http://repository.usmf.md:80/xmlui/handle/20.500.12710/10713 2026-10-13T11:22:26Z 2026-10-13T11:22:26Z Cemortan, Maria Bubulici, Cristina Vicol, Maria-Magdalena Grajdean, Elena Scripnic, Gabriela Manic, Milena http://repository.usmf.md:80/xmlui/handle/20.500.12710/29004 2024-11-22T10:38:10Z 2024-01-01T00:00:00Z

Assessment of the cases of postpartum hemorrhage in multiparous women Cemortan, Maria; Bubulici, Cristina; Vicol, Maria-Magdalena; Grajdean, Elena; Scripnic, Gabriela; Manic, Milena 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 Ashkar, Laila http://repository.usmf.md:80/xmlui/handle/20.500.12710/28444 2024-11-20T12:26:03Z 2024-01-01T00:00:00Z

Variation of the mastoid segment of the facial canal and of the stylomastoid foramen Ashkar, Laila Introduction. Taking into consideration that the ratio of the facial nerve iatrogenic injuries in primary mastoidectomy is 0.6%-3.7%, and a twice higher ratio of 4%-10% is reported for the revision surgery, the knowledge about variability of the mastoid segment of the facial canal and its exit orifice is of high clinical significance for the head and neck surgery. Aim of study. The purpose of our study was to determine the variability and specific features of the mastoid segment of the facial canal and of the stylomastoid foramen. Methods and materials. Our research was carried out at the Department of anatomy and clinical anatomy of Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova. Out of 82 temporal bones, 41 were from the right side and 41 were from the left one. The length of the mastoid segment of the facial canal, its exit angle, the transverse and longitudinal diameters of the stylomastoid foramen were taken. For the database storage an Excel 2019 sheath was used. For the statistical analysis of the obtained morphometric parameters the descriptive and inferential statistics methods were applied. Results. Three variants of the mastoid segment exit angle were determined: sharp, right and obtuse angles. The exit angle of the mastoid segment on the right temporal bones had a mean value of 112.9±23.61° and on the left side it was 113.1±19.76°, p=0.971. The mean length of the mastoid segment on the right temporal bones was 15.7±3.66 mm and on the left bones it was 14.5±3.84 mm, p=0.153. The transverse diameter of the stylomastoid foramen on the right specimens was 2.9±0.80 mm, and on the left ones it was 2.4±0.60 mm, with a statistically significant difference, p=0.012. The longitudinal diameter of the right stylomastoid foramens had a mean value of 3.3±0.96 mm, and of the left orifices it was 2.7±0.81 mm, with a statistically significant difference, p=0.007. Variable shapes of the stylomastoid foramen were established: oval, round, triangular, quadrangular, semilunar and irregular shapes. Conclusion. Both the mastoid segment of the facial canal and the stylomastoid foramen are subjected to individual variability. Three variants were characteristic of the mastoid segment exit angle: sharp, right and obtuse ones. The exit angle of the