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THE EFFECTS OF FATIGUE AND PAIN ON DAILY LIFE ACTIVITIES IN SYSTEMIC LUPUS ERYTHEMATOSUS
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Abstracts from 10th Congress of the European Federation of Internal Medicine/European Journal of Internal Medicine 22S (2011) S1–S112
The likelihood of being on thiazide diuretics increased with hyponatremia severity (P<0.0001) and patients in group 1 were 3.6 times (CI95%:1.9-6.8) more likely to be on thiazide diuretics compared to group 4. The in-hospital mortality ranged between 2-7% between the groups (NS). One patient developed osmotic demyelinisation syndrome but survived. Only 31% of patients in group 1 were evaluated with a basic laboratory investigation. Conclusions: Thiazide diuretics and SIADH were dominating etiologies, however, the frequency of adequate diagnostic testing was low. SCREENING FOR ADRENAL FAILURE IN PATIENTS WITH TYPE 2 DIABETES MELLITUS AND RECURRENT HYPOGLYCAEMIA Nantia Othonos1, Logan Manikam1, Harit Buch1 & Rousseau Gama1,2. 1 Departments of Clinical Chemistry, New Cross Hospital, Wolverhampton, West Midlands, UK; 2Research Institute, Healthcare Sciences, Wolverhampton University, Wolverhampton, West Midlands, UK Background: Addison’s disease is known to be associated with type 1 diabetes mellitus (T1DM) as part of the autoimmune polyendocrine syndromes. However, there is no such association between adrenal failure and type 2 diabetes mellitus (T2DM). We, therefore, retrospectively audited referrals for short synacthen tests (SST) on patients with T2DM. Methods: A Seven year retrospective study was undertaken were we looked at the indications for and results of SST on patients with T2DM referred for exclusion of adrenal failure. A normal SST was defined as a serum cortisol increase of >200 nmol/l over baseline and peak serum cortisol response >550 nmol/l. Results: There were 89 referrals SSTs in patients with T2DM. Recurrent hypoglycaemia was the sole indication for a SST in 55 patients and in 4 patients in combination with other indications such as weight loss. Seventeen SSTs were performed on patients with known or suspected hypothalamic–pituitary– adrenal axis disorder including three on long-term steroids. The remaining 12 SSTs were requested for other miscellaneous indications. Three patients had suboptimal cortisol responses to synacthen, all of who were on longterm steroid therapy. Conclusion: In this study we have shown that all patients with T2DM who had SST because of recurrent hypoglycaemia had normal SSTs. It is, therefore, recommended that patients with T1DM with unexplained recurrent hypoglycaemia be screened for Addison’s disease. However, patients with T2DM and recurrent hypoglycaemia should not be referred for SST in the absence of other features of adrenal failure as association with Addison’s disease is uncommon. TUBERCULOSIS-INDUCED IMMUNE HEMOLYTIC ANEMIA: 2 CASE REPORTS Suayp Oygen, Mehmet Hursitoglu, Gulkan Kaplan, Ledjana Kllogjeri, Asli Gokbelen, Ozge Vural, Fatih Borlu. Sisli Etfal Training And Research Hospital, Istanbul, Turkey Introduction: Normochrom normocythic anemia (NNA) is the most frequent hematological finding in tuberculosis (TB) but Immune hemolytic anemia (IHA) is very rare. We represented 2 cases of úHA due to TB. Case 1: A 38-year-old previously healty male was admitted to our hospital because of recent onset of fever, rash and scleral jaundice. Physical examination(PE) revealed axillary temperature 37.5°C, macular rash on his back, scleral jaundice and 1cm palpable hepatomegaly. On admission hemoglobin (Hb) was 8.5g/dl and compatible with anemia of chronic disease. On the 5th day of admission, Hb decreased to 6.2g/dl without any sign of bleeding. Low haptoglobulin level and positive Coombs’ tests indicated úHA and steroid therapy was started(for a short period). On control chest x-ray film there was new onset of bilateral peural effusion. Sputum test for acid-fast bacilli(AFB) was positive. Patient’s miliary TB and anemia responded well to anti-TB treatment. Case 2: A 74 year-old male, with history of partial gastrectomy due to peptic ulcer 20 years ago, referred for investigation of 9.0g/dl Hb level. There was clubbing on PE. Laboratory findings revealed positive Coombs’ tests and low haptoglobulin level. There was a cavitary lesion on thorax CT. Sputum tests for AFB were positive. The patient’s IHA attributed to TB and treated accordingly. Conclusion: IHA is very rare in TB. Treatment options are steroid and anti-TB drugs. In the first case, due to milliary TB we initiated steroid for a short period but both patients’ clinical picture was improved by anti-TB treatment.
