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INTERSTITIAL LUNG DISEASE: ABOUT TWO CASES
Abstracts from 10th Congress of the European Federation of Internal Medicine/European Journal of Internal Medicine 22S (2011) S1–S112 to determine the frequency of hypocalcaemia and hyperphosphatemia in patients with CRF. Methods: In this cross-sectional study data were collected through a checklist and from biochemical analysis of serum calcium (corrected for serum albumin), albumin, phosphorus, PTH, creatinine of patients admitted with CRF at Hasheminejad hospital in 12 months (2010) study. Results: One hundred CRF patients (53% males, mean age 60 ±16 years) were enrolled in the study that 31% were on Hemodialysis (HD). Associated- HTN & diabetes was the most common cause of CRF(28%). Hyperphosphatemia and hypocalcaemia were reported in 40% and 15% of patients respectively. Mean of age in patients with hypocalcemia was significantly lower than patients without hypocalcemia (41.20±18.12 vs 64.14±13.88 years, p=0.001). Ninety percent of patients with hyperphosphatemia were categorized as ESRD in comparison with 46.7% of those without hyperphosphatemia, (p=0.001). There were significant negative associations among the following variables, serum calcium level and serum PTH level, (r=-0.486, p=0.001); between serum phosphorus level and serum calcium level, serum phosphorus level and GFR, (r=-0.285, p=0.004) and (r=-0.474, p=0.001) respectively. Conclusion: Based on our findings, most of the patients with hyperphosphatemia and hypocalcemia were categorized as ESRD. Therefore conducting clinical trial to explore the impact of applying new methods and strategies of controlling calcium and phosphorus metabolism on the outcome of the CRF and hemodialysis patients is necessary. SULODEXIDE TREATMENT IN PATIENTS WITH TYPE 2 DIABETES MELLITUS AND INTERMITTENT CLAUDICATION Corina Moldovan, Felicia Marc, Dorina Farcaü. University of Oradea, Faculty of Medicine and Pharmacy Background: To prove the efficacy and safety of treatment with Sulodexide in patients with diabetes mellitus type 2 and intermittent claudication. Methods: 30 patients with DM type 2 and chronic peripheral arterial obstructive disease (intermittent claudication) diagnosed through colour EchoDoppler method, aged between 45 – 75 years, with a history of claudication for at least six months, were treated with sulodexide 60 mg intramuscular 10 days, than oral 2 cps of 25 mg twice/day, while 30 patients received placebo. We evaluated at the beginning of the study, at 3 and 6 months: the anklebrachial index (ABI), pain-free walking distance, maximal walking distance with standard test (3km/hour and 10% slope), plasma fibrinogen. Results: ABI raised from 0.60 to 0.68 in sulodexide group and from 0.59 to 0.61 in placebo group (p=0.05); pain-free walking distance was raised by 82.4±7,2m from baseline in sulodexide group, by 30,2±4,5m in placebo group (p<0,001); maximal walking distance was raised by 145,4±8,8m from baseline in sulodexide group, by 42,3±7,2m in placebo group (p<0,001). Fibrinogen decrease with sulodexine by 32,4±7,4mg/dl, increase by 31,3± 6,7mg/dl with placebo (p< 0,001). Side effects were observed in 5 patients with sulodexide, in 4 patients with placebo: diarrhea, epigastrical pain, nausea, hematoma at the injection site. Conclusions: Sulodexide improves the walking ability of peripheral arterial obstructive disease patients, lowers plasma fibrinogen. The treatment was well tolerated. EPIDEMIOLOGICAL REPORT OF PATIENTS WITH DIAGNOSIS OF PRIMARY BILIARY CIRRHOSIS IN A PRINCIPAL HOSPITAL IN SPAIN Belén Mora, Blanca Pinilla, María Fernández, Olga López, Teresa Blanco, María Gómez, Antonio Muiño. Hospital General Universitario Gregorio Marañón Background: Primary biliary cirrhosis (PBC) is an autoimmune liver disease characterised by inflammation and progressive intrahepatic bile-duct destruction that leads to chronic cholestasis, fibrosis and eventually cirrhosis of the liver. Fatigue and pruritus are the most common symptoms, although the frequency of asymptomatic disease arise sixty percent. PBC is associated to others autoimmune disease, like sclerodermia and Sjögren. In our study, we describe clinical features of patients with diagnosis of PBC from 2004 to 2010 in a principal hospital in Spain. Methods: Observational retrospective study of patients with diagnosis of PBC from 2004 to 2010 in a principal hospital in Spain. We analyzed the prevalence of initial symptoms, diagnosis criteria, autoimmune diseases associated, liver histological findings, the progression to cirrhosis and the presence of hepatocellular carcinoma.
