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P0573 THE RISK FACTORS FOR GESTATIONAL DIABETES MELLITUS AMONG KOSOVA PREGNANT WOMEN
S190
Abstracts from 8th Congress of the European Federation of Internal Medicine / European Journal of Internal Medicine 20S (2009), S1–S283
Objectives: It is the classification of diabetic ulcers and the correlation of their severity with the values of HbA1c. Materials & methods: The study included 52 patients aged 52-88 years with diabetes mellitus type II, during the period 2007-2008. Besides the type, we studied the duration of the disease, the administered medication and the value of HbA1C. The ulcers were classified on the basis of the following factors: the presence or absence of foot pulse, depth of the involved tissue (deep or shallow ulcers), if the ulcer is found on the finger or the rest of the foot and the presence or absence of multiple ulcers. Finally, all the suffering ends were depicted with X-ray of the soft tissue, in order to search for calcifications and osteolytic damages. Results: Among the 52 patients, 45 had HbA1c levels above 9%. 17 of the 45 were hospitalized, while 8 of them were led to amputation. Patients with HbA1c 7.5-9% and <7%, had much milder injuries and almost no one was hospitalised for further treatment of the ulcer. It should be noted that most patients (regardless of the ulcer severity and the value of HbA1c) had calcifications on foot x-rays. 5 of them that were led to amputation had osteolytic damages. Discussion & conclusion: There is a direct correlation among the regulation of diabetes (with HbA1c monitoring), the clinical appearance and the prognosis of the diabetic ulcer. The correct education and awareness of the patient can lead to a better chance of avoiding the lower-extremity amputation. Keywords: diabetic ulcer, classification, HbA1c, amputation
P0573 THE RISK FACTORS FOR GESTATIONAL DIABETES MELLITUS AMONG KOSOVA PREGNANT WOMEN
Merita Emini Sadiku 1 , Shefqet Lulaj 2 , Gani Bajraktari 1 , Ahmet Brovina 1 , Shqiponja Ponosheci 2 , Brikena Daci 2 , Erduan Sefedini 1 , Izzet Sadiku 3 . 1 University Clinical Center of Kosova, Clinic for Internal Diseases, Prishtina, Kosova; 2 University Clinical Center of Kosova, Clinic for Obstetric and Gynecology, Prishtina, Kosova; 3 Clinic for Infection Diseases, University Clinical Center of Kosova, Prishtina, Kosova Introduction: Gestacional Diabetes Mellitus (GDM) is glucose intolerance first diagnosed during the pregnancy. GDM is diagnosed with screening of pregnant women for risk factors and at women with high risk factors testing for abnormal glucose tolerance. Objectives: This survey is aming to show the high risk factors for GDM in Kosova pregnant women and incidence of GDM. Materials & methods: In this prospectiv survey participated 202 patients in the Clinic for Obstertics and Gynecology in University Clinical Center of Kosova during 2006. Separation of the groups for risk factors (low, middle and high risk factors) for GDM was done through clinical screening as personal history for GDM, family history for typ 2 Diabetes Mellitus, obesity, ages and glucose intolerance based on criteria of American Diabetes Association (ADA). Oral glucose tolerance test (OGTT) with 75 g glucose was done for midle and high risk groups for GDM, based on criteria of ADA, and diagnosing of GDM was done. Results: Incidence of GDM for pregnamnt women with 24-28 geatational weeks was 2.5%. Main characteristics of high risk group of women for GDM compare to the other risk groups with high statistical significance (p=0.0001) are: ages above 30 (62.5%), positive glucose intolerance (50%), personal history for GDM (30.6%), familiar history for DM (36.1%), obesity (30.6%), previous child birth with weight higher than 4000g (12.5%), vulvovaginitis (48.6%) and polyhidramnion (4.2%). Risk factors Preterm birth Preterm birth with malformations Habitual abortion Risk for abortion Death of fetus in uterus Polihydramnion Obesity Child birth >4000 g Glucose intolerance Personal history for GDM Family history for GDM Hypertension Edema Vulvo-vaginitis Urinary infection
Control Low risk Middle risk High risk % % % % 8.0 – 20.0 20.0 – – – – – – – 12.0 4.0 4.0 28.0
18.1 2.4 36.1 14.5 9.6 – – – 2.4 – – 30.1 1.2 3.6 22.9
4.5 – 45.5 9.1 9.1 – – – – – – 27.3 4.5 – 18.2
15.3 4.2 40.3 18.1 13.9 4.2 30.6 12.5 50.0 30.6 36.1 43.1 11.1 48.6 34.7
