84 32nd World Congress of Internal Medicine (October 24-28, 2014) WCIM 2014
PS 0148 Neurology
Increased Risk of Stroke and Post-Stroke Adverse Events in Patients with Diabetes: Two Nationwide Pop- ulation-Based Retrospective Cohort Studies
Yi-Chun CHOU1, Chien-Chang LIAO2, Ta-Liang CHEN2
China Medical University Hospital, Taiwan R.O.C1, Taipei Medical University Hospital, Taiwan R.O.C2 Background: The relationship between diabetes and stroke is not completely un- derstood. This study evaluated stroke risk and post-stroke mortality in patients with diabetes.
Methods: We identifi ed 24,027 adults newly diagnosed with diabetes in 2000-2003 using Taiwan’s National Health Insurance Research Database. A comparison cohort of 96,108 adults without diabetes was randomly selected from the same dataset, with frequency matched by age and sex. Stroke events in 2000-2008 were ascertained from medical claims. Adjusted hazard ratios (HRs) and 95% CIs of stroke associated with diabetes were calculated. A nested cohort study of 22,348 hospitalized stroke patients between 2000 and 2009 calculated adjusted odds ratios (ORs) and 95% CIs of adverse events after stroke in patients with and without diabetes.
Results: During 821,563 person-years of follow-up, there were 4,629 newly diagnosed stroke cases. The incidences of stroke for people with diabetes and without were 10.1 and 4.5 per 1,000 person-years, respectively (P < 0.0001). Compared with people with- out diabetes, the adjusted HR of stroke was 1.75 (95% CI 1.64-1.86) for people with diabetes. The ORs of post-stroke pneumonia, urinary tract infection, and mortality associated with diabetes were 1.28 (95% CI 1.10-1.37), 1.57 (95% CI 1.44-1.71), and 1.59 (95% CI 1.36-1.87), respectively.
Conclusions: Diabetes was associated with stroke. Patients with diabetes had more adverse events and subsequent mortality after stroke. Prevention of stroke and post- stroke adverse events is needed in this susceptible population.
PS 0149 Neurology
The Impact of Non-Motor Symptoms on Qol in Japa- nese Patients with Parkinson’s Disease: A Cross-Sec- tional Study
Mayumi TOYAMA1, Yasuyuki OKUMA2, Mitsutoshi YAMAMOTO3, Kenichi KASHIHARA4, Kazuto YOSHDA5, Hidemoto SAIKI6, Tetsuya MAEDA7, Yoshio TSUBOI8, Takeo NAKAYAMA1
Kyoto University, Japan1, Juntendo University Shizuoka Hospital, Japan2, Kagawa Prefectural Central Hospital, Japan3, Okayama Kyokuto Hospital, Japan4, Japanese Red Cross Asahikawa Hospital, Japan5, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Japan6, Research Institute for Brain and Blood Vessels Akita, Japan7, Fukuoka University, Japan8
Background: Parkinson’s disease (PD) is increasingly recognized as multidimensional disorder. In addition to classic motor symptoms, patients have a variety of non-motor symptoms (NMS) that substantially affect quality of life (QoL). However, the preva- lence of NMS and the relative impact of non-motor symptoms on QoL in PD have not been well documented in Japanese PD patients.
In this study, we have the following objectives:
1) To determine the prevalence of NMS in Japanese PD patients.
2) To study the impact of NMS on the QoL in Japanese PD patients.
Methods: This was a multi-center cross-sectional epidemiologic study. We recruited outpatients from seven Neurology departments at general hospitals across Japan between October 2010 and September 2011. A total of 824 Japanese PD patients was included in this study. NMS of patients was evaluated by Non-Motor Symptoms Scale (NMSS). Parkinson’s Disease Questionnaire-39 (PDQ-39) was used to evaluate the QoL of PD patients. Multivariate analyses were used to evaluate the direct impact of NMSs on QoL using PDQ-39, after adjusting for age, sex, disease duration, and the Unifi ed Parkinson’s Disease Rating Scale (UPDRS) Part I, Part II, Part III and Part IV.
Results: The mean of total NMSS score was 37.4±35.4. The highly prevalent NMSS do- mains were sleep/fatigue (87.6%) and urinary (86.1%). The highly prevalent NMSS items were nocturia (72.0%) and constipation (71.6%). In multivariate analyses after adjustment for age, sex, disease duration, UPDRS Part I, Part II, Part III, and Part IV, total score of NMSS has statistical signifi cance with PDQ-39 (p=0.00, ß=0.16, Adj-R squared=0.65).
