Introduction. 

Hemophilia is a genetic disorder characterized by impaired blood coagulation, leading to increased bleeding risk. The severity of hemophilia varies significantly among individuals, influenced by genetic factors, family inheritance patterns, and the occurrence of complications such as hemarthrosis. Understanding these interrelationships is crucial for developing tailored management strategies for affected children. The purpose of this article is to explore the correlations between clinical severity and various factors, including modes of inheritance, hemarthrosis incidence, types of genetic mutations, and inhibitor presence in pediatric patients with hemophilia. By elucidating these relationships, the study aims to contribute to improved diagnostic and therapeutic approaches in this population.

Materials and methods

This retrospective analysis included 90 pediatric patients diagnosed with hemophilia. Clinical data regarding disease severity, inheritance patterns, hemarthrosis incidents, genetic mutation types, and inhibitor levels were collected and analyzed statistically to identify significant associations.

Results

The analysis revealed a strong correlation between familial inheritance patterns and disease severity, with moderate forms predominating in known inheritance cases. Hemarthrosis was most prevalent in severe cases, particularly affecting the knee and elbow joints. The study also found significant associations between genetic mutations, especially missense mutations, and the severity of hemophilia. Furthermore, elevated inhibitor levels were exclusively observed in severe forms of the disease.

Conclusions

The findings highlight the intricate relationships between clinical characteristics and hemophilia severity, emphasizing the necessity for individualized treatment strategies. Understanding these dynamics can facilitate better management of hemophilia in pediatric patients, ultimately improving their quality of life.

Introduction 

Axial spondylitis is a chronic inflammatory disease primarily affecting the axial skeleton but can also involve peripheral joints. Axial spondylitis is often associated with extra-articular manifestations, such as inflammatory bowel diseases, emphasizing the need for rigorous monitoring and personalized therapeutic approaches. The interactions between axial spondylitis and inflammatory bowel diseases fall under the concept of “immune-mediated inflammatory diseases”, sharing common pathogenetic mechanisms. This study analyzes the prevalence and characteristics of inflammatory bowel diseases in patients with axial spondylitis.

Objective

The objective of this study was to describe the baseline characteristics of patients with axial spondylitis, evaluate the prevalence of inflammatory bowel diseases in this population, and identify correlations between the two conditions, contributing to a better understanding of their pathogenetic and clinical interactions.

Materials and methods

This prospective observational study included 257 axial spondylitis patients followed over two years. Patients were selected according to ASAS criteria for axial spondylitis and clinical guidelines for inflammatory bowel diseases. Analyses included clinical evaluations, laboratory tests, and imaging studies. Data were processed using SPSS v22.0. Continuous variables were expressed as mean ± standard deviation or median and interquartile range, and categorical variables as percentages. Correlations were assessed using Spearman’s coefficient, with results considered significant at p<0.05.

Results

Among the 257 patients included (168 men and 89 women, mean age 48.2 ± 13.1 years), 13.2% were recently diagnosed with axial spondylitis. Of these, 5.1% had inflammatory bowel diseases, distributed as follows: Crohn's disease (3.1%), ulcerative colitis (1.2%), and indeterminate colitis (0.8%). In 53.8% of cases, the diagnosis of inflammatory bowel diseases preceded axial spondylitis. Multivariate analysis identified the absence of a family history of axial spondylitis as a significant risk factor for inflammatory bowel diseases (OR = 3.4; p = 0.025). The prevalence of inflammatory bowel diseases increased with axial spondylitis duration, reaching 6.5% in patients with disease progression over eight years.

Conclusions

The study highlights a high prevalence of inflammatory bowel diseases in axial spondylitis patients, indicating the need for rigorous clinical monitoring. The absence of a family history of axial spondylitis was identified as a major risk factor for inflammatory bowel diseases. These findings emphasize the importance of a multidisciplinary clinical approach, including active screening for inflammatory bowel diseases and collaboration between rheumatologists and gastroenterologists, to improve patient prognosis and quality of life.

Introduction

Psoriatic arthritis (PsA) is a complex autoimmune disease with genetic and immunological components influencing its pathogenesis. HLA antigens are critical in determining genetic predisposition and clinical variability. This study aims to explore HLA antigen diversity in PsA patients and its relationship to clinical variants.

