Disglicemiile la pacienții cu COVID-19

Timofei Mosneaga Republican Clinical Hospital, Endocrinology Department, Nicolae Testemitanu SUMPhBackground. SARS-CoV-2 infection contributes to the development of extrapulmonary manifestations such as diabetes mellitus and stress hyperglycemia, both of which have poor prognosis, higher rate of complications and increased risk of mortality. Objective of the study. The aim of the study was to evaluate the rate of people with different degree of dysglycemia among hospitalized patients with confirmed COVID-19. Material and Methods. The study is retrospective. We analyzed fasting blood glucose in 1791 patients with severe forms of COVID-19 during their hospitalization period and treatment of SARS-CoV-2 infection. HbA1c was evaluated at people with high fasting blood glucose levels to reveal the pre-existing diabetes. Results. The mean age of the patients included in the study was 57.72 ± 12.34 years, the mean value of BMI was 30.54 ± 5.51 kg / m2, the average level of fasting blood glucose value was 8.66 ± 4.45 mmol/l and HbA1c - 7.2 ± 1.94%. According to anamnestic data at admission 22% of patients knew about their diabetes. Blood glucose analysis during hospitalization showed that only 28% of patients had blood glucose levels within normal values. Analyzing the level of fasting blood glucose and HbA1c, primary diabetes was diagnosed in 7% of patients, prediabetes in 15% and 28% of patients had solitary changes in fasting blood glucose. Conclusion. To conclude, SARSCoV-2 infection predisposes to appearance of dysglycemia in patients with severe forms of COVID-19, especially in people with risk factors for the development of diabetes (age, obesity, cardiovascular disease etc.) and those who have administered glucocorticoid treatment.Introducere. Infecția SARS-CoV-2 poate contribui la dezvoltarea manifestărilor extrapulmonare, așa ca diabetul zaharat și hiperglicemia, ambele având un prognostic nefavorabil și un risc sporit de mortalitate. Scopul lucrării. Analiza ratei persoanelor care au prezentat diferit grad de disglicemii, printre pacienții cu forme severe de COVID-19. Material și Metode. Am analizat glicemia a jeun la 1791 de pacienți cu forme severe de COVID-19, la momentul spitalizării și pe parcursul tratamentului infecției SARS-CoV-2. La persoanele cu valori majorate ale glicemiei a jeun a fost efectuată HbA1c, pentru a exclude diabetul zaharat preexistent. Rezultate. Pacienții incluși în studiu au avut o vârstă medie de 57,72±12,34 ani, valoarea medie a IMC de 30,54 ±5,51 kg/m2, valorile medii ale glicemiilor fiind de 8,66 ± 4,45mmol/l și a HbA1c de 7,2 ± 1,94 %. Conform datelor anamnestice, la momentul spitalizării 22% dintre pacienți se cunoșteau cu diabet zaharat. Analiza glicemiilor pe parcursul spitalizării a evidențiat că doar 28% dintre pacienți au avut valorile glicemice în limitele valorilor normale. În urma analizei glicemiei a jeun și a HbA1c s-a diagnosticat diabetul zaharat primar depistat la 7%, prediabetul la 15% dintre pacienți, iar 28% dintre pacienți au avut modificări solitare ale glicemiei a jeun. Concluzii. Putem presupune că infecția SARS-CoV-2 predispune la apariția disglicemiilor la pacienții cu forme severe de COVID-19, în special la persoanele care prezintă factori de risc pentru dezvoltarea diabetului zaharat (vârsta, obezitatea, patologiile cardiovasculare etc) și la cei care au administrat tratament cu glucocorticoizi

