through a regression logistics model we evaluated which variables (genetic, biochemical 12 years) undergoing ambulatory BP monitoring. Thirty-nine subjects who presented with white-and environmental) were linked, in a significant and independent way, with CAD. Results: We ve- coat phenomenon (office BP value, as measured by the physician, elevated by at least 15 % overrified that PON1 55 MM genotype, had a higher distribution in the CAD population, but did not the mean 24-hour ABPM) and 46 comparable subjects who did not disclose this alert reactionreach statistical significance as risk factor for CAD, and PON1 199 RR presented a relative risk 80% completed a series of validated psychological tests evaluating: quality of life, cognitive behaviour,higher in relation to the population without that polymorphism. The association of mutated po- hostility, cynicism, anger, anxiety, coping ability and strategies. Among the various tests, the sco-lymorphisms in the same gene belonging to the same pathophysiological systems that codify for res of three relevant scales (healthcare-related fears, mental efficiency and behavioural disenga-the same enzymatic protein, (PON 55 MM + PON 192 RR), did not increase the risk for DAC gement) resulted significantly higher (Fishers exact probability test, alpha level p< 0.05)in the(OR=1.767; p=0.057, Ns). The interaction between PON1 192 RR and MTHFR 1298 AA, sited white-coat group. No significant difference between the two groups, regarding signs and repres-in different genes, increased the risk for CAD. Similarly, the association between PON1 RR and sion of anger, cynicism, hostility, or anxiety state. Our data seem to indicate that the subjects mostECA 8 GG, was linked to an even higher risk (OR=5.6; p=0.002). After logistic regression, smo- likely to show an overt BP increase in the medical environment are those who present with heal-king habits, family history, fibrinogen, diabetes, Lp (a) and PON1 192 RR + ECA 8 GG interac- thcare-related fears and, emotional instability, but are not necessarily anxious. They disclose hightion, were kept in the regression model and proved to be an independent risk factors for CAD. coping skills addressed to the cognitive resolution of stressing situation (such as BP measurementConclusion: If separately estimated, PON1 192 RR genotype presented a relative risk for CAD in the clinical setting) but are not able to accompany these strategies with an adequate beha-80% higher than in the population without this genotype. The association with other genetic po- vioural response and involvement in the management of their clinical condition.lymorphisms sited in different genes, codifying for different enzymes and belonging to differentpathophysiological systems, always increased the risk for CAD. After correction for the other clas-sical and biochemical risk factors, PON1 192 RR + ECA 8 GG association remained a significantand independent risk factor for CAD.3. ACE DD GENOTYPE IS A CORONARY RISK FACTOR, IN THE 4. VALIDATION OF THE FRAMINGHAM AND SCORE SCORES BYPRESENCE OF OTHER RISK FACTORS “CARDIAC CTA”M.I. Mendonça, A.I. Freitas, A.C. Sousa, S. Gomes, P. Faria, A. Pereira, B. Silva, Sonia Schneer, Eli Atar, Gill Bachar, Ran Kornowski, Dana Marcovici, Victoria BeilinM. Serrão, N. Santos, S. Freitas, A. Brehm, A. Cardoso Idit Maya, Dror DickerBackground: ACE DD genotype is a risk factor of coronary artery disease in the presence of con- Background: Cardiovascular disease remains a leading cause of morbidity and mortality wor-ventional risk factors. There is some controversy on the importance of DD gene polymorphism ldwide. Recently computerized tomographic angiography (CTA) was established as a tool for earlyin cardiovascular risk in general and coronary risk in particular. Aim: The aim of this study is to detection of coronary atherosclerosis. There is disagreement as to the accuracy of “Cardiac CTA”evaluate the coronary artery disease risk in the presence (and absence) of conventional risk fac- in prediction of future cardiovascular risk, when compared to conventional clinical risks scorestors. Methodology: We performed a case control study with 305 cases and 505 controls. Cases (e.g. Framingham and Systematic Coronary Risk Evaluation [SCORE] scores). Methods: CTA ofwere coronary patients and controls normal persons without any known disease. Cases and con- coronary arteries was preformed in 190 asymptomatic patients with at least one atherogenic risktrols were similar in terms of age and sex. Percentages for the categorical variables and means ± factor as primary screening for the presence of cardiovascular disease. In these patients the Fra-standard deviation for the continuous ones, were performed. The groups were compared using mingham and SCORE scores were calculated. Statistic analysis was preformed using regressionthe Chi square test and Student T test. Afterwards, the relative risk of coronary artery disease in models. Results: 190 subjects (84% males). The mean age is 55± 9.7 years. When comparingthe DD genotype, in the presence (and absence) of the coronary risk factors was determined. Re- SCORE and Framingham risk factors we found significant correlations to calcium score (CS) andsults: The risk associated to DD genotype triplicates, when it is associated to hypertension plaque severity. SCORE calculation <2 vs.>2 was related to higher incidence of CS >100, 21.9%(OR=3.19; p<0.0001), losing significance in its absence (OR=1.34; p=Ns), the same happening vs. 42.9% respectively (OR=2.68, p=0.001). When comparing high risk SCORE (>4) vs. low riskwith dyslipidemia (OR=2.67; p<0.0001 vs. OR=1.48; p=0.024), diabetes (OR=5.95; p<0.0001 vs. (<4) CS>100 per CTA was 50% vs. 27.1% respectively (OR=2.7, p=0.001). High-risk FraminghamOR=1.46; p=0.019), smoking habits (OR=3.25; p<0.0001 vs. OR=1.32; p=Ns) or any other risk fac- score (>20) vs. low risk (<20) was related to higher incidence of CS > 100, 53.3% vs. 28.6% (ORtors studied (OR=2.61; p<0.0001 vs. OR=0.70; p<0.0001). Conclusions: We can conclude that 3.18, p=0.001). High risk SCORE vs. low risk was related to higher plaque severity (79.2% vs.ACE DD polymorphism is, in general, a risk factor of coronary artery disease (OR=1.88; p<0.001). 59.4% respectively; OR 2.6, p=0.001). High-risk Framingham score vs. low risk was also relatedThe risk increases and is significant in the presence of the conventional risk factors and decrea- to higher plaque severity (93.3% vs. 59% respectively; OR=3.18). The variables that best predic-ses loosing significance, in their absence. This work can explain the differences other authors have ted severity of plaque stenosis were age, gender, diabetes and hypertension. Conclusions: Ourfound in the evaluation of DD genotype risk. work has found the Framingham and SCORE scores to be good predictors of coronary artery di- sease when compared to cardiac CTA. In light of these exploratory findings, the use of those cli- nical scores seems to be important in identifying patients at risk for coronary atherosclerosis and treating them properly, before symptoms may develop. 8
  12. 12. 5. MEDICAL CO-MORBIDITIES: AN OBSTACLE TO GUIDELINES 6. THE DIAGNOSTIC APPLICATION OF THE BIOMARKER C-REACTIVECOMPLIANCE IN ACUTE CORONARY SYNDROME? PROTEIN IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION:Manuel Sousa; Ana Rita Francisco; Pedro Amador; Sara Gonçalves; Lígia Mendes; A PROSPECTIVE STUDYFilipe Seixo; José Ferreira Santos; Carlos Perdigão Ovidiu Burta, Olivia Ligia Burta, Radu Stefan Roatis, Syed Minnatullah QadriIntroduction: Compliance with therapeutic guidelines for Acute Coronary Syndrome (ACS) is de- Objective: Acute Myocardial Infarction (AMI) is a leading cause of morbidity and mortality throu-terminant for the reduction of future events. The presence of non-cardiovascular medical co-mor- ghout the world. The purpose of this research was to investigate the possibility of using C-Reac-bidities (NCMCM) may be responsible for sub-optimal guideline adherence that many clinical tive Protein (CRP) as a potential biochemical marker in the event of an AMI in comparison toregistry show. Objective: Determine how the presence of NCMCM interferes with the treatment conventional biomarkers. Materials and Methods: The present study was undertaken by evalua-of ACS. Methods: we studied 146 consecutive in-patients (mean age 64  13 years; 71 ting the biochemical parameter of CRP using the nephelometric procedure “Chromatest”, on% males) admitted with the diagnosis of ACS. The prevalence