Sindroame neuropsihiatrice în lupusul eritematos sistemic: evaluarea lor prin utilizarea instrumentelor neuropsihologice validate

Catedra Medicină Internă N3 USMF ’’Nicolae Testemiţanu’’Diagnosis problems in neuropsychiatric SLE remains a challenge for clinicians. Our purpose was to study the neuropsychiatric syndromes in patients with systemic lupus erythematosus and their impact on quality of life. We examined 60 patients who met the ACR diagnostic criteria, Hochberg M. 1997. Special investigations focused assessment of disease activity, index of organic damage, cumulative glucocorticosteroid dose administered, assessing quality of life according to SF-36 questionnaire. Activity of disease in SLE patients showed that in patient with the nervous system involvement was medium/high in 81. 2%, while in group without nervous system involvement - medium/low in 85.7% cases. Analyzing the data of index of organic damage (DI) got low level in both groups found it, when high and very high found only in patients with nervous system affecting. Clinical correlations between DI and nervous system involvement in systemic lupus was found. Application of SF-36 questionnaire in patients with systemic lupus erythematosus showed that low quality of life is determined by the involvement of the nervous system, predominantly by mental health. Problema diagnosticului afectării neuropsihiatrice în cadrul LES, rămîne o provocare pentru clinicieni. Obiectivul lucrării: studierea sindroamelor neuropsihiatrice la pacienţii cu lupus eritematos sistemic şi impactul lor asupra calităţii vieţii. Am examinat 60 pacienţi care au respectat criteriile de diagnostic ACR, Hochberg M.,1997. Investigaţiile speciale au vizat aprecierea activităţii bolii, indexul lezării organice, doza cumulativă de glucocorticosteroizi administraţi, aprecierea calităţii vieţii conform chestionarului SF-36. Referitor la activitatea LES am constatat că la pacienţii cu afectarea sistemului nervos în cadrul lupusului a fost medie /înaltă în 81.2%, iar în lotul fară afectarea sisitemului nervos – medie/joasă la 85.7% cazuri. Analizând datele IL am depistat nivel jos în ambele grupuri, atunci când IL înalt şi foarte înalt am constatat numai la pacienţi cu efectarea sistemului nervos. Au fost apreciate corelaţii clinice ale indicelui lezării organice şi implicarea sistemului nervos în lupus. Aplicarea chestionarului SF-36 la pacienţii cu lupus eritematos sistemic a demonstrat că calitatea vieţii joasă este determinată de implicarea sistemului nervos, preponderent prin sănătatea mentală

Clinical diapason of nervous system implication in systemic lupus erythematosus

Catedra Medicină Internă N3 USMF’’ Nicolae Testemiţanu’’It is often useful to classify the neurological syndromes in SLE as diffuse or focal. Our purpose was application of 1999 ACR classification of neuropsychiatric syndromes in patients with systemic lupus erythematosus. We examined 84 patients who met the ACR diagnostic criteria, Hochberg M. 1997. Special investigations focused on the assessment of the disease activity, index of organic damage, administered corticosteroid cumulative dose, and assessing quality of life according to SF-36 questionnaire. Neurological component of the study concerned the general neurological examination, neuropsychological testing - to confirm and establish scale intensity Hamilton depression scale Hamilton to detect anxiety, mini mental status examination - Mini Mental State Examination (MMSE) for cognitive function estimation, the performance of electroneuromiografy (ENMG), magnetic resonance imaging (MRI) and brain computer tomography (CT). Focal and diffuse clinical parameters suggests further therapeutic conduct. Quality of life index is inversely proportional to disease activity and damage index in patients neurolupus. Este adesea util de a clasifica sindroamele neurologice în LES ca difuze sau focale. Obiectivul lucrării: studierea sindroamelor neuropsihiatrice la pacienţii cu lupus eritematos sistemic Am examinat 84 pacienţi care au respectat criteriile de diagnostic ACR, Hochberg M.,1997. Investigaţiile speciale au vizat aprecierea activităţii bolii, indexului lezării organice, doza cumulativă de glucocorticosteroizi administraţi, cercetarea anticorpilor anti-P ribosomal, dar şi aprecierea calităţii vieţii conform chestionarului forma scurtă cu 36 întrebări, stratificate în 8 domenii, Short Form-36 (SF-36). Componentul neurologic al studiului a vizat examenul neurologic general, efectuarea testelor neuropsihologice– scala Hamilton de evaluare a depresiei, scala Hamilton de evaluare a anxietăţii, examinarea statutului mini mental - Mini Mental State Examination (MMSE) pentru depistarea deficitului cognitiv, electroneuromiografiei (ENMG), imagistica prin rezonanţă magnetică (IRM) şi tomodensitometria cerebrală (CT). Studiul relevă incidenţa clinică a manifestărilor difuze mai mare comparativ cu cele focale. Atribuirea parametrilor clinici la focale şi difuze sugerează conduita terapeutică ulterioară. Indicele de calitate a vieţii este invers proporţional cu activitatea bolii şi indexul lezării organice pentru pacienţii neurolupus

