Hyponatremia--risk factor in patients with chronic heart failure--clinical, evolutive and therapeutic implications.

UNLABELLED: Patients with heart failure are, by definition, hemodynamically unstable. This condition may be accentuated by medication (digitalis, diuretics, antiarrhythmics), so that they become more sensitive to electrolyte disturbances. Hyponatremia is the most common electrolyte disorder, particularly common in the intensive care unit. AIM: The evaluation of the incidence of hyponatremia in patients diagnosed with chronic heart failure in order to establish a correlation with the evolution, prognosis and therapeutic implications. MATERIAL AND METHODS: We analyzed retrospectively 120 patients diagnosed with chronic heart failure NYHA II-IV classes, admitted in the Cardiology Clinic between 2009 and 2013. We analyzed electrolytic disturbances which occurred during different strategies of therapy. RESULTS: 120 patients with heart failure were admitted in the Cardiology Clinic between 2009 and 2013, 92 males and 28 females. Diagnosis was established by classical criteria. Evaluation was very complex and included: complete clinical examination, electrocardiogram, echocardiography, chest ray examination and biochemical analyses especially hepatic, renal function and electrolyte status. CONCLUSIONS: The data obtained showed that electrolyte disturbances are frequent in patients with chronic heart failure, irrespective of NYHA class. Hyponatremia is usually associated with diuretic therapy and may play a very important role in the subsequent development of life-threatening complications. Patients with heart failure who develop hyponatremia during their evolution had a worse prognosis.

Associated factors of ejection fraction in insulin-treated patients with type 2 diabetes.

AIM OF THE STUDY: to evaluate the relation between ejection fraction (EF), diabetes characteristics and cardiovascular risk factors. MATERIAL AND METHODS: We carried out a cross-sectional study in 171 patients with insulin-treated type 2 diabetes hospitalized at the Sf. Spiridon Emergency Clinical Hospital, Iasi. All patients were evaluated for asymptomatic organ damage and cardiovascular risk factors of hypertension and diabetes metabolic control. Global ejection fraction (EF) was evaluated through 2-D echocardiography. RESULTS AND DISCUSSION: In the studied group the ejection fraction had significant negative correlations with the duration of the disease (p=0.007) and the presence of microalbuminuria (p=0.001). There were some differences between the categories realized by grouping the patients according to the presence of hypertension and/or previous myocardial infarction. In patients without personal history of cardiovascular disease EF was correlated only with LDLc levels. In the hypertensive patients without myocardial infarction it was correlated with diabetes duration, Hb A1e and LDLc, In those patients with both conditions, EF had significant correlations with Hb A1e and microalbuminuria. CONCLUSIONS: These results emphasized that the determinants associated with heart failure in patients with type 2, insulin-treated diabetes, differ according to the presence of high blood pressure and myocardial infarction.

Butyrylcholinesterase activity-biomarker for predicting the outcome in acute cholinesterase inhibitor poisoning--a 30-year retrospective analysis.

AIM: To assess the role of butyrylcholinesterase (BuChE) activity as a predictive biomarker in acute cholinesterase inhibitor poisoning in a cohort from a regional tertiary care hospital. MATERIAL AND METHODS: Plasma butyrylcholinesterase activity on admission and at regular intervals during admission and clinical outcomes of cases admitted to the Toxicology Clinic of "Sf. Spiridon" Emergency Hospital Iasi, Romania between 1983 and 2013 were evaluated. RESULTS: A total number of 606 patients were included in the study. The mean BuChE-activity level on admission was 1.54 ml NaOH N/100. A correlation between the amount of ingested organophosphates/carbamates (OPs/CMs) and low cholinesterase activity on admission was found. 66.66% of the patients were admitted to hospital within 8 hours after poisoning. The initial, daily and mean total atropine doses administrated were 9.65 mg, 10.51 mg and 69.39 mg, respectively. 67.16% of the investigated patients received Toxogonin for 6.41 days showing a slow increase in BuChE activity afterwards. The average number of hospital days was 11.22. The study revealed that complications occurred in patients with BuChE-activity levels below 1.4 mL NaOH N/100. A positive correlation between mortality rate (3.8% of patients) and the lowest BuChE-activity level on admission (0.89 mL NaOH N/100) was found. CONCLUSIONS: BuChE activity on admission and its level during hospital stay represent an important predictive factor for acute cholinesterase inhibitors poisoning.

[Uric acid, cardiovascular events and renal dysfunction: a circumstantial connection?]. / Acidul uric, evenimentele cardiovasculare si disfunctia renala--o legatura conjuncturala?

