The climate change impact on the heart failure patients’ care

Introduction. Climate change represents long-term changes in temperature and weather patterns, with various impacts on human health. These changes have contributed to increased rates of death due to heat stroke and non-infectious diseases, including cardiovascular, pulmonary, malnutrition, and contagious diseases. Heart failure (HF) is a condition with heightened vulnerability in the face of climate change, necessitating adjustments in the management of these patients. Aim. The goal of our review was to analyze the impact of climate change on heart failure patients’ care. Material and methods. We conducted a straightforward bibliographic study by searching for the keywords “climate change,” “cardiovascular disease,” “heart failure,” and “patients' care” using the search system of the PubMed database. We focused on articles from the last 5 years. As a result, we identified 75 sources of information and examined 15 of them. These sources encompassed all the keywords, allowing us to explore the impact of climate change on heart failure etiology, monitoring, and treatment. Results. Patients with HF are a group with increased vulnerability in the context of climate change. Climate change affects heart health through rising air temperatures, increased air pollution, and shifts in dietary patterns. The mechanisms of worsening HF include: increased blood viscosity, surface blood circulation, and sweating, which leads to increased cardiac workload, dehydration, salt depletion, hemoconcentration, and increase risk of thrombosis. In addition, heat stress was suggested to induce the release of interleukins modulating local and systemic acute inflammatory responses that can result in HF by increasing damage to heart tissue and inflammation with increased levels of B-type natriuretic peptide and C-reactive protein, both of which are predictors of HF prognosis and severity. Increased cardiac strain and output, arrhythmias, and peripheral oedema may render HF patients vulnerable to heatrelated sudden death and inhospital mortality. The hemodynamic changes determined by heat stress may be lesstolerated in patients with HF, with a poor cardiovascular reserve, especially in case of valvular heart diseases or cardiomyopathies. Chronic exposure to air pollution is similar to traditional risk factors, which can lead to the initiation of oxidative stress, and low-grade inflammation and create harmful biological intermediates. The general principles of care include fluid intake, avoidance of the hottest environments, use of appropriate clothes, and reduced physical activity during hot weather. The care of HF patients can be affected by the modifications in drug absorption, distribution, and elimination, and subsequently, the therapeutic response. Another issue is that some drugs can interfere with normal thermoregulatory function, including changes in cardiac output and sweat rate, peripheral vasodilation, and dehydration. Additional care should include patient education about the prevention and management of climate change-related issues. Conclusions. Climate changes negatively influence patients with heart failure, which implies changes and adjustments in therapeutic strategies and care

Test-retest reliability of patients global assessment, physician global assessment and Womac Index in knee osteoarthritis

Introduction: In osteoarthritis pain and physical function are the main outcome measures, and selfreport questionnaires are the preferent assessment method. This is evidence suggesting that self-reports of physical function represents what people experience while performing activities rather than their ability to perform activities. Objective: To study reliability characteristics for global assessments and compared test reliability of both PGA, MDGA vs. WOMAC in knee osteoarthritis. Methods: Patients that were at least 40 years old and had experienced clinical symptoms of OA in the knee at least 3 months before inclusion into study were eligible for inclusion in this trial. All patients were required to fulfill the American College of Rheumatology classification criteria for OA in the knee. The Patient Global Assessment (PGA) asked a patient to rate on the scale how they feel overall. The Physician Global Assessment (MDGA) is a similar item completed by the assessing physician. Both these measures were incorporated into other indices. To assess patient pain we used the Western Ontario and McMaster Universities Index; The WOMAC contains five pain, two stiffness, and 17 physical function items, and is available in five-point Likert (LK) and 100-mm visual analogue (VA). Results: We examined 53 patients with OA of 50 years old. Patients completed the PGA, visual analog scale for pain (VAS Pain), VAS Fatigue, VAS Sleep and PGA. Physicians completed the MDGA at the time of the patients appointment day. Test results were assessed using interclass correlations (ICC). “Substantial” reliability was between 0.69-0.79 and “almost perfect” > 0.80. As endpoint, physical function and the patient’s global assessment were evaluated at baseline and at the 8 week. The Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index was used to assess physical function and pain. This study was conducted according to the principles of the Declaration of Helsinki (1996) and good clinical practice. In the study participated three rheumatologists and 53 patients. Test reliability was 0.702 for PGA, 0.961 for MDGA, and 0.897 for WOMAC; VAS results were 0.742 for Pain, 0.741 for Fatigue, and 0.800 for Sleep. The correlation between PGA and MDGA was -0.172. The WOMAC measured pain in 50%, stiffness in 42.7% and physical function in 53.9%. Conclusion: The patients with osteoarthritis had relatively low physical function and knee pain. The Patient Global Assessment, Physician Global Assessment, WOMAC index, and VAS Pain, VAS Fatigue, and VAS Sleep all showed good to excellent test-retest reliability in OA after hospitalization. MDGA was more reliable than PGA. The correlation between PGA and MDGA was low

