Effects of neuromuscular electrical stimulation in patients with heart failure - review.

Research conducted in the last two decades suggests that neuromuscular electrical stimulation of the lower limb muscles (NMES) may be a "bridge" to conventional exercise or an alternative for patients with advanced chronic heart failure (CHF), non-compliant or non-responsive to physical training. Through stimulating the work of the skeletal muscles, NMES increases the functional capacity, muscle mass and endurance in patients with CHF. A beneficial effect of NMES on functional capacity, vascular endothelial function, quality of life and aerobic enzymes activity has been shown. A significant benefit of this novel therapy in heart failure is the fact that the procedure can be home-based, after prior guidance of the patient.

Determining factors of diuresis in chronic kidney disease patients initiating hemodialysis.

BACKGROUND: Patients with stage 5 chronic kidney disease (CKD) begin chronic hemodialysis with variable diuresis levels correlated to a comparable low glomerular filtration rate. Residual diuresis influences long-term evolution of the hemodialyzed patient, modifying the prognosis even if optimal Kt/ V is achieved. AIM OF THE STUDY: The present study emphasizes the main determining factors of diuresis in a cohort of stage 5 CKD subjects at the beginning of hemodialysis. MATERIAL AND METHODS: 216 patients with stage 5 CKD starting chronic hemodialysis were included in the study, and were grouped according to their residual diuresis: group A (urine output ≤ 500 mL/ day); group B (urine output between 500-1200 mL/ day); group C (urine output ≥ 1200 mL/ day). RESULTS: Glomerular etiology, cardiac systolic dysfunction, severe malnutrition, emergency dialysis initiation and lack of permanent vascular access were proved to be associated with significant low diuresis. Age, gender, estimated glomerular filtration rate (GFR) and the presence of systemic hypertension did not influence the amount of daily diuresis. CONCLUSIONS: In CKD stage 5 patients, residual diuresis presents large variations in conditions of comparable low GFR. Factors influencing residual diuresis may be distinct from those that influence residual GFR.

Perioperative evaluation of cardiac surgical risk: particularities in the emergency surgery - from the guidelines to the clinical practice.

RATIONALE: Cardiac risk in patients undergoing surgery depends on many factors from the patient's cardiovascular history to the surgical procedure itself, with its particularities, the type of anesthesia, fluid exchanges and the supervision of the patient. Therefore, this risk must be carefully considered and it determines the endorsement of perioperative measures with important medical implications. OBJECTIVE: Perioperative cardiac risk evaluation guidelines were published since 2010 and they represent a highly important assessmnet tool. Emergency surgery requires an adaptation of the guidelines to the actual medical situations in extreme conditions. METHODS, RESULTS, DISCUSSION: Analyzing the way the perioperative evaluation itself is conducted is an extremely important tool. Quantifying the clinical application of the guidelines, one can monitor real parameters and find solutions for improving medical care. The current study was conducted on a representative sample of 8326 patients, respecting the recommendation strategies for calculating the surgical risk adapted for the emergency surgery setting. The dominant conclusion is the need to develop a standardized form, summarized for quick and objective assessment of perioperative cardiac risk score. Only a complex medical team could calculate this score while the decisional team leader for the surgical patient remains the surgeon.

Metabolic syndrome and mean platelet volume variation in patients with chest pain and negative cardiac enzymes.

INTRODUCTION: The mean platelet volume (MPV) is an easily measurable parameter directly correlated with platelet aggregation function, proven to be increased in acute coronary syndromes, but also in the presence of cardiovascular risk factors such as the metabolic syndrome, dyslipidemia, diabetes mellitus, arterial hypertension. OBJECTIVE: This study intended to assess the role of the metabolic syndrome in MPV variation in patients presenting with chest pain. MATERIALS AND METHODS: We retrospectively analyzed data from 122 patients with chest pain and negative cardiac enzymes admitted consecutively to our clinic from September 1st 2011 to January 30th 2012. Our group included 27 (22.13%) patients with stable angina (SA), 74 (60.65%) patients with unstable angina (UA) and 21 (17.22%) patients with non-coronary chest pain. RESULTS: Patients with UA had a higher mean value of the MPV 9.31 ± 1.19 fL compared to patients with SA 8.72 ± 1.14 fL (p=0.0279) and patients with non-coronary chest pain 8.85 ± 0.90 L (p=0.0908). All the patients with metabolic syndrome had increased MPVs, regardless of the etiology of chest pain. Patients with non-coronary chest pain presented significantly higher MPVs if associated with metabolic syndrome or arterial hypertension. CONCLUSIONS: Patients with cardiovascular risk factors, especially complex ones like the metabolic syndrome had an increased MPV, as did the patients with UA whether or not associated with the risk factors. In patients without such comorbidities, the MPV could be useful in distinguishing unstable angina from non-coronary chest pain.

