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P0188 RELATIONSHIP BETWEEN ANTHROPOMETRIC MEASUREMENTS AND LIPID PARAMETERS
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Abstracts from 8th Congress of the European Federation of Internal Medicine / European Journal of Internal Medicine 20S (2009), S1–S283
Aim: We aimed to research the frequency of hospitalization at our clinic due to iatrogenic causes, especially patients with warfarin overdose. Method: We enrolled 2958 patients at our study who were followed up at our clinic between January 2005 and October 2008. 104 patients (%4,3) were hospitalized due to iatrogenic diseases, 62 of them were hospitalized with warfarin overdose. Results: 62 of 104 cases (%59,6) had warfarin overdose, 30 cases (%28,8) showed erosive gastritis and/or peptic ulcer related with prescribed non steroid anti inflamatuar drugs. 3 patients (%2,9) had acute renal failure and/or acute tubular necrosis which was caused by nephrotoxic agents, 3 patients (%2,9) had digitalis poisoning, 3 cases had postoperative hypoparathyrodizm and 3 cases had other iatrogenic diseases (such as acute hemorrhagic gastritis due to steroid, gastrointestinal hemorrhage due to fraxiparine usage and contrast nephropathy). We recorded the symptoms, indications for warfarin, comorbid diseases, doses on weekly basis (mg/week), urea, creatine, aspartate transaminase, alanine aminotransferase and INR levels in warfarin overdose cases at admission to the Clinic. Conclusion: We emphasize that it is crucial to prescribe warfarin elaborately because of the fact that it has a small therapeutic range and it is necessary to evaluate the indications and risks of complications carefully before prescription. Keywords: Warfarin, overdose, iatrogenic
P0186 A MAN WITH ABDOMINAL PAIN
Nike Sanchez, Maria Moreno, Marco Bustamante, Norma Tobares, Arturo Lopez, Cristina Prado, Jose Carlos De La Flor. Hospital Clinico San Carlos Introduction: a clinical manifestation of atrial fibrillation is the embolic disease. In the esplenic infarct affected patients tipically presents a left cuadrant abdominal pain without fever. Other causes of splenic infarct are: hypercoagulable state, trauma, hemoglobinopathy,septic emboli in endocarditis and torsion. The main thromboembolic event in atrial fibrillation is stroke. Other sites of embolism include extremities and abdominal organs. Clinical case: 47-years old man consults for acute abdominal pain and dyspnoea. He has a rheumatic mitral valve disease with severe insufficiency and mild stenosis. On examination the heart rhythm were irregular; the abdomen was soft, painful on palpation in left upper and lower quadrants, without palpable organomegaly and bowel sounds present. The electrocardiogram revealed atrial fibrillation.The abdominal arteriography was normal. CT scan showed multiples areas without contrast captation in wedge forms in both kidneys and splen. These findings suggest splen and kidney infarcts. Presented a mild elevation of creatinine.Other laboratories test were no relevants. Anticoagulant treatment was initiated with satisfactory resolution. Conclusion: Inside the contex of atrial fibrillation, these findings are unusual but in the clinical practice would be necessary to take into account this possibility according with the abdominal pain.
P0187 SERUM ADHESION MOLECULES AND TUMOR NECROSIS FACTOR IN PATIENTS WITH STROKE
Konstantinos Lempesopoulos 2 , Vasiliki Papalimneou 1 , Zoe Zachariadou 1 , Dimitrios Syrigos 1 , Alexander Tzovaras 1 , Stamatis Kartas 1 , George Adamoulas 1 , Spyridon Paximadas 1 , Nausika Sakarelou 1 . 1 Elpis General Hospital; 2 A. Fleming General Hospital Introduction: adhesion molecules are proteins located on the cell surface involved with the binding with other cells or extracellular matrix. TNF is a cytokine involved in systemic inflammation and stimulates the acute phase of reaction. Objectives: the study examines the role of adhesion molecules in patients with stroke in the first and third day of the event and its behavior in the same period of time. Materials and methods: we examined twenty patients (11 male and 9 female age 75.9±6.8) with stroke and obtained measurements of serum TNF, ICAM, VCAM and e-Selectin in the two survey days. Results: the estimated mean values of serum adhesion molecules of the patients with stroke in the first and third survey days are: TNF 26,59±10,38 and 38.84±15.8 pg/ml, ICAM 445.58±65 and 439,61±79,2 ng/ml, VCAM 555.5±156.6 and 575.4±161.8ng/ml, e-Selectin 52.7±13.8 and 52.6±16.0ng/m adhesion molecules in the first and third day of the study
are not statistical significant. The estimated linear correlation coefficients between the values of serum adhesion molecules in the first and third survey days were statistically positively significant (p<0.01) indicating that, the relationship is direct and that the v l. They indicate that, the differences between the estimated mean of serum alues of serum adhesion molecules in the first and third survey days increase together. Discussion and conclusion: it seems that, is important to compare the estimated mean values and correlation coefficients with the ones before the stroke as well as in 5th, 7th, 9th survey days of stroke.
