- Email: [email protected]
P0122 ARTERIAL AND VENOUS THROMBOSIS ACCOMPANYING HYPERTHROIDISM
Abstracts from 8th Congress of the European Federation of Internal Medicine / European Journal of Internal Medicine 20S (2009), S1–S283 outcome of acute infectious illness. The Subjective Global Assessment (SGA) is a well-validated tool for the screening of malnutrition. There is some evidence about poor nutritional status being associated with a higher mortality from community acquired pneumonia (CAP). However, despite the success of the SGA classification technique in these groups of patients, has not been applied to study the relationship between malnutrition and death in patients having CAP. Objectives: This study analyzes the use of the Subjective Global Assessment (SGA) as a screening tool to appraise the nutritional status of patients having community-acquired pneumonia (CAP). We also studied the relationship between malnutrition and the risk of death in CAP patients. Materials & methods: 98 patients presenting CAP were included. Age, sex, clinical features, co-morbidities and laboratory findings were recorded on admission. Patients were classified into SGA categories: Well-nourished (A); at risk to become undernourished (B) or severely undernourished (C), and followed up to the main endpoints: death or recovery. A logistic regression model controlling for co-morbidities was applied to estimate Odds ratios of death for each one of the SGA categories in comparison to the remaining ones. Finally, the predictive value of SGA was estimated considering death as the outcome variable. Results: 32 CAP patients (32.65%) were classified as SGA class A; 44 (44.90%) as SGA-B, and 22 (22.45%) as SGA-C. Pneumonia resulted in death in 3/32 SGA-A (9,37%), 8/44 SGA-B (18,18%) and 10/22 SGA-C patients (45,45%). SGA-C patients showed significantly higher Odds ratios for death in comparison to SGA-A patients (OR = 6.085, CI 95% 1.071 – 34.591; p= 0.042) Considering death as the outcome variable, SGA-A class had the highest predictive negative value (0.906), while SGA-C class showed the highest predictive positive value (0.455). Discussion & conclusion: Malnutrition or the risk of malnutrition showed a high prevalence in our series. Mortality due to CAP rose accordingly to the severity of malnutrition. SGA is a reliable and easy tool for the screening of malnutrition in CAP patients. SGA provides a simple estimation of the nutritional status and it is a good predictor of the risk of death, SGA should be included in the routine assessment of CAP patients. Keywords: subjective global assessment, nutrition assessment, pneumonia
P0120 BILATERAL PANUVEITIS AS A RARE MANIFESTATION OF SYSTEMIC SARCOIDOSIS
Victoria Pardo Gutiérrez, Cristina Muñoz Esteban, Ana Mª Arnáiz García, Gema Arozamena Martínez, Miguel Angel Núñez Viejo, Javier Velasco Montes, Gonzalo Martínez De Las Cuevas, Marta Aller Fernández, Fernando Ortiz Flores. Departament of Internal Medicine. University Hospital Marqués De Valdecilla. Santander. Spain Introduction: sarcoidosis is an important etiology of inflammatory eye disease and has a myriad of manifestations (anterior/posterior uveitis or both, retinal vasculitis, keratoconjunctivitis and conjunctival follicles), which are involved in 25-80% of patients, being the presenting symptom in 5% of cases. Posterior-segment involvement is reported in nearly 30% of patients with ocular sarcoidosis. Panuveitis occurs in about 10 to 15% of patients with uveitis. Objectives: analyse clinical features of one patient with bilateral panuveitis and systemic sarcoidosis. Methods: chart review. Results: a 54 years old man with fever syndrome and constitutional symptoms in the last three weeks was admitted to our unit. He presented a normal physical examination except a mild hepatomegaly. Blood tests revealed an increased erythrocyte sedimentation rate and C-reacted