CUTOFF POINT OF WAIST CIRCUMFERENCE FOR THE DIAGNOSIS OF METABOLIC SYNDROME IN TURKISH POPULATION

Abstracts from 10th Congress of the European Federation of Internal Medicine/European Journal of Internal Medicine 22S (2011) S1–S112 SHPT. Cut-offs for lower tertiles of 25(OH)D and iCa were 57 nmol/l and 1.22 mmol/l, respectively. Results: Mean PTH was 6.8±3.8 and 15.9±5.8 pmol/l after GB and DS, respectively. 25(OH)D was 68±23 and 61±35 nmol/l, and iCa 1,24±0,05 and 1.18±0.11 mmol/l, respectively. We found SHPT in 37/97 (38%) GB patients and in 11/11 (100%) DS patients. There were no differences between the associations of SHPT and tertiles of 25(OH)D. In the total population, the upper 2 tertiles of iCa were associated with lower prevalence of SHPT (OR 0.4; p<0.05) compared with the lower tertile. This was not significant in GB patients, but mean iCa was shifted towards the lower reference range. Conclusion: The prevalence of SHPT 5 years after gastric bypass and duodenal switch is high despite adequate calcium and vitamin D supplementation. A shift of serum calcium due to the decreased ingestion and the decreased absorptive surface in the intestine are probable explanations for the high prevalence of SHPT. COMPARISON OF GLYCEMIC EXCURSION IN PATIENTS WITH NEW ONSET TYPE II DIABETES MELLITUS BEFORE AND AFTER TREATMENT WITH REPAGLINIDE Sharabeh Hezarkhani1, Shokoofeh Bonakdaran1, Reza Rajabian2, Sima Sedeghi3, Mohammad Khajehdaloie4. 1Department of Endocrinology, Golestan University of Medical Sciences, Gorgan, Iran; 2Department of Endocrinology, Mashhad University of Medical Sciences, Mashhad, Iran; 3 Department of Rheumatology, Golestan University of Medical Sciences, Gorgan, Iran; 4Mashhad University of Medical Sciences, Mashhad, Iran Introduction: Due to industrialization and sedentary life, incidence of type 2 diabetes (DM2) is seriously increasing. Repaglinide is a glucose reducing agent that predominantly reduces post-prandial glucose. CGMS monitors blood glucose excursions over a 3-days period. The aim was to determine the blood glucose excursions in patients with new onset DM2. Methods: Ten patients with new onset DM2, aged between 30-60 years entered this study. As the first therapeutic management, patients received diabetic regimen and moderate exercise for 3-weeks, if they did not achieve blood glucose goal (FBS<120mg/dl, 2hppG<180mg/dl), patients were considered to undergo 3-days CGMS at baseline and after 4-weeks on repaglinide 0.5mg Tid. Results: Mean age of patients was 45.7±6.46 years. Mean excursions of blood glucose was not different at the onset and end of treatment (6±4.05 VS 7.6±5.2 episodes, P=0.49) and also between mean duration of hypoglycemic episodes before and after therapy (zero VS 5.1±14.1 hours, P=0.28). There was no significant difference between hyperglycemia episodes before and after therapy. (7.6±5.2 VS 5.7±4.1, P=0.42) but mean hyperglycemia duration was significantly reduced at the end of therapy (21±26.17 VS 57.7±35.3, P=0.001). Patients experienced a mean of 0.3±0.67 episodes of hypoglycemia after therapy that showed no significant difference with before it (P=0.19). Mean FBS (with CGMS) after therapy was significantly lower than before it (142.9±54.31 VS 222.9±82.6 P<0.001). Conclusion: This study demonstrates that repaglinide (with the lowest effective dose and duration) beside CGMS, can reduce FBS significantly and postprandial BS to target goal, and hypoglycemic events are significantly low. The repaglinide is a safe and effective treatment for new onset diabetic patients and CGMS is an effective adjuvant therapy for control of DM in these patients. GENETIC AND FUNCTIONAL ANALYSES OF THE MRAS AND HNF1A GENES IN DIABETES AND DIABETIC NEPHROPATHY Eva Horova1, Martin Prazny1, Katerina Kankova2, Kerstin Brismar3, Harvest F. Gu3. 13rd Department Of Internal Medicine, 1st Faculty Of Medicine, Charles University, Prague, Czech Republic; 2Department of Pathological Physiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic; 3Rolf Luft Center for Diabetes Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Solna, Stockholm, Sweden Background: Evidence has recently indicated that the MRAS and HNF1A genetic polymorphisms are associated with coronary artery disease. The MRAS and HNF1A genes are located in chromosomes 3q and 12q within the linkage regions of diabetes and diabetic nephropathy (DN). We thus performed genetic and functional analyses of these two genes to evaluate their impact on diabetes and DN. Methods: MRAS and HNF1A genetic polymorphisms were genotyped in 1399 Czech subjects of European descent including non-diabetic controls, type

