Epidemiological and clinical aspects of Tinea pedis

Catedra Dermatovenerologie USMF "Nicolae Testemiţanu"Tinea pedis cause pain and discomfort limiting working capacity of patients. Some diseases such as: diabetes mellitus, eczema, psoriasis, patology of peripherial vessels are often associated with Tinea, worsening a process current. In this article are present some epidemiological and clinical aspects of Tinea pedis at 235 patiens which were treated in the Republican Clinic of Dermatology during last 2 years. For more effective clinical monitoring and for optimisation of treatment at 14 patiens has been defined the severity index of Tinea pedis and onychomycosis, using clinical scales such as SCIO, AFSS, SCETP. Micozele plantare cauzează durere şi discomfort, fiind capabile să limiteze activitatea de zi cu zi a pacienţilor. În plus, unele boli cum ar fi: diabetul zaharat, eczema, psoriazisul, patologiile vasculare periferice se asociază frecvent cu aceste patologii, agravînd evoluţia infecţiei micotice. În acest articol sînt elucidate unele aspecte epidemiologice şi clinico-evolutive la 235 pacienţi trataţi în Clinica Republicană de Dermatovenerologie în ultimii doi ani. Pentru un monitoring clinico-evolutiv cât mai efectiv şi pentru optimizarea tratamentului la 14 pacienţi a fost estimat gradul de severitate în tinea pedis şi onicomicoză utilizând scorurile clinice SCIO, AFSS, SCETP

Прогностические эхокардиографические параметры у госпитализированных пациентов с легочной тромбэмболией

Pulmonary embolism (PE) is considered one of the most common cardiovascular diseases with considerable mortality. Echocardiography remains an important investigation in the evaluation of these patients, with some echocardiographic parameters playing an incremental role in prognostic evaluation.Objectives: To determine the spectrum of echocardiographic changes in patients hospitalized with pulmonary embolism at the Institute of Cardiology of the Republic of Moldova and to highlight parameters with significant prognostic value in relation to risk scores for mortality stratification in PE. Materials and methods: We prospectively enrolled 168 patients admitted to the Institute of Cardiology. All patients were evaluated by transthoracic echocardiography. Results: Parameters most associated with in-hospital mortality at 30 days were: right atrial area (RA) >18cm2 (p=0.007), tricuspid valve regurgitation (TR) grade (p=0.002), tissue systolic velocity of the anterior wall of the right ventricle (RV) (p=0.03), inferior vena cava diameter (p=0.04), RV/LV ratio >1.0 (p=0.04), and TAPSE/PSAP index <0.4 (p<0.008). Conclusions: Echocardiographic parameters such as tricuspid valve regurgitation grade, RA area, tissue systolic velocity of the anterior RV wall, TAPSE/PSAP index, and interventricular ratio have additive value in evaluating prognosis in patients with PE.Trombembolismul pulmonar acut (TEP) este considerat printre cele mai frecvente boli cardiovasculare cu o mortalitate considerabilă. Ecocardiografia rămâne a fi o investigație importantă în evaluarea acestor pacienți, unii parametri ecocardiografici având rol incremental în evaluarea prognosticului.Obiective: determinarea spectrului modificărilor ecocardiografice la pacienții cu trombembolism pulmonar spitalizați în IMSP Institutul de Cardiologie din Republica Moldova și evidențierea unor parametri cu o valoare prognostică importantă în raport cu scorurile de risc pentru stratificarea mortalității în TEP. Materiale și metode: am înrolat în studiu prospectiv 168 pacienți internați în Institutul de Cardiologie. Toți pacienții au fost evaluați prin ecocardiografia transtoracică.Rezultate: Parametrii care s-au asociat cel mai mult cu mortalitatea intraspitalicească la 30 zile au fost: aria atriului drept (AD) >18cm2 ( p =0,007), gradul de regurgitare a valvei tricuspide (VTR) ( p =0,002), viteza sistolică tisulară a peretelui anterior ventricului drept (VD) ( p =0,03), diametru venei cave inferioare ( p =0,04), raportul VD/VS >1,0 (p=0,04) și indexul TAPSE/PSAP <0,4 (p<0,008).Concluzii: Parametrii ecocardiografici precum: gradul de regurgitare a valvei tricuspide, aria AD, viteza sistolică tisulară a peretelui anterior VD, indexul TAPSE/PSAP, raportul interventricular au o valoare aditivă pentru a evalua prognosticul la pacienții cu TEP.Тромбэмболия легочной артерии (ТЭЛА) считается одним из наиболее распространенных заболеваний сердечно-сосудистой системы с значительной смертностью. Эхокардиография остается важным методом исследования при оценке состояния этих пациентов, причем некоторые эхокардиографические параметры играют инкрементальную роль в оценке прогноза. Цели: Определение спектра изменений в эхокардиографии у пациентов, госпитализированных с легочной тромбоэмболией в Институте кардиологии Республики Молдова, и выявление параметров с значимым прогностическим значением относительно оценки риска смертности при ТЭЛА. Материалы и методы: В нашем исследовании были включены 168 пациентов, госпитализированных в Институт кардиологии. Все пациенты прошли трансторакальное эхокардиографическое исследование. Результаты: Параметры, наиболее ассоциированные с интрастационарной смертностью через 30 дней, были следующими: площадь правого предсердия (ППП) >18 см2 (p=0,007), степень регургитации трехстворчатого клапана (РТК) (p=0,002), скорость тканевого систолического движения передней стенки правого желудочка (ПЖ) (p=0,03), диаметр нижней полой вены (p=0,04), отношение ПЖ/ЛЖ >1,0 (p=0,04) и индекс TAPSE/PSAP <0,4 (p<0,008). Выводы: Эхокардиографические параметры, такие как степень регургитации трехстворчатого клапана, площадь ППП, скорость тканевого систолического движения передней стенки ПЖ, индекс TAPSE/PSAP и отношение межжелудочковых стенок, имеют дополнительное значение при оценке прогноза у пациентов с ТЭЛ