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Results: From 2004 to 2010, we analyzed data from fifty patients jointed our hospital with the diagnosis of PBC. 94 percents of the patients were women, with a middle age of 54 years (range age between 19 and 86). We only approached data about symptoms about 20 patients. Fatigue was present in 50% and pruritus in 60%. The autoimmune diseases that coexisted with PBC were: haemolytic anaemia in 2%, sclerodermia in 6% and Sjögren in 10%. The prevalence of thyroid dysfunction was 28%, although we did not can established the autoimmune cases. 28% had hyperlipidemia, 22% osteoporosis; sarcoidosis and celiac disease were not presence in any patient. Elevated serum alkaline phosphatase were described in 93.5% of the patients and 92.8% were AMA auto antibodies-positive patients. Liver biopsy was performed in 66.7% of the patients, 19.2% of findings were normal, 53.8% stage I-II and approximately 27% established cirrhosis. Liver transplantation was performed in 16% of the patients and hepatocellular carcinoma was reported in one case. Conclusion: PBC primarily affects women, with females-males ratio 10:1. In our study data are similar to this preponderance. The middle aged in our cohort is also similar to the age described in bibliography. 16% of the patients were asymptomatic at diagnosis, although the absence of data about that in the histories revised could differ to reality. In symptomatic patients, pruritus was the most common complaint. Thyroid dysfunction and hyperlipemia are the most prevalence disease associated to PBC in our patients. More than 90% presented serum markers of the disease and the diagnosis was confirmed with histological findings in more than 60%. In clinical practice, the presence of these markers should put in alert on the investigation with other procedures to reach the diagnosis of the disease and the association to other conditions. Conclusions: • PBC affected primarily young women. • Most patients have serum markers of the disease, which are the base to suspect it. HODGKIN LYMFHOMA PRESENTED AS A MEDITERRANEAN SPOTTED FEVER Diana Moura, João Santos, Romina Rodrigues, Sergey Belykh, Rita Faria, Diana Gala, Mufulama Cadete, Maria Banza, Célio Fernandes. Serviço de Medicina II, Hospital de Santo André, Leiria, Portugal Mediterranean spotted fever is an endemic zoonosis caused by Rickettsia coronni an intracellular gram-negative bacteria. Severe cases of Mediterranean spotted fever can present with atypical signs. This presentation should lead to the consideration of different diagnosis, usually of infectious origin or malignancies. The authors describe a case of a 68 year-old man that was hospitalized for persistent hyperthermia. He reported being bitten by a tick two months before having started oral treatment with oral doxycycline, with resolution of the symptoms. Nevertheless, after having completed the treatment he initiated fever. He also reported asthenia, holocranial headache and abdominal pain associated with dysuria, polaquiuria and tenesmo. Denied dyspnea or other respiratory symptoms as well as cutaneous rash. He referred contact with animals (rabbits and goats) but denied ingestion of unpasteurized milk or derivatives, as well as no- drinkable water or recent travelling. The laboratory exams showed moderate hypocromic microcytic anemia, an elevated sedimentation velocity and C-reactive protein. Serologic markers were negative except for Rickettsia coronni. Other causes were excluded, like brain or abdominal abscesses. Thoracic-abdominal computer tomography showed multiple lymphadenopaties associated with hepatomegaly, splenomegaly. Taking in consideration this facts a malignant process was suspected. A needle aspiration biopsy was performed revealing a Hogking Lymphomatype 2 nodular esclerosis. The authors aim to demonstrate that the initial approach to the patient presenting with fever should include a comprehensive history, physical examination. Newer diagnostic modalities, updated serology, viral cultures, computed tomography, and magnetic resonance imaging, have important roles in the assessment of these patients. INTERSTITIAL LUNG DISEASE: ABOUT TWO CASES Sofia Moura1, Elisabete Pinelo1. 1Internal Medicine Department, Centro Hospitalar do Nordeste, Bragança, Portugal Background: Interstitial lung diseases (ILDs) are a group of individually rare disorders, there are over 200 described, with an acute or chronic evolution, with varying degrees of inflammation and/or fibrosis.