Health-related quality of life and economic burden of knee osteoarthritis

State Medical and Pharmaceutical University “Nicolae Testemitanu", Chisinau, Republic of MoldovaIntroduction: Patients with knee osteoarthritis have the symptoms that often are debilitating and causing physical impairment, can affect the psychosocial wellbeing of the patient. The impact of knee OA on patient’s lives has not been well studied in developing countries. Purpose and objectives: Of this study was to assess the health-related quality of life (QoL) and burden in patients with OA in Republic of Moldova. Materials and methods: This study is a retrospective, cross-sectional, nonrandomized, with subjects stratified according to disease severity based on functional limitation and absence of joint prosthesis. Subjects were recruited from primary care and rheumatology. There were 256 patients whom fulfill the American College of Rheumatology classification criteria for OA in the knee. A questionnaire embrace information on demographic and socioeconomic characteristics, function limitation, use of health and social services, and effect on occupation and living arrangements over the previous 12 months. The costs were calculated as direct and indirect. The QoL was assessed by KOOS - Knee injury and Osteoarthritis Outcome Score. This study was conducted according to the principles o f the Declaration of Helsinki (1996) and good clinical practice. Results: There were 256 patients integrated in the study including 196 females and 60 males, mean age 64.9 ± 0.6 years (range 37 to 82 years). Disease duration 8.1 ± 0.02 years (range 1- 51).The KOOS results showed that the QoL - 35.7% qualified as low. OA affected family or close relationships in 66%. The level of activity in daily living was 44.0% lower that the level of pain with 57.1% or other symptoms - 64.9%. The average cost excluding joint replacement was $685, the direct costs 71.04$485) per person per year and indirect costs - 29% ($190). The direct costs are comparable to those reported in Western countries; however, the insurance cover just 50.7% from direct costs. Conclusion: Patients with knee osteoarthritis have impaired QoL as well as substantial socioeconomic burden attributable to disease. The economic impact of OA is largely placed on the patients, they having relatively high out-of-pocket expenditures

Case report: a 55 old woman with preudotumor cerebri, urticarial vasculuitis and suspected Sjogren syndrome

Internal Medicine Department, State Medical and Pharmaceutical University "Nicolae Testemitanu”, Chisinau, Republic of MoldovaCase report: We report a case of a 55 old woman presenting complaints of severe and permanent headache with progressive decrease of visual acuity (VA) for 6 months, xerophtalmia, xerostomia and urticarial eruption. The medical history of the patient is marked by autoimmune thyroiditis and active tobacco smoking (10 cigarettes / day during 20 years). The physical examination was remarkable by a normal body mass index and skin lesions specific for urticarial vasculitis. The remainder of examination was normal. The CBC, biochemical, auto-antibodies and radiological examinations were normal too. The evaluations included the assessment of the cephalalgia: complete neurologic examination, fundus examination, MR1 of the brain and a lumbar puncture. The results have revealed a papilledema, a decrease of VA and an elevation of the opening pressure at the lumbar puncture. The diagnosis conclusion was the presence of pseudotumor cerebri, which is a disorder clinically manifested by chronically elevated intracranial pressure of unknown etiology associated with visual abnormalities. The skin biopsy revealed small vessels wall deposits of IgG and C3, and a polynuclear perivascular infiltrate. The last question was the etiology of the Sicca syndrome, who is supposed to be a Sjogren syndrome. The Shirmer test and the salivary gland scintigraphy confirmed our suspicion. We proceeded to salivary gland biopsy, whose result is on pending. Conclusion: We report a case of a smoking woman who presents a pseudotumor cerebri, urticarial vasculutis where was suspected Sjogren syndrome, defined as a systemic chronic inflammatory disorder characterized by lymphocytic infiltrates in exocrine glands. If the principle of parsimony is used, the three entities can be linked: to our known, in the medical literature where are few case reports concerning the association of Sjogren syndrome and pseudotumor cerebri as a very rare neurological complication. In its turn, the urticarial vasculitis is a known manifestation of Sjogren syndrome

