Bulletin of the Academy of Sciences of Moldova. Medical Sciences

In memoriam Professor Dmitri SAIN - doctor, scientist, colleague and citizen

2024-01-22

In this article, the life and activity of the scientist, successful manager, colleague and citizen Dmitri Sain, doctor of medical sciences, research professor, is reported. About the remarkable work and achievements as a scientist, doctor and devoted citizen. Its remarkable contribution to the development of medical science, as well as the strengthening of international collaborations in the field of science and innovation in medicine, is elucidated. He successfully coordinated and implemented the National Tuberculosis Control and Prophylaxis Program and demonstrated significant efficiency in the management and monitoring of the most complex forms of tuberculosis, drug-resistant tuberculosis and associated with various comorbidities.

Medical and legal aspects of the divergence of clinical and anatomopathological diagnosis within the specialized medical institution

Ion HAIDARLI — 2024-01-22

Based on the analysis of specialized literature, normative and legislative acts, as well as data from own research, the medical and legal aspects of the divergences between clinical and anatomopathological diagnosis are presented. Thus, through the analysis of the archive materials of Institute of Phthisiopneumology «Chiril Draganiuc» it was established that the percentage of autopsies in the period 2013-2022 varied between 68.5% and 94.4%. Having a stable growth trend (R2=0.7542), this indicator averaged 83.7%. The percentage of diagnostic discrepancies during this period ranged from 7.0% to 24.5%, with a mean of 14.4%. The downward trend of this indicator from 24.5% in 2013 to 16.8% in 2022 was not conclusive (R2=0.3097).

Patients’ perception of their safety in the hospital

Constantin PISARENCO — 2024-01-22

In order to analyze how patients perceive their personal safety during spitalization - was analyzed dates using a specially created questionnaire. Was carried out a detailed analysis of the structural components of patient satisfaction and identifying potential areas where patient safety could be improved, including active using of safety protocols and active involvement from pations part in treatment decisions. The findings underline the complexity and multifaceted nature of the issue of patient safety in hospitals and point to the need for a comprehensive and targeted approach to improving this important area of medical practice.

The problem of insufficient adherence of tuberculosis patients to treatment: causes and solutions

Serghei PISARENСO — 2024-01-22

This research is dedicated to the problem of insufficient adherence of tuberculosis patients to treatment. The authors conducted a comprehensive analysis of the reasons behind this phenomenon and proposed a number of solutions to overcome it. The research is based on synthesizing the authors’ own experience, analyzing surveys of patients and doctors, as well as studying sources from various scientific citation databases. The conclusion is drawn that the insufficient adherence of tuberculosis patients to treatment is a serious problem that requires a comprehensive approach and active involvement of all parties. The findings of this work can be useful for phthisiologists, healthcare specialists, government representatives, and NGOs involved in tuberculosis issues.

Medical Errors: An Analysis of Physicians’ Perceptions

Constantin PISARENCO — 2024-01-22

The article provides a detailed analysis of health professionals’ perceptions of medical errors. Information was collected through an opinion survey conducted among physicians. The article explores contributing factors to medical errors and ways of reduction of them, with a focus on improving reporting systems and increasing information of these issues within the medical community.

Stages of implementation of the National Tuberculosis Registry in the Republic of Tajikistan

Oktam BOBOHODJAEV — 2024-01-22

The implementation of the National TB Registry in the Republic of Tajikistan ensured the high-quality collection, storage and transmission of statistical information from all regions of the country to the State Institution “Republican Center for the Protection of the Population from Tuberculosis”. The National TB Registry has significantly improved the reporting process, including obtaining timely information on various requests: Ensured the collection, storage, processing of data on TB patients with drug-sensitive and resistant forms; Contributed to the generation of standard statistical reports and ensuring the timely exchange of data on TB patients between TB institutions at various levels; Improved information reliability control; Provided a stable mechanism for the exchange of information between laboratories and clinical service; Provided analysis of information for management decisions and in scientific research.The National TB Registry allows timely receipt of laboratory test results, which, in particular, significantly reduces the time interval from the moment of diagnosis to admission for treatment, and contributes to an increase in the reliability of registration of chemotherapy outcomes. The national TB registry has sufficient potential for further improvement.

Features of detection of latent tuberculosis infection in patients with inflammatory intestinal diseases

Gylystan BABAEVA — 2024-01-22

A quarter of the world’s population has latent tuberculosis infection (LTBI). Systemic immunosuppression is a risk factor for the reactivation of LTBI and the development of active tuberculosis, and such reactivation is associated with a substantial risk of morbidity and mortality. Despite the growing global prevalence of inflammatory bowel diseases (IBD) and the use of immunosuppressive therapies, current recommendations for LTBI testing and treatment in IBD patients lack a systematic approach due to a lack of evidence. Currently, the main challenge in accurately diagnosing inflammatorybowel diseases (IBD) is the high prevalence of conditions that lead to intestinal lesions mimicking IBD.

Tuberculosis experience in possible respiratory infectious disease outbreaks with lessons learned during the COVID-19 pandemic

Oktam BOBOHODJAEV — 2024-01-22

The analysis of the lessons learned during the COVID-19 pandemic was carried out and the provision of treatment and preventive services to the population in health care facilities was improved in case of possible emergencies in connection with possible outbreaks of respiratory infectious diseases in the Republic of Tajikistan using the experience of the anti-tuberculosis service.During the COVID-19 pandemic, individual employees of anti-tuberculosis facilities reflected the relationship of coronavirus infection with contacts at work. The relationship between the dynamics of reducing the incidence of tuberculosis among employees of specific medical institutions and the volume of implemented interventions for anti-tuberculosis infection control, which, in combination with other anti-epidemic measures, plays a significant role in reducing the risk of spreading tuberculosis infection and is an essential element of protecting the health of medical workers, has been scientifically proven. The experience of TB facilities in complying with infection control rules and regulations can be used to prepare health systems for various likely outbreaks of respiratory infections.

TB/COVID-19 co-infection: What we have?

