CAPILLAROSCOPY IN CHIDREN WITH RAYNAUD’S PHENOMENON

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica MoldovaIntroducere. Fenomenul Raynaud (FR) reprezintă o afecțiune vazospastică, caracterizată prin schimbări trifazice a culorii tegumentelor. Conform studiilor, cel mai frecvent, fenomenul Raynaud este izolat (primar). Însă, la o parte de pacienți cu FR, acesta face parte din tabloul clinic al unei afecțiuni autoimune specificate. Scopul lucrării. Evaluarea modificărilor capilaroscopice la pacienții cu fenomen Raynaud primar și secundar. Material și metode. S-a efectuat un studiu prospectiv pe un lot de 61 copii cu FR în perioada anului 2022. Diagnosticul de FR a fost stabilit conform International Consensus Criteria for the Diagnosis of Raynaud’s Phenomenon. Tehnica examinării și interpretarea rezultatelor s-a efectuat în baza consensului Standardisation of nailfold capillaroscopy for the assessment of patients with Raynaud’s phenomenon and systemic sclerosis. Rezultate. Au fost studiați 61 pacienți cu FR, vârsta medie de 14,5±3,27 ani, dintre care 45 (73%) erau fete, iar 19 (17%) - băieți. Paternul capilaroscopic normal a fost detectat la 13 pacienți (21%), aceștia toți fiind cu FR primar. Paternul capilaroscopic nespecific a fost vizualizat la 39 copii (64%), dintre care au predominat, de asemenea, pacienții cu FR izolat - 27 pacienți (69%). Paternul scleroderma a fost depistat la 7 pacienți (11,5%), dintre care, 4 (57%) au avut diagnosticul de sclerodermie sistemică sau dermatomiozită juvenilă. Concluzii. Capilaroscopia este o metodă non-invazivă și informativă, cu impact important asupra stratificării riscului de dezvoltare a unei boli autoimune sistemice. Astfel, pacienții cu un pattern capilaroscopic normal au cel mai mic risc de progresie, pe când cei cu patern sclerodermic, au cea mai mare rată de tranziție.Background. Raynaud’s phenomenon (RP) is a vasospastic disorder, characterized by triphasic color changes of the skin. Most of the patients with RP will have no other health issues, thus RP is considered isolated. In a small subgroup of patients, RP will be the first sign of a connective tissue disease (secondary RP). Objective of the study. Evaluation of capillary changes in children with primary and secondary RP. Material and methods. A prospective study that included 61 children diagnosed with RP was performed during 2022. The diagnosis of RP was based on “International Consensus Criteria for the Diagnosis of Raynaud’s Phenomenon”. Examination technique and the reading of the results based on „Standardization of nailfold capillaroscopy for the assessment of patients with Raynaud’s phenomenon and systemic sclerosis”. Results. 61 patients with RP were studied, with a mean age of 14.5±3.27, of which 43 (73%) were girls. A normal capillaroscopic pattern were seen in 13 patients (21%), all of them being diagnosed with primary RP. Non-specific capillaroscopic pattern was seen in 39 children (64%), of which 27 patients (69%) also had primary RP. Scleroderma pattern was seen in 7 patients, of which 4 patients (54%) had an underlying connective tissue disease (systemic sclerosis and juvenile dermatomyositis). Conclusion. Capillaroscopy is a non-invasive but informative method with an important impact on the risk stratification for patients RP. Thus, patients with normal pattern have the lowest risk, but those with scleroderma – the highest risk to progress to a specified connective tissue disease

Влияние лечения антиоксидативным препаратом Vita Grapes на прооксидантивных показатели при идиопатическом ювенильном артрите

