23 research outputs found
INTEGRATION OF SEMI-SUBSISTENCE AGRICULTURAL FARMS
Intensive agriculture, industrial type, contributed to environmental degradation and pollution. Thus, on the one hand, makes intensive use of chemicals has led to neglect of duty to maintain the natural fertility of the soil organic matter through proper fattening. On the other hand, organizing specialized industrial environments, high animal breeders, considered the only marketable livestock production, neglecting the production of manure, thus representing a break with the brutal nature of biological circuits Following the experience accumulated over two centuries, mankind has drawn valuable education obligation to safeguard the habitat of nature as a collaborator. In this respect, the main task of our times is to develop appropriate technologies humanist ideal, so that man can become a being as fully integrated into the social and cosmic environment. In the present period as a peasant household current form, is typical of developing countries. It is generated by the result of families who received income from farming and increase farm animalelor.Gospodãria organizational structure is the basic economic and agricultural economy. On the basis of the idea that organic production is the main cause of degradation of the biological quality of products is inadequate human intervention at various structural levels of the biosphere, and the most severe effects on humans resulting from the cumulation of errors relating to soil, plants and animals. Organic farming places emphasis on quality natural products, the quantity and productivity issues as a peripheral level. A balanced rural development policy for the future is not an option but a necessity, especially considering the fact that the issue of agriculture and rural development has important national connotations and is a very complex and timely in Romania Regional development is a concept that aims at stimulating and diversifying economic activities, encouraging private sector investment, helping to reduce unemployment and ultimately lead to improved living standards, according to the regions of the country\'s developmentPeasant household, sustainable development, farms, subsistence, european agriculture
Определение метаболических нарушений и роли диабета у пациентов с кардиоренальным синдромом
IP Universitatea de Stat de Medicină și Farmacie
Nicolae TestemițanuDiabetul zaharat este un factor de risc cardiovascular recunoscut, dar și un factor ce provoacă nefropatie. Conform Consensului ADQI (Acute Dialysis Quality Initiative), diagnosticul de sindrom cardiorenal de tip 2 este stabilit când o patologie cardiacă provoacă afectarea renală, iar sindromul cardiorenal de tip 5 – când o patologie preexistentă, cum este diabetul, induce concomitent insufi ciență cardiacă și renală. Totodată, prevalența obezității, a sindromului metabolic și a rezistenței la insulină este destul de înalta la pacienții nondiabetici cu insufi ciență cardiacă. Aceste comorbidități cresc riscul de diabet zaharat, formând un cerc vicios. Scopul studiului a fost determinarea perturbărilor metabolice și a rolului DZ la pacienții cu sindrom cardiorenal. Studiul prospectiv a inclus 170 de pacienți cu insufi ciență cardiacă, internați în Clinica de cardiologie, SCM „Sfânta Treime” din Chișinău, în perioada ianuarie 2016 – decembrie 2017. Au fost evaluați 170 de pacienți: 83 cu sindrom cardiorenal și 87 fără afectare renală. Diabet zaharat a fost atestat în 50,6% cazuri în lotul de studiu și în 46,0% cazuri în lotul de control. În studiul dat, diabetul zaharat nu este un factor independent de risc pentru sindromul cardiorenal. Acest lucru poate fi explicat prin scurta durată a DZ. Însă acesta este un important marker pentru prognosticul mortalității și a evenimentelor cardiovasculare acute.The role of diabetes is well known as a cardiovascular risk factor as well as in the nephropathy development and progression. The ADQI (Acute Dialysis Quality Initiative) defines the type 2 cardiorenal syndrome when a cardiac pathology leads to kidney damage, and type 5 cardiorenal syndrome is considered when a pre-existing pathology leads to both cardiac and renal impairment. On the other hand, the prevalence of obesity, metabolic syndrome and insulin resistance is quite high in non-diabetic heart failure patients. These comorbidities increase the risk of diabetes and other glycemic disorders, thus constituting a vicious circle. Purpose of the study was to assess the metabolic disturbances and type 2 diabetes impact in cardiorenal syndrome patients. The prospective study included 170 heart failure patients with reduced and intermediate ejection fraction who were hospitalized in the Cardiology Clinic, SCM “Sfаnta Treime» in Chisinau between January 2016 and December 2017. 