of NCMCM was determined and blood samples (5ml) collected on admission with AMI. Blood samples were also collected in thethe population was divided in 2 different groups according to the presence or absence of same patients after an interval of 10 days and the procedure was repeated to determine CRP va-NCMCM. Compliance with pharmacologic treatment, including medication with acetylsalicylic lues. The subjects studied were initially excluded to bear other medical conditions that may de-acid, clopidogrel, any heparin (NFH – non fractioned heparin; LMWH – low molecular weight he- termine an increase in CRP values. In a total, the blood samples of 20 patients with AMI and 20parin), beta-blocker (BB), angiotensin converter enzyme inhibitor (ACEI) and statin, was evalua- healthy volunteers (controls) was analyzed for CRP. Results: The analysis of the patients sera forted in each group. Pharmacological compliance was defined as complete when all of the CRP values the revealed the following. The mean CRP value for both males and females collec-recommended drugs were used. Furthermore, the completion of reperfusion procedures (me- tively with AMI for the day of admission (D1) was 6.092 mg/l. The mean values for males andchanical or pharmacological) in ACS with ST elevation and the performance of coronary angio- females exclusively with AMI on D1 were 6.406 mg/l and 5.779 mg/l respectively. The meangraphy in ACS without ST elevation during hospitalization were also studied. Differences in the value for both males and females collectively with AMI after an interval of 10 days (D2) was 2.793compliance with therapeutic guidelines were analyzed in both groups. Results: 54% of the patients mg/l. The mean values of CRP exclusively for males and females with AMI on D2 were 2.495presented at least one of NCMCM (23% chronic renal failure, 20% gastrointestinal disease, 14% mg/l and 2.393 mg/l respectively. The mean value of CRP in control group on D1 for both maleschronic pulmonary disease, 9% cancer, 7% haematological disease). Compliance with therapeu- and females was 0.834 mg/l. The mean values of CRP on D1 for males and females exclusivelytic guidelines was lower in patients with NCMCM: in patients without co-morbidities there was were 0.839 mg/l and 0.824 mg/l. The mean values of CRP on D2 exclusively for males and fe-complete pharmacological compliance in 85.5% vs 69.4% in those with co-morbidities (p=0.028); males were 0.84 mg/l and 0.828 mg/l respectively. The values were studied in comparison to thein patients without co-morbidities complete pharmacological compliance plus reperfusion or co- troponin levels. Conclusion: Our study clearly shows the higher values of CRP in patients with AMIronary angiography were performed in 74.2% vs 55.6% (p=0.025). Conclusions: Compliance in comparison to normal subjects. The high values clearly indicate the detrimental effects of athe-with therapeutic guidelines established for treatment of ACS is still insufficient, particularly in pa- rosclerosis associated inflammation. CRP values remain elevated for a longer period of time intients with non-cardiovascular medical co-morbidities. comparison to other biomarkers of AMI. The values of CRP however, do not indicate any signi- ficant relationship with patient mortality as patients who died had different values of CRP in their serum samples. Males have slightly higher CRP values than females in both the control and pa- tients with AMI. The study warrants the need for further research in the potential of CRP and ac- centuates the possibility of concomitant use of CRP with other biomarkers due its reasonable efficacy and price.7. PREVALENCE OF LOWER EXTREMITY ARTERIAL DISEASE IN A 8. THE INVESTIGATION OF THE CAROTID STATE OF CORONARY ARTERYPOPULATION OF ITALIAN HOSPITALIZED PATIENTS OPERATED PATIENTSL Pasqualini, I Salvatore, D Siepi, BPR Kouadio, R Hijazi , MV Amoruso, MF Cacioni, Stefán JánosS Giaggioli, G. Schillaci, E. Mannarino Object: The comparison of the carotid US report with the coronary state, graft number, smoking,Lower Extremity Arterial Disease (LEAD), even if recognized as a crucial risk factor for cardiova- hypertension, diabetes and lipid parameters. Patients’ data.: The investigated period is 12 months:scular death, is