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CLINICAL SIGNIFICANCE OF DEAMIDATED GLIADIN PEPTIDE ANTIBODIES IN PATIENTS WITH CHRONIC LIVER DISEASES
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Abstracts from 10th Congress of the European Federation of Internal Medicine/European Journal of Internal Medicine 22S (2011) S1–S112
were presenting polytreatments. The most frequent reason was multifactorial caused by multi pathology followed by polypharmacy and CHF. More than 50% were treated with fluid therapy. In few patients was revealed pulmonary disease or central nervous system disease. Few cases of central pontine myelinolysis as a complication to hiponatremia treatment were found. Only a few patients joined ICU and less than 20% died during the admission. The average stay was high by the high percentage of polytreated patients, which would give an idea of the high multi pathology, as well as the not despitable percentage of mortality and a high average patients age.
Marsh grade I and III were found in 2 and 5 patients respectively, and HLA-DQ related with celiac disease in 11/14 patients, while no one mentioned gastrointestinal symptoms. Conclusions: The prevalence of anti-DGP is increased in patients with chronic liver diseases, but the specificity for celiac disease is low. However, the presence of “suspicious” histological findings cannot exclude an early or latent type, necessitating a close monitoring of patients.
CEREBRAL ATTACKS IN PATIENTS WITH CHRONIC LIVER DISEASES: THROMBOSIS OR HEMORRHAGE THE EUROASPIRE SURVEYS - THE EXPERIENCE AT THE ISLAND OF MADEIRA João Gaspar1, João Freitas1, Ana Fino1, Eva Pereira2, M. Luz Brazão1. 1Hospital Central Do Funchal - Serviço De Medicina; 2Hospital Central Do Funchal - Serviço Cardiologia Background: The EUROASPIRE collection of studies was a group of 3 surveys conducted by the European Society of Cardiology. Their objective was to assess if the recently approved guidelines by the aforementioned society were being followed in patients at high cardiovascular risk, if they were effective and to compare the findings with previous surveys. It was concluded that despite the available drug regimes to prevent primary and secondary events, the targets were not met. This was attributed to the high prevalence of poor lifestyle factors and the consensus that more was needed in the chapter of patient education and motivation. We decided to conduct a study in the island of Madeira, Portugal, to compare the reality in our island with the findings of the EUROASPIRE surveys. Methods: We conducted a retrospective analysis of patients admitted to the Cardiology Department with the diagnosis of an ischemic event, between 2005 and the first semester of 2010; we compared the prevalence of cardiovascular risk factors in these patients, namely hypertension, overweight/obesity, smoking habits, diabetes type II and dyslipidemia, throughout this period. Results: Throughout this period, there was an increase in the prevalence of hypertension, diabetes and obesity; smoking remained unchanged and there was a decrease in the prevalence of dyslipidemia. Conclusion: The same trends were found in our study; the authors conclude that there is a need for a higher investment in patient education and the creation of multidisciplinary teams involved in patient formation pre and post cardiovascular events.
Doina Georgescu, Camelia Gurban, Costin Georgescu, Liviu-Andrei Georgescu. University of Medicine and Pharmacy”V Babes”, Timisoara, Romania Background: The concept of so-called ”auto-anticoagulation” in patients with chronic liver diseases is very much challenged lately. Methods: 54 patients( 31 men, 23 women), 38–95 years, were admitted last year to the Clinic of Neurology, County Hospital Timisoara, with acute stroke and chronic liver diseases. 30 non cirrhotic patients (55,55%): 6 chronic viral C hepatitis, 24 nonalcoholic steatohepatitis (NASH), 24 cirrhosis of various causes (Child A=14, B=7, C=3). Patients were thoroughly neurological and gastroenterological examined. They undertook biochemical exams, viral serology, us abdominal scans, upper digestive endoscopy, Duplex of carotidian arteries with assessment of intima-media thickness (IMT), plaque, velocimetrics, cerebral CT or MRI. Results: 44 patients (81,48%) developed acute ischemic stroke, 25 having non cirrhotic stage (46,29%), 4 transient ischemic attacks, 3 patients having non cirrhotic stage (5,55%). 6 acute hemorrhagic stroke, 2 having non cirrhotic stage (3,70%). 45 patients (83,33%) exhibited features of early carotidian atherosclerosis. The other 9 patients (16,66%) displayed advanced aspects of atherosclerosis: 6 having ecogenic plaques, 3 also calcifications. 7 patients (12,96%) had features of unstable plaques with associated thrombosis; 5 patients stenosis of carotids <50%, 2 patients 50-70%, and 2 patients >70%. 10 patients had low platelet count, 31 patients having INR over 1,4 ( 21 with INR 1,4-1,7; 7 with INR 1,71-2, 20; and 3 with INR>2,20). Conclusions: No matter the stage of liver disease, ischemic thrombotic stroke was diagnosed more often than the hemorrhagic one (81,48%), raising the problem of a hypercoagulability status. An elevated INR does not appear to correlate to the coagulation status in chronic liver disease, questioning the usefulness of some traditional coagulation tests.