THE EFFECTS OF FATIGUE AND PAIN ON DAILY LIFE ACTIVITIES IN SYSTEMIC LUPUS ERYTHEMATOSUS Filiz Özel1, Gülümser Argon2. 1Ege University School of Nursing Internal Medicine Nursing Department, Doctorate Student, Turkey; 2Ege University School of Nursing Internal Medicine Nursing Department, Prof., Turkey Background: Systemic Lupus Erythematosus (SLE) is an autoimmune disease affecting young people in their most productive years. As with many chronic diseases, fatigue and pain are the symptoms of SLE, affecting the activities of daily life. The aim of this study was to determine the effects of the pain and fatigue on daily life activities of SLE patients. Methods: The study sample included 74 SLE patients in a university hospital and two local hospital outpatient departments between 30.9.2009 and 15.5.2010. Data was collected using the Fatigue Severity Scale, Katz’s Daily Life Activities Index, Lawton and Brody’s Instrumental Daily Life Activities Index, and the McGill Pain Scale. Results: The mean scores were 6.0 (fatigued) on the Fatigue Severity Scale, 18.0 (independent) on the Daily Life Activities Index, 24.0 (independent) on the Instrumental Daily Life Activities Index, and 1.56 (discomforting) for pain felt at the moment of questioning on the McGill Pain Scale. A low-level negative relationship was observed between scores on the Fatigue Severity Scale and the Daily Life Activities Index (p<0.05, r = -0.298), and between Fatigue and Instrumental Daily Life Activities scores (p<0.05, r = -0.354). A medium-level positive relationship was observed between scores on the Fatigue Severity Scale and the McGill Pain Scale (p<0.05, r = 0.478). Conclusion: This study determined that pain and fatigue affected the daily lives of SLE patients. The study should be repeated on a larger sample. Key words: Systemic lupus erythematosus, pain, fatigue WHEN TO ADJUST SERUM CHLORIDE FOR ANION GAP CALCULATION? Mustafa Gezer, Fatih Bulucu, Kadir Ozturk, Orhan Demir. Gulhane school of medicine Department of internal medicine Backround: Different methods have been suggested and used to correct serum chloride levels, necessary for calculation of anion gap, due to changes in sodium levels. Therefore in the present study, it was investigated whether serum chloride levels correction is always necessary for anion gap calculation. Method: Four hundred nine (409) serum chloride levels were collected, retrospectively. Some of them were obtained from the same patients in different times and conditions. Subsequently, all serum chloride levels were corrected by using to the two methods suggested in AcidBase.org ( they make correction considering absolute difference between serum sodium and chloride levels or using its proportion to serum sodium levels) and the method suggested by Feldman et al(they suggest another formula). Then, all the data were divided into three groups, according to the serum sodium levels, as hyponatremia, normonatremia and hypernatremia groups. Result: The serum chloride levels were compared to the adjusted chloride levels derived from above mentioned methods. in both hyponatremic and hypernatremic groups the measured serum chloride levels were different from those of the adjusted chloride levels(p<0.001 for all comparisons). however, there was no statistical significance among these parameters in normonatremic group. Conclusion: It seems that there is no necessity to adjust serum chloride levels in calculation of serum anion gap of normonatremic patients. HICCUPS – FIRST SYMPTOM OF NEUROLOGIC MALFORMATION Monica Palma Anselmo, Luciana Bento, Renata Ribeiro, Henrique Martins. Serviço Medicina I, Hospital Fernando Fonseca, Amadora, Portugal Hiccups usually present as a common annoyance lasting for short periods. Rarely, it may be the sign of a serious disease. We present a case of 27 years-old man with 2 weeks history of hiccups which triggered his visit to A&E department. A further history of slight left hand hemiparesis, nausea and vomiting was elicited. Hiccups were regular (one every 4 seconds) and only stopped during sleep. Initial neurologic examination suggested peripheral pathology. Laboratory evaluation revealed: Hemoglobin 14.2 g/dL; Leucocites 8200; CRP 2.39 mg/dL; Electrolyte concentrations were normal as well as hepatic and kidney function panels. Abdominal ultrasound and CT scan had pathologic changes. Subsequent