Gylzar ALIEVA — 2024-01-22

Evaluarea impactului COVID-19 asupra evoluției clinice a tuberculozei la pacienții internați la Institutul de Cercetare a Bolilor Pulmonare din Baku.Au fost examinați 103 pacienți cu coinfecție TB/COVİD-19 cu vârsta cuprinsă între 21-74 de ani. La pacienții cu coinfecție TB/COVİD-19, durata bolii TB până la 1 lună a fost la 13,8%, de la 1 la 6 luni la 4,6% și mai mult de 6 luni la 81,6% dintre pacienți. Durata bolii COVID-19 până la 1 săptămână a fost la 35,6%, mai mult de 1 săptămână la 64,4% dintre pacienți. Infecția cu două infecții diferite care afectează țesutul pulmonar a contribuit la inexactități frecvente în examinarea radiologică a pacienților cu coinfecție TB/COVID-19. Majoritatea pacienților (79,6%) au fost diagnosticați cu TB pulmonară, 54,2% dintre aceștia având un proces bilateral. TB extrapulmonară a fost diagnosticată la 7,8% dintre pacienți. Pneumonia virală din cauza COVID-19 a fost observată la 78,6% dintre pacienți. Simptomele clinice ale paci-enților cu coinfecție TB/COVİD-19 sunt caracterizate de o abundență de plângeri de la același pacient. Cazurile cu forme rezistente de tuberculoză în rândul acestor pacienți a constituit 16,5%, ceea ce este mai mare decât rata tuberculozei rezistente din țară. Dintre acestea, 9 au fost caz nou cu rezistență la medicamentele antituberculoase. Flora respiratorie secundară a fost identificată la 42,7% dintre pacienții cu coinfecție TB/COVİD-19. În rândul pacienților cu coinfecție TB/COVİD-19 decesul a fost observat în 9,7% din cazuri, ceea ce este mult mai mare decât ratele mortalității prin TB și COVID-19 din țară.

Tuberculosis among labor migrants in the Republic of Tajikistan

Oktam BOBOHODJAEV — 2024-01-22

In the structure of patients with tuberculosis, labor migrants in 2021 in the Republic of Tajikistan amounted to 16.9%. Among labor migrants with tuberculosis there were men - 85.0%, most of whom were young people aged 19-29 years. Of the total number of TB patients, identified in 2021who was in migration, 68.6% suffered from pulmonary forms of tuberculosis, 73.9% of which were bacterial excretory. Among labor migrants, 79.0% of patients suffered from an infiltrative form, 10.1% - focal, 4.6% - disseminated, tuberculoma - 4.2%, extrapulmonary forms of tuberculosis were detected in 10.6% of cases.

RECURRENCE OF PULMONARY TUBERCULOSIS ASSOCIATED WITH COMORBIDITIES - CURRENT INTERDISCIPLINARY PROBLEM

Elena TUDOR — 2024-01-22

Introduction. The recurrence of pulmonary tuberculosis remains a significant public health problem in many countries of the world, despite the remarkable progress in the treatment and rehabilitation of patients with new cases of tuberculosis. It is demonstrated that the high incidence of recurrence of pulmonary tuberculosis is conditioned by the influence of some factors combination. Currently, the comorbidities, which impose the risk of disease recurrence directly or indirectly, are of a major importance. Thus, it is important to study the clinical and epidemiological characteristics of pulmonary tuberculosis recurrence associated with the comorbidities. Materials and methods. There were studied 715 patients with pulmonary tuberculosis recurrence, including 503 patients with comorbidities, as well as statistical reporting data for the Right Bank region of the Dniester River and ATU (Autonomous Territorial Unit) of Gagauzia, Republic of Moldova during 2019-2021. Results. The obtained results demonstrate that in phthisiopulmonology the presence of comorbidities constitutes a significant and important medico-social problem. In the structure of relapses associated with comorbidities, it was noted the predominance of extensive infiltrative processes, high frequency of cases with destruction in the lung tissue and bacillary cases. The need to review and improve the general antituberculosis measures accepted both in the work of phthisiopneumologists and primary care specialists is argued in order to improve the prognosis of TB treatment associated with comorbidities. Conclusion. The recurrence of pulmonary tuberculosis associated with comorbidities requires an integrated multidisciplinary approach.

Profile of gene mutations responsible for M.tuberculosis resistance to antituberculosis drugs.

Nelly CIOBANU — 2024-01-22

The implementation of rapid diagnostic tests and drug susceptibility testing requires a complex approach to these methods. The pattern of gene mutations responsible for resistance to first-line antituberculosis drugs was studied in patients with resistant tuberculosis undergoing treatment in the inpatient department of the Phthisiopneumology Institute. The obtained results were compared with similar data from previous studies. It was determined that in the last 5 years the resistance to RIF is predominantly determined by the rpoB S531L mutation (82.9%), for the resistance to INH the katG S315T1 mutation (94.6%) is responsible.

The resistance profile of M. Tuberculosis in secondary cases of tuberculosis in relation to the index case

Andrei CORLOTEANU — 2024-01-22

The article presents data obtained as a result of the study of the concordance of the resistance profile of M. tuberculosis to firstand second-line antituberculosis drugs in secondary cases from tuberculosis households in relation to the index case. The data demonstrate concordance of the first-line antituberculosis drug resistance profile (HRES) in 63.2% of index-secondary pair cases, and in 40.7% of second-line antituberculosis drug pair index-secondary cases. The high con- cordance of the resistance profile to first-line and second-line antituberculosis drugs provides important evidence for the development of regimens for the treatment of an indoor contact with tuberculosis without TSM (Drug Susceptibility Test) results, until they are obtained, by using a TB treatment regimen tailored to the TSM results of the index case, also using the resistance profile of the TB-DR index case to select a preventive TB treatment regimen for infected household contacts.