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Abstracts from 10th Congress of the European Federation of Internal Medicine/European Journal of Internal Medicine 22S (2011) S1–S112
Methods: Case 1: A 67-year old female with a history of hypertension, dyslipidemia and hay occupational exposure; was admitted to our hospital with dry chough, pleuritic chest pain, dyspnea and crackles. Chest radiograph revealed reticulonodular infiltrates. Computed tomography showed interstitial pattern and ground glass opacity, suggesting interstitial pneumonia. Case 2: A 67-year old female with a history of hypertension, dyslipidemia, obesity, hypothyroidism and Pemphigus vulgaris with both mucosal and cutaneous involvement treated with immunosuppressive drugs (azathioprine, mycophenolate mofetil and rituximab), actually suspended by side effects. Admitted to our hospital with the initial diagnosis of intersticial pneumonia; computed tomography: bilateral and difuse infiltrates and a reticular pattern. Despite antiobiotic treatment the pacients kept radiologic abnormalities. Infection was excluded. The study was continued by bronchoscopy with bronchoalveolar lavage (BAL). Results: In both cases bronchoscopy with bronchoalveolar lavage showed a marked CD8 lymphocytosis and a CD4/CD8 ratio < 1. Diagnosis: case 1- extrinsic allergic alveolitis; case 2- rituximab associated interstitial lung disease? In the first case the pacient iniciated treatment with prednisone 1mg/Kg/day, in the second case intravenous immune globulin; both with good clinical and radiologic response. Conclusion: This two cases described above, highlights the diversity and the difficulty of etiological diagnosis of the ILDs. SERUM CONCENTRATIONS AND ADIPOSE TISSUE EXPRESSION OF PIGMENT EPITHELIUM-DERIVED FACTOR (PEDF) IN OBESE PATIENTS WITH TYPE 2 DIABETES MELLITUS: THE INFLUENCE OF VERY-LOW-CALORIE DIET Miloš Mráz1, Pavel Trachta1, Zuzana Stránská1, Zden áka Lacinová1, Denisa Haluzíková1,2, Ve ára Toušková1, Martin Matoulek1, Šte ápán SvaĀina1, Martin Haluzík1. 13rd Department of Medicine, General University Hospital, Charles University, Prague, CR; 2Department of Sports Medicine, General University Hospital, Charles University, Prague, CR Background: The aim of our study was to explore the possible role of pigment epithelium-derived factor (PEDF), a novel metabolic regulator, in the positive metabolic effects of short term very-low-calorie diet (VLCD) in obese patients with type 2 diabetes mellitus (T2DM). Methods: Thirteen obese females with T2DM and 17 healthy lean sex- and age-matched controls (C) were included into the study. Serum concentrations and subcutaneous adipose tissue (SCAT) expression of selected parameters were assessed at baseline and after 3 weeks of VLCD (energy intake 2500 kJ/ day). Results: Compared to C subjects serum PEDF was significantly elevated in T2DM group and correlated positively with BMI, fasting glucose, insulin, HOMA index, CRP and IL-6 in the combined population of T2DM and C patients. mRNA expression of PEDF, adiponectin and adiponectin receptor 2 was significantly reduced in SCAT of T2DM subjects, while no expression change was seen in other investigated parameters. Three weeks of VLCD markedly decreased body weight and improved glycemia, insulin resistance and inflammatory profile. PEDF serum concentrations and mRNA expression showed no significant change after VLCD. The same was true for mRNA expression of other studied factors. Conclusion: Our results show that serum PEDF is increased in patients with T2DM and obesity and correlates well with nutritional status, parameters of glucose metabolism and inflammatory markers. The lack of change in serum concentrations or mRNA expression after VLCD does not support a significant role of PEDF in the positive metabolic effects of short-term caloric restriction. Acknowledgement: Supported by IGA 10024-4, MSM0021620814, MZOVFN2005. MICRORNA A NEW BIOMARKER FOR VASCULAR DISEASE Mariana Anton1, Anca Botezatu2, Iulia V Iancu2, Irina Huica2, Minerva Muraru1, Ion Bruckner1, Danut Isacoff1, Elena Lupeanu3, Gabriela Anton1. 1“Coltea” Clinical Hospital, University of Medicine and Pharmacy, Bucharest, Romania; 2“St. S Nicolau” Institute of Virology, Genetic Engineering Dept., Bucharest, Romania; 3“Ana Aslan” National Institute of Gerontology and Geriatrics, Bucharest, Romania Purpose: Small noncoding RNAs, (miRNAs), identified as important transcriptional and posttranscriptional inhibitors of gene expression, are also implicated in the pathogenesis of various cardiovascular diseases.