Risk factors involved in the occurrence of ischemic stroke

Cardiology Department, State University of Medicine and Pharmacy "Nicolae Testemitanu", Chisinau, Republic of MoldovaIntroduction: About 60% to 80% of all ischemic strokes can be attributed to increasing blood pressure, blood cholesterol, smoking, diabetes mellitus and atrial fibrillation [American Heart Association, June 29 2006; Potential New Risk Factors for Ischemic Stroke. What Is Their Potential? Graeme J. Hankey]. Hypertension is the single most important modifiable risk factor for ischemic stroke. Various lifestyle factors have been associated with increased stroke risk. These include obesity, physical inactivity, diet, and acute triggers such as emotional stress. Obesity has been associated with higher levels of blood pressure, blood glucose, and atherogenic serum lipids, which are independent risk factors for stroke. Materials and Methods: Our study included 50 patients with hypertension and cognitive impairment, hospitalized in the cardiology department, Holy Trinity Hospital. We determined the association between MMSE score and incident CV events, adjusted for stroke, diabetes mellitus, atrial fibrillation, smoking and sedentary. We divided patients according to MMSE in 3 categories: 1. Lack of cognitive dysfunction: M M SE-24-30points; 2. Moderate cognitive dysfunction: M M SE-18-23points; 3. Severe cognitive dysfunction: 0-17points. Maximum score for MMSE is 30 points. The table shows that severe cognitive deficit is characteristic of patients with stroke, sedentary, diabetes mellitus. Moderate cognitive dysfunction was characteristic for smoking patients, diabetes mellitus and atrial fibrillation. Conclusion: Doctors have long called high blood pressure “the silent killer” because a person can have high blood pressure and never have any symptoms. Blood pressure is the most important risk factor in the occurrence of stroke. In our study we tried to demonstrate the relationship between high blood pressure and other risk factors involved in the occurrence stroke, and cognitive deficits caused by these

Hypertension as a risk factor for stroke

Cardiology Department, State University of Medicine and Pharmacy "Nicolae Testemitanu", Chisinau, Republic of MoldovaIntroduction: Uncontrolled high blood pressure increases a person’s stroke risk by four to six times. Over time, hypertension leads to atherosclerosis and hardening of the large arteries. The risk of stroke is directly related to how high the blood pressure is. Case presentation: The patient X 63 years old, women hospitalized in Holy Trinity with Clinical Diagnosis: Left hemisphere stroke with mild right hemiparesis. Motor dysphasia. Arterial hypertension III degree, very high additional risk. Ischemic heart disease. Stable angina pectoris functional class II. Heart Failure II NYHA. Diabetes mellitus type II. Complaints at the admission: Limitation of movements in the right hand and leg, speech disorders, memory disturbances, general weakness. History of current disease: She is considered hypertensive for 10 years, she followed regular medical treatment. On March 7, morning when she woke up, she felt a general weakness, dizziness, lost of consciousness for a short period of time. Hereditary history: aggravated (mother suffered from hypertension, died of ischemic stroke). Medical history: hypertension for 10 years, diabetes mellitus type II-7years. Objective data: General condition of medium gravity; Body mass index (BMI) = 36.98-obesity class 2(G = 90 kg, T = 156 cm). Cardiovascular: auscultation of heart sounds rhythmic, attenuate, with noise II aorta. Blood pressure - 180/80 mmHg on left hand, 175/80 mm Hg on right hand. SCORE Index - risk of developing a cardiovascular event in the next 10 years is 6.5%. Mini Mental State Examination severe cognitive impairment (19 points). Neurological examination: - asymmetric face; - swallowing preserved; - deviated to the right tongue; - right-mild hemiparesis, hypotonia; - pathological reflexes: Babinski sign positive on right side. Investigations and laboratory results: - Biochemical analysis of blood - total cholesterol-7 mmol/1; - ECG: sinus rhythm, heart rate=72, intermediate axis, left ventricular hypertrophy. - Head Computed Tomography scan: Discussion: Major risk factor is the patient's uncontrolled hypertension values. Patient’s other cardiovascular risk factors: diabetes mellitus type II, women age over 60, dyslipidemia, obesity, stress. Conclusion: Stroke is a serious problem that has a multitude of causative global risk factors. A large percentage of strokes can be prevented if risk factors are known and closely monitored. Reducing the incidence of stroke requires prevention and management of changeable risk factors

