http://repository.usmf.md:80/xmlui/handle/20.500.12710/32546 2026-04-04T02:56:18Z 2026-04-04T02:56:18Z Dragan, Diana Groppa, Stanislav http://repository.usmf.md:80/xmlui/handle/20.500.12710/33006 2026-04-02T08:14:28Z 2026-01-01T00:00:00Z

First seizure in the elderly: causes, impact and perspectives Dragan, Diana; Groppa, Stanislav Background. In recent years, epilepsy in the elderly has emerged as a growing public health concern. The first epileptic seizure in an older adult often represents a critical juncture, both diagnostically and therapeutically, requiring a tailored approach distinct from that used in younger individuals. Objective(s). This study aims to investigate the etiological factors, clinical characteristics, and prognostic outcomes of primary epileptic seizures with onset in the population aged over 60. Materials and methods. This retrospective study included 46 patients who experienced primary epileptic seizures after the age of 60. All patients were evaluated and followed at the National Epileptology Center. The diagnosis was established based on clinical assessment, neuroimaging, and either standard electroencephalography or long-term monitoring. Results. The average age was 72.5 ± 9.9 years, and cerebrovascular (CVD) pathology was the leading cause of epilepsy (43.5%), followed by brain tumors (19.6%). All patients presented focal epileptic seizures, most frequently with focal motor semiology (41.3%) or focal seizures evolving into bilateral tonic-clonic seizures (30.43%). In this age group, focal seizures involving one side of the body were associated with CVD in 81.8% of cases. 1/3 had ≥ 4 cardiovascular comorbidities (82.61%). A significant percentage (13.1%) included elderly individuals without an obvious cause for the seizures, no risk factors, and tonicclonic seizures during sleep. Conclusion(s). In elderlies, an apparently isolated first seizure reflects an underlying vascular brain lesion. Early recognition and diagnosis of epileptic seizures in this population are essential, as they may reduce recurrence rates and mitigate the negative impact on quality of life.

2026-01-01T00:00:00Z Ignat, Gloria Bugai, Rodica http://repository.usmf.md:80/xmlui/handle/20.500.12710/33005 2026-04-01T08:36:02Z 2026-01-01T00:00:00Z

Evolutionary peculiarities of diabetes mellitus in liver cirrhosis Ignat, Gloria; Bugai, Rodica Background. Diabetes mellitus is a common comorbidity in patients with liver cirrhosis, negatively influencing the evolution and prognosis of the disease. Its evolutionary forms, especially hepatogenic diabetes, have specific mechanisms and clinical features, which require early recognition and selective treatment. Objective(s). Analysis of the evolutionary and clinico-pathogenetic characteristics of diabetes mellitus in liver cirrhosis, highlighting the differences from type 2 diabetes and the therapeutic implications. Materials and methods. A study of the scientific literature published in 2013-2024 was conducted, using PubMed, ScienceDirect, MEDLINE and Wiley data. Terms used: "hepatogenic diabetes", "liver cirrhosis", "insulin resistance". From the articles, 10 relevant studies were selected according to the criteria of topicality, clinical validity, and scientific value. Results. Diabetes in cirrhosis may be pre-existing or acquired later in the form of hepatogenic diabetes. It is characterized by hepatic insulin resistance, β-cell dysfunction, and frequently falsely low HbA1c values. The most recommended diagnostic method is the oral glucose tolerance test. Glucose metabolism disorders can reach 80%, and clinical diabetes occurs in about 30% of patients. Its evolution is associated with an increased risk of hepatic encephalopathy, infections, hemorrhages, and post-transplant mortality. Treatment requires individualized adjustments, and therapeutic options are limited by the remaining liver function. Conclusion(s). Diabetes mellitus in liver cirrhosis has a particular evolution, being often underdiagnosed and difficult to treat. Early diagnosis and personalized therapeutic approach are essential for preventing complications and reducing mortality; achieving these goals requires multidisciplinary collaboration.

2026-01-01T00:00:00Z Botnaru, Anastasia Ciobanu, Natalia http://repository.usmf.md:80/xmlui/handle/20.500.12710/33004 2026-04-01T08:29:36Z 2026-01-01T00:00:00Z

Ischemic stroke in the vertebrobasilar territory: clinical and imaging examination Botnaru, Anastasia; Ciobanu, Natalia Background. Vertebrobasilar ischemic stroke is a major emergency, associated with a variable clinical picture and high risk of severe disability or death. Involvement of this territory may cause balance disorders, diplopia, dysarthria, dysphagia, and coma. Rapid diagnosis relies on accurate imaging. Objective(s). Analysis of clinical and imaging features in patients with vertebrobasilar ischemic stroke to highlight the correlation between clinical manifestations and lesion location. Materials and methods. The study will be based on the analysis of medical records of patients admitted to the Neurology Department of the Institute of Emergency Medicine with vertebrobasilar ischemic stroke. Anamnestic, clinical, and imaging data (CT and/or brain MRI) will be collected and correlated with neurological status at admission. Results. The identified clinical spectrum suggests involvement of the brainstem and cerebellum, with symptoms such as vertigo, ataxia, dysarthria, diplopia, and dysphagia, which may indicate specific vascular syndromes, including lateral medullary infarction (Wallenberg syndrome) or anterior inferior cerebellar artery (AICA) involvement. Ischemic lesions detected on brain MRI, localized in pontine or cerebellar regions, may explain the symptom variability. Detailed imaging analysis and correlation with clinical manifestations will clarify pathological mechanisms and guide therapeutic strategies to optimize prognosis. Conclusion(s). Ischemic stroke in the vertebrobasilar territory has a variable prognosis. Early recognition of suggestive clinical signs and proper use of imaging are essential for accurate diagnosis and optimal treatment. MRI is superior to CT in detecting brainstem lesions.

2026-01-01T00:00:00Z Buruiană, Daniela Țurcanu, Adela http://repository.usmf.md:80/xmlui/handle/20.500.12710/33003 2026-04-01T08:09:12Z 2026-01-01T00:00:00Z

Biomarkers with predictive role in chronic advanced liver disease Buruiană, Daniela; Țurcanu, Adela Background. Von Willebrand factor (VWF) is currently considered a biomarker of endothelial dysfunction, its determining role in the evolution of advanced chronic liver disease being highlighted, so that its high concentration has been associated with favoring the formation of thrombi in the intrahepatic circulation. Objective(s). The purpose of this work is to study the role of VWF in the progression of advanced chronic liver disease and highlight it as a non-invasive biomarker with a major predictive role. Materials and methods. To realize this analytical work, relevant scientific publications from medical databases such as PubMed, NCBI, Web of Science, which have been published in the last 5 years were selected and analyzed. The search terms used in English included: "chronic liver disease", "venous thrombosis" and "von Willebrand factor". Results. Increased levels of VWF, as well as the compensatory decrease in the ADAMTS13 enzyme, can condition endothelial damage, increase of factor VIII, platelet hyperaggregability and respectively the development of thrombotic events at the level of splanchnic circulation. Considering the significant role of endothelial dysfunction in the pathogenesis of portal hypertension, and consequently the prognosis of liver cirrhosis, VWF concentration acquires particular importance. In this context, the imbalance between VWF and ADAMTS13 has been implicated in the progression of advanced chronic liver disease and the exacerbation of portal hypertension. Conclusion(s). As a biomarker of endothelial dysfunction, VWF is also a noninvasive biomarker with an important predictive role in advanced chronic liver disease. In this way, the poor prognosis in patients with liver cirrhosis was correlated with the imbalance between VWF and ADAMTS13.

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