Methods: 60 patients (32-84 years old, mean age 46.5) with various degree of vascular damage were enrolled. The vascular diseases included acute myocardial infarction (AMI), stroke, diastolic dysfunction, heart failure (HF) and were confirmed by biochemical, vascular Doppler, cerebral CT scan and echocardiography examination. White blood cells expression levels of three miRNAs (miR126, miR21 and miR155) were estimated in real-time PCR (ABI reagents). As control group, white blood cells from patients without vascular damage were used. The expression levels of investigated miRNAs were normalized versus RNU43 house keeping gene. Statistical analysis was performed using Mann-Whitney test. Results: When compared with normal group, only miR126 levels were significantly changed in patients with vascular damage (p=0.0315). The significant values for miR126 were observed in patients with stroke and AMI. miR21 expression levels were comparable for all types of vascular damage when compared with control, no significant association with any type of disease being noted. In AMI and HF patients we found a significant decrease of miR155 expression (p=0.0303) and a moderate decrease of miR 126 (p=0.048). No significant changes in studied microRNAs were observed in diastolic dysfunction.. Conclusions: Cardiac damage is correlated with miR55 expression levels. miR126 was modified in patients with vascular damage. Controversly,our results displayed miR126 higher values in vascular damages, due probably to biological samples we used (RNAs isolated from white blood cells). INITIAL EFFECTS OF HUNGER STRIKE ON THE METABOLISM OF YOUNG MALE PATIENTS: A CASE REPORT Vasiliki Mylona, Eleni Armeni, George Karlis, Nikolaos Magkas, Theodoros Kontzialis, Kalliopi Sereti, Chrysoula Kairi, Antonis Karanasos, Hlias Makrygiannis. 2nd Department of Internal Medicine, Sismanogleio Hospital, Athens, Greece Background: Hunger strike, described as voluntary refusal of food and/or fluids, is a rare condition. We report the case of patients, capable of decision making, who undertook hunger strike avoiding the intake of food, whereas they drank unlimited amounts of tea with sugar. Methods: Four male patients with a mean age of 29.25years (range: 20 - 34 years), without a past medical facts or abnormal alcohol consumption, were hospitalized after 41 days of starvation. Physical and biochemical examination was performed at baseline, before any administration of treatment. Results: The subjects exhibited low mean levels of BMI, 17.48kg/m2 (range: 15.87 – 20.01kg/m2), mentioning a mean weight loss of 8kg, and were slightly hypotensive (range, systolic blood pressure: 90 – 133mmHg; diastolic blood pressure: 58 – 73mmHg), with mean levels of diuresis 2662.5cc/day. Three patients had decreased levels of urea (mean: 7.75mg/dl; range: 6-11mg/dl), whereas mean levels of creatinine, electrolytes, transaminases, billirubin (direct and indirect) were within the normal range. Biological markers of rabdomyolysis were found to be elevated, namely CPK levels in two subjects (mean: 140U/lt range 80 – 194U/lt) and LDH levels in all subjects (mean, 326.5IU/lt; range 269 – 439IU/lt). Furthermore, levels of INR were higher in three cases (mean: 1.397, range: 1.15 – 1.5), while aPTT was elevated in two cases (mean: 36.96sec, range: 27.44 – 41.61sec). Conclusions: These young male subjects showed decreased levels of urea and prolonged aPTT and especially INR, an early and sensitive marker of liver synthetic dysfunction. First stages of hunger strike might deteriorate liver synthetic function, in young patients. A STUDY OF PERI-OPERATIVE CARE IN PARKINSON’S DISEASE PATIENTS IN A DISTRICT GENERAL HOSPITAL Subramaniam Nagasayi, Kailash Krishnan, Suhail Hussain, Sam Abraham. Department of Elderly Medicine, Wrexham Maelor Hospital, Wrexham, United Kingdom Background: Parkinson’s disease (PD) is a complex neurodegenerative disorder affecting in excess of 100000 people in the U.K. With advances in anaesthesia, perioperative care and technical expertise, more patients with Parkinson’s disease undergo surgical procedures. Methods: A retrospective study of forty two patients with Parkinson’s disease undergoing surgical procedures in a district general hospital was conducted. Analysis was based on age, urgency and type of procedure, anaesthesia, duration, complications and length of stay. All aspects of pharmacotherapy