Juvenile Idiopathic Arthritis is considered a chronic disease, disabling, with a high socio-economic impact. In idiopathic juvenile arthritis, the production of free radicals of oxygen exceeds the antioxidant capacity of the cells. Free oxygen radicals attack lipids, proteins, DNA by peroxidation reactions. A biomarker of oxidative stress is considered to be malondialdehyde – an aldehyde that occurs in the body following the degradation of polyunsaturated fatty acids in the absence of antioxidants. Material and methods. 50 patients with Juvenile Idiopathic Arthritis were selected. The children were divided into 4 groups: group I ‒ 14 children with Juvenile Idiopathic Arthritis who received treatment with Metotrexat and Vita Grapes ‒ antioxidant drug; group II ‒ 12 children treated with Metotrexate, Prednisolone and Vita Grapes; group III ‒ 11 children only treated with Methotrexate; group IV ‒ 13 children treated with Metotrexate and Prednisolone. Results. After 3 months of treatment, prooxidant indicators were analyzed between groups, and their values were reduced in groups I and II, which administered Vita Grapes the antioxidant drug compared to groups III and IV that did not receive the antioxidant drug (p> 0,05). Conclusions. Vita Grapes has antioxidant action, increasing the antioxidant capacity of the body and decreasing the values of prooxidant indicators.USMF ”Nicolae Testemițanu”, IMSP Institutul Mamei și CopiluluiЮвенильный идиопатический артрит считается хроническим заболеванием, инвалидизирующим, с высоким социально-экономическим воздействием. При идиопатическом ювенильном артрите вырабатываются свободные радикалы кислорода которые превышают антиоксидантную способность клеток. Свободные радикалы кислорода атакуют липиды, белки, ДНК в результате реакций перекисного окисления. Биомаркером окислительного стресса считается малоновый диальдегид – альдегид, который возникает в организме после распада полиненасыщенных жирных кислот в отсутствие антиоксидантов. Материал и методы. Было отобрано 50 пациентов с идиопатическим ювенильным артритом. Дети были разделены на 4 группы: I группа ‒ 14 детей с ювенильным идиопатическим артритом, которые получали лечение Метотрексатом и Vita Grapes ‒ антиоксидантный препарат; II группа ‒ 12 детей, получавших Метотрексат, Преднизолон и Vita Grapes; III группа ‒ 11 детей, получавших только Метотрексат; IV группа ‒ 13 детей, получавших только Метотрексат и Преднизолон. Результаты. После 3 месяцев лечения прооксидантные показатели были проанализированы между группами, и их значения были снижены в группах I и II, которые принимали антиоксидантный препарат Vita Grapes, по сравнению с группами III и IV, которые не получали антиоксидантный препарат (p>0,05). Выводы. Vita Grapes обладает антиоксидантным действием, повышает антиоксидантную способность организма и снижает прооксидантных показатели

Влияние различных схем лечения на клинических показателях и радиологических изменениях при идиопатическом ювенильном артрите

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemițanu”, IMSP Institutul Mamei și CopiluluiBackground. Juvenile Idiopathic Arthritis is a chronic disease, disabling, with a high socio-economic impact. Material and methods. 50 patients with Juvenile Idiopathic Arthritis were selected. The children were divided into 4 groups: group I ‒ 14 children with Juvenile Idiopathic Arthritis who received treatment with Metotrexat and Vita Grapes ‒ antioxidant drug; group II ‒ 12 children treated with Metotrexate, Prednisolone and Vita Grapes; group III ‒ 11 children only treated with Methotrexate; group IV ‒ 13 children treated with Metotrexate and Prednisolone. Results. Analyzing the clinical indicators on groups after 3 months of treatment, it was observed that the number of painful joints and swollen joints did not show statistically significant differences (p> 0,05), while the analogous visual pain scale, the overall disease evaluation by the physician and by the patient as well as the disease activity score ‒ DAS28 decrease in groups I and II in which the antioxidant drug Vita Grapes was administered compared with groups III and IV not treated with the antioxidant drug. Analyzing the Sharp score after 3 months of treatment resulted in much lower values in groups I and II, which administered the antioxidant drug Vita Grapes compared with groups III and IV, which did not receive treatment with the antioxidant drug. Conclusions. Antioxidant drug Vita Grapes has a positive effect on the clinical indicators of patients with Juvenile Idiopathic Arthritis with their diminished to positive values. Including Vita Grapes in the treatment has prevented the progression of joint injuries, with a favorable effect on the joint structures.Введение. Ювенильный идиопатический артрит считается хронической патологии, инвалидизирующим, с высоким социально-экономическим воздействием. Материал и методы. Было отобрано 50 пациентов с идиопатическим ювенильным артритом. Дети были разделены на 4 группы: I группа ‒ 14 детей с ювенильным идиопатическим артритом, которые получали лечение Метотрексатом и Vita Grapes ‒ антиоксидантный препарат; II группа ‒ 12 детей, получавших Метотрексат, Преднизолон и Vita Grapes; III группа ‒ 11 детей, получавших только Метотрексат; IV группа ‒ 13 детей, получавших только Метотрексат и Преднизолон. Результаты. Анализ клинических показателей по группам через 3 месяца лечения показал, что число болезненных суставов и опухших суставов не показывает статистически значимых различий (р>0,05), в то время как визуальная аналогичная шкала болей, общая оценка заболевания врачом и пациентом, а также индекс активности DAS28 уменьшались в I и II группах, которые получили антиоксидантный препарат Vita Grapes по сравнению с группами III и IV, не получавшими этот антиоксидантный препарат. Анализ показателя Sharp после 3 месяцев лечения показал его снижение в группах I и II, которые получали антиоксидантный препарат Vita Grapes, по сравнению с группами III и IV, которые не получали лечение антиоксидантным препаратом. Заключение. Антиоксидантный препарат Vita Grapes оказывает положительное влияние на клинические показатели пациентов с ювенильным идиопатическим артритом с их снижением. Включение Vita Grapes в лечение предотвратило прогрессирование поражение суставов, что благоприятно сказалось на суставных структурах

