Objectives

Improvement of early diagnosis of psoriatic arthritis based on clinical data, immunological and mathematical research methods.

Material and methods

The study was carried out between 2019 and 2022 at the Rheumatology and Nephrology Discipline, in the arthrology and rheumatology departments of the Timofei Moşneaga Republican Clinical Hospital. To accomplish the tasks set out in the study, 110 patients were examined, including 55 patients with psoriatic arthritis (group I) and 55 patients with rheumatoid arthritis (group II).

Results

The range with the highest probability of psoriatic arthritis for the instrumental index is between 0.54 and 1.86. Of the 55 patients with psoriatic arthritis in 95% of patients clinical, laboratory, immunological and instrumental indices were within the range of the highest probability of the disease, which indicates a fairly high reliability of the mathematical model.

Conclusions

Immune disorders in the early stages of rheumatoid arthritis and psoriatic arthritis are nonspecific and are characterized by an increase in CD16+ (26.2±1.5) and CD29+ (24.8±2.1) in rheumatoid arthritis, which is significantly higher than in psoriatic arthritis CD16+ (22.0±1.3) and CD29+ (17.4±3.2) (p <0.05). A mathematical model of rheumatoid arthritis and psoriatic arthritis has been developed, which serves as an additional way of diagnosing rheumatoid arthritis and early psoriatic arthritis.

Objectives

The objective was to evaluate the relationship of comorbid pathology with the clinical and ultrasound characteristics of the evolution of psoriatic arthritis in order to optimize the management. 

Conclusions

According to ultrasound data, the frequency of detection of enthesitis and synovitis was significantly higher than during the clinical examination (p < 0.01). For its part, the psoriatic arthritis activity index (DAPSA) did not correlate with inflammatory changes detected during extensive ultrasound of large joints and entheses according to the "gray scale" and the use of Power-Doppler (p > 0.05). On the other hand, vascularization in the entheses is an index of activity independent of age and activity of psoriatic arthritis and psoriasis (p > 0.05), and it is a sign of active inflammation which correlates with laboratory markers of inflammation (hs-CRP, p < 0.05; ESR, p < 0.01).

Objectives

To assess the efficacy and harmlessness of the cytoprotective treatment with meldonium of ischemic heart disease by developing personalized approaches.

Materials and methods

Our study included 160 patients with IHD (117 men and 43 women) aged 37 to 81 years. Of them, 142 patients had angina pectoris of stable effort from different functional classes, and 21 – unstable angina pectoris. The average age of patients was 59.26±0.74 years. All patients were divided into 2 groups: 1 group (n=80) only with background treatment and 2 group included (n=80) with background treatment and meldonium. The observation period was 12 months (one year). 

Results

Significant differences were found in the pathogenesis of the underlying pathology and in the effectiveness of meldonium treatment in men and women. In this way, for men on the background of exertion angina is characteristic of more frequent occurrence of myocardial infarction, and for women – heart failure and diabetes mellitus, but meldonium remain the same effectiveness for both groups. Men smoke 16 times more, and women suffer from abdominal obesity 2 times more, which could be the cause of the more atherogenic lipid profile in them. According to the survey, the hereditary predisposition to cardiovascular diseases is higher in women, although most likely women are simply better informed about the pathologies of relatives and they were more disciplined in treatment with meldonium.

Discussions

The effectiveness of treatment in women is significantly better according to the indicators of subjective and objective improvement compared to men, which is confirmed by many existing studies. Sex factor determines the presence of a number of pathogenetic peculiarities of the course of ischemic heart disease, and therefore can be considered as one of the criteria for personalizing pharmacotherapy, however, for the individual choice of metabolic corrector, this factor is not significant. The age factor determines some pathogenetic peculiarities of the course of ischemic heart disease and the effectiveness of pharmacotherapy, however, it is not decisive for the choice of metabolic corrector.

Conclusions

The standard criteria for the personalization of pharmacotherapy in cardiology - sex, age, environmental risk factors, the presence of an underlying disease and concomitant pathology, pharmacogenetic and psychological profile - affect the pathogenesis of the development of coronary artery disease, to some extent determining the sensitivity of patients to meldonium, but they are not decisive for a personalized choice of metabolic corrector. 