Dualitatea relaţiei dintre osteoartroza genunchiului şi maladiile cardiovasculare

Osteoartroza și bolile cardiovasculare (BCV) sunt două condiții patologii predominante în populația în vârstă de peste 70 de ani. Datele de literatură prezintă rezultate controversate cu privire la interrelația dintre osteoartroza și maladiile cardiovasculare, evidențiindu-se o serie de factori de risc comuni (așa ca obezitatea, sedentarismul etc.), precum și verigi patogenetice intercalate. Osteoartroza și BCV se asociază la un număr mare de pacienți din multe motive: factori de risc comuni (îmbătrânirea și obezitatea), etiologia comună (de exemplu, inflamația cronică) și indirect, prin pierderea funcționalității articulare și dizabilitate, precum și utilizarea de analgezice care conduc la creșterea riscului cardiovascular. Complexitatea interacțiunilor dintre aceste patologii rămâne incomplet elucidată și necesită cercetări suplimentare

Stratificarea riscului cardiovascular la pacienții cu lupus eritematos sistemic

Disciplina de medicină internă-semiologie, Catedra de urgenţe medicale, Catedra de medicină de familie, Disciplina de cardiologie, USMF „Nicolae Testemiţanu”, Congresul consacrat aniversării a 75-a de la fondarea Universității de Stat de Medicină și Farmacie „Nicolae Testemițanu” din Republica Moldova, Ziua internațională a științei pentru pace și dezvoltareBackground. The survival rate of patients with systemic lupus erythematosus (SLE) has improved over the last decades; still the most common cause of death is cardiovascular disease (CVD). Therefore, the appropriate management by CV risk stratification, using clinical tools, is of major importance. Objective of the study. To evaluate and compare the CV risk factors in patients with SLE. Material and Methods. Cross-sectional study of traditional and non-traditional CV risk factors in SLE patients (SLICC,2012). The CV risk stratification was based on SCORE versus SLE CV risk equation. Results. A total of 96 SLE patients were analyzed. The female: male ratio was 14:1 and the mean age was 43,2±12,1 years. The disease duration was 89,7±45,5 months and the activity by SLEDAI was 8.08±7.1 points. The 10-year risk provided by SCORE was 7.8±9.0. Overall, 12.5% participants had high risk, 45.8% had moderate 41.7% low CV risk. The most common traditional CV risk factors were arterial hypertension (50%), age (16,6%) and hypercholesterolemia (12.5%). Non-traditional risk factors were high disease activity (33,3%), secondary APL syndrome (33,3%) and renal lupus (20.8%). Using SLE CV Risk Equation, we established that 29.1% of patients had high risk, compared to only 12,5% by SCORE. Conclusion: Patients with SLE have a high CV risk, as in addition to traditional CV risk factors, they have non-traditional risk factors such as high disease activity, lupus nephritis and APL syndrome. Therefore, specific tool for CV risk stratification will give a more accurate estimation. Introducere. Supraviețuirea pacienților cu lupus eritematos sistemic (LES) s-a ameliorat semnificativ în ultimele decenii, cu toate acestea, boala cardiovasculară (BCV) rămâne cea mai frecventă cauză de deces. Deci managementul adecvat prin stratificarea riscului CV, este de importanță majoră. Scopul lucrării. Evaluarea și compararea factorilor de risc CV la pacienții cu LES. Material și Metode. În studiul transversal al pacienților cu LES (SLICC, 2012), au fost studiați factorii de risc CV tradiționali și netradiționali. Stratificarea riscului CV s-a bazat pe ecuațiile de calcul al riscului SCORE versus LES. Rezultate. Un lot de 96 pacienți cu LES, raportul F: B 14:1, vârsta medie de 43,2 ± 12,1 ani. Durata bolii a fost de 89,7 ± 45,5 luni, activitatea SLEDAI de 8,08 ± 7,1 puncte. Riscul SCORE, a fost de 7,8 ± 9,0 p. În total, 12,5% participanți au avut risc ridicat, 45,8% - risc moderat, iar 41,7% - risc mic. Factorii de risc CV tradiționali au fost HTA (50%), vârsta (16,6%) și hipercolesterolemia (12,5%). Factorii de risc netradiționali au fost: activitatea înaltă a bolii (33,3%), sindromul AFL (33,3%) și lupusul renal (20,8%). Prin Ecuația de Risc CV în LES, 29,1% dintre pacienți au avut un risc ridicat, comparativ cu doar 12,5% conform SCORE (p <0,05). Concluzii. Pacienții cu LES au un risc CV ridicat, prin asocierea factorlor de risc tradiționali și netradiționali (activitatea bolii, nefrita lupică și sindromul AFL). Pentru utilizarea clinică este recomandat instrumentul specific pentru stratificarea riscului CV în LES

