Introduction

The aim of study was to establish if the treatment of overactive bladder in women and its result reported by patients were different depending on the findings of urodynamics, performed before botulinum toxin injection. We obtained clinical data based on the necessity and importance of performing urodynamic tests up to surgical treatment with botulinum toxin A injection in detrusor muscle, at patients diagnosed with idiopathic overactive bladder and detrusor overactivity, offering a guarantee of an effective and long-lasting treatment and assure with predictive parameters for some postoperative complications.

Material and methods

The research was carried out at the Department of Urology and Surgical Nephrology, during the years 2019 – 2022. After applying the inclusion and exclusion criteria, 36 women diagnosed with overactive bladder were enrolled in the prospective pilot study, aged between 18 and 70 years, refractory to drug treatment and investigated urodynamic by excluding/including the presence of detrusor overactivity and clinically using voiding diary/24h, bladder symptoms and Quality of Life questionnaires before and after botulinum toxin A injection. The primary data were analyzed and presented as a mean and standard deviation.

Results

All women involved in the study were diagnosed clinically and urodynamic with overactive bladder, of which 55.5% of cases were associated with detrusor overactivity and subsequently received BTX-A injectable surgical treatment with a dose of 100U. At urodynamics, the low values of the indices obtained at cystometry were established: first sensation of bladder filling (79.8±56.3 ml), first desire to void (117.8±103.2 ml), strong desire to void (162±125 ml) and maximal cystometric capacity (183.4±139.8 ml), which correlated in 100% cases with OAB symptoms (urinary urgency, frequency and nocturia) from the OABSS validated questionnaire. The capacity of the bladder at each sensation was lower, being inversely proportional to the detrusor overactivity present in women with OAB. Based on UDS data, the diagnosis of OABi with detrusor overactivity was confirmed by establishing the presence of phasic detrusor contractions (3.9±1.1), increased values of detrusor pressure (45.9±23.9 cmH2O) and the presence of bladder hypocompliance (10.6±11.5 ml/cmH2O), these data in 100% of cases predicted an effective BTX-A injection. Daily activity and psychosocial behavior improved after intradetrusor botulinum injections toxin was influenced by reducing daytime urination from 28% to 40% and urinary urgency from 30 to 69%.

Conclusions

This study identified a number of statistically significant urodynamic variables associated with objective clinical data, which confirm the impact of severity of idiopathic overactive bladder symptoms and the subsequent effect of botulinum toxin type A injections in case of urodynamic confirmation of detrusor overactivity presence.

Introduction

According to the current recommendations of the European Association of Urology and the International Society of Urology, open simple prostatectomy is the reference standard in the surgical treatment of benign prostatic hyperplasia of large size (>80 ml). Extended trauma and a high complication rate reduce the chances to use this method. In this context, several minimally invasive laser surgical treatment techniques have been proposed in order to provide an optimal treatment to patients. Transurethral endoscopic vapoenucleation of the prostate using laser energy is a new concept in endourological surgery.

Material and methods

Between September 2019 and December 2019, 93 patients with benign prostatic hyperplasia underwent surgical treatment. Two surgical methods were applied: transurethral Thulium:YAG laser prostate vapoenucleation (45 patients) and open simple prostatectomy (48 patients). All patients were evaluated preoperatively and postoperatively (3 and 6 months) using the International Prostate Symptom Score, Quality of Life Score and International Erectile Function Index, physical examination and digital rectal examination, prostate specific antigen assessment, transrectal prostate ultrasound examination and assessment of residual urine volume, uroflowmetry. Postoperative complications were recorded according to the Clavien-Dindo classification, 2004. The inclusion criteria were total prostate volume ≥80 cm3, age ≤80 years, residual urine volume ≥70 ml, Qmax ≤10 ml/s.

