The Pattern of Anemia in Lupus

Anemia is a frequent incident for patients with systemic lupus erythematosus (SLE), its incidence being reported as 18–80%. Anemia of chronic disease (ACD) is the most common hematological syndrome in the evolutionary context of SLE. In anemia of the chronic disease, cytokines stimulate the production of hepcidin, an acute phase protein, which destroys ferroportin produced by hepatocytes. As a result, Fe (iron) is not able to come out from the erythrocytes and macrophages and is trapped within them. Anemias from chronic disease are usually hypoproliferative processes. This chapter reviews the correlation between systemic lupus erythematosus and anemia of chronic disease in general (but iron-deficiency anemia in particular). This text reviews different important methods of examination used to diagnose the pathological process of lupus as an immune disease and of the hematopoietic system some of these methods include (general blood analysis, Coombs test, serum iron, hematocrit etc.). Furthermore, it will discuss the physiopathological mechanism of anemic syndrome in systemic lupus erythematosus and the changes of the immune system. In conclusion, the relevance of anemia (independent of its cause) is estimated as being both a short-term activity of the disease and long-term prognostic factor for the evolution of SLE

Peculiarieties of systemic lupus erythematosus associated with anaemia

Catedra Medicină Internă nr.3, USMF ”Nicolae Testemiţanu”We examined 26 patients with anemia from 53 SLE patients that were included in our study. There were evaluated blood and standard immunological tests in association with erythropoietin level by ELISA test, disease activity was appreciated by SLAM. After the investigations we determined the following forms of anemia: anaemia of chronic disease (ACD) n = 9 (34. 6%), iron deficiency anaemia (AID) n = 12 (46. 1%), autoimmune hemolytic anaemia (AHA) n = 2 (7. 7%) and other causes n = 3 (11. 5%). Haematological abnormalities manifested by anemia (Нb < 100 g / l) were detected in 100% of patients, leukopenia (< 4 х 109 /l) 30.7%, lymphopenia (<1500/ mm 3 ) in 34.6%, and thrombocytopenia (< 100 х 109 /l) only in 11.5% cases. Laboratory investigations revealed immunological changes in 53.8% of examined patients, performed by detecting antiDNA-dc, ANA and aCL antibodies. Assessment of disease activity according to SLAM showed that low activity had only 3 (11.5%) patients, moderate activity was in 18 (69. 2%) patients and major activity was detected in 5 (19. 2%) patients. Anemia is a common manifestation of systemic lupus erythematosus and can be detected by simple clinical and laboratory tests. Am evaluat 26 de pacienţi cu anemie în LES din 53 pacienţi cu LES care au fost încluşi în lotul de studiu. S-au efectuat testele hematologice şi imunologice standard, s-a asociat evaluarea eritropoetinei prin metoda ELISA, aprecierea activităţii bolii s-a efectuat după SLAM. După investigaţii am întâlnit următoarele forme de anemii: anemia bolii cronice (ABC) n = 9 (34. 6%), anemia fierodificitară (AF) n = 12 (46. 1%), anemie hemolitică autoimună (AHA) n = 2 (7. 7%) şi alte cauze n = 3 (11. 5%). Modificări hematologice manifestate prin anemie (Нb < 100 g/l) au fost depistate la 100 % de pacienţi, leucopenia (< 4 х 109 /l) la 30.7%, limfopenie (<1500/ mm 3 ) la 34.6% şi trombocitopenie (< 100 х 109 /l) numai la 11.5 %. Cercetările paraclinice au pus în evidenţa modificări imunologice la 53.8% de pacienţi examinaţi, traduse prin depistarea antiADN-dc, ANA şi anticorpii aCL. Aprecierea activităţii bolii după SLAM au arătat că activitatea joasă a maladiei au avut numai 3(11.5 %) de pacienţi, activitatea moderată a fost la 18(69.2 %) de pacienţi şi activitate majoră a fost depistată la 5(19.2 %) pacienţi. Anemie este o manifestare frecventă a lupusului eritematos sistemic şi poate fi depistată prin teste simple clinice şi paraclinice