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1 (T1DM) and type 2 (T2DM) diabetic patients with and without DN with TaqMan allelic discrimination. Gene expression levels in kidney of diabetic Goto-Kakizaki (GK) and Wistar rats were detected with real time RT-PCR. Results: SNP rs2259816 in the HNF1A gene was found to associate with DN in T1DM. The gene expression was decreased in kidney tissues of GK rats compared to Wistar and insulin treated GK rats. There was neither statistically significant association in the MRAS genetic polymorphism with DN nor variation of MRAS gene expression in kidney of GK and Wistar rats. Conclusion: Data of the present study suggest that the HNF1A gene, but not MRAS, may have primary genetic impact on the development of DN. POOR RESPONSE AFTER PEDIATRIC EXTRACORPOREAL MEMBRANE OXYGENATION SUPPORT FOR SEVERE NECROTIZING PNEUMOCOCCUS PNEUMONIA Yung-Feng Huang1, Po-Yen Liu1, Chiun-Yen Pan2, Kai-Sheng Hsieh1. 1 Department of Pediatrics, Kaohsiung Veterans General Hospital, Taiwan; 2Division of Cardiac Surgery, Department of Surgery; Kaohsiung Veterans General Hospital, Taiwan Background: Conventional treatment of respiratory failure involves positive pressure ventilation with high concentrations of inspired oxygen. If adequate gas exchange still cannot be achieved extracorporeal membrane oxygenation (ECMO) may be an option. Severe necrotizing pneumococcus pneumonia can cause significant pulmonary morbidity leading to ECMO rescue. Reported survival of severe necrotizing pneumococcus pneumonia with adult respiratory distress syndrome(ARDS) requiring ECMO has been poor, and prolonged time on ECMO is associated with increased mortality. Methods: We collected data retrospectively on patients from year 2007 to 2008. We present 2 pediatric cases of severe necrotizing pneumococcus pneumonia ARDS and 3 case enterovirus-71 menigoencephalitis with ARDS after ECMO treatment. Results: Acute lung injury scores were 3.53. Two severe necrotizing pneumococcus pneumonia were expired. Enterovirus-71 menigoencephalitis with ARDS was shown no mortality and more sequelae with late treatment with ECMO. Conclusions: We find children with pneumococcus pneumonia with ARDS in our institution requiring prolonged ECMO and high mortality. Our experience suggests that there may be use for prolonged ECMO and high mortality in children with severe necrotizing pneumococcus pneumonia. CUTOFF POINT OF WAIST CIRCUMFERENCE FOR THE DIAGNOSIS OF METABOLIC SYNDROME IN TURKISH POPULATION Mehmet Hursitoglu1, Tufan Tukek2, M.Ali Cikrikcioglu3, Yildiz Yigit4, Mustafa Cakirca3, Guzin Zeren5, S.Rabus Apikoglu6, Osman Kara2, Ilker Cordan2, Mikail Yetmis3, Pinar Soysal3. 1Internal Medical Department, Sisli Etfal Training & Research Hospital, Sisli, Istanbul,Turkey; 2Internal Medical Department, Okmeydani Training & Research Hospital, Okmeydani, Istanbul,Turkey; 3Internal Medical Department, Bezmi-Alem Vakif University, Fatih, Istanbul, Turkey; 4Internal Medical Department, Bagcilar Training & Research Hospital, Bagcilar, Istanbul,Turkey; 5Aile Saglik Merkezi, Sivas, Turkey Background: Metabolic syndrome(MetS) is a worldwide health problem. Its main components are dyslipidemia, abdominal obedity, elevation of arterial blood pressure and dysregulated glucose homeostasis. Abdominal obesity and/or insulin resistance have gained increasing attention as the core manifestations of the syndrome. The International Diabetes Federation (IDF) recommends population- and country-specific definition of cutoff points of waist circumference (WC) for the diagnosis of abdominal obesity. The purpose of this study was to determine WC cutoff values of Turkish population. Methods:The study was conducted on a total of 1379 subjects (767 female and 612 male). The participants were evaluated for the presence of IDF criterias (other than WC) of the diagnosis of MetS. Results: The prevalence of •2 IDF risk factors (other than WC) in male and female was 48%, and 47%, respectively To determine the cutoff values of WC for predicting •2 risk factors, a receiver operator characteristic (ROC) curve was plotted for each sex separately (Figure 1). The area under the ROC curve for men and female was 0.69 and 0.75, respectively. The cutoff values of WC for predicting the presence of multiple risk factors (with at least 80% sensitivity) for men and women were 94 cm and 96 cm, respectively.