Acute phase proteins in patients with recurrent pulmonary tuberculosis

Elena TUDOR — 2024-01-22

Objective. Study of initial levels of acute phase proteins in patients with pulmonary tuberculosis with and without relapse as predictors of unfavorable disease progression. Materials and methods. 2 groups of patients were examined: the base group - 55 patients with pulmonary tuberculosis with relapse and the control group - 55 patients with pulmonary tuberculosis without relapse. Acute phase protein content was studied in patients before and after the intensive phase of treatment. The content of complement factors C3 and C4, haptoglobin, ceruloplasmin, properdin, C-reactive protein, IL-6, VSH, leukocyte content was studied. Results. The obtained results reveal that acute phase proteins can be considered basic predictors of ineffective antituberculosis treatment: the high indices of leukocyte, C-reactive protein, IL-6, ESR, and haptoglobin.

General non-specific adaptation reactions and levels of organism reactivity in patients with pulmonary tuberculosis and associated with the human immunodeficiency virus at the stages of medication

Vasile ANTIPA — 2024-01-22

The data of 165 patients were analyzed, of which 121 with pulmonary tuberculosis, new cases, who were treated according to the modified DOTS schemes with retrosternal instillation of the 10%-5ml isoniazid solution and 44 patients with pulmonary tuberculosis associated with human immunodeficiency virus, who received standard antituberculosis and antiretroviral treatment. The patients were assessed the reactions of general nonspecific adaptation, the reactivity levels of the organization and the sum of the score accumulated by the patient according to the method of L.H.Garcavi and coaut., 1979. It was found that in the quotas of patients from both groups up to treatment prevailed low levels of reactivity of the organism, which after the intensive phase DOTS (and corresponding - antiretroviral treatment) in patients only with pulmonary tuberculosis or more maintained at 50%, and in the group and with HIV Association low levels remained the same. Pathological adaptation reactions at that time in the first group persisted in every third patient, while in the other group they remained without changes. These data are useful in assessing the risk of activation of the process, the progno-sis of further evolution of the disease and the correction of curative measures.

THE EFFICIENCY OF IMMUNE MODULATOR BIVEL IN THE PREVENTION OF PULMONARY TUBERCULOSIS IN EXPOSED CHILDREN FROM THE MULTIDRUG-RESISTANT TUBERCULOSIS SITES

Olha SAKHELASHVILI-BIL — 2024-01-22

120 exposed children/adolescents (75 children and 45 adolescents) from the multi-drug resistant tuberculosis sites underwent the complex clinical radiological and immunological examination.Insignificant functional disorders of cellular response (immunoregulatory processes) caused by the prevalence of suppressor and cytotoxic reactions by 1.3 times and by the prevalence of pro-inflammatory cytokines in the regulatory system (2.0 times above the norm, TNF-α/IL 10.0. р<0.01) were revealed in the infected children/adolescents from the multi-drug resistant tuberculosis sites, while their СD3+. СD3+СD4+. СD3+СD8+ were within norm. The evident disorders of the regulatory system and cell immune system were eliminated after the completion of the autumn-spring BI-V course. The non-specific immune regulator BI-V is efficient for the prevention of multi-drug resistant tuberculosis for the exposed children/adolescents from the multi-drug tuberculosis sites. Consequently, the latent TB infection grew into the active form by 2.8 times less often in the children that took BI-V as compared to the infected children who did not take the drug.

Experience of using mCRL in patients with drug-resistant TB and evaluation of treatment effectiveness and adverse effects

Irada AHUDOVA — 2024-01-22

Objective. To study the frequency of adverse events when using new drugs in the treatment regimen for patients with MDR-TB and evaluate the effectiveness of new shorter regimens. Material and methods of research. New shortened regimens have been used for the treatment of patients with MDR- TB since September and February 2020 in two institutions (MJ and GS). 225 MDR cases were identified in the treatment regimens, Bdq, Lzd, Lfx, Cfz, Cs were prescribed to 106 patients. Gender balance: men 58 (67.4%), women 28 (32.56%).Almost 67 (79.76%) patients had a bilateral process with decay cavities, and 17 (20.24%) patients had a process without decay. The main side effect of bedaquiline is cardiotoxicity, which manifests itself in prolongation of the QT interval and an increase in QTcF (Fridericia coefficient) calculated using the Fridericia formula. The cardiotoxicity of bedaquiline persists after taking it for another 6 months, i.e. has a cumulative effect. In this connection, with the use of bedaquiline in treatment regimens, an electrocardiographic (ECG) study is initially performed. When monitoring treatment with bedaquiline in the first month, an ECG study is performed after 14 days, before the end of the course of treatment is carried out monthly, after the end of the course for 3 months. SAEs were identified in 3 patients. Hypokalemia, myelosuppression and hyperglycemia were noted accordingly in the 1 patient Peripheral neuropathy (moderate) was observed in 7 patients.Results. Culture conversion was observed in 63 patients (75%) who took Bdq, Lzd, Lfx, Cfz, Cs treatment regimens for 9 months. Time to culture conversion was ≤ mean (or median) in 10 (25%) cases, ≥ mean (or median) in 97 (75%) cases In the remaining 16 (18%) patients, the isolation of mycobacteria persisted, and additional detection of resistance to the main drugs provided a rationale for prolonging the course of treatment. In 5 patients dropped out, these patients were discharged for violations of the nosocomial regimen and took drugs only from 28 days to 2 months. There was no prolongation of the QT interval (0.48-0.51 s). All continued the course with bedaquiline. Peripheral neuropathy (moderate) occurred in 7 (8%) patients taking linezolid. All patients (with mild neuropathy) continued the course with linezolid. These patients were prescribed pyridoxine until the end of the regimen. Myelosuppression was observed in 59 patients. 10 of them had grade 1, 3 had grade 2, and only 1 had grade 3 myelosuppression. Nearly all of those treated with clofozemin had a dark brown skin tone. Treatment outcomes and course completion were 63(75%), failure 16(19%). Conclusion. The effectiveness of shortened treatment regimens for MDR/TB patients with the inclusion of new anti-TB drugs (Bdq, Lzd, Lfx, Cfz, Cs) in the treatment regimen turned out to be quite high, side effects were eliminated in time with the help of careful monitoring. In earlier terms, sputum conversion and closure of decay cavities were noted.

