Volume 18 (2021): Issue 6 (December 2021)

Introducere. Arteriopatia obliterantă a membrelor inferioare (AOMI) reprezintă consecinţa afectării aterosclerotice a arterelor distale, cu o prevalenţă crescută în special în rândul pacienţilor de gen masculin. Prezentarea clinică este variabilă, de la prezenţa clasică a claudicaţiei intermitente şi până la apariţia semnelor clinice de ischemie acută la nivelul membrelor inferioare. Diagnosticul este stabilit în cele mai multe cazuri pe baza indicelui gleznă-braţ cu o valoare sub 0,9. Managementul terapeutic are drept deziderate principale reducerea riscului de apariţie a unui eveniment acut cardiovascular, îmbunătăţirea statusului functional şi prevenirea declinului fizic şi psihic deopotrivă. Recuperarea cardiovasculară joacă un rol important, având implicaţii prognostice pe termen scurt şi lung.

Materiale şi metode. Studiul prezentat în lucrarea de faţă este unui descriptiv, retrospectiv, bazat pe un lot de 70 de pacienţi diagnosticaţi cu AOMI care au fost evaluaţi în cadrul Clinicii de Recuperare Cardiovasculară. Au fost constituite două loturi, în funcţie de prezenţa sau nu a claudicaţiei intermitente (60 pacienţi, respectiv 10 pacienţi).

Rezultate. Analiza statistică a inclus o varietate de parametri demografici, clinico-paraclinici şi terapeutici deopotrivă, urmărind să se evidenţieze factorii cu impact asupra apariţiei şi progresiei claudicaţiei intermitente şi, implicit, efectul acestora asupra prognosticului pe termen lung. Genul masculin, fumatul, hipertensiunea arterială, diabetul zaharat, prezenţa bypass-ului aortocoronarian în antecedente şi profilul lipidic modificat sunt parametri semnificativi statistic în studiul prezentat.

Concluzii. Evoluţia AOMI este marcată de simptomatologie şi de corecţia factorilor de risc prezenţi, recuperarea cardiovasculară asigurând la aceşti pacienţi îmbunătăţirea statusului functional şi creşterea calităţii vieţii.

Scopul studiului a fost de a determina relaţia între doi factori de risc cardiovascular cunoscuţi (ateroscleroza subclinică şi hipertensiunea arterială) şi ficatul gras nonalcoolic (NAFLD - nonalcoholic fatty liver disease) la pacienţii cu diabet zaharat de tip 2. Au fost incluşi 92 de subiecţi cu diabet zaharat de tip 2 trataţi cu antidiabetice orale sau doar regim igienodietetic. Ultrasonografia abdominală şi ultrasonografia Doppler au fost utilizate pentru a evalua severitatea steatozei hepatice şi a aterosclerozei subclinice, prin măsurarea grosimii intimămedie carotidiană (GIM). Vârsta medie a lotului de studiu a fost de 60,38 ±10,37 ani. Mai mult de 90% dintre subiecţi au prezentat diferite stadii de încărcare grasă hepatică. 61% dintre pacienţi au avut valori anormale ale GIM. 75% dintre pacienţi au prezentat valori crescute ale tensiunii arteriale. S-a demonstrat o relaţie semnificativă statistic între gradul de steatoză hepatică şi GIM (r =0.3636, p =0.0004). De asemenea, s-a constatat o corelaţie semnificativă între gradul de încărcare grasă hepatică şi tensiunea arterială sistolică. Rezultatele susţin ipoteza că NAFLD poate reprezenta un predictor cardiovascular prin relaţia sa directă cu GIM şi tensiunea arterială.

The presence of albuminuria has long been recognized as an adverse prognostic feature in patients with renal disease. Those patients with appreciable albuminuria are much more likely to develop tubulointerstitial scarring and fibrosis and progress to end-stage renal failure. For many years it was thought that excess albuminuria was simply a marker of a more severe renal disease which was more likely to progress as a result of this severity rather than as a result of the albuminuria itself. This conviction was strengthened by the general assumption that albumin was a benign or inert molecule serving primarily to exert oncotic pressure and act as a carrier within the circulation.

