Introduction

The hallmark of most B-cell neoplasia is proliferation of B-cells and clonal rearrangement of the immunoglobulin gene, which is lambda or kappa light chain restricted. Since fresh tissue is not always available to determine clonality, immunohistochemical (IHC) staining for kappa and lambda light chains is often performed on formalin-fixed, paraffin-embedded (FFPE) tissue. Commercially available polyclonal antibodies typically produce high background staining and have a significant false negative rate, which makes it difficult to prove clonality. We developed a series of monoclonal antibodies to human kappa and lambda light chain constant regions by immunizing mice with purified kappa and lambda immunoglobulin light chains.

Materials and methods

Screening of the hybridoma populations and clone selection was performed in two steps. Primary screening was done by ELISA in plates coated with purified human kappa and lambda light chains fixed with 10% formalin. The positive populations were then selected by IHC staining of FFPE containing B-cell neoplasms with known immunophenotype.

Results

We selected eight hybridomas that produced highly specific monoclonal antibodies (mAbs) directed to the constant regions of kappa (four clones) and lambda light chains (four clones). The antibodies were used for IHC staining and direct immunofluorescence microscopy on FFPE tissues. Plasma cell neoplasms could be stained without antigen retrieval. For uniform and reproducible staining of diffuse large B-cell lymphomas and some marginal zone B-cell lymphomas with plasmacytoid differentiation, a heat-based antigen retrieval procedure was necessary. Compared with commercial polyclonal antibodies to kappa and lambda light chains these mAbs demonstrated lower background staining and produced fewer false negative results.

Introduction

Umbilical cord pathology can contribute to neonatal asphyxia, stillbirth, and postnatal death in numerous cases. However, the diagnosis of umbilical cord pathology remains imperfect, and its impact on pregnancy course and outcome is often underestimated. Therefore, prenatal diagnosis of umbilical cord pathology is becoming increasingly important in preventing intra- and postnatal morbidity and mortality. Early detection of these abnormalities enables the development of necessary strategies for optimal pregnancy and delivery management.

Material and methods

The study included 190 patients divided into 2 groups: L1 – 95 patients with UC abnormalities, and L0 – 95 with a normal UC. A p-value of less than 0.05 was regarded as statistically significant. 

Results

The development of umbilical cord pathology was frequently observed in pregnant women exposed to harmful workplace factors (psychological and emotional stress, p=0.01), harmful habits (smoking, p=0.04), and primiparas (p=0.005) with complicated gynecological and somatic histories, as well as those with a history of UC pathology in previous pregnancies (p<0.0001). Pregnancy and labor progression in patients with cord pathology showed a high rate of complications compared to control group, including urinary tract disorders (p=0.02), preterm labor at 27-28 weeks (p=0.01), polyhydramnios, which was ten times more frequent (p=0.002), and fetal growth restriction (p=0.02). In the study group, a prolonged second stage of labor was observed (p=0.01), along with acute fetal hypoxia, which required urgent pregnancy termination (p=0.01) through vacuum extraction (p=0.0009) or C-section (p=0.04).

Conclusions

The analysis of the anamnestic and clinical peculiarities of the perinatal period in patients with UC pathology, compared to pregnant women without this pathology, confirmed that this commonly encountered obstetric condition represents a considerable risk factor for perinatal complications.

Introduction

Osteoporosis remains a major public health issue, particularly affecting the elderly, and is characterized by decreased bone mass and deterioration of bone structure, increasing the risk of severe fractures. The development of specific and precise tools that allow for the identification and estimation of the influence of modifiable factors on the development of osteoporosis is an important step in early intervention for at-risk individuals. 

Material and methods

The initial version of the questionnaire was created to identify modifiable factors contributing to the development of osteoporosis, including the type and frequency of drinking water consumption, water quality, knowledge about its mineral composition, dietary preferences, alcohol and tobacco use, physical activities, and stressful situations. The questionnaire initially contained 65 questions, organized into three sections. Five experts reviewed the content validity, evaluating the clarity, cultural and linguistic relevance, structure, and coherence of the questions. The feedback led to adjustments, reducing the questionnaire to 52 questions. A pre-test was conducted with 30 adults from the Republic of Moldova, confirming the validity and internal consistency of the questionnaire, with a Cronbach’s Alpha coefficient of 0.768.

