4 articles
Metformin is the most widely used oral antidiabetic agent, belonging to the biguanide pharmacological group. Lactic acidosis associated with metformin is a rare event with an incidence of 19 cases per 100,000 patient-years. The risk of developing lactic acidosis when taking this drug is increased by several factors, such as age > 65 years; concomitant diseases that have the ability to induce hypoxemia (chronic kidney disease, congestive heart failure, cardiogenic shock, acute respiratory distress, sepsis, advanced liver disease, history of lactic acidosis); excessive alcohol consumption; and administration of iodinated contrast media.
A 46-year-old man self-administered 50 metformin tablets at a dose of 500 mg each. Twelve hours after ingestion, he requested emergency medical assistance, presenting with the following symptoms: drowsiness, repeated vomiting, lethargy, and dizziness. The patient’s condition was assessed as serious, so he was admitted to the intensive care unit. The patient’s personal pathological history revealed the presence of comorbidities: type 2 diabetes mellitus, toxic liver cirrhosis, hypertension and chronic kidney disease. Paraclinical investigations revealed the presence of metabolic acidosis, but with lactate <5 mmol/l; progressive renal dysfunction with creatinine values in the first 24 hours up to 1184 µmol/l, urea – 34.5 mmol/l; severe hypoglycemia - 1.68 mmol/l; moderate cytolytic, cholestatic, inflammatory; hepatocellular insufficiency syndrome; coagulation disorders; and pancreatic dysfunction.
Since metformin is easily dialyzable, it was decided to promptly initiate intermittent hemodialysis. Fourteen hemodialysis sessions were performed, with a gradual reduction of creatinine to 112.1 µmol/l. Recurrent episodes of hypoglycemia were corrected with 40% glucose solution. Subsequently, hyperglycemia was resolved with insulin.
Metformin should be used with caution in patients with concomitant pathologies. Metformin-induced lactic acidosis is potentially fatal. Early identification of metformin intoxication, with prompt initiation of renal replacement measures and dynamic monitoring of biochemical parameters, is essential.
Community-acquired pneumonia (CAP) remains a major cause of morbidity and mortality, particularly in patients with chronic heart failure (CHF), who are at increased risk of adverse outcomes. Identifying reliable predictors of disease severity in this population is essential for timely risk stratification and optimization of therapeutic strategies.
Assessment of clinical and disease-course characteristics, oxidative stress, and predictors of CAP severity in patients with CHF.
A total of 210 patients were enrolled in the study 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. The research was conducted based on clinical examination of patients, daily monitoring of the inflammatory process, assessment of comorbidities, and paraclinical investigations. Statistical analysis of the collected data was performed using a wide range of methods, including descriptive statistics, correlational analysis, and regression models.
The age of patients in the study group ranged from 50 to 92 years, with a mean of 70.6 ± 8.89 years (95% CI [68.8–72.3]), (F = 18.109; p = 0.205). In Group 1, the proportion of women was 57 (54.3%; 95% CI [44.8-64.1]), and that of men was 48 (45.7%; 95% CI [35.9-55.2]). In Group 2, the proportion of men was higher than that of women: 54 (51.4%; 95% CI [42.3-61.0]) men and 51 (48.6%; 95% CI [39.0-57.7]) women, respectively (χ2 = 0.686; df = 1; p = 0.407). Ischemia-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). The IMA threshold value of 218.98 µM/L was determined for patients with CHF and severe CAP. The mean NT-proBNP values in Group 1 patients were 1371.88 ± 498.91 pg/ml, compared to Group 2: 58.19 ± 48.22 pg/ml, (F = 721.54; p < 0.0001). The NT-proBNP threshold value of 1665.73 pg/ml was identified for severe CAP in CHF patients. A method which allows early detection in 87.0% of cases of patients with CHF at high risk of severe community-acquired pneumonia was developed.
Our hypothesis that community-acquired pneumonia in patients with chronic heart failure is more frequently associated with a severe clinical course was confirmed. The proposed NT-proBNP and ischemia-modified albumin threshold values, together with our risk estimation formula, may improve early therapeutic intervention to prevent severe complications.
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.