Aplicarea criteriilor neuropsihiatrice ACR, 1999 în lupusul eritematos sistemic

Catedra Medicină Internă nr.3, Catedra Neurologie USMF “Nicolae Testemiţanu”Nervous system involvement in systemic lupus erythematosus (SLE) is recognized for over 100 years. American College of Rheumatology criteria (ACR) 1997 classification of SLE, include neuropsychiatric (NP) manifestations as seizures and psychosis. ACR lupus research and commission convened in 1999 an ad - hoc multidisciplinary committee to develop standard nomenclature for neuropsychiatric systemic lupus erythematosus (NPSLE). Purpose of the our study was to evaluate neuropsychiatric syndromes in patients with SLE by the NPSLE criteria. We examined 60 consecutive patients with SLE who met the ACR criteria, forming the study group. Special investigations focused assessment of disease activity, estimated implementation of Hamilton depression scale, Hamilton rating scale for anxiety, and cognitive dysfunction assessment by Mini Mental Status Scale. During the study was identified 21 (35. 0%) cases of depression, 7 (11. 7%) of anxiety and 17 (28. 3%) patients of cognitive dysfunction. Application of neuropsychological tests showed early detection of nervous system involvement and adequate treatment of systemic lupus erythematosus Implicarea sistemului nervos în lupusul eritematos sistemic (LES) este recunoscută de peste 100 de ani. Criteriile Colegiului American de Reumatologie (ACR) 1997 pentru clasificarea LES, includ manifestări neuropsihiatrice (NP) convulsiile şi psihoza. ACR şi comisia pentru cercetare a lupusului a convocat în 1999 un comitet ad-hoc multidisciplinar, pentru a dezvolta nomenclatura standard pentru lupusul eritematos sistemic neuropsihiatric. Obiectivul lucrării: evaluarea sindroamelor neuropsihiatrice la pacienţii cu lupus eritematos sistemic prin aplicarea criteriilor neuropsihiatrice ale lupusului eritematos sistemic (NPLES).În studiu am inclus 60 pacienţi consecutivi cu LES care au respectat criteriile ACR, 1997, formând lotul de studiu. Investigaţiile speciale au vizat aprecierea activităţii bolii, aplicarea scalei Hamilton de estimare a depresiei şi de evaluare a anxietăţii, precum şi aprecierea disfuncţiilor cognitive prin scala Mini Mental Status. Pe parcursul studiului au fost identificate 21 (35.0 %) cazuri de depresie, 7(11.7%) cazuri de anxietate şi 17(28.3%) cazuri de disfuncţii cognitive. Aplicarea testelor neuropsihologice a demonstrat depistarea precoce a implicării sistemului nervos şi tratamentul adecvat al lupusului eritematos sistemi

