MedEspera 2024

Assessment of the cases of postpartum hemorrhage in multiparous women

2024-11-22T10:38:10Z

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.

From oxidative stress to bone healing: a biochemical insight into the fracture recovery process

2024-11-20T13:05:10Z

From oxidative stress to bone healing: a biochemical insight into the fracture recovery process Dănilă, Alexandru 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). Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica Moldova

Immunohistochemical particularities as prognostic factors in diffuse large B-cell non-Hodgkin lymphoma

2024-11-29T11:27:32Z

Immunohistochemical particularities as prognostic factors in diffuse large B-cell non-Hodgkin lymphoma Dudnic, Cristina Introduction. Diffuse Large B-Cell Lymphoma (DLBCL), the most common type of NonHodgkin Lymphoma (NHL) globally, is classified into two distinct biological categories based on the gene expression profile (GEP): the germinal center B-cell (GCB) subtype and the activated Bcell (ABC) or non-GCB subtype. Aim of study. Identification of Immunohistochemical Particularities as Prognostic Factors in Diffuse Large B-Cell Non-Hodgkin Lymphoma. Methods and materials. Data from medical scientific literature were examined, identified through Google Search and databases such as PubMed, Cochrane, Scopus, along with international clinical guidelines from NCCN and ESMO. Results. Studies have indicated that determining the cell of origin phenotype in DLBCL using gene expression profile (GEP) is significant for establishing the prognosis. Tumors with the GCB phenotype showed a better clinical course compared to those with the ABC/non-GCB phenotype. The classification into GCB and non-GCB subtypes, using the Hans algorithm, suggests a correlation between the expression of CD10 and BCL6 genes in DLBCL GCB and MUM1 in DLBCL non-GCB. In a study led by Patrascu A-M and his team (2017) on a sample of 601 patients, subjects with GCB type DLBCL exhibited a higher overall survival rate and progression-free survival compared to those with non-GCB DLBCL, although the prognosis may vary depending on the specific markers expressed within the same subtype. Studies using fluorescent in situ hybridization (FISH) reported that 7% to 10% of DLBCL cases harbored genetic translocations MYC, BLC2, and/or BCL6 and were termed “double-hit” lymphoma (DHL) or triple-hit lymphoma. More than 90% of patients with DHL present high-risk clinical features, such as leukocytosis, central nervous system (CNS) involvement, lactate dehydrogenase values three times above the upper limit, and an advanced disease stage. The presence of MYC rearrangements in combination with BCL2 and/or BCL6 has been described as a distinct entity with prognostic significance, presenting a poor long-term prognosis, refractoriness to therapy, and an increased risk of relapse. Conclusion. Research and studies emphasize the importance of evaluating the expression of MYC, BCL2, and BCL6 genetic rearrangements, through IHC and FISH, in patients recently diagnosed with DLBCL, for a more accurate assessment of disease progression, prognosis, and progressionfree survival. the gene expression profile (GEP): the germinal center B-ce ll (GCB) subtype and the activated Bcell (ABC) or non-GCB subtype. Aim of study. Identification of Immunohistochemical Particularities as Prognostic Factors in Diffuse Large B-Cell Non-Hodgkin Lymphoma. Methods and materials. Data from medical scientific literature were examined, identified through Google Search and databases such as PubMed, Cochrane, Scopus, along with international clinical guidelines from NCCN and ESMO. Results. Studies have indicated that determining the cell of origi n phenotype in DLBCL using gene expression profile (GEP) is significant for establishing th e prognosis. Tumors with the GCB phenotype showed a better clinical course compared to those wi th the ABC/non-GCB phenotype. The classification into GCB and non-GCB subtypes, using the Hans algorithm, suggests a correlation between the expression of CD10 and BCL6 genes i n DLBCL GCB and MUM1 in DLBCL non-GCB. In a study led by Patrascu A-M and his team ( 2017) on a sample of 601 patients, subjects with GCB type DLBCL exhibited a higher overall surviva l rate and progression-free survival compared to those with non-GCB DLBCL, although the pr ognosis may vary depending on the specific markers expressed within the same subtype . Studies using fluorescent in situ hybridization (FISH) reported that 7% to 10% of DLBCL cases harbored genetic translocations MYC, BLC2, and/or BCL6 and were termed “double-hit ” lymphoma (DHL) or triple-hit lymphoma. More than 90% of patients with DHL present high-r isk clinical features, such as leukocytosis, central nervous system (CNS) involvement, lac tate dehydrogenase values three times above the upper limit, and an advanced disease stage. The pres ence of MYC rearrangements in combination with BCL2 and/or BCL6 has been described as a dis tinct entity with prognostic significance, presenting a poor long-term prognosis, refract oriness to therapy, and an increased risk of relapse. Conclusion. Research and studies emphasize the importance of eval uating the expression of MYC, BCL2, and BCL6 genetic rearrangements, through IHC and FISH, in patients recently diagnosed with DLBCL, for a more accurate assessment of disease progression, prognosis, and progressionfree survival. Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica Moldova