Introduction

Primary myelofibrosis is a rare myeloproliferative neoplasm that affects 0.2-1.5 people per 100,000. As a rule, the diagnosis is confirmed after 60 years, but recently, hematologists around the world have encountered the problem of primary myelofibrosis in young people. The classic manifestations of myelofibrosis are characterized by splenomegaly, cytopenia, and bone marrow fibrosis, but in patients younger than 40 years, the diagnosis is most often made in the prefibrotic stage of the neoplasm. The aim of the paper is to identify and evaluate the clinical and hematological features of primary myelofibrosis in young patients in the prefibrotic stage.

Material and methods

A retrospective study was performed on clinical cases of primary myelofibrosis, registered at the Oncological Institute of the Republic of Moldova. The diagnosis was confirmed according to 2016 WHO criteria based on histological and molecular studies. We enrolled young patients under the age of 40 who had been diagnosed with prefibrosis in our study and analyzed them for clinical manifestations and complete blood count parameters. To optimize the analysis, all patients were divided into two groups according to their age: 18–29 and 30–40 years old.

Results

Changes in the complete blood count, manifested by thrombocytosis and leukocytosis, are the main laboratory patterns of primary myelofibrosis in young patients in the prefibrotic stage. The most relevant clinical features are splenomegaly and hepatomegaly, but no correlation between these manifestations has been found.

Conclusions

The classical clinical and hematological characteristics of primary myelofibrosis do not specify low- and intermediate-risk patients’ management in the prefibrotic stage, as compared with the other chronic myeloproliferative BCR-ABL-negative neoplasms. The proliferation type of primary myelofibrosis is characteristic for young patients with pre-fibrotic stage. According to our results, the main manifestations in the prefibrotic stage are detected in a complete blood count and comprise anemia, leucopenia, leukocytosis, and thrombocytosis.

Introduction

Prostatitis is an inflammatory process of the prostate, which continues to be considered one of the most common urological diseases in men under 45. Predisposing factors such as trophic, microcirculatory, and congestive disorders contribute to the onset and development of the inflammatory process in the prostate, as do risk factors such as the urethral catheter, urethrocystoscopy, endoscopic surgery for infection, and deterioration of the integrity of the urethral epithelium. The purpose of this study was to determine the impact of chronic inflammation and fibrosis of the prostate on urodynamics and local prostatic microcirculation and to evaluate the efficacy of conservative treatment.

Material and methods

The study included 58 patients (with pronounced clinical symptoms such as dysuria, stranguria, nocturnal frequent micturition 2-4 times per night, and residual urine greater than 50 mL) who received Adenosprosine® 250 mg treatment.

Results

A comparative study of the obtained data was performed on the pre- and post- treatment investigations with Adenoprosine® 250 mg suppositories, thus determining the correlation between urodynamic and microcirculation disorders depending on the degree of inflammation and prostate fibrosis.

Conclusion

According to the study results, we can outline that the level of microcirculation and urodynamic impairment indicates the level of prostate fibrosis. This process is reversible in chronic prostatitis with antifibrotic and anti-inflammatory therapy supplemented with Adenoprosine® 250 mg.

Introduction

Specialists are currently interested in the method of choice for surgical treatment in patients with enlarged benign prostate hyperplasia (> 80 cm3). The introduction of laser and bipolar technologies for benign prostate hyperplasia surgery has allowed effective treatment regardless of the size of the prostate gland. 

Material and methods

During 2020-2021, 65 patients underwent surgical treatment for large benign prostate hyperplasia. Depending on the type of surgical treatment performed, 3 study groups were identified: 22 patients underwent transurethral Thulium:YAG laser prostate vapoenucleation; 21 patients underwent transurethral bipolar prostate enucleation; and 21 patients underwent a simple prostatectomy. All patients were examined before and after surgery (at 3 and 6 months) using the International Prostate Symptom Score, Quality of Life Score, prostate-specific antigen assessment, transrectal prostate ultrasound examination, and uroflowmetry to assess residual urine volume. Postoperative complications were recorded in accordance with the 2004 Clavien-Dindo classification.

