Particularities of skin damage in thyroid diseases

Catedra Endocrinologie, USMF „Nicolae Testemiţanu”Skin is the organ where metabolic, circulatory and vegetative activities of the organism are expressed. Thyroid pathology has a higher prevalence during the last years and one of the organs where its dysfunction manifests is the skin. Thyroid hormones are involved in the maintainance of skin’s homeostasis, as well as in the homeostasis of the skin annexes and of the sebacious glands etc. Emphasyzing the pathologic skin semiology frequently leads to a correct endocrinologic diagnosis. Pielea este organul, la nivelul căruia este exprimată activitatea metabolică, circulatorie şi vegetativă a organismului. Patologia tiroidiană înregistrează o prevalenţă tot mai înaltă în ultimii ani şi unul din organele asupra căruia se manifestă disfuncţia ei este pielea. Hormonii tiroidieni sunt implicaţi în menţinerea homeostaziei pielii, fanerelor, glandelor sebacee etc. Evidenţierea semiologiei tegumentare patologice de cele mai multe ori orientează spre un diagnostic endocrinologic corect

Peculiarities of skin damage in diabetes mellitus

(Conducător ştiinţific – Lorina Vudu, dr., conferenţiar universitar) Catedra Endocrinologie, USMF „Nicolae Testemiţanu”Hormones are known to be essential in regulating physiologic processes in each system of the body, including the skin. Endocrine diseases, through excess or deficiency of hormones, result in changes in the cutaneous function and morphology. DZ has a lot of skin implications. All skin manifestations are the result of vascular, neurological, infectious, metabolic or aftercare disorders. Hormonii sunt cunoscuţi ca fiind factori esenţiali în reglarea proceselor fiziologice în fiecare sistem al corpului, inclusiv a celui cutanat. Patologiile endocrine, prin excesul sau deficitul hormonal, implică modificări cutanate atât funcţionale, cât şi morfologice. DZ are largi implicaţii dermatologice. Toate manifestările cutanate sunt rezultat a tulburărilor vasculare, neurologice, infecţioase, metabolice sau posttratament

Deep vein thrombosis in patient with thrombophilia – an increased risk for pulmonary thromboembolism

Conducător ştiinţific – Brocovschi Victoria, asistent universitar Clinica medicală N 2, USMF „Nicolae Testemiţanu”Thrombophilia – characterized a series of hypercoagulable states that predispose to the formation of intravascular thrombosis. This syndrome is usually rare, but the importance of knowing it can not be underestimated because thrombophilia is the main risk genetically acquired which predisposes people to develop advance venous thrombophilia and leads to a high incidence of pulmonary thromboembolism which has an increased mortality. Trombofilia caracterizează o serie de stări de hipercoagulabilitate, care predispun la formarea de tromboze intravasculare. Acest sindrom de regulă se întâlneşte rar, însă importanţa cunoaşterii nu poate fi subestimată deoarece se ştie că este principalul factor de risc dobândit care predispune persoanele la formarea trombozei venoase profunde şi mai mult, la o incidenţă crescută a tromboembolismului pulmonar

Actualităţi în tratamentul hepatitei cronice virale C

În acest reviu este prezentată actualitatea şi terapia de viitor a hepatitei virale C cronice, care constituie la moment o problemă mondială majoră de sănătate, cauzând ciroză hepatică, insufi cienţă hepatică şi carcinom hepatocelular. La momentul actual terapia de bază se bazează pe utilizarea interferonilor pegilaţi, ribavirinei şi inhibitorilor de protează, dar reieşind din procentul mic al răspunsului virusologic susţinut în cadrul tratamentului hepatitei virale C cronice genotipul 1, lumea ştiinţifi că a elaborat noi medicamente, ţintă fi ind proteazele NS3, NS4 şi NS5