170 patients were evaluated: 83 subjects with cardiorenal syndrome and 87 heart failure subjects without renal impairment. Diabetes mellitus was found in 50,6% of the study group and 46,0% of the control group. In the pre sent study, diabetes mellitus is not an independent risk factor for cardiorenal syndrome. This can be explained by the short duration of diabetes, according to the literature data in the natural course of the diabetes the risk of nephropathy is increased after 5 years.Роль диабета хорошо известна как сердечно-сосудистый фактор риска, а также в развитии и прогрессировании нефропатии. ADQI (Инициатива по качеству острого диализа) определяет кардиоренальный синдром 2-го типа, когда патология сердца приводит к нарушению функции почек, а кардиоренальный синдром 5-го типа рассматривается, когда ранее существовавшая патология приводит к сердечной и почечной недостаточности. С другой точки зрения, распространенность ожирения, метаболического синдрома и инсулинорезистентности довольно высока у пациентов с сердечной недостаточностью при отсутствии диабета. Эти заболевания увеличивают риск диабета и других гликемических расстройств, образуя тем самым порочный круг. Целью данного исследования было оценить метаболические нарушения и влияние диабета 2 типа у пациентов с кардиоренальным синдромом. В проспективное исследование были включены 170 пациентов со сердечной недостаточностью со сниженной и средней фракцией выброса, госпитализированных в кардиологическую клинику МКБ «Святая Троица» г. Кишинэу, в период с января 2016 года по декабрь 2017 года. Были обследованы 170 пациентов: 83 с кардиоренальным синдромом и 87 со сердечной недостаточностью без нарушения функции почек. Сахарный диабет был обнаружен у 50,6% пациентов основной группы и у 46,0% контрольной группы. В настоящем исследовании сахарный диабет не является независимым фактором риска развития кардиоренального синдрома. Это можно объяснить короткой продолжительностью диабета. Согласно литературным данным в естественном течении диабета, риск нефропатии увеличивается через 5 лет
Transcriptomics predicts compound synergy in drug and natural product treated glioblastoma cells.
Pathway analysis is an informative method for comparing and contrasting drug-induced gene expression in cellular systems. Here, we define the effects of the marine natural product fucoxanthin, separately and in combination with the prototypic phosphatidylinositol 3-kinase (PI3K) inhibitor LY-294002, on gene expression in a well-established human glioblastoma cell system, U87MG. Under conditions which inhibit cell proliferation, LY-294002 and fucoxanthin modulate many pathways in common, including the retinoblastoma, DNA damage, DNA replication and cell cycle pathways. In sharp contrast, we see profound differences in the expression of genes characteristic of pathways such as apoptosis and lipid metabolism, contributing to the development of a differentiated and distinctive drug-induced gene expression signature for each compound. Furthermore, in combination, fucoxanthin synergizes with LY-294002 in inhibiting the growth of U87MG cells, suggesting complementarity in their molecular modes of action and pointing to further treatment combinations. The synergy we observe between the dietary nutraceutical fucoxanthin and the synthetic chemical LY-294002 in producing growth arrest in glioblastoma, illustrates the potential of nutri-pharmaceutical combinations in targeting this challenging disease
The diagnostic significance of intima-media determination in patients with different ischemic cardiopathy variants
Departamentul Medicină Internă,
USMF Nicolae Testemiţanu,
IMSP SCM Sfânta Treime, Laboratorul hepatochirurgical, USMF Nicolae TestemiţanuThe process of systemic atherosclerosis has a long asymptomatic period corresponding with the occurrence of manifested cardiovascular disease, such as myocardial infarction
or ischemic stroke, which results in the invalidity of the
patient, lowering its quality of life, decreasing life expectancy and increasing spending in public health or death. The
rise in the index of average thickness is intimate-the first
observable sign of atherosclerosis, vascular damage from its
substrate, being represented by fibrocelular hypertrophy and
hyperplasia of smooth muscle cells in the media pressure
¿Doctor, qué piensa usted sobre sus pacientes con EPOC?