Results

Transurethral Thulium:YAG laser vaponucleation of prostate has proven a high surgical efficiency level. The baseline urodynamic and ultrasonographic indicators after transurethral vapoenucleation at 6 months postoperatively were similar to those in the control group (open simple prostatectomy). The duration of recovery of patients after classical surgery was significantly longer. At the same time, the rate of postoperative complications after prostate vapoenucleation was lower. Patients in the ThuVEP group did not require blood transfusions.

Conclusions

According to obtained results, we can assume that transurethral vapoenucleation of the prostate with laser energy will soon become a new „gold standard” in the surgical treatment of large benign prostate hyperplasia.

Introduction

Hematological inflammatory markers may be promising diagnostic markers for assessing the severity of intrahepatic cholestasis of pregnancy. The aim of the study was to evaluate and compare the levels of hematological inflammatory markers in intrahepatic cholestasis of pregnancy.

Material and methods

A prospective cohort study of 142 clinical cases, divided into two groups depending on the presence of cholestasis gravidarum, was carried out. The research was conducted by assessing the level of bile acids and hematological inflammatory markers in the mother's blood, as well as by studying medical records. The IBM Statistics SPSS 21 program was used to process the statistical data. To compare categorical variables, the χ² without the Yates' continuity correction test was applied.

Results

There was an increase in platelet-to-lymphocyte ratio in pregnant women with intrahepatic cholestasis of pregnancy compared to the control group (146.0±6.8 versus 135.2±7.3, respectively). The values of neutrophil-to-lymphocyte ratio and the average volume of platelets were similar in both groups. At the same time, the study found a decrease in the values of erythrocyte distribution among women whose pregnancy was complicated by cholestasis gravidarum.

Conclusions

The study showed a significant increase in platelet-to-lymphocyte ratio in women whose pregnancy was complicated by cholestasis gravidarum, as well as an increase in this indicator with increasing levels of bile acids. Thus, this ratio may be a promising diagnostic marker in assessing the severity of intrahepatic cholestasis of pregnancy.

Introduction

The COVID-19 pandemic has a major negative impact on health and socio-economic well-being. Understanding the characteristics of COVID-19 disease and identifying the wide range of factors affecting health and quality of life can be the key to providing viable solutions to improve the management of patients and their physical and psycho-emotional rehabilitation. The purpose of the present study was to evaluate the influence of SARS CoV-2 infection on the health status of adults hospitalized with the diagnosis of COVID-19 in the Republic of Moldova.

Material and methods

The presented study is a retrospective, cohort, consisting of a sample of 7441 patients randomly selected, aged 18 y/o and older, hospitalized in 10 public medical institutions in Chisinau, Moldova. Diagnosis of COVID-19 was confirmed by detection of CoV-2 SARS RNA. The data in the patients' medical records were processed and stored according to the unified, pre-established form, prepared in accordance with the requirements of the software „Electronic Patient Record COVID-19”. The severity of COVID-19 disease was assessed using two principles: (1) according to the criteria of the National Clinical Protocol PCN-371; (2) according to the 7-point graduated scale developed by the WHO Special Committee (V.3.0, 3 March 2020) in randomized multicenter clinical trials.

Result

Only 30.07% patients mentioned the presence of a close contact with a COVID-19 positive person. The average age of the patients in the study was 52.83 years. Mild form was diagnosed in 5.00% of patients, medium - 66.15%, severe –20.67%, critical-8.18%. The main complaints of patients were fever, fatigue or physical asthenia, cough, and headache. More than 1/4 of those hospitalized have severe or critical forms of COVID-19; more than 1/3 - require oxygen therapy, and every 6-th patient needs non-invasive high-flow oxygen ventilation or mechanical ventilation. Old age, male sex, chronic comorbidities increase statistically significantly the probability of patients having an unfavorable prognosis in COVID-19. 7.93% of patients died, according to the age group:  every 2-nd patient over 90 years, every 3-rd over 80 years, every 5-th over 70 years, and every 9-th over 60 years died.

