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TAKO TSUBO CARDIOMYOPATHY ASSOCIATED WITH AN OVERDOSE OF THE SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITOR VENLAFAXINE
Abstracts from 10th Congress of the European Federation of Internal Medicine/European Journal of Internal Medicine 22S (2011) S1–S112 LATE ABSTRACTS PULMONARY HYPERTENSION AND TYPE 2 DIABETES: FORTUITOUS ASSOCIATION? Djanette Hakem, Toufik Bounzira, Nacer Ouadahi, Abdelhalim Boudjelida, Moufida Ibrir, Malika Boucelma, Hayat Lafer, Abdelkrim Berrah. Dr Mohammad-Lamine Debaghine, Bab El Oued Universitary Hospital Centre Background: To report and to discuss association of primitive pulmononary hypertension and nephropathy of type 2 diabetes. Case report: Old man of 44 years, in the family history of type 2 diabetes, treated for type 2 Diabetes mellitus for 18 years, at the stage of microangiopathic complications (bilateral severe proliferative retinopathy, diabetic nephropathy stage 4, and of peripheral and dysautonomia neuropathy) by novomixt insulin 30. This patient report hypertension diagnosed 8 months ago witch treatment was stopped because not tolerated (disabling orthostatic hypotension). He presents also hypercholesterolemiae treated by statin. The treatment referring to the cardiovascular risks factors is completed by ant platelet drug and nephroprotector treatment by conversine enzyme inhibitor (CEI). Hospitalization is justified by the apparition of nephrotic syndrome making suspect an amylosis referring to the hight proteinuria estimated over to 5g/day, the clinical context (majoration of neuropathy and the no tolerated hypertension drugs). The kidney investigations confirms the impure nephritic syndrome showering daily proteinuria over 5g associated with hypo albuminemia, hypoproteinemia, hypercholesterolemia, hematuria and failure renal function (Creatinine Clearance estimated by MDRD is about 43ml/min). So treatment is reinforced by diuretic (furosemide 80mg / day) and a preventive dose of heparin dose is instituted. The complications of diabetes are evaluated and objectives proliferative retinopathy. The arterial and veinous echodöppler (abdominal, inferiors limbs) and cervical arterial echodoppler imaging was normal (not stenosis). We are surprised to fund pulmonary hypertension estimated about 60 mm Hg in echocardiography Doppler ultrasound method - without achievements valvular - motivating the realization as a matter of urgency of a perfusion scan which does not find pulmonary embolism. The thoracic angio tomo-densitometry precise the character of primitive PAH and exclude thrombogeneous event according to thrombogenous context linked to nephritic syndrome. We discuss the opportunity of kidney biopsy (amylosis? nephroangiosclerosis? diabetic nephropathy?) and therapeutically option of PAH considering proliferation retinopathy and renal failure. Conclusion: The originality of this case report is relative to the association of diabetic nephropathy and primitive PAH witch is no reported in the literature (others etiology to considers for PPAH or fortuitous association?) if the thromboembolis is definitely excluded and the difficulties of the conventional treatment in this situation (proliferative acute retinopathy, failure kidney function and long term of anticoagulant) and the adequate treatment to reduce the PAH (place of inhibitors receptors of the endotheline?).
