Introduction

Cholestatic jaundice installed in gallstones is considered a multifactorial pathogenetic process. The correlation of endogenous hepatic intoxication with the reaction of the pro- and antioxidant system, characteristic of various complications of gallstones associated with cholestatic jaundice, remains an undefined subject.

Material and methods

The study included the investigation of 105 patients with complicated gallstones and associated cholestatic jaundice, and the control group – 35 patients with uncomplicated gallstones. The age of the patients varied between 51 and 72 years, with an F/M ratio of 3/1.

Results

The degree of endotoxemia, assessed at hospitalization by peptides with average mass values, was consistent with the inflammation present in groups 2 and 3, reporting a statistically significant difference compared to the control group [p c/2 < 0.001 (t = 11.1); p c/3 < 0.001 (t = 11.07)]. DAM, as the final product of lipid peroxidation, evaluated at hospitalization, shows double marked values in all groups compared to the control group [p < 0.001 (t = 10.7); (t = 10.9); (t = 16.5)]. The antioxidant activity, assessed at hospitalization, shows a statistically significant decrease in superoxide dismutase values [p < 0.001 (t = 6.4); (t = 4.1); (t = 5.7)], as well as catalase [p < 0.001 (t = 6.7); (t = 5.6); (t = 7.2)] in all groups, by 30-40% compared to the control group.

Conclusions

In established cholestatic jaundice, there is an obvious activation of lipoperoxidation processes, contributing to the increase of endogenous intoxication and early suppression of antioxidant activity. There is a direct relationship between the increase in prooxidant activity and the level of endogenous intoxication in all complications of gallstones associated with cholestatic jaundice, but it is more elevated in infectious complications, indicating a need for an early approach.

Introduction

In attempt to find an answer regarding the possible scenarios of epilepsy evolution in women of reproductive age (e.g. worsening, remission, antiepileptic drug resistance, status epilepticus occurence), preferably - objective, based on simple, replicable, observable indicators that can be included in a mathematical probability estimation model, could significantly improve their quality of life and increase the effectiveness of prescribed treatments.

Materials and methods

Bidirectional, cohort, descriptive-analytical study, conducted between 2016-2020. Primary data were collected in the Diomid Gherman Institute of Neurology and Neurosurgery, the State Hospital of Republic of Moldova and the Excellence Private Medical Institution. Out of 366 unique parameters, which were recorded in the 159 patients enrolled in the study at each visit (total, 4 documentation visits over 5 years period), 10 parameters were selected for multivariate analysis, considered relevant for predicting clinically significant outcomes. Criteria for parameter relevance were: reaching p≤0.1 in univariate analysis, easy documentation. Subsequently, testing for multicollinearity (calculation of variance inflation factor) and the contribution of each parameter in the formula was performed using the Akaike informativeness criteria. The performance of the developed predictive models was expressed by the area under the ROC curve, positive and negative prognostic power. Statistical analysis: GraphPad Prism, v. 9 trial (Graph Pad Software, Boston, USA).

Results

Age at onset of the disease 14.0±6.3 years; age at first referral to specialist 24.0±7.2 years. The developed predictive model, based on 3 parameters (depressive state, annual frequency of seizures, presence of brain lesions on MRI) has a positive predictive value of 83%, negative  of 62%, with an area under the ROC curve of 0.72 (95%CI = 0.56 to 0.88) and a probability of occurrence of 96%.

Conclusions

Depressed patients with documented structural lesions on MRI and a high frequency of epileptic seizures have a progressive, significant risk (an OR of 5.3-24.0) of developing resistance to antiepileptic drugs.

Introduction

The description of clinical manifestations of parasitic infestation includes joint damage manifested by arthralgia and arthritis, however, until today; the form of joint damage in parasitic infections is not clinically defined. The multitude of parasites creates a heterogeneous joint involvement, and the intensifying of specific manifestations would be an important premise in clinical diagnosis.

Objective

Assessment of immunological changes in the context of parasitosis and their ratio depending on the clinical variant of parasitic arthritis.

Material and methods

A group of 161 patients with parasitic arthritis was selected, established in two stages of compliance according to specific and serological criteria. The average age was 47.0±2.1 years, 72 men / 89 women. The average duration of joint syndrome was 50.4±15.6 months. The first group (97 patients) had parasitic arthritis of echinococcosis infestation, the 2nd (31 patients) – parasitic arthritis of Toxocara cannis and the 3rd (33 patients) had  parasitic arthritis of Giardia lamblia infestation.

Results and discussion

IgA was increased above normal in all patients with parasitic arthritis (4.25±0.001; p < 0.001). IgM showed significant changes, depended on infestation agent (p < 0.05). Patients with normal IgG levels predominated, except for patients from the group with echinococcosis parasitic arthritis (p > 0.05). The amount of IgE exceeds normal values in Echinococcus parasitic arthritis (38.40 ng/ml), Toxocara canis (34.16 ng/ml), Giardia lamblia (45.06 ng/ml).