Secondary prevention of sudden cardiac death in patient with ischemic heart disease

2024-11-28T14:02:48Z

Secondary prevention of sudden cardiac death in patient with ischemic heart disease Pruteanu, Albert Introduction. Sudden cardiac death (SCD) is the cause of about ½ of all cardiovascular deaths, while up to 50% is the first manifestation of heart disease. The annual incidence of SCD increases with age, so in the eighth decade of life it reaches 200 cases per 100.000 population. Case statement. A 68 years old man known with heart disease for about 25 years, when he suffered acute myocardial infarction, simultaneously suffers from hypertension, atrial fibrillation receiving irregular treatment. The general condition worsened 6 years ago, when he developed a syncope, being resuscitated by the application of the precordial blow, which was repeated during hospitalization on 25.09.17. On the ECG, there was sustained ventricular tachycardia, suppressed by electric cardioversion. The patient was examined at the Institute of Cardiology by echocardiography: dilation of the heart chambers, moderate hypertrophy of the LV myocardium, severe of the IVS, hypokinesia and akinesia of the basal and middle segment, posterior and lateral walls of the LV, FE LV -36%; on the ECG: tahi-bradi form of atrial fibrillation; on coronarography: absence of stenotic lesions on the coronary arteries. Drug treatment with rivaroxaban, aspirin, bisoprolol, amiodarone, lisinopril, rosuvastatin, spironolactone and furosemide was initiated. On 04/10/17 was implanted with a cardiac defibrillator (ICD) Iforia3 VR-T type VVI Biotronik. After discharge from the hospital, the patient's condition stabilized, notable that 6 electrical discharges of the ICD were recorded only in the first year after implantation. Over 6 years the patient is in good condition and continues the drug treatment for chronic heart failure; on ECG: stimulated rhythm with HR 70 b/min; ECoCG parameters show improvement. Discussions. The case demonstrate the role of device therapy, additional to optimal drug therapy with angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, beta-blockers, and mineralocorticoid receptor antagonist to prevent SCD and improve condition of patients with ischemic heart disease. Conclusion. Sudden cardiac death (SCD) occurs unexpectedly and is usually the result of ventricular arrhythmia in patients with structural heart disease. Implantable cardioverter defibrillator (ICD), with biventricular stimulation, has been shown to be protective for ischemic heart disease and heart failure patients with a reduced ejection fraction of <35% (HFrEF). while up to 50% is the first manifestation of heart disease. The annual incidence of SCD increases with age, so in the eighth decade of life it r eaches 200 cases per 100.000 population. Case statement. A 68 years old man known with heart disease for about 25 ye ars, when he suffered acute myocardial infarction, simultaneously suff ers from hypertension, atrial fibrillation receiving irregular treatment. The general condition worse ned 6 years ago, when he developed a syncope, being resuscitated by the application of the precor dial blow, which was repeated during hospitalization on 25.09.17. On the ECG, there was sustained v entricular tachycardia, suppressed by electric cardioversion. The patient was examined at the Institute of Cardiology by echocardiography: dilation of the heart chambers, moderate hypertrophy of the LV myocardium, severe of the IVS, hypokinesia and akinesia of the basal and middle segment, posterior and lateral walls of the LV, FE LV -36%; on the ECG: tahi-bradi form o f atrial fibrillation; on coronarography: absence of stenotic lesions on the corona ry arteries. Drug treatment with rivaroxaban, aspirin, bisoprolol, amiodarone, lisinopril, r osuvastatin, spironolactone and furosemide was initiated. On 04/10/17 was implanted with a cardiac defibrillator (ICD) Iforia3 VR-T type VVI Biotronik. After discharge from the hospital, the patient's condition stabilized, notable that 6 electrical discharges of the ICD were re corded only in the first year after implantation. Over 6 years the patient is in good condit ion and continues the drug treatment for chronic heart failure; on ECG: stimulated rhythm with HR 70 b/mi n; ECoCG parameters show improvement. Discussions. The case demonstrate the role of device therapy, addit ional to optimal drug therapy with angiotensin-converting enzyme inhibitors, angioten sin II receptor blockers, beta-blockers, and mineralocorticoid receptor antagonist to prevent SCD an d improve condition of patients with ischemic heart disease. Conclusion. Sudden cardiac death (SCD) occurs unexpectedly and is usually the result of ventricular arrhythmia in patients with structural heart disease. Implantable cardioverter defibrillator (ICD), with biventricular stimulation, has been shown to be protective for ischemic heart disease and heart failure patients with a reduced eje ction fraction of <35% (HFrEF). Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica Moldova