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

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

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

Железодефицитная анемия при воспалительных заболеваниях кишечника

USMF Nicolae Testemițanu, IMSP SR ACSR, Conferinţa consacrată aniversării celor 40 de ani de la fondarea SCM Sfânta Treime 17 iunie 2016 Chișinău, Republica MoldovaInflammatory bowel disease (IBD) represents a group of intestinal disorders that cause prolonged inflammation of the digestive tract, with genetic determinism, consequence of an inappropriate immune response to exogenous stimulation. They are characterized by recurrent episodes of inflammation of the gastrointestinal tract, interspersed with periods of remission. Inflammatory bowel diseases are currently treated with predominantly digestive symptoms, but in medical practice we meet and associated systemic manifestations of basic pathology. Extraintestinal manifestations are generally related to the activity of the bowel disease and may precede or be simultaneous to the bowel symptoms, the presence of these symptoms is commonly associated with a decline in the quality of patients with IBD life, which requires a quick diagnosis, accurately and treatment suitable. One of the most common manifestations of IBD is anemia, in case that is not diagnosed and treated has a significant impact on quality of life.Воспалительные заболевания кишечника (ВЗК) это группа полиэтиологических заболеваний, возникающих вследствие неадекватного иммунного ответа на экзогенные раздражители. Они характеризуются повторяющимися эпизодами воспаления желудочнокишечного тракта, чередующимися с периодами ремиссии. Воспалительные заболевания кишечника представлены патологиями с преимущественно симптомами co cтороны желудочно-кишечного тракта, но в медицинской практике встречаются и системные проявления, связанные с основным заболеванием. Внекишечная симптоматика, обусловленная течением заболевания может предшествовать или ассоциироваться с кишечными симптомами. В совокупности это отрицательно влияет на качество жизни пациентов с ВЗК и определяет постановку правильного предварительного диагноза и назначения адекватного лечения. Одной из самых распространенных проявлений ВКЗ является анемия, которая без своевременной диагностики и лечения оказывает значительное влияние на прогноз пациентов и влияет на качество жизни

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%)