Activitatea fizică la studenți: un studiu epidemiologic transversal în Republica Moldova și Franța

Université d’État de Médecine et de Pharmacie „Nicolae Testemițanu”, République de Moldavie, Unisversité de Rouen, FranceIntroduction. Physical activity is the key component of a student's healthy lifestyle, which is a fundamental factor contributing to academic success. The importance of physical activities during the study period is determined particularly by the student's working regime, which is often characterized by sedentary lifestyle, reduced mobility and constant working position. Material and methods. A cross-sectional epidemiological study (2017-2018) was carried out. The study sample consisted of 783 students, including 430 students from the Republic of Moldova and 353 students from France. The data collection was performed by using a questionnaire that was completed by each study participant online, in electronic form. Results. The mean body mass index (kg/m2) of students from Chisinau was 21.5±0.10 (ranging between 16.16 and 34.72) and of students from Rouen - 22.65±0.22 (15.75-43.76) (p<0.001). 43.9% students from Chisinau and 56.4% students from Rouen practice sport (p<0.001). Both men (98.5%) and women (98.4%) from Chisinau practice same-intensity physical activities, until sweating. A slightly more different situation was reported in students from Rouen, where only 88.8% of women exercise until sweating, compared to men – 93.1%. Conclusions. The results of the research showed a slightly significant difference among students from both countries, as well as in their gender distribution.Introducere. Activitatea fizică reprezintă una din componentele de bază ale unui stil de viață sănătos al unui student – un factor primordial, care contribuie la succesul academic. Importanța activităților fizice în perioada studiilor este determinată, în special, de faptul că regimul de lucru al studentului se caracterizează adesea prin sedentarism, mobilitate redusă sau poziţie de lucru invariabilă. Material și metode. A fost proiectat un studiu epidemiologic transversal (2017-2018), eșantionul de studiu fiind constituit din 783 studenți, dintre care 430 de respondenți din Republica Moldova și 353 - din Franța. Datele au fost colectate în baza unui formular cu întrebări, care a fost completat de către fiecare participant la studiu, în format electronic, în regim online. Rezultate. Valoarea medie a indicelui masei corporale (kg/m2) pentru studenții din Chișinău a constituit 21,5±0,10 (limitele cuprinse între 16,16 și 34,72), iar pentru studenții din Rouen - 22,65±0,22 (15,75-43,76) (p<0,001). Astfel, practică sportul: 43,9% studenți din Chișinău și 56,4% studenți din Rouen (p<0,001). Atât bărbații (98,5%), cât și femeile (98,4%) din Chișinău practică activitățile fizice cu aceeași intensitate, până la transpirație. O situație puțin mai deosebită atestându-se la studenții din Rouen, unde femeile fac exerciții fizice până la transpirație doar în 88,8% cazuri, în comparație cu bărbații – 93,1%. Concluzii. Rezultatele cercetării au arătat că diferențele au fost puțin semnificative atât după criteriul de gen, cât și la nivel de țări

