DSpace Community: Moldovan Journal of Health Sciences

Monograph review. “Atrial fibrillation” – a landmark monograph for contemporary cardiology

2026-10-28T09:02:49Z

Title: Monograph review. “Atrial fibrillation” – a landmark monograph for contemporary cardiology Authors: Revenco, Valeriu

Severe metformin intoxication without development of lactic acidosis: clinical case

2026-10-28T08:50:16Z

Title: Severe metformin intoxication without development of lactic acidosis: clinical case Authors: Bivol, Elena; Dumitraș, Tatiana; Gușanu, Olesea; Sîrbu, Felicia; Stîngaci, Daniela Abstract: Introduction. Metformin is the most widely used oral antidiabetic agent, belonging to the biguanide pharmacological group. Lactic acidosis associated with metformin is a rare event with an incidence of 19 cases per 100,000 patient-years. The risk of developing lactic acidosis when taking this drug is increased by several factors, such as age > 65 years; concomitant diseases that have the ability to induce hypoxemia (chronic kidney disease, congestive heart failure, cardiogenic shock, acute respiratory distress, sepsis, advanced liver disease, history of lactic acidosis); excessive alcohol consumption; and administration of iodinated contrast media. Case history. A 46-year-old man self-administered 50 metformin tablets at a dose of 500 mg each. Twelve hours after ingestion, he requested emergency medical assistance, presenting with the following symptoms: drowsiness, repeated vomiting, lethargy, and dizziness. The patient’s condition was assessed as serious, so he was admitted to the intensive care unit. The patient’s personal pathological history revealed the presence of comorbidities: type 2 diabetes mellitus, toxic liver cirrhosis, hypertension and chronic kidney disease. Paraclinical investigations revealed the presence of metabolic acidosis, but with lactate <5 mmol/l; progressive renal dysfunction with creatinine values in the first 24 hours up to 1184 µmol/l, urea – 34.5 mmol/l; severe hypoglycemia - 1.68 mmol/l; moderate cytolytic, cholestatic, inflammatory; hepatocellular insufficiency syndrome; coagulation disorders; and pancreatic dysfunction. Results and treatment. Since metformin is easily dialyzable, it was decided to promptly initiate intermittent hemodialysis. Fourteen hemodialysis sessions were performed, with a gradual reduction of creatinine to 112.1 µmol/l. Recurrent episodes of hypoglycemia were corrected with 40% glucose solution. Subsequently, hyperglycemia was resolved with insulin. Conclusions. Metformin should be used with caution in patients with concomitant pathologies. Metformin-induced lactic acidosis is potentially fatal. Early identification of metformin intoxication, with prompt initiation of renal replacement measures and dynamic monitoring of biochemical parameters, is essential.

Carney complex - clinical case presentation and literature review

2026-10-28T07:57:09Z

Title: Carney complex - clinical case presentation and literature review Authors: Borș, Elena; Gușanu, Olesea; Bivol, Elena Abstract: Introduction. Carney complex (CNC) is a rare genetic disorder with multisystem involvement. Endocrine manifestations include primary pigmented nodular adrenocortical disease with Cushing’s syndrome, pituitary tumors secreting GH and/ or prolactin, thyroid and gonadal tumors. Non-endocrine tumors associated with CNC include myxomas of the heart, breast, and skin; ductal adenomas of the breast, cutaneous lentigines, psammomatous melanocytic schwannomas, osteochondromyxomas, and an increased predisposition to various malignancies. Case presentation. Patient X.Y, a 54-year -old woman, was diagnosed in 2013 with GH-secreting pituitary microadenoma and underwent surgery via a transfrontal approach. In 2022, the patient presented with dyspnea on moderate exertion, hypertensive episodes, retrosternal discomfort, vertigo, headache. Echocardiography revealed a 20 × 30 mm mass, attached to the interatrial septum, suggestive of a left atrial myxoma. IGF 1 was 218 ng/ml (reference range 67.3-201), while the other hormonal axes were normal. The patient underwent minimally invasive cardiac surgery for myxoma resection, without postoperative complications. At 6 months after intervention, echocardiography showed no residual mass, interatrial septal defect or valvular regurgitation. As IGF-1 had remained slightly elevated for over 10 years and repeated MRI scans during this period showed no recurrence, pituitary somatotroph cell hyperplasia was assumed. The patient reported adverse reactions to dopamine agonists, and therefore octreotide 10 mg, intramuscular monthly was initiated. Conclusions. Cardiac myxomas are the leading cause of mortality in CNC, early diagnosis is imperative to reduce cardiovascular mortality and improve quality of life.

Assessment of knowledge, attitudes, and practices regarding oral health in different population groups

2026-10-13T08:48:20Z

Title: Assessment of knowledge, attitudes, and practices regarding oral health in different population groups Authors: Băișanu, Adela; Spinei, Larisa; Uncuța, Diana Abstract: Introduction. Oral health is an essential component of overall health and well-being. The levels of knowledge, attitudes, and behaviors related to oral health are key determinants in the prevention of dental and periodontal diseases. Assessing these aspects across different population groups is crucial for identifying specific educational needs and developing effective strategies for the promotion and maintenance of oral health. Materials and methods. Data from scientific publications indexed in PubMed, Hinari, SpringerLink, NCBI, and Medline databases were analyzed. The selection criteria included current evidence regarding oral health knowledge, attitudes, and practices among different population groups. Observational, cross-sectional, descriptive and quantitative studies, as well as meta-analyses published between 2005 and 2026, were included. Results. The vast majority of the adult population (>90%) demonstrated a high level of oral health knowledge; however, fewer than half exhibited positive attitudes and appropriate behaviors necessary for proper oral care. Among adolescents, the proportion of individuals with satisfactory oral health knowledge ranged from 59% to 77%, while positive attitudes ranged from 57% to 92%. Female adolescents showed significantly better knowledge, attitudes, and behaviors related to oral health compared with their male counterparts. Dental students demonstrated higher levels of oral health knowledge and more positive attitudes than students from other academic disciplines, with significant improvements observed alongside academic progression and increasing clinical experience. They were better trained in toothbrushing techniques, reported a higher frequency of toothbrushing, used supplementary oral hygiene products more frequently, had a lower prevalence of gingival diseases, and attended preventive dental check-ups more regularly. Conclusions. Although oral health knowledge is generally satisfactory, it is not always reflected in appropriate oral health behaviors. The implementation of oral health education programs at all educational levels is essential for improving oral hygiene practices and promoting the overall health of the population.