5 articles
Pulmonary thromboembolism (PTE) is a major cardiovascular emergency associated with significant mortality. Systemic inflammation contributes to the pathogenesis of thrombosis and to disease severity, and hematological indices derived from the complete blood count, such as the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR), have been proposed as prognostic predictors.
A prospective observational study was conducted on a cohort of 182 consecutively investigated patients at Holy Trinity Municipal Clinical Hospital and the Institute of Cardiology. The diagnosis of PTE was confirmed by CT pulmonary angiography. Clinical data, inflammatory hematological indices, echocardiographic parameters, and severity scores were analyzed during the course of inpatient care. The prognostic value of NLR and PLR was assessed using ROC curve analysis.
Pulmonary thromboembolism was confirmed in 153 patients (84.1%, 95% CI [78.7, 89.4]). Elevated NLR was identified in 82 patients (45.1%; 95% CI [37.8, 52.3]), and elevated PLR in 89 patients (48.9%; 95% CI [41.6, 56.2]). Overall mortality was 17.0% (95% CI [11.6, 22.5]) (31 patients). Elevated NLR was present in 26 (14.3; 95% CI [9.2, 19.4]) of deceased patients (p<0.00001), while elevated PLR was present in 22 (12.1%; 95% CI [7.4, 16.8]) of deceased patients (p = 0.012). ROC analysis demonstrated that NLR has a very good predictive ability for mortality (AUC = 0.799), whereas PLR has good predictive ability (AUC = 0.715). Additionally, NLR was significantly correlated with severity according to the PESI score (AUC = 0.614; p = 0.0048). Echocardiography revealed right ventricular dysfunction in 80.2% (95% CI [74.4, 86.0]) of patients and reduced TAPSE in 57.7% (95% CI [50.5, 64.9]) of patients.
The neutrophil-to-lymphocyte ratio is an important prognostic marker of severity and mortality in pulmonary thromboembolism, with a predictive value superior to that of the platelet-to-lymphocyte ratio. Integrating inflammatory hematological indices with clinical scores and imaging assessment may improve risk stratification and the management of patients with pulmonary thromboembolism.
In the cold days of January, when the Soroca Fortress seems to have stood guard for centuries at the country’s border, we celebrate a Man of rare spiritual nobility who, for a lifetime, has watched over the health of the heart of his fellow men – Valeriu Revenco, University Professor, Habilitated Doctor of Medical Sciences. Born on January 16, 1956, in the city of Soroca, Professor Revenco is, for
Patients with heart failure frequently present with varying degrees of skeletal muscle dysfunction, from early fatigue to sarcopenia and cachexia. Sarcopenia, defined as the loss of muscle mass and/or function, contributes to the physical dimension of frailty. Both conditions are associated with adverse outcomes in heart failure. Although sarcopenia and frailty often coexist, they are distinct syndromes with a bidirectional relationship with heart failure. According to European data, the prevalence of sarcopenia ranges from 20-50% in heart failure with reduced ejection fraction and approximately 18% in heart failure with preserved ejection fraction. This study aimed to evaluate sarcopenia among frail patients with chronic heart failure and to identify associated risk and protective factors.
A cross-sectional observational study was conducted on 44 frail patients with chronic heart failure. Data collection included clinical, functional, and anthropometric parameters, using the SARC-Calf questionnaire, gait speed and the Timed Up and Go test. Patients were stratified into three study groups according to frailty severity assessed by the Edmonton Frail Scale: Study Group 1 – mild frailty, Study Group 2 – moderate frailty, and Study Group 3 – severe frailty. Statistical analysis included Chi-square and Fisher’s exact tests. Odds Ratios with 95% Confidence Intervals were calculated. A p < 0.05 was considered statistically significant.
Of the 44 patients included, 32 (72.7%) were women and 12 (27.3%) men, with a mean age of 67.3 ± 8.9 years. Sarcopenia risk (SARC-Calf ≥4) was identified in 56.8%, and severe sarcopenia in 15.9%, exclusively among women. Functional impairment was present in 88.9% of Study Group 1, 91.7% of Group 2, and 100% of Group 3. Arterial hypertension (71.4%), diabetes mellitus (57.1%), and obesity (42.8%) were more prevalent among sarcopenic patients. C-reactive protein levels >6 mg/L and elevated NT-proBNP were associated with sarcopenia risk (p = 0.039). Metformin use was linked to absence of sarcopenia (p = 0.008), while low physical activity, statin use, and inflammation were more frequent in sarcopenic patients.