Results

To ensure content validity, experts evaluated the questionnaire, and based on their comments and suggestions, semantic and syntactic reformulations and modifications were made. As a result, 13 questions were eliminated, reducing the second version of the questionnaire to 52 questions. During the pre-testing stage, the order and content of the questions were deemed appropriate by the respondents. The average time required to complete the questionnaire was 14.19 minutes (SD ± 1.567), with a minimum of 11.90 minutes and a maximum of 17.33 minutes. The sample used in the pre-testing stage included 30 respondents, the majority of whom (93.3%) were women. The respondents’ ages ranged from 25 to 72 years, with a mean age of 50.37 ± 2.6 years. The distribution of respondents was balanced between urban (53.3%) and rural (46.7%) areas. Regarding education level, 56.6% had higher education, 26.7% had secondary vocational education, and 16.7% had no higher education.

Conclusions

The study demonstrated that the new questionnaire is a valid and reliable instrument for assessing the impact of modifiable risk factors on morbidity due to osteoporosis. Ongoing research is necessary to refine and further validate the questionnaire within the broader population.

Introduction

Disability-adjusted life years (DALY) is a multidimensional measure used to quantify specific tasks of the disease. Chronic liver disease attributed to hepatitis Delta virus (HDV) is one of the major causes that contribute to morbidity and mortality in our country. The DALY estimate in HDV-induced liver disease has the potential to highlight both fatal and nonfatal outcomes of the disease and thus, help in policy making and allocation of health resources. 

Material and methods

This was an analytical prognostic study conducted in the 2021–2024 period, with the enrollment of 104 patients with HDV-induced liver disease. YLL was predictively rated using Child-Pugh's estimate of the remaining years of life. The chronic liver disease questionnaire was used to evaluate patients' disabilities along with the disability weights of the Global Burden of Disease study, calculating YLD. The impact of DALY was interpreted according to the patient's safety indicators.
Results. 104 patients with HDV, originating in different areas of the country, were evaluated, with an average age of 56 ±4.5 years. Substantial YLD losses caused by HDV were mainly reported in working class. The greatest losses of YLD and DALY were caused by cirrhosis of the liver, followed by hepatocellular carcinoma.  A great rate of mortality attributed to HDV was seen in the 45-59 and 60-74 age group. A total of 739.1 YLL in male gender and 719.5 in females were recorded for cirrhosis. Overall, men attest a DALY value of 1358.44 total/29.53 per person, and women registered – 1477.3total /25.47 per person.

Conclusions

Chronic liver disease attributed to HDV is a medical challenge in Republic of Moldova. Loading the national medical system with serious and overwhelmed patients, make the DALY calculation approach a priority setting.

Introduction

Guided bone regeneration (GBR) is a surgical method that allows the formation of new bone in areas of atrophy of the maxillary bone. The integration of the graft or the augmented bone under the mucosal flap and the primary healing of the soft tissues are essential conditions for preventing the exposure of the regeneration site and infectious complications that inevitably lead to the failure of the GBR procedure.

Materials and methods

This study presents the results of a cohort study that includes 70 patients who underwent GBR. The research involved techniques for forming muco-periosteal flaps: the Modified Periosteal Releasing Incision (MPRI) according to the principle of the double flap technique (DF) and the coronal advanced lingual flap (CALF). The study group included patients who underwent GBR using perforated titanium membrane, while the second group underwent GBR using bioresorbable poly-4 hydroxybutyrate (P4HB) synthetic mesh. The patients were evaluated periodically to monitor postoperative progress, the cases of dehiscence of the area related to augmentation site were recorded, measured and classified according to Fontana. Statistical results were generated and processed by the R Studio program. 

Results

In the study groups, a total of 8 cases of gingival dehiscence were registered, 4 cases in each group. In two cases, partial removal of the titanium membrane was performed by milling it, and the remaining 6 cases of dehiscence were remedied with rinses with oral antiseptic solution and scheduled visits for local care until the appearance of granulation tissue and epithelization. 

Conclusions

Protective membrane, flap formation, thread tension and suture relaxation all play crucial roles in guided bone augmentation without dehiscence. In our study, the small number of dehiscence cases recorded as complications did not provide significant statistical results, namely due to the technique of performing the flap according to contemporary methods, a fact also described by the specialized literature.

