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Clinical-radiological features and oxidative stress in patients with community-acquired pneumonia and heart failure

Wed, 01 Jan 2025 00:00:00 GMT

Title: Clinical-radiological features and oxidative stress in patients with community-acquired pneumonia and heart failure Authors: Cașcaval, Virginia; Dumitraș, Tatiana; Fetco-Mereuţă, Diana; Matcovschi, Sergiu; Grib, Livi; Talmaci, Cornelia Abstract: Background and Objective: Diagnosing community-acquired pneumonia (CAP) in patients with chronic heart failure (CHF) can be challenging. This study aimed to examine the clinical and paraclinical diagnostic characteristics, along with oxidative stress (OS) markers, in individuals suffering from both CAP and CHF. Methods: A total of 210 patients were enrolled and divided into two groups: group 1 (n = 105) – patients with CAP associated with CHF and group 2 (n = 105) – patients with CAP without CHF. Key Content and Findings: Worsening of dyspnoea was present in 98 (93.3%) patients in group 1, compared to group 2 – 73 (69.5%) patients, P < 0.0001. Bilateral extension of pneumonia was more frequent in group 1 compared to group 2: 63 (60.0%) patients versus 57 (54.3%) patients, respectively, P = 0.515. The presence of pleural effusion was more common in group 1 compared to group 2: 41 (39.0%) patients versus 14 (13.3%) patients, P < 0.0001. The total antioxidant activity (AAT), by CUPRAC method, had higher values in group 1 (6.70 ± 4.62) versus group 2 (4.99 ± 4.29), P = 0.006. Conclusions: Bilateral extension of pneumonia, presence of pleural effusion, worsening of preexisting dyspnoea and the elevation of total antioxidant activity values (CUPRAC method) are useful tools in the early diagnosis of CAP in patients with CHF.; Introducere: Diagnosticul pneumoniei comunitare (PC) pe fundalul insuficienței cardiace cronice (ICC) poate fi dificil. Scopul lucrării a fost de a analiza particularitățile clinice și paraclinice de diagnostic, precum și parametrii stresului oxidativ (SO), la pacienții cu PC și ICC. Metode: În studiu au fost incluși 210 de pacienți, divizați în 2 loturi: grupul 1 (n = 105) – pacienți cu PC asociată cu ICC și grupul 2 (n = 105) – pacienți cu PC fără ICC. Rezultate: Agravarea dispneei fost prezentă la 98 (93.3%) pacienți din grupul 1, comparativ cu grupul 2, unde aceasta a fost prezentă la 73 (69.5%) pacienți, P < 0,0001. Extinderea bilaterală a pneumoniei s-a întâlnit mai frecvent în grupul 1 comparativ cu grupul 2: 63 (60.0%) pacienți versus 57 (54.3%) pacienți, respectiv, P = 0,515. Prezența revărsatului pleural a fost mai frecvent întâlnită în lotul 1, comparativ cu lotul 2: 41 (39.0%) pacienți versus 14 (13.3%) pacienți, P < 0,0001. Activitatea antioxidantă totală (AAT), prin metoda CUPRAC, a avut valori mai mari în grupul 1 (6,70 ± 4,62) versus grupul 2 (4,99 ± 4,29), P = 0,006. Concluzii: Extinderea bilaterală a pneumoniei, prezența revărsatului pleural, agravarea dispneei preexistente și elevarea valorilor activității totale prin metoda CUPRAC, sunt instrumente utile de diagnostic precoce a pneumoniei comunitare la pacienții cu insuficiență cardiacă cronică.