CLINICAL SIGNIFICANCE OF DEAMIDATED GLIADIN PEPTIDE ANTIBODIES IN PATIENTS WITH CHRONIC LIVER DISEASES Nikolaos K. Gatselis1, Kalliopi Zachou1, George Tzelas2, Stella Gabeta1, George K. Koukoulis3, Anastasios Germenis4, George N. Dalekos1. 1 Department of Medicine and Research Lab of Internal Medicine, Medical School, University of Thessaly, Larissa, Thessaly, Greece; 2Department of Gastroenterology, University Hospital, Larissa, Greece; 3Department of Pathology, Medical School, University of Thessaly, Larissa, Thessaly, Greece; 4Department of Immunology and Histocompatibility, Medical School, University of Thessaly, Larissa, Thessaly, Greece Background: We have shown that the specificity of autoantibodies against tissue-transglutaminase (anti-tTG) for the diagnosis of celiac disease is low in patients with chronic liver diseases. Serology has evolved with the identification of more specific antibodies against deamidated gliadin peptides (anti-DGP). We assessed the significance of anti-DGP in patients with chronic liver diseases. Methods: We studied 667 patients (426 chronic viral hepatitis, 94 autoimmune liver diseases, 61 alcoholic liver disease, 46 non-alcoholic fatty liver disease, 40 with other liver disorders). Anti-DGP were measured by ELISA, while anti-tTG were determined by ELISA and a microsphere-based flow cytometric assay. Anti-DGP(+) patients were investigated for IgA antiendomysial antibodies and were invited to undergo a small-intestinal biopsy and HLA-DQ allele typing. Results: Anti-DGP were detected in 57/667 (8.5%), while anti-tTG in 38/667 (5.7%) patients (p=0.05). Fifty-three were anti-DGP(+)/anti-tTG(-), 34 antiDGP(-)/anti-tTG(+), and 4 anti-DGP(+)/anti-tTG(+), with increased age characterizing the first group of patients (p<0.01). Anti-DGP were related with cirrhosis and increased IgA (p<0.05). Small intestinal biopsy and HLA-DQ typing was performed in 14/57 anti-DGP(+) patients. Histological changes of
USEFULNESS OF THE CURRENT ELECTRICAL CRITERIA FOR THE LEFT VENTRICULAR HYPERTROPHY IN CLINICAL PRACTICE Gabriela Silvia Gheorghe1, Ana Cristea2, Andreea Sorina Berbec2, Andrei Cristian Dan Gheorghe1, Ioan Tiberiu Nanea1, Mariana Nanea1. 1 University of Medicine and Pharmacy, Carol Davila, Bucharest, Romania; 2Clinical Hospital, Th Burghele, Bucharest, Romania Background: ECG versus ECHO criteria accuracy for left ventricular hypertrophy (LVH). Method: Patients (pts) with arterial hypertension (HTA), aortic stenosis (AS) and aortic regurgitation (AR) having ECHO LVH (interventricular septum (IVS) or posterior wall (PW) diastolic thickness > 11.5 mm: moderate (mLVH) if IVS and PW < 13 mm and severe (sLVH) if IVS or PW 13 mm). ECG Cornell (C) (S V3 + R aVL > 24 mm in men and >20 mm in women) and Sokolow-Lyon (S-L) (S V1 +R V5 or V6 > 35 mm). Results: 136 pts, 66.84 +/-12.45 years old, 62.3% women; 97% HTA, 23.52% AS and 10.14% AR; 49.27% had body mass index (BMI) 25-30. 30.14% had ECHO mLVH and 69.8% sLVH. 21.5% had S-L and 26.47% C LVH; 79.3% in S-L group and 77.7% in C group, had ECHO sLVH. Positive predictive value for sLVH was 77.78% for C and 78.57% for S-L. The sensibility for mLVH was 19.04% for C and 14.23% for S-L; for sLVH, 29.16% for C and 22.91% for S-L. Overweight decresed the sensibility of S-L but not of C. 96% pts from the S-L and 76.6% from the C group ( p<0.05), had both S-L and C criteria of LVH. Conclusions: S-L and C have low sensibility for mLVH, comparing to ECHO. The positive predictive value is higher for the sLVH. Most pts with S-L have also C LVH, but the reverse is not true. The obesity reduces the diagnostic value of S-L but not of C.
