An alarm signal for the medical world addressed from the pathological anatomy service in the Republic of Moldova

Department of Morphopathology, Nicolae Testemitsanu State University of Medicine and Pharmacy Chisinau, the Republic of Moldova, Department of Microscopic Morphology/Histology, Angiogenesis Research Center, Victor Babes University of Medicine and Pharmacy, Timisoara, RomaniaBackground: Maintaining the quality and safety of pathology services is crucial for the efficient delivery of health care. However, pathology is, perhaps, the least understood of the medical specialties. In particular, the scope of pathology and the integral role it plays in all areas of medicine are not well recognized even by some of those working in health care environments. Strategic partnerships have as the main goal the enlargement of collaborative research and partnership on national and international level, mainly, but not exclusively in European Research Area. There is a perceived need for improved management practices, use of new technologies, and increased use of some categories of the personnel. Issues with the employment program were mentioned, including tracking, matching people to jobs, training, and finding more opportunities. There was a call for greater visibility in the community (both medical and scientific). The problems facing pathology teaching and pathology teachers mirror those of most other medical disciplines, namely a lack of time and money, and competing pressures from many other sources. Conclusion: There is the danger of producing doctors who cannot explain disease to their patients, who abuse laboratories and who have no interest in pursuing pathology as a career, leading to a slow and possibly irreversible decline in pathology as a medical profession

Влияние гиполипидемической длительной терапии на некоторые факторы риска пациентов со старым инфарктом миокарда и сахарным диабетом второго типа

Department of Chronic Heart Failure, Institute of Cardiology, Congresul III al Medicilor de Familie din Republica Moldova, 17–18 mai, 2012, Chişinău, Republica Moldova, Conferinţa Naţională „Maladii bronhoobstructive la copii”, consacrată profesorului universitar, doctor habilitat Victor Gheţeul, 27 aprilie, Chişinău, Republica MoldovaScopul studiului. Determinarea influenţei tratamentului hipolipemiant de durată asupra unor factori de risc la bolnavii cu infarct miocardic vechi şi diabet zaharat tip 2. Material şi metode În studiu au fost incluşi 54 de pacienţi cu Q-Infarct miocardic vechi şi diabet zaharat tip 2 (vârsta medie de 58,88 ± 0,92 ani), dintre care 31 de bărbaţi şi 23 de femei. Pacienţii au fost divizaţi în 2 grupuri: I grup – pacienţi cu Q-Infarct miocardic vechi şi diabet zaharat tip 2, care au administrat tratament standard şi tratament hipolipemiant cu Lovastatină (doza medie – 33,15 mg/zi), timp de 1 an, şi al II grup – pacienţi cu Q-Infarct miocardic vechi şi diabet zaharat tip 2, care au administrat numai tratament standard. Corecţia glicemiei a fost efectuată cu Glibenclamid (doza medie – 7,7 mg/zi). La toţi pacienţii a fost efectuată lipidograma (cu determinarea colesterolului total, trigliceridelor, HDL-colesterolului, LDL-colesterolului), fibrinogenul, proteina C-reactivă şi aprecierea grosimii intima-media a arterei carotide, conform metodei propuse de Pignoli. Rezultate Pacienţii cu infarct miocardic vechi şi diabet zaharat tip 2 au valori înalte ale colesterolului total, trigliceridelor, LDLcolesterolului, proteinei C-reactive şi indicele intima-media. Administrarea tratamentului hipolipemiant de durată a redus nivelul colesterolului total cu 28,41% (p < 0,01), trigliceridelor - cu 17,96 % (p < 0,05), LDL-colesterolului - cu 31,49% (p < 0,001), proteina C-reactivă - cu 18,46% (p < 0,05), fibrinogen - cu 20,41% (p < 0,01) şi indicele intima-media - cu 13,91% (p < 0,05). Pe fundal de dietă hipolipemiantă a existat o tendinţă de majorare a nivelului proteinei C-reactive, a fibrinogenului şi indicelui intima-media, dar statistic nesemnificativ. Datele sunt prezentate în tabelul. 1. Concluzie Tratamentul hipolipemiant de durată este efectiv în reducerea factorilor de risc la bolnavii cu infarct miocardic vechi şi diabet zaharat tip 2

Исследование качества жизни у больных с хронической сердечной недостаточностью ишемического происхождения с систолической дисфункцией или с сохраненной функцией левого желудочка