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Results: From 2004 to 2010, we analyzed data from fifty patients jointed our hospital with the diagnosis of PBC. 94 percents of the patients were women, with a middle age of 54 years (range age between 19 and 86). We only approached data about symptoms about 20 patients. Fatigue was present in 50% and pruritus in 60%. The autoimmune diseases that coexisted with PBC were: haemolytic anaemia in 2%, sclerodermia in 6% and Sjögren in 10%. The prevalence of thyroid dysfunction was 28%, although we did not can established the autoimmune cases. 28% had hyperlipidemia, 22% osteoporosis; sarcoidosis and celiac disease were not presence in any patient. Elevated serum alkaline phosphatase were described in 93.5% of the patients and 92.8% were AMA auto antibodies-positive patients. Liver biopsy was performed in 66.7% of the patients, 19.2% of findings were normal, 53.8% stage I-II and approximately 27% established cirrhosis. Liver transplantation was performed in 16% of the patients and hepatocellular carcinoma was reported in one case. Conclusion: PBC primarily affects women, with females-males ratio 10:1. In our study data are similar to this preponderance. The middle aged in our cohort is also similar to the age described in bibliography. 16% of the patients were asymptomatic at diagnosis, although the absence of data about that in the histories revised could differ to reality. In symptomatic patients, pruritus was the most common complaint. Thyroid dysfunction and hyperlipemia are the most prevalence disease associated to PBC in our patients. More than 90% presented serum markers of the disease and the diagnosis was confirmed with histological findings in more than 60%. In clinical practice, the presence of these markers should put in alert on the investigation with other procedures to reach the diagnosis of the disease and the association to other conditions. Conclusions: • PBC affected primarily young women. • Most patients have serum markers of the disease, which are the base to suspect it. HODGKIN LYMFHOMA PRESENTED AS A MEDITERRANEAN SPOTTED FEVER Diana Moura, João Santos, Romina Rodrigues, Sergey Belykh, Rita Faria, Diana Gala, Mufulama Cadete, Maria Banza, Célio Fernandes. Serviço de Medicina II, Hospital de Santo André, Leiria, Portugal Mediterranean spotted fever is an endemic zoonosis caused by Rickettsia coronni an intracellular gram-negative bacteria. Severe cases of Mediterranean spotted fever can present with atypical signs. This presentation should lead to the consideration of different diagnosis, usually of infectious origin or malignancies. The authors describe a case of a 68 year-old man that was hospitalized for persistent hyperthermia. He reported being bitten by a tick two months before having started oral treatment with oral doxycycline, with resolution of the symptoms. Nevertheless, after having completed the treatment he initiated fever. He also reported asthenia, holocranial headache and abdominal pain associated with dysuria, polaquiuria and tenesmo. Denied dyspnea or other respiratory symptoms as well as cutaneous rash. He referred contact with animals (rabbits and goats) but denied ingestion of unpasteurized milk or derivatives, as well as no- drinkable water or recent travelling. The laboratory exams showed moderate hypocromic microcytic anemia, an elevated sedimentation velocity and C-reactive protein. Serologic markers were negative except for Rickettsia coronni. Other causes were excluded, like brain or abdominal abscesses. Thoracic-abdominal computer tomography showed multiple lymphadenopaties associated with hepatomegaly, splenomegaly. Taking in consideration this facts a malignant process was suspected. A needle aspiration biopsy was performed revealing a Hogking Lymphomatype 2 nodular esclerosis. The authors aim to demonstrate that the initial approach to the patient presenting with fever should include a comprehensive history, physical examination. Newer diagnostic modalities, updated serology, viral cultures, computed tomography, and magnetic resonance imaging, have important roles in the assessment of these patients. INTERSTITIAL LUNG DISEASE: ABOUT TWO CASES Sofia Moura1, Elisabete Pinelo1. 1Internal Medicine Department, Centro Hospitalar do Nordeste, Bragança, Portugal Background: Interstitial lung diseases (ILDs) are a group of individually rare disorders, there are over 200 described, with an acute or chronic evolution, with varying degrees of inflammation and/or fibrosis.