La evaluación del trabajo que desarrollamos en atención primaria es una forma de detectar los puntos débiles, ayudándonos a mejorar. El objetivo del presente trabajo es conocer la opinión de los médicos de familia de un centro de salud (CS) sobre sus pacientes con EPOC. Como método se ha utilizado una encuesta a la que respondieron los médicos antes y después de presentar los resultados de la evaluación de esos pacientes. Se ha evaluado anualmente durante un periodo de tres años (junio 2008 - mayo 2011) una muestra aleatoria de 137 pacientes con diagnóstico activo de EPOC en su historia clínica electrónica (HCE). La prevalencia registrada de EPOC en el CS ha pasado de 3,07% en 2009 a 3,23% en 2011. El porcentaje de pacientes diagnosticados incorrectamente de EPOC en la HCE ha sido del 20,4%. La edad media era de 70,3 años (DE 12,4) y el 69,3% eran varones. En el tercer año evaluado, constaba un 31% de pacientes fumadores, un porcentaje similar de no fumadores y en el 38% restante no había registro de dicho hábito. Se registraron 89 espirometrías. En el 69,3% se realizó una radiografía de tórax. La vacuna antineumocócica sólo constaba en el 12,4% de los casos. A la vista de estos datos cuantitativos nos damos cuenta de que existen aspectos susceptibles de mejorar, pero esto sólo si conocemos la realidad objetiva que nos aporta la evaluación de nuestro trabajo y no sólo la sensación subjetiva de cómo creemos tener controlados a nuestros pacientes
¿Doctor, qué piensa usted sobre sus pacientes con EPOC?
La evaluación del trabajo que desarrollamos en atención primaria es una forma de detectar los puntos débiles, ayudándonos a mejorar. El objetivo del presente trabajo es conocer la opinión de los médicos de familia de un centro de salud (CS) sobre sus pacientes con EPOC. Como método se ha utilizado una encuesta a la que respondieron los médicos antes y después de presentar los resultados de la evaluación de esos pacientes. Se ha evaluado anualmente durante un periodo de tres años (junio 2008 - mayo 2011) una muestra aleatoria de 137 pacientes con diagnóstico activo de EPOC en su historia clínica electrónica (HCE). La prevalencia registrada de EPOC en el CS ha pasado de 3,07% en 2009 a 3,23% en 2011. El porcentaje de pacientes diagnosticados incorrectamente de EPOC en la HCE ha sido del 20,4%. La edad media era de 70,3 años (DE 12,4) y el 69,3% eran varones. En el tercer año evaluado, constaba un 31% de pacientes fumadores, un porcentaje similar de no fumadores y en el 38% restante no había registro de dicho hábito. Se registraron 89 espirometrías. En el 69,3% se realizó una radiografía de tórax. La vacuna antineumocócica sólo constaba en el 12,4% de los casos. A la vista de estos datos cuantitativos nos damos cuenta de que existen aspectos susceptibles de mejorar, pero esto sólo si conocemos la realidad objetiva que nos aporta la evaluación de nuestro trabajo y no sólo la sensación subjetiva de cómo creemos tener controlados a nuestros pacientes
Particularities of intima-media determination in patients with different variants of ischemic heart disease (Literature review)
Departamentul Medicină Internă,
USMF Nicolae Testemiţanu, IMSP SCM Sfânta Treime, Laboratorul hepato-chirurgical,
USMF Nicolae TestemiţanuAtherosclerosis and its consequences are more common meet in ischemic heart disease and stroke, are and will continue to be present and in the next 20 years, the main cause of mortality of the population around the globe. Incidentally, the latter’s share in the structure of morbidity and general mortality has reached major odds and in the Republic of Moldova
Management of stable angina in men (Literature review)
Departament of Internal Medicine,
SMPhU Nicolae Testemitanu, SMPI MCH Sfanta Treime, Hepato-Surgical Laboratory, SMPhU N. TestemitanuThe classical description of Stable Angina, which
is valid and today, has been made for the first time by
William Beberdeb in 1772. His article about almost
20 patients called “Some considerations about chest
diseases”. He made a very detailed and excellent description, since the Stable Angina is called up today
Heberden’s angina [1, 5]. He described very clear
its precipitation to the effort and emotions. Hunter
died suddenly, in 1793, at the age of 65, and at the
autopsy made by his disciple Edward Jenner it was
found the intense coronary artery ossification. These
findings allowed the determination of a relation
between Stable Angina and coronary disease [8, 9].
