8 articles
The COVID-19 pandemic has posed the biggest challenge to the global health system. Kidney damage is common in COVID-19 and ranges from mild proteinuria to severe acute kidney injury.
Objective. The aim of the study was to establish the dynamics of COVID-19 in patients who develop acute kidney injury and to identify risk factors for developing acute kidney injury associated with COVID-19.
A retrospective descriptive study was conducted, including 40 patients of both sexes, aged between 37 and 88 years, who were admitted to the intensive care unit of the Timofei Moșneaga Republican Clinical Hospital during the period 2020-2022. Statistical analysis was performed using the Student’s t-test.
The most common factors identified as determinants were advanced age, comorbidities, mechanical ventilation, and nephrotoxic drugs. The presence of proteinuria, hematuria, and leukocyturia was identified. Urea and creatinine levels were elevated on admission and continued to rise; 10% of patients required renal replacement therapy. It was observed that the greater the degree of lung damage, the earlier mechanical ventilation was instituted, which could lead to the development of early acute kidney injury. All patients were mechanically ventilated and developed acute kidney injury, contributing to a severe course of COVID-19.
Acute kidney injury is one of the most frequent and severe complications encountered among mechanically ventilated patients with severe forms COVID-19 and is often associated with a fulminant course and a high mortality rate.
Detrusor overactivity has been detected in approximately 50% of women with overactive bladder symptoms. According to the NICE guidelines, urodynamic testing is mandatory confirm the diagnosis of detrusor overactivity before performing minimally invasive treatment.
This study retrospectively analyzes 76 women, categorized into two groups based on age: reproductive age (n = 49) and climacteric period (n = 27), referred to the Timofei Moșneaga Republican Clinical Hospital between 2022 and 2024 for symptoms of overactive bladder. The research focused on physical examination, questionnaires, bladder diary, urinalysis, and urodynamic measurements before and after botulinum toxin type A injections in 30 patients with overactive bladder refractory to first-line therapy.
In women with overactive bladder, the reproductive group was as follows: moderate problems (51%) > very severe problems (31%), severe problems (18%) (p = 0.02); in the group of women in the climacteric period: severe problems (48%) > very severe problems (37%) > moderate problems (15%) (p = 0.10). Based on urodynamics data, the diagnosis of overactive bladder with detrusor overactivity was confirmed by establishing the presence of phasic contractions of the detrusor (3.9 ± 1.15), increased values of detrusor pressure (45.9 ± 23.9 cmH2O) and reduced bladder compliance (10.4 ± 11.4 ml/cmH2O). In 100% of cases, these findings predicted an effective botulinum toxin type A injection. Daytime urinary frequency, nocturia, and urinary urgency scores improved significantly after botulinum toxin type A injection by 41.7%, 26.1% and 34.1%, respectively.
The study revealed age differences in overactive bladder symptom severity between the women in both groups. The reproductive period group experienced moderate complications, while the climacteric period group had more severe complications. Administration of botulinum toxin type A through detrusor injection has been shown to be efficacious in the management of overactive bladder.
Upon reaching the distinguished age of 70, Professor Victor Botnaru remains an emblematic figure in the field of medicine in the Republic of Moldova. A Habilitated Doctor in Medical Sciences, Professor Botnaru has devoted his entire life to research, education, and the advancement of medical practice, contributing significantly to the progress of pulmonology and internal medicine. Born on July 6,
Medicine is a fascinating field that demands sacrifices. Those who are passionate about this profession devote their entire lives to studying for the benefit of human health and conducting profound research, so that later their scientific contributions may be reflected in innovation and medical practice. One such individual is Professor Nicolae Fruntașu, who turns 90 and who, alongside his teachin
Introduction Ion Ababii, doctor habilitatus in medical sciences, university professor, academician of the Academy of Sciences of Moldova (ASM), former head of the Department of Otorhinolaryngology and rector of the Nicolae Testemițanu State University of Medicine and Pharmacy from the Republic of Moldova (Nicolae Testemițanu SUMPh), former Minister of Health and Social Protection of the Republic o
COVID-19 was initially considered a predominantly respiratory infection, with mortality associated with progression of respiratory failure, but currently is recognized as a multisystem disease with a wide range of manifestations. One of the most common complications of COVID-19 is acute kidney injury (AKI), which predominantly evolved to chronic kidney disease (CKD). The objective of the study was to investigate the types of acute kidney injury and their prognostic value in hospitalized patients with COVID-19 with evolution to chronic kidney disease.
The study utilized a comprehensive database of patients admitted to general department of COVID-19 at Timofei Moșneaga Republican Clinical Hospital from 2020 to 2022 years (in total 1000 patients). The first part of the study was a retrospective study, focusing on patients with confirmed COVID-19 and lung injury was diagnosed by computer tomography. The second part was a prospective study assessing the prognostic value of inflammatory markers, renal functional status and kidney injury.
AKI occurs in 29.6% of patients with COVID-19. The risk of AKI and CKD is higher in patients with more comorbidities, a more severe course of disease, elevated levels of ASAT/ALAT > 1.6 and hematuria at admission, which significantly increases the risk of progression to CKD. Patients with a history of CKD, and who had ASAT > 40 U/L, ASAT/ALAT > 1.6 and hematuria, experience the onset of AKI before hospitalization. Independent negative predictors of hospital-developed AKI include hypertension, Charlson Comorbidity Index > 4 points, respiratory failure, ASAT/ALAT > 1.6, D-dimers > 250 ng/ml, and hematuria. Hospital mortality in patients with COVID-19 was 20.8%, compared to 8.5% in patients without AKI, and this rate increased to 50% when AKI developed (p < 0.001).