Cognitive dysfunction and diabetes mellitus – a way towards dementia

USMF ”Nicolae Testemițanu”, Catedra Endorcinologie USMF ”Nicolae Testemițanu”, Catedra Psihiatrie, Narcologie şi Psihologie Medicală USMF ”Nicolae Testemițanu”, Laboratorul Endocrinologie, Primul Congres Naţional al Societăţii Endocrinologilor cu participare internaţională dedicat jubileului de 50 ani de la fondarea serviciului endocrinologic din Republica Moldova 9-11 octombrie 2014Diabetul zaharat de tip 2 are impact negativ asupra întregului organism, inclusiv și asupra sistemului nervos. Evoluția cronică a diabetului influențează negativ funcțiile cognitive. Scopul studiului a vizat studierea prezenței / absenței disfuncției cognitive la pacienții cu diabet zaharat de tip 2. Investigațiile clinico-paraclinice, inclusiv clinico-psihologice a 19 pacienți cu diabet zaharat de tip 2 au demonstrat prezența disfuncțiilor cognitive de diferită severitate la 42,2% dintre ei. Deficitul cognitiv a corelat pozitiv cu nivelul de HDL-colesterol și, negativ cu valoarea IMC, nivelul glicemiei și trigliceridelor, ceea ce demonstrează necesitatea monitorizării riguroase a parametrilor menționați în procesul de compensare a diabetului de tip 2, fenomen, care ar permite întârzierea declinului cognitiv și creșterea calității vieții diabeticului.Type 2 diabetes mellitus has a negative impact on the entire body, including the nervous system. The evolution of chronic diabetes is detrimental to the cognitive functions. The aim of the study was aimed to study the presence of cognitive dysfunction in patients with type 2 diabetes clinical laboratory investigations, including clinical psychological 19 patients with type 2 diabetes have demonstrated the presence of different severity of cognitive dysfunction in 42.2% between them. Cognitive deficit correlated positively with HDL cholesterol and negatively with the BMI, blood sugar and triglycerides, which demonstrates the need for strict monitoring of the parameters set in the clearing of type 2 diabetes, a phenomenon that would allow to delay cognitive decline and improve quality of life for diabetics

Carbon monoxide as a gaseous messenger in the cerebrovacular circulation

Catedra de Biochimie şi Biochimie Clinică USMF „N.Testemiţanu”The primary objectives of this article are to review the potential role of carbon monoxide (CO) as an endogenous mediator in cerebrovascular circulation. It is produced from heme by a constitutively expressed enzyme (heme oxygenase (HO)-2) expressed highly in the brain and by an inducible enzyme (HO-1). CO production is regulated by controlling substrate availability, HO-2 catalytic activity, and HO-1 expression. CO dilates arterioles by binding to heme that is linked to large conductance Ca2+ activated K+ channels (BKCa channels), which elevates channel Ca2+ sensitivity, increases coupling of Ca2+ sparks to BKCa channel openings and, thereby, hyperpolarizes the vascular smooth muscle. In addition to dilating blood vessels, CO can either inhibit or accentuate vascular cell proliferation and apoptosis, depending on conditions. Rolul monoxidului de carbon (CO) ca mediator endogen în circulaţia cerebrovasculară reprezintă conţinutul acestui articol. Este produs de hem la acţiunea unei enzime constitutive (hemoxigenaza (HO)-2) expresată intens în creier şi a unei enzime inductibile (hemoxigenaza (HO)-1). Sinteza CO este reglată prin controlul cantităţii de substrat disponibil, activitatea catalitică a HO-2 şi expresia HO-1. CO induce dilatarea arteriolelor prin cuplarea cu proteina hem şi ataşarea acestui complex la canalele BKCa, mărind astfel afinitatea canalelor faţă de ionii de Ca2+. Ulterior are loc cuplarea ionilor la canal şi activarea lor, ceea ce duce la hiperpolarizarea membranei prin transportul ionilor de K+ in exteriorul celulei. În afară de acţiunea vasodilatatoare, CO poate inhiba sau induce atît proliferarea, cît şi apoptoza celulelor vasculare, în dependenţă de condiţii

