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INDIVIDUAL CORONARY RISK EVALUATION IN MALE RAILWAY WORKERS
Abstracts from 10th Congress of the European Federation of Internal Medicine/European Journal of Internal Medicine 22S (2011) S1–S112 Conclusions: There is no evidence of progression from diastolic to systolic dysfunction. Our findings strongly suggest that both of them are completely different syndromes. New investigations need to be performed to understand pathogenesis of HFPEF in order to know specific therapeutic targets. ANTIPHOSPHOLIPID SYNDROME AND CRONIC HEPATITIS C – A CASE REPORT Ana Faria, Ana Filipa Carvalho, Ricardo Pereira e Silva, João Mascarenhas Araújo. Department of Internal Medicine, Medicine Ward 1, Hospital Fernando da Fonseca Background: Several studies describe a statistical correlation between viral infections and elevated antiphospholipid antibodies; it is reported that about 20% of patients with Hepatitis C Virus (HCV) infection have elevated anticardiolipin levels. However, an association between HCV and antiphospholipid syndrome itself is yet to be demonstrated. Case report: A 36 year old woman, with chronic HCV infection under irregular treatment with ribavirin and pegylated interferon, was admitted to the hospital with right-sided hemiparesis and aphasia; a cranial CT scan was performed and confirmed left hemispheric stroke. There were no previous thrombotic events in her medical history, and the gynecological/ obstetric history was also unremarkable. The initial laboratory findings included frankly elevated levels of anticardiolipin and anti-beta2 glycoprotein 1 antibodies; this elevation persisted on reevaluation workup after sixteen weeks. The final diagnosis of antiphospholipid syndrome was thus determined, and the patient was directed to an autoimmune consult for additional follow-up. Conclusion: The pathogenic role of HCV infection in this patient’s antiphospholipid syndrome remains controversial, as there are very few case reports and thus no proven statistical correlation; however, the possibility of an association, and not a just mere coincidence, cannot be excluded. BICUSPID AORTIC VALVE – A SILENT DANGER Elsa Gonçalves1, Ana Barroso1, Carla Costa1, Miguel Costa1, Pilar Barbeito1, Bruno Vale1, Carlos Oliveria1. 1Internal Medicine, Hospital Santa Maria Maior, Barcelos, Portugal. Background: The Bicuspid Aortic Valve (BAV) is the most common congenital cardiac malformation, affecting 1-2% of the population with strong male predominance. In most cases remains undetected until infection. Case Presentation: A 62-year-old man admitted for 3-week history of intermittent afternoon fever and chest pain. Associated symptoms included abdominal discomfort and anorexia. Physical examination revealed fever, diastolic murmur and splinter haemorrhages. Transesophageal echocardiogram showed 12mm vegetation over BAV, severe aortic regurgitation and 10 mm vegetation over the anterior leaflet of mitral valve. The patient was unaware of his BAV. Two months prior to the diagnosis he was submitted to a prostatectomy complicated by urinary tract infection and treated with antibiotics. Subacute infective endocarditis (IE) was diagnosed by the following DUKE’s criteria: presence of vegetations, predisposing heart condition (BAV), fever, vascular phenomena such as splenic embolization, and blood culture positive for Enterococcus faecalis. One week after diagnosis, the patient was admitted on Intensive Unit Care, with ruptured cerebral mycotic aneurysms. Conclusion: Subacute IE commonly presents with already damaged heart valve and is usually preceded by invasive procedures, represented here by unknown BAV and concomitant prostatectomy. Embolic events are a frequent and live threatening complication, being the brain and spleen the most prevalent sites of embolization. The detection of a BAV will not only make it possible to offer antibiotic prophylaxis for IE but should also increase the index of clinical suspicion of endocarditis. INDIVIDUAL CORONARY RISK EVALUATION IN MALE RAILWAY WORKERS Svetlana G. Gorokhova1, Elena V. Muraseeva2, Eduard V. Generozov3, Oleg Yu. Atkov4. 1I.M. Sechenov First Moscow State Medical University, Moscow, Russia; 2N.A. Semashko Central Clinical Hospital No 2 of the Russian Railways JSC, Moscow, Russia; 3Research Institute of Physico-Chemical Medicine, Moscow, Russia; 4 Russian State Medical University, Moscow, Russia Background: Coronary artery disease (CAD) is multifactorial pathology and has genetic component. The aim of this study was to estimate different cal-