mastoid segment of the facial canal was higher on the left side, but the length of the mastoid segment was higher on the right side. Both the transverse and the longitudinal diameters of the stylomastoid foramen were higher on the right side. The transverse diameter of the stylomastoid foramen, on both sides, had lower mean values compared to the mean values of its longitudinal diameter. primary mastoidectomy is 0.6%-3.7%, and a twice higher ratio of 4%-10% is reported for the revision surgery, the knowledge about variability of the mast oid segment of the facial canal and its exit orifice is of high clinical significance for t he head and neck surgery. Aim of study. The purpose of our study was to determine the variability and s pecific features of the mastoid segment of the facial canal and of the st ylomastoid foramen. Methods and materials. Our research was carried out at the Department of anatomy and clinical anatomy of Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova. Out of 82 temporal bones, 41 were from the right side and 41 were from the left one. The length of the mastoid segment of the facial canal, its exit angle, the transverse and longitudinal diameters of the stylomastoid foramen were taken. For the database storage an Excel 2019 sheath was used. For the statistical analysis of the obtained m orphometric parameters the descriptive and inferential statistics methods were applied. Results. Three variants of the mastoid segment exit angle were determined: sharp, right and obtuse angles. The exit angle of the mastoid segment on the right temporal bones had a mean value of 112.9±23.61° and on the left side it was 113.1±19.76°, p=0.971. The mean l ength of the mastoid segment on the right temporal bones was 15.7±3.66 mm and on the left bones it was 14.5±3.84 mm, p=0.153. The transverse diameter of the stylomastoid for amen on the right specimens was 2.9±0.80 mm, and on the left ones it was 2.4±0.60 mm, with a st atistically significant difference, p=0.012. The longitudinal diameter of the right stylomasto id foramens had a mean value of 3.3±0.96 mm, and of the left orifices it was 2.7±0.81 mm, with a statistically significant difference, p=0.007. Variable shapes of the stylomastoid foramen were es tablished: oval, round, triangular, quadrangular, semilunar and irregular shapes. Conclusion. Both the mastoid segment of the facial canal and the stylomastoid foramen are subjected to individual variability. Three variants were chara cteristic of the mastoid segment exit angle: sharp, right and obtuse ones. The exit angle of th e mastoid segment of the facial canal was higher on the left side, but the length of the mastoid se gment was higher on the right side. Both the transverse and the longitudinal diameters of the st ylomastoid foramen were higher on the right side. The transverse diameter of the stylomastoid for amen, on both sides, had lower mean values compared to the mean values of its longitudinal diameter. Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica Moldova

