DSpace Collection: The 10th International Medical Congress for Students and Young Doctors, 24-27 April, 2024

Assessment of the cases of postpartum hemorrhage in multiparous women

2024-11-22T10:38:10Z

Title: Assessment of the cases of postpartum hemorrhage in multiparous women Authors: Cemortan, Maria; Bubulici, Cristina; Vicol, Maria-Magdalena; Grajdean, Elena; Scripnic, Gabriela; Manic, Milena Abstract: Introduction. Postpartum hemorrhage (PPH) is one of the leading obstetric complications, affecting 5-15% births. Being a major factor in maternal mortality and morbidity, PPH causes about 25% of maternal deaths worldwide. Aim of study. The aim of the study was to assess the cases of PPH in multiparous women, admitted to the Tertiary Perinatal Center. Methods and materials. The retrospective study was performed by assessing 81 clinical cases of PPH in multiparous women. Total blood loss in labor or C-section was performed by using graduated vessels, and all the sterile material used was weighted. For continuous variables, the mean values and standard deviation of the mean were calculated; the median (Me) as well as the interquartile range (Q1;Q3) in the case of a distribution of characteristics that differs from the normal. Results. The average age of women was 31.6±5.5 years (Me 32 (28;35.5)), varying in the limits of 20-42 years. The majority of participants delivered for the second time - 38 cases (46.9% (95% CI 33.3-59.9)), however, 30 women (37.0% (95% CI 25.9-48.2)) gave birth for the third time, and 13 women (16.1% (95% CI 8.5-27.4)) had 4th – 9th delivery. In 41 cases (50.6% (95% CI 40.7- 61.7)) a c-section was performed. The mean blood loss in vaginal delivery was 850±308 (Me 800 (600;1050)) mL, varying in the limits of 500– 1600 mL. Compared to the mean blood loss in Csection – 1752±1093 (Me 1500 (1100;1850)) mL, varying in the limits of 1000 – 5250 mL. In the structure of PPH there were assessed 26 cases (32.1% (95% CI 20.9-47.0)) of the placental defect or placenta adherens, 15 cases (18.5% (95% CI 10.3-30.5)) of lacerations of the birth canal, 11 cases (13.6% (95% CI 7.4-23.4)) of uterine atonia, and 2 cases (2.5% (95% CI 0-7.3)) of uterine rupture. Hence, in 46 women (56.8% (95% CI 44.6-69.1)) it was applied conservative management of the cases. However, in 20 cases (24.6% (95% CI 15.0-38.1)) an operative management was applied, from which 7 cases (8.6% (95% CI 3.7-14.7)) hemostatic sutures were applied. In 13 cases (16.0% (95% CI 8.5-27.4)) hysterectomy was performed, from which 9 cases (69.2% (95% CI 31.6-100)) subtotal hysterectomy without annexes was the elective method for definitive hemostasis. Conclusion. PPH is a major obstetric complication, which occurs more frequently in multiparous women, in association with placental pathology and birth canal trauma, explained by overextension of the uterus and coagulation disorders, requiring extensive surgical management.

