http://repository.usmf.md:80/handle/20.500.12710/10713 2026-07-24T00:11:51Z 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/20.500.12710/28557 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 http://repository.usmf.md:80/handle/20.500.12710/28545 Title: Prevalence of POAF following cardiac surgery and comparative study on the preferred treatment modalities Authors: Joy, Anugrah Abstract: Introduction. Postoperative atrial fibrillation (POAF) is a common arrhythmia after cardiac surgery, with an incidence ranging from 10-65%. It is more common in older patients and noncardiac surgery patients. POAF usually develops between day 2 and 4, with the maximum incidence on day 2. Risk factors include age, hypertension, obesity, diabetes, inflammation, and longer pump and cross clamp times. Stroke is the most significant clinical outcome, and female gender is a risk factor for cardiovascular disease. Aim of study. This literature review is investigating the prevalence outcome and management of POAF following cardiac surgery. Methods and materials. The study included articles published in English, cohort studies, randomized controlled trials and management in cardiac surgery for POAF. Search was conducted filtering articles based on the keywords "Postoperative Atrial Fibrillation,” “POAF following cardiac surgery," “POAF management,” etc. on databases (PubMed, Google Scholar, Embase, Cochrane…etc.). Results. The review analyzed 1849 studies, excluding duplicates, ineligible records, and 1338 records. After evaluating 396 studies, 40 were included, with 346 deemed eligible. The study found apixaban and edoxaban are more effective than rivaroxaban in treating POAF. POAF was linked to increased risk of death in men but not in women. The AF recurrence rate was higher in cardiac surgery patients (CS) compared to non-cardiac surgery patients (NCS). In long-term follow-up, CVA was more common in patients with POAF after CS compared to NCS. Atrial fibrillation occurred in a higher percentage of patients in the landiolol group compared to the control group. Most patients with POAF had a history of hypertension and diabetes mellitus, with male predominance. Vitamin D treatment reduced the risk of POAF development by 0.24 times. Atrial fibrillation developed after CABG in 156 patients, with patients with POAF generally older and more often presenting comorbidities. New-onset POAF was independently related to the presence and number of fQRS in patients undergoing CABG surgery. Conclusion. The different aspects of POAF facilitate an all-inclusive approach for factors such as gender disparity, surgical methods, anticoagulant choice, etc. The gathered outcomes from these studies deliver helpful data for clinicians, focusing on the need for individual risk management and treatment methods to decrease the effect of POAF on patients. surgery, with an incidence ranging from 10-65%. It is more co mmon in older patients and noncardiac surgery patients. POAF usually develops between day 2 and 4, with the maximum incidence on day 2. Risk factors include age, hypertension, obesity, diabetes, inflammation, and longer pump and cross clamp times. Stroke is the most sig nificant clinical outcome, and female gender is a risk factor for cardiovascular disease. Aim of study. This literature review is investigating the prevalence ou tcome and management of POAF following cardiac surgery. Methods and materials. The study included articles published in English, cohort studi es, randomized controlled trials and management in cardiac sur gery for POAF. Search was conducted filtering articles based on the keywords "Postoperative A trial Fibrillation,” “POAF following cardiac surgery," “POAF management,” etc. on databases (PubMed, Google Scholar, Embase, Cochrane…etc.). Results. The review analyzed 1849 studies, excluding duplicates, ineligible records, and 1338 records. After evaluating 396 studies, 40 were included, with 346 de emed eligible. The study found apixaban and edoxaban are more effective than rivaroxab an in treating POAF. POAF was linked to increased risk of death in men but not in women. The AF r ecurrence rate was higher in cardiac surgery patients (CS) compared to non-cardiac surgery patie nts (NCS). In long-term follow-up, CVA was more common in patients with POAF after CS com pared to NCS. Atrial fibrillation occurred in a higher percentage of patients in the landi olol group compared to the control group. Most patients with POAF had a history of hypertension and dia betes mellitus, with male predominance. Vitamin D treatment reduced the risk of POAF dev elopment by 0.24 times. Atrial fibrillation