Methods: Throat swab was taken in search of the H1N1 virus and administration of oseltamivir (Tamiflu®) began. At the same time taking into account the chronicity of symptoms and radiological image, sputum culture was sent for Ziehl-Neelsen staining and search Mycobacterium tuberculosis by microscopy and PCR and we started administration of tuberculostatic treatment with streptomycin, ethambutol, rifampicin and isoniazid. Result: The patient became afebrile within two days from the initiation of antiviral therapy and proved positive for influenza A. Newer radiological assessment with chest CT showed thick walled cavities (caves) in the upper lung fields, bronchiectasis, peribronchial thickening, tree-in-bud image and enlarged mediastinal and hilar lymph nodes. Clinical suspicion confirmed by positive Ziehl-Neelsen stain and microscopic finding of mycobacteria and a positive PCR. The patient’s clinical condition improved, restored the hypoxia and took anti-tuberculosis treatment for nine months. Conclusion: The prevalence of TB is still important in populations with poor sanitation, which together with recent influenza pandemic should not be neglected. TAKO TSUBO CARDIOMYOPATHY ASSOCIATED WITH AN OVERDOSE OF THE SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITOR VENLAFAXINE Eduardo Oliveros Acebes, Salvador Gamez Casado, Maria Ferrer Civeira, Inma Muñoz Roldán, Marta Clavero Olmos, Alejandro García-Espona Pancorbo, Maria Victoria Villalba García, Cristina López Gozález- Cobos. Gregorio Marañon Hospital Background: Tako Tsubo (TTC) is a spontaneous and reversible myocardiopathy. It is often associated with physical or emotional stress. It is defined as a reversible acute left ventricular (LV) apical dysfunction. It can simulate acute coronary syndrome (ACS). Our objective is to describe a case of TTC after an overdose of Venlafaxine and to analyze clinical course and treatment of patients with TTC. Methods: We present a case of TTC after an overdose of Venlafaxine and a series of 20 patients with TTC admitted in our hospital between January 2009 And March 2011. Table1 Characteristics of 21 patients with TTC N Age % Female Thoracic pain % Dyspnoea % Emotional trigger % EAP% Shock % Death %
18 patients 65±16 years 85,7% (n=18) 52,4% (n=11) 19% (n=4) 33,3% (n=7) 19% (n=4) 14,3% (n=3) 1 patient
Results: A healthy 30-year-old woman admitted in the emergency room with sudden onset of breath shortness, after a Venlafaxine overdose for attempt of suicide.
A CASE OF COINFECTION FROM PULMONARY TUBERCULOSIS AND INFLUENZA A (H1N1) VIRUS Ioannis Dimitriadis1, Athanasios Panoutsopoulos1, Anna Tarantili1, Paraskevi Kalamara2, Konstantina Vogiatzi1, Paraskevi Papaioannou1, Georgios Andrianopoulos1. 1Department of Internal Medicine, General Hospital of Argos, Greece; 2Department of Radiology, General Hospital of Argos, Greece Background: The Mycobacterium tuberculosis infection and disease from pulmonary tuberculosis is still prevalent in populations with poor sanitary conditions. In conjunction with the pandemic of influenza A virus (H1N1), it should remain a high clinical suspicion of disease. Purpose: We discuss the case of a patient with newly diagnosed pulmonary tuberculosis who fell ill from influenza A. Materials: A 35 year-old patient, economic immigrant, employed in agricultural work and smoker presented with progressively worsening dyspnea during the last two months, cough and fatigue. An episode of spontaneous pneumothorax is reported from his medical history. During the clinical examination, we discovered a high fever (39.7°C) and SatO2 85%, reduction in respiratory whispering and radiological evaluation of the chest showed pulmonary infiltrates bilaterally with the formation of voids particularly in the upper lung fields.
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Fig 1.
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Abstracts from 10th Congress of the European Federation of Internal Medicine/European Journal of Internal Medicine 22S (2011) S1–S112
Tachypnea and diaphoresis, blood pressure 145/100 and oxygen saturation was 85%. Thorax X-Ray showed mild pulmonary edema. An EKG showed precordial T-wave inversion (Fig. 1). Echocardiogram demonstrated TTC apical ballooning. She was admitted in the intensive care unit and received an ACEinhibitor and a beta-blocker. She was completely recovered in the next 24 hours and her echocardiogram was normal. Conclusions: There has only been reported one case of TTC because of a Venlafaxine overdose. The physiopathology of TTS remains unknown; it could be related to sympathetic overstimulation. TTC simulates ACS, but has milder symptoms and better prognosis.