Современное лечение хронического вирусного гепатита B

IMSP SCM Sfânta Treime, USMF Nicolae TestemițanuThe main treatment goal of the chronic hepatitis B is the permanent and profound suppression of the viral replication in order to prevent its complications, such as cirrhosis, liver failure and hepatocellular carcinoma. The ideal aim of the antiviral therapy is the disappearance of HBsAg, which can rarely be achieved with the currently available anti-HBV agents (interferons and nucleoside/nucleotide analogues). However, it has been shown that the majority of patients with chronic hepatitis B will present clinical improvement after the treatment with nucleoside/nucleotide oral drugs and the pharmacological class used will depend on the level of the viral load and on the clinical features of the patient. Another method of treatment that also presents interest is the therapeutic vaccination with the prophylactic vaccines with HBsAg, resulting in a temporary decrease of the viral load, which is more effective when used in combination with other antiviral treatments, and requiring further studies.Основной целью лечения хронического вирусного гепатита В является постоянное и глубокое подавление вирусной репликации для предотвращения его осложнений, таких как цирроз печени, печеночная недостаточность и гепатоцеллюлярная карцинома. Идеальной задачей противовирусной терапии является исчезновение HBsAg, которое редко можно достичь с помощью противовирусных препаратов, действительных в настоящее время (интерфероны и аналоги нуклеозидов/нуклеотидов). Тем не менее, было доказано, что большинство пациентов с хроническим гепатитом B имеют клиническое улучшение после лечения оральными аналогами нуклеозидов/нуклеотидов, и используемый класс препаратов будет зависеть от степени вирусной нагрузки и клинических особенностей пациента. Представляет интерес также терапевтическая вакцинация профилактическими вакцинами с HBsAg, в результате чего имеет место временное снижение вирусной нагрузки. Этот метод является более эффективным при использовании в комбинации с другими противовирусными препаратами и также требует дальнейших исследований

Infective endocarditis with negative blood cultures, case report

Disciplina Cardiologie, Clinica Medicală nr.3, Departamentul Medicină Internă, USMF „Nicolae Testemiţanu”, IMSP Institutul de CardiologieInfective endocarditis represents an annual incidence of 3-9 cases per 100,000 population. Male / female ratio is 2:1. Patients with prosthetic valves, intracardiac devices, congenital heart disease, or recurrence of infectious endocarditis, develops more frequent IE, 27% -50% patients didn’t have history of predisposing cardiac diseases. Diagnosis IE establishment requires two major DUKE criteria: pathogen detection in three blood cultures and echocardiographic demonstration of endocardial involvement in the infectious process. Incidence of negative blood cultures IE remains high, especially in countries with poorly developed economies (> 50%), which is explained by unjustified antimicrobial medicines intaking, inadequate doses, before the IE diagnosis establishing, or impossibility of specific microorganisms collecting, that can develop IE (mycoplasma, bartonela, fungi, etc). Causative pathogen detection delay negatively influences the evolution and prognosis of disease, causing shortness of early appropriate treatment, according to the antibioticogram. We present a clinical case of IE with negative blood cultures, late diagnosis, which needed an empirical long-term antibacterial therapy with valvular reprotezation. Endocardita infecţioasă prezintă o incidenţă anuală de 3-9 cazuri la 100.000 populaţie. Raportul barbaţi/femei este de 2:1. Pacienţii cu proteze valvulare, dispozitive intracardiace, cardiopatii congenitale, sau recurenţă de endocardita infectioasă, dezvoltă mai frecvent EI, iar 27%-50% din pacienţi nu au antecedente cunoscute de patologii cardiace predispozante. Stabilirea diagnosticului cert de EI necesită 2 criterii majore DUKE: depistarea agentului patogen în 3 hemoculturi şi demonstrarea ecocardiografică a implicării endocardului în procesul infecţios. Incidenţa EI cu hemocultură negativă rămâne înaltă, mai cu seamă în tările cu o economie slab dezvoltată (> 50%), care se explică prin administrarea nejustificată a preparatelor antimicrobiene, în doze neadecvate, înainte de stabilirea diagnosticului de EI, sau de imposibilitatea de a preleva microorganisme specifice, care pot dezvolta EI (micoplasma, bartonela, fungii,etc.). Temporizarea depistării agentul patogen cauzativ influenţează negativ evoluţia şi pronosticul maladiei, provoacă dificultăţi de tratament adecvat precoce, conform antibioticogramei. Prezentăm un caz clinic de EI cu hemoculturi negative, diagnosticat tardiv, care a a necesitat tratament antibacterian empiric, de lungă durată cu reprotezare valvulară

