The 10th International Medical Congress for Students and Young Doctors, 24-27 April, 2024 http://repository.usmf.md:80/handle/20.500.12710/27983 2026-07-21T16:35:52Z 2026-07-21T16:35:52Z Cemortan, Maria Bubulici, Cristina Vicol, Maria-Magdalena Grajdean, Elena Scripnic, Gabriela Manic, Milena http://repository.usmf.md:80/handle/20.500.12710/29004 2024-11-22T10:38:10Z 2024-01-01T00:00:00Z

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.

2024-01-01T00:00:00Z Dunas, Adriana Musteață, Vasile http://repository.usmf.md:80/handle/20.500.12710/28557 2024-11-29T11:37:28Z 2024-01-01T00:00:00Z

Title: Treatment of generalized nodal non-Hodgkin's lymphomas Authors: Dunas, Adriana; Musteață, Vasile Abstract: Introduction. Non-Hodgkin's lymphomas (NHL) comprise a diverse group of malignant lymphoid tumors, with multiple distinct histological and immunohistochemical subtypes. Understanding and differentiating these subtypes is crucial for effective diagnosis and treatment. NHL survival rates have improved recently due to the advances in treatment strategies and options. The past decade has seen remarkable progress with the addition of new therapeutic modalities such as antibody-targeted therapy, bispecific antibody therapy, epigenetic modulator therapy, CAR-T cell therapy, and conventional chemotherapy. Aim of study. Identification and evaluation of treatment options for generalized nodal nonHodgkin lymphomas in the Republic of Moldova. Methods and materials. The ambulatory files and medical records of 84 patients with a morphologically confirmed diagnosis of generalized nodular non-Hodgkin's Lymphoma were studied, in terms of performed treatment and remission rates. The staging was realized according to the criteria of Lugano Classification of Malignant Lymphomas. The patients’ follow-up was performed at the comprehensive cancer center, and related to the hospitalized and outpatient care. The mainly used antineoplastic regimens were those combined with anti-CD20 monoclonal antibodies Rituximab (R-CHOP, R-COP, BR) and conventional chemotherapy (CHOP and CHOEP). Results. The patients included in the study were aged over 40 to 78 years, with the incidence rate of 37% at the age of 60-70. All patients were hospitalized with several locations of the enlarged lymph nodes, and 68% - with B symptoms (sweating, weight loss). According to the WHO classification, diffuse large B cell lymphoma represented 57% of cases, prolymphocytic lymphoma – 13 % of cases. Marginal zone lymphoma, lymphocytic, lymphoblastic and other unspecified lymphomas were revealed at diagnosis in smaller percentages. All types of lymphoma were confirmed by morphological and immunohistochemical examination, 95% of them being CD20+. The administered combined immunochemotherapy treatment showed complete remission rates in 70% of cases. A complete remission rate of 13% was achieved under the combined chemotherapy with radiotherapy. Post-chemotherapy complications were: pancytopenia (39%), mucositis, stomatitis (89%), respiratory infections (53%), nausea and vomiting (85%). Conclusion. The majority of patients achieved complete remission under the combined treatment with chemotherapy and Rituximab. The international studies have demonstrated that maintenance therapy with anti-CD20 antibodies (Rituximab) prolongs remission and survival rates. lymphoid tumors, with multiple distinct histological and imm unohistochemical subtypes. Understanding and differentiating these subtypes is crucial for effective diagnosis and treatment. NHL survival rates have improved recently due to the advances in treatment strategies and options. The past decade has seen remarkable progress with the additio n of new therapeutic modalities such as antibody-targeted therapy, bispecific antibody therap y, epigenetic modulator therapy, CAR-T cell therapy, and conventional chemotherapy. Aim of study. Identification and evaluation of treatment options for generalized nodal nonHodgkin lymphomas in the Republic of Moldova. Methods and materials. The ambulatory files and medical records of 84 patients wit h a morphologically confirmed diagnosis of generalized nodular no n-Hodgkin's Lymphoma were studied, in terms of performed treatment and remission ra tes. The staging was realized according to the criteria of Lugano Classification of Malignant Lym phomas. The patients’ follow-up was performed at the comprehensive cancer center, and related to the hospitalized and outpatient care. The mainly used antineoplastic regimens were those combine d with anti-CD20 monoclonal antibodies Rituximab (R-CHOP, R-COP, BR) and conventional c hemotherapy (CHOP and CHOEP). Results. The patients included in the study were aged over 40 to 78 years, with the incidence rate of 37% at the age of 60-70. All patients were hospitalized wit h several locations of the enlarged lymph nodes, and 68% - with B symptoms (sweating, weight loss) . According to the WHO classification, diffuse large B cell lymphoma represented 57% of cases, prolymphocytic lymphoma – 13 % of cases. Marginal zone lymphoma, lymphocytic, lympho blastic and other unspecified lymphomas were revealed at diagnosis in smaller percentages . All types of lymphoma were confirmed by morphological and immunohistochemical examinatio n, 95% of them being CD20+. The administered combined immunochemotherapy treatment sho wed complete remission rates in 70% of cases. A complete remission rate of 13% was achiev ed under the combined chemotherapy with radiotherapy. Post-chemotherapy complications we re: pancytopenia (39%), mucositis, stomatitis (89%), respiratory infections (53%), nausea and v omiting (85%). Conclusion. The majority of patients achieved complete remission u nder the combined treatment with chemotherapy and Rituximab. The international studies have demonstrated that maintenance therapy with anti-CD20 antibodies (Rituximab) prolongs remi ssion and survival rates. Description: Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica Moldova