Material and methods

A cohort of 103 PsA patients, diagnosed according to CASPAR (2006) criteria, was studied. Patients were received treatment in rheumatology departments from 2005–2024. Two groups were formed: 76 patients with PsA and cutaneous psoriasis (Group I) and 27 without cutaneous manifestations (Group II). Each group was further subdivided into clinical variants: axial, oligoarticular, polyarticular, distal interphalangeal, and mutilans.

Results

Significant correlations were identified between HLA antigens and PsA severity. Aggressive HLA antigens, including HLA-B27, B8, and B62, were associated with severe disease forms and high DAPSA scores (≥50), while protective antigens like HLA-A2 and A3 correlated with reduced activity (DAPSA <20). Group I exhibited HLA-B27/B62 and HLA-B27/A3 combinations linked to mixed articular and cutaneous involvement, whereas Group II had distinct profiles (e.g., HLA-B27/B62, HLA-B27/B11). Factorial analysis highlighted the immunogenetic variability between clinical subtypes, emphasizing HLA antigens' predictive and therapeutic relevance.

Conclusions

HLA antigens significantly influence PsA severity and clinical diversity. Integrating genetic profiling into clinical practice offers promising opportunities for improving diagnostic precision, therapeutic outcomes, and patient quality of life.

Introduction

The superficial circumflex iliac artery (SCIA) is a branch that originates either from the external iliac artery (EIA), or common femoral artery (CFA). Its anatomic variability is particularly relevant in plastic surgery, general surgery, and traumatology/orthopedics.

Material and methods 

We retrospectively reviewed 2158 ultrasonographic images of the anterior thigh region from the Republican Medical Diagnostic Center, Functional Diagnosis Department, Chisinau, Republic of Moldova. Rigorous inclusion and exclusion criteria were applied. Additionally, 29 bibliographic sources were reviewed and discussed.

Results

The mean age of the patients was 63.4±10.68 years. In 387 cases (17.93%),SCIA originated from the CFA, while in 1771 cases (82.07%) it emerged from the EIA. SCIA originated from the CFA unilaterally in 194 cases (8.99%) on the left side and 142 cases (6.58%) on the right side, while bilateral origin from the CFA was observed in 51 cases (2.36%)

Discussion

The results in literature were suggestive for a higher prevalence of SCIA origin from the CFA with only one author suggesting the origin of this branch from the EIA, which aligns with our findings. This information is valuable for clinical applications, including hernia repairs, vascular and endovascular surgical interventions, nerve blocks, and skin grafts transplantation.

Conclusions

The most common origin of the SCIA was from the EIA. No significant sex differences were observed, but laterality showed notable variations. Age was analyzed as a factor.

Introduction

Globally, colorectal cancer (CRC) has become one of the top three causes of death from neoplasms. CRC represents a heterogeneous group of tumors, manifested both by clinical signs and the pathogenesis of its development. Most colorectal carcinomas develop from preexisting adenomas. The aim of this article is to assess the histopathological aspects and variants of primary colon neoformations in correlation with their location and morphological characteristics.

Material and methods

Prospective clinical study based on the analysis of treatment outcomes in 255 patients with colonic and rectal neoformations, treated in the Nicolae Anestiadi Surgery Department No.1, Institute of Emergency Medicine, between 2018 and 2022. The mean age was 61.3±1.05 years. There were 145 (56.9%) men and 110 (43.1%) women, with a male to female ratio of 1.31:1. The following qualitative nominal variables were analyzed: location, number, dimensions, tumor appearance, histopathological type, and degree of tumor extension.

Results

Through imaging, colonoscopy, and intraoperative methods, 255 patients with colonic neoformations were identified. Upon analyzing these subjects, 77 (30.2%) patients were diagnosed with malignant neoplasm of the colon or rectum with various histological types, and 178 (69.8%) patients were diagnosed with precursor lesions of malignancy.

Conclusions

The detailed analysis of the morphopathological characteristics of the tumor formations, in addition to confirming the malignancy, provides important information for establishing the therapeutic attitude.

Introduction

The irrational use of antibiotics is one of the main factors contributing to the accelerated development of antimicrobial resistance worldwide. Despite the regulations established to control the procurement of antimicrobial drugs, the rate of self-prescribing and self-treatment with antimicrobials remains very high in most countries. To plan further measures to combat this resistance, a thorough understanding of the current reasons behind this behavior is required. The aim of the study is to explore the general public's knowledge, attitudes, and behavior regarding antibiotic consumption.

