Bulletin of the Academy of Sciences of Moldova. Medical Sciences

The evolution of patient management in infectious and autoimmune diseases in the post-COVID-19

Thu, 30 Apr 2026 00:00:00 +0300

Aim: To examine the changes implemented and emerging trends in managing patients with autoimmune and infectious
neurologic pathology in the postCOVID-19 period, with focus on clinical and epidemiological experience.
Materials and Methods: A systematic literature review was carried out following PRISMA criteria, using Google Scholar and PubMed databases. Keywords included: „neuromuscular diseases”, „infectious disease”, „multiple sclerosis”,
„autoimmune diseases”, „telemedicine”, „post-Covid-19 era”. Articles published between 2023–2025 were considered; 369 articles were initially identified, of which 24 were included after screening titles and abstracts.
Results: Telemedicine and telerehabilitation have become important complementary tools for patients with multiple sclerosis and other autoimmune diseases, although limitations remain in terms of access and technological literacy. The use of digital devices and digital biomarkers for monitoring is increasing, but further validation is needed. In infectious pathology, after easing restrictions there is a notable rise in the incidence of bacterial and viral meningitis, partly due to decreased vaccination coverage. For autoimmune disease patients, challenges include adapting immunosuppressive or biologic therapies after SARS-CoV-2 infection, and ensuring multidisciplinary care.
Conclusions: Management of autoimmune and infectious pathologies in the post-COVID-19 era requires more flexible and personalized care models, strengthening digital infrastructure, epidemiological surveillance and vaccination programs, as well as integrating digital biomarkers and multidisciplinary teams for optimal patient outcomes.

Evaluation of the effectiveness of IgM and IgG anti-tuberculosis antibodies in the primary diagnosis of patients with suspect

Irada AHUNDOVA, Kenul KERIMOVA, GULIZAR ALIEVA, Gamar AHMADZADE — Wed, 29 Apr 2026 00:00:00 +0300

This study assessed the diagnostic value of serological assays for IgM and IgG antibodies in the initial work-up of tuberculosis, including extrapulmonary disease. In a single-center observational cohort (n=200; 64 – active TB, 136

– controls), ELISA IgM/IgG testing was performed at baseline as part of a comprehensive diagnostic algorithm. IgM demonstrated very low sensitivity (4.7%) with high specificity (99.3%); PPV 75.0%, NPV 68.9% (LR+≈6.38; LR−≈0.96). IgG showed sensitivity 20.3% and specificity 86.8%; PPV 41.9%, NPV 69.8% (LR+≈1.53; LR−≈0.92). Serology is unsuitable for screening or ruling out active TB and should be considered only as an adjunct in patients with moderate/ high pre-test probability; definitive diagnosis still relies on microbiological and molecular confirmation.

Diagnostics of latent tuberculosis infection in children and adolescents using diaskintest in the Republic of Azerbaijan.

Wed, 29 Apr 2026 00:00:00 +0300

Objective: To determine the prevalence of latent and active tuberculosis infection among children under 17 years of age living in Baku using modern diagnostic methods.Materials and Methods: A total of 300 clinically healthy children were examined. The diagnostic algorithm included the Mantoux test with 2 TU PPD-L, Diaskintest, and the interferon-ɣ release assay (QuantiFERON-TB Gold Plus). In cases of positive results or clinical indications chest radiography and bacteriological studies were performed.
Results: Latent tuberculosis infection was detected in 28% of the examined children, while active tuberculosis was diagnosed in 2%. In 4% of cases, changes were identified that require follow-up observation.The most diagnostically valuable methods for detecting latent infection were IGRA and Diaskintest.
Conclusion: The study confirms the high prevalence of latent tuberculosis infection among children and highlights the need for active screening using highly specific diagnostic tools.

HE INFLUENCE OF HIV INFECTION ON THE PROCESSES OF LUNG TISSUE REMODELING IN TUBERCULOSIS PATIENTS DURING ANTI-TB TREATMENT

Wed, 29 Apr 2026 00:00:00 +0300

The adaptive immune response to tuberculosis develops approximately six weeks after infection. In HIV, this process is disrupted due to delayed activation of CD4 lymphocytes. Immune cells in combination with mycobacteria stimulate the synthesis of matrix metalloproteinase-9 (MMP-9), which breaks down collagen. Its breakdown product (hydroxyproline) is a biomarker of lung tissue destruction. The ratio of MMP-9 to tissue inhibitor of metalloproteinases-1 (TIMP-1) (MMP-9/TIMP-1) reflects the balance between degradation and repair of lung tissue. In addition, aldosterone plays an important role, as it can activate monocytes, enhance inflammation, disrupt fibrinolysis, and stimulate collagen synthesis by fibroblasts. Its elevated level is associated with the development of pulmonary fibrosis. In patients with MDR-TB without HIV infection, the processes of pulmonary tissue remodeling were more typical: the balance between MMP-9, TIMP-1, and hydroxyproline was maintained, which contributed to the development of fibrosis and limitation of inflammation. In patients with TB/HIV coinfection, there was a marked imbalance in fibrosis factors: increased levels of MMP-9 and hydroxyproline with insufficient activation of TIMP-1, which led to a more generalized process and worse clinical outcomes. Aldosterone levels decreased during treatment in both groups, but this decrease was less pronounced in TB/HIV patients, confirming abnormalities in the fibrosis system in this group of patients.

THE COURSE OF RESISTANT PULMONARY TUBERCULOSIS COMBINATED WITH HIV-INFECTION AMONG ADULTS

Manana SAKHELASHVILI, Zoriana PISKUR, Olga SAKHELASHVILI-BIL — Wed, 29 Apr 2026 00:00:00 +0300

The researched group was 1.5 times dominated by male patients (42: 68.8%), over female (19: 31.2%), while the majority of people were aged 31 to 50 years. 9.8% (6) of patients with chemoresistant pulmonary TB were hospitalized in serious condition. The average number of bed-days in hospital was (61.7 ± 4.5). 16 (26.2%) patients with chemoresistant TB died in the hospital.

Our research shows that among patients with CR-PTB/HIV, rifampicin (R) resistance was 2 times more common than resistance to combination HRZE and Pre-XDR (32.8% vs. 16.4%, P < 0.05). Resistance to combination HRZ was the least common (1.4%). In some cases, they showed resistance to new anti-TB drugs (Bdg and Dlm). Disseminated PTB was 2.4 times more often diagnosed than miliary TB, and infiltrative PTB was 4.0 times more likely among CR-PTB/HIV.

Clinical presentation and diagnosis of tuberculosis comorbidity, pneumocystis carinii, herpes and cytomegalovirus pneumonia in patients with immunodeficiency in advanced stages of HIV infection.

Vladimir MISHIN, Anastasia MISHIN, Dmitrii LEJNEV, Ivan SHASHENCOV — Wed, 29 Apr 2026 00:00:00 +0300

The features of clinical manifestations in comorbidity of tuberculosis, pneumocystis carinii and herpesvirus pneumonia in 25 patients and in comorbidity of tuberculosis, pneumocystis carinii pneumonia and cytomegalovirus pneumonia in 21 patients (1a and 2a main groups) were studied in comparison with the same 25 and 21 patients without pneumocystis pneumonia (control groups 1b and 2b), stage 4B and 5 of HIV infection, in the progression phase and in the absence of antiretroviral therapy. All patients suffered from drug addiction, consumed alcoholic beverages and smoked tobacco products, and also had secondary diseases: viral hepatitis B or C and chronic obstructive pulmonary disease (in 66.3%). It has been established that this comorbidity is characterized by pronounced immunodeficiency with a CD4+ lymphocyte count of less than 50 cells/μl of blood and a viral load of more than 500,000 RNA copies of HIV/ml of blood and generalization of tuberculosis with multiple extrapulmonary lesions. The clinical picture was characterized by a syndrome of intoxication, general inflammatory and respiratory manifestations, and CT of the chest organs visualized a complex of a simultaneous combination of four pathological syndromes: dissemination, pleural pathology, increased pulmonary pattern and adenopathy, and the area of lung damage in all patients was 80-100%. This determines the similarity of clinical manifestations and visualization of CT changes in this comorbidity, which makes it difficult to distinguish them due to the simultaneous layering of several pathologies with the same type of clinical manifestations and requires a comprehensive

etiological diagnosis of specific diseases to prescribe timely comprehensive treatment and reduce the mortality rate of this severe contingent of patients.