2024-01-01T00:00:00Z Dănilă, Alexandru http://repository.usmf.md:80/handle/20.500.12710/28453 2024-11-20T13:05:10Z 2024-01-01T00:00:00Z

Title: From oxidative stress to bone healing: a biochemical insight into the fracture recovery process Authors: Dănilă, Alexandru Abstract: Introduction. Within bone tissue, osteoclasts release oxidative stress (OS) compounds, vital for calcified tissue breakdown and bone healing after fractures. However, imbalances between oxidant compounds like reactive oxygen species (ROS) and antioxidant defenses, may result in bone loss and osteoporosis. Understanding the molecular intricacies of OS in bone tissue provides valuable insights into potential therapeutic approaches aimed at improving fracture recovery process and preserving overall bone health. Aim of study. To explore the biochemical pathways involved in OS induced damage in bone tissue, impairing fracture healing and enhancing fracture risk. Methods and materials. The groundwork of this scientific review is based upon a conscientious analysis of 20 publications from established databases like Science Direct, Springer Link, PubMed. All the publications were selected from a period spanning the last five years. Keywords used: oxidative stress, bone health, fracture healing. Results. ROS, acting as signaling agents, can hinder osteogenic derivation, influencing the dynamic relationship between osteoblasts (OBs), responsible for synthesizing crucial organic and inorganic compounds (collagen, osteocalcin, osteopontin, hydroxyapatite) and osteoclasts (OCs) in bone tissue. Superoxide, as a member of the ROS family, has both physiological (redox signaling) and pathological (pro-apoptotic cascade, cellular necrosis) influence on bone tissue. Its reaction with nitric oxide (NO) produces peroxynitrite, which is highly reactive towards DNA and proteins. Given that OCs constitutively produce NO for their normal function, elevated superoxide levels directly affect the OB/OC ratio, thus affecting bone homeostasis. Impaired fracture healing due to OS can be reversed by means of specialized molecules like superoxide dismutase (SOD), glutathione peroxidase (GPx), vitamin C (ascorbic acid), vitamin E (α-tocopherol) and carotenoids (β-carotene). The mitochondrial protein SIRT3, essential for OC and OB differentiation, proves noteworthy in the inflammatory and ischemic microenvironment during the initial stages of fracture healing, diminishing OS and favoring bone formation. Post-fracture damage to tissue generates a conspicuous amount of free radicals following the ischemia-reperfusion process, which emphasize the importance of SIRT3’s OS decreasing properties, and suggest its relevance in mitigating the harmful effects of oxidative damage in the aftermath of a fracture. Conclusion. Exploring the biochemical intricacies of OS in the context of bone healing offers valuable insights into the mechanisms underlying fracture recovery. Increased levels of plasma biomarkers of oxidant status, like malondialdehyde, marks the need for lifestyle/dietary changes and/or antioxidant supplementation, as to prevent fracture damage directly or indirectly (diseases