Then, in 1799, the scientist Parry linked the Stable
Angina problem with the poor blood flow with the
obstruction of the coronary arteries, and in 1809 the
well-known scientist Bums said that Stable Angina
develops because “offer of energy and exhaustion
are not balanced”. This important conception remains valid up today [5].
In 1933, the famous Britain cardiologist Sir
Thomas Lewis launched the concept that ischemia
includes not only changes in the structure of coronary arteries, but and in and their tonicity, therefore
a supply deficit may be caused by inadequate coronary tone and the deficit can cup by vasodilation [7,
9]. These methods remain today of major importance
in the diagnosis of Stable Angina, very informative,
accessible and safe at the same time [6, 7]. An important step in the diagnosis of the Stable Angina was
innovation in technique viewing of coronary arteries.
Selective coronary angiography was introduced by
MasonSones in 1959 in the United States. He relied
on the works of German doctor Werner Forssmann,
who in 1929 tried this method by himself by inserting a catheter through the cubital vein to the right
atrium. Later he and is honored with the Nobel Prize
for developing the method of the human body
probing
Particularities of management in men’s stable angina
Departament of Internal Medicine, SMPhU N. Testemitanu, SMPI MCH Sfanta Treime, Hepato-Surgical Laboratory, SMPhU Nicolae TestemitanuIntroduction
In the US the AP has a prevalence of 3.3%, for
men – 3.4%, and for women – 3.2%. In the European
countries, according to the data of European Society
of Cardiology (ESC), the prevalence of AP raises increases with age for both sexes: from 4-7% for men
aged between 45 and 64, and from 5-7% from the
women of the same age, from 12-14% for the men
aged between 65 and 84 and 10-12% for women of
the same age [1, 2].
The most common AP complication is the acute
myocardial infarction (AMI). In the United States
the prevalence of the myocardial infarction among
adults aged ≥20 is 2.8%, 4.0% for men and 1.8 for
women. The scientists, who studied this field, have
calculated that every 43 seconds an American citizen may develop AMI [1]. According to population
studies of Olmsted County and Framingham, the
patients with AP develop AMI in 3.-3.5 % per year,
so in 30 patients with AP, the AMI progresses in one
person [2, 5].
In the United States, IHD causes 146.5 deaths
per 100000 of population among men and 80.1 per
100000 of population among women. IHD is responsible for 25.3% of deaths [4, 5]. In Europe, IHD is
responsible for 1.8 million of deaths per year, which
corresponds to 20% of men and 21% of women. In
the Republic of Moldova the death rate because of
IHD per 100.000 of population is 138 per men and
51 per women, simultaneously, Romania presents
a death rate approximately 2 times smaller: 75 per
100.000 of population – men and 21 per 100.000 –
women, and the highest death rate because of IHD
is in Russia: 186 per 100.000 of population – men and
44 per 100.000 of population – at women [6].
Various observational studies have proved the
existence of sex differences both in clinical and paraclinical presentation, and in therapeutic options
which are not effective and safe in equal measures
for men and women. At the same time, it has been
proved that the men are involved to a lesser extent
in the population studies pointing the cardiovascular diseases, so from 62 randomized studies in
Europe only 33.5% of participants were women [3,
5]. It was found that men with AP who seek medical
attention have a superficial approach, involving
more frequently the noninvasive methods versus the
invasive methods, and they have a lesser possibility
than men of revascularization treatment. So, among
the men with AP, 4.2% of them dispose of revascularization, meanwhile only in 2.4% of women with AP
dispose of this option of treatment [2, 5].
Taking into consideration the growing of the
incidence of AP in women, the determination of
a late diagnosis because of clinical atypical manifestations and the reduced involvement of women
with AP in population studies, we intend to study
the AP peculiarities of women from the Republic of
Moldova, which means an actual health and social
problem.
The aim of the study: to study the etiological,
clinical and paraclinical peculiarities and the treatment of stable angina in men.
Objectives of the study. To study the cardiac
predisposing factors and comorbidities in men with
stable angina. To analyze the peculiarities of clinical
evolution of stable angina in men. To evaluate the
paraclinical results in patients that was included in
the study. To evaluate the treatment of stable angina
in men.