Thyrotoxic cardiomyopathy: clinical particularities

Catedra Endocrinologie, USMF „Nicolae Testemiţanu”Thyrotoxic cardiomyopathy represents the myocardial injury caused by the toxic effects of the thyroid hormones. The duration of the thyrotoxicosis, the age and gender of the patient are important factors for the development of thyrotoxic cardiomyopathy and its clinical manifestations. Its most common symptoms are: palpitations, angina pectoris, dyspnoea and arrythmic heart contractions. The physical examination will frequently determine tachycardia, arrythmic heart contractions, systolic hypertension, orthostatic hypotension, enlargement of heart dullness at percussion, systolic murmurs and pulmonary rales (in case of heart failure). Cardiomiopatia tireotoxică reprezintă leziunea miocardului, cauzată de către efectele toxice ale hormonilor tiroidieni. Durata tireotoxicozei, vârsta şi sexul bolnavului reprezintă factori importanţi în dezvoltarea cardiomiopatiei tireotoxice şi manifestărilor ei clinice. Cele mai frecvente simptome ale cardiomiopatiei tireotoxice sunt palpitaţiile, angina pectorală, dispneea şi contracţiile cardiace aritmice. La examenul obiectiv deseori se atestă tahicardie, contracţii cardiace aritmice, hipertensiune sistolică, hipotensiune ortostatică, lărgirea matităţii cordului la percuţie, sufluri sistolice şi raluri pulmonare (în caz de insuficienţă cardiacă)

Pulmonary thromboembolism in patients with risk factors

(Conducător ştiinţific – Brocovschi Victoria, asistent universitar) Clinica medicală N 2, USMF „Nicolae Testemiţanu”Pulmonary thromboembolism is a multifactorial disease, influenced by the interaction of genetic and acquired risk factors. Almost 80-90% of cases of DVT detailed research may reveal at least one risk factor. Risk factors interact with one another, acting synergistically and additively. Acquired “classic” risk factors– age, obesity; “risk periods” like surgery, trauma, immobilization, medical conditions, pregnancy, postpartum period, oral contraceptive use, not only predispose apparently healthy people to DTV, but trigger DTV on genetically prone land. Tromboembolismul pulmonar (TEAP) reprezintă o afecţiune multifactorială, fiind influenţat de interacţiunea unor factori de risc genetici şi dobândiţi. Aproape 80-90% din cazurile de TVP la o cercetare amănunţită poate evidenţia cel puţin un factor de risc. Factorii de risc interacţionează între ei, acţionând sinergic şi aditiv. Factorii „clasici” dobândiţi de risc - vârsta, obezitatea; “perioadele de risc” reprezentate de intervenţii chirurgicale, traumatisme, imobilizare, afecţiuni medicale, sarcină, perioada postpartum, utilizarea contraceptivelor orale, nu numai predispun persoane aparent sănătoase la TVP, dar reprezintă trigger pentru TVP pe un teren predispus geneti