like osteoporosis, diabetes mellitus, age-related hormonal modifications). tissue breakdown and bone healing after fractures. However, imbalan ces between oxidant compounds like reactive oxygen species (ROS) and antioxidant defenses, ma y result in bone loss and osteoporosis. Understanding the molecular intricacies of OS in bone tissue provi des valuable insights into potential therapeutic approaches aimed at improving fracture recovery proc ess and preserving overall bone health. Aim of study. To explore the biochemical pathways involved in OS induced dam age in bone tissue, impairing fracture healing and enhancing fracture risk. Methods and materials. The groundwork of this scientific review is based upon a conscien tious analysis of 20 publications from established databases like Science Direct, Springer Link, PubMed. All the publications were selected from a period spanning the last five years. Keywords used: oxidative stress, bone health, fracture healing. Results. ROS, acting as signaling agents, can hinder osteogenic derivat ion, influencing the dynamic relationship between osteoblasts (OBs), responsible for synthesi zing crucial organic and inorganic compounds (collagen, osteocalcin, osteopontin, hydroxyapatite ) and osteoclasts (OCs) in bone tissue. Superoxide, as a member of the ROS family, has both physiolog ical (redox signaling) and pathological (pro-apoptotic cascade, cellular necrosis) influence on bone t issue. Its reaction with nitric oxide (NO) produces peroxynitrite, which is highly reactive towards DNA and proteins. Given that OCs constitutively produce NO for their normal function, elevated superoxide levels directly affect the OB/OC ratio, thus affecting bone homeostasis. Impaired fracture healing due to OS c an be reversed by means of specialized molecules like superoxide dismutase (SOD), glutathione peroxidas e (GPx), vitamin C (ascorbic acid), vitamin E (α-tocopherol) and carotenoids (β-carotene). The mitochondrial protein SIRT3, essential for OC and OB differentiation, proves noteworthy in the inflammat ory and ischemic microenvironment during the initial stages of fracture healing, diminishing OS and fa voring bone formation. Post-fracture damage to tissue generates a conspicuous amount of free radicals following the ischemia-reperfusion process, which emphasize the importance of SIRT3’s OS decreasing properties, and suggest its relevance in mitigating the harmful effects of oxidative damage in the aftermath of a fracture. Conclusion. Exploring the biochemical intricacies of OS in the context of bone healing offers valuable insights into the mechanisms underlying fracture recovery. Increa sed levels of plasma biomarkers of oxidant status, like malondialdehyde, marks the need for lifestyle /dietary changes and/or antioxidant supplementation, as to prevent fracture damage directly or indirectly (diseases like osteoporosis, diabetes mellitus, age-related hormonal modifications). Description: Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica Moldova

2024-01-01T00:00:00Z Croitoru, Vera http://repository.usmf.md:80/handle/20.500.12710/28483 2024-11-22T11:18:19Z 2024-01-01T00:00:00Z