Aplicarea criteriilor sindromului antifosfolipidic obstetrical

Catedra Medicină Internă nr.3 USMF ”Nicolae Testemiţanu”The antiphospholipid syndrome (APS) is characterized by recurrent arterial and/or venous thrombosis and pregnancy morbidity manifested by early or late losses. Laboratory diagnosis of APS relies on the demonstration of a positive test for antiphospholipid antibodies (aPL). In clinical practice, the gold standard tests are those that detect anticardiolipin antibodies (aCL) and/or the lupus anticoagulant (LA). Although other specificities for aPL have been described their clinical utility and standardization has still to be established. Persistence of aPL positive tests must be demonstrated, and other causes and underlying factors considered. Correct identification of patients with APS is important, because prophylactic anticoagulant therapy can prevent thrombosis from recurring, and treatment of affected women during pregnancy can improve fetal and maternal outcome. Studierea manifestărilor sindromului antifosfolipidic obstetrical (SAFLo) – afecţiune care se prezintă clinic cu recurenţe de tromboze venoase sau arteriale şi/sau patologie obstetricală. Confirmare de laborator în SAFL sunt nivelurile ridicate de anticorpi anticardiolipinici şi/sau anticoagulantul lupic. Sindromul antifosfolipidic reprezintă un domeniu de interes susţinut şi o problemă cu importante valenţe medico-sociale. Utilizarea criteriilor de diagnostic în SAFLo presupune diagnostic precoce şi tratament adecvat

Anemia bolii cronice în lupus eritematos sistemic

Am examinat 59 din 86 de pacienţi cu LES şi anemie, care au fost incluşi în studiul nostru. Au fost evaluate analizele de sânge şi testele imunologice standarde, nivelul eritropoietinei după testul ELISA, activitatea bolii a fost apreciată după SLAM. În urma investigaţiilor am stabilit următoarele forme de anemii: anemia bolii cronice (ABC) n = 34 (57,6%), anemia fi erodifi citară (AFD), n = 20 (33,9%), anemia hemolitică autoimună (AHA) n = 3 (5,1%) şi alte cauze n = 2 (3,4%). Activitatea bolii a fost evaluată după SLAM: activitate minimală au avut doar 12 (20,3%) pacienţi, activitate moderată a fost depistată la 36 (61,0%) şi activitate înaltă – la 11 (18,6%) bolnavi. Anemia este o manifestare comună la pacienţii cu lupus eritematos sistemic şi poate fi detectată prin teste simple clinice şi de laborator

Alimentaţia, ca factor de risc pentru dezvoltarea constipaţiilor la gravide

Catedra Igiena si Epidemiologie USMF „N. Testemitanu”We have studied 364 pregnant women. These women were divided in two groups (182 women with constipation in pregnancy and 182 without constipation). The diagnosis of constipation was established depending on the Criteria from the Rome III. In the result of investigation we have determined the role of alimentation, as one of the risk factors in the development of constipation in pregnancy. Lotul de studiu a fost prezentat de 364 gestante. Femeile au fost divizate în doua grupe (182 de femei cu constipat ii în sarcina s i 182 fa ra constipat ii). Diagnosticul de constipat ii a fost stabilit pe baza Criteriilor de la Roma III. În rezultatul studiului noi am stabilit rolul alimentat iei ca factor de risc pentru dezvoltarea constipat iilor la gravide

Chronic inflammation as a new cardiovascular disease factor

Department of Internal Medicine, Cardiology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, The 8th International Medical Congress for Students and Young Doctors, September 24-26, 2020Introduction. Cardiovascular disease (CVD) is a major public health problem, in most areas of the world. While traditional risk factors for the development of CVD have been researched, the science community has recently identified chronic Inflammation as an additional risk factor. Inflammation is the result of the body's immune system activity recognizing and removing harmful stimuli to start the healing process. Chronic inflammation is referred to as a long-term disorder. Chronic inflammatory disorders include diseases such as rheumatoid arthritis (RA), systemic sclerosis (SSc), systemic lupus erythematosus (SLE), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) etc., which play a crucial role in the process of atherogenesis. Aim of the study. This research was on studying cardiovascular patients, that previously have been diagnosed with a form of chronic inflammation, to show that patients with chronic inflammatory diseases are likely at high risk of developing CVD. Materials and methods. The aim of the research consisted in studying cardiovascular patients, that have been previously diagnosed with a form of chronic inflammation, to show that patients with chronic inflammatory diseases are likely to be at a high risk of developing CVD. Results. By studying the significant inflammatory indicators like C-reactive protein, fibrinogen, Cytokines interleukin, the helper T cells, LDL cholesterol, triglycerides, etc. and their effects on atherosclerosis we can underline the pathophysiology of atherogenesis. When the pro-inflammatory activity starts, it also commences the alteration of lipoprotein concentrations, oxidative stress, and macrophage accumulation, the injury of the endothelial and the activation of the immune system. All these factors and many others are increasing the risk of the atherosclerosis/arteriosclerosis and supported by the traditional factors they create the best conditions for the development of CVD. Patients with rheumatoid arthritis are in the group of an increased risk of CVD; the EULAR recommendations in 2017, updated in 2019, announced that the estimated risks are multiplied by 1.5- 2 for all patients with RA. The same data was found on systemic lupus erythematosus, in which the risks increase by 2-3 times. A similarity was suggested also on psoriatic arthritis and systemic sclerosis. Conclusions. Chronic inflammatory disorders, influenced by their pro-inflammatory effects are relevant as the new risk factors of Cardiovascular disease such as atherosclerosis, arteriosclerosis, acute coronary syndrome, etc