Institute of Cardiology, Department of Chronic Heart Failure, Congresul III al Medicilor de Familie din Republica Moldova, 17–18 mai, 2012, Chişinău, Republica Moldova, Conferinţa Naţională „Maladii bronhoobstructive la copii”, consacrată profesorului universitar, doctor habilitat Victor Gheţeul, 27 aprilie, Chişinău, Republica MoldovaThe aim of this study was to determine changes in quality of life in patients with chronic HF in relation to the degree of LV systolic dysfunction and NYHA functional class. The study included 337 patients with ischemic heart failure, functional class NYHA II and III. All patients included were Romanian-speaking. To determine the quality of life in the study population, three questionnaires were used (validated version in Romanian): Minnesota Living with Heart Failure Questionnaire (Minnesota LHF Q), Mac New Heart Disease HRQL questionnaire and MOS-SF-36 questionnaire, short form. It Significant differences in quality of life between groups of patients with NYHA functional class II and III were identified after the application of all three questionnaires. In groups of patients with and without LV systolic dysfunction, application of Minnesota and MacNew questionnaires did not determine significant differences between groups in quality of life indices. And, the application of the generic SF-36 questionnaire has highlighted that physical functioning and pain indices and total physical component were more favorable in patients without LV systolic dysfunction. Thus, differences of quality of life were more evident in groups of patients divided according NYHA functional class than in groups of patients with or without LV systolic dysfunction.Целью исследования было в определении качества жизни у пациентов с хронической сердечной недостаточностью (ХСН) в зависимости от степени систолической дисфункции левого желудочка и функционального класса (ФК) NYHA. В исследование было включено 337 пациентов с сердечной недостаточностью (ФК II - III NYHA) ишемического происхождения. Для определения качества жизни были использованы 3 опросника (Minnesota LHF Q, MacNew Heart Disease HRQL и MOS SF-36). Статистически достоверные различия качества жизни были определены при использовании 3 опросников в группах больных разделенных в зависимости от ФК NYHA. При использовании опросников Minnesota LHF Q и MacNew, достоверные различия качества жизни в группах с нормальной функцией ЛЖ и с систолической дисфункцией ЛЖ не были определены. При применении вопросника SF-36 было установлено, что физическое функционирование, индекс боли и общий физический компонент были более благоприятными в группе пациентов с сохраненной функцией ЛЖ. Таким образом, различия в качестве жизни были более очевидны в группе больных, разделенных в зависимости от ФК NYHA, чем в группах больных с систолической дисфункцией ЛЖ или без нее

Исследование психометрических качеств опросников Minnesota LHF Q, MacNew Heart Disease HRQL и MOS SF-36 у больных с хронической сердечной недостаточностью ишемического происхождения

Department of Chronic Heart Failure, Institute of Cardiology, State University of Medicine and Pharmacy „Nicolae Testemitanu”, Chisinau, Republic of MoldovaUntil now there have not been validated instruments that assess the quality of life in patients with cardiovascular disease in the Republic of Moldova. The 6 stages of Minnesota LHF Q, MacNew Heart Disease HRQL and MOS SF-36 questionnaires were validated, followed by a pilot study – 337 patients with ischemic chronic heart failure in II-III NYHA functional classes. To determine the psychometric qualities of the questionnaires we performed a test-retest method looking at correlations between the components of the questionnaires and quality of life indices, which were analyzed according to the age, sex, living environment, and studies. Our results demonstrated the questionnaires’ reliability and validity through the indication of linguistic validation that had been carried out successfully. Thus, it can be a methodological basis for future clinical trials in the Republic of Moldova.В настоящее время в Республике Молдова инструменты для оценки качества жизни пациентов с сердечно-сосудистой патологией не валидированы. Нами были выполнены все 6 этапов валидации трёх опросников (Minnesota LHF Q, MacNew Heart Disease HRQL и MOS SF36), с последующим проведением пилотного исследования – 337 пациентов с сердечной недостаточностью (ФК II-III NYHA) ишемического происхождения. Чтобы определить психометрические качества опросников было проведено двойное тестирование пациентов, корреляции между компонентами опросников, были проанализированы параметры качества жизни в зависимости от возраста, пола, условий жизни, наличия высшего образования. Полученные результаты продемонстрировали надежность и валидность опросников. Таким образом, проведение данной валидации составит методологическую основу для последующего проведения в нашей стране сравнимых клинических исследований в области кардиологии

2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC

2016 ESC on Acute and Chronic H

Effect of Systemic Hypertension With Versus Without Left Ventricular Hypertrophy on the Progression of Atrial Fibrillation (from the Euro Heart Survey).

Hypertension is a risk factor for both progression of atrial fibrillation (AF) and development of AF-related complications, that is major adverse cardiac and cerebrovascular events (MACCE). It is unknown whether left ventricular hypertrophy (LVH) as a consequence of hypertension is also a risk factor for both these end points. We aimed to assess this in low-risk AF patients, also assessing gender-related differences. We included 799 patients from the Euro Heart Survey with nonvalvular AF and a baseline echocardiogram. Patients with and without hypertension were included. End points after 1 year were occurrence of AF progression, that is paroxysmal AF becoming persistent and/or permanent AF, and MACCE. Echocardiographic LVH was present in 33% of 379 hypertensive patients. AF progression after 1 year occurred in 10.2% of 373 patients with rhythm follow-up. In hypertensive patients with LVH, AF progression occurred more frequently as compared with hypertensive patients without LVH (23.3% vs 8.8%, p = 0.011). In hypertensive AF patients, LVH was the most important multivariably adjusted determinant of AF progression on multivariable logistic regression (odds ratio 4.84, 95% confidence interval 1.70 to 13.78, p = 0.003). This effect was only seen in male patients (27.5% vs 5.8%, p = 0.002), while in female hypertensive patients, no differences were found in AF progression rates regarding the presence or absence of LVH (15.2% vs 15.0%, p = 0.999). No differences were seen in MACCE for hypertensive patients with and without LVH. In conclusion, in men with hypertension, LVH is associated with AF progression. This association seems to be absent in hypertensive women