largely underdiagnosed in clinical practice and particularly in older population. from 01.01.2006. to 31.12.2006. Patients had CABG surgery: 155, the male/female is 115 /40 /74The purpose of this study was to identify LEAD, using the ankle–brachial index (ABI) in a large %/, mean age: male 69,6 year, female : 65,7 year. Associated diseases: hypertension: 138 patients/series of hospitalized patients in a Department of Internal Medicine, and to investigate the asso- 89%/, diabetes : 65 /419%/, CRF: 2 patients, hyperlipidemia: 80 /51,6%/, smoker: 34 /21,9%/. Ca-ciation of this index with cardiovascular risk factors. We measured ABI in 829 consecutive patients rotid US report: normal: 128 patients (82,5%) non-significant stenosis :15 patients (9,6%) signifi-(462 men and 367 women) aged 50 years or older (73.2 ± 9.9 yrs). ABI, measured by an ultra- cant stenosis: 7 patients (4,5 %) , occlusion: 4 patients (2,5%) (intima/media proportion: notsound Doppler device, was considered abnormal when below 0.90. Patients with a history or examined). Carotid intervention : 7 patients, stent implantation : 6, carotid endarterectomy: 1, po-symptoms suggestive of LEAD were excluded from the study. An ABI lower than 0,90 was de- stoperative death: none, presurgical death: 1 patient. Results: by the number of grafts and se-tected in 278 patients (34%). LEAD patients were older (74.2 ± 10.4 yrs vs 70.5 ± 9.2 yrs, p<0.001) riousness of the carotid US report: normal carotid artery: mean graft number : 3, non-significantand more frequently men (60% vs 41%, p <0.001). Also sigarette smoking (57.4% vs 40.2%), dia- stenosis. 3,2, signifcant stenosis: 3,6, occlusion: 4,2 graft. The data of the patients with normal ca-betes (30.7% vs 21.5%) and hypercholesterolemia (31.3% vs 20.2%) were significantly more fre- rotid US finding / 128/ : male/female: 97/31, diabetes: 53 /41%/ , smoker: 29/23%/, hyperten-quent in patients with LEAD (all p < 0.05), whereas hypertension and obesity had no significant sion: 114/89%/, hyperlipidemia: 68/ 53%/ patients. Patients with non-significant stenosis / 15/ :relation to LEAD. In a stepwise logistic regression analysis, age, male sex, smoking, and hyper- male/female: 10/5, diabetes: 8/53%/, smoker : 2/13%/, hypertension. 13/87%/, hyperlipidemia:cholesterolemia were found to be independently associated with LEAD. A simple, bedside ABI 5/ 33%?. Patients with significant carotid artery stenosis /7/: male/female: 5/2, diabetes: 4/57%/,measurement revealed a large proportion of patients with unrecognized LEAD. These data sug- smoker: 1/17%/, hypertension: 7 (100%), hyperlipidemia: 3/43%/ patients. The data of patientsgest that ABI measurement should be included in the evaluation of cardiovascular risk in hospi- with carotid occlusion : 4 male patients, diabetes: none/!/, smoking: 2 /50%/, hypertension:4talized patients aged 50 years or older. /50%/, hyperlipidemia: 4 /100%/ patients. Conclusion: The more serious carotid state was asso- ciated with worse coronary findings. The patients with significant stenosis of the carotid artery got more periferial bypass graft . The patients with smoking, diabetes, hypertension and hyperlipide- mia have worse carotid findings and got more coronary graft. 9
  13. 13. 9. EFFECTS OF LOW-GRADE SYSTEMIC INFLAMMATION ON 10. HCV INFECTION AND CAROTID ATHEROSCLEROSIS: EVIDENCE OFENDOTHELIAL MICROPARTICLE LEVELS IN SUBJECTS AT INCREASED VIRAL LOCALIZATION INSIDE THE PLAQUECARDIOVASCULAR RISK AL Zignego, R Abbate, B Chellini, R Marcucci, F Sofi, V Sollazzo, C Giannini, D Prisco,Pirro M, Vaudo G, Alaeddin A, Bagaglia F, Paoletti L, Razzi R, Mannarino MR, Schillaci M BoddiG, Mannarino E BACKGROUND. Hepatitis C virus (HCV) infection is a major health problem due to its high pre-Background and aims. Exposure to multiple cardiovascular risk factors is primarily responsible for valence and pathological sequelae including hepatic and extrahepatic disorders. It has been shownendothelial injury and contributes to activate a low-grade systemic inflammation, which in turn fur- that infection pathogens can induce macrophage foam cell formation and/or activate the immunether enhances the degree of endothelial damage. Traditional risk factors are also believed to pro- response and potentiate the