Research

The influence of diabetes mellitus on blood vessels amount in case of breast cancer

Ecaterina Foca1*, Dumitru Brinza2, Elena Portnoi2, Ecaterina Carpenco1, Valeriu David1, Lilian Saptefrati1, Veaceslav Fulga1
https://doi.org/10.52645/MJHS.2023.1.01

Abstract▼

Introduction

Breast cancer is one of the most common cancers in females worldwide. There are evidences that women with diabetes mellitus have a 40% higher risk of mortality. CD34 is a cell surface glycoprotein, which functions as a cell-cell adhesion factor. Although its expression is traditionally related to hematopoietic cells, it is actually found on many other types of cells, endothelial too. Nowadays there are evidences that CD34 is a prognostic indicator by emphasizing its low expression in malignant tumors compared to benign ones. The aim of study was to determine the presence and numerical distribution of CD34+ vessels in the normal mammary gland, as well as in NST breast carcinomas, with and without diabetes mellitus type 2. 

Materials and methods

We processed immunohistochemically 58 invasive breast carcinomas of NST type. In 29 of cases, tumors were associated with diabetes. 

Results

The present study did not reveal any statistical and morphological differences in CD34 expression between compared groups. 

Conclusions

The expression of CD34 in breast cancer stroma is not homogenous, irrespective of association with diabetes mellitus type 2. The question if breast carcinoma and diabetes mellitus are concurrent or associated disorders remains open. Probably, the effect of carcinoma prevails in influencing the structure of the tumor microenvironment. We expect a further confirmation in larger study groups.

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Clinical efficacy of midline lumbar interbody fusion arthrodesis with neuronavigation-guided cortical bone trajectory screws in the treatment of degenerative lumbar spondylolisthesis: a prospective randomized controlled trial

Serghei Borodin
https://doi.org/10.52645/MJHS.2023.1.02

Abstract▼

Introduction

Currently, the standard treatment of degenerative spondylolisthesis involves pedicle screw fixation to enhance the success of intervertebral fusion. The traditional pedicle screw techniques require extensive lateral muscle dissection, resulting in significantly increased surgical-related morbidity. To address some of these shortcomings, the Midline Lumbar Interbody Fusion (MIDLIF®) technique has recently been developed. It involves the combination of the cortical bone trajectory screw fixation of the spine with intervertebral cage placement to achieve a solid interbody fusion. So far, the clinical efficacy of the MIDLIF technique in the treatment of low-grade degenerative spondylolisthesis is still unknown. All existing publications are studies with a low level of relevance or scientific evidence.

Materials and methods

A prospective randomized controlled trial was conducted between 2017 and 2022. The study analyzed the clinical and radiological effectiveness of the MIDLIF arthrodesis technique compared to the traditional lumbar interbody fusion techniques, used exclusively in the treatment of degenerative lumbar spondylolisthesis.

Results

The study enrolled 112 eligible patients with degenerative low-grade spondylolisthesis, randomly assigned into two groups. At 1 year post-operatively, MIDLIF provided a significantly better improvement in postoperative relief of low back pain and radiating pain, as well as a significantly better functional recovery. Additionally, MIDLIF resulted in lower surgical morbidity compared to traditional fusion techniques.

Conclusions

The success rate of MIDLIF arthrodesis is similar to that associated with traditional fusion techniques. At the same time, MIDLIF offers all the specific benefits of a minimally invasive approach, such as less postoperative pain, faster functional recovery, less bleeding, and fewer blood transfusions. Thus, MIDLIF might be a good alternative to the traditional intervertebral fusion techniques in the treatment of degenerative low-grade spondylolisthesis.

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Diagnostic and prognostic markers of seronegative rheumatoid arthritis

Alesea Nistor1,2
https://doi.org/10.52645/MJHS.2023.1.03

Abstract▼

Introduction

Rheumatoid arthritis (RA) is the most common inflammatory disease of the joints, the prevalence of which is increasing in the population, leading to the emergence of new cases of the disease in young and middle-aged people, which has enormous medical and social significance. The study objective was to optimize the diagnosis and prediction of seronegative early rheumatoid arthritis outcomes by identifying the most significant clinical, laboratory and instrumental predictors of joint destruction.