P0188 RELATIONSHIP BETWEEN ANTHROPOMETRIC MEASUREMENTS AND LIPID PARAMETERS
Ömer Önder Sava¸s, Nadire Küçüközta¸s, Özlem Barak Serkant, Tevfik Tanju Yılmazer, O˘guzhan Deniz Aydın, Murat Suher. Atatürk Training and Research Hospital Internal Diseases Clinic Aim: Obesity and dislipidemia are increasing problems in many countries and are related to multiple cardiovascular risk factors. Although imaging techniques can determine total body fat and its distribution reliably, simple anthropometric measurements remain important in clinical practice. The purpose of this study was to determine the association between some simple anthropometric measurements and lipid parameters. Materials and method: Two hundred sixty seven patients who were hospitalized at Internal Medicine Clinic of Ankara Ataturk Teaching and Research Hospital between May 2004-May 2007 were included in this study. The patients with diabetes and taking lipid lowering agent were excluded. In all patients, waist circumference (WC), waist to hip ratio (WHR), waist to height ratio (W/Ht), body fat index (BFI), body mass index (BMI) and total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL), low density lipoprotein (LDL), the ratio of total cholesterol to high density lipoprotein (TC/HDL) were recorded. There was correlation between BFI with TC, LDL and between BMI, WC, W/Ht with TG. Results: There wasn’t any significant correlation between anthropometric measurements with HDL. Among lipid profile, TG showed the closest correlation with WC and BMI (p=0,015, p=0,010). Conclusion: BFI, BMI, WC and W/Ht can be used as predictor of dyslipidemia in clinical practice. Key words: Anthropometric measurements, hyperlipidemia, obesity
P0189 PREVALENCE RATES OF MEDICATION ERRORS IN MEDICATION PROCESS PHASES
Ana Belen Jimenez Muñoz 2 , Maria Paz Rodriguez Perez 2 , Maria Teresa Aldámiz-Echevarría Lois 1 , Cristina Lopez Gonzalez-Cobos 1 , Maria Gomez Antúnez 1 , Francisco Javier Cabrera Aguilar 1 , Blanca Pinilla Llorente 1 , Antonio Muiño Miguez 1 . 1 Medicina Interna 2 A; 2 Medicina Preventiva. Hospital Gregorio Marañon. Madrid Introduction: The purpose of drug therapy is to obtain defined clinical outcome that improve the patient’s quality of life guaranteeing minimal risk. However healthcare risk epidemiology identifies medication error as the commonest cause of adverse effects on patients. Medication error can occur at any phase of complex medication process: prescription, transcription and administration. Objectives: To investigate medication error rate in the different process phases with their clinical repercussions. Materials & methods: We conducted a descriptive observational study with analytical components. Process deviations were then analysed separately in each of the phases reviewing. Subsequently, by consensus, a multidisciplinary group made up clinical, pharmacy and quality department staff classified the errors by type and the repercussion. Results: We studied 757 inpatients. There has been analysed a whole of 5466 drug prescriptions, representing a mean of 7,2 per patient (95% CI, 6,9-7,5). The global error rate has been 10,49% (95% CI, 9,9-11,0). The error prevalence rate in prescriptions was 4,79% (95% CI 4,21-5,36). The most frequent errors in this phase were “mistake of form”” because not observing the international standards for the correct prescription. The highest error rate was found in transcription (14,6%, 95% CI 13,6-15,5).We observed the administration of 1879 doses, and we obtained in this phase a 9,3% error rate (95% CI, 7,9-10,6). The commonest errors in this phase were omission administration (2,8%), followed by administration with a frequency other that transcribed/prescribed (1,8%).
