International Conference on Internal Medicine November 01-02, 2016 San Francisco, USA

Filomena Pietrantonio has completed her medical degree from Catholic University of the Sacred Heart of Rome and she has completed residencies in Internal Medicine (Catholic University of Sacred Heart, Rome), Clinical Psicology (University “Sapienza” of Rome) and Cardiology (Torvergata University of Rome). She is co-Director in internal Medicine Department in S. Eugenio Hospital in Rome. She has published 28 papers in reputed journals and has been serving as an editorial board member of International Journal of Community & Family Medicine.

Background: Chronic diseases are the major cause of death (59%) and disability, (46%) of global disease burden. According to the\r\nFuture Hospital Commission of the Royal College of Physicians, Medical Division (MD) will be responsible for all hospital medical\r\nservices from emergency to specialist wards focusing on the management of acute medical patients.\r\nMethods: To better manage polypathological patients requiring hospitalization, we propose the hospital counterpart of Chronic Care\r\nModel (CCM), the Acute Complex Care Model (ACCM). Target population is acutely ill complex and poly-pathological patients\r\n(AICPPs), admitted to hospital and requiring continuous monitoring and high technology resources. Th e mission is to improve\r\nthe AICPPs management through pre-defi ned intra-hospital tracks and a global, multidisciplinary, patient centered approach. Th e\r\nACCM leader is internal medicine specialist (IMS) who summarizes health problems, establishes priorities and restores health\r\nbalance in AICPPs. Admitted patients, evaluated according to validated criteria, should be allocated in High Dependency Areas\r\n(HDAs) to receive more frequent clinical and nursing monitoring than in ordinary wards, even if less than in Intensive Care Unit.\r\nACCM advantage is patient safety, thanks to a more favorable nurse/patients ratio, quicker responses to changes in clinical conditions\r\nand more functional allocation of resources.\r\nResults: Preliminary data collected in two Rome MD (50 patients) showed: Mean age 73 years, more than 4 active comorbidities, need\r\nof continuous monitoring, high technology resources, an average of 4 urgent investigations and 2 specialists consultations performed\r\nduring the fi rst 72 hours from admission.\r\nConclusions: Epidemiological transition leading to a progressive increase in “chronically unstable” patients needing frequent\r\nhospitalizations, enhances the role of hospital IMS. ACCM represents a practical response to this epochal change of roles.

Filomena Pietrantonio has completed her Medical degree from Catholic University of the Sacred Heart of Rome and has completed Residencies in Internal\r\nMedicine (Catholic University of Sacred Heart, Rome), Clinical Psychology (University “Sapienza” of Rome) and Cardiology (Torvergata University of Rome). She\r\nis the Co-Director in Internal Medicine Department in Sant’Eugenio Hospital in San Francisco, USA. She has published 28 papers in reputed journals and has been\r\nserving as an Editorial Board Member of International Journal of Community & Family Medicine.

Background & Aim: International guidelines demonstrate the importance of nutrition and lifestyle as risk factors in chronic diseases\r\n(CD). In order to validate the INS fi rst realized through a pilot study in the race Strafadoi Lazio, the same questionnaire (CRF) was\r\nadministered to a total of 157 athletes during 3 races in 2014.\r\nMethods: CRF was realized to identify, through a composite index, modifi able risk factors in causing CD taking into account: Weight,\r\ndiet and physical activity. Weight was measured using BMI according to the WHO stratifi cation, physical activity as weekly frequency\r\nand average activity duration. Foods were evaluated qualitatively enhancing their eff ect on metabolism and food combination.\r\nResults: INS was calculated by multiplying: Nutrition index, BMI index and physical activity index. Maximum INS value is 0.92\r\nstratifi ed in 4 ranges between 0.01 and 0.92 (very low - low high - very high ). Th e athlete sample, selecting individuals with normal\r\nBMI, doing regularly exercise and following balanced diet, shows high INS value: 0.47-0.69 (75% of the sample) and very high value:\r\n0.69-0.92 (23%). INS seems to be direct correlate with physical activity index (moderate direct correlation: 0.756) and less linked to\r\nnutritional index (0.408) and to BMI Index (0.472).\r\nConclusions: Th e INS is the fi rst composite index that combines nutritional status with other factors such as BMI and diet. Th e\r\nvalidation shows how it can be able to relate adequately to fundamental health determinants and can be a useful tool in evaluation of\r\nCD risk factors.

Kuladeep Krishna Gidda has obtained his MBBS degree from Sri Venkateswara Medical Colleg, India. He has worked at Vishnu Sree Hospital, Tirupati and\r\nimmigrated to the USA in 2015. He successfully passed the required examinations for ECFMG certifi cation and was ECFMG certifi ed in 2016. He was highly\r\nmotivated to perceive a career in the fi eld of internal medicine and currently participating in NRMP 2017.