developed after CABG in 156 patients, with patien ts with POAF generally older and more often presenting comorbidities. New-onset POAF was i ndependently related to the presence and number of fQRS in patients undergoing CABG surgery. Conclusion. The different aspects of POAF facilitate an all-inclusi ve approach for factors such as gender disparity, surgical methods, anticoagulant choice, etc. The gathered outcomes from these studies deliver helpful data for clinicians, focusing on t he need for individual risk management and treatment methods to decrease the effect of POAF on pa tients. Description: Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica Moldova 2024-01-01T00:00:00Z http://repository.usmf.md:80/handle/20.500.12710/28549 Title: The correct early diagnosis established by the multidisciplinary team is the key to success in the treatment of the post-myocardial infarction patient, complicated with renal infarction and pneumonia-infarction Authors: Gobjila, Ion Abstract: Introduction. According to the ESC guideline for the management of Acute Coronary Syndrome (ACS) it meets a spectrum of conditions, from symptoms and signs, with or without 12-lead ECG changes and with or without positive troponins. ACS is the cause of death in 1.9 million male patients and 2.2 million female patients annually. Case statement. In the given article I present the clinical case of a 66-year-old male patient, diagnosed in an outpatient setting with arrhythmia and aggravated pectoral angina. The given case was studied through the lens of the ACS guideline of the ESC (2023), articles on the subject of ACS, AMI, renal infarction and infarction-pneumonia. Discussions. From the patient's laboratory analyses: complete blood count – thrombocytopenia (142-167 x 10^9/l), blood biochemistry – no changes, Troponins – negative (0.07 ng/ml). On ECG: tachysystolic atrial fibrillation-flutter and signs of left bundle branch block of His fascicle. On echocardiography: mild dilatation of the left atrium, right atrium, hypertrophy of the left ventricular myocardium, multiple regions with akinesia and dyskinesia and apical parietal thrombus with dimensions of 28x18 mm, fixed, ejection fraction – 45%. The patient's clinic is complicated by discomfort and dull pain in the right meso-hypogastrium. Computed tomography of the internal organs shows signs of renal infarction, thrombosis of the hepatic veins and inferior vena cava, infarction-pneumonia on the right. At coronary angiography, subocclusive LAD stenosis was detected, at renal arteriography - no pathological changes. Conclusion. Due to early established multidisciplinary diagnosis, high-performance investigative methods and effective targeted therapy, the patient was treated and discharged with improvement and curative ambulatory measures. (ACS) it meets a spectrum of conditions, from symptoms an d signs, with or without 12-lead ECG changes and with or without positive troponins. ACS is th e cause of death in 1.9 million male patients and 2.2 million female patients annually. Case statement. In the given article I present the clinical case of a 66-year-old male patient, diagnosed in an outpatient setting with arrhythmia and aggrava ted pectoral angina. The given case was studied through the lens of the ACS guideline of the ESC (2023), articles on the subject of ACS, AMI, renal infarction and infarction-pneumonia. Discussions. From the patient's laboratory analyses: complete blood c ount – thrombocytopenia (142-167 x 10^9/l), blood biochemistry – no changes, Troponins – ne gative (0.07 ng/ml). On ECG: tachysystolic atrial fibrillation-flutter and signs of left bundle branch block of His fascicle. On echocardiography: mild dilatation of the left atrium, righ t atrium, hypertrophy of the left ventricular myocardium, multiple regions with akines ia and dyskinesia and apical parietal thrombus with dimensions of 28x18 mm, fixed, ejection fract ion – 45%. The patient's clinic is complicated by discomfort and dull pain in the right meso-hy pogastrium. Computed tomography of the internal organs shows signs of renal infarctio n, thrombosis of the hepatic veins and inferior vena cava, infarction-pneumonia on the right. At coron ary angiography, subocclusive LAD stenosis was detected, at renal arteriography - no patholog ical changes. Conclusion. Due to early established multidisciplinary diagnosis, high- performance investigative methods and effective targeted therapy, the patient was t reated and discharged with improvement and curative ambulatory measures. Description: Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica Moldova 2024-01-01T00:00:00Z