Results

There was a significant difference in the mean operative time ranging from 72±19 min (ThuVEP group) vs. 56±10 min (SP group) and 70±15 min (TUEB group), as well as a decrease in hemoglobin levels, viz. 1.2±0.4 g/dl vs. 2.6±1.1 g/dl vs. 1.6±0.5 g/dl (ThuVEP vs. SP vs. TUEB). The catheterization lasted for 2±1 days (ThuVEP) vs. 10±1 days (SP) vs. 3±1 days (TUEB). A significant improvement in Qmax was registered in the ThuVEP group (122.9%) and in the TUEB group (111.7%). However, patients after a simple prostatectomy showed an increase in Qmax of only 94%. The PVR values were reported to be the same. ThuVEP is an effective surgical technique for large BPH patients. The reduced trauma and lower complication rate of ThuVEP, as well as its effectiveness, have confirmed the need for widespread implementation of minimally invasive laser interventions.

Conclusions

The advantages of ThuVEP compared to TUEB and especially to SP are obvious. Thus, the maximum improvement in PVR was obtained in the ThuVEP group and amounted to 84.6%. The Qmax values in this group of patients also showed an excellent +122% increase. Considering the similar postoperative urodynamic results obtained after all types of surgical interventions, which were assessed within the present research (ThuVEP, TUEB, and SP), as well as a significantly lower complication rate (14.27%) found in the ThuVEP group, we consider it rational to use Thulium:YAG laser energy in the treatment of large BPH.

Introduction

Urinary drainage is a key part of ureteropelvic junction obstruction treatment. Both external and internal drainage methods have been widely used for many years, but there is now relevant research comparing these methods and their impact on surgical outcomes in adults. The aim of the current research was to assess the efficacy and safety of two different types of urinary drainage on adult pyeloplasty.

Material and methods

We conducted a retrospective and prospective clinical controlled study in the Department of Urology at the Republican Clinical Hospital from Chisinau. We reviewed 118 consecutive adult pyeloplasties for ureteropelvic junction obstruction. In 62 (52.54%) patients, we used double-J ureteral stent insertion (DJ); in another 56 (47.46%) patients, we used different types of external drainage (ED): uretero-pyelo-nephrostomy, nephrostomy, or a combination of both. Operative time, hospital stay, use of analgesics, overall complications, type of complications, and success rates were compared between the two groups.

Results

The mean operative time in the DJ group was 93.52±18.10 min. vs. 95.77±20.48 min. in the ED group (p = 0.001). The average postoperative hospital stay in the DJ group was 8.45±2.02 days vs. 14.71±3.45 days in the ED group (p=0.000). The DJ group used 7.77±3.48 analgesics on average, while the ED group used 9.86±4.64 (p = 0.006). Overall complication rate was 9.68% in the DJ group and 32.14% in the ED group (p = 0.002). The most frequent complication for all patients was acute pyelonephritis (12.71%): 4.84% in the DJ group vs. 21.43% in the ED group (p = 0.007). The success rate was 96.77% in the DJ group and 92.86% in the ED group.

Conclusions

Both urinary drainage methods appear equivalent concerning overall success rates, but double-J ureteral stents are associated with a shorter operating time, fewer postoperative pain medications, a shorter postoperative hospital stay, and a lower number of postoperative complications compared with external urinary drainage methods.

Introduction

The literature suggests that the mode and timing of delivery have a greater impact on adverse neonatal outcomes than the number of previous cesarean sections.

Materials and methods

A retrospective observational case-control study was carried out. The study included 352 pregnant women with a singleton pregnancy and at least one previous cesarean section: 177 pregnant women with two or more previous cesarean sections (experimental group) and 175 with a primary cesarean section (control group). Excel tables were used to organize the data. For comparing categorical variables in groups, the χ² test was used. A p < 0.05 was considered statistically significant.

