Призыв к бдительности в отношении лиц с суицидальным риском

Department of Psychiatry, Narcology and Medical Psychology Nicolae Testemitanu State Medical and Pharmaceutical University, Congresul III al Medicilor de Familie din Republica Moldova, 17–18 mai, 2012, Chişinău, Republica Moldova, Conferinţa Naţională „Maladii bronhoobstructive la copii”, consacrată profesorului universitar, doctor habilitat Victor Gheţeul, 27 aprilie, Chişinău, Republica MoldovaThe authors propose an approach, which urges the doctors to be more vigilant to keep in view signs indicating suicide behavior risk in patients who complain of a somatic disease problem. To facilitate this subtle assessment of the mental status, there have been presented a series of signs indicating that the patient is at a suicide risk limit. We showed a wide range of suicide risk factors, many of which are found in social and family environment of our country, especially on the background of endless social turmoil, economic and spiritual crisis, declining of the people`s living standards in Moldova. The report argues that the concern for early diagnosis and, particularly, for administration of complex remedial measures for people with suicidal behavior is extremely important.Авторы выступили с обращением к практикующим врачам, призывая их быть более бдительными, чтобы не упустить признаки, указывающие на суицидальный риск у пациента, обратившегося с соматической патологией. Для облегчения обследования/оценки психического статуса были представлены критерии, указывающие на то, что данный пациент находится на грани суицидального риска, а также широкий спектр факторов суицидального риска, связанных с социальной средой нашей страны, особенно на фоне нескончаемых социальных потрясений, экономического и духовного кризиса, снижения уровня жизни людей в Республике Молдова. Статья аргументирует чрезвычайную важность ранней диагностики и, особенно, принятия комплексных мер по коррекции и профилактике суицидального поведения

Apoptosis of microcardioplegia-protected myocardium in valvular heart disease

IMSP Spitalul Clinic Republican, IMSP IFP „Chiril Draganiuc”Apoptoza, definită iniţial ca moarte programată a celulei, depăşeşte acest cadru când este vorba de stări patologice, cum ar fi ischemia acută a miocardului. Apoptoza prezintă interes sporit ca componentă a schimbărilor survenite în miocardul pacienţilor cu valvulopatii cardiace, supuşi operatiilor pe cord deschis. Studiul a fost dedicat depistării semnelor de apoptoză pe fundalul ischemiei miocardului cauzate de clamparea aortei de diferită durată în operaţiile cu CEC si microcardioplegie la pacienţii fără precondiţionare ischemică. Studiul a inclus 25 de pacienţi cu valvulopatii reumatismale supuşi operaţiei de protezare a valvei mitrale şi anuloplastia valvei tricuspide. Pentru protecţia miocardului s-a aplicat cardioplegia sangvina cu K+ şi Mg++. Bioptatele din atriul drept prelevate iniţial, la 55 şi 110 min. de clamp aortal, colorate cu hematoxilină-eozină, Van-Gieson şi cu picrofuxină după metoda Lie au fost examinate la microscopul fotonic. La momentul clampării aortei concomitent cu schimbările ischemice cronice se evidenţiază modificări iniţiale caracteristice apoptozei: pierderea contactului intercelular, ondularea şi fragmentarea cardiomiocitelor, reducerea volumului celular, nucleul îşi pierde forma iniţială (alungire, bombare, fragmentare). Captarea fuxinei (ceea ce denotă gradul de hipoxie celulară) la această etapă este mai mult la nivelul unor organite citoplasmatice. La 55 minute de clamp aortal, respectiv după 2 reperfuzii, se observă cele mai vaste modificări microscopice ce definesc apoptoza. Hipoxia celulară este marcantă – fuxinofilia cuprinde toată aria celulară, celule solitare şi grupuri de celule. La 110 minute de clamp aortal, la cea de-a cincia microcardioplegie/reperfuzie, se observă modificări celulare caracteristice apoptozei de intensitate medie. Modificările hipoxice par a fi mai puţin manifestate. Concluzii: Ischemia miocardului indusă în operaţiile cu CEC stimuleaza procesul de apoptoză a cardiomiocitelor. Repertfuzia repetată a miocardului cu microcardioplegie atenuează schimbările hipoxice, lăsând impresia de precondiţionare a muşchiului inimii. Dezvoltarea apoptozei cardiomiocitelor impune aplicarea agenţilor cu efect antiapoptotic pe perioada arestului cardiac.Apoptosis, originally defined as programmed cell death, is beyond the framework when it comes to medical conditions such as acute myocardial ischemia. It is of increased interest as part of changes in the myocardium of patients with valvular heart disease, undergoing open heart surgery. The study includs 25 patients with rheumatic valvular heart disease undergoing prosthetic mitral valve surgery and tricuspid valve annuloplasty. For myocardial protection blood cardioplegia with K + and Mg + + was applied. Samples, taken from the right atrium at 1-2, 55 and 110 minutes after aortic cross-clamping, stained with hematoxylin-eosin, Van Gieson and Lie, were examined in photon microscope. At initial stage of aortic Xclamp, chronic ischemic changes are completed by changes proper for apoptosis: loss of intercellular contact, waving and cardiomyocyte fragmentation, reduced cell volume. The nucleus loses its original shape through elongation, swelling, fragmentation. Fuxin capture (which reveals a cellular hypoxia) at this stage is more of the cytoplasmic organelles. At 55 minutes of aortic clamp, i.e. after 2 reperfusion, were observed the largest microscopic changes that define apoptosis. Cellular hypoxia was marked: fuxinofilia includes all areas of solitary cells and cell clusters. At 110 minutes of aortic clamp, after the fifth microcardioplegy / reperfusion, apoptotic cellular changes are of medium intensity. Hypoxic changes appear to be less manifest. Conclusions: Myocardial ischemia induced by CPB operations stimulates cardiomyocyte apoptosis process. Repeated reperfusion of hypoxic myocardium with microcardioplegy attenuates hypoxic changes, giving the effect of preconditioning of the heart muscle. Development of cardiomyocyte apoptosis requires the application of antiapoptotic agents during cardiac arrest

Historical development issues in extracorporeal circulation service in Moldova

IMSP Spitalul Clinic Republica

Historical development issues in extracorporeal circulation service in Moldova

IMSP Spitalul Clinic Republica