The study included 116 patients with AP, admitted to the Municipal Hospital Sfanta Treime and
the Cardiological Institute during September 2015
– November 2016. Diagnostic of Stable Angina was
determined by clinical criteria: anamnesis, clinical
manifestations, objective data; instrumental examination: electrocardiography in all patients, effort
test and coronary angiography in patients selected
for revascularization by coronary artery bypass grafting, Holter monitor ECG, stress test medication in a
group of patients for technical reasons; Laboratory
tests: lipidogram, coagulation, blood glucose, blood
counts in all patients, and markers of myocyte injury
in some patients with UAP for financial reasons.
Results and discussions
According to the study goals and objectives,
we analyzed in detail AP patients with predisposing
factors to determine, comorbidities, clinical manifestations and complications, results paraclince
specific treatment and preventive measures in these
patients. Starting from the paper’s purpose patients
were divided into 2 groups according to sex. In our
study group were predominantly men, numbering
67, which constituted 57,8%, compared to women
– 49 which corresponds to 42,2%. AP increased prevalence among men is explained by the fact that
women have a protective role of ovarian hormones
in premenopausal period. We aimed to evaluate patients in the study depending on age and sex, the
data is illustrated in the following graphic.
In patients aged up to 64 years, AP predominates in men than women: ≤44 years (2,8% vs 0%),
45-54 years (16,5% vs 9,2%); 55-64 years old (46,5%
vs 29,4%) and after age 65, AP prevalence is higher
in women compared to men: 65-74 years old (32%
vs 22,8%); 75-84 years old (26,8% vs 11%); ≥85 years
(2,6% vs 0,4%). This phenomenon can be explained
by the combination of a new risk factor in women
and certain post-menopausal and longer life expectancy of women than men [1, 4].
Analyzing the results, we note that the initial
diagnosis of AP was established more frequently in
men (62.6%) compared to women (51.6%). Acute
Coronary Syndrome was suspected equally to men
(22.4%) and women (23.72%). At the same time, women were hospitalized more frequently with other
diagnoses (24.2%) vs men (12.2%).
According to the pain location, we can observe
that in men typical retrosternal pain and precordial
pain is determined 82,4% vs 88,5% in biggest proportion compared to women‘s. At the same time, for
women’s prevailed pain in the atypical locations in
5.2% and missing of the pain in 12.4%. This results
is explaining by a big prevalence of atypical clinical
picture of AP.
Analyzing this obtained results, we can observe, that men’s pain radiates predominantly on a left
shoulder – 67.2 % vs 48.4 %, during the time that
extension of the pain in other regions is present
more frequently for women’s. In the left shoulder and
hand – 17.8% vs 9.8%, interscapulo – vertebral 17.8%
vs 14.8%, throat – 8% vs 6.6%, mandible – 3.2% and
other locations – 4.8% vs 1.6%. Studying the data
obtained, we note that in most of the patients, the
AP gives the administration of nitroglycerin, a rate
less prevalent in men (59.1%) than in women (62.3%).
Anginal pain at rest was determined that yield more
often in men (21.5%) than in women (17.1%), and
improving crisis management nitroglycerin angina
both at rest and was in an amount almost equal to
both sexes 19.4% vs 20.6%. Various observational
studies have proved the existence of sex differences
both in clinical and paraclinical presentation, and in
therapeutic options which are not effective and safe
in equal measures for men and women. At the same
time, it has been proved that the men are involved
to a lesser extent in the population studies pointing
the cardiovascular diseases, so from 62 randomized
studies in Europe only 33.5% of participants were
women [Stramba-Badiale M., 2009]. It was found
that men with AP who seek medical attention have
a superficial approach, involving more frequently
the noninvasive methods versus the invasive methods, and they have a lesser possibility than men
of revascularization treatment. So, among the men
with AP, 4.2% of them dispose of revascularization,
meanwhile only in 2.4% of women with AP dispose
of this option of treatment. In the study group gr
II IC prevailed in almost equal proportion in both
sexes, women (57.8%) vs men (59.1%), followed by
IC gr. III (36.2%) vs. (35.6%). Gr. IV IC and IC gr. I was
in the minority.
We should notice that the anti-ischemic therapy, most commonly administered beta-AB, slightly
more prevalent in men (73.2%) vs (68.6%), BCC, commonly administered to women (56.2%) vs ( 44.5%)
and less nitrates: 14.9% for women vs 12.2% men.