Title: Bioethical aspects of the rehabilitation of patients with type 2 diabetes in conditions of anti-pandemic restrictions Authors: Croitoru, Vera Abstract: Introduction. Rehabilitation is essential for many health conditions such as acute stroke, cardiac events and endocrine diseases and others. It is estimated that due to the SARS COV-2 pandemic, an estimated range of 1.3–2.2 million people in Europe had to interrupt their rehabilitation treatments. Shortly after the start of the pandemic, there were reports of an increase in new-onset diabetes presentations. Having diabetes was a risk factor for worse COVID-19, but also having COVID-19 was a risk factor for newly diagnosed diabetes and hyperglycemic emergencies. An essential support in rehabilitation in covid is that of bioethics. Aim of study. Evaluation of the specificity of rehabilitation in patients with type 2 diabetes during the period of anti-pandemic restrictions through the lens of bioethical benchmarks. Methods and materials. Data from the scientific literature were studied, identified from the databases PubMed, Cochrane, Scopus, international clinical protocols, about 50 sources. Results. According to studies, it has been shown that during the COVID-19 pandemic, rehabilitation services and outpatient visits were affected, practically suspended, general healthcare services were reduced, face-to-face consultations were restricted, virtual consultations were switched to and some aspects of the consultation such as blood tests were omitted. A study of 25 million patients in the UK reported a significant reduction in type 2 diabetes diagnoses during the pandemic period. A recent report from the National Health Services (NHS), UK, World Health Organization (WHO) outlined the ethical obligations of healthcare providers during the pandemic in three distinct categories: moral, professional, legal. Guiding principles were emphasized to guide the conduct of ethics during the Covid-19 period: social and clinical value, favorable riskbenefit ratio, independent review, informed consent and respect for patients. Rehabilitation should be performed in a self-supervised manner via telemedicine. The most valuable bioethical benchmarks were the principles of information, autonomy, therapeutic integrity, vulnerabilities and the doctor-patient relationship. In some cases, it may be wiser to delay admission to rehabilitation until patients are no longer at risk of spreading COVID-19 to uninfected people, but poor blood glucose control is associated with serious complications, including mortality, and improving the control of risk factors is a priority. Conclusion. Anti-pandemic restrictions have imposed new conditions on the rehabilitation act. The pandemic has highlighted the importance of guidance according to bioethical principles. events and endocrine diseases and others. It is estima ted that due to the SARS COV-2 pandemic, an estimated range of 1.3–2.2 million people in Europe had to int errupt their rehabilitation treatments. Shortly after the start of the pandemic, t here were reports of an increase in new-onset diabetes presentations. Having diabetes was a risk factor for worse COVID-19, but also having COVID-19 was a risk factor for newly diagnosed diabetes a nd hyperglycemic emergencies. An essential support in rehabilitation in covid is that of bioethi cs. Aim of study. Evaluation of the specificity of rehabilitation in patie nts with type 2 diabetes during the period of anti-pandemic restrictions through the lens of bioethical benchmarks. Methods and materials. Data from the scientific literature were studied, identifie d from the databases PubMed, Cochrane, Scopus, international clinic al protocols, about 50 sources. Results. According to studies, it has been shown that during the COVID -19 pandemic, rehabilitation services and outpatient visits were affecte d, practically suspended, general healthcare services were reduced, face-to-face consultations were restricted, virtual consultatio ns were switched to and some aspects of the consultation such as blood tests were omitted. A study of 25 million patients in the UK reported a significant reduc tion in type 2 diabetes diagnoses during the pandemic period. A recent report from the National Healt h Services (NHS), UK, World Health Organization (WHO) outlined the ethical obligations of healt hcare providers during the pandemic in three distinct categories: moral, professional, legal. Guiding principles were emphasized to guide the conduct of ethics during the Covid-19 period: social an d clinical value, favorable riskbenefit ratio, independent review, informed consent and respec t for patients. Rehabilitation should be performed in a self-supervised manner via telemedicine. The most valuable bioethical benchmarks were the principles of information, autonomy, therapeutic integrity, vulnerabilities and the doctor-patient relationship. In some cases, it may be wiser to delay admission to rehabilitation until patients are no longer at risk of spr eading COVID-19 to uninfected people, but poor blood glucose control is associated with serious compli cations, including mortality, and improving the control of risk factors is a priority. Conclusion. Anti-pandemic restrictions have imposed new conditions on the rehabilitation act. The pandemic has highlighted the importance of guidance acc ording to bioethical principles. Description: Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica Moldova

2024-01-01T00:00:00Z