Ювенильный идиопатический артрит в практике семейного врача

IP Universitatea de Stat de Medicină și Farmacie Nicolae Testemițanu, IMSP Institutul Mamei și CopiluluiArtrita juvenilă idiopatică (AJI) reprezintă o boală infl amatorie cronică multisistemică, caracterizată prin semne clinice și paraclinice de infl amație articulară de geneză nedeterminată, cu o durată de cel puțin șase săptămâni, cu debut până la vârsta de16 ani și care necesită un suport specializat. În anul 2013 a fost elaborat primul protocol clinic național dedicat artritei juvenile idiopatice, în care a fost descrisă detaliat forma sistemică a AJI. În 2016 a apărut Protocolul clinic național ”Artrita juvenilă idiopatică la copii”, care a fost elaborat în conformitate cu ghidurile internaționale actuale privind AJI. Protocolul clinic național a urmărit scopurile: 1) majorarea numărului de pacienți cărora diagnosticul de AJI li se va stabili în primele trei luni de la debutul bolii; 2) sporirea calității examinărilor clinice și paraclinice la pacienții cu AJI; 3) ameliorarea calității tratamentului aplicat bolnavilor cu AJI; 4) creșterea numărului de pacienți cu AJI supravegheați conform recomandărilor protocolului clinic național; 5) majorarea numărului de pacienți cu AJI cu inducerea remisiunii; 6) sporirea numărului de bolnavi cu AJI la care se menține funcția articulară și activitatea zilnică; 7) majorarea numărului de pacienți cu AJI cu o calitate a vieții ameliorată. În anul 2019 au fost analizate noi surse bibliografi ce, precum ”Nelson Th e Textbook of Pediatrics”, volumul 21, recomandările Colegiului American de Reumatologie (ACR) și ale Ligii Internaționale a Asociațiilor de Reumatologie (ILAR). În anul 2020, în protocolul clinic național, la compartimentul ”Tratamentul AJI” vor fi introduse noile preparate biologice utilizate în perioada pediatrică în tratamentul acestei afecțiuni, precum golimumabul și adalimumabul. Juvenile idiopathic arthritis (JIA) is a systemic chronic infl ammatory disease, characterized by clinical and paraclinical signs of joint’s infl ammation, idiopathic genesis, is present during 6 weeks and appears until 16 years. In 2013, the fi rst national clinical protocol dedicated to JIA was elaborated. Th e systemic form of JIA was described in detail. In 2016, the National Clinical Protocol ”Juvenile idiopathic arthritis in children” was elaborated according with the international guidelines on JIA. Th e national clinical protocol has the following aims: 1) to increase the number of patients diagnosed with JIA in the fi rst 3 months of disease; 2) to increase the quality of clinical and paraclinical examinations of patients with JIA; 3) to increase the quality of treatment of patients with JIA; 4) to increase the number of patients with JIA carry according to the recommendations of the national clinical protocol; 5) to increase the number of patients with JIA in remission; 6) to increase the number of active patients with JIA; 7) to increase the number of patients with JIA with high quality of life. In 2019 new bibliographic sources were studied and analyzed, such as ”Nelson the Textbook of Pediatrics”, vol. 21, ACR and ILAR recommendations. In 2020 new biological drugs used in the pediatric period in the treatment of JIA, such as Golimumab, Adalimumab, will be introduced in the national clinical protocol at the compartment ”Treatment of JIA”. Ювенильный идиопатический артрит (ЮИА) ‒ системное хроническое воспалительн е заболевание, характеризующееся клиническими и параклиническими признаками воспаления суставов, продолжительностью шесть недель, появляется у детей до 16-лет. В 2013 году был разработан первый национальный клинический протокол, посвященный ЮИА, в котором была подробно описана системная форма ЮИА. В 2016 году был разработан Национальный клинический протокол «Ювенильный идиопатический артрит у детей» в соответствии с международными руководствами по ЮИА. Национальный клинический протокол имеет следующие цели: 1) увеличить количество пациентов, у которых ЮИА будет диагностирован в течение первых трёх месяцев с момента возникновения заболевания; 2) повысить качество клинических и параклинических исследований у пациентов с ЮИА; 3) улучшить качество лечения больных с ЮИА; 4) увеличить количество пациентов с контролируемым ЮИА, в соответствии с рекомендациями национального клинического протокола; 5) увеличить число пациентов с ЮИА с индукцией ремиссии; 6) увеличить количество пациентов с ЮИА с поддержанием функции суставов и ежедневной активности; 7) увеличить количество больных с ЮИА с улучшенным качеством жизни. В 2019 году были изучены и проанализированы новые библиографические источники, такие как «Nelson Th e Textbook of Pediatrics», том 21, рекомендации ACR и ILAR. В 2020 году новые биологические препараты, используемые в педиатрическом периоде для лечения ЮИА, такие как голимумаб и адалимумаб, будут введены в национальный клинический протокол в отделении «Лечение ЮИА»

