Institutional Governance of the Francophonie after 50 Years of Existence, between Geopolitical Interest and the Challenges of Economic Development/Strategy

Economy is a priority for the International Organization of Francophonie (OIF), whose objective is to build, together with its member states and governments, associate members and observers, a new model of economic growth in the Francophone space adjusted to the current context of globalization. The actions currently carried out by OIF in the economic sector are based on the priorities of the Economic Strategy adopted by the heads of Francophone states and governments at the Summit of the Francophonie held in Dakar in 2014, even though the organization is built around the affiliation to the French language and the promotion of the diversity of Francophone cultures. By adopting an economic strategy, the Francophone states and governments committed to defend the joint interests of the Francophone space and impose a common reform vision, particularly in the field of trade, access to financing sources and for a more efficient valorisation of innovation and creativity in the service of sustainable development. From this perspective, OIF supports entrepreneurship as a priority, an effort considered essential for a truly inclusive and long-lasting growth, giving particular attention to economic initiatives carried out by young people and women, as part of the gender equality and youth policy. The main objective is to support and strengthen the business environment from an institutional, financial and regulatory perspective. Moreover, the organization has the capacity to gather together expert networks, to facilitate the exchange of expertise, best practices and prediction analyses in the entrepreneurial field, being a truly supportive relay of contacts between professional networks. By its uniqueness and specificity in the current multilateral landscape, OIF is characterized by its capacity to act simultaneously on three essential levels: 1. states and governments; 2. national institutions and civil society; 3. non-governmental organizations and the private sector. The added value of OIF is to take on the role of a facilitator in relation to the national Francophone administrations, acting for the identification and implementation of innovative economic models that generate an inclusive sustainable development. On the background of an international reflection, started at the end of last year, in the context of its 50-year anniversary, regarding OIF directions and governance, this paper revels the main challenges and trends of economic development in the Francophone countries, in a period marked by the disturbance of geopolitical balances, the exacerbation of certain outbreaks of security and economic crises. As part of this effort of evaluation of the institutional governance of the Francophonie and OIF’s place on the current multilateralism scene, answers are sought to a series of questions, that concern the academic and research environment, as well as the national administrations that invest politically and financially in the Francophonie cause: Do the current priorities of the Institutional Francophonie and the current structure of the organization meet the economic development needs and expectations of the Francophone populations that they represent? What would be the added value of the Francophonie in terms of sustainable development, the strengthening of the Francophone economic space, the support for education and Francophone culture or in the field of settling international conflicts? What would be the priority intervention axes

Sincopa la adulţi:Terminologie, clasificare, strategie diagnostică

Sincopa este un sindrom clinic frecvent întâlnit în spectrul larg al condiţiilor clinice ce cauzează pierderea tranzitorie de conştienţă. În majoritatea cazurilor, sincopa este rezultatul reducerii temporare a perfuziei cerebrale, reprezentând o consecinţă a unei hipotensiuni sistemice tranzitorii. Sunt prezentate clasifi carea şi mecanismele de producere a sincopelor. La majoritatea pacienţilor, sincopa este relativ benignă. Într-un grup mic de pacienţi (în primul rând, cei cu patologie structurală cardiacă), sincopa indică la o maladie severă şi un pronostic alarmant. Diferenţierea acestor două grupuri, aprecierea genezei simptomaticii pacientului, pronosticului şi iniţierea tratamentului efectiv sunt obiectivele principale ale managementului stărilor sincopale. Anamnesticul minuţios, examenul fi zic multilateral, folosirea raţională a testelor diagnostice ajută la stabilirea diagnosticului corect şi asigură succesul tratamentului

Cardiomiopatia aritmogenă de ventricul drept, evaluare diagnostică şi tratament

Cardiomiopatia aritmogenă de ventricul drept (CAVD) este o formă rară de cardiomiopatie cu determinism predominant genetic, caracterizată prin pierderea progresivă a masei miocitare şi înlocuirea acesteia cu ţesut fi broadipos ce determină disfuncţie ventriculară, aritmii ventriculare şi moarte subită. Deşi este o afecţiune mai puţin frecventă, însă, riscul sporit de moarte subită la persoane fără manifestare clinică sau chiar fără modifi care structurală ventriculară, impune depistarea activă a acesteia