Dextrocardia cu situs inversus – modificări electrocardiografice

Background. Dextrocardia with situs inversus is a rare congenital anomaly, with an incidence 1:20000 of alive births, with equal involvement of men and women, diagnosed on imaging evaluation by: electrocardiogram (ECG), echocardiography (EcoCG) and computed tomography (CT). Objective of the study. Evaluation of electrocardiographic criteria in dextrocardia with situs inversus. Material and Methods. The literature review on the field with the evaluation of electrocardiographic changes in patients with dextrocardia for the early establishment of the anomaly that will facilitate their management in the future. Results. Patients with dextrocardia and situs inversus are in 95% asymptomatic, being detected at the routine examination. At ECG: negative P and T waves in the I, aVL leads, the decrease of the R waves and the predominance of the S waves in the V1-V6 leads, the electrical axis of the heart with right deviation, where T flattened in the V4-V6 leads. EcoCG and CT of the internal organs detect a mirror anatomy of the visceral organs with trilobar lung on the left and bilobar on the right, liver and gallbladder on the left and spleen and stomach on the right. Early detection of this abnormality is for real use in the management and treatment of emergency surgical conditions in these patients. Conclusion. Electrocardiographic changes suggestive of dextrocardia with situs inversus in an asymptomatic patient will allow us to diagnose the genetic abnormality early and will be of real use to prevent subsequent diagnostic errors in surgical emergencies. Introducere. Dextrocardia cu situs inversus este o anomalie congenitală rară, cu incidența de 1:20000 nașteri vii, cu afectarea în egală măsură a bărbaților și femeilor, diagnosticată în evaluarea imagisică prin: electrocardiogramă (ECG), ecocardiografie (EcoCG) și tomografie computerizată (CT). Scopul lucrării. Evaluarea criteriilor electrocardiografice în dextrocardia cu situs inversus. Material și Metode. Revista literaturii în domeniu cu evaluarea modificărilor electrocardiografice la pacienții cu dextrocardie și situs inversus pentru stabilirea timpurie a anomaliei cu facilitarea managnmentul acestora. Rezultate. Pacienții cu dextrocardie și situs inversus în 95% sunt asimptomatici, fiind depistați în examenul de rutină. La ECG standart diagnosticăm: unde P și T negative în derivațiile I, aVL, descreșterea undelor R și predominarea undelor S în derivațiile V1-V6, axa electrică a cordului cu deviație dreaptă, unde T aplatizate în V4-V6. EcoCG și CT organelor interne decelează o anatomie în oglindă a organelor viscerale cu plămân trilobar pe stânga și bilobar pe dreapta, ficatul și vezica biliară pe stângă, iar splina și stomacul pe dreapta. Depistarea precoce a acestei anomalii este de un real folos în managmentul și tratamentul stărilor chirurgicale de urgență la acești pacienți. Concluzii. Modificările electrocardiografice sugestive pentru dextrocardie cu situs inversus la un pacient asimptomatic ne vor permite să diagnosticăm precoce anomalia genetică și vor fi de un real folos pentru a preveni erorile diagnostice ulterioare în cazul urgențelor chirurgicale

