ASSESSMENT OF ADVERSE DRUG REACTIONS AS CARDIOVASCULAR RISK FACTORS.

UNLABELLED: A wide range of pharmaceutical substances can induce side-effects expressed as cardiovascular changes or events, adding to other risk factors or worsening preexisting cardiovascular diseases. AIM: Continuous study focused on iatrogenic conditions representing cardiovascular risk factors. METHODS: We developed a descriptive study of patients admitted to the Iasi Vth Internal Medicine and Geriatrics-Gerontology Clinic between 1998-2013, focusing on iatrogenic conditions representing cardiovascular risk factors. RESULTS: We have diagnosed 81 cases of drug-induced hypertension, and 43 patients with hypertensive crises; 72 cases of iatrogenic hyperglycemia; 36 cases of drug-induced hyperuricemia; 50 cases of drug-induced dyslipidemias; and 17 cases of iatrogenic obesity. These iatrogenic diseases were more common in women and the elderly. Twenty-eight patients have developed simultaneous adverse drug reactions induced by the same drug and manifest as different cardiovascular risk factors. CONCLUSIONS: Cardiovascular risk factors can be induced to a significant extent by chronic drug administration. Some medications (e.g., NSAIDs, corticoids, beta-blockers, diuretics, contraceptives) can act on the same patient by multiple pathogenic links. The adverse drug reactions can be cardiovascular risk factors that persist in time, or can be removed (by discontinuing the administration of the implicated drug). The highest importance of their acknowledgment relies on the possibility of their prevention through carefully balancing the benefits and the risk of each new medication.

Respiratory rehabilitation in healing depression and anxiety in COPD patients.

UNLABELLED: Chronic Obstructive Pulmonary Disease (COPD) is an inflammatory affection of the whole lung, characterized by an accelerated loss of the pulmonary functions, that reduces the patients' independence and stops them from having a normal, active life. The medical rehabilitation is considered "Third class rehabilitation", after preventive medicine and pharmaceutical medicine, and the respiratory rehabilitation recovery represents a complex structure of service addressing to patients with chronic pulmonary illnesses whose aim is to optimize the physical performances, psycho-social and autonomy. AIM AND OBJECTIVES: The main objective of this study is to show the importance of respiratory rehabilitation that is correctly and timely made, based on the gravity and stage of the illness, the COPD patient's associated illnesses and their importance in improving the patient's mental and physical quality of life. Patients from the study were assigned a complex pulmonary rehabilitation regimen consisting of 10 physical exercise sessions and 10 educational sessions, for two weeks, followed by 3 physical education sessions and medical education per week, for six weeks. MATERIAL AND METHOD; The research included 35 COPD patients from the 5th medical Geriatric and Gerontology. Clinic during 1.03.2014-30.11.2014. Patients from the study were assigned a complex pulmonary rehabilitation regimen consisting of 10 physical exercise sessions and 10 educational session for two weeks, followed by 3 sessions a week for 6 weeks. The dyspnea evaluation was made by BORG and MRC dyspnea scales, the quality of life was measured by St. George and CAT questionnaires, and anxiety and anxiety and depression were quantified by Hamilton Anxiety Rating Scale (HARS) and Hamilton Depression Rating Scale (HDRS). RESULTS: The gradation of dyspnea on BORG scale was correlated with the variation of the expiratory capacity that varied at COPD patients, suggesting that hyperinflation has a major role in producing the dyspnea. The average score measurement was about 75.25 ± 5.9. the positive effects of rehab were validated by decreasing the St. George score by 16% to the initial value. Respiratory rehab was an important way of treatment due to effort tolerance increasing and the patient's independence. Depression was significantly more pronounced in women (Z = -1.876: p = 0.039). The little value of maximum respiratory volume per second (VEMS) was correlated to a bigger HARS and HDRS score. CONCLUSIONS: The prevalence and importance of symptoms of anxiety and depression in COPD patients requires a specific questionnaire as routine screening procedure, for detecting early symptoms and preventing their progress.