Should we increase betablocker after cardiac resynchronization therapy: the results of the caribe-hf study (cardiac resynchronization in combination with betablocker treatment in advanced chronic heart failure)

Cardiac resynchronization therapy (CRT), combined with optimal medical therapy (OMT), is an established treatment for patients with advanced chronic heart failure (ACHF). In ACHF, carvedilol at the dose used in clinical trials reduces morbidity and mortality. However, patients often cannot tolerate the drug at the targeted dosage. Aim of the CARIBE-HF prospective observational study was to investigate the role of CRT in the implementation of carvedilol therapy in patients with ACHF. Methods: One hundred and 6 patients (aged 65±12 [mean±sd] years) with ACHF were enrolled and treated with OMT, in which carvedilol was titrated up to the maximal dose (phase 1). Subsequently, patients with left ventricular (LV) ejection fraction < 35%, NYHA class III-IV and QRS interval ≥ 120 msec were assigned to CRT. Both CRT and NO-CRT patients underwent long-term follow-up till 7 years (1193,98±924 days), while efforts to up-titrate the carvedilol dose were continued during the second phase (471±310 days). Phase 1 was completed by 84 patients (79%), and 15 (18%) underwent CRT. The mean carvedilol dose in the CRT group was 19.0±17.8 mg, against 32.7±19.1 mg in the remaining 69 patients (p=0.018). At the end of phase 2, CRT patients presented a significantly greater variation of increasing in the carvedilol dose than NO-CRT patients ( 20.0±19.8 mg vs –0.3±20.5 mg; p=0.015), a greater NYHA class reduction (-0.8±0.6 vs -0.2±0.7; p=0.011), and a greater increase in LV ejection fraction ( 10.8±9 vs 3.1±6.1; p=0.018). In conclusion, the data from the CARIBE study suggest that, in ACHF, CRT may be effective in enabling the target dose of carvedilol to be reached. The significant improvement seen in LV function was probably due to a synergistic effect of CRT and carvedilol. During the extended follow-up (mean 1193,98±924 days) the mean dosage of carvedilol in CRT group was significantly higher (

Lo screening della disfunzione ventricolare sinistra sistolica asintomatica in un campione di popolazione ad alto rischio cardiovascolare in Lombardia: lo studio DAVID-Berg

Background. Prevalence of asymptomatic left ventricular systolic dysfunction (ALVSD) increases with age and cardiovascular (CV) risk exposure. Early diagnosis and treatment allow reducing heart failure and fatal and non-fatal event rates. Data on ALVSD prevalence in Italy are still scarce and ALVSD remains commonly under-diagnosed in primary care, where diagnostic facilities are limited. Among subjects at high CV risk in primary care, we assessed the prevalence of ALVSD and the relative predictive value of N-terminal pro-brain natriuretic peptide (NT-proBNP) and the Framingham Heart Failure Risk Score (FHFRS). Conclusions. In subjects at high CV risk in primary care, prevalence of ALVSD is 5.3%; for diagnosis NT-proBNP adds predictive value to the FHFRS and is equivalent to the combination of FHFRS and ECG. Because of its practical advantages, NT-proBNP might be routinely used for ALVSD screening in primary care

Bolile aortei: protocol clinic naţional PCN-242

IMSP Institutul de Cardiologie, Departamentul Cardiochirurgie ISMP SCRAcest protocol a fost elaborat de grupul de lucru al Ministerului Sănătăţii al Republicii Moldova (MS RM), constituit din colaboratorii IMSP Institutul de Cardiologie în colaborare cu IMSP Spitalul Clinic Republican. Protocolul clinic naţional este elaborat în conformitate cu ghidurile internaţionale actuale privind bolile aortice (ESC, 2014) şi poate servi drept bază pentru elaborarea protocoalelor instituţionale (extras din protocolul naţional aferent pentru instituţia dată, fără schimbarea structurii, numerotaţiei capitolelor, tabelelor, figurilor, casetelor etc.), în baza posibilităţilor reale ale fiecărei instituţii în anul curent. La recomandarea Ministerului Sănătăţii pentru monitorizarea protocoalelor instituţionale pot fi folosite formulare suplimentare, care nu sunt incluse în protocolul clinic naţional