Conclusions

(1) The uncertainty of the source of infection lead to delay specific prophylactic public health measures; (2) In COVID-19, in a hospital-type medical management, the emphasis should be placed mainly on patients over the age of 50; (3) There is no specific clinical manifestation in COVID-19, that would allow to distinguish the disease from other pathologies; (4) Age over 60 y.o, male sex, and chronic cardiovascular diseases, diabetes mellitus, chronic kidneys diseases and malignant tumors unfavorable influence the evolution of COVID-19; (5) Antibiotic administration remains at a high level in hospitalized patients and is often unjustified and unnecessary.

Objectives

Study of clinical manifestations in psoriatic arthritis: enthesitis, dactylitis, peripheral arthritis, axial arthritis, skin manifestations, for early diagnosis, which would allow the establishment of an adjusted treatment and the elaboration of measures to prevent complications.

Results

The clinical examination of primary or referred patients with cutaneous manifestations, revealed peripheral arthritis in 15 patients (24.6%), dactylitis – in 37 (60.7%), heel pain was detected in 32 (52.5%), axial arthritis – in 30 (49.2%), enthesitis, distal interphalangeal arthritis and tendonitis were not detected. Those who primary or referred with joint manifestations, in 35 (57.4%) of patients was present peripheral arthritis, dactylitis in 40 (65.6%), enthesis of the elbow joints in 11 (18%), knee joints - in 8 (13.1%), the calcaneal region - to 25 (41%), arthritis of the distal interphalangeal joints was detected in 21 (34.4%), tendinitis - to 13 (21.3%).

Discussions

The obtained results allow us to state that one of the directions in improving the diagnosis of PsA consists in the use of ultrasound examination and MRI imaging of the joints of the hands and feet. This makes it possible to effectively identify the characteristic of enthesopathy, edema of tissues, as well as destructive changes in the joints of the hands and feet.

Conclusions

In the study group of patients with psoriasis, in 25 (24.2%) no joint damage was detected. The frequency of detection of psoriatic arthritis and other rheumatic diseases (rheumatoid arthritis, osteoarthritis, ankylosing spondylitis etc.) was 59.2% and 16.6%, respectively, 32 (52.5%) out of 61 (59.2%) patients with PsA were primarily diagnosed. The sensitivity and specificity of the mPEST (Psoriasis Epidemiology Screening Tool) questionnaire in relation to the CASPAR criteria were 77% and 69% respectively. The highest indicators of sensitivity, specificity and accuracy in the diagnosis of PsA has ultrasound and MRI: 88%, 92%, 89% and respectively, 89%, 94%, 91%

Introduction

Despite numerous fundamental clinical studies on the frequency, pathogenesis, clinical features of spondyloarthritis (SpA) in intestinal infectious diseases (IID) and intestinal damage in SpA, there are currently a number of unresolved problems, one of which is the problem of early diagnosis of arthropathies, especially associated with IID, which makes it necessary to continue the research in the scientific problem.

Purpose of the study

Appreciation of the features of early manifestations of axial arthropathies in intestinal infectious diseases in order to improve their early diagnosis.

Objectives of the study

Identification of clinical variants of axial arthropathies in patients with infectious intestinal diseases and instrumental description of axial lesion by conducting comparative analysis of clinical and laboratory parameters in these patients depending on the presence of axial arthropathies. Development of an algorithm for the early detection of axial spondyloarthritis in intestinal infectious diseases.

Material and methods

During 2015-2021, 141 patients were analyzed retrospectively, out of which 50 patients with SpA from the Republican Clinical Hospital „Timofei Moşneaga” and 91 patients with infectious intestinal diseases from the gastro-enterology and hepatology departments of the Republican Clinical Hospital „Timofei Moşneaga”. Depending on the etiology of IID, subjects were divided into 2 groups: the first group included patients with Yersinia enterocolitica or Campylobacter jejuni (Y±C), the second with Salmonella enteritidis or Shigella flexneri (S±Sh).