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Abstracts from 10th Congress of the European Federation of Internal Medicine/European Journal of Internal Medicine 22S (2011) S1–S112
Methods: Case 1: A 67-year old female with a history of hypertension, dyslipidemia and hay occupational exposure; was admitted to our hospital with dry chough, pleuritic chest pain, dyspnea and crackles. Chest radiograph revealed reticulonodular infiltrates. Computed tomography showed interstitial pattern and ground glass opacity, suggesting interstitial pneumonia. Case 2: A 67-year old female with a history of hypertension, dyslipidemia, obesity, hypothyroidism and Pemphigus vulgaris with both mucosal and cutaneous involvement treated with immunosuppressive drugs (azathioprine, mycophenolate mofetil and rituximab), actually suspended by side effects. Admitted to our hospital with the initial diagnosis of intersticial pneumonia; computed tomography: bilateral and difuse infiltrates and a reticular pattern. Despite antiobiotic treatment the pacients kept radiologic abnormalities. Infection was excluded. The study was continued by bronchoscopy with bronchoalveolar lavage (BAL). Results: In both cases bronchoscopy with bronchoalveolar lavage showed a marked CD8 lymphocytosis and a CD4/CD8 ratio < 1. Diagnosis: case 1- extrinsic allergic alveolitis; case 2- rituximab associated interstitial lung disease? In the first case the pacient iniciated treatment with prednisone 1mg/Kg/day, in the second case intravenous immune globulin; both with good clinical and radiologic response. Conclusion: This two cases described above, highlights the diversity and the difficulty of etiological diagnosis of the ILDs. SERUM CONCENTRATIONS AND ADIPOSE TISSUE EXPRESSION OF PIGMENT EPITHELIUM-DERIVED FACTOR (PEDF) IN OBESE PATIENTS WITH TYPE 2 DIABETES MELLITUS: THE INFLUENCE OF VERY-LOW-CALORIE DIET Miloš Mráz1, Pavel Trachta1, Zuzana Stránská1, Zden áka Lacinová1, Denisa Haluzíková1,2, Ve ára Toušková1, Martin Matoulek1, Šte ápán SvaĀina1, Martin Haluzík1. 13rd Department of Medicine, General University Hospital, Charles University, Prague, CR; 2Department of Sports Medicine, General University Hospital, Charles University, Prague, CR Background: The aim of our study was to explore the possible role of pigment epithelium-derived factor (PEDF), a novel metabolic regulator, in the positive metabolic effects of short term very-low-calorie diet (VLCD) in obese patients with type 2 diabetes mellitus (T2DM). Methods: Thirteen obese females with T2DM and 17 healthy lean sex- and age-matched controls (C) were included into the study. Serum concentrations and subcutaneous adipose tissue (SCAT) expression of selected parameters were assessed at baseline and after 3 weeks of VLCD (energy intake 2500 kJ/ day). Results: Compared to C subjects serum PEDF was significantly elevated in T2DM group and correlated positively with BMI, fasting glucose, insulin, HOMA index, CRP and IL-6 in the combined population of T2DM and C patients. mRNA expression of PEDF, adiponectin and adiponectin receptor 2 was significantly reduced in SCAT of T2DM subjects, while no expression change was seen in other investigated parameters. Three weeks of VLCD markedly decreased body weight and improved glycemia, insulin resistance and inflammatory profile. PEDF serum concentrations and mRNA expression showed no significant change after VLCD. The same was true for mRNA expression of other studied factors. Conclusion: Our results show that serum PEDF is increased in patients with T2DM and obesity and correlates well with nutritional status, parameters of glucose metabolism and inflammatory markers. The lack of change in serum concentrations or mRNA expression after VLCD does not support a significant role of PEDF in the positive metabolic effects of short-term caloric restriction. Acknowledgement: Supported by IGA 10024-4, MSM0021620814, MZOVFN2005. MICRORNA A NEW BIOMARKER FOR VASCULAR DISEASE Mariana Anton1, Anca Botezatu2, Iulia V Iancu2, Irina Huica2, Minerva Muraru1, Ion Bruckner1, Danut Isacoff1, Elena Lupeanu3, Gabriela Anton1. 1“Coltea” Clinical Hospital, University of Medicine and Pharmacy, Bucharest, Romania; 2“St. S Nicolau” Institute of Virology, Genetic Engineering Dept., Bucharest, Romania; 3“Ana Aslan” National Institute of Gerontology and Geriatrics, Bucharest, Romania Purpose: Small noncoding RNAs, (miRNAs), identified as important transcriptional and posttranscriptional inhibitors of gene expression, are also implicated in the pathogenesis of various cardiovascular diseases.
