Introduction 

Obesity is a metabolic disease that presents a real challenge for the medical system due to the significant increase in the number of obese people in recent decades. Currently, 38% of the global population is overweight or obese. Obesity is an important risk factor for multiple chronic pathologies and lung infections, especially pneumonia. For obese subjects, chronic proinflammatory status due to an excess of fat cells is characteristic.

Material and methods 

This prospective cohort study is based on clinical and laboratory examinations of patients hospitalized with community-acquired pneumonia in the Department of Internal Medicine at „Holy Trinity” Municipal Hospital, Chisinau, Republic of Moldova. The study included 210 patients with community-acquired pneumonia, divided into two groups: the base group (group 1) consisted of 105 patients with varying degrees of obesity, and the control group (group 2) consisted of 105 normal-weight patients. The research was conducted according to the principles of the Helsinki Declaration - WMA Declaration of Helsinki - Ethical Principles for Medical Research Involving Human Subjects. The study was approved by the Research Ethics Committee of the Nicolae Testemiţanu State University of Medicine and Pharmacy, with the issuance of favorable opinion no. 46 from March 27, 2018. All patients were examined clinically and paraclinically (radiological examination, pulse oximetry screening, complete blood count, erythrocyte sedimentation rate, fibrinogen, LDH, C-reactive protein, oxidative stress markers). The obtained data were statistically analyzed using Statistical Package for the Social Sciences (SPSS) version 20. 

Results 

According to the obtained data, the most common comorbidities associated with obesity were cardiovascular and metabolic diseases. The main symptom that prevailed in the obese was dyspnea (97%). Obese subjects showed more frequent signs of acute respiratory failure (86.7%), required oxygen therapy with an average duration of 7.62±6.23 days, showed increased serum levels of LDH (286.31±94.66 U/L) and C-reactive protein (66.08±71.44 mg/l), data that influenced the clinical course of pneumonia. 

Conclusions 

Patients with obesity and community-acquired pneumonia presented with infectious symptoms and acute respiratory failure, increased values of inflammatory markers, and required oxygen therapy more frequently compared to those of normal weight.

Background

Lung cancer exhibits high global incidence and mortality rates. Surgical resection remains crucial to diagnosis, staging, and treatment of non-small cell lung cancer (NSCLC). However, advanced stages often require multimodal approaches. Prehabilitation, innovative perioperative techniques, and the exploration of immunotherapy hold promise for improving outcomes.

Materials and methods

This two-phase observational cohort study included a retrospective arm (100 patients, traditional treatment) and a prospective arm (100 patients, innovative perioperative management, and risk stratification). Descriptive and inferential statistics were used to evaluate data, identify risk factors, and compare the 2-year survival between treatment groups.

Results

Despite advances, lung cancer prognosis remains poor, with limited cure rates. Mean survival in the traditional approach was 1.3 years with a 5-year survival of only 1%. While prehabilitation and innovative techniques showed potential, no statistically significant differences in survival times were observed between the treatment groups. Patients with stage III (Charlson score 0-4) and stage I-II (Charlson score 5-12) demonstrated comparable outcomes, highlighting the importance of comorbidity burden.

Conclusions

Targeted screening protocols are of paramount importance for early detection and intervention. Population-wide smoking cessation programs, environmental protection measures, and the promotion of healthy lifestyles are vital for prevention and reducing incidence. Standard chemotherapy and radiotherapy offer limited therapeutic benefits in advanced lung cancer. This highlights a pressing need for breakthroughs in basic research to develop novel treatment paradigms that significantly improve outcomes. While this study did not reveal statistically significant survival differences between traditional and innovative perioperative approaches, prehabilitation and optimization techniques hold promise and deserve further research. The development of anti-tumor immunotherapy offers a significant potential in non-surgical lung cancer treatment, especially given the limitations in advanced-stage disease management. Harnessing the immune system to fight cancer represents a promising new frontier.

Introduction

Non-Hodgkin lymphoma (NHL) encompasses a diverse group of malignancies arising from malignant proliferation of lymphocytes, each subtype characterized by unique epidemiological, etiological, and clinical features. Prognostication is essential for guiding treatment decisions and improving patient outcomes. Prognostic scores, including traditional and molecular systems, offer insights into survival prediction. The aim of the present study was to evaluate the applicability of traditional prognostic scores based on clinical markers and laboratory biomarkers in predicting the outcomes of patients with primary nodal NHL.