Results

In patients with IID, the following clinical variants of arthropathies have been identified: axial lesion (spinal inflammatory pain according to ASAS criteria (2009) in 42.9%, axial spondyloarthritis (axSpA) in 28.6%, AS in 15.4%), arthralgia - 38.5%, arthritis - 13.2%. Conventional radiography imaging and magnetic resonance imaging (MRI) of the sacroiliac joints (SI) increased the incidence of SpA from 6.6% (n = 6) to 28.6% (n = 26).

Conclusions

In patients with IID, the following clinical variants of arthropathies have been identified: axial lesion (spinal inflammatory pain according to ASAS criteria (2009) in 42.9%, axSpA in 28.6%, ankylosing spondylitis in 15.4%), arthralgia – 38.5%, arthritis – 13.2%. Imaging in the form of conventional radiography and MRI of SI joints increased the incidence of SpA from 6.6% (n = 6) to 28.6% (n = 26). Axial arthropathies, arthralgia, arthritis, and uveitis are encountered more frequently. At the same time, the possibility of detecting axSpA is greater if arthritis, arthralgia, inflammatory back pain, uveitis is present. Patients with S±Sh have a higher chance of developing axSpA compared to patients with Y±C.

Introduction

Surface electromyography has proven to be a useful instrument for the assessment of success rate for different dental treatments. However, due to numerous variables that may influence the data like age, gender, fat tissue thickness etc. it is necessary to adjust the obtained values to a reference group with the same parameters. 

Material and methods

A number of 33 patients were included in the study (21 women and 12 men) aged between 43-67 years old (mean 54± SD1.26). Surface electromyography of masticatory muscles was used in these patients to assess the average value in a time span and overlapping coefficients. Totally 10 parameters from each patient were recorded: TAL, TAR, MML, MMR, PocTA, PocMM, BAR, Asym, TORS, Impact. Data were stored in an Excel spreadsheet and then analyzed statistically using RStudio software. 

Results

Based on the results of our study, the main EMG activity indices in middle-aged Moldavian individuals had the following values: for the left temporalis (TAL) was 42 µV, median 18.8 with a minimum of 3.8 and a maximum of 190 µV. For the right temporalis (TAR) the mean was 51.4 µV, median – 32.9, a minimal value of 7.9 and a maximum of 248 µV. The left masseter had a mean of 48.7 µV, median 12.3, a minimal value of 1.5 and a maximum value of 439 µV. The right masseter had a mean of 42.1 µV, a median of 16.3, minimum value 11.4 and maximum 243 µV. The overlapping coefficients deviated with 20.5% from the normal range provided by the manufacturer. 

Conclusions

Electromyographic activity of masticatory muscles in healthy patients can be used for comparison with patients that had various dental treatment but have the same age, gender, ethnicity, etc. The overlapping coefficients did not perfectly match in the normal range provided by manufacturer even if these subjects had previously minimum dental procedures. 

Introduction

Mandibular prognathism is a facial disharmony characterized by an anterior relationship of the mandible to the upper jaw. Some authors associate the increased volume of the tongue with the development of this anomaly. Currently in scientific literature it is debated whether the tongue actively shapes the surrounding tissues or adapts to existing conditions. The aim of this study is to evaluate the volume of the tongue at the patients with class III malocclusion compared to class I patients using three-dimensional volumetric analysis based on computed tomography. 

Material and methods

The three-dimensional calculation of the tongue volume was performed using the technology of virtual surgical planning on 15 subjects with class III compared to class I, based on DICOM data of multidetector computed tomography. 

Results

As a result of a detailed analysis, the volume of the language was correlated with the values of the angles SNA, SNB as well as the Witts values. 

Conclusion

In conclusion, we attest to a higher volume of tongue at patients with class III compared to class I.

Introduction

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.

Materials and methods

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.

Results

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.

Conclusions

Novel discovered biomarkers could predict disease development, activity, and severity of diverse organ involvement, predict risk of complications of systemic sclerosis.