Methods: 60 patients (32-84 years old, mean age 46.5) with various degree of vascular damage were enrolled. The vascular diseases included acute myocardial infarction (AMI), stroke, diastolic dysfunction, heart failure (HF) and were confirmed by biochemical, vascular Doppler, cerebral CT scan and echocardiography examination. White blood cells expression levels of three miRNAs (miR126, miR21 and miR155) were estimated in real-time PCR (ABI reagents). As control group, white blood cells from patients without vascular damage were used. The expression levels of investigated miRNAs were normalized versus RNU43 house keeping gene. Statistical analysis was performed using Mann-Whitney test. Results: When compared with normal group, only miR126 levels were significantly changed in patients with vascular damage (p=0.0315). The significant values for miR126 were observed in patients with stroke and AMI. miR21 expression levels were comparable for all types of vascular damage when compared with control, no significant association with any type of disease being noted. In AMI and HF patients we found a significant decrease of miR155 expression (p=0.0303) and a moderate decrease of miR 126 (p=0.048). No significant changes in studied microRNAs were observed in diastolic dysfunction.. Conclusions: Cardiac damage is correlated with miR55 expression levels. miR126 was modified in patients with vascular damage. Controversly,our results displayed miR126 higher values in vascular damages, due probably to biological samples we used (RNAs isolated from white blood cells). INITIAL EFFECTS OF HUNGER STRIKE ON THE METABOLISM OF YOUNG MALE PATIENTS: A CASE REPORT Vasiliki Mylona, Eleni Armeni, George Karlis, Nikolaos Magkas, Theodoros Kontzialis, Kalliopi Sereti, Chrysoula Kairi, Antonis Karanasos, Hlias Makrygiannis. 2nd Department of Internal Medicine, Sismanogleio Hospital, Athens, Greece Background: Hunger strike, described as voluntary refusal of food and/or fluids, is a rare condition. We report the case of patients, capable of decision making, who undertook hunger strike avoiding the intake of food, whereas they drank unlimited amounts of tea with sugar. Methods: Four male patients with a mean age of 29.25years (range: 20 - 34 years), without a past medical facts or abnormal alcohol consumption, were hospitalized after 41 days of starvation. Physical and biochemical examination was performed at baseline, before any administration of treatment. Results: The subjects exhibited low mean levels of BMI, 17.48kg/m2 (range: 15.87 – 20.01kg/m2), mentioning a mean weight loss of 8kg, and were slightly hypotensive (range, systolic blood pressure: 90 – 133mmHg; diastolic blood pressure: 58 – 73mmHg), with mean levels of diuresis 2662.5cc/day. Three patients had decreased levels of urea (mean: 7.75mg/dl; range: 6-11mg/dl), whereas mean levels of creatinine, electrolytes, transaminases, billirubin (direct and indirect) were within the normal range. Biological markers of rabdomyolysis were found to be elevated, namely CPK levels in two subjects (mean: 140U/lt range 80 – 194U/lt) and LDH levels in all subjects (mean, 326.5IU/lt; range 269 – 439IU/lt). Furthermore, levels of INR were higher in three cases (mean: 1.397, range: 1.15 – 1.5), while aPTT was elevated in two cases (mean: 36.96sec, range: 27.44 – 41.61sec). Conclusions: These young male subjects showed decreased levels of urea and prolonged aPTT and especially INR, an early and sensitive marker of liver synthetic dysfunction. First stages of hunger strike might deteriorate liver synthetic function, in young patients. A STUDY OF PERI-OPERATIVE CARE IN PARKINSON’S DISEASE PATIENTS IN A DISTRICT GENERAL HOSPITAL Subramaniam Nagasayi, Kailash Krishnan, Suhail Hussain, Sam Abraham. Department of Elderly Medicine, Wrexham Maelor Hospital, Wrexham, United Kingdom Background: Parkinson’s disease (PD) is a complex neurodegenerative disorder affecting in excess of 100000 people in the U.K. With advances in anaesthesia, perioperative care and technical expertise, more patients with Parkinson’s disease undergo surgical procedures. Methods: A retrospective study of forty two patients with Parkinson’s disease undergoing surgical procedures in a district general hospital was conducted. Analysis was based on age, urgency and type of procedure, anaesthesia, duration, complications and length of stay. All aspects of pharmacotherapy