Mortality of tuberculosis patients through associated diseases and other causes

Aurelia USTIAN — 2024-01-22

Study of the mortality of tuberculosis patients by associated diseases and other causes. Materials and methods. A comparative, retrospective analysis of 222 cases of death due to tuberculosis, associated diseases and other causes in the municipality of Chisinau in two time periods was carried out: period I (2001-2003) - 157 and period II (2018-2020) - 65 cases. Results. In period II, compared to period I, there was a shift in age towards 65+ (over 1/3 of cases); approximately½ cases of deaths were from retreatment cases; the infiltrative form of tuberculosis predominated; increased oncological pathology; the number of liver diseases has decreased, there have been cases of death after perforating gastric ulcer and COVID-19. In both periods, patients also died from other causes: In period I - septicemia - 2; road accidents -15, freezing- 8 and suicides - 2 cases; In period II- peritonitis -2, drowning - 2, frostbite - 2, drug overdose - 2 and suicide - 1 case.Conclusion. The most common associated diseases that contributed to the death of tuberculosis patients were: oncological pathology, diseases of the cardiac system, cerebral stroke.

Detection of chronic bronchoobstructive diseases in the Republic of Moldova according the prism of the recommendations of international guidelines

Doina RUSU — 2024-01-22

Chronic obstructive pulmonary disease is an important public health problem. According to literature data, chronic lung diseases are underdiagnosed and there are many medical, psychological, social and economic barriers. In order to highlight the barriers and facilitating factors for the detection of chronic obstructive pulmonary disease at the level of primary care, a mixed qualitative-quantitative study was carried out, with a survey of 1190 participants and focus groups with doctors. Every fourth patient with respiratory symptoms does not report them to the family doctor and every second symptomatic patient does not perform a spirometry test. The most important barriers are low addressability after medical assistance, underestimation of respiratory symptoms, lack of doctors, professional overload and low access to spirometry at the primary care level.

Our experience in treating patients with bullous dystrophy complicated by pneumothorax

Rafic KERIMOV — 2024-01-22

Bullous emphysema of the lung is a local alteration of lung tissue characterized by the destruction of alveolar septa and the formation of air cysts with a diameter of more than 0.5 cm (bullae), the walls of which are lined with alveolar epithelium (with lung tissue density below -860 HU). The aim of the study was to determine effective tactics and select a rational type of surgical intervention in cases of spontaneous pneumothorax where complete lung re-expansion was not achieved through drainage. It was found that men are affected 5-10 times more often than women, predominantly among patients with bronchopulmonary diseases. By draining the pleural cavity, complete lung re-expansion was achieved within 7-10 days in 273 patients (66.3%), within 11-30 days in 16 patients (3.9%), while 123 patients (29.9%) required surgical intervention for full lung re-expansion.

The pathological reactions of brachial artery during and their significance in treatment of patients with chronic obstructive pulmonary disease

Constantin MARTINIUC — 2024-01-22

Background. The purpose of this study was to analyse the pathological reactions of brachial artery (BA) during test with reactive hyperemia (RH) for endothelial function (EF) estimation and their applicable significance in treatment of patients with chronic obstructive pulmonary disease (COPD). Material and methods. There were investigated 61 patients, mean age 47,7±5,11 years with moderate to severe forms of COPD (by GOLD criterion). Endothelial dysfunction (ED) estimation was performed non-invasive, using probe with RH with brachycephalic arteries Duplex with high resolution 8,0-10,0 MHz („Logiq S8” „General Electric”, SUA) by David S. Celermajer proposed method. ED was considered when EF index was less than 10%.Results. The analysis of obtained data revealed considerable decreasing of EF: mean EF index was 7,14±11,22%, between -15,0% and 29,4%. In 10 patients after RH test was noted pathological reaction of BA: instead of awaited endothelial-dependent BA dilatation, there were observed spastic and negative reactions (in limits between 0% and -15,0%). In parallel there were visualized in a. carotis solitary and binary atherosclerotic plagues with 20-40% of vascular stenosis without any clinical manifestations. The levels of total cholesterol and LDL-C also were elevated: 7,5±2,0 mm/l и 4,7±1,8 mm/l, respectively. In all 10 patients with pathological BA reactions do not reduced mean and systolic pulmonary artery pressure after 5 weeks of treatment with perindopril (mean dose 2,9±1,5 mg once daily) or valsartan (mean dose 54,5±15,4 mg once daily).Conclusions. Thus, BA pathological reaction during RH test for ED estimation may be used like a criterion predictor of efficacity of treatment with perindopril or valsartan and for prognosis of survival in patients with severe forms of COPD.

Clinical assessment of the severity of bronchopulmonary dysplasia in children born prematurely

Svetlana SCIUCA — 2024-01-22

Bronchopulmonary dysplasia (BPD) - chronic lung disease, which evolves with broncho-obstructive syndrome, signs of respiratory failure, pulmonary fibrosis.Aim. Analytical case-control study included 41 children with BPD and 40 preterm children without BPD, who were clinically evaluated. Methods. Evaluation of clinical respiratory syndromes and degree of severity of bronchopulmonary dysplasia in premature infants. Results. The study demonstrated that the O2 saturation determined by pulse oximetry in premature children with BPD is reduced - 94.5±0.4%, compared to the O2 saturation of premature children without BPD (97.85±0.14%), which is significantly higher (F stat = 66.7, T stat = 8.17, p<0.0001).Children with mild grade BPD present intercostal retractions in 22.2%: 95%CI 2.8-60, in moderate grade BPD - 52.6%: 95%CI 28.9-75.6 and in severe grade DBP all the children had chest retractions. Depending on the degrees of severity, children with mild BPD present intercostal retractions in 22.2%, in moderate BPD - 73.7% and in severe BPD all children had intercostal retractions. Costal retractions, which is an indicator of respiratory insufficiency, was found in all preterm infants with severe BPD, in 52.6%: 95%CI 28.9-75.6 preterm infants with moderate BPD. Premature children with mild BPD did not present costal retractions at the stage of diagnosis confirmation (χ2 = 15.3; p<0.001).Conclusions. According to the study, bronchopulmonary dysplasia in children born prematurely is manifested by signs of respiratory insufficiency - accelerated breathing, intercostal and thoracic retractions, low values of O2 saturation. The severity of signs of respiratory impairment is dependent on the degree of bronchopulmonary dysplasia, having a clinical expression through different forms of thoracic retractions.

