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QUALITY OF ANTICOAGULATION MONITORING: COMPARISON OF ANTICOAGULATION CLINIC VERSUS ROUTINE MEDICAL CARE
Abstracts from 10th Congress of the European Federation of Internal Medicine/European Journal of Internal Medicine 22S (2011) S1–S112 STUDY OF THE RATE OF TOTAL STIMULATED SALIVA AND HYPERPIGMENTATION IN THE ORAL MUCOSA OF PATIENTS DIAGNOSED WITH HEREDITARY HEMOCHROMATOSIS. SERIES OF 25 CASES Alejandro del Castillo-Rueda, Miguel A. Sánchez-Pablo. Iron Disorders Unit, Internal Medicine Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense, Madrid, Spain Background: To study lesions in the oral cavity of patients with hereditary hemochromatosis and determine their association with iron overload. Methods: We took a clinical history, examined the pigmentation of the oral mucosa, and measured total stimulated saliva production. We correlated our results with epidemiological, phenotypic, and genotypic findings. Patients with associated diseases or drug therapy causing xerostomia were excluded. Results: We evaluated 25 patients (20 men, mean age 52 years) over a period of 6 months. No patient complained of xerostomia and pigmentation was not detected in the oral mucosa. The total stimulated salivary flow was reduced in 9 patients who had an average ferritin level of 796,5 Pg/l. The decline in total stimulated salivary rate was significantly correlated with ferritin levels (p = 0.002). Patients with ferritin levels within the normal range also had normal SSF. Conclusions: We found no pigmented lesions in the oral mucosa; we did observe a decrease in total stimulated salivary flow that correlated with ferritin levels. Therefore, hyposialia caused by functional impairment of the salivary glands may be an early marker of iron deposition. INFECTIOUS ETIOLOGY OF GUILLAIN-BARRÉ SYNDROME, MORE THAN 10 YEARS OF EXPERIENCE Alberto Díaz1, Alejandra Peláez2, Bernard Doger3, Patricia García1, Pablo García1, Laura Benítez1, Claudia Pérez1, Camino Gómez1, Juan Antonio Vargas1. 1Medicina Interna, Hospital Universitario Puerta De Hierro Majadahonda, Madrid, Spain; 2Neurología, Hospital Universitario Puerta De Hierro Majadahonda, Madrid, Spain; 3Oncología Médica, Hospital Universitario Puerta De Hierro Majadahonda, Madrid, Spain Background: Guillain-Barré Syndrome (GBS) is viewed as an inflammatory, autoimmune and acute polirradiculoneuropaty clinically characterised by flaccid paralysis, sensory deficit and hiperproteinorraquia. Our objective is to determine incidence, epidemiology and morbimortality of GBS in our Sanity Area between 1999 and 2011. Methods: a retrospective, descriptive, observational study was drawn up with the patients diagnosed of GBS and subtypes at our Hospital, that covers a population of more than 600.000. We revised medical histories of the 50 patients with the National Institute of Neurological and Communicative Disorders and Stroke (NINDS) criteria for GBS and variants. Results: the mean age is 50 years old, most of them men (64%). The incidence is 0.72 per 100.000 annually, lower than 1.5 per 100.000 of the main studies. 60% of patients report an infectious antecedent, most commonly a respiratory-tract infection or gastroenteritis. The most frequent isolated microorganism is Mycoplasma pneumonie (15%). We do not find evidence of Campylobacter jejuni, the most common agent in the main publications. We remarked a high incidence of Miller-Fisher subtype in our survey (20%). Most of patients (65%) were treated with high-dose intravenous immunoglobulin for 5 days, without adverse reactions. Rehabilitation is needed in 25% of patients for at least one year. No death was reported. Conclusion: our annual incidence is low. Two-thirds of patients report an antecedent of infectious disease. Mycoplasma pneumonie is the most frequent antecedent pathogen for GBS. Intravenous immunoglobulin is the mainstay of therapy. QUALITY OF ANTICOAGULATION MONITORING: COMPARISON OF ANTICOAGULATION CLINIC VERSUS ROUTINE MEDICAL CARE Jose Diaz-Benito, Luisa Muñoz-Garde. Navarre Health Service, Pamplona, Spain Background: The evidence indicates that high-quality anticoagulation management results in better health outcomes. Demands for oral anticoagulation have increased greatly in recent years. Worldwide, centers are being overwhelmed for international normalized ratio (INR) monitoring. A study find that 72.7 % of INRs are within range at large anticoagulation clinics of the country. Our study has been performed to assess the quality of anticoagulation therapy in a routine care setting