Sex- and age-related differences in the management and outcomes of chronic heart failure: an analysis of patients from the ESC HFA EORP Heart Failure Long-Term Registry

Aims: This study aimed to assess age- and sex-related differences in management and 1-year risk for all-cause mortality and hospitalization in chronic heart failure (HF) patients. Methods and results: Of 16 354 patients included in the European Society of Cardiology Heart Failure Long-Term Registry, 9428 chronic HF patients were analysed [median age: 66 years; 28.5% women; mean left ventricular ejection fraction (LVEF) 37%]. Rates of use of guideline-directed medical therapy (GDMT) were high (angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, beta-blockers and mineralocorticoid receptor antagonists: 85.7%, 88.7% and 58.8%, respectively). Crude GDMT utilization rates were lower in women than in men (all differences: P\ua0 64 0.001), and GDMT use became lower with ageing in both sexes, at baseline and at 1-year follow-up. Sex was not an independent predictor of GDMT prescription; however, age >75 years was a significant predictor of GDMT underutilization. Rates of all-cause mortality were lower in women than in men (7.1% vs. 8.7%; P\ua0=\ua00.015), as were rates of all-cause hospitalization (21.9% vs. 27.3%; P\ua075 years. Conclusions: There was a decline in GDMT use with advanced age in both sexes. Sex was not an independent predictor of GDMT or adverse outcomes. However, age >75 years independently predicted lower GDMT use and higher all-cause mortality in patients with LVEF 6445%

Progression From Paroxysmal to Persistent Atrial Fibrillation. Clinical Correlates and Prognosis

Objectives: We investigated clinical correlates of atrial fibrillation (AF) progression and evaluated the prognosis of patients demonstrating AF progression in a large population. Background: Progression of paroxysmal AF to more sustained forms is frequently seen. However, not all patients will progress to persistent AF. Methods: We included 1,219 patients with paroxysmal AF who participated in the Euro Heart Survey on AF and had a known rhythm status at follow-up. Patients who experienced AF progression after 1 year of follow-up were identified. Results: Progression of AF occurred in 178 (15%) patients. Multivariate analysis showed that heart failure, age, previous transient ischemic attack or stroke, chronic obstructive pulmonary disease, and hypertension were the only independent predictors of AF progression. Using the regression coefficient as a benchmark, we calculated the HATCH score. Nearly 50% of the patients with a HATCH score &gt;5 progressed to persistent AF compared with only 6% of the patients with a HATCH score of 0. During follow-up, patients with AF progression were more often admitted to the hospital and had more major adverse cardiovascular events. Conclusions: A substantial number of patients progress to sustained AF within 1 year. The clinical outcome of these patients regarding hospital admissions and major adverse cardiovascular events was worse compared with patients demonstrating no AF progression. Factors known to cause atrial structural remodeling (age and underlying heart disease) were independent predictors of AF progression. The HATCH score may help to identify patients who are likely to progress to sustained forms of AF in the near future. \ua9 2010 American College of Cardiology Foundation

Impact of non-cardiac comorbidities on hf outcomes in patients after coronary revascularization therapy

IMSP Institute of Cardiology, Republic of MoldovaIntroduction Heart failure (HF) and non-cardiac comorbidities often coexist. However, the prevalence and prognostic impact of non-cardiac comorbidities on the hospitalization rates and all-cause mortality according to the two phenotypes of HF remain inadequately studied Purpose To analyze the impact of 15 non-cardiac comorbidities on hospitalization rate and all-cause mortality and their interaction with EF Material and methods A 48 months prospective observational study enrolled 166 patients. They underwent coronary artery bypass grafting, percutaneous coronary angioplasty and previously where admitted to the cardiac rehabilitation department and correlated to the association of noncardiac comorbidities in particular EF phenotypes. HFmrEF defined as EF from 40-49% and HFpEF as EF ≥ 50%. Results HFmrEF patients had a similar clinical profile to that of HFpEF patients in terms of age, body mass index and blood pressure (p<0,001). The HFmrEF and HFpEF groups had similar re-hospitalization rates and all-cause mortality (p<0,001). From non-cardiac comorbidities, a greater impact on hospital re-admission was seen through obstructive bronchopulmonary diseases, thyroid gland diseases and ischemic stroke (the results a presented in the next table) Conclusions Non-cardiac comorbidities contribute both to mortality and to hospital re-admissions, thus, we determined the importance of including the management of comorbidities as a part of heart failure treatment in both patient categories