protein, moderate pattern of cholestasis and elevated serum angiotensin converting enzyme (ACE). A chest X-ray and thoracic-abdominal CT were normal. An ophthalmological examination revealed bilateral posterior uveitis, papillitis and signs of retinal vasculitis, without visual loss. Gallium-67 lung scanning showed typical “lambda” pattern (bilateral hilar adenopathy). In a transjugular percutaneous liver biopsy we observed hepatocellular degeneration, cholostasis with necrosis and ductopenia, but no granulomas were seen. Biopsy of minor salivary gland was also inespecific. Clinical diagnosis of sarcoidosis was made with no histological confirmation. We started topic ocular and systemic treatment with corticosteroids plus cyclopegics and inmunosuppresors (Methotrexate, 7,5 mg per week) plus corticosteroids (Prednisone 30mg per day), respectively, with improvement of general status and important decrease of papillitis. Conclusions: granulomatous inflammation of the conjunctiva is a common
S45
manifestation of ocular sarcoidosis. Many patients who have sarcoidosis can have silent or asymptomatic uveitis, and no specific extraocular manifestations of sarcoidosis. All patients should undergo an ophthalmologic examination at the time of initial evaluation because ocular sarcoidosis have significant impact on visual prognosis
P0121 YOUNG MAN WITH SUBCUTANEOUS NODULES: A CASE REPORT
Victoria Pardo Gutiérrez, Cristina Muñoz Esteban, Ana Mª Arnáiz García, Marta Aller Fernández, Fernando López Gutiérrez, Pablo Garmilla Ezquerra, Samuel García Rubio, Fernando Ortiz Flores. University Hospital Marqués De Valdecilla. Santander. Spain Introduction: sarcoidosis is a multisystemic disease which diagnosis is established when clinical and radiological evidence is supported by a biopsy showing non-caseating granulomas in different organs. There are dermatological symptons in up to 25% of patients, usually presented as lupus pernio or erythema nodosum. The appereance of specific subcutaneous nodules as a manifestation of this entity is rare. Objectives: analyse clinical features of one patient with subcutaneous sarcoidosis as first manifestation of systemic disease. Methods: chart review. Results: a 43 years old man with constitucional symptoms and fever in the last two months was admitted to our unit. He presented several non-tender, firm, nodular subcutaneous lesions located in four extremities, including forearms, one painful erythematous plaque of 5x7 cm of diameter in lateral region of left leg and a palpable right axilar lymph node He did not present another extracutaneous manifestations. Ophthalmological examination was normal. Blood and urine analyses only revealed a mild elevation of serum angiotensin converting enzyme (ACE) and hypercalciuria without hypercalcemia. Right paratracheal node enlargement and bilateral adenopathy were observed in a chest X-ray and confirmed by thoracic CT. An echography of both arms showed inespecific subcutaneous involvement and hyperemia. Bronchoscopy with multiple transbronquial lung biopsies of paratracheal adenopathies only revealed the presence of inflammatory cells. Definitively diagnosis was made by a cutaneus biopsy of the erithematous plaque in left leg, showing non-caseating granulomas with multinuclear cells, compatible with sarcoidosis. Low-dose corticosteroids and hydroxychloroquine treatment was started with good tolerance. General status and cutaneous lesions improvement was observed after several week of treatment. Conclusions: sarcoidosis is a systemic disease with important skin involvement. Subcutaneous nodular lesions are the least frequent of dermatological symptons, and may be the first manifestation of extracutaneous or systemic sarcoidosis, but its prognostic significance is not well established. Subcutaneous sarcoidosis is usually infradiagnosed and may be considered in patients presenting subcutaneous nodules.