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Methods: Medical record data extraction from physician practices in the routine medical management of vitamin K antagonists, that is, management not overseen by an anticoagulation clinic. The INR values were obtained from CoaguChek point-of-care testing prothrombin time monitor. The cross-section-of-the-files methodology was calculated by taking each patient whose INR value is in range at one point in time divided by the total number of INR’s done on all patients at that point in time Results: The final sample consisted of 53 outpatients who were receiving acenocoumarol in November 2010. Fifty-one percent of patients were male; mean age was 77.7 years (SD 10.8). The most frequent indication for oral anticoagulation was chronic nonvalvular atrial fibrillation. We found that 75.5 % of the INRs were within range, 18.9 % below range, and 5.6 % above range. There was a significant correlation between age and weekly acenocoumarol dose (r=–0.49; P=0.01). Seventeen percent of patients have systolic blood pressure higher than 140 mmHg. Conclusions: The quality of oral anticoagulation with acenocoumarol in routine medical care was similar to that observed in anticoagulation clinics of the country. Physicians tend to under treat more than over treat. HYPOVITAMINOSIS D AND HIP FRACTURE IN OSTEOPOROSIS: FRAX INDEX. Cristina Díez Romero, Itxasne Cabezón Estévanez Paloma Díez Romero, Miguel Angel Artacho Rodríguez, María Torrea Valdeperez, Maria Olmedo Samperio, Chiara Fanciulli, Isabel Perez Tamayo, Carnen Cuenca Carvaja, Jose Santiago Filgueira Rubio, Laura Cano Alcade. H.U.Gregorio Marañón, Medicina Interna III Background: Osteoporosis is a systemic skeletal disease with a great susceptibility to fractures. Hip fracture is the most serious of all osteoporotic fractures. In this paper, we study the relationship between the index FRAX and levels of vitamin D. And calculate the percentage of patients with hypovitaminosis D present hip fracture. Methods: The study included 86 patients from a query of osteoporosis in a tertiary hospital, aged between 40 and 85 years, both men and women, all Caucasian. Age,sex, BMI, blood levels of vitamin D, PTH, bone mineral density, FRAX index, intake of steroid or not, alcohol and snuff. And the presence or absence of prior hip fracture, family history of hip fracture and a history of rheumatoid arthritis. Results: Of the patients studied, 94.2% were women and 5.8% male, with a mean age of 66.69+/-10.07 ng/dl, 89.5% of patients had hypovitaminosis D. As the average vitamin D 17.81+/-10.07 ng/dl. 36.4% of patients with hip fracture had vitamin D deficiency There is a negative relationship between vitamin D deficiency and the rate FRAX, there being a correlation ratio -0.223, with p=0.0047. Conclusions: This study has found that the lower the levels of vitamin D in blood, the greater the probability of an osteoporotic hip fracture or higher in the next 10 years, ie the higher the index FRAX. The average vitamin D was lower among patients with hip fracture among people who did not have this complication, although in both groups was observed hypovitaminosis D. COMPLICATED MULTIPLE HEPATIC HEMANGIOMAS: A CASE REPORT WITH CLINICAL AND PATHOLOGYCAL FINDINGS Corina Dima-Cozma1, George Ioan Pandele1, Adrian Pantazescu2, Elena Gologan3, Doinita Radulescu4. 1Department of Internal Medicine, “Gr. T. Popa” University of Medicine and Pharmacy, Iaüi, Romania; 2Surgical Department, Emergency Hospital “Sf. Ioan”, Iaüi, Romania; 3Gastroenterology Department, “Gr. T. Popa” University of Medicine and Pharmacy, Iaüi, Romania; 4Pathology Department, “Gr. T. Popa” University of Medicine and Pharmacy, Iaüi, Romania Background: Hepatic hemangiomas are common benign tumors, occuring at all ages. Most of the cases are asymptomatic, often discovered accidentally on abdominal ultrasonography. Very rarely, giant or multiple hemangiomas could evoluate with spontaneous rupture and necrosis and may cause abdominal pain, fever and thrombocytopenia. Methods: We report a case of a 70 year old woman presented a complaint of right upper abdominal pain and fever. The biological evaluation revealed inflammatory markers, mild anemia and normal liver function tests. The abdominal ultrasound and computed tomography scan showed multiple lesions in segments III, IV and VIII of the liver, consistent with the features