Results

Termination of the pregnancy by cesarean section at 39 + 0 – 39 + 6 weeks of gestation (56.5% and 27.4%, respectively; p < 0.001) was statistically significantly more frequent in the experimental group. Analysis of deliveries revealed that emergency cesarean sections in pregnancy (18.9% and 9.0%, respectively; p < 0.01) and emergency cesarean sections during labor (60.6% and 30.5%, respectively; p < 0.001) were performed statistically significantly more frequently in the control group. Planned cesarean sections during pregnancy (60.5% and 20.6%, respectively; p < 0.001) were performed statistically significantly more frequently in the experimental group. The rate of full-term neonates was statistically significantly higher in women from the experimental group (96.6% and 83.4%, respectively; p < 0.001), and the rate of post-term neonates was statistically significantly higher in women from the control group (12.0%; p < 0.001). The Apgar score values 1 minute after birth equal to 8–10 points (130 – 84.4% and 10 – 47.6%, respectively; p < 0.001) were statistically significantly more frequent in pregnant women without acute fetal distress during labor, and the Apgar score values 1 minute after birth equal to 1–7 points (11 – 52.4% and 24 – 15.6%, respectively; p < 0.001) were statistically significantly more frequent in pregnant women with acute fetal distress during labor. Similar results were found in the Apgar score at 5 minutes after birth.

Conclusions

In our research, it was demonstrated that the mode and timing of delivery have a greater impact on adverse neonatal outcomes than the number of previous cesarean sections.

Introduction

In the pharmaceutical field, the quality management is a priority and the risk management is a valuable component of an effective quality system. It involves anticipating hazards and controlling risk through a process of risk awareness, reduction, and review. The aim of this paper was to reveal the usefulness of modern risk management strategies and to assess the impact of risk management in the provision of quality services by community pharmacies.

Material and methods

The causes that can lead to medication errors in community pharmacies were identified by applying the CNAM Method combined with the Delphi Technique, later the risks were categorized by the Ishikawa diagram, analyzed and evaluated by applying the expert analysis method (MAE) in risk assessment, graphically represented by the Matrix risks and ranked, highlighting pharmacy activities during which medication errors may occur.

Results

The risk factor was calculated for 56 potential risks that can cause medication errors, of which 8 for the activity of ordering medicines, 8 potential risks for the activity of receiving products, 6 risks for the activity of storing products, 17 risks for the preparation of drugs and 17 risks for drug dispensing activity. Applying the MAE method in risk assessment, risk occurrence probability and outcome impact values were obtained for each risk. The potential risks of error were graphically represented using the Risk Matrix. Thus, the following activities with a major level of risk were highlighted, for which urgent measures to minimize the impact are required: illegible writing in prescriptions (15.5), fatigue of pharmaceutical staff (15.48), overwork/multitasking (14.99), prescriptions containing errors (14.26), insufficient staff knowledge (13.81), ordering inappropriate quantities of products in pharmacies (13.59), incomplete prescriptions (12.86) and similar packaging of medicines (12.63).

Conclusions

The results of this paper provide the basis for further research in order to develop a Risk Management Plan in community pharmacy. The causes that can lead to errors in the pharmacy have been identified, by highlighting pharmaceutical activities, during which risks of errors may occur. The work has practical use, and the research results can be applied by pharmacies, contributing to the improvement of their performance.

Introduction

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.

Material and methods

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.

Results

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.

Conclusions

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.

Introduction

Osteitis condensans ilii (OCI) is a condition characterized by benign sclerosis of the iliac bone in the portion adjacent to the sacroiliac joints, which is radiologically manifested by triangular opacities at the level of this portion. Among the clinical manifestations, localized low back or lumbosacral pain is often attested, which is found in the gestational or post-partum period. The pain may worsen during physical exertion or during menstruation and may be accompanied by myalgia.

Material and methods

The epidemiological, clinical and paraclinical data were used to highlight this study, followed by the conclusions of multidisciplinary specialists, retrieved from the inpatient medical records of 3 women with OCI, who were admitted for diagnosis and treatment.

Results

3 cases of imaging-determined OCI will be presented, which were initially diagnosed with seronegative spondyloarthritis (SpA). Through them, we would determine the varieties between the OIC forms and their differential diagnosis with SpA. The results of the lab tests do not reveal specific changes, so the markers of inflammation (C-reactive protein, erythrocyte sedimentation rate) were normal. Also, unlike SpA, the marker HLA-B27 is in most cases negative. 