Material and methods

A cross-sectional study was conducted using a questionnaire developed by the World Health Organization to assess the general public’s knowledge, attitudes, and behavior regarding the use of antimicrobial preparations. The questionnaire was administered in 10 randomly selected locations in the Chisinau municipality, including bus and trolleybus stops, shopping centers, universities, and medical institutions.

Results

The survey included a sample of 572 participants with an average age of 36 years. The majority were female (60.0%). The overall level of awareness of the benefits and harms of antibiotics was 63.8%, and appropriate antibiotic use practices were demonstrated by 68.3% of respondents. These practices include purchasing antibiotics with a prescription (60.0%) and taking antibiotics until completing the course of treatment (77.0%). 

Conclusions

Misconceptions and counterintuitive antimicrobial use practices undoubtedly complicate efforts to combat AMR and can lead to unintended consequences. Developing educational measures and promoting the responsible use of antibiotics are crucial priorities in combating antibiotic resistance and ensuring effective treatment outcomes.

Introduction

In the context of increasing global consumption of bottled water, assessing its chemical composition and impact on public health becomes essential. Although perceived as a safe alternative, bottled water exhibits variability in its chemical composition, and advanced filtration methods can remove essential minerals. Consumers opt for bottled water due to its taste and convenience, yet awareness of associated risks remains limited. This study proposes the development and validation of a questionnaire to evaluate public perceptions of bottled water quality and its health impact, providing a valuable tool for public education and regulatory policies.

Material and methods

The questionnaire was developed to analyze consumer attitudes and behaviors regarding bottled water. Structured into four sections (socio-demographic data, consumption habits, perceptions of quality, and health impact), it underwent multiple validation stages. A panel of experts assessed the relevance of the questions, and a pilot study was conducted with a sample of 32 adults (aged 24-62) to evaluate validity and internal consistency using the Cronbach's alpha coefficient. Final validation was based on the feedback collected and statistical analysis performed using SPSS Statistics 27.

Results

S-CVI/Ave and S-CVI/UA are indicators of questionnaire content validity, calculated based on item validity scores and the percentage of agreement among evaluators. The S-CVI/Ave and S-CVI/UA values exceeded the minimum standard of 0.80, while the I-CVI index ranged between 0.83 and 1.00, demonstrating excellent item validity. Following respondent feedback, 18 questions were revised, and 6 were removed, resulting in a second version with 61 items. The validity sample comprised 84.4% women and 15.6% men, aged 24 to 62 years. Most respondents considered the questions clear and easy to understand, although suggestions were made to improve clarity and avoid redundancy. Internal consistency was confirmed through the Cronbach's alpha coefficient, which was acceptable for most domains, except one, where the coefficient was below 0.70 but was retained due to the validity of the questions.

Conclusions

The questionnaire for assessing bottled water consumption was successfully validated, demonstrating content validity and internal consistency. Face validity ensured the clarity of the questions.

Introduction

Carotenoids and chlorophylls are plant pigments that play a vital role in plant life, participating in the process of photosynthesis and in the synthesis of growth regulators, stress signalers and fungicide attack agents. Research from the last decades has shown that, widely used as nutrients, chlorophyll and carotenoid pigments have beneficial effects on the human body. They exert antioxidant, energizing, detoxifying, anti-inflammatory properties, and can be applied in the prevention and treatment of 21st century diseases (cancer, cardiovascular diseases, low immunity), which are related to numerous causal factors (excessive chemicalization of the food industry, progressive climate change and environmental pollution), which reflects on the quality of human health.

Material and methods

We aimed to determine the content of carotenoid and chlorophyll pigments in different plant organs (stems, leaves, flowers and aerial parts), collected during the flowering period from 2 species, G. verum and G. aparine from the spontaneous flora of the Republic of Moldova. Determination was carried out by spectrophotometric method with the Metertech UV/VIS SP 8001 spectrophotometer,used as an extractant ethyl alcohol at 60% and 95% concentration. The data were reported as mean values ± standard deviation (SD).