DISABILITY IN PATIENTS WITH IDIOPATHIC INFLAMMATORY MYOPATHIES

Introduction. Idiopathic inflammatory myopathies (IIMs) are a heterogeneous group of disorders, characterized by chronic muscle weakness, low muscle endurance and by the presence of inflammatory cell infiltrates in muscle tissue, with organ damage and disability. The objective of the study was to determine the degree of disability in a Moldavian cohort of patients with idiopathic inflammatory myopathies, by Rankin’s scale. Methods. We performed a cross-sectional study, from December 2015 to December 2018, in which were included patients with IIMs. Demographic and clinical data were collected using a special questionnaire, including employment status, upholding dose of corticosteroids. In order to estimate the degree of functional disability at the time of the research, we applied the modified Rankin’s scale, with possible scores from 0-no disability to 5-totally dependent. Results. 65 IIMs patients were enrolled in the study. Male to female ratio was 1:3.3, the patients’ mean age was 50.2±11.7 years, the mean disease duration 95.2±6.89 months. According to modified Rankin’s scale, the 1st degree was found in 20 cases (30.77%), the 2nd degree in 24 patients (36.92%), 11 patients (16.92%) had 3rd degree, 8 patients (12.31%) 4th degree, and 5th degree was determined in 2 patients (3.08%). Many variables were analyzed and we determined that the dose of prednisolone-equivalent <10 mg (RR 2.2; 95% CI 1.34 to 3.6, p<0.01) and disease duration less than 2 years are protective factors (RR 0.4; 95% CI 0.2 to 0.9, p<0.05) for severe degree of disability (≥ 3). Conclusion. Our study has shown that patients with idiopathic inflammatory myopathies have a mild disability in 67.69% of the cases, moderate in 16.92% and severe disability was found in 15.39% of the cases. The dose of prednisolone-equivalent <10 mg and disease duration less than 2 years were determined as protective factors against the severe degree of disability

Мультиморбидность: специфическая концепция семейной медицины

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu“, Centrul Naţional de Sanătate Publică, Centrul Naţional Ştiinţifico-Practic de Medicină PreventivăPatologiile cronice netransmisibile sunt principala cauză de morbiditate şi mortalitate la nivel global. Astfel, odată cu îmbătrânirea populaţiei şi creşterea expunerii la factorii de risc pentru bolile cronice, prevalenţa fenomenului de multimorbiditate creşte, acesta fiind definit ca asocierea concomitentă a două şi mai multe patologii cronice la acelaşi individ. Datele de literatură consemnează că pacienţii cu multimorbiditate utilizează mai frecvent serviciile medicale, cauzează costuri de sănătate mai mari, dar rezultatele intervenţiilor terapeutice sunt mai joase. Astfel, multimorbiditatea ar putea fi considerată o cauză de ineficienţă a asistenţei medicale, de conduită suboptimă a pacienţilor cu boli cronice şi de bariere în comunicare. În ciuda prevalenţei tot mai mari a multimorbidităţii, există puţine date cu privire la dimensiunile fenomenului, factorii determinanţi ai acestuia şi impactul lor asupra practicii medicilor de familie din Republica Moldova. Astfel, scopul studiului a fost de a determina frecvenţa pacienţilor cu multimorbiditate în practica cotidiană a medicului de familie şi identificarea particularităţilor acestor pacienţi. Chronic non-transmissible pathologies are the main cause of morbidity and mortality globally. The ageing of populations and increasing exposure to risk factors for chronic diseases, the prevalence of chronic disease multimorbidity is rising. The definition of multimorbidity is the concomitant association of two and more chronic pathologies in the same individual. The available data suggests that patients with multimorbidity are more likely to use medical services, cause higher health costs, but the results of therapeutic interventions are lower. The multimorbidity could be considered a cause of ineffectiveness of health care, suboptimal behavior of patients with chronic diseases and communication barriers. Despite the increasing prevalence of multimorbidity, there is few data on the power of the phenomenon, its determinants and its impact on the practice of family doctors in the Republic of Moldova. The purpose of the study was to determine the frequency of patients with multimorbidity in the family physician’s daily practice and to identify the particularities of these patients. Хронические непередаваемые патологии являются основной причиной заболеваемости и смертности во всем мире. Таким образом, при старении населения и увеличении подверженности к факторам риска хронических заболеваний, распространенность явления полиморбидности возрастает, что определяется как сопутствующая ассоциация двух и более хронических патологий у одного и того же человека. Имеющиеся данные литературы позволяют предположить что пациенты с полиморбидностью чаще обращаются за медицинской помощью, приводят к более высоким затратам на здравоохранение, но результаты терапевтических вмешательств ниже. Таким образом, полиморбидность можно считать причиной неэффективности медицинского обслуживания, субоптимального поведения пациентов с хроническими заболеваниями и коммуникационных барьеров. Несмотря на растущую распространенность полиморбидности, мало данных о масштабах явления, его детерминантах и его влиянии на практику семейных врачей в Республике Молдова. Таким образом, целью исследования было определить частоту пациентов с полиморбидностью в повседневной практике семейного врача и определить особенности этих пациенто