P0122 ARTERIAL AND VENOUS THROMBOSIS ACCOMPANYING HYPERTHROIDISM
Oylum Ekiztas, Birgul Onec, Derya Yildirim, Selma Karaahmetoglu Ozkan, Erdal Eskioglu. Ankara Numune Education and Research Hospital, Department of Internal Medicine Introduction: Throid diseases may interfere with the coagulation system and may cause thromboembolic events. It is known that hyperthroidism causes arterial thrombosis and venous thrombosis as well. Most of the studies about arterial thrombosis in hyperthroidism are about the patients who are complicated with atrial fibrilation. We would like to report our case because arterial thrombosis in hyperthroidism patients without atrial fibrilation are rare. Case: 57 year old woman patient presenting intermittent fever, nousea, vomitting, stomach ache and shrinkage. During the research of the fever ethiology, we found that the patient had overt hyperthroidism. The computarised tomographies of the thorax and abdomen demonstrated pulmonary arterial thrombosis, pulmonary infarct and thrombosis at superior mesenteric artery with a constriction of more than %50. There was also deep venous thrombosis seen in the low extremity doppler ultrasonography. Our research involved predisposing factors such as connective tissue diseases, malignancies, enfections and the other diseases causing hypercoagulable state like antiphospholipid syndrom but the etiology of the thrombosis could not be found out. The physical examination and the electrocardiogram of the patient excluded atrial fibrilation. In our opinion, the arterial and venous thrombosis were related to hyperthroidism because we excluded all other likely reasons. We could not
S46
Abstracts from 8th Congress of the European Federation of Internal Medicine / European Journal of Internal Medicine 20S (2009), S1–S283
reveal any possible etiology for the arterial thrombosis in a hyperthroidism patient without the atrial fibrilation. Results: Hyperthroidism may affect the coagulation system by mostly causing hypercoagulation and thromboembolic events. The studies about thrombosis in hyperthroidism usually demonstrated that hyperthyroidism and arterial thrombosis are usually seen in patients complicated with atrial fibrillation. It is a rare case of arterial and venous thrombosis accompanying hyperthroidism without atrial fibriallation. In our case we could not find any predisposing factors causing both venous and arterial thrombosis else than hyperthroidism. We suggest that there may be a relationship between thrombosis and hyperthroidism and recommend to the clinicians to keep in mind that arterial thrombosis may be seen without atrial fibrilation at hyperthroidism patients.
P0123 SWEET SYNDROME (ACUTE FEBRILE NEUTROPHILIC DERMATOSIS)
Fatma Alıbaz Öner, Nesrın Ünalan, Mehmet Emın Pı¸skınpa¸sa, Mecdı Ergüney. Istanbul Education and Research Hospital Introduction: Sweet syndrome is a rare dermatological disease characterized fever, leukocytosis, well-demarcated, erythematous papüles and plaques which show dense neutrophilic infiltration.Sweet syndrome presents in three clinical groups; classic or idiopathic form, a malignancy associated or paraneoplastic form, drug-induced form. Case report: A 71-year-old woman presents with painful and erythematous rashes in her hands and distal part of legs.On the physical examination; She had erythematous, edematous plaques in her hands and distals of legs. The other system examinations were normal. Hb: 11,5 gr/dl, Hct: 34, plt: 251000, WBC: 18400, kidney and hepatic function tests,electrolyte levels were normal. Erytrocyte sedimantation rate: 105 mm/hour, CRP:12,1 m IU/ML, ASO:315 m IU/ML.After dermatology consultation, A punch biopsy was performed on her left leg. The patient was started on oral antihistaminic and topical cortocosteroid.On biopsy; focal dermal neutrophilic infiltrations were found. Classical sweet syndrome was diognosed with both major criterias and three minor citerias. Discussion & conclusion: Acute febrile neutrophilic dermatosis was first described by Sweet in 1964. There is a broad incidence peak in the fourth to seventh decades; women average age 50 and men age 65.The etiology is unknown but is thought to be a hypersensitivity reaction that leads to cytokine stimulation and subsequent neutrophil activation and infiltration. Plaques usually appear on your back, neck, arms and face. These tender and painful eruptions may develop blisters, pustules or ulcers, causing your skin to burn or itch. The diagnostic criteria are summarized in table 1. Criteria
Classic/Malignancy-associated
Drug-induced
1
Abrupt onset of painful erythematous plaques/nodules
2
Histopathologic evidence of a dense neutrophilic infiltrate without evidence of leukocytoclastic vasculitis. Fever > 38°C
3 4
Association: underlying malignancy, inflammatory disease, pregnancy; OR preceded by upper respiratory or gastrointestinal infection or vaccination.
Temporal relationship: between drug ingestion and clinical presentation; OR recurrence after oral challenge
5
Excellent response to treatment with systemic glucocorticoids or potassium iodide.
Temporally related resolution of lesions after drug withdrawal or treatment with systemic glucocorticoids.
6
Abnormal labs at presentation (3 of 4): ESR > 20mm/hr, (+) C reactive protein, WBC > 8000, neutrophils > 70 percent
Diagnosis
Both major criteria (1 and 2), and 2 of 4 minor criteria (3-6).