Material and methods

The study includes 82 patients (22 men and 60 women), aged 17 to 70 years (average of 45.02±12.4 years), with the presence of articular syndrome (arthritis). All subjects were classified in the following groups: group I – 41 patients - 11 men and 30 women, whose average age was 44.46±13.36 years (average duration of the disease 6.0±2.9 months) with early seronegative rheumatoid arthritis (eRA), and group II consisted of 41 patients aged 45.55±11.12 years - 11 men and 30 women, with a diagnosis of seropositive rheumatoid arthritis (RA) (average duration of the disease of 6.8±3.7 months). 

Results

In the seronegative eRA group, the average Value of “prognostic index” (PrI) calculated from the data at the time of the initial survey was 5.67±1.72 points. PrI values in patients with transformation in RA within 1 year were significantly higher – 6.68±1.61, than without transformation in RA 4.52±0.96 points, p < 0.0001. At the same time, the values of PrI < 6 points were observed in 17 (20.7%) patients, PrI > 8 – in 25 (30.48%) patients, intermediate values (between 6 and 8 points) – in 40 (48.78%) patients, p < 0.001. Thus, in most patients with transformation in RA, the PrI values were more than 6 points.

Conclusions

In 53% of patients with seronegative RA, there is a transformation into seropositive rheumatoid arthritis during the first 18 months of the development of the disease. Features of early rheumatoid arthritis, in comparison with stabile RA are a polyarthritis presentation of the onset with damage to the joints of the hands, prolonged morning stiffness (more than 1 hour), moderate or high level of activity, the presence of productive synovitis and erosion during ultrasonography.

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Metabolic syndrome in patients with gout

Larisa Rotaru
https://doi.org/10.52645/MJHS.2023.1.04

Abstract▼

Introduction

The definition of metabolic syndrome is not yet consistent. However, many studies have been conducted in the latest decades about the effect of increased uric acid on metabolic syndrome development. Large epidemiological studies on the association between hyperuricemia and MS showed that increased concentration of serum urea is often observed in subjects with metabolic syndrome. The aim of the study was to characterize specific dysmetabolic changes and features of extraarticular evolution in patients with gout.

Materials and methods

A descriptive study was conducted that included 501 patients with gout. The mean age of gout (423 men and 78 women) was 49.2 (36.9; 59.9). The diagnosis of gout was established according to the classification criteria for gout ACR/EULAR 2015. The raw data was processed in SPSS version 26.0.

Results

According to our data, the highest severity of obesity and LDL-cholesterol was detected in those with tophaceous gout, which also caused an increase in the frequency of high blood pressure and type 2 diabetes, with age differences in the frequency of detection of metabolic syndrome and insulin resistance. Our data have noted that serum levels of uric acid correlated with the risk of developing both metabolic syndrome as well as its components - obesity, hypertension, and dyslipidemia, but inversely correlated with hyperglycemia.

Conclusions

Gout is associated with a severe lipid metabolism dysfunction, significantly increasing the rate of metabolic syndrome especially among patients with chronic tophaceous gout, than in the group of patients with gout under the age of 59 years. On the other hand, in patients with the onset of gout who are ≤59 years lipid metabolism disorders occur significantly earlier than in patients with the onset of gout at the age of ≥60 years.

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Clinical expression of parasitic arthritis – joint inflammatory process

Maia Grosu1*, Liliana Groppa1,2, Eugeniu Russu1
https://doi.org/10.52645/MJHS.2023.1.05

Abstract▼

Introduction

Parasitic arthritis is associated with infestation of the patient's body of parasitic species of worms and protozoan microorganisms. Now it has been established that parasitic arthritis can be caused by almost any species of these creatures. The objective of the study was to research the clinical-evolutionary features of cases of parasitic infections associated with damage of the osteo-articular system in helminthic pathologies.

Materials and methods

161 patients were included in the study, which were divided into 3 groups of differentiated observation by the pathogen of infestation and the clinical variant of parasitic arthritis. The first group (97 patients) consisted of patients with parasitic arthritis associated with echinococcosis infestation, the 2nd (31 patients) – patients with parasitic arthritis associated with Toxocara canis and the 3rd (33 patients) included subjects with parasitic arthritis associated with of Giardia lamblia infestation. 

Results and discussion

Echinococcosis was manifested more often by the axial (65.67%) and peripheral (31.34%) clinical forms, while the mixed form was being extremely rare (2.98%) (p < 0.001).The power of connection with the type of arthritis has reached the degree of statistical significance (p < 0.001). Parasitic arthritis due to Toxocara canis showed an overwhelming predominance of peripheral forms of joint syndrome (70.96%), with an insignificant share of axial (12.9%) and mixed form (16.13%) (p < 0.01), with a connection to the peripheral form of parasitic arthritis (p < 0.01). The clinically developed form of parasitosis caused by Giardia lamblia manifested a predominantly mixed joint syndrome (57.89%), confirming a predominantly peripheral impairment (36.84%) of the axial (5%) with a statistically significant difference (p < 0.05), as well as a connection for the mixed-peripheral form of parasitic arthritis (p < 0.05). 