The cytoprotective benefited equally to men (41.3%)
and women (39.2%). For prophylactic antiplatelet
prevailed slightly more prevalent in men (71.2%)
vs women (70.3%). Statins and anticoagulants were
given less frequently in women.
Conclusions
Angina pectoris is higher in men than in women
(57,8% vs 42,2%). The rate of pathology is changing
with age, up to 64 years, angina is more frequent is
meat in men (65,8%) vs 38,6 in women, and after the
age of 65 years, women prevail (61,4% vs 34,2%).
In patients with angina clinical picture was more
often represented by the retrosternal pain in 52,7%
and dependent in physical exertion in 68,5% of
medium intensity, with a duration of 5-10 minutes
at those with stable angina (15,9%) and 20 minutes
from those with unstable angina (14,7%), that were
ameliorated after nitroglycerin intaking. Men representing the angina pectoris have administrated
the pharmacological treatment mostly with: notice
that the anti-ischemic therapy, most commonly administered beta-AB, slightly more prevalent in men
(73.2%) vs (68.6%), BCC, commonly administered to
women (56.2%) vs (44.5%) and less nitrates: 14.9%
for women vs 12.2% men
The impact of the risk factors in myocardial infarction with ST segment elevation
USMF Nicolae Testemiţanu,
Departamentul Medicină Internă,
IMSP Institutul de Cardiologie,
IMSP SCA Sfânta TreimeAcute Myocardial Infarction with ST segment elevation (STEMI) is a serious disease with the incidence of 66 per 100,000 population, which rapidly results in patient decompensation and high mortality. In recent decades, ischemic heart disease has grown in both developed and developing countries. With increased life expectancy and demographic changes in the age profile of the population, combined with the emergency of multiple cardiovascular risk factors in the everyday life, increased the rate of coronary artery disease. Risk factors for ischemic coronary artery disease can be grouped in modifiable and non-modifiable factors. The modifiable risk factors are hypertension, smoking, hyperglycemia, diabetes mellitus, lack of physical activity and obesity. The main non-adjustable risk factors are gender, age, family history, and consanguineous marriages. After examining the anamnestic, clinical, and paraclinical data in 167 patients with STEMI, it was determined that STEMI developed more frequently in males (71.3%). We determined that the risk factor with the highest rate was arterial hypertension, which was found in 69 patients (41.3%), of which 50.0% in women and 37.8% in men, followed by dyslipidemia, which was detected in 67 patients (40.1%), men with dyslipidemia, were in the ratio of 42.0% and women in 35.4%. Smoking was reported in 23.4%, being higher in males 31.1% than in females 4.2%. Diabetes mellitus was detected in 22.2%, more often encountered among women 29.2%, than men 19.3%.Introducere
Infarctul miocardic cu supradenivelare de segment ST (STEMI) este o maladie gravă, cu incidența de
66 cazuri la 100000 populație, ce conduce progresiv la
decompensarea stării pacientului, urmată de o mortalitate înaltă. În ultimele decenii, boala coronariană
ischemică (BCI) a demonstrat o creștere atât în țările
dezvoltate, cât și în cele în curs de dezvoltare. Odată cu
mărirea speranței de viață, modificarea demografică în
profilul de vârstă al populației, multiplicarea factorilor
de risc (FR) cardiovasculari, s-a determinat majorarea
ratei maladiilor coronariene [3].
Conform studiului INTERHEART, factorii de risc
ai BCI pot fi grupați în factori modificabili și nemodificabili. Printre FR importanți ce răspund de un număr
mare de accidente coronariene ischemice sunt: hipertensiunea arterială (HTA), fumatul, hiperglicemia,
diabetul zaharat (DZ), sedentarismul și obezitatea.
Aceștia sunt FR modificabili, care pot fi corijați printr-un mod de viață sănătos, alimentație corectă,
tratament medicamentos optim, care au un impact
major asupra incidenței globale a BCI. Principalii FR
nemodificabili sunt: sexul, vârsta, istoria familială,
căsătoriile consangvine și locul de naștere [2].
Scopul lucrării a fost studierea impactului factorilor de risc în infarctul miocardic acut cu supradenivelare de segment ST.