2024-01-01T00:00:00Z Parapuravalappil Sathyan, Krishnadas http://repository.usmf.md:80/xmlui/handle/20.500.12710/28446 2024-11-20T12:30:02Z 2024-01-01T00:00:00Z

Biochemical aspects of heart diseases in patients with diabetes mellitus Parapuravalappil Sathyan, Krishnadas Introduction. The prevalence of diabetes mellitus is continuously increasing globally and is estimated to reach approx. 366 million by 2030. According to the latest research, the cardiovascular changes due to diabetes are based on metabolic, hormonal and genetic imbalances. Aim of study. Elucidation of biochemical aspects of cardiovascular diseases induced by diabetes, in order to improve diagnosis and to develop effective treatment methods. Methods and materials. To achieve the proposed goal, a bibliographic search was performed using 5 bibliographic sources, between the 2020-2023, including those of the Medical Scientific Library of USMF "Nicolae Testemitanu", data of the electronic libraries such as PubMed, Cambridge Journals Online, Elsevier, Medline, MedScape, Diabetes Care and Diabetologia. Results. Diabetes Mellitus forms a hyperglycemic condition in patients, which leads to the increased secretion of interleukin 6 (IL-6), interleukin-1β (IL-1β). This can induce cardiovascular problems like atherosclerosis and heart failure. The interleukin 6 (IL-6) has the role in the atherothrombosis formation in the coronary heart disease, heart failure. Interleukin 1β (IL-1β) decreases the beta-adrenergic responsiveness of calcium channels and increases the activity of nitric oxide synthase (NOS), resulting in decreased myocardial contractility, increased myocardial hypertrophy and induces cardiomyocyte apoptosis. Interleukin-1beta (IL-1β) can be detected in the endothelium and macrophages of the coronary arteries affected with atherosclerosis and coronary arteries from nonischemic cardiomyopathy hearts. Recently has been discovered a member of the interleukin family - interleukin 34 (IL-34). Its levels are high in coronary heart disease and diabetes. Interleukin 34 (IL-34) has pro-inflammatory actions, causing atherosclerosis and insulin resistance. Interleukin 6 (IL-6) and interleukin 1β (IL-1β) stimulate the production of C- reactive protein. Sodium-glucose co-transporter-2 (SGLT2) inhibitors lower the interleukin levels which would lower the risk of cardiovascular outcomes and diabetes. Conclusion. Type 2 diabetes patients are at high risk of cardiovascular diseases like atherosclerosis, myocardial infarction, heart failure due to the increased secretion of inflammatory cytokines like interleukin 6 (IL-6), interleukin 1β (IL-1β). Scientific studies propose the implementation of regimes with SGLT2 inhibitors: canagliflozin, empagliflozin which are beneficial against the cardiovascular consequences of diabetes in humans. estimated to reach approx. 366 million by 2030. According to the late st research, the cardiovascular changes due to diabetes are based on meta bolic, hormonal and genetic imbalances. Aim of study. Elucidation of biochemical aspects of cardiovascular di seases induced by diabetes, in order to improve diagnosis and to develop effective trea tment methods. Methods and materials. To achieve the proposed goal, a bibliographic search was perfo rmed using 5 bibliographic sources, between the 2020-2023, including those of the Medical Scientific Library of USMF "Nicolae Testemitanu", data of the electronic libraries such as PubMed, Cambridge Journals Online, Elsevier, Medline, MedScape, Diabet es Care and Diabetologia. Results. Diabetes Mellitus forms a hyperglycemic condition in pati ents, which leads to the increased secretion of interleukin 6 (IL-6), interleukin -1β (IL-1β). This can induce cardiovascular problems like atherosclerosis and heart failure. The inte rleukin 6 (IL-6) has the role in the atherothrombosis formation in the coronary heart dise ase, heart failure. Interleukin 1β (IL-1β) decreases the beta-adrenergic responsiveness of calcium channels and increases the activity of nitric oxide synthase (NOS), resulting in decreased myocar dial contractility, increased myocardial hypertrophy and induces cardiomyocyte apoptosis. Interleukin-1be ta (IL-1β) can be detected in the endothelium and macrophages of the coronary arteries affected with atherosclerosis and coronary arteries from nonischemic cardiomyopathy hear ts. Recently has been discovered a member of the interleukin family - interleukin 34 (IL-34). Its levels are high in coronary heart disease and diabetes. Interleukin 34 (IL-34) has pro-inflamm atory actions, causing atherosclerosis and insulin resistance. Interleukin 6 (IL-6) and interleuki n 1β (IL-1β) stimulate the production of C- reactive protein. Sodium-glucose co-transporter-2 (SGLT2) inhibitors lower the interleukin levels which would lower the risk of cardiovascular outc omes and diabetes. Conclusion. Type 2 diabetes patients are at high risk of cardiovascu lar diseases like atherosclerosis, myocardial infarction, heart failure due to the increased secretion of inflammatory cytokines like interleukin 6 (IL-6), interleukin 1β (IL-1β). Scientific studies propose the implementation of regimes with SGLT2 inhibitors: canaglifl ozin, empagliflozin which are beneficial against the cardiovascular consequences of di abetes in humans. Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica Moldova

2024-01-01T00:00:00Z Stici, Vlada http://repository.usmf.md:80/xmlui/handle/20.500.12710/28448 2024-11-20T12:45:32Z 2024-01-01T00:00:00Z