Conclusions

Parasitic arthritis is characterized by the diversity of clinical joint manifestations, which fall into 3 clinical variants: induced by infestation with Echinococcus, Toxocara canis and Giardia lamblia, among which giardiasis correlates with a more severe clinical course, followed by echinococcosis and toxocariasis. Despite a large number of painful and inflamed joints that are also associated with an advanced radiological stage of joint damage, parasitic arthritis is characterized by a comparatively diminished articular painful syndrome.

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The impact of secondary pulmonary hypertension in elderly patients with chronic obstructive pulmonary disease

Ecaterina Luca*, Nicolae Bodrug
https://doi.org/10.52645/MJHS.2023.1.06

Abstract▼

Introduction

Chronic obstructive pulmonary disease (COPD) is considered an important disease in the structure of morbidity and mortality and a rising public health problem with increasing global age prevalence. Exacerbation of COPD in the elderly has a significant negative impact on the clinical and paraclinical picture, daily activity capacity, and quality of life. The need for correct diagnostic management is dictated by the severity of the pathology in the elderly and the high frequency of cardiac complications. Studying the clinical-paraclinical picture and the diagnostic capacity of natriuretic peptides in COPD patients with cardiovascular complications was the aim of the present research.

Material and methods

We conducted an analytical, observational, case-control study with the use of modern research methods. The study included 194 elderly patients (≥ 65 years old) divided into two study groups: those with only COPD (COPD group) and those with associated pulmonary hypertension (PHCOPD group). Patients underwent clinical, paraclinical, and functional investigation methods with subsequent mathematical-statistical data processing.

Results

The study groups were similar according to socio-demographic data. The clinical assessment revealed that PHCOPD patients had, in comparison with COPD patients, statistically significantly more frequent and severe complaints. The objective examination determined that in PHCOPD patients, the values of the objective examination indices were much more affected than in the COPD group. At the complex geriatric assessment, the COPD group of patients shows a lower degree of dependence and less cognitive impairment. The multidimensional assessment of COPD reflected more severe impairment according to the CAT, SGRQ, CCQ, mMRC, BODE questionnaires, and 6MWT test in the PHCOPD group compared to the COPD group. Spirographic, radiographic, ultrasonographic, and echocardiographic evaluations correlated with age, inflammatory syndrome, and natriuretic peptide level.

Conclusions

The PHCOPD group patients present a clinical picture, exercise capacity, objective data, complex geriatric assessment scores, and a multidimensional assessment of COPD that is statistically more frequent and severely affected compared to the COPD group. The impact of hemodynamic disturbances in COPD could be confirmed by the correlation of paraclinical data, such as the inflammatory response syndrome, increased natriuretic peptides, echocardiography data, and indices of internal organ ultrasound examination.

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The role of digital tomosynthesis in laryngeal cancer: comparison with radiography and computed tomography

Dorina Jovmir-Popa1,2*, Ion Codreanu1, Igor Gavrilașenco1,2, Marina Harea1,2
https://doi.org/10.52645/MJHS.2023.1.07

Abstract▼

Introduction

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.

Material and methods

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.

Results

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.

Conclusions

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.

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Awareness of the culture of patient safety among medical staff in neurosurgery departments from Moldova

Silvia Danu
https://doi.org/10.52645/MJHS.2023.1.08

Abstract▼

Introduction

To improve outcomes for patients and prevent avoidable surgical errors, neurosurgeons must change the culture of patient safety. The purpose of the study was to explore the perception of Patient Safety Culture (PSC) and the factors influencing it among the staff in the neurosurgical departments from Republic of Moldova. 

Material and methods

A cross sectional study was conducted in neurosurgical departments using the Hospital Survey on Patient Safety Culture (HSOPSC). Descriptive statistics were carried out, comprised the Cronbach "α" coefficient, frequency of positive answers (PPRs), level of minimum and maximum of 95% confidential interval, F. Galton correlation coefficient, Kendall rank coefficient, Harrington scale. 