Treat-to-target strategy in the treatment of rheumatoid arthritis

2024-11-21T13:39:54Z

Title: Treat-to-target strategy in the treatment of rheumatoid arthritis Authors: Sufichaev, Simona Abstract: Introduction. Rheumatoid arthritis (RA) is a chronic autoimmune condition characterized by progressive joint inflammation and structural damage that frequently results in severe disability. Aim of study. The "Treat-to-Target" (T2T) strategy is a paradigm in the management of RA, with an emphasis on how well it works to improve clinical outcomes and how to apply it practically. Methods and materials. The data were collected from literature searches of Pubmed, Embase and Cochrane Library for studies published up to October 2023. The search strategy was composed of both controlled vocabulary such as Medical Subject Headings and keywords. The total number of 51 literature sources was analyzed. Results. According to our literature review, the target strategy is used to acquire data on the results of RA patients treated with a T2T approach, including disease activity measures, radiographic progression, functional status, and patient-reported outcomes. This strategy has a positive influence on both the prevention of long-term joint damage and the achievement of low disease activity or sustained remission. The main objective of T2T strategy is achievement of sustained remission by DAS28 and radiological data. Implementation of new therapeutic agents, such as biologic and targeted synthetic disease-modifying anti-rheumatic drugs (DMARDs) help reach T2T objectives. Some authors report difficulties of incorporating T2T into standard clinical practice. According to the results of our review, the comprehension of T2T as a flexible and patient-focused method of managing RA can substantially contribute to better prognosis and outcome of the patients with RA. Healthcare providers are strongly advised to optimize their treatment strategies, ultimately improving the long-term outcomes and quality of life for individuals with rheumatoid arthritis. The data from our review show this by clarifying the clinical benefits and addressing implementation challenges. Conclusion. Treat-to-Target (T2T) strategy is changing the landscape of management of rheumatoid arthritis (RA). The summary of available data highlights the effectiveness of T2T in enhancing clinical outcomes, with a focus on maintaining remission or low disease activity, halting radiographic progression, and improving overall patient well-being. The examination of T2T's practical application exposed the complexities and difficulties involved in incorporating this dynamic approach into standard clinical practice. Although the advantages are obvious, obstacles like patient preferences, resource limitations, and the practicality of frequent monitoring call for thoughtful analysis and well-thought-out solutions in order to ensure successful adoption. progressive joint inflammation and structural damage that frequently results in severe disability. Aim of study. The "Treat-to-Target" (T2T) strategy is a paradigm in the management of RA, with an emphasis on how well it works to improve clinical outcome s and how to apply it practically. Methods and materials. The data were collected from literature searches of Pu bmed, Embase and Cochrane Library for studies published up to October 2023. The search strategy was composed of both controlled vocabulary such as Medical Subject Headin gs and keywords. The total number of 51 literature sources was analyzed. Results. According to our literature review, the target strategy is used to acquire data on the results of RA patients treated with a T2T approach, including diseas e activity measures, radiographic progression, functional status, and patient-reported outco mes. This strategy has a positive influence on both the prevention of long-term joint damage and the achievement of low disease activity or sustained remission. The main objective of T2T strategy is achievement of sustained remission by DAS28 and radiological data. Implementatio n of new therapeutic agents, such as biologic and targeted synthetic disease-modifying anti- rheumatic drugs (DMARDs) help reach T2T objectives. Some authors report difficulties of incor porating T2T into standard clinical practice. According to the results of our review, the com prehension of T2T as a flexible and patient-focused method of managing RA can substantially co ntribute to better prognosis and outcome of the patients with RA. Healthcare providers are strongly advised to optimize their treatment strategies, ultimately improving the long-term o utcomes and quality of life for individuals with rheumatoid arthritis. The data from our r eview show this by clarifying the clinical benefits and addressing implementation challenges. Conclusion. Treat-to-Target (T2T) strategy is changing the landscape of mana gement of rheumatoid arthritis (RA). The summary of available data highlights the effectiveness of T2T in enhancing clinical outcomes, with a focus on maintaining rem ission or low disease activity, halting radiographic progression, and improving overall patient well-bei ng. The examination of T2T's practical application exposed the complexities and difficu lties involved in incorporating this dynamic approach into standard clinical practice. Although t he advantages are obvious, obstacles like patient preferences, resource limitations, and the pra cticality of frequent monitoring call for thoughtful analysis and well-thought-out solutions in order to ensure successful adoption. Description: Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica Moldova