Роль лечения антиоксидативным препаратом Vita Grapes на антиоксидантивных показатели при идиопатическом ювенильном артрите

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemițanu”, IMSP Institutul Mamei și CopiluluiBackground. Juvenile Idiopathic Arthritis is considered a chronic disease, disabling, with a high socio-economic impact. Antioxidant barrier is a complicated system of enzymes, elements and substances that are formed to protect aerobic organisms against increased oxygen concentrations, resulting in the production of free radicals of oxygen. Material and methods. 50 patients with Juvenile Idiopathic Arthritis were selected. The children were divided into 4 groups: group I ‒ 14 children with Juvenile Idiopathic Arthritis who received treatment with Metotrexat and Vita Grapes ‒ antioxidant drug; group II ‒ 12 children treated with Metotrexate, Prednisolone and Vita Grapes; group III ‒ 11 children only treated with Methotrexate; group IV ‒ 13 children treated with Metotrexate and Prednisolone. Results. Analytical confrontation of antioxidant indicators among groups studied at 3 months of treatment determined their increase in groups I and II, which administered the Vita Grapes antioxidant drug, compared to groups III and IV, which did not follow antioxidant treatment (p>0,05). Conclusion. Vita Grapes has positively influenced antioxidant indicators by increasing catalase and ceruloplasmin values and modulating total antioxidant activity, superoxide dismutase, glutathione peroxidase and glutathione reductase, thus exhibiting strong antioxidant activity.Введение. Ювенильный идиопатический артрит считается хроническим заболеванием, инвалидизирующим, с высоким социально-экономическим воздействием. Антиоксидантный барьер представляет собой сложную систему ферментов, элементов и веществ, которые образуются для защиты аэробных организмов от повышения концентрации кислорода, что приводит к образованию разрушительных свободных радикалов кислорода. Материал и методы. Было отобрано 50 пациентов с идиопатическим ювенильным артритом. Дети были разделены на 4 группы: I группа ‒ 14 детей с ювенильным идиопатическим артритом, которые получали лечение Метотрексатом и Vita Grapes ‒ антиоксидантный препарат; II группа ‒ 12 детей, получавших Метотрексат, Преднизолон и Vita Grapes; III группа ‒ 11 детей, получавших только Метотрексат; IV группа ‒ 13 детей, полу- чавших только Метотрексат и Преднизолон. Результаты. Аналитическая конфронтация антиоксидантных показателей среди групп, изученных через 3 месяца лечения, определила их увеличение в группах I и II, которые получали антиоксидантный препарат Vita Grapes, по сравнению с группами III и IV, которые не получали антиоксидантной терапии (p>0,05). Заключение. Vita Grapes оказывает положительное влияние на антиоксидантные показатели, увеличивая значения каталазы и церулоплазмина и модулируя общую антиоксидантную активность, супероксиддисмутазу, глутатионпероксидазу и глутатионредуктазу, таким образом проявляя сильную антиоксидантную активность

