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O0008 MANAGEMENT OF ACUTE HEADACHE IN HOSPITAL SETTING-HOW WELL ARE WE DOING?
Abstracts from 8th Congress of the European Federation of Internal Medicine / European Journal of Internal Medicine 20S (2009), S1–S283 tricular ejection fraction (LVEF). Pulmonary capillary pressure was estimated from tricuspid regurgitation pressure gradient, to which right atrial pressure was added. It was estimated to be 5 mm Hg if no peripheral edema was present on physical examination and 10 mm Hg if peripheral edema was recorded. Renal function was calculated by MDRD. We determined hazard ratio (HR) derived from the stepwise multivariable Cox proportional hazard model to identify predictors of all-cause mortality. Kaplan-Meier survival plots were performed from baseline to time of all-cause mortality. Results: A total of 56 patients have PH. Prevalence rate was 25.68% (CI95% 0.19-0.31). Average age was 75.79 years (SD 7.81) and the 30.4% was older than 80 years. Age was classified into groups of ten years. During a follow-up period of 180 days, all-cause mortality was 23.3% (51 patients). Twenty patients of them (37.7%) died in the group with PH, and 31 patients (19.1%) died in the other group. In the baseline characteristics of population we did not find any differences between both groups. Nevertheless, in-hospital time was longer in the group with PH (13.54 vs. 9.76 days; p 0.005). PH was associated to adjusted HR 2.15 (CI95% 1.21-3.82; p=0.0009), independent of age, known chronic obstructive pulmonary disease (COPD) and impaired renal function. Other statistically significant predictors factors in multivariante analysis were groups of age (HR 2.14 CI95% 1.37-3.34; p=0.001), atrial fibrillation (HR 2.27 CI95% 1.18-4.39; p=0.014), renal failure (HR 2.04 CI95% 1.14-3.65; p=0.016) and hyponatremia (HR 1.79 CI95% 1.01-3.15; p=0.043). Kaplan-Meier survival curves showed higher mortality in patients with pulmonary hypertension (Log Rank <0.006). Predictors of 180 days all-cause mortality in HFPSF
Pulmonary hypertension Age (10-years groups) Atrial fibrillation Renal FailureeFGR < 60 ml/min/1.73 m2 Hyponatremia (Na+ < 134 mEq/L)
HR
Confidence Interval
P
2.15 2.14 2.27 2.04 1.79
1.21-3.82 1.37-3.34 1.18-4.39 1.14-3.65 1.01-3.15
0.009 0.001 0.014 0.016 0.043
S3
impairing their invasion capability. To clarify this point we have evaluated in vitro: 1. whether anti-CagA antibodies may recognize antigens of trophoblast cells; 2. whether anti-CagA antibodies may affect invasiveness of isolated trophoblast cells; 3. whether antibodies anti-CagA may modulate Matrix Metalloprotease-2 (MMP-2) protein activity. Materials and methods: Placenta samples were obtained from healthy women. Trophoblast cells were cultured for 72 hours in a medium containing increasing concentration of polyclonal anti-CagA antibodies (from 6 to 200 μg/ml). Binding of anti-CagA antibodies to trophoblast cells was verified through flow cytofluorimetry and immunoflurescence, while the invasive potential of these cells was assessed by using a membrane invasion culture system. MMP-2 activity was evaluated by gelatin zimography. Results: We observed that anti-CagA antibodies recognized antigens of trophoblast cells of all samples, showing a dose-dependent binding up to the highest concentration of 200 μg/ml. This data has also been confirmed by immunofluorescence. Incubation of trophoblast cells with increasing doses of anti-CagA antibodies significantly reduced their invasiveness. Furthermore these data were confirmed by a significant reduction of MMP-2 protein activity. Conclusions: This preliminary study reports, for the first time, that antiCagA antibodies are able to recognize antigens expressed on the surface of trophoblast cells, and to reduce their invasiveness ability. The inhibitory effect of anti-CagA antibodies on trophoblast cells is directly related to the concentration of the same antibodies. These data give biological plausibility to the theory that CagA-positive strains of H. pylori may play a role in trophoblast-related diseases, such as pre-eclampsia and poliabortivity. Further studies are now needed in order to identify the cross-reactive antigens responsible for this phenomenon.