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culation models for individual coronary risk index, based on the number of risk alleles in candidate genes and conventional risk factors, and to reveal relationship between the index and CAD. Methods: The study included 159 railway workers (men, mean age 43.6 ± 6.4 y) subjected to coronary angiography for CAD diagnosis. SNP genotyping from the 12 candidate genes was performed using MALDI mass spectrometry. Principal Component Analysis allowed us to detect the structure of the data set. Genetic risk index and total individual coronary risk index (TICR) were calculated for each patient by different calculation models. According to index values, individual risk was classified as mild, intermediate or severe. Results: Genetic risk index and TICR were significantly associated with CAD, and in case of TICR the correlation was the closest one. The most accurate calculation model was TICR with 1st principal component genes (NOS, ACE, AGT-235, AGT-174, AGTR, CRP-1) (R = 0.53, p = 0.000). According to this model, TICR value in workers averaged 8.12 (95% CI: 6.96 – 9.27), mode 7. Mild TICR was in 10%, intermediate – 54%, severe – 36% of these patients. Conclusion: Calculation models for individual coronary risk, which include genetic and conventional risk factors, are better than models based on genetic risk only. Assessment of TICR may be used for early detection of workers with CAD risk. A RARE CASE OF INFECTIVE ENDOCARDITIS Mónica Grafino, Andreia Pestana, Ana Alho, Maria Adélia Castelo Branco, Glória Silva. Department of Medicine, Hospital Pulido Valente, Lisbon, Portugal Cardiac device-related infective endocarditis (CDRIE) – permanent pacemakers and implantable cardioverter defibrillators – is an infrequent situation associated with high mortality, morbidity and financial cost. It is one of the most difficult forms of infective endocarditis to diagnose. Recommended treatment consists in prolonged antibiotic therapy and cardiac device (CD) removal. We report the case of an 84-year-old women with many co-morbidities including chronic heart failure by ischemic and valvular disease and implanted pacemaker. She was admitted in our hospital with decompensated heart failure for lack of compliance of therapy. In the fifth day of hospitalization, the patient started with fever and we documented peripheral phlebitis. She performed three blood cultures, transthoracic and transesophageal echocardiography (TEE). The blood cultures were positive to Enterococcus faecalis and the TEE identified a lead vegetation. We admitted CDRIE (pacemaker) and the patient started ampicillin and gentamicin, based on culture and susceptibility results. The patient completed six weeks of antimicrobial therapy with good results. Taking in consideration the previous difficulties in lead extraction and the patient’s co-morbidities, we decided not remove the CD. In conclusion CDRIE must be suspected in the presence of unexplained fever in a patient with a CD. Despite the standard treatment includes prolonged antibiotic therapy and CD extraction, it must be individualized assessing benefit-risk. Keywords: Cardiac device-related infective endocarditis; pacemaker; Enterococcus faecalis PM (PARTICLES MATTERS) AND HEALTH EFFECTS IN A POLLUTION EPISODE IN ATHENS K. N. Grigoropoulos1,5, C. Panagopoulos6, A. Gialouris3, N. Kouris4, G. Ferentinos5, G. Polichetti2, E. Thoma6, J. Papadopoulos1, P.T. Nastos7, Z. Tsirogiani1, M. Spiridopoulos5. 1IKA – Social Security Institute – 1st Aid Health Station, Piraeus, Greece; 2University of Naples, School of Medicine, Department of Neuroscience, 80131, Naples, Italy; 3Regional General Hospital “ELPIS”, 1st Division of Internal Medicine, 11522, Athens, Greece; 4S. Sarande Government Hospital, division of Pneumonology, San Sarande Albania; 5University Patras, Department of Geology-enviroment,Rio,26500, Patras, Greece; 6National Technical University of Athens, Laboratory of Physical Metallurgy, Athens, Greece; 7 University of Athens, Laboratory of Climatology and Atmospheric Environment, Athens, Greece Background: The mega cities’ pollution problem during the last two decades, occupied the whole European scientific community, Asia and the U.S.A. The atmosphere remains suffocating due to rapid industrial development and the ever increasing traffic. Registered health problems are numerous and dramatic in all ages groups, but particularly in infants, old people and patients suffering chronic diseases.
