http://repository.usmf.md:80/handle/20.500.12710/27983 The 10th International Medical Congress for Students and Young Doctors, 24-27 April, 2024 2026-08-11T08:18:33Z 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/20.500.12710/28438 Title: Anatomical variants of the median sacral artery Authors: Rotaraș, Alina Abstract: Introduction. Knowing the anatomical variants of the median sacral artery has the applied significance, since it is necessary for the surgeons when choosing the operational techniques, in order to ensure the safe access to the presacral space structures. The median sacral artery (hereinafter referred to as the ‘MSA’) is an azygos blood vessel, which is located in the midline, is of small calibre, begins at the dorsal semi-circumference of the abdominal aorta, at the level of the bifurcation thereof, and ends in glomus coccygeum. The MSA is a continuation of the abdominal aorta and a source of vascularisation for the coccyx region of the human organism. Aim of study. Assessing the anatomical variants of the median sacral artery, based on the morphological and topographical criteria, which were found in different reference sources. Methods and materials. The information on this topic was selected from 15 reference sources, and the specified data were analyzed, from the point of view of morphological and topographical variations of the median sacral artery. Results. It has been stated, based on the information as provided in the specialized references, that median sacral artery arises, in the majority of cases, in the dorsal part of the aorta, over the bifurcation thereof, at a distance of 5 to 18 mm, and more seldom directly at the bifurcation level. In reference to the posterior midline, the MSA is more frequently located on the left side of the midline, in case – right on the midline, and in the remaining cases, on the right side of the midline. It has been also stated that in those cases when the abdominal aorta bifurcation is over the level of inferior vena cava formation, then the median sacral artery has a descending rectilinear pathway, and only sometimes – a descending sinuous pathway. In reference to the left/right common iliac veins, there have been identified the following locations of the MSA: its location in the midline, as correlated to both veins, has been stated in 40.9% of cases; its deviation to the left, next to the left common iliac vein has been stated in 31.2% of cases; its direction to the right common iliac vein has been stated in 27.3% of cases. Several authors mention the cases of rare occurrence, when the median sacral artery priorly intersects the left common iliac vein, on its pathway. Conclusion. The point of origin of the median sacral artery varies, and it may have different pathways, both rectilinear and sinuous ones. Topographically, the MSA is located differently, in reference to blood vessels and adjacent formations. Knowing the anatomical variants of the median sacral artery, as pertaining to its morphological and topographical peculiarities, will be a great benefit for the practical medicine and it has a major importance when carrying on surgical interventions at the presacral space level, or various gynecological procedures. significance, since it is necessary for the surgeons when choosing the operational techniques, in order to ensure the safe access to the presacral space structures. The median sacral artery (hereinafter referred to as the ‘MSA’) is an azygos blood vessel, which is located in the midline, is of small calibre, begins at the dorsal semi-circumfe rence of the abdominal aorta, at the level of the bifurcation thereof, and ends in glomus coccygeum. The MSA is a continuation of the abdominal aorta and a source of vascularisation for the coccyx region of the human organism. Aim of study. Assessing the anatomical variants of the median sacral artery, based on the morphological and topographical criteria, which were found in different reference sources. Methods and materials. The information on this topic was selected from 15 reference sources, and the specified data were analyzed, from the point of view of morphological and topographical variations of the median sacral artery. Results. It has been stated, based on the information as provided in the specialized references, that median sacral artery arises, in the majority of cases, in the dorsal part of the aorta, over the bifurcation thereof, at a distance of 5 to 18 mm, and more seldom directly at the bifurcation level. In reference to the posterior midline, the MSA is more frequently located on the left side of the midline, in case – right on the midline, and in the remain ing cases, on the right side of the midline. It has been also stated that in those cases when the abdominal aorta bifurcation is over the level of inferior vena cava formation, then the median sacral artery has a descending rectilinear pathway, and only sometimes – a descending sinuous pathway. In referenc e to the left/right common iliac veins, there have been identified the following locatio ns of the MSA: its location in the midline, as correlated to both veins, has been stated in 40.9% of c ases; its deviation to the left, next to the left common iliac vein has been stated in 31.2% of cases; its direction to the right common iliac vein has been stated in 27.3% of cases. Several authors m ention the cases of rare occurrence, when the median sacral artery priorly intersects the left common iliac vein, on its pathway. Conclusion. The point of origin of the median sacral artery varies, and it may have different pathways, both rectilinear and sinuous ones. Topographically, the MSA is located differently, in reference to blood vessels and adjacent formations. Know ing the anatomical variants of the median sacral artery, as pertaining to its morphological and top ographical peculiarities, will be a great benefit for the practical medicine and it has a major importance when carrying on surgical interventions at the presacral space level, or various gynecological procedures. Description: Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica Moldova 2024-01-01T00:00:00Z http://repository.usmf.md:80/handle/20.500.12710/28439 Title: Anatomo clinical argumentation of reflexogenic zones Authors: Zaharco, Daniela Abstract: Introduction. A reflexogenic zone can be defined as a specific region