Material și metode
Prezentul studiu retrospectiv-prospectiv a fost
efectuat pe un lot de 167 de pacienți cu STEMI, care
prezentau stenoze semnificative ale arterelor coronare și ulterior au fost internați în IMSP Institutul de
Cardiologie și în SCM Sfânta Treime, în perioada mai–
august a anului 2015. Vârsta medie a pacienţilor a fost
de 63,8 ani, minim 33 și maxim 91 ani. Prima quartilă
(delimitează cele mai mici 25% din date) este de până
la 56 de ani, cea de-a treia quartilă (delimitează cele
mai mari 25% din date) este după 72 de ani, mediana
fiind de 64 de ani, cu o deviere-standard (n-1) de
11,48 ani. Pacienţii examinaţi au fost repartizaţi în
două loturi: bărbați 71,3% (119) și femei 28,7% (48).
Au fost cercetate datele anamnestice și investigațiile
de laborator la bolnavii cu STEMI.
Rezultate și discuții
În concordanță cu scopul și obiectivele lucrării,
au fost examinați 167 pacienți cu STEMI, evaluând
anamneza și rezultatele de laborator. Cercetările
efectuate au demonstrat că rata STEMI a fost mai
mare în rândul pacienților de sex masculin (71,3%
sau 119 persoane), comparativ cu pacientele de
sex feminin (28,7% sau 48). La bolnavii cu STEMI au
fost studiați principalii factori de risc ce pot duce la
dezvoltarea BCI, și anume tabagismul, dislipidemia,
DZ și HTA.
În baza datelor anamnestice, clinice și paraclinice a 167 de pacienți cu STEMI, am determinat
că FR cu cea mai mare rată a fost HTA, depistată la
41,3%, urmată de dislipidemie cu 40,1%, tabagism
cu 23,4% și DZ cu 22,2% cazuri. Analizând datele
statistice dintr-un studiu recent efectuat pe un lot de
1210 pacienți, s-a determinat că rata DZ la bolnavii cu
STEMI coincide, fiind de respectiv 21%, HTA – 35%,
dislipidemii – 48% și tabagism – 57%. Diferența tabagismului din studiul nostru și studiul citat poate fi
explicată prin două variabile: subiectivă – pacientul
nu denotă faptul că este fumător, și obiectivă –
diferența dintre numărul pacienților din studii [1]. Pentru a examina mai detaliat rata FR, lotul de
pacienți a fost repartizat pe sexe. La analiza datelor
am obținut că rata tabagismului a fost mai mare la
bărbați (31,1%) decât la femei (4,2%); bărbații cu dislipidemii au constituit 42%, iar femeile – 35,4%; DZ a
fost o comorbiditate mai frecventă la femei (29,2%)
decât la bărbați (19,3%). HTA a fost asociată maladiei
de bază la 50% femei și la 37,8% bărbați.
Analizând datele din studiul INTERHEART, am
determinat că referitor la DZ și HTA acestea sunt
relativ asemănătoare; rata HTA la bărbați și la femei
este de 35% și respectiv 53%, comparativ cu 37,8% la
bărbați și 50% la femei în studiul propriu. Frecvența
DZ în studiul citat este de 16% la bărbați și 26% la
femei, comparativ cu 19,3% la bărbați și 29,2% la
femei [4].
Cu toate acestea, rata dislipidemiei și a tabagismului diferă considerabil în alte studii similare, fiind
relatată în dislipidemie de 46% la bărbați și 58% la
femei; în cazul tabagismului – 68% la bărbați și 17%
la femei. Diferența dată poate fi cauzată de lotul mic
de pacienți cercetați de noi, de diferențele dintre
etniile loturilor studiate, lotul de referință fiind din
Anatolia Centrală, Turcia [1].
Concluzii
1. Infarctul miocardic cu supradenivelare de
segment ST s-a dezvoltat mai frecvent la bărbați
(71,3%), cu predilecție la vârsta de 50-59 ani (31,4%),
la femei (28,7%) acesta survenind preponderent la
vârstele cuprinse între 70 și 79 de ani (40,4%).
2. La pacienții cu infarct miocardic cu supradenivelare de segment ST, factorii de risc prioritari au
fost: hipertensiunea arterială (41,3%), înregistrată
mai frecvent la femei (50%); dislipidemia (40,1%),
preponderentă la bărbați (42%); diabetul zaharat
(22,2%), atestat mai frecvent la femei (29,2%), și
tabagismul (23,4%), cu o rată mai mare la bărbați
(31,1%)