O0008 MANAGEMENT OF ACUTE HEADACHE IN HOSPITAL SETTINGHOW WELL ARE WE DOING?
Syed Raza 1 , Asis Kumar 2 . 1 Calderdale Royal Hospital; 2 Huddersfield Royal Infirmary
Figure 1. Cumulative survival at 180 days by pulmonary hypertension
Discussion & conclusion: Pulmonary hypertension is a frequent condition associated with increased short-term mortality in patients with HFPSF. This relation was independent of known COPD. Keywords: Pulmonary Hypertension. Heart Failure.
O0007 CAGA-POSITIVE STRAINS OF H. PYLORI CROSS REACT WITH TROPHOBLAST CELLS: A ROLE FOR PRE-ECLAMPSIA AND POLIABORTIVITY?
Francesco Franceschi, Nicoletta Di Simone, Giovanni Gigante, Davide Roccarina, Bianca Giupponi, Guido De Marco, Giovanni Gasbarrini, Antonio Gasbarrini, Alessandro Caruso, Nicolò Gentiloni Silveri. Catholic University Background: The role of bacterial and viral infections in trophoblast diseases, such as pre-eclampsia and poliabortivity, has been extensively studied in the past few years. Interestingly, while trophoblast cells show an endothelial phenotypic profile, a study from our group has shown that antibodies anti-CagA cross-react with endothelial cells, possibly playing a role in some vascular diseases. Based on this finding, we have hypothesized that CagA-positive strains of H. pylori may also recognize antigens of trophoblast cells, thus
Background: Headache is a common cause for admission to hospital. The management of headache in acute hospital setting is variable which at times leads to sub-optimal care of this common medical condition. Aim: The aim of our study is to identify how best we investigate and manage patients with acute headache in hospital setting. Methodology: We studied 105 case notes of patients who were admitted to Medical Assessment Unit of our hospital with headache as main presenting complaint between December 2007 and May 2008. Data were recorded in pre-designed Performa showing source of referral, demographic profile, management details, analgesic use and specialty referrals on discharge. We also looked at the average length of stay in the hospital. Data were later analyzed in the audit department. Outcome/results: Majority of patients were self referred middle-aged females. Radiological imaging (CT scan and MRI) was used in almost 70% of patients prior to lumbar puncture and usually within 48 hours. Lumbar puncture was performed in about 40% of patients while only 6% of patients had abnormal CSF result. Fundoscopic examination at the time of admission was performed only in 65% of patients. Paracetamol was the most commonly prescribed analgesic but about one-third of the patient’s required opioid and non-steroidal anti-inflammatory analgesics in addition. 80% of patients did not require any referral for specialist opinion. Average hospital stay of the patients was 22 hours, most of them being discharged home within 48 hours of admission. Summary and conclusion: Our study showed that neuro- imaging was used on clinical judgment alone and no specific criteria were used. It is also recognized that there is no guideline as to which patients should be referred for specialist opinion. A significant number of patients had no specific diagnosis at discharge. A well-structured guideline on the management of headache with emphasis on identifying and investigating the sinister headaches would be useful. Proper clinical examination including fundoscopy is essential in all patients with headaches. Analgesic overuse headache should be promptly recognized and managed. Key words: Acute headache, Neuro-imaging
Pulmonary hypertension Age (10-years groups) Atrial fibrillation Renal FailureeFGR < 60 ml/min/1.73 m2 Hyponatremia (Na+ < 134 mEq/L)
HR
Confidence Interval
P
2.15 2.14 2.27 2.04 1.79
1.21-3.82 1.37-3.34 1.18-4.39 1.14-3.65 1.01-3.15
0.009 0.001 0.014 0.016 0.043
S3
impairing their invasion capability. To clarify this point we have evaluated in vitro: 1. whether anti-CagA antibodies may recognize antigens of trophoblast cells; 2. whether anti-CagA antibodies may affect invasiveness of isolated trophoblast cells; 3. whether antibodies anti-CagA may modulate Matrix Metalloprotease-2 (MMP-2) protein activity. Materials and methods: Placenta samples were obtained from healthy women. Trophoblast cells were cultured for 72 hours in a medium containing increasing concentration of polyclonal anti-CagA antibodies (from 6 to 200 μg/ml). Binding of anti-CagA antibodies to trophoblast cells was verified through flow cytofluorimetry and immunoflurescence, while the invasive potential of these cells was assessed by using a membrane invasion culture system. MMP-2 activity was evaluated by gelatin zimography. Results: We observed that anti-CagA antibodies recognized antigens of trophoblast cells of all samples, showing a dose-dependent binding up to the highest concentration of 200 μg/ml. This data has also been confirmed by immunofluorescence. Incubation of trophoblast cells with increasing doses of anti-CagA antibodies significantly reduced their invasiveness. Furthermore these data were confirmed by a significant reduction of MMP-2 protein activity. Conclusions: This preliminary study reports, for the first time, that antiCagA antibodies are able to recognize antigens expressed on the surface of trophoblast cells, and to reduce their invasiveness ability. The inhibitory effect of anti-CagA antibodies on trophoblast cells is directly related to the concentration of the same antibodies. These data give biological plausibility to the theory that CagA-positive strains of H. pylori may play a role in trophoblast-related diseases, such as pre-eclampsia and poliabortivity. Further studies are now needed in order to identify the cross-reactive antigens responsible for this phenomenon.