Clinical variability of Toxocara canis infection in children

Corina ROTARU-LUNGU — 2024-01-22

Toxocariasis maintains significant relevance at present. This study focuses on presenting the diversity of clinical symptoms and the specific clinical course of toxocariasis in children. Early diagnosis becomes crucial for initiating effective antiparasitic treatment, thereby contributing to reducing the risk of recurrence and chronicity of the condition.

Chronic migraine in mature patients according to the harmful atmosphere in the family during childhood. Role of personality disorders.

Ion MOLDOVANU — 2024-01-22

One of the unresolved issues, discussed in international publications, is the role of Borderline Personality Disorder in migraine patients as a factor in migraine chronicity. In our study, a group of 177 patients with Migraine was analyzed in detail. We extracted patients with Borderline Personality Disorder and Migraine for comparison with patients with Migraine without Borderline Personality Disorder. The statistical difference is significant (P<0.05).

Acute intestinal occlusion in pregnant women

Irina PALADII — 2024-01-22

Introduction. Intestinal occlusion in pregnant women is characterized by the difficulty of diagnosis and the negative prognosis for the pregnant woman (35-50%) and the fetus (60%). Purpose. Study of the etiology and particularities in the management of pregnant women with acute intestinal occlusion. Material and methods. We conducted a study of the treatment of 4 pregnant women with acute intestinal occlusion. Patients were examined clinically, laboratory, USG, abdominal X-ray, consulted by a gynecologist, surgeon, endoscopist, etc. Results. The treatment performed in 4 pregnant women with acute intestinal occlusion was complex, individual, successful. Surgical interventions: caesarean section, laparotomy was performed, new borns alive. In 2 patients the pregnancy was preserved. Conclusions. The causes of mechanical intestinal occlusion in pregnant women were volvulus of the sigmoid colon and intra-abdominal adhesion process after previous operations. The management peculiarities of pregnant women with intestinal occlusion were: diagnostic difficulties, late referral, unclear clinical picture.

Pelvic fractures healing in osteosynthesis by external device

Anna KUSTUROVA — 2024-01-22

Aim: To analyze radiological data of pelvic fractures healing after osteosynthesis by external device, to determine the possibility of correction during the union and terms of fixation. Background. Visualization of fracture healing and knowledge of X-ray manifestations in dynamics makes it possible to control and manage the reparative process of bone tissue during union of the pelvic bones. Material and methods. The clinical and radiological picture of pelvic fractures healing and the results of treatment in 207 polytrauma patients were studied. All observations are divided by the type of fracture according to M.Tile classification. Results: The analysis of long-term treatment outcomes of pelvic trauma was carried out in 154(74,39%) patients, in the period from 1,5 to 16 years after surgery. All patients showed complete healing of the pelvic fractures and long bones injuries and their functional recovery. Conclusions: Correction of the pelvic ring injuries with an external fixation device is possible in almost all cases.X-ray dynamics provides control of the union process of the pelvic bones and allows to manage it.

Polytrauma: pelvic fractures and lesions to the urinary system

Anna KUSTUROVA — 2024-01-22

Purpose. Determination of the management particularities in polytrauma patients with pelvic fractures and the urinary organs injuries. Material and methods. A retrospective study was carried out, 61 medical records of the patients with polytrauma: injuries of the pelvic ring and urinary system were analyzed. Results. Based on the study, the main tactical aspects in the conduct of patients were identified: stabilization of the general condition of patients, early fixation of the pelvic ring with external device, restoration of the integrity of the urinary bladder, drainage of the urinary bladder and pathological accumulation of urine in the pelvic cavity. Conclusions. The preventive results of the treatment of polytraumapatients with lesions of the pelvic bones and urinary system indicates that early surgical correction of the pelvic ring with an external fixation device and the restoration of the integrity of the urinary bladder is possible in almost all cases. This requires special equipment, qualified and trained personnel.

CARACTERISTICILE CLINICE ȘI COMORBIDITĂȚILE PACIENȚILOR CU ISCHEMIE ACUTĂ A EXTREMITĂȚILOR REVASCULARIZAȚI ÎN MOD URGENT: STUDIU PROSPECTIV

Alexandru PREDENCIUC — 2024-01-22

Acute ischemia is a critical condition that occurs when there is a sudden decrease in arterial blood flow to an extremity and threatens its viability. This clinical condition requires urgent intervention to prevent the development of irreversible ischemia and possible loss of a limb. Analysis of the clinical and demographic characteristics of patients with acute ischemia is crucial for the effective prevention, diagnosis and treatment of this medical emergency. An individualized treatment approach with a choice of management strategy in accordance with clinical data and comorbidities can improve treatment outcomes. This article reflects the clinical characteristics assessed in 266 patients with acute limb ischemia who underwent urgent revascularization.

Acute peripheral ischemia associated with SARS-CoV-2 infection: experience in diagnosis and treatment

Vasile CULIUC — 2024-01-22

The study aimed to evaluate the outcomes of treatment of acute limb ischemia (ALI) in patients with novel coronavirus infection (COVID-19). The study group included 62 patients; 67 extremities: upper - 19 (28.3%), lower - 48 (71.6%).Distribution of cases according to ALI grades (Rutherford): I - 7 (10.4%), IIA - 10 (14.9%), IIB - 34 (50.7%), III - 16 (23.8%). COVID-19 was confirmed by the polymerase chain reaction test; 45 (72.5%) patients being documented to have lung injury. Fifty (80.6%) patients underwent surgical treatment on 52 limbs. Amputation rate during hospitalization (9.4±9 days) - 19.4%; mortality rate - 43.5%, being significantly influenced by the presence or absence of lung damage55.5% vs . 11.7% (P=0.002; χ² test). The following serum biomarkers served as potential predictors of mortality: C-reactive protein to albumin ratio, platelets to lymphocytes and fibrinogen to albumin ratio. At follow-up of 21 (25%-75%IQR 19-28) months overall and amputation-free survival rates were 56.4% and 57.1%.