Results

Experimental data obtained on the comparative application of 2 concentrations of ethyl alcohol (60 and 95%) for the extraction of carotenoid and chlorophyll pigments show that 95% ethyl alcohol is the most efficient for all analyzed samples. The determination of carotenoid pigments in different organs of G. verum and G. aparine species indicates that the maximum carotenoid content is extracted from the aerial parts of G. verum sp. (52.66 mg/%) than those of G. aparine (27.38 mg/%); compared to the content of chlorophyll pigments, which is quantitatively predominant in G. aparine sp. (chlorophyll a – 2.85 and chlorophyll b – 4.33 mg/l) compared to G. verum sp. (chlorophyll a – 1.2 and chlorophyll b – 1.9 mg/l). 

Conclusions

The results of spectrophotometric determination of carotenoids, chlorophylls a and b in different organs of G. verum and G. aparine sp. denote that the highest content of pigments is extracted with 95% ethyl alcohol in aerial parts in both species of the spontaneous flora of the Republic of Moldova.

Introduction

Despite worldwide decreasing trends in the incidence of gastric cancer, the disease remains a significant global health burden, one of the leading causes of cancer death worldwide, and its prevention is a priority for the health system. Intestinal-type gastric carcinoma originates in dysplastic epithelium, which, in turn, develops in the environment of chronic atrophic gastritis and gastric intestinal metaplasia.

Material and methods

Narrative literature review. A bibliographic search was conducted in the databases PubMed, Hinari, SpringerLink, National Center for Biotechnology Information, and Medline. Articles published between 2000-2024 were selected based on the following keywords: "gastric intestinal metaplasia" and "gastric epithelial dysplasia", used in different combinations with the terms "epidemiology", "clinical picture", "risk factors", "classification", "diagnosis", and "management" to maximize the search yield. After processing the information from the databases according to the search criteria, 215 full articles were found. The final bibliography contains 34 relevant sources, considered representative of the materials published on the subject of this summary article.

Results

Gastric intestinal metaplasia represents the replacement of the gastric epithelium with two types of intestinal-type epithelium (enteric or colonic) as an adaptive response to chronic injury, while gastric epithelial dysplasia is defined as unequivocal neoplastic change of the gastric epithelium (intraepithelial neoplasia) without evidence of stromal invasion. Gastric intestinal metaplasia and gastric epithelial dysplasia are preneoplastic lesions of gastric cancer. The estimated annual risk of gastric adenocarcinoma in patients with gastric intestinal metaplasia is 0.13-0.25%, and in patients with gastric epithelial dysplasia it is 1.36%, depending on the extent and type of the lesion.

Conclusions

Despite the lack of a specific treatment for gastric intestinal metaplasia, the management strategy, according to current clinical guidelines, includes eradication of Helicobacter pylori infection, screening for early detection of gastric cancer, and control of other risk factors. Appropriate management of high-grade gastric epithelial dysplasia requires endoscopic resection due to its potential for progression to carcinoma and the possibility of coexisting carcinoma. For low-grade gastric epithelial dysplasia, which has a lower risk of malignant transformation, scientists recommend annual endoscopic surveillance with biopsy and histological examination.

Introduction

Currently, extensive research has shown that almost all published prediction models are poorly studied and have significant limitations, leading to their predictive performance often being overestimated. Additionally, there is still no universally accepted scoring system, primarily due to the need for adaptation to heterogeneous patient samples (including patient numbers, clinical profiles, and risk factors) and/or ongoing differences in the organization of healthcare systems across various countries.

Material and methods

This is a narrative literature review. A bibliographic search was conducted in the PubMed, Hinari, SpringerLink, National Center for Biotechnology Information, and Medline databases. Articles published between 2000 and 2024 were selected based on keyword combinations such as "artificial intelligence", "prediction model", "algorithm", "machine learning", and "COVID-19". Information on machine learning predictive models was selected and processed to identify characteristics that can be used to predict diagnosis, severity, length of hospital stay, ICU admission, treatment, vaccination, and mortality in COVID-19 patients. After processing the data according to the search criteria, 125 full-text articles were identified. The final bibliography includes 52 relevant sources, which were considered representative of the literature on this synthesis article topic.

Results

Artificial intelligence techniques are increasingly being used to predict outcomes in COVID-19 patients, particularly in estimating mortality among individuals infected with SARS-CoV-2, which can rapidly and effectively support clinical decision-making. According to the analysis of multiple studies, strong predictors of mortality in COVID-19 patients include advanced age, male gender, comorbidities, reduced levels of calcium, albumin, red blood cells, and oxygen saturation, as well as lymphopenia, elevated blood urea nitrogen, creatinine, lactate dehydrogenase, D-dimers, neutrophils, interleukin-6, procalcitonin, bilirubin, ferritin, aspartate aminotransferase, and troponin.