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Methods: Medical record data extraction from physician practices in the routine medical management of vitamin K antagonists, that is, management not overseen by an anticoagulation clinic. The INR values were obtained from CoaguChek point-of-care testing prothrombin time monitor. The cross-section-of-the-files methodology was calculated by taking each patient whose INR value is in range at one point in time divided by the total number of INR’s done on all patients at that point in time Results: The final sample consisted of 53 outpatients who were receiving acenocoumarol in November 2010. Fifty-one percent of patients were male; mean age was 77.7 years (SD 10.8). The most frequent indication for oral anticoagulation was chronic nonvalvular atrial fibrillation. We found that 75.5 % of the INRs were within range, 18.9 % below range, and 5.6 % above range. There was a significant correlation between age and weekly acenocoumarol dose (r=–0.49; P=0.01). Seventeen percent of patients have systolic blood pressure higher than 140 mmHg. Conclusions: The quality of oral anticoagulation with acenocoumarol in routine medical care was similar to that observed in anticoagulation clinics of the country. Physicians tend to under treat more than over treat. HYPOVITAMINOSIS D AND HIP FRACTURE IN OSTEOPOROSIS: FRAX INDEX. Cristina Díez Romero, Itxasne Cabezón Estévanez Paloma Díez Romero, Miguel Angel Artacho Rodríguez, María Torrea Valdeperez, Maria Olmedo Samperio, Chiara Fanciulli, Isabel Perez Tamayo, Carnen Cuenca Carvaja, Jose Santiago Filgueira Rubio, Laura Cano Alcade. H.U.Gregorio Marañón, Medicina Interna III Background: Osteoporosis is a systemic skeletal disease with a great susceptibility to fractures. Hip fracture is the most serious of all osteoporotic fractures. In this paper, we study the relationship between the index FRAX and levels of vitamin D. And calculate the percentage of patients with hypovitaminosis D present hip fracture. Methods: The study included 86 patients from a query of osteoporosis in a tertiary hospital, aged between 40 and 85 years, both men and women, all Caucasian. Age,sex, BMI, blood levels of vitamin D, PTH, bone mineral density, FRAX index, intake of steroid or not, alcohol and snuff. And the presence or absence of prior hip fracture, family history of hip fracture and a history of rheumatoid arthritis. Results: Of the patients studied, 94.2% were women and 5.8% male, with a mean age of 66.69+/-10.07 ng/dl, 89.5% of patients had hypovitaminosis D. As the average vitamin D 17.81+/-10.07 ng/dl. 36.4% of patients with hip fracture had vitamin D deficiency There is a negative relationship between vitamin D deficiency and the rate FRAX, there being a correlation ratio -0.223, with p=0.0047. Conclusions: This study has found that the lower the levels of vitamin D in blood, the greater the probability of an osteoporotic hip fracture or higher in the next 10 years, ie the higher the index FRAX. The average vitamin D was lower among patients with hip fracture among people who did not have this complication, although in both groups was observed hypovitaminosis D. COMPLICATED MULTIPLE HEPATIC HEMANGIOMAS: A CASE REPORT WITH CLINICAL AND PATHOLOGYCAL FINDINGS Corina Dima-Cozma1, George Ioan Pandele1, Adrian Pantazescu2, Elena Gologan3, Doinita Radulescu4. 1Department of Internal Medicine, “Gr. T. Popa” University of Medicine and Pharmacy, Iaüi, Romania; 2Surgical Department, Emergency Hospital “Sf. Ioan”, Iaüi, Romania; 3Gastroenterology Department, “Gr. T. Popa” University of Medicine and Pharmacy, Iaüi, Romania; 4Pathology Department, “Gr. T. Popa” University of Medicine and Pharmacy, Iaüi, Romania Background: Hepatic hemangiomas are common benign tumors, occuring at all ages. Most of the cases are asymptomatic, often discovered accidentally on abdominal ultrasonography. Very rarely, giant or multiple hemangiomas could evoluate with spontaneous rupture and necrosis and may cause abdominal pain, fever and thrombocytopenia. Methods: We report a case of a 70 year old woman presented a complaint of right upper abdominal pain and fever. The biological evaluation revealed inflammatory markers, mild anemia and normal liver function tests. The abdominal ultrasound and computed tomography scan showed multiple lesions in segments III, IV and VIII of the liver, consistent with the features