Роль каталазы и церулопласмина в патогенезе ювенильного идиопатического артрита

Université d’Etat de Médecine et de Pharmacie «Nicolae Testemitanu», Département de pédiatrie, L’Institut de Recherche en soins de Santé Maternelle et InfantileIntroduction. The pathogenesis of juvenile idiopathic arthritis (JIA) is complex, in a permanent study. The oxidative stress has an important part in the perpetuating of infl ammatory response. The antioxidant barrier is a complicated system of enzymes, elements and substances that are formed to protect the aerobic organisms against high concentrations of oxygen. A marker of the antioxidant system is catalase. Catalase is an enzyme that breaks down hydrogen peroxide into water and molecular oxygen. Activity of catalase in cells is very important. Another component of the antioxidant system is ceruloplasmin. Ceruloplasmin is a polyfunctional protein, is an extracellular antioxidant enzyme. Material and methods. 150 children with JIA and 20 real healthy children were included in a randomized study. The study involved 98 boys (65,3%) and 52 girls (34,7%) aged between 18 and 221 months (mean 134,22±4,71 months). Disease duration was from 1,0 month to 198,0 months (mean 36,19±3,22 months). Time addressing the rheumatologist after the onset of disease was from 1,0 month to 72,0 months (mean 6,01±0,86 months). The distribution depending on the clinical form was as follows: oligoarticular form – 61 (40,7%) children, polyarticular form – 59 (39,3%) children, systemic form – 18 (12,0%) children, arthritis with entesits – 9 (6,0%) children, psoriatic arthritis – 2 (1,3%) children and others arthritis – 1 (0,7%) child.The authors appreciated the indices of the antioxidant system (catalase and ceruloplasmin) at 90 patients with JIA and 20 healthy children. Results obtained. A low endogenous antioxidant capacity was registered in JIA and the functionals parameters of catalase were found much lower at the patients with JIA, compared with the control group. Have noted higher values of catalase in oligoarticular and polyarticular forms versus systemic form (p<0,05). Ceruloplasmin noted a trend towards values in oligoarticular and polyarticular forms compared with the systemic form (p> 0,05). The values of catalase were found to be lower for disease duration up to 6 months and higher for disease duration exceeding 24 months. The study of ceruloplasmin showed lower values for disease duration exceeding 24 months compared with disease duration up to 6 months. Catalase and ceruloplasmin were investigated by functional class (FC) after Steinbrocker. We noted higher values of catalase for FC I, II compared with FC III, IV (p>0,05). Research ceruloplasmin determined higher values for FC III, IV and lower values for FC I, II (p>0,05). Catalase and ceruloplasmin were studied by radiological stage after Steinbrocker. Catalase noted practically the same values for radiologicals stages I, II and for radiologicals stages III, IV (p>0,05). Ceruloplasmin had higher values in radiologicals stages III, IV and lower in radiologicals stages I, II (p> 0,05). Conclusions. Endogenous antioxidant capacity is low in JIA, characterized by low levels of catalase and ceruloplasmin. Catalase and ceruloplasmin resulted in much lower values in systemic arthritis compared with oligoarticular and polyarticular forms, refl ecting a capacity of endogenous antioxidant protection than lower in systemic arthritis compared with the others variants of JIA. Depending on the duration of the disease, ceruloplasmin showed higher values for disease duration up to 6 months compared with disease duration exceeding 24 months, which shows a higher endogenous antioxidant capacity during early JIA background of an intensity high oxidative processes specific to this stage of the disease. Catalase found lower values for functionals classes III, IV by Steinbrocker.Введение. Патогенез ювенильного идиопатического артрита (ЮИА) достаточно сложный процесс. Важ- ную роль в сохранении воспалительного процесса имеет окислительный стресс. Антиоксидантный барьер яв-ляется сложной системой антиоксидантных ферментов, элементов и веществ, которые образуются для за- щиты аэробных организмов против концентрации кислорода. Материал и методы. В данное исследование были включены 150 детей с ЮИА и 20 здоровых детей. У 90 больных с ЮИА и 20 здоровых детей была оценена антиоксидантная система (каталаза и церулоплазмин). Результаты исследования. Был зарегистрирован низкий внутренний антиоксидантный потенциал при ЮИА, уровень каталазы были обнаружены значительно ниже у пациентов с ЮИА по сравнению с контрольной группой. Отмечалось высокие значения каталазы при олигоартикулярном и полиартикулярном вариантах по сравнению с системном варианте (р<0,05). Церулоплазмин не показал статистической разницы, но отметил тенденцию к снижению значения при олигоартикулярном и полиартикулярном вариантах по сравнению с системном варианте (р>0,05). Уровень каталазы был низкий при длительностью заболевания до 6 месяцев и высокий при длительно- стью заболевания более 24 месяцев. Уровень церулоплазмина был низким при длительностью заболевания более 24 месяцев, по сравнению с длительностью заболевания до 6 месяцев. Был исследован уровень каталазы и церуло- плазмина при функциональному классу (ФК) по Штейнброкеру. Таким образом, мы отметили высокие значения каталазы при ФК I, II по сравнению с ФК III, IV (р>0,05). Исследования церулоплазмина определяло более высокие значения при ФК III, IV и более низкие значения при ФК I, II (р>0,05). Уровень каталазы и церулоплазмина был ис- следован при радиологической стадии по Штейнброкеру. Каталаза отметила практически одинаковые значения при радиологических стадии I, II и радиологических стадии III, IV (р>0,05). Уровень церулоплазмина был выше при радиологических стадии III, IV по сравнению с радиологических стадии I, II (р>0,05). Выводы. Эндогенный антиоксидантный потенциал низкий при ЮИА и характеризуется низким уровнем каталазы и церулоплазмина. Каталаза и церулоплазмин имеют гораздо более низкие значения при системном варианте по сравнению с олигоартикулярном и полиартикулярном вариантах, что отражает более низкую способность эндогенной антиоксидантной защиты при системном варианте по сравнению с другими вари- антами ЮИА. В зависимости от длительности заболевания, церулоплазмин показал более высокие значения при длительности заболевания до 6 месяцев по сравнению с длительностью заболевания более 24 месяцев, что свидетельствует о более высокой эндогенной антиоксидантной защиты в начале ЮИА. Каталаза имеет более низкие значения при функциональных классах III, IV по Штейнброкеру