P-value p=0.1602 p=0.875 p=0.2341 p=0.966 p=0.3003 p=0.0001 p=0.0001 p=0.0001 p=0.0001 p=0.0001 p=0.0001 p=0.059 p=0.020 p=0.0001 p=0.848
Discussion & conclusion: With screening it’s possible early diagnosis of
GDM and prevention of fetal and maternal morbidity and mortality. Pregnant women in our country have same high risk factors for GDM as were described in literature. Keywords: Gestational Diabetes Mellitus,risk factors
P0574 AUTOIMMUNE THYROID DISEASE AND AUTOIMMUNE RHEUMATIC DISORDERS
Ivica Lazurova 1 , Karim Benhatchi 1 , Jozef Rovensky 2 , Darina Kozakova 2 , Hedwiga Wagnerova 1 , Maria Tajtakova 1 , Yehuda Shoenfeld 3 . 1 Medical Faculty University Košice, Slovakia; 2 National Institute of Rheumatic Diseases, Piešt’any, Slovakia; 3 Sheba Medical Center, University Tel Aviv, Israel Chronic autoimmune thyroiditis (ATD) frequently overlaps with autoimmune rheumatic diseases. However data about the prevalence of non organ specific autoantibodies in patients with ATD are still inconsistent. The aim of the study was to evaluate the prevalence of various non organ specific autoantibodies in patients with ATD as well as the presence of ATD in patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). Subjects and Methods: Group 1 comprised of 80 patients with ATD and a second group of 80 patients with rheumatic autoimmune disorders (SLE and RA). Control group consisted of 34 healthy subjects without known ATD or a systemic disease. Group 1 was examined for the presence of non organ specific autoantibodies (ANA, ENA, anti-dsDNA, SSA, SSB, n-RNP, DNP, aCL, ANCA and CRP). Serum fT3, fT4, TSH and antibodies against thyroglobulin (anti-TG), thyroperoxidase (anti-TPO) as well as ultrasound of thyroid gland were determined in group 2. Results: Patients with ATD had a significantly higher prevalence of ANA than the control subjects (45% v.s. 14.7%, p<0.001). There were no significant differences in the prevalence of other antibodies between the groups. ANA positive patients were younger than ANA negative and had a significantly higher anti-TG values (p <0.05). The prevalence of ATD in group 2 was significantly higher than in the control subjects (24% v.s. 8%, p<0.05). No significant differences in the prevalence of ATD were detected between SLE and RA. Conclusion: Authors conclude that ANA is the most frequent non organ specific antibody associated with ATD while the other antibodies occur rarely. The prevalence of ATD in SLE and RA patients is 24%. These results indicate that it is clinically important to screen patients with SLE and RA for the coexistence of thyroid autoimmune disease. Keywords: Autoimmune thyroid disease - rheumatoid arthritis - systemic lupus erythematosus
P0575 PRIMARY HYPERALDOSTERONISM: RESULTS OF OUT-PATIENT SCREENING
Ludmila Brunerova, Richard Sotornik, Ivan Rychlik. 3rd Faculty of Medicine and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic Introduction: Primary hyperaldosteronism (PHA) is the most frequent form of secondary hypertension (prevalence 5-13%) and its occurance increases with the severity of hypertension (prevalence 30% in resistant hypertension). PHA must be thought of in case of severe hypertension, resistent hypertension, hypertension connected with hypokalemia or with adrenal tumor. Objectives: The aim of our study was to screen selected patients for PHA, eveluate the subtype of PHA, perform special treatment and follow up the effects. Methods: We screened 46 patients (average age 59,8±10,5 years; average duration of hypertension was 10,1±7,4 years and average number of antihypertensive drugs per patient was 3,4±1,2) with resistant or severe hypertension (87%) and/or hypokalemia (present in 16%), positive therapeutic test with spironolactone (6,5%) or presence of adrenal tumor (13%). All the patients underwent screening testing for PHA with double evaluation of aldosteron (ALD)/plasma renin activity (PRA) ratio after standard correction of antihypertensive medication. ALD was measured using DPC and PRA using Immunotech method. In positive screening (ALD/PRA > 20 ng/dl/ng/ml/h in combination with ALD > 416 pmol/l) the patients underwent confirmatory testing using intravenous saline loading. After confirmation CT and adrenal venous sampling for cortisol and aldosterone was performed. Lateralisation was confirmed if aldosterone/kortisol ratio from one side was 5× greater then that from the other side. Patients who were proved to have unilateral