Abstracts from 8th Congress of the European Federation of Internal Medicine / European Journal of Internal Medicine 20S (2009), S1–S283
Aim: We aimed to research the frequency of hospitalization at our clinic due to iatrogenic causes, especially patients with warfarin overdose. Method: We enrolled 2958 patients at our study who were followed up at our clinic between January 2005 and October 2008. 104 patients (%4,3) were hospitalized due to iatrogenic diseases, 62 of them were hospitalized with warfarin overdose. Results: 62 of 104 cases (%59,6) had warfarin overdose, 30 cases (%28,8) showed erosive gastritis and/or peptic ulcer related with prescribed non steroid anti inflamatuar drugs. 3 patients (%2,9) had acute renal failure and/or acute tubular necrosis which was caused by nephrotoxic agents, 3 patients (%2,9) had digitalis poisoning, 3 cases had postoperative hypoparathyrodizm and 3 cases had other iatrogenic diseases (such as acute hemorrhagic gastritis due to steroid, gastrointestinal hemorrhage due to fraxiparine usage and contrast nephropathy). We recorded the symptoms, indications for warfarin, comorbid diseases, doses on weekly basis (mg/week), urea, creatine, aspartate transaminase, alanine aminotransferase and INR levels in warfarin overdose cases at admission to the Clinic. Conclusion: We emphasize that it is crucial to prescribe warfarin elaborately because of the fact that it has a small therapeutic range and it is necessary to evaluate the indications and risks of complications carefully before prescription. Keywords: Warfarin, overdose, iatrogenic
P0186 A MAN WITH ABDOMINAL PAIN
Nike Sanchez, Maria Moreno, Marco Bustamante, Norma Tobares, Arturo Lopez, Cristina Prado, Jose Carlos De La Flor. Hospital Clinico San Carlos Introduction: a clinical manifestation of atrial fibrillation is the embolic disease. In the esplenic infarct affected patients tipically presents a left cuadrant abdominal pain without fever. Other causes of splenic infarct are: hypercoagulable state, trauma, hemoglobinopathy,septic emboli in endocarditis and torsion. The main thromboembolic event in atrial fibrillation is stroke. Other sites of embolism include extremities and abdominal organs. Clinical case: 47-years old man consults for acute abdominal pain and dyspnoea. He has a rheumatic mitral valve disease with severe insufficiency and mild stenosis. On examination the heart rhythm were irregular; the abdomen was soft, painful on palpation in left upper and lower quadrants, without palpable organomegaly and bowel sounds present. The electrocardiogram revealed atrial fibrillation.The abdominal arteriography was normal. CT scan showed multiples areas without contrast captation in wedge forms in both kidneys and splen. These findings suggest splen and kidney infarcts. Presented a mild elevation of creatinine.Other laboratories test were no relevants. Anticoagulant treatment was initiated with satisfactory resolution. Conclusion: Inside the contex of atrial fibrillation, these findings are unusual but in the clinical practice would be necessary to take into account this possibility according with the abdominal pain.
P0187 SERUM ADHESION MOLECULES AND TUMOR NECROSIS FACTOR IN PATIENTS WITH STROKE
Konstantinos Lempesopoulos 2 , Vasiliki Papalimneou 1 , Zoe Zachariadou 1 , Dimitrios Syrigos 1 , Alexander Tzovaras 1 , Stamatis Kartas 1 , George Adamoulas 1 , Spyridon Paximadas 1 , Nausika Sakarelou 1 . 1 Elpis General Hospital; 2 A. Fleming General Hospital Introduction: adhesion molecules are proteins located on the cell surface involved with the binding with other cells or extracellular matrix. TNF is a cytokine involved in systemic inflammation and stimulates the acute phase of reaction. Objectives: the study examines the role of adhesion molecules in patients with stroke in the first and third day of the event and its behavior in the same period of time. Materials and methods: we examined twenty patients (11 male and 9 female age 75.9±6.8) with stroke and obtained measurements of serum TNF, ICAM, VCAM and e-Selectin in the two survey days. Results: the estimated mean values of serum adhesion molecules of the patients with stroke in the first and third survey days are: TNF 26,59±10,38 and 38.84±15.8 pg/ml, ICAM 445.58±65 and 439,61±79,2 ng/ml, VCAM 555.5±156.6 and 575.4±161.8ng/ml, e-Selectin 52.7±13.8 and 52.6±16.0ng/m adhesion molecules in the first and third day of the study
are not statistical significant. The estimated linear correlation coefficients between the values of serum adhesion molecules in the first and third survey days were statistically positively significant (p<0.01) indicating that, the relationship is direct and that the v l. They indicate that, the differences between the estimated mean of serum alues of serum adhesion molecules in the first and third survey days increase together. Discussion and conclusion: it seems that, is important to compare the estimated mean values and correlation coefficients with the ones before the stroke as well as in 5th, 7th, 9th survey days of stroke.