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Abstracts from 10th Congress of the European Federation of Internal Medicine/European Journal of Internal Medicine 22S (2011) S1–S112

Fig 1. The ROC curves for waist circumference (WC) to predict the presence of •2 risk factors (other than WC) of the metabolic syndrome, as defined by the International Diabetes Federation in men and women. (a) Cut-off value of WC yielding the maximal sensitivity plus specificity for predicting the presence of •2 risk factors. (b) Cut-off value of WC yielding at least 80% sensitivity for predicting the presence of •2 risk factors. AUC, area under ROC curve.

Conclusions: For Turkey, it is more rational to use the WC cutoff points identified at this study (ie, 94 cm for men, and 96 cm for women) than to use the IDF’s cutoff points recommended for the Europid subjects for the diagnosis of MetS. SERUM TOTAL BILIRUBIN (TBIL) LEVEL AND PERIPHERAL ARTERY DISEASE (PAD) Konstantina Bakalakou1, Efstathios Taxiarchou2, Athanasios Marinakos2, Anastasia Nouli2, Emilia Stouraitou2, Kimon Papanikitas2, Chrisanthi Margariti2, Sotirios Patsilinakos2, Ioannis Ioannidis1. 12nd Department Of Internal Medicine Konstantopoulio General Hospital Athens Greece; 2 Cardiology Department, Konstantopoulio General Hospital N. Ionia Greece Introduction: Bilirubin has been recently identified as antioxidant and antiinflammatory agent and may provide important protection against cardiovascular and inflammatory diseases. Aim: The aim of the study was to investigate the association of TBil levels and PAD. Material - Method: A total of 142 patients referred to outpatient department of Konstantopoulio Hospital were selected for the study using predetermined inclusion criteria. Ankle brachial index (ABI), TBil concentration and lipid levels were measured. Cardiovascular risk factors, (diabetes, smoking, coronary artery disease (CAD), stroke, hypertension and family history of cardiovascular disease.) were recorded. Patients were divided in a PAD (ABI<0,9) and a non-PAD (ABI:0,91-1,3) group. Exclusion criteria were: 1) Medical history of liver or biliary disease, 2) Increase in serum AST or ALT levels of greater than twice the upper normal limit, 3) serum albumin< 3,5mg/dl, 4) TBil >1.2mg/dl and 5) acute febrile disease. Results: The PAD group consisted of 67 patients (52 males) with mean age: 64.46 ± 11.5 years. In the non-PAD group were included 75 patients (56 males) mean age: 63.9 ± 8.9 years. TBil concentrations were significantly lower in PAD than in nonPAD group (0.6452 ± 0.26149 vs 0.7580 ± 0.23596 p=0,008). Multiple regression analysis after adjustment for sex, age, and disease/control status showed a positive correlation with high density lipoprotein cholesterol (p=0,021) and an inverse association with history of CAD (p=0,002) and smoking (p=0,025). There was no association between bilirubin and diabetes, hypertension or stroke (p=0.29, p=0.95, p=0.057 respectively), in our study. Conclusion: Lower serum TBil levels may be related to higher risk for peripheral artery disease. CYTOMEGALOVIRUS REACTIVATION IN IMMUNOCOMPETENT PATIENTS ADMITTED TO THE INTENSIVE CARE UNIT Razieh Jahangard, Mona Hedayat. Infectious Diseases Introduction: Cytomegalovirus (CMV), a deoxyribonucleic acid virus belonging to the herpes family, is a common viral infection affecting 60 to 100% of all individuals by adulthood, depending on geographic and socioeconomic