Optional therapeutic management of intermediate-risk pulmonary embolism patients

Background: Few studies have evaluated the thrombolytic treatment in patients with intermediate-high risk pulmonary embolism, making this study more valuable. Material and methods: It was a prospective, non-randomized, open-label, single-center study. Eligible patients at the age of 18 or older with an acute pulmonary embolism (PE) confirmed by CT pulmonary angiography with onset until 14 day and signs of right ventricular (RV) overload on echocardiography took part in the study. Pulmonary Arterial CT Obstruction Index Rate (PACTOIR) was used to define the localization and the expansion zone of thromboembolism. This study included 18 patients with intermediate risk and acute submassive pulmonary thromboembolism. In thrombolysis (TT) group (n=9) were used 50 mg of tissue-plasminogen activator (t-PA) administered in infusion as 0.4 mg/h for 2 hours. In the standard anticoagulation group, unfractioned heparin (UFH) was administered as a bolus of 70 units/kg or a maximum of 5000 units, followed by continuous infusion at an initial rate of 16 units/kg or a maximum of 1000 units/h. Results: The mean age for TT group was 69 vs 63 for the UFH group. PACTOIR was 100% in 3 patients in the half-dose rt-PA group and in 2 patients in the UFH group. RV/LV diameter ratio decreased from baseline to 48 h post-procedure (1.55 vs. 1.13; mean difference, -0.42; p < 0.0001). Mean pulmonary artery systolic pressure was 55 mm Hg in both groups (p < 0.05), with 53 [43–60] in TT group vs. 41.5 [37–45] mmHg in UFH group, P< 0.05). The rate of secondary endpoints was significantly higher in the UFH group with a high rate of pulmonary hypertension (0 vs. 19%, p=0.003). Conclusions: Half-dose thrombolytic therapy in patients diagnosed with submassive pulmonary embolism significantly reduced death and hemodynamic decompensation in the first 7 days compared to anticoagulant therapy only. With all that being said, it can be concluded that patients with high-intermediate risk PE could benefit from reduced-dose TT

эхокардиография Speckle tracking &ndash; применения в ишемической болезни сердцa

Speckle tracking echocardiography &ndash; application in ischemic heart disease.Speckle tracking este o metodă nouă &icirc;n ecocadiografie, ce se bazează pe evaluarea deformării miocardului și reprezintă un marker surogat fidel &icirc;n evaluarea contractilității, țin&acirc;nd cont de structura și mecanica complicată a miocardului. Imaginile strain permit depistarea disfuncției cardiace &icirc;n etape subclinice &icirc;n mai multe patologii: cardiotoxicitatea la pacienții oncologici, diabetul zaharat, valvulopatiile asimptomatice cu fracție de ejecție a ventriculului st&acirc;ng normală, cardiopatii cu hipertrofie miocardică; este metoda perfectă de evaluare a insuficienței cardiace cu fracție de ejecție păstrată sau moderat scăzută, oferind și informații prognostice importante. Rezultate promițătoare par a fi &icirc;n cardiopatia ischemică, &icirc;n special pentru selectarea pacienților cu sindroame coronariene acute fără elevarea segmentului ST cu patologie coronariană obstructivă, &icirc;nsă p&acirc;nă la moment, lipsesc algoritme clare de implementare a ecografiei speckle tracking &icirc;n practica clinică de zi cu zi.эхокардиография Speckle tracking &ndash; применения в ишемической болезни сердц