Abstracts from 8th Congress of the European Federation of Internal Medicine / European Journal of Internal Medicine 20S (2009), S1–S283
Objectives: It is the classification of diabetic ulcers and the correlation of their severity with the values of HbA1c. Materials & methods: The study included 52 patients aged 52-88 years with diabetes mellitus type II, during the period 2007-2008. Besides the type, we studied the duration of the disease, the administered medication and the value of HbA1C. The ulcers were classified on the basis of the following factors: the presence or absence of foot pulse, depth of the involved tissue (deep or shallow ulcers), if the ulcer is found on the finger or the rest of the foot and the presence or absence of multiple ulcers. Finally, all the suffering ends were depicted with X-ray of the soft tissue, in order to search for calcifications and osteolytic damages. Results: Among the 52 patients, 45 had HbA1c levels above 9%. 17 of the 45 were hospitalized, while 8 of them were led to amputation. Patients with HbA1c 7.5-9% and <7%, had much milder injuries and almost no one was hospitalised for further treatment of the ulcer. It should be noted that most patients (regardless of the ulcer severity and the value of HbA1c) had calcifications on foot x-rays. 5 of them that were led to amputation had osteolytic damages. Discussion & conclusion: There is a direct correlation among the regulation of diabetes (with HbA1c monitoring), the clinical appearance and the prognosis of the diabetic ulcer. The correct education and awareness of the patient can lead to a better chance of avoiding the lower-extremity amputation. Keywords: diabetic ulcer, classification, HbA1c, amputation
P0573 THE RISK FACTORS FOR GESTATIONAL DIABETES MELLITUS AMONG KOSOVA PREGNANT WOMEN
Merita Emini Sadiku 1 , Shefqet Lulaj 2 , Gani Bajraktari 1 , Ahmet Brovina 1 , Shqiponja Ponosheci 2 , Brikena Daci 2 , Erduan Sefedini 1 , Izzet Sadiku 3 . 1 University Clinical Center of Kosova, Clinic for Internal Diseases, Prishtina, Kosova; 2 University Clinical Center of Kosova, Clinic for Obstetric and Gynecology, Prishtina, Kosova; 3 Clinic for Infection Diseases, University Clinical Center of Kosova, Prishtina, Kosova Introduction: Gestacional Diabetes Mellitus (GDM) is glucose intolerance first diagnosed during the pregnancy. GDM is diagnosed with screening of pregnant women for risk factors and at women with high risk factors testing for abnormal glucose tolerance. Objectives: This survey is aming to show the high risk factors for GDM in Kosova pregnant women and incidence of GDM. Materials & methods: In this prospectiv survey participated 202 patients in the Clinic for Obstertics and Gynecology in University Clinical Center of Kosova during 2006. Separation of the groups for risk factors (low, middle and high risk factors) for GDM was done through clinical screening as personal history for GDM, family history for typ 2 Diabetes Mellitus, obesity, ages and glucose intolerance based on criteria of American Diabetes Association (ADA). Oral glucose tolerance test (OGTT) with 75 g glucose was done for midle and high risk groups for GDM, based on criteria of ADA, and diagnosing of GDM was done. Results: Incidence of GDM for pregnamnt women with 24-28 geatational weeks was 2.5%. Main characteristics of high risk group of women for GDM compare to the other risk groups with high statistical significance (p=0.0001) are: ages above 30 (62.5%), positive glucose intolerance (50%), personal history for GDM (30.6%), familiar history for DM (36.1%), obesity (30.6%), previous child birth with weight higher than 4000g (12.5%), vulvovaginitis (48.6%) and polyhidramnion (4.2%). Risk factors Preterm birth Preterm birth with malformations Habitual abortion Risk for abortion Death of fetus in uterus Polihydramnion Obesity Child birth >4000 g Glucose intolerance Personal history for GDM Family history for GDM Hypertension Edema Vulvo-vaginitis Urinary infection
Control Low risk Middle risk High risk % % % % 8.0 – 20.0 20.0 – – – – – – – 12.0 4.0 4.0 28.0
18.1 2.4 36.1 14.5 9.6 – – – 2.4 – – 30.1 1.2 3.6 22.9
4.5 – 45.5 9.1 9.1 – – – – – – 27.3 4.5 – 18.2
15.3 4.2 40.3 18.1 13.9 4.2 30.6 12.5 50.0 30.6 36.1 43.1 11.1 48.6 34.7