AIM: The relationship between asymptomatic hyperuricemia, cardiovascular events and renal dysfunction was studied (affirmed or challenged) long time ago. To investigate this relationship we conducted this study. MATERIAL AND METHODS: We analyzed 163 patients consecutively admitted in the Intensive Cardiac Care Unit of the 1st Cardiology Clinic, County Hospital "St. Spiridon" Iasi. The cut-off value of serum uric acid was defined as 7 mg%. There were recorded anthropometric, anamnesis, clinical and paraclinical data. RESULTS: We compared the normal uricemia group (108 patients) with the hyperuricemia group (55 patients). The serum uric acid value was 5.22 +/- 1.16 mg% in the normouricemia group and 8.58 +/- 1.86 mg% in the hyperuricemia group. The statistically significant differences between the two groups relate to sex, smoking as cardiovascular risk factor, diastolic blood pressure and ejection fraction (lower in the hyperuricemia group were the dilated cardiomyopathy prevail). If the patients are grouped according to creatinine clearance less than or greater than 60 ml/min we found statistically significant differences between the two groups in terms of serum uric acid value (p < 0.001), age (p < 0.001), renal dysfunction and dyslipidaemia (p 0.001). CONCLUSIONS: The analysis performed doesn't demonstrate the role of uric acid as independent risk factor in a group that includes patients with different heart diseases (dilated cardiomyopathy, ischemic heart disease or hypertension).

Electrolyte disturbances in patients with chronic heart failure--clinical, evolutive and therapeutic implications.

UNLABELLED: Patients with heart failure are, by definition, hemodynamic unstable. Often, this condition may be accentuated by medication (digitalis, diuretics, antiarrhythmics), so that they become more sensitive to electrolyte disturbances, reacting sometimes violently with severe and life threatening rhythm troubles. AIM: the evaluation of the incidence of electrolyte disturbances in patients diagnosed with chronic heart failure in order to establish a correlation with the evolution, prognosis and therapeutic implications. MATERIAL AND METHODS: We analyzed retrospectively 100 patients diagnosed with chronic heart failure NYHA II-IV classes, admitted in Cardiology Clinic during 2009-2011. We analyzed electrolytic disturbances occurred during different strategies of therapy. RESULTS: 100 patients with heart failure were admitted in Cardiology Clinic during 2009-2011, 75 males and 25 females. Diagnosis was established by classical criteria. Evaluation was very complex and included: complete clinical examination, electrocardiogram, echocardiography, chest ray examination and biochemical analyses especially hepatic, renal function and electrolyte status. CONCLUSIONS: The obtained data showed that electrolyte disturbances are frequent in patients with chronic heart failure, irrespectively of NYHA class. Hyperkalaemia, hypokalaemia and hyponatraemia are associated with diuretic therapy and may play a very important role in subsequent development of life-threatening arrhythmias.

New original in vitro method to assess cholinesterase reactivity in organophosphate poisoning.

Assessment of organophosphate poisoning could benefit from a safe, non-expensive, easy to perform, quick (< 1 hour) test, which evaluates the level of cholinesterase activity "in vitro" regarding to the capability of oximes to reactivate OF-blocked cholinesterase. In the proposed protocol, 0.5 mL of sample serum is incubated, prior to the evaluation of level of cholinesterase activity, with 5 microL of a Toxogonin dilution (0.125 mg) for 30 minutes at 37 degrees C. For the standardization of the newly proposed protocol, several important issues were documented in the present article. The new original method of assessing cholinesterase reactivability will consist in an advantage for the diagnosis, prognostic evaluation and therapeutic orientation in OF intoxication.

[Non-traumatic rhabdomyolysis in medical practice]. / Rabdomioliza non-traumatica in practica medicala.

UNLABELLED: Rhabdomyolysis, meaning "disintegration of striated muscle", is a potentially life-threatening syndrome resulting from release of muscular cell constituents into the circulation. The aim of this study is to determine frequence and causes of rhabomyolysis in internal medicine practice, as well as diagnostic and therapeutic discussions, based on a retrospective study in patients addressed to a medical clinic of an universitary emergency hospital. RESULTS: The most common causes of rhabdomyolysis in general practice are represented by muscular trauma, muscle enzyme deficiencies, electrolyte abnormalities, infections, drugs, toxins and endocrine disorders. Frequent encountered clinical manifestations are weakness, myalgia and tea-colored urine, and the most sensitive laboratory finding of muscle injury is an elevated plasma creatine kinase level. The management of patients with rhabdomyolysis includes early vigorous hydration, together with specific measures (urine alkalinization, mannitol, hemodialysis).

[Electrocardiographic changes in acute organophosphate poisoning]. / Modificari electrocardiografice in intoxicatia acuta cu pesticide organofosforice.