Chronic Miliarial Gout Associated with Carpal Tunnel Syndrome: A Very Rare Clinical Presentation

Wed, 08 Aug 2018 00:00:00 GMT

Title: Chronic Miliarial Gout Associated with Carpal Tunnel Syndrome: A Very Rare Clinical Presentation Authors: Sadovici-Bobeica, Victoria; Mazur-Nicorici, Lucia; Nicorici, Aliona; Salaru, Virginia; Loghin-Oprea, Natalia; Garabajiu, Maria; Istrati, Valeriu; Mazur, Minodora Abstract: Abstract This case report describes an unusual form of gout, called miliarial gout, in association with carpal tunnel syndrome in a 54-year-old woman. Miliarial gout was first described in 2007 and is a very rare presentation of chronic tophaceous gout. The latter condition can cause carpal tunnel syndrome, but this association has not previously been described in association with miliarial gout. In addition, the authors discuss the use of the parsimony principle in internal medicine whereby a single cause is first sought for different symptoms presenting at the same time. Description: Department of Internal Medicine, State University of Medicine and Pharmacy "Nicolae Testemițanu", Chisinau, Republic of Moldova Laboratory of Immunology, Institute of Oncology, Chisinau, Republic of Moldova Department of Family Medicine, State University of Medicine and Pharmacy "Nicolae Testemițanu", Chisinau, Republic of Moldova

Consecinţele timpurii ale miopatiilor inflamatorii idiopatice

Sun, 01 Jan 2017 00:00:00 GMT

Title: Consecinţele timpurii ale miopatiilor inflamatorii idiopatice Authors: Loghin-Oprea, Natalia; Vetrilă, Snejana; Mazur-Nicorici, Lucia; Mazur, Minodora Abstract: Idiopathic infl ammatory myopathies (IIM) are a group of rare diseases characterized by asthenia of skeletal muscles. Early approach to disease leads to a favorable evolution of the disease and less outcomes. The aim of this study is to assess the short-term outcomes in patients with IIM. We conducted a transversal study enrolling 12 patients (7 women, 5 men) with IIM, the mean age was 54.1±12.1 (30–67) years and the follow–up period was 16±9.4, (7-25) months. Patients were assessed by aplying specifi c questionnaires and modern, validated clinical tools.We found in all patients muscle damage manifested by muscular dysfunction – 11 (91.7%) patients and atrophy in one (8,3%) patient, confi rmed by moderate muscle strengh, which implies disability – 10 (83.3%) patients. Gastrointestinal damage was manifested by dysphagia in 3 (25.0%) patients, hepatic steatosis – 3 (25.0%), dismotility – 5 (41.7%) patients. Endocrine damage like dyslipidemia had 4 (33.3%), secondary amenorrhea – 4 (33.3%), diabetes mellitus in 2 (16.6%) patients. Despite moderate disease activity the most common disease outcomes obtained were muscular – 100% patients, gastrointestinal – 91.7% and endocrine – 83.3% patients. Description: Departamentul Medicină Internă, USMF Nicolae Testemiţanu

Sindromul Evans – manifestare inițială nespecifică a lupusului eritematos sistemic