P0124 VENOUS THROMBOEMBOLISM RISK ASSESSMENT AND PROPHYLAXIS IN HOSPITALISED MEDICAL PATIENTS
Rakesh Kishore Panchal, Syed Fayyaz Hussain. Kettering General Hospital, Rothwell Road, Kettering, Northants, United Kingdom Nn16 8uz Introduction: Hospitalisation for acute medical illness is associated with an eightfold increased relative risk for venous thromboembolism (VTE). Pulmonary embolism accounts for 5-10% of deaths in hospitalised patients. Despite their existence, risk assessment strategies and thromboprophylaxis recommendations are not well implemented in hospitalised patients internationally. Objectives: To assess the risk of VTE and use of thromboprophylaxis strategies in adult internal medicine patients admitted to a district general hospital in the United Kingdom. Materials & methods: On a single day all adult internal medical inpatients were assessed for risk of VTE based on a review of medical notes and prescription charts. An evidence-based risk assessment tool was used to evaluate VTE risk and determine whether patients were receiving recommended thromboprophylaxis. Results: Of 193 internal medicine inpatients (53% male), 190 (98%) were aged ≥40 years. Survey demonstrated 142 (74%) medical patients at risk of VTE. Some form of thromboprophylaxis was prescribed to 74 (52%) at-risk patients (35% low molecular weight heparin and 18% thromboembolic
Characteristics and reasons for hospitalisation of assessed medical patients (193) Sex Age (years) Length of Hospitalisation (days) Reason for hospitalisation Respiratory Cardiology Infection (non-respiratory) Stroke Neurology (non-stroke) Oncology Gastroenterology Renal disease Haematology Endocrine/Metabolic Rheumatology Dermatology Other
102 (53%) Male, 91 (47%) Female 190 (98%) > 40yrs [51% > 75years] 6.0 [1-50]
Risk factors for venous thromboembolism Before admission Age >75 years Chronic Respiratory failure Chronic Heart failure Body mass Index > 30 (kg/m2 ) Previous venous thromboembolism Varicose veins or venous insufficiency Contraceptive/Hormone Replacement/Chemotherapy Admission Category Risk Factor Acute Heart Failure Acute Respiratory Failure Active Cancer/Inflammatory Disease (including infection) Other medical condition
All 5 criteria Prevalence of VTE in Internal Medicine
Localized lesions may be successfully treated with intralesional or topical glucocorticoids. Alternative treatments include doxycycline, potassium iodide, colchicine, indomethacin, dapsone, cyclosporine, cyclophosphamide, chlorambucil, and clofazamine Lesions are generally on upper extremities and face.Leg lesions are rare. Our case is interesting because of both the syndrome or the leg lesions are rare. Key words: Febrile neutrophilic dermetosis
Method of Thromboprophylaxis
54 (28%) 34 (18%) 23 (12%) 19 (10%) 18 (9%) 15 (8%) 14 (7%) 6 (3%) 4 (2%) 2 (1%) 2 (1%) 1 (0.5%) 1 (0.5%)
98 (51%) 32 (17%) 32 (17%) 14 (7%) 11 (6%) 3 (1%) 3(1%) 18 (9%) 42 (22%) 58 (30%) 75 (39%)
P0120 BILATERAL PANUVEITIS AS A RARE MANIFESTATION OF SYSTEMIC SARCOIDOSIS
Victoria Pardo Gutiérrez, Cristina Muñoz Esteban, Ana Mª Arnáiz García, Gema Arozamena Martínez, Miguel Angel Núñez Viejo, Javier Velasco Montes, Gonzalo Martínez De Las Cuevas, Marta Aller Fernández, Fernando Ortiz Flores. Departament of Internal Medicine. University Hospital Marqués De Valdecilla. Santander. Spain Introduction: sarcoidosis is an important etiology of inflammatory eye disease and has a myriad of manifestations (anterior/posterior uveitis or both, retinal vasculitis, keratoconjunctivitis and conjunctival follicles), which are involved in 25-80% of patients, being the presenting symptom in 5% of cases. Posterior-segment involvement is reported in nearly 30% of patients with ocular sarcoidosis. Panuveitis occurs in about 10 to 15% of patients with uveitis. Objectives: analyse clinical features of one patient with bilateral panuveitis and systemic sarcoidosis. Methods: chart review. Results: a 54 years old man with fever syndrome and constitutional symptoms in the last three weeks was admitted to our unit. He