Conclusions

This suggests that the key aspects of immunity against parasites are mainly determined by the size of the harmful organisms that the immune system needs to combat. Macroorganism includes unique defense mechanisms that can be effective against multicellular helminths: high production of IgA and IgE and activation of key effector cells – eosinophils.

Introduction

Spinal Muscular Atrophy (SMA) is a genetic disorder caused by the loss of the survival motor neuron (SMN1) gene in over 95% of cases. Additionally, mutations in genes associated with the SMA chromosomal region can influence disease progression. Aim: To analyze the status of the NAIP and GTF2H2 genes in correlation with SMA.

Material and methods

The study included 105 patients suspected for SMA of which 50 with confirmed with SMA and 55 without causative deletions, and 107 healthy, unrelated individuals. The molecular genetics methods used were mPCR, PCR-RFLP and MLPA.

Results

From 105 patients, 50 were confirmed with SMA. In this group were identified in 8 patients (16%) with a homozygous deletion of exon 5 of the NAIP gene, 4 patients (8%) had a heterozygous status, and 2 (4%) had duplications. In the rest of the patients (55), in which deletions of SMN1 exon 7 were not identified, homozygous deletion of exon 5 of the NAIP gene was established in one patient (2%), 3 patients (5%) had duplications of exon 5 of the NAIP gene, and one patient had 5 copies of the NAIP gene. In the 107 healthy controls, one patient (1%) was identified with a deletion of exon 5 of the NAIP gene. None of the patients with combined deletions of SMN1 and NAIP had deletions in GTF2H2. 

Conclusions

The frequency of deletions in the NAIP gene was found to be higher in the SMA patient group compared to the control group. Thus, a significant relationship was identified, the P value being <0.00001. The significance threshold was set at p<0.05. The genetic patterning of genes associated with SMA is an important aspect in the study of molecular pathophysiology and assessment of disease prognosis, especially in the approach to gene therapies.

Introduction

Intestinal anastomosis dehiscence has been and remains a critical problem in modern colorectal surgery, associated with significant morbidity and mortality. Currently, there are various studies focused on the development of a method to protect intestinal anastomosis. The new method with the use of biological substances is the local application of platelet-rich plasma.

Material and methods

The experimental study included 42 rats, which were divided into two groups. Group 1 – application of unprotected colon anastomosis (n = 21); group 2 – local application of platelet-rich plasma on the colon anastomosis (n = 21). 37 patients were included in the clinical study, who underwent colon anastomosis. The patients were divided into 2 groups: group I (n = 16) had unprotected colon anastomosis and group II (n = 21) - protected anastomosis with platelet-rich plasma.

Results

It was experimentally proven that platelet-rich plasma does not aggravate the adhesion process and actually increases significantly the mechanical resistance of colon anastomosis. Microscopical examination demonstrated the acceleration of regenerative processes, in particular, angiogenesis and fibrillogenesis. The clinical study showed significant improvement of the postsurgical results – absence of colon anastomosis dehiscence in cases where local application of platelet-rich plasma was used. 

Conclusions

A statistically significant increase in dehiscence pressure of the anastomosis at 3rd, 7th and 8th day after surgery was noticed in group 2 vs. group 1. Using platelet-rich plasma does not influence significantly the process of abdominal adhesion, leads to increased regeneration process in the anastomosis area, especially neogenesis and fibrillogenesis (p < 0.5). Using platelet-rich plasma significantly improves the post-surgical results.

Introduction

Placentation and autochthonous vascularization during the early period of intrauterine development in primary placental insufficiency are important stages in the establishment of embryo-haemochorial circulation. Vascular and angiogenesis dysfunctions in the early period of gestation are essential in the development of changes in placental vascular status with severe repercussions on pregnancy outcome in the first trimester of gestation.

The purpose of the work

Evaluation of vascular density by the application of the anti-CD31 antibody in the chorio-villar germinal site in short-term dysregulated pregnancies.

Material and methods

184 cases were divided into 2 groups: stagnant pregnancies (SP (L1 = 144 cases) and early spontaneous abortion (ESA) (L2 = 40 cases). Control material: pregnancies resolved at social indications/desire (A) (n = 18) distributed according to gestational term (3-5 weeks), (6-9 weeks), and (10-12weeks). The estimation of the histomorphological features was performed by applying the classical conventional method with hematoxylin-eosin (H.E.), and the immunohistochemical evaluation of the vascular density in the chorio-villar profile with the help of the endothelial marker anti-CD31. The statistical relationships between fetal conceptus assessment forms, gestational term, and age were analyzed.