P-value p=0.1602 p=0.875 p=0.2341 p=0.966 p=0.3003 p=0.0001 p=0.0001 p=0.0001 p=0.0001 p=0.0001 p=0.0001 p=0.059 p=0.020 p=0.0001 p=0.848
Discussion & conclusion: With screening it’s possible early diagnosis of
GDM and prevention of fetal and maternal morbidity and mortality. Pregnant women in our country have same high risk factors for GDM as were described in literature. Keywords: Gestational Diabetes Mellitus,risk factors
P0574 AUTOIMMUNE THYROID DISEASE AND AUTOIMMUNE RHEUMATIC DISORDERS
Ivica Lazurova 1 , Karim Benhatchi 1 , Jozef Rovensky 2 , Darina Kozakova 2 , Hedwiga Wagnerova 1 , Maria Tajtakova 1 , Yehuda Shoenfeld 3 . 1 Medical Faculty University Košice, Slovakia; 2 National Institute of Rheumatic Diseases, Piešt’any, Slovakia; 3 Sheba Medical Center, University Tel Aviv, Israel Chronic autoimmune thyroiditis (ATD) frequently overlaps with autoimmune rheumatic diseases. However data about the prevalence of non organ specific autoantibodies in patients with ATD are still inconsistent. The aim of the study was to evaluate the prevalence of various non organ specific autoantibodies in patients with ATD as well as the presence of ATD in patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). Subjects and Methods: Group 1 comprised of 80 patients with ATD and a second group of 80 patients with rheumatic autoimmune disorders (SLE and RA). Control group consisted of 34 healthy subjects without known ATD or a systemic disease. Group 1 was examined for the presence of non organ specific autoantibodies (ANA, ENA, anti-dsDNA, SSA, SSB, n-RNP, DNP, aCL, ANCA and CRP). Serum fT3, fT4, TSH and antibodies against thyroglobulin (anti-TG), thyroperoxidase (anti-TPO) as well as ultrasound of thyroid gland were determined in group 2. Results: Patients with ATD had a significantly higher prevalence of ANA than the control subjects (45% v.s. 14.7%, p<0.001). There were no significant differences in the prevalence of other antibodies between the groups. ANA positive patients were younger than ANA negative and had a significantly higher anti-TG values (p <0.05). The prevalence of ATD in group 2 was significantly higher than in the control subjects (24% v.s. 8%, p<0.05). No significant differences in the prevalence of ATD were detected between SLE and RA. Conclusion: Authors conclude that ANA is the most frequent non organ specific antibody associated with ATD while the other antibodies occur rarely. The prevalence of ATD in SLE and RA patients is 24%. These results indicate that it is clinically important to screen patients with SLE and RA for the coexistence of thyroid autoimmune disease. Keywords: Autoimmune thyroid disease - rheumatoid arthritis - systemic lupus erythematosus
P0575 PRIMARY HYPERALDOSTERONISM: RESULTS OF OUT-PATIENT SCREENING
Ludmila Brunerova, Richard Sotornik, Ivan Rychlik. 3rd Faculty of Medicine and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic Introduction: Primary hyperaldosteronism (PHA) is the most frequent form of secondary hypertension (prevalence 5-13%) and its occurance increases with the severity of hypertension (prevalence 30% in resistant hypertension). PHA must be thought of in case of severe hypertension, resistent hypertension, hypertension connected with hypokalemia or with adrenal tumor. Objectives: The aim of our study was to screen selected patients for PHA, eveluate the subtype of PHA, perform special treatment and follow up the effects. Methods: We screened 46 patients (average age 59,8±10,5 years; average duration of hypertension was 10,1±7,4 years and average number of antihypertensive drugs per patient was 3,4±1,2) with resistant or severe hypertension (87%) and/or hypokalemia (present in 16%), positive therapeutic test with spironolactone (6,5%) or presence of adrenal tumor (13%). All the patients underwent screening testing for PHA with double evaluation of aldosteron (ALD)/plasma renin activity (PRA) ratio after standard correction of antihypertensive medication. ALD was measured using DPC and PRA using Immunotech method. In positive screening (ALD/PRA > 20 ng/dl/ng/ml/h in combination with ALD > 416 pmol/l) the patients underwent confirmatory testing using intravenous saline loading. After confirmation CT and adrenal venous sampling for cortisol and aldosterone was performed. Lateralisation was confirmed if aldosterone/kortisol ratio from one side was 5× greater then that from the other side. Patients who were proved to have unilateral