DSpace Collection: The 10th International Medical Congress for Students and Young Doctors, 24-27 April, 2024

Assessment of the cases of postpartum hemorrhage in multiparous women

Mon, 01 Jan 2024 00:00:00 GMT

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.

Treatment of acute non-lymphoblastic leukemias

Mon, 01 Jan 2024 00:00:00 GMT

Title: Treatment of acute non-lymphoblastic leukemias Authors: Pusca, Adelina Abstract: Introduction. Acute myeloid leukemias (AML) are a group of hematological malignancies with primary involvement of the bone marrow (BM). These disorders of hematopoietic system develop due to genetic changes in blood cell precursors that lead to the overproduction of neoplastic clonal myeloid blast cells. It is the most common group of leukemias among the adult population and account for 80% of all cases. Ongoing research and clinical trials continue to explore new therapies and management approaches for AML, including targeted therapies, immunotherapies and personalized medicine strategies based on a patient's genetic mutations. Aim of study. Identification of clinical and laboratory features, evaluation of the effectiveness of different treatment methods of AML. Methods and materials. We present the results of retrospective and prospective analysis of medical records of patients with AML, diagnosed and treated at the Institute of Oncology between 2016-2023. The type of leukemia was identified according to the WHO classification of hematological malignancies and FAB classification of acute leukemias. Our study enrolled 50 adult patients. Results. All of the studied patients presented with anemic syndrome, 87.3% - with hemorrhagic syndrome, 52.1% - with proliferative syndrome and 66.19% - with infectious complications. According to the complete blood count parameters, 97% of the patients had low hemoglobin and erythrocyte levels, 66.17% - leukocytosis, in 19.71% - leukopenia and all patients had changes in the leukocyte formula. Blast cells in the peripheral blood were found in 67% of cases. The BM aspiration revealed more than 20% blasts at diagnosis in 95.7% of cases. According to the FAB classification, M3 and M4 predominated - 22.55% and 35.2% respectively. Induction and consolidation treatments were carried out according to 2+5, 3+7 regimes, low doses of Cytarabine and ATRA. Maintenance treatment was performed with 2+5, 5+Mercaptopurin, 5+Cyclophosphamide and Cytarabin+Mercaptopurin. The chemotherapy treatment was associated with complications: pancytopenia - 73%, infectious complications - 23%, ATRA syndrome - 4%. The mortality rate among studied patients was 57.7%. The most frequent causes of death in our study were multiple organs dysfunction syndrome and hemorrhagic stroke. Conclusion. AML are oncological diseases with progressive evolution and unfavourable prognosis. Early diagnosis and adequate treatment initiation will contribute to the increase of survival. In spite of advances of treatment and increased life expectancy, AML may still be considered a challenging disease for management, especially in old patients. primary involvement of the bone marrow (BM). These diso rders of hematopoietic system develop due to genetic changes in blood cell precursors that lead to the overproduction of neoplastic clonal myeloid blast cells. It is the most common group of leukemi as among the adult population and account for 80% of all cases. Ongoing research and clinica l trials continue to explore new therapies and management approaches for AML, including targeted therap ies, immunotherapies and personalized medicine strategies based on a patient's gene tic mutations. Aim of study. Identification of clinical and laboratory features, eval uation of the effectiveness of different treatment methods of AML. Methods and materials. We present the results of retrospective and prospective a nalysis of medical records of patients with AML, diagnosed and treat ed at the Institute of Oncology between 2016-2023. The type of leukemia was identified according to the WHO clas sification of hematological malignancies and FAB classification of ac ute leukemias. Our study enrolled 50 adult patients. Results. All of the studied patients presented with anemic syndrome, 87.3% - with hemorrhagic syndrome, 52.1% - with proliferative syndrome and 66.19% - with i nfectious complications. According to the complete blood count parameters, 97% of th e patients had low hemoglobin and erythrocyte levels, 66.17% - leukocytosis, in 19.71% - leukopeni a and all patients had changes in the leukocyte formula. Blast cells in the peripheral bl ood were found in 67% of cases. The BM aspiration revealed more than 20% blasts at diagnosis in 95. 7% of cases. According to the FAB classification, M3 and M4 predominated - 22.55% and 35.2% respect ively. Induction and consolidation treatments were carried out according to 2+5, 3+7 regimes, low doses of Cytarabine and ATRA. Maintenance treatment was performed with 2+5, 5+ Mercaptopurin, 5+Cyclophosphamide and Cytarabin+Mercaptopurin. The chemotherap y treatment was associated with complications: pancytopenia - 73%, infectious complica tions - 23%, ATRA syndrome - 4%. The mortality rate among studied patients was 57.7%. The mo st frequent causes of death in our study were multiple organs dysfunction syndrome and hemorrh agic stroke. Conclusion. AML are oncological diseases with progressive evolution and unfavourable prognosis. Early diagnosis and adequate treatment initiati on will contribute to the increase of survival. In spite of advances of treatment and increased life expectancy, AML may still be considered a challenging disease for management, especia lly in old patients. Description: Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica Moldova