immune inflammatory reaction underlying atherosclerosis. A link bet-mote endothelial release of membrane microparticles (MPs), whose generation has been ween HCV infection and increased risk of atherosclerotic disease has been recently suggested. Thisreproduced in vitro under C-reactive protein (CRP) exposure. We investigated whether activation study was aimed to evaluate the association between HCV infection and carotid atherosclerosisof a low-grade systemic inflammation under exposure to multiple traditional cardiovascular risk in 1900 patients consecutively referred to the “Center for evaluation of cardiovascular risk factors”factors has an influence on the number of circulating endothelial MPs. Methods. The total bur- of the University of Florence who showed a prevalence of anti-HCV positivity of 3,3%. METHODS.den of traditional cardiovascular risk factors, the number of circulating CD31+/CD42- endothelial In 63 HCV+ patients (34 m, 29 f, aged 71+6 yrs , range 53-82 yrs) and in 201 age-matchedMPs and plasma CRP levels have been quantified in 200 subjects without overt cardiovascular HCV – patients (140 males, 61 females, 68  10 yrs , range 45-80 yrs ) the status of ca-disease and at increased cardiovascular risk because of their exposure to at least 3 traditional car- rotid arteries (number of carotid plaque and carotid intima-media thickness) was studied by highdiovascular risk factors. Results. Levels of circulating endothelial MPs were positively correlated with resolution B-mode ultrasonography (Sonolayer SSA 270A equipped with a 7.5 MHz transducer).plasma CRP levels (r=0.28, p<0.05). After participants were grouped according to tertiles of the In all patients the prevalence of both traditional (smoking habit, hypertension, diabetes, dyslipi-estimated Framingham risk scores, we found that higher estimated cardiovascular risk was paral- demia, family history of premature coronary artery disease (CHD)) and new risk factors for caro-leled by increasing endothelial MPs levels. The presence of plasma CRP above the median value tid atherosclerosis (fibrinogen, C reactive protein (CRP), Lp(a) lipoprotein and homocysteine) andin the cohort further icreased the number of endothelial MPs. In a multivariate analysis plasma main liver functional parameters were also investigated. The presence of HCV RNA sequences wasCRP levels independently predicted the number of circulating endothelial MPs. Conclusions. The evaluated by high sensitive PCR-based methods in the carotid plaque tissue as well as in the cor-exposure to multiple cardiovascular risk factors contributes to injury the mature endothelium, pos- responding serum from ten HCV-positive patients who underwent carotid revascularization. RE-sibly through an increased membrane fragmentation into microparticles. Low-grade systemic in- SULTS. The prevalence of carotid lesions was significantly higher in HCV positive (80.6%) thanflammation may play a significant role in risk factor-induced endothelial MPs release. in HCV negative patients (51%, p<0.01). None of the traditional risk factors for atherosclerosis sho- wed a higher prevalence in the HCV positive than in the negative group. Interestingly, the pre- valence of smokers (6.45% vs 22.3%) and premature familiar history for CHD (16% vs 21.6%) was significantly lower in the HCV positive group (p<0.05 vs HCV negative pts). At multivariate re- gression analysis HCV infection remained as an independent risk factor for carotid atherosclero- sis. Among new risk factors , only Lp(a) and homocysteine plasma levels were significantly (p<0.01 vs HVC – pts) higher in HCV positive patients. Principal parameters of liver function did not dif- fer between the 2 groups. Interestingly, HCV RNA sequences were detected in the majority of available plaque tissues (in 7 out of 10) and frequently in the absence of serum HCV RNA, ru- ling out the possibility of samples contamination by circulating particles. CONCLUSION. Our data obtained on an Italian population strengthen the possible role of HCV infection in facilita- ting the occurrence of carotid atherosclerotic lesions, independently of the classic risk factors for atherosclerosis. A finding of special importance was the demonstration of HCV RNA sequences in carotid plaque tissues, even in the absence of serum HCV RNA positivity. Remarkably, serum markers of inflammation showed similar pattern in HCV + and HCV - populations. These data strongly suggests that HCV infection does act by a local action inside the plaque and strengthens the opportunity for further studies investigating the molecular mechanisms involved. 10