Cardiac complications often accompany poisoning with organophosphates. These may be serious and often fatal, being represented by cardiac arrhythmias, electrocardiographic abnormalities and conduction defects, as well as myocardial infarction, a rarely reported complication of acute pesticide poisoning. The extent and pathogenesis of cardiac toxicity from these compounds is not yet clearly defined. We report the case of a 57-year-old woman who presented to our emergency department with coma and acute non-cardiogenic pulmonary edema, as a result of organophosphates ingestion. She was resuscitated for asystole presented shortly after admission; prolonged QTc interval, ST-T changes, right bundle branch block, ventricular tachycardia were recorded. Finally she developed acute anteroseptal myocardial infarction and died despite serum cholinesterase normalization. We believe that admission in an intensive care unit, careful electrocardiographic and enzymatic monitoring of all patients is important for the diagnosis and treatment of cardiac complications of organophosphates poisoning.

[Sudden death in organophosphoric poisoning--an unaccountable pathophysiologic mechanism?]. / Moartea subita din intoxicatia cu organofosforice. Un mecanism fiziopatologic neexplicabil?

UNLABELLED: Sudden death related in literature to appear in IV-th - VIII-th day from organophosphoric intoxication does not have an unanimous accepted physiopathologic explanation. PURPOSE: Pharmacodynamic study of myocardial trichlorfon level in acute experiment. MATERIAL AND METHOD: Gas chromatographic determination of myocardial trichlorfon quantity in an experiment on white, male Wistar rats, daily sacrificed for the heart, until the tenth day from an digestive administration of a dose of 200mg/kg trichlorfon. RESULTS (mcg/g myocardial tissue): I day = 8, II day = 13.63, III day = 15, IV day = 18.96, V day = 19.6, VI day = 20.83, VII day = 21.21, VIII day = 21.33, IX day = 19.69, X day = 19.41. CONCLUSIONS: An organophosphoric direct toxic mechanism is suggested, through accumulation over time of a certain level of myocardial concentration.

[Role of calcium and magnesium ions in cerebrospinal fluid in alcoholic-traumatic coma]. / Rolul determinarii ionilor de calciu si magneziu în LCR în coma etilico-traumatica.

The goal of investigation was to determine the role of calcium and magnesium ions in the cerebrospinal fluid in ethylic-traumatic coma. We measured the level of calcium in the cerebrospinal fluid within simple photometric test and the magnesium level within xylidyl blue photometric test. We found a high mortality in patients with high level of calcium in cerebrospinal fluid and low level of magnesium in cerebrospinal fluid. At patients with ethylic-traumatic coma high levels of calcium in cerebrospinal fluid are caused by the excitatory amino acids cascade and increased of hematoencephalic barrier permeability. Decreased levels of magnesium in cerebrospinal fluid are associated with convulsions and a poor prognosis of the patients. These analyses are very important for establishment of prognosis in patients with ethylic-traumatic coma.

[Staging and diagnosis in accidental hypothermia]. / Stadializarea si diagnosticul urgentelor hipotermice.

Core body temperature below 35 degrees C is defining arbitrarily hypothermia. There is no worldwide consensus concerning the staging and resuscitation strategies in such a vital emergency, not even in rewarming strategy. Accidental hypothermia has its own "survival chain", modifying some steps or the timing in the common cardiopulmonary resuscitation protocol, according to some particularities of the metabolism in such an accident. Taking into account the two major events during hypothermic conditions (ventricular fibrillation and coma), we have proposed a better borderline between the three severity classes, based on clinical, paraclinical and prognostic arguments. The interest in this special environmental emergency situation is coming not only from its incidence, but especially from its particular long time period in which the resuscitation maneuvers could be effective, so that a literature review mixed with our practical observations may be of didactical and legal benefit also.

[Recent data about the LDL-atherogenesis relationship]. / Date recente asupra relatiei LDL-aterogeneza.

The steps în pathophysiology of ATS make easier the understanding of waves of processes that lead to the disfunction of the endothelial cells, hypertrophy of the arterial wall and în the end to the complication which drawn from this process. Atherogenic process which is characterised by proaterofenethic and atherogenetic mechanism imbalance suppose three phases: early, transition and terminal phase. The initial phase involve the focal influx and LDL-cholesterol accumulation în the arterial intima, the ROS (reactive oxygen species) and azot generation by smooth muscular cells, macrophages and endothelial cells and oxidative modification of LDL. Scientific data revealed that LDL oxidation is mediated by peroxinitrite (ONOO) anion which could act directly over the thiol groups or indirectly through OH and NO radicals from peroxinitrous acid breakdown and who initiate the polyunsaturated fatty acids peroxidation and the oxidation of apolipoprotein B-100. LDL completely oxidated are recognised by scavenger receptors which are not regulated by up and down regulation. The last event of the early atherogenic process is the formation of foam cells from macrophages through LDL modified captation by scavenger receptors.