Efectele tratamentului cu preparatul antioxidant Vita Grapes asupra oxidului nitric în artrita juvenilă idiopatică

Universitatea de Stat de Medicină și Farmacie ”Nicolae Testemițanu”, IMSP Institutul Mamei și CopiluluiJuvenile Idiopathic Arthritis is a chronic disease, disabling, with a high socio-economic impact. Material and methods. 50 patients with Juvenile Idiopathic Arthritis were selected. The children were divided into 4 groups: group I ‒ 14 children with Juvenile Idiopathic Arthritis who received treatment with Metotrexat and Vita Grapes ‒ antioxidant drug; group II ‒ 12 children treated with Metotrexate, Prednisolone and Vita Grapes; group III ‒ 11 children only treated with Methotrexate; group IV ‒ 13 children treated with Metotrexate and Prednisolone. Results. After the 3 months of treatment, the level of Nitric Oxide was higher in groups I and II, which administered the antioxidant drug Vita Grapes compared with groups III and IV, which did not receive antioxidant treatment (p> 0,05). Conclusion. Vita Grapes increases the nitric oxide level, ensuring the active remodeling of bone tissue necessary for children, especially those with Juvenile Idiopathic Arthritis. In the first two groups after the antioxidant treatment the nitric oxide level increased signifi cantly, while in the III and IV groups nitric oxide level increased insignificantly.Ювенильный идиопатический артрит считается хронической патологией, инвалидизирующей, с высоким социально-экономическим воздействием. Материал и методы. Было отобрано 50 пациентов с идиопатическим ювенильным артритом. Дети были разделены на 4 группы: I группа ‒ 14 детей с ювенильным идиопатическим артритом, которые получали лечение Метотрексатом и Vita Grapes ‒ антиоксидантный препарат; II группа ‒ 12 детей, получавших Метотрексат, Преднизолон и Vita Grapes; III группа ‒ 11 детей, получавших только Метотрексат; IV группа ‒ 13 детей, получавших только Метотрексат и Преднизолон. Результаты. После 3-х месячного периода лечения мы отметили гораздо более высокий рост оксида азота в I и II группах, которые получали антиоксидантный препарат Vita Grapes, по сравнению с группами III и IV, которые не получали антиоксидантную терапию (p> 0,05). Заключение. Vita Grapes повышает уровень оксида азота, обеспечивая активное ремоделирование костной ткани, необходимое для детей, особенно с ювенильным идиопатическим артритом. В первых двух группах после антиоксидантной терапии уровень оксида азота значительно увеличился, в то время как в III и IV группах уровень оксида азота увеличился незначительно.Artrita juvenilă idiopatică se consideră o maladie cronică, invalidizantă, cu impact social-economic înalt. Material și metode. Au fost selectaţi 50 pacienţi cu artrită juvenilă idiopatică, cărora, la medicaţia de fond (Metotrexat, Prednisolon), li s-a suplimentat un preparat cu efect antioxidant – extract Vita Grapes. Copiii au fost divizaţi în 4 loturi de studiu subcurativ: lotul I – 14 copii cu artrită juvenilă idiopatică, care au urmat tratament cu Metotrexat și Vita Grapes; lotul II – 12 copii trataţi cu Metotrexat, Prednisolon și Vita Grapes; lotul III – 11 copii medicaţi doar cu Metotrexat; lotul IV – 13 copii trataţi doar cu Metotrexat și Prednisolon. Rezultate. După termenul de 3 luni curative am confruntat titrele NO între loturile studiate, remarcând majorarea lui mult mai pronunţată în loturile I și II, cărora li s-a administrat preparatul cu efect antioxidant Vita Grapes, comparativ cu loturile III și IV, care nu au urmat tratament antioxidant (p>0,05). Concluzie. Preparatul Vita Grapes crește nivelul oxidului nitric, asigurând remodelarea activă a ţesutului osos necesară copiilor, în special celor cu artrită juvenilă idiopatică. Astfel, în primele două loturi, după tratamentul antioxidant, nivelul oxidului nitric s-a majorat semnificativ, pe când în loturile III și IV nivelul oxidului nitric s-a majorat nesemnificativ