  14. 14. Oral Communications Thursday, May 8, 2008 PNEUMOLOGY
  15. 15. 1. ANEMIA IN COPD PATIENTS AS A PREDICTIVE FACTOR OF HOSPITALARY 2. EVALUATING THE ROLE OF INTRAVENOUS MAGNESIUM SULPHATE AS ANREADMISSION ADJUNCT TO STANDARD THERAPY IN SEVERE ACUTE ASTHMAGargallo E; Casado P; Gallego M; Szymaniec J; Gil-Sanz C. Anupam K. Singh, S.N. Gaur, Raj KumarINTRODUCTION AND OBJETIVES: Anemia is a prevalent pathology associated with many chro- Background: Though intravenous(IV) Magnesium Sulphate(MgS04) has additive effect to beta-nic diseases. COPD in industrialized countries is one of the pathologies that causes more morbi- 2 agonists, its additive benefit in face of combination tharapy with beta-2-agonists and ipratro-mortality, and consumes a great amount of health resources. We selected a group of severe pium(standard therapy of severe acute exacerbation of asthma) remains unadressed.RecentCOPD patients that were admitted at our hospital, and determine if the presence of anemia mo- Meta-analyses emphasise need for such study Aim:To evaluate the role of IV MgSO4 when useddified the number of hospitalary admissions of these patients. MATERIAL AND METHODS: 85 as an adjunct to standard therapy of severe exacerbations of asthma. Method:Randomized,singlepatients admitted at our service, diagnosed of severe COPD by spirometry during the first three blinded,placebo-controlled study was carried out in emergency department of a tertiary referralmonths of 2006 were chosen for our study. We first determine the prevalence of anemia in this centre in india.Patients aged 18-60 years presenting with acute asthma and PEFR < 100Lmingroup following the OMS criteria for anemia (levels under 13 g/dl for men, and under 12 g/dl were included All patients received IV Hydrocortisone on arrival.In group1(controls), patients werefor women). We evaluated the mortality rate of patients that had anemia, and compared if this nebulised with salbutamol and ipratropium thrice at 20 minutes interval and were given 2gm IVgroup presented more frequency of hospitalary readmission during the next 12 months. RE- MgSO4 in 200 ml normal saline at 30 minutes. In group2 patients were nebulised similarly,butSULTS: 57 of the 85 patients included were men, and 8 women. 24% (20) had anemia. 6% of were given only IV normal saline at 30 minutes for blinding. PEFR was evaluated at baseline andpatients with anemia died during the study. Hospitalary readmission was 65% in the group of ane- at 30 minutes interval.The primary efficacy end point was PEFR%predicted(pred.) at 120 mins andmia, compared with the ones that didn´t have anemia, 57%. Differrences were statistical signifi- odds ratio(O.R.) of admission.(derived from comparing proportion of groups attaining PEFRcatives (p<0.05). CONCLUSIONS: Prevelence of anemia in our study group was 24%, mainly >60%pred. at 120 minutes). Results: Both groups of 30 patients each,were matched with respectmen. Global mortality rate was 14%, and 6% in patients with COPD and anemia. Patients with to demographic and pulmonary parameters(Baseline PEFR% :32.6+4.8% in group2 vs.32.1+5.4%severe EPOC and anemia needed higher number of readmissions during the following months in group1, p=0.88).At 120 minutes,there was a higher meanPEFR%pred(66.6+4.3% vs.that continued the study. 61.7+3.3%) and %improvement from baseline (33.5+3.5% vs 29.6+3.7%), in group 2 as com- pared to group 1(MeanDifference=4.36%,C.I.2.16-6.59,p<0.001).The O.R. for admission in group 2 with respect to group1was lower and significant.(O.R=0.16,C.I.