O0008 MANAGEMENT OF ACUTE HEADACHE IN HOSPITAL SETTINGHOW WELL ARE WE DOING?
Syed Raza 1 , Asis Kumar 2 . 1 Calderdale Royal Hospital; 2 Huddersfield Royal Infirmary
Figure 1. Cumulative survival at 180 days by pulmonary hypertension
Discussion & conclusion: Pulmonary hypertension is a frequent condition associated with increased short-term mortality in patients with HFPSF. This relation was independent of known COPD. Keywords: Pulmonary Hypertension. Heart Failure.
O0007 CAGA-POSITIVE STRAINS OF H. PYLORI CROSS REACT WITH TROPHOBLAST CELLS: A ROLE FOR PRE-ECLAMPSIA AND POLIABORTIVITY?
Francesco Franceschi, Nicoletta Di Simone, Giovanni Gigante, Davide Roccarina, Bianca Giupponi, Guido De Marco, Giovanni Gasbarrini, Antonio Gasbarrini, Alessandro Caruso, Nicolò Gentiloni Silveri. Catholic University Background: The role of bacterial and viral infections in trophoblast diseases, such as pre-eclampsia and poliabortivity, has been extensively studied in the past few years. Interestingly, while trophoblast cells show an endothelial phenotypic profile, a study from our group has shown that antibodies anti-CagA cross-react with endothelial cells, possibly playing a role in some vascular diseases. Based on this finding, we have hypothesized that CagA-positive strains of H. pylori may also recognize antigens of trophoblast cells, thus
Background: Headache is a common cause for admission to hospital. The management of headache in acute hospital setting is variable which at times leads to sub-optimal care of this common medical condition. Aim: The aim of our study is to identify how best we investigate and manage patients with acute headache in hospital setting. Methodology: We studied 105 case notes of patients who were admitted to Medical Assessment Unit of our hospital with headache as main presenting complaint between December 2007 and May 2008. Data were recorded in pre-designed Performa showing source of referral, demographic profile, management details, analgesic use and specialty referrals on discharge. We also looked at the average length of stay in the hospital. Data were later analyzed in the audit department. Outcome/results: Majority of patients were self referred middle-aged females. Radiological imaging (CT scan and MRI) was used in almost 70% of patients prior to lumbar puncture and usually within 48 hours. Lumbar puncture was performed in about 40% of patients while only 6% of patients had abnormal CSF result. Fundoscopic examination at the time of admission was performed only in 65% of patients. Paracetamol was the most commonly prescribed analgesic but about one-third of the patient’s required opioid and non-steroidal anti-inflammatory analgesics in addition. 80% of patients did not require any referral for specialist opinion. Average hospital stay of the patients was 22 hours, most of them being discharged home within 48 hours of admission. Summary and conclusion: Our study showed that neuro- imaging was used on clinical judgment alone and no specific criteria were used. It is also recognized that there is no guideline as to which patients should be referred for specialist opinion. A significant number of patients had no specific diagnosis at discharge. A well-structured guideline on the management of headache with emphasis on identifying and investigating the sinister headaches would be useful. Proper clinical examination including fundoscopy is essential in all patients with headaches. Analgesic overuse headache should be promptly recognized and managed. Key words: Acute headache, Neuro-imaging