Materials and methods

This study included 78 NHL patients treated at the Chisinau Oncological Institute from 2017 to 2021. Clinical and biological data were collected, and the following prognostic scores were calculated: International Prognostic Index (IPI), The combined index of hemoglobin, albumin, lymphocyte, and platelet (HALP score), Platelet to Lymphocyte Ratio (PLR), Neutrophil to Lymphocyte Ratio (NLR), Albumin/Globulin ratio (AG), and Charlson comorbidity index (CCI). Statistical analyses, including descriptive statistics, ROC curve analysis, and Kaplan-Meier survival curves, were conducted.

Results

Of the patients, 40 (51.2%) were female, with a mean age of 57.1 ± 10.2 years. Peripheral lymph nodes were predominantly affected (84.6%), with diffuse large B-cell lymphoma being the most prevalent subtype (59.0%). Prognostic scores, including the International Prognostic Index (IPI), Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) score, and Charlson Comorbidity Index (CCI), demonstrated varying levels of discriminatory ability in predicting overall survival (OS). Notably, the HALP score (AUC = 0.650; p = 0.026), IPI (AUC = 0.745; p = 0.0002), and CCI (AUC = 0.636; p = 0.043) were statistically significant predictors of OS.

Conclusions

Traditional prognostic scores (IPI. HALP score, CCI) offer valuable prognostic information for NHL patients. Further research is needed to validate these findings and explore cost-effective prognostic strategies.

Introduction

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.

Objective

To investigate the symptoms of DIE and determine its impact on QoL to optimize its diagnostics.

Materials and methods

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.

Results

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).

Conclusions

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.

Introduction

Nitric oxide (NO) is a gaseous molecule that is a biological mediator that carries out important regulation of physiological processes necessary for the functioning of tissues. We hypothesized that nonspecific inhibition of all isoforms of NOs would cause pancreatic damage and created a model of experimental pancreatitis based on NOs inhibition. Along with the study of the mechanisms of development of chronic pancreatitis, the search for medicines to treat and inhibit the progression of this disease continues.

Purpose of the research

To study the protective effect of glutargin on the pancreas of rats with chronic pancreatitis induced by a blocker of NOs. 

Material and methods

The work was carried out on 21 laboratory white male Wistar rats weighing 180-230 g. Chronic pancreatitis was induced by intraperitoneal administration of the NOs blocker - N-nitro-L-arginine (L-NNA) (Sigma-Aldrich, USA) at a dose of 40 mg/kg of body weight. Rats in group I (n = 7) were injected with L-NNA for 12 days, rats in group II (n = 7) were injected intraperitoneally with glutargin 20 mg/kg, after 20 minutes they were injected with L-NNA - within 12 days. Rats of the control group (n = 7) were injected intraperitoneally with 0.9% NaCl solution. The rats were euthanized on the 45th day and biochemical and morphological studies were carried out.

Results

After the introduction of the NOs blocker, deterioration of the general condition of the animals was determined, a sharp increase in the level of nitrites/nitrates to 80.22±19.91 μmol/l, control 32.61±4.55 μmol/l (р < 0.05); protein-bound hydroxyproline (PBH) to 215.21±22.01μmol/l, control 178.67±26.39 μmol/l, (p < 0.05); free hydroxyproline (FH) to 14.74±1.84 μmol/l, control 9.96±0.71 μmol/l, (p < 0.05); malondialdehyde (MDA) to 5.67±0.88 nmol/ml, control 3.62±0.13, (р < 0.05). Pronounced structural changes with stasis of formed blood elements in the vessels, focal accumulation of leukocytes in the parenchyma, dystrophy of acinar cells and fibrosis in the atrophy zone were determined in the pancreas of rats. Administration of glutargin contributed to the restoration of general behavioral reactions of rats, normalization of MDA – 4.81±0.15 nmol/ml, control 4.50±0.23, (p > 0.05); ceruloplasmin (CP) – 591.71±68.07 mg/ml, control – 663.25±34.05 mg/ml, (p > 0.05); PBH 183.62±5.98 μmol/l, control – 179.28±9.19 μmol/l, (p > 0.05); FH – 9.44±1.13 μmol/l, control – 9.96±0.71 μmol/l, (p > 0.05) and prevented the development of pronounced structural changes in the pancreas.

Conclusions

In chronic pancreatitis induced by a NOs blocker, glutargin can prevent chronic pancreatitis by normalizing collagen metabolism, inhibiting oxidative stress, and severity of pancreatic parenchymal damage.

Introduction

This article provides an overview of current knowledge and global experience regarding the use of emicizumab, with a focus on its specific considerations in pediatric practice. Emicizumab, a monoclonal antibody, operates uniquely compared to other therapies. It has been approved in Moldova since 2019 for preventing bleeding in hemophilia patients. Significant data from clinical studies and accumulated clinical practice provide answers to most questions physicians have when prescribing emicizumab. The article presents recommendations based on current information and global experience to aid decision-making in emicizumab usage. The purpose of this article is to provide information on management tactics for pediatric patients with hemophilia A receiving emicizumab. 