NECROTIC PURPURA: ETIOLOGICAL ASPECTS Malek Kechida, Olfa Harzallah, Rim Klii, Amira Hamzaoui, Silvia Mahjoub. Internal Medicine Department. Fattouma Bourguiba Hospital Background: Necrotic purpura is a clinical symptom of a wide spectrum of causes. The aim of our study was to analyze its etiological profile. Methods: Medical records of 24 patients presenting with a necrotic purpuric rash (as an initial symptom or during their follow up) were retrospectively analyzed. Results: Patients were 15 males and 9 females with a mean age of 45.5 years. Purpuric rash revealed the responsible disease in 20/24 patients. It occurred on average 14 days before the other symptoms. These symptoms were fever in 3 cases, gastro-intestinal bleeding in 9 patients, arthralgia/arthritis in 10 patients, abdominal pain in 7 patients and renal involvement in 6 cases. Skin biopsy was contributive in 17 patients showing leucocytoclastic vasculitis in 15 cases with IgA deposits in only 2 cases. IgA deposits were confirmed in another two cases by a renal biopsy. The most frequent cause of necrotic purpura was Henoch Schonlein Purpura in 12 cases. The other causes were Wegener granulomatosis in 1 case, Chürg Strauss syndrome in 1 case, rheumatoid arthritis in 1 case, polyarteritis nodosa in 3 cases, CMV infection in 1 case and drug induced purpura in 1 case. Cryoglobulin’s dosage, available in only half of patients, wasn’t positive in any case. Comments: Given its wide spectrum of causes, the etiological diagnosis of necrotic pupura requires often a deep investigation especially if it’s an isolated symptom. In our series, Henoch Schonlein purpura was the most frequent cause.
URINARY TRACT INFECTIONS AFTER ORTHOPAEDIC PROCEDURES AND RISK FACTORS Aikaterini Masgala1, Efstathios Chronopoulos2, Ioannis Lazarettos2, Georgios Nikolopoulos3, Stergios Lallos2, Emmanouil Brilakis2, Zoi Tagalaki1, Nikolaos Efstathopoulos2. 11st Department of Internal Medicine Konstantopoulio Hospital; 22nd Orthopedic Department University of Athens; 3Hellenic Centre Of Infection and Disease Control Background: Urinary retention is a common postoperative problem in orthopaedic surgery, so an indwelling Foley catheter is often needed. This poses an increased risk of bacteriuria or urinary tract infection. In our study we tried to identify the risk factors for urinary tract infection after orthopaedic procedures. Methods: This is a case control study. The cases (patients with infection) and controls (patients without infection) were matched only to number. As risk factors were considered the age, sex, type of operation (arthroplasty, fracture repair, spine surgery), chemoprophylaxis, type of anesthesia, time of surgical procedure (emerging or scheduled). We used logistic regression analysis to evaluate the risk factors for urinary tract infections. Results: During one year, 33 cases and 33 controls were recorded. Of the cases, 28 (86.7%) were females and 5 (13.3%) were males. Of the controls, 25 (77.8%) were females and 8 (22.2%) were males. The mean age for cases was 76.9 years and for controls 68.5 years. All patients carried urinary catheter for 3 to 7 days. Eschericia. coli was isolated in 12 (36.3%) patients, Pseudomonas aeruginosa in 10 (30.3%), Klebsiella pneumoniae in 4 (12.1%), Acinetobacter spp in 4 (12.1%) and Enterococcus spp. in 3 (9%) patients. Using logistic regression analysis we found that only the age was significant risk factor for urinary tract infection (p=0.015) Conclusion: The most common pathogen isolated was E. coli. Although the presence of urinary catheter is related to urinary tract infection, in our study age seems also to play important role.