PITUITARY HORMONAL PREDICTORS IN JUVENILE IDIOPATHIC ARTHRITIS

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica MoldovaIntroducere. Majoritatea bolilor endocrine și artrita cronică sunt boli cu evoluție îndelungată, iar semnele precoce ale disfuncției endocrine nu sunt specifice și sunt adesea umbrite de manifestările clinice ale altor boli în absența testelor biochimice specifice. Un prognostic pe termen lung al AJI poate fi afectat de aceste comorbidități endocrine care conduc la scăderea calității și a duratei de viață. Scopul lucrării este de a analiza corelațiile hormonilor hipofizari cu indicii de activitate ai artritei juvenile idiopatice. Material și metode. Studiul a inclus 97 copii diagnosticați cu AJI în secția Reumatologie al IMC. La momentul includerii în studiu s-au analizat parametrii clinici, precum și indicii de laborator – de evaluare ai AJI, precum și hormonii hipofizari (TSH, prolactina, LH, FSH). Datele obținute au fost prelucrate statistic prin teste descriptive, de evaluare a mediilor, corelație și regresie lineară. Rezultate. În dependență de durata bolii, valoare serică medie a prolactinei a fost statistic semnificativ mai mare la subiecții cu o durată stabilită a bolii și în debutul bolii de până la 3 ani. Prin regresie lineară s-a identificat dependență dintre prolactină și durata bolii, DAS28 și JADAS71. Valoarea categorială a TSH corelează cu DAS28 (r = 0,936). S-a constatat, de asemenea, corelație puternică direct proporțională dintre valoarea categorială a volumului estimat al glandei tiroide și indicele de activitate a bolii DAS28 (r = 0,446). Scorul JADAS71 corelează invers proporțional moderat cu valoarea absolută a TSH (r = -0,205). Incidența valorilor scăzute ale FSH la băieți a fost identificată mai elevată (15,8%) față de grupul fetelor (11,5%). Tropii hipofizari – LH și FSH, corelează moderat, invers proporțional cu vârsta copilului la înrolare în cercetare. Concluzii. Copiii cu artrită idiopatică juvenilă pot dezvolta disfuncție endocrină. Diagnosticul precoce și monitorizarea comorbidităților sunt esențiale la copiii cu artrită idiopatică juvenilă, ceea ce ar putea preveni influența negativă a acestora asupra stării de sănătate.Background. Most endocrine diseases and chronic arthritis are long-term diseases. And the early signs of endocrine dysfunction are not specific and are often overshadowed by the clinical manifestations of other diseases in the absence of specific biochemical tests. A long-term prognosis of JIA may be affected by these endocrine comorbidities leading to decreased quality and length of life. Objective of the study is to analyze the correlations of pituitary hormones with indices of activity in juvenile idiopathic arthritis. Material and methods. The study included 97 children diagnosed with JIA from the rheumatology department of IMC. At the time of inclusion in the study, clinical parameters were analyzed, as well as laboratory indices of monitoring in JIA, as well as pituitary hormones (TSH, prolactin, LH, FSH). The obtained data were statistically processed through descriptive tests, evaluation of means, correlation and linear regression. Results. The mean serum value of prolactin was statistically significantly higher in subjects with a prolonged duration of the disease and in the onset of the disease up to 3 years. Through linear regression, a dependence was identified between prolactin and the duration of the disease, DAS28 and JADAS71. The categorical value of TSH correlates with DAS28 (r = 0.936). A strong direct proportional correlation was also found between the categorical value of the estimated volume of the thyroid gland and the DAS28 disease activity indices (r = 0.446). The JADAS71 score correlates moderately inversely proportionally with the absolute value of TSH (r = -0.205). The incidence of low FSH values in boys was found to be higher (15.8%) compared to the group of girls (11.5%). Pituitary tropes – LH and FSH, correlate moderately, inversely proportionally with the child’s age at enrollment in the research. Conclusions. Children with juvenile idiopathic arthritis may develop endocrine dysfunction. Early diagnosis and monitoring of comorbidities are essential in children with juvenile idiopathic arthritis, which could prevent their negative influence on health status

Dietele hipocalorice frecvent utilizate de către pacienți în autotratamentul obezității