Physiopathological aspects of the subclinical alterations of thyroid function associated with acute coronary syndromes.

The subclinical modification of thyroid function represents an important risk factor for the development of acute coronary syndromes, neglected up to this day. Knowledge of the physiopathological processes implicated in the alteration of thyroid function that induces cardiovascular dysfunction is a necessity for the understanding of the phenomena and for the finding of the adequate therapeutic solutions. While recognizing the thyroid dysfunction as a modifiable risk factor for the acute coronary syndrome, we encountered a new challenge for the clinical research regarding its implications. The ability to manage the altered thyroid homeostasis may represent a new stage of prevention at a population level for the reduction of the cardiac risk, a stage which implies a risk factor that may remain clinically mute for a long period of time if left undiagnosed, however influencing the development of the acute coronary syndromes.

Clinical, biological, echocardiographic and therapeutic determinants of the length of hospital stay of patients with acute heart failure.

HYPOTHESIS: The length of hospital stay (LOS) is a unanimously accepted measure of risk and treatment efficacy for in-patients. PURPOSE: Our aim was to identify the parameters with predictive value for the LOS of patients with acute heart failure (AHF). METHODS: We analyzed 125 patients consecutively admitted to our clinic with a slight male predominance (54.4%) and a mean age of 71.54 years. Patients were divided into groups according to the clinical form at presentation and left ventricular function. Mean LOS was of 8.74 days. RESULTS: Patients with LVEF<30% had a significantly higher LOS compared to those with LVEF>30% (F(2)=6.54, p<0.05). The same difference was discovered for those who received inotropic support (p<0.001), i.v. loop diuretic>140mg (p<0.001) as well as for those with QRS>160ms (p<0.05) or LBBB. The linear regression equation exposed a single significant statistical model indicating that the need for vasopressor amines, mean diuretic dose and PAAT<90msec explain 56% of the variance of LOS F(3.46)=20.55, p<0.001. The highest contribution to the model was achieved by the need for vasopressor amines (ß=0.66), with a unique contribution of 42% to the variance of the number of days of stay. The mean dose of diuretic had ß=0.27 and a unique contribution to the model of 7.2%, followed by PAAT<90 msec with ß=0.26 and a unique contribution to the model of 7%. CONCLUSIONS: LOS is influenced by numerous parameters, some specific to certain clinical forms of AHF while others are independent, which is why evaluations on larger groups of patients are further needed.

Histomorphometric study regarding the evolution under treatment of the changes appearing at the level of the gingival mucosa in diabetic children.

The values of the glucose influence the status of the periodontium, but also the periodontitis influences the glucose balance by increasing the resistance to insulin. In the case of children in the first step the gingivitis appears, than if the glucose control is not made and the dental hygiene is defective the evolution is towards advanced periodontal disease. The present histomorphometric study wants to emphasize the eventual changes that appear at the level of the gingival epithelium before and after starting a correct treatment of the periodontal disease. The histomorphometric study indicates an average nuclear area of the keratinocytes of 211.65 µm² in the batch studied before the application of the treatment and an increase of the average nuclear area to 234.88 µm² after the treatment (p=0.010538). The nuclear volume before the treatment has an average value of 2396.61 µm³, after the treatment it reaches the value of 2996.924 µm³. The area of the keratinocytes has an average of 495.43 µm², after the treatment it reaches the value of 724.89 µm², noticing a 14.6% (p=0.004) increase of the cellular area. Before the treatment, we notice a ballooning of the cells from the intermediary level, the existence of some pyknotic nuclei and the disappearance of the nucleoli. The associated gingival pathology diabetes mellitus type 1 in the case of children and teenagers is treatable within six months, macroscopically and microscopically the gingival mucosa approaching to normal conditions. In the case of children and teenagers diagnosed with type 1 diabetes, the dental check is mandatory in order to prevent the gingival and periodontal diseases.