LONG TERM OUTCOME OF CHRONIC HEPATITIS C PATIENTS SUCCESSFULLY TREATED WITH COMBINED ANTIVIRAL THERAPY Vasilis Papastergiou1, Lamprini Skorda2, Manolis Papamanolis1, Maria Stampori1, Niki Samara1, Philipos Lisgos1, Dimitris Mamalis1, Stylianos Karatapanis1. 1Liver Clinic, 1st Department of Internal Medicine, General Hospital of Rhodes; 2Department of Internal Medicine, “Konstantopoulio” General Hospital of Athens, Greece Background: Patients with chronic hepatitis C (CHC) who achieved sustained virological response (SVR) following standard combination therapy are traditionally considered “cured”. However the long-term outcome of these patients regarding late relapse of viremia and the progression of liver disease has not been fully elucidated. The aim of this study was to evaluate the long-term outcome of CHC patients who responded successfully to previous combined antiviral therapy. Methods: There were included 144 CHC patients (M/F=93/51, mean age = 46.2±9.4), in the present study. All patients had developed sustained viral response (SVR) following combination therapy with pegylated interferonalpha plus ribavirin. All patients had at least 12 months of follow-up after the end of treatment. During the follow-up period all participating patients have been retested for liver biochemistry every 6 months and for HCV-RNA at yearly intervals. Results: The mean duration of follow-up was 46 months (12-126 months). Distribution of genotypes was: genotype 1=76 patients (52.7%), genotype 2/3=38 patients (26.3%) and genotype 4=30 patients (20.8%). All patients retained their HCV-RNA negativity and no-one developed late relapse of viremia. Liver biochemical tests were persistently normal in 122/144 (84.7%) patients. One patient developed hepatocellular cancer (HCC) 3 years following the end of treatment and another decompensated cirrhosis 4 years after treatment. Conclusion: No recurrence of HCV viremia was observed among our study population. Long-term prognosis in CHC patients with an SVR to therapy is excellent. However, a case of late development of HCC and a case of decompensated cirrhosis were detected during long term follow-up.
NEUTROPHIL GELATINASE-ASSOCIATED LIPOCALIN (NGAL): A NEW MARKER OF DIABETIC NEPHROPATHY? Christina Tsigalou1, Theocharis Konstantinidis1,2, Milada Konstantinidou3, Gioulia Romanidou4,5, Eleni Konstantinidou1, Liana Fotiadou3, Ioanna Alexandropoulou2, Theodora Gioka1, A. Lygera3, Stella Argyriadou3, Georgia Kampouromiti1, Theodoros C. Constantinidis2. 1Immunology Department of Microbiology Laboratory, University General Hospital of Alexandroupolis, Alexandroupolis, Greece; 2Regional Public Health Laboratory (East Macedonia-Thrace) Alexandroupolis, Greece; 3Health Centre of Chrisoupolis, Kavalla, Greece; 4General Hospital “Sismanoglio” Komotini, Greece; 5Nephrology Department University Hospital of Alexandroupolis, Alexandroupolis, Greece Background: The aim of this study was to investigate the possible association of NGAL and type-2 diabetic nephropathy. Methods: The study included 24 patients who fulfilled WHO criteria for T2DM (11/13 m/f). Serum Glucose, creatinine (Cr), urinary albumin and Cr concentrations were measured using an automatic biochemical analyzer. Serum and urine NGAL (sNGAL/uNGAL) were detected by a sandwich EnzymeLinked ImmunoSorbent Assay kit (BioVendor, Czech Republic).The minimal detection limit was 0.02ng/ml. Serum samples were diluted 1:30 according to the instructions. Patients were divided into 2 groups according to their urinary albumin concentration: group 1 with normoalbuminuria (n=16), group 2 with microalbuminuria or macroalbuminuria (n=8). Results: In comparison with the age-sex-matched control group, patients with T2DM demonstrated a higher level of sNGAL 92.32ng/ml vs 59.32ng/ ml (p<0.001).The sNGAL level in second group was higher than in group 1: 182.85ng/ml vs 72.2ng/ml (p<0.001). Levels of uNGAL in group 2 were higher than in group1 (p<0.001). The level of sNGAL, but not uNGAL or the uNGAL/cr ratio was found to be directly and positively correlated with serum creatinine values (p<0.001). We also showed that sNGAL levels were not significantly correlated with the uNGAL and uNGAL/cr ratio. No significant correlation was found between s/uNGAL and Glucose level (p>0.05). Conclusion: Our results may suggest that serum NGAL maybe more useful in detecting the early stage of diabetic nephropathy since the content of serum NGAL changed more sharply than urine NGAL. We expect for more and more studies about NGAL and diabetic nephropathy in the future.