The role of HIV co-infection in the severity and evolution of multidrug-resistant tuberculosis.

Igor IVANES — Wed, 29 Apr 2026 00:00:00 +0300

Multidrug-resistant tuberculosis (MDR-TB) combined with HIV infection remains a critical public health challenge in the Republic of Moldova, where overlapping epidemics significantly complicate diagnosis and treatment.

Aim of the study. To describe the epidemiological, clinical, and therapeutic characteristics of patients with TB/HIV co-infection and drug-resistant TB during 2021.

Materials and Methods. A retrospective descriptive study was conducted on 160 TB/HIV patients, of whom 57 had drug-resistant TB. Data were extracted from the national SIMETB database and hospital medical records.

Results. MDR-TB was confirmed in 82.5% of drug-resistant cases. The majority were young men, socially vulnerable, and unemployed, with frequent behavioral risk factors such as alcohol consumption, smoking, and injection drug use. Most cases were diagnosed passively, at advanced stages, with 49.1% presenting severe immunosuppression (CD4 <200 cells/mm³). Treatment success was achieved in 59.6% of patients, while mortality reached 40.4%.

Conclusions. MDR-TB in HIV-positive individuals in Moldova is marked by late diagnosis, severe immunosuppression, and poor outcomes. Strengthening active case-finding, integrating TB/HIV services, and improving adherence support are essential to reduce mortality and improve prognosis.

Characteristics of T lymphocyte proliferation depending on oxidative stress and antioxidant activity in patients with relapsed pulmonary tuberculosis.

Wed, 29 Apr 2026 00:00:00 +0300

The study included 130 patients, which comprised: a) an main group - 65 patients with relapsed pulmonary tuberculosis and b) a control group - 65 patients with pulmonary tuberculosis. The patients’ leukocyte formula, lymphocyte proliferation in the lymphocyte blast transformation reaction with phytohemagglutinin, the state of oxidative stress reactions and antioxidant activity were determined. The study showed that in patients with relapsed pulmonary tuberculosis: lymphocyte proliferation in both groups of patients was significantly lower than in healthy controls, and in patients with relapsed pulmonary tuberculosis, the content of transformed lymphocytes was even lower than in patients without relapse; In patients with relapse of pulmonary tuberculosis, the degree of oxidative damage to proteins and the predisposition of lipoproteins to oxidation significantly increase according to the AOPP marker and the oxidative stress indicator malondialdehyde (MDA), which indicates the severity of oxidative stress reactions in these patients compared to patients with pulmonary tuberculosis; patients with relapse of pulmonary tuberculosis had significantly lower total antioxidant activity, determined by the ABTS method and the CUPRAC method, which reflects the suppression of total antioxidant activity; patients with relapse of pulmonary tuberculosis had significantly lower activity of the superoxide dismutase enzyme, which reflects the suppression of the activity of the enzymatic link of antioxidant protection; in patients with relapse of pulmonary tuberculosis, a more pronounced and reliable increase in the activity of haptoglobin and ceruloplasmin proteins was noted compared to patients with pulmonary tuberculosis; In patients with relapsed tuberculosis, malondialdehyde (MDA) and superoxide dismutase and catalase enzyme activity may be potential biomarkers of suppressed lymphocyte proliferation indices due to a strong correlation.

Tuberculosis with multiple localizations - medico-social and clinical-instrumental aspects.

Wed, 29 Apr 2026 00:00:00 +0300

Tuberculosis (TB) with multiple localizations (TBML) is life-threatening, especially when diagnosis and treatment are delayed. The diagnosis of TBLM is difficult, because of variable symptoms and signs, evolving under the “masks” of other diseases, and diagnostic methods have limited significance, particularly among immunocompromised individuals.

The aim of the study was to evaluate the medico-social aspects, demographic and clinical-instrumental characteristics in patients with TBML.
Material and methods. A descriptive observational study that included 120 patients with TBLM hospitalized in IMSP Institute of Pneumology “Chiril Draganiuc” during the years 2022-2024 was conducted.
Results. TBML predominantly affected men of working age from rural areas. Various medico-social factors were involved in development of TBML. New cases predominated, with bilateral extensive pulmonary involvement, polymorphic lesions, multiple destructive elements, with a subacute, slowly progressive onset. Simultaneously with pulmonary TB, the involvement of one organ with the following extrapulmonary localization predominated: intestine, urinary tract, larynx and lymph nodes. Diagnosis of TBML was based on complex evaluation and predominant clinical examinations in association with molecular genetic tests.
Conclusions. A number of medical and social factors were associated with TBML. Most of the cases of TBML were identified by examination of symptomatic persons with bilateral extensive lung involvement, polymorphic lesions and multiple destructive elements. The complexity approach, clinical, instrumental and laboratory examinations confirmed diagnosis of TBML.

Phagocytosis in pulmonary tuberculosis associated with COVID-19 infection.

Tatiana OSIPOV — Wed, 29 Apr 2026 00:00:00 +0300

In the context of the persistence of the pandemic caused by the new coronavirus infection, it becomes essential to study the impact of COVID-19 infection on the evolution of pulmonary tuberculosis (TB) when the two pathologies coexist. The aim of the research was to study the characteristics of indises of phagocytosis and microbicidal activity of phagocytes in patients with COVID-19-associated pulmonary TB. The study included 42 patients: a) research group – 21 patients with pulmonary TB and COVID-19, b) control group – 21 patients with pulmonary TB. In these patients, the functional activity of neutrophils used NBT test, phagocytic index (PI) and phagocytic number (PN), as well as the activity of acid and alkaline phosphatase were evaluated. Changes in the functional-metabolic activity of neutrophil granulocytes in patients with COVID-19associated pulmonary TB were due to reduced acid and alkaline phosphatase activity, NBT test parameters, PN and PI. The reduction of these parameters in segmented neutrophils may be a marker of viral superinfection, such as COVID-19 infection.

The characteristics of the clinical, radiological and microbiological evolution of secondary tuberculosis in adolescents.

Wed, 29 Apr 2026 00:00:00 +0300

According to literature data, in the current alarming epidemiological conditions, in the pediatric group, forms of tuberculosis characteristic of adults are attested. A study was conducted on a group of 121 adolescent patients in the Pediatric Pneumophthisiology Department of CMHP, Chisinau mun. 2023- 2024. The age of adolescents included in the study was 11-18 years. Household contact statistically significantly predominated over close contact: 72 (59.5 ± 3.92%) cases compared to 17 (14 ± 3.0%) cases (p < 0.05). Antituberculosis chemoprophylaxis was followed by only 22 (18.2 ± 3.4%) patients. Sputum smear results found a significant predominance of patients with a “negative” sputum microscopy result 81 (66.9 ± 4.16%) cases. Limited pulmonary infiltrates were described in 30 (31.3 ± 4.6%) patients,

medium-extended infiltrates – in 34 (35.4 ± 4.8%) patients and extensive infiltrates were assessed in 32 (33.3 ± 4.71%). In the structure of clinical forms of secondary tuberculosis in children, infiltrative pulmonary tuberculosis predominated, followed by tuberculous pleurisy.

Risk factors and clinical manifestations in patients with pulmonary infections caused by nontuberculous mycobacteria.