Sincopa la pacientul cu patologie cardiovasculară multiplă

Sincopele au un impact major asupra calității vieții și pronosticului ei, mai ales, în cazul asocierii episoadelor sincopale cu patologia cardiovasculară (CV) multiplă. Scopul acestei prezentări a fost aprecierea influenței patologiei CV multiple asupra apariției stărilor sincopale, rolului comorbidităților asupra decompensării și calității vieții cu calcularea riscului de mortalitate pe termen lung la pacientul cu sincopă cardiogenă. Cazul clinic a inclus un pacient de 64 de ani, bărbat, internat în IMSP SCM “Sfânta Treime” (15.03.2017), cu diagnosticul clinic: Cardiopatie mixtă (ischemică, hipertensivă, dismetabolică, pulmonară), decompensată. Angină pectorală stabilă de efort, CF III. Stenoză moderată de valvă aortică. Insuficiență de valvă mitrală și tricuspidă, gr.III. Hipertensiune arterială, gr.III, risc adițional foarte înalt, hipertrofi a ventriculului stâng (VS) concentrică și excentrică, cu afectarea relaxării miocardului VS. Fibrilație atrială cronică, tahisistolică, risc trombembolic înalt și hemoragic crescut, CF III EHRA. Extrasistolie ventriculară solitară. Insufi ciență cardiacă cronică CF III (NYHA), st. C (ACC/AHA), accese de astm cardiac. Bronhopneumopatie obstructivă cronică, st. III GOLD, în exacerbare. Hipertensiune pulmonară moderată. Diabet zaharat tip II, subcompensat, cu complicații multiple. Ciroză hepatică cardiogenă. Pielonefrită cronică bilaterală, în remisie incompletă. Nefrolitiază pe stânga. Rezultate. Pacientul cu patologie CV multiplă atestă recurență sincopală la interval de 2-3 luni și o astfel de evaluare a sincopei: scorul Martin = 4 puncte, cu risc crescut de aritmii cardiace sau moarte subută pe parcurs de 1 an; scorul OESIL = 3 puncte, cu risc de mortaliate crescut în decurs de 1 an, scorul EGSYS = 7 puncte, cu același risc pe 2 ani. Concluzii. Patologia СV multiplă predispune în evoluție la recurențe sincopale, iar comorbiditățilе concomitente predispun la decompensarea patologiei CV de bază cu alterarea calității vieții și creșterea riscului de mortalitate

Evaluarea performanţei cognitive la pacienţii cu hipertensiune arterială

Studiile contemporane au enunţat date care reflectă că 45,3% din pacienţii hipertensivi suferă de scăderea performanţelor cognitive. Prezentul studiu a fost efectuat pe un lot de 75 de pacienţi internaţi în SCM ,,Sfânta Treime” în perioada 2013-2014. Pacienţii au fost repartizaţi în 2 loturi. Primul lot a inclus 26 pacienţi (34,66%) cu HTA şi deficit cognitiv. Lotul doi a inclus 49 pacienţi (65,33%) cu HTA şi absenţa deficitului cognitiv. Au fost aplicate teste special de teterminare a deficitului cognitiv: Scala Mini Mental State Examination și Testul Ceasului

Particularităţile evoluţiei sindromului antifosfolipidic obstetrical la pacientă cu anamnestic agravat, caz clinic

Catedra Medicină Internă nr.3, IMSP Institutul de CardiologieObstetrical antiphospholipid syndrome (OAPS) - is characterized by recurrent arterial and/or venous thrombosis and pregnancy morbidity, manifested by early or late losses and increase of aCL level. The clinical features of APS are multisimptomatic and involve in pathogenic process most organs and systems. The aim of study was the presentation of clinical case of obstetrical antiphospholipid syndrome in young patient, whose pregnancy resulted, the birth of healthy child with highlighting diagnostic and therapeutic options. Studierea manifestărilor sindromului antifosfolipidic obstetrical (SAFLo) – afecţiune care se prezintă clinic cu recurenţe de tromboze venoase sau arteriale şi/sau patologie obstetricală şi niveluri crescute de anticorpii anticardiolipinici Tabloul clinic al SAFL este multisimptomatic implicând în procesul patogen majoritatea organelor şi sistemelor. Obiectivul studiului: Prezentarea cazului clinic - sindromul antifosfolipidic obstetrical la pacienta tânără, sarcina căreia s-a soldat cu naşterea copilului sănătos după intervenţia de diagnostic şi terapeutică