Results

Distribution of pregnancies by profile: (SP) – 78.2% vs (ESA) – 21.8%, with vascular disturbances attested in 100% of cases by increasing the density of avascular chorionic villi in the case of stagnant pregnancies in 75% of cases. The application of immunoexpression with anti-CD31 at the level of the stroma of the chorionic villi determined PVI with a maximum mean in the control group (91.51±0.71) vs the ESA and SP groups (82.29±12.96 and 57.47±6.53, respectively). The index of vascularization with lumen (IV/L+) and vascularization index without lumen (IV/L-) were statistically significantly different (p = 0.011) for (SP). Applying the student t-test revealed statistically significant differences for PVI in most groups, except PSD vs SP at the age of 10-12 gestation of weeks (w.g.) At the same time, there are statistically significant differences between the means of vessels with lumen within PSD and SP (t31 = 5.500, p = 0.000005), and the means of vessels without lumen registered statistically significant differences in the PSD and SP groups (t12 = 3.862, p = 0.002).

Conclusions

Pregnancy evolution depends on the degree of vascularization, as well as on the quality of the vascular network. Disruption of placental vasculature is one of the basic links in the development of primary placental insufficiency during placentation.

Introduction

Chronic pancreatitis (CP) is a common disease with a complex pathogenesis, characterized by difficulties in its diagnosis and treatment.

Purpose of the study

To determine the main pathogenetic links of clinical and morphological forms of CP, markers of disease progression, to develop a diagnostic algorithm and principles of treatment of patients.

Material and methods

210 patients with CP were examined, who were divided into 4 groups: I - obstructive, II - calcifying, III - fibrous-parenchymal, IV – CP, complicated by pseudocyst. Instrumental, functional, morphological, biochemical, immunological, microbiological methods were used. To study the main morphological and biological changes in the pancreas during the development of CP and to study the effectiveness of the proposed treatment, we conducted experimental studies on 45 laboratory white Wistar male rats weighing 180-230 g.

Results

Imbalance of the immune system, oxidative stress, toxic-metabolic disorders, and diseases of the biliary system are important in the development of various forms of CP. However, there are differences in the severity of these changes. The most pronounced activity of fibrotic processes in the pancreas is typical for patients with a long course of the disease and in the presence of complications (pseudocyst). The most unfavorable course and prognosis are seen in the calcifying form of CP. The markers of CP progression are the value of the calcification coefficient of 0.5-1.0, the translocation of DNase I from the cytoplasm to the nucleus of the acinar cell, the activation of collagen formation, the increase in the level of fibrosis activators (TGF-β1, TNF-a), and the intensification of lipid peroxidation processes. An early marker of apoptosis is the translocation of DNase I from the cytoplasm to the nucleus of an acinar cell.

Conclusions

The developed diagnostic algorithm allows assessing the pathophysiological features of functional and organic disorders of the pancreas, predicting the course of the disease and choosing the optimal treatment. The proposed treatment of patients with CP effectively reduces the severity of pain and oxidative stress, normalizes the cytokine profile, improves the general condition and quality of life of patients.

Introduction

In the last years the high prevalence of the tic disorder and Gilles de la Tourette syndrome (GTS) was confirmed. The available therapies can temporarily suppress the tics, but not eliminate them definitively, that implies a strict individual assessment of the risks and benefits for every patient. The recent scientific studies confirmed the efficiency of some diagnostic and therapeutic options, and infirmed the other ones. Thus, a qualitative analysis and adjustment of the recommendations to the actual conditions and possibilities of the Republic of Moldova (RM) is required.

Material and methods

All the guidelines for the diagnosis and treatment of GTS and tic disorders were found in the PubMed database.  The articles containing the keywords „Tourette diagnosis“, „Tourette treatment“, „tic diagnosis“ or „tic treatment“ and published after 2021 were selected. The availability in RM of the medications recommended by the international guidelines was verified on the site of the Medicines and Medical Devices Agency of RM. The final text includes the qualitative analysis and synthesis of the recommendations, adapted to the conditions and possibilities of RM.

Results

The diagnosis of tics needs only clinical observation, and usually other investigations are not indicated. It is extremely important to identify patients whose tics do not need treatment, but just monitoring and informing about their nature. There are three main therapeutic methods directed against tics: behavioural therapy, pharmacotherapy, and, in some particular cases, neurosurgical approach (deep brain stimulation). The first two methods are available in RM. The efficiency of other tics treatment had been not confirmed yet. A particular attention is paid to the management of the specific comorbidities of GTS and tics. 