Abstracts from 10th Congress of the European Federation of Internal Medicine/European Journal of Internal Medicine 22S (2011) S1–S112
were presenting polytreatments. The most frequent reason was multifactorial caused by multi pathology followed by polypharmacy and CHF. More than 50% were treated with fluid therapy. In few patients was revealed pulmonary disease or central nervous system disease. Few cases of central pontine myelinolysis as a complication to hiponatremia treatment were found. Only a few patients joined ICU and less than 20% died during the admission. The average stay was high by the high percentage of polytreated patients, which would give an idea of the high multi pathology, as well as the not despitable percentage of mortality and a high average patients age.
Marsh grade I and III were found in 2 and 5 patients respectively, and HLA-DQ related with celiac disease in 11/14 patients, while no one mentioned gastrointestinal symptoms. Conclusions: The prevalence of anti-DGP is increased in patients with chronic liver diseases, but the specificity for celiac disease is low. However, the presence of “suspicious” histological findings cannot exclude an early or latent type, necessitating a close monitoring of patients.
CEREBRAL ATTACKS IN PATIENTS WITH CHRONIC LIVER DISEASES: THROMBOSIS OR HEMORRHAGE THE EUROASPIRE SURVEYS - THE EXPERIENCE AT THE ISLAND OF MADEIRA João Gaspar1, João Freitas1, Ana Fino1, Eva Pereira2, M. Luz Brazão1. 1Hospital Central Do Funchal - Serviço De Medicina; 2Hospital Central Do Funchal - Serviço Cardiologia Background: The EUROASPIRE collection of studies was a group of 3 surveys conducted by the European Society of Cardiology. Their objective was to assess if the recently approved guidelines by the aforementioned society were being followed in patients at high cardiovascular risk, if they were effective and to compare the findings with previous surveys. It was concluded that despite the available drug regimes to prevent primary and secondary events, the targets were not met. This was attributed to the high prevalence of poor lifestyle factors and the consensus that more was needed in the chapter of patient education and motivation. We decided to conduct a study in the island of Madeira, Portugal, to compare the reality in our island with the findings of the EUROASPIRE surveys. Methods: We conducted a retrospective analysis of patients admitted to the Cardiology Department with the diagnosis of an ischemic event, between 2005 and the first semester of 2010; we compared the prevalence of cardiovascular risk factors in these patients, namely hypertension, overweight/obesity, smoking habits, diabetes type II and dyslipidemia, throughout this period. Results: Throughout this period, there was an increase in the prevalence of hypertension, diabetes and obesity; smoking remained unchanged and there was a decrease in the prevalence of dyslipidemia. Conclusion: The same trends were found in our study; the authors conclude that there is a need for a higher investment in patient education and the creation of multidisciplinary teams involved in patient formation pre and post cardiovascular events.
Doina Georgescu, Camelia Gurban, Costin Georgescu, Liviu-Andrei Georgescu. University of Medicine and Pharmacy”V Babes”, Timisoara, Romania Background: The concept of so-called ”auto-anticoagulation” in patients with chronic liver diseases is very much challenged lately. Methods: 54 patients( 31 men, 23 women), 38–95 years, were admitted last year to the Clinic of Neurology, County Hospital Timisoara, with acute stroke and chronic liver diseases. 30 non cirrhotic patients (55,55%): 6 chronic viral C hepatitis, 24 nonalcoholic steatohepatitis (NASH), 24 cirrhosis of various causes (Child A=14, B=7, C=3). Patients were thoroughly neurological and gastroenterological examined. They undertook biochemical exams, viral serology, us abdominal scans, upper digestive endoscopy, Duplex of carotidian arteries with assessment of intima-media thickness (IMT), plaque, velocimetrics, cerebral CT or MRI. Results: 44 patients (81,48%) developed acute ischemic stroke, 25 having non cirrhotic stage (46,29%), 4 transient ischemic attacks, 3 patients having non cirrhotic stage (5,55%). 6 acute hemorrhagic stroke, 2 having non cirrhotic stage (3,70%). 45 patients (83,33%) exhibited features of early carotidian atherosclerosis. The other 9 patients (16,66%) displayed advanced aspects of atherosclerosis: 6 having ecogenic plaques, 3 also calcifications. 7 patients (12,96%) had features of unstable plaques with associated thrombosis; 5 patients stenosis of carotids <50%, 2 patients 50-70%, and 2 patients >70%. 10 patients had low platelet count, 31 patients having INR over 1,4 ( 21 with INR 1,4-1,7; 7 with INR 1,71-2, 20; and 3 with INR>2,20). Conclusions: No matter the stage of liver disease, ischemic thrombotic stroke was diagnosed more often than the hemorrhagic one (81,48%), raising the problem of a hypercoagulability status. An elevated INR does not appear to correlate to the coagulation status in chronic liver disease, questioning the usefulness of some traditional coagulation tests.