Epilepsy associated with cerebral toxoplasmosis

2024-11-21T14:16:12Z

Title: Epilepsy associated with cerebral toxoplasmosis Authors: Olaru, Natalia; Dragan, Diana; Vataman, Anatolie; Chiosa, Vitalie Abstract: Introduction. Parasitic infections of the central nervous system (CNS) are an acquired cause of epileptic seizures and epilepsy in countries with low and medium economic incomes, including the Republic of Moldova. Cerebral toxoplasmosis is caused by the intracellular protozoan parasite, Toxoplasma gondii, which forms brain cysts, especially in immunocompromised patients. Parasite proliferation and microglia produce a modulation in the expression of pro-inflammatory genes, with the establishment of chronic latent infection. The latest studies show that toxoplasmosisinduced structural damage in the brain parenchyma and recurrent inflammation interfere with GABAergic signaling, which is mainly responsible for the occurrence of epileptic seizures, using it as a carbon source for parasite metabolism and facilitating parasite dissemination. Aim of study. Evaluation of neurological manifestations, seizure semiology, electrophysiological and neuroimaging changes in epilepsy caused by cerebral toxoplasmosis, and the neurobiological mechanisms involved in epileptogenesis. Methods and materials. The study included 11 patients with cerebral toxoplasmosis and epileptic seizures. The diagnosis was established based on the clinical manifestations, serological tests analysis, electrophysiological (EEG) and neuroimaging examination. Results. In the study 8 patients were HIV positive, stage C3 and 1 patient suffered from congenital toxoplasmosis. Typical seizure semiology showed focal onset: clonic 54.2%, tonic, cognitive and focal to bilateral tonic-clonic. EEG abnormalities was found in 39.2 % as focal slowing and focal epileptiform discharges. All patients performed neuroimaging, which identified cystic lesions in affected areas of CNS: frontal and temporal lobes, basal ganglia, thalami, periventricular regions and cerebellar white matter. Conclusion. Toxoplasmosis is a frequent opportunistic infection in immunocompromised patients, a late complication of HIV infection and usually occurs in patients with CD4-T-cell counts below 200/mm3.The clinical manifestations and epileptic seizures caused by cerebral toxoplasmosis are polymorphic and depends on the number and location of the cysts, and also on the host's immune response. epileptic seizures and epilepsy in countries with low an d medium economic incomes, including the Republic of Moldova. Cerebral toxoplasmosis is caused by the intracellular protozoan parasite, Toxoplasma gondii, which forms brain cysts, especially in immunocompromised patients. Parasite proliferation and microglia produce a modulation in the ex pression of pro-inflammatory genes, with the establishment of chronic latent infection. The latest studies show that toxoplasmosisinduced structural damage in the brain parenchyma and recurrent inflammation interfere with GABAergic signaling, which is mainly responsible for the occur rence of epileptic seizures, using it as a carbon source for parasite metabolism and faci litating parasite dissemination. Aim of study. Evaluation of neurological manifestations, seizure semiolo gy, electrophysiological and neuroimaging changes in epilepsy caused by cerebral toxopla smosis, and the neurobiological mechanisms involved in epileptogenesis. Methods and materials. The study included 11 patients with cerebral toxoplasmosis an d epileptic seizures. The diagnosis was established based on the clini cal manifestations, serological tests analysis, electrophysiological (EEG) and neuroimaging exami nation. Results. In the study 8 patients were HIV positive, stage C3 and 1 patie nt suffered from congenital toxoplasmosis. Typical seizure semiology showed focal ons et: clonic 54.2%, tonic, cognitive and focal to bilateral tonic-clonic. EEG abnormalities was foun d in 39.2 % as focal slowing and focal epileptiform discharges. All patients performed neuroimagi ng, which identified cystic lesions in affected areas of CNS: frontal and temporal lobes, basal ganglia, thalami, periventricular regions and cerebellar white matter. Conclusion. Toxoplasmosis is a frequent opportunistic infection in im munocompromised patients, a late complication of HIV infection and usually occurs in pa tients with CD4-T-cell counts below 200/mm3.The clinical manifestations and epileptic seizures cau sed by cerebral toxoplasmosis are polymorphic and depends on the number and location of the cys ts, and also on the host's immune response. Description: Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica Moldova

RpoB S450L mutation and transmission features of MDR mycobacterium tuberculosis strains in the Republic of Moldova.