Silent angina pectoris in a patient with diabetes mellitus, clinical case

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica MoldovaIntroducere. Angina pectorală silențioasă (APs) se dezvoltă la: pacienți absolut asimptomatici cu defect al sistemului de avertisment anginal, în 30% la bolnavii cu infarct miocardic în anamnestic, în 80% la cei cu angină pectorală instabilă (API), angină Prinzmetal și la 70% - cu angină pectorală stabilă (APS). Scopul lucrării. Prezentăm cazul clinic a unui pacient tânăr hipertensiv, fumător, cu fibrilație atrială, genealogie agravată, care se internează de urgență cu dispnee inspiratorie la efort fizic minimal, palpitații și cefalee. Material și metode. Bărbat, 54 de ani, internat cu API în secția de cardiologie SCM „Sfânta Treime”. Din anamnestic: hipertensiv de 15 ani, diabet zaharat de 11 ani, fibrilație atrială de 6 ani. Investigațiile efectuate: electrocardiografia, ecocardiografia, coronaroangiografia, radiografia toracelui, ultrasonografia abdominală, marcherii injuriei miocitare, hemoglobina glicată, analize hematologice și biochimice. Rezultate. Starea generală a pacientului cu agravare: dispnee inspiratorie la efort fizic minimal, aritmie, cefalee. Obiectiv: murmur vezicular în plămâni, zgomote cardiace ritmice, cu FCC 156 b/min, TA - 160/100 mmHg. Paraclinic: ECG: fibrilație atrială cu FCC 160-96 b/min, hipertrofie VS. Bloc incomplet de ram stâng anterior. EcoCG: Hipertrofie VS. FE 48%. Coronaroangiografia: leziuni aterosclerotice pe LAD 80-85%. CFC-MB 25 U/L, troponine negative. Glicemia (11,8 mmol/l), dislipidemie. Tratament: angioplastie coronariană cu implantare de stent, nitrați, inhibitorii enzimei de conversie, blocanții canalelor de calciu, antiagregante și antidiabetice. Concluzii. Pacient tânăr, fumător, hipertensiv, cu diabet zaharat dezvoltă angină pectorală silențioasă. Este internat la timp, investigat prompt prin coronaroangiografie, depistat cu leziuni aterosclerotice pe LAD și rezolvat prin angioplastie coronariană cu pronostic favorabil.Background. Silent angina pectoris (sAP) develops in absolutely asymptomatic patients with a defect in the angina warning system, in 30% of patients with a history of myocardial infarction, in 80% among them had unstable angina pectoris (APu), Prinzmetal’s angina and in 70 % - with stable angina pectoris (SAP). Objective of the study. We present the clinical case of a young hypertensive, smoking patient with atrial fibrillation, aggravated genealogy, who was urgently admitted with inspiratory dyspnea on minimal physical exertion, palpitations and headache. Materials and methods. Man, 54 years old, hospitalized with UAP in the MCH „Holy Trinity”, Cardiology Department. Medical history: hypertension for 15 years, diabetes during 11 years, atrial fibrillation during 6 years. Investigations performed: electrocardiography, echocardiography, coronary angiography, chest x-ray, abdominal ultrasound, markers of myocyte injury, glycated hemoglobin, hematological and biochemical analyses. Results. General state of the patient with worsening: inspiratory dyspnea on minimal physical effort, arrhythmia, headache. Objective: vesicular murmur in the lungs, rhythmic heart sounds, with HB 156 b/min, BP - 160/100 mmHg. Paraclinical: ECG: atrial fibrillation with HB 160-96 b/min, LV hypertrophy. Incomplete anterior left bundle branch block. EcoCG: Hypertrophy LV, EF 48%. Coronary angiography: atherosclerotic lesions on LAD 80-85%. CK-MB 25 U/L, negative troponins. Glucose (11.8 mmol/l), dyslipidemia. Treatment: coronary angioplasty with stent implantation, nitrates, angiotensin-converting enzyme inhibitors, calcium channel blockers, antiplatelet agents, and antidiabetic drugs. Conclusions. A young, smoking, hypertensive patient with diabetes mellitus develops silent angina pectoris. He was admitted on time, promptly investigated with coronary angiography, diagnosed with atherosclerotic lesions in the LAD and resolved by coronary angioplasty with a favorable prognosis

The diagnostic significance of intima-media determination in patients with different ischemic cardiopathy variants

Departamentul Medicină Internă, USMF Nicolae Testemiţanu, IMSP SCM Sfânta Treime, Laboratorul hepatochirurgical, USMF Nicolae TestemiţanuThe process of systemic atherosclerosis has a long asymptomatic period corresponding with the occurrence of manifested cardiovascular disease, such as myocardial infarction or ischemic stroke, which results in the invalidity of the patient, lowering its quality of life, decreasing life expectancy and increasing spending in public health or death. The rise in the index of average thickness is intimate-the first observable sign of atherosclerosis, vascular damage from its substrate, being represented by fibrocelular hypertrophy and hyperplasia of smooth muscle cells in the media pressure