7 articles
Tick-borne infections (TBIs) are increasingly recognized as a public health concern in North America and Europe, with Lyme disease being the most notable. The Centers for Disease Control and Prevention (CDC) acknowledges that official statistics likely underestimate the true incidence of TBIs due to diagnostic challenges and underreporting. Co-infections, where multiple pathogens are transmitted through a single tick bite or multiple bites, complicate diagnosis and treatment, leading to more severe symptoms and longer illness durations. Studies indicate a significant percentage of Lyme disease patients also have co-infections, with babesiosis being a common co-infection.
A comprehensive narrative literature review was conducted using PubMed and Scopus, resulting in 52 manuscripts. Additional reports from the CDC and European Centre for Disease Prevention and Control (ECDC), as well as relevant academic books, were included to meet the study's objectives. The Elicit platform was utilized to enhance reference identification and information synthesis.
The paper provides an overview of tick-borne co-infections, emphasizing the diagnostic challenges posed by overlapping and nonspecific symptoms. It discusses various diseases, including Lyme disease, babesiosis, anaplasmosis, ehrlichiosis, Rocky Mountain spotted fever, and tick-borne encephalitis, detailing their causative organisms, vectors, clinical features, and common co-infections. The review critically examines diagnostic methods such as serological tests, molecular tests, and blood smears, highlighting issues like the „window period” false negatives/positives, and differentiating active from past infections. It also explores emerging technologies and biomarkers, including multiplex assays and next-generation sequencing, which enhance detection capabilities but face challenges in data analysis and standardization.
Accurate diagnosis is crucial to manage these infections effectively, particularly in vulnerable populations. The rise in co-infections and inadequate testing presents a significant public health challenge, necessitating improved surveillance and diagnostic approaches.
Deep infiltrating endometriosis (DIE) is considered the most painful form of endometriosis, responsible for reducing the women's quality of life (QoL). Its management presents difficulties in medicine. The #Enzian classification reflects locations of DIE and simplifies its medical management. International guidelines recommend studies of QoL in women with endometriosis.
To investigate the symptoms of DIE and determine its impact on QoL to optimize its diagnostics.
A cohort study was conducted over 2 years at the Gheorghe Paladi Municipal Clinical Hospital, including 190 patients with endometriosis, who were divided into groups: main group - 85 patients with DIE, control group - 105 other endometriosis forms. To objectify the pain, Visual Analog Scale and Biberoglu and Behrman (B&B) were used. Endometriosis was staged with the #Enzian classification. For the analysis of QoL, three standardized questionnaires were used. Data were recorded in Excel and statistically calculated with the SPSS program.
Pelvic pain syndrome according to the Visual Analog Scale and B&B scales in the main group was 3 times more pronounced than in the control group (p < 0.01). Lesions of DIE according to the #Enzian statistically correlated with chronic pelvic pain, dysmenorrhea, dyspareunia, dysuria, dyschezia >7 points (VAS), catamenial rectal tenesmus, defecation disorders, menometrorrhagia, hematuria, bladder tenesmus, hydronephrosis with ureteral stenting during pregnancy, catamenial cough and hemoptysis, chest pain and spontaneous pneumothorax, hemorrhagic scar, hiccups, and the frenicus symptom (p < 0.05). According to the questionnaires of QoL, DIE significantly influences life determinants by 44.27%, compared to the control group at 3.64% (p < 0.01), allowing realization of life determinants in a maximum of 58.54% vs. the control group’s 92.18% (p < 0.01). Additionally, psychological well-being in patients with DIE is lower than that in the control group (44.29% vs. 81.38%, p < 0.01).
High-intensity pain syndrome and extragenital symptoms correlated with compartments of #Enzian will assist in the preoperative multidisciplinary diagnosis of DIE. The high influence on life determinants, the low realization of life potential, and the low psychological well-being confirm the significant impact of DIE on QoL, classifying it as a disability.
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.
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.
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.
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.
Chronic pancreatitis (CP) is a common disease with a complex pathogenesis, characterized by difficulties in its diagnosis and treatment.
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.
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.
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.
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.
Digital tomosynthesis is a relatively new imaging modality that is already used in the diagnosis of breast cancer and has shown promising results in evaluating patients with pulmonary, osteoarticular, and other pathologies. However, up to date, there are no published studies related to the usefulness of digital tomosynthesis in the evaluation of patients with laryngeal cancer. The purpose of this study was to evaluate the clinical role of digital tomosynthesis in the diagnosis of laryngeal cancer and compare the imaging results with those obtained by digital radiography and computed tomography.
