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Lately, easier and shorter tests have been used in the functional evaluation of cardiac patients. Among these, walking speed (WS) and Timed Up and Go (TUG) tests are associated with all-cause mortality, mainly cardiovascular and the rate of re-hospitalization, especially in the elderly population. We prospectively analyzed a group of 38 patients admitted to the Cardiology Clinic from Elias Hospital, Romania, with chronic coronary syndrome (CCS) (n=22) and STEMI (n=16). We assessed the patients immediately after admission and before discharge with G-WALK between the 1st and 30th of September 2019. Our study group had a mean age of 62.7±12.1 years. Patients with a low WS were older (69.90±12.84 vs. 59.90±10.32 years, p=0.02) and had a lower serum hemoglobin (12.38±1.20 vs. 13.72±2.07 g/dl, p=0.02). The WS significantly improved during hospitalization (p=0.03) after optimal treatment. The TUG test performed at the time of admission had a longer duration in patients with heart failure (14.05 vs. 10.80 sec, p=0.02) and was influenced by patients' age (r=0.567, p=0.02), serum creatinine (r=0.409, p=0.03) and dilation of right heart chambers (r=0.399, p=0.03). WS and TUG tests can be used in patients with CCS and STEMI, and are mainly influenced by age, thus having a greater value among the elderly. [ABSTRACT FROM AUTHOR]

Objective: We evaluated the effects of neuromuscular electrical stimulation (NMES) therapy on functional capacity and oxidative stress in patients hospitalized for acute heart failure (AHF). Design: We included 30 consecutive patients admitted for AHF with a left ventricular ejection fraction ≤ 50% who were randomized into two groups: NMES therapy added on conventional rehabilitation (CR) (n = 15, 67.2 ±13.35 years) and CR alone (n = 15, 63.26 ± 10.29 years). NMES therapy was performed at the level of the quadriceps muscle bilaterally, daily, for 60 minutes with a frequency of 10 Hz. Results: The mean duration of NMES therapy was 6.93 ± 2.54 days. Functional capacity assessed by the 6 minute walk test was significantly improved in the group with NMES therapy (p=0.036). The oxidized LDL value showed a decreasing trend compared to the admission value in the group with NMES therapy, but without statistical significance. Conclusion: This paper shows that for patients with AHF, NMES therapy used for a short term and initiated early during the hospitalization period improves exercise tolerance, suggesting the importance and possible necessity of including it as standard cardiac recovery therapy. NMES did not influence the plasmatic value of oxidized LDL. [ABSTRACT FROM AUTHOR]

Aims - The objective of our study is to compare pharmaco-invasive strategy (PhIS) in terms of safety and efficacy, with primary percutaneous coronary intervention (pPCI) strategy as standard therapy for STEMI patients from remote areas. Background - At present, primary percutaneous coronary intervention (pPCI) is the preferred reperfusion strategy for STEMI patients. However, despite pPCI being the gold standard, it is not always achievable due to variables such as lack of cardiac catheterization services and delays in the first medical contact-to-balloon time. Methods - This observational study is based on a prospective analysis of a cohort of 157 patients with ST-elevation myocardial infarction, over nine months, at Elias University Hospital (EUH). The study assessed the safety and efficacy of a sequence of fibrinolytic therapy in the first contact hospital before being referred to our center for PCI (PhIS, 35 patients, 22.29%) versus angioplasty alone (pPCI, 122 patients, 77.70%) during hospitalization. The primary outcomes studied were in-hospital death, and major adverse cardiac events (MACE), while secondary outcomes were the length of in-hospital stay, and the safety of the procedure. Results - The median reperfusion time was lower for the PhIS group compared to the primary PCI group (4 hours, IQR:6.25 vs 7 hours, IQR:12.38, p<0.05). The left ventricular systolic function (%) on arrival at EUH was higher in the PhIS group compared with the PCI alone group (46.55; 95%CI 42.42-49.15 vs 41.73; 95%CI 39.91-43.34; p=0.04). The mean number of diseased vessels, including the culprit-lesion, were similar in the two groups (2.84 vs 2.82, p=0.09). The in-hospital mortality rate was lower in the PhIS group than in the primary PCI group (1 patient; 2.9% vs 18 patients; 14.80%; p=0.05), while the number of in-hospital major adverse cardiac events (MACE) was not significantly different (17.10% vs 26.20%; p=0.27). There was no difference of the median length of hospitalization (6 days, IQR:2 vs 5 days, IQR:3; p=0.67) for the PhIS, and primary PCI groups, respectively. The safety endpoints of the procedures were similar in the two groups. Conclusions - Pharmaco-invasive strategy (PhIS) had clinical and procedural outcomes (in-hospital MACE, length of in-hospital stay) similar to primary percutaneous coronary intervention (pPCI), in case of long distances to catheterization laboratories. Efficient thrombolysis makes PhIS a viable alternative in saving lives with a lower rate of in-hospital death than pPCI. Performed thrombolysis in a local non-PCI center and referral of the STEMI patients to a 24/7 catheterization laboratory may be a good option for areas where the infrastructure of such facilities is weak. [ABSTRACT FROM AUTHOR]