Some results of perinatal complications in pregnant women with polycystic ovary syndrome

Victoria VOLOCEAI — 2024-01-22

Purpose. Evaluation of the results of complications in the perinatal period in pregnant women with (PCOS) polycys-tic ovary syndrome.Material and methods. The research carried out for the accumulation, processing and analysis of data was a retrospective study that was carried out during the years 2020-2022 within IMSP SCM no. 1, the patients were divided into 2 groups: Group I - 60 patients with polycystic ovary syndrome and pregnancy achieved. Group II - 60 patients with normal pregnancy. According to its character, the study carried out is descriptive observational. The method of accumulating and extracting data from the medical documentation did not allow the determination of anamnestic-clinical peculiarities, clinical and paraclinical investigations (laboratory and instrumental), the evolution of the pregnancy and the birth of the pregnant women included in the study, including the assessment of the status of the newborn at birth. Results. From the results of the study, it can be confirmed that there were no statistically significant differences (>0.05) between the 2 groups included in the study. Live children were born - 50 (94.34±0.32) in group I compared to 58 (96.7±0.63) in group II. Neonatal death was registered only in group I - 3 (5.66±0.32) cases and neonatal death only in group II - 2 (3.3±0.63) cases. Conclusion. The results of the comparative study show that pregnancy in pregnant women with PCOS ends with macrosomicfetuses - 26.43%; with an Apgar score of 7-8 in - 38.3%; who did not require transfer to the neonatal intensive care unit - 64%. Strict antenatal monitoring of pregnancy remains the gold standard for favorable perinatal outcomes.

The particulars of the evolution of pregnancy and birth in pregnant women with polycystic ovary syndrome

Victoria VOLOCEAI — 2024-01-22

Purpose. Identifying the particularities of pregnancy and birth in pregnant women with (PCOS) polycystic ovary syndrome. Material and methods. The study was retrospective which took place during the years 2020-2022 within IMSP SCM no. 1, patients divided into 2 groups: Group I - 60 patients with polycystic ovary syndrome and pregnancy achieved. Group II - 60 patients with normal pregnancy. According to its nature, the study carried out is descriptive observational. The method of accumulating and extracting data from the medical documentation did not allow the determination of anamnestic-clinical peculiarities, clinical and paraclinical investigations (laboratory and instrumental), the evolution of the pregnancy and the birth of the pregnant women included in study, including the assessment of the status of the newborn at birth. Results. From the results of the conducted study we can confirm the following particularities of the pregnancy evolution in pregnant women with PCOS, that in the II group predominantly a single pregnancy was obtained in 57 (95±0.28%) cases and a twin pregnancy in 3 (5±0.28%). The same results were obtained in group I, 42 (70±0.59%) cases of single pregnancy and 16 (26.7±0.57%) cases of twin pregnancy. Through these research results, a significant statistical difference was found in these 2 groups (p<0.05), these obtained results of the study coincide with the data from the literature, which we can confirm that the obtained data of our study are true. Conclusion. The results of the comparative study show that the pregnancy of pregnant women with PCOS is completed mainly at term - 58.5% and mainly by caesarean section - 62.26%.

Systemic Approach to Reduce the Risk of Medical Errors

Serghei PISARENСO — 2024-01-22

Background. Medical errors pose a significant problem. By learning from past mistakes, developing and applying preventive measures, we can reduce the risk of errors and their consequences in the provision of medical services. Objective of the study. Developing recommendations as systemic measures to reduce the risk of errors in providing medical care. Material and Methods. A synthesis was made of the experience in the medical and legal field, analyzing reports from internal quality audits of medical activities and relevant literature sources. Results and discussion. The risk of medical errors continues to be one of the main risks in the provision of medical care, including specialized assistance. The medical literature has accumulated a multitude of descriptions, classifications and causes of these errors. In order to reduce the risk of medical errors within the medical organization, a number of recommendations were developed in the form of planned systematic measures. The implementation of these measures led to an improvement in the quality of medical care, contributed to the prevention of medical errors, in which case the persons who committed them can be held civil and criminal liability. Conclusion. The implementation of the generalized recommendations in this study, in the form of planned systematic measures, effectively reduces the risk of medical errors, the frequency, and the severity of their medicolegal consequences.

Patient Safety: Modern Challenges and Means of Ensuring in the Medical Field

Mihaela MANEA — 2024-01-22

In the article, the importance of patient safety in a medical organization is discussed. Through a literature review and interviews with healthcare workers, modern challenges and safety measures in the medical field have been explored, including safety culture, education and staff training, technology utilization, and active patient participation. The results emphasize that patient safety requires a systemic approach and constant efforts from all participants in the medical organization.

Ethical dilemmas in imaging diagnosis

Nadejda PISARENCO — 2024-01-22

The article highlights the important role of imaging diagnosis in diagnosing and evaluating diseases. It emphasizes that in the modern stage of imaging diagnosis, ethical principles such as fairness, patient welfare, confidentiality, and consent play a central role. Attention is drawn to the fact that the application of these principles is accompanied by ethical dilemmas. In this sense, an assessment is made of these dilemmas, as well as of the rules of appropriate interaction of medical workers with patients. It is concluded that, considering the rapid development of technologies and patients’ needs, there is a need for constant discussion and analysis of ethical issues in imaging diagnosis.

Instruments for implementing quality management in hospital institutions

Fiodor GREJDEAN — 2024-01-22

This article describes the quality of medical services that cause a lot of confusion in contemporary world. The quality of medical care is measured by customer satisfaction, depending on the specifics of the medical services offered. The paper analyzes the types of criteria used in measuring quality in hospital institutions: structure criteria, process criteria and result criteria. All these criteria are used to measure the quality of healthcare.