Социально-экономическое воздействие при идиопатических воспалительных миопатии

Socio-economic impact in idiopathic inflammatory miopathiesIntroducere. Micopatiile inflamatorii idiopatice (MII) sunt un grup eterogen de tulburări, caracterizat prin slăbiciune musculară cronică, rezistență musculară scăzută și prin prezența infiltrațiilor celulelor inflamatorii &icirc;n țesutul muscular, cu leziuni ale organelor și handicap. Obiectivul studiului a fost de a determina statutul socio-economic și gradul de dizabilitate la pacienții cu miopatii inflamatorii idiopatice. Metode. Am efectuat un studiu transversal, din decembrie 2015 p&acirc;nă &icirc;n decembrie 2018, &icirc;n care au fost incluși pacienții cu MII. Datele demografice și clinice au fost colectate utiliz&acirc;nd un chestionar special, inclusiv statutul de angajare și profesional, care susține doza de corticosteroizi. Pentru a estima gradul de invaliditate funcțională la momentul cercetării, am aplicat scara Rankin modificată, cu posibile scoruri de la 0 - nici o dizabilitate la 5 - total dependentă. Rezultate. &Icirc;n studiu au fost incluși 65 de pacienți cu MII. Raportul dintre bărbați și femei a fost de 1:3,3, v&acirc;rsta medie a pacienților a fost de 50,2&plusmn;11,7 ani, durata medie a bolii fiind de 95,2&plusmn;6,89 luni. Conform scalei Rankin modificate, gradul I a fost găsit &icirc;n 20 de cazuri (30,77%), gradul II la 24 pacienți (36,92%), 11 pacienți (16,92%) au gradul III, 8 pacienți (12,31%) gradul IV și gradul V a fost determinat la 2 pacienți (3,08%). Statutul salariatului &icirc;n grupul cu MII a fost de 9 (13,85%) dintre cei 65 de pacienți angajați cu normă &icirc;ntreagă, 7 (10,77%) cu jumătate de normă, 7 (10,77%) șomeri, 10 (15,38%, 6 (9,23%) au fost gospodari, iar 26 (40,0%) au fost pensionați cu dizabilități &icirc;n conformitate cu criteriile și nu au funcționat la momentul cercetării. Concluzie. Studiul nostru a arătat că pacienții cu miopatie inflamatorie idiopatică au un statut socio-economic scăzut, cu un loc de muncă redus și cu un handicap semnificativ.Социально-экономическое воздействие при идиопатических воспалительных миопати