Clinical ”Odyssey” in Wilson's disease patients from the Republic of Moldova

Mon, 01 Jan 2024 00:00:00 GMT

Title: Clinical ”Odyssey” in Wilson's disease patients from the Republic of Moldova Authors: Cumpătă, Veronica Abstract: Introduction. Wilson's disease (WD) presents high clinical heterogeneity, independent of age and sex. In our country, it is the first study that analyzes the phenotype of patients with this genetic disorder. Aim of study. The study aims to evaluate the clinical features of patients with WD in the Republic of Moldova. Methods and materials. A retrospective and prospective study was performed on 170 people suspected of WD, between 2006 and 2023. The modified Leipzig Scoring System was used to specify the diagnosis; a score ≥ 4 points establishes the diagnosis of WD. All patients were genetically tested by the Sanger sequencing method. Statistical analysis was performed using EpiInfo. Results. Out of 170 people, 50 patients had a score of≥ 4 points. The mean age was 23 years ± 9.3 (range 5-46 years), and the median was 24.5 years. 23% of pts are <18 years old. The female/male ratio is 1:1.5. The average duration of the period of the diagnosis was 25.7 months (range 1-96 months). All persons were of Caucasian origin. No consanguineous relationships have been described. Hepatic onset was associated in 43.9%, in both sexes equally, while neurological onset was associated in 56.09%, predominating in men (73.09%). Patients with hepatic presentation are diagnosed at younger ages (17.67 years ± 9.07), while those with neuro-psychiatric type are diagnosed at older ages (27.39 years ± 7.81) and with longer diagnosis delays. After examination, liver disease was diagnosed in 52.17% of those with neurological onset; and in those with hepatic onset, neurological lesions were detected in 16.7%. In 58.82%, the liver phenotype was represented by liver cirrhosis (decompensated – 70%). The most frequent neurological manifestations were postural instability – 43.47%, pseudo-bulbar syndrome (dysphagia, dysarthria) - 35%, and tremors of the limbs - 30%. The psychiatric presentation includes depression - 47%, sleep disturbance - 25%, and mood changes - 17%. The Kayser-Fleischer ring was identified in 32%, of which 75% was associated with neurological lesions. Splenomegaly was identified in 58.54%, of which 79.17% were associated with hepatomegaly. One patient underwent a liver transplant due to acute liver failure. Genetic testing was performed in 92%, and most of them were compound heterozygotes. The most common mutation was p.H1069Q (69.57%). Conclusion. Our study observed that hepatic presentation was diagnosed at younger ages, while neuropsychiatric manifestations were identified at older ages and with longer diagnostic delays. Also, the late establishment of the diagnosis was associated with various complications and irreversible organic damage. sex. In our country, it is the first study that analyzes th e phenotype of patients with this genetic disorder. Aim of study. The study aims to evaluate the clinical features of pat ients with WD in the Republic of Moldova. Methods and materials. A retrospective and prospective study was performed on 170 peopl e suspected of WD, between 2006 and 2023. The modified Leipzig Scoring System was used to specify the diagnosis; a score ≥ 4 points establishes t he diagnosis of WD. All patients were genetically tested by the Sanger sequencing method. Statistica l analysis was performed using EpiInfo. Results. Out of 170 people, 50 patients had a score of≥ 4 points. The mea n age was 23 years ± 9.3 (range 5-46 years), and the median was 24.5 years. 23% of pts are <18 years old. The female/male ratio is 1:1.5. The average duration of the period of the dia gnosis was 25.7 months (range 1-96 months). All persons were of Caucasian origin. No consangui neous relationships have been described. Hepatic onset was associated in 43.9%, in both sex es equally, while neurological onset was associated in 56.09%, predominating in men (73.09%). Patient s with hepatic presentation are diagnosed at younger ages (17.67 years ± 9.07), while those wit h neuro-psychiatric type are diagnosed at older ages (27.39 years ± 7.81) and with longer di agnosis delays. After examination, liver disease was diagnosed in 52.17% of those with neurologic al onset; and in those with hepatic onset, neurological lesions were detected in 16.7%. In 58. 82%, the liver phenotype was represented by liver cirrhosis (decompensated – 70%). The mo st frequent neurological manifestations were postural instability – 43.47%, pseudo-bulbar s yndrome (dysphagia, dysarthria) - 35%, and tremors of the limbs - 30%. The psyc hiatric presentation includes depression - 47%, sleep disturbance - 25%, and mood changes - 17% . The Kayser-Fleischer ring was identified in 32%, of which 75% was associated with neurolog ical lesions. Splenomegaly was identified in 58.54%, of which 79.17% were associated with hepatom egaly. One patient underwent a liver transplant due to acute liver failure. Genetic testi ng was performed in 92%, and most of them were compound heterozygotes. The most common mutation was p.H1069Q (69.57%). Conclusion. Our study observed that hepatic presentation was diagnosed at younger ages, while neuropsychiatric manifestations were identified at older ages and with longer diagnostic delays. Also, the late establishment of the diagnosis was asso ciated with various complications and irreversible organic damage. Description: Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica Moldova