Methods: Throat swab was taken in search of the H1N1 virus and administration of oseltamivir (Tamiflu®) began. At the same time taking into account the chronicity of symptoms and radiological image, sputum culture was sent for Ziehl-Neelsen staining and search Mycobacterium tuberculosis by microscopy and PCR and we started administration of tuberculostatic treatment with streptomycin, ethambutol, rifampicin and isoniazid. Result: The patient became afebrile within two days from the initiation of antiviral therapy and proved positive for influenza A. Newer radiological assessment with chest CT showed thick walled cavities (caves) in the upper lung fields, bronchiectasis, peribronchial thickening, tree-in-bud image and enlarged mediastinal and hilar lymph nodes. Clinical suspicion confirmed by positive Ziehl-Neelsen stain and microscopic finding of mycobacteria and a positive PCR. The patient’s clinical condition improved, restored the hypoxia and took anti-tuberculosis treatment for nine months. Conclusion: The prevalence of TB is still important in populations with poor sanitation, which together with recent influenza pandemic should not be neglected. TAKO TSUBO CARDIOMYOPATHY ASSOCIATED WITH AN OVERDOSE OF THE SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITOR VENLAFAXINE Eduardo Oliveros Acebes, Salvador Gamez Casado, Maria Ferrer Civeira, Inma Muñoz Roldán, Marta Clavero Olmos, Alejandro García-Espona Pancorbo, Maria Victoria Villalba García, Cristina López Gozález- Cobos. Gregorio Marañon Hospital Background: Tako Tsubo (TTC) is a spontaneous and reversible myocardiopathy. It is often associated with physical or emotional stress. It is defined as a reversible acute left ventricular (LV) apical dysfunction. It can simulate acute coronary syndrome (ACS). Our objective is to describe a case of TTC after an overdose of Venlafaxine and to analyze clinical course and treatment of patients with TTC. Methods: We present a case of TTC after an overdose of Venlafaxine and a series of 20 patients with TTC admitted in our hospital between January 2009 And March 2011. Table1 Characteristics of 21 patients with TTC N Age % Female Thoracic pain % Dyspnoea % Emotional trigger % EAP% Shock % Death %
18 patients 65±16 years 85,7% (n=18) 52,4% (n=11) 19% (n=4) 33,3% (n=7) 19% (n=4) 14,3% (n=3) 1 patient
Results: A healthy 30-year-old woman admitted in the emergency room with sudden onset of breath shortness, after a Venlafaxine overdose for attempt of suicide.
A CASE OF COINFECTION FROM PULMONARY TUBERCULOSIS AND INFLUENZA A (H1N1) VIRUS Ioannis Dimitriadis1, Athanasios Panoutsopoulos1, Anna Tarantili1, Paraskevi Kalamara2, Konstantina Vogiatzi1, Paraskevi Papaioannou1, Georgios Andrianopoulos1. 1Department of Internal Medicine, General Hospital of Argos, Greece; 2Department of Radiology, General Hospital of Argos, Greece Background: The Mycobacterium tuberculosis infection and disease from pulmonary tuberculosis is still prevalent in populations with poor sanitary conditions. In conjunction with the pandemic of influenza A virus (H1N1), it should remain a high clinical suspicion of disease. Purpose: We discuss the case of a patient with newly diagnosed pulmonary tuberculosis who fell ill from influenza A. Materials: A 35 year-old patient, economic immigrant, employed in agricultural work and smoker presented with progressively worsening dyspnea during the last two months, cough and fatigue. An episode of spontaneous pneumothorax is reported from his medical history. During the clinical examination, we discovered a high fever (39.7°C) and SatO2 85%, reduction in respiratory whispering and radiological evaluation of the chest showed pulmonary infiltrates bilaterally with the formation of voids particularly in the upper lung fields.
S103
Fig 1.
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Abstracts from 10th Congress of the European Federation of Internal Medicine/European Journal of Internal Medicine 22S (2011) S1–S112
Tachypnea and diaphoresis, blood pressure 145/100 and oxygen saturation was 85%. Thorax X-Ray showed mild pulmonary edema. An EKG showed precordial T-wave inversion (Fig. 1). Echocardiogram demonstrated TTC apical ballooning. She was admitted in the intensive care unit and received an ACEinhibitor and a beta-blocker. She was completely recovered in the next 24 hours and her echocardiogram was normal. Conclusions: There has only been reported one case of TTC because of a Venlafaxine overdose. The physiopathology of TTS remains unknown; it could be related to sympathetic overstimulation. TTC simulates ACS, but has milder symptoms and better prognosis.