Depression as a cardiovascular risk factor

Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, The 6th International Medical Congress for Students and Young Doctors, May 12-14, 2016Introduction: Over the past 20 years, research has found that depression not only is more common in cardiac patients than in the general population, but depression is also a risk factor for cardiac morbidity and mortality, independent of traditional risk factors. This link between depression and cardiac morbidity likely involves both physiologic and behavioral effects of depression. Objectives: To determine the association between risks of depression using Hamilton Rating Scale for Depression (HRSD) and cardiovascular (CV) events. Methods: Our study included 84 patients (23 patients with cardiovascular disease and depression, 61 patients with cardiovascular disease without depression) hospitalized in the cardiology department. We divided patients according to Hamilton scale in 4 categories: 1. absence of depression: 0-1points; 2. mild depression: 8-17 points; 3. moderate depression: 18-25 points; 4. severe depression: >26 points. Maximum score for Hamilton scale is 50 points. Results: During the study has been identified the absence of depression in 37 patients (44%) where HRSD7) in 24 patients (28,6 %), moderate (HRSD> 17) in 20 patients (23,8%) and severe (HRSD> 25) in 3 patients (3,6%). Stratification of comorbidities in patients with cardiovascular disease and depression: essential hypertension: 12 patients (52,2%). Chronic heart failure: 11 patients (47,8%). Acute Coronary Syndrome: 7 patients (30,4%). Stroke: 6 patients (26,1%). Ischemic heart disease. (Angina pectoris): 6 patients ( 26,1%). The results observed predominance of patients with essential hypertension, chronic heart failure and acute coronary syndrome, depression, results that are consistent with international literature, where depression has a negative impact on CVD. The Hamilton Depression Rating Scale (HAM-D) has proven useful for many years as a way of determining a patient’s level of depression before, during, and after treatment. An experienced clinician while working with psychiatric patients should administer it. Discussion:We found that baseline Hamilton scale had the strongest association with CHD. Key challenges in this line of research concern the measurement of depression, the definition and relevance of certain subtypes of depression, the temporal relationship between depression and CHD Conclusion: Hamilton scale is detecting tool for depression in predicting cardiovascular disease

Infective endocarditis complicated by peripheral stigmatus, case report

Disciplina Cardiologie, Clinica Medicală nr.3, Departamentul Medicină Internă, USMF „Nicolae Testemiţanu”, IMSP SCM „Sfânta Treime”Infective endocarditis (IE) presents a microbial infection with insidious or sudden onset involving in infectious process endocardium and other heart structures. IE prevalence ranges from 1.9 to 6.2 cases per 100,000 persons / year, and it’s mortality ranges between 20-50%. IE is a characteristic lesion locating frequent vegetation in heart valves - 77-82%, although it may involve horde trends, papillary muscles, ventricular and atrial endocardium, atrial and ventricular septal defects. Approximately 10-25% of patients with cutaneous manifestations present - the peripheral stigmat, that develops more frequently in patients with staphylococcal trigger, or in patients with IE late diagnosed. We report the clinical case of a 61-year-old man with secondary streptococcal etiology endocarditis with comorbidities (viral B hepatitis, gastric haemorrhage) with vascular skin manifestations. Endocardita infecţioasă (EI) prezintă o infecţie microbiană cu debut insidios sau brusc implicând în procesul infecţios endocardul şi alte structuri ale cordului. Incidenţa EI variază între 1,9-6,2 cazuri la 100.000 persoane/an, iar mortalitatea constituie 20-50%. Leziunea caracteristică EI este vegetaţia cu localizarea mai frecventă pe valvele cardiace – 77-82%, cu toate că poate implica hordele tendineie, muşchii papilari, endocardul ventricular şi atrial, defectele septale atriale şi ventriculare. Aproximativ 10-25% din pacienţii cu EI prezintă manifestări cutanate –stigmat-ul periferic, care se dezvoltă mai frecvent la pacienţii cu trigger stafilococic, sau la bolnavii cu EI depistată tardiv. Raportăm cazul clinic a unui bărbat de 61 de ani cu endocardită infecţioasă secundară, etiologie streptococică, cu comorbidităţi (hepatită virală B, hemoragie gastrică) cu manifestări vasculare tegumentare