Clinical and hematological features and diagnostic options in extranodal aggressive non-Hodgkin's lymphomas

Mon, 01 Jan 2024 00:00:00 GMT

Title: Clinical and hematological features and diagnostic options in extranodal aggressive non-Hodgkin's lymphomas Authors: Pîrlii, Iulius Abstract: Introduction. Lymphomas can be simply defined as malignant neoplasms of lymphocytes and their precursor cells. Common sites of extranodal manifestations are the gastrointestinal tract, especially the ventricle, pharynx, thyroid gland and skin. In the head and neck region, the most common site is Waldeyer's ring. Aim of study. To identify and evaluate the clinical-evolutionary, hematological features and diagnostic options in aggressive extranodal non-Hodgkin's lymphomas. Methods and materials. We studied the ambulatory cards and medical records of 80 patients with morphologically confirmed diagnoses of non-Hodgkin's lymphoma, who had at least one extranodal presentation. Results. Among studied patients, all had at least one extranodal involvement, in 43% of cases the nasopharynx was affected, 38% the liver, 25% the spleen, 14% the spinal cord. Most patients spend 4 months -1 year to establish a concrete diagnosis. Sometimes this was due to the patient's own fault, postponing the visit to the doctor until the last moment or atypical symptoms making the diagnosis more difficult to establish. The presence of B symptoms was recorded in 42% of patients, and 76% had stage IV at diagnosis. The anemic syndrome was present in 14% of cases, with specific changes in the differential blood count. The final diagnosis was proved on the basis of morphology and immunohistochemical examination of the biopsied lymph nodes or tissue. The immunohistochemistry panel used was: CD20, CD3, CD5, CD10, CD45, BCL2, BCL6, Ki-67, IRF4/MUM1, and MYC which confirmed the diagnosis of lymphoma with the specification of the immunohistochemical type. Complete staging and monitoring of the disease evolution was possible due to high-precision MRI, CT PET-CT investigations. Patients received treatment courses of RCHOP, RCOP, BR with 80% of cases achieving clinic-morphological remission. Conclusion. A surgically excised tissue with immunohistochemical examination is widely accepted as the gold standard for lymphoma diagnosis based on current international guidelines. It should be evaluated by immunocytochemistry, flow cytometry (if received unfixed), FISH studies, DNA and RNA extraction for molecular diagnosis. their precursor cells. Common sites of extranodal manif estations are the gastrointestinal tract, especially the ventricle, pharynx, thyroid gland and skin. In the head and neck region, the most common site is Waldeyer's ring. Aim of study. To identify and evaluate the clinical-evolutionary, hema tological features and diagnostic options in aggressive extranodal non-Hodgkin's lymp homas. Methods and materials. We studied the ambulatory cards and medical records of 80 pa tients with morphologically confirmed diagnoses of non-Hodgkin's lymphom a, who had at least one extranodal presentation. Results. Among studied patients, all had at least one extranodal invo lvement, in 43% of cases the nasopharynx was affected, 38% the liver, 25% the spleen, 14% t he spinal cord. Most patients spend 4 months -1 year to establish a concrete diagnosis. Someti mes this was due to the patient's own fault, postponing the visit to the doctor until the last mom ent or atypical symptoms making the diagnosis more difficult to establish. The presence of B symptoms was recorded in 42% of patients, and 76% had stage IV at diagnosis. The anemic syndrome was pres ent in 14% of cases, with specific changes in the differential blood count. The fina l diagnosis was proved on the basis of morphology and immunohistochemical examination of the bio psied lymph nodes or tissue. The immunohistochemistry panel used was: CD20, CD3, CD5, CD10, CD45, BCL2, BC L6, Ki-67, IRF4/MUM1, and MYC which confirmed the diagnosis of lymphoma with the specification of the immunohistochemical type. Complete staging and monitoring o f the disease evolution was possible due to high-precision MRI, CT PET-CT investigations . Patients received treatment courses of RCHOP, RCOP, BR with 80% of cases achieving clinic- morphological remission. Conclusion. A surgically excised tissue with immunohistochemical exami nation is widely accepted as the gold standard for lymphoma diagnosis based o n current international guidelines. It should be evaluated by immunocytochemistry, flow cytometry (if received unfixed), FISH studies, DNA and RNA extraction for molecular diagnosis. Description: Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica Moldova