3 articles
Adult epilepsy generates a burden that extends beyond seizure counts and includes adverse treatment effects, role restriction, emotional distress, and the social devaluation attached to the diagnosis. The methodological problem is not the absence of patient-reported measures, but the heterogeneity with which disease-specific quality-of-life and stigma instruments are selected, interpreted, and combined in adult studies.
A structured narrative methodological review was conducted using PubMed/MEDLINE, Scopus, Web of Science, Embase, Cochrane Library, and the institutional repository of the Nicolae Testemițanu State University of Medicine and Pharmacy. The synthesis focused on the Quality of Life in Epilepsy Inventory family, especially the 89-, 31-, 31-P, and 10-item forms, the adolescent 48-item comparator, and adult epilepsy stigma measures such as the Epilepsy Stigma Scale (ESS) variants, the Stigma Scale of Epilepsy (SSE), and the Epilepsy Self-Stigma Scale (ESSS). Special attention was given to publications from the Republic of Moldova and Romania because regional evidence is sparse but clinically relevant.
QOLIE-31 emerged as the most defensible adult comparative instrument because it balances breadth, feasibility, and international comparability. QOLIE-31-P was particularly useful for patient-centred and real-world designs, while QOLIE-10 served primarily as a screening instrument and QOLIE-89 retained value for comprehensive psychometric work. The 48-item version was methodologically informative but remained adolescent-oriented rather than a primary adult endpoint. Across the stigma literature, ESS, SSE, and ESSS were clearly not interchangeable because they capture overlapping but distinct constructs, including perceived stigma, felt stigma, and internalized self-stigma.
The working hypothesis was supported across international, regional, and Moldovan sources: the greater the clinical and psychosocial severity of epilepsy, the lower the epilepsy-specific quality of life. Seizure frequency, uncontrolled or drug-resistant epilepsy, polytherapy, adverse medication effects, depression, anxiety, and stigma were the most recurrent determinants of lower scores. For adult studies intended for Moldovan settings and the MJHS submission, QOLIE-31 or QOLIE-31-P, combined with one clearly defined stigma scale and a standardized set of severity variables, offers the strongest methodological balance.
Chronic kidney disease and COVID-19 are both associated with significant morbidity. Patients with chronic kidney disease are at risk for severe COVID-19, and SARS-CoV-2 infection may accelerate CKD progression. This study aimed to compare renal outcomes in CKD patients with and without prior COVID-19 and to identify predictors of progression.
We conducted a prospective cohort study of 280 pre-dialysis CKD patients (stages G2–G5), followed for 12 months. Of these, 140 had a history of COVID-19 (post-COVID group), and 140 had no such history (control group). Baseline assessments included renal function (eGFR, creatinine, urea), inflammatory markers (CRP, ferritin, LDH), hematologic indices (hemoglobin, leukocytes, platelets), and SF-36 quality of life scores. CKD progression was defined as a ≥30% eGFR decline or the initiation of dialysis. Analyses included group comparisons, correlations, logistic regression, and ROC curves.
Baseline characteristics and mean eGFR (~60 mL/min/1.73 m²) were similar across groups. CRP and ferritin levels were elevated in both groups without significant differences. Post-COVID patients reported lower vitality and higher social functioning on SF-36 (both p < 0.001). After 12 months, the post-COVID group showed greater eGFR decline (–3.1 vs –1.2 mL/min) and a higher progression rate (28% vs 15%, p < 0.01). Multivariable analysis identified prior COVID-19 (adjusted OR ≈2.3, 95% CI: 1.3–4.0) and low baseline hemoglobin as independent predictors of progression; CRP and ferritin were not predictive. LDH showed a modest association. Hemoglobin alone predicted progression with an AUC of 0.78; the combined model (COVID status + hemoglobin) yielded an AUC of 0.85.
CKD patients with prior COVID-19 experienced a faster renal function decline over one year than those without COVID-19. Persistent anemia and elevated LDH were also associated with increased progression risk. These findings emphasize the importance of post-COVID renal monitoring and early intervention in CKD patients to prevent deterioration.
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.