Biochemical changes of the vascular endothelium in diabetic pathology Stici, Vlada Introduction. Diabetes mellitus (DM) is a multifactorial pathology that has become a worldwide problem due to its rapid spread and progression. Persistent hyperglycemia in DM induces disruption of vascular homeostasis by interfering with metabolic, hormonal and genetic imbalances. As a result of these disturbances, the functionality of the vascular endothelial cells changes, thus the amplification of proinflammatory and procoagulant processes, characteristic of diabetic pathology, takes place. Aim of study. Elucidation of biochemical aspects in the pathogenesis of vascular changes caused by diabetes mellitus, which disrupt the quality of life. Detailed analysis of the molecular processes and understanding of the underlying mechanisms that contribute to the vascular dysfunction associated with DM. Methods and materials. Analysis of published literature from the information resources of the Medical Scientific Library at Nicolae Testemitanu State University of Medicine and Pharmacy and articles from specialized medical scientific journals included in databases such as PubMed, Cambridge Journals Online, Elsevier, Diabetes Care, Medline and MedScape. Results. In DM the vascular endothelium regulates the passage of macromolecules and circulating cells in the blood. This is a major target of oxidative stress, which leads to the activation of the polyol pathway, the acceleration of the formation of protein kinase C (PKC) isoforms and the intensification of the hexosamine pathway, which is due to the overproduction of superoxide anion at the level of the mitochondrial respiratory chain and promotes the formation of advanced glycation end products (AGEs). Glycated biological compounds, as well as collagen in the vascular endothelium and respiratory chain proteins in the mitochondria, undergo irreversible changes, lose their ability to act, which contributes to the installation of fibrotic and atrophic processes in the organs affected by the complications of diabetes and lead to the amplification of oxidative stress, which is closely related to the glycation process. Activation of PKC in the cells of the vascular wall leads to an increased expression of vascular endothelial growth factor that increases the permeability of the endothelial barrier and inhibits nitric oxide synthase, due to the direct effect of free radicals, which react with nitric oxide by inactivating it. Free radicals determine the activation of the hexosamine pathway that induces the procoagulant state attributed to diabetic pathology. Conclusion. The structural changes in the vessels in diabetic patients are due to the alterations occurring as a result of oxidative stress and inflammation. Scientific studies propose the implementation of regimes with antioxidants: polyphenols, vitamins C and E, beneficial against the consequences of diabetes. problem due to its rapid spread and progression. Persistent hy perglycemia in DM induces disruption of vascular homeostasis by interfering with m etabolic, hormonal and genetic imbalances. As a result of these disturbances, the funct ionality of the vascular endothelial cells changes, thus the amplification of proinflammatory and pro coagulant processes, characteristic of diabetic pathology, takes place. Aim of study. Elucidation of biochemical aspects in the pathogenesis of vascular changes caused by diabetes mellitus, which disrupt the quality of life. Detai led analysis of the molecular processes and understanding of the underlying mechanisms that contribute to th e vascular dysfunction associated with DM. Methods and materials. Analysis of published literature from the information resourc es of the Medical Scientific Library at Nicolae Testemitanu State University of Medicine and Pharmacy and articles from specialized medical scientific journals i ncluded in databases such as PubMed, Cambridge Journals Online, Elsevier, Diabetes Care, Medline and MedScape. Results. In DM the vascular endothelium regulates the passage of macromolecules and circulating cells in the blood. This is a major target of oxidative stre ss, which leads to the activation of the polyol pathway, the acceleration of the formation of prot ein kinase C (PKC) isoforms and the intensification of the hexosamine pathway, which is due to the overproduction of superoxide anion at the level of the mitochondrial respiratory chain and promotes the formation of advanced glycation end products (AGEs). Glycated biological compounds, as well as collagen in the vascular endothelium and respiratory chain proteins in the mitocho ndria, undergo irreversible changes, lose their ability to act, which contributes to the installation of fibrotic and atrophic processes in the organs affected by the complications of diabetes and lead to the amplification of oxidative stress, which is closely related to the glycation process. Activat ion of PKC in the cells of the vascular wall leads to an increased expression of vascular endothel ial growth factor that increases the permeability of the endothelial barrier and inhibits nitric oxide synthase, due to the direct effect of free radicals, which react with nitric oxide by inactivati ng it. Free radicals determine the activation of the hexosamine pathway that induces the procoagulant st ate attributed to diabetic pathology. Conclusion. The structural changes in the vessels in diabetic pati ents are due to the alterations occurring as a result of oxidative stress and inflammatio n. Scientific studies propose the implementation of regimes with antioxidants: polyphenols, vitamins C and E, beneficial against the consequences of diabetes. Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica Moldova

2024-01-01T00:00:00Z