of the human body that, through stimulation or pressure, can influence or trigger responses in other parts of the organism. These can be considered true "mirrors" of internal organs or systems, reflecting their condition, whether it is one of health or imbalance. Aim of study. Determining the importance of reflexogenic zones in the medical and therapeutic context, including their role in diagnosis, as well as illustrating how these areas can influence the health of the human body. Methods and materials. The presented work was created through a literature review using articles published in databases such as PubMed, NCBI, and Science Direct, as well as anatomy textbooks and international literature on alternative medicine. Results. The state of internal organs can influence the appearance of external projection areas, for example, the appearance of moles, papillomas, keratomas, and condylomas, the emergence of vascular patterns on the facial skin, reddening or cyanosis of the lips and nails in the case of chronic pathology. Also, it can manifest with pain in the skin, muscles, periosteum, blood vessels, and fascia, which represents its projection. It was proven that a chronic kidney disease can lead to shoulder elevation on the same side of the body. Chronic lung diseases are often accompanied by kyphosis in the thoracic region of the spine. These aspects are based on visceral sensitivity, viscero-visceral, somato-visceral and viscero-somatic connections. For visceral sensitivity are responsible afferent visceral fibers that transmit information about the internal state of the body to the central nervous system (CNS). This information is processed unconsciously and contributes to the automatic regulation of vital functions, such as blood pressure, blood chemical composition, heart rate, respiratory rate, and vascular resistance. Viscero-visceral connections describe the interactions where one viscus can influence the functioning of another. Somato-visceral and viscero-somatic connections illustrate the interaction between internal organs and somatic structures. Stimulation of a somatic area can have effects on the functioning of a visceral organ. Conversely, dysfunctions of visceral organs can lead to manifestations in somatic areas, such as referred pain, a phenomenon in which pain from a visceral organ is felt in a superficial area of the body. It is explained by the dermatomal law, according to which visceral pain radiates to the cutaneous zones, also known as Zaharin-Head zones. Dermatomes correspond to the spinal segment at which the respective organ developed during embryonic development. An illustrative example is cardiac pain, which can be felt in the dermatomes C8-T1, also renal, ureteral, or testicular pain is referred to the dermatomes L1-L2. In the case of angina pectoris pain appears in the left shoulder and arm, in the case of gastric ulcer disease – in the interscapular region, and in the case of appendicitis – in the right inguinal region. Conclusion. Knowing and studying reflexogenic areas is important to understanding the human body's complexity and developing effective therapies such as reflexology, acupuncture, acupressure, physiotherapy, kinesiotherapy, hirudotherapy, cupping therapy, and others, which are components of traditional medicine, and as alternative treatment methods are proven to be effective and with fewer side effects. stimulation or pressure, can influence or trigger responses in other parts of the organism. These can be considered true "mirrors" of internal organs or systems, reflecting their condition, whether it is one of health or imbalance. Aim of study. Determining the importance of reflexogenic zones in the medi cal and therapeutic context, including their role in diagnosis, as well as illustrating how these areas can influence the health of the human body. Methods and materials. The presented work was created through a literature re view using articles published in databases such as PubMed, NCBI, and Science Direct, as well as anatomy textbooks and international literature on alternative medicine. Results. The state of internal organs can influence the appearance of external projection areas, for example, the appearance of moles, papillomas, keratomas, and condylomas, the e mergence of vascular patterns on the facial skin, reddening or cyanosis of the lips and nails in the case of chronic pathology. Also, it can manifest with pain in the skin, muscles, periosteum, blood vessels, and fascia, which represents its projection. It was proven that a chronic kidney disease can lead to shoulder elevation on the same side of the body. Chronic lung diseases are often accompanied by kyphosi s in the thoracic region of the spine. These aspects are based on visceral sensitivity, viscero-vi sceral, somato-visceral and viscero-somatic connections. For visceral sensitivity are responsible afferent visceral fibers that transmit information about the internal state of the body to the central nervous system (CNS). This information is processed unconsciously and contributes to the automatic regulation of vital f unctions, such as blood pressure, blood chemical composition, heart rate, respiratory rate, and va scular resistance. Viscero-visceral connections describe the interactions where one viscus can influence the func tioning of another. Somato-visceral and viscero-somatic connections illustrate the interaction between int ernal organs and somatic structures. Stimulation of a somatic area can have effects on the functioni ng of a visceral organ. Conversely, dysfunctions of visceral organs can lead to manifestations in somatic areas, such as referred pain, a phenomenon in which pain from a visceral organ is felt in a supe rficial area of the body. It is explained by the dermatomal law, according to which visceral pain radia tes to the cutaneous zones, also known as Zaharin-Head zones. Dermatomes correspond to the spinal segment at which the respective organ developed during embryonic development. An illustrative example is c ardiac pain, which can be felt in the dermatomes C8-T1, also renal, ureteral, or testicular pain is referred to the dermatomes L1-L2. In the case of angina pectoris pain appears in the left shoulder and arm, in the case of gastric ulcer disease – in the interscapular region, and in the case of appendicitis – in the right inguinal