presented a normal physical examination except a mild hepatomegaly. Blood tests revealed an increased erythrocyte sedimentation rate and C-reacted protein, moderate pattern of cholestasis and elevated serum angiotensin converting enzyme (ACE). A chest X-ray and thoracic-abdominal CT were normal. An ophthalmological examination revealed bilateral posterior uveitis, papillitis and signs of retinal vasculitis, without visual loss. Gallium-67 lung scanning showed typical “lambda” pattern (bilateral hilar adenopathy). In a transjugular percutaneous liver biopsy we observed hepatocellular degeneration, cholostasis with necrosis and ductopenia, but no granulomas were seen. Biopsy of minor salivary gland was also inespecific. Clinical diagnosis of sarcoidosis was made with no histological confirmation. We started topic ocular and systemic treatment with corticosteroids plus cyclopegics and inmunosuppresors (Methotrexate, 7,5 mg per week) plus corticosteroids (Prednisone 30mg per day), respectively, with improvement of general status and important decrease of papillitis. Conclusions: granulomatous inflammation of the conjunctiva is a common
S45
manifestation of ocular sarcoidosis. Many patients who have sarcoidosis can have silent or asymptomatic uveitis, and no specific extraocular manifestations of sarcoidosis. All patients should undergo an ophthalmologic examination at the time of initial evaluation because ocular sarcoidosis have significant impact on visual prognosis
P0121 YOUNG MAN WITH SUBCUTANEOUS NODULES: A CASE REPORT
Victoria Pardo Gutiérrez, Cristina Muñoz Esteban, Ana Mª Arnáiz García, Marta Aller Fernández, Fernando López Gutiérrez, Pablo Garmilla Ezquerra, Samuel García Rubio, Fernando Ortiz Flores. University Hospital Marqués De Valdecilla. Santander. Spain Introduction: sarcoidosis is a multisystemic disease which diagnosis is established when clinical and radiological evidence is supported by a biopsy showing non-caseating granulomas in different organs. There are dermatological symptons in up to 25% of patients, usually presented as lupus pernio or erythema nodosum. The appereance of specific subcutaneous nodules as a manifestation of this entity is rare. Objectives: analyse clinical features of one patient with subcutaneous sarcoidosis as first manifestation of systemic disease. Methods: chart review. Results: a 43 years old man with constitucional symptoms and fever in the last two months was admitted to our unit. He presented several non-tender, firm, nodular subcutaneous lesions located in four extremities, including forearms, one painful erythematous plaque of 5x7 cm of diameter in lateral region of left leg and a palpable right axilar lymph node He did not present another extracutaneous manifestations. Ophthalmological examination was normal. Blood and urine analyses only revealed a mild elevation of serum angiotensin converting enzyme (ACE) and hypercalciuria without hypercalcemia. Right paratracheal node enlargement and bilateral adenopathy were observed in a chest X-ray and confirmed by thoracic CT. An echography of both arms showed inespecific subcutaneous involvement and hyperemia. Bronchoscopy with multiple transbronquial lung biopsies of paratracheal adenopathies only revealed the presence of inflammatory cells. Definitively diagnosis was made by a cutaneus biopsy of the erithematous plaque in left leg, showing non-caseating granulomas with multinuclear cells, compatible with sarcoidosis. Low-dose corticosteroids and hydroxychloroquine treatment was started with good tolerance. General status and cutaneous lesions improvement was observed after several week of treatment. Conclusions: sarcoidosis is a systemic disease with important skin involvement. Subcutaneous nodular lesions are the least frequent of dermatological symptons, and may be the first manifestation of extracutaneous or systemic sarcoidosis, but its prognostic significance is not well established. Subcutaneous sarcoidosis is usually infradiagnosed and may be considered in patients presenting subcutaneous nodules.
