WCIM 2014 SEOUL KOREA 101
Poster Session
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
PS 0210 Family Medicine
Stagnating and Low Infl uenza Vaccine Coverage among Polish Elderly in 2008-2012
Ewa GYRCZUK1, Aneta NITSCH-OSUCH1, Katarzyna ZYCINSKA1, Kazimierz WARDYN1 Warsaw Medical University, Poland1
Background: Despite having no higher attack rate than in younger adults, infl uenza’s effects are more signifi cant in older adults. It has been recognized for many years that people 65 years and older are at greater risk of serious complications from infl uenza compared with young, healthy adults. There is a limited literature on the vaccination coverage rates in Central Eastern European countries, including Poland. The aim of the study was to describe the infl uenza vaccine coverage among the Polish elderly aged
> 65 years in a fi ve years period 2008-2012- in a general population and in a single primary care setting.
Methods: The retrospective analysis of infl uenza vaccine coverage among patients older than 65 years from a single primary care clinic was conducted. The payment of infl uenza vaccine for the elderly was provided by a local goverment. The inactivated trivalent split vaccine was used for all vaccinated patients. Patients were informed about the free infl uenza vaccines by standing posters at the clinic. Age and sex dis- tribution of patients who decided to be vaccinated against infl uenza was described as well as the willingness to repeat the vaccination during consecutive seasons. The vaccine coverage rate was calculated as a percentage of vaccinated individuals among all patients over the age of 65 years.
Results: In the analyzed period, 2008-2012, the infl uenza vaccine coverage among the elderly in a general Polish population ranged from 7,6% (in 2012 ) to 11,3% (in 2009).
In a single primary care setting the infl uenza vaccine coverage rate among seniors was the highest one in 2010 (31,56%) and the lowest one in 2012 (21%). Generally, less than 50% of vaccine doses were given every year to the elderly.
Conclusions: Infl uenza vaccine coverage among Polish elderly is on stagnating low level.
PS 0211 Family Medicine
The Realities of the Russian Out-Patient Clinic: The Patient with a Chronic Pain Syndrome
Arkadiy VERTKIN1, Anna NOSOVA1 Moscow State Medical University, Russia1
Background: During the period of one week a random screening study of the inci- dence of the outpatients with somatic pathology visits was carried out. From 106 per- sons the major part was women of the middle working age. 2/3 of the older patients applied regarding acute exacerbation of chronic somatic diseases. Only 8% complained of pains.Active questioning revealed that 90% had a pain syndrome.
Methods: They had been suffering from pains for a long time: 33% - for 1-3 years, 27% - for 5-10 years and 34% suffered long intensive pain. 36% came to the outpa- tient department to see a general internist.
Results: But unfortunately the general internist pays attention to it only in 24% of the cases and indicates pain in the diagnosis. The patient tries to cut short the pain syndrome. The choice of NSAID is frequently empiric. So, the patient takes medicines which he often chooses by himself, without the doctor’s participation in spite of the fact that together with NSAID it is necessary to take daily some preparations for the other somatic diseases. Besides, for many patients pain control means treatment combined with gluco-corticosteroids, while anticoagulants are added to the treat- ment of the patients with AF. All of them have high risks of side effects in the form of hemorrhage.But in 76% of the cases the patients are not informed and in 68% of the cases the doctor doesn’t carry out the monitoring survey.In connection with the above it is necessary to use a preparation with the minimum of side effects, with the signifi cant pain alleviating effect – amtolmetin guacil – NO donator, providing for the protection function of the GI tract mucous membrane.
Conclusions: This causes the pain syndrome progressing which brings about the patient’s life quality degradation and this gives rise to depression, anxiety, a sense of helplessness.
PS 0212 Gastroenterology
Glucocorticoid Therapy is Accompanied by Induction of Gastroparesis
Sybille D. REICHARDT1, Martin OPPERMANN1, Holger M. REICHARDT1 University of Göttingen Medical School, Germany1
Glucocorticoids (GCs) are widely used in the clinic to treat autoimmune and atopic diseases but they also cause many side-effects. Here we characterized a yet unknown activity of GCs in the stomach, namely the induction of gastroparesis by oral applica- tion of dexamethasone. Using conditional knock-out mice we initially ruled out that enterocytes or macrophages were responsible for the observed effect. This finding suggested that the stomach itself was the primary target of GC action. Against our expectations, however, impaired gastric emptying was also unrelated to the enhanced HCl production after dexamethasone administration. In contrast, we found that oral GC therapy up-regulated arginase 2 in the stomach. Importantly, this effect should lead to the depletion of L-arginine and thereby impede production of nitric oxide, which is required for gastric motility. In support of this notion, supplementing the drinking water with L arginine prevented the induction of gastroparesis by dexameth- asone in mice. Our fi ndings suggest that combining L-arginine with orally applied GCs might reduce treatment-related gastrointestinal complications. Furthermore, our data provide a plausible explanation for the well-known anti-emetic effect of GCs. In the future it will be intriguing to explore whether the observed phenomenon can be con- fi rmed in patients under high-dose GC therapy as well.
PS 0213 Gastroenterology
Electrophysiological Characterization of Gastrointesti- nal Tract Motility in Patients with Axial Hiatal Hernia
Viacheslav MATIANIN1, Pavel KOSENKO1, Sergey VAVRINCHUK1 Regional Hospital Number Two, Russia1
Background: Evaluation of electrophysiological parameters of gastrointestinal tract motility in patients with axial hiatal hernia.
Methods: Object of study is 20 patients with axial hiatal hernia. The studied phenom- enon is electrophysiological indicators of gastrointestinal tract motility. The method of investigation is peripheral electrogastroenterography (PEGEG) with the help of
“Gastroskan-HEV” device according to standard procedures. Static data processing is a discriminative analysis.
Results: The analysis of peripheral electrogastroenterography (PEGEG) indicators for patients with axial hiatal hernia revealed statistically signifi cant changes of 22 indica- tors mainly due to changes of Pi, Pi/Ps, Pi/P(i +1) parameters and Krhythm. Signifi cant differences with the control group are revealed on basal and stimulated Pi, Pi/Ps, Pi/
P(i +1) parameters and Krhythm of stomach, duodenum and colon. There was a sta- tistically signifi cant doubling in basal and stimulated values of Pi/P(i +1) of stomach / duodenum, indicating that there was a motor discoordination of gastroduodenal junc- tion. Change in colon PEGEG indicators in our opinion has been associated with the presence of neuro-refl ex connections between the stomach and colon, and manifested in a signifi cant increase in the stimulated Pi/Ps colon index. During the discriminative analysis of PEGEG indicators the patients with axial hiatal hernia were distributed in a separate from the control group with 97.7% accuracy.
Conclusions: The discriminative analysis of PEGEG indicators in patients with axial hiatal hernia revealed signifi cant changes of 22 PEGEG indicators mostly of stomach and colon, refl ecting violations of discoordination of gastrointestinal motor activity with a high degree of difference from the group of healthy individuals.