region. Conclusion. Knowing and studying reflexogenic areas is important to understandi ng the human body's complexity and developing effective therapies such as reflexology, acupuncture, acupressure, physiotherapy, kinesiotherapy, hirudotherapy, cupping therapy, and ot hers, which are components of traditional medicine, and as alternative treatment methods are proven to be effective and with fewer side effects. Description: Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica Moldova 2024-01-01T00:00:00Z http://repository.usmf.md:80/handle/20.500.12710/28551 Title: The significant impact of artificial intelligence in TAVI Authors: Tofan, Lucian Abstract: Introduction. Currently, TAVI represents a benchmark in the treatment of patients with severe aortic stenosis, becoming a durable and preferred option compared to the traditional SAVR method. The success of TAVI significantly relies on the careful evaluation of the patient before, during, and after the procedure. A new paradigm in the assessment of patients for TAVI has emerged with the introduction of AI, providing more flexible, adaptable, and potentially more accurate approaches for risk estimation and patient selection in the context of the TAVI procedure. Aim of study. Through the analysis of existing studies and literature, we aim to highlight the ways in which AI can enhance various aspects of the TAVI procedure, from diagnosis and planning to image analysis and complication management. Understanding how AI can contribute to the planning and execution of the TAVI procedure can optimize the patient selection process, reduce complications, and improve post-procedural outcomes for patients. Methods and materials. This is a synthesis of newest medical articles and national protocols published during the years 2021-2024, found by the search engines Google Scholar, HINARI, and NCBI. Results. Decision algorithms contribute to establishing a personalized patient profile, determining the relative benefits of TAVI compared to other treatment options. A study cohort of 151 patients shows that simulation algorithms can provide a virtual preview of the procedure with 100% sensitivity, allowing the medical team to prepare efficiently for the intervention. This contributes to optimizing the size and positioning of the valve or blood vessels course, based on imagistic analysis, and assessing relevant anatomical details, automatically with 100% precision in 2 min compared to the 10 min required for manual measuring. This visualizing opportunity can lead to a decrease in post-procedural complications, such as paravalvular regurgitation, with a 76% positive prediction and 100% negative prediction. Already knowing the probability of readmission, with a high probability, predicted by AI in the study of a 917 patient cohort, and the patient's postoperative mortality, validated in a study of 10,000 patients, where the accuracy reached 80% of cases, physicians can more easily guide the clinical future of the patient in the right direction. The AI feedback can contribute to the continuous improvement of the procedure and treatment, based on accumulated clinical experience. Conclusion. Integrating this technology into TAVI practice, brings significant benefits in improving efficiency, accuracy, and clinical outcomes. A current worrisome trend is data privacy of patients because of the need for large and high-quality datasets and the development of precise, reliable, and interpretable artificial intelligence algorithms. aortic stenosis, becoming a durable and preferred option co mpared to the traditional SAVR method. The success of TAVI significantly relies on the c areful evaluation of the patient before, during, and after the procedure. A new paradigm in the assessm ent of patients for TAVI has emerged with the introduction of AI, providing more flexibl e, adaptable, and potentially more accurate approaches for risk estimation and patient sele ction in the context of the TAVI procedure. Aim of study. Through the analysis of existing studies and literature, we a im to highlight the ways in which AI can enhance various aspects of the TAVI procedur e, from diagnosis and planning to image analysis and complication management. Understanding how AI can contribute to the planning and execution of the TAVI procedure can optimize the patient selection process, reduce complications, and improve post-procedural outcomes for pati ents. Methods and materials. This is a synthesis of newest medical articles and nati onal protocols published during the years 2021-2024, found by the search engines Google Scholar, HINARI, and NCBI. Results. Decision algorithms contribute to establishing a personalized pa tient profile, determining the relative benefits of TAVI compared to other treatmen t options. A study cohort of 151 patients shows that simulation algorithms can provide a virtual previe w of the procedure with 100% sensitivity, allowing the medical team to prepare effic iently for the intervention. This contributes to optimizing the size and positioning of the valve or blood ve ssels course, based on imagistic analysis, and assessing relevant anatomical details, autom atically with 100% precision in 2 min compared to the 10 min required for manual measuring. This vi sualizing opportunity can lead to a decrease in post-procedural complications, such as paraval vular regurgitation, with a 76% positive prediction and 100% negative prediction. Already knowing the probability of readmission, with a high probability, predicted by AI in the study of a 917 patient cohort, and the patient's postoperative mortality, validated in a study of 10,000 patients, where the accuracy reached 80% of cases, physicians can more easily guide the clinical future of the patient in the right direction. The AI feedback can contribute to the continuous improveme nt of the procedure and treatment, based on accumulated clinical experience. Conclusion. Integrating this technology into TAVI practice, brings sig nificant benefits in improving efficiency, accuracy, and clinical outcomes. A c urrent worrisome trend is data privacy of patients because of the need for large and high-qualit y datasets and the development of precise, reliable, and interpretable artificial intelligence algorithms. Description: Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica Moldova 2024-01-01T00:00:00Z