The General Practitioner's role in diagnosing and monitoring the pacients with rheumatoid arthritis (RA) is not very well established in Romania. RA, a chronic inflammatory disease with a progressive evolution, systemic symptoms and severe disfunctions, decreases the quality of life, leading to early retiring and the descrease of life expectancy with 5 to 10 years. Establishing PRE-RA (Personalized Risk Estimator for Rheumatoid Arthritis) for first degree relatives of the RA affected patients, according to age, gender, family history and risk behavior, allows the prevention and the delay of the disese. Some preventing measures are the following: giving up smoking, mediteranean diet, weigh control, statines therapy in order to descrese the cardiovascular risk, oral hygiene. RA begins with a prolonged asymptomatic period, characterized by the presence of asymptomatic smallairway disease, certain infections and inflammatory disease (gut, periodontium, genitourinary tract) or dysbiosis. We can find increased circulating disease specific autoantibodies or increased levels of cytokines and chemokines. A good knowledge of the first symptoms is very important for the general practitioner (GP) and could also help the rheumatologist to start the treatment immediately after the occuring of the disease. The GP could have a very important role together with the rheumatologist and the hole team in surveying the disease evolution and also the associated comorbidities, complications and possible opposite reactions to the treatment. The GP is also involved in the pacients' and their families' counciling, and his presence in the multidiscipinary teams increases the adherence, compliance and persistence to the therapy. [ABSTRACT FROM AUTHOR]

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Metabolic syndrome is also called insulin resistance syndrome or catecholamine excess syndrome and is a cluster of cardiometabolic factors that result in increased incidence of cardiovascular disease and diabetes type 2. Due to sedentary lifestyle and hypercaloric diet with an increased content of saturated fat and carbohydrates that characterizes modern life style of the population, especially in urban areas, the prevalence of metabolic syndrome is increasing, thus becoming a very topical issue for the medical world. During the years 2013-2014 we conducted an observational study on a sample of 111 hypertensive patients without major cardiovascular events such as myocardial infarction or stroke, aged between 48 and 83 years, who have determined the prevalence of modern cardiovascular risk factors such as hs CRP, serum uric acid, 24-hour proteinuria, serum fibrinogen and the ratio of apo B/apo A1, associated with the metabolic syndrome. The study was conducted separately by gender in the sense that we followed prevalence of these modern risk factors associated with metabolic syndrome in both genders, women and men. We also watched the influence of risk factors related to lifestyle on metabolic syndrome. Finally, we determined the correlation of these factors with the risk of death from cardiovascular disease to observe their influence on the prognosis of metabolic syndrome. [ABSTRACT FROM AUTHOR]

The total cardiovascular risk of hypertensive patients is due to the simultaneous action of risk factors, hypertension-mediated target organ damage or to the presence of established cardiovascular disease. The clustering of cardiovascular risk factors which act simultaneously in patients with hypertension will cause a higher risk than the sum of individual risks due to their multiplicative effect in developing of the atherosclerosis process. This effect is particularly relevant in young patients apparently healthy with a low absolute risk and at who the presence of cardiovascular risk factors in high levels can hide an elevated relative risk of cardiovascular disease which makes as the intensive measures of lifestyle changes to achieve the control of risk factors over time, decreasing the risk of cardiovascular disease. During the years 2017-2018, we performed a retrospective observational study on 280 hypertensive patients, from who 123 patients (43.9%) got established cardiovascular disease called case and the other group called control consists of 157 patients (56.1%) without cardiovascular disease. The study showed that the number of cases with occurred cardiovascular disease has constantly exceeded the number of expected cases after clustering of at least six cardiovascular risk factors upwards, proving that the cardiovascular risk factors do not act individually but synergistically, which what has a multiplicative effect on process of atherosclerosis. [ABSTRACT FROM AUTHOR]

High blood pressure is a global threat due to its consequences on morbidity and mortality through cardiovascular diseases such as myocardial infarction, stroke or chronic kidney disease. In Romania the prevalence of hypertension has registered an upward trend of 45% of the general population equivalent of 7.4 million persons compared to 40% in 2011. [ABSTRACT FROM AUTHOR]

The increase in the number of cesarean sections led to severe complications, such as the ectopic scar pregnancy and the morbidly adherent placenta. The incidence of scar pregnancy is 1/2000 of pregnancies, the more frequently associated with the higher the number of cesarean sections. These can cause severe bleeding, rupture of the uterus, bladder or digestive injury or maternal mortality. The general practitioner has an important role in the diagnosis and monitoring of these patients. He knows the patient's history, is asked in permanent by it and sometimes is in the situation of being the only one checking pregnancy. This work aims to review the diagnostic and monitoring criteria for ectopic scar pregnancy helpful to family physicians. Addressing all patients with a scarred uterus for early screening ultrasound may increase the rate of diagnosis. The family doctor is an essential partnership in monitoring these high risk cases. [ABSTRACT FROM AUTHOR]