Abstracts from 10th Congress of the European Federation of Internal Medicine/European Journal of Internal Medicine 22S (2011) S1–S112
The likelihood of being on thiazide diuretics increased with hyponatremia severity (P<0.0001) and patients in group 1 were 3.6 times (CI95%:1.9-6.8) more likely to be on thiazide diuretics compared to group 4. The in-hospital mortality ranged between 2-7% between the groups (NS). One patient developed osmotic demyelinisation syndrome but survived. Only 31% of patients in group 1 were evaluated with a basic laboratory investigation. Conclusions: Thiazide diuretics and SIADH were dominating etiologies, however, the frequency of adequate diagnostic testing was low. SCREENING FOR ADRENAL FAILURE IN PATIENTS WITH TYPE 2 DIABETES MELLITUS AND RECURRENT HYPOGLYCAEMIA Nantia Othonos1, Logan Manikam1, Harit Buch1 & Rousseau Gama1,2. 1 Departments of Clinical Chemistry, New Cross Hospital, Wolverhampton, West Midlands, UK; 2Research Institute, Healthcare Sciences, Wolverhampton University, Wolverhampton, West Midlands, UK Background: Addison’s disease is known to be associated with type 1 diabetes mellitus (T1DM) as part of the autoimmune polyendocrine syndromes. However, there is no such association between adrenal failure and type 2 diabetes mellitus (T2DM). We, therefore, retrospectively audited referrals for short synacthen tests (SST) on patients with T2DM. Methods: A Seven year retrospective study was undertaken were we looked at the indications for and results of SST on patients with T2DM referred for exclusion of adrenal failure. A normal SST was defined as a serum cortisol increase of >200 nmol/l over baseline and peak serum cortisol response >550 nmol/l. Results: There were 89 referrals SSTs in patients with T2DM. Recurrent hypoglycaemia was the sole indication for a SST in 55 patients and in 4 patients in combination with other indications such as weight loss. Seventeen SSTs were performed on patients with known or suspected hypothalamic–pituitary– adrenal axis disorder including three on long-term steroids. The remaining 12 SSTs were requested for other miscellaneous indications. Three patients had suboptimal cortisol responses to synacthen, all of who were on longterm steroid therapy. Conclusion: In this study we have shown that all patients with T2DM who had SST because of recurrent hypoglycaemia had normal SSTs. It is, therefore, recommended that patients with T1DM with unexplained recurrent hypoglycaemia be screened for Addison’s disease. However, patients with T2DM and recurrent hypoglycaemia should not be referred for SST in the absence of other features of adrenal failure as association with Addison’s disease is uncommon. TUBERCULOSIS-INDUCED IMMUNE HEMOLYTIC ANEMIA: 2 CASE REPORTS Suayp Oygen, Mehmet Hursitoglu, Gulkan Kaplan, Ledjana Kllogjeri, Asli Gokbelen, Ozge Vural, Fatih Borlu. Sisli Etfal Training And Research Hospital, Istanbul, Turkey Introduction: Normochrom normocythic anemia (NNA) is the most frequent hematological finding in tuberculosis (TB) but Immune hemolytic anemia (IHA) is very rare. We represented 2 cases of úHA due to TB. Case 1: A 38-year-old previously healty male was admitted to our hospital because of recent onset of fever, rash and scleral jaundice. Physical examination(PE) revealed axillary temperature 37.5°C, macular rash on his back, scleral jaundice and 1cm palpable hepatomegaly. On admission hemoglobin (Hb) was 8.5g/dl and compatible with anemia of chronic disease. On the 5th day of admission, Hb decreased to 6.2g/dl without any sign of bleeding. Low haptoglobulin level and positive Coombs’ tests indicated úHA and steroid therapy was started(for a short period). On control chest x-ray film there was new onset of bilateral peural effusion. Sputum test for acid-fast bacilli(AFB) was positive. Patient’s miliary TB and anemia responded well to anti-TB treatment. Case 2: A 74 year-old male, with history of partial gastrectomy due to peptic ulcer 20 years ago, referred for investigation of 9.0g/dl Hb level. There was clubbing on PE. Laboratory findings revealed positive Coombs’ tests and low haptoglobulin level. There was a cavitary lesion on thorax CT. Sputum tests for AFB were positive. The patient’s IHA attributed to TB and treated accordingly. Conclusion: IHA is very rare in TB. Treatment options are steroid and anti-TB drugs. In the first case, due to milliary TB we initiated steroid for a short period but both patients’ clinical picture was improved by anti-TB treatment.