Патология щитовидной железы, вызванная интерфероном

Interferon-alpha (IFNα) is the cornerstone therapeutic agent for chronic hepatitis infection. A major and common adverse effect of this treatment is the development of thyroid disease during therapy. The prevalence of thyroid disease during IFN treatment is extremely variable, ranging between 1 and 35%. Interferon induced thyroiditis (IIT) can be classified as autoimmune type (Hashimoto’s thyroiditis, Graves’ disease and the production of thyroid autoantibodies (TAb’s) without clinical disease) and non-autoimmune type (destructive thyroiditis and non-autoimmune hypothyroidism). The etiology of IIT is unknown and may be secondary to immune modulation by IFNα and/or direct effects of interferon on the thyroid. We describe two patients with diffuse goiter and hypothyroidism associated with chronic hepatitis infection and interferon based therapies. In this way, we consider that early detection and therapy of these conditions is important in order to avoid complications of thyroid disease.Интерферон-α (ИФН-α) является препаратом первого выбора в лечении хронического вирусного гепатита. Несмотря на свою эффективность, лечение ИФН-α часто вызывает патологию щитовидной железы. Распространенность данной патологии варьирует от 1 до 35%. Тиреоидиты, спровоцированные ИФН-α, делятся на аутоиммуные (болезнь Грейвса, тиреоидит Хашимото и ассимтоматическое выделение антитиреоидных антител) и неаутоиммуные (деструктивный тиреоидит и неаутоиммуный гипотиреоз). Этиология тиреоидита, вызванного ИФН-α, остаётся неизвестной, возможно, являясь последствием иммунных реакций и/или прямым побочным действием ИФН-α на клетки щитовидной железы. В статье описываются два случая лечения вирусного хронического гепатита ИФН-α осложненные: один – диффузным токсическим зобом, другой – гипотиреозом. В заключение, выявление дисфункции щитовидной железы посредством определения гормонального статуса является обязательным в случае приёма ИФН-α

Diabetul zaharat necomplicat: protocol clinic naţional PCN-33

Catedra Endocrinologie, FRSC, USMF „Nicolae Testemiţanu”Acest protocol a fost elaborat de grupul de lucru al Ministerului Sănătăţii al Republicii Moldova (MS RM), constituit din specialiştii Catedrei Endocrinologie a Universităţii de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”. Protocolul clinic naţional este elaborat în conformitate cu ghidurile internaţionale actuale privind diabetul zaharat la persoanele adulte şi va servi drept bază pentru elaborarea protocoalelor clinice instituţionale. La recomandarea MS RM pentru monitorizarea protocoalelor instituţionale pot fi folosite formulare suplimentare, care nu sunt incluse în protocolul clinic naţional

Modern approach to epilepsy treatment

State Medical and Pharmaceutical University “Nicolae Testemițanu”, Chișinău, Republic of MoldovaIntroduction: Long regular use of antiepileptic drugs aimed at reducing frequency of seizures or stopping them completely without any significant side-effects is by far the main principle of epilepsy treatment. Attention is drawn to the issues of tolerability of antiepileptic therapy and compliancy, mutual understanding between the physician and the patient. Purpose and Objectives: To determine the response to treatment of patients presenting with different types of seizures and the possibility of efficient therapeutic care of patients with epilepsy. Materials and methods: This study is based on retrospective analysis of medical documentation of patients hospitalized in 1MSP SCP. The study group was represented by 36 patients (19 men and 17 women) diagnosed with epilepsy. Results: During this study, we have evaluated the response to antiepileptic treatment given to patients presenting with different types of seizures. 21 patients (58%) had polymorphic seizures and 15 patients (42%) generalized tonic-clonic seizures. 26 patients (72%) received monotherapy and 10 patients (28%) were treated using polytherapy. Carbamazepine was used as monotherapy in 88% (23 patients) and valproate in 12% of the cases (3 patients). The polytherapy included double-therapy in 25% of cases (9 patients) and triple-therapy in 3% of the cases (1 patient). As the end result of the treatment in patients with epilepsy, we have obtained an adequate control of seizures (absence of seizures) in 36% of the cases (13 patients). A reduction of seizures’ frequency by more than 50% was observed in 36% (13 patients) and the seizures’ frequency was unchanged in 28% of the cases (10 patients). Reported treatment failure was most likely due to the short term of treatment, although refractory epilepsy in these patients is not excluded. Analyzing the adherence to treatment in ambulatory conditions, we found that 24 patients (67%) complied with the recommendations and continued treatment at home, while 12 patients (33%) dropped out of therapy. Conclusions: The study shows that polymorphic seizures are better controlled by monotherapy (37.5%-complete control) versus polytherapy (16.6%-complete control), whereas generalized tonic-clonic seizures show positive response to polytherapy (50%) versus monotherapy (30.7%). Polymorphic seizures have a good response (reduction o f >50% of seizures’ frequency) with polytherapy (50%) versus monotherapy (37.5%), whereas generalized tonic-clonic seizures, show similar response to both monotherapy and polytherapy. We’ve concluded that polymorphic seizures have a better response to treatment when compared with generalized tonic-clonic seizures, both in monotherapy and in polytherapy