CLINICAL SIGNIFICANCE OF DEAMIDATED GLIADIN PEPTIDE ANTIBODIES IN PATIENTS WITH CHRONIC LIVER DISEASES Nikolaos K. Gatselis1, Kalliopi Zachou1, George Tzelas2, Stella Gabeta1, George K. Koukoulis3, Anastasios Germenis4, George N. Dalekos1. 1 Department of Medicine and Research Lab of Internal Medicine, Medical School, University of Thessaly, Larissa, Thessaly, Greece; 2Department of Gastroenterology, University Hospital, Larissa, Greece; 3Department of Pathology, Medical School, University of Thessaly, Larissa, Thessaly, Greece; 4Department of Immunology and Histocompatibility, Medical School, University of Thessaly, Larissa, Thessaly, Greece Background: We have shown that the specificity of autoantibodies against tissue-transglutaminase (anti-tTG) for the diagnosis of celiac disease is low in patients with chronic liver diseases. Serology has evolved with the identification of more specific antibodies against deamidated gliadin peptides (anti-DGP). We assessed the significance of anti-DGP in patients with chronic liver diseases. Methods: We studied 667 patients (426 chronic viral hepatitis, 94 autoimmune liver diseases, 61 alcoholic liver disease, 46 non-alcoholic fatty liver disease, 40 with other liver disorders). Anti-DGP were measured by ELISA, while anti-tTG were determined by ELISA and a microsphere-based flow cytometric assay. Anti-DGP(+) patients were investigated for IgA antiendomysial antibodies and were invited to undergo a small-intestinal biopsy and HLA-DQ allele typing. Results: Anti-DGP were detected in 57/667 (8.5%), while anti-tTG in 38/667 (5.7%) patients (p=0.05). Fifty-three were anti-DGP(+)/anti-tTG(-), 34 antiDGP(-)/anti-tTG(+), and 4 anti-DGP(+)/anti-tTG(+), with increased age characterizing the first group of patients (p<0.01). Anti-DGP were related with cirrhosis and increased IgA (p<0.05). Small intestinal biopsy and HLA-DQ typing was performed in 14/57 anti-DGP(+) patients. Histological changes of
USEFULNESS OF THE CURRENT ELECTRICAL CRITERIA FOR THE LEFT VENTRICULAR HYPERTROPHY IN CLINICAL PRACTICE Gabriela Silvia Gheorghe1, Ana Cristea2, Andreea Sorina Berbec2, Andrei Cristian Dan Gheorghe1, Ioan Tiberiu Nanea1, Mariana Nanea1. 1 University of Medicine and Pharmacy, Carol Davila, Bucharest, Romania; 2Clinical Hospital, Th Burghele, Bucharest, Romania Background: ECG versus ECHO criteria accuracy for left ventricular hypertrophy (LVH). Method: Patients (pts) with arterial hypertension (HTA), aortic stenosis (AS) and aortic regurgitation (AR) having ECHO LVH (interventricular septum (IVS) or posterior wall (PW) diastolic thickness > 11.5 mm: moderate (mLVH) if IVS and PW < 13 mm and severe (sLVH) if IVS or PW 13 mm). ECG Cornell (C) (S V3 + R aVL > 24 mm in men and >20 mm in women) and Sokolow-Lyon (S-L) (S V1 +R V5 or V6 > 35 mm). Results: 136 pts, 66.84 +/-12.45 years old, 62.3% women; 97% HTA, 23.52% AS and 10.14% AR; 49.27% had body mass index (BMI) 25-30. 30.14% had ECHO mLVH and 69.8% sLVH. 21.5% had S-L and 26.47% C LVH; 79.3% in S-L group and 77.7% in C group, had ECHO sLVH. Positive predictive value for sLVH was 77.78% for C and 78.57% for S-L. The sensibility for mLVH was 19.04% for C and 14.23% for S-L; for sLVH, 29.16% for C and 22.91% for S-L. Overweight decresed the sensibility of S-L but not of C. 96% pts from the S-L and 76.6% from the C group ( p<0.05), had both S-L and C criteria of LVH. Conclusions: S-L and C have low sensibility for mLVH, comparing to ECHO. The positive predictive value is higher for the sLVH. Most pts with S-L have also C LVH, but the reverse is not true. The obesity reduces the diagnostic value of S-L but not of C.