Conclusions

The diagnosis of tics is based on the recognition of their clinical manifestations and precise anamnesis. Only some patients with tics need treatment but all of them should be informed about the tics’ nature, causes and evolution. The behavioural therapy could be effective in some patients, while in others would be more convenient the pharmacotherapy or the combination of both. The neurosurgical treatment (deep brain stimulation) is reserved to severe tics, that are resistant to other therapies.

Introduction

Evaluation of patient volemia arriving at a medical service today still represents a challenge for specialists, especially in those who need surgical and anesthetic intervention. One of the most common systemic side effect to anesthesia is hypotension. Spinal Anesthesia-Induced Hypotension (SAIH) because of sympathetic blockade is most frequently cited as a complication of subarachnoid anesthesia, its severity being influenced by the patient's volemic state. The aim of this literature review is to analyze if „routine” preanesthetic preloading reduces the incidence of SAIH in patients undergoing spinal anesthesia, also to emphasize the efficacy of preanesthetic assessment of the IVC/Ao (Inferior Vena Cava/Abdominal Aorta) Index measured by ultrasound in determination of patients’ volemia.

Material and methods

Narrative literature review. Bibliographic search in the PubMed, NCBI and Google Academic databases, using the keywords: „hypotension inferior vena cava”, „hypotension spinal anesthesia”, „inferior vena cava/aorta diameter”, „preloading hypotension”, which were combined with each other. The final bibliography included 40 references.

Results

The principles of perianesthetic volemia management and prevention of arterial hypotension after the administration of the spinal block were detected in different groups of patients: the elderly, adult patients, anesthesiologic assistance in obstetrics and in various types of surgical interventions. Hypotension incidence data in patients with and without preanesthetic volume repletion were detected. At the same time, the effectiveness of the ultrasonographic assessment of IVC/Ao index in assessing patient's volume status was determined. The information was analyzed and synthesized in the article.

Conclusions

The effectiveness of routine preloading in reducing the incidence of arterial hypotension after spinal anesthesia did not prove its benefits in normovolemic patients, and ultrasonographic assessment of the IVC/Ao Index in assessing the volume status appears to be a simple, rapid, non-invasive, cost-effective volume assessment, which does not require the presence of a specialized imagist, being practically devoid of contraindications.

Introduction

Myeloid sarcomas (MS) are extramedullary manifestations of myeloid neoplasms, associated with conditions like acute myeloid leukemia (AML), myelodysplastic syndromes (MDS), and myeloproliferative neoplasms (MPN). MS presents as tumor masses in various body sites, often expressing myeloid or monocytic markers. This case report details an unusual biphasic MS relapse with a significant "intravascular" component.

Materials and methods

A 59-year-old male with a history of JAK2-V617F positive MDS/MPN underwent allogeneic hematopoietic stem cell transplantation and presented with abdominal pain, skin lesions, and systemic symptoms. Biopsy of colonic masses was performed, and subsequent analysis was carried out.

Results

The biopsy revealed a neoplasm with solid and intravascular components. The solid part was mainly composed of monocytic lineage cells expressing specific markers, with a small population of myeloid blasts. In contrast, the "intravascular" component was mainly myeloid blasts expressing different markers. Genetic analysis uncovered JAK2 (V617F) and KRAS (G12C) mutations. Despite treatment, the disease progressed, and the patient eventually passed away.

Conclusions

Myeloid sarcomas are challenging to diagnose, often being mistaken for large cell lymphomas. They can manifest as isolated extramedullary relapses, with a unique molecular profile. This case stands out due to its biphasic nature, featuring distinct components with differing characteristics, which has not been documented previously in English literature. It underscores the intricate and diverse nature of myeloid sarcomas, emphasizing the need for further research to comprehend their biology and behavior effectively.

Introduction

COVID-19 infection affects people of any age or gender. It was found that children up to 6 months of age have a major risk of developing a severe form of the infection. Contemporary diagnostic imaging methods of high sensitivity, such as lung CT, allow to establish the degree of lung damage, the volume and the sequelae arising from enduring the COVID-19 infection. The long-term consequences of the COVID-19 infection are still being researched. Pneumonia in the infection of COVID-19 can lead to the long-term development pulmonary fibrosis, atelectasis, bronchiectasis.

Case report

The 5-month-old boy is admitted to the Pneumology Clinic with dyspnea, tachypnea, acrocyanosis, agitation, food refusal. It is known from the anamnesis that at the age of 4 months the child suffered a severe form of the COVID-19 infection. Non-contrast lung CT was performed which suggests fibro-atelectatic changes in both lungs, predominantly in the apical and basal segments.

Conclusions

Infants show an increased vulnerability to develop  bronchopulmonary changes after COVID-19. The case is suggestive from a clinical point of view, emphasizing the connection between the form, the evolution of the disease, and the consequences arising from the COVID-19 infection. Fibrotic pulmonary evolutionary changes are suggestive of SARS-CoV-2 virus infection.