Patients who developed AKI during admission had a higher incidence of negative outcomes compared to those with AKI prior to admission. Independent predictors of in-hospital mortality in COVID-19 patients were increased serum CRP. Death in hospitalized patients with COVID-19 and AKI was independently associated with factors such as age > 75 years, history of CKD, admission to Intensive Care Unit, leukocytosis, and ASAT/ALAT > 1.6.
Overactive bladder (OAB) is a common and chronic complex of symptoms that increases in prevalence with advancing age and has a known adverse effect on the quality of life. OAB is a highly prevalent condition affecting 16.6% people from Europe. Women are more commonly affected, and there is an increased incidence with age. Studies in the United States suggest a prevalence of up to 43% in women. The use of urodynamics in the diagnosis of OAB remains controversial. Although it is a gold standard diagnostic test for detrusor overactivity, it is an invasive procedure and therefore should be limited to those with refractory OAB.
A prospective and randomized study was performed in 60 patients with OAB symptoms who followed behavioral therapy without any effect. The study cohort was divided in two groups. 30 patients (group A) with the mean age of 40 years were treated without a prior urodynamic study, and 30 patients (group B) with a mean age of 41.5 years with overactive detrusor, underwent a urodynamic testing prior to pharmacotherapy based on EAU guidelines that recognize the benefit from addition of Mirabegron 50 mg/day to Solifenacin 5 mg/day, and on the AUA guidelines that recommends combination therapy in patients with OAB. The study was performed during 2019-2022, at the Department of Urology and Surgical Nephrology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova.
The success rate (61%) in the group A of patients was lower than in group B (81%). The proportion of patients who had urge urinary incontinence (UUI) (OAB wet) rather than frequency-urgency (OAB dry) in this series was high (50%), and this may have been a significant factor in our success rate. According to the results of the questionnaire, the clinical manifestations have improved after treatment, however in 50% of cases of urinary frequency and in 20% of urinary urgency remained unchanged. The symptomatology and urodynamic did not display different behavior between the groups. The mean post-treatment score for group A was 11.7 ± 3.27 and for group B was 15.32 ± 2.14. Ten subjects (8 receiving pharmacotherapy from group A and 2 from group B) presented with adverse events. The most frequent reported adverse events were dry mouth (15%), dyspepsia (6%), and headache (9%). Other than dry mouth, no adverse event occurred in >10% of subjects.
Urodynamics can influence the treatment decisions in determining treatment pathways in women presenting with OAB. Women treated based on UDS diagnoses appear to have greater reductions in symptoms than those who do not.
The aim of study was to establish if the treatment of overactive bladder in women and its result reported by patients were different depending on the findings of urodynamics, performed before botulinum toxin injection. We obtained clinical data based on the necessity and importance of performing urodynamic tests up to surgical treatment with botulinum toxin A injection in detrusor muscle, at patients diagnosed with idiopathic overactive bladder and detrusor overactivity, offering a guarantee of an effective and long-lasting treatment and assure with predictive parameters for some postoperative complications.
The research was carried out at the Department of Urology and Surgical Nephrology, during the years 2019 – 2022. After applying the inclusion and exclusion criteria, 36 women diagnosed with overactive bladder were enrolled in the prospective pilot study, aged between 18 and 70 years, refractory to drug treatment and investigated urodynamic by excluding/including the presence of detrusor overactivity and clinically using voiding diary/24h, bladder symptoms and Quality of Life questionnaires before and after botulinum toxin A injection. The primary data were analyzed and presented as a mean and standard deviation.
All women involved in the study were diagnosed clinically and urodynamic with overactive bladder, of which 55.5% of cases were associated with detrusor overactivity and subsequently received BTX-A injectable surgical treatment with a dose of 100U. At urodynamics, the low values of the indices obtained at cystometry were established: first sensation of bladder filling (79.8±56.3 ml), first desire to void (117.8±103.2 ml), strong desire to void (162±125 ml) and maximal cystometric capacity (183.4±139.8 ml), which correlated in 100% cases with OAB symptoms (urinary urgency, frequency and nocturia) from the OABSS validated questionnaire. The capacity of the bladder at each sensation was lower, being inversely proportional to the detrusor overactivity present in women with OAB. Based on UDS data, the diagnosis of OABi with detrusor overactivity was confirmed by establishing the presence of phasic detrusor contractions (3.9±1.1), increased values of detrusor pressure (45.9±23.9 cmH2O) and the presence of bladder hypocompliance (10.6±11.5 ml/cmH2O), these data in 100% of cases predicted an effective BTX-A injection. Daily activity and psychosocial behavior improved after intradetrusor botulinum injections toxin was influenced by reducing daytime urination from 28% to 40% and urinary urgency from 30 to 69%.
This study identified a number of statistically significant urodynamic variables associated with objective clinical data, which confirm the impact of severity of idiopathic overactive bladder symptoms and the subsequent effect of botulinum toxin type A injections in case of urodynamic confirmation of detrusor overactivity presence.