NECROTIC PURPURA: ETIOLOGICAL ASPECTS Malek Kechida, Olfa Harzallah, Rim Klii, Amira Hamzaoui, Silvia Mahjoub. Internal Medicine Department. Fattouma Bourguiba Hospital Background: Necrotic purpura is a clinical symptom of a wide spectrum of causes. The aim of our study was to analyze its etiological profile. Methods: Medical records of 24 patients presenting with a necrotic purpuric rash (as an initial symptom or during their follow up) were retrospectively analyzed. Results: Patients were 15 males and 9 females with a mean age of 45.5 years. Purpuric rash revealed the responsible disease in 20/24 patients. It occurred on average 14 days before the other symptoms. These symptoms were fever in 3 cases, gastro-intestinal bleeding in 9 patients, arthralgia/arthritis in 10 patients, abdominal pain in 7 patients and renal involvement in 6 cases. Skin biopsy was contributive in 17 patients showing leucocytoclastic vasculitis in 15 cases with IgA deposits in only 2 cases. IgA deposits were confirmed in another two cases by a renal biopsy. The most frequent cause of necrotic purpura was Henoch Schonlein Purpura in 12 cases. The other causes were Wegener granulomatosis in 1 case, Chürg Strauss syndrome in 1 case, rheumatoid arthritis in 1 case, polyarteritis nodosa in 3 cases, CMV infection in 1 case and drug induced purpura in 1 case. Cryoglobulin’s dosage, available in only half of patients, wasn’t positive in any case. Comments: Given its wide spectrum of causes, the etiological diagnosis of necrotic pupura requires often a deep investigation especially if it’s an isolated symptom. In our series, Henoch Schonlein purpura was the most frequent cause.
URINARY TRACT INFECTIONS AFTER ORTHOPAEDIC PROCEDURES AND RISK FACTORS Aikaterini Masgala1, Efstathios Chronopoulos2, Ioannis Lazarettos2, Georgios Nikolopoulos3, Stergios Lallos2, Emmanouil Brilakis2, Zoi Tagalaki1, Nikolaos Efstathopoulos2. 11st Department of Internal Medicine Konstantopoulio Hospital; 22nd Orthopedic Department University of Athens; 3Hellenic Centre Of Infection and Disease Control Background: Urinary retention is a common postoperative problem in orthopaedic surgery, so an indwelling Foley catheter is often needed. This poses an increased risk of bacteriuria or urinary tract infection. In our study we tried to identify the risk factors for urinary tract infection after orthopaedic procedures. Methods: This is a case control study. The cases (patients with infection) and controls (patients without infection) were matched only to number. As risk factors were considered the age, sex, type of operation (arthroplasty, fracture repair, spine surgery), chemoprophylaxis, type of anesthesia, time of surgical procedure (emerging or scheduled). We used logistic regression analysis to evaluate the risk factors for urinary tract infections. Results: During one year, 33 cases and 33 controls were recorded. Of the cases, 28 (86.7%) were females and 5 (13.3%) were males. Of the controls, 25 (77.8%) were females and 8 (22.2%) were males. The mean age for cases was 76.9 years and for controls 68.5 years. All patients carried urinary catheter for 3 to 7 days. Eschericia. coli was isolated in 12 (36.3%) patients, Pseudomonas aeruginosa in 10 (30.3%), Klebsiella pneumoniae in 4 (12.1%), Acinetobacter spp in 4 (12.1%) and Enterococcus spp. in 3 (9%) patients. Using logistic regression analysis we found that only the age was significant risk factor for urinary tract infection (p=0.015) Conclusion: The most common pathogen isolated was E. coli. Although the presence of urinary catheter is related to urinary tract infection, in our study age seems also to play important role.