The study was carried out between 2015 and 2019 at the Institute of Oncology in the Republic of Moldova and included 253 consecutive patients with laryngeal cancer referred to the Institute of Oncology during this period. All patients underwent digital radiography and digital tomosynthesis investigations. In 41 patients who provided written informed consent, computed tomography was performed. The results of all imaging investigations were compared.
The statistical analysis revealed a high degree of agreement and a strong linear correlation between the data obtained with digital tomosynthesis and computed tomography, as well as concordance correlation coefficients for different parameters between 0.63 and 1.0 (mean value = 0.82±0.11). For comparison, the concordance correlation coefficients for the same parameters obtained for digital radiography versus computed tomography ranged between 0.08 and 0.93 (mean value = 0.43±0.25). An updated imaging algorithm that includes digital tomosynthesis has also been proposed for investigating patients with suspected laryngeal cancer.
The study demonstrated the usefulness of digital tomosynthesis for the evaluation of patients with laryngeal cancer. When compared to computed tomography, which is considered the gold standard, digital tomosynthesis revealed a much higher performance compared to digital radiography. Considering the availability of low-dose protocols for digital tomosynthesis, the modality might also be helpful for laryngeal cancer screening in a high-risk population. However, new studies are also required to confirm our findings and define the place of digital tomosynthesis in the imaging algorithm for patients with laryngeal cancer.
Non-Hodgkin's lymphoma is a group of malignant tumors that develop from hematopoietic cells located outside the medullary. They are one of the most common forms of hemoblastosis. Non-Hodgkin lymphoma develops in people of all ages. Morbidity of non-Hodgkin lymphoma increases with age reaching its highest level in people over 50 years of age.
A study was carried out through a narrative review of the literature in the form of a synthesis article. The article summarized and systematized various primary studies, dedicated to the epidemiological and diagnostic aspects of aggressive extranodal NHL.
Aggressive extranodal NHL remains a major problem, with a fairly large increase in incidence globally. This trend is observed in several countries of the world; thus morbidity increases by 3% annually for women and by 4% for men. Globally, aggressive non-Hodgkin's lymphoma continues to affect the working-age population. Although patients with primary extranodal NHL tend to report to a medical specialist at a lower stage than those with primary ganglion disease, the number of those addressing in advanced stages continues to be increased.
Although diagnosing NHL does not involve great impediments, primary care physicians often detect patients in the late stages of the disease either because of delayed referral to the doctor or because of incorrect diagnosis. Despite the development of new methods of diagnosis and treatment, aggressive extranodal NHL continues to be a current problem of clinical medicine and public health, requiring increased managerial and financial efforts.
Due to the heterogeneous nature of systemic sclerosis, it is difficult to predict disease progression and complications. Despite the discovery of novel autoantibodies associated with systemic sclerosis (SSc), there is an unmet need for biomarkers for diagnosis, disease progression, and response to treatment.
An analytical, qualitative study was performed with a narrative review of literature in the form of a synthesis article. Relevant primary sources published in 2020-2022 were identified and selected, using data extraction and analysis.
Anti-citrullinated protein/peptide antibody could be useful in identifying patients with a more prominent joint disease. Of most interest, the anti-carbamylated protein antibodies (anti-CarP) could be a relevant biomarker related to fibrotic skin and lung disease. Positive anti-RNA (Ribonucleic acid) polymerase III antibody and antinuclear antibodies (ANA) negativity were significantly associated with GAVE (gastral antral vascular ectasia). Autoantibodies against telomeres may help identify systemic sclerosis with lung disease. Osteopontin links myeloid activation and disease progression in systemic sclerosis. CTRP (C1q tumor necrosis factor-related proteins) 9 protein levels may be biomarker of lung disease severity. CD (cluster differentiation) 21-low B cells are linked to vascular damage. L-tyrosine, L-tryptophan, and 1-methyl-adenosine distinguished healthy controls from SSc patients. L-leucine, L-isoleucine, xanthosine, and adenosine monophosphate differentiated between progressing and stable SSc-ILD. CECs (circulating endothelial cells) are a direct indicator of systemic vascular damage. Levels of the protein, galectin-3, are associated with heart involvement in people with systemic sclerosis. Low levels of the galectin-10 protein (Gal-10) in scleroderma associate with inflammation and vascular changes in the lungs, leading to pulmonary arterial hypertension (PAH). High levels of the CD146 protein may be a potential biomarker in identifying people with systemic sclerosis. Blood levels of the protein endocan increased in scleroderma patients who are at risk for pulmonary arterial hypertension . FLCs (free light chain) could be employed as useful potential biomarker of early diagnosis and to follow disease activity.
Novel discovered biomarkers could predict disease development, activity, and severity of diverse organ involvement, predict risk of complications of systemic sclerosis.