Alina MALIC, Adriana NIGULEANU, Tatiana OSIPOV, Vasile POPA — Wed, 29 Apr 2026 00:00:00 +0300

The incidence of pulmonary infection with NTM increases with age and varies significantly between countries. NTMs are opportunistic pathogens that cause disease, especially in immunocompromised patients or with pre-existing lung disease. In 2021-2024, 22 patients with pulmonary mycobacteriosis were admitted to the MCHP. The majority of patients were men, MAC predominated, followed by M. kansasii. Risk factors included the medical-biological, HIV- infection, respiratory system pathology, harmful habits, hystory of tuberculosis (TB). Age over 51 years old had 50% of the patients. History of TB had 1/3 of the patients. Among the associated diseases the respiratory system diseases predominated (86,4%): COPD, bronchiectasis, neoplastic processes, othres. Diagnosis was estableshed in the period up 2 weeeks from hospitalisation in 68,8% cases. Clinical picture were presented by bronchopulmonary, toxico-infection syndromes.

Severe community-acquired pneumonia - clinical management and challenges.

Doina RUSU — Wed, 29 Apr 2026 00:00:00 +0300

Severe community-acquired pneumonia is associated with increased medical cost and risk of mortality. Clinical, prognostic aspects and challenges in clinical management were analyzed by evaluating 1379 patients with community- acquired pneumonia, hospitalized in the pre-pandemic period (2013-2019) in the “Chiril Draganiuc” Pneumological Institute. Currently, there are still a series of controversies regarding severity scores, etiology and management aspects, predictors of unfavorable evolution.

Features of the course of COPD as a comorbid condition of COVID-19.

Wed, 29 Apr 2026 00:00:00 +0300

Introduction. COPD is a common comorbidity in patients with COVID-19, associated with an increased risk of severe forms and mortality.
Method. The study included patients with COPD and SARS-CoV-2 infection, divided into three groups: outpatient, outpatient consultation and hospitalized. Clinical parameters, respiratory function, Charlson score and vaccination status were analyzed.
Results. Hospitalized patients were older, had lower respiratory function and more comorbidities. The proportion of vaccinated patients was significantly lower in this group (33%) compared to outpatient patients (63%), suggesting the protective role of vaccination.
Conclusions. The evolution of patients with COPD and COVID-19 is determined by age, severity of lung disease and comorbidities. Vaccination reduces the risk of severe forms and hospitalization, highlighting the importance of prevention and an integrated approach to this vulnerable category.

Fungal allergy – features of molecular diagnosis.

Wed, 29 Apr 2026 00:00:00 +0300

The clinically relevant mold species are Alternaria, Aspergillus, Cladosporium, and Penicillium. The rate of fungal sensitization was 7.7% (26/338) among patients. Most patients with allergic respiratory diseases are sensitized to Alternaria, the fungus with the highest allergenic potential, with a sensitization rate of 5.3% (18/338). Aspergillus second among patients sensitize d to fungi, with a sensitization rate of 2.7% (9/338), followed by Cladosporium with a sensitization rate of 1.2% (4/338). The least frequently implicated in the sensitization of patients with allergic respiratory diseases is Penicillium, with a sensitization rate of 0.9% (3/338).

Consanguineous marriages as a risk factor for the development of primary bronchiectasis.

Ilgar MUSTAFAE, Reihan GADJIEVA, Nailea — Wed, 29 Apr 2026 00:00:00 +0300

Objective: To assess the impact of consanguinity on the development of primary bronchiectasis (BE). Methods: Single-center study of 163 patients with clinically and radiologically confirmed BE (2015–2025). Results: Primary BE was diagnosed in 112 (68.7%) patients; among them, parental consanguinity was documented in 69 cases (61.6%). Consanguinity was significantly more frequent in congenital (primary) vs post-infectious forms (χ²=47.5; p<0.0001). Patients with primary BE were younger (26.4±3.7 years) than those with secondary forms (32.1±4.1 years; p<0.05). Primary ciliary dyskinesia (~30%) and cystic lung hypoplasia (~19%) predominated among primary etiologies; cystic fibrosis cases showed more severe courses. Conclusion: Consanguinity is an important risk factor for genetically determined primary BE; systematic family history and molecular genetic testing should be incorporated into standard diagnostic pathways.

Open abdomen – surgical treatment options for peritonitis.

Wed, 29 Apr 2026 00:00:00 +0300

The article presents data from the specialized literature on the treatment of diffuse peritonitis, considered one of the difficult and complex problems of surgery, characterized by a high mortality rate <70%. The analysis of 30 patients with progressive peritonitis, who were treated using the laparostomy method – “open abdomen”, is presented. The main stages of temporary closure of the abdominal cavity using the traditional laparostomy method and laparostomy with the use of a vacuum suction system in the study group are described in detail. In conclusion, it is summarized that management through the open abdomen (laparostomy) remains an important element in surgical treatment of extensive peritonitis. The choice of treatment method should be individual, taking into account the patient’s biological condition and local intraoperative conditions.

When Parkinson is Not Parkinson – Diagnostic and Management Challenges of Essential Tremor: Case Series from the Movement Disorders Center.

Madalina CEBUC, Elena COSTRU-TASHNIC, Olga GAVRILIUC — Wed, 29 Apr 2026 00:00:00 +0300

Introduction: Tremor (Tr), a rhythmic and involuntary movement characteristic of disorders such as essential tremor (ET) and Parkinson’s disease (PD), can be a source of confusion for general neurologists.
The aim of this study was to identify the difficulties associated with the diagnosis and management of ET in the Republic of Moldova, based on the experience of the Movement Disorders Center.
Materials and Methods: A retrospective analysis of 14 clinical cases with ET/ET-plus evaluated at the Movement Disorders Center of the “D. Gherman” Institute of Neurology and Neurosurgery (2024–2025) was conducted. Demographic, clinical, and therapeutic data were collected, and descriptive statistical analysis was performed using SPSS v.23.
Results: Among 87 patients suspected of PD, 14 were confirmed with ET (simple ET 3 [21.4%], ET-plus 9 [64.3%], PD + ET 2 [14.3%]), with a median age at presentation of 73 years and tremor onset at 66 years. All patients exhibited kinetic and postural tremor of the upper limbs, with involvement of the head (57.1%), chin (7.1%), and voice (7.1%). Associated motor symptoms included ataxia (42.9%) and parkinsonism (21.4%). Most patients (57.1%) had prior treatments with partial or no effect; propranolol 60 mg/day was initiated in 78.6% of cases.
Conclusions: Diagnosis and management of tremor remain challenging due to the overlap of ET and PD symptoms, limited access to functional investigations, essential medications, and the lack of surgical options. The results highlight the need for standardized protocols and continuous training of neurologists to optimize long-term management.

Acute pulmonary edema – critical mortality factor in patients with chronic kidney disease.

Iuliana SMOLENSCHI, Sergiu MATCOVSCHI, Lilia VLASOV, Natalia CAPROSH — Wed, 29 Apr 2026 00:00:00 +0300

Acute pulmonary edema (APE) is a common complication in patients with chronic kidney disease (CKD). This study aims to analyze the incidence of APE as the main cause of death in patients with CKD. We evaluated 55 patients with CKD including clinical examinations, laboratory data and paraclinical investigations, and the data were statistically processed. The results revealed that acute pulmonary edema is the main cause of death among patients with CKD, observed in 58% of patients. The differences in mortality between sexes suggest an increased risk for men, dependent of age or other known risk factors, which requires a personalized approach to care according to sex.

Multidimensional approach and mortality risk stratification scores in chronic obstructive pulmonary disease.

Ana POPA, Tatiana HARGHEL, Natalia CAPROSH, Sergiu MATCOVSCHI — Wed, 29 Apr 2026 00:00:00 +0300

Chronic obstructive pulmonary disease (COPD) is associated with systemic manifestations and frequent cardiovascular comorbidities. These comorbidities significantly affect patient prognosis. We prospectively evaluated 426 hospitalized patients with COPD exacerbations using spirometry, CAT and mMRC questionnaires, comorbidity indices, and biomarkers. Independent predictors of mortality included elevated BNP, reduced FEV1, and higher CODEX score. Multidimensional assessment provides superior prognostic stratification compared to spirometry alone.