P0188 RELATIONSHIP BETWEEN ANTHROPOMETRIC MEASUREMENTS AND LIPID PARAMETERS
Ömer Önder Sava¸s, Nadire Küçüközta¸s, Özlem Barak Serkant, Tevfik Tanju Yılmazer, O˘guzhan Deniz Aydın, Murat Suher. Atatürk Training and Research Hospital Internal Diseases Clinic Aim: Obesity and dislipidemia are increasing problems in many countries and are related to multiple cardiovascular risk factors. Although imaging techniques can determine total body fat and its distribution reliably, simple anthropometric measurements remain important in clinical practice. The purpose of this study was to determine the association between some simple anthropometric measurements and lipid parameters. Materials and method: Two hundred sixty seven patients who were hospitalized at Internal Medicine Clinic of Ankara Ataturk Teaching and Research Hospital between May 2004-May 2007 were included in this study. The patients with diabetes and taking lipid lowering agent were excluded. In all patients, waist circumference (WC), waist to hip ratio (WHR), waist to height ratio (W/Ht), body fat index (BFI), body mass index (BMI) and total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL), low density lipoprotein (LDL), the ratio of total cholesterol to high density lipoprotein (TC/HDL) were recorded. There was correlation between BFI with TC, LDL and between BMI, WC, W/Ht with TG. Results: There wasn’t any significant correlation between anthropometric measurements with HDL. Among lipid profile, TG showed the closest correlation with WC and BMI (p=0,015, p=0,010). Conclusion: BFI, BMI, WC and W/Ht can be used as predictor of dyslipidemia in clinical practice. Key words: Anthropometric measurements, hyperlipidemia, obesity
P0189 PREVALENCE RATES OF MEDICATION ERRORS IN MEDICATION PROCESS PHASES
Ana Belen Jimenez Muñoz 2 , Maria Paz Rodriguez Perez 2 , Maria Teresa Aldámiz-Echevarría Lois 1 , Cristina Lopez Gonzalez-Cobos 1 , Maria Gomez Antúnez 1 , Francisco Javier Cabrera Aguilar 1 , Blanca Pinilla Llorente 1 , Antonio Muiño Miguez 1 . 1 Medicina Interna 2 A; 2 Medicina Preventiva. Hospital Gregorio Marañon. Madrid Introduction: The purpose of drug therapy is to obtain defined clinical outcome that improve the patient’s quality of life guaranteeing minimal risk. However healthcare risk epidemiology identifies medication error as the commonest cause of adverse effects on patients. Medication error can occur at any phase of complex medication process: prescription, transcription and administration. Objectives: To investigate medication error rate in the different process phases with their clinical repercussions. Materials & methods: We conducted a descriptive observational study with analytical components. Process deviations were then analysed separately in each of the phases reviewing. Subsequently, by consensus, a multidisciplinary group made up clinical, pharmacy and quality department staff classified the errors by type and the repercussion. Results: We studied 757 inpatients. There has been analysed a whole of 5466 drug prescriptions, representing a mean of 7,2 per patient (95% CI, 6,9-7,5). The global error rate has been 10,49% (95% CI, 9,9-11,0). The error prevalence rate in prescriptions was 4,79% (95% CI 4,21-5,36). The most frequent errors in this phase were “mistake of form”” because not observing the international standards for the correct prescription. The highest error rate was found in transcription (14,6%, 95% CI 13,6-15,5).We observed the administration of 1879 doses, and we obtained in this phase a 9,3% error rate (95% CI, 7,9-10,6). The commonest errors in this phase were omission administration (2,8%), followed by administration with a frequency other that transcribed/prescribed (1,8%).