P0122 ARTERIAL AND VENOUS THROMBOSIS ACCOMPANYING HYPERTHROIDISM
Oylum Ekiztas, Birgul Onec, Derya Yildirim, Selma Karaahmetoglu Ozkan, Erdal Eskioglu. Ankara Numune Education and Research Hospital, Department of Internal Medicine Introduction: Throid diseases may interfere with the coagulation system and may cause thromboembolic events. It is known that hyperthroidism causes arterial thrombosis and venous thrombosis as well. Most of the studies about arterial thrombosis in hyperthroidism are about the patients who are complicated with atrial fibrilation. We would like to report our case because arterial thrombosis in hyperthroidism patients without atrial fibrilation are rare. Case: 57 year old woman patient presenting intermittent fever, nousea, vomitting, stomach ache and shrinkage. During the research of the fever ethiology, we found that the patient had overt hyperthroidism. The computarised tomographies of the thorax and abdomen demonstrated pulmonary arterial thrombosis, pulmonary infarct and thrombosis at superior mesenteric artery with a constriction of more than %50. There was also deep venous thrombosis seen in the low extremity doppler ultrasonography. Our research involved predisposing factors such as connective tissue diseases, malignancies, enfections and the other diseases causing hypercoagulable state like antiphospholipid syndrom but the etiology of the thrombosis could not be found out. The physical examination and the electrocardiogram of the patient excluded atrial fibrilation. In our opinion, the arterial and venous thrombosis were related to hyperthroidism because we excluded all other likely reasons. We could not
S46
Abstracts from 8th Congress of the European Federation of Internal Medicine / European Journal of Internal Medicine 20S (2009), S1–S283
reveal any possible etiology for the arterial thrombosis in a hyperthroidism patient without the atrial fibrilation. Results: Hyperthroidism may affect the coagulation system by mostly causing hypercoagulation and thromboembolic events. The studies about thrombosis in hyperthroidism usually demonstrated that hyperthyroidism and arterial thrombosis are usually seen in patients complicated with atrial fibrillation. It is a rare case of arterial and venous thrombosis accompanying hyperthroidism without atrial fibriallation. In our case we could not find any predisposing factors causing both venous and arterial thrombosis else than hyperthroidism. We suggest that there may be a relationship between thrombosis and hyperthroidism and recommend to the clinicians to keep in mind that arterial thrombosis may be seen without atrial fibrilation at hyperthroidism patients.
P0123 SWEET SYNDROME (ACUTE FEBRILE NEUTROPHILIC DERMATOSIS)
Fatma Alıbaz Öner, Nesrın Ünalan, Mehmet Emın Pı¸skınpa¸sa, Mecdı Ergüney. Istanbul Education and Research Hospital Introduction: Sweet syndrome is a rare dermatological disease characterized fever, leukocytosis, well-demarcated, erythematous papüles and plaques which show dense neutrophilic infiltration.Sweet syndrome presents in three clinical groups; classic or idiopathic form, a malignancy associated or paraneoplastic form, drug-induced form. Case report: A 71-year-old woman presents with painful and erythematous rashes in her hands and distal part of legs.On the physical examination; She had erythematous, edematous plaques in her hands and distals of legs. The other system examinations were normal. Hb: 11,5 gr/dl, Hct: 34, plt: 251000, WBC: 18400, kidney and hepatic function tests,electrolyte levels were normal. Erytrocyte sedimantation rate: 105 mm/hour, CRP:12,1 m IU/ML, ASO:315 m IU/ML.After dermatology consultation, A punch biopsy was performed on her left leg. The patient was started on oral antihistaminic and topical cortocosteroid.On biopsy; focal dermal neutrophilic infiltrations were found. Classical sweet syndrome was diognosed with both major criterias and three minor citerias. Discussion & conclusion: Acute febrile neutrophilic dermatosis was first described by Sweet in 1964. There is a broad incidence peak in the fourth to seventh decades; women average age 50 and men age 65.The etiology is unknown but is thought to be a hypersensitivity reaction that leads to cytokine stimulation and subsequent neutrophil activation and infiltration. Plaques usually appear on your back, neck, arms and face. These tender and painful eruptions may develop blisters, pustules or ulcers, causing your skin to burn or itch. The diagnostic criteria are summarized in table 1. Criteria
Classic/Malignancy-associated
Drug-induced
1
Abrupt onset of painful erythematous plaques/nodules
2
Histopathologic evidence of a dense neutrophilic infiltrate without evidence of leukocytoclastic vasculitis. Fever > 38°C
3 4
Association: underlying malignancy, inflammatory disease, pregnancy; OR preceded by upper respiratory or gastrointestinal infection or vaccination.