Conclusions: NMS were highly prevalent in Japanese PD patients.
NMS have a direct negative impact on QoL in Japanese PD patients.
PS 0150 Neurology
Increased Risk of Fracture and Post-Fracture Adverse Events in Patients with Parkinson’s Disease: Two Nation- wide Population-Based Retrospective Cohort Studies
Chien-Chang LIAO1, Ta-Liang CHEN1 Taipei Medical University, Taiwan R.O.C1
Background: The relationship between Parkinson’s disease (PD) and fracture is not completely understood. This study evaluated fracture risk and post-fracture mortality in patients with diabetes.
Methods: We identifi ed 1624 adults aged 40 years and older newly diagnosed with PD in 2000-2003 using the Taiwan National Health Insurance Research Database. Com- parison cohort consisted of 6496 adults without PD randomly selected from the same dataset, frequency matched by age and sex. Events of fracture in 2000-2008 were ascertained from medical claims. Adjusted hazard ratios (HR) and 95% confidence interval (CI) of fracture associated with PD was calculated. Another nested cohort study consisting of 397,766 patients with fracture admission between 2004 and 2010 calculated the adjusted odds ratios (ORs) and 95% CIs of adverse events after fracture in patients with and without PD.
Results: During 51,287 person-years of follow-up, there were 1402 newly diagnosed fracture cases. The incidences of fracture for people with diabetes and without dia- betes were 40.4 and 24.1 per 1000 person-years, respectively (P < 0.0001). Compared with people without PD, the adjusted HR of fracture was 1.96 (95% CI 1.74-2.21) for people with PD. The ORs of post-fracture urinary tract infection, pneumonia, septice- mia, stroke, and mortality associated with PD were 1.61 (95% CI 1.54-1.69), 1.48 (95%
CI 1.40-1.56), 1.45 (95% CI 1.37-1.54), 1.50 (95% CI 1.41-1.60), and 1.27 (95% CI 1.18-1.38), respectively.
Conclusions: PD was associated with fracture. Patients with PD had more adverse events and subsequent mortality after fracture. Prevention of fracture and post-frac- ture adverse events is needed in this susceptible population.
PS 0151 Neurology
Arnold Chiari with Hemiparesis, Hemisensory Loss with Lower Cranial Nerve Palsy
Vikas ASATI1, Girish Bhageshwar RAMTEKE1, Vinatak JATALE1, Vep Prakash PANDEY1 MGM Medical College and MY Hospital, India1
The Chiari I malformation (CMI) is caudal displacement of cerebellar tonsils into cervical spinal-canal. CMI is defi ned by tonsillar herniation more than 5 mm below foramen-magnum, may be congenital or acquired. We are presenting case of Arnold chiari with hemiparesis, hemisensory loss with lower cranial nerve palsy. 50 year male, complaints of tingling, numbness left LL, UL since 7 months, Weakness left LL, UL 6 months, drycough, diffi culty in swallowing, regurgitation of food, headache 3 months.
Decubitus –supine position left leg extended laterally rotated, higher functions normal.
Trigeminal- there is loss of all sensation modalities on left side of face, Gag refl ex is normal with normal palatal movement, Left side shoulder cannot be raised, power of tongue is slightly decreased on left, resting nystagmus with fast component toward right side. On attempting to see right side nystagmus increases while on seeing to left decreases. Heel-knee, fi nger-nose-test on right side is normal, on left side unable to do due to motor weakness. MRI Brain parenchyma normal. Inferior cerebellar tonsillar herniation in dorsal subarachnoid space extending about 6-7 mm below the poste- rior arch of atlas-Chiari Malformation type I, Mild indentation is seen on the dorsal surface of upper cervical cord. Minimal inferior displacement of 4th ventricle, no hydrocephalus, no syrinx. Discussion: Chiari malformations consist of varying degree of ectopia of cerebellum. Incidence in MRI is between 0.56% and 0.77%.Type I: Elon- gation of tonsils and medial parts of the inferior lobes of cerebellum into cone-shaped projections, which accompany medulla oblongata into spinal canal. Type II Displace- ment of parts of inferior vermis, pons, medulla-oblongata together with elongation of fourth ventricle (most cases with spina bifi da). Type III The entire cerebellum herniates into the cervical canal. Type IV is with Cerebellar hypoplasia.