Introduction

A lot of research and studies are currently being carried out in the field of elaboration and optimization of topical pharmaceutical forms used in the treatment of various types of acne. Acne vulgaris is a disease with a complex etiopathogenesis with potential negative psychosocial effects on the quality of life of patients, and its prevention is based on the successful management of risk factors. There are currently many topical and systemic treatment options available, so the choice of therapy depends on the form and severity of the condition. The advantage of topical pharmaceutical forms is the ability to target early stages of acne lesions.

Material and methods

Statistical, systemic, informational and sociological analysis were used as methods of analysis. Documentation with the State Drug Nomenclature and Classification, evaluation of topical prescription for acne treatment, dispensed in the Vasile Procopisin University Pharmaceutical Center (UPhC), the study of active pharmaceutical ingredients (API) and technological characteristics of topical pharmaceutical forms.

Results

Topical treatment for acne should be based on its type and severity. The basic therapy for the treatment of mild acne refers to external applications, due to their action to prevent lesions. Treatment should be maintained over time to prevent recurrence. For domestic patients are accessible drugs with keratolytic, bacteriostatic and anti-inflammatory properties for topical treatments as benzoyl peroxide, salicylic acid, sulfur, azelaic acid, zinc oxide and antibiotic. The analysis of the use of anti-acne medications, in treating mild to moderate acne, by the age group, identified that for adolescents treatment is being focused on combating the causative agent of sebum production using salicylic acid in 32.5% cases and with age increase, the aim is to suppress inflammatory processes requiring retinoids, and in case of absence, can be substituted by benzoyl peroxide.

Conclusions

The therapeutic approach in clinical practice must be done individually, considering the severity and shape of acne lesions.

Introduction

COVID-19 is currently considered a systemic disease affecting the immune system, primarily, lungs, heart, central nervous system, kidneys, intestines, liver and spleen. Impaired liver function and the presence of biochemical changes in liver can be found in approximately 14-53% of adults infected with SARS-CoV-2. Impaired liver function in patients infected with COVID-19 may occur due to a direct effect of the virus on hepatocytes, as well as being secondary to factors such as a systemic inflammatory response of the infected host, the onset of hypoxia (associated with lung damage), multiple organ failure, or due to abusive treatment using overlapping and hepatotoxic drugs.

The purpose of this article is to describe a clinical case study regarding the clinical and paraclinical manifestations of liver damage in a 12-year-old child infected with SARS-CoV-2, hospitalized at the Municipal Children’s Clinical Hospital „Valentin Ignatenco”, Republic of Moldova.

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 the 12-year-old child with moderate COVID-19 infection, who was admitted for emergency treatment. 

Results

A 12-year-old patient F. was admitted to the „Covid-19” subunit, complaining of severe general malaise, fever up to 39°C, cough, rhinorrhea. The objective clinical examination revealed hepatomegaly and lack of splenomegaly. Laboratory findings determined leukocytosis 15.88 x109/l, neutrophilia 72.2%, lymphopenia 26.1%, increased ESR (Erythrocyte Sedimentation rate) – 20 mm/h, increased CRP (C-reactive protein) >12.0 mg/l, increased ALT (alanine aminotransferase) by 16 (50.9-487-764 U/l) values compared to the normal reference and a 3-fold increase in AST (aspartate aminotransferase) that is higher than the normal range (55.8 - 113 - 181 U/l), an increased fibrinogen - 5.3 g/l, increased ferritin - 2834 pmol/l and D-dimer levels - 762 ng/ml. Hepatomegaly was detected on abdominal ultrasound. Covid-19 infection was confirmed by a rapid test of nasopharyngeal exudate for SARS-CoV-2 antigens.

Conclusions

Patients with the novel coronavirus (COVID-19) show varying degrees of liver dysfunction, especially those with increased levels of AST and ALT. A question arises within the clinical practice, as whether the liver damage occurred due to direct viral hepatotoxicity or due to the drugs used in COVID-19 treatment.