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culation models for individual coronary risk index, based on the number of risk alleles in candidate genes and conventional risk factors, and to reveal relationship between the index and CAD. Methods: The study included 159 railway workers (men, mean age 43.6 ± 6.4 y) subjected to coronary angiography for CAD diagnosis. SNP genotyping from the 12 candidate genes was performed using MALDI mass spectrometry. Principal Component Analysis allowed us to detect the structure of the data set. Genetic risk index and total individual coronary risk index (TICR) were calculated for each patient by different calculation models. According to index values, individual risk was classified as mild, intermediate or severe. Results: Genetic risk index and TICR were significantly associated with CAD, and in case of TICR the correlation was the closest one. The most accurate calculation model was TICR with 1st principal component genes (NOS, ACE, AGT-235, AGT-174, AGTR, CRP-1) (R = 0.53, p = 0.000). According to this model, TICR value in workers averaged 8.12 (95% CI: 6.96 – 9.27), mode 7. Mild TICR was in 10%, intermediate – 54%, severe – 36% of these patients. Conclusion: Calculation models for individual coronary risk, which include genetic and conventional risk factors, are better than models based on genetic risk only. Assessment of TICR may be used for early detection of workers with CAD risk. A RARE CASE OF INFECTIVE ENDOCARDITIS Mónica Grafino, Andreia Pestana, Ana Alho, Maria Adélia Castelo Branco, Glória Silva. Department of Medicine, Hospital Pulido Valente, Lisbon, Portugal Cardiac device-related infective endocarditis (CDRIE) – permanent pacemakers and implantable cardioverter defibrillators – is an infrequent situation associated with high mortality, morbidity and financial cost. It is one of the most difficult forms of infective endocarditis to diagnose. Recommended treatment consists in prolonged antibiotic therapy and cardiac device (CD) removal. We report the case of an 84-year-old women with many co-morbidities including chronic heart failure by ischemic and valvular disease and implanted pacemaker. She was admitted in our hospital with decompensated heart failure for lack of compliance of therapy. In the fifth day of hospitalization, the patient started with fever and we documented peripheral phlebitis. She performed three blood cultures, transthoracic and transesophageal echocardiography (TEE). The blood cultures were positive to Enterococcus faecalis and the TEE identified a lead vegetation. We admitted CDRIE (pacemaker) and the patient started ampicillin and gentamicin, based on culture and susceptibility results. The patient completed six weeks of antimicrobial therapy with good results. Taking in consideration the previous difficulties in lead extraction and the patient’s co-morbidities, we decided not remove the CD. In conclusion CDRIE must be suspected in the presence of unexplained fever in a patient with a CD. Despite the standard treatment includes prolonged antibiotic therapy and CD extraction, it must be individualized assessing benefit-risk. Keywords: Cardiac device-related infective endocarditis; pacemaker; Enterococcus faecalis PM (PARTICLES MATTERS) AND HEALTH EFFECTS IN A POLLUTION EPISODE IN ATHENS K. N. Grigoropoulos1,5, C. Panagopoulos6, A. Gialouris3, N. Kouris4, G. Ferentinos5, G. Polichetti2, E. Thoma6, J. Papadopoulos1, P.T. Nastos7, Z. Tsirogiani1, M. Spiridopoulos5. 1IKA – Social Security Institute – 1st Aid Health Station, Piraeus, Greece; 2University of Naples, School of Medicine, Department of Neuroscience, 80131, Naples, Italy; 3Regional General Hospital “ELPIS”, 1st Division of Internal Medicine, 11522, Athens, Greece; 4S. Sarande Government Hospital, division of Pneumonology, San Sarande Albania; 5University Patras, Department of Geology-enviroment,Rio,26500, Patras, Greece; 6National Technical University of Athens, Laboratory of Physical Metallurgy, Athens, Greece; 7 University of Athens, Laboratory of Climatology and Atmospheric Environment, Athens, Greece Background: The mega cities’ pollution problem during the last two decades, occupied the whole European scientific community, Asia and the U.S.A. The atmosphere remains suffocating due to rapid industrial development and the ever increasing traffic. Registered health problems are numerous and dramatic in all ages groups, but particularly in infants, old people and patients suffering chronic diseases.