THE EFFECTS OF FATIGUE AND PAIN ON DAILY LIFE ACTIVITIES IN SYSTEMIC LUPUS ERYTHEMATOSUS Filiz Özel1, Gülümser Argon2. 1Ege University School of Nursing Internal Medicine Nursing Department, Doctorate Student, Turkey; 2Ege University School of Nursing Internal Medicine Nursing Department, Prof., Turkey Background: Systemic Lupus Erythematosus (SLE) is an autoimmune disease affecting young people in their most productive years. As with many chronic diseases, fatigue and pain are the symptoms of SLE, affecting the activities of daily life. The aim of this study was to determine the effects of the pain and fatigue on daily life activities of SLE patients. Methods: The study sample included 74 SLE patients in a university hospital and two local hospital outpatient departments between 30.9.2009 and 15.5.2010. Data was collected using the Fatigue Severity Scale, Katz’s Daily Life Activities Index, Lawton and Brody’s Instrumental Daily Life Activities Index, and the McGill Pain Scale. Results: The mean scores were 6.0 (fatigued) on the Fatigue Severity Scale, 18.0 (independent) on the Daily Life Activities Index, 24.0 (independent) on the Instrumental Daily Life Activities Index, and 1.56 (discomforting) for pain felt at the moment of questioning on the McGill Pain Scale. A low-level negative relationship was observed between scores on the Fatigue Severity Scale and the Daily Life Activities Index (p<0.05, r = -0.298), and between Fatigue and Instrumental Daily Life Activities scores (p<0.05, r = -0.354). A medium-level positive relationship was observed between scores on the Fatigue Severity Scale and the McGill Pain Scale (p<0.05, r = 0.478). Conclusion: This study determined that pain and fatigue affected the daily lives of SLE patients. The study should be repeated on a larger sample. Key words: Systemic lupus erythematosus, pain, fatigue WHEN TO ADJUST SERUM CHLORIDE FOR ANION GAP CALCULATION? Mustafa Gezer, Fatih Bulucu, Kadir Ozturk, Orhan Demir. Gulhane school of medicine Department of internal medicine Backround: Different methods have been suggested and used to correct serum chloride levels, necessary for calculation of anion gap, due to changes in sodium levels. Therefore in the present study, it was investigated whether serum chloride levels correction is always necessary for anion gap calculation. Method: Four hundred nine (409) serum chloride levels were collected, retrospectively. Some of them were obtained from the same patients in different times and conditions. Subsequently, all serum chloride levels were corrected by using to the two methods suggested in AcidBase.org ( they make correction considering absolute difference between serum sodium and chloride levels or using its proportion to serum sodium levels) and the method suggested by Feldman et al(they suggest another formula). Then, all the data were divided into three groups, according to the serum sodium levels, as hyponatremia, normonatremia and hypernatremia groups. Result: The serum chloride levels were compared to the adjusted chloride levels derived from above mentioned methods. in both hyponatremic and hypernatremic groups the measured serum chloride levels were different from those of the adjusted chloride levels(p<0.001 for all comparisons). however, there was no statistical significance among these parameters in normonatremic group. Conclusion: It seems that there is no necessity to adjust serum chloride levels in calculation of serum anion gap of normonatremic patients. HICCUPS – FIRST SYMPTOM OF NEUROLOGIC MALFORMATION Monica Palma Anselmo, Luciana Bento, Renata Ribeiro, Henrique Martins. Serviço Medicina I, Hospital Fernando Fonseca, Amadora, Portugal Hiccups usually present as a common annoyance lasting for short periods. Rarely, it may be the sign of a serious disease. We present a case of 27 years-old man with 2 weeks history of hiccups which triggered his visit to A&E department. A further history of slight left hand hemiparesis, nausea and vomiting was elicited. Hiccups were regular (one every 4 seconds) and only stopped during sleep. Initial neurologic examination suggested peripheral pathology. Laboratory evaluation revealed: Hemoglobin 14.2 g/dL; Leucocites 8200; CRP 2.39 mg/dL; Electrolyte concentrations were normal as well as hepatic and kidney function panels. Abdominal ultrasound and CT scan had pathologic changes. Subsequent