ECHOGENICITY OF THROMBOTIC MASSES IN PATIENTS WITH VARICOSE VEINS OF THE LOWER LIMBS COMPLICATED BY ACUTE SUPERFICIAL VENOUS THROMBOSIS

Vasile CULIUC, Dumitru CASIAN, Evghenii GUTU, Igor DONTU — Wed, 29 Apr 2026 00:00:00 +0300

Introduction. Previous studies have revealed that measuring thrombus echogenicity could be useful in managing patients with deep vein thrombosis of lower limbs. Our study aimed to analyse the echogenicity of thrombi in subjects with superficial vein thrombosis (SVT) and varicose veins.
Materials and methods. Duplex ultrasound was performed in 50 patients with varicose veins and SVT of both the trunk of the great saphenous vein and the subcutaneous tributaries. A series of images of the thrombi from the trunk and varicose tributaries were captured and analyzed in Adobe Photoshop®, CS6.0 (Adobe Systems, USA), and the grey scale median (GSM) thrombus echogenicity was determined using the „lasso tool” and „histogram”.

Results. Varicose tributary thrombus had a significantly higher echogenicity compared to saphenous trunk thrombus: 69.2±17.2 (95% CI 64.4-74.2) vs. 46.4±14.8 (95% CI 42.2-50.6) GSM units, p<0.0001. GSM values in varicose branches demonstrated a strong positive correlation (r=0.79 [95%CI 0.65-0.87], p<0.0001) with the time since the onset of SVT, while the echogenicity of the thrombus in the trunk had only a moderate correlation (r=0.42 [95%CI 0.16-0.63], p<0.01). In the linear regression model, assessing the dynamics of echogenicity depending on the duration of SVT, the R2 coefficient was three times higher for the tributaries – 0.54 vs. 0.18 for the trunk. Thrombus echogenicity increased with each day from the onset of the disease: by +3.4±0.4 GSM units in tributaries (p<0.0001) and by +1.7±0.5 GSM units in the trunk (p<0.01). There were no significant differences in GSM values in patients of different gender, age and body mass.

Conclusion. Significantly higher echogenicity of the thrombotic masses in the subcutaneous varicose tributary compared with that of the saphenous thrombus, as well as the strong positive correlation of echogenicity with SVT duration, point to the secondary character of involvement of the superficial vein trunks and centripetal progression of thrombosis.

Contemporary profile of the patient with polycystic ovary syndrome.

Victoria VOLOCEAI — Wed, 29 Apr 2026 00:00:00 +0300

Aim.The aim of our research included identifying the medical and social specifics of the contemporary profile of patients with polycystic ovary syndrome (POS) in the Republic of Moldova, in order to improve the diagnosis and management in the treatment of this disease.
Materials and methods. 138 patients selected according to the Rotterdam criteria for polycystic ovary syndrome, hospitalized in the Department of Aseptic Gynecology of the Municipal Clinical Hospital No. 1 in Chisinau, were analyzed. Results. Certain medical and social determinants had a direct or indirect role in the evolution of polycystic ovary syndrome. In the current study, we established that the main impact was had by BMI, irregular menstrual cycle, family
history, hormonal level, duration of treatment and infertility.

Conclusions.We have compiled a contemporary profile of SOP patients - young women of reproductive age, usually overweight, who have irregular menstrual cycles, a family history of SOP, and infertility for nearly 1 year of regular or regular sexual life.

LOD efficiency and pronouncement factors in the treatment of polycystic ovary syndrome infertility.

Victoria VOLOCEAI — Wed, 29 Apr 2026 00:00:00 +0300

Purpose. To establish the prognostic factors of positive LOD response in the treatment of infertility in polycystic ovary syndrome.
Materials and methods. 138 clinical cases of patients selected according to the Rotterdam criteria for polycystic ovary syndrome, hospitalized in the Department of Aseptic Gynecology No. 1 of the Municipal Clinical Hospital No. 1 in Chisinau city, were analyzed.
Results. Age is an important prognostic criterion. The success rate is significantly higher in patients up to 35 years of age (p=0.79, χ²=11.738). Obesity with a BMI >30 kg/m2 represented a lower ovulation rate (p < 0.01) compared to those with a BMI (26 – 29) - 18%. In patients with T > 4.5nmol/l, the ovulation rate is – 13% (p < 0.05) lower than the ovulation rate - 20.2% in women with slightly elevated T 2.6-4.4nmol/l. Patients with normal T < 2.6 represented a higher success rate (p<0.01) (ovulation rate – 42.3%) compared to the other groups. The LH level has a significant impact: patients who responded after LOD had pretreatment LH concentrations ≥ 10IU/l (p=0.29, χ²=20.862, p<0.001) than those who had lower LH < 10IU/l, before LOD.
Conclusions. The success rate of treatment with visual impairment (LOD) correlates with the following criteria: age, duration of infertility, BMI, LH, T.

Headache characteristics attribute to acute infections in Republic of Moldova: prospective multicentric study.

Wed, 29 Apr 2026 00:00:00 +0300

Introduction. Headache is a frequent symptom associated with acute infections; however, data regarding its characteristics and the risk of chronification remain limited, particularly outside the context of COVID-19 infection.
Materials and methods. The national cohort from the Republic of Moldova included 40 patients with headache attributed to acute infections, within the framework of the international INFECT-Head study. Evaluation was performed using a standardized questionnaire, and statistical analysis employed χ² tests, Mann-Whitney test, and logistic regression. Results. The mean age of patients was 47.4±15.5 years, with 60% being female. Current headache was severe in 72.5% of cases, predominantly bilateral, with pressing or pulsating quality, and an average duration of 8.2±7.9 hours. Common associated symptoms included vertigo (60%), photophobia (40%), and myalgia (42.5%). Headache intensity was not correlated with fever or clinical markers. Persistence beyond two weeks and intermittent evolution with attacks
were associated with an increased risk of chronification (p<0.05).

Discussion. The phenotype of post-infectious headache is heterogeneous and influenced by a history of primary headache. The identified risk factors for chronification suggest increased vulnerability in a subset of patients; however, the small sample size limits the generalizability of results.
Conclusions. Headache in acute infections shows significant clinical variability and may persist long-term. Persistence
>2 weeks and intermittent evolution may represent risk factors for chronification, highlighting the importance of careful monitoring and early intervention.

Risk factors of stroke in young adults: a retrospective cohort study.

Wed, 29 Apr 2026 00:00:00 +0300

Introduction: The incidence of ischemic stroke in young adults (defined by several studies as the population aged 18- 50) accounts for approximately 15% - 18% of the total number of ischemic stroke cases. Many studies have highlighted the significant impact of traditional vascular risk factors in the etiology of ischemic stroke among the young adult population.
Purpose: To assess the risk factors and causes of ischemic stroke among young adults in an institutional cohort.
Materials and Methods: A retrospective cohort study was conducted using the electronic data registry of the Institute of Neurology and Neurosurgery, by analyzing medical records of patients hospitalized with a diagnosis of ischemic stroke between October 2017 and February 2022. Predominantly traditional risk factors were analyzed in young adults with ischemic stroke.
Results: From 2056 medical records analyzed, 79 patients (3.8%) were identified as young adults, 55 males and 24 females, with an average age of 43.24 ± 7.35 [min 21; max 50]. 65 patients (82.3% of cases) were diagnosed with primary ischemic stroke, and 14 patients (17.7% of cases) with recurrent ischemic stroke. The most frequent traditional risk factors found among young adults were hypertension (75.9% – 60 patients), dyslipidemia (36.7% - 29 patients), the presence of atherosclerotic plaques (34.2% – 27 patients, of which 10 had occlusions), smoking (30.4% - 24 patients), obesity (29.1% – 23 patients), and type II diabetes (21.5% – 17 patients). 27 individuals had high total cholesterol levels, and 16
individuals had high triglyceride levels. For prevention, antihypertensive treatment was administered by only 33 patients (41.8%), antithrombotic therapy –- by 22 patients (27.85%), and lipid-lowering drugs by 8 patients (10.1%).