Post-pulmonary embolism syndrome: long-term complications of pulmonary embolism

Background: People who survive an episode of pulmonary embolism have an increased risk of developing chronic complications even despite curative anticoagulant treatment. The association of dyspnea, low functional capacity, right heart failure, chronic thromboembolic pulmonary hypertension or chronic thromboembolic pulmonary disease is part of the notion of post-pulmonary embolic syndrome (PPES). Due to the fact that this syndrome is still not clearly described and mainly underdiagnosed, a Poor awareness of the disease by patients and physicians lead to delaying specific treatment with unlikely improvement of quality of life for these patients. Chronic thromboembolic pulmonary hypertension is the most severe complication, which, if not diagnosed and not treated in time, can lead to fatal consequences. To improve the overall health outcomes of patients with acute PE, adequate measures to diagnose it and strategies to prevent long-term outcomes of pulmonary embolism are essential. Conclusions: In this article, the data from the latest publications have been summarized to clarify the notion of PPES and its diagnostic algorithm

Cердечно-сосудистые поражения у пациентов, перенесших коронавирус

Objectives: to highlight the cardiovascular sequelae of Covid-19, especially subclinical dysfunction of the left ventricle. Materials and methods: the study included 74 Covid-19 convalescent patients with no history of cardiovascular disease, with a mean age of 42.01 years ± 1.4 years. Patients were assessed by speckle tracking echocardiography. Results: The results of our study determined that 41 (55.4%) Covid-19 convalescent patients have subclinical left ventricular systolic dysfunction, the mean GLS in the group being 15.8 ± 0.39, while in the control group no person has GLS &lt;16% (p &lt;0.001). Other manifestations were: diastolic dysfunction - 23 (31.1%), right ventricular dysfunction - 22 (30.1%), pericardial effusion - 19 (25.7%), symptoms - 67 (90%). Conclusions: Subclinical cardiac dysfunction is a common complication encountered in convalescent Covid-19 patients, and determination of GLS by speckle tracking echocardiography remains a practical and cost-effective tool to detect this injury; The persistence of symptoms, included in longCovid, does not correlate with the results of imaging investigations.Scopul: evidențierea sechelelor cardiovasculare Cov id-19, în special a disfuncției subclinice de ventricul stâng. Materiale și metode: studiul a inclus 74 pacienți convalescenți Covid-19, fără patologie cardiovasculară în antece- dente, cu vârsta medie 42.01 ani ±1.4 ani. Pacienții au fost evaluați prin ecocardiografie speckle tracking.Rezultate: Rezultatele studiului nostru au determinat că 41 (55.4%) pacienți convalescenți Covid-19 prezintă disfunc- ție sistolică subclinică de ventricul stâng, GLS mediu în grup fiind 15.8±0.39, pe când în lotul de control nici o persoană nu are GLS &lt; 16% (p&lt;0.001). Alte manifestări au fost: disfuncție diastolică - 23 (31.1%), disfuncție de ventricul drept- 22 (30.1%), efuzie pericardică -19 (25.7%), simptome- 67 (90%).Concluzii: Disfuncția subclinică cardiacă este o complicație frecvent întâlnită la pacienți convalescenți Covid-19, iar determinarea GLS prin ecocardiografia speckle tracking rămâne un instrument practic și costeficient pentru a depista această injurie; Persistența simptomelor, încadrate în longCovid, nu se corelează cu rezultatele investigațiilor imagisticЦель: выявить сердечно-сосудистые последствия Covid-19, особенно субклиническую дисфункцию левого желудочка. Материалы и методы: в исследование были включены 74 пациентов, перенесших Covid-19 без сердечно-сосудистых заболеваний в анамнезе, средний возраст которых составил 42,01 ± 1,4 года. Пациентов обследовали с помощью эхокардиографии speckle tracking. Результаты: Результаты нашего исследования выявили, что 41 (55,4%) выздоровевших пациентов после перенесенного Covid-19 имеют субклиническую систолическую дисфункцию левого желудочка; среднее значение GLS в группе пациентов перенесших Covid-19 составляет 15,8 ± 0,39, в то время как в контрольной группе ни у одного обследованного GLS&lt;16% ( р &lt;0,001). Другие проявления: диастолическая дисфункция - 23 (31,1%), правожелудочковая дисфункция - 22 (30,1%), перикардиальный выпот - 19 (25,7%), симптомы - 67 (90%). Выводы: Субклиническая сердечная дисфункция является частым осложнением у выздоравливающих пациентов перенесших Covid-19; определение GLS с помощью эхокардиографии speckle tracking является практичным и экономически эффективным инструментом для выявления этого нарушения; Перетестирование симптомов, включенных в longCovid, не коррелирует с результатами параклинических исследований