Results

Medical staff from neurosurgical departments from five hospitals voluntarily participated in the study n=345. Most of the respondents rated the patient's safety grade as “excellent” and “very good”. The value of the frequency of positive responses to the dimensions of the survey varies between 37.3% (CI 95% [34.8-39.9]) (staffing) and 85.0% (CI.95% [83.1-86.9]) (teamwork within units). The dimensions with the highest score of the PPRs stand out: „teamwork within units”, „organizational learning- continuous improvement” and „supervisor/manager expectations and actions promoting patient safety”. Analyzing the effect of the influence of patient safety culture factors on the degree of patient safety appreciated by the staff, we notice that the dimensions with the greatest influence are “Feedback and Communication About Error”, “Teamwork Across Units”, “Management Support for Patient Safety”, “Handoffs and transitions”, “Communication openness”. We found significant correlations among patient safety culture composites with the degree of patient safety with differences in the strength of the correlation.

Conclusions

The results reflected the positive attitude of the staff towards most composites of the patient safety culture. The study made it possible to highlight the strong and vulnerable points of the patient safety culture and the factors influencing the patient safety degree in neurosurgical departments from Moldova.

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Qualitative and quantitative determination of proteins in extracts of some medicinal plants

Angelica Ohindovschi1,3*, Margit Cichna-Markl2, Maria Cojocaru-Toma1,3, Tatiana Calalb3, Nicolae Ciobanu1,6, Cornelia Fursenco3,4, Cristina Ciobanu1,6, Anna Benea1,3, Livia Uncu4,5
https://doi.org/10.52645/MJHS.2023.1.09

Abstract▼

Introduction

Global consumption of plant protein is increasing and high-fiber plants have health benefits through valuable phytochemicals. Plant proteins serve as an alternative to animal proteins to meet consumer demand on the one hand and reduce the risk of disease on the other. 

Material and methods

We performed qualitative and quantitative determination of proteins in extracts by sodium dodecyl sulfate–polyacrylamide gel electrophoresis (SDS-PAGE) and total content of proteins by Bradford assay.

Results

Applied methods for the qualitative and quantitative determination of proteins in dry extracts of medicinal plants: Agrimonia eupatoria L., Cichorium intybus L., Galium verum L., and Solidago virgaurea L. confirm that proteins were detected in all dry extracts and were determined the total content of them.

Conclusion

For all extracts obtained from aerial parts of: Agrimonia eupatoria, Cichorium intybus, Galium verum and Solidago virgaurea we find a low protein concentration, which implies minimizing allergic reactions and intolerance to the extracts studied.

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Morality, ethics, and professional deontology: non-traditional sources of medico-pharmaceutical law

Alexandru Znagovan
https://doi.org/10.52645/MJHS.2023.1.10

Abstract▼

Introduction

Moral, ethical, and professional deontological rules have a substantial impact on the social relations of legal regulation regarding liability for abuses and violations of citizens' rights – people taking medication – patients as part of the health care system. The identification of the place and role of moral norms, ethics, and professional deontology, their quality as specific non-traditional primary sources in the development of the health care system, and the sub-branch of pharmaceutical law in the Republic of Moldova were the focus of the present study.

Material and methods

The secondary descriptive synthesis study of normative-legal acts as primary specific non-traditional sources, viewed through the lens of the protection of the rights of the consumer of medicines, the patient – the ultimate beneficiary of the social relations in the field of health care – spanned the years 1991 to 2021. The most relevant sources subject to analysis are the Constitution of the Republic of Moldova, the Code of Ethics for doctors and pharmacists in the Republic of Moldova, laws, and sub-legislative acts, etc. The study is based on the use of several recognized techniques and methods of analysis: systemic approach, synthesis, logical-legal deduction, content and comparative analysis, etc.

Results

Both the literature and recognized authors state that respect for moral, ethical, bioethical, and professional deontological norms in the field of health care has always been highly appreciated in society, which has led to the recognition of the nobility of medical and pharmaceutical activity. The results presented in this paper have made it possible to highlight aspects that recommend that the investigation of the role of legal regulation in medical and pharmaceutical activities also question the place and role of moral, ethical, and bioethical norms, as they generally have the same thematic orientation and influence on law, legislation, the practice of applying the law, and vice versa.

Conclusions

The accomplished study allowed the identification of the dialectical and organic unity between moral, ethical, bioethical, and deontological sources with the rules of law - the moral-legal foundation of medico-pharmaceutical law. The consolidation of legal and moral norms demonstrates the structuring of the sub-branch of medico-pharmaceutical law. The analysis of the normative-legal acts in the Republic of Moldova confirms both the functionality of the „moral-ethics-deontology-law” system and the importance given to the protection of the rights of the consumer of medicines, the patient, as the ultimate beneficiary of social relations in the field of health care.