Conclusions: Like other studies, ours shows a high prevalence of traditional, potentially modifiable risk factors for ischemic stroke in young adults, so it highlights the need of implementation of more rigorous national prevention measures and control of risk factors, particularly for young individuals.

Performance of computer-assisted detection software in pulmonary tuberculosis screening.

Nicolai NALIVAICO — Wed, 29 Apr 2026 00:00:00 +0300

Chest X-ray examination (CXR) play an important role in the detection of pulmonary tuberculosis (TB). However, due to a shortage of radiologists and considerable inter-reader variability among human CXR interpreters, this use of radiography is limited and its performance is variable, particularly in countries with a high burden of tuberculosis. A computer-aided detection (CAD) system can overcome some of these constraints, as CAD generates a standardized interpretation of a digital CXR image that can be used to identify individuals who may benefit from further diagnostic testing. The World Health Organization (WHO) in its 2021 tuberculosis screening guidelines recommended new CAD software systems, but an increase in the number of new and updated versions of CAD products has necessitated an update of these guidelines. The Foundation for Innovative New Diagnostics (FIND) has established an independent CXR image archive and validation platform to evaluate various CAD products on the diagnostic accuracy of CAD software systems, using the FIND CXR image archive.

ARTIFICIAL INTELLIGENCE IN PULMONOLOGY: CLINICAL PERSPECTIVES AND LEGAL CHALLENGES

Constantin PISARENCO, Serghei PISARENCO — Wed, 29 Apr 2026 00:00:00 +0300

Artificial intelligence (AI) is reshaping pulmonology across diagnosis, personalized therapy, telemedicine, and outcome prediction. Deep learning accelerates interpretation of CT/MRI and chest radiographs; machine-learning models using raw spirograms, questionnaires, and digital inhalers improve early detection and exacerbation forecasting. Remote patient monitoring with wearables enables pre-emptive care, while multi-omics and digital twins open paths to precision medicine. High-risk regulatory frameworks (EU AI Act) and ethical oversight ensure transparency, safety, and human control. For Moldova, phased adoption–standards, PACS/EHR integration, AI literacy, and pilots for COPD, asthma, and tuberculosis–can reduce delays and inequities. This review synthesizes methods, governance, and pragmatic steps for trustworthy, locally adapted implementation at scale.

RADIOLOGICAL DIAGNOSIS OF TUBERCULOSIS IN CHILDREN: POSSIBILITIES AND LIMITATIONS OF THE NATIONAL PROTOCOL

Nadejda PISARENCO — Wed, 29 Apr 2026 00:00:00 +0300

Pediatric tuberculosis remains a critical public health issue, complicated by low sensitivity of microbiological methods and non-specific clinical presentations. In 2023, Moldova adopted the National Clinical Protocol PCN-55, significantly emphasizing radiological techniques such as digital radiography, computed tomography, and digital tomosynthesis. This article analyzes the strengths and limitations of these imaging methods according to national and international standards, highlighting the need for further standardization and training of radiologists to enhance diagnostic effectiveness and treatment outcomes of childhood tuberculosis within the national healthcare system.

Allergen-specific immunotherapy in allergic rhinitis: role, mechanisms, and clinical efficacy.

Corina ROTARU-LUNGU, Larisa PROCOPISHIN, Tatiana GORELCO — Wed, 29 Apr 2026 00:00:00 +0300

This paper provides an updated analysis of the available data on the clinical efficacy, safety profile, indications, and practical implementation of allergen-specific immunotherapy (AIT). The immunological mechanisms are described, highlighting the shift from a Th2-driven proinflammatory response to a tolerant immunologic profile. The role of AIT in reducing symptoms, decreasing medication use, preventing disease progression, and improving quality of life is emphasized.

PREDICTION AND PREVENTION OF COMPLICATIONS OF LONG COVID IN COPD AND ASTHMA

Serghei PISARENCO, Larisa PROCOPISHIN — Wed, 29 Apr 2026 00:00:00 +0300

Background. Patients with chronic obstructive pulmonary disease (COPD) and bronchial asthma belong to the high- risk group for severe COVID-19 and the development of long COVID.
This study aimed to assess long COVID complications in COPD and asthma patients and to substantiate preventive measures based on international data and experience of the Republic of Moldova.

Methods. A review of scientific publications from 2020–2025 was conducted, along with analysis of official reports and normative acts of Moldova, including estimates of long COVID prevalence were calculated.
Results. Pre-existing COPD and asthma increase the risk of long-term post-COVID sequelae by approximately 30– 40%. Long COVID complications predominantly include chronic dyspnea, fatigue, reduced exercise tolerance, worsened control of the underlying disease, and psycho-emotional disorders. In Moldova, tens of thousands of people are estimated to suffer from post-COVID complications, but systematic case recording is absent.
Conclusions. Implementation of key preventive measures is required: full vaccination and boosters for at-risk groups, early administration of antivirals, continuous control of COPD/asthma, as well as development of rehabilitation and monitoring programs for patients with long COVID.

NEGATIVE CARDIAC TROPISM IN PNEUMOLOGY: CLINICAL, PHARMACOLOGICAL AND PATHOPHYSIOLOGICAL ASPECTS

Serghei PISARENCO, Constantin MARTÎNIUC — Wed, 29 Apr 2026 00:00:00 +0300

Pneumology include severe pulmonary diseases, primarily tuberculosis (TB) and COPD (COPD), both of which significantly impact the cardiovascular system. This review summarizes the current evidence on the negative cardiotropic effects of these diseases and their respective treatments. Antituberculosis drugs such as Bedaquiline and Delamanid increase the risk of QT interval prolongation and arrhythmias, requiring careful cardiac monitoring. Chronic hypoxia, caused by extensive lung damage, induces pulmonary hypertension, leading to cor pulmonale and right-sided heart failure. Endogenous intoxication due to inflammatory and necrotic byproducts, together with exogenous factors such as smoking and alcohol consumption, further compromise cardiovascular function. Systemic inflammation, which is characteristic of both TB and COPD, contributes to the development of atherosclerosis and cardiac complications, independent of common risk factors. Combined pathogenetic mechanisms are common in clinical practice and complicate patient management. The results of the review emphasize the need for integrated cardiopulmonary care and regular cardiovascular assessments.

NON-MEDICAL RISKS IN THE MANAGEMENT OF PATIENTS WITH COPD AND LONG COVID SYNDROME

Serghei PISARENCO — Wed, 29 Apr 2026 00:00:00 +0300

Chronic obstructive pulmonary disease (COPD) and long COVID represent chronic conditions that significantly affect patients’ health and quality of life. Along with medical factors, non-medical risks are becoming increasingly important: social isolation, mental and cognitive disorders, advanced age, limited access to medical care and digital technologies, and low self-care ability. These factors reduce adherence to therapy, complicate the implementation of medical recommendations, and contribute to adverse outcomes. This paper analyzes their role in patient management and proposes strategies for a comprehensive approach that takes into account the social determinants of health and the biopsychosocial model of care.