2024-11-26T13:38:08Z

Title: RpoB S450L mutation and transmission features of MDR mycobacterium tuberculosis strains in the Republic of Moldova. Authors: Chesov, Elena Abstract: Introduction. The Republic of Moldova (RM) faces a significant challenge with a high prevalence of multidrug-resistant tuberculosis (MDR-TB). Aim of study. This study aims to explore the potential impact of rpoB S450L mutations on the phylogenetic features n of MDR Mycobacterium tuberculosis strains in RM. Methods and materials. We randomly selected MTB isolates from the biobank of the National Reference Tuberculosis Laboratory in RM, covering the period 2013-2018. After extracting MTB DNA, whole-genome sequencing (WGS) was performed. On the sequencing data a phylogenetic tree for the studied strains was generated, with consequent assessment of the impact of rpoB gene mutations on tree distribution. Results. All 288 strains included in the study had at least one resistant mutation in the rpoB gene. Clustering rate in the sequenced strains was (51,7%). It was higher in lineage 4 (L4) then in lineage 2 (L2) strains (63% for L4 vs 36.3% for L2, p < 0,001). In our study, 86.4% of MDR MTB strains exhibited the S450L mutation in the rpoB gene, with a frequency of 43% in lineage L2 and 57% in L4. Strains harboring the rpoB S450L mutation had a higher clustering rate (55,8% vs 25.6%, p=0.0005). As well, among L4 strains with rpoB S450L mutations clustering rate was higher than in those without it (66% vs 31.8%, p=0.0016). However, the difference in clustering rate in L2 strains with and without rpoB S450L was statistically unsignificant (39.2% vs 17.6%, p=0.1068). Compensatory mutations were found in 93.2% of strains with mutations in rpoB S450L, of which 83.9% were in the rpoC gene and 9.2% in the rpoB gene, whereas strains without the S450L mutation had a lower rate (38,4%) of compensatory mutation, of which in the rpoC (5.1%) and rpoB gene (33.3%). Conclusion. The rpoB S450L mutation appears linked to the evolution of resistance and transmission dynamics of distinct MTB lineages in the Republic of Moldova. of multidrug-resistant tuberculosis (MDR-TB). Aim of study. This study aims to explore the potential impact of rpoB S450L mutations on the phylogenetic features n of MDR Mycobacterium tuberculosis strains in RM. Methods and materials. We randomly selected MTB isolates from the biobank of the National Reference Tuberculosis Laboratory in RM, covering the period 2013-2018. After extracting MTB DNA, whole-genome sequencing (WGS) was performed. On the sequenc ing data a phylogenetic tree for the studied strains was generated, with consequent as sessment of the impact of rpoB gene mutations on tree distribution. Results. All 288 strains included in the study had at least one resist ant mutation in the rpoB gene. Clustering rate in the sequenced strains was (51,7%). It was hi gher in lineage 4 (L4) then in lineage 2 (L2) strains (63% for L4 vs 36.3% for L2, p < 0,001). In our study, 86. 4% of MDR MTB strains exhibited the S450L mutation in the rpoB gene, with a frequenc y of 43% in lineage L2 and 57% in L4. Strains harboring the rpoB S450L mutation had a higher clustering rate (55,8% vs 25.6%, p=0.0005). As well, among L4 strains with rpoB S450L mutations clu stering rate was higher than in those without it (66% vs 31.8%, p=0.0016). However, the differ ence in clustering rate in L2 strains with and without rpoB S450L was statistically unsig nificant (39.2% vs 17.6%, p=0.1068). Compensatory mutations were found in 93.2% of strains with m utations in rpoB S450L, of which 83.9% were in the rpoC gene and 9.2% in the rpoB gene, whereas strains without the S450L mutation had a lower rate (38,4%) of compensatory mutation, of which in the rpoC (5.1%) and rpoB gene (33.3%). Conclusion. The rpoB S450L mutation appears linked to the evolution of res istance and transmission dynamics of distinct MTB lineages in the R epublic of Moldova. Description: Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica Moldova