Background. In most cases, people with obesity (OBT) try to follow different low-calorie diets (LCD) for self-treatment (ST), but do not go to the dietitian (D) for advice. Diets that promised a decrease in body weight in a short time were attractive. Objective of the study. Evaluation of low-calorie diets most commonly used in self-treatment of obesity. Material and Methods. The descriptive study was performed at UCPMA to determine the spectrum of low-calorie diets most commonly used in the selftreatment of obesity. Data sources were: medical cards and 1 questionnaire - diet selection criteria (DSC). Research methods: observational, epidemiological, clinical and statistical. Results. In the study participated 87 patients with OBT, aged between 20 and 70 years, who practiced OBT self-treatment using different LCD and were not consulted by D. The study found that 10 LCD were used more frequently as follows: Rina-19 (21.9%); Danish 14 (16.2%); Dukan-13 (14.2%); Dissociation-11 (12.7%); Kremlin-8 (9.2%); Ketogenic-7 (8.1%); Ballerina-5 (5.9%); Montignac-5 (5.9%); Japanese-3 (3.5%); Flash-2 (2.4%). The following main criteria on which patients with OBT were based in the selection of LCD were highlighted: rapidity of effect; minimal physical and psycho-emotional effort; obtaining expected body changes. Conclusion. LCD Rina, Danish and Dukan are more frequently selected by people with OBT as ST. Introducere. În cele mai multe cazuri, persoanele care suferă de obezitate (OBT) încearcă să urmeze diferite diete hipocalorice (DHC) pentru autotratare (AT), dar nu se adresează la medicul dietetician (MD) pentru a primi recomandări. Au fost atractive dietele ce promiteau o scădere a masei corporale în scurt timp. Scopul lucrării. Evaluarea dietelor hipocalorice cel mai frecvent utilizate în autotratarea obezității. Material și Metode. .Studiul descriptiv a fost realizat la CUAMP pentru determinarea spectrului de diete hipocalorice cel mai frecvent utilizate în autotratamentul obezității. Surse de date au fost: cartelele medicale și 1 chestionar - criterii de selecție a dietei (CSD). Metodele de cercetare: observaționale, epidemiologice, clinice, statistice. Rezultate. În studiu au participat 87 de paciente cu OBT, cu vârsta între 20 și 70 ani, care au practicat autotratamentul OBT prin utilizarea diferitor DHC și care nu au fost consultate de către MD. S-a determinat că mai frecvent au fost utilizate 10 DHC după cum urmează: Rina-19 (21,9%); Daneză-14 (16,2%); Dukan-13 (14,2%); Disociată-11 (12,7%); Cremlin-8 (9,2%); Ketogenică-7 (8,1%); Balerina-5 (5,9%); Montignac-5 (5,9%); Japoneză-3 (3,5%); Fulger-2 (2,4%). Au fost evidențiate următoarele criterii principale pe care se bazau pacientele cu OBT în selectarea DHC: rapiditatea efectului; efort fizic și psiho-emoțional minim; obținerea unor schimbări corporale scontate. Concluzii. DHC Rina, Daneza și Dukan sunt mai frecvent selectate de către persoanele cu OBT în calitate de AT

Immunization of children with rheumatic diseases

Introduction. The development of vaccines enables protection against many potentially fatal infectious diseases, reducing mortality worldwide. Vaccinating children with autoimmune diseases is vitally important. Material and methods. A structured search was performed in PubMed and HINARI, using Romanian and English search terms: rheumatic diseases, children, vaccine, immunity. Results. Children with autoimmune rheumatic diseases are at higher risk of infections and need a personalized vaccination schedule, taking into account disease activity, background treatment, risk of infections, vaccine safety and efficacy. The new EULAR 2021 vaccination recommendations for children with rheumatic diseases include general principles such as timing of vaccination, relationship with immunosuppressive treatment, relationship with the national immunization program and responsibilities. General principles are separated from individual recommendations for specific vaccinations, patient groups or drugs. Conclusions. Immunization in children with autoimmune/autoinflammatory rheumatic diseases undergoing immunosuppressive treatment needs to be promoted and supported, and the importance of completing vaccination schedules should be emphasized. Strategies to compensate for lower vaccine responses or rapid antibody decline include measuring antibody levels to determine the optimal time to administer booster doses as needed. Larger studies are needed that include children with rheumatic diseases, in order to develop evidencebased guidelines for their vaccination.Introducere. Dezvoltarea vaccinurilor permite protecția împotriva multor maladii infecțioase cu potențial fatal, scăzând mortalitatea la nivel mondial. Vaccinarea copiilor cu maladii autoimune prezintă o importanță vitală. Material și metode. A fost efectuată o cercetare structurată în PubMed și HINARI, folosind termenii în limba română și engleză: maladii reumatice, copii, vaccin, imunitate. Rezultate. Copiii cu maladii reumatice autoimune prezintă un risc mai mare pentru infecții și au nevoie de un program de vaccinare personalizat, luând în considerare evoluția bolii, tratamentul de fond, riscul pentru infecții, siguranța și eficacitatea vaccinului. Noile recomandări EULAR 2021 de vaccinare a copiilor cu maladii reumatice includ principiile generale – momentul vaccinării, relația cu tratamentul imunosupresorși cu programul național de imunizare, dar și responsabilități. Principiile generale sunt separate de recomandările individuale privind vaccinările specifice, grupuri de pacienți sau medicamente. Concluzii. Imunizarea copiilor cu maladii reumatice autoimune/autoinflamatorii supuși tratamentului imunosupresiv se impune a fi promovată și susținută, iar importanța finalizării schemelor de vaccinare ar trebui subliniată. Strategiile pentru compensarea celor mai mici răspunsuri la vaccin sau declinul rapid al anticorpilor includ măsurarea nivelurilor de anticorpi pentru a determina momentul optim pentru administrarea dozelor de rapel la necesitate. Sunt indispensabile studiile cât mai vaste care ar include copiii cu afecțiuni reumatice, pentru a fi posibilă realizarea ghidurilor bazate pe dovezi în vaccinarea acestora