NATIONAL CLINICAL PROTOCOLS IN PHTHISIOPULMONOLOGY: EVALUATION AND ENSURING QUALITY AND SAFETY

Serghei PISARENCO, Constantin PISARENCO — Wed, 29 Apr 2026 00:00:00 +0300

In the context of healthcare reform in the Republic of Moldova, national clinical protocols are becoming particularly important. Their main purpose is to standardize diagnosis and treatment, reduce medical risks, improve patient safety, and serve as a guideline for medical and forensic examinations. This study is devoted to the analysis of phthisiopulmonological protocols. It identified the most significant nosologies, assessed the frequency of protocol updates, and examined the medical and legal risks associated with the untimely revision of documents. In the Republic of Moldova, 10 protocols for adults and 14 for children have been approved. They cover diseases and conditions such as tuberculosis, pneumonia, chronic obstructive pulmonary disease, sarcoidosis, idiopathic interstitial pneumonitis, bronchiectasis, obstructive sleep apnea syndrome, smoking cessation, and a number of rare diseases. The average age of the protocols for adults is 5.7 years, which indicates the need for their accelerated revision. A medical-legal analysis has shown that untimely updating of protocols reduces their evidential value and increases the risk of liability for healthcare professionals.

TELEMEDICINE IN PHTHISIOPULMONOLOGY MOLDOVA: MEDICAL EFFECTS AND LEGAL FRAMEWORK

Constantin PISARENCO, Serghei PISARENCO — Wed, 29 Apr 2026 00:00:00 +0300

Телемедицина, понимаемая как дистанционное оказание медицинской помощи с использованием информационно-коммуникационных технологий, становится эффективным инструментом для улучшения лечения заболеваний легких. В Республике Молдова, где сохраняется высокая заболеваемость туберкулезом, хронической обструктивной болезнью легких (ХОБЛ), астмойимуковисцидозом, внедрение телемедицинских решенийспособно повысить доступность специализированной помощи, улучшить приверженность пациентов к терапии и снизить нагрузку на систему здравоохранения. В статье анализируются международные исследования, национальные нормативные акты и опыт пилотных проектов. Определены преимущества и барьеры, включая недостаточную инфраструктуру, низкий уровень цифровой грамотности, неопределенность правового регулирования и риск уголовной ответственности врачей за халатность. Предлагаются меры по совершенствованию законодательства, модернизации инфраструктуры и созданию системы страхования профессиональной ответственности.

Advancing patient safety in modern healthcare: policies, strategies, and practices.

Galina BUTA, Olga ALEXEI — Wed, 29 Apr 2026 00:00:00 +0300

Patient safety is globally recognized as a strategic priority, as medical errors remain a leading cause of preventable morbidity and mortality with major medical, ethical, social, and economic consequences. The World Health Organization estimates that in low- and middle-income countries, approximately 134 million preventable adverse events occur annually, resulting in 2.6 million deaths, while in Europe 8–12% of hospitalized patients are affected, half of these events being avoidable.

This study aims to evaluate the particularities of patient safety culture in the Republic of Moldova, compare them with European models, and formulate recommendations for strengthening the national framework. The methodology was based on a narrative review of 131 international and national sources (2000–2025), selected using SANRA criteria, with a focus on the legislative framework, public policies, and internationally validated instruments (HSOPS, MaPSaF, SAQ, MOSPSC).

The results indicate that in Moldova, the regulatory framework is fragmented: general regulations and the National Council for Health Evaluation and Accreditation (established in 2024) exist, but a dedicated patient safety law, a non- punitive incident reporting system, and mandatory training programs are still lacking. In contrast, Romania, France, and the United Kingdom have established consolidated legal and institutional frameworks based on „just culture” transparent reporting, and integration of safety into accreditation processes.

The conclusions highlight the need to adopt dedicated legislation, create a national electronic reporting registry, integrate validated instruments into periodic evaluations, and develop continuous training programs. Strengthening an organizational culture of safety is essential for Moldova’s alignment with European and international standards.

Diagnostic and management controversies in ANCA-associated interstitial lung diseases.

Diana CALARASH, Akmal SHARAF, Alexandru — Wed, 29 Apr 2026 00:00:00 +0300

ANCA-associated vasculitides (AAVs) are rare but carry major prognostic significance. Increasing evidence shows that they extend beyond vascular inflammation and frequently involve interstitial lung disease (ILD), most often with a UIP pattern, which is linked to high mortality. The issue is particularly relevant since ILD may precede vasculitis and mimic isolated pulmonary fibrosis, raising the risk of underdiagnosis. Conventional vasculitis therapies have proven ineffective in halting fibrosis and increase infection risk, while antifibrotic agents offer promise but remain insufficiently studied. The absence of clear guidelines and dedicated trials creates clinical uncertainty, making AAV-ILD an emerging field at the crossroads of pulmonology and rheumatology, where urgent research is needed and the potential to improve outcomes is considerable.

Management of patients with neurodegenerative diseases in the post-COVID-19 era: lessons learned and future directions.

Wed, 29 Apr 2026 00:00:00 +0300

Background: Neurodegenerative diseases (NDs) are progressive disorders with a major impact on autonomy and quality of life, and the COVID-19 pandemic has exacerbated their burden by limiting access to care.
Objective: To synthesize post-pandemic data and clinical experience to propose directions for optimizing the management of patients with NDs.
Methods: The study used a mixed-methods approach, combining a narrative literature review (PRISMA, PubMed/ Scopus, 2024–2025) and in-depth interviews with neurologists, patients, and caregivers at the „Diomid Gherman” Institute of Neurology and Neurosurgery, analyzed thematically.
Results: Analysis of the included articles (n=10) and interviews (neurologists n=7; patients and caregivers n=15) identified four main directions: service adaptation, social impact and isolation, changes in individual care environments, and perspectives on the healthcare system, highlighting the digitalization of consultations, the development of home- and community-based care, and persistent gaps in access to multidisciplinary management in the Republic of Moldova.
Conclusion: The findings emphasize the need to strengthen resources and standardize services to ensure equitable, patient-centered management of NDs in the post-pandemic period.

Respiratory recovery in post-COVID-19 syndrome.

Paraschiva POSTOLACHE, Vlad-Florin OIEGAR, Constantin GHIMUSH — Wed, 29 Apr 2026 00:00:00 +0300

Post-COVID-19 syndrome represents a complex clinical entity characterized by the persistence of symptoms for at least two months after the initial SARS-CoV-2 infection. This multisystemic condition involves respiratory, cardiovascular, neurological, and psychological dysfunctions, generating a significant impact on patients’ quality of life. The present article examines the pathogenic mechanisms involved, including immune dysregulation, viral persistence, intestinal dysbiosis, and endothelial dysfunction. Diagnostic modalities and symptom severity assessment are also presented, with emphasis on the importance of respiratory function tests, exercise capacity evaluation, and quality of life assessment. Pulmonary rehabilitation, as the cornerstone in the management of post-COVID-19 syndrome, is detailed, highlighting the role of physical training, breathing techniques, and multidisciplinary support. In addition, specific aspects of post- COVID-19 interstitial lung disease (PC-ILD) and related therapeutic strategies are discussed. The article highlights the need for an individualized approach and careful monitoring of patients to optimize outcomes and improve prognosis.

The role of serum biomarkers in predicting futile recanalization and functional outcome in patients with ischemic stroke undergoing mechanical thrombectomy.

Wed, 29 Apr 2026 00:00:00 +0300

Introduction: Despite the technical success of mechanical thrombectomy (MT) in patients with acute ischemic stroke due to large vessel occlusion, over 60% of patients remain with poor functional outcomes (“futile recanalization”). Early identification of high-risk patients represents a clinical priority.
Objective: To provide a narrative review of the literature regarding the predictive value of serum biomarkers (inflammatory, hemostatic, and blood–brain barrier integrity markers) for futile recanalization and neurological outcomes. Materials and methods: A narrative literature review was conducted using the PubMed database, employing both free keywords (“ischemic stroke,” “thrombectomy,” “biomarkers,” “prediction”) and corresponding MeSH terms, covering
the period 2016–2025. A total of 2.043 publications were identified, with 46 studies included in the final analysis.