Materials and methods

Over 40 publications were reviewed, consisting of recommendations, study results, and observations related to emicizumab use in pediatric patients with Hemophilia A.

Results

In 2017, emicizumab became the first registered non-factorial therapy for Hemophilia A. It was approved for use in treating the inhibitory form of the condition. In 2018, indications for emicizumab were expanded to include patients with the inhibitory form of hemophilia A and severe hemophilia A without inhibitors. Emicizumab is used to prevent bleeding and is not intended to stop an already occurring bleeding. If bleeding has occurred, the patient will need to be prescribed FVIII or bypassing agents. Emicizumab is administered as a loading dose of 3 mg/kg once a week for the first 4 weeks, followed by a maintenance dose of 1.5 mg/kg once a week, 3 mg/kg once every two weeks, or 6 mg/kg once every four weeks. The dose is based on the patient's body weight, which needs regular monitoring. If a dose is missed, it should be administered as soon as possible before the next scheduled dose, and the injection schedule should not be altered. Emicizumab can be used in children under one year to prevent bleeding. 

Conclusions

Hemophilia, caused by a deficiency in coagulation factors VIII or IX, is a bleeding disorder. The main treatment-related complication in hemophilia patients is the development of inhibitors – alloantibodies that neutralize the procoagulant activity of infused FVIII or factor IX. The reasons why only 20%-30% of Hemophilia A patients develop inhibitors remain a challenge. Emicizumab, a bispecific monoclonal antibody, bridges the gap between activated factor IX and factor X to replace the missing activated factor VIII, thereby restoring hemostasis.

Introduction

The term "hepatitis" implies liver damage by inflammatory cells, a condition with numerous origins. Viruses, predominantly hepatitis B and C viruses cause most cases of hepatitis, which can lead to chronic liver diseases. Assessing the general knowledge and awareness of the population regarding viral hepatitis is crucial for developing targeted and effective strategies to address these epidemics. This knowledge can help tailor interventions for different population strata, such as youth and adults, thereby enhancing the impact of prevention and care efforts.

Materials and methods

An exhaustive search of relevant literature was performed in electronic databases such as PubMed, Scopus, and Web of Science. Key terms included "viral hepatitis B," "viral hepatitis C," "knowledge," "attitudes," "practices," and "population." Articles included in the analysis were selected based on predefined inclusion and exclusion criteria.

Results

In a Nigerian hospital, 33% of healthcare workers lacked knowledge of hepatitis B, and 35% were not immunized. In an Iraqi study, 75% believed HBV is more easily transmitted than HIV, and 33.9% knew HBV could spread through toothbrushes. In India, most medical students were aware of hepatitis B (84.8%). Their knowledge about transmission through blood transfusion (81.06%) and needles (74.1%) was good, but they had poor knowledge about other modes of transmission and clinical features. A study in Tehsil Wazirabad, Gujranwala found good knowledge about hepatitis C transmission and symptoms. In Saudi Arabia, dental students revealed insufficient knowledge about hepatitis B infection. Practice levels varied, with 47.2% showing high practice and 22% low practice. Female participants exhibited higher knowledge, attitudes, and practices. In Gauteng province, South Africa, a 2015 study found that healthcare workers had inadequate knowledge of viral hepatitis. The average knowledge score was 2.0 out of 6, while practice and attitude scores were higher.

Conclusions

A significant difference in knowledge levels regarding viral hepatitis B and C was highlighted within the population. The overall level of knowledge regarding viral hepatitis B and C remains inadequate among both medical personnel and the general population. There is a growing need for education and awareness about viral hepatitis B and C.

Introduction

Among working-age adults, diabetes is a primary cause of visual impairment. Pan-retinal photocoagulation, the standard treatment for proliferative diabetic retinopathy, is effective but comes with well-established adverse effects, including limitations on the peripheral visual field. The mechanism of vascular proliferation is thought to be triggered by vascular endothelial growth factor (anti-VEGF). Anti-VEGF medications have been studied extensively in the treatment of diabetic macular edema, and the results suggest that treatment with anti-VEGF medications causes a decrease in diabetic retinopathy. Anti-VEGF therapies can be used to treat underlying proliferative diabetic retinopathy in cases of vitreous bleeding when platelet-rich plasma cannot be used, delaying, or reducing the necessity for a vitrectomy. However, the limitations of anti-VEGF therapy require careful patient selection and constant observation. Recent clinical trials and recommendations for the use of anti-VEGF in proliferative diabetic retinopathy are presented in this review.