WCIM 2014 SEOUL KOREA 85
Poster Session
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
PS 0152 Neurology
Subacute Sclerosing Pan Encephalitis(SSPE): A Rare Presentation
Amith RAM1, Bhageshwar Girish RAMTEKE1, Anjali MATANI1, Apoorva PAURANIK1, Archana VERMA1, Anurag BAHEKAR1
MGM Medical College and MY Hospital, India1
Subacute Sclerosing Pan-Encephalitis is a prototype neurodegenerative disease of childhood characterised by onset of neurological symptoms between 5 and 15 years of age with a progressive downhill course and death within 2–4 years. Incidence of adult onset SSPE has been reported between 1–1.75% and 2.6%. To-date less than 140 cases of adult onset SSPE have been published, the majority being case reports.
A 24 year old male presented with progressive neurological syndrome characterised by very frequent myoclonic jerks associated with brief dystonic posturing of upper limbs for 8 months. No history of seizures, cognitive decline or personality changes, no history-of measles in childhood but immunized. Routine blood investigations normal.
EEG-periodic complexes, CSF- mild increase in proteins, normal sugar, cell count. Mea- sles antibody titre elevated, serum as well as CSF levels, CSF/serum antibody quotient 2.62 which was strongly suggestive of SSPE. Other antibody titres were unremarkable.
MRI-bilateral & near symmetrical T2 hyperintense signal in posterior putamen, slightly larger on right, restriction of diffusion & are hypo on T1. No cortical or white matter changes seen. Our patient is not classical case of SSPE. Atypical for age, late-onset, qualifi es as adult-onset of SSPE (defi ned onset after 18 years), well preserved cogni- tion. He did not have seizures, spasticity or visual complaints which are common. Im- aging fi ndings are also atypical as common fi ndings early in disease are white matter changes and cortical atrophy mainly in the posterior region of brain and the hyperin- tense signals seen in late course of the disease are seen early in this patient. EEG Ste- reotyped periodic complexes with normal background and is strongly suggestive SSPE.
MRI reveals T2 hyperintense lesions in bilateral putaminal region slightly larger on right side. Treatment: No curative-therapy is available, few disease-modifying agents have been tried which may delay progression.
PS 0153 Diabetes
Basal-Bolus Insulin Regimens and a Discharge-Strategy in Hospitalized Patients with Type 2 Diabetes Can Improve and Maintaining Control Glucemic During Several Years
Pedro REALES FIGUEROA1, Yasser HESSEIN ABDOU1, Maria MARTIN-TOLEDANO LUCAS1, Ibrahim HAMAD1, Adrian RUIZ FERNÁNDEZ1, Juan VELASCO FRANCO1, Marta SALAS CABAÑAS1
Hospital Gutierrez Ortega, Spain1
Aims: Current guidelines recommend the use of a basal-bolus insulin regimen in hospitalized patients with hyperglycemia or type 2 DM. In addition a simple strategy facilitating the rec- onciliation of medication on discharge can improve glycemic control post-discharge. With our study we want to test whether this better glycemic control is maintained over time.
Methods: Our study is a prospective and observational study during routine clinical prac- tice. It has been held in an Department of Internal Medicine during hospitalization, with follow-up visit at 3 months after discharge and followed up for 3 years. Study patients (30) were treated with a regimen of basal-bolus insulin during hospitalization and an adjustment of their antidiabetic treatment at discharge. As a control group we included patients(30) hospitalized with similar characteristics, treated with other regimen of insulin or oral antidi- abetic agents and to which either no treatment adjustment is recommended at discharge.
A follow-up to all patients at 3 months after discharge and again after 3 years I realize.
Results: Comparing the study group with the control group we found no differences in baseline HbA1c (8,52%±0,81 vs 8,61%±0.72; p:0,652), age (67,7±3,76 vs 67,8±3,71; p:0,86), sex (16 male vs 17 mal) and BMI (30,33±1,62 Kg/m2 vs 30,41±1,63 Kg/m2). Compared with baseline, the HbA1c at 3 months after discharge is lowe r(7,51%±0.81 vs 8,52%±0,81;p:0,001) and 3 years after discharge also remains lower(7,81%±0,81vs8,52%±0,81; p:0,013). Com- pared with control subjects, patients included in study have lower HbA1c at 3 months after discharge (7,51%±0,81 vs 8,71% ± 0,81:p:0,004) and lower HbA1c at 3 years after discharge (7,81%±0,81 vs 8,91%±0,81; p:0,002).
Conclusion: This study confi rm that protocols to manage hyperglycemia with basal-bolus insulin regimens are also feasible and effective in routine clinical practice, and demonstrate that a simple strategy facilitating the reconciliation of medication on discharge can im- prove glycemic control post-discharge, that remains after 3 years or follow.