Results: C-reactive protein and the neutrophil-to-lymphocyte ratio were found to be independent predictors of 3-month mortality and disability after MT. D-dimers and thrombocytopenia were associated with poor prognosis, while MMP-9, S100B, and NfL provided information on blood–brain barrier disruption and neuronal injury, with variable prognostic significance. Integrating these biomarkers into a multiparametric panel may enhance risk stratification accuracy.
Conclusions: Serum biomarkers may complement clinical and imaging parameters, providing a valuable tool for identifying patients at high risk of futile recanalization and for developing personalized therapeutic strategies.

Hemothorax. Algorithm of treatment tactics

Rafic KERIMOV, Rashid GULIEV — Wed, 29 Apr 2026 00:00:00 +0300

The article focuses on the diagnosis and treatment of hemothorax. It discusses major causes (traumatic, spontaneous,
iatrogenic), therapeutic approaches, and surgical indications. Emphasis is placed on early chest tube drainage, video-assisted
thoracoscopic surgery (VATS) in stable patients, and thoracotomy in unstable cases. The role of antibiotic prophylaxis and
intrapleural fibrinolytic therapy in reducing complications is highlighted. Timely diagnosis and individualized strategies
decrease mortality and improve outcomes.

THE ROLE OF MICRO-RNA IN HEART FAILURE

Wed, 29 Apr 2026 00:00:00 +0300

Introduction. Micro-RNAs (miRNAs) are small RNA molecules that play an important role in the gene expression controlling in eukaryotic cells. Currently, circulating miRNAs are considered potential diagnostic biomarkers and therapeutic targets for cardiovascular diseases, including heart failure (HF).
Materials and Methods. A literature review of the last 10 years was conducted, using 30 bibliographic sources, including those from the “Nicolae Testemițanu” USMF Scientific Medical Library and electronic libraries such as PubMed, Elsevier, Cambridge Journals Online, Hinari, Medline, and MedScape and the American Physiological Society Journal.
Results. A number of studies have estimated the major role of miRNAs in the diagnosis and treatment of HF. Increased expression of miR-21, miR-182, miR-122, has been observed in the plasma of patients with heart failure. The prognostic value of miRNA-182 was found to be superior to that of natriuretic peptide and high-sensitivity C-reactive protein in HF. Increased expression of miR-30d acts as a “protective factor” against hypertrophy and tumor necrosis factor-α- mediated apoptosis. At 33 days post-ischemia/reperfusion injury, hearts treated with antimiR-21 showed reduced cardiac fibrosis and hypertrophy, along with improved regional and global cardiac function. The treatment with CDR132L led to a significant reduction in cardiac remodeling, as evidenced by a decrease in the left ventricular end-systolic volume and left atrial volume on magnetic resonance imaging (MRI), along with attenuation of myocardial interstitial fibrosis and cardiomyocyte size on histological examination.
Conclusions. miRNAs play a key role in regulating molecular processes involved in heart failure development and progression, such as cardiac hypertrophy, fibrosis, apoptosis, and inflammation. The dysregulation of specific miRNAs contributes to disease progression and deterioration of cardiac function. Identifying specific miRNAs as biomarkers and therapeutic targets provides promising opportunities for the development of more effective treatments and early diagnostic methods in heart failure.

Correlation between gastroesophageal reflux disease, obstructive sleep apnea syndrome and cognitive decline.

Wed, 29 Apr 2026 00:00:00 +0300

Introduction. Gastroesophageal reflux disease (GERD) affects approximately 10–40% of adults worldwide, while obstructive sleep apnea (OSAS) has an estimated prevalence of 9–38% in the adult population. The coexistence of these two conditions occurs in approximately 40–60% of cases and is associated with subtle cognitive impairments in over 50% of affected individuals, impacting memory, attention, and executive functions.
Materials and Methods. The study included 30 GERD patients who were consulted or treated at the Clinical Hospital of Rehabilitation and Chronic Care, Chișinău. OSAS risk was assessed using the STOP-Bang questionnaire, and cognitive function was evaluated with the AD-8 questionnaire. In parallel, a literature review of publications from 2015–2025 was conducted to integrate recent data regarding the prevalence, mechanisms, and interactions between GERD, OSAS, and cognitive impairment.
Results. In our study (n=30, mean age 59.7 years, 60% women), 83% of patients with GERD had intermediate or high risk of obstructive sleep apnea (STOP-Bang ≥3), and 60% had AD-8 scores ≥2, suggestive of cognitive decline. BMI (body mass index) was strongly correlated with abdominal circumference (r=0.71), while STOP-Bang correlated with weight (r=0.59) and neck circumference (r=0.55). Age was moderately associated with AD-8 scores (r=0.32).
Conclusions. Integrated screening of GERD patients for OSAS and cognitive impairment using STOP-Bang and AD-8 enables early identification of high-risk individuals. Neurological consultation is essential to differentiate cognitive deficits secondary to fragmented sleep from neurodegenerative disorders. Multidisciplinary management can improve sleep quality, reduce digestive symptoms, and prevent cognitive decline.

The role of bronchoscopy in the diagnosis of patients with сhronic obstructive pulmonary disease and gastroesophageal reflux disease.

Mihaela STOICA, Ecaterina MUNTEANU, Oxana SARBU, Valeriu ISTRATI — Wed, 29 Apr 2026 00:00:00 +0300

Introduction. Chronic Obstructive Pulmonary Disease (COPD) and Gastroesophageal Reflux Disease (GERD) are frequently associated conditions, each potentially exacerbating the other. Literature data indicate that the prevalence of GERD in patients with COPD ranges from 17% to 78%, depending on the diagnostic method used. Bronchoscopy and bronchoalveolar lavage (BAL) provide valuable information, alongside other essential investigations, for assessing the impact of GERD on COPD.
Materials and Methods. A literature review was conducted using the PubMed, Scopus, Google Scholar, and HINARI databases, employing keywords such as “GERD,” “COPD,” “bronchoscopy,” “bronchoalveolar lavage (BAL),” and “diagnosis,” covering publications from 2017 to 2025.
Results. Flexible bronchoscopy revealed hyperemia, edema, and bronchial remodeling, with mucopurulent secretions in patients with COPD and GERD. Cytologically, BAL showed increased neutrophils and eosinophils; immunocytologically, a decreased CD4/CD8 ratio and the presence of B lymphocytes and NK cells were observed; markers of gastroesophageal microaspiration such as pepsin, gastrin, bile acids, IL-6, IL-8, TNF-α, and NO were also detected. Literature data indicate that testing for H. pylori is associated with inflammation and irritation of the esophageal and bronchial mucosa, findings also evident in BAL, contributing to COPD severity and the presence of GERD.
Conclusions. Bronchoscopy and BAL are essential tools for evaluating patients with COPD and GERD, providing direct or indirect evidence of gastroesophageal reflux microaspiration. These findings enable personalized patient management, reduction of exacerbations, and improvement in quality of life.

Gastric bronchogenic cyst: review of literature.

Elena PLEŞCO, Dumitru CAZACU, Igor MISHIN — Wed, 29 Apr 2026 00:00:00 +0300

Bronchogenic cyst represents rare congenital malformation, usually is benign, predominantly affecting of female. Currently, etiology and mechanism of this pathology remain fully unclear. In the majority of cases the pathology is asymptomatic or has minor symptoms. Despite the use of high-performance investigations, definitive preoperative diagnosis remains a challenge due to the absence of pathognomonic signs. Surgical treatment with complete removal of gastric bronchogenic cyst represents the most effective approach for these patients.

Thoracic splenosis.

Elina SHOR, Vadim GHEORGHIȚA, Igor MIȘIN — Wed, 29 Apr 2026 00:00:00 +0300

Thoracic splenosis is a rare pathology that develops as a result of autotransplantation of splenic tissue into the thoracic cavity following splenic and diaphragmatic injury. It is mostly asymptomatic and is incidentally diagnosed using regular chest radiography or thoracic computed tomography. Iinvestigation with ⁹⁹ᵐTc scans can identify splenic tissue quite accurately may prevent an unnecessary and potentially harmful operation.

