Multidimensional indexes and phenotypes in the evaluation of the risk of chronic obstructive pulmonary disease exacerbation

Department of Pneumology and Allergology, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova, The 8th International Medical Congress for Students and Young Doctors, September 24-26, 2020Introduction. COPD is a considerable element in worldwide chronic morbidity and mortality and invariably leads to a deterioration in the quality of life and death from it and its complications. Multiple studies had shown that exacerbations must be considered in evaluation and management of patients with COPD. Each exacerbation significantly damages quality of life and worsens the prognosis, due to association with a lung function impairment, so it also can serve as an independent prognostic factor. The task of a practitioner is to identify patients at increased risk for exacerbation, which still remains a challenge. Aim of the study. Comparative assessment of prognostic value of different approaches in COPD exacerbations: GOLD ABCD classification, multidimensional indices and phenotypes. Materials and methods. In the study were included 433 patients, hospitalized during the period of 2012-2016. The phenotypes and the following COPD classifications were used in order to assess spirometric data (FEV1 (forced expiratory volume in 1 second), FVC (forced vital capacity), FEV1/FVC) and e-BODE (exacerbation, body-mass index, airflow obstruction, dyspnoea and exercise): GOLD (The Global Initiative for Chronic Obstructive Lung Disease) 2001, GOLD ABCD 2011 and GOLD ABCD 2017. Results. 352 (81%) men and 81 (19%) women with mean age 62,7 ± 9,8 years participated in research. e-BODE index and phenotypic classification showed a high correlation with exacerbation frequency (e-BODE AUC 0.908 and phenotypic classification AUC 0.995) whereas GOLD classifications underestimated the risk (GOLD 2001 AUC (area under the curve) - 0.623, GOLD ABCD AUC - 0.546 and GOLD ABCD 2017 AUC - 0.545). Conclusions. COPD diagnosis and management needs a personalized medicine strategy including assessment and prevention of future exacerbations

Clinical Case of a Gastric Diverticulum Operated by Laparoscopic Approach

A gastric diverticulum is a rare disease, occurring in 0.04% of cases on contrast X-rays and 0.01-0.11% of cases of upper GI tract endoscopies. Diagnosis is often difficult due to non-specific symptoms, such as a feeling of fullness in the epigastrium after eating, dyspepsia, nausea and vomiting. In the case of symptomatic diverticulum, surgical treatment is indicated, where a priority is given to laparoscopic interventions. In the article, we present a case of a gastric diverticulum in a 37-year-old woman who was successfully operated laparoscopically

Asthma and stroke: a narrative review

AbstractAsthma is a heterogeneous disease, usually characterized by chronic airway inflammation, bronchial reversible obstruction and hyperresponsiveness to direct or indirect stimuli. It is a severe disease causing approximately half a million deaths every year and thus possessing a significant public health burden. Stroke is the second leading cause of death and a major cause of disability worldwide. Asthma and asthma medications may be a risk factors for developing stroke. Nevertheless, since asthma is associated with a variety of comorbidities, such as cardiovascular, metabolic and respiratory, the increased incidence of stroke in asthma patients may be due to a confounding effect. The purpose of this review is to analyze the complex relationship between asthma and stroke.</jats:p