More recently this view has been challenged with the accumulation of evidence suggesting that albumin is able to influence the function of cells with which it makes contact in the manner of a signaling molecule.

Muscle cramps appearing in liver cirrhosis substantially affect the quality of life of these patients. The prevalence of painful muscle cramps can be up to 88%. The exact mechanism by which these muscle cramps occur is unknown. The management of this symptom is not easy because there is no uniformly accepted recommendation about what kind of supplementation or medicine (or both) can be used exactly. The aim of our study is to review the treatment options for muscle cramps in liver cirrhosis.

We found in the literature (using the keywords „liver cirrhosis", „muscle cramps", „treatment" and „quality of life") 32 articles of this topic. Treatment options currently are: vitamin supplementations (vitamin E, 1 - α hydroxy vitamin D), amino acid supplementations (taurine, branched - chain amino acids, L - carnitine, albumin), mixed herbal medicines (Niuche-Shen-Qui-Wan), zinc and medications (eperisone hydrochloride, quinine and quinidine sulphate, baclofen, methocarbamol, orphenadrine). Vitamin supplementations and amino acid supplementations are targeting the possible pathophysiological causes of muscle cramps (nerve function or energy metabolism alterations which are unique to liver cirrhosis). New aspects started to use medications especially antispasmodic agents (methocarbamol, orphenadrine) and antispasticity agents (baclofen) to relieve muscle cramps. We also found a multicenter study and two systematic reviews (performed in 2013 and 2014). From 2014 there is no systematic article appeared in this topic and we considered it important to survey the new treatment options next to the treatment options already known.

In severe cases of SARS-CoV-2 infection, death occurs as a result of hypo-oxygenation of peripheral tissues. The lung, severely damaged, can not ensure the transfer of oxygen to the blood. It is necessary to increase the alveolar concentration of oxygen by supplementation, with or without mechanical ventilation. The relatively poor outcomes are related to the fact that the entire chain of oxygen transport to the mitochondria is compromised. The oxygen transport capacity is drastically reduced especially by overproduction of immature red blood cells and hemoglobin damage. The oxygen excess is toxic to the lung, causing characteristic lesions that evolve to fibrosis and that add to the respiratory distress induced by COVID19. The administration of oxygen in a concentration well above the level in the atmosphere causes a real explosion of oxidizing free radicals, which are particularly aggressive.

It is recommended to use oxygen sparingly, at the borderline of coverage of the demand, for a duration as limited as possible, as well as the combination of antioxidants.

Background. Hypernatremia is an electrolyte disturbance frequently encountered in patients in intensive care units (ICUs). On admission, 2-6% of patients have hypernatremia, and 7-26% develop hypernatremia during their stay. Hypernatremia was found to be an independent risk factor for mortality. While the underlying pathology of hypernatremia can be characterized as a net increase in total sodium or a net loss of free water, clinical diagnosis of the underlying pathology is not always clear. Tetraparetic patients are a special risk group for hypernatremia. They are immobilized for long periods and depend entirely on nursing.

Case report. We presented a challenging case of a 49-year-old patient with a history of subarachnoid hemorrhage, complicated with an episode of extreme hypernatremia accompanied by hydrocephalus.

Conclusion. Even though the most serious complication of hypernatremia is subarachnoid hemorrhage, the severe episode of hypernatremia did not result in re-bleeding. The patient's extreme serum sodium levels (197 mmol/L) mentioned in the literature as incompatible with life, together with the absence of re-bleeding, confers particularity to the current case.

Chronic obstructive pulmonary disease (COPD) is a chronic disease of the respiratory airways due to partially reversible obstruction of the airflow caused by an abnormal inflammatory response to toxic substances, most often cigarette smoke. COVID-19 is a mild to severe respiratory disease caused by a coronavirus from the genus Betacoronavirus. Chronic cor pulmonale is a severe complication of COPD. Stroke is common in the course of COVID disease,with a major impact on the patient.