LONG TERM OUTCOME OF CHRONIC HEPATITIS C PATIENTS SUCCESSFULLY TREATED WITH COMBINED ANTIVIRAL THERAPY Vasilis Papastergiou1, Lamprini Skorda2, Manolis Papamanolis1, Maria Stampori1, Niki Samara1, Philipos Lisgos1, Dimitris Mamalis1, Stylianos Karatapanis1. 1Liver Clinic, 1st Department of Internal Medicine, General Hospital of Rhodes; 2Department of Internal Medicine, “Konstantopoulio” General Hospital of Athens, Greece Background: Patients with chronic hepatitis C (CHC) who achieved sustained virological response (SVR) following standard combination therapy are traditionally considered “cured”. However the long-term outcome of these patients regarding late relapse of viremia and the progression of liver disease has not been fully elucidated. The aim of this study was to evaluate the long-term outcome of CHC patients who responded successfully to previous combined antiviral therapy. Methods: There were included 144 CHC patients (M/F=93/51, mean age = 46.2±9.4), in the present study. All patients had developed sustained viral response (SVR) following combination therapy with pegylated interferonalpha plus ribavirin. All patients had at least 12 months of follow-up after the end of treatment. During the follow-up period all participating patients have been retested for liver biochemistry every 6 months and for HCV-RNA at yearly intervals. Results: The mean duration of follow-up was 46 months (12-126 months). Distribution of genotypes was: genotype 1=76 patients (52.7%), genotype 2/3=38 patients (26.3%) and genotype 4=30 patients (20.8%). All patients retained their HCV-RNA negativity and no-one developed late relapse of viremia. Liver biochemical tests were persistently normal in 122/144 (84.7%) patients. One patient developed hepatocellular cancer (HCC) 3 years following the end of treatment and another decompensated cirrhosis 4 years after treatment. Conclusion: No recurrence of HCV viremia was observed among our study population. Long-term prognosis in CHC patients with an SVR to therapy is excellent. However, a case of late development of HCC and a case of decompensated cirrhosis were detected during long term follow-up.
NEUTROPHIL GELATINASE-ASSOCIATED LIPOCALIN (NGAL): A NEW MARKER OF DIABETIC NEPHROPATHY? Christina Tsigalou1, Theocharis Konstantinidis1,2, Milada Konstantinidou3, Gioulia Romanidou4,5, Eleni Konstantinidou1, Liana Fotiadou3, Ioanna Alexandropoulou2, Theodora Gioka1, A. Lygera3, Stella Argyriadou3, Georgia Kampouromiti1, Theodoros C. Constantinidis2. 1Immunology Department of Microbiology Laboratory, University General Hospital of Alexandroupolis, Alexandroupolis, Greece; 2Regional Public Health Laboratory (East Macedonia-Thrace) Alexandroupolis, Greece; 3Health Centre of Chrisoupolis, Kavalla, Greece; 4General Hospital “Sismanoglio” Komotini, Greece; 5Nephrology Department University Hospital of Alexandroupolis, Alexandroupolis, Greece Background: The aim of this study was to investigate the possible association of NGAL and type-2 diabetic nephropathy. Methods: The study included 24 patients who fulfilled WHO criteria for T2DM (11/13 m/f). Serum Glucose, creatinine (Cr), urinary albumin and Cr concentrations were measured using an automatic biochemical analyzer. Serum and urine NGAL (sNGAL/uNGAL) were detected by a sandwich EnzymeLinked ImmunoSorbent Assay kit (BioVendor, Czech Republic).The minimal detection limit was 0.02ng/ml. Serum samples were diluted 1:30 according to the instructions. Patients were divided into 2 groups according to their urinary albumin concentration: group 1 with normoalbuminuria (n=16), group 2 with microalbuminuria or macroalbuminuria (n=8). Results: In comparison with the age-sex-matched control group, patients with T2DM demonstrated a higher level of sNGAL 92.32ng/ml vs 59.32ng/ ml (p<0.001).The sNGAL level in second group was higher than in group 1: 182.85ng/ml vs 72.2ng/ml (p<0.001). Levels of uNGAL in group 2 were higher than in group1 (p<0.001). The level of sNGAL, but not uNGAL or the uNGAL/cr ratio was found to be directly and positively correlated with serum creatinine values (p<0.001). We also showed that sNGAL levels were not significantly correlated with the uNGAL and uNGAL/cr ratio. No significant correlation was found between s/uNGAL and Glucose level (p>0.05). Conclusion: Our results may suggest that serum NGAL maybe more useful in detecting the early stage of diabetic nephropathy since the content of serum NGAL changed more sharply than urine NGAL. We expect for more and more studies about NGAL and diabetic nephropathy in the future.