The aspects of the continuing formation oriented to the education in health of the medical assistants

Angela BARONCEA — 2024-01-22

In this scientific paper there are described some aspects of the continuing formation of the medical assistants oriented to the education in health which represent a complex and exhaustive human phenomenon that includes more dimensions which interact by participating actively to the formation of the person’s personality.Hereinafter, the author confirms the important role of education for health in the formation and development of a conception and some balanced positive behaviors, starting from the youngest age with the purpose of consolidating the health, the harmonious development and strengthening of the human body as well as the adaptation to the environmental and social conditions.

Recurrence of pulmonary tuberculosis associated with non-specific lung diseases - a current problem in phthisiopneumology

Елена TUDOR — 2024-01-22

The analysis of the specialized literature demonstrates an increase in the incidence of pulmonary tuberculosis recurrence. In the development of relapse of pulmonary tuberculosis an important role belongs to comorbidities, among which nonpecific lung diseases are of major importance. The association of tuberculosis with non-specific lung diseases determines the presence of a syndrome of mutual aggravation, characterized by severe clinical symptoms.

Adverse hematological and coagulability reactions to the use of antituberculosis preparations

Nicolae BACINSCHI — 2024-01-22

Treatment of tuberculosis requires long-term use of antituberculosis drugs with a high risk of side effects. In recent decades, along with the frequent and detailed side effects (gastrointestinal symptoms, hepatotoxicity, neurotoxicity, allergic reactions), hematological and coagulation disorders have been described when taking antituberculosis drugs. Their main manifestations can be: iron deficiency anemia, hemolytic anemia, megaloblastic and sideroblastic anemia, thrombocytopenia, thrombocytopenic purpura, leukopenia, eosinophilia, agranulocytosis, deep vein thrombosis, thromboembolism, disseminated intravenous coagulopathy, etc. Although these side effects are rare, they require special attention because they can appear more frequently in the case of intermittent or interrupted treatment and present diagnostic difficulties.

Interaction of antituberculosis drugs with food

Nicolae BACINSCHI — 2024-01-22

The peculiarities of the development and evolution of tuberculosis require a rich and varied diet to restore the nutritional status, reduce the incidence of gastrointestinal adverse reactions and increase adherence to treatment. Food can modify the pharmacokinetic parameters (Cmax, AUC, Tmax) and thus influence the effectiveness of antituberculosis drugs or contribute to the development of resistance. Rifampicin and isoniazid need to be taken on an empty stomach. Food does not significantly influence the pharmacokinetic parameters of pyrazinamide and ethambutol. Calcium-rich products will decrease the absorption of fluoroquinolones. Acidic drinks reduce the absorption and Cmax of cycloserine/terizidone and increase the absorption of paraaminosalicylic acid. Pharmacodynamic interaction can be observed when isoniazid is combined with products containing tyramine and histamine, with increased manifestations of adverse reactions.

Safety profile of antituberculosis drugs

Lucia ȚURCAN — 2024-01-22

Studying the safety profile of antituberculosis drugs is a priority for the development of a treatment regimen as efficient as possible and with a high degree of tolerability for patients. The development of side adverse reactions of antituberculosis drugs continues to remain one of the main causes of low compliance or even abandonment of the administered treatment. The detection, reporting and analysis of adverse effects associated with the administration of antituberculosis drugs, both for first-line and second-line drugs, serves as a guarantee of successful treatment.

Tuberculosis of the larynx - aspects of diagnosis and treatment

Elena TUDOR — 2024-01-22

Tuberculosis is a chronic infectious and transmissible disease caused by Mycobacterium tuberculosis. It represents the most common granulomatous pathology affecting the larynx. In most cases it is secondary to pulmonary tuberculosis. Laryngeal tuberculosis is a public health problem due to changes in the clinical pattern of the disease that frequently leads to misdiagnosis and delayed treatment, which increases the risk of contagion. The purpose of this paper is to highlight the diagnostic and treatment aspects of laryngeal tuberculosis.

Tuberculosis: past and present

Igor IVANES — 2024-01-22

Tuberculosis is a serious infectious disease with a global impact, causing a significant number of deaths each year. It continues to pose a major challenge to the healthcare system and requires sustained efforts for control and prevention. The aim of this study was to analyze the historical aspects of tuberculosis and the outcomes of global and local control programs. The materials and methods involved research of specialized literature. The main conclusions include the historical evolution of tuberculosis, the impact of discoveries and medical advancements on its treatment and control, as well as the ongoing need to implement effective prevention and treatment strategies.

IMMUNOLOGICAL REACTIVITY AND NATURAL RESISTANCE IN PATIENTS WITH TUBERCULOSIS, TOXOCARIASIS AND TUBERCULOSIS ASSOCIATED WITH TOXOCARIASIS

Angela GUILA — 2024-01-22

Introduction. Parasitic diseases continue to affect the population of many countries of the world. About 2 billion people on the planet are infected with helminths, including Toxocara canis. Invasion with Toxocara canis represents a strong endogenous factor in the formation of the regulatory imbalance of the immune system. The integral evaluation of these indices serves as an important criterion in the diagnosis of toxocarosis and the effectiveness of the applied therapy. In the context of the above, information about research on immune reactivity and natural resistance of tuberculosis patients in association with toxocariasis is of interest. Material and methods. This article is a systematic review of the relevant literature between the year 2001 and 2022. The material for the study was electronic sources published through the web Medline, EMBASE, Global Health, Scopus and Web of science; PubMed; crossref; Google Scholar and others. The following keywords were used “immunological reactivity”, “natural resistance”, “parasitic diseases”, “toxocara canis”, “tuberculosis and toxocariasis”, “immunity”, “helminthiasis”, “toxocariasis”. Bibliographic resources have been systematized by subject and content. The results were grouped and systematized according to the relevant criteria and the level of scientific evidence. Results. Parasites, in particular, Toxocara canis and M. tuberculosis use different mechanisms to alter the immune response, but these mechanisms can interact with significant consequences for the immunological reactivity of each infection. Chronic helminthic infection causes a wide range of changes in the immune system. Conclusion. The immune reactivity and natural resistance of tuberculosis patients in association with toxocarosis is insufficiently elucidated.

