http://repository.usmf.md:80/handle/20.500.12710/10713 2026-04-03T22:24:55Z http://repository.usmf.md:80/handle/20.500.12710/29004 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 http://repository.usmf.md:80/handle/20.500.12710/28453 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 http://repository.usmf.md:80/handle/20.500.12710/28483 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 http://repository.usmf.md:80/handle/20.500.12710/28465 Title: The involvement of micro-RNAs in cardiovascular pathologies Authors: Bairamculov, Azamat Abstract: Introduction. Micro-RNAs are short molecules of ribonucleic acid with significant regulatory functions in controlling gene expression within eukaryotic cells. These small molecules play a crucial role in post-transcriptional regulation, influencing various cellular processes. Currently, circulating miRNAs are recognized as potential diagnostic biomarkers and emerging therapeutic targets for cardiovascular diseases. Their stability in body fluids and differential expression patterns in various cardiac conditions make them promising candidates for further research and clinical applications in the field of cardiology. Aim of study. Understanding the involvement of miRNAs in cardiovascular disease development is crucial for enhancing diagnostic precision, predicting disease progression, and pinpointing effective therapeutic targets. This exploration aims to refine diagnosis, prognosis, and therapeutic strategies in the managing cardiovascular conditions. Methods and materials. A comprehensive literature review has been performed, covering the past decade and incorporating information from 30 sources. These sources encompassed materials from the Scientific Medical Library of "Nicolae Testemitanu" State University of Medicine and Pharmacy. Additionally, electronic libraries, including PubMed, Elsevier, Cambridge Journals Online, Hinari, Medline and MedScape have been utilized to gather relevant data. Results. Several studies have underscored the pivotal role of micro-RNAs in both diagnosing and treating cardiovascular diseases. Notably, elevated levels of miRNA-636, miRNA-380, and miRNA-17 have been observed in the plasma of individuals experiencing acute myocardial infarction (AMI). Additionally, miRNA-126, miRNA-37, and miR-221 show increased levels in heart failure patients. Furthermore, the prognostic efficacy of miRNA-182 surpasses that of natriuretic peptide and high-sensitivity C-reactive protein in heart failure (HF). Other studies have shown that MiR-499 had a more precise and significantly higher predictive value than the most reliable biomarkers for AMI: c troponin I (cTnI) and creatinkinase MB (CK-MB). In mouse models, intramyocardial injection of vesicles containing miRNA-99 has demonstrated a preventive effect on hypoxia-induced apoptosis and promoted autophagy. This intervention has resulted in improved left ventricular function and increased survival during four weeks after AMI. Conclusion. Presently, miRNAs have the potential to be employed for diagnostic and therapeutic purposes in various cardiovascular diseases. They exert their influence on specific cellular pathways or processes through structures like liposomes, vesicles, or viral vectors designed for intracellular miRNA delivery. functions in controlling gene expression within eukaryotic ce lls. These small molecules play a crucial role in post-transcriptional regulation, influencing various cellular processes. Currently, circulating miRNAs are recognized as potential diagnostic bio markers and emerging therapeutic targets for cardiovascular diseases. Their stability in body fluids and differential expression patterns in various cardiac conditions make them promisi ng candidates for further research and clinical applications in the field of cardiology. Aim of study. Understanding the involvement of miRNAs in cardiovascular d isease development is crucial for enhancing diagnostic precision, predictin g disease progression, and pinpointing effective therapeutic targets. This exploration aims to r efine diagnosis, prognosis, and therapeutic strategies in the managing cardiovascular conditions. Methods and materials. A comprehensive literature review has been performed, cov ering the past decade and incorporating information from 30 sources. These sources encompassed materials from the Scientific Medical Library of "Nicolae Testemitanu" State University of Medicine and Pharmacy. Additionally, electronic libraries, including Pub Med, Elsevier, Cambridge Journals Online, Hinari, Medline and MedScape have been utilized to gathe r relevant data. Results. Several studies have underscored the pivotal role of mic ro-RNAs in both diagnosing and treating cardiovascular diseases. Notably, elevated leve ls of miRNA-636, miRNA-380, and miRNA-17 have been observed in the plasma of individuals ex periencing acute myocardial infarction (AMI). Additionally, miRNA-126, miRNA-37, and miR-221 show increased levels in heart failure patients. Furthermore, the prognostic effica cy of miRNA-182 surpasses that of natriuretic peptide and high-sensitivity C-reactive protein i n heart failure (HF). Other studies have shown that MiR-499 had a more precise and significantly high er predictive value than the most reliable biomarkers for AMI: c troponin I (cTnI) and creat inkinase MB (CK-MB). In mouse models, intramyocardial injection of vesicles containi ng miRNA-99 has demonstrated a preventive effect on hypoxia-induced apoptosis and promoted autophagy. This i ntervention has resulted in improved left ventricular function and increased survival during four weeks after AMI. Conclusion. Presently, miRNAs have the potential to be employed for dia gnostic and therapeutic purposes in various cardiovascular diseases. They exert their influence on specific cellular pathways or processes through structures like liposomes, ve sicles, or viral vectors designed for intracellular miRNA delivery. Description: Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica Moldova 2024-01-01T00:00:00Z