factors. Following CMV infection, as evident by CMV seropositivity, the virus remains latent in T lymphocytes throughout the person’s life. CMV reactivation, as a consequence of impaired cell-mediated immunity, has been associated with increased mortality in immunocompromised individuals. The purpose of the present study was to evaluate CMV reactivation and its associated risk factors as well as its impact on mortality among immunocompetent patients admitted to intensive care units (ICU). Materials and Method: We prospectively assessed quantitative plasma CMV DNA by weekly real-time polymerase chain reaction (PCR) in a cohort of 132 CMV-seropositive immunocompetent adults admitted to ICU between March 2009 and April 2010. Clinical measurements were assessed by personnel blinded to CMV PCR results. Risk factors for CMV reactivation and its association with hospital and ICU length of stay were assessed by multivariable logistic regression and proportional odds models. Result: One hundred thirty two patients were enrolled in the present study. The overall rate of active CMV infection was 34% (P < 0.0001), which was increased to 42.2% among those who were hospitalized for •7 days (P < 0.001). The overall mortality rate associated with active CMV infection was 1.93 times higher than that without CMV infection (p = 0.001). The strongest risk factors for CMV viremia were older age, male gender, severe sepsis, care in a trauma or burn ICU (compared to medical or coronary ICU), blood product transfusion, and mechanical ventilation. Conclusions: CMV reactivation occurs frequently in immunocompetent patients admitted to ICU, especially in those with ICU stay •7 days. Accordingly, mortality rate is significantly increased with active CMV infection. BETA-2 AGONIST AND LACTIC ACIDOSIS Sérgio Janeiro, Suzane Ribeiro, Daniel Trabulo, Susana Marques, Ermelinda Pedroso. Centro Hospitalar De Setúbal Background: Lactic acidosis may be present in many acute situations associated with Asthma, like the state of poor tissue perfusion or oxygenation (hypovolemic shock, sepsis). However, more rarely, can be related to excessive administration of beta-agonists. Methods: We present a case of a 17-year-old patient, who was under intermittent use of salbutamol inhaler and was admitted to the Emergency Room during an acute exacerbation of asthma. Results: It was detected severe metabolic acidosis with increased anion gap and progressive hyperlactataemia in the first 6 hours after admission, without any evidence of hypoxia, hypovolemia or sepsis. Conclusions: Excluded other pathologies that could justify this acidosis (renal failure, diabetes or drug intoxication), and due to the persistence of sinus tachycardia and hypokalaemia, we believe that the lactic acidosis was caused by a beta2-agonist overdose. Discontinuation of the medication led to complete recovery and serum lactate levels returned to normal in 24h without any specific treatment. Failure to recognize this entity, mainly among young people who abuse of this therapy during a crisis, can lead to severe and irreversible consequences. SPECIAL CARE UNIT IN SERVICE OF INTERNAL MEDICINE: A SERIES OF ONE YEAR Margarida Jardim, Catarina Dias, Carlos Lélis, António Teixeira, Maria da Luz Brazão. Hospital Central do Funchal, Serviço de Medicina Interna, Portugal Background: The first Intermediate Care Units in North America emerged in the 60s, in response to pressure in the management of admissions and the rising cost of beds of intensive care unit. The Special Care Unit was created in October 2005, equipped with four beds was created to accommodate patients who require greater vigilance and monitoring. Methods: We consulted the medical records of 259 patients who were admitted to the Special Care Unit over a period of one year. We evaluated the following parameters: distribution by sex, age group, Office of origin, reason for admission, personal history, date and day of hospitalization, complications and destination. Results: In 2010 were admitted to the Special Care Unit 259 patients, 52.2% were female and 47.8% were male, the average age for females was 68 years and male was 66, 55, 5% of patients came from the ER, 23.9% of the Department of Internal Medicine, 14.2% of the Department of Critical Care