Introduction

Spironolactone (Spir) is a selective and competitive antagonist of aldosterone that increases the excretion of water and sodium while decreasing the excretion of potassium (K+ sparing diuretic). The substance was studied to develop qualitative and quantitative methods of analysis and to validate them according to documents regulating the quality of active pharmaceutical ingredients in the development of pharmaceutical forms. 

Material and methods

A new dosage form (powder) with Spir was developed and analyzed by a spectrophotometry method using a UV-Vis spectrophotometer (Agilent 8453, USA) with 10.0 mm matched quartz cells at 238±2nm, with methanol as the blank. The method was validated for specificity, linearity, precision, accuracy, robustness, LOD and LOQ. 

Results

The method was found to be linear in the drug concentration range of 5.0 to 30.0 μg/ml, with a correlation coefficient (R2) of 0.9994 for Spir. The LOD of Spir was 0.5 μg/ml and the LOQ was 1.4 μg/ml, indicating the method’s sensitivity. The method was established as accurate (mean recovery values of concentration at 80%, 100%, 120% ranging between 99.9 and 101.7%). Repeatability precision and intermediate precision %RSD values amongst six sample solutions were from 0.13% to 0.25% for Spir (less than 2%). The accuracy (recovery) ranged between 99.9% and 101.7%, with standard deviations ranging from 0.08% to 0.17%. 

Conclusions

In the presence of common excipients, such as microcrystalline cellulose, lactose monohydrate, and stearic acid, no interferences were observed. This method was found to be suitable for the routine analysis of Spir from the newly developed pharmaceutical form.

Introduction

The Coronavirus Disease 2019 (COVID-19) pandemic presented a significant challenge for global society, leaving a profound impact across the board. Although COVID-19 cases are still reported, they are no longer at previously high levels. One of the key tools in combating the pandemic was Artificial Intelligence (AI), which played a vital and advancing role throughout the pandemic. AI contributed significantly to the gradual reduction in COVID-19 cases. Effective coordination of the pandemic response, timely management, and the integration of AI into the medical system were crucial factors in achieving success.

Materials and methods

A comprehensive literature review focusing on publications from 2019 to 2024 was conducted using Google Scholar, PubMed, and Science Direct. Twenty publications were selected for their relevance to AI in the COVID-19 response, based on criteria such as accessibility, language, and publication type.

Results

The review focused on the significant role of AI during the COVID-19 pandemic, highlighting its impact on public health and medical systems. In countries like the USA, China, and South Korea, AI was crucial in tracking the virus, predicting infection trends, and optimizing resource allocation. AI models helped identify outbreak hotspots and enabled targeted interventions, while natural language processing efficiently managed extensive data. Conversely, in countries such as Brazil, Mexico, India, and many African nations, AI was used less extensively due to limitations in technological infrastructure and data availability. The pandemic drove a closer integration of AI with medical services, streamlining processes and saving time. AI also enhanced laboratory efficiency and supported the development of new medications and vaccines. Despite its potential, the uneven adoption highlighted disparities in technological readiness and resource allocation during the crisis.

Conclusions

The COVID-19 pandemic has once again highlighted that we live in an era of advanced technology and underscores the need for closer integration between healthcare systems and artificial intelligence. This integration allows for more effective and timely management of current and future health challenges. AI contributes to a more rapid and high-quality response to emergencies, providing innovative solutions for both existing and upcoming challenges.

Objective

The objective of this study was to conduct a bibliographic analysis of current data regarding the impact of parasitic infestations on immune status and the progression of osteoarticular diseases within the context of parasitic infections.

Material and methods

This was a qualitative analytical study presented as a narrative literature review. Relevant primary sources published between 2016 and 2022 were identified and selected using data extraction and analysis methods.

Results and discussion

The concept of "parasitic therapy" has generated considerable interest among researchers, the public, and patients for whom standard treatments have been ineffective or offered limited results. Although studies exploring the role of parasitic infections in arthritis are less common than in other fields, animal models suggest that parasitic infections may alleviate joint inflammation. However, further research is needed across different forms of arthritis, including clinical data collection and double-blind, controlled clinical trials.