Advances in implantable technologies used in auditory rehabilitation of patients with severe and profound hearing loss.

Sergiu VETRICEAN, Radu-Dorin LUNGU — Wed, 29 Apr 2026 00:00:00 +0300

In cases of severe or profound hearing loss, conventional hearing aids become ineffective, requiring advanced
implantable solutions such as cochlear implants, auditory brainstem implants, electro-acoustic hybrid systems, and boneanchored hearing systems. Innovations - from atraumatic electrodes and sound processors with artificial intelligence
algorithms to robot-assisted insertion - have improved sound perception, surgical success rates, and social integration,
outlining new directions for personalized auditory rehabilitation and the rapid integration of emerging technologies into
clinical practice.

Management of Epistaxis in ENT Emergencies – Therapeutic Approach, Intervention Tactics, and Particularities in Epistaxis Associated with Chronic Alcoholism.

Wed, 29 Apr 2026 00:00:00 +0300

Epistaxis represents one of the most common ENT emergencies, with a variable clinical spectrum and a significant impact on medical practice. The main risk factors include hypertension, nasal trauma, the use of anticoagulants, and systemic conditions, which influence both the severity and recurrence of bleeding episodes. In the context of chronic alcoholism, liver damage, coagulopathy, thrombocytopenia, and vascular fragility contribute to more severe, recurrent hemorrhagic episodes that are difficult to control through conventional methods. Therapeutic management requires a stepwise, multidisciplinary approach, integrating both standard ENT measures and the correction of associated systemic disorders. This review summarizes current data on epidemiology, risk factors, and treatment strategies, with an emphasis on the specific features of patients with chronic alcoholism.

Laryngeal Precancerous Lesions: From Screening to Therapeutic Intervention.

Wed, 29 Apr 2026 00:00:00 +0300

Precancerous lesions of the larynx, including leukoplakia, erythroplakia, epithelial dysplasia, and recurrent papillomatosis, carry a variable risk of progression to squamous cell carcinoma and represent a critical point in laryngeal cancer prevention. The aim of this article is to synthesize current data on etiopathogenesis, screening, early diagnosis, and treatment options. The methodology consisted of a narrative review of the recent literature and international guidelines. The results show that the risk of malignant transformation depends on the degree of dysplasia (3–10% in mild cases, up to 35–40% in severe dysplasia). Modern endoscopic technologies, such as narrow band imaging and autofluorescence, improve diagnostic accuracy, while endoscopic excision with CO₂ or KTP laser remains the therapeutic standard. Emerging therapies—including photodynamic therapy, antivirals, antiangiogenic agents, and HPV vaccination—offer promising perspectives in reducing recurrences.

In conclusion, the management of precancerous laryngeal lesions must be multidisciplinary and personalized, while the integration of molecular biomarkers and modern technologies provides future directions with significant impact on patient prognosis.

The use of autologous septal and auricular cartilage transplants in nasal reconstructive surgical procedures.

Victor OSMAN, Vitalie OSMAN, Viorel NACU, Ana-Maria CHIRIAC — Wed, 29 Apr 2026 00:00:00 +0300

Surgical interventions for nasal reshaping have significantly increased in popularity in recent years. An important aspect of these procedures is the use of autologous transplants, particularly cartilage derived from the nasal septum and auricular pavilion. The study aims to analyze the use of autologous septal and auricular cartilage in rhinoplasty, with the purpose of providing an updated and comprehensive database on these practices in aesthetic and reconstructive surgery. The study included an exhaustive bibliographic review of 51 sources obtained from platforms such as Medlife, PubMed, Google Scholar, and ResearchGate. The selection criteria included articles in English, Romanian, and Russian, published between 2000 and 2024, that provided relevant data on the use of autologous cartilage in rhinoplasty. The reviewed studies showed that the most commonly used type of cartilage transplant in rhinoplasty and rhino-septoplasty is autologous septal cartilage, due to its availability and favorable biological characteristics. The results indicate that autologous cartilage transplants are effective in correcting tissue deficiencies and adjusting the nasal tip. The main advantage of these transplants is that they are biocompatible, do not resorb, and do not cause adverse reactions, unlike other types of transplants, such as costal cartilage. The use of autologous transplants, particularly septal and auricular cartilage, is an effective and safe method in modern rhinoplasty. These transplants are preferred due to their favorable integration and lack of inflammatory reactions.

The Evolution of Acute Cerebrovascular Disease Patient Management in the Post–COVID-19 Period: A Systematic Review.

Wed, 29 Apr 2026 00:00:00 +0300

Stroke represents a major public health issue, causing millions of deaths annually and generating a significant burden in terms of disability. The COVID-19 pandemic profoundly influenced the management of patients with acute stroke, leading to reduced hospital admissions and delays in therapeutic procedures. Studies have shown a decrease in thrombolysis and thrombectomy during the early months, as well as prolonged critical intervals such as “onset-to-door” and “door-to-CT,” mainly due to epidemiological measures and the mandatory use of protective equipment.

In the post-pandemic period, healthcare systems have adapted their protocols, with some being maintained and others discontinued. Recent data indicate improvements in “door-to-needle” times and more efficient clinical workflows. At the same time, the persistence of post-COVID vascular risk complicates patient outcomes, as SARS-CoV-2 infection has been shown to double cardiovascular risk up to three years after the acute episode, with vaccination significantly mitigating these adverse effects.

Innovative methods, such as rapid tests for detecting large vessel occlusions and the expansion of telestroke networks, are modernizing therapeutic strategies. The systematic review of literature published between 2020–2025 highlights regional variability in service organization but also demonstrates a clear trend toward improved efficiency in the post-pandemic era. Conclusions emphasize the need to strengthen telemedicine, standardize protocols, and minimize therapeutic delays to optimize outcomes for stroke patients.

Непрерывное обучение медсестер имеет первостепенное значение в предоставлении качественных медицинских услуг.

Wed, 29 Apr 2026 00:00:00 +0300

Introduction. In this scientific work, the author states that over time, the social, cultural, economic and political dimensions have been analyzed, while the prospective dimension of education based on both initial training and continuing education has been less studied.
Purpose of the study. To develop and approve a relevant experimental program model in the prospective continuing education of nurses focused on health education of the population in the community.
Research methodology. It consists of: 1. Theoretical methods: analysis, synthesis, comparison, generalization, systematization of pedagogical and medical concepts and phenomena 2. Experimental methods: pedagogical experiment;
Empirical methods: observation, investigation, questionnaires. 4. Data interpretation methods: mathematical and statistical analysis and processing of experimental results.

Results and conclussions. Prospective education refers to the design, organization and structuring of instructional- training approaches in accordance with the defining features of the future society.

Stages of training and research within the „Nicolae Testemiţanu” department of social medicine and health management – 80 years after its founding.

Wed, 29 Apr 2026 00:00:00 +0300

Introduction. The paper describes the historical period from 1945 to the present of the scientific research carried out by the staff of the Department of Social Medicine and Health Management “Nicolae Testemițanu”, which includes the following scientific directions: scientific research results, participation in various scientific forums.
The purpose of the paper. It is to estimate the scientific developments carried out by different leaders of this department during this period of time, which included the issues of Public Health, management and organization of medical assistance to the rural population in different stages of development of society.
Materials and methods. a cross-sectional study of the research carried out within the Department of Social Medicine and Health Management “Nicolae Testemițanu” during the period 1945 to the present was carried out. The primary materials served as reports, laws, orders approved by the Ministry of Health during this period.
Results and discussions. Social Medicine is a branch of medicine that deals with the study of the health status of the population and the determining factors that influence it, based on several objectives and methods of statistical, experimental, historical, economic, sociological, epidemiological investigation, oriented towards the scientific argumentation of the priority directions for the development of the health system in the Republic of Moldova.