Conclusions

According to the results of the presented clinical cases, OCI is often confused with sacroiliitis, which leads to misdiagnosing and erroneous treatment tactics. Thus, in order to establish a true diagnosis, it is necessary to collect a detailed history, perform a comprehensive objective examination, which includes the character of the pain and its triggers, the lack of inflammatory lab markers and the radiological presence of the sclerosis areas at the level of the iliac bone, not involving the sacroiliac joints.

Introduction

Despite significant advances in diagnosis, medical management and antimicrobial therapy, sepsis in the puerperium remains an important cause of maternal morbidity and mortality. The abnormalities associated with the clinical syndrome of sepsis result from a nonspecific innate inflammatory response. This is due to the fact that sepsis represents a systemic inflammatory response syndrome (SIRS) to infection or injury; therefore, it can rapidly progress to septic shock and death despite aggressive treatment. Severe sepsis with MODS has a mortality rate of 20–40%, rising to around 60% if septicemic shock develops. Symptoms of sepsis may be less distinctive than in the non-pregnant population and are not necessarily present in all cases; therefore, a high index of suspicion is necessary. The major pathogens causing sepsis in the puerperium are: group A streptococcus (GAS), also known as Streptococcus pyogenes, Escherichia coli, Staphylococcus aureus, Streptococcus pneumonia, methicillin-resistant S. aureus (MRSA), Clostridium septicum, Morganella morganii and antibiotic-resistant Stenotrophomonas Moltrophilia.  Multiple risk factors for maternal sepsis have been identified: obesity, impaired glucose tolerance/diabetes, impaired immunity/immunosuppressant medication, anemia, vaginal discharge, history of pelvic infection, amniocentesis and other invasive procedures, cervical cerclage, prolonged spontaneous rupture of membranes, caesarean section, wound hematomas, retained products of conception, GAS infection, vaginal trauma. 

Material and methods

Presentation of case report using the following key-words: „infection”, „systemic inflammatory response syndrome (SIRS)”, „severe sepsis”, „septic shock”, „multiorgan dysfunction syndrome (MODS)”.

Results

We present a case of perinatal infections complicated with MODS.

Conclusions

The presence of pelvic hematomas triggers the sepsis caused by multiple infections in perinatal period and can significantly increase the morbidity related to bleeding, infection, surgery and blood product transfusion. The clinical situation may worsen in the presence of pre-existing pathological conditions before pregnancy.

Introduction

An attempt was made to detect the pathogenetic factors involved in the occurrence of the disease by studying the clinical and laboratory data of 160 patients diagnosed with chronic osteomyelitis of the jaws treated in the clinic of oro-maxillo-facial surgery between 2005 and 2022. The patients studied were or are still drug users who use illicitly produced (amphetamine-type drugs) or other drugs (abbreviated α-PVP). We obtained positive results in the treatment of toxic osteomyelitis of the jaws following the implementation of a conservative and surgical treatment scheme.

Materials and methods

Detailed anamnesis of disease development, clinical examination, pictures, an orthopantomogram, general blood analysis and biochemical profile, urine analysis, blood markers, and AIDS analysis.

Results

The study of the composition of used substances is an important factor in the definition and development of the given disease's cause and mechanism. According to the patient's statement, this disease developed following the use of the amphetamine drug. This drug contained the main substance – ephedrine, and also red phosphorus and iodine, which accumulate and cause trophic changes. Almost all organisms' systems are affected by amphetamine intoxication. Given that only surgical treatment has a small effect on any of the patients in this group, we devised a conservative presurgical treatment plan. We prescribe medication for these patients: detoxification of the body from drugs that cause spasm of small blood vessels and accumulate in bone tissue, causing necrosis. Lavages of the mouth cavity are performed daily, and necrectomy is eventually performed.

Conclusions

Assistance to drug addicts with jaw necrosis is a demanding subject given that the majority of their population is unemployed and without insurance. According to unofficial data, there are only 5000 such patients in Chisinau.