Clinical, evolutive and diagnostic considerations of community-acquired pneumonia in obese patients: Summary of the doctoral thesis in medical sciences: 321.01 Internal Medicine (Pneumology)

Abstract

Thesis structure: the thesis is presented on 120 pages of basic text, including 4 chapters, general conclusions, practical recommendations, 277 bibliographic sources, 20 tables, 21 figures, 12 annexes, 2 innovator's certificates, 2 implementation acts, information of results publication and a statement on assuming responsibility. The results obtained were published in 26 scientific papers (11 articles and 15 abstracts in national and international journals), and the results were presented at 15 national and international conferences. Keywords: community-acquired pneumonia, obesity, oxidative stress, clinical course, comorbidities, severity scores. Field of study: Internal Medicine, Pulmonology. Aim of the study: Highlighting the clinical and paraclinical course and oxidative stress characteristics of community-acquired pneumonia in obese patients. Study objectives: determining clinical and paraclinical characteristics of community-acquired pneumonia in obese patients; estimation of the associated comorbidities, clinical course and complications of community-acquired pneumonia in obese patients; assessment of prooxidant and antioxidant status markers in community-acquired pneumonia in obese; correlation of anthropometric features with community-acquired pneumonia severity and cardiometabolic risk assessment in obese patients; community-acquired pneumonia severity assessment scores (CURB-65, PORT/PSI, DSCRB-65, SIRS, CAP-PIRO) according to the presence of obesity and elaboration a method for assessing the risk of developing severe community-acquired pneumonia in obese patients. Scientific novelty and originality of the research: The impact of obesity on the persistence of clinical symptoms and signs of pneumonia, on the duration of hospitalization, the need for transfer to the intensive care unit and the need for mechanical ventilation was evaluated. The particularities of oxidative stress in community-acquired pneumonia in obese patients were highlighted. Scientific solved problem: The research results allowed the development of a calculation formula for assessing the risk of developing severe community-acquired pneumonia in obese patients, which will allow early diagnosis of severe pneumonia and timely transfer to the intensive care unit to minimize possible complications. Theoritical significance: Patients with community-acquired pneumonia and obesity require a more detailed therapeutic approach, given the longer hospital stay, higher rate of acute respiratory failure, more frequent need for transfer to intensive care, and need for mechanical ventilation. The more advanced proinflammatory and prooxidative status is confirmed as the body mass index increases. The applicative value of the thesis: Compared to other existing community-acquired pneumonia assessment severity scores, the DS-CRB-65 score demonstrated the highest sensitivity and specificity. Threshold values for prooxidative markers of oxidative stress were established for the diagnosis of severe community-acquired pneumonia. Implementation of scientific results: The methodical recommendations were used in the Pulmonology Department, Internal Medicine Department and Intensive Care Department of the ,,Holy Trinity” Municipal Clinical Hospital, as well as in the didactic process at the Discipline of Clinical Synthesis, Department of Internal Medicine, ,,Nicolae Testemitanu” State University of Medicine and Pharmacy.