A 50-year old female presented with two days of progressively worsening of shortness of breath, cough and muscle cramps in\r\nthe lower limbs. She had the history of frequent fl are up of asthma, 30 pack years of smoking history. Review of systems was\r\nremarkable for dry cough and shortness of breath for two days partially relieved with the rescue inhaler. She denied chest pain,\r\nexcessive sweating, palpitations and passing out. Vitals, blood pressure 110/68, pulse 90 bmp, temp 98.2 F recorded orally, respiratory\r\nrate 24/min with saturation 94%. She had wheeze at both the lung bases. CVS examination was normal. EKG showed normal sinus\r\nrhythm. She used 8 to 10 times a day the rescue inhaler containing Levalbuterol in the past three days. Labs revealed WBC of 11 with\r\n10% eosinophils, CPK was 98 U/L, her serum electrolytes Na 140 mEq/L, K 3.3 mEq/L, Ca 9.2 mEq/L, Cl 100 mEq/L, HCO3 22 mEq/L,\r\nchest X-ray showed non-specifi c fi ndings related to obstructive lung disease. Peak fl ow meter readings were low. Ankle brachial index\r\nscore of 1.2, arterial Doppler lower extremities showed no abnormalities. All the above lab workup revealed no abnormalities except\r\nincreased eosinophil count and low potassium levels. She was not on any drugs which are known to lower serum potassium levels,\r\naft er doing all the work up she was prescribed with starting dose of 40 mg oral prednisone tapered in one week, Tudorza inhaler and\r\nasked her to hold the rescue inhaler and follow-up in 1 week. During her follow-up visit, she told that her symptoms were relieved\r\nand repeated electrolyte labs were normal. Shortness of breath and cough are the common problems encountered by the Internist. But\r\nmuscle cramps in patients taking beta agonist inhaler are usually rare. Even though she has 30 pack years of smoking history, normal\r\nankle brachial index and arterial Doppler ruled out the peripheral artery disease. Normal CPK ruled out infl ammatory causes of her\r\ncomplaint. Th e point is an orderly approach is imperative in determining the less common causes of this problem. One approach is\r\ntaking a detailed history and sorting out the reasons for the problem so that the possibility of missing the rare causative factors can\r\nbe minimized and also the unnecessary diagnostic workup can be prevented. In this patient with known history of asthma presenting\r\nwith worsening shortness of breath and cough clearly indicates as an asthmatic fl are up. But with detailed history it became evident\r\nthat she used rescue inhaler an excessive number of times a day than suggested, giving the clues for her lower limb muscle cramps.\r\nLevalbuterol, a short-acting beta agonist, is the drug present in her rescue inhaler which can rarely lower the serum potassium level\r\ncausing the muscle cramps. Physicians should be profi cient in addressing rare possibilities. Understand the side eff ects of the drugs\r\nof asthma. Although widely studied in the literature, recognize that short-acting beta agonist (SABA) in an inhaled quantity is an\r\nuncommon cause of muscle cramps. SABA causing muscle cramps should be suspected in a patient with decreased serum potassium\r\nlevels with no other known factors for lowering potassium and when rest of the workup is normal. Th is case illustrates that SABA even\r\nin inhaled amounts can cause muscle cramps mostly when taken more than six times a day.

Ayda Javanbakht has completed her medical doctorate at the age of 25 years from Mashhad university of medical sciences, Iran

It is estimated that 15% of people are infertile in industrialized nations, and it has become a top priority for many health organizations and governments. The reasons of infertility are categorized in three different groups: genetic, anatomic and environmental factors. Infection is one of the environmental reasons that can cause infertility in male and female. human papillomaviruses (HPVs) can cause different malignancies in asymptomatic women. The role of HPVs in causing infertility in male and female is controversy. In this study, we compared the frequency of HPVs in fertile and infertile women. In this case control study from 2014-2016, both cervical and vaginal smears were prepared from infertile and fertile women in Mashhad, Iran. HPVs were detected by polymerase chain reaction. All data were analyzed by SPSS v.16 and p value <0.05 considered as statistical significant. In the current study, 115 infertile women with the mean age of 30.5±5.6 years and 90 fertile women with the mean age of 32.6±9.3 years were included (p=0.07). Among women who were infertile (cases), 121(52.6%) of 230 smears were positive, while in control group (who were fertile), 75 (41.7%) of 180 smears were positive (p=0.052). There was no significant differences between having history of previous abortion between groups (p=0.07). The frequency of HPV had no statistically significant association among infertile and fertile women. However, the prevalence of HPV in both groups of the participants was high.