Material and methods

The effectiveness of anti-VEGF medicines in the treatment of diabetic retinopathy was the subject of a comprehensive review of the scientific and medical literature. A structured search was performed in the PubMed, Scopus, and HINARI databases, considering relevant articles published in the last 10 years. The search terms used (in English) were: “angiogenesis inhibitors”, “anti-VEGF”, “pan-retinal photocoagulation”, “intravitreal injection”, “diabetic retinopathy”. Accurate diagnosis, side effects, quality of life, and patient satisfaction were analyzed and compared for each treatment option.

Results

Anti-VEGF treatments have been demonstrated to be beneficial in reducing macular edema, enhancing visual acuity, and slowing the advancement of diabetic retinopathy. While generally safe, different anti-VEGF medicines have varied side effects profiles.

Conclusion

When choosing an anti-VEGF treatment for diabetic retinopathy, factors such as patient satisfaction, quality of life, side effects, and correct diagnosis should be taken into account. While anti-VEGF treatments show promise, further study is required to fully understand their advantages and disadvantages and to optimize their application.

Introduction

With the complexities of contemporary healthcare systems and the paramount importance of high-quality patient care, Simulation-Based Medical Education (SBME) has emerged as a pivotal innovation in the process of training healthcare professionals. This study explores the integration of SBME in undergraduate medical education to bridge the gap between theoretical knowledge and clinical practice, thereby preparing students with the necessary competencies for effective healthcare delivery.

Material and methods

Employing a narrative review approach, this study meticulously examined relevant literature from multiple databases, including Google Scholar, PubMed, and MedEdPublish. Following objectives, we chose the sources that were best suited to explore our research questions, focusing on keywords such as „simulation”, „undergraduate medical education”, „simulation-based medical education”, „theoretical frameworks”, „procedural framework” „curriculum design”, „training efficacy”, and „training evaluation” with no restriction for the date of publications.

Results

The review identified foundational educational theories underpinning SBME, such as Experiential Learning Theory and Adult Learning Theory, and traced the evolution of simulation methods from simple anatomical models to sophisticated high-fidelity simulators and virtual reality technologies. Various simulation techniques, including task trainers, manikins, and standardized patients, were analyzed for their educational value. Significant benefits of SBME, such as enhanced safety, repeatability, and adaptability, were highlighted alongside challenges like high costs and limited access. Comparative analysis revealed SBME's advantages over traditional clinical education, particularly in learning efficiency and scalability.

Conclusions

SBME represents a transformative approach in undergraduate medical education, offering a dynamic and interactive learning environment that significantly enhances clinical skills, critical thinking, and confidence. Despite its challenges, the integration of simulation-based methodologies into medical curricula is essential for addressing the evolving needs of medical training and improving patient care outcomes. Future research should focus on longitudinal studies to assess the long-term impact of SBME on clinical practice and explore the integration of emerging technologies to enhance the efficacy and accessibility of simulation-based training.

Introduction

Acoustic neuroma is a benign tumor that arises from the glial Schwann sheath junction of the vestibulocochlear nerve. It has an incidence of 1:100000 population. Despite the fact that this is a rare tumor, it accounts for approximately 6% of all intracranial tumors and 80% of tumors localized in cerebellopontine angle. Treatment of acoustic neuroma is represented by “Wait and Scan” monitoring, radiologic and surgical treatment. The latter remains the primary treatment for acoustic neuroma and consists of 3 main approaches: retrosigmoid approach, middle cranial fossa approach and translabyrinthine approach. Until now, in our country, acoustic neuroma surgery was done only by retrosigmoid approach.

Case presentation

The first translabirinthine surgery for acoustic neuroma in our country was done on 09.12.2021 on a 60-year-old patient who, during preparation for cochlear implant surgery, was accidentally diagnosed with 3rd grade right acoustic neuroma, according to Koos classification. Patient had cophosis on the right ear and moderate hearing loss in the left ear. During the surgery, a gross total resection of the tumor was accomplished. The patient was discharged from the medical institution on 20.12.2021 in a satisfactory condition. Magnetic resonance imaging performed 3 months and 1 year after the surgery showed no complications or tumor remnants. 

Conclusion

The current report, which describes an accidental diagnosis of acoustic neuroma during preparation for a cochlear implantation surgery, resulted in acoustic neuroma surgery through the translabyrinthine approach. This serves as an eloquent example of why it is necessary to perform initially a magnetic resonance examination in cases of sensorineural hearing loss or tinnitus. The translabyrinthine approach in acoustic neuroma surgery allows for the removal of tumors of any size without affecting the brain, especially the cerebellum. In our case, where the patient had cophosis on the side of the tumor, this was the most appropriate surgical approach.