From the medical to the bio-psychosocial approach of COPD patients through the lens of the International Classification of Functioning, Disability and Health

Diana CONDRATCHI — 2024-01-22

The article presents the literature review, in which the results of the research regarding the course of the medico-social expertise over the years are presented, starting from the medical and work expertise and with the elucidation of the latest bio-psychosocial approaches of the disabled person. At the same time, the article reflects the principles of implementation of the International Classification of Functioning, Disability and Health in patients with COPD. The following databases were used as a source of scientific literature: Google Scholar, PubMed and eLibrary. The keywords that were used in the search: "COPD", "CIF", "numeric codes", "bio-psychosocial model of disability".

Primary liposarcoma of the colon

Eugen GUȚU — 2024-01-22

The authors present a review of literature on the diagnosis, treatment and morphological features of a rare cancer - primary liposarcoma of the colon.

Primary retroperitoneal mucinous tumors

Eugen GUTSU — 2024-01-22

The authors present a review of the literature on the diagnosis, treatment and morphological features of rare tumorsprimary retroperitoneal mucinous tumors.

Xanthogranulomatous appendicitis

Elina ȘOR — 2024-01-22

Xanthogranulomatous inflammation is characterized histologically by a collection of lipid-laden macrophages admixed with lymphocytes, plasma cells, neutrophils, and often multinucleated giant cells with or without cholesterol clefts, that develops most often in the kidneys and gallbladder. But the involvement of vermiform appendix in the disease process is quite rare with only few cases are reported in literature. Xanthogranulomatous appendicitis is usually identified retrospectively on surgical pathology, that is associated with significant diagnostic and therapeutic dilemmas due to its variable presentation.

Circadian variations of neurotransmitters and cognitive dysfunctions

Irina IURCU — 2024-01-22

To anticipate and adapt to recurring daily events driven by the earth’s rotation, organisms exhibit regulatory mechanisms designed to control homeostasis under different lighting conditions, called circadian rhythm (CR).The CR represents an endogenous biological network that coordinates 24-hour cycles at the genetic, biochemical, physiological, and behavioral levels. CR control systems transmit timing signals throughout the organism, with all internal processes exhibiting a daily maximum and minimum activity level managed through modulation of neurotransmission in critical neural structures.Knowing the daily variations of neurotransmitter activity in the central nervous system is essential in establishing effective neuroprotection mechanisms. This study summarizes current knowledge on the interplay between circadian rhythm, neurotransmitter fluctuations, and their impact on neuroprotection and mental health.

Isolated renal tuberculosis in children.

Olga KISELEVICH — 2024-01-22

At the present stage of development of tuberculosis as a science, special attention should be paid to detection of extrapulmonary forms. While it is easier to suspect extrapulmonary localization against the background of generalized process, isolated lesions of one organ cause great difficulties for doctors and represent a multidisciplinary problem. Particular attention should be paid to changes in urine, which may be accompanied by MBT kidney involvement.

Implementation algorithm of the International Classification of Functioning, Disability and Health in a patient with chronic obstructive pulmonary disease: clinical case

Diana CONDRATSCHI — 2024-01-22

The article presents the clinical case of the patient with chronic obstructive pulmonary disease (COPD) reflected through the biopsychosocial approach with the help of 2 classifications: the International Classification of Diseases (ICD- 10) and the International Classification of Functioning, Disability and Health (ICF), a fact that offers the formulation of a complete, comprehensive [4] diagnosis that would merge the necessary measures of medical assistance with those of social protection. Thus, it will be possible to integrate information about the patient’s state of health with that about the dynamics of the disease from a biological, social and personal perspective.

Post-COVID-19 pulmonary damage in infants

Corina CONICA — 2024-01-22

COVID-19 infection affects any age and gender. Among the pediatric population, the most vulnerable are children up to 3-5 years old. Infants are especially affected, they present the most complications following post-COVID19 lung damage. The article presents the case of an infant who suffered severe SARS-CoV-2 infection. With the help of high-precision imaging investigations, such as Computed Tomography, it was possible to detect the bronchopulmonary changes that occurred after enduring the infection.

Pulmonary hemosiderosis in a child

Rodica SELEVESTRU — 2024-01-22

Idiopathic pulmonary hemosiderosis is a rare respiratory disease that often beginning before the age of 10 years. In the pediatric population, it can be manifested only by isolated iron deficiency anemia, without association of other symptoms, sometimes with late diagnosis. We will present a clinical case of pulmonary hemosiderosis with metabolic damage, characterized by the accumulation of hemosiderin in alveolar macrophages and increased levels of ferritin. The progression of lung dysfunction is evaluated imaging by lung CT.

Spontaneous heterotopic pregnancy

Ana MISHINA — 2024-01-22

The authors presented a documented case of spontaneous heterotopic pregnancy (uterine in combination with ruptured left tubal pregnancy). A laparoscopic tubectomy was performed. The uterine pregnancy progressed and finalized in time with the birth of a healthy child through the natural genital tract. A review of the literature on the diagnostic features and surgical treatment of heterotopic pregnancy is presented.

Ovarian Brenner tumor

Ana MISHINA — 2024-01-22

The authors presents a clinical observation of a rare pathology - Brenner’s tumor of the ovary. A narrative review of the literature on the diagnosis and treatment of this pathology is given.

Reliability of clinical and biochemical indices in patients with breast cancer associated with pregnancy in the preand postoperative period

Corneliu URECHE — 2024-01-22

Breast cancer has an annual increasing trend. About 1.5 million women get breast cancer every year in the world. The proportion of breast cancer in women during the fertile period, as well as pregnancy-associated mammary gland cancer (CGMaS), also increases [1-4]. The pathology is associated and requires a multidisciplinary approach (obstetrics, surgery, oncology, etc.). Clinical and biochemical indicators of a specific somato-functional status require to be studied and to record its particularities. A study issue will also be the changes in metabolism in patients with CGMaS and gestosis.