Sindromul coronarian acut şi Infarctul miocardic acut: protocol clinic naţional PCN-81

IMSP Institutul de CardiologieAcest protocol a fost elaborat de grupul de lucru al Ministerului Sănătăţii al Republicii Moldova constituit din colaboratorii IMSP Institutul de Cardiologie. Protocolul clinic naţional este elaborat în conformitate cu ghidurile internaţionale actuale privind sindromul coronarian acut și infarctul miocardic şi poate servi drept bază pentru elaborarea protocoalelor instituţionale (extras din protocolul naţional aferent pentru instituţia dată, fără schimbarea structurii, numerotaţiei capitolelor, tabelelor, figurilor, casetelor etc.), în baza posibilităţilor reale ale fiecărei instituţii în anul curent. La recomandarea Ministerului Sănătăţii pentru monitorizarea protocoalelor instituţionale pot fi folosite formulare suplimentare, care nu sunt incluse în protocolul clinic naţional

Cardiomiopatia hipertrofică: protocol clinic naţional PCN-248

IMSP Institutul de Cardiologie, IMSP Spitalul Clinic RepublicanAcest protocol a fost elaborat de grupul de lucru al Ministerului Sănătăţii al Republicii Moldova, constituit din colaboratorii IMSP Institutul de Cardiologie, în conformitate cu ghidul Societății Europene de Cardiologie “Cardiomiopatia hipetrofică” şi poate servi drept bază pentru elaborarea protocoalelor instituţionale, în baza posibilităţilor reale ale fiecărei instituţii, în anul curent. La recomandarea Ministerului Sănătăţii pentru monitorizarea protocoalelor instituţionale pot fi folosite formulare suplimentare, care nu sunt incluse în protocolul clinic naţional

Long‐term outcomes of phenoclusters in preclinical heart failure with preserved and mildly reduced ejection fraction

Aims The identification of subjects at higher risk for incident heart failure (HF) with preserved ejection fraction (EF) suitable for more intensive preventive programmes remains challenging. We applied phenomapping to the DAVID-Berg population, comprising subjects with preclinical HF, aiming to refine HF risk stratification. Methods The DAVID-Berg study prospectively enrolled 596 asymptomatic outpatients with EF &gt; 40% with hypertension, diabetes mellitus or known cardiovascular disease. In this cohort, we performed an unsupervised cluster analysis on 591 patients, including clinical, laboratory, electrocardiographic and echocardiographic parameters. We tested the association between each cluster and a composite outcome of HF/death. Results The median age was 70 years, 55.5% were males and the median EF was 61.0%. Phenomapping provided three different clusters. Subjects in Cluster 3 were the oldest and had the highest prevalence of atrial fibrillation, the lowest estimated glomerular filtration rate (eGFR), the highest N-terminal pro-brain natriuretic peptide (NT-proBNP) and the largest left atrium. During a median follow-up of 5.7 years, 13.4% of subjects experienced HF/death events (N = 79). Compared with Clusters 1 and 2, Cluster 3 had the worst prognosis (log-rank test: Cluster 3 vs. 1 P &lt; 0.001; Cluster 3 vs. 2 P = 0.008). Cluster 3 was associated with a risk of HF/death 2.5 times higher than Cluster 1 [adjusted hazard ratio (HR) = 2.46, 95% confidence interval (CI) 1.24-4.90]. Conclusions Based on phenomapping, older patients with lower kidney function and worse diastolic function might represent a subset of preclinical HF with EF &gt; 40% who deserve more efforts to prevent clinical HF