Sarcopenia was highly prevalent in frail heart failure patients, particularly among women. Cardiac dysfunction, inflammation, and metabolic comorbidities are key contributors, highlighting the need for early screening and tailored interventions.
Diagnosing community-acquired pneumonia in patients with chronic heart failure can be challenging. Oxidative stress and inflammatory response play an important role in the development and diagnosis of community-acquired pneumonia and are also involved in many cardiovascular diseases, including chronic heart failure.
A total of 210 patients were enrolled and divided into two groups: group 1 (n = 105) – patients with community-acquired pneumonia associated with chronic heart failure, and group 2 (n = 105) – patients with community-acquired pneumonia without chronic heart failure. Several biomarkers were measured. For oxidative stress, we assessed prooxidant markers (ischemic modified albumin, advanced glycation end-products, advanced oxidation protein products, malonic dialdehyde) and antioxidant markers (total antioxidant activity with CUPRAC and ABTS methods, superoxide dismutase and catalase). Inflammatory status was assessed by determining leukocyte count, erythrocyte sedimentation rate, lactate dehydrogenase, fibrinogen and C-reactive protein. In all patients, N-terminal pro b-type natriuretic peptide values were determined.
The age of patients in the study group ranged from 50 to 92 years, with an overall mean of 70.6 ± 8.89 years (95% CI [68.8-72.3]), (F = 18.109; p = 0.205). Ischemic modified albumin values were higher in patients in Group 1 compared to Group 2: 236.60 ± 57.23 µM/L and 229.77 ± 64.35 µM/L, respectively (F = 0.660; p = 0.045). Serum lactate dehydrogenase had higher values in Group 1, compared to the control group: 232.65 ± 109.80 units/L and 192.40 ± 44.98 units/L, respectively (p = 0.001). The mean fibrinogen values were also higher in Group 1 (5.24 ± 1.60 g/L), compared to Group 2 (4.51 ± 1.78 g/L), p = 0.002. Total antioxidant activity by CUPRAC method, had higher values in Group 1 (6.70 ± 4.62) versus Group 2 (4.99 ± 2.29), p = 0.006.
The coexistence of community-acquired pneumonia and chronic heart failure resulted in a higher inflammatory response and greater accumulation of pro-oxidative reaction products. This condition was characterized by increased serum lactate dehydrogenase, erythrocyte sedimentation rate and fibrinogen levels. Furthermore, the state of heightened oxidative stress was marked by increased ischemic modified albumin and total antioxidant activity detected with CUPRAC method.
Obesity is a metabolic disease that presents a real challenge for the medical system due to the significant increase in the number of obese people in recent decades. Currently, 38% of the global population is overweight or obese. Obesity is an important risk factor for multiple chronic pathologies and lung infections, especially pneumonia. For obese subjects, chronic proinflammatory status due to an excess of fat cells is characteristic.
This prospective cohort study is based on clinical and laboratory examinations of patients hospitalized with community-acquired pneumonia in the Department of Internal Medicine at „Holy Trinity” Municipal Hospital, Chisinau, Republic of Moldova. The study included 210 patients with community-acquired pneumonia, divided into two groups: the base group (group 1) consisted of 105 patients with varying degrees of obesity, and the control group (group 2) consisted of 105 normal-weight patients. The research was conducted according to the principles of the Helsinki Declaration - WMA Declaration of Helsinki - Ethical Principles for Medical Research Involving Human Subjects. The study was approved by the Research Ethics Committee of the Nicolae Testemiţanu State University of Medicine and Pharmacy, with the issuance of favorable opinion no. 46 from March 27, 2018. All patients were examined clinically and paraclinically (radiological examination, pulse oximetry screening, complete blood count, erythrocyte sedimentation rate, fibrinogen, LDH, C-reactive protein, oxidative stress markers). The obtained data were statistically analyzed using Statistical Package for the Social Sciences (SPSS) version 20.
According to the obtained data, the most common comorbidities associated with obesity were cardiovascular and metabolic diseases. The main symptom that prevailed in the obese was dyspnea (97%). Obese subjects showed more frequent signs of acute respiratory failure (86.7%), required oxygen therapy with an average duration of 7.62±6.23 days, showed increased serum levels of LDH (286.31±94.66 U/L) and C-reactive protein (66.08±71.44 mg/l), data that influenced the clinical course of pneumonia.
Patients with obesity and community-acquired pneumonia presented with infectious symptoms and acute respiratory failure, increased values of inflammatory markers, and required oxygen therapy more frequently compared to those of normal weight.