Clinical case: Dextrocardia - disease or a norm variation

State Medical and Pharmaceutical University „Nicolae Testemițanu”, Chisinau, Republic of MoldovaIntroduction: Dextrocardia is a rare clinical entity, with the location of the heart, and apex orientation to the right, with an incidence of 0.2-1%, and associated with situs inversus in 1/3 of the patients. In the absence of other structural modifications it presents no cardiovascular rise, the risk of coronary artery disease (CAD) being similar to that of the general population. Dextrocardia was first described by Fabricius H. in 1606, but situs inversus - by Severinus M. in 1643. It often associates with other congenital malformations (CM) - single ventricle, ventricular septal defect, tricuspid atresia. Clinically, dextrocardia shows no manifestations, except when associated with severe CM. Its confirmation needs a standard ECG, with the electrodes placed on the right, and an EchoCG evaluation. Clinical case. Patient B., 62 years, admitted in PMSI MCH „Holy Trinity”, Acute Miocardial Infarction (AMI) Department with the Diagnose: Ischaemic cardiopathy. Unstable Angina. Miocardial infarction (1991). NYHA II HF. Dextrocardia. At onset it presents with constrictive retrosternal pain at little physical activity lasting 15 minutes, suppressed by 3 tablets of nitroglicerine and inspiratory dyspnea. From history, in 1991 the patient underwent an AMI. Regular treatment with cu p-blockers, diuretics, antiagregants. On physical examination: overall condition of medium severity; normal-colored skin; vesicular breath sounds; rhithmic heart sounds, HR-70 b/min, B P -130/80 mm/Hg; painless abdomen on palpation. On standart ECG-microvoltage, heart electric axis(HEA)- right deviation, negative P wave, inversed T wave in D I and AVL, R wave decrease from VI to V6. Right ECG: sinus rhythm, HR60 b/min., normal HEA. Left ventricle(LV) hypertrophy. Antero-septal and apical LV postinfarction sequelae. EchoCG: Dextrocardia; ascending Aorta wall induration; moderate dilation of the LA, RA and LV; hypertrophy of the LV myocardium; adequate LV contractility (EF-57%); LV antero-septal hypokinesia and apical akinesia. Mild PHT. Abdominal USG: Situs inversus. Laboratory tests - no deviations. The patient received the following treatment: anticoagulants, antiplatelets, nitrates, P-blockers, statins, metabolic drugs. Conclusion: Pacient B., 62 years, with dextrocardia and myocardial infarction develops an unstable angina, with typical clinical signs. The patient is hospitalized, following treatment according to the clinical guidelines, with positive results. In the specialized literature, patients with dextrocardia, in the absence of CM, need no particular approach of CAD, which was also seen in the case above

Clinical case: inferior myocardial infarction of the left ventricle, extended to the right ventricle

State Medical and Pharmaceutical University „Nicolae Testemițanu”, Chișinău, Republic of MoldovaIntroduction: Acute myocardial infarction of the right ventricle (AMI RV) is rarely met, it being associated with an inferior AMI of the left ventricle (AMI LV) in 33-50% of the cases, determining the increase of early morbidity and mortality. The symptoms of hypotension, clear pulmonary areas and turgid jugular veins are considered a marker of the RV lesion in patients with inferior AMI. Approximately 25-50% of AMI RV present with hemodynamic disturbances. Female gender, age over 70 years, arterial hypertension, smoking, atrio-ventricular block and bundle branch block are predictive factors for the RV implication in patients with inferior AMI. The patient R., 72 years old, was admitted to the Cardiology Department nr. 1 of the PMSI Institute of Cardiology with the diagnosis: Ischaemic cardiopathy. Inferior acute myocardial infarction. Cardiac asthma accesses. Acute cardiac failure II Killip. Complaints: Constrictive pain in the right parasternal and in the epigastric areas, inspiratory dyspnea at light physical effort, cardiac asthma accesses, calf swelling, fatigue. History of the disease: The general state has been worsening for 2 weeks with epigastric pain, dyspnea progression, and apparition of cardiac asthma accesses. Ambulatory Echo-CG determined RV cardiomegaly, ejection fraction decrease (35%) and presence of akinetic areas. He was immediately hospitalized in the Cardiology Department of PMSI Institute of Cardiology. Clinical examination: General state severe, pale skin, acrocyanosis. Hoarse vesicular murmur in the lungs. Rhythmic, diminished heart sounds, with HR=74 beats/minute, BP=140/90 mm Hg. Liver +4 cm. Paraclinical investigations: ECG at admission: Sinus rhythm, HR=95/minute, LV myocardium hypertrophy, repolarization changes on the inferior wall of the LV. Repeated ECG: comparatively, with no visible changes. Echo-CG: M oderate aortic stenosis. Regurgitation of the AoV of the Ilnd degree. Moderate dilation of the LA, RA, RV. Akinesia of the inferior wall of the LV, of the basal and medium segments in the lateral and posterior walls of the LV. Akinesia of the RV wall. Regurgitation of the TV of the Illrd degree, MV of the Ilnd degree. Severe pulmonary hypertension. Markers of myocardial necrosis: negative. Treatment: Beta-blockers, nitrates, diuretics, ACE inhibitors, anticoagulants, antiplatelets. Conclusion: The patient R., 72 years old, presenting with an extended AMI, involving the LV and RV, which determined intensive therapy. According to literature data, patients with an inferior AMI of the LV, involving the RV, have a worst prognosis