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Review

The current assessment and management of thyroid nodules

Cristina Cojocaru*, Alin Bour
https://doi.org/10.52645/MJHS.2023.1.11

Abstract▼

Introduction

The widespread use of diagnostic imaging favored the increasing incidence of thyroid nodules. Although most of nodules are benign, their clinical importance lies in the need to exclude malignancy. In assessing and managing thyroid nodules may occur the phenomenon of overdiagnosis and overtreatment on one hand and the risk of missing an aggressive thyroid cancer on the other hand. The equilibrium that has to be reached by health care providers.

Materials and methods

We conducted a PubMed, MEDLINE, ISI Web of Science, Cochrane databases search for the relevant and recent guidelines, meta-analysis, randomized controlled trial, reviews articles related to „thyroid nodules assessment”, „thyroid nodules management”, „thyroid nodules guidelines”, „thyroid nodules surgery”.

Results

The initial assessment of thyroid nodules includes an evaluation of clinical, laboratory and sonographic risk factors. Due to the sonographic features and size, the nodules are selected for biopsy. Cytologically benign nodules are usually followed-up, minimally invasive techniques may be required in certain cases. In suspected or confirmed malignancy, the treatment options of thyroid nodules include surgery or active surveillance. The main controversies appear in management of nodules with inconclusive cytology, low-risk cancers, multinodular goiters, hyperfunctioning nodules, and thyroid incidentalomas.

Conclusions

Thyroid nodules due to the high incidence and heterogeneity of background diseases cannot be evaluated and managed in one standardized approach. In the existing literature, there are discussed multiple options for diagnosis and treatment of thyroid nodules. We have reviewed the guidelines recommendations, novel published data, and controversial questions for health care professionals, to understand and provide efficient, personalized, and cost-effective management of patients with thyroid nodules in order to avoid automatic intensive testing and intervention and balancing each case from the patient expectations and demands.

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Loco-regional analgesia in oncology. Influence on cancer recurrence rate. Literature review

Ruslan Baltaga1,2, Andrei Perciun3, Andrei Badan1, Radu Turchin1,4, Valeria Cotelea1,2*
https://doi.org/10.52645/MJHS.2023.1.12

Abstract▼

Introduction

A major role and, at the same time, a question mark, both for patients and doctors, is the possibility that drugs and anesthetic techniques influence cancer metastasis. Cancer is the leading cause of death worldwide. This trend will continue in the future. Most of the deaths of cancer patients are due to complications arising from metastases. The metastasis process of a tumor depends on its intrinsic properties and interaction with the host. The treatment of tumors by performing a surgical intervention, radical or palliative, has a significant impact. For these reasons, the rate of survival and migration of cancer cells in the perioperative period is studied quite insistently and complexly. Thus, surgical intervention and anesthetic support in cancer patients becomes of great importance, because it represents the vulnerable link, both from the point of view of the operation itself, as well as the possibility that drugs, anesthetic techniques may or may not influence tumor metastasis.

Material and methods

Primary scientific studies published from 1996 to 2021 dedicated to loco-regional anesthesia and its influence on the perioperative period and on cancer metastasis were studied. To achieve the proposed goal, scientific sources PubMed, Medscape, SCOPUS, MEDLINE were researched. Keywords used for searching: loco-regional anesthesia, fascia plane anesthesia, metastasis. More than 80 reference sources were identified, 67 were selected for analysis.

Results and discussions

The surgical procedure, itself, performed for curative purposes, also known as tumor resection – is a risk factor for metastasis by creating an environment with high potential for tumor cell survival. This stimulates tumor growth and angiogenesis, can remodel lymphatic pathways, allowing metastasis of tumor cells. Hemotransfusion is associated with increased risk of metastasis. Regional anesthesia could reduce cancer recurrence through several mechanisms.

Conclusions

Regional anesthesia could reduce cancer recurrence by reducing the need for opioids or inhaled anesthetics, or by reducing the stress response during surgery. There is scientific in vitro evidence of a protective effect of systemic lidocaine on recurrent cancer, although relevant clinical data are limited.

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Monograph Review

"Gout: new advances in the diagnosis and management of an old disease" Author: Larisa Rotaru, PhD, associate professor

Alexandru Corlateanu

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„Safety of anesthesia outside the operating room” Author: Baltaga Ruslan, PhD, associate professor

Serghei Șandru

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