=0.05-0.77, p<0.05). Conclusion: IV MgSO4 improves pulmonary function and reduces admission rates,when used as an adjunct to standard therapy in severe acute asthma .Thus IV MgS04 should added in severe acute exa- cerbations routinely to prevent potentially fatal complications.3. SURVIVAL IN PATIENTS WITH PULMONARY ARTERIAL HYPERTENSION ted quality of life in patients with systemic sclerosis. All our patients within three months of the-RELATED TO SYSTEMIC SCLEROSIS rapy with Iloprost and bosentan exhibited resolution of multiple fingertip ulcers and reduction ofMazzuca S, Cimino R, Iannazzo P, Paravati S, Nestico’ E, Galasso S, Giancotti S, Pintaudi C, mean number of new digital ulcers, thus opening new perspectives in the treatment of digital ul-Galasso D. cers in systemic sclerosis.Pulmonary Arterial Hypertension affects approximately 16% of patients with Systemic Sclerosis(SSc),today, is the most common cause of death in SSc. Breathlessness is common in patientswith SSc, thus SSc-associated Pulmonary Arterial Hypertension (SSc- PAH) is often diagnosed toolate for patients to derive maximum benefit from disease- modifying therapies. Objectives :Toevaluate the clinical efficacy and the effects on survival and on quality of life of Iloprost, a prosta-cycin analogue, associated with Bosentan, an endothelin receptor antagonist, in the treatment ofpatients with SSc-PAH. Materials and Methods: we performed the study on 142 consecutive pa-tients (122 W- 20 M ) with SSc from January 1998 to December 2007. The patients were selec-ted for study if they fulfilled the diagnosis of SSc according to the criteria of the American Collegeof Rheumatology and diagnosis of Limited Skin Sclerosis as defined by LeRoy (1988). The patientshad a mean age 51,2 years (range 13-84), and mean duration of disease 12,2 years ± 7,5 (range1-24 years). In 24 patients (17%) we detected pulmonary hypertension: 15 patients with SSc-PAHwithout interstizial pulmonary involvement established by HRCT, 9 patients with pulmonary hy-pertension and interstitial lung disease on HRCT defined by the presence of at least 1 of the 2following radiologic features: ground-glass opacification and honeycombing ( micro or macrocy-stic reticular pattern). From April 2004 we enrolled 8 patients (7 W-1M), mean age 50,4 ± 13,2years,2 patients with diffuse skin SSc, 6 patients with limited skin SSc and mean duration of di-sease 9,1 years , all patients affected by pulmonary arterial hypertension in absence of significantrestrictive lung disease and interstitial lung disease on HRCT. To assess PAH, we used tricuspid gra-dient detected on echocardiography and to increase the specificity, we used a threshold of pul-monary arterial systolic pressure of ≥ 45 mmHg. All eight patients underwent therapywith Iloprost, given by intravenous infusion, at progressively increasing doses (from 0,5 to 2ng/Kg/min) over a period of 6h each day for 6 days with repeated cycles of one day at regularintervals of 14 days for 36 months, and Bosentan started at 62,5 mg twice a day and increasedto 125 mg twice a day sfter 1 month. All patients compiled Short Form -36 for Quality Life. In eightpatients we detected 28 digital ulcers. Statistical analysis were performed using Fisher’s exact testfor the comparison of frequencies, paired t-test were used for comparisons of variation in valueswithin the same individual. Univariate analysis of survival was performed by log rank test. Results:A woman, 63 years old, with diffuse skin SSc and SCL-70 positive, for hyperosmotic diabeticcoma during 12° month died. In our case series all patients developed significant improvementin exercise capacity, as documented by six minutes walking test with 351±93 m at baseline andmean increase of 44,8 m at 12° month of therapy (p<0,011) and 411±71 m (p<0,001) at 36 °month. Although pulmonary systolic pressure showed only a modest reduction, all patients si-gnificantly improved NYHA functional class from III to NYHA functional class I (p<0,02); the im-provement of the functional class occurred within three months, and was lasting for all the 36months of follow-up. Our case seris recorded clinical improvement in conjiunction with impro-vement on the six minutes walking test that has been shown to be an acceptable outcome mea-sure. By echocardiography the pulmonary arterial systolic pressure had decreased from 53±16mmHg to 50±14 mmHg at 12° month (p NS) and to 44±9 mmHg at 36° month (p<0,32); Theinstrument of Short Form-36 showed score 35±11 at baseline and 59±7,2 after 36 months of fol-low-up (p<0,002). The Short Form-36 is a valid instrument for the evaluation of the health-rela- 12

×