Temporal relationship: between drug ingestion and clinical presentation; OR recurrence after oral challenge
5
Excellent response to treatment with systemic glucocorticoids or potassium iodide.
Temporally related resolution of lesions after drug withdrawal or treatment with systemic glucocorticoids.
6
Abnormal labs at presentation (3 of 4): ESR > 20mm/hr, (+) C reactive protein, WBC > 8000, neutrophils > 70 percent
Diagnosis
Both major criteria (1 and 2), and 2 of 4 minor criteria (3-6).
P0124 VENOUS THROMBOEMBOLISM RISK ASSESSMENT AND PROPHYLAXIS IN HOSPITALISED MEDICAL PATIENTS
Rakesh Kishore Panchal, Syed Fayyaz Hussain. Kettering General Hospital, Rothwell Road, Kettering, Northants, United Kingdom Nn16 8uz Introduction: Hospitalisation for acute medical illness is associated with an eightfold increased relative risk for venous thromboembolism (VTE). Pulmonary embolism accounts for 5-10% of deaths in hospitalised patients. Despite their existence, risk assessment strategies and thromboprophylaxis recommendations are not well implemented in hospitalised patients internationally. Objectives: To assess the risk of VTE and use of thromboprophylaxis strategies in adult internal medicine patients admitted to a district general hospital in the United Kingdom. Materials & methods: On a single day all adult internal medical inpatients were assessed for risk of VTE based on a review of medical notes and prescription charts. An evidence-based risk assessment tool was used to evaluate VTE risk and determine whether patients were receiving recommended thromboprophylaxis. Results: Of 193 internal medicine inpatients (53% male), 190 (98%) were aged ≥40 years. Survey demonstrated 142 (74%) medical patients at risk of VTE. Some form of thromboprophylaxis was prescribed to 74 (52%) at-risk patients (35% low molecular weight heparin and 18% thromboembolic
Characteristics and reasons for hospitalisation of assessed medical patients (193) Sex Age (years) Length of Hospitalisation (days) Reason for hospitalisation Respiratory Cardiology Infection (non-respiratory) Stroke Neurology (non-stroke) Oncology Gastroenterology Renal disease Haematology Endocrine/Metabolic Rheumatology Dermatology Other
102 (53%) Male, 91 (47%) Female 190 (98%) > 40yrs [51% > 75years] 6.0 [1-50]
Risk factors for venous thromboembolism Before admission Age >75 years Chronic Respiratory failure Chronic Heart failure Body mass Index > 30 (kg/m2 ) Previous venous thromboembolism Varicose veins or venous insufficiency Contraceptive/Hormone Replacement/Chemotherapy Admission Category Risk Factor Acute Heart Failure Acute Respiratory Failure Active Cancer/Inflammatory Disease (including infection) Other medical condition
All 5 criteria Prevalence of VTE in Internal Medicine
Localized lesions may be successfully treated with intralesional or topical glucocorticoids. Alternative treatments include doxycycline, potassium iodide, colchicine, indomethacin, dapsone, cyclosporine, cyclophosphamide, chlorambucil, and clofazamine Lesions are generally on upper extremities and face.Leg lesions are rare. Our case is interesting because of both the syndrome or the leg lesions are rare. Key words: Febrile neutrophilic dermetosis
Method of Thromboprophylaxis
54 (28%) 34 (18%) 23 (12%) 19 (10%) 18 (9%) 15 (8%) 14 (7%) 6 (3%) 4 (2%) 2 (1%) 2 (1%) 1 (0.5%) 1 (0.5%)
98 (51%) 32 (17%) 32 (17%) 14 (7%) 11 (6%) 3 (1%) 3(1%) 18 (9%) 42 (22%) 58 (30%) 75 (39%)