Sun, 01 Jan 2017 00:00:00 GMT

Title: Sindromul Evans – manifestare inițială nespecifică a lupusului eritematos sistemic Authors: Garabajiu, Maria; Mazur, Minodora; Sadovici-Bobeică, Victoria; Caun, Elena; Mazur-Nicorici, Lucia Abstract: Rezumat Introducere. Lupus eritematos sistemic (LES) este o maladie autoimună polisindromică, afectarea hematologică fi ind caracteristică bolii. Sindromul Evans este o manifestare hematologică rară a LES, această asociere presupunînd pronostic rezervat. Această manifestare hematologică poate tergiversa stabilirea diagnosticului de lupus. Drept exemplu este cazul pacientei M., 31 ani, care la internare a prezentat acuze la fatigabilitate, fotosensibilitate, mialgii, cefalee periodică, depresie, dispnee ușoară și echimoze solitare pe gambe. Din anamneză am constatat că pacienta se consideră bolnavă de 10 luni, cu acuze la dispnee, apariția peteșiilor și echimozelor, epistaxis, sîngerare menstruală abundentă. Peste 1,5 luni a fost stabilit diagnosticul de sindromul Evans și a inițiat tratament cu prednisolon. Persistența manifestărilor sindromului Evans, precum și apariția semnelor noi a necesitat consultația reumatologului. Rezultatele investigațiilor au permis stabilirea diagnosticul de lupus eritematos sistemic conform criteriilor SLICC 2012, prin prezența a 7 criterii clinice și 3 criterii imunologice (prezenţa ANA şi anti-ADNdc, scăderea C3, C4). Debutul sindromului Evans a necesitat tratament doar cu glucocorticosteroizi, însă, la confi rmarea LES, tratamentul a presupus necesitatea antimalaricelor de sinteză, conform ghidului treat to target [1]. Concluzie. Anemia hemolitică cu trombocitopenie autoimună – sindromul Evans, fi ind manfestare inițială a LES, poate conduce la întîrzierea diagnosticului, dar inducerea promptă a terapiei cu glucorticosteroizi, care sunt de bază în ambele patologii, permit scăderea oportună a activității maladiei cu îmbunatatirea stării generale a pacientului și, de asemenea, pronosticul bolii pe termen lung. Introduction. Systemic lupus erythematosus (SLE) is a palindromic autoimmune disease and haematological implication is common for the disease. Evans syndrome is a rare hematologic manifestation of SLE and the combination of these pathologies presuppose varied prognosis. In cases of lupus onset with these symptoms the diagnosis of disease may be delayed. As an example we present a case of patient M., 31 years old, presented at admission complaints of fatigue, photosensitivity, myalgia, recurrent headache, depression, mild dyspnea and unique bruises on legs. From the history of disease, we detect that the patient is considered ill for 10 months, when appeared dyspnea, petechiae, ecchymosis, epistaxis and heavy menstrual discharges. In a 1,5 month was established the diagnosis of Evans syndrome and started treatment with prednisolone. The persistence of Evans syndrome as well as new symptom’s appearance required rheumatologist consultation. Examination results confi rm the diagnosis of systemic lupus erythematosus conform SLICC 2012 classifi cation criteria by the presence of 7 clinical and the 3 immunological criteria (presence of ANA şi anti-dsDNA, C3, C4 lowering). The onset of Evans syndrome required treatment only with glucocorticosteroids, however, after the confi rmation of SLE treatment involved antimalarials, according to treat to tatget guideline [1]. Conclusion. Autoimmune hemolytic anemia and thrombocytopenia - Evans syndrome, as early presentation of SLE, may lead to delay in diagnosis, but prompt inducing glucorticosteroid therapy, which is basic in both pathologies, allow opportune lowering of disease activity with improving patient’s general condition, and also, it’s long-term prognosis. Введение. Системная красная волчанка (СКВ) является полисиндромным, аутоиммунным заболеванием и гематологические проявления являются характерными для болезни. Синдром Эванса является редким гематологическим проявлением СКВ и сочетание этих патологий подразумевает разноречивый прогноз. В случаях де- бюта волчанки такими гематологическими проявлениями, диагноз заболевания может задерживаться. В качестве примера представлен случай пациентки М., 31 год, которая поступила с жалобами на усталость, фоточувствительность, миалгию, реккурентную головную боль, депрессию, одышку; и единичными гематомами на ногах. Из истории болезни мы выявили, что пациентка считается больной в течение 10 месяцев, когда появились одышка, петехии, гематомы, носовые кровотечения и обильные менструальные кровотечения. Через полтора месяца был установлен диагноз синдрома Эванса и начато лечение преднизолоном. Персистентность синдрома Эванса, а также появление новых симптомов потребовали консультацию ревматолога. Результаты исследований позволили установить диагноз системной красной волчанки в соответствии с критериями SLICC 2012 по наличию 7 кли- нических и 3 иммунологических критериев (наличие ANA и анти-дцДНК, снижение С3, С4). Дебют синдрома Эванса требовал лечения только глюкокортикостероидами, однако, подтверждение СКВ лечение вовлекает необходимость противомалярийных средств, в соответствии с руководством treat to target [1]. Вывод. Аутоиммунная гемолитическая анемия и тромбоцитопения - синдром Эванса, как раннее проявление СКВ, могут привести к задержке в диагностике, но своевременное начало глюкортикостероидной терапии, которая является основой при обеих патологиях, позволяет своевременно снизить активность болезни с улучшением общего состояния пациента, а также, ее долгосрочный прогноз. Description: Disciplina de medicină internă-semiologie, Disciplina de cardiologie, Departamentul Medicină Internă, IP USMF “Nicolae Testemițanu”, Catedra de kinetoterapie, IP USEFS