Conclusions

Artificial intelligence techniques provide potential advantages over conventional assessment methods. The information obtained from machine learning and deep learning algorithms, including easily accessible and interpretable data, can assist healthcare workers in making accurate decisions for the appropriate and timely care of COVID- 19 patients. This can improve patient outcomes, reduce the burden on healthcare systems, and ultimately decrease mortality rates.

Introduction

Despite advances in non-operative and surgical management, calcaneal fractures remain severe injuries with relatively poor clinical outcomes. These fractures predominantly affect young, active individuals and are often associated with long-term sequelae, permanent disability, a considerable reduction in quality of life, and a substantial economic impact due to work incapacity and rehabilitation needs.

Material and methods

This study is a narrative literature review. A bibliographic search was conducted using PubMed, Hinari, SpringerLink, National Center for Biotechnology Information, and Medline databases. Articles published from 1990 to 2024 were selected based on keyword combinations such as “calcaneal fracture,” “comminuted calcaneal fracture,” “orthopedic treatment”, “surgical treatment,” “minimally invasive treatment,” “osteosynthesis,” “locking plate,” and “locked intramedullary nail.” After processing information from these databases according to the search criteria, 225 full-text articles were identified. The final bibliography includes 56 relevant sources, which were considered representative of the materials published on the topic of this synthesis article.

Results

Surgical treatment using open reduction and internal fixation for displaced intra-articular calcaneal fractures was superior to non-surgical treatment in restoring Bohler’s angle, achieving more stable calcaneal height and width, improving functional recovery, reducing the number of patients requiring orthopedic footwear, and enabling return to pre-injury activities, though it carries a high risk of complications. The minimally invasive approach via the sinus tarsi and the extended lateral L-shaped approach are equally effective for treating Sanders type II and III fractures in terms of restoring anatomical structures, radiological outcomes, and functional recovery. However, the sinus tarsi approach is effective in reducing wound complication rates (3.6–6.3% vs. 13.5–31.2%, respectively; p < 0.05), pain syndrome rates, time to surgery (p < 0.0001), surgery duration (p < 0.05), and hospital stay duration. Therefore, the minimal incision approach is a good alternative to the extended lateral L-shaped approach.

Conclusions

The current concept in managing calcaneal fractures involves developing an individualized treatment plan based on the patient’s characteristics and functional requirements, comorbidities, fracture type, and associated injuries, as well as the surgeon’s experience with the selected surgical technique.

Introduction

Immediate loading of dental implants is an evolving discipline requiring validation through clinical and statistical analyses. This study presents a case of immediate implantation and loading to evaluate predictability and outcomes. Immediate restoration reduces treatment time, promotes rapid aesthetic recovery, and addresses patient expectations for functional rehabilitation. Success in such cases relies heavily on maintaining primary stability and avoiding micromovements during osseointegration.

Material and methods

A 47-year-old patient underwent extraction of teeth 11 and 13, followed by immediate post-extraction implantation. Implants were loaded with provisional restorations within 48 hours. Statistical analysis included torque measurements, Periotest values, and aesthetic evaluations. Comparative data were reviewed against existing literature to assess clinical significance.

Results

Primary stability was achieved with insertion torque of 50 Ncm and Periotest values of -5 and -6. Literature indicates success rates for immediate loading between 94-98%, and this case corroborated these findings with stable and aesthetic results. Surveys revealed 85% satisfaction with comfort and appearance, and the gingival profile remained stable post-treatment.

Conclusions

Immediate loading is a predictable and effective method when conditions for atraumatic extraction, implant stability, and soft tissue management are met. The study reinforces the viability of this approach in improving patient outcomes and minimizing recovery periods while maintaining aesthetics.

Monograph details

Musteaţă V. Leucemia mieloidă cronică: incursiuni contemporane în profilul epidemiologic, clinico-biologic, diagnosticul şi tratamentul [Chronic myeloid leukemia: contemporary insights into the epidemiological, clinical-biological profile, diagnosis and treatment]. Chișinău: Medicina, 2024. 167 p. ISBN 978-9975-82-395-1. Romanian.