Comparative histomorphometric study of bone tissue synthesized after electric and ultrasound stimulation.

The clinical use of the alternative therapies in traumatology is conditioned by the knowledge and understanding of their actions on the bone tissue. The hereby study aims at the comparative assessment of the effectiveness of the direct current and ultrasounds in treating the fractures. Thus, we have proceeded to a comparative histological study of the bone tissue in the fractured area and the biomechanical description and the three-dimensional model of the stimulated bone's behavior by using micro-CT X-rays and the finite element analysis. The findings clearly show that the bone, which has been stimulated during a period of two weeks, has regained its functions, that is 85% of the compression one and 95% of the shearing one. These values prove that 90% of the bone structure has healed.

[Thrombolysis: Bucarest registry]. / La thrombolyse. Registre roumain de Bucarest.

The end-point of this retrospective study was to evaluate the standard of care in terms of in-hospital morbidity and mortality for patients with acute myocardial infarction (AMI) treated by thrombolysis within the first 12 hours from the start of the symptoms in five cardiology centers from Bucarest for a period of 5 years (2000-2004). This retrospective registry on a central database included 1814 patients (73.63% men, mean age 59.9 +/- 11.8 years), presented in an average time of 211.63 minutes from pain start. The most frequently used fibrinolitic was streptokinase (66.21%), administered most often in 30 minutes and for a subgroup in 20 minutes--accelerated regimen, with a good efficiency for the reperfusion of the culprit vessel evaluated non-invasively (clinical, electrical and biological methods). The global in-hospital mortality was 11.1%. The only predictors of in-hospital mortality were female gender and advanced age (>75 years) [p < 0.05]. The rate of haemorrhagic complications was not different from the one described by other clinical studies. The treatment by anticoagulants, antiaplatelets agents like aspirin, ACE inhibitors and statins were significant determinants of in-hospital survival. In the subgroup followed-up for 1 year (315 patients), the most frequent complication was the heart failure. In conclusion, in Bucarest, where availability of primary angioplasty in AMI was limited, thrombolysis with streptokinase was still very much used, with acceptable low in-hospital mortality and relatively high rate of artery reperfusion appreciated by non-invasive methods.

[Pain in Ophthalmology]. / Durerea în oftalmologie.

The pain, one of the most common and unpleasant symptoms of human experience, is a psychophysiological phenomenon made of physical (elementary) pain and psychological pain. The ocular pain may result from stimulation of trigeminal nerve fibres anywhere within the eye, the surrounding tissues, the deep orbit, and the base of the middle and anterior cranial fossae. An ocular pain which is accompanied by another ocular signs can easily suggest a diagnosis for ophthalmologist, but a deep pain which involves the frontal bone and the deep orbit often asks an interdisciplinary consultation.

[Choroidal neovascularization]. / Neovascularizatia coroidiana.

Choroidal neovascularization (CNV) may occur in any ocular condition affecting the integrity of the choriocapillaris-Bruch's membrane-retinal pigment epithelium-outer retinal layer complex. CNV in the macula is a major cause of severe central visual loss. A variety of clinical symptoms suggest the diagnosis of CNV. Fluorescein and indocyanine green angiography play a very important role in the detection and precise localization of CNV in relation to the centre of the foveal avascular zone. In the present, CNV benefits by many treatment possibilities. The goal of treatment is specifically to decrease the risk of visual acuity loss.

[High-altitude retinopathy]. / Retinopatia de mare altitudine.

High-altitude retinopathy is a very rare ocular disease in our country, which can occur isolately or as a part of high-altitude illness. This paper presents the case of a patient with high-altitude illness and the diagnosis and treatment problems of this case.