Conclusions

While only a few studies have demonstrated that parasitic infections may worsen preexisting diseases, the scientific consensus is that parasitic infections can create an immunoregulatory environment, reducing the severity of coexisting conditions. Finally, more rigorous animal studies are required to thoroughly investigate immunomodulatory mechanisms and potential side effects of parasitic infections in the presence of other diseases.

Introduction

Elevated or imbalanced levels of markers of oxidative stress and inflammation are often observed in various somatic pathologies and mental disorders, including schizophrenia.

Purpose of the study

This study aims to investigate the mechanisms of pathogenesis and the evidence supporting the use of niacin skin and oral tests in patients with schizophrenia.

Materials and methods

A literature review was conducted on the specific reactions to the niacin skin or oral test in patients with schizophrenia, first-episode psychosis, and those at clinical high risk for psychosis (CHR-P). Evidence-based data up to and including 2024 were reviewed, with 48 literary sources selected.

Results

An attenuated niacin-induced flush, coupled with low vitamin B3 levels, an imbalance in the Redox-Ratio and omega-3/omega-6 fatty acids, and elevated phospholipase A2 levels, are the main evidence-based findings associated with schizophrenia.

Conclusions

The niacin skin and oral tests in patients with schizophrenia and those at high risk for psychosis are characterized by an abnormal response to niacin. Additional markers may further validate positive test results for niacin.

Introduction

Hepatic amyloidosis is characterized by the deposition of fibrillar amyloid proteins, which result from light chain amyloidosis (AL) immunoglobulin fragments, in the extracellular space and the vessel walls of the liver. A case of primary hepatic amyloidosis without evidence of a primary or secondary cause of amyloid deposition is rare. This case was unique to the Republic of Moldova, presenting a diagnostic and therapeutic challenge for clinicians. Because the liver is rarely affected, this pathology remains underdiagnosed and is associated with a reserved prognosis.

Clinical case presentation

An unusual case of primary hepatic amyloidosis is reported in a previously asymptomatic 59-year-old woman who presented at admission with peripheral edema, ascites, and hepatomegaly. Biochemical tests revealed severe cholestasis with normal bilirubin levels and acute liver failure. Liver damage caused by viral hepatitis or autoimmune diseases was excluded. A percutaneous bone marrow biopsy was normal, and Bence Jones protein was negative, indicating no evidence of primary amyloidosis. The definitive diagnosis was based on liver biopsy, which revealed apple green birefringence on polarizing microscopy after positive Congo red staining.

Conclusions

The reported case highlights the need to differentiate between infiltrative diseases, such as amyloidosis, when a patient presents with rapidly progressive severe cholestasis and acute liver failure. Future studies should focus on the availability of specific therapies for primary amyloidosis to improve the survival rate of these patients.

Introduction

MALT lymphoma is the most common type of extranodal non-Hodgkin lymphoma. In two-thirds of cases, it originates in the stomach and is strongly associated with Helicobacter pylori infection. It presents a complex clinical picture, that can resemble multiple conditions, and typically follows a benign course. 

Clinical case presentation

This report discusses an uncommon case of a 52-year-old female who presented to the oncologist with insignificant weight loss, episodes of melena and fatigue. The disease started in 2018 with upper gastrointestinal bleeding from a gastric ulcer caused by H. pylori, which was later eradicated. The patient underwent multiple upper endoscopies over the years, with no evidence of malignancy. During the most recent investigation, an ulcerated mass of about 20 mm with infiltration of the adjacent mucosa was found. The biochemical and serological examination was within normal values. Abdominal computed tomography revealed unexplained perigastric and intestinal lymphadenopathy. The patient underwent total gastrectomy and lymph node dissection due to suspected gastric cancer. Histological and immunohistochemical examinations confirmed advanced MALT lymphoma with tumour cells positive for cluster of differentiation 45, 20 (CD45, CD20) and B-cell lymphoma 2 (BCL2). Given the advanced stage of the disease, adjuvant polychemotherapy was also administered, and the patient's condition improved significantly. 

Conclusions

MALT lymphoma is a rare condition that requires close attention and a high index of suspicion, even in unusual cases like the